CA2925484A1 - Electrically self-powered surgical instrument with manual release - Google Patents
Electrically self-powered surgical instrument with manual release Download PDFInfo
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- CA2925484A1 CA2925484A1 CA2925484A CA2925484A CA2925484A1 CA 2925484 A1 CA2925484 A1 CA 2925484A1 CA 2925484 A CA2925484 A CA 2925484A CA 2925484 A CA2925484 A CA 2925484A CA 2925484 A1 CA2925484 A1 CA 2925484A1
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- Prior art keywords
- motor
- anvil
- staple
- surgical instrument
- switch
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
- A61B17/115—Staplers for performing anastomosis in a single operation
- A61B17/1155—Circular staplers comprising a plurality of staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00734—Aspects not otherwise provided for battery operated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2927—Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2931—Details of heads or jaws with releasable head
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
- Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
- Y02A90/00—Technologies having an indirect contribution to adaptation to climate change
- Y02A90/10—Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
Abstract
An electrically operated surgical instalment includes a surgical end effector having an actuation assembly effecting a surgical procedure when actuated and a handle connected to the end effector for actuating the assembly. A part of the assembly moves between start and fully actuated positions. The handle has a self-contained power supply and a drive assembly disposed entirely within the handle. The drive assembly has an electrically powered motor and a controller electrically connected to the power supply and to the motor. The controller selectively operates the motor. A transmission mechanically connects the motor to the moving part and selectively displaces the moving part anywhere between the start and fully extended positions when the motor is operated. A manual release is mechanically coupled to the transmission to selectively interrupt the transmission and, during interruption, displaces the moving part towards the start position independent of motor operation.
Description
ELECTRICALLY SELF-POWERED SURGICAL INSTRUMENT WITH MANUAL RELEASE
This application is a divisional of Canadian patent application Serial No.
2699481 filed internationally on October 4, 2008 and entered nationally in Canada on March 11, 2010.
Technical Field The present invention lies in the field of surgical instruments, in particular but not necessarily, stapling devices. The stapling device described in the present application is a hand-held, fully electrically self-powered and controlled surgical stapler with a manual release.
Medical stapling devices exist in the art. Ethicon Endo-Surgery, Inc. (a Johnson &
Johnson company; hereinafter "Ethicon") manufactures and sells such stapling devices. Circular stapling devices manufactured by Ethicon are referred to under the trade names PROXIMATE
PPH, CDH, and ILS and linear staplers are manufactured by Ethicon under the trade names CONTOUR and PROXIMATE. In each of these exemplary surgical staplers, tissue is compressed between a staple cartridge and an anvil and, when the staples are ejected, the compressed tissue is also cut. Depending upon the particular tissue engaged by the physician, the tissue can be compressed too little (where blood color is still visibly present in the tissue), too much (where tissue is crushed), or correctly (where the liquid is removed from the tissue, referred to as dessicating or blanching).
Staples to be delivered have a given length and the cartridge and anvil need to be within an acceptable staple firing distance so that the staples close properly upon firing. Therefore, these staplers have devices indicating the relative distance between the two planes and whether or not this distance is within the staple length firing range. Such an indicator is mechanical and takes the form of a sliding bar behind a window having indicated thereon a safe staple-firing range. These staplers are all hand-powered, in other words, they require physical actuations by the user/physician to position the anvil and stapler cartridge about the tissue to be stapled and/or cut, to close the anvil and stapler cartridge with respect to one another, and to fire and secure the staples at the tissue (and/or cut the tissue). No prior art staplers are electrically powered to carry out each of these operations because the longitudinal force necessary to effect staple firing is typically on the order of 250 pounds at the staple cartridge. Further, such staplers do not have any kind of active compression indicator that would optimizes the force acting upon the tissue that is to be stapled so that tissue degradation does not occur.
One hand-powered, intraluminal anastomotic circular stapler is depicted, for example, in U.S.
Patent No. 5,104,025 to Main et al., and assigned to Ethicon. As can be seen most clearly in the exploded view of FIG. 7 in
This application is a divisional of Canadian patent application Serial No.
2699481 filed internationally on October 4, 2008 and entered nationally in Canada on March 11, 2010.
Technical Field The present invention lies in the field of surgical instruments, in particular but not necessarily, stapling devices. The stapling device described in the present application is a hand-held, fully electrically self-powered and controlled surgical stapler with a manual release.
Medical stapling devices exist in the art. Ethicon Endo-Surgery, Inc. (a Johnson &
Johnson company; hereinafter "Ethicon") manufactures and sells such stapling devices. Circular stapling devices manufactured by Ethicon are referred to under the trade names PROXIMATE
PPH, CDH, and ILS and linear staplers are manufactured by Ethicon under the trade names CONTOUR and PROXIMATE. In each of these exemplary surgical staplers, tissue is compressed between a staple cartridge and an anvil and, when the staples are ejected, the compressed tissue is also cut. Depending upon the particular tissue engaged by the physician, the tissue can be compressed too little (where blood color is still visibly present in the tissue), too much (where tissue is crushed), or correctly (where the liquid is removed from the tissue, referred to as dessicating or blanching).
Staples to be delivered have a given length and the cartridge and anvil need to be within an acceptable staple firing distance so that the staples close properly upon firing. Therefore, these staplers have devices indicating the relative distance between the two planes and whether or not this distance is within the staple length firing range. Such an indicator is mechanical and takes the form of a sliding bar behind a window having indicated thereon a safe staple-firing range. These staplers are all hand-powered, in other words, they require physical actuations by the user/physician to position the anvil and stapler cartridge about the tissue to be stapled and/or cut, to close the anvil and stapler cartridge with respect to one another, and to fire and secure the staples at the tissue (and/or cut the tissue). No prior art staplers are electrically powered to carry out each of these operations because the longitudinal force necessary to effect staple firing is typically on the order of 250 pounds at the staple cartridge. Further, such staplers do not have any kind of active compression indicator that would optimizes the force acting upon the tissue that is to be stapled so that tissue degradation does not occur.
One hand-powered, intraluminal anastomotic circular stapler is depicted, for example, in U.S.
Patent No. 5,104,025 to Main et al., and assigned to Ethicon. As can be seen most clearly in the exploded view of FIG. 7 in
2 Main et al., a trocar shaft 22 has a distal indentation 21, some recesses 28 for aligning the trocar shaft 22 to serrations 29 in the anvil and, thereby, align the staples with the anvils 34. A tracer tip 26 is capable of puncturing through tissue when pressure is applied thereto.
FIGS. 3 to 6 in Main et al.
show how the circular stapler 10 functions to join two pieces of tissue together. As the anvil 30 is moved closer to the head 20, interposed tissue is compressed therebetween, as particularly shown in FIGS. 5 and 6. If this tissue is overcompressed, the surgical stapling procedure might not succeed.
Thus, it is desirable to not exceed the maximum acceptable tissue compression force. The interposed tissue can be subject to a range of acceptable compressing force during surgery. This range is known and referred to as optimal tissue compression or OTC, and is dependent upon the .10 type of tissue being stapled. While the stapler shown in Main et al.
does have a bar indicator that displays to the user a safe staple-tiring distance between the anvil and the staple cartridge, it cannot indicate to the user any level of compressive force being imparted upon the tissue prior to stapling.
It would be desirable to provide such an indication so that over-compression of the tissue can be avoided.
Disclosure of Invention The invention overcomes the above-noted and other deficiencies of the prior art by providing a electrically self-powered surgical device that uses the self-power to effect a medical procedure.
For example, in a linear endocutter, the electric on-board power can position an anvil and stapler cartridge with respect to one another about tissue to be stapled and/or cut, and, after closing the anvil and stapler cartridge with respect to one another, firing and securing the staples at the tissue (and/or cutting the tissue). Further, the electrically self-powered surgical device can indicate to the user a user-pre-defined level of compressive force being imparted upon the tissue prior to firing the staples.
The present invention also provides methods for operating the electric surgical stapling device to staple when optimal tissue compression (OTC) exists. Further provided is a manual release device that allows recovery from a partial actuation or a jam.
An offset-axis configuration for the two anvil and staple firing sub-assemblies creates a device that can be sized to comfortably fit into a user's hand. It. also decreases manufacturin.g difficulty by removing previously required nested (co-axial) hollow shafts.
With the axis of the anvil sub-assembly being offset from the staple firing sub-assembly, the length of the threaded rod for extending and retracting the anvil can be decreased by approximately two inches, thereby saving in manufacturing cost and generating a shorter longitudinal profile.
An exemplary method for using the electric stapler includes a power-on feature that permits entry into a manual mode for testing purposes. in a surgical procedure, the stapler is a one-way device. In the test mode, however, the user has the ability to move the trocar back and forth as desired. This test mode can be disengaged and the stapler reset to the use mode for packaging and shipment. For packaging, it is desirable (but not necessary) to have. the anvil be at a distance from the staple cartridge. Therefore, a homing sequence can be programmed to place the anvil 1 cm (for example) away from the staple cartridge before powering down for pack-aging and shipment. Before use, the trocar is extended and the anvil is removed. Vibe stapler is being used to dissect a colon, for example, the trocar is retracted back into the handle and the handle is inserted trans-anally into the colon to downstream side of the dissection while the anvil is inserted through a laparoscopic incision to an upstream side of the dissection. The anvil is attached to the trocar and the two parts are retracted towards the handle until a staple ready condition occurs. The staple firing sequence is started, which can be aborted, to staple the dissection and simultaneously cut tissue at the center of the dissection to clear an opening in the middle of the circular ring of staples. The staple firing sequence includes an optimal tissue compression (OTC) measurement and feedback control mechanism that causes staples to be tired only when the compression is in a desired pressure range, referred to as the OTC range. This range or value is known beforehand based upon known characteristics of the tissue to be compressed between the anvil and staple cartridge.
Some exemplary procedures in which the electric stapler can be used include colon dissection and gastric bypass surgeries. There are many other uses for the electric stapler in various different technology areas.
'With the foregoing and other objects in view, there is provided, in accordance with the invention, an electrically operated surgical instrument, including a handle and a surgical end effector having an actuation assembly operable to effect a surgical procedure when actuated, a part of the actuation assembly operable to move between a start position and a fully actuated position. The handle is connected to the end effector for actuating the actuation assembly.
The handle has a self-contained power supply disposed entirely within the handle, a drive assembly disposed entirely within the handle and having an electrically powered motor and a controller electrically connected to the power supply and to the motor and selectively operating the motor, a transmission mechanically connecting the motor to the moving part and being operable to selectively displace the moving part anywhere between the start and fully extended positions when the motor is operated, and a manual release mechanically coupled to the transmission to selectively intetrupt the transmission and, during interruption, displace the moving part towards the start position independent of operation of the motor.
In accordance with another feature of the invention, the surgical end effector is surgical linear stapling endocutter and the moving part includes at least a staple-actuating and tissue-cutting slide.
In accordance with a further feature of the invention, the drive assembly and the transmission are operable to actuate a stapling-cutting feature of the endocutter.
In accordance with an added feature of the invention, the power supply is a removable battery pack containing at least one battety.
In accordance with an additional feature of the invention, the power supply is a series connection of between four and six CR123 or CR2 power cells.
In accordance with yet another feature of the invention, the controller includes a multi-state switch operable to cause rotation of the motor in a forward direction when the switch is in a first state and to cause rotation of the motor in a reverse direction when the switch is in a second state.
In accordance with yet a further feature of the invention, the transmission has a motor drive side and an actuation drive side and the manual release is coupled therebetween.
In accordance with yet an added feature of the invention, the manual release is mechanically disposed in the transmission.
In accordance with yet an additional feature of the invention, the motor drive side has a series of rotation-reducing gears including a last gear, the actuation drive side has at least one gear and a rack-and-pinion assembly coupled to the at least one gear and directly connected to at least a portion of the moving part, and the manual release is mechanically coupled between the at least one gear and the last gear.
In accordance with again another feature of the invention, the motor has an output gear and the series of gears has a first stage coupled to the output gear.
hi accordance with again a further feature of the invention, the series of gears includes first, second, and third stages, and a cross-over gear with a shaft crossing from said motor drive side to said actuation drive side and the cross-over gear is coupled to the third stage.
In accordance with again an added feature of the invention, the series of gears has a cross-over gear with a shaft crossing from the motor drive side to the actuation drive side, the cross-over gear is coupled to the series of gears, a castle gear is rotationally fixedly coupled about the cross-over shaft and longitudinally translatable thereon, the castle gear having ca.stellations extending towards the actuation drive side, the at least one gear of the actuation drive side includes a first pinion having castellation slots shaped to mate with the castellations, a bias device is disposed between the cross-over gear and the castle gear and imparts a bias upon the castle gear towards the actuation drive side to permit selective engagement of the castle gear with the first pinion and, 5 thereby, cause a corresponding rotation of the first pinion with rotation of the shaft when so engaged, and the manual release has a release part shaped and positioned to provide an opposing force to overcome the bias on the castle gear and disengage the castle gear from the first pinion when the manual release is at least partially actuated.
in accordance with again an additional feature of the invention, the at least one gear of the actuation drive side includes a second pinion stage having a second pinion shaft, a second pinion gear coupled to the first pinion and rotationally fixed to the second pinion shaft, and a third pinion rotationally fixed to the second pinion shaft, the third pinion being a pinion of the rack-and-pinion assembly and longitudinally moving a rack thereof when rotated.
In accordance with still another feature of the invention, the manual release has a rest state in which the release part provides the opposing force at a magnitude less than the bias to the castle gear, a first partially actuated state in which the release part provides the opposing force at a magnitude greater than the bias to the castle gear and move the castellatims out from the castellation slots, and a second partially actuated state in which the manual release rotates the pinion to move the rack longitudinally in a withdrawing direction.
hi accordance with still a further feature of the invention, the at least one gear of the actuation drive side includes at least one release gear and the first pinion is directly connected to the at least one release gear to rotate the at least one release gear when rotated.
In accordance with still an added feature of the invention, the at least one gear of the actuation drive side includes first and second stage release gears and the .first pinion is directly connected to the first stage release gear to rotate the first and second release gears when rotated.
In accordance with a concomitant feature of the invention, the manual release includes a manual release lever rotatably connected to the handle and having a one-way ratchet assembly, and the at least one release gear has an axle directly connected to the ratchet assembly to rotate in a corresponding manner with the lever when the lever is at least partially actuated and to rotate independent of the lever when the lever is not actuated.
With the objects of the invention in view, there is also provided a method for operating a surgical instrument, including the steps of mechanically coupling a manual release to a transmission of a surgical instrument having a self-contained power supply disposed entirely within a handle thereof, the transmission translating movement of an electrically powered motor inside the handle to movement of a part of a surgical end effector connected to the handle, the part being operable to move anywhere between a start position and a fully actuated position, and selectively interrupting the transmission with the manual release to move the part towards the start position independent of motor operation.
With the objects of the invention in view, there is also provided a surgical instrument, including a method for operating a surgical instrument, including the steps of providing a surgical end effector at a distal end of a surgical instrument handle, the end effector having an actuation assembly operable to effect a surgical procedure when actuated, the actuation assembly having a part operable to move between a start position and a fully actuated position, disposing a self-contained power supply and an electrically powered motor entirely within a handle and connecting a motor controller to the motor and to the power supply to selectively operate the motor with the controller, mechanically connecting the motor to the moving part through a transmission operable to selectively displace the moving part anywhere between the start and fully extended positions when the motor is operated, and mechanically coupling a manual release to the transmission to selectively interrupt the transmission and, during interruption, displace the moving part towards the start position independent of motor operation.
Although the invention is illustrated and described herein as embodied in an electrically self-powered surgical instrument with manual release, it is, nevertheless, not intended to be limited to the details shown because various modifications and structural changes may be made therein and the scope of the claims should not be limited by the preferred embodiments set forth in the examples, but should be given the broadest interpretation consistent with the description as a whole.
The construction and method of operation of the invention, however, together with additional objects and advantages thereof, will be best understood from the following description of specific embodiments when read in connection with the accompanying drawings.
Brief Description f Drawings Advantages of embodiments of the present invention will be apparent from the following detailed description of the preferred embodiments thereof, which description should be considered in conjunction with the accompanying drawings in which:
FIG. I is a perspective view from a side of an exemplary embodiment of an electric stapler according to the invention;
FIG. 2 is a fragmentary side devotional view of the stapler of FIG. 1 with a right half of a handle body and with a proximal backbone plate removed;
FIG, 3 is an exploded, perspective view of on anvil control assembly of the stapler of FIG. 1;
FIG, 4 is an enlarged, fragmentary, exploded, perspective view of the anvil control assembly of FIG. 3;
FIG. 5 is a fragmentary, perspective view of a staple firing control assembly of the stapler of FIG. 1 from a rear side thereof, FIG, 6 is an exploded, perspective view of the staple firing control assembly of the stapler of FIG.!;
FIG. 7 is an enlarged, fragmentary, exploded, perspective view of the staple firing control assembly of FIG. 6;
FIG. 8 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from below the handle body portion of the stapler of FIG. 1;
FIG. 9 is a fragmentary, enlarged, horizontally cross-sectional view from below a proximal portion of the anvil control assembly FIG. 8;
FIG, 10 is a fragmentary, enlarged, horizontally cross-sectional view from below an intermediate portion of the anvil control assembly of FIG. 8;
FIG. 11 is a fragmentary, enlarged, horizontally cross-sectional view from below a distal portion of the anvil control assembly of FIG. 8;
FIG. 12 is a fragmentary, vertically cross-sectional view from a right side of a handle body portion of the stapler of FIG. 1;
FIG. 13 is a fragmentary, enlarged, vertically cross-sectional view from the right side of a proximal handle body portion of the stapler of FIG. 12;
FIG. 14 is a fragmentary, enlarged, vertically cross-sectional view from the right side of an intermediate handle body portion of the stapler of FIG. 12;
FIG. 15 is a fragmentary, further enlarged, vertically cross-sectional view from the right side of the intermediate handle body portion of the stapler of FIG. 14;
FIG. 16 is a fragmentary, enlarged, vertically cross-sectional view from the right side of a distal handle body portion of the stapler of FIG. 12;
FIG. 17 is a perspective view of a portion of an anvil of the stapler of FIG.
