CA2131340A1 - Endoscopic surgical instrument and staples for applying purse string sutures - Google Patents

Abstract

ABSTRACT OF THE DISCLOSURE

A surgical staple for securing a purse string suture to human tissue comprises a staple body of deformable material formed into a loop through which the purse string suture is threaded. The staple body includes a pair of legs which are deformable into an overlapping configuration upon insertion into the tissue to secure the staple body and the purse string suture to the tissue. Alternatively, the staple body includes two or more legs including barbed ends for anchoring the legs to the tissue. To secure the purse string suture, a plurality of staples is positioned about the periphery of the tubular section of tissue, the purse string suture is threaded through the loops in the staples, and the staples are driven into the tissue to secure the purse string suture thereto. In addition, surgical instruments for open surgery and endoscopic surgery are provided for applying the staples and the purse string suture to the tissue. The instruments include a pair of staple cartridges each having a row of staple receiving slots intersected by an elongated central slot which allows the purse string suture to be attached to the staples in the cartridge prior to the operation of the instrument.

Description

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~D08COPIC 8~R~IcaL I~B~R~N~T A~D BTAPLS~
FOR app~yIN~ P~R8~ 8TRIN~ 8U~DR~8 C~088-R~F~RENCJB TO ~L~T~D APpLICAT~0~8 This i~ ~ continuation-in-part of U S Patent applic~tion Serial No 07/88I,018, filed Hay 8, 1992 saC~Ro~ND or T~ SNV~NTIO~

~ o~ t~ t~o~
ThQ pr--ent inv ntion g-ner~lly rel~tes to a ~urgic~l in tru~ent ~nd ~t~pl-- for ~pplying pur~o ~tring ~uture- to hu~an tis-ue and, ~ore particularly, to ~ ~urgic~l in-trum~nt ~nd ~ethod in wh~ch ~ purse ;~
~tring ~uture i- ~ocurod to hu~n ti~u- by a plur~lity o~ ~t~pl-~ In ~ddition, thi- inv ntion rel~t~- to ~
urgic~l ~tapl~ ~or -curing ~ pur~- ~tring ~uture to hun~n ti~uo in ~hich th- ~t~pl- body i~ ~dapt-d to b ~lld~bly ~tt~ch-d to th pur - ~trlng ~utur In an alt-rn~tlv- ~poct, thi~ invention r~l-t - to ndo-eopic ln tru-ent~ ~nd ~ thod- ~nd, ~ore partlcularly, to an ndo~eople ~urgical in-trument and ~-t~od ~or apply~ng pur~ ~trlng utur-- to body ti~-u-by plurallty o~ tapl--D-~ori~tlon o~ ~h- ~rlor Art -~
In th- prior art, it i~ known to use ~ pur~-~trlng uture to elo-e a tubular ~eetion o~ ti~u-, - g , inte~tlnal tl~-u , prior to the p-r~ormance o~ an nd-to- nd ~n~to o~l~ wlth a clreular wturing in tru- nt Tb~ pur~- tring ~uture i- attach d to a urglc~l ne-dl- whlch 1~ u~ d by ~ ~urg~on to ~nu~lly ~tltch th pur~- trlng ~uture dbout the perlph ry o~
th tubular -ctlon o~ tl~-u A~t r th pur~e ~trlng utur i~ ~titch d to the ti~ou-, the end~ o~ th~ pur~e '::

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~tring ~uture are pulled to tighten the stitche~ and dr~w the tissue toget~er Then, the pur~e ~tring suture i~ wr~pped ~nd tighten~d ~bout the tubular ~ction of -~
tis~ue In the ~nu~l stitching of the p~rse ~tring ~utur , it is difficult to obtain uniform penetr~tion of the purse ~tring suture into the ti-sue It is al~o dltricult to obtain ~titches which are unirorm in length and ar~ v-nly paced apart A- a r-sult, ome o~ tho ~titche~ ~ay rip away ~ro~ tho ti~-u- when the end~ o~
th- pur~- ~tring uture are pull~d Pur~- ~tring suture devico~ are known in the prior art which co~pri~o a pair o~ -rrated tis~ue cla~ping ~w~ pro~ided with teeth for cl~mping the~
ti~ue to b utur d th rebetw n 8uch devices includ n- dl- pas~g-- Yhich xt-nd through the teeth on each ~--~aw ~or r-ceiving a ne dl- attached to a suture to be thr~ad~d through tb ti~u In u~-, the tissu~ to b wtur d i~ cluop d b-tw -n th ~w- and th- n-edle i~ ~-~nu~lly pas~-d through th needle pass~ges in both ~aw~
to thr ~d th- utur through the tis~u- Therearter, th ~aw~ ar op n d ~nd th pur-e ~tring ~utur is tlgbt n d and wr-pp d to draw th tl--u- tog-th r B c u th- tl~u ray b gath-r d un ~-nly b-tw -n th-~wa, it i~ ~oo-ti di~icult to obtain uni~or~
p n tratlon o~ th n edl- and uture into th- tis~u Thu~, wh n th nd~ of tb pur8- 8tring uture are pull-d to gath r th ti~UQ tog th , tb~r~ i8 a t nd ncy for at l-a-t ~o-- of tb ~titche- for ed by thQ ~ ~
pur~ ~tring utur to rlp away fro~ tb ti~u- A180, ' . '' lt i~ po ~ibl- that o- of th ~titch ~ uay xt~nd tbrough both wall~ of th tubular ~-ction of ti~su with tb r -ult that th tl-~u i~ not uni~or-ly dr~wn tog th r whon th~ nd~ of tb pur~- ~tring ~utur~ ar pull d to dr~w th ti~-u- tog~th r " ~
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~1~13~ ~, In the prlor art, it has been propo~d to provide pur~e ~tring euture device~ which utilize a plurality of ~taplec for applying pur~e string ~uture~
to hu~an ti~ue ~oth anvil carrying device~ and a m illess devices have been proposed for applying the ~taple~ and the purs~ ~tring ~uturQs to the tissue For ~xa~pl-, U S Patent 4,749,114 di~c1060~ a pur~- tring applie~tor whleh lneludo- an anvil carri-r with a plurality of anvil- ~or ln-~rtlon in a tubular ~-etion of ti~u and a pair of ~taple e~rtridge6 di~po~ d on oppo-ite eide- of th anvil carrier Eaeh eartr$dge ha~ a row of ~taples and the pur~e ~tring ~utur xtend~ acro~ eaeh row of staples The applieator includ ~ a pair of pu-hera each having a plurality of pu-h-r fing-r- for driving th- atapl-- ~rom th Q rtridg-~ through th- tl-~u- ag~in t the anvil~ of th earri-r Tb- tapl-- in ach row ar~ defor~ed and ~-eur d to th tir~u- and th pur-- trlng ~utur i~
~lidably r tain d b~tw n th- ~tapl-~ ~nd th ti~u-$n ~ddition, U 8 Pat-nt 4,821,939 di~clo~
an anvlll--- ~urg~eal tapl-r for applying pur~- string ~utur ~ to hu~an tl-~u Ih- t~pl-r lnelud ~ a pair of ~tap Q rtridg-~ aeh h~ving a plurallty of op-ning~
~or r eolving a plural$ty of ~urgieal ~t~pl-~ Th-2S Qrtridg-~ inelud- oppo~ d pro~-ction- which d~fin groov - at both nd- of th- Qrtridg-~ to rce~iv~ a -~
pur~ ~tring autur ~ae~ eartridg~ includ-~ a pair o~ -~
~atapl- ~orJing lip~ which d fin an outl-t of l----r ~idth th~n th op ning~ Eaeh e~rtridg- include~ a plurality o~ pu her~ ~or driving th tapl-- ~ron the op ning~ through th outl-t~ and into th- ti~ue cla~p d b tw en th cartridg-- A- the ~taple~ ar- xpell~d ~rou th- opening~, th lip~ d ~or~ the ~t~ple l-g~
lnwardly tow~rd ~ch oth-r to pen trat lnto and grip 3S th tl-~ue Th pur~- tring ~utur i- locatcd ~13~3~
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underneath each staple and iB thereby attached to the ti~ue ~ ~-In the ~bove examples, the purse ~tring ~uture i~ located und~rne~th the ~taples ,nd is retain~d ag~in-t the tl~ue by th- ~t~ples Con~gu~ntly~ wh~n th~ nd- o~ the purso tring ~uture ~re pulled by ~urgoon to draw th- tis~u- together, there is some r ~l~tanc- to uov ~ nt o~ th- purs- trlng ~uture r-lativ to th- ~tapl-- and ti--uo Thu-, lt 1~
po--~bl- that o~ portion~ o~ the ti~uo m~y not bo tightly drawn tog~th-r by pulling on the end~ o~ the pur~- tring ~utur~
Accordingly, it i8 desirable to provide a urgical ~tapl- ~or -curlng a purse ~tring suture to ~ -lS hu~n ti~u which do-- not cla~p th- pur-- ~trlng ~-utur again t th- ti~u- Al-o, it i8 d-~irabl~ to provid- a urgical tapl- ~or -curlng a pur-~ tring utur which pr --nt- ~ini~al r--i-tanc- to th- ~o~ nt o~ th pur-- tring ~uturo a~t-r th tapl- i- -cur d to th~ ti~-u- ln addition, it 1- do~irabl- to provld ` ;
a ~urgical ~tapl- ~or ~-curing a pur~- trlng ~utur- ln whlc~ th- ~tapl- body i- lld~bly attach-d to th pur~
~tr~ng ~utur `; ;
Furth r, lt i- d ~irAbl~ to provid- a ~ethod ~or ~ curing a pur~- tring ~utur- to hu~an tl~u by a plur~lity o~ tapl-- which ar lid~bly attached to the pur~- ~tring utur ~nd pr ~ont ~inl~al ro~l~tance to th~ ~ov ~ont o~ th- pur-- tring ~uture r-latlv to th -~
ti~eu Al~o it i- d -lrabl- to provld- a urglc~l in tru nt having a tapl- c~rtridg- in whlch th purs -~
tr~ng utur c~n b- lidably attach~d to th ~urgical etapl-~ prior to tb~ op ration of th in tru~ent to -;
o-cur th ~tapl-~ and th- pur~- tring uture to th ti~u ., " '', , ..

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Further, it i~ desirable to provide an endo~copic ~urgical instrument and method for securing purse ~tring ~uture by a plurality o~ staple~ which are ~lidably ~ttaehed to the purse string suture and pre~ent ~in~al reei~tanc~ to the ~ovement of ths pur~e string ~uture relative to the tissue For sueh Qndoscopic urgical in~tru~ent, it i- desirable to provide a staplQ
eartrldg- eontaining pur-- tring outur~ and staplQ~
that i- in--rtabl- into th ln-tru~-nt Further, lt i-d-~irabl- to provid ~n ndoaeopie surgi¢al in-trument having ~ rotatabl- and/or ~rticulatabl- endo~copie portion ~nd a knif- bladQ for eutting thQ tissuQ aft~r it h~ b~en ~tapl~d ~u-~r o~ ~- S~v-~tlo~
Th- pre~-nt im ntion aehi-v-~ an i~proved ~urgie~l atapl- for a-curing ~ pur~- tring ~utur~ to huran ti--u- Th urgieal ~tapl- eo~pri~-~ a ~tapl-body eo pri~ing an longat d trip of d-for~blo ~t ri~l lneluding ~ pair o~ l g- ~dapt d to b- in~-rt-d ~nto th ti~-u , th- l-g- b ing d ~or ~bl- upon ;
~n -~t~on into t~ ti~u to ~-eur- th t~pl- body to th t~-au-, and th tapl- body ineluding r-ana ~or ~lidably attaehing th pur~e ~tring autur to the tapl- Pr ~ r~bly, th r e-iving ~ an- eo~pri~e~ an yel-t ~or~ d on th tapl- body through whieh th- pur~
tr~ng utur i- thr ad d Th y l-t ean b- loe~t-d on -~
th oppo~it- ~id o~ th tapl- body ~roa th t~pl-l g- or on th ~a~ id o~ th tapl- bo~y ~- th ~t~pl~ l~g~
; In ~ pr ~err~d ~bodi~ nt o~ th urgical ~t~pl-, th~ ~tapl- body i~ for~ d into ~ loop to provid-~n y l-t through which the ~utur i~ threaded The p loop i- ~or~ d on th~ oppo~it~ dde o~ the ~taple body ~ ~3 ~

fron the staple legs or on the s~me ~ide of th~ ~tapl~ -body a~ the staple legs ;~
Another e~bodi~ent of t~e ~urgical st~ple ~-cooprise~ ~ ~taple body including two or ~ore legs S ~d~pted to be in6erted into the tissue, the legs including barbed ends for anchoring the leg~ to the ti~ue, and the st~ple body including means for slidably rec-i~ing th~ pur~- tring suture Pre~er~bly, the ~urgical ~tapl- co~pri--- a ~tapl- body shapod lnto a r$ng to provide an ey~l-t ~or receiving a pur~Q ~tr~ng ~uture ~nd including two or ~ore leg- with barbed end- ;~
~or anchoring th- l-g- to the ti~ue In ~ pre~erred ~obodi~ nt Or the ~urgical t~ple, ~ plur~lity o~ leg~
xt nd in a tan-like configuration from the ~taple body `
Th l g- ~r~ b nt ~ltern~tely torw~rd ~nd rearward r l~tiv~ to th~ ring Anoth r ~p ct o~ th in~ention relate~ to an i~prov-d ~thod ~or -curing a pur~- ~tring suture to a ~-tubular ~-ction o~ ti~u . Tho a thod co~prise~ the ~t p~ o~ po-itioning ~ plurality o~ ~taple~ ~bout th-riph ry o~ ~ tubul~r ection of ti~u-, ~lidably ~tt~chlng a pur~- tr~ng utur- to th- ~taple-, and dr~vlng th ~t~ - into th tl--u- to -cur th- pur--~txing utur th r-to ~r f-r~bly, eaoh o~ the stapl~
includ-- an y l-t through ~hich th~ pur~e tring suture i- thx aded to ~tt~ch th- pur~- tring ~utur- to t~
tapl $h~ pr ~-nt im ntion al-o ~chi-v~ ~n irprov d ~urgicnl in tru ont for ~pplying pur~- ~tring utur~ to hu~an tic-u- Th~ pur~ tring cutur ~n~tru-~nt co~pri--- ~ pair of ~tapl- c~rtridg~- h~vlng Oppo~a ti~u- clu ping ~urfac-~ for cl~ ping th- ti~u~
th~r b-tw n A row of t~pl- r c~iving lot~ i~ foro~d in ach of th c~rtridg - with ~ach lot being adapt d to r c~iv a tnpl- with it- l-g~ pointing tow~rd th- ~

,'. . ',: ., :.:, :' ~ '', ti~sue cla~ping surface of the cartridge A central slot extends along the tio~ue clamping surface of each csrtridge for receiving ~ pursQ otr$ng outure connected to the ~taple~ in each of the staple receiving olot6 A
staple pusher bar iB olidsbly ~ounted in esch cartridge and sdspted to engage ~nd b4nd the legs of each otaple toward the tis~ue clamping surfsce o~ the cartridge upon ~ov-~ent of th- ~tapl- pu~her bar relative to the cartr~dqe Actuating ~-~no i- provided ~or ~lldinq th-puoher bsr in esch tspl- c~rtridge to b~nd the ot~plQ
l go and -cur- the ~tspl-o ~nd the puroe otring outure to th- ti--ue cla~ped b tween the csrtridges Prefer~bly, the centrsl slot in each stsple ¢~rtridge inter-ect~ ach of the otsple receiving oloto th-r in Al-o, th- otspl~ pu-her bar io nov~bl~
r l~tiv- to the csrtridg- in 8 direction parsllel to the row of otspl-~ th r in Th- pu~her b~r includ - 8 ri-- of oppo--d pair- ot w dg---hap-d protruoion-¢orr ~ponding to th t~pl- r c-iving loto in th-¢artridg , with a¢h pair of wedge-oh~ped protrusiono b ing ~dspt d to ngag and b nd the l-go of th- otapl-to~ard th- t~-u clanping ~ur~a¢- into an ov rlapp-d ¢on~gurat~on wh-n th ~tapl- pu~h~r bsr 1- ~ov d longitudinally r-latlv- to th- c~rtridg According to another aop ct of th imention, ~t~pl- ¢~rtridg co pri~ n longst-d housing including ~ tioou engaging ourf~c , a plurality of trsn~v r~e d oto xt nding into the houoing fro~ the tioou ngsging urfac for r c iving tapl-- th r in, and an longat d ¢ ntral lot for rec~i~ing a puro ~tring utur attach d to ~ach of the otapl~ Th~
longst d central olot xt~ndo longitudinslly slong th~
hou ing ~nd inter--ct- th trsn veroe dot~ A otapl-pu h r bar i~ olidsbly ~ounted for longitudinsl ~ove~ nt 3S in th~ hou-ing with th tapl~ pu~her bar being ~dapt~d .. ~,.

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,. ': . '.:' to engage and bend the leg6 of e~ch 6taple toward the tissue clamping surface to ~ecure the staple~ ~nd the purse string suture to the tissue Another a~pect of the invention comprises an ndo~copic ~tapler ha~ing a pair of ~aws At lQast one ~ ; -of the ~W8 i~ ~ovable b~tween an open po~$t~on ~nd ~
clo~-d po~ition Each ~aw contalns a ~tapl~ cartridge ~or holding a plural~ty o~ ~tapl~- E~oh cartridge contain~ a clo--r ~ech~ni-n ~or closing the ~taple~
Th- instru~ent ha~ a handl- portion containing a ~aw actuator for noving th- ~aw and a trigger Dechani~ for actuating the clo--r ~ ch~nis~
Oth-r featur~ of the invention include rotation of thc ndo~copic portion relative to the ~`
handle portion, articulation of the ~aw~ between a ~traight conf~guration and an angled configuration, a ~aw articulation control on the handlc, a cutting blade ~ `~
~or cutting ti~u ad~acont th ~aw-, and a blade ctu tor on the handl-In an alt-rnati~ a~p ct of th~ invention, the ~t~pl- cartri~g- i~ con~gur~d to coact with another cartrl~g- o~ th- ~a - d~-~gn $h- t~pl- pu~h-r ~ar ~lthln th cartridg- co ct~ wlth anoth-r tapl- pu-h-r bar o~ th ~a - conflguratlon which i~ locat d in anoth-r c~rtrldg ad~ac-nt to th- fir~t cartridge The c~rtrldg ha~ a plurality of tapl- recQi~ing ~lot~ and -c ntral longltudlnal ~lot for p r~itting pa-~age o~ a longltudinally ~xtending ~utur ~ ~-An lt rnatlv a~p ct of the in~ ntion includec an ndo~copic ~urgical ~taplQr having a ~ `
~tapl~ng portion locat d at it- di~tal ond for applying -~ -~ plurality of ~tapl-~ in a ~ingl- application wh-r in ;~
th ~tapling portion i~ articulatabl- b4twe~n a ~traight configur~tion und an angl d con~iguration An articulation control in th handl- ~ariably articulat-~

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g the ~tapling portion A trigger mechanism in the handle ~etu~tes tbe ~tapling portion ~ -An alternative a~pect of the invention include~ a ~ethod for applying purse ~tring outure and S ~taple- to a body ti~ue endo~eopically Tbe method ineludo~ tbQ st~ps of providing an elongated surgical in tru~ent with a e~rtridge eont~ining purse ~tring ~utur ~nd tapl~-, ext-nding th- e~rtridge through troc~r ~nd into a body e~vity ad~e-nt a body ti~sue, and firing th~ t~pl-- into th body ti~uo without piereing eo~plet-ly tbrougb tbe bo~y ti~sue ~o ~ to r t~in tb- utur on th~ body tis~u~
Alt-rnativ- tep- in tbe mothod in ~ccordance with th- i m ~ntion inelud providing a s~cond cartridg- --~t th di~tal nd of th longat-d in-trument, pro~iding --~ -t of ~aw at th- di~tal -nd oS th- in~tru~-nt, elo~ing tb~ ~w~ around two lay r~ oS body ti~ue, firing tapl-- fron ~eb eartrldg- wh~r-in aeh t~pl-pi-r¢ - on- oS th l~y r~ of ti--u- without pi~reing th~
oth r of th lay r~ Or ti-~u , ~rticulating the ~aw~ to ~n ~ngl-d po-ition ~St r th ~aw~ ~r- ext~nded through th- tro Q r, rot~tlng t~ ~o-eopie portion r-l~tiv- to th- h~ndl- portlon, provldlng a knir- bl~d- ~d~ w -nt on of th ~w~ and euttlng th body ti-~u- with th- knlf 2~ bl~d ;

Th for going ~nd oth-r ob~-et-, a~peet~ and ~dvantag - wlll b- b tt r und-r tood fro~ th- followlng d-t~ d de~criptlon of th pr f rr d bodi~ nt~ of th i~vention Yith ref-renc to th drawing-, ln whlch Fig 1 i~ ~ ~ide vleY of ~ flrst e bodi ent of a urglc~l ~t~pl~ for ~curing a purse ~trlng ~uture to hu~n ti~-ue;
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Fig. 2 ic a top view of the 6urgical staple of Fig. ~
Fig. 3 ~hows the 6urgical ~taple of Fig. 1 ~-:
with it~ leg~ defor~ed to attach thei staple and a pursa S ~tring ~uture to the tissue;
Fig 4 is a side view of a ~econd embodiment of a surgic 1 ~taple for securing a pur~e string ~uture to hu~an tissu-;
Fig S i~ a bottom ~iew ot the surgical ~tapl-ot rlg. 4s Fig 6 how~ th urgical ~taple ot Fig 4 w~th it~ leg- detor-ed to ~ttach the ~taple and a pur~e ~tring ~uture to the ti~u Fig 7 i~ a aid~ view o~ a third embodi~ent ot lS a ~urgical ~taple tor s-curing a purse string suture to hu an ti-~u~
Fig 8 ~how~ th ~urgical ~taplQ ot Flg 7 with it~ l-g- d-tor- d to ~ttach the ~taple and a purse ~tr~nq ~utur to th- ti~u Fig 9 i- a la vi~iw ot a tourth embodiment ~ ~
ot a urgical tapl- tor -curing a pur~e string sutur ; ;;
to hu ~n tl~u-7 ~;
Flg 10 how~ th ~urglc~l ~taple ot Flg 6 wlth ~t~ l-g~ d-torn d to att-ch th- ~tapl- and a pur~-~tring utur to th ti~u Flg 11 1~ an nl-rg-d view o~ a ~odified tor~
o~ thi urglcal tapl- ~hown in Fig ls i ~-Flg 12 i- n nl~rg d ~iew ot another forn ot th- urgical tapl- hown in Fig l; ~;
Fig 13 ~- n nlargid vi-w ot a ~odit~-d for~
o~ th~ ~urgical ~tapl- bown in Fig 4 Fig 1~ hon ~ pur~- ~tring ~utur ~ecur-d to tubul~r -ction of tia~u- by a plurality of ~tapl-~ in ccord~nci with thl~ im nt~on;
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Fig 15 6how6 a fifth ombodi~nt of a 6urgical ~taple for securing a purse 6tring suture to human ti~6ue which include6 ~ plurality of legs provided with ~
barb~d onds for anchoring the ~t~ple in the tisaue; -~ -Fig 16 i~ ~n ond view of thQ surgical st~pl~
o~ Yig lS; ~ -Flg 17 show- th~ ~urgic~l ~tapl~ of Fig 15 anchor d in th- ti~u- wlth a pur-- tring ~utur-thr ~d-d th-r~throughs F~g 18 how a pur-- tring ~utur- thr-~d~d ~nto ~ plurality of ~urgic~l t~pl~- of th~ typ- 6hown in Yig ls ~ -Yig 19 how- ~ purse string ~uture thread d into ~ plur~lity of ~urgic~l st~pl-- of th~ typ- hown in Fig 4;
Fig 20 ~how~ a pur-- ~tring utur~ thr~d~d ln~o a plur~lity of ~urgical t~pl-- of th- type ~hown ln Jlg lSs Flg 21 i~ ~ p r~p ctlv ~i-w ~howing th~
~ur~ tring ln-truD nt of th pr --nt in~ ntlon wlth lt~ ~aw~ op nl ;
rlg 22 1- ~ ~ld ~l-w o~ th pur-- ~trlng ~utur ~n tru -nt ~th ~t- ~-w clo--ds rlg 23 1~ ~ botto- ~l w of th pur - trlng utur ~n~tru nt;
Flg 2~ n nd vl-v o~ th~ pur~ ~trlng ~utur ln~tru-~nt;
rlg 2S 1~ a partl~lly cut~w~y pl~n ~l~w of -~;
t~ oppo~lt ~id of th pur~o tring ~utur~ in~trur~nt ~hovn in rlg 22 s Flg 26 i~ an hl~rg d ~ectlon t~ n ~long ~ ~-lln 26-26 of Flg 22;
rlg. 27 1~ ~ partl~lly cut~w~y ~lew of one of ~ -th ~w- of th- ln~tru~ent;

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Fig 28 i8 a partially cutaway perspective view of a first embodiment of a staple cartridge Sor use with the pur~e ~tring ~uture in~trument;
Fig 29 iB a top view of the ti~ue clamping - -~
surface of the ~taple cartridge of Fig 28;
Fig 30 i~ a top vi~w of the staple pu~her bar w d in th- stàple cartridge Or Fig 28s Fig 31 i- a v-rtlcal ~ction howing the tl~u ¢la~p~d b tw -n a pair o~ tapl- cartridg~ prior `
to th- operatlon of th ~taple push-r b~rss Flg 32 i~ a vortical ~ectlon showing the , `~
ti~u~ clamped b tw en a pair of ~taple cartridges aft~r th op~ration of the taple pusher bar~
Fig 33 1~ a partially cutaway per~pective ~ -lS vi~w of a -cond 00bodi nt of a stapl- cartridge for u~- with th- pur-- tring utur- in-tru~nts Figa 3~A-D illu trat ~odifi¢ation~ o~ the ~tapl- pw h r bar of th cartridg- of Fig 33s Fig 35 i~ a top vi-w of th ti~u- cla~ping ~urfa¢ of th- tapl- cartrldg~ of Flg 33s ~ i Flg 36 i~ a partlally cutaway p r~p-¢tiv-o~ ~ thlrd abod~ ~nt o~ a tapl- aartridg- ~or u--wlth th tapl- ~hown ln Flg l9t Fig 37 1- a partially ¢utaw~y p-r~p ctiv ~i-w of a fourth abod~ -nt of a tapl- cartridgo for u with th tapl- hown ln Fig l9s Fig 38 i- a id ~l-w of a ti~u ¢utting tool uJ-d with th pur-- tring in tru~ nt of th~ , pr ~ont i m ntions Fig 39 i~ a ~lan ~i-w of th ti~u- ¢utting tool of Fig 38s Fig 40 i- an nlarg d ~-ction tak n along lin ~0-~0 of Fig 38s Fig ~ an nlarg d ~-ction tak n along lin 41-~1 of Fig 38S

t~

3 ~

Fig 42 is an enlarg~d, partially cutaway plan vie~ of another D~hodi~ent of the tis6uQ cutting tool Fig 43 is a side view of the tissu~ cutting tool of Fig 42;
Fig 44 is ~n onl~rged ~ction taken along lln- 4~ o~ Flg 42;
Fig 45 ~- a p-r-p~ct~v- vi-w o~ an ondoscoplc ~urg$cal $n-tru~-nt in accordanc- with the invent~ons Fig ~6 i~ a partial persp-ctive v~ew of th~
d$~tal nd portion Or th endo-copic surgical in~trument ~hown in Fig ~5 with th ~w~ in ~n open position Fig ~7 i~ ~n ~ tion~l vi~w, partially in - -cro~ ction, Or th- ndo-copic ~urgic~l in~tru~-nt ~hown $n F$g 4S w$th tb ndo-copic portion rot~tsd 90 rolatlv~ to tb- handl- port$ons Fig ~8 $- an l-vational vi~w Or the di~tal nd portion o~ tb ndo~¢op$c ~urg$cal in~tru~ nt ~-~bown in rig ~7 witb tb- ~aw port$on art$¢ulat-d 45 ;
Fig 49 $~ an l vat$onal v$-w Or tb~
ndo-¢opl¢ ~urgl¢al $n tru~ nt hown in F$g 47 wlth th-~w portlon art~¢ulat ~ 90 t Flg 50 1~ a p r~p ¢t$v vi-w Or a cartridg ~or u~- $n an ndo-¢op$c ~urgl¢al $n tru~ent $n a¢¢ordan¢ wlth th- im ntlons Flg 51 1- an xplod d v$~w Or th- ¢artridgs ~hown ln Flg 50 wh r ln a portlon Or th~ ~taple ba~
brok n away to lllu-trat lnt~rlor d~tallJ ;~ x Fig 52 1- a p r~p ct$v- v$-w Or a portion th- cartr$dg~ hown ln Flg 50 wher~$n a port$on Or the <~
cartrldg hou ing ha~ ~ n r sov d to $11u~trat~ ~-lnt~rlor dotail; ~ ~ -Flg 53 i~ a p r~p ctiv- vi-w Or th~ ¢artridg~ -a~ hown ln Flg 52 with th ~tapl- pu-h r bar and ~tapl- $n a clo- d po itlons , ~ :,,, '~ ' ' ' ~ - . , , ., . , , ; . - . .

Fig 54 i6 a per6pective view of a portion of ;
the cartridge 6hown in Fig so with portion~ broken ~way to illu~trate interior detail;
Fig 55 iB a perspective view of the cartridge a~ ~hown in Fig 54 with ~taple6 and a ~uture in~erted th~rein Fig 56 i8 a p~r-pectiv~ view of the ~-c~rtridge, ~tapl-- and ~uture a~ ~hown ln Flg 55 wh-r-ln th- hook on th r talning plat- aro in~erted into ~y-lct~ o~ th- t~pl~
Flg 57 1~ a por~p ctive view of the cartridg~, tapl-- and ~utur a~ 6hown ln Fig 56 with th ~tapl- pu~her bar ~nd taple~ in a partially clo~Qd po~ition;
Fig 58 i- a p r~p CtiVQ ViQW of the -~
c~rtridgo, ~tapl-- and utura ~hown in Fig 57 with the at pl- pu~h r bar ~nd tapl-- in a ~ully clo~d po~itlon wh-r in th hook- ~r- di- ngag-d ~ro~ th ~yol-t- of th-~t pl--~
Fig 59 i- a p r~p ctlv- ~iow of two c~rtr~dg - ~or w in an ndo-copic urglcal in~tru~ nt ln c4ordan¢ wlth th- im ntlon whor-ln th- cartrldg-~
po-ltlon d d~c nt ac~ othor~
Flq 60 i~ a ach --tl¢ vl-w o~ utur- and t~pl-- ~- in -rt d into th two ¢artrldg-~ ~hown in ;~
rlg 59t Fig 61 i~ a p r p ctiv- ~iow of two `
cartridg~ ~or w in an ndo~copic ~urg~cal ln~tr,u~nt in ~¢¢ordanc~ with th inv ntion, ach having a lngl-~utur w ll, wh r in th cartridg~ aro po~ltion d ~d~c nt ach oth r~
Fig 62 i~ a ¢h -~tic vi-w of ~utur~ and ct~plo~ ~ in~rt d into th~ two cartridg~ ~hown in -~
~lg 61;
" .

~3~3i~ :

Fig 63 i~ an exploded por~pective view of two cartridge~ for use in an endo~eopic ~urgical in~truoent in accordanee with the invention with a eartridgo holder between thQm;
Fig 63A i~ a partial per~pective view of the upper ~taple pusher bar shown in Fig 63;
Fig 638 i~ a partial per~pective view of the low r ~t~ple pu-h-r b~r ~hown ln Flg 637 Fig 6~ p r~p-etiv- vi-w o~ th- a~mbly 10 o~ th- two eartridg~- and eartridga holder ~hown in Flg 63~ - -Fig 64A i~ a partial per~p ctive view o~ th~
~tapler pusher bars in~erted in the cartr~dge~ in Fig Fig 6S i- ~n enlarged eros~-~eetional view o~
two ~ully-load-d eartridg ~ ~or u~- in an endo~eopie ~urgie~l in~truo nt in ~eeordane with th- lnv-ntion wh-r in th- eartridg - ar po-ition-d ad~ae-nt aeh oth rs Flg 66 i- an l-vational vi~w partially in ~-etion ot th in~tru~nt ~hown in Flg 45 with the ~w~
in un op n ~o-lt~on ~nd ~n ~ bly ot two e~rtridge~
~n4 ~ e~rtri~g hold-r b-ing in--rt-d th~r~between7 Flg 67 i~ ~n l-v~tion~l ~i-w o~ the 2S in tru~ nt ~ hown in Fig 66 with th- ~w~ elosed; ~
Fig 68 i~ ~n enl~rged ero~ eetional view ~ -t~k n ~long th lln- 68-68 in Flg 67S
Fig 69 i- ~n elev~tion~l ~iew, p~rtl~lly brok~n ~w~y, or th- riring ~eehani~ ot ~n endoseopie ~urgic~l in~tru- nt in ~ccordance wlth the inv~tions Flg 70 1- an el vatlonal vlew o~ the firlng ni~a a~ ~hown in Flg 69 wlth the rlring pln havlng ;-~
b n rireds Fig 71 i~ an elevational view, partially in 35 croaa-~-ction, Or the in~tru ent ~hown in Fig 45 3 ~ ~ :

illu~trating the firing ~echani~ and the trigger ~echanism;
Fig 72 i8 ~n el-vational view of the in~tru~ent ~ ~hown in Fig 71 with the firing pin and trigger being shown in the fired po~ition;
Fig 73 is a perspective view, partially broX-n away, o~ an alt~rnative e~bodiment Or the firing ehani-~ ln aeeord~ne- wlth tho lnv-ntlons F$g 74 i- an nlarged cros~-s~ctional vi~w o~
a portion o~ th- ~lrlng m-chanis~ ohown in Fig 73;
Flg 75 i~ a cro-~-sectional view Or a portion o~ th~ hing- ~tructur~ conn~cting the ~aw portion and th- out r tube;
Flg 76 i~ a cro~ ctional vlQw of th~ hingQ
~tructur a- ~hown in Fig 75 with thQ ~aw portion art$eulat~d 90 ;
Fig 77 1~ an l-vational vi-w o~ th- ~aw portion o~ th- in trun nt hown in Fig 45 with portion~
brok n away to illu~trat- lnt-rlor d-tail;
Fig 78 i- an l-vational vi-w o~ th-in trun-nt hown ln Fig 4S with portlon- brok~n ~way to illw tr t- th- euttinq blad- n~ euttlng blad- aetuatlng oeb nl~s Fig 79 i- a cro~ -etional vi~w of thQ ~aw portlon tak n along th~ lin 79-79 in Fig 77s --Fig 80 i~ an l-vational vi-w, partially brok n avay, of th- handl- o~ an ndo~copi~urgical ~n~tru nt in aceordanc- with th- inv ntion wh-r-in th handl- l v r ~ac-- downwardlyt Flg 81 1- a ero~ ctlonal vi-w o~ th b~ndl- tak n aiong th lin 81-81 in Flg 80s Fig 82 i~ a cro~----ctional vi-w o~ th handl- a- ho~n in Fig 81 with th~ lidable r~tainor loeat d in a di~tal po-itlons ~ 3 ~ ~J ~

Fig 83 i8 an elevational view of the handle of an endoscopic surgical in~trument in accordance with th~ inv~ntion with the l~ver ~hown in ~n open po~ition in phanto~ lines;
Fig 84 is a sche~atic representation of ti~u- co~pre---d b-tw~en two cartridge- for u-e in an ndo~copic urgical in-tru~ent in aocordance with the ;~
lm ntion~
Fig 8S i- a vi-w Or the ti--u- and cartridg--~hown in Fig 84 w$th th- tapl~s de~or~ d to a partially clo--d po-ition;
Fig 86 i~ a vi w Or the tissue and cartridge~
~hown in Fig 85 with the ~taple~ in a rully closed po~ition; ;
lS Pig 87 i~ a partial p r~pective view of body ti~u co pr-~- d b~tw -n two ~aw- Or an ndo~copic urglcal in tru- n~ ln accordanc with th- inventlon wh-r ln th- body ti~u- 1~ partlally tran--cteds and rlg. 88 1~ a part$al p r~pectlv vlew Or th~
body tl~u- and ~aw portion- hown ln Flg 87 wh~reln ~h- body tl-~u- 1~ fully tr~n--ct-d ' , ~ '''''' R r-rrlng to Fig 1, th- pre-ent lnventlon 1B
-bo~i-d in a urglcal ~tapl-, gen rally S0, ~or curing a pur~ tring ~utur to hu~n ti~ue The ~taplo 50 ha a ~tapl- body co~prl~ing an ~longated ~trlp Or d ror ~bl- ~at rial whlch 1~ ~haped lnto a loop 52 at th c nt r of th trlp ~h- loop S2 provlde- an ~0 op ning or ~y~l~t S~ for r c~lvlng a pur~e trlng ~utur~ Th~ tapl- body al~o ha~ a palr of ar~ 56 and 58 vhlch ~xt nd ~ub~tantlally horlzontally rro~ oppo~lte ~ld ~ of th~ loop 52 Th~ ar~ 56 and 58 hav- outer portion~ 60 and 62, r -p ctiv ly, which curve downwardly and provld~ a palr of d p nding l g~ 64 and 66 whlch ~r~

.

. . - ..

2~3~3~

angled inwardly toward each other The tips 68 and 70 of the leg~ s4 and 66 are bevelled to provide sharp point6 which f~cilitate the insertion of the legs 64 ~nd 66 into human ti66ue The loop 52 is formed on the opposite side Or the staple body ~rom legs 64 and 66 A~ shown in Fig 3, the ~urgical stapl~ 50 is particularly us-~ul ~or ~curing a purso string suturo 80 to a ~oction o~ hu~an tls-u~ 82, e g , a tubular ~action o~ int~stinal tl~-u- Th~ purse string suture 80 ia threaded through th- ey~let 54 derined by the loop 52 ~nd i- slidably attached to the ~tapl~ 50 The ar~
S6 ~nd 58 ar- d-~or~d by applying pressur~ to th- outèr portion- 60 and 62 (Fig 1) to in-ert the legs 64 and 66 into th- ti-~u~ 82 Wh n th- de~or~atlon is co~pleted, th- l~g~ 64 and 66 are ~ov d into an overlapping con~iguratlon (Fig 3) Thu-, the ~t~ple 50 is ~or~ d i~to th con~iguration o~ a ~igur ight including th-~n~ll upp r loop S2 ~or in -rtlon o~ th- pur~- string autur 80 and ~ l~rg lo~ r loop 84 d ~ined by ar-~ 56 ~n4 S8 ~nd ov-rlapping l g- 6~ and 66 ~or conn-ction to tb- t~u 82 R-~-rrlng to ~lg ~, ln a ~-cond ibodi~ nt o~
tho l m ntlon, a ~urgl¢al ~tapl-, g-n rally 90, includ-a ~ ~t~pl- body co pri~lng an longat~d trip o~
d ~or ~bl- ~at rial which i- ~haped into a loop 92 at th- c nt r o~ th ~tr$p ~h loop 92 provid~- an op nlng or y l-t 9~ ~or r c-~ving a pur~- ~tring ~ -~
utur ~h- ~tapl- body al-o ha a p~ir o~ aN 96 and 9B ~hich xt~nd ~ro- oppo~it ~id-~ o~ th loop 92 ~nd ~hlch olop ~lightly do w ard ~ro- th horizontal Th out r portion- 100 ~nd 102 of ~r 96 ~nd 98 ar curv d ~-do~nv rdly and provid~ a pair o~ l~g~ 104 and 106 which ~r angl~d inwardly tow~rd ach oth~r Th tip 108 and 110 o~ l g- 10~ and 106 ar b v ll~d to pro~id~ ~harp 3S point- which ~acilitat- th in -rtion o~ l~g- 104 and 3 ~

-- 19 -- ' -' ,~

106 into the tis~ue The loop 92 i~ formed on the sa~e side of the staple body as the legs 104 and 106 As ~hown ~n Fig 6, thQ surgical staple 90 i~
u4 d to secure th~ purs- str$ng suture 80 to th~ human t~--u~ 82 Th~ pur~e ~tring ~uture 80 is ~ns-rtQd into th- y let 94 d-~in d by th~ loop 92 and is slidably attach d to th- ~tapl- 90 Th- ar~ 96 and 98 ar-d ~or~d by applying pr --ur- to th~ out-r portlon~ 100 and 102 (Flg 4) to in~ert th- legs 104 and 106 lnto the 10 ti~u 82 Wh n th- d-for~tlon i- co~plet~d, th l-g-10~ and 106 ar ov d into an ov~rlapping conflgurat~on (Flg 6) A- a r--ult, th~ stapl~ 90 is defor~ed into a doubl--loop con~iguration with the s~all upp~r loop 92 ~or in~-rtion o~ th pur~a tring ~utur- 80 which i-15 nclo~ d by a larq~ low r loop 114 d-~ln d ~y th~ ar~
96 and 98 and l g- 10~ and 106 ~or conn-ction to th-ti~u 82 R ~-rrlnq to Flq 7, in a thlrd e~bodil~nt o~ ;
th lmcntion, a ~urg~cal ~tapl~, g~n~rally 120, 20 lnclud-- a t~pl- ba~y ca Ipri~ing an longat-d trlp Or d-ror~bl- Jat-rl~l whlch 1~ ~hap-d lnto a loop 122 at th c nt-r o~ th atrip Th loop 122 pro~rld-~ an o~n~ng or ey l-t 12~ ~or r c lving a pur~ ~tring -~
~utur $h ~tapl- body al-o ha- a pair o~ ar~ 126 and 2~ 128 vhich cxt-nd ~ub-t~ntially horizont~lly ~roql oppo~ id~ o~ th loop 122 Th~ out~r portion~ 130 and 132 o~ ar-~ 126 nd 128 cur~ downwardly and provld a palr o~ d p ndlng l g- 13~ and 136 ext ndlng p rp ndlcularly dow~ard rros aN 126 and 128, 30 rp ctiv ly q~ tip- 138 and 1~0 of th~ l~g- 134 and 136 ar b~v ll d to provld- harp polnt~ ~hich ~ `racllltat- th in--rtion Or th~ 134 and 136 into hu~n tl-zu $h loop 122 i- for~d on th~ 6a~ ~ld - -Or th- ~tapl- body a~ th l~g- 13~ and 136 ~3~3~ ) A~ shown in Fig 8, the ~urgical st~ple 120 1 used to secure the pur~e string suture 80 to the human tis~ue 82 The purse ~tring 80 iB inserted into the eyelet 124 defined by the loop 122 and is ~lidably attached to the ~taple 120 Th~ arm~ 126 and 128 ar~
d~or~d by applying pre~sure to thQ outQr portions 130 and 132 (Flg S) to ln--rt th- l g- 126 and 128 into the ti~u 82 Wh-n th~ d-for~atlon 1- compl-t-d, th- l-g-134 and 136 ar mov d lnto an ov-rlapplng conflguratlon (Fig 8) A~ a r -ult, th~ t~pl- 120 is defor~d into a doubl--loop conflguration with a small upper loop 122 for ln~-rtlon of th pur - ~trlng ~utur~ 80 whlch i~
onclo~-d by a larg~ low r loop 144 for connQction to th~
ti- u 82 R-~-rrlng to Flg 9, in ~ fourth e~bodln~nt of th l m ntion, a urgical ~taple, g-nerally lS0, lnclu~ a tapl- body co~pri~ing an long~t-d ~trip o~
d-for-abl- ~at rial ~hich 1~ ~hapQd lnto a loop 152 at th c nt r of th trip Th loop lS2 providQ~ an op nlng or y l-t lS~ for r c i~ing a pur-- ~trlng ~utur Th ~t pl- body ~l~o h~- a palr Or ar~J 156 and 158 x*-ndlng fro oppo~lt- ~d of th- loop 152 whlch ar cb ¢urv 4 ln a ~ clrcul~r configuratlon ~h or~ lS6 and 158 t r-ln~t- in a pair of d-p~nding l-g~ ~r 160 and 162, r p ctlv ly, ~hlch polnt downwardly fro th otapl- body and tov~rd ach oth r Th tip~ 16~ and 166 o~ l-g~ 160 and 162 ar b v ll-d to provid- ~harp ;~
polnt~ to ~acllitat th ln~-rtion o~ th- l g- lCOIand 162 lnto th tl~ u A~ ~bown ~n Fig 10, th~ urgical ~tapl- lS0 ~ -lr u~ d to -cur- th e ~trlng utur 80 to th - huran tl--u- S2 Th pur~- ~tring sutur- 80 i~ in~rt d lnto th y-l-t lS~ d ~in d by th loop 152 and 1~ ~ ;
d ldably attach d to th ~tapl- 150 Th- ar ~ lS6 an~
3S lS8 ar d-~or ad by applylng pr-~ur to th out-r ,,, ~,".....
,~
" .

3 ~
- 21 - ~
.
portions thereof to insert the l~g8 160 and 162 into the tissue 82 When the defor~ation iB co~pleted, the legs -~
160 and 162 are ~ov~d into an overlapping configuration (Fig 10) Thu~, the staple 150 t~nd~ to assume the -configuration of ~ figure ~ight including th~ small uppcr loop 152 for in~ertion of the pur~e string suturc ~
80 ~nd ~ l~rg- low r loop 168 d-fin-d by ~r~ 156 and - ;
158 ~nd ov rlapping log- 160 and 162 ~or conn~ctlon to th~ ti--u 82 In th- obodi~ nt- of Flg~ 1, 4, 7 and 9, the body of th- urgic~l ~taplo 50 conpris-~ an ~long~t~d ~trlp of d-for-~bl- ~at-rial ~uch a~ ~tainless ste~l Pr f-rably, th ~trip ha~ a round cross ~ection with dlu ct~r in the r~ng- of 0 3 to O S ~illi~et~rs ~ferring to Fig 11, in ~ ~cdifi~d for~ of th fir~t bodi~ nt, th- out-r portlon- 60 ~nd 62 o~
ar-~ 56 ~nd 58 ar curv d in a ~ circular ~hap~ to provi~ th- l-g- 6~ and 66 Ih- tapl- 50 con~i-t~ of an longat d ~trlp of ~t~inl t--l h~ving a round cro~c ~-ction ~ith a dia~ t-r o 0 3 r- The loop 52 1 round and lt- inn-r dla~t r, 1 - , th- di~c ter o~
y l-t 5~ 1~ 0.7 ~ ~h ~tapl- 50 ha~ a Width o~ S ~, ~ h l9ht ~lthout th- loop S2) o~ 2 5 n, and an ov h ight (lncluding th loop 52) of 3 S
R-f-rring to Fig 12, in anoth~r for of th fi t bodi nt, ~tapl- 50 includ-- a loop 52 which i~
g n rally triangular in hap~ Th width of ~y~l-t S~
i~ 1 r- Th- tapl- S0 con i~t of an ~longat-d ~tFip o~ ~tainl ~ ~t l having a roun~ cro - -ction with a dian t r o~ 0 3 na Th ~tapl- S0 ha~ a width o~ S nJ, a height (witnout th loop 52) of 2 5 ~ , and an ov-rall h ight ~includlng th loop 52) of 3 5 ~
R-f rring to Fig 13, in an xa pl~ of tho ~ cond 4bodi nt, th- tapl- 90 con~i-t- of an 3S longat d trip of ~tainl--- ~t- l havinq a round ¢ro~
"'' ' ',', :
~".

- 22 - ~ ~3~

~ection with a diamet~r of 0 3 ~ The dia~eter of eyelet 94 de$ined by loop 92 is 0 8 ~m The ~taple 90 ha~ ~n overall width of S ~m and an overall heiqht of 2 5 ~
Referring to Fig 15, in a fifth e~bodiment oS
th im ntion, a ~urgical stapl~, gQn~rally 170, co pri~-~ a stapl- body in the Sor~ oS a ring 172 which provld-~ a clrcular y l-t 174 tor r c-iving a pur~
trlng ~utur~ Th tapl- body includ~ a plurality ot l g- 176 ext-ndlng downward in a San-likQ conSiguratlon Sro~ th ring 172 Fach l-g 176 includo- a barb 178 SorJ~d ad~ac nt to it- low r end for anchoring the lQg ~-in huran ti~u-A~ ~hown in Fig- 15 and 16, the cent-r~o~t l g 176 i- locat d in th a~ v rtlcal planQ a- ring 172 Th oth r l g- 176 ar b~nt alt~rnat-ly Sorward ~nd r arward r lativo to th- ring 172 and th c-nt-r~o~t `~
l g 176 Th barb- 178 on th k-nt l g~ 176 Sac~ ` `
out~ardly away Sro~ th -v rtical plan- of th~ ring 172 A~ ho~n in Fig 17, th urgical tapl- 170 1~ u d to ~-cur th~ ~ur~o trlng utur- 80 to th huJan tl-~u 82 5h~ ~ur-- trlng utur 80 1- ~n--rt d lnto th- y l-t 17~ d Sin~d by th loop 172 and 1-lld bly attach d to th tapl- 170 Th n, th- ~urgical ~* pl- 170 i- dri~ n into th- ti-~u- 82 o that th l g~
176 ar dri~ n b-low th ~ur~ac- oS th- ti~u~ 82 whilo th rlng 172 r ain abov th- ur~ac o~ th- ti~u 82 Ih b~rb- 178 anchor th l-g~ 176 in th- tl~u- with th-ring 172 holding th pur~- trlng ~utur 80 ~t th ~ur~ c o~ th tl-~N 82 ~ ~-~ f rrln; to Flg 1~, in th ~thod o~ th pr nt ~nv~ntlon, a plurallty o~ ~urgic~l tapl-~ o~
th- typ- dl~clo- d h r in ar u~ d to ~cur~ th pur~
~tring utur 80 to a tubular ~-ction o~ ti-~u 82 Although a plurallty o~ ~tapl-~ 50 1- ~hown, lt i~
:

understood that ~ny of the ~bove st~ple embod~ents can be u~ed -In ~ccord~nce wi~h the method, a plur~lity of ~tapl~ 50 are po~itioned about th~ periphery of th~
tubular ~ection o~ tl~u- 82 The purs~ string suture 80 1- ~tt~ch~d to the ~tapl~s by thre~ding the purse ~trlng ~utur- 80 through th- y~lQt~ 54 provided $n th ~tapl-- S0 Th-n, th- taplo- S0 ar- drivon into tho tl~u 82 to ~-cur- th pur-- tring 80 thoreto ~0 Aft-r th- pur - tring utur~ 80 i~ securod to th~ tubular ~-ction o~ ti~au 82, th- opposit~ Qnds o~
th- pur~- tring utur 80 ~r pull-d to dr~w the ti~-u~
tog~th r Th~ y l~t~ 54 of th~ staple~ 50 sl$d~bly ~-~
upport th- pur- tring ~uturo abov th- tissu~ 82 o th~t th ~tapl-~ 50 o~-r ~lniral r ~i~tanc~ to ~ov~ nt -of th pur~- ~tring utur 80 whon it~ ~nd~ ar pull-d ~o co pl-to th- proc dur , tho pur~ ~tring utur- 80 $-tlght n d an~ wrapp~d ~bout th- tubular -ction o~
t~u- 82 A~ hown ln F$g 18, ~ plural$ty of ~tapl-~ 50 -o~ th- typ ~ho~n $n ~lg 1 ¢an b u--d to -¢ur th FuS~ ~trlng ~utur~ 80 to th- tubul~r ~-ct$on o~ tl~u 82. 5h ~ur~- trlng ~utur- 80 1- thr-ad-d through th-loop- 52 o~ th- ~t~pl-~ 50 and i~ d $dably r ¢~v-d 2S thor ~n ~$th th ~tapl-~ S0 po-$t$on~d about th p r$ph ry of tho tubular ct$on o~ t$~-uo 82, th at~pl~a 50 ar do~or~ d to b-nd th~ ~tapl- log~ 64 and - 66 $nto ~n ov rlapping con~$gurat$on (F$g 3) to forn th loop 8~ xt nding $~to th- t$~u- 82 to -cur th-pur~ ~tr$ng ~uturo 80 th r to ~$nllarly, a~ hown $n F$g 19, a plural$ty o~ -~tapl-~ 90 o~ th~ typ hown ~n F$g 4 can b u~ d to - ~i ~ cur tho pur~o ~tring utur- 80 to th- tubular -ct$on o~ t$~uo 82 ~ho pur~o ~tr$ng ~utur 80 $~ thr ad d ~
through th- loop 92 o~ tha ~tapl-~ 90 and i- d id~bly ~;-', ~ ',',.,', .

: ri, i~ ~ 3 ~

received therein With the staples 90 po~ltioned about the periphery of the tubular ~ection of tissue 82, the ~taples so are deformed to bend the 6taple legs 104 and 106 into an overlapping configuration (Fig 6) to for~
S the loop 114 extending into the ti~ue 82 to secure the pur~e ~tring 80 thereto Furth-r, a~ hown in Flg 20, ~ plurality o~
~taplo~ 170 o~ th- typ- hown in Fig 15 can be u~d to ~cur th pur-- tring ~utur~ 80 to the tubular ~ectlon of t$~uo 82 Th- pur~Q ~tring ~uture 80 i~ thr~aded through th- ~y-l-t~ for~d in tho taple- 170 and i~
lldbbly r c-iv d th~rein When the staplQ~ 170 are po~ition~d about th periph~ry of the tubular section of tl~u 82, th ~tapl-a 170 ar- drlv n into th- tl~u~ 82 lS to a-cur th- pur - trlng utur ther-to The barb d nd~ o~ l~g~ 176 anchor th- ~tapl-- 170 to the tl~u-R-~ rring to Fig- 21 and 22, th inv ntion i~
-bodl-d ln a urgical tapling in-tru~ nt 200 ~or apply~ng pur - tring utur - to hu~an tis-u- Th-~urglcal ln-tru nt 200 ¢o-prla-~ pair o~ longat d ndl-~ 201 nd 202 plvot-lly conn-ct-d by A pivot pln 203 ln a aci~ora-llk- rrang n-nt A palr o~ ~lng r grlpc or ring~ 20~ and 20S 1- provid d at th- r-ar o~
handl-- 201 and 202, r ~p ctiv ly, to ~ac$1itat- th 2S h ndllng ~nd op ratlon ot th ~urgical ln-tru~nt 200 by ~ -a urg on Th h~ndl- 201 and 202 ar provid-d wlth h-l-tch ~r-~ 206 and Z07 which pro~-ct inwardly ~ro- th t~ng grip- 20~ and 205, r ~p~ctlv ly Th- l~tch ar-~ ;
- 206 and 207 are adapt d to int~rlock when th h~ndl-~
201 and 202 ar pivot ~ tog th r to ~ clo-ed podtion A ~ing r t 208 pro~-ct- r arwardly ~ro~ th~ botto o~
~ing r grip 20~
Ao ~hown in Flg- 22 and 23, th- handl~ 201 and 202 ln¢lud- ~ront portlon- 209 an~ 210 which upport a pair o~ tl~u- clu plng ~aw 211 ~nd 212, , :~, .:

~3~3~

r~pectively Prefer~bly, the ~a~r~ 211 and 212 pro~ect perpendicularly from the front handle portion~ 209 and 210 A~ shown in Fig 2~, the ~aws 211 and 212 h~ve rlat, outer surraces 213 and 214, rQspectively, which are taper~d inwardly toward th~ out~r tips of the ~aw~
Also, th~ ~aw~ 211 and 212 have flat, inner surface~ 215 d 216, rosp~ctively, wh~c~ arQ oriented at a slight ~ngl~ with r -p ct to ~ch other A- ~ r~sult, whon th- ` ` `
h~ndl-- 201 ~nd 202 ~r- clo--d to brlng th~ tlp~ ot ~w-211 ~nd 212 tog-th-r, th- r-~r portion~ of th- ~urf~ce-215 and 216 ar -par~t-d by a di-t~nce 5~ whlch prorld-~
~11 a~ount of pl~y in the ~ove~ent of handles 201 ~nd 202 to bring th~ jaw~ 207 and 208 to a fully clo~ed po~itlon A hown in Flg-. 21 ~nd 22, the outer tlp Or ~w 211 includ - ~ p~ir ot t~b~ 217 which ~r~ r~c~ d -by ~id~ notch-- 218 torn d ~t th- tip of ~w 212. Th ` ;
t~b~ 217 ~int~in th ~w~ 211 and 212 in ~lign~nt wh n th h~ndl-- 201 ~nd 202 ~r clo--d In ~dditlon, a tlat t~b 219 d pond tro- th upp r a D 209 at a point ad~ac nt to th r~ar ot th- ~aw 211 Th~ depending t~b ~;
219 ov rl~p~ a ~l~t ~urt~c 220 on th lower ar~ 210 vh-n th- h~ndl-~ 201 and 202 ~r clo~-d aa ~ho~n ln ~ig 22, th ~w~ 211 and 212 aupport a pair ot longat d tapl- eartridg ~ 222 tor r e i~lng th urgleal tapl-- and th pur~ ~tring ~utur ~ to b appll d to th tl~u~ Eaeh ~tapl-cartrldg- 222 inelud - a plurallty ot tran~v-r~ ~lot~ ;
22~ ~pae d unltor~ly apart along th eartrldg 222 tor r e ~v~ng th tapl to b attach d to th- ti~u Al o, adh ot tb tapl- eartridg ~ 222 includ ~ ~ ;
ctapl~ ~oraing r~ehani-a, xplain d in r- d tail k-lov, tor dri~ing th tapl-~ into th- ti~u cla~p~d -~
b t~ n th ~aw 211 and 212 to attaeh th pur - ~tring wtur to th tl~u ~ ~
. .:

,., . , . , . .,, , ,.,~ ", ", , .

~1~1 3~

Referring to Figs 21 and 22, the pur~e string suture instrument 200 includes a ~taple actuating lever 225 pivotally ~ounted by a p~vot pin 226 on th~ handle 201 The levar 225 i~ bifureated at its front end to --provide a slot 228 (Fig 21) which allows the latch ar~
206 to pro~ect upwardly through thQ lever 225 The l~teh ar~ 206 inelude~ a r~arwardly oxtending should-r 228 whleh -rv ~ top to ll~lt th- upward movomont o~ th- l-v-r 225 An upright, bi~ureatod ar~ 229 i~ ;
provid d at th ~ront o~ th- l-ver 225 ~nd i- eonn~et~d to an olongat-d ~lexible wirQ 230 A~ ~hown in Fig 25, th- ~ront nd o~ wir 230 i- formQd into an elongated loop 232 which i- slidably attached to the back of h~ndl- 201 by a ~er-w 233 The front end of the loop 232 i~ attaeh d to a palr o~ wir-- 23~ whieh, in turn, ;
~r attach-d to a pair o~ pivot ar~ 236 for aetuatinq th etapl- ~oraing ~ ehanio~ o~ th- eartrldg-~ 222 wh n th- l-v r 225 i~ op rat d A~ hown in Fig~ 21 and 22, a locking dl~e 238 i- pivotally ~ount d on ~ ~lang- 239 whieh xtend-r ~r~rdly ~ro~ th- ~lng r grlp 20~ ~h- loeklng dl-e 238 1- ~lvotabl- b tw -n ~n upp r po-ltlon ~Flg 22) in ~hieh th l-v-r 225 1~ ng~g d by th dl~e 238 and loek-d agaln~t th ~hould-r 228 and a low~r po~ltion (Flg 21) in ~hieh th di~e 238 ngage- th- ~inger r -t 208 ~nd th l-v r 22S i~ di~ ngag d and unloeked 2Or plvot~l ~4v n nt A~ hoYn in Fig 27, th- pivot ar~ 236 ie pl~ot~lly unt d on th rrOnt handle portion 209 by a ~¢r w 2~2 $h pl~ot ar~ 236 include~ an upright ring r 2~3 which i~ lid~bly r c iv~d in a tran~ver~- ~lot 2 ror-~d ln a ~tapl- pu h r bar 2~0 which i~ ~lld~ble longltudinally r lati~ to th~ ~tapl- c~rtridge 222 ~h rront nd o~ the wire 234 i~ bent at ~ right angl-3S und r c iv d in ~ lot 2~S rO d in the pivot ~r~ 236 , ~ .
' :,, 2~ ~3 ~

.
A cur~ed spring 246 h~- it~ front end r~c~l~ed ln the slot 245 ~nd it~ re~r end anchored in ~ hole 247 for~ed in the front h~ndle portion 209 The ~pring 246 -$ncludQs ~ front portion 248 which curve~ in ~ cloaXwi~-dir etion ~round the screw 242 ~nd ~ re~r portion 249 vhich curve- in ~ countQrclockwise dlrectlon about ~ -uoun~ing ~crew 2S0 The ~pr$ng 246 is ~rr~nged to norn411y bl~- th- pl~ot ~r- 236 ln a olookwlo- dlr-atlon about th- ~cr w 242 o th~t th- t~pl- pu~h-r b~r 240 1-b$~--d $nto th- ~t~pl- c~rtrldg- 222 Wh-n th~ wir- 234 $~ pull d r ~rw~rdly, th- p$~ot ~r~ 236 is pivoted $n count relockwl~e direction ~g~inst the bi~s of the pring 236 to lide the st~ple pusher b~r 240 outw~rd ~;
rol~tl~ to th ~t~pl- e~rtridg- 222 Ao explained -~
lS b~low, th$~ ~l$d$ng ot$on Or the tapl- pusher b~r 2~0 e~u~ ~ th~ ~t~pl~ to b d ror~d ~nd s~aur-d to the tl~u el~p d b tw n th ~w~ 211 ~nd 21~ ;~
R-r rring to Fig 28, ~ ~lr~t e~bodir nt o~
th- ~t~pl- e~rtrldg- 222 1~ ~d~pt d ror u-- w$th th ~t~pl- S0 (Fig 1) Th t~pl- c~rtr$dg- 222 eo~pr$~
an lonqat d roct~ngular hou ing 2Sl includ$ng ~ palr of ~d- ~all- 252 whlch ~lld~bly r c-lv- th- t~pl- pu-h r b~r 2~0 th-r b tw -n Th tapl- cartr$dg- 251 lnelud ~ plurallty of tr n~v r-- tapl- r cQivlng ~lot~ 224 vh$ch xt-nd v-rtlcally do~nv rd $nto th~ hou~$ng 251 A~ ~hown ~n F$g 29, ac~ tapl- r-c ~v$ng lot 224 1 loe~t d b-tw n a pa$r of ridg - 253 wh$ch ~xt-nd upvardly ~ron th- top of th hou lng 251 Eaeh p~lr of rldg - 253 1~ p rat d by a vall-y or d-pr--~$on 254 ~ro- th- n Yt a~ae nt palr of ridg~- 253 Th ~tapl-c rtr~dg hou~ng 2Sl 1~ ~lop-d upwardly nd $nw~rdly at lt~ out r ~dg ~ to d f$n- lop~d ~urfac ~ 25S whlch t r in~t ~t th top of th r$dg - 253 An long~t d v rt$cal ~lot 256 xt nd long$tud$nally along th ~ ,,; ,,, - 28 - i~

center of the hou6ing 251 The top6 o~ the ridges 253 provide flat t~cue cla~ping surface~
The 6taple r~ceiving slot~ 224 tFig 28) ext~nd downwardly fro~ the ti~ue cl~ping ridge~ 253 and inter~ect the c ntral ~Qrtical slot 256 Ea~h ~lot 224 i~ d~fined by a front w~ll 25i, a rQar wall 258 and a pair of end wall- 259 which ~xtend v-rtically downward into th- hou-in~ 2Sl Th- tapl- 50 i~ in~rt~d ~nto th lot 25~ with lt- l-g- 6~ and 66 pointing upward toward th ti~au- cla~ping ridge- 253 A plat~ 260 i~
~-cur d in~id- th- hou ing 251 b~neath the pu~h~r bar 2~0 and provid-~ a l-dg for cupporting th- ar~s 56 and 58 of th ~tapl- S0 Th- plat- 260 lnclude~ a slot 261 align d with ~ch tapl- r c~i~ing lot 224 for r c iving th loop 52 of th tapl- 50 5h- ~tapl- pu h r bar 2~0 (Fig 30) con~i~t~
of a g n-rally r ctangular plat provid d with ~ ~-ri-- -;~
of oppo~ d palr o~ w dg---hap d protru~ion~ 262 xt ndlng inwardly fro- it- oppo-it- id - ~ach w dg -~hap d protru~lon 262 d ~in - a flat upright urfac- 263 ~hlch 1~ align d wlth th r 4r wall 258 (Fig 28) of th ~lot 22~ and a ta~l- fornln~ dg 26~ whlch i~ ~lant-d ln~ sdly toward tb- c nt-r o~ th pu h r bar 2~0 ~h w 4g -~hap d protru~ion- 262 ar ori-nt d uch that th ¢l aranc- b tw ~n th oppo~ d tapl- for ing dg - 26 d-¢r a- - a~ th pu h r bar 2~0 1~ advanc-d in th-dlr ction o~ arrow A ~ch oPPo d p~ir of tapl-tornlng dg - 26~ provid ~ ~ tir-t t of v rtical -~
urtac ~ 265 whi¢`h ar wid-ly pac d ap~rt ~nd a ~-cond ~ t ot v rtlcal urtac ~ 266 whlch ~r- n~rrowly ~p~¢ d ap rt Th ~tapl- 50 ~n~ rt d in ach lot 22~
locat d ad~ac nt to th tront w~ll 263 ot th- push r b~r 2~0 ~h pur- tring utur 80 i- thr ~ded through th~
loop 52 or th t pl- S0 ln nch lot 22 .

As sho~n in Fig 31, the tis~ue 82 is clamped ~--between the pair of staple c~rtridges 222 prior to the actuation of the ~taple pu~her bar~ 240 The staple leg~ 6~ ~nd 66 are locat-d b-tw~en th~ ~ur~aces 265 o~
th~ push~r bar 240 When the pusher bar 240 i~ adv~nced in the direction of arrow A (Fig 30), the slanted edges 264 ngag~ ~nd b nd the ~taple legs 64 and 66 toward oach oth-r AB hown ln Flg 32, the tips 68 and 70 o~
th ~t~pl~ l~gs 6~ and 66 ar- guidQd lnto the tl~sue 82 b tw en tho rldg-- 253 o~ th~ staple cartridgQ 222 Wh n th- pu~h r bar 2~0 i~ ~ully adv~nced, the staple -~
l g~ 64 ~nd 66 are located between the sur~ace~ 266 o~
th~ ~t~ple pu~h-r b~r 240 AB ~ re~ult, each ~taple 50 i~ de~oro d into the con~igur~tion of a figure eight with thc ~taple l g- 6~ and 66 overlapp~d to ~orn the loop 84 to s~cur~ th ~tapl- 50 and th~ pur~e string ~utur 80 to th ti~u 82 R-~-rring to Fig 33, in ~n altern~tiv o bodi~ nt, a tapl- cartridg- 270 co~pri~o~ an long~t d r-ctangul~r hou lng 271 including ~ p~ir o~
al~ wall~ 272 which lid~bly r-¢~ t~pl~ pu~her b~r 273 t~ r~b tv -n ~h- tapl- cartrldg~ 270 includ--~ plur~llty of tr~n~v r~- t~pl- r c-iving ~lot~ 274 whlch xt-nd v rtic~lly dovnvard into tho housing 271 2S E~ch t~pl- r c iving lot 27~ i- loc-t-d between ~ pair of rldg ~ 275 which xt-nd upYardly frou th- top o~ th hou~lng 271 Each pair of ridgo- 275 i~ ~eparatod by v~ll-y or d~pr ~lon 276 fro- th noxt ad~acont pair of ridg 275 Th t pl- c rtridg- hou~ing 271 i~ ~lop d up~rdly nd inw~rdIy t it~ out r dgo~ to de~in ~lop d urf-c-- 277 whlch t r in~t ~t tho top o~ th-ridg~ 275 An olong t d vortic~l lot 278 ext-nd~
longltudlnally long th c nt-r of th- hou-ing 271 Th top of th v-rt$cal lot 27S op n- lnto a longitudlnal V-ch~p d groov d fin d by lnclln d ~ur~w-~ 279 which r ~ "

- 30 ~

are sloped upwardly and outwardly fro~ the vertical slot 278 and terminate at the top of ridges 275 The tops of th- ridge~ 275 provide flat tissue cla~ping surface~
The ~t~plQ r~ceiving ~lot~ 274 extend downw~rdly from the ti~ue cl~mping ridges 275 and inter~-ct thQ centr~l ~ rtic~1 slot 278 E~ch ~lot 274 i- d-tin~d by a tront w~ll 280, ~ r-~r wall 281 ~nd p~ir ot nd wall- 282 which xt nd ~rtic~lly downward into th- hou~ing 271 Th- t~pl- 50 i- insert~d into th- lot 274 with it- log- 64 ~nd 66 pointing upw~rd tow~rd th ti~-u- clu ping ridg ~ 275 A pl~t- 283 i-~-cur~d in id- th- hou ing 271 b n~ath th- pusher bar 273 ~nd provid-- ~ l dgQ for upporting th~ ~r~s 56 ~nd -~
58 ot th- ~t~pl- 50 ~h- pl~t 283 inolud-- ~ notch 284 lS align d vith ~ch ~t4pl- r c-i~ing lot 274 for r c i~ing th- loop 52 ot th t~pl- 50 R-t-rring to Pig- 33 ~nd 35, in ~ pr ~erred ibodin nt ot th t~pl- c~rtridg 270, ~ch ~t~pl-r c i~ing lot 27~ includ - ~ r c -- 285 tor~ed in it~
tront v~ll 280 ~h purpo-- ot th- r ¢--~ 28S i- to nl~rg th t~pl- ro¢ ~vlng lot 274 ~llow th- l g- 64 n4 ~6 ot th~ ~t~pl- 50 to b b nt into ~n o~-rl~pping con~lgur~tlon ln th- bodi ont o~ Fig 33, tho ~tapl~
pu h r bar 273 includ a -ri-- o~ oppo--d p~ir~ ot ~ -w d g -~hap d protru-ion 286 xt ndlng lnwardly ~ro~ it-oppo~lt- dd - ~ach w dg~--h~p d protru~ion 286 d ~ln a rlat uprlght ~ur~ac- 287 align d wlth th- re~r ;~
~all 281 ot th~ lot 25~ Alco, ~ch w~dg~-~hap-d protru lon 286 d-~ln ~ a stapl~ ~or ing ~dg~ 288 which lc dant d lnw~rdly toward th c~nt r o~ th~ pu-h-r bar 273 In thl- e~bodir nt, a V--hap d ~taple ~oroing chann l ~xt-nd~ along th ~dg 288 ot ach w~dg--~h~p4d protruJion 286 ' ' ' :: ' ' ' '' ~' - 31 - C~3~3~

A ~taple 50 i8 lnsertQd into ~ach ~lot 274 with its legfi 64 ~nd 66 loc~ted ad~cent to the front wall~ 281 of the pu~her bar 273 m e pur6e string suture 80 is threaded through the loop 52 of the staple 50 in ~ach d ot 274 When the pusher bar 273 iB
~dvanced in th~ direction of arrow A, the ~lanted edges 288 ngage thQ ~taple leg~ 64 and 66 and bend the legs 64 ~nd 66 toward ach oth-r A- a r -ult, th- tip~ 68 and 70 of tho ~tapl- l-g- 64 and 66 ar- gulded lnto tho tl~u~ 82 abov- th- ridge- 275 of the ~taple cartridge 270 ~h~n th- pu~h-r bar 273 18 fully advanced, the ~tapl- 50 i~ d-for- d into the configuration of a figure ` -~ight vith the stapl~ leg~ 64 and 66 o~erl~pped into the loop 8~ (Fig 3) to -cur- th- tapl~ 50 and th- purse ~tring utur 80 to thc ti-~ue 82 ~lg~ 34A-D illu trat~ exa~ple- of tho con~iguration- whlCh can b- u d Sor th- ~taple forming dg 288 of th- tapl- pu-h~r bar 273 In Fig 34A, the protru~ion 286 ha- a tapl- foruing edge 288 con~i~ting of an upright, v-rtically ori-nt d ~urfaco 290 In Fig ;~
3~B, th ~tapl- ~or-i~g dg 288 includ-~ lopod ~ur~ac ~ 291 and 292 whloh int r~-ct at an longat-d ap-Y lln- 293 to d ~in- a V--hap d ~tapl- for~ing ch4nn-1 qh ourSac-~ 291 and 292 ar gual in ize and ar ~lop d at quai and oppo~lt- angl-- to th- vortlcal Tn Flg 3~C, th- tapl- for ing dg 288 ha- a V-~hapod chann l con i-ting oS lop d urfac-- 294 and 295 which r lop d at dif~ r nt angl-~ and int-r~-ct at an long t d ap x lin 296 clo~-r to th- botton oS th tapl- RU~h r bar 273 Tn Flg 3~D, th ~taplo Sor~lng d g 28B con-i-t- o~ a Slat ~urSac- 297 vhlch i~ lop d upwardly and outvardly at an angl- a oS approxl-~t-ly 10 ~ro- th vertlcal A~ hown in Fig 36, anoth-r Ybodl~ont oS tho ~tapl- cartridg- 222 includ - a ~odiflod tapl- pu-h-r ,:

- 32 ~

bar 300 for u~e with a 6taple 50 ~Fig 19) in which the loop 52 i~ triangular in shape The ~taple pusher bar 300 includes a sQri~ of opposed pairs of w~dge-shaped protru~io~s 302 extending $nvardly from its opposite S ~id~ ch wedge--h~ped protrus~on 302 defines a flat upright ~urfac- 303 which i~ aligned with th~ r~ar wall 2S8 o~ th slot 224 and a staple ~orming edge 304 which ~ nt~d toward th- c-nt-r o~ th- pu~h-r bar 301 Th~ ;
atapl- ~or~ing edg~- 304 provid- a ~ir~t ~t o~ vertlcal ~ur~ac-~ 305 which ar widely ~pac~d apart and a sQcond ~-t o~ vert~cal ~ur~ac-~ 306 which ar- narrowly spaced ~part On ~ach id- o~ th- ~tapl- push-r b~r 301, l dq 307 pro~-ct- invardly toward th- c~nt~r of tbe puah r bar 301 Each l dg~ 307 ~ provid~d with an ~longat d b v-ll-d dg 308 which allow- th- l-dg- 307 to ~ov pa~t th triangul~rly ~hap d loop 52 o~ th- ~ ~
~tapl- 50 wh-n th ~tapl- pu-h r bar 300 i~ actuat-d A ~ i p ir o~ oppo~d notch - 309 i~ ~oru d in th l-dg-~ 307 ~ -to r c $~ th- ~r J S6 ~nd S8 o~ th- tapl- 50 A~ ho~n in ~ig 37, anoth-r nbodi~ nt o~ th ~t~pl- cartridg 270 lnclud-~ ~ ~odi~l-d ~tapl- pu~h-r ` `
b-r 310 ~or UJ wlth ~tapl- 50 (Flg 19) ln whloh th-loop 52 1- trlangular ln hap Th tapl- pu-h-r bar ~ ;
310 includ - a plurallty o~ pair- o~ w-dg--~hap-d r~p~
ach including an upwardly inclin d ~urrac~ 312 ~nd ~nwardly dant d ~ur~ac- 313 ~or d~or~inq th l~g~ 64 -~ 66 ot th ~tapl- S0 wh n th pu-h~r bar 310 i~ `
actuat~ On ach id of th tapl- pu-h~r bar 310, l~g 317 pro~ lnwardly towar~l th c~nt-r of th~
pu h r b~r 310 ~ch l dg~ 317 i~ pro~rid-d with an --~longat d b~v lld ~dg 318 which allow th- l~dg- 317 - -to ~ pa-t th- trlangul~rly hap d loop 52 o~ th-~tapl- 50 wh n th tapl- pu~h r bar 310 i- actuat~d A
palr of oppo~ d notch - 319 i~ fo~ d in th~ l dg-~ 317 to r c iv th- ar ~ 56 and 58 of ach ~tapl~ 50 ,.
. ", : , Referring to Fiq 38, a ti~sue cutting too~ or knife 320 includes an elongated handle 321 provided with finger loop 322 ~t one end of the handle 321 to ~ ~
racilitate use of the knife 320 by a surgeon The ot~er ~;
end o~ handle 321 i8 attached to ~n exten~ion rod 323 whioh, in turn, is attaehed to a knife head 324 which ~upports a eutting blade 325 The knl~e head 324 inelud~- the ¢urvod slot 326 ~Flg 40) whl¢h extend~
~ero~ a ~ront portion o~ th- he~d 324 The ¢utting bl~d- 325 i~ forc- ~it into the ~lot 326 ~nd pro~ect~
outwardly ~nd ~orwardly ~ro~ one side o~ the head 324 The extension rod 323 ineludes an axi~lly extending ~haft 327 (Fig 38) whieh is received in an axial bore for~ed in the handle 321 Th~ shart 327 i8 secured to th- handle 321 by a tran v rse retainer serQw 328 The ~nif~ head 324 includ-- an axially ~xtending ~haft 329 rec ivQd in an ~xi~l bor forn d in th- extension rod 323 and ~eeur~d by a r tain r ~er-w 330 to th~ exten~ion rod 323 A ~hown in Flg 41, the sh~t 327 i~ notched to r e iv th- r tain r er w 328 Al~o, the ~hart 329 1~ noteh-d to r e lv th r taln r erew 330 R ~-rring to Plg ~2, ln an alt rnatlv- bo~ nt to th- tl--u-euttlng tool, a knif- h ad 332 whleh i- d tachably eonn et d to th xt-n-ion rod 323 Th- knif- head 332 2S inelud ~ an axially xt-nding ~haft 333 (Fig 43) which ~ r e~v d in an ~xial bor for-~d in the exten-ion rod 323 and $- ~-eur d by th r tainer serew 330 The sha~t 333 $nelud ~ on- or r- noteh-- 334 for r-ceiving th-r ta$ner ¢r ~ 330 Th knif h ad 332 includ ~ a r ovabl- cupport 33S which upport a knife bl~d~ 336 xt nding outwardly and forwardly fro~ on id- of th knif h ad 332 Th knif- upport 335 in¢lude- a p~ir of ~l xibl- ar 337 provid d with hook d nd- 338 which ar captur d by a pair of notche- 339 for d in th-3S knif h ~d 332 Al~o, a ~cr w 340 (Pig 44) i~ thre~d~d i, ",, ,,, ~;,.

2 1 3 ~ 3 ~

into an axial borQ 340 in the knifQ h~ad 332 to ~cure the knife ~upport 335 and thQ knifQ bl~de 336 to tha knife head 332 A protective brac~et 341 (Fig 42) is pivotally attach~d to the knife head 332 by a pair of ~crew~ 342 The bracket 341 includes a p~ir of flange~
343 which nor~ally cover the notch~s 339 when the knife ~upport 335 i- att~ched to the knife hQad 332 To allow r plac-~nt o~ the knit- support 335 and kni~ blad- 336, th cr w- 3~2 ar- loo~-n-d and th~
brack t 3~ plvot-d away trou th- knlt- h~ad 332 to YpO~- th~ notch~ 339 A a re-ult, the knif~ ~upport 33S c~n b- d-t~ched tro th knlt~ h-ad 332 Atter ~noth r knlf- ~upport 335 1- fltt~d on th knif- he~d 332, th brack-t 341 i- pivot d $nwardly ~nd th- screw~
3~2 ~r tight-n~d to -cur th- brack t 34~ ov r th-notch ~ 339 ., . .. ~.
In th- op r~tlon of th pur-- ~t~ing utur~
in tru nt 200, a plurallty ot tapl-- S0 ar- in--rt~d lnto th tapl- r ¢ l~lng lot- 22~ ot both taplQ
¢artrldg-- 222 E~ch tapl- S0 i- ori-nt-d with its loop 52 r c-l~ d in th- not¢h 261 at th- bottou o~ t~-~ta~l- r ¢ l~ing lot 22~ nd vlth lt- l-g- 6~ and 66 po$nt~ng upwardly toward th tl~u- cla~ping rldg-~ 2S3 A ~ngl- pur~- trlng ~utur 80 1~ thr ad d through th loop~ 52 ot all tapl-- 50 in both ~taple ¢~rtridg ~ ~
222 ~;
Atter th tapl-- S0 and th- pur~- trlng utur 80 ar- load d into th- t~pl- cartrldg~- 222, th ;
~av~ 211 and 212 ar op n-d by gr~-plng tlng-r grlp~ 204 ~n4 20S and noving th h~ndl-- 201 and 202 apart Th ~n~tru nt 200 i- po~ition d wlth lt- op ned ~aw~ 211 un~ 212 on oppo~lt- ide- of ~ tubular ~-ctlon of ti~sue 82 $hen, th ~w~ 211 and 212 ~r clo~-d by gr~sping the f~ng r grlp- 20~ and 20S and ~ovlng handl-~ 201 and 202 tog th r to cl~p th tl--u- 82 b tw -n th-3s - 2~ 4~

cartrldge6 222 on the jaws 211 and 212 The handles 201 and 202 are l~tched together by the latch ar~s 206 and 207 to hold the ~aw~ 211 and 212 clo~ed As ~hown in Flg 31, the tissue 82 is pinched S botween the oppo~ed tl~ue clamping ridge~ 253 and urged into a ~light bulge at the center of each staple cartridge 222 Initially, prior to the actuation of the ~tapl- pu~her bar 240, th- widely pac-d vertical ~ur~ac-~ 265 o~ th~ pu h-r bar 240 ar- loc~ted ~d~c~nt to th- ~tapl~ l-g- 64 and 66 Rer-rring to Fig~ 21 and 22, the 6taple actuating l-v-r 225 i~ unlocked by pivoting the locking di~c 238 ~ro~ it~ upper locked po~ition to its lower unlocked po~ition (~hown in phanto~ linos) engaging lS ~ing r r ~t 208 Th-n, th ~tapl- actuating lever 225 i~ d-pr-~-d to pivot ar~ 229 in a clockwi~o diroctlon about pivot pin 226 and to pull th- ~loxibl- wir 230 r arwardly A~ a r -ult, th- conn-cting wir - 234 ~ro pull-d r arwardly and ach plvot arn 236 (Fig 27) i~
pivot-4 ~bout it- pivot cr-w 2~2 again t th- bia~ o~
pring 248 ~h pivotal ~ovenont o~ ach pivot arn 236 1~ tr~n~nltt d a~a th- pln 243 ~nd lot 2~ lnto long~tu~n~l aov a-nt o~ tb t~pl- pu-h r bar 240 ~n th d$r ction o~ arrow A r l~tiv to th ~taple 2S cartridg 222 ~ ~-rring to Flg 28, whon th pu~her bar 2~0 i~ novd in th dir ction o~ arrow A, the l~ntod ~t~pl-~orn~ng dgo- 26~ ngag ~nd b nd th ~t~pl- leg- 64 ~nd 66 to~ar~ ach oth-r A hown in Fig 32, th- tip- 68 and 70 o~ th tapl- l-g~ 6~ and 66 ar guid-d into th-ti- u 82 b tw -n th ridg - 253 o~ the ~taplo c~rtridg 222 ~h n th pu~h r bar 2~0 i~ fully adv~nc-d, th otapl- l g~ 6~ ~nd 66 ar locat d b two~n th- n~rrovly ~pac d v rtlc~l ~urrac ~ 266 o~ tho ~tapl- pu-h-r b~r 2~S ~ach tapl- S0 i- d-~orJod into th- configur~tion - 36 - 21~3~

of a figure eight with the staple leg~ 64 and 66 overl~pped to form the loop 84 to ~ecure the 6taple 50 ;
and the purse string ~uture 80 to the tissuQ 82 When the st~ple ~ctuating lever 225 iB ..
dopres~ed, the st~ple pusher bars 240 in both staplo c~rtridg~ ~rQ si~ultan-ously ~ctu~ted A- a result, all ot th- t~pl-- 50 ln both c~rtrldg-- 222 ~r~
~ult~n-ou~ly bent to -cur th- pur-- trlng utur- 80 ;
to th- ti~u-N~xt, prior to the op ning o~ ~w- 211 ~nd `
212, th- tubul~r -ction ot ti--ue 82 is cut crosswi~e in tront ot th- ~w~ 211 ~nd 212 by u~ing the knife 320 (Fig 38) Th- knit- 320 i- positioned with its cutting ~ ~
blad~ 335 ~d~c~nt to th! tront of tho pur~ string ~;
~utur in tru~ nt 200 Th-n, u~ing th- tront dges ot th- ~aw~ 211 ~nd 212 a~ a guid , th- cutting blado 335 1~ dr~wn ~¢ro-- th ~ront o~ th pur~- ~tring sutur~
in4tru -nt 200 to ¢ut th- tubular -ctlon ot ti~u- in th cro~wi-- dlr ¢tlon Att-r th~ ti~u i~ cut7 the h~ndl-~ 201 and 202 ar unlatch d and ~ov-d apart to ~-p~rat th- ~aw~ 211 and 212 and uncla~p th- tl-~u-A~ ~ho~n ~n Flg 1~, th- pur-- trlng utur 80 r ~aln~
~ttach d to th tubular -ctlon ot tl~-u~ 82 by plurallty ot tapl-- S0 Th r att-r, both nd~ ot th-2S yur~ tring utur 80 ~r pull d to clo~e the tubul~r ~ ction ot' ti~ue 82 an~ th pus~ ~tring ~utur 80 1B
tight ned und wr~pp d ~bout th- tubular ~-ctlon ot ti~-u 82 The loop, 52 ot th taple- S0 allow the Fur~e ~tring utur 80 to b- ~ov d ~-ily through th ~t~pl~J~ 50 with ~ini~al r -i-tanc- or interter~nce tro~
the ti~ue 82 Preter~bly, the pur- ~tring ~utur- in~tru~ent 200 i- a r-us~ble tool con truct d ot ~tainle~s t- l Th- ~tapl- cartridg - 222 are on --hot di~,po~abl- unit~
3S which ar d tach~bl~ tro- the ~aw- 211 and 212 ot the .....

_ 37 _ ~3~

instrument A1BO, the tis~ue eutting tool 320 is con~trueted of 6t~inles6 ~teel In ~nother ~peet in accordance with the invention, there i8 provided ~ purse string suture t~pler for endo~eopic U80. Referring to Fig 45, the ~utur stapler 410 ineludos ~ rotat~ble endoseopie portlon 412 and a handl- portion 414 The endoscopie portion 412 inelud-~ a ~aw portion 41S havlng a pair o~
artieulating ~aw~ 416 and 418, an out-r tub- 420 and a ro*ation knob 422, ~ d-~eribod in detail below The hJndl- portlon 414 inelud~- ~ handle 424, a lever 426 ~or op-ning ~nd elo-ing th- ~aw~, a lateh 430, a safety loek button 432, ~ ~w articul~tion erank 434, a staple ~iring trigg-r 436, and ~ blad aetuator 438, a~
d ~eribod in d tail bolov Ro~-rring to Fig- 4S and 46, the ~W8 416 and 418 ~r ~ovabl- b twoon an op n po-itlon ~Flg 46) and elo~ d po~ltion (Fig 45) Pr fQrably, on- ~aw 416 1-~ov bl- ~nd th- oth-r ~v 418 i- ~tation~ry ~a~h ~w eont~$n a tapl- e~rtridg 440 a~ d -orib d in d~tall ~10~l.
~ -rrlng to Flg~ 47-49, th- ~aw portion 41S
~ artleul~t~bl~ unit b-tw n a po-ition that i~
p~rall-l to th out r tub (Fig 47) and angl~d 25 po ition (Fig 48 and 49) Pr f-rably, th~ ~w~ ~y ~ri~ly angl d b-tw n ~ parall-l orlontatlon (Fig 47) nd ~ 90 orl-ntation (Fig 49) by ov-~ nt o~ th~
~rticul~tion cranlc ~34 A~ ~- n in Flg- 45 and 47, th~ ondo~copic 30 portion 412 i- rot~tabl- r l~t~ to the handle portlon ~1~ In Fig 47, th- ndo copic portion 412 h~ n rokat d 90 o that th ~ portion 41S artlcul~t-~ ln d~ard iir ct$on rath r than ~ lator~l diroction r l~tiv to th hanal- portion 414 .... : ~
The rot~tion of the endoscopic portion 412 rel~tiv~ to the handle portion 414 i~ effected by a rot~table connection betwe n the outer tube 420 and the -handle 424 A rotation knob 422 iB connected to the 5 prox~l snd of th- outer tube 420 -~
Referring to Figs S0 ~nd 51, e~ch st~ple c~rtridg- 440 lnclud-- ~ c~rtridgo housing 442, ~ staple b~- 444, ~ r-tain-r pl~t- 446 (F~g Sl), and ~ staple pu~h-r b~r 448 R ~-rring to Fig Sl, th- cartridg-10 hou~ng 442 dofin~- ~n int-rior spacQ 450 for hou~ing th- ~t~pl- b~-- 444, r~t~in r pl~te 446 ~nd taple pu~h-r b~r 448 Th- c~rtridge hou~ing 442 do~nes ~
c ntr~l longitudin~l d ot 452 ~or allowing passage of longltudin~lly--xt-ndlng utur , ~nd ~urth~r derines a plur~llty o~ tr~n~v-r~-, t~pl- r-ceiving slots 454 ~or -~llo~inq p~ g- o~ t~pl-~ ~ d--crib d h~reln Th c~rtridg hou-ing 442 (Flg 51) d-~ine-~lur~llty or longltudlnally xt nding w ll~ 456 for r~ bly cont~inlng ~ plur~llty o~ loop~ o~ ~n xt-nd d l-ngth o~ utur , ~ dl-cu~--d rurth r b low A c~tch ~S9 on th ld- o~ th cartrldg hou-lng nqage~
corr-~pon41ng llp 486 (~ lg 65) ln th- ~w ~or curlng th Q rtrldg- ln th ~w $h ~tapl- ba-- 444 ~Flg 51) de~ine~ a plur~llty o~ tran v r~- notch-- 4S8 ~or rec-ivlng and upporting ~tapl-~ E~ch notch 458 hold~ a ~taple honn by th t~pl- 460 in4ic~ted by phanto~ line~
Th- r taln r plat 446 ~Flg 51) lnclude~
plurallty o~ upright hook~ 462 Tho retainer plat 446 1~ loc~t d und r th tapl~ ba~- 444 The hook~ 462 Yt nd upH~rdly through hook-r~c~i~ing lot- 464 in th ~taplo ba~- 444 $h lot~ 464 ar lightly extended in th- lon~ltu~inal dir ctlon to p~r-it th- hooX~ 462 to nov longitudinally ~ithln th~ ~lot~ 464 a ~all ~;
3S dl~tanc . :~:
"' '. ~' .' ",'', 21313~ 3 The ~taple pu~her bar 448 (Fig~ S0 and 51) deflne6 a plurality of wedge~ 450 The stapler pu~her bar 448 is directly ~bove ~nd in ~butting rel~tionship to the ~taple ba~e 444 The staple-pusher bar 448 functions to clo~e pur~e ~tring staples in a fashion ~imilar to the non-Qndo-copic instru~ent a~ de~crib~d above Referring to a pre~erred embodlment o~ the Qndo w oplc version o~ thQ
inv ntlon ln Flg- 52 and 53, ach staplo 467 1~
lnitlally r~t~ln-d on ~ ~t~ple ba-~ 444 by ~ hook 466 which Qxt~nd~ through th- eyelet or th~ ~t~ple (Fig 52) 8utur 468 extend~ through the eyelet of the ~taplo 467 and rQsts on the hook 466 The staple pusher bar 4~8 i~ ~ov-d longltudln~lly in the dlrectlon of the ~rrow 469 A- tho ~t~pl- pu~her bar 448 ~oves longitudin~lly, tho wedg-~ 450 lift and clo~o the ~rms Or th ~taplo 467 (Fig S3) Th- hook 466 rot~in~ the ~t~pl- ~67 on th- tapl- ba~- ~4~ until th- hook 466 i~
di~-ng~g d ~ftor full clo-ur- o~ th~ ~t~pl- 467 (Fig 53) ~hu~, th ~tapl- pu~h-r bar 448 and ~tapl~
ba ~ M ~or- ~n ~c~-ably vhich ~unction~ a- a tapl-¢lo--r r~¢hani~ It vill b- appr ciat-d th~t th-~tapl-~, ~tapl- pu~h r bar and w dg-~ ~ay b- ¢on~truct-d in ~ vari-ty o~ d--ign- ~i~ilar to th v~riety o~
d ~ign- d~cu~- d ~bov~ r g~rding th- non--ndo~copic ~p ct o~ the i m ntion Th- ~ bly, inter~ction, ~nd ~ove~ent of the ~tapl--, utur , ~tapl- pu-h r b~r, ~nd r tain-r pl~te within th- cartridg ar illu~tratcd in F$g~ 54-58 Re~ ring to Fig 5~, th cartridg hou~ing 442 contain~
th ~t~plc pu~her b~r 4~8, t~pl- ba~- 444 ~nd r tain~r plato ~6 Thc r tain r platc ~6 i~ initially po~ltion-d in a proxi~l po~ition wherein th hook- 462 ~nd ~62~ ar po~ltion d at thc proxi al end o~ the hook "", :' ~c~ " ;~

i2 1 3 ~ ~ ~ 3 .~ ~

receiving slot~ 464 in the ~taple base 444 (hook 462a ~ho~n p~rti~lly cut-~w~y to reve~l prox~mal end of ~lot 464) Referring to Fig 55, the st~ples 467 with suture 470 threaded therethrough ~re nQxt placed in the notch ~ 458 of thQ ~t~pl- b~e-444 Th- staple~ 467 ~r ori-nt d with their l~g~ pointing upw~rd The ~uture 470 ~xt nd~ longltudln~lly, r--ting on top o~ the hook R~-rring to Fig S6, th- hooks 462 ~r n-xt ~ov d longitudin~lly to th- di~t~l ~nd o~ the hook-roc i~ing lot- 46~ by longitudin~lly ~oving th~
r~t~in r pl~t 446 A~ th hook~ 464 are ~ov~d, thQy ng~g th y l-t- o~ th- t~pl~- 467 The c~rtridge ~0 1- now r-~dy ~or ue~
~ ~-rrlng to Fig 57, th ~gu-rc- ror clwing tho ~t~plo- ~67 i~ b gun wh n tho et~plo pu~her b~r 448 i~ ~ov d proxi~lly in th- dir~ction o~ th~ ~rrcw 472 A~ th- t~pl- yu h-r b~r 448 ~nv ~ proxi~lly, the v dg ~ 450 on th t~pl- pu-h r b~r 4~8 cont~ct th ~rns o~ tb~ ~tapl-- ~67, ~nd pu h th- ~r J upw~rdly 8nd ~n~ rdly t4w~rd ~ clo~-d ~o-ition ~h- ~ l-t~ o~ tb-~tapl-~ ~r r t~ln d by th~ hooX~ ~62 whil- th~ ~t~pl-~D ~r ~ov d to~rd th clo~-~ po~ltion A protrw ion ~74 x~nd~ downw~rdly fro~ th~
~t4~1- pw h r b~r ~8 und cont~ct- ~ wing 476 xt-ndlng -outY~rdly ~ro th r t41n r pl~t- ~6 (Fig 57) A~ th ~t~pl- pw h r b~r ~8 tr~v~l~ proxi~lly, th- protru~ion ~ ;-~7~ ¢~tch J th wing ~76 nd pull~ it proxi~lly (Flg-57 und 58) Thu~, tb tapl- p wh~r b~r U 8 pull~ th~
r~t~n r pl~t ~6 proxiu~lly ~ th t~pl~ pu h~r b~r ~8 co pl~t ~ it~ rov - nt toY~rd ~ proxi ~l po~itlon -A~ th- r t~n pl~to ~6 rov ~ proxi~lly, it~ hook~
~62 ~r di~-ng~g~d ~ro- th ey-l~t~ o~ th~ ~tapl-~ ~67 ~i~
, ' ~' . ,' .
....

213~3~ 'i (Fig 58) and the st~ples 467 and suture 470 may be re~oved fro~ the cartridge 440 ~ eferring to Fig 59, each cartridge 440 i~
~atched with ~nother cartridge 440, ~o th~t a single pur~e ~tring a~y be threaded through the 6t~ples that ~ro lo~d-d in both c~rtridges 440 The two cartridge~ -440 ar in ~uxt~po~-d r-l~tlon~hip wherein the longitudin~l ~lot- 452 ~nd th- tran~ver~ ~t~ple r~c-i~ing ~lot- 454 in th cartridges 440 face each oth r Th~ ~utur i- thr~d~d through the eyelets in th~ ~t~plo~ o~ both c~rtridgo~ Th- extr~ length of th-~utur i~ ins-rt~d into th w 11~ 4~6 of ach cartrldge 440 Th nd~ o~ th utur are d-tach~bly in~Qrt~d into a notch ~77 on th~ id o~ o~ch cartridg- 440 ~ig 60 i- ~ ~ch -atic illu tration o~ th- ins~rtion o~
th~ ~utur 470 into th~ ~t~pl-- 467, notch~ 477, and - ach w ll 456, wh r in ach w ll 456 r-l~ bly cont~ins a ~ingl- loop o~ ~utur 470 Th nuib r oS w 11~ u~y b vari-d a~ nQ-d-d Alt rnati~ ly, th r nay b a ingl- w ll 478 in ach cartridg 441 a- ho~n ln Flg 61 Th- notch-~ 479 for ~ c ~ving th- nd~ o~ th- utur ~y b on th top ~nd botto- ~ld ~ o~ th~ c rtrldg-~ 440 Hultipl- loop~ o~
~utur 470 ar r l-~-~bly cont~in d in each w ll 478 ~ ;
2S ~ch--~tl~ally ~hown in Flg 62 ~ -~-rring to Flg- 63 ~nd 64, a cartridg~
hold~r 480 1~ u~od to t-~porarlly hold tvo cartridg~
440 ln ~uxt~po~-d r l~tion hip b-~or- th-y ~r~ in-~rt-d into th ~aw~ o~ th~ ~tapl-r Th- cartridg- hold-r ~80 ha~ Qall po-t- 482 xt nd~ng upw~rdly ~nd downw~rdly Th~ po t- ~82 ~$t into corr ponding hol~- 48~ in th c~rtridg-~ 440 with a d~t~ch~bl- pr ~ ~it Th~ two cartrldg-~ 440 ~ h ld by th c~rtridg~ hold~r 480 (Flg 64) ay b conv-nl-ntly tor d ~nd v-ntu~lly pl~c d 2~3~3~

into the open jaws of a ~tapler according to the invention Fig 65 illu~trate~ a cro~-sectional view of two fully loaded cartridges 440, including cartridge hou ing~ 442, ~tapl~ pu~h~r b~r~ 448, rotainer plate~

4~6, hook- ~62, ~t~pl- b~ 44, tapl~- 467, c~tche~
459, w~ 456, d utur 470, a- load~d into a pair of ~aw~ 416 ~nd 418 ha~ing r taining lip- 486 R-~-rrlng to Fig~ 66 an~ 67, th- ~aw- 416 and 418 ~r ~ov~bl- b-tw--n an op n po-ition (Fig 66) and a clo~ d po-ition (Fig 67) Pr ~-r~bly, tho upper ~aw -416 1- uov~bl- whll- th low-r ~w 418 r-~ains ~tatlon~ry A prlng ~86 bl~ tho upper ~aw 416 toward th- op n po-ltlon A Yodg- u-chanlc~ actu~t ~ th ~ovablo upp~r ~aw 416 ~Fig- 66 und 67) Th~ w dg- 488 i- ~ttached to a longitudin~lly--xt~nding driv rod 490 whlch xtonds proxi ally within th out-r tub 420 ~nd into th- handl-424 Th- v dg 48B and driv rod 490 ~r- lid~bly ~ont~ind Yithin th out-r tub- 420 and h~ndl- 424 A
l-v r 426 in th h~n41- 424 v ~ th- w dg- 488 and drlv rod 490 long~tudlnally Wh n th l v r 426 an~ ~w 416 sr op-n-d ~lg 66), th- w ~g 488 1~ r tract-d ~ro the ~o~bl-uyp r ~aw 416 ~h n th l v r 426 $~ clo--~ ~Fig 67), ~;
th w d q- 488 i- dri~ n und r th roar nd 491 o~ tho novabl- ~a~ 416, thu~ clo ing th ~aw Th- conn ction 492 b tw -n th w dge 488 ~nd dr~v- rod 490 p-rnlt~ rotation o~ th ~dg 488 r-latlvQ
to th driv ro~ 490 ~b n th ndo copic portion 412 1-rot~t d relativ to th handl~ portion 414 Pr ~r~bly, th connection 492 ~ ot th- ball and ~ock~t typ~
R-~ rr~ng back to Fig~ 47-49, an ~rticulation linkag ~ bly 493 articulat ~ th ~a~ portion 41S ~ -3S Th llnkag- a~-ably 493 lnclud ~ an artlculation link ~ ;

~ .
., . ~,"';~ ~
.

3 ~r~
~ 43 ~

494 that i~ connected to the fixed ~aw The connection i~ offset ~rom the axis 496 of articulation of the jaw A drive link 498 extends proximally fro~ the articulation link 494 and is connected to a longitudin~lly-ext~nding articulation tube 500 Th~
articulation tub~ 500 ~lido~ longitudinally in~ide the outor tub~ 420 Th~ articul~t~on link~gQ 493 i~ controlled by an articulation crank 434 in th- handlo 424 (Figs 47 and 49) A driv r tub- 502 ~xtend~ di~tally fro~ the crank ~34 and i- rotatably fitted with the ~rticulation tub~ 500 Qxt-nding proxi~ally from th~ linkago 493 Pr~f-r~bly, th~ conn ction b~t~e-n th~ drivQr tubQ 502 and articulation tub~ 500 includ ~ a radial flang- 504 oxt~nding fro~ th~ articulation tub- 500 and fitting to a circuo~-r-ntial groov~ in~id- th- driv~r tube 502 Th- driv r tub~ 502 ha~ a v-rtical slide portion S06 at it~ proxi al nd (~ig~ 47 and 49) A
bar S08 a~ix-d to th crank 434 xt~nds latQrally fro~
t~ cr~nk into th ~lid- Ih bar 508 lid~- v-rtlcally ln th~ d- ~ortion 506 ~o aa to p r~t th- crank 43 to rotato and th-roby ~ov- th- driv- tub- 504 di-t~lly ~nd proxin411y Th- int-raction o~ th articul~tion linkag~
493 and crank ~34 i- --n in Fig- 47-49 In Fig 47, th- ~av portlon 415 i- ~ully xt nd-d A~ th~ crank 434 i~ turn d count-rclockwi~-, th- articulat$on link~g- 493 io pull d ln a proxixal tir ction, ~nd th- ~aw portion 41S ~ariably articulat ~ on axl~ 496 (45 in Flg 48, 90' in Fig 49) Com ~r -ly, wh~n th~ crank 434 i~
rotat d clock~i-~, th~ ntir~ articulation link~g~ 493 ~ ~;
i~ ari~ n in a di-tal air ction ~n4 th ~w portion 415 -r turn~ to~ard lt~ fully xt-nd d po~ition (Fig 47) Th ~w~ ar ~nvabl- b~tw--n their op-n-d ~nd clo--d po-ltlon in any angl- o~ artlcul~tion $he 2~3~3~

ability to op~n and close whil- articulated iB .
facilitated by the de6ign of the rear end 491 of the ~ovable upper jaw 416 Referring to Figs~ 66 and 68, th rear end 491 of the ~ovable upper j~w has a h~ i~pher~cal lowsr ~urface The he~lspherical low~r ~urtac- pernit~ the w~dge 488 to fit undsr and lift up th- r ar ~nd 491 of th- ~o~abl- ~aw 416 and thereby clo~- the ~o~abl- ~aw 416 wh n th- ~aw- are arti¢ulat-d , ;
to any angl-Th- firing u chani-~ ~or ~o~lng th- taple pw h r bar- i- illu-trat-d in Fig~ 69 and 70 R-~orring to Fig 69, a ~iring pin S10 1~ longitudin~lly ~lidabl- within a lott-d ¢ylinder 512 in the lowQr ~aw 418 A ~pring 514 in th cylind-r 512 b$a~e- tha pin lS 510 t ward a di-tal po-ltlon a- h w n Th pin 510 xt nd- upwardly and ngag-- the proxi~al nd portion ~-516 o~ th low r tapl- pu h-r bar 448a that extend~
proxloally ~roe th cartridg r ~0 R-~-rring to ~ig 70, th- ~taple~ in the cartridg ~ ar ~lr d wh n th ~lring pin S10 ~ove~ in a ~roxi~al dlr-ction a- tb- pln 510 ~ov--, lt e~gaqe~
n~ ~Ull~ th- low r t~pl- pu~h-r b~r 4~8a ln a ~rox~
dlr c*lon Thu~, th tapl-- ln tb- low r ~aw 418 ar ~lr d Tha ~t~pl-~ ln th upp r ~aw 416 are ~lred at tb a tire du to th lnt rlocking arrange~ent o~ th~
~tapl- pu~h r bar~ 4~8 and 4~8a in the upper and lower -~-~ n-~av~ Thw , the upp r tapl- pu her bar 448 ~ove~ ;
proxi~ally vlth th lov r tapl~ push-r bar 448a $h ~tapl- pu h r bar in accordanc- wlth th-inv ntlon i- con~igur d o a- to int-rlock with anoth r -~
~tapl- pu~b r bar o~ the ~a~e de ign that i~ plac d ad~ac nt to and in a irror-i~ag~ r lation~hip to lt $hw , wh n two cartrldg - ar loadod ln an ad~c-nt and ~-~irror-i~age r lation~hip to ~ach oth r in the ~aw~ o~
th ndo~copic ~utur ~tapl-r a- d--crlbed h-r-in, the .,, , .:, C~

staple pu~her bar~ of each cartridge are interlocked, and each b~r will coact with and draw the other when ~oved in a proxi~al direction ~ ;
Referring to Figs 63A ~nd 63B, each ~taple S puaher bar 448 and 448a ha~ a fin 518 and a cros6 member 520 RQferring to FIG 64A, the interconnection of the ---tapl- pu~her bar~ occur~ whon th fin 518 of one ~tapl-r pu-h-r b~r 448 catch-~ and hold~ the cro~a J ~b-r 520 of th oth r tapl- pu~her bar 448a a~ it ~ov-~ in a proxi~al dir-ction ~he coaction of the ~taple pusher bare rseults ~-in ~ ~t~pl- cartridge which i~ uniquely con~igured to co~ct with anothor c~rtridge of ~ ~ub~tantially similar d ~ign Thu~ ingl- c~rtridge de~ign can be ussd to ~ `
fulf$11 th requ$r~ nt- of pl~cing co~cting cartridgs~
in th upp r and low r ~aw- of a ~uture ~tapler Th flring ~ chan~ ctu~t d by ~ tr$gg-r chan$~n a~ ~ho~n in Fig- 71 and 72 Tn Fig 71, th-f$r$ng ~ chan$~n i- r ~dy to b- fir-d A ~iring c~bl-S22 $- conn ct-d to th flr$ng pin 510 ~nd extend~
~rox~ally into th handl- 424 Th- c~bl- Ç22 i-attach d to a plat 524 ln id th- handl- 424 ~h-~lat 524 ~- attach-d to th- h ndl- with a hing- p~n 526 Th plat 524 rotate~ l$ghtly about the hinge pin S26 ~$th$n th conf$n c o~ th $nt-rior of the h~ndl- ~
424 A trigg r 436 xt-nd~ lat r~lly ~ro th pl~t~ and ~ ;
throug~ ~ lot S30 $n th handl- ~24 (al-o hown in Fig 4S) Th f$r$ng u ch~n$~ $- fir d by ~oving the trigg r 436 upwardly fron ~ pr -~iring po-ltlon ~lg ;~
71) to ~ fired po-ition (Pig 72) a~ the trigger 436 ~ov ~ upw~rdly, th pl~t 52~ rotat~ counterclock~
~bout it- hlnge 526 and th c~bl- 522 i~ pulled by the pl~t- 524 in a proxi~al directlon A- th- c~ble S22 ,','.~ ;.~ ' :.' , :: . .':

~ ~3~3'~ :
- 46 - ~ -moves, it draw~ the firing pin 510 in ~ proxi~al direction Thus, the firing mech~nism iB ~ctuated An altern~tive firing pin ~echanism i~ shown ~-in Fig~ 73 ~nd 74 Referring to Fig 73, the -S ~ltern~tive firing pin ~ech~nism includes ~ firing pin 532 that i~ ro_~t~bly nounted $n ~ box fr~me 534 The ~iring pin 532 xtend- fro~ ~ rot~ting cylinder 536 th~t xt nd~ b-tw-~n th- lde- of th~ ~ra~ S34 An ~ tlcally ~tr~tch~bl- band S38 1~ attaohQd on ~ w~
of th fr~ ~ 534 ~nd xt-nd- ~round ~ portion oS the cylind-r 536 b for ~tt~ching to the cylinder 536 The ~tretchabl~ b~nd 538 bi~e~ th- rotation oS the cylinder `~
536 in ~ counterclockwi-- dir~ction The firing c~ble S40 i~ ~tt~ch d to th- cylind~r ~nd wr~p- ~round it ~t lS l-~-t one full revolution before extendlng proximally to~rd th trigg~r nech~ni~
Ref-rring to Fig 74, th- ~lternative firing pin r-ch~ni~ fir d when the flrlng c~bl- 540 nove~
proxi~lly ~nd c~u--- th cylinder 536 ~nd firing pin S32 to rotat- cl w kwi-- A- tho cylind-r and pin ;~
rotat-, th ~lrlng pin ngag-- th- low~r t~pl- pu~h-r ;
b~r ~48a un~ ~oV ~ lt ln a proxl-~l dlr ctlon R-~-rring to ~lg~ 75 and 76, th- ~lrlng c~bl~
S~O ~a ~l-xibl- ln ord r to p rnit it to b nd wh~r~ it pa~ a ~roa th low r ~aw ~18 ~nd into the out~r tub~
~20 wh n th ~aw portlon ~15 i~ artlculated to an angled po~ition In Fig 75, tb ~aw portion 415 1~ ln a ~arall-l ori-ntatlon ln Plg 76, th ~aw portlon 415 ia in a 90 angl d ori ntation Th out r ~ur~ac~ o~
th corn r tructur~ 5~2 in tb out r tubQ 420 (Fig 76) ia round d and ~Jooth in ord r to p~r-it tb ¢~bl~ 540 to lid longitudinally around it a~ily ~h blad- and blad- a¢tuating ~ch~ni~ ar~
~hown in Flg~ 77-79 R ~-rring to Fig 77, th- bl~d

5~2 ic ~lldably ~ount d on a tra¢k 5~4 on th low r ~w 3 A 'i~

418 The blade 542 extend~ upwardly and moves ad~acent to the lateral ~urface of both jaws The blade 542 i5 slidable along the track between a di~tal posltion and a proximal position A blade cable 546 that is a~fixed to the blade -- -542 and extQnds both proximally and distally from the blad- 542 ~or pullinq tho blado in ith-r a proxi~al or di~tal dir-ction Th- cabl- 546 i~ looped around a lat rally--xt-ndlnq rod S48 at th- di~tal ~nd o~ th~
traek ~nd two ~trand~ xt-nd proxi~ally ~ro~ th~ rod 548 along th~ traek 544 At th- proxi~al ~nd of the track, th- two trand- o~ th- eabl- 546 onter the interior of tho lowor ~aw 418 throuqh an apQrture 550 R~-rring to Fig 78, th- two cabl~ strands 5~6a and 546b di~id- in th- out-r tub~ 420 and rQ~in dl~id d a~ th y ~xt-nd proxirally into th~ h~ndl- 424 ~trand S46a i~ trung around a pull-y 552 at th-proxi al nd o~ th handl- 424 Th- two trand~ 546 and 5~6b ~ -t at a blad actuator 438 Th< blad aetuator 438 i- attach-d to th-blad eabl- 546 within th handl- 424 Th- blad-aetuator ~38 xt nd- lat-rally out-id- th- h-ndl- 42 through longitudinally--xt ndlng lot 5S6 (~-- Flg 45) ln th~ handl- 424 Tb blad actuator 438 i~
anipulat-d by a u~-r o~ th ln~tru-~nt in ord-r to ~ov th- blad 542 along th traek 544 ln th- low r ~aw 418 Ih- blad ~etuator 438 i- ~ov d di~tally in ord r to ~ovo th blad~ S42 proxi ally and, vic- v r~a, th aetuator 438 1~ nNv d proxiually ln ord-r to ~ov- th bl~d- 542 dl~tally rlg 79 illu-trat-- th- po~itioning o~ th ~ -;
eabl- 546 in th~ lat ral portion Or th~ low r ~aw ~18 ~-~nd ~d~e nt th~ artleulatisn link 494 and drivo link --498 (alao - n in rlg~ 48, 49 and 68) ~ocau~- o~ th-~l xibillty o~ th blad e~bl~ 546, it b nd- with th .. . ....

-2 ~ 3 ~

~aw portion 415 when the ~aw portion i~ articulated and ~oved to an angled position (Figs 48 and 49) The link~ 494 ~nd 498 have rounded smooth sur~ac~s that per~it the c~ble 546 to ~lide around the~ Qasily Re~erring to Fig 80, a l~tch 430 ~or latching th~ l-ver 426 to tho handle 424 in the closed position 1~ ~hown ~h- latch 430 1~ hlng-~bly attached at the proxi~al end o~ th- handl- 424 Th- latch has a catch 5S0 ~hlch ngag~- th~ l~ver 426 and holds it in the clo- d po-ition In ord-r to rele~s- th~ er 426, th-latch 430 i~ d pres~ed o as to diseng~ge it rrO~ the l~v r 426 ~nd p r~it the levQr 426 to ~o~e ~ro~ its clo~-d positlon to an open po~ition (shown a~ le~er 426 ln phanto- lin-~ in Flg 83) A locking ~echani~ ~or locklng the latch 430 ~nd l-v r 426 in th- clo~-d po~ltlon i~ ad~c~nt the latch ln th- int rior o~ th handl- 424 (Fig~ 80-82) ~;
R-~-rrlng to Flg 81, an la-tically b ndabl- ~top 552 ic conn ct d to th int rior ~ac- o~ on- ~ide o~ th~
h~n41- ~24 Th- top 552 i- bia- d to angl- away ~ro~
th ~nn-r ~ac o~ th ld o~ th h~ndl- 424 ~ow v-r a r taln r 5~4, al-o ount d to th lnn-r ~ac- o~ th- slde o~ th handl- 424, ngag ~ th~ ~top 552 and ~aintain~ it ln a po ition ~lu h again t th- inn r ~aco o~ the ~ ~
h~ndl- In thl~ flu~h po ltlon, th~ ~top 552 doe- not ~- ;
abut th in id ~ac- o~ th~ latch 430 and per~it~ tha latch to ~ d pr -- d Thu~, ~h n the ~top 552 i~
di~ ngag d ~ro th Iatch 430, th latch i~ unloc~d R-~ rring to ~ig 82, th retain~r 554 i~
~lidabl- toward a di-tal po-ition wh r~in it di~ng~g-~
th- ~top SS2 ~nd p rnit~ th ~top S52 to ~ov- to it~
w tr ~ d po-ition angllng away ~ro~ th~ int~rior ~aco oi th- ~id- o~ th handl- 424 In thi~ po-ition, th~ ;
~top 552 abut- th in-id ~ac o~ th- latch 430 and C~ 13~3 ~

prevents the latch 430 fro~ being depre6~d Thus, when the 6top 552 engages the latch 430, the latch is locked a portion of the r~tainer 554 extende lat~rally through a longitudinal ~lot in the ~ido of the handl- wh~re it i~ connected to a lock button 432 (Figs ~ -45, 81-83) Th- lock button 432 i~ ~anipulated by the u--r o~ th~ in~tru~ nt in ord r to ~ov- th- ~lidablc r-ta~n-r 554 ~or locking and unlooking thc latch 430 5ho ~cqu nc o~ op ration o~ th- ~veral actuator~ and button- i~ illu tratod in Fig 83 Fir~t, th l v r 426 ic clo- d by ~oving it in the direction o~
th- arrow 560 in ordcr to clo~- th- ~aw~ Second, the -lock button 432 i~ ~ov d in th~ direction of the arrow 562 in ord~r to lock th~ l~v-r 426 in th- closed po~ition Third, th trigg-r 436 i- ~ov-d in th- -dir ction o~ th arrow 564 in ord-r to fir th- stapl-c Fourth, th blad ctuator 438 i- ~ov-d in th dir-ctlon o~ th arrow 566 ln ord r to ~ov th cutting blad Th- ln -rtlon o~ th tapl-- 467 ~roc th~ ~a~-~16 nd 418 $nto ti-~u S68 i- 111u tr~t-d ~n Fig~ 8~-86 ln Fig 84, th- ~aw~ 416 and 418 ar- olo~-d ~h-y c4-pr -- ti~-u- 568 b tw -n th ~h- tapl-- 467 ar ~ ;
r 4dy ~or ~lr1ng In Flg 8S, th ~tapl-c 467 ar partlally b nt and hav pi-rc d th ti~u- 568 In Fig 2S 86, th- t~pl-- 467 ar ~ully b nt wh r in th-ir tip~
grip and hold th ti~-u S68 Th ~utur 470 i~
r tain d ln th y l-t~ o~ th tapl-- 467 E~ch ~t~pl~
4C7 pl-r¢-~ and r tain a c1ngl- lay r o~ ti~u- 568 ;~
Th r ~or~, wh n th ~wc 416 and ~18 ar r-~ov d, th~
t~o lay r o~ ti~u ar ~r c to -parat~ a- ~hown in ~ -~
Flg 14 Th~ ¢uttinq op r~tion 1- illu-tr~t~d in Fig-87 and 88 In Fig 87, th- ~aw~ 416 and 418 ar~ clos~d Tb ~aw portlon 41S i- hown artlculat d 90 ~ho bl~de 542 1~ bown a- lt novo~ prox~lly and cut~ tl~u 568 ' :' ~ '," ' 2 13 ~3 ~
- 50 - :~
~':
~way fro~ tho ~WB 416 ~nd 418. In Flg. 88, the blade h~ co~pl~ted itB tr~vol proxi~lly ~nd rosides ~ithin a bl~de hou~ing 570. Ihe tiB8Ue 568 is fully cut and separated Th~ ~pparatu- dascribed h~rein i~ u~able in ~
thod ~or applying pur~e ~tring suture and staple~ to a body ti--uo ndoscopically In th- pre~erred method, a ~ully loadod stapler 410, wlth taple c~rtridg~s 440 in~orted ln th- ~aw- 416 and 418 and the ~aw~ closed ~
~hown in Fig 4S, i- in-erted lnto and through a troc~r cannula Th- ~aw portion 415 xtends fron the trocar ~ -c~nnula and into a body cavity The ~aw portion 415 i~
articulat~d a8 ncce~-ary to be positioned ad~acent body ti~u 568 Th- ~w~ ar th-n open-d by ~oving the l v r 426 to ~n op4n po~ition ~ody tis~ue 568 i~
inr-rt d botw~n th- ~aw 416 and 418 PrQ~erably, the body ti~u- ha- two lay-r~ that ar pr~ d tog~ther, ~uch a- two lay r- o~ a tubular organ a- ~hown in Fig 14 Th ~aw 416 and 418 ~r~ th n closed by ~oving th-l v r 426 to th clo~od po-ition Th- l-ver is latched ¢lo d ~nd t~l- lock 432 1- ~ctu~t-d to lock th- l-v-r ~h ~t~pl-~ ar- th n ~lr d by di-t~l ~ov-~-nt o~ th- ~lrlng trlqg r 436 Th knlr- blad 542 i~ th~n actuat-~ by th knlf- blad actuator 438 Th~ kni~e blad i- rov d ~roxi ally in ord r to cut tho t~u-Aft r th body ti~ cut, th lock button 432 ~ ~ prox~ally to unlock th~ latch 430 Th l~t¢h 430 lo d pr --~ and th l-n r 426 1- op-ned to op n th ~a~ 416 and 418 A- th ~aw~ 416 and 418 ar~
30 op n~, ach nd of th pur-- ~trlng utur 470 i~
r ta~ ln notch 477 $n th upp r and low r ~w- ~S~o Fig~ 59 and 60) Th ~aw ar~ rov-d away fro~ th body ti~ u ¢onta~n~ng th pur-- ~trlng ~taplQ~ 467 and outur 470 A- th ~aw~ ar v d away frol~ th- ti~u-, ~13~

the 6uture 61ips frs~ the ~ell~ 456 and eventually the ~ ~
notche~ 477 in the j~w6 ~ -The re~ult i~ the application of a 6erie6 of pursQ ctring ~taples having eyel~ts oxtond$ng fro~ the S ~urface of the body tissuQ and a pur~o string 6uture oxtQnding through ~ach of the eyelets ~i~ilar to the ~tapl-~ 50 and ~utur- 80 a- hown in Fig 1~
Pr-f rably, each tapl~ p n-trat-- into only one layer o~ body t~-~u- Th pur-- ~tring ~utur- ~ay then b-tlght n d a~d knott-d u-lng conv nt~onal t-chniqye- a~
n c ~ary according to th n d~ o~ the particular ~urg ry b-ing p rfor d Th im-ntion in it~ broad-r a~pects is not l~ lt d to th ~p c~ic d tail- of th pr-f-rr-d lS Dbodi~ nt~ hown and d--crib d, and tho-- kill~d in th- art vill r cogniz- that th- im-ntion can b-practic d with ~odi~cat~on within th- pirit and ~cop~
o~ th- pp nd d cla~ o ..
.....
:

'".. :,~'.-.
. ' `''. ,''`

.''' ',' ..: ' .-:: ., .',:

Claims (86)

WHAT IS CLAIMED:

1. A surgical staple for securing a purse string suture to tissue, comprising:
a staple body comprising an elongated strip of deformable material including a pair of legs adapted to be inserted into the tissue, said legs being deformable upon insertion into the tissue to secure the staple body to the tissue; and said staple body including means for slidably attaching the purse string suture to the staple.

2. The staple of Claim 1, wherein: said receiving means comprises an eyelet formed on said staple body through which the suture is threaded.

3. The staple of Claim 2, wherein:
said eyelet is located on the opposite side of said staple body from said legs.

4. The staple of Claim 2, wherein: said eyelet is located on the same side of said staple body as said legs.

5. The staple of Claim 1 wherein:
said legs are deformable into an overlapping configuration to secure said staple body to the tissue.

6. The staple of Claim 5, wherein:
said legs are angled toward each other prior to being deformed.

7. A surgical staple for securing a purse string suture to tissue, comprising:

a staple body comprising an elongated strip of deformable material including a pair of legs adapted to be inserted into the tissue, said legs being deformable upon insertion into the tissue to secure said staple body to the tissue; and said staple body being formed into a loop through which the suture is threaded prior to the insertion of said legs into the tissue.

8. The staple of Claim 7, wherein:
said loop is formed on the opposite side of said staple body from said legs.

9. The staple of Claim 7, wherein: said loop is formed on the same side of said staple body as said legs.

10. The staple of Claim 7, wherein: said legs are deformable into an overlapping configuration to form another loop extending into the tissue for securing said staple body to the tissue.

11. The staple of Claim 10, wherein: said legs are angled toward each other prior to being deformed.

12. A surgical staple for securing a purse string suture to tissue, comprising:
a staple body including two or more legs adapted to be inserted into the tissue, said legs including barbed ends for anchoring said legs to the tissue, and said staple body including means for slidably receiving the purse string suture.

13. A surgical staple for securing a purse string suture to tissue, comprising:

a staple body shaped into a ring to provide an eyelet for receiving a purse string suture, said staple body including two or more legs with barbed ends for anchoring said legs to the tissue.

14. The staple of Claim 13, which includes: a plurality of legs extending in a fan-like configuration from said staple body.

15. The staple of Claim 14, wherein:
said legs are bent alternately forward and rearward relative to said ring.

16. A surgical staple, comprising: a staple body including two or more legs adapted to be inserted into human tissue, said legs including barbed ends for anchoring said legs in the tissue.

17. A method for securing a purse string suture to tissue, comprising:
positioning a plurality of staples adjacent to the tissue;
attaching a purse string suture to said staples; and driving the staples into the tissue to secure the purse string suture thereto.

18. A method for securing a purse string suture to tissue, comprising:
positioning a plurality of staples adjacent to the tissue, each of said staples including a pair of deformable legs;

attaching a purse string suture to said staples; and deforming the staple legs into an overlapping configuration to secure the staples and the purse string suture to the tissue.

19. A method for securing a purse string suture to a tubular section of tissue, comprising:
positioning a plurality of staples about the periphery of a tubular section of tissue, each of said staples including an eyelet for receiving the purse string suture;
threading the purse string suture through the eyelets of said staples to attach the purse string suture to the staples; and driving the staples into the tissue to secure the purse string suture thereto.

20. A method for securing a purse string suture to a tubular section of tissue, comprising:
positioning a plurality of staples about the periphery of a tubular section of tissue, each of said staples including a loop for receiving the purse string suture and a pair of deformable legs;
threading the purse string suture through the loops of each staple; and deforming the staple legs into an overlapping configuration to form another loop extending into the tissue to secure the staples and the purse string suture to the tissue.

21. A surgical instrument for applying a purse string suture to tissue, comprising:

a pair of staple cartridges having opposed tissue clamping surfaces for clamping the tissue therebetween;
a row of staple receiving slots formed in each of said cartridges, each slot being adapted to receive a staple with its legs pointing toward the tissue clamping surface of said cartridge;
a central slot extending along said tissue clamping surface of each staple cartridge for receiving a purse string suture connected to the staples in each of said staple receiving slots;
a staple pusher bar slidably mounted in each cartridge and adapted to engage and bend the legs of each staple toward the tissue clamping surface of said cartridge upon movement of said staple pusher bar relative to said cartridge; and actuating means for sliding the pusher bar in each staple cartridge to bend the steple legs and secure the staples and the purse string suture to the tissue clamped between said cartridges.

22. The surgical instrument of Claim 21, wherein:
said central slot in each cartridge intersects each of said staple receiving slots therein.

23. The surgical instrument of Claim 21, wherein:
said staple pusher bar is movable relative to said cartridge in a direction parallel to the row of staples therein.

24. The surgical instrument of Claim 21, wherein:

said pusher bar includes a series of opposed pairs of wedge-shaped protrusions corresponding to the staple receiving slots in said cartridge, each pair of wedge-shaped protrusions being adapted to engage and bend the legs of the staple toward the tissue clamping surface into an overlapped configuration when said staple pusher bar is moved longitudinally relative to said cartridge.

25. A staple cartridge, comprising: an elongated housing including a tissue engaging surface, a plurality of transverse slots extending into said housing from said tissue engaging surface for receiving staples therein, and an elongated central slot for receiving a purse string suture attached to each of the staples, said central slot extending longitudinally along said housing and intersecting said transverse slots; and a staple pusher bar slidably mounted for longitudinal movement in said housing, said staple pusher bar being adapted to engage and bend the legs of each staple toward the tissue clamping surface to secure the staples and the purse string suture to the tissue.

26. The staple cartridge of Claim 25, wherein:
said pusher bar includes a series of opposed pairs of wedge-shaped protrusions corresponding to the staple receiving slots formed in said housing, each pair of wedge-shaped protrusions being adapted to engage and bend the legs of the staple toward the tissue clamping surface into an overlapped configuration when said staple pusher bar is moved longitudinally relative to said housing.

27. The staple cartridge of Claim 26, wherein:
each wedge-shaped protrusion has a staple forming edge slanted inwardly toward the center of said staple pusher bar for engaging and bending the staple legs inwardly toward each other as said staple pusher bar is moved relative to said cartridge.

28. The staple cartridge of Claim 25, wherein:
each staple receiving slot is located between a pair of ridges which extend upwardly from the top of the housing.

29. The staple cartridge of Claim 25, wherein:
each pair of ridges is separated by a depression from the next adjacent pair of ridges.

30. The staple cartridge of Claim 25, wherein:
said elongated central slot opens into a longitudinal V-shaped groove defined by inclined surfaces which are sloped upwardly and outwardly from the central slot and terminate at the top of said ridges.

31. The staple cartridge of Claim 25, wherein:
each staple includes an eyelet which extends in the opposite direction from the staple legs for receiving the purse string suture; and said housing includes a plurality of recesses at the bottom of said staple receiving slots for receiving the eyelets of the staples therein.

32. A surgical instrument for applying a plurality of staples attached to a purse string suture to tissue, comprising:
a pair of elongated handles pivotally connected together, said handles supporting a pair of jaws for receiving the tissue therebetween;
a pair of staple cartridges mounted on said jaws, said cartridges having opposed tissue clamping surfaces for clamping the tissue therebetween;
a row of staple receiving slots formed in each of said cartridges, each slot being adapted to receive a staple with its legs pointing toward the tissue clamping surface of said cartridge;
a central slot extending along said tissue clamping surface of each staple cartridge for receiving a purse string suture connected to the staples in each of said staple receiving slots;
a staple pusher bar slidably mounted in each cartridge and adapted to engage and bend the legs of each staple toward the tissue clamping surface of said cartridge upon movement or said staple pusher bar relative to said cartridges; and actuating means on one of said handles for sliding the pusher bar in each staple cartridge to bend the staple legs and secure the staples and the purse string suture to the tissue clamped between said cartridges.

33 The surgical instrument of Claim 32, wherein said actuating means comprises:
a staple actuating lever pivotally mounted on one of said handles;
means for connecting said staple actuating lever to the staple pusher bar in each of said cartridges; and said staple actuating lever being manually pivotable to displace said connecting means to move the staple pusher bar in each of said cartridges.

34. The surgical instrument of claim 33, which includes;
a locking member pivotally mounted on one of said handles and movable between a first position in which said staple actuating lever is locked against movement and a second position in which said staple actuating lever is unlocked for movement.

35. A surgical stapler for endoscopic use comprising:
an endoscopic portion being insertable through a trocar cannula, said endoscopic portion including a pair of jaws, at least one of said jaws being movable between an open position and a closed position;
a handle portion connected to said endoscopic portion;
a staple cartridge in each jaw for holding a plurality of purse string staples and suture;
a closer mechanism in each cartridge for closing said staples;
a jaw actuator in said handle portion for moving said movable jaw between said open and closed positions; and a trigger mechanism in said handle portion for actuating said closer mechanism.

36. A surgical stapler in accordance with claim 35 wherein said endoscopic portion is rotatable relative to said handle portion.

37. A surgical stapler in accordance with claim 35 wherein said jaws are variably articulatable between a straight configuration and an angled configuration.

38. A surgical stapler in accordance with claim 37 wherein said jaws are variable articulatable between said straight configuration and a perpendicular configuration.

39. A surgical stapler in accordance with claim 37 including a jaw articulation control mechanism in said handle portion for variably articulating said jaws.

40. A surgical stapler in accordance with claim 35 wherein said cartridge includes an interior portion for housing said closer mechanism, a central longitudinal slot for permitting passage of said suture out of said cartridge, a plurality of staple receiving slots for permitting passage of said staples out of said cartridge.

41. a surgical stapler in accordance with claim 40 wherein said closer mechanism includes a staple base for releasably holding said staples and a staple pusher bar, said stapler pusher bar being movable between an open position wherein said staples are open and a closed position wherein said staples are closed.

42. A surgical stapler in accordance with claim 41 wherein said staple pusher bar moves in a longitudinal direction.

43. A surgical stapler in accordance with claim 41 wherein said staple base includes a plurality of notches for retaining individual staples.

44. A surgical stapler in accordance with claim 41 including a retainer plate adjacent said staple base for releasably retaining said staples in said staple base.

45. A surgical stapler in accordance with claim 44 wherein said retainer plate includes a plurality of hooks for releasably engaging said staples.

46. A surgical stapler in accordance with claim 45 wherein said retainer plate is movable between an engaged position wherein in said hooks are engaged with said staples and a disengaged position wherein said hooks are disengaged from said staples.

47. A surgical stapler in accordance with claim 46 wherein said retainer plate moves in a longitudinal direction.

48. A surgical stapler in accordance with claim 46 wherein said staple pusher bar and said retainer plate coact with each other wherein said retainer plate is moved to said disengaged position when said staple pusher bar is moved to said closed position.

49. A surgical stapler in accordance with claim 35 wherein said closer mechanism coact with each other wherein one of said closer mechanisms is actuated when the other of said closer mechanisms is actuated.

50. A surgical stapler in accordance with claim 41 wherein said staple pusher bars in said cartridges coact with each other wherein one of said stapler pusher bars moves to said closed position when the other of said staple pusher bars moves to said closed position.

51. A surgical stapler in accordance with claim 35 wherein each said cartridge defines a well for releasably containing said suture.

52. A surgical stapler in accordance with claim 51 wherein each said cartridge defines a plurality of said wells for releasably containing said suture.

53. A surgical stapler in accordance with claim 52 wherein the number of said wells in each said cartridge is in the range of about two to about ten.

54. A surgical stapler in accordance with claim 52 wherein a single loop is placed in each of said wells.

55. A surgical stapler in accordance with claim 35 wherein said endoscopic portion includes a movable knife blade for cutting tissue adjacent said jaws.

56. A surgical stapler in accordance with claim 55 wherein said knife blade is located on a track in one of said jaws, said knife blade being slidable on said track.

57. A surgical stapler in accordance with claim 55 including a knife blade actuator in said handle portion for moving said knife blade.

58. A surgical stapler in accordance with claim 35 wherein said jaw actuator includes a lever for moving said movable jaw b between said open position and said closed position.

59. A surgical stapler in accordance with claim 58 including a drive rod extending distally from said lever and a wedge extending distally from said drive rod, said wedge extending to said movable jaw.

60. A surgical stapler in accordance with claim 59 wherein said movable jaw is hinged and includes a rear portion, said rear portion being engageable with said wedge.

61. A surgical stapler in accordance with claim 60 wherein said rear portion of said movable jaw includes a hemispherical surface for engagement with said wedge.

62 a surgical stapler for endoscopic use comprising:
an endoscopic portion being insertable through a trocar cannula, said endoscopic portion including a distal end portion;
a hand portion connected to said endoscopic portion;
a stapling portion located at said distal end portion for applying a plurality staples in a single application; said stapling portion having a pair of jaws, at least one of said jaws being movable from a closed position to an open position; said stapling portion being mounted for articulation between a straight configuration and an angled configuration;
an articulation control in said handle portion for variably articulating said stapling portion; and a trigger mechanism in said handle portion for actuating said stapling portion.

63. A surgical stapler in accordance with claim 62 wherein at least one of said jaws includes a removable cartridge for holding said staples.

64. A surgical stapler in accordance with claim 62 including a cutting blade at said distal end portion.

65. A surgical stapler in accordance with

claim 65 wherein said cutting blade is longitudinally movable.

66. A surgical stapler in accordance with claim 65 wherein said cutting blade is located adjacent stapling portion.

67. A surgical stapler in accordance with claim 66 including a cutting blade actuator in said handle portion for moving said cutting blade.

68. A surgical stapler for endoscopic use comprising:
an endoscopic portion being insertable through a trocar cannula, said endoscopic portion including a pair of jaws, at least one of said jaws being movable between an open position and a closed position;

a handle portion connected to said endoscopic portion;
a staple cartridge in each jaw for holding plurality of staples;
a closer mechanism in each cartridge for closing said staples;
a jaw actuator in said handle portion for moving said movable jaw between said open and closed positions; and a trigger mechanism in said handle portion for actuating said closer mechanism.

69. A surgical stapler in accordance with claim 68 wherein said endoscopic portion is rotatable relative to said handle portion.

70. A surgical stapler in accordance with claim 68 wherein said jaws are variably articulatable between a straight configuration and an angled configuration.

71. A surgical stapler in accordance with claim 70 wherein said jaws are variably articulatable between said straight configuration and a perpendicular configuration.

72. A surgical stapler in accordance with claim 70 including a jaw articulation control mechanism in said handle portion for variably articulating said jaws.

73. A cartridge for holding surgical staples comprising:
a housing for holding surgical staples; and a staple pusher bar located in said housing for closing said staples, said staple pusher bar being movable from an open position wherein said staples are open to a closed position wherein said staples are closed, said staple pusher bar being configured to coact with a second staple pusher bar having the same configuration when said second staple pusher bar is located in an adjacent housing wherein when one of said staple pusher bars moves to its closed position the other of said staple pusher bars is moved into its closed position.

74. A cartridge for holding surgical staples and suture comprising:
a cartridge housing defining a) an interior portion, b) a central longitudinal slot for permitting passage of a longitudinally extending suture out of said cartridge housing, and c) a plurality of staple receiving slot for permitting passage of staples out of said cartridge;
a staple base within said housing for releasably holding staples;
a retainer plate within said housing, said retainer plate having a plurality of hooks for releasably engaging said staples; and a staple pusher bar within said housing for closing said staples, said staple pusher bar being longitudinally movable from an open position wherein said staples are open to a closed position wherein said staples are closed.

A cartridge for holding surgical staples in accordance with claim 74 wherein said staple pusher ha- is longitudinally movable.

76. A cartridge in accordance with claim 74 wherein said retainer plate is movable from an engage position to a disengaged position.

77. A cartridge in accordance with claim 74 wherein said cartridge housing defines a well for releasably containing said suture string.

78. A cartridge in accordance with claim 74 wherein said cartridge housing defines a plurality of wells for releasably containing said suture.

79. A cartridge in accordance with claim 78 wherein the number of said wells is in the range of about two to about ten.

80. A method for endoscopically applying purse string suture and staples to a body tissue comprising:
a) extending a trocar cannula into a body cavity;
b) providing an elongated surgical instrument with a cartridge containing purse string suture and staples, said cartridge being located at a distal end of said instrument;
c) extending said cartridge through said trocar and placing said cartridge adjacent a body tissues; and d) firing said staples into said body tissue without piercing completely through said body tissue so as to retain said suture on said body tissue with said staples.

81. A method for endoscopically applying purse string suture and staples in accordance with claim 80 wherein step b) includes providing a second cartridge on said distal end of said instrument, said second cartridge containing purse string suture and staples, and providing a set of jaws at said distal end of said in instrument, each of said jaws containing one of said cartridges, at least one of said jaws being movable b between an open position and a closed position, and step e) includes closing said jaws around said body tissue.

82. A method for endoscopically applying purse string suture and staples in accordance with claim 81 wherein said body tissue has at least two layers and step d) includes firing staples from each of said cartridges wherein each staple pierces one of said layers of tissue without piercing the other of said layers.

83. A method for endoscopically applying purse string suture and staples in accordance with claim 81 wherein said body tissue is tubular and step d) includes firing staples from each of said cartridges wherein each staple pierces one layer of said tubular body tissue without piercing another layer of said tissue.

84. A method for endoscopically applying purse string suture and staples in accordance with claim 81 wherein said jaws are articulatable between a parallel position that is parallel to said elongated element and an angled position that is oriented at an angle to said elongated element and step e) includes articulating said jaws to an angled position after said jaws are extended through said trocar.

85. A method for endoscopically applying purse string suture and staples in accordance with claim 80 wherein said surgical instrument includes an endoscopic portion that is rotatably connected to a handle portion and step c) includes rotating said endoscopic portion relative to said handle portion

86. A method for endoscopically applying purse string suture and staples in accordance with claim 81 wherein step b) includes providing a knife blade connected to at least one of said jaws, said knife blade being movable for cutting tissue adjacent to said jaws;
wherein said method includes the following step:
a) cutting said body tissue with said knife blade.