CA1267822A - Surgical fastener applying apparatus - Google Patents
Surgical fastener applying apparatusInfo
- Publication number
- CA1267822A CA1267822A CA000493022A CA493022A CA1267822A CA 1267822 A CA1267822 A CA 1267822A CA 000493022 A CA000493022 A CA 000493022A CA 493022 A CA493022 A CA 493022A CA 1267822 A CA1267822 A CA 1267822A
- Authority
- CA
- Canada
- Prior art keywords
- fasteners
- body tissue
- cartridge
- remainder
- forming means
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Lifetime
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07242—Stapler heads achieving different staple heights during the same shot, e.g. using an anvil anvil having different heights or staples of different sizes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
- A61B2017/2929—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
Landscapes
- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Molecular Biology (AREA)
- General Health & Medical Sciences (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Animal Behavior & Ethology (AREA)
- Engineering & Computer Science (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Toys (AREA)
- Catching Or Destruction (AREA)
- Dental Tools And Instruments Or Auxiliary Dental Instruments (AREA)
Abstract
ABSTRACT OF THE DISCLOSURE
In apparatus for substantially simultaneously applying a plurality of surgical fasteners to body tissue the fasteners are prevented from all reaching peak formation force at the same time in order to reduce the maximum force required to operate the apparatus.
In apparatus for substantially simultaneously applying a plurality of surgical fasteners to body tissue the fasteners are prevented from all reaching peak formation force at the same time in order to reduce the maximum force required to operate the apparatus.
Description
~2~7~
This invention relates to surgical fastener applying apparatus, and more particularly to surgical fastener applying apparatus of the type that applies a plurality of surgical Easteners simultaneously or substantially simultaneously.
Among the known types of surgical fastener applying instruments are several that apply a plurality of surgical fasteners simultaneously or substantially simultaneously. For example, Hirsch et al~ U.S. patent 3,275,211 shows apparatus for simultaneously applyin~ a plurality of metal surgical staples in a linear array. As another example, Conta et al. U.S. patent 4,304,236 shows apparatus for simultaneously applying a plurality of metal surgical staples in a circular array.
In the present context, a surgical fastener applying instrument is said to apply a plurality of surgical fasteners "simultaneously" or "substantially simultaneously" if, during at least some portion of the fastener applying stroke of the apparatus, all of the fasteners are simultaneously in motion relative to the fastener holding portion of the apparatus. Apparatus which simultaneo~sly or substantially simultaneously applies a plurality of surgical Easteners is therefore different from apparatus such as that shown in Green U.S.
patent 4,429,695 which completes the application o~ some surgical fasteners b~fore the application of other fasteners has begun. Apparatus of the type shown in the Green '695 patent is not of interest in relation to the present invention.
The fasteners applied by instruments of the types shown in the above-mentioned Hirsch et al. and Conta et al. patents need not be metal surgical staples. For example, Green U.S. patent ~,506~671 shows two-part surgical fasteners made of resinous materials which can be used as an alternative to metal surgical staples. Such two-part fasteners typically have a fasl:ener part and a retainer part. The prongs of the fastener parl: are driven part way through the tissue to be fastened, whereupon the ~L2~ii7~322 ends of the prongs interlock with the associated retainer part to secure the tissue. As used herein, khe term "surgical fastener" is generic to metal staples, two-part resinous fasteners, and the like.
Most of the known surgical fasteners are characterized by a relatively sharp peak force requirement during application. For example, relatively little force is required to push the sharply pointed legs of metal surgical staples through tissue. However, when the ends of the staple legs reach the anvil of the stapler, a relatively -large force is required to begin to bend or crimp the staple legs. Once the staple legs have begun to bend, the force required to continue bending the staple legs is substantially less than the force required to initiate bending. Similarly, the force required to push the prongs of two-part fasteners through tissue is typically substantially less than the force required to cause the ends of the prongs to interlock with the retainer part oE the fastener.
As used herein, the term "formation force"
refers to the force required to apply a surgical ~astener, and the term "peak formation force" refers to the maximum force required during application of a surgical fastener.
In general, a surgical fastener reaches its peak Eormation force when it first contacts or engages the associated "fa~tener forming means", i.e., the anvil of the stapler in the case of metal staples or the retainer part of the fastener in the case of two-part resinous fasteners.
Several of the known surgical fastener applying instruments simultaneously apply approximately 30 surgical fasteners. For some surgical procedures, there is interest in simultaneously applying even more than 30 fasteners (e.g., 60 or more fastene~s)~ Because all of these fasteners are applied simultaneously, all of the fasteners reach their peak formation force simultaneously, thereby requiring the surgeon to apply a very large force to the fastener applying apparatus. This may make the apparatus relatively difficult to operate. In addition, ~2 Ei7~
the need to provide structures which can receive and transmit such large forces may increase the size, cost, and complexity of the fastener applying apparatus. The size of the apparatus may also undesirably increase as a result of the application of an increased number of fasteners.
In view of the foregoing, it is an object of this invention to improve surgical fastenec applying apparatus of the type which simultaneously applies a large number of surgical fasteners.
It is another object of this invention to reduce the maximum force required to operate surgical fastener applying apparatus of the type which simultaneously applies a plurality of surgical fasteners.
It is still another object of this invention to reduce the size of the apparatus required to apply a large number of surgical fasteners.
These and other objects of the invention are accomplished in accordance with the principles of the invention by including in surgical fastener applying apparatus of the type described above means for causing at least one of the fasteners to reach peak formation force before at least one other fastener reaches peak formation force. In general, this is accomplished by including in the apparatus means for causing at least one fastener to engage the fastener Eorming means before at least one other fastener enqages the fastener forming means. For e~ample, in apparatus for substantially simultaneously applying a plurality of metal surgical staples, the above-mentioned means causes at least one staple to contact theanvil of the stapler before at least one other staple contacts the anvil. The staples may contact the anvil successively, or the staples may be grouped in two or more groups so that the groups contact the anvil successively.
In the case of apparatus which substantially simultaneously applies a plurality of two-part resinous fasteners, the above-mentioned means causes at least one fastener part to interlock with its associated retainer ~l26~
part before at least one other fastener part interlocks with its associated retainer part. Once again, the fastener and retainer parts may interlock successively, or the fasteners may be grouped in two or more groups so that the groups interlock successively.
The invention reduces the maximum force required to apply a given number of surgical fasteners because it prevents all of the fasteners from reaching their peak formation force at the same time.
Various embodiments of the invention have been developed. In a first embodiment, some of the fastener pushers are shorter than other pushers so that the fasteners associated with the shorter pushers are retarded relative to the other fasteners. In a second embodiment, the structure which drives the pushers is stepped so that some pushers are retarded relative to other pushers. In a third embodiment, the anvil structure associated with some fasteners (staples~ is recessed relative to the anvil surface associated with other fasteners so that the ~ ~0 fasteners associated with the more recessed anvil surface ; reach that surface after the other fasteners reach the less recessed anvil surface. In the two-part fastener equivalent of the third embodiment, the retainer parts associated with some fastener parts are recessed relative to the retainer parts associated with the other fastener parts. In a fourth embodimentl the fasteners themselves vary in 8i ze so that they do not all reach peak formation force at the same time. In the case of metal staples, for example, the legs of some staples are shorter than the legs of other staples so that the staples with longer legs contact the anvil before the staples with shorter legs.
Similarly, the legs of the fastener parts of some two-part fasteners can be made shorter than other fastener part legs so that the fastener parts with longer legs interlock with their associated retainer parts before the fastener par~s with shorter legs interlock with their associated retainer parts. In a fifth embodiment, the structure that pushes the fasteners to~ard the fastener forming means 32~
(i.e., the anvil or retainer parts) is angled slightly so that some fasteners are pushed slightly ahead of other fasteners.
In accordance with another aspect of the invention, the size of apparatus for applying a large number of surgical fasteners can be reduced by placing two fasteners in each fastener holding aperture in the apparatus. The apertures are shaped to keep the fasteners in each aperture separate from one another and to prevent them from becoming entangled with one another as they are driven from the aperture and thereby applied to tissue.
Further features of the inventionl its nature and va~ious advantages will be more apparent ~rom the accompanying drawings and the following detailed description of the invention.
Figures 1 and 2 are force diagrams useful in explaining the principles of the invention.
Figure 3 is a perspective view of a first illustrative embodiment of the invention.
Figure 4 is an elevational view of a portion of the apparatus of Figure 3 showing an early stage in the operating cycle of that apparatus.
Figures 5-7 are views similar to Figure ~
showing successive stages in the operating cycle o~ the apparatus oE Figure 3.
Figure 8 is a cross sectional view taken along the line 8-8 in Figure 5.
Figures 9 and 10 are views similar to Figure 8 corresponding, respectively, to the operating cycle stages shown in Figures 6 and 7.
Figures 11-16 are detailed sectional views showing successive stages in the formation o~
representative staples in the apparat~s of Figure 3.
Figure 17 is an elevational view of the front of the staple holding cartridge in the apparatus of Figure 3.
Figure 18 is an enlargement of a portion of Figure 17.
, Figure 19 is a cross sectional view taken along ~L2~822 the line 19-19 in Figure 17~
Figure 20 is an elevational view of the anvil in the apparatus of Figure 3.
Figures 21 and 22 are cross sectional views taken respectively along the lines 21-21 and 22-22 in Figure 20.
Figure 23 is a view similar to Figure 5 showing an alternative embodiment of the invention~
Figure 24 is a view similar to Figure 8 showing another alternative embodiment of the invention.
Figure 25 is another view similar to Figure 8 showing yet another alternative embodiment of the invention.
Figure 26 is another view si~ilar to Figure 8 showing still another alternative embodiment of the nventlon .
Figure 27 is another view similar to Figure 8 showing yet another alternative embodiment of the invention.
Figure 28 is a view generally similar to Figure 5 showing still another alternative embodiment of the invention.
In Figure 1, the Eorce required to apply a typical metal surgical staple is plotted as a Eunction of the displacement of the associated staple pusher. (See also Figure 59 of Green et al. U.S. patent 3,4~4,533).
The initial force requirement (region A) is relatively low as the pusher pushes the sharply pointed legs of the staple through the tissue. As soon as the ends of the skaple legs contact the anvil of the stapler, however, the force requirement increases very rapidly (region Bi to the peak formation force C, i.e., the force required to initiate bending of the staple legs~ Once bending has been initiated, the force requirement decceases rapidly again (region D).
The formation force requirement for the typical two-part resinous surgical fastener (Figure 2) is generally similar to that described above. Initially ~2~782~:
(region A), relativel~ little force is required to push the sharply pointed ends of the fastener part prongs through the tissue. However, when the latches on the fastener part prongs contact the latches on the associated retainer part, the formation force requirement increases very eapidly (region B) to the peak formation force C, i.e., the force required to cause the latches on the fastener and retainer parts to interloc~. Thereafter (region D), the force requirement drops off rapidly again.
In accordance with this invention, apparatus for substantially simultaneously applying a plurality of surgical fasteners characterized by formation force curves like those shown in Figures 1 and 2 is constructed so that all of the fasteners do not reach their peak formation lS force C at the same time. In particular, the surgical fastener applying apparatus of this invention is constructed so that at least some of the fasteners reach their peak formation force C while at least some other fasteners are still at their relatively low in~tial formation ~orce A, and so that the fasteners that are first to reach peak formation force have returned to relatively low formation force D when the fasteners that are last to reach peak formation force reach their peak formation force C. In this way, the maximum force required to operate the fastener applying apparatus of this invention is substantially less than i~ would be iE
all of the fasteners reached peak formation force at the same time.
A first illustrative embodiment of the invention is shown in Figures 3-22 in the context of surgical fastener applying apparatus. As shown in Figure 3, this apparatus includes a reusable actuator 20 for removably receiving and actuating a dispos~able staple holding cartridge 50. When cartridge 50 is placed in cartridge holder 22, cartridge holder 22 can be moved toward anvil 24 by rotation of clamp actuator 26 (compare Figures 4 and 5). The tissue 28 to be fastened is thereby clamped between cartridge 50 and anvil 24. Alignment pin 30 is ~267~
pushed through cartridge 50 into anvil 24 to help register and align elements 50 and 24 and to help confine kissue 28 between those elements.
When tissue 28 is fully clamped as shown in Figure 5, handle 32 tFigure 3) is pivoted to the rear to drive fastener actuator bar 34 in the distal direction as shown in Figure 6. Fastener actuator bar 34 enters the rear of cartridge 50 and pushes pusher driver 52 in the distal direction. This in turn pushes all of pushers 54a and 54b in the distal direction. Some of pushers 54 (i.e., those designated 54a) are slightly longer than the other pushers ~i.e., those designated 54b). (Pushers 54a and 54b are joined together in groups of two or three for reasons (such as reduction of the number of separate parts in the apparatus) having nothing to do with the present invention). The difference in length of pushers 54a and 54b is typically relatively small (e.g., .008-.012 inches) and is exaggerated in the accornpanying drawings to better illustrate the invention.
When pushers 54 are pushed in the di~tal direction as described above, they push staples 56 toward anvil 24 as shown progressively in Figures 11-16. Anvil 24 has pockets 36 for clinching staples 56 in the conventional manner. (In order to facilitate comparison of the progress of staples 56a (associated with relatively long pushers 54a) with the progress of staples 56b (associated with relatively short pushers 54b), a staple 56b is superimposed on a staple 56a in Figures 11-16, although in that respect Figures 11-16 are not true views of the apparatus). As shown in Figure 11, the ends of the legs of staples 56a reach the surface of anvil 24 before the ends of the legs of staples 56b reach that surface.
Accordingly, staples 56a reach peak formation force C
(Figure 1) while staples 56b are still in relatively low initial formation force region A. As pushers 54 continue to move in the distal direction, the ends of the legs of staples 56a begin to bend inwardly as shown in Figure 12, and the ends of the legs of staples 56b continue to move 12~ii7~
toward the surface of anvil 24. Accordingly, staples 56a pass peak formation force C and enter reduced formation force region D before staples 56b reach peak formation force C.
5Continued distal motion of pushers 54 causes staples 56a to conkinue to bend, and causes staples 56b to reach pea~ formation force C and to begin to bend as shown in Figure 13. Accordingly, when staples 56b reach peak formation force C, staples 56a are already well past peak 10formation force and into reduced formation force region D.
Still further distal motion of pushers 54 causes staples 56a and 56b to continue to bend as shown in Figures 14-16. Because pushers 54a are slightly longer than pushers 54b, staples 56a are clinched slightly more 15than staples 56b at the end of the staple applying stroke of the apparatus as shown in Figure 16. This does not adversely affect the resulting staple array.
When all of staples 56 have been fully clinched as shown in Figure 16, the stapling operation is complete.
20~andle 32 is accordingly released and clamp actuator 26 is rotated to proximally retract cartridge holder 22 and cartridge 50. This releases the clamping pressure on tissue 28 as shown in Figure 7. The apparatus can be removed from the tissue when alignment pin 30 is 25proximally retracted.
Because staples 56a pass through peak formation force C before staples 56b, the maximum force required to operate the apparatus i9 substantially less than it would be if all of staples 56 passed through peak formation 30force C at the same time.
In accordance with another aspect of the invention illustrated by the embodiment of Figures 3-22, the width W SFigure 8) of cartridge SQ and anvil 24 can be kept relatively small even though a large number o~
35fasteners is applied by the apparatus by using two staples 56 in each cartridge slot 58 instead of one staple in each ;~ slot as is customary. The structure Facilitating the US2 ~ of two staples 56 in each cartridge slot 5~ is best seen ~:67~32~:
in Figures 8-10 and 17-22. As shown in Figure 18, the opposite ends o~ each cartridge slot 56 have two laterally spaced grooves 60 parallel to the axis along which staples 56 are driven. Each groove 60 receives and guides one leg of one of the two staples 56 in the slot. The distal end of each pusher 54 also has two parallel, laterally spaced grooves 62 (see Figures 8-10). Each groove 62 receives the backspan oE a respective one of the two staples in the associated slot 58. Each of anvil pockets 36 also has two laterally spaced grooves 38 parallel to grooves 62 (see Figures 8-10 and 20~22) . Each of grooves 38 receives and guides the end of one leg of one of the two staples driven into pocket 36 in order to clinch the staples. Thus although two staples 56 are provided in each slot 58 ~ the foregoing structure keeps the staples in each slot separate from one another and prevents them from becoming entangled with one another as they are driven.
Although two staples 56 are employed in each slot 58 in the embodiment shown in Figures 3-22 ~ those skilled in the art will appreciate ~hat this is not necessarily the case, and that a single staple 56 could be used in each slot 58 if desired. See also the embodiments shown in Figures 24-27 tdiscussed below) in which the same number of fasteners are employed as in the embodiment of Figures 3-22~ but in which each fastener has its own slot 58.
Those skilled in the art will also recognize that two-part resinous surgical fasteners of the type shown, for e~ample, in Green U.S. patent 4r506r671 can be substituted for metal surgical staples 56 in the embodiment shown in Figures 3-22. This is illustrated by Figure 23, which is similar to Figure 5 but shows the apparatus with two-part resinous fasteners 70 in place of metal surgical staples 56. The ~astener parts 72 of fasteners 70 replace staples 56. The retainer parts 74 of fasteners 70 replace anvil pockets 36. In other respects the construction and operation of the apparatus of Figure 23 can ~e generally slmilar to the construction and ~2~78~
operation of the apparatus of Figures 3-22. ~ecause pushers 54a are slightly longer than pushers 54b, fastener parts 72a interlock with retainer parts 74a before fastener parts 72b interlock with retainer parts 74b.
Accordingly, fasteners 70a reach peak formation force C
(Figure 2) while fasteners 70b are still in relatively low formation foece region A, and fasteners 70b do not reach peak formation force C until fasteners 70a have passed through peak formation force C into reduced formation force region D. The maximum force required to operate the apparatus is therefore substantially less than it would be if all of fasteners 70 reached peak formation force C at the same time.
Figure 24 shows another embodiment of the invention in which all of pushers 54 are the same length, but in which pusher driver 52 is notched, grooved, or otherwise stepped so that it begins to push some oE
pushers 54 (i.e., those designated 54c) befoee it begins to push other pushers ~i.e., those designated 54d).
Figure 24 is similar to Figure 8, but with the following differences. First, there is only one staple 56 in each cartridge slot 58. Second, there are four rows of cartridge slots 58 instead of only two rows as in Figure 8. Third, all of pushers 54 are the same length. And fourth, pusher driver 52 contains a shallow central groove 64 so that when pushed in the distal direction, it contacts outer pusher rows 54c before it contacts inner pusher rows 54d. Accordingly, outer staple rows 56c are pushed slightly ahead of inner staple rows 56d and staples 56c pass through peak formation force C before staples 56d reach that force level. As in the embodiment of Figures 3-22, the maximum force required to operate the apparatus o~ Figure 24 is substantially less than it would be if all of staples 56 reached peak formation force C at the same time. The depth of groove 64 can be similar to the difference between the lengths of pushers 54a and 54b in the embodiment of Figures 3-22. Those skilled in the art will appreciate that two-part cesinous surgical fasteners ~7~
of the type shown in Figure 23 can be substituted for metal staples 56 in the embodiment of Fiyure 24 if desired.
Figure 25 shows yet another embodiment of the invention in which some of anvil pockets 36e are deeper than other anvil pockets 36f. In other respects the embodiment of Figure 25 is similar to the embodiment of Figure 24 except that pusher driver 52 is not grooved in Figure 25. Because inner anvil pockets 36e are deeper than outer anvil pockets 36f, staples 56f contact anvil 24 before staples 56e. Accordingly, staples 56f pass through peak formation force C before staples 56e reach that force level. The maximum force required to operate the apparatus is therefore substantially less than it would be if all of staples 56 reached peak ~ormation force C at the same time. The difference in depth between anvil pockets 36e and 36f can be similar to the difference between the lengths of pushers 54a and 54b in the embodiment of Figures 3-22.
Once again, those skilled in the art will appreciate that two-part resinous fasteners of the type shown in Figure 23 can be substituted for metal staples 56 in the apparatus of Figure 25 if desired. This is illustrated in Figure 26. Inner retainer parts 74e are recessed relative to outer retainer parts 74f so that outer fasteners 70f interlock before inner fasteners 70e.
In this way all of fasteners 70 do not pass through peak formation force C at the same time and the maximum force required to operate the apparatus is according~y reduced.
Still another embodiment oF the invention is shown in Figure 27. In this embodiment (which is similar to the embodiment of Figure 25 e~cept that all of anvil pockets 36 are of the same depth)~ the legs of inner staples 56g are slightly shorter than the legs of outer staples 56h. Accordingly, outer staples 56h pass through peak formation force C before inner staples 56g pass through that force level. The result again is to reduce the maximum force required to operate the apparatus. The 678;~:~
difference in staple leg length in this embodiment can be similar to the difference between the lengths oE pusher~
54a and 54b in the embodiment oE Figures 3-22.
As in the case oE the previously described embodiments, those skilled in the art will recognize that two-part resinous fasteners can be substituted for metal staples 56 in the embodiment of Figure 27. In that event, the legs of the fastener parts of some of those fasteners are made longer than the legs of the fastener parts of the other fasteners in order to achieve operation similar to that described above in eelation to Figure 27.
Yet another alternative embodiment of the invention is shown i.n Figure 28. Staples 202 are driven in the distal direction when the proximal end of cable 112 is pulled in the proximal direction. This causes cam bar 230 to move down relative to pusher actuator member 240.
As cam bar 230 moves down, it is also forced to move in the distal direction by cam follower pins 232 t~aversing cam slots 354 and 454. Because cam slots 354 and 454 have different shapes, the lower end of cam bar 230 initially moves more rapidly in the distal direction than the upper end of cam bar 230. This causes lower staples 202 to reach peak formation force C beEore upper staples 202 reach that force level. ~lthough all of staples 202 are in motion at the same time relative to fastener holding part 210 ~th~reby satisEy.ing the above definition of substantially simultaneous staple application), the staples reach and pass through peak formation force C
progressively, from the bottom of the apparatus to the top as viewed in Figure 28. Accordingly, at least some of staples 202 pass through peak formation force C before other staples reach that force level ~nd the maximum force required to operate the apparatus is substantially less than it would be if all of staples 202 reached peak formation force C at the same time~
As in the previously described embodiments, two~
part resinous fasteners of the type shown in Figure 23 can be substituted for metal staples 202 in the em~odiment oE
~7~
Figure 28 if desired.
It will be understood that the embodiments shown and described herein are only illustrative of the principles of the invention, and that various modifications can be made by those skilled in the art without departing from the scope and spirit of the invention. For example, other structures for angling or inclining elements such as fastener actuator bar 34, pusher driver 52, and/or cam bar 230 to achieve a result similar to that described above in relation to Figure 28 will be apparent to those skilled in the art.
This invention relates to surgical fastener applying apparatus, and more particularly to surgical fastener applying apparatus of the type that applies a plurality of surgical Easteners simultaneously or substantially simultaneously.
Among the known types of surgical fastener applying instruments are several that apply a plurality of surgical fasteners simultaneously or substantially simultaneously. For example, Hirsch et al~ U.S. patent 3,275,211 shows apparatus for simultaneously applyin~ a plurality of metal surgical staples in a linear array. As another example, Conta et al. U.S. patent 4,304,236 shows apparatus for simultaneously applying a plurality of metal surgical staples in a circular array.
In the present context, a surgical fastener applying instrument is said to apply a plurality of surgical fasteners "simultaneously" or "substantially simultaneously" if, during at least some portion of the fastener applying stroke of the apparatus, all of the fasteners are simultaneously in motion relative to the fastener holding portion of the apparatus. Apparatus which simultaneo~sly or substantially simultaneously applies a plurality of surgical Easteners is therefore different from apparatus such as that shown in Green U.S.
patent 4,429,695 which completes the application o~ some surgical fasteners b~fore the application of other fasteners has begun. Apparatus of the type shown in the Green '695 patent is not of interest in relation to the present invention.
The fasteners applied by instruments of the types shown in the above-mentioned Hirsch et al. and Conta et al. patents need not be metal surgical staples. For example, Green U.S. patent ~,506~671 shows two-part surgical fasteners made of resinous materials which can be used as an alternative to metal surgical staples. Such two-part fasteners typically have a fasl:ener part and a retainer part. The prongs of the fastener parl: are driven part way through the tissue to be fastened, whereupon the ~L2~ii7~322 ends of the prongs interlock with the associated retainer part to secure the tissue. As used herein, khe term "surgical fastener" is generic to metal staples, two-part resinous fasteners, and the like.
Most of the known surgical fasteners are characterized by a relatively sharp peak force requirement during application. For example, relatively little force is required to push the sharply pointed legs of metal surgical staples through tissue. However, when the ends of the staple legs reach the anvil of the stapler, a relatively -large force is required to begin to bend or crimp the staple legs. Once the staple legs have begun to bend, the force required to continue bending the staple legs is substantially less than the force required to initiate bending. Similarly, the force required to push the prongs of two-part fasteners through tissue is typically substantially less than the force required to cause the ends of the prongs to interlock with the retainer part oE the fastener.
As used herein, the term "formation force"
refers to the force required to apply a surgical ~astener, and the term "peak formation force" refers to the maximum force required during application of a surgical fastener.
In general, a surgical fastener reaches its peak Eormation force when it first contacts or engages the associated "fa~tener forming means", i.e., the anvil of the stapler in the case of metal staples or the retainer part of the fastener in the case of two-part resinous fasteners.
Several of the known surgical fastener applying instruments simultaneously apply approximately 30 surgical fasteners. For some surgical procedures, there is interest in simultaneously applying even more than 30 fasteners (e.g., 60 or more fastene~s)~ Because all of these fasteners are applied simultaneously, all of the fasteners reach their peak formation force simultaneously, thereby requiring the surgeon to apply a very large force to the fastener applying apparatus. This may make the apparatus relatively difficult to operate. In addition, ~2 Ei7~
the need to provide structures which can receive and transmit such large forces may increase the size, cost, and complexity of the fastener applying apparatus. The size of the apparatus may also undesirably increase as a result of the application of an increased number of fasteners.
In view of the foregoing, it is an object of this invention to improve surgical fastenec applying apparatus of the type which simultaneously applies a large number of surgical fasteners.
It is another object of this invention to reduce the maximum force required to operate surgical fastener applying apparatus of the type which simultaneously applies a plurality of surgical fasteners.
It is still another object of this invention to reduce the size of the apparatus required to apply a large number of surgical fasteners.
These and other objects of the invention are accomplished in accordance with the principles of the invention by including in surgical fastener applying apparatus of the type described above means for causing at least one of the fasteners to reach peak formation force before at least one other fastener reaches peak formation force. In general, this is accomplished by including in the apparatus means for causing at least one fastener to engage the fastener Eorming means before at least one other fastener enqages the fastener forming means. For e~ample, in apparatus for substantially simultaneously applying a plurality of metal surgical staples, the above-mentioned means causes at least one staple to contact theanvil of the stapler before at least one other staple contacts the anvil. The staples may contact the anvil successively, or the staples may be grouped in two or more groups so that the groups contact the anvil successively.
In the case of apparatus which substantially simultaneously applies a plurality of two-part resinous fasteners, the above-mentioned means causes at least one fastener part to interlock with its associated retainer ~l26~
part before at least one other fastener part interlocks with its associated retainer part. Once again, the fastener and retainer parts may interlock successively, or the fasteners may be grouped in two or more groups so that the groups interlock successively.
The invention reduces the maximum force required to apply a given number of surgical fasteners because it prevents all of the fasteners from reaching their peak formation force at the same time.
Various embodiments of the invention have been developed. In a first embodiment, some of the fastener pushers are shorter than other pushers so that the fasteners associated with the shorter pushers are retarded relative to the other fasteners. In a second embodiment, the structure which drives the pushers is stepped so that some pushers are retarded relative to other pushers. In a third embodiment, the anvil structure associated with some fasteners (staples~ is recessed relative to the anvil surface associated with other fasteners so that the ~ ~0 fasteners associated with the more recessed anvil surface ; reach that surface after the other fasteners reach the less recessed anvil surface. In the two-part fastener equivalent of the third embodiment, the retainer parts associated with some fastener parts are recessed relative to the retainer parts associated with the other fastener parts. In a fourth embodimentl the fasteners themselves vary in 8i ze so that they do not all reach peak formation force at the same time. In the case of metal staples, for example, the legs of some staples are shorter than the legs of other staples so that the staples with longer legs contact the anvil before the staples with shorter legs.
Similarly, the legs of the fastener parts of some two-part fasteners can be made shorter than other fastener part legs so that the fastener parts with longer legs interlock with their associated retainer parts before the fastener par~s with shorter legs interlock with their associated retainer parts. In a fifth embodiment, the structure that pushes the fasteners to~ard the fastener forming means 32~
(i.e., the anvil or retainer parts) is angled slightly so that some fasteners are pushed slightly ahead of other fasteners.
In accordance with another aspect of the invention, the size of apparatus for applying a large number of surgical fasteners can be reduced by placing two fasteners in each fastener holding aperture in the apparatus. The apertures are shaped to keep the fasteners in each aperture separate from one another and to prevent them from becoming entangled with one another as they are driven from the aperture and thereby applied to tissue.
Further features of the inventionl its nature and va~ious advantages will be more apparent ~rom the accompanying drawings and the following detailed description of the invention.
Figures 1 and 2 are force diagrams useful in explaining the principles of the invention.
Figure 3 is a perspective view of a first illustrative embodiment of the invention.
Figure 4 is an elevational view of a portion of the apparatus of Figure 3 showing an early stage in the operating cycle of that apparatus.
Figures 5-7 are views similar to Figure ~
showing successive stages in the operating cycle o~ the apparatus oE Figure 3.
Figure 8 is a cross sectional view taken along the line 8-8 in Figure 5.
Figures 9 and 10 are views similar to Figure 8 corresponding, respectively, to the operating cycle stages shown in Figures 6 and 7.
Figures 11-16 are detailed sectional views showing successive stages in the formation o~
representative staples in the apparat~s of Figure 3.
Figure 17 is an elevational view of the front of the staple holding cartridge in the apparatus of Figure 3.
Figure 18 is an enlargement of a portion of Figure 17.
, Figure 19 is a cross sectional view taken along ~L2~822 the line 19-19 in Figure 17~
Figure 20 is an elevational view of the anvil in the apparatus of Figure 3.
Figures 21 and 22 are cross sectional views taken respectively along the lines 21-21 and 22-22 in Figure 20.
Figure 23 is a view similar to Figure 5 showing an alternative embodiment of the invention~
Figure 24 is a view similar to Figure 8 showing another alternative embodiment of the invention.
Figure 25 is another view similar to Figure 8 showing yet another alternative embodiment of the invention.
Figure 26 is another view si~ilar to Figure 8 showing still another alternative embodiment of the nventlon .
Figure 27 is another view similar to Figure 8 showing yet another alternative embodiment of the invention.
Figure 28 is a view generally similar to Figure 5 showing still another alternative embodiment of the invention.
In Figure 1, the Eorce required to apply a typical metal surgical staple is plotted as a Eunction of the displacement of the associated staple pusher. (See also Figure 59 of Green et al. U.S. patent 3,4~4,533).
The initial force requirement (region A) is relatively low as the pusher pushes the sharply pointed legs of the staple through the tissue. As soon as the ends of the skaple legs contact the anvil of the stapler, however, the force requirement increases very rapidly (region Bi to the peak formation force C, i.e., the force required to initiate bending of the staple legs~ Once bending has been initiated, the force requirement decceases rapidly again (region D).
The formation force requirement for the typical two-part resinous surgical fastener (Figure 2) is generally similar to that described above. Initially ~2~782~:
(region A), relativel~ little force is required to push the sharply pointed ends of the fastener part prongs through the tissue. However, when the latches on the fastener part prongs contact the latches on the associated retainer part, the formation force requirement increases very eapidly (region B) to the peak formation force C, i.e., the force required to cause the latches on the fastener and retainer parts to interloc~. Thereafter (region D), the force requirement drops off rapidly again.
In accordance with this invention, apparatus for substantially simultaneously applying a plurality of surgical fasteners characterized by formation force curves like those shown in Figures 1 and 2 is constructed so that all of the fasteners do not reach their peak formation lS force C at the same time. In particular, the surgical fastener applying apparatus of this invention is constructed so that at least some of the fasteners reach their peak formation force C while at least some other fasteners are still at their relatively low in~tial formation ~orce A, and so that the fasteners that are first to reach peak formation force have returned to relatively low formation force D when the fasteners that are last to reach peak formation force reach their peak formation force C. In this way, the maximum force required to operate the fastener applying apparatus of this invention is substantially less than i~ would be iE
all of the fasteners reached peak formation force at the same time.
A first illustrative embodiment of the invention is shown in Figures 3-22 in the context of surgical fastener applying apparatus. As shown in Figure 3, this apparatus includes a reusable actuator 20 for removably receiving and actuating a dispos~able staple holding cartridge 50. When cartridge 50 is placed in cartridge holder 22, cartridge holder 22 can be moved toward anvil 24 by rotation of clamp actuator 26 (compare Figures 4 and 5). The tissue 28 to be fastened is thereby clamped between cartridge 50 and anvil 24. Alignment pin 30 is ~267~
pushed through cartridge 50 into anvil 24 to help register and align elements 50 and 24 and to help confine kissue 28 between those elements.
When tissue 28 is fully clamped as shown in Figure 5, handle 32 tFigure 3) is pivoted to the rear to drive fastener actuator bar 34 in the distal direction as shown in Figure 6. Fastener actuator bar 34 enters the rear of cartridge 50 and pushes pusher driver 52 in the distal direction. This in turn pushes all of pushers 54a and 54b in the distal direction. Some of pushers 54 (i.e., those designated 54a) are slightly longer than the other pushers ~i.e., those designated 54b). (Pushers 54a and 54b are joined together in groups of two or three for reasons (such as reduction of the number of separate parts in the apparatus) having nothing to do with the present invention). The difference in length of pushers 54a and 54b is typically relatively small (e.g., .008-.012 inches) and is exaggerated in the accornpanying drawings to better illustrate the invention.
When pushers 54 are pushed in the di~tal direction as described above, they push staples 56 toward anvil 24 as shown progressively in Figures 11-16. Anvil 24 has pockets 36 for clinching staples 56 in the conventional manner. (In order to facilitate comparison of the progress of staples 56a (associated with relatively long pushers 54a) with the progress of staples 56b (associated with relatively short pushers 54b), a staple 56b is superimposed on a staple 56a in Figures 11-16, although in that respect Figures 11-16 are not true views of the apparatus). As shown in Figure 11, the ends of the legs of staples 56a reach the surface of anvil 24 before the ends of the legs of staples 56b reach that surface.
Accordingly, staples 56a reach peak formation force C
(Figure 1) while staples 56b are still in relatively low initial formation force region A. As pushers 54 continue to move in the distal direction, the ends of the legs of staples 56a begin to bend inwardly as shown in Figure 12, and the ends of the legs of staples 56b continue to move 12~ii7~
toward the surface of anvil 24. Accordingly, staples 56a pass peak formation force C and enter reduced formation force region D before staples 56b reach peak formation force C.
5Continued distal motion of pushers 54 causes staples 56a to conkinue to bend, and causes staples 56b to reach pea~ formation force C and to begin to bend as shown in Figure 13. Accordingly, when staples 56b reach peak formation force C, staples 56a are already well past peak 10formation force and into reduced formation force region D.
Still further distal motion of pushers 54 causes staples 56a and 56b to continue to bend as shown in Figures 14-16. Because pushers 54a are slightly longer than pushers 54b, staples 56a are clinched slightly more 15than staples 56b at the end of the staple applying stroke of the apparatus as shown in Figure 16. This does not adversely affect the resulting staple array.
When all of staples 56 have been fully clinched as shown in Figure 16, the stapling operation is complete.
20~andle 32 is accordingly released and clamp actuator 26 is rotated to proximally retract cartridge holder 22 and cartridge 50. This releases the clamping pressure on tissue 28 as shown in Figure 7. The apparatus can be removed from the tissue when alignment pin 30 is 25proximally retracted.
Because staples 56a pass through peak formation force C before staples 56b, the maximum force required to operate the apparatus i9 substantially less than it would be if all of staples 56 passed through peak formation 30force C at the same time.
In accordance with another aspect of the invention illustrated by the embodiment of Figures 3-22, the width W SFigure 8) of cartridge SQ and anvil 24 can be kept relatively small even though a large number o~
35fasteners is applied by the apparatus by using two staples 56 in each cartridge slot 58 instead of one staple in each ;~ slot as is customary. The structure Facilitating the US2 ~ of two staples 56 in each cartridge slot 5~ is best seen ~:67~32~:
in Figures 8-10 and 17-22. As shown in Figure 18, the opposite ends o~ each cartridge slot 56 have two laterally spaced grooves 60 parallel to the axis along which staples 56 are driven. Each groove 60 receives and guides one leg of one of the two staples 56 in the slot. The distal end of each pusher 54 also has two parallel, laterally spaced grooves 62 (see Figures 8-10). Each groove 62 receives the backspan oE a respective one of the two staples in the associated slot 58. Each of anvil pockets 36 also has two laterally spaced grooves 38 parallel to grooves 62 (see Figures 8-10 and 20~22) . Each of grooves 38 receives and guides the end of one leg of one of the two staples driven into pocket 36 in order to clinch the staples. Thus although two staples 56 are provided in each slot 58 ~ the foregoing structure keeps the staples in each slot separate from one another and prevents them from becoming entangled with one another as they are driven.
Although two staples 56 are employed in each slot 58 in the embodiment shown in Figures 3-22 ~ those skilled in the art will appreciate ~hat this is not necessarily the case, and that a single staple 56 could be used in each slot 58 if desired. See also the embodiments shown in Figures 24-27 tdiscussed below) in which the same number of fasteners are employed as in the embodiment of Figures 3-22~ but in which each fastener has its own slot 58.
Those skilled in the art will also recognize that two-part resinous surgical fasteners of the type shown, for e~ample, in Green U.S. patent 4r506r671 can be substituted for metal surgical staples 56 in the embodiment shown in Figures 3-22. This is illustrated by Figure 23, which is similar to Figure 5 but shows the apparatus with two-part resinous fasteners 70 in place of metal surgical staples 56. The ~astener parts 72 of fasteners 70 replace staples 56. The retainer parts 74 of fasteners 70 replace anvil pockets 36. In other respects the construction and operation of the apparatus of Figure 23 can ~e generally slmilar to the construction and ~2~78~
operation of the apparatus of Figures 3-22. ~ecause pushers 54a are slightly longer than pushers 54b, fastener parts 72a interlock with retainer parts 74a before fastener parts 72b interlock with retainer parts 74b.
Accordingly, fasteners 70a reach peak formation force C
(Figure 2) while fasteners 70b are still in relatively low formation foece region A, and fasteners 70b do not reach peak formation force C until fasteners 70a have passed through peak formation force C into reduced formation force region D. The maximum force required to operate the apparatus is therefore substantially less than it would be if all of fasteners 70 reached peak formation force C at the same time.
Figure 24 shows another embodiment of the invention in which all of pushers 54 are the same length, but in which pusher driver 52 is notched, grooved, or otherwise stepped so that it begins to push some oE
pushers 54 (i.e., those designated 54c) befoee it begins to push other pushers ~i.e., those designated 54d).
Figure 24 is similar to Figure 8, but with the following differences. First, there is only one staple 56 in each cartridge slot 58. Second, there are four rows of cartridge slots 58 instead of only two rows as in Figure 8. Third, all of pushers 54 are the same length. And fourth, pusher driver 52 contains a shallow central groove 64 so that when pushed in the distal direction, it contacts outer pusher rows 54c before it contacts inner pusher rows 54d. Accordingly, outer staple rows 56c are pushed slightly ahead of inner staple rows 56d and staples 56c pass through peak formation force C before staples 56d reach that force level. As in the embodiment of Figures 3-22, the maximum force required to operate the apparatus o~ Figure 24 is substantially less than it would be if all of staples 56 reached peak formation force C at the same time. The depth of groove 64 can be similar to the difference between the lengths of pushers 54a and 54b in the embodiment of Figures 3-22. Those skilled in the art will appreciate that two-part cesinous surgical fasteners ~7~
of the type shown in Figure 23 can be substituted for metal staples 56 in the embodiment of Fiyure 24 if desired.
Figure 25 shows yet another embodiment of the invention in which some of anvil pockets 36e are deeper than other anvil pockets 36f. In other respects the embodiment of Figure 25 is similar to the embodiment of Figure 24 except that pusher driver 52 is not grooved in Figure 25. Because inner anvil pockets 36e are deeper than outer anvil pockets 36f, staples 56f contact anvil 24 before staples 56e. Accordingly, staples 56f pass through peak formation force C before staples 56e reach that force level. The maximum force required to operate the apparatus is therefore substantially less than it would be if all of staples 56 reached peak ~ormation force C at the same time. The difference in depth between anvil pockets 36e and 36f can be similar to the difference between the lengths of pushers 54a and 54b in the embodiment of Figures 3-22.
Once again, those skilled in the art will appreciate that two-part resinous fasteners of the type shown in Figure 23 can be substituted for metal staples 56 in the apparatus of Figure 25 if desired. This is illustrated in Figure 26. Inner retainer parts 74e are recessed relative to outer retainer parts 74f so that outer fasteners 70f interlock before inner fasteners 70e.
In this way all of fasteners 70 do not pass through peak formation force C at the same time and the maximum force required to operate the apparatus is according~y reduced.
Still another embodiment oF the invention is shown in Figure 27. In this embodiment (which is similar to the embodiment of Figure 25 e~cept that all of anvil pockets 36 are of the same depth)~ the legs of inner staples 56g are slightly shorter than the legs of outer staples 56h. Accordingly, outer staples 56h pass through peak formation force C before inner staples 56g pass through that force level. The result again is to reduce the maximum force required to operate the apparatus. The 678;~:~
difference in staple leg length in this embodiment can be similar to the difference between the lengths oE pusher~
54a and 54b in the embodiment oE Figures 3-22.
As in the case oE the previously described embodiments, those skilled in the art will recognize that two-part resinous fasteners can be substituted for metal staples 56 in the embodiment of Figure 27. In that event, the legs of the fastener parts of some of those fasteners are made longer than the legs of the fastener parts of the other fasteners in order to achieve operation similar to that described above in eelation to Figure 27.
Yet another alternative embodiment of the invention is shown i.n Figure 28. Staples 202 are driven in the distal direction when the proximal end of cable 112 is pulled in the proximal direction. This causes cam bar 230 to move down relative to pusher actuator member 240.
As cam bar 230 moves down, it is also forced to move in the distal direction by cam follower pins 232 t~aversing cam slots 354 and 454. Because cam slots 354 and 454 have different shapes, the lower end of cam bar 230 initially moves more rapidly in the distal direction than the upper end of cam bar 230. This causes lower staples 202 to reach peak formation force C beEore upper staples 202 reach that force level. ~lthough all of staples 202 are in motion at the same time relative to fastener holding part 210 ~th~reby satisEy.ing the above definition of substantially simultaneous staple application), the staples reach and pass through peak formation force C
progressively, from the bottom of the apparatus to the top as viewed in Figure 28. Accordingly, at least some of staples 202 pass through peak formation force C before other staples reach that force level ~nd the maximum force required to operate the apparatus is substantially less than it would be if all of staples 202 reached peak formation force C at the same time~
As in the previously described embodiments, two~
part resinous fasteners of the type shown in Figure 23 can be substituted for metal staples 202 in the em~odiment oE
~7~
Figure 28 if desired.
It will be understood that the embodiments shown and described herein are only illustrative of the principles of the invention, and that various modifications can be made by those skilled in the art without departing from the scope and spirit of the invention. For example, other structures for angling or inclining elements such as fastener actuator bar 34, pusher driver 52, and/or cam bar 230 to achieve a result similar to that described above in relation to Figure 28 will be apparent to those skilled in the art.
Claims (14)
EXCLUSIVE PROPERTY OR PRIVILEGE IS CLAIMED ARE DEFINED AS
FOLLOWS:
1. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a fastener carrying means having a plurality of fasteners therein;
forming means opposite said fastener carrying means to form said fasteners after penetration through body tissue; and drive means including a longitudinal shaft and a drive bar located on a distal end of said shaft for applying a positive drive force to drive said fasteners from said fastener carrying means through the body tissue and toward said forming means;
wherein at least one of said forming means and said drive means causes some of said fasteners to reach peak formation force before the remainder of said fasteners reach peak formation force.
a fastener carrying means having a plurality of fasteners therein;
forming means opposite said fastener carrying means to form said fasteners after penetration through body tissue; and drive means including a longitudinal shaft and a drive bar located on a distal end of said shaft for applying a positive drive force to drive said fasteners from said fastener carrying means through the body tissue and toward said forming means;
wherein at least one of said forming means and said drive means causes some of said fasteners to reach peak formation force before the remainder of said fasteners reach peak formation force.
2. An apparatus as set forth in claim 1 wherein said drive means further includes pusher means arranged between said drive bar and said fasteners, and wherein said pusher means associated with some oE said fasteners are longer than said pusher means associated with the remainder of said fasteners.
3. An apparatus as set forth in claim 1, wherein said drive bar has a distal surface comprising first portions to contact said pushers associated with some of said fasteners, and second portions to contact said pushers associated with the remainder of said fasteners, and wherein said second portions are recessed relative to said first portions.
4. An apparatus as set forth in claim 1 wherein said forming means comprises an anvil haviny an anvil surface with staple-clinching grooves formed therein, wherein said fasteners comprise staples which are applied by clinching against said anvil surface in said staple-clinching grooves, and wherein said staple-clinching grooves associated with some of said staples are shallower than said staple-clinching grooves associated with the remainder of said staples.
5. An apparatus as set forth in claim 1 wherein said fasteners comprise resinous tissue-piercing parts, and said forming means includes resinous retainer parts releasably mounted therein, and wherein said resinous retainer means associated with the remainder of said fasteners are recessed on said forming means relative to said resinous retainer parts associated with some of said fasteners.
6. In an apparatus for applying a plurality of surgical fasteners to body tissue, the combination comprising:
a plurality of fasteners;
a fastener-carrying means;
forming means opposite said fastener-carrying means to form said fasteners after penetration through body tissue;
drive means including a longitudinal shaft and a drive bar located on a distal end thereof for applying a positive drive force to drive said fasteners from said fastener carrying means simultaneously through the body tissue and towards said forming means;
wherein some of said fasteners are longer than the remainder of said fasteners, said longer fasteners thereby contacting said forming means and reaching peak formation force before the remainder of said fasteners contact said forming means and reach peak formation force.
a plurality of fasteners;
a fastener-carrying means;
forming means opposite said fastener-carrying means to form said fasteners after penetration through body tissue;
drive means including a longitudinal shaft and a drive bar located on a distal end thereof for applying a positive drive force to drive said fasteners from said fastener carrying means simultaneously through the body tissue and towards said forming means;
wherein some of said fasteners are longer than the remainder of said fasteners, said longer fasteners thereby contacting said forming means and reaching peak formation force before the remainder of said fasteners contact said forming means and reach peak formation force.
7. An apparatus as set forth in claim 6 wherein said fasteners comprise staples and wherein said forming means comprises an anvil having staple-clinching grooves formed therein.
8. An apparatus as set forth in claim 6 or 7 wherein said fasteners comprise resinous tissue-piercing parts, and wherein said forming means includes resinous retainer parts releasably mounted thereon and adapted to fasten with a respective resinous tissue-piercing part.
9. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a cartridge containing a plurality of fasteners and a plurality of pushers for pushing said fasteners from said cartridge, at least some of said pushers being longer than the remainder of said pushers;
forming means opposite said cartridge to form said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and toward said forming means with said fasteners being pushed by said longer pushers reaching peak formation force on said forming means before the remainder of said fasteners.
a cartridge containing a plurality of fasteners and a plurality of pushers for pushing said fasteners from said cartridge, at least some of said pushers being longer than the remainder of said pushers;
forming means opposite said cartridge to form said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and toward said forming means with said fasteners being pushed by said longer pushers reaching peak formation force on said forming means before the remainder of said fasteners.
10. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a cartridge containing a plurality of fasteners and a plurality of pushers for pushing said fasteners from said cartridge;
forming means opposite said cartridge to form said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and toward said forming means, said driving means including a driver for pushing said pushers and being recessed to enable some of said fasteners to reach peak formation force on said forming means before the remainder of said fasteners.
a cartridge containing a plurality of fasteners and a plurality of pushers for pushing said fasteners from said cartridge;
forming means opposite said cartridge to form said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and toward said forming means, said driving means including a driver for pushing said pushers and being recessed to enable some of said fasteners to reach peak formation force on said forming means before the remainder of said fasteners.
11. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a cartridge including a plurality of fasteners;
an anvil for forming said fasteners opposite said cartridge and including pockets of different depths to receive and form said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and toward said anvil, said means causing some of said fasteners to contact some of said pockets and reach peak formation force on said anvil before the remainder of said fasteners.
a cartridge including a plurality of fasteners;
an anvil for forming said fasteners opposite said cartridge and including pockets of different depths to receive and form said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and toward said anvil, said means causing some of said fasteners to contact some of said pockets and reach peak formation force on said anvil before the remainder of said fasteners.
12. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a cartridge including a plurality of fasteners at least some of said fasteners being of longer length than the remainder of said fasteners;
forming means opposite said cartridge to form said fasteners after penetration through body tissue; and means for driving said fasteners from said fastener carrying means through the body tissue and towards said forming means, said driving means causing said fasteners of longer length to contact said forming means and reach peak formation force on said forming means before said remainder of said fasteners.
a cartridge including a plurality of fasteners at least some of said fasteners being of longer length than the remainder of said fasteners;
forming means opposite said cartridge to form said fasteners after penetration through body tissue; and means for driving said fasteners from said fastener carrying means through the body tissue and towards said forming means, said driving means causing said fasteners of longer length to contact said forming means and reach peak formation force on said forming means before said remainder of said fasteners.
13. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a cartridge including a plurality of fasteners;
retaining means opposite said cartridge including a plurality of retainers to respectively receive said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and towards said retaining means in staggered relation to said retainers to cause some of said fasteners to interlock with and reach peak formation force on said respective retainers before the remainder of said fasteners.
a cartridge including a plurality of fasteners;
retaining means opposite said cartridge including a plurality of retainers to respectively receive said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and towards said retaining means in staggered relation to said retainers to cause some of said fasteners to interlock with and reach peak formation force on said respective retainers before the remainder of said fasteners.
14. An apparatus for applying a plurality of surgical fasteners to body tissue comprising:
a cartridge including a plurality of fasteners, some of said fasteners being of longer length than the remainder of said fasteners;
retaining means opposite said cartridge including a plurality of retainers to respectively receive and interlock with said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and towards said retaining means to cause said longer fasteners to interlock with and reach peak formation force on said respective retainers before the remainder of said fasteners.
a cartridge including a plurality of fasteners, some of said fasteners being of longer length than the remainder of said fasteners;
retaining means opposite said cartridge including a plurality of retainers to respectively receive and interlock with said fasteners after penetration through body tissue; and means for driving said fasteners from said cartridge through the body tissue and towards said retaining means to cause said longer fasteners to interlock with and reach peak formation force on said respective retainers before the remainder of said fasteners.
Applications Claiming Priority (4)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US662,679 | 1984-10-19 | ||
| US06/662,679 US4580712A (en) | 1984-10-19 | 1984-10-19 | Surgical fastener applying apparatus with progressive application of fastener |
| US06/782,732 US4767044A (en) | 1984-10-19 | 1985-10-04 | Surgical fastener applying apparatus |
| US782,732 | 1985-10-04 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1267822A true CA1267822A (en) | 1990-04-17 |
Family
ID=27098576
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000493022A Expired - Lifetime CA1267822A (en) | 1984-10-19 | 1985-10-16 | Surgical fastener applying apparatus |
Country Status (10)
| Country | Link |
|---|---|
| US (1) | US4767044A (en) |
| EP (1) | EP0198886B1 (en) |
| JP (1) | JPH0616786B2 (en) |
| AT (1) | ATE85881T1 (en) |
| AU (1) | AU580634B2 (en) |
| BR (1) | BR8506999A (en) |
| CA (1) | CA1267822A (en) |
| DE (1) | DE3587120T2 (en) |
| GB (1) | GB2183525B (en) |
| WO (1) | WO1986002254A1 (en) |
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| US4978049A (en) * | 1989-05-26 | 1990-12-18 | United States Surgical Corporation | Three staple drive member |
| US5100042A (en) * | 1990-03-05 | 1992-03-31 | United States Surgical Corporation | Surgical fastener apparatus |
| US5116349A (en) * | 1990-05-23 | 1992-05-26 | United States Surgical Corporation | Surgical fastener apparatus |
| US5219111A (en) * | 1991-03-11 | 1993-06-15 | Ethicon, Inc. | Pneumatically actuated linear stapling device |
| US5415334A (en) * | 1993-05-05 | 1995-05-16 | Ethicon Endo-Surgery | Surgical stapler and staple cartridge |
| WO1995023557A1 (en) * | 1994-03-01 | 1995-09-08 | United States Surgical Corporation | Surgical stapler with anvil sensor and lockout |
| US5489058A (en) * | 1994-05-02 | 1996-02-06 | Minnesota Mining And Manufacturing Company | Surgical stapler with mechanisms for reducing the firing force |
| US5480089A (en) * | 1994-08-19 | 1996-01-02 | United States Surgical Corporation | Surgical stapler apparatus with improved staple pockets |
| US5941442A (en) * | 1995-10-27 | 1999-08-24 | United States Surgical | Surgical stapler |
| US5797537A (en) * | 1996-02-20 | 1998-08-25 | Richard-Allan Medical Industries, Inc. | Articulated surgical instrument with improved firing mechanism |
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1985
- 1985-10-04 US US06/782,732 patent/US4767044A/en not_active Expired - Lifetime
- 1985-10-15 JP JP60504660A patent/JPH0616786B2/en not_active Expired - Lifetime
- 1985-10-15 WO PCT/US1985/001982 patent/WO1986002254A1/en active IP Right Grant
- 1985-10-15 EP EP85905286A patent/EP0198886B1/en not_active Expired - Lifetime
- 1985-10-15 BR BR8506999A patent/BR8506999A/en unknown
- 1985-10-15 DE DE8585905286T patent/DE3587120T2/en not_active Expired - Lifetime
- 1985-10-15 GB GB08615608A patent/GB2183525B/en not_active Expired
- 1985-10-15 AT AT85905286T patent/ATE85881T1/en not_active IP Right Cessation
- 1985-10-15 AU AU48710/85A patent/AU580634B2/en not_active Ceased
- 1985-10-16 CA CA000493022A patent/CA1267822A/en not_active Expired - Lifetime
Also Published As
| Publication number | Publication date |
|---|---|
| AU580634B2 (en) | 1989-01-19 |
| EP0198886A4 (en) | 1988-04-18 |
| BR8506999A (en) | 1987-01-06 |
| EP0198886B1 (en) | 1993-02-24 |
| GB8615608D0 (en) | 1986-07-30 |
| DE3587120D1 (en) | 1993-04-01 |
| US4767044A (en) | 1988-08-30 |
| WO1986002254A1 (en) | 1986-04-24 |
| JPS61502036A (en) | 1986-09-18 |
| JPH0616786B2 (en) | 1994-03-09 |
| DE3587120T2 (en) | 1993-08-05 |
| EP0198886A1 (en) | 1986-10-29 |
| GB2183525B (en) | 1989-01-05 |
| GB2183525A (en) | 1987-06-10 |
| AU4871085A (en) | 1986-05-01 |
| ATE85881T1 (en) | 1993-03-15 |
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