I;
FIG. 18 is a fragmentary, cross-sectional view of a removable stapling assembly including the anvil, a stapler cartridge, a force switch, and a removable cartridge connecting assembly of the stapler of FIG. 1;
FIG. 19 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from above the handle body portion of the stapler of FIG. 1 with the anvil rod in a fully extended position;
FIG. 20 is a fragmentary, side elevational view of the handle body portion of the stapler of FIG 1 from a left side of the handle body portion with the left handle body and the circuit board removed and with the anvil rod in a fully extended position;
FIG. 21 is a fragmentary, side elevational view of the handle body portion of the stapler of FIG. 20 with the anvil rod in a 1-cm anvil closure position;
FIG. 22 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from above the handle body portion of the stapler of FIG. 1 with the anvil rod in a safe staple firing position;
FIG, 23 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from above the handle body portion of the stapler of FIG, 1 with the anvil rod in a fully retracted position;
FIG. 24 is a fragmentary, horizontally cross-sectional view of the firing control assembly from above the handle body portion of the stapler of FIG. I;
FIG, 25 is a fragmentary, enlarged, horizontally cross-sectional view from above a proximal portion of the firing control assembly of FIG. 24;
FIG. 26 is a fragmentary, enlarged, horizontally cross-sectional view from above an intermediate portion of the firing control assembly of FIG. 24;
FIG. 27 is a fragmentary, enlarged, horizontally cross-sectional view from above a distal portion of the firing control assembly of FIG. 24;
FIGS. 28 and 29 are shaded, fragmentary, enlarged, partially transparent perspective views of a staple cartridge removal assembly of the stapler of FIG. 1;
FIG, 30 is a schematic circuit diagram of an exemplary encryption circuit for interchangeable parts of the medical device according to the invention;
FIG. 31 is a bar graph illustrating a speed that a pinion moves a rack shown in FIG. 32 for various loads;
FIG. 32 is a fragmentary, perspective view of a simplified, exemplary portion of a gear train according to the present invention between a gear box and a rack;
FIG. 33 is a fragmentary, vertically longitudinal, cross-sectional view of a distal end of an articulating portion of an exemplary embodiment of an end effector with the inner tube, the pushrod-blade support, the anvil, the closure ring, and the near half of the staple sled removed;
FIG. 34 is a schematic circuit diagram of an exemplary switching assembly for a power supply according to the invention;
FIG. 35 is a schematic circuit diagram of an exemplary switching assembly for forward and reverse control of a motor according to the invention;
FIG, 36 is a schematic circuit diagram of another exemplary switching assembly for the power supply and the forward and reverse control of the motor according to the invention;
FIG. 37 is a left side elevation& view of the device according, to the invention with the outer shell removed;
FIG. 38 is an enlarged left side elevational view of a portion the device of FIG. 37 with the left side frame removed;
FIG. 39 is a right side elevational view of the device of FIG. 37;
FIG. 40 is an enlarged right side elevational view of a portion the device of FIG. 38 with the right side frame removed;
FIG. 41 is a perspective view of the device portion of FIG. 40 from the right rear;
FIG. 42 is a rear elevational view of the device portion of FIG. 40;
FIG. 43 is a perspective view of the device portion of FIG. 40 from the left rear with the first to third stage cover removed;
FIG. 44 is a perspective view of the device portion of FIG. 40 from above the right side with the power supply removed;
FIG. 45 is a perspective view of the device portion of FIG. 44 with the manual release lever in a first intermediate position with the castle gear in the separated position;
FIG. 46 is a perspective view of the device portion of FIG. 45 with the manual release lever in a second intermediate position;
FIG. 47 is a top plan view of the device portion of FIG. 46 with the manual release lever in a third intermediate position;
FIG. 48 is an enlarged perspective view of the manual release assembly from the right side with the second stage release gear, two cam plates, and a pawl spring removed with the pawl in an 5 upper, unratcheting position;
FIG, 49 is a perspective view of the manual release lever from below a right front side;
FIG. 50 is a perspective view of the manual release lever from below a right rear side;
FIG-. 51 is a perspective view of the manual release lever from below aleft rear side;
FIG. 52 is a perspective view of a cam plate from a left side;
JO FIG. 53 is a perspective view of a castle gear from a right side;
FIG. 54 is a perspective view of a fourth stage pinion from the left side;
FIG. 55 is a perspective view of the device portion of FIG. 44 from above a front right side with a pawl against a pawl cam;
FIG, 56 is a perspective view of the device portion of FIG. 55 with the pawl off of the pawl cam and against a ratchet. gear and with the castle gear in the separated position;
FIG. 57 is a perspective view of the device portion of FIG. 44 from above a front left side with the manual release in an intermediate position;
FIG. 58 is a perspective view of the device portion of FIG. 57 with the manual release in another intermediate position;
FIG. 59 is an enlarged right side elevational view a a portion of the device of FIG. 40 with the end effector control handle in an unactuated position;
FIG. 60 is an enlarged right side elevational view of a the device portion of FIG. 59 with the end effector control handle in a partially actuated position;
FIG. 61 is an enlarged perspective view of a shaft connector portion of the device of FIG. 37 from above the front right side with a removable end effector shaft secured in a frame;
:FIG. 62 is an enlarged perspective view of the shaft connector portion of FIG. 61 with shaft securing device removed to permit removal of the end effector shaft from the frame;
FIG. 63 is an elevational view of the interior of a left half of the outer shell of the device of FIG. 37;
FIG. 64 is an elevational view of the interior of a right half of the outer shell of the device of FIG. 37;
, FIG. 65 is an elevational view of the exterior of the right half of the outer shell of the device of FIG. 37; and FIG. 66 is an elevational view of the exterior of the left half of the outer shell of the device of FIG. 37.
Best Mode for Carrying Out the Invention Aspects of the invention are disclosed in the following description and related drawings directed to specific embodiments of the invention. Additionally, well-known elements of exemplary embodiments of the invention will not be described in detail or will be omitted so as not to obscure the relevant details of the invention. The scope of the claims should not be limited by the preferred embodiments set forth in the examples, but should be given the broadest interpretation consistent with the description as a whole.
Before the present invention is disclosed and described, it is to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. It must be noted that, as used in the specification and the appended claims, the singular forms "a", "an", and "the" include plural references unless the context clearly dictates otherwise.
While the specification concludes with claims defining the features of the invention that are regarded as novel, it is believed that the invention will be better understood from a consideration of the following description in conjunction with the drawing figures, in which like reference numerals are carried forward. The figures of the drawings are not drawn to scale. Further, it is noted that the figures have been created using a computer-aided design computer program. This program at times removes certain structural lines and/or surfaces when switching from a shaded or colored view to a wireframe view. Accordingly, the drawings should be treated as approximations and be used as illustrative of the features of the present invention.
Referring now to the figures of the drawings in detail and first, particularly to FIGS. 1 to 2 thereof, there is shown an exemplary embodiment of an electric surgical circular stapler 1. The present application applies the electrically powered handle to a circular surgical staple head for ease of understanding only. The invention is not limited to circular staplers and can be applied to any surgical stapling head, such as a linear stapling device, for example. Such an exemplary embodiment is described, in particular, starting with FIG. 37.
The powered stapler 1 has a handle body 10 containing three switches: an anvil open switch 20, an anvil close switch 21, and a staple firing switch 22. Each of these switches is electrically connected to a circuit board 500 (see FIG. 12) having circuitry programmed to carry out the stapling fiinctions of the stapler 1. The circuit board 500 is electrically connected to a power supply 600 contained within the handle body 10. One exemplary embodiment utilizes 2 to 6 Lithium CR123 or CR2 cells as the power supply 600. Other power supply embodiments are possible, such as rechargeable batteries or a power converter that is connected to an electric mains (in the latter embodiment., the stapler would not be self-powered or self-contained). As used herein, the terms self-powered or self-contained when used with regard to the electric power supply (600) are interchangeable and mean that the power supply is a complete and independent unit in and of itself and can operate under its own power without the use of external power sources.
For example, a power supply having an electric cord that is plugged into an electric mains during use is not self-powered or self-contained, Insulated conductive wires or conductor tracks on the circuit board 500 connect all of the electronic parts of the stapler 1, such as an on/off switch 12, a tissue compression indicator 14, the anvil and firing switches 20, 21, 22, the circuit board 500, and the power supply 600, for example.
I 5 But these wires and conductors are not shown in the figures of the drawings for ease of understanding and clarity.
The distal end of the handle body 10 is connected to a proximal end of a rigid anvil neck 30.
Opposite this connection, at the distal end of the anvil neck 30, is a coupling device 40 for removably attaching a staple cartridge 50 and an anvil 60 thereto.
Alternatively, the staple cartridge 50 can be non-removable in a single-use configuration of the stapler 1. These connections will be described in further detail below.
= FIG. 2 shows the handle body 10 with the right half 13 of the handle body 10 and the circuit board 500 removed. As will be discussed below, a proximal backbone plate 70 is also removed from the view of HG. 210 allow viewing of the internal components inside the handle body 10 from the right side thereof. What can be seen from the view of FIG. 2 is that there exist two internal component axes within the handle body 10. A first of these axes is the staple control axis 80, which is relatively horizontal in the view of FIG. 2. The staple control axis 80 is the centerline on which lie the components for controlling staple actuation. The second of these axes is the anvil control axis 90 and is disposed at an angle to the staple control axis 80. The anvil control axis 90 is the centerline on which lie the components for controlling anvil actuation. It is this separation of axes 80, 90 that allows the electric stapler 1 to be powered using a handle body 10 that is small enough to fit in a physician's hand and that does not take up so much space that the physician becomes restricted from movement in all necessary directions and orientations.
Shown inside the handle body 10 is the on/off switch 12 (e.g., a grenade pin) for controlling power (e.g., battery power) to all of the electrical components and the tissue compression indicator 14. The tissue compression indicator 14 indicates to the physician that the tissue being compressed between the anvil 60 and the staple cartridge 50 has or has not been compressed with greater than a pre-set compressive force, which will be described in further detail below. This indicator 14 is associated with a force switch 400 that has been described in co-pending U.S. Patent Provisional Application Serial No. 60/801,989 filed May 19, 2006, and titled "Force Switch".
The components along the anvil control axis 90 make up the anvil control assembly 100. An anvil control frame 110 is aligned along the anvil control axis 90 to house and/or fix various part of the anvil control assembly 100 thereto. The anvil control frame 110 has a proximal mount 112, an intermediate mount 114, and a distal mount 116. Each of these mounts 112, 114, 116 can be attached to or integral with the control frame 110. In the exemplary embodiment, for ease of manufacturing, the proximal mount 112 has two halves and is separate from the frame 110 and the intermediate mount 114 is separate from the frame 110.
At the proximal end of the anvil control assembly 100 is an anvil motor 120.
The anvil motor 120 includes the drive motor and any gearbox that would be needed to convert the native motor revolution speed to a desired output axle revolution speed. In the present case, the drive motor has a native speed of approximately 10,000 rpm and the gearbox converts the speed down to between approximately 50 and 70 rpm at an axle 122 extending out from a distal end of the anvil motor 120. The anvil motor 120 is secured both longitudinally and rotationally inside the proximal mount 112.
A motor-shaft coupler 130 is rotationally fixed to the axle 122 so that rotation of the axle 122 translates into a corresponding rotation of the motor coupler 130.
Positioned distal of the coupler 130 is a rotating nut assembly 140. The nut assembly 140 is, in this embodiment, a two part device having a proximal nut half 141 and a distal nut half 142 rotationally and longitudinally fixed to the proximal nut half 141. It is noted that these nut halves 141, 142 can be integral if desired. Here, they are illustrated in two halves for ease of manufacturing. The proximal end of the nut assembly 140 is rotationally fixed to the distal end of the coupler 130. Longitudinal and rotational support throughout the length of these two connected parts is assisted by the intermediate 114 and distal 116 mounts.
A proximal nut bushing 150 (see FIG. 3) is interposed between the intermediate mount 114 and the proximal nut half 141 and a distal nut bushing 160 is interposed between the distal mount 116 and the distal nut half 142 to have these pans spin efficiently and substantially without friction within the handle body 10 and the anvil control frame 110. The bushings 150, 160 can be of any suitable bearing material, for example, they can be of metal such as bronze or a polymer such as nylon. To further decrease the longitudinal friction between the rotating nut assembly 140 and the coupler 130, a thrust washer 170 is disposed between the proximal bushing 150 and the proximal nut half 141.
Rotation of the coupler 130 and nut assembly 140 is used to advance or retract a threaded rod 180, which is the mechanism through which the anvil 60 is extended or retracted. The threaded rod 180 is shown in further detail in the exploded view of FIGS. 3 to 4 and is described in further detail below. A rod support 190 is attached to a distal end of the anvil control frame 110 for extending the supporting surfaces inside the nut assembly 140 that keep the rod 180 aligned along the anvil control axis 90. The rod support 190 has a smooth interior shape corresponding to an external shape of the portion of the rod 180 that passes therethrough. This mating of shapes allows the rod 180 to move proximally and distally through the support 190 substantially without friction. To improve frictionless movement of the rod 180 through the support 190, in the exemplary embodiment, a cylindrical rod bushing 192 is disposed between the support 190 and the rod 180. The rod bushing 192 is not visible in FIG. 2 because it rests inside the support 190. However, the rod bushing 192 is visible in the exploded view of :FIGS. 3 to 4. With the rod bushing 192 in place, the internal shape of the support 190 corresponds to the external shape of the rod bushing 192 and the internal shape of the rod bushing 192 corresponds to the external shape of the portion of the rod 180 that passes therethrough. The rod bushing 192 can be, for example, of metal such as bronze or a polymer such as nylon.
The components along the staple control axis 80 form the staple control assembly 200. The staple control assembly 200 is illustrated in Fla 5 viewed from a proximal upper and side perspective. The proximal end of the staple control assembly 200 includes a stapling motor 210.
The stapling motor 210 includes the drive motor and any gearbox that would be needed to convert the native motor revolution speed to a desired revolution speed. In the present case, the drive motor has a native speed of approximately 20,000 rpm and the gearbox converts the speed to approximately 200 rpm at an output axle 212 at the distal end of the gearbox.
The axle 212 cannot be seen in the view of FIG. 5 but can be seen in the exploded view of FIGS, 6 to 7.
The stapling motor 210 is rotationally and longitudinally fixed to a motor mount 220. Distal of the motor mount 220 is an intermediate coupling mount 230. This coupling mount 230 has a 5 distal plate 232 that is shown, for example in FM. 6. The distal plate 232 is removable from the coupling mount 230 so that a rotating screw 250 can be held therebetween. It is this rotating screw 250 that acts as the drive for ejecting the staples out of the staple cartridge 50. The efficiency in transferring the rotational movement of axle 212 to the rotating screw 250 is a factor that can substantially decrease the ability of the stapler 1 to deliver the necessary staple ejection longitudinal 10 force of up to 250 pounds. Thus, an exemplary embodiment of the screw 250 has an acme profile thread.
There are two exemplary ways described herein for efficiently coupling the rotation of the axle 212 to the screw 250. First, the stapling motor 210 can be housed "loosely" within a chamber defined by the handle body 10 so that it is rotationally stable but has play to move radially and so 15 that it is longitudinally stable but has play to move. In such a configuration, the stapling motor 210 will "find its own center" to align the axis of the axle 212 to the axis of the screw 250, which, in the exemplary embodiment, is also the staple control axis 80.
A second exemplary embodiment for aligning the axle 212 and the screw 250 is illustrated in FIGS. I to 5, for example. In this embodiment, a proximal end of a flexible coupling 240 is fixed (both rotationally and longitudinally) to the axle 212. This connection is formed by fitting the distal end of the axle 212 inside a proximal bore 241 of the flexible coupling 240.
See FIG. 12. The axle 212 is, then, secured therein with a proximal setscrew 213. The screw 250 has a proximal extension 251 that fits inside a distal bore 242 of the flexible coupling 240 and is secured therein by a distal setscrew 252. It is noted that the 'figures of the drawings show the flexible coupling 240 with ridges in the middle portion thereof. in an exemplary embodiment of the coupling 240, the part is of aluminum or molded plastic and has a spiral or helixed cut-out around the circumference of the center portion thereof. In such a configuration, one end of the coupling 240 can move in any radial direction (360 degrees) with respect to the other end (as in a gimbal), thus providing the desired flex to efficiently align the central axes of the axle 212 and the screw 250.
The proximal extension 251 of the screw 250 is substantially smaller in diameter than the diameter of the bore 231 that exists in and through the intermediate coupling mount 230. This bore 231 has two increasing steps in diameter on the distal side thereof. The first increasing step in diameter is sized to fit a proximal radius screw bushing 260, which is formed of a material that is softer than the intermediate coupling mount 230. The proximal radius screw bushing 260 only keeps the screw 250 axially aliened and does not absorb or transmit any of the longitudinal thrust. The second increasing step in diameter is sized to fit a proximal thrust bearing 270 for the screw 250. In an exemplary embodiment of the thrust bearing 270, proximal and distal plates sandwich a bearing ball retainer plate and bearing balls therebetween. This thrust bearing 270 absorbs all of the longitudinal thrust that is imparted towards the axle 212 while the up to 250 pounds of longitudinal force is being applied to eject the staples in the staple cartridge 50. The proximal extension 251 of the screw 250 has different sized diameters for each of the interiors of the screw bushing 260 and the thrust bearing 270. The motor mount 220 and the coupling mount 230, therefore, form the two devices that hold the flexible coupling 240 therebetween.
The rotating screw 250 is held inside the distal plate 232 with a distal radius screw bushing 280 similar to the proximal radius screw bushing 260. Thus, the screw 250 rotates freely within the distal plate 232. To translate the rotation of the screw 250 into a linear distal movement, the screw 250 is threaded within a moving nut 290. Movement of the nut 290 is limited to the amount of movement that is needed for complete actuation of the staples; in other words, the nut 290 only needs to move through a distance sufficient to form closed staples between the staple cartridge 50 and the anvil 60 and to extend the cutting blade, if any, within the staple cartridge 50, and then rebut the same. When the nut 290 is in the proximal-most position (see, e.g., FIG. 12), the staples are at rest and ready to be fired. When the nut 290 is in the distal-most position, the staples are stapled through and around the tissue interposed between the staple cartridge 50 and the anvil, and the knife, if any, is passed entirely through the tissue to be cut. The distal-mast position of the nut 290 is limited by the location of the distal plate 232. Thus, the longitudinal length of the threads of the screw 250 and the location of the distal plate 232 limit the distal movement of the nut 290.
Frictional losses between the screw 250 and the nut 290 contribute to a significant reduction in the total pounds of force that can be transmitted to the staple cartridge SO through the cartridge plunger 320. Therefore, it is desirable to select the materials of the screw 250 and the nut 290 and the pitch of the threads of the screw 250 in an optimized way it has been found that use of a low-friction polymer for manufacturing the nut 290 will decrease the friction enough to transmit the approximately 250 pounds of longitudinal force to the distal end of the cartridge plunger 320 ¨ the amount of force that is needed to effectively deploy the staples. Two particular exemplary materials provide the desired characteristics and are referred to in the art as DELRINO
AF Blend Acetal (a thermoplastic material combining TEFLON fibers uniformly dispersed in DELRINO
acetal resin) and RULONO (a compounded form of TEE fluorocarbon) or other similar low-friction polymers.
A nut coupling bracket 300 is longitudinally fixed to the nut 290 so that it moves along with the nut 290. The nut coupling bracket 300 provides support. for the relatively soft, lubricious nut material. In the exemplary embodiment shown, the bracket 300 has an interior cavity having a shape corresponding to the exterior shape of the nut 290. Thus, the nut 290 fits snugly into the coupling bracket 300 and movement of the nut 290 translates into a corresponding movement of the nut coupling bracket 300. The shape of the nut coupling bracket 300 is, in the exemplary embodiment, dictated by the components surrounding it and by the longitudinal forces that it has to bear. For example, there is an interior cavity 302 distal of the nut 290 that is shaped to receive the distal plate 232 therein. The nut coupling bracket 300 also has a distal housing 304 for receiving therein a stiffening rod 310. The stiffening rod 310 increases the longitudinal support and forms a portion of the connection between the nut 290 and a cartridge plunger 320 (see, i.e., EEG. 5), which is the last moving link between elements in the handle body 10 and the staple cartridge 50. A firing bracket 330, disposed between the distal end of the nut coupling bracket 300 and the stiffening rod 310, strengthens the connection between the nut coupling bracket 300 and the rod 310.
Various components of the stapler I are connected to one another to form a backbone or spine. This backbone is a frame providing multi-directional stability and is made up of four primary parts On order from proximal to distal): the anvil control frame 110, the proximal backbone plate 70 (shown in FIGS. 3 to 4 and 6 to 7), a distal backbone plate 340, and the anvil neck 30. Each of these four parts is longitudinally and rotationally fixed to one another in this order and forms the skeleton on which the remainder of the handle components is attached in some way.
Lateral support to the components is provided by contours on the inside surfaces of the handle body 10, which in an exemplary embodiment. is formed of two halves, a_ lefl. half II and a right half 13. Alternatively, support could be single frame, stamped., or incorporated into the handle halves 11, 13.
Functionality of the anvil control assembly 100 is described with regard to FIGS. 17 to 27.
To carry out a stapling procedure with the stapler 1, the anvil 60 is removed entirely from the stapler 1 as shown in FIG. 17. The anvil open switch 20 is depressed to extend the distal end of the trocar tip 410 housed within the staple cartridge and which is longitudinally fixedly connected to the screw 250. The point of the trocar tip 410 can, now, be passed through or punctured through tissue that is to be stapled. The user can, at this point, replace the anvil 60 onto the trocar tip 410 from the opposite side of the tissue (see FIG. 18) and, thereby, lock the anvil 60 thereon. The anvil closed switch 22 can be actuated to begin closing the anvil 60 against the staple cartridge 50 and pinch the tissue therebetween within an anvil-cartridge gap 62.
To describe how the trocar tip controlling movement of the anvil 60 occurs, reference is made to FIGS. 8 to 10, 1410 15, and 18. As shown in dashed lines in FIG. 15,a rod-guiding pin 143 is positioned within the central bore 144 of the distal nut half 142. As the threaded rod 180 is screwed into the rotating nut 140, 141, 142, the pin 143 catches the proximal end of the thread 182 to surround the pin 143 therein, Thus, rotation of the nut 140 with the pin 143 inside the thread 182 will cause proximal or distal movement of the rod 180, depending on the direction of nut rotation.
The thread 182 has a variable pitch, as shown in FIGS. 14 to 15, to move the anvil 60 at different longitudinal speeds. When the pin 143 is inside the longer (lower) pitched thread portion 183, the anvil 60 moves longitudinally faster. in comparison, when the pin 143 is inside the shorter (higher) pitched thread portion 184, the anvil 60 moves longitudinally slower. it is noted that the pin 143 is the only portion contacting the thread 182 when in the longer pitched thread portion 183. Thus, the pin 143 is exposed to the entire longitudinal force that is acting on the rod 180 at this point in time.
.15 The pin 143 is strong enough to bear such forces but may not be sufficient to withstand all longitudinal force that could occur with anvil 60 closure about interposed tissue.
As shown in FIG. 14, the rod 180 is provided with a shorter pitched thread portion 184 to engage in a corresponding internal thread 145 at the proximal end of the central bore 144 of the proximal nut half 141. When the shorter pitched thread portion 184 engages the internal thread 145, the entire transverse surface of the thread portion 184 contacts the internal thread 145. This surface contact is much larger than the contact between the pin 143 and any portion of the thread 182 and, therefore, can withstand all the longitudinal force that occurs with respect to anvil 60 closure, especially when the anvil 60 is closing about tissue during the staple tiring state. For example, in the exemplary embodiment, the pin 143 bears up to approximately 30 to 50 pounds of longitudinal force. This is compared to the threads, which can hold up to 400 pounds of longitudinal force ¨ an almost 10-to-1 difference.
An alternative exemplary embodiment of anvil control assembly 100 can entirely remove the complex threading of the rod 180. lin such a case, the rod 180 has a single thread pitch and the anvil motor 120 is driven (through corresponding programming in the circuit board 500) at different speeds dependent upon the longitudinal position of the single-thread rod 180.
In any embodiment for driving the motors 120, 210, the control programming can take many forms. In one exemplary embodiment, the microcontroller on the battery powered circuit board 508 can apply pulse modulation (e.g., pulse-width, pulse-frequency) to drive either or both of the motors.
Further, because the stapler 1 is a device that has a low duty cycle, or is a one-use device, components can be driven to exceed acceptable manufacturers' specifications.
For example, a gear box can be torqued beyond its specified rating. Also, a drive motor, for example, a 6 volt motor, can be overpowered, for example, with 12 volts.
Closure of the anvil 60 from an extended position to a position in which the tissue is not compressed or is just slightly compressed can occur rapidly without causing damage to the imetposed tissue. Thus, the longer-pitched thread portion 183 allows the user to quickly close the anvil 60 to the tissue in a tissue pre-compressing state. Thereafter, it is desirable to compress the tissue slowly so that the user has control to avoid over-compression of the tissue. As such, the shorter pitched thread portion 184 is used over this latter range of movement and provides the user with a greater degree of control. During such compression, the force switch 400 seen in FIG. 18 and described in co-pending U.S. Patent Provisional Application Serial No.
60/801,989 can be used to indicate to the user through the tissue compression indicator 14 (and/or to the control circuitry of the .15 circuit board 500) that the tissue is being compressed with a force that. is greater than the pre-load of the spring 420 inside the force switch 400. it is noted that FIG. 18 illustrates the force switch 400 embodiment in the normally-open configuration described as the first exemplary embodiment of U.S. Patent Provisional Application Serial No. 60/801,989. A strain gauge can also be used for measuring tissue compression.
FIGS. 19 to 23 illustrate movement of the rod 180 from an anvil-extended position (see FIGS, 19 to 20), to a 1-cm-closure-distance position (see FIG. 21), to a staple-tire-ready position (see FIG. 22), and, finally, to an anvil fully closed position (see FIG. 23).
Movement of the rod 180 is controlled electrically (via the circuit board 500) by contact between a portion of a cam surface actuator 185 on the rod 180 and actuating levers or buttons of a series of micro-switches positioned in the handle body 10.
A rod-fully-extended switch 610 (see FIG. 19) is positioned distal in the handle body 10 to have the actuator 185 compress the activation lever of the rod-fully-extended switch 610 when the rod 180 (and, thereby, the anvil 60) is in the fully extended position. A 1-cm switch 612 is positioned in an intermediate position within the handle body 10 (see FIGS. 20 to 21) to prevent a 1-cm cam surface portion 186 of the rod 180 from pressing the activation button of the 1-cm switch 612 when the rod 180 (and, thereby, the anvil 60) is within 1 cm of the fully closed position. After passing the I-cm closure distance, as shown in FIG. 22, the cam surface actuator 185 engages a staple-fire-ready switch 614. The lower end of the actuator 185 as viewed in FIGS, 22 to 23 has a bevel on both the forward and rear sides with respect to the button of the staple-fire-ready switch 614 and the distance between the portion on the two bevels that actuates the button (or, only the flat portion thereof) corresponds to the acceptable staple forming range (i.e., safe firing length) of the 5 staples in the staple cartridge 50. Thus, when the button of the staple-fire-ready switch 614 is depressed for the first time, the distance between the anvil 60 and the staple cartridge 50 is at the longest range for successfully firing and closing the staples. While the button is depressed, the separation distance 62 of the anvil 60 (see FIG. 18) remains within a safe staple-firing range_ However, when the button of the staple-fire-ready switch 614 is no longer depressed because the 10 actuator 185 is positioned proximally of the button, then staples will not fire because the distance is too short for therapeutic stapling. FIG. 23 show the rod 180 in the proximal-most position, which is indicated by the top end of the actuator 185 closing the lever of a rod fully-retracted switch 616.
When this switch 616 is actuated, the programming in the circuit board 500 prevents the motor 120 from turning in a rod-retraction direction; in other words, it is a stop switch for retracting the rod 180 15 in the proximal direction.
It is noted that FIGS. 2 to 3, 11 to 12, and 16 illustrate the distal end of the rod 180 not being connected to another device at its distal end (which would then contact the proximal end of the force switch 400). The connection band or bands between the distal end of the rod 180 and the proximal end of the force switch 400 are not shown in the drawings only for clarity purposes. In an exemplary 20 embodiment, the pull-bands are flat and flexible to traverse the curved underside of the cartridge plunger 320 through the anvil neck 30 and up to the proximal end of the force switch 400. Of course, if the force switch 400 is not present, the bands would be connected to the proximal end of the =trocar tip 410 that release* connects to the proximal end of the anvil 60.
Functionality of the staple control assembly 200 is described with regard to FIGS. 12 to 16 and 24 to 27, in particular, to FIG. 24. The stapling motor 210 is held between a motor bearing 222 and a motor shaft cover 224. The axle 2.12 of the stapling motor 210 is rotationally connected to the proximal end of the flexible coupling 240 and the distal end of the flexible coupling 240 is rotationally connected to the proximal end of the screw 250, which rotates on bearings 260, 270, 280 that are disposed within the intermediate coupling mount 230 and the distal plate 232. The longitudinally translating nut 290 is threaded onto the screw 250 between the coupling mount 230 and the distal plate 232. Therefore, rotation of the axle 212 translates into a corresponding rotation of the screw 250.
The nut coupling bracket 300 is longitudinally fixed to the nut 290 and to the stiffening rod 310 and the firing bracket 330. The firing bracket 330 is longitudinally fixed to the cartridge plunger 320, which extends (through a non-illustrated staple driver) up to the staple cartridge 50 (or to the staples). With such a connection, longitudinal movement of the nut 290 translates into a corresponding longitudinal movement of the cartridge plunger 320. Accordingly, when the staple tiring switch 22 is activated, the stapling motor 210 is caused to rotate a sufficient number of times so that the staples are completely fired from the staple cartridge 50 (and the cutting blade, if present, is extended to completely cut the tissue between the anvil 60 and the staple cartridge 50).
Programming in the circuitry, as described below, then causes the cartridge plunger 320 to retract after firing and remove an.y portion of the staple firing parts and/or the blade within the staple cartridge 50 from the anvil-cartridge gap 62.
Control of this stapling movement, again, occurs through micro-switches connected to the circuit board 500 through electrical connections, such as wires. A first of these control switches, the proximal staple switch 618, controls retraction of the staple control assembly 200 and defines the proximal-most position of this assembly 200. To actuate this switch, an actuation plate 306 is attached, in an adjustable manner, to a side of the nut coupling bracket 300.
See, e.g., FIGS, 6 and 24. As such, when the nut 290 moves proximally to cause the plate 306 on the nut coupling bracket 300 to activate the proximal staple switch 618, power to the stapling motor 210 is removed to stop tiother proximally directed movement of the staple control assembly 200.
A second of the switches for controlling movement of the staple control assembly 200 is located opposite a distal transverse surface of the stiffening rod 310. See, e.g. FIG. 27. At. this surface is disposed a longitudinally adjustable cam member 312 that contacts a distal staple switch 620. In an exemplary embodiment, the cam member 312 is a screw that is threaded into a distal bore of the stiffening rod 310. Accordingly, when the nut 290 moves distally to cause the cam member 312 of the stiffening rod 310 to activate the distal staple switch 620, power to the stapling motor 210 is removed to stop further distally directed movement of the staple control assembly 200.
FIGS. 28 and 29 illustrate a removable connection assembly to permit replacement of a different staple cartridge 60 on the distal end of the anvil 30.
The proximal-most chamber of the handle body 10 defines a. cavity for holding therein a power supply 600. This power supply 600 is connected through the circuit board 500 to the motors 120, 210 and to the other electrical components of the stapler 1.
The electronic components of the stapler 1 have been described in general with respect to control through the circuit board 500. The electric stapler 1 includes, as set forth above in an exemplary embodiment, two drive motors 120, 210 powered by batteries and controlled through pushbuttons 20, 21, 22. The ranges of travel of each motor 120, 210 are controlled by limit switches 610, 616, 618, 620 at the ends of travel and at intermediary locations 612, 614 along the travel. The logic by which the motors 120, 210 are controlled can be accomplished in several ways. For example, relay, or ladder logic, can be used to define the control algorithm for the motors 120, 210 and switches 610, 612, 614, 616, 618, 620. Such a configuration is a simple but limited control method. A more flexible method employs a microprocessor-based control system that senses switch inputs, locks switches out, activates indicator lights, records data, provides audible feedback, drives a visual display, queries identification devices (e.g., radio frequency identification devices (RFIDs) or cryptographic identification devices), senses forces, communicates with external devices, monitors battery life, etc. The microprocessor can be part of an integrated circuit constructed specifically for the purpose of interfacing with and controlling complex electro-mechanical systems.
.15 Examples of such chips include those offered by A tmel, such as the Mega 128, and by PIC, such as the PIC 16F684.
A software program is requited to provide control instructions to such a processor. Once fully developed, the program can be written to the processor and stored indefinitely. Such a system makes changes to the control algorithm relatively simple; changes to the software that are uploaded to the processor adjust the control and user interface without changing the wiring or mechanical layout of the device.
For a disposable device, a power-on event is a one time occurrence. In this case, the power-on can be accomplished by pulling a tab or a release that is permanently removed from the device.
The removal enables battery contact, thus powering on the device.
In any embodiment of the device, when the device is powered on, the control program begins to execute and, prior to enabling the device for use, goes through a routine that. ensures awareness of' actual positions of the extend/retract and firing sub-assemblies, referred to as a homing routine. The homing routine may be executed at the manufacturer prior to shipping to the user. In such a case, the homing routine is performed, the positions of the assemblies are set, and the device is shipped to the user in a ready-to-use condition. Upon power-up, the device verifies its positions and is ready to use.
Visual indicators (e.g., LEDs) are used to provide feedback to the user. In the case of the pushbutton switches 20, 21, 22, they can be lit (or backlit) when active and unlit when not active.
The indicators can blink to convey additional information to the user. In the case of a delayed response after a button press, a given light can blink at an ever-increasing rate as the response becomes imminent, for example. The indicators can also light with different colors to indicate various states.
Cams are used in various locations at the stapler 1 to activate limit switches that provide position information to the processor. By using linear cams of various lengths, position ranges can be set. Alternatively, encoders can be used instead of limit switches (absolute and incremental .10 positioning. Limit switches are binary: off or on. Instead of binary input, for position information, encoders (such as optical encoders) can be used to provide position information. Another way to provide position feedback includes mounting pulse generators on the end of the motors that drive the sub-assemblies. By counting pulses, and by knowing the ratio of motor turns to linear travel, absolute position can be derived.
Use of a processor creates the ability to store data. For example, vital, pre-loaded information, such as the device serial number and software revision can be stored. Memory can also be used to record data while the stapler 1 is in use. Every button press, every limit switch transition, every aborted tire, every completed fire, etc., can be stored for later retrieval and diagnosis. Data can be retrieved through a programming port or wirelessly. In an exemplary embodiment, the device can be put into diagnostic mode through a series of button presses. in this diagnostic mode, a technician can query the stapler I for certain data or to transmit/output certain data. Response from the stapler 1 to such a query can be in the form of blinking LEDs, or, in the case of a device with a display, visual character data, or can be electronic data. As set forth above, a strain gauge can be used for analog output and to provide an acceptable strain band.
Alternatively, addition of a second spring and support components can set this band mechanically.
An exemplaty control algorithm for a single tire stapler I can include the following steps:
o Power on.
o Verify home position and go to home position, if necessary/desired.
o Enable extend/retract buttons (lit) and disable (unlit) staple fire button.
o Enable staple fire button only after full extension (anvil removal) and subsequent retraction with extend/retract buttons remaining enabled.
o Upon actuation of staple fire button, retract anvil until force switch is activated.
o Begin countdown by blinking fire button LED and increase blink, rate as firing cycle becomes imminent. Continue monitoring of force switch and retract anvil so that force switch remains activated.
o During staple fire cycle, any button press aborts staple fire routine.
o If abort occurs before staple firing motor is activated, firing cycle stops, anvil is extended to home position, and staple fire button remains active and ready for a re-fire.
o Alternatively, if the abort occurs during movement of tiring motor, firing cycle stops, firing motor is retracted, anvil is returned to home position, and firing 0 button is rendered inactive. Accordingly, stapler (or that staple cartridge) cannot be used.
o After countdown to fire is complete, staple range limit switch is queried for position. If staple range limit switch is activated -- meaning that anvil is within an acceptable staple firing range -- then staple firing motor is activated and firing cycle proceeds. if staple range limit switch is not activated, then firing cycle is aborted, anvil is returned to home position, and staple firing button remains active ready for a re-fire attempt.
o After a completed staple firing, anvil remains in closed position and only the extend button remains active. Once anvil is extended to at least the home =,.() position, both extend and retract buttons are made active. Staple fire button remains inactive after a completed staple firing.
Throughout the above exemplary cycle, button presses, switch positions, aborts, and/or fires can be recorded.
In a surgical procedure, the stapler is a one-way device. In the test mode, however, the test user needs to have the ability to move the troc.ar 410 and anvil 60 back and forth as desired. The power-on feature permits entry by the user into a manual mode for testing purposes. This test mode can be disengaged and the stapler reset to the use mode for packaging and shipment.
For packaging, it is desirable (but not necessary) to have the anvil 60 be disposed at a distance from the staple cartridge 50. Therefore, a horning sequence can be programmed to place the anvil 60 one centimeter (for example) away from the staple cartridge 50 before powering down for packaging and shipment.
When the electric stapler is unpackaged and ready to be used for surgery, the user tums the stapler on (switch 12). Staples should not be allowed to fire at any time prior to being in a proper staple-firing position and a desired tissue compression state. Thus, the anvil/trocar extend/retract function is the only function that is enabled. In this stale, the extend and retract buttons 20, 21 are lit 5 and the staple firing switch 22 is not lit (i.e,, disabled).
Before use inside the patient, the trocar 410 is extended and the anvil 60 is removed. If the stapler is being used to anastomose a colon, for example, the trocar 410 is retracted back into the anvil neck 30 and the staple cartridge 50 and anvil neck 30 are inserted trans-anally into the colon to a downstream side of the dissection. The anvil 60, in contrast, is inserted through an upstream 10 laparoscopic incision and placed at the upstream side of the dissection.
The anvil 60 is attached to the trocar 410 and the two parts are retracted towards the staple cartridge 50 until a staple ready condition occurs. As set forth above, the anvil is moved to a distance that does not substantially compress and, specifically, does not desiccate, the tissue therebetween. At this point, staple firing can occur when desired.
15 The staple firing sequence is started by activating the staple fire switch 22. Staple firing can be aborted anytime during the firing sequence, whether prior to movement (during the blanching cycle) or during movement (whether the staples have started to form or not).
The software is programmed to begin a staple firing countdown sequence because it is understood that the tissue needs to be compressed and allowed to desiccate before staple tiring should occur. Thus, after the 20 staple firing switch 22 is activated, the anvil 60 closes upon the interposed tissue and begins to compress the tissue. The staple thing sequence includes an optimal tissue compression (OTC) measurement and a feedback control mechanism that causes staples to be fired only when the compression is in a desired pressure range, referred to as the OTC range, and a sufficient time period has elapsed to allow fluid removal from the compressed tissue. The OTC range is known 25 beforehand based upon known characteristics of the tissue that is to be compressed between the anvil 60 and the staple cartridge 50 (the force switch can be tuned for different tissue OTC ranges). It is the force switch 400 that provides the OTC measurement and supplies the microprocessor with information indicating that the OTC for that particular tissue has been reached. The OTC state can be indicated to the user with an LED, for example.
When the firing sequence begins, the staple fire switch 22 can be made to blink at a given rate and then proceed to blink faster and faster, for example, until firing occurs. If no abort is triggered during this wait time, the OTC state will remain for the preprogrammed desiccation duration and staple filing will occur after the countdown concludes. In the example of colon anastomosis with a circular stapler, stapling of the dissection occurs simultaneously with a cutting of tissue at the center of the dissection. This cutting guarantees a clear opening in the middle of the circular ring of staples sufficient to create an opening for normal colon behavior after the surgery is concluded.
As the liquid from the interposed compressed tissue is removed, the compressive force on the tissue naturally reduces. En some instances, this reduction can be outside the OTC range. Therefore, the program includes closed-loop anvil-compression control that is dependent upon continuous measurements provided by the force switch 400. With this feedback, the compressed tissue is kept within the OTC range throughout the procedure and even after being desiccated.
During the staple firing cycle, any actuation of a control switch by the user can be programmed to abort the staple fire routine. IT an abort occurs before the staple firing motor 210 is activated, the firing cycle stops, the anvil 60 is extended to a home position, and the staple fire switch 22 remains active and ready for a re-fire attempt, if desired.
Alternatively, if the abort occurs during movement, of the staple firing motor 210, the firing cycle stops and the staple firing motor 210 is caused to extend the anvil 60 to its home position. At this point, the staple firing switch 22 is rendered inactive_ Accordingly, the stapler (or that particular staple cartridge) can no longer be used (unless the staple cartridge is replaced).
It is noted that before a staple firing can occur, a staple range limit switch is queried for relative position of the staple cartridge 50 and anvil 60. If the staple range limit switch is activated ¨
meaning that anvil 60 is within an acceptable staple firing range -- then the staple firing motor 210 can be made active and the tiring cycle can be allowed to proceed. If the staple range limit switch is not activated, then the firing cycle is aborted, the anvil 60 is returned to the home position, and the staple firing switch 22 remains active and ready for a re-fire attempt.
Powering (also referred to as actuating, powering, controlling, or activating) of the motor and/or the drive train of any portion of the end effector (e.g.õ anvil or stapler/cutter) is described herein. It is to be understood that such powering need not, be limited to a single press of an actuation button by the user nor is the powering of a motor limited to a single energizing of the motor by the power supply. Control of any motor in the device can require the user to press an actuation button a number of times, for example, a first time to actuate a portion of the end effector for a first third of movement, a second time for a second third of movement, and a third time for a last third of movement. More specifically for a surgical stapler, a first exemplary actuation can move the staple sled or blade past the lock-out, a second exemplary actuation can move the part up to the tissue, and a third exemplary actuation can move the sled past all staples to the end of the staple cartridge.
Similarly, powering of a motor need not be constant, for example, where the motor is energized constantly from the time that the blade begins movement until it reaches the end point of its movement. Instead, the motor can be operated in a pulsed mode, a first example of which includes periodically switching on and off the power supplied by the power supply to the motor during actuation of an end effector function. More specifically for a stapler, the motor can be pulsed ten times/second as the stapl &cutter moves from its proximal/start position to its distal-most position.
This pulsing can be directly controlled or controlled by microprocessor, either of which can have an adjustable pulse rate. Alternatively, or additionally, the motor can be operated with a pulse modulation (pulse-width or pulse-frequency), with pulses occurring at very short time periods (e.g., tenths, hundredths, thousandths, or millionths of a second). Accordingly, when the power supply, the motor, and/or the drive train are described herein as being powered, any of these and other possible modes of operation are envisioned and included.
After a completed staple firing, the anvil 60 remains in the closed position and only the extend switch 20 remains active (all other switches are deactivated). Once the anvil 60 is extended to at least the home position, both the extend and retract switches 20, 21 are made active but the retraction switch 21 does not permit closure of the anvil 60 past the home position. The staple fire switch 22 remains inactive after a completed staple firing.
As set forth above, the anvil neck 30 houses a linear force switch 400 connected to the trocar 410. This switch 400 is calibrated to activate when a given tensile load is applied. The given load is set to correspond to a desired pressure that is to be applied to the particular tissue before stapling can occur. Interfacing this switch 400 with the processor can ensure that the firing of staples only occurs within the OTC range.
The following text is an exemplary embodiment of a program listing for carrying out the methods according to the invention as described herein. The text that follows is only submitted as exemplary and those of skill in the art can appreciate that programming the methods according to the invention can take many different forms to achieve the same functionality.
'Circular Stapler Program using the rev 3c board (cb280 chipset) V8.03 (C8-3c-080306.CUL) '8-3-06 'Modified program to abort with only fire button, added pbcotmt variable 'Added PNIIIM ramping '7-28-06 'final tweaks - stan is now an integer etc.
'7-17-06 This version written for the 3c board.
'7-14 DEBUGGING VERSION
= Program written for 3c board using the Cubloc 280 chipset Note: this program is a modified version of the ones noted below. All changes not related to the addition of the FIR limit switches 'apply. The programs below were written to deal with the "gray logic" of the 1 cm switch. This version uses 'a limit switch at either end of the extend/retract stage.
N6,20 Final Version of Gray Logic program as used in prototype 0, serial number 100 'V6.05 'modified the extend to cm 1 and retract to cm I routines to make sure that when they are called that they move the motor until the cm 'switch is closed; le: When the anvil is all the way out and the retract.
button is pressed, retract the anvil until the cm limit switch 'is closed regardless of whether the retract button is released before the cm switch is closed. Same change for when the anvil is 'extended from the 1 cm position.
'made changes to comments in the extend/retract routines 'V6.02 'added loop requiring the release of both buttons to exit jog routine, and a 1 second delay at the end of jog subroutine before 'going back to main routine 'reformatted datadump labels 'added variables for high and low speed pwm values 'added extend only capability at end of completed fire to prevent crushing stapled tissue 'NOT WORKING- REMOVED added checks To ensure 1 cm switch Is made when extending Or retracting from the I cm And fully extended positions respectively 1V6,01.
'All prior versions were made for testing the program on the Cubloc development board. All outputs were pulled LOW, The actual device 'requires all the outputs to be pulled high (+5V). This version is set-up to run on the actual device.
'limited the values of the EEPROM data to 255 max 'added delays before changes in motor direction, made program run smoother 'removed pwmoff commands. They were not allowing the motors to stay on when changing subroutines (for some reason) EVS.27 'added the recording ofjog routine button presses 'added the recording of datadump requests 'V5,26 'added the recording of Extend/Retract button presses 'added serial number field in eeprom 'the datadump routine now keeps running total of data as it is read from eeprom 'V5.25 (circular-stapler-5-25.cul) 'added code to allow storage of data each power on cycle in eeprom 'V5.24 works well, no known bugs (oircular-stapler-5-24.cul) %MS Medical LLC (c) 2006 'MAP
1)10 Extend Button ?II Retract Button 712 Fire Button 713 Extend Limit P14 Retract Limit T1 5 Fire Forward Limit 716 Fire Back Limit 717 1 cm Limit Switch 718 Staple Range Limit Switch P19 Force Switch P20 Extend Button LED
P21 Retract :Button LED
722 Fire Button LED
P23 Force LED (blue) 1P24 Not USED
P25 Not USED
P26 Not USED
1P27 Not. USED
1P28 Not USED
'P29 Staple Range LED (green) Const Device=cb280 'Comfl le Tech. Cubloc CB280 chipset Dim ver As String*7 ver="3C-8.03" 'set software version here Dim extendbutton As Byte Dim retractbutton As Byte Dim firebutton As Byte Dim &stout As Byte Dim firstback As Byte Dim cmstatus As Byte 11 cm limit switch status Dim srstatus As Byte 'staplerange limit switch status Dim x As Integer Dim powerons As Byte 'store in eeprom address 2 Dim cycnumfires As Byte 'store in eeprom (powerons*5) Dim cycabortfires As Byte 'store in eeprom (powerons*5)+1 Dim cycers As Byte 'store in eeprom, number of cycle extend/retract presses Dim cycjogs As Byte Dim arm As Byte Dim completefire As Byte Dim staplerangestatus As Byte Dim bail As Byte Dim ds As Integer 'eeprom data start location for individual cycle data writing Dim fast As Integer Dim slow As Integer Dim extendonly As Byte Dim extlimit As Byte Dim retlimit As Byte Dim speed As Integer 5 Dim dracula As Byte initalize outputs Out 20,0 'extend button LED
10 Out 21,0 'retract button led Out 22,0 The button led Out 23,0 'force led Out 29,0 'staple range led 15 'initialize variables firstout=0 firstback=0 completeftre=0 arm-0 20 bail.=0 cycnamfires---0 cycabort1ires-0 cycers=0 cycjogs-0 25 extendon1r0 'CHANGE PWM VALUES HERE
fast=60000 'highspeed pwm value slow=60000 lowspeed pwm value 30 speed-0 Output 5 'turns on pwm output for PINCH
Output 6 VirlIS on pwm output for FIRE
'read totals from eeprom powerons-Eeread(2,1) Incr poweronstincrement total power on number If powerons>,.-255 Then powerom.,-255 'limit number of recordtx1powerons to an integer of one byte max flewrite 2,powerons,1 'write total power on number to eeprom ds-powerons*5 '.10G and DATADUMP Check 'push any button within 2 (or so) seconds to go to jog routine 'hold all three buttons on at startup to dump the data For x-:1 To 50 If Keyir(l 0,20)=0 And Keyir(l 1,20)=0 And Keyin(12,20)=0 Then datadutnp 'write all stored data to the debug screen Exit For Elseif Keyin(I 0,20)=0 Or Keyin(11,20),---0 Or Keyin(12,20)4 Then 'either eir button or the tire button pressed jog Exit For End if Delay 20 Next ------ ----- --------. 'HOMING SEQUENCES
cmstatus=Keyin(17,20) 'read the status of the lent limit switch if cmstatus=0 Then homeretract Elseif =status-1 Then homeextend End If 'Return .fire motor to back position hotnefire 'this returns the fire motor to the full retracted condition (P6 limit switch) ********
'Main Loop ************************************************
********
Do Debug "Main Loop",Cr 'Delay 1000 cmstatusr---Keyin(17õ20) 'read the I cm switch istaplerangestatus-:Keyin(5,20) 'read the staplerange limit switch extendbutton¨Keyin(1 0,20) retractbuttorr.Keyi n(11,20) firebutton=Keyin(12,20) If cmstatus=0 And Keyin(13,20)<>0 Then Out 20,1 'turn extend led on Out 21,1 'turn retract. led on El self cmstattis=0 And Keyi n(I 3,20)-0 Then Out 20,0 'turn off extend led because extend limit met Out 21,1 'turn on retract limit Elseif emstatus=1 Then Out 20,1 Out 21,0 End If 'check firebutton led status If tirstout=1 And firstback=1 And arm=1 And c.ompletefire<>1 And cmstatus<>0 Then Out 22,1 'turn on tire button led Else Out 22,0 'turn off fire led End If 'check for extend retract button press If extendbutton=0 And cmstatus=0 Then extend Elseif cmstatus=1 And extendbutton=0 Then extend End If If retrac1button-0 And crnstatus=0 Then 'And extendonly=0 retract End If 'check for firebutton press If firebutton=0 And firstout=1 And firstback=1 And arm=1 And completefire<>1 And cmstatus<>0 Then initialfire Loop 'keep looping ti l powerdown End 'End of program SUBROUTINES
"
'HOME: retract to cm switch=not pressed ------------------Sub homeretractO 'retract until 1 cm switch is open 'Debug "Horneretract",Cr 'Delay 1000 PWIT1 0,slow,60000 Do Until Keyin(17,20)-1 'retract until 1 cm switch is open.
Out 31,1 'ER motor reverse Loop Out 31,0 'er motor off Out 21,0 'turn retract led Off Out 20,1 'turn extend led On Pwmoff 0 'turn pwm off End Sub 'HOME: extend to cm switch=pressed Sub homeextendo 'extend until 1 cm switch is closed Debug "Homextend",Cr Delay 1000 Pwm 0,slow,60000 If Keyin(17,20)=1 Then Do Until Keyin(17,20)=0 'now the 1 cm switch is pressed Out 30,1 'ER motor forward DDD
Loop End If Out 30,0 'DDD
Pwmoff 0 Delay 300 homeretract 'once the switch is made, call homeretract End Sub 'Fire motor horning routine Sub hoinefireo Debug "Homefire",Cr 'Delay 1000 Pwm 1,slowõ60000 Do Until Keyin(16,20):::0 'retract firing stage until back switch is closed Out 33,1 Loop Out 33,0 Pwmoffi End Sub '10(1 Routine Sub jog() Out 20,1 Out 21,1 Do Delay 25 If Keyi n(10,20)=0 And Keyin(11,20)=0 Then Exit Do 'if both buttons pressed, exit jog routine and start horning routine after 1 second delay If Keyin(I 0,20)=0 And Keyin(11,20)<>0 And Keyin(12,20)<>0 Then Pwin 0,slow,60000 'Out 30,1 'extend motor forward Do Until Keyirt(10,20)<>0 Or Keyin(13,20)=0 Out 30,1 'extend motor on forward D:DD
Loop Out 30,0 'extend motor off forward DDD
Pwtnoff 0 incr cycjogs If cycjogS>=255 Then cycjogs=255 Eewrite ds+3,cycjogs,1 End If If Keyin(11,20)=0 And Keyin(10,20)<>0 And Keyin(12,20)<>0 Then Pwm 0,slow,60000 Do Until Keyin(11,20)<>0 Or Keyin(14,20)-0 Out 31,1 'extend motor reverse Loop Out 31,0 'extend motor off reverse :Pwmoff 0 Incr cycjogs If cycj ogs>=255 Then cycjogs=255 Eewrite ds-v3,c3rcjogs,1 End If If Keyirt(12,200 And Keyin(10,20)=0 Then jog the fire motor forward :Pwm 1,slow,60000 Do Until Keyin(10,20)<>0 Or Keyin(12,20)<>0 Or Keyin(15,20)=0 Out 32,1 'fire motor forward Loop Out 32,0 'fire motor off forward Pwmoff 1 bier cycjogs If cycjogs>=255 Then cycjogs=255 Eewrite ds+3,cycjogs,1 End If If Keyin(12,20).0 And Keyin(11,20)-0 Then 'jog the fire motor reverse Pwm 1,slow,60000 Do Until Keyin(11,20)<>0 Or Keyin(12,20)<>0 Or Keyin(16,20)=0 Out 33,1 'fire motor reverse Loop Out 33,0 Tire motor off reverse Pwmoff Incr cycjogs =
If cycjogs>=255 Then cycjogs=255 Eewrite ds+3õcycjogs,1 End If 5 Loop Do Until Keyin(10,20)=I And Keyin(1.1,20)=1 'let off both buttons before exiting jog routine Delay 10 Loop 10 Out 20,0 'turn on eir button Ieds Out 21,0 Delay 1000 End Sub 'Extend until extend limit is met Sub extend() Out 22,0 'turn off fire button led while extending Out 21,0 'turn off retract button led while extending Pwin 0,fast,60000 Do Until Keyin(10,20)=1 Or Keyin(13,20)=0 'extend until either the extend limit is closed or the extend button is released /5 Out 30,1 'ER motor forward DDD
Loop Out 30,0 'DDD
If firstout--.0 Then 'this will keep the extend motor going on the first extension until the anvil is all the way out Do Until Keyin(13,20--0 Out 30,1 DDD
Loop End If Out 30,0 'DDD
Pm:I-toff 0 Incr cycers If cycers>=255 Then cycers=255 Eemite ds+2,cycers, 1 If Keyin(13,20)=0 Then firstout-- I 'set the firstout flag to enable .fire button Out 20,0 'turn off extend led End If End Sub 'Retract: until cm switch is open Sub retract() Out 22,0 'turn off tire button led while retracting Out 20,0 'turn off extend button led while retracting Pwm 0,fast,60000 Do Until Keyin(11,20)=1 Or Keyin(17,20)1 'retract until either the lcm switch goes open or the extend button is released Out 313 'ER motor reverse Loop Out 31,0 Pwmoff Incr cycers If cycers>=255 Then cycers=255 &write ds+2,cycers,1 If Keyin(17,20)=2t Then firstback=1 Out 21,0 'turn retract led off End If If firstout-1 And firstback---1 Then arm-1 'set the ann flag to arm the tire button End Sub 'D.ATADUMP Routine Sub datadump() Dim chef As Byte Dim tf As Byte 'total fires Dim ta As Byte 'total aborts Dim ers As Integer Dim tj As Byte Dim tdd As Byte Dim stan As Integer Dim kyle As Byte Dim token As Byte Dim ike As Byte Dim kenny As Byte Dim sn As Byte tf-0 ta-0 ers-0 tj-0 td&O
Eewrite ds+4,1,1 'write 1 to the ds+4 eeprom register denoting that datadump was accessed Delay 1000 sn-Eeread(0,1) Debug "Circular Stapler Stored Data",Cr Debug "Version ",ver,Cr Debug "KN1S Medical ILLC",Cr Debug" .........................
Debug Cr Debug "Serial Number: ",Dec sn,Cr poweronvzSeread(2,1) If powerons>=255 Then powerons-255 Debug "Total Cycles: ",Dec powerons,Cr Debug Cr Debug "-------- ------- ----------",Cr Debug Cr For stan--5 To (powerons*5) Step 5 Debug "Cycle ",Dec (stan/5),Cr Debug" -------------------chef=Eeread(stan,l) tf=chef+tf Debug "Completed Fires: ",Dec chef,Cr ky le-Eeread(stan+1,1) taAyle+-ta Debug "Aborted Fires: ",Dec kyle,Cr toketr:::Eeread(stan+2,1) ers=token+ers Debug "Fills: ",Dec token,Cr ike.,Eeread(statr+-3,1) tj=ike-1 Debug "Jogs: ",Dec ike,Cr kenny=Eeread(stan+4,1) tdd---kenny tdd Debug "Datadumps: ",Dec kenny,Cr Debug Cr Next 'stan Debug" ......................... ",Cr Debug "Cycle Totals",Cr Debug Cr Debug "Completed Fires: ",Dec tf,Cr Debug "Aborted Fires: ",Dec ta,Cr Debug "FIR Presses: "Dec ers,Cr Debug "Jog Presses: ",Dec tj,Cr Debug "Datadumps: ",Dec tdd,Cr Debug Cr Delay 1000 For x=1 To If 'blink the number of completed firing cycles Out 22,1 Delay 500 Out 22,0 Delay 500 Next ex Do Until Adin(0)>800 And Keyin(3,20)=1 'wait until datadump buttons are released Loop End Sub 'Initial fire Sub initialfire0 Dim f As Integer Dim p As Integer Dim t As Integer Dim y As Integer Dim z As Integer Dim q As :Integer Dim jimmy As Integer Dim butter As Integer Dim numblinks As Integer Dim fbcount As Integer Debug cir,Cr 'turn off extend and retract buttons to show that they are not active for abort?
Out 20,0 'extend button Out 21,0 'retract button bail=0 t=15 'total blink time p-.3 'number of blink periods Pwm 0,fa.st,60000 'start blink and adjust pinch motor to force fr(t*1000)/p fbcount=0 If Keyi n(12,20)-1 Then tbcount-1 For y=1 Top numblinks" (t*y)/p For z-1 To numblinks timmy=finumblinks butter=timmy/50 'calibrate this to seconds If timmy---0 Then timtny=1 If Keyin(12,20)=0 And fbcount=1 Then bail"] 'set abortfue flag Exit For End If If Keyin(12,20)=1 Then fbcount=1 Do Until Keyin(19,20)----,0 Or Keyin(14,20).--0 'retract until force switch met or retract limit met Out 31,1 If Keyin(12,20),---0 And fbcount=1 Then bail=1 'set abortfire flag Exit Do End If If Keyin(12,20)=1 Then tbcount=1 Loop If bail=1 Then Exit For Out 31,0 Out 23,1 'force led Out 22,1 'fire button led For q=0 To butter Delay 10 If Keyin(12,20)=0 And tbcourxt= I Then bal1=1 'set abortfire flag Exit For End If if Keyin(12,20)..:1 Then fhcount-:1 If Keyin(19,20)=I Then Out 23,0 Next 'q If baiFl Then Exit For Do Until Keyin(19,20)=0 Or Keyin(14,20) 'retract until force switch met or retract limit met Out 31,1 If .Keyin(i 2,20)=0 And fbcount=1 Then ball.-1 'set abortilre flag Exit Do End If If Keyin(12,20)-1 Then .fficount-1 Loop Out 31,0 Out 23,1 if Keyin(12,20)=0 And fbcount;=-1 Then 'set abortflre flag Exit For End If if Keyin(12,20)=1 Then fbcount=1 Out 22,0 For cr0 To butter Delay 10 If Keyin(12,20):-0 And fbc,ount-.1 Then bail=1 'set abortfire flag Exit For End if If Keyin(12,20)= I Then tbcount=1 5 if Keyin(19,20)= I Then Out 23,0 Next 'q If bail= I Then Exit For Next 'z Debug Dec? tbcount,Cr 10 if bail=1 Then Exit For Next 'y PwinotT 0 If bail =1 Then 15 abortfire Else 'staplerangecheck finalfire End If 20 End Sub 'Staple Range Check Routine Sub staplerangecheck() srstatus=Keyin(29,20) 'read the staplerange limit switch If srstatus=0 Then finalfire Else abortilre End If End Sub ' 'Final Fire Routine Sub final-fire() Out 23,0 'turn force led off Out 20,0 'turn extend led off Out 21,0 'turn retract led off Out 22,1 'Turn on fire led to signify final fire abort ready Pwmoff 1 'Fwrn 1 fast,60000 'Out 32,1 Tire motor forward ODD
COM pletefire:" 1 Do Until Keyin(15,20)=0 'fire forward until forward limit is met If speed>=60000 Then speed=60000 If speed<60000 Then speed=speed+10000 End If Nan 1õspeed,60000 Out 32,1 Delay 50 If Keyin(12,20)-0 Then 'Or :Keyiri(10,20)..0 Or Keyin(11,20)-0 bai 1=1 Exit Do End If Loop Out 32,0 'fire motor fwd off DDD
speed=0 Delay 250 Do Until Keyin(16,20)=0 'retract fire motor If speed>-60000 Then speed'-60000 If speed<60000 Then speed=speed+10000 End If PwIn 1,speed,60000 Out 33,1 Delay 50 Loop speed,=0 Out 33,0 Pwmoff I
Out 22,0 'turn tire led off Out 21,0 'turn off retract led extendonly=1 iner cycnumfires If cycntunfires>255 Then cycnumfires=255 Eewrite ds,cycnumfires,1 'write the current cycle number of fires to the eeprorn Delay 200 End Sub 'return to the main routine 'Abort fire Sub abortfire() 'Debug "Fire aborted before firing! !",Cr Out 31,0 'turn retract motor off Out 32,0 'turn tire forward off DDD
Out 23,0 'turn force led off Pwm 1,fast,60000 Delay 250 Do Until Keyin(16,20)=0 'retract fire motor Out 33,1 Loop Out 33,0 Pwmoff 1 Out 22,0 'turn fire led off Incr cycabortfires If cycabortfires>=255 Then cycabortfires=255 Eewrite ds+1,cycabortfires,1 'write the current cycle abortfires to the eeprom Delay 200 homeextend 'extend to lcm End Sub Also mentioned above is the possibility of using identification devices with removable and/or interchangeable portions of the end effector. Such identification devices, for example, can be used to track usage and inventory.
One exemplary identification device employs radio-frequency and is referred to as an RF1D.
In an exemplary embodiment where a medical stapler uses re-loadable, interchangeable staple cartridges, such as the stapler I described herein, an RFID can be placed in the staple cartridge to ensure compatibility with the particular stapler and an RFID reader for sensing compatible staple cartridges can be associated with the handle. In such a configuration, the reader interrogates the RFID mounted in the cartridge. The RFID responds with a unique code that the stapler verifies. If the stapler cartridge is labeled as verified, the stapler becomes active and ready for use. If the cartridge is rejected, however, the stapler gives a rejected indication (e.g., a blinking LED, an audible cue, a visual indicator). To avoid accidental or improper reading of a nearby staple cartridge, the antenna of the RFID reader can be constructed to only read the RFID when the staple cartridge is installed in the stapler or is very nearby (optimally, at the distal end of the device). Use of the RFID can be combined with a mechanical lockout to ensure that only one fire cycle is allowed per staple cartridge. RFIDs have drawbacks because the readers are expensive, the antennas are required to be relatively large, and the distance for reading is relatively close, typically measured in centimeters.
Other wireless authentication measures can be employed. Active RFIDs can be used.
Similarly, infrared (ER) transmission devices can be used. However, both of these require the generation of power at the receiving end, which is a cost and size disadvantage.
Another exemplary identification device employs encryption. With encryption comes the need for processing numbers and, associated with such calculations, is use of processing chips (e.g., a microprocessor), one of which is to be placed on the interchangeable part, such as a staple cartridge or a replaceable end effector shaft. Such encryption chips have certain characteristics that can be analyzed for optimization with the surgical instrument of the present invention. First, a separate power source for the interchangeable part is not desired. Not only would such a power source add cost, it would also add undesirable weight and take up space that is needed for other features or is just not available. Thus, power supply to the part should come from the already existing power supply within the handle. Also, supply of power should be insured at all times.
Because the interchangeable part is relatively small, the encryption chip should be correspondingly small. Further, both the handle and the interchangeable pan are configured to be disposable, therefore, both encryption processors should have a cost that allows disposability. Finally, connections between the encryption device on the interchangeable part and the corresponding encryption device on the handle should be minimized. As will be discussed below, the encryption device according to the present invention provides all of these desirable characteristics and limits the undesirable ones.
Devices for encrypted identification are commercially available. One of such encryption devices is produced by Dallas Semiconductor and is referred to as the DS2432 chip. The DS2432 chip not only provides encrypted identification between a reader and a transponder, but it also has a memory that can be used to store device-specific information, which information and its uses will be described in further detail below. One beneficial characteristic of the DS2432 is that it is a 1-wire device. This means that the power and both of the input and output signals travel on the same line.
With a 1-wire device such as the DS2432, there is only the need for a single wire to traverse the distance from the handle body 10 through the anvil neck 30 to the interchangeable staple cartridge 50 in order to make a connection between the handle and the end effector. This configuration satisfies the characteristic of having a minimal amount of electrical connections and has a correspondingly reduced cost for manufacture. It is true that the DS2432 chip requires ground, however, the metallic anvil neck 30 is electrically conducting and is connected to ground of the device 1, therefore, an exemplary embodiment for the ground connection of the DS2432 chip is made by direct electrical contact through a lead to the neck 30 or by directly connecting the chip's ground to the neck 30.
One exemplary encryption circuit configuration places a first encryption chip on the interchangeable part (e.g., the staple cartridge). Ground for the first encryption chip is electrically connected to a metallic portion of the interchangeable part which, in turn, is electrically connected to ground of the device, for example, to the neck 30. The 1-wire connection of the DS2432 chip is electrically connected to a contact pad that is somewhere on the interchangeable part but is electrically disconnected from ground. For example, if the interchangeable part is a linear 60 mm staple cartridge, the DS2432 can be attached to or embedded within the electrically insulated distal end of the cartridge distal of the last staple set. The encryption chip can be embedded on a side of the cartridge opposite the staple ejection face so that it is neither exposed to the working surfaces nor to the exposed tissue when in use. The ground lead of the DS2432 chip can be electrically connected to the metallic outer frame of the staple cartridge, which is electrically connected to ground of the stapler. The 1-wire lead is electrically connected to a first conductive device (such as a pad, a lead, or a boss) that is electrically insulated from the metallic frame of the cartridge. A single electrically conductive but insulated wire is connected at the proximal end to the circuit board or to the appropriate control electronics within the handle of the device.
This wire is insulated from electrical contact with any other part of the stapler, especially the grounded frame, and travels from the handle, through the neck and up to the receiving chamber for the interchangeable part. At the distal end, the insulated wire is exposed and electrically connected to a second conductive device (such as a pad, a lead, or a boss) that is shaped to positively contact the first conductive device on the cartridge when the cartridge is locked into place in the end effector. In such a configuration, the two conductive devices form a direct electrical connection every time that the interchangeable part (e.g., the staple cartridge) is inserted within the end effector, in one particular embodiment, contact can be made only when the part is correctly inserted.
The DS2432 is also only a few square millimeters in area, making the chip easy to install on a small interchangeable part, such as a staple cartridge, while simultaneously satisfying the minimal size requirement. It is noted that the DS2432 chip is relatively inexpensive. To keep all communication with the DS2432 chip hidden from outside examination, a DS2460 (also manufactured by Dallas Semiconductor) can be used to perform a comparison of an encrypted transmission received from a DS2432 with an expected result calculated internally. The characteristics of both of these chips are explained, for example, by Dallas Semiconductors' Application Note 3675. The DS2460 chip costs significantly more than the DS2432 chip, but is still inexpensive enough to be disposed along with the handle. It is noted that the number of disposable interchangeable parts of medical devices (such as the surgical instrument of the present invention) typically outnumber the handle that receives the interchangeable parts by a significant amount.
Accordingly, if the 0S2432 chip is placed in the interchangeable part and the DS2460 chip is placed in the handle, the low cost 5 encryption characteristic is satisfied. There exists an alternative circuit configuration using two DS2432 chips that is explained in MG, 2 of Application Note 3675, which circuit eliminates the need of the more expensive DS2460 chip by performing the comparison with a local microprocessor (e.g., microprocessor 2000). In such a configuration, the cost for adding encryption into the device 1 is reduced, however, as explained, the configuration gives up some aspects of security by making 10 available to inspection both numbers that are to be compared.
The process for electronically verifying the identity of an interchangeable part on a medical device using encryption is described with an exemplary embodiment having one 0S2432 chip and one DS2460 chip. The exemplary control circuit for the encryption device is shown in FIG. 30, This exemplary embodiment is described using a linear stapler having a handle containing therein a 15 circuit board with a microprocessor 2000. One free I/O pin 2010 of the microprocessor 2000 is connected to a first lead 2110 of the .DS2460 and another pin 2020 is connected to a second lead 2120. Each interchangeable part 2200 is provided with a DS2432 chip and the 1-wire lead is connected to a third I/O pin 2030 of the microprocessor 2000.
To start the process, an interchangeable part 2200 is connected to the device, mating 20 electrical contact with ground and with the 1-wire lead. When the microprocessor 2000 detects that a new part 2200 has been connected to the device 1, it runs an authentication routine. First, the microprocessor 2000 initiates a random number request to the DS2460 over the first communication pin 2010. The DS2460 has a pre-programmed secret number that is the same as the pre-programmed secret numbers stored in each of the DS2432 chips contained on the interchangeable parts 2200.
25 Therefore, when the same random number is provided to both the 0S2432 and the 1DS2460 chips, the output result from each of the two chips will be identical. The DS2460 generates a random number and supplies it, via the second pin 2020, to the microprocessor 2000 for forwarding, via pin 2030, on to the DS2432 over the 1-wire lead. When the DS2432 receives the random number, it applies its SEA-1 algorithm (developed by the National Institute of Standards and Technology 30 (MST)) to cryptographically generate a hash code reply. This hash code reply is transmitted back over the 1-wire lead to the microprocessor 2000 and is forwarded, via either pin 2010 or 2.020 to the DS2460. During this period of time, the DS2460 is also calculating its own a hash code reply. First, the DS2460 internally applies the same random number sent to the DS2432 to its own SEA-1 algorithm and stores, internally, the generated hash code reply. The DS2460 also stores the hash code reply transmitted from the 0S2432 through the microprocessor 2000. Both of the hash code replies are compared and, if they are identical, the interchangeable part 2200 is confirmed as authenticated. If there is a difference between the hash code replies, then the part 2200 is rejected and the device is placed in a state where the part 2200 either cannot be used or can be used, but only after certain safeguards are met. For example, data regarding the time, date, environment, etc. and characteristics of the unauthenticated part can be stored for later or simultaneous transmission to the manufacturer Or its agent) to inform the manufacturer that the user is attempting to use or has used an unauthorized part 2200 with the device. If there was no encryption in the messages, the authentication messages could be intercepted and counterfeit, pirated, or unauthorized parts 2200 could be used without having to purchase the parts 2200 from an authorized distributor. hi the exem platy encryption embodiment described herein, the only information that is transmitted across lines that can be examined is a single random number and a single hash code reply. It is understood that it would take hundreds of years to decrypt this SRA4-generated reply, thus reducing any incentive for reverse engineering.
Because the chips used in this example each have secure memories that can only be accessed after authentication occurs, they can be programmed to employ multiple secret keys each stored within the memory. For example, if the DS2460 has multiple keys stored therein and the parts 2200 each have only one key selected from this stored set of multiple keys, the DS2460 can act as a "master" key to the "general" single keys of the parts 2200.
By authenticating the interchangeable part of the surgical instrument of the present invention, many positive results are obtained. First, the instrument manufacturer can prevent a user from using unauthorized parts, thereby insuring use of only authorized parts. Not only does this guarantee that the manufacturer can receive royalties from sales of the interchangeable part, but it also allows the manufacture to insure that the quality of the surgical parts remains high.
Having the encryption circuitry contain memory dramatically enhances the benefits provided by the present invention. For example, if a single end effector of a linear stapler can receive 30 mm, 60 mm, and 120 mm staple cartridges, for example, each size of the cartridges could be provided with an individualized key and the handle can be programmed to store and use each tat' these three keys. Upon receiving a hash code reply that corresponds to one, but not the other two internally calculated hash code replies, the handle would know what kind of cartridge has been inserted in the device. Each cartridge could also contain in its memory cartridge-specific parameters, such as staple sled movement length, that are different among the various sized cartridges and, therefore, cause the handle to behave differently dependent upon the cartridge detected. The parameters examined can also account for revision levels in the particular part. For example, a revision I cartridge could have certain parameters for use and, by detecting that particular cartridge, programming could cause the handle to not allow use of revision 1 cartridges but allow use of revision 2 cartridges, or vice-versa.
Having memory on the encryption chips can also allow the cartridge to keep track of other kinds of data. For example, the cartridge can store the identity of each handle to which it was connected, the identity of the handle that fired the cartridge, the time, date and other temporal data when use and/or connection occurred, how long it took to fire the cartridge, how many times the firing trigger was actuated during staple tiring, and many other similar parameters. One parameter in particular could record data when the cartridge misfires_ This would allow the manufacturer to determine if the cartridge was faulty or if user-error occurred, for example, the latter being investigated to assist the user with remedial measures or other training. By having memory available .15 at the handle, other handle-relevant parameters could be stored, for example, duration of each procedure, speed of each staple firing, torque generated at each tiring, and/or load experienced throughout each firing. The memory could be powered for years merely from the lithium-based power cells already present in the handle. Thus, longevity of handle data can be ensured. The memory can be used to store all uses of a particular handle, along with relevant calendar data. For example, if a handle is only certified for use in a single surgical procedure but the handle has data indicating that staple cartridges were fired days or weeks apart, then, when it was finally returned to the manufacturer for recycling, the manufacturer could detect that the user (hospital, doctor, clinic, etc.) was improperly and, possibly, unsafely, using the handle. Encrypted authentication can be used with removable battery packs as well. Moreover, sensors can be added to any portion of the device for communicating information to be stored within the memory of the encryption chips. For example, temperature sensors can transmit operating room temperature existing when the cartridge was fired. This temperature reading can be used to determine if later infection was caused by improper temperature control existing during the procedure (e.g., in countries where air-conditioning is not available).
In the unlikely event that the stapler becomes inoperable during use, a mechanical override or bail-out is provided to allow manual removal of the device from the patient.
All bailout uses can be recorded with the memory existing on these encryption chips. Furthermore, data that could indicate why bailout was necessary could be stored for later examination. For quality assurance, when bailout is detected, the handle can be programmed to indicate that a certified letter should be sent to the customer/user informing them of the bailout use.
As described above, the present invention is not limited to a circular stapler, which has been used as an exemplary embodiment above, and can be applied to any surgical stapling head, such as a linear stapling device, for example. Accordingly, a linear stapler is being used in the text that follows for various exemplary embodiment. However, use of a linear stapler in this context should not be considered as limited only thereto_ Described above are components that exist along the staple control axis 80 of linear and circular staplers and these components form the staple control assembly 200. As set forth therein, the required force for proper staple ejection and tissue cutting can be over 200 pounds and, possibly, up to 250 pounds. :ft has been determined that minimum requirements for carrying out the desired stapling and cutting functions with a linear electric surgical stapler for human tissue (such as colon tissue, for example) are:
delivering approximately 54.5 kg (120 pounds) of force over a stroke of about 60 mm (-2.4") in approximately 3 seconds; or 2) delivering approximately 82 kg (180 pounds) of force over a stroke of about 60 mm (-2.4") in approximately 8 seconds.
The electric-powered, hand-held linear surgical stapling device of the present invention can meet these requirements because it is optimized in a novel way as set forth below.
To generate the force necessary to meet the above-mentioned requirements, the maximum power (in watts) of the mechanical assembly needs to be calculated based upon the maximum limits of these requirements: 82 kg over 60 mm in 3 seconds. Mathematical conversion of these figures generates an approximate maximum of 16 Watts of mechanical power needed at the output of the drive train. Conversion of the electrical power into mechanical power is not 1:1 because the motor has less than 100% efficiency and because the drive train also has less than 100% efficiency. The product of these two efficiency ratings forms the overall efficiency. The electrical power required to produce the 16 Watts of mechanical power is greater than the 16 Watts by an inverse product of the overall efficiency. Once the required electrical power can be determined, an examination of available power supplies can be made to meet the minimum power requirements.
Thereafter, an examination and optimization of the different power supplies can be made. This analysis is described in detail in the following text.
Matching or optimizing the power source and the motor involves looking into the individual characteristics of both. When examining the characteristics of an electric motor, larger motors can perform a given amount work with greater efficiency than smaller motors. Also motors with rare-earth magnets or with careless construction can deliver the same power in a smaller size, but at higher cost. Further, in general, larger motors cost less than smaller motors if both are designed to deliver the same power over a given period of time. Larger motors, however, have an undesirable characteristic when used in surgical stapling devices because the handle in which they are to be placed is limited by the size of an operator's hand. Physicians desire to use devices that are smaller and lighter, not larger and heavier. Based upon these considerations, cost, size, and weight are factors that can be optimized for use in the surgical stapler handle of the present invention.
Available motors for use within a physician's hand include motors with relatively inexpensive ceramic magnets and motors with relatively expensive rare earth (i.e., neodymium) magnets. However, the power increase of the latter as compared to the former is not sufficiently large to warrant the substantial increase in cost of the latter. Thus, ceramic magnet motors can be selected for use in the handle. Exemplary motors come in standard sizes (diameter) of 27.5 mm or 24 mm, for example. These motors have a rated efficiency of approximately 60%
(which decreases to 30% or below depending upon the size of the load). Such motors operate at speeds of approximately 30,000 rpm (between 20,000 and 40,000 rpm) when unloaded.
Even though such conventional motors could be used, it would be desirable to reduce the size even fitrther. To that effect, the inventors have discovered that coreless, brush-type, DC motors produce similar power output but with a significant reduction in size. For example, a 17 mm diameter coreless motor can output approximately the same power as a standard 24 mm diameter motor. Unlike a standard motor, the coreless motor can have an efficiency of up to 80%. Coreless motors almost all use rare earth magnets.
With such a limited volume and mechanical power available, it. is desirable to select a mechanical gear train having the greatest efficiency. Placing a rack and pinion assembly as the final drive train control stage places a high-efficiency end stage in the drive train as compared to a screw drive because, in general, the rack and pinion has an approximate 95%
efficiency, and the screw drive has a maximum of about 80% efficiency. For the linear electric stapler, there is a 60 mm travel range for the stapling/cutting mechanism when the stapler has a 60 mm cartridge (cartridges ranging from 30 mm to 100 mm can be used but 60 mm is used in this example for illustrative purposes).
With this travel range, a 3-second, full travel duration places the rack and pinion extension rate at 0.8 inches per second. To accomplish this with a reasonably sized rack and pinion assembly, a gear train should reduce the motor output to approximately 60 rpm. With a motor output speed of approximately 30,000 rpm, the reduction in speed for the drive train becomes approximately 500:1.
To achieve this reduction with the motor, a 5-stage drive train is selected.
it is known that such 5 drive trains have an approximate 97% efficiency for each stage. Thus, combined with an approximate 95% efficiency of the rack and pinion, the overall efficiency of the drive train is (0.95X0.97)5 or 82%. Combining the 60% motor efficiency with the 82% drive train efficiency yields an overall electrical to final mechanical efficiency of approximately 49.2%. Knowing this overall efficiency rating, when determining the amount of electrical power required for operating the 10 stapler within the desired requirements, the actual electrical power needed is almost. twice the value that is calculated for producing the stapling/cutting force, To generate the force necessary to meet the above-mentioned requirements, the power (in watts) of the mechanical assembly can be calculated based upon the 82 kg over 60 mm in 3 seconds to be approximately 16 Watts. It is known that the overall mechanical efficiency is 49.2%, so 32,5 15 Watts is needed from the power supply (16 mech. watts 32.5 elec. Watts x 0.492 overall efficiency.). With this minimum requirement for electrical power, the kind of cells available to power the stapler can be identified, which, in this case, include high-power Lithium Primary cells. A
known characteristic of high-power Lithium cells (e.g., CRI 23 or (R.2 cells) is that they produce about 5 peak watts of power per cell. Thus, at least six cells in series will generate the required 20 approximate amount of 32.5 watts of electrical power, which translates into 16 watts of mechanical power. This does not end the optimization process because each type of high-power Lithium cell manufactured has different characteristics for delivering peak power and these characteristics differ for the load that is to be applied.
Various battery characteristics exist that differentiate one battery of a first manufacturer from 25 another battery of a second manufacturer. Significant battery characteristics to compare are those that limit the power that can be obtained from a battery, a few of which include:
= type or electrolyte in the cell;
= electrolyte concentration and chemistry;
= how the anode and cathode are manufactured (both in chemistry and in 30 mechanical construction); and = type and construction of the PTC (positive temperature coefficient of resistance) device.
Testing of one or more of these characteristics gives valuable information in the selection of the most desirable battery for use in the stapling device. It has been found that an examination of the last characteristic -- PTC device behavior -- allows an optimization of the type of battery to perform the desired work.
Most power sources are required to perform, with relative certainty and efficiency, many times throughout a long period of time. When designing and constructing a power source, it is not typical to select the power source for short-duration use combined with a low number of uses.
However, the power source of an electric stapling device is only used for a short duration and for a small number of times. In each use, the motor needs to be ready :for a peak load and needs to perform without error. This means that, for surgical staplers, the stapling/cutting feature will be carried out during only one medical procedure, which has cycle counts of between 10 and 20 uses at most, with each use needing to address a possible peak load of the device.
After the one procedure, the device is taken out of commission and discarded. Therefore, the power source for the present invention needs to be constructed unlike any other traditional power supply.
I 5 The device according to the present invention is constructed to have a limited useful life of a power cell as compared to an expected useful life of the power cell when not used in the device.
When so configured, the device is intended to work few times after this defined "life span." It is known that self-contained power supplies, such as batteries, have the ability to recover after some kind of use. For optimization with the present invention, the device is constructed within certain parameters that, for a defined procedure, will perform accordingly but will be limited or unable to continue performance if the time of use extends past the procedure. Even though the device might recover and possibly he used again in a different procedure, the device is designed to use the power cells such that they will most likely not be able to perform at the enhanced level much outside the range of intended single use periods or outside the range of aggregate use time. With this in mind, a useful life or clinical life of the power supply or of the device is defined, which life can also be described as an intended use. It is understood that this useful/clinical life does not include periods or occurrences of use during a testing period thereof to make sure that the device works as intended.
The life also does not include other times that the device is activated outside the intended procedure, i.e., when it is not activated in accordance with a surgical procedure.
Conventional batteries available in the market are designed to be used in two ways: (1) provide a significant amount of power for a short duration (such as in a high-drain digital device like cameras) or (2) provide a small amount of power over a long duration (such as a computer's clock =
backup). If either of these operations is not followed, then the battery begins to heat up. If left unchecked, the battery could heat to a point where the chemicals could cause significant damage, such as an explosion. As is apparent, battery explosion is to be avoided, These extremes are prevented in conventional batteries with the presence of the Pit device ¨ a device that is constructed to limit conduction of the battery as the battery increases in temperature (i.e,, a positive temperature coefficient of resistance), The FTC device protects batteries and/or circuits from overcurrent and overtemperature conditions. Significantly, the PVC device protects a battery from external short circuits while still allowing the battery to continue functioning after the short circuit. is removed. Some batteries provide short-circuit and/or overteruperature protection using a one-time fuse. However, an accidental short-circuit of such a fused battery causes the fuse to open, rendering the battery useless. PVC-protected batteries have an advantage over fused batteries because they are able to automatically "reset" when the short circuit is removed, allowing the battery to resume its normal operation. Understanding characteristics of the PVC device is particularly important in the present invention because the motor will be drawing several times greater current than would ever be seen in a typical high-drain application.
The 'PTC device is provided in series with the anode and cathode and is made of a partially conducting layer sandwiched between two conductive layers, for example. The device is in a low-resistance condition at a temperature during a normal operation (depending on circuit conditions in which the device is used, for example, from room temperature to 400 C.). On exposure to high temperature due to, for example, unusually large current resulting from the formation of a short circuit or excessive discharge (depending on circuit conditions in which the device is used, for example, from 60* to 1300 C), the PVC device switches into an extremely high-resistance mode.
Simply put, when a PTC device is included in a circuit and an abnormal current passes through the circuit, the device enters the higher temperature condition and, thereby, switches into the higher resistance condition to decrease the current passing through the circuit to a minimal level and, thus, protect electric elements of the circuit and the batteryiies. .At the minimal level (e.g., about 20% of peak current), the battery can cool off to a "safe" level at which time greater power can be supplied.
The partially conducting layer of the PTC. device is, for example, a composite of carbon powder and polyolefin plastic. Further description of such devices is unnecessary, as these devices are described and are well known in the art.
Because FTC circuits of different manufacturers operate with different characteristic behaviors, the present invention takes advantage of this feature and provides a process for optimizing the selection of a particular battery to match a particular motor and a particular use. An examination of the time When the PTC device switches to the higher resistance condition can be used as this indicator for optimizing a particular motor and drive train to a battery. It is desirable to know when the PIC device makes this switch so that, during normal stapler use, the PTC device does not make this change.
Exemplary batteries were loaded with various levels from approximately 3 amps to = approximately 8 amps. At the high end, the PTC device changed to the high-resistance state almost immediately, making This current level too high for standard CR123 cells. It was determined that, for between 4 and 6 amps, one manufacturer's cell had PTC activation sooner than another .10 manufacturer's cell. The longest PIC changeover duration for the second manufacturer was >3 minutes f.or 4 amps, approximately 2 minutes for 5 amps, and almost 50 seconds for 6 amps. Each of these durations was significantly greater than the 8-second peak load requirement. Accordingly, it was determined that the second manufacturer's cells would be optimal for use at peak amps as compared to the first manufacturer's cells.
Initially, it was surmised that higher amperes with lower or constant voltage would generate higher power out of the power cell(s). Based upon the configuration of 6 cells in series, the peak voltage could be 18 volts with a peak current of only 6 amps. Placing cells in parallel, in theory, should allow a higher peak amperage and a 3x2 configuration (two parallel set of three cells in series) could have a 9 volt peak with up to a 12 amp peak.
Different single cells were investigated and it was confirmed that a relatively low voltage (about 1,5 to 2 volts) and approximately 4 to 6 amperes produces the highest power in Watts. Two six-cell configurations were examined: a 6x1 series connection and a 3x2 parallel connection. The 3x2 configuration produced the greatest peak amperes of approximately 10 amps.
The 6x1 configuration produced about 6 amps peak and the single cell was able to peak at 5-6 amps beibre the PTC device changed state. This information indicated the state at which any single cell in the series group would be activating its Pit device and, thus, limiting current through the entire group of cells. Thus, the tentative conclusion of yielding peak amps at lower voltage with a 3x2 configuration was maintained.
Three different CR123 battery configurations were tested: 4x1, 6x1, and 3x2, to see how fast the pinion would move the rack (in inches per second ("IPS")) for the 120# and 180# loads and for a given typical gearing The results of this real world dynamic loading test are shown in the chart of FIG. 31, for both the 1201iload = the 4x1 battery pack was able to move the load at about 0,6 IPS at approximately 2.5 amps but at approximately 8 volts;
= the 6x1 battery pack was able to move the load at. about 0,9 IPS at approximately 2,5 amps but at approximately 13 volts; and = the 3x2 battery pack was able to move the load at about 0,4 IPS at approximately 2.5 amps but at approximately 6 volts;
and the 1804 load:
= the 4x1 battery pack was able to move the load at about 0.65 IPS at approximately 4 amps but at approximately 7.5 volts;
= the 6x1 battery pack was able to move the load at about. 0.9 IPS at approximately 4 amps but at approximately 12 volts; and = the 3x2 battery pack was able to move the load at about 0.4 IPS at approximately 4 amps but at approximately 7 volts.
Clearly, the peak current was limited and this limit was dependent upon the load. This experiment revealed that the motor drew a similar current regardless of the power supply for a given load but that the voltage changed depending upon the battery cell configuration. With respect_ to either load, the power output was the greatest in the 6x1 configuration and not in the 3x2 configuration, as was expected. From this, it was determined that the total power of the cell pack is driven by voltage and not by current and, therefore, the parallel configuration (3x2) was not the path to take in optimizing the power source.
Traditionally, when designing specifications for a motor, the windings of the motor are matched to the anticipated voltage at which the motor will be run. This matching takes into account the duration of individual cycles and the desired overall life of the product.
In a case of an electric stapling device the motor will only be used for very short cycles and for a very short life, traditional matching methods yield results that are below optimal. Manufacturers of the IMAMS give a voltage rating on a motor that corresponds to the number of turns of the windings. The lower the number of turns, the lower the rated voltage. Within a given size of motor winding, a lower number of' turns allows larger wire to be used, such that a lower number of turns results in a lower resistance in the windings, and a higher number of turns results in a higher resistance. These characteristics limit the maximum current that the motor will draw, which is what creates most of the heat and damage when the motor is overdriven. For the present invention, a desirable configuration will have the lowest winding resistance to draw the most current from the power supply (i.e., battery pack). By .ninning the motor at a voltage much higher than the motor rating, significantly greater power can be drawn from similarly sized motors. This trait was verified with testing of nearly identical coreless motors 5 that only varied in winding resistance (and, hence, the number of rums).
For example, 12-volt and 6-volt rated motors were run with 6 cells (i.e., at 19.2 volts). The motors rated for 12 volts output peak power of 4 Watts with the battery voltage only falling slightly to 18 volts when drawing 0.7 amps. In comparison, the motors rated for 6 volts output 15 Watts of power with the voltage dropping to 15 volts but drawing 2 amps of current. Therefore, the lower resistance windings were 10 selected to draw enough power out of the batteries. It is noted that the motor windings should be balanced to the particular battery pack so that, in a stall condition, the motor does not draw current from the cells sufficient to activate the PTC, which condition would impermissibly delay use of an electric surgical stapler during an operation.
The 6x1 power cell configuration appeared to be more than sufficient to meet the 15 requirements of the electric stapling device. Nonetheless, at this point, the power cell can be fiirther optimized to determine if six cells are necessary to perform the required work. Four cells were, then, tested and it was determined that, under the 1204 load, the motor/drive train could not move the rack over the 60 mm span within 3 seconds. Six cells were tested and it was determined that, under the 120# load, the motor/drive train could MONT the rack over the 60 mm span in 2.1 seconds ¨ much 20 faster than the 3-second requirement. it was further determined that, under the 1804 load, the motor/drive train could move the rack over the 60 mm span in less than 2.5 seconds ¨ much quicker than the 8-second requirement. At this point, it is desirable to optimize the power source and mechanical layout to make sure that there is no "runaway" stapling/cutting; in other words, if the load is significantly less than the required 1804 maximum, or even the 1204 maximum, then it would 25 not be desirable to have the rack move too fast.
The gear reduction ratio and the drive system need to be optimized to keep the motor near peak efficiency during the firing stroke. The desired stroke of 60 min in 3 seconds means a minimum rack velocity of 20 mm/sec (-0.8 inches/second). To reduce the number of variables in the optimization process, a basic reduction of 333:1 is set in the gear box.
This leaves the final 30 reduction to be performed by the gears present between the output shaft 214 of the gear box and the rack 217, which gears include, for example, a bevel gear 215 and the pinion 216 (which drives the rack), a simplified example of which is illustrated in FIG. 32.
These variables can be combined into the number of inches of rack travel with a single revolution of the output shaft 214 of the 333:1 gearbox. if the gearbox output (in rpm) never changed, it would be a simple function to match the inches of rack travel per output shaft. revolution ("[PR.") to the output rpm to get a desired velocity as follows:
(60 rpm 1 revolution/second (rps); I rps (i.P. 0.8 IPR. 3 0.8 in/sec).
In such an idealized case, if the IPR is plotted against velocity, a. straight line would be produced.
Velocity over a fixed distance can be further reduced to Firing Time. Thus, a plot of Firing Time versus IPR would also be a straight line in this idealized case. However, output of the motor (in rpm) and, therefore, of the gearbox, is not fixed because this speed varies with the load. The degree of load determines the amount of power the motor can put out. As the load increases, the tprns decrease and the efficiency changes. Based upon an examination of efficiency with differing loads, it has been determined that efficiency peaks at just over 60%. However, the corresponding voltage and amperes at this efficiency peak are not. the same as at the point of peak.
power. Power continues to increase as the load increases until the efficiency is falling faster than the power is increasing. As the IPR increases, an increase in velocity is expected, but. a corresponding increase in IPR lowers the mechanical advantage and., therefore, increases the load. This increasing load, with the corresponding decrease in efficiency at progressively higher loads, means that a point will exist when greater velocity out of the rack is no longer possible with greater IPR.
This behavior is reflected as a deviation from a predicted straight line in the plot of Firing Time (in sec) versus IPR.
Experimentation of the system of the present invention reveals that the boundary between unnecessary mechanical advantage and insufficient mechanical advantage occurs at approximately 0.4 IPR.
From this .T.PR value, it is possible to, now, select, the final gear ratio of the bevel gear 215 to be approximately three times greater (3:1) than the sprocket of the output shaft. This ratio translates into an approximate IPR of 0.4.
Now that the bevel gear 215 has been optimized, the battery pack can be reexamined to determine if six cells could be reduced to five or even four cells, which would save cost and . considerably decrease the volume needed for the power supply within the handle. A constant load of approximately 120# was used with the optimized motor, drive train, bevel gear, and rack and pinion and it was discovered that use of 4 cells resulted in an almost 5 second time period for moving the rack 60 mm. With 5 cells, the time was reduced to approximately 3.5 seconds.
With a 6-ce1l configuration, the time was 2.5 seconds. Thus, interpolating this curve resulted in a minimum cell configuration of 5.5 cells. Due to the fact that cells only can be supplied in integer amounts, it was discovered that the 6-cell configuration was needed to meet the requirements provided for the electric stapling device.
From this, the minimum power source volume could be calculated as a fixed value, unless different sized cells could be used that provided the same electrical power characteristics. Lithium cells referred as CR2s have similar electrical power characteristics as have CR123s but are smaller.
Therefore, using a 6-cell power supply of CR2s reduced the space requirement by more than 17%.
As set forth in detail above, the power source (i.e., batteries), drive train, and motor are optimized for total efficiency to deliver the desired output force within the required window of time .10 for completing the surgical procedure. The efficiency of each kind of power source, drive train, and motor was examined and, thereafter, the type of power source, drive train, and motor was selected based upon this examination to deliver the maximum power over the desired time period. In other words, the maximum-power condition (voltage and current) is examined that can exist for a given period of time without activating the PTC (e.g., approximately 15 seconds).
The present invention locates the voltage-current-power value that optimizes the way in which power is extracted from the cells to drive the motor. Even after such optimization, other changes can be made to improve upon the features of the electric stapler 1.
Another kind of power supply can be used and is referred to herein as a "hybrid" cell. In such a configuration, a rechargeable Lithium-ion or Lithium-polymer cell is connected to one or more of the optimized cells mentioned above (or perhaps another primary cell of smaller size but of a similar or higher voltage). In such a configuration, the Li-ion cell would power the stapling/cutting motor because the total energy contained within one CR2 cell is sufficient to recharge the Li ion cell many times, however, the primary cells are limited as to delivery. Li-ion and Li-Polymer cells have very low internal resistance and are capable of very high currents over short durations. To harness this beneficial behavior, a primary cell (e.g., CR123, CR2, or another cell) could take 10 to 30 seconds to charge up the secondary cell, which would form an additional power source for the motor during firing. An alternative embodiment of the Li-ion cell is the use of a capacitor; however, capacitors are volume inefficient. Even so, a super capacitor may be put into the motor powering system; it may be disconnected electrically therefrom until the operator determines that additional power is required. At such a time, the operator would connect the capacitor for an added "boost" of energy.
=
=
As mentioned above, if the load on the motor increases past a given point, the efficiency begins to decrease. In such a situation, a multi-ratio transmission can be used to change the delivered power over the desired time period. When the load becomes too great such that efficiency decreases, a multi-ratio transmission can be used to switch the gear ration to return the motor to the higher efficiency point, at which, for example, at least a 180# force can be supplied. It is noted, however, that the motor of the present invention needs to operate in both forward and reverse directions. In the latter operating mode, the motor must be able to disengage the stapling/cutting instrument from out of a "jammed" tissue clamping situation. Thus, it would be beneficial for the reverse gearing to generate more force than the forward gearing, With significantly varying loads, e.g., from low pounds up to 180 pounds, there is the possibility of the drive assembly being too powerfill in the lower end of the load range. Thus, the invention can include a speed governing device. Possible governing devices include dissipative (active) governors and passive governors. One exemplary passive governor is a flywheel, such as the energy storage element 56, 456 disclosed in U.S. Patent Application No.
2005/0277955 to Palmer et al. Another passive governor that can be used is a "fly"
paddlewheel. Such an assembly uses wind resistance to govern speed because it absorbs more force as it spins faster and, therefore, provides a speed governing characteristic when the motor is moving too fast.
Another kind of governor can be a compression spring that the motor compresses slowly to a compressed state.
When actuation is desired, the compressed spring is released, allowing all of the energy to be transferred to the drive in a relatively short amount of time. A further exemplary governor embodiment can include a multi-stage switch having stages that are connected respectively to various sub-sets of the battery cells. When low force is desired, a first switch or first part of a switch can be activated to place only a few of the cells in the power supply circuit.
As more power is desired, the user (or an automated computing device) can place successive additional cells into the power supply circuit. For example, in a 6-cell configuration, the first 4 cells can be connected to the power supply circuit: with a first position of a switch, the fifth cell can be connected with a second position of the switch, and the sixth cell can be connected with a third position of the switch.
Electric motors and the associated gear box produce a certain amount of noise when used, The stapler of the present invention isolates the motor and/or the motor drive train from the handle to decrease both the acoustic and vibration characteristics and, thereby, the, overall noise produced during operation. In a first embodiment, a dampening material is disposed between the handle body and both of motor and the drive train, The material can be foam, such as latex, polyester, plant-based, polyether, polyetherimide, polyimide, polyolefin, polypropylene, phenolic, polyisocyanates, polyurethane, silicone, vinyl, ethylene copolymer, expanded polyethylene, fluoropolymer, or styrofoam. The material can be an elastomer, such as silicone, polyurethane, chloroprene, butyl, polybutadiene, neoprene, natural rubber, or isoprene. The foam can be closed cellular, open cellular, flexible, reticular, or syntactic, for example. The material can be placed at given positions between the handle and motor/gear box or can entirely fill the chamber surrounding the motor/gear box, In a second embodiment, the motor and drive train are isolated within a nested box configuration, sometimes referred to as a "Chinese Box" or "Russian nesting doll." in such a.
configuration, the dampening material is placed around the motor/gear box and the two are placed within a first box I 0 with the gear box shaft protruding therefrom. Then, the first box is mounted within the "second box" -- the handle body and the dampening material is place between the first box and the handle interior.
The electric stapler of the present invention can be used in surgical applications. Most stapling devices are one-time use. They can be disposed after one medical procedure because the cost is relatively low. The electric surgical stapler, however, has a greater cost and it. may be desirable to use at least the handle for more than one medical procedure.
Accordingly, sterilization of the handle components after use becomes an issue. Sterilization before use is also significant.
Because the electric stapler includes electronic components that typically do not go through standard sterilization processes (i.e., steam or gamma radiation), the stapler needs to be sterilized by other, possibly more expensive, means such as ethylene-oxide gas. It would be desirable, however, to make the stapler available to gamma radiation sterilization to reduce the cost associated with gas sterilization. It is known that electronics are usable in space, which is an environment where such electronics are. exposed to gamma radiation. In such applications, however, the electronics need to work while being exposed. In contrast, the electric stapler does not need to work while being exposed to the gamma sterilization radiation. When semiconductors are employed, even if the power to the electronics is turned off, gamma radiation will adversely affect the stored memory.
These components only need to withstand such radiation and, only after exposure. ceases, need to be ready for use. Knowing this, there are various measures that can be taken to gamma-harden the electronic components within the handle. First, instead of use MOSFET memory, for example, 'Usable link memories can be used. For such memories, once the fuses are programmed burnt), the memory becomes permanent and resistant to the gamma sterilization. Second, the memory can be mask-programmed. if the memory is hard programmed using masks, gamma radiation at the level for medical sterilization will not adversely affect the programming.
Third, the sterilization can be performed while the volatile memory is empty and, after sterilization, the memory can be programmed through various measures, for example, a wireless link including infrared, radio, ultrasound, or Illuetooth communication can be used. Alternatively, or additionally, external 5 electrodes can be contacted in a clean environment and these conductors can program the memory.
Finally, a radiopaque shield (made from molybdenum or tungsten, for example) can be provided around the gamma radiation sensitive components to prevent exposure of these components to the potentially damaging radiation.
As set forth herein, characteristics of the battery, drive train, and motor are examined and .10 optimized for an electric stapling application. The particular design (i.e., chemistry and PIC) of a battery will determine the amount of current that can be supplied andlor the amount of power that can be generated over a period of time. It has been determined that standard alkaline cells do not have the ability to generate the high power needed over the short period of time to effect actuation of the electric stapling device. It was also determined that some lithium-manganese dioxide cells also 15 were unable to meet the needs for actuating the stapling device.
Therefore, characteristics of certain lithium-manganese dioxide cell configurations were examined, such as the electrolyte and the positive temperature coefficient device.
Lt is understood that conventional lithium-manganese dioxide cells (e.g., CR123 and CR2) are designed for loads over a long period of time. For example, SUREFIREft markets flashlights 20 and such cells and states that the cells will last for from 20 minutes to a few hours (3 to 6) at the maximum lumen output of the flashlight. Load upon the cells(s) during this period of time is not close to the power capacity of the battery(ies) and, therefore, the critical current rate of' the battery(ies) is not reached and there is no danger of overheating or explosion. If such use is not continuous, the batteries can last through many cycles (i.e., hundreds) at this same full power output.
25 Simply put, such batteries are not designed for loads over a period of 10 seconds or less, for example, five seconds, and are also not designed for a small number of uses, for example, ten to fifteen. What the present invention does is to configure the power supply, drive train, and motor to optimize the power supply (i.e., battery ) for a small number of uses with each use occurring over a period of less than ten seconds and at a load that. is significantly higher than rated.
30 All of the primary lithium cells that were examined possess a critical current rate defined by the respective Pit device andior the chemistry and internal construction. If used above the critical current rate for a period of time, the cells can overheat and, possibly, explode. When exposed to a =
very high power demand (close to the PTC threshold) with a low number of cycles, the voltage and amperage profiles do not behave the same as in prior art standard uses. It has been found that some cells have PTC devices that prevent generation of power required by the stapler of the present invention, but that other cells are able to generate the desired power (can supply the current an voltage) for powering the electric stapling device. This means that the critical current rate is different depending upon the particular chemistry, construction, and/or PTC of the cell.
The present invention configures the power supply to operate in a range above the critical current rate, referred to herein as the "Super-Critical Current Rate." It is noted within the definition of Super-Critical Current Rate also is an averaging of a modulated current supplied by the power supply that is above the critical current rate. Because the cells cannot last long while supplying power at the Super-Critical Current Rate, the time period of their use is shortened. This shortened time period where the cells are able to operate at the Super-Critical Current Rate is referred to herein as the "Super-Critical Pulse Discharge Period," whereas the entire time when the power supply is activated is referred to as a "Pulse Discharge Period." In other words, the Super-Critical Pulse Discharge Period is a time that is less than or equal to the Pulse Discharge Period, during which time the current rate is greater than the critical current rate of the cells. The Super-Critical Pulse Discharge Period for the present invention is less than about 16 seconds, in other words, in a range of about one-half to fifteen seconds, for example, between two and four seconds and, more particularly, at about three seconds. During the life of the stapling device, the power supply may be subjected to the Super-Critical Current Rate over the Pulse Discharge Period for at least one time and less than twenty times within the time of a clinical procedure, for example, between approximately five and fifteen times, in particular, between ten and fifteen times within a period of five minutes, Therefore, in comparison to the hours of use for standard applications of the power supply, the present invention will have an aggregate use, referred to as the Aggregate Pulse Time, of, at most, approximately 200 to 300 seconds, in particular, approximately 225 seconds. It is noted that, during an activation, the device may not be required to exceed or to always exceed the Super-Critical Current Rate in a given procedure because the load presented to the instrument is dependent upon the specific clinical application (i.e.: some tissue is denser than others and increased tissue density will increase load presented to device), :However, the. stapler is designed to be able to exceed the Super-Critical Current Rate for a number of times during the intended use of the surgical procedure. Acting in this Super-Critical Pulse Discharge Period, the device can operate a sufficient amount of times to complete the desired surgical procedure, but not many more because the power supply is asked to perform at. an increased current.
When performing in the increased range, the force generated by the device, e.g., the electric stapler 1, is significantly greater than existed in a hand-powered stapler. In fact, the force is so much greater that it could damage the stapler itself. In one exemplary use, the motor and drive assemblies can be operated to the detriment of the knife blade lock-out feature -- the safety that prevents the knife blade 1060 from advancing when there is no staple cartridge or a previously fired staple cartridge in the staple cartridge holder 1030. This feature is illustrated in FIG. 33. As discussed, the knife blade 1060 should be allowed to move distally only when the staple sled 102 is present at the firing-ready position, i.e., when the sled 102 is in the position illustrated in Fla 33. If the sled 102 is not present in this position, this can mean one of two things, either there is no staple cartridge in the holder 1030 or the sled 102 has already been moved distally ¨ in other words, a partial or full firing has already occurred with the loaded staple cartridge. Thus, the blade 1060 should not be allowed Co move, or should be restricted in its movement. Accordingly, to insure that the sled 102 can prop up the blade 1060 when in a firing state, the sled 102 is provided with a lock-out contact surface 104 and the blade 1060 is provided with a correspondingly shaped contact nose 1069. It is noted at this point that, the lower guide wings 1065 do not rest against a floor 1034 in the cartridge holder 1030 until the blade 1060 has moved distally past an edge 1035. With such a configuration, if the sled 102 is not present at the distal end of the blade 1060 to prop up the nose 1069, then the lower guide wings 1065 will follow the depression 1037 just proximal of the edge 1035 and, instead of advancing on the floor 1034, will hit the edge 1035 and prevent further forward movement of the blade 1060. To assist with such contact when the sled 102 is not present (referred to as a "lock our), the staple cartridge 1030 has a plate spring 1090 (attached thereto by at least one rivet 1036) for biasing the blade 1060. With the plate spring 1090 flexed upward and pressing downward against the flange 1067 (at least until the flange 1067 is distal of the distal end of the plate spring 1090), a downwardly directed force is imparted against the blade 1060 to press the wings 1065 down into the depression 1037. Thus, as the blade 1060 advances distally without the sled 102 being present, the wings 1065 follow the lower curve of the depression .1037 and are stopped from further distal movement when the distal edge of the wings 1065 hit the edge 1035.
This safety feature operates as described so long as the force transmitted by the knife blades 1062 to the blade 1060 is not great enough to tear off the lower guide wings1065 from the blade 1060. With the forces able to be generated by the power supply, motor and drive train of the present invention, the blade 1060 can be pushed distally so strongly that the wings 1065 are torn away. If this occurs, there is no way to prevent distal movement of the blade 1060 or the sled 102.
Accordingly, the present invention provides a way to lower the forces able to be imparted upon the wings 1065 prior to their passage past the edge 1035. In other words, the upper limit of force able to be applied to the blade 1060 is reduced in the first part of blade travel (past the edge 1035) and increases after the wings 1065 have cleared the edge 1035 and rest on the floor 1034. More specifically, a first exemplary embodiment of this two-part force generation limiter takes the form of a circuit in which only one or a few of the cells in the power supply are connected to the motor during the first part of the stapling/cutting stroke and, in the second part of the stapling/cutting stroke, most or all of the cells in the power supply are connected to the motor. A first exemplary form of such a circuit is illustrated in MG, 34. In this first embodiment, when the switch 1100 is in the "A" position, the motor (e.g., stapling motor 210) is only powered with one power cell 602 (of a possible four in this exemplary embodiment). However, when the switch 1100 is in the "B"
position, the motor is powered with all four of the cells 602 of the power supply 600, thereby increasing the amount of force that can be supplied to the blade 1060. Control of the switch 1100 between the A and B positions can occur by positioning a second switch somewhere along the blade control assembly or along the sled 102, the second switch sending a signal to a controller after the wings 1065 have passed the edge 1035. It is noted that this first embodiment of the control circuit is only exemplary and any similarly performing assembly can provide the lock-out protection for the device, see, for example, the second exemplary embodiment illustrated in FIG.
36.
A first exemplary form of a forward and reverse motor control circuit is illustrated in FIG, 35. This first exemplary embodiment uses a double-throw, double pole switch 1200. The switch 1200 is normally spring-biased to a center position in which both poles are off The motor M
illustrated can, for example, represent the stapling motor 210 of the present invention. As can be seen, the power-on switch 1210 must be closed to turn on the device. Of course, this switch is optional. When a forward movement of the motor M is desired, the switch 1200 is placed in the right position as viewed in FIG. 35, in which power is supplied to the motor to run the motor in a first direction, defined as the forward direction here because the "+" of the battery is connected to the "+" of the motor M. In this forward switching position, the motor M can power the blade 1060 in a distal direction. Placement of an appropriate sensor or switch to indicate the forward-most desired position athe blade 1060 or the sled 102 can be used to control a fiarward travel limit switch 1220 that interrupts power supply to the motor M and prevents further forward travel, at least as long as the switch 1220 remains open. Circuitry can be programmed to never allow this switch 1220 to close and complete the circuit or to only allow resetting of the switch 1220 when a new staple cartridge, for example, is loaded.
When a reverse movement of the motor M is desired, the switch 1200 is placed in the left position as viewed in FIG. 35, in which power is supplied to the motor to run the motor in a second direction, defined as the reverse direction here because the "-" of the battery is connected to the "+"
of the motor M. In this reverse switching position, the motor M can power the blade 1060 in a proximal direction. Placement of an appropriate sensor or switch to indicate the rearward-most desired position of the blade 1060 or the sled 102 can be used to control a rearward travel limit switch 1230 that interrupts power supply to the motor Ni and prevents further rearward travel, at least as long as the switch 1230 remains open. It is noted that other switches (indicated with dotted arrows) can be provided in the circuit to selectively prevent movement in either direction independent of the limit switches 1220, 1230.
It is noted that the motor can power the gear train with a significant amount of force, which translates into a high rotational inertia. As such, when any switch mentioned with respect to FIGS.
34 and 35 is used to turn off the motor, the gears may not just stop. Instead, the rotational inertia continues to propel, for example, the rack 217 in the direction it was traveling when power to the motor was terminated. Such movement can be disadvantageous for many reasons.
By configuring the power supply and motor appropriately, a circuit can be formed to substantially eliminate such post-termination movement, thereby giving the user more control over actuation.
FIG. 36 illustrates an exemplary embodiment where the motor (for example, stapling motor 210) is arrested from further rotation when forward or reverse control is terminated. FIG. 36 also illustrates alternative embodiments of the forward/reverse control and of the multi-stage power supply. The circuit of Fla 36 has a motor arrest sub-circuit utilizing a short-circuit property of an electrical motor. More specifically, the electrical motor M is placed into a short-circuit so that an electrically generated magnetic field is created in opposition to the permanent magnetic field., thus slowing the still-spinning motor at a rate that substantially prevents inertia-induced over-stroke. To explain how the circuit of FIG. 36 can brake the motor M, an explanation of the 'forward/reverse switch 1300 is provided. As can be seen, the forward/reverse switch 1300 has three positions, just 10 like the switch 1200 of FIG. 35. When placed in the right position, the motor Ni is actuated in a forward rotation direction. When placed in the left position, the motor M is actuated in a rearward rotation direction. When the switch 1300 is not actuated ¨ as shown in FIG. 36 the motor M is short circuited, This short circuit is diagrammatically illustrated by the upper portion of the switch 1300. It is noted that the switching processes in a braking switch is desired to take place in a time-delayed manner, which is also referred to as a break-before-make switching configuration. When switching over from operating the motor M to braking the motor M, the double-pole, double throw 5 portion of the forward/reverse switch 1300 is opened before the motor short circuit is effected.
Conversely, when switching over from braking the motor M to operating the motor M, the short circuit is opened before the switch 1300 can cause motor actuation. Therefore, in operation, when the user releases the 3-way switch 1300 from either the forward or reverse positions, the motor M is short-circuited and brakes quickly.
.10 Other features of the circuit in FIG, 36 have been explained with regard to FIG 35. For example, an on/off switch 1210 is provided. Also present is the power lock-out switch 1100 that only powers the motor with one power cell 602' in a given portion of the actuation (which can occur at the beginning or at any other desired part of the stroke) and powers the motor M with all of the power cells 602 (here, for example, six power cells) in another portion of the actuation.
IS A new feature of the reverse and forward limit switches 1320, 1330 prevents any further forward movement of the motor M after the forward limit switch 1320 is actuated. When this limit is reached, the forward limit switch 1320 is actuated and the switch moves to the second position. In this state, no power can get to the motor for forward movement but power can be delivered to the motor for reverse movement. The forward limit switch can be programmed to toggle or be a one-20 time use for a given staple cartridge. More specifically, the switch 1320 will remain in the second position until a reset occurs by replacing the staple cartridge with a new one. Thus, until the replacement occurs, the motor M can only be powered in the reverse direction.
lithe switch is merely a toggle, then power can be restored for additional further movement, only when the movement has retreated the part. away from actuating the switch 1320.
25 The reverse limit switch 1330 can be configured similarly. When the reverse limit is reached, the switch 1330 moves to the second position and stays there until a reset occurs. It is noted that, in this position, the motor M is in a short-circuit, which prevents motor movement in either direction, With such a configuration, the operation of the stapler can be limited to a single stroke up to the forward limit and a single retreat up to the rear limit. When both have occurred, the 30 motor M is disabled until the two switches 1320 are reset.
Referring now to the figures of the drawings in detail and first, particularly to FIGS. 37 to 40 thereof, there is shown an exemplary embodiment of an electric surgical device 1000 according to , -, the invention, which, in this embodiment, is an electric surgical linear stapler. FIG. 37 shows the left side of the device 1000 with the handle's outer shell 1001 and 1002 removed.
Similarly, FIG. 39 shows the right side of the device 1000 with the handle's outer shell removed.
The two halves of the outer shell 1001 and 1002 are only shown in FIGS. 63 to 66 to allow for clear viewing of the internal assemblies. Also not shown in these and the subsequent figures is the end effector. An exemplary embodiment of a linear stapling end effector is described in detail in the family of co-owned and co-pending patent applications including U.S. Provisional Patent Application No.
60/702,643 filed July 26, 2005, 60/760,000 filed January 18, 2006, and 60/811,950 filed June 8, 2006, and U.S. Patent No.
8,579,176 issued November 12, 2013, U.S. Patent No. 7,404,508 issued July 29, 2008, U.S.
Published Application No. 20070073341 published March 29, 2007 and U.S. No.
Patent 7,419,080 issued September 2, 2008.
FIG. 38 shows the mechanical assembly of the device 1000 with the left-side frames 1010 removed. FIG. 40, in comparison, shows the mechanical assembly both the left-and right-side frames 1010, 1020 removed.
FIG. 37 shows the gear cover plate 1105, under which are the first-, second-, and third-stage gears 1110, 1120, 1130 of the motor transmission assembly. Also appearing in FIG. 37 is the end effector closing assembly 1400. This end effector closing assembly 1400 will be explained in greater detail with regard to FIGS. 59 to 60.
FIGS. 37 to 38 also show the electric power and power control assemblies. The electric power assembly 1500 in this exemplary embodiment is a removable battery pack containing one or more batteries 1510. As set forth above, one exemplary power supply is a series connection of between four and six CR123 or CR2 power cells. Here, there are six batteries 1510. One of these batteries 1510a, the one on the upper left in FIG. 37, is placed in an electrically disconnectable configuration so that power can be supplied selectively to the motor 1520 through either the single battery 1510a or the entire set of six batteries 1510. This is beneficial in applications where only a small amount of power is needed or where full torque is desired to be prohibited. One such prohibition is mentioned above with regard to moving the staple sled or blade past the lock-out. The exemplary circuit only connects this one cell 1510a to the motor 1520 during the first part of the stapling/cutting stroke and, in the second part of the stapling/cutting stroke, all of the cells 1510, 1510a in the power supply are connected to the motor 1520. See FIG. 34.
The power supply control assembly 1600 in the exemplary embodiment takes the form of a rocker switch 1610. In one actuated direction of the rocker switch 1610, the motor 1520 is caused to =
rotate in a first direction, for example, forward, and in the other actuated direction of the rocker switch 1610, the motor 1520 is caused to rotate in an opposite second direction, for example, reverse.
The electrically powered drive train in the exemplary embodiment is used to operate one feature of a linear cutter/stapler. Here, the drive train is being used to actuate the stapling/cutting feature. To do this, the drive train is connected to a linear actuator 1700, which, in the present embodiment, is in the form of a toothed rack that translates distally and proximally along a rack guide 1720. As shown in FIG. 38, the rack 1700 is in a relatively proximal position. To minimize the size of the shell 1001, 1002 at the proximal end (right side of FIG 38)., the rack 1700 has a pivoting portion 1710 that pivots freely in the downward direction (as viewed in FIG. 38) when the pivoting portion 1710 is not contained within the rack guide 1720. As the rack 1700 moves distally (to the left in FIG. 38), the bottom of the pivoting portion 1710 contacts the proximal end of the rack guide 1720 and is caused to pivot upward to a position that is substantially coaxial with the remainder of the rack 1700 due to the shape of the rack guide 1720. The proximal end of the rack guide 1720 is seen in FIG. 41.
The teeth 1702 of the rack 1700 are shaped to interact with a final stage of the drive train in a rack-and-pinion configuration. While various features of the drive train are visible in virtually all of FIGS. 37 to 47, the explanation of the drive train is easily seen with particular reference to FIGS. 43 and 46. It is noted here that some of the transmission stages shown in many of the figures have no teeth. This is because the gears are merely diagrammatic representations of a particular exemplary embodiment, Thus, the lack of teeth, or even the number or size of teeth present, should not be taken as limiting or fixed. Additionally, many of the gears illustrated are shown with a central band located inside the teeth. This band should not be considered as part of the device 1000 and is, merely, a limitation of the software used to create the figures of the instant application.
The explanation of the drive train starts from the motor 1520. An output gear 1522 of the motor '1520 is connected to the first, second, and third stages 111.0, 1120, 1130 of the transmission.
The third stage 1130 is coupled to the final gear present on the left side of the device 1000. This couple is difficult to view in all of the figures because of its interior location. FIGS. 55 to 56, however, show the coupling of the third stage 1130 to the fourth stage, cross-over gear 1140. As mentioned above, the output of the third stage 1130 is only diagrammatically illustrated -- as a cylinder without teeth. Continuing to refer to FIG. 46, the cross-over gear 1140 is rotationally coupled to a fourth stage shaft 1142, which shaft 1142 crosses over the rack 1700 from the left side of the device 1000 to the right side. The right side of the shaft 1142 is not directly coupled in a rotational manner to any of the gears on the right side. Instead, it rotates inside a shaft bearing 1144 that fits inside a corresponding pocket within the right side frame 1020, which frame 1020 is removed from the view of:FIG. 46 to allow viewing of the right side drive train.
A castle gear 1146 (shown by itself in FIG. 53) is positioned on the cross-over shaft 1142 to be rotationally fixed therewith but longitudinally translatable thereon. To permit such a connection, the shaft 1142 has a non-illustrated interior slot in which is disposed a non-illustrated pin that passes through two opposing ports 11462 of the castle gear 1146. By fixedly securing the pin to the castle gear 1146, rotation of the shaft 1142 will cause a corresponding rotation of the castle gear 1146 while still allowing the castle gear 1146 to freely translate along the longitudinal axis of the shaft 1142, at least to the extent of the slot in the shaft 1142. As can be seen in FIG. 46, the right-side castellations 11464 of the castle gear 1146 are shaped to fit between corresponding castellation slots 11482 on the left-side of a fourth stage pinion 1148, which is illustrated by itself in FIG. 54.
Because the castle gear 1146 is required to mate securely with the fourth stage pinion 1148, a right-side biasing force F is needed. To supply this bias, a non-illustrated compression spring, for example, can be provided to have one end contact the right face of the cross-over gear 1140 and the other opposing end contact the left face of a central flange 11468, which projects radially away from the outer cylindrical suiface of the castle gear 1146. (This flange 11468 will be described in more detail below with respect to the manual release feature of the device 1000.) Any other similarly functioning bias device can be used instead of the exemplary spring. Such a configuration allows the castle gear 1146 to be selectively rotationally engaged with the fourth stage pinion 1148. More specifically, when the castle gear 1146 is not acted upon by any force other than the force F of the bias device, the castellations 11464 will be mated with the castellation slots 11482 and any rotation of the shaft. 1142 will cause a corresponding rotation of the fourth stage pinion 1148. However, when a force opposing and overcoming the bias F is applied, the castellations 11464 exit the castellation slots 11482 and any rotation of the shaft 1142 has no effect on the fourth stage pinion 1148. It is this selective engagement that allows a manual release to occur.
Before such release is explained, the tight side drive train is described.
The fourth stage pinion 1148 is directly engaged with a fifth stage 1150 of the drive train, which has a fifth stage shaft 1152, a fifth stage input gear 1154 rotationally fixed to the fifth stage shaft 1152, and a fifth stage pinion 1156, also rotationally fixed to the fifth stage shaft 1152. The teeth of the fifth stage pinion 1156 are directly coupled to the teeth .1702 of the rack 1700. Thus, any rotation of the fifth stage input gear 1154 causes a corresponding rotation of the fifth stage pinion and a longitudinal movement of the rack 1700. As viewed in the exemplary embodiment of :FIG. 46, a clockwise rotation of the fifth stage input gear 1154 causes a proximally directed movement of the rack 1700 (retract) and a counter-clockwise rotation of the fifth stage input gear 1154 causes a distally directed movement of the rack 1700 (extend).
Based upon the above connection of the five stages of the drive train, rotation of the motor shaft in one direction will cause a longitudinal movement ot7the rack 1700, but only when the castle gear '1146 is engaged with the fourth stage pinion 1148. When the castle gear 1146 is not engaged with the fourth stage pinion 1148, rotation of the motor has no effect on the rack 1700. It is in this uncoupled state of the two gears 1146, 1148 that a manual. release of the rack 1700 becomes possible.
In operation of the device 1000, the rack 1700 moves distally (extends) to actuate some part of an end effector. In the embodiment of a linear surgical stapling/cutting device, when the rack.
1700 moves distally, the sled (carrying the stapling actuator and cutting blade) that causes both stapling and cutting to occur is moved distally to effect both stapling and cutting. Because the tissue placed between the jaws of the end effector is different in virtually every surgical procedure, a physician cannot anticipate times when the sled will be jammed or stuck for any reason. In a jammed case, the sled will need to be retracted distally without use of the motor. There also exists the possibility of a power loss or the possibility that the motor fails in a catastrophic fashion rendering the output shaft fixed. If this occurred when the sled was in a distal position, the jaws of the end effector would be held Shut on the tissue therebetween and, consequently, the sled would have to be moved proximally before the jaws could be opened and the tissue could be released. in such a case, the rack 1700 will need to be retracted distally without use of the motor. To effect this desired function, the invention is provided with a manual release assembly 1800.
in each of FIGS. 37 to 44, 55, 59 to 62, the manual release lever 1810 is in the un-actuated (e.g., down) position. In FIGS. 45 and 57, the manual release lever 1810 is in an intermediate position. And, in FIGS. 46, 47, 56, and 58, the manual release lever 1810 is approximately in a fully actuated (e.g., up) position.
When the manual release lever 1810 is in the un-actuated position, as can be seen in FIG. 44, the castle gear 1146 is engaged with the fourth stage pinion 1148. Thus, any rotation of the output gear 1522 of the motor 1520 causes movement of the rack 1700. The fourth stage pinion 1148 is not only directly connected to the -fifth stage input gear 1154, however. It is also directly connected to a first stage release gear 1820, which, in turn, is directly connected to a second stage release gear 1830. Thus, any rotation of the fourth stage pinion 1148 necessarily causes a rotation of the second stage release gear 1830 (the direction of which being dependent upon the number of gears therebetween). If the axle of this gear 1830 was directly connected to the manual release lever 1810, 5 the lever 1810 would rotate every time the fourth stage pinion 1148 rotated. And, if the fourth stage pinion 1148 rotated more than one revolution, the lever 1810 could possibly be caused to rotate through a full 360 degree revolution. As expected, this does not occur due to the presence of a one-way gear assembly coupling the manual release lever 1810 to the second stage release gear 1830 (see explanation of FIG. 48 below). it is noted that the first stage release gear 1820 has a toothed shaft 10 1822 extending coaxially therefrom. This toothed shaft 1822 is directly coupled to an indicator wheel 1840. As can he seen on the right surface of the wheel 1840, there is a curved shape linearly expanding about the axis of the wheel 1840 and having a different color from the remainder of the surface. When coupled with the window 1004 present on the right side shell 1002 (see FIGS. 64 to 65), the colored shape becomes more and more visible in a linear manner --corresponding to a linear 15 distance of the rack 1700 traveled from the fully proximal (e.g., retracted) position.
The one-way gear assembly coupling the manual release lever 1810 to the second stage release gear 1830 is shown in F1G. 48. This assembly is formed by providing a ratchet gear 1850 centered at a pivot point of the lever 1810 and extending an axle 1852 of the ratchet gear 1850 into and through a center bore 1832 of the second stage release gear 1830. With the axle 1852 fixed to 20 the bore 1832 of the second stage release gear 1830 in this way, any rotation of the second stage release gear 1830 causes a corresponding rotation of the ratchet gear 1850.
But, merely having this ratchet gear 1850 rotate with the second stage release gear 1830 does not, by itself, assist with a manual release of the rack 1700 when the motor 1520 is not powering the drive train.
To create the manual release function, two manual releasing items are present.
The first item 25 is a device that uncouples the right side gear train from the left side gear train and motor. This prevents the manual release from having to overcome the resistance offered by both the motor 1520 and the gears of the left side train when the manual release is actuated. The uncoupling occurs when the castle gear 1146 separates from the fourth stage pinion 1148. To cause this uncoupling, a cam plate 1860 is disposed between the ratchet gear 1850 and the second stage release gear 1830 and is 30 rotationally fixed to the axle 1852. The cam plate 1860 is shown by itself in FIG. 52. The cam plate 1860 is provided with a ramped cam surface 1862 that is positioned to interact with the central flange 11468 of the castle gear 1146. Interaction of the cam plate 1860 with the central flange 11468 can be seen in the progression of FIGS. 44 to 47 and in FIGS. 57 to 58.
In FIG. 44, the manual release lever 1810 is in an unactuated position, which means that it is desired to have the castle gear 1146 rotationally coupled with the fourth stage pinion 1148. In this way, any rotation of the motor 1520 will be translated into a rotation of the fourth stage pinion 1148 and a movement of the rack 1700. In FIGS. 45 to 47 and Site 58, the manual release lever 1810 is in one of a few actuated positions, each of which is illustrated as being sufficient to rotate the cam plate 1860 to have the ramped cam surface 1862 contact the central flange 11468 of the castle gear 1146 and force the castle gear 1146 towards the left side sufficient to separate the castellations 11464 from the castellation slots 11482 of the fourth stage pinion 1148. In this position, the castle gear 1146 is rotationally uncoupled from the fourth stage pinion 1148. Thus, any rotation of the motor 1520 (or the gears of the left side train) will be entirely independent from the right side gear train, thus preventing any movement of the rack 1700 based upon. rotation of the motor .1520_ After the right side gear train become rotationally independent from the right side motor and gear train, to have a manual rack release function, the rack 1700 needs to be moved in the proximal direction. To supply this movement, a second of the two above-mentioned manual releasing items is provided. This second item interacts with the teeth 1832 of the ratchet gear 1850 so that a counter-clockwise rotation of the manual release lever 1810 (when viewed from the right side of the device 1000) causes the ratchet gear 1850 to spin in a counter-clockwise direction ¨
this direction is desired in the illustrated embodiment because such rotation causes a clockwise rotation of the fifth stage pinion 1156 -- a rotation that corresponds to proximal movement (e.g., retraction) of the rack 1700.
To control the ratchet gear 1850 with this counter-clockwise lever 1810 movement, the invention provides a ratchet pawl 1870 that is rotatably mounted on a locking boss 1814 of the lever 1810, This configuration is best illustrated in FIG. 48. A non-illustrated leaf spring is secured in a spring channel 1816 of the lever 1810 to bias the pawl 1870 in a direction D towards the ratchet gear 1850.
It is noted that if the pawl 1870 were not restrained in some way, however, the pawl 1.870 would always contact the teeth 1852 of the ratchet gear 1850 and prevent any clockwise rotation of the gear 1850¨ which occurs in the present embodiment when the castle gear 1146 and the fourth stage pinion 1148 are engaged with one another (see, i.e., FIG, 44) and rotate together. To prevent this condition, as shown in FIGS, 44 and 55, the distal end of the pawl -1870 has a widened portion 1872 that extends out from the pawl cavity 1818 towards the second stage release gear 1830. With the presence of a second cam plate 1880 between the second stage release gear 1830 and the cam plate 1870, a pawl cam 1882 can be positioned to contact the bottom surface of the widened portion 1872 and retain the pawl 1870 in the pawl cavity 1818 (by providing a force in a direction opposite to direction D and against bias of the leaf spring) when the lever 1810 is in a home or unactuated position. This contact between the pawl 1870 and the pawl cam 1882 is shown in FIGS. 44 and 55.
Thus, when the lever 1810 is not actuated, the pawl 1870 has no contact with the teeth 1852 of the ratchet gear 1850. In contrast, when the manual release has rotated past a position sufficient to separate the ratchet gear 1850 from the fourth stage pinion 1148, the bottom surface of the pawl 1870 no longer contacts the pawl cam 1882 of the non-rotating second cam plate 1880 and is, there-time, free to move in the direction D (caused by the biasing force of the leaf spring) to engage the teeth 1852 of the ratchet gear 1850 when rotating counter-clockwise. Thus, when rotating clockwise, the pawl 1870 ratchets against the top surfaces of the teeth 1852.
After about fifteen degrees of travel of the lever 1810, for example, the pawl 1870 no longer is in contact with the pawl cam 1882 and the castellations 11464 of the castle gear 1.146 are no longer engaged with the castellation slots 11482 of the fourth stage pinion 1148. At this point, the pawl 1870 is permitted to move towards the axle 1852 and engages one of the teeth 1852 of the ratchet gear 1850. Further counter-clockwise movement of the lever 1810 turns the ratchet gear 1850 correspondingly, which causes a corresponding counter-clockwise rotation of the second stage release gear 1830. In turn, rotation of the second stage release gear 1830 causes clockwise rotation of the first stage release gear 1820, counter-clockwise rotation of the fourth stage pinion 1148, and clockwise rotation of the fifth stage input gear 1154, respectively. As indicated above, clockwise rotation of the fifth stage input gear 1154 causes proximal movement of the rack 1700 ¨ the desired direction of movement during a manual release of the end effector feature connected to the rack 1700. As the lever 1810 is released, a return bias 1890 forces the lever 1810 back to its unactuated position (see FIG. 44), which causes the pawl cam .1882 to return the pawl :1870 to its upper position in the pawl cavity 1818 where it is disengaged from the teeth 1852 of the ratchet gear 1850. It is noted that contact between the pawl cam 1882 and the lower surface of the widened portion 1872 is made smooth by shaping the respective top front and top rear surfaces of the pawl cam 1882 and bottom front and bottom rear surfaces of the widened portion 1872. It is further noted that the return bias 1890 is shown in FIGS. 46, 57, and 58, for example, as a coil spring, one end of which is wrapped around a bolt secured to the lever 1810 and the other opposing end being a shaft that is secured to a portion of the shell 1001, 1002, illustrated in FIGs. 63-66. The opposing shaft of the coil spring 1890 moves in the illustrations only due to the limitations of the drawing program. This movement does not occur in the invention.
As discussed above, one exemplary embodiment of the end effector for the device 1000 of the present invention includes a set of jaws that close down upon tissue disposed therebetween and a stapler/cutter to secure together each of two sides of the tissue as it is being cut. The manual release described above can be coupled to the stapler/cutter and the end effector closing assembly 1400 can be coupled to the jaws to close the jaws together when actuated. FIGS. 59 to 60 illustrate one exemplary embodiment of the couple between the jaws and the. end effector closing assembly 1400.
Here, the end effector closing assembly 1400 is comprised of a handle 1410 having a lever support 1412 and pivoting about a handle pivot .1414. The lever support 1412 is pivotally connected to a first end of a link 1420. A second opposing end of the link 1420 is pivotally connected to a slider shaft 1430. The end effector shaft assembly 1900 includes an outer shaft 1910 and an inner shaft 1920. The inner shaft 1910 is longitudinally fixed to the frames 1010, 1020 and to the lower jaw of the end effector and, therefore, is the longitudinally fixed component of the end effector. The outer shaft 1920 is connected about the inner shaft 1910 and longitudinally translates thereon. The upper jaw of the end effector pivots in relation to the lower jaw. To cause the pivoting, the outer shaft 1920 is extended from a proximal position, shown in FIG. 59, to a. distal position, shown in FIG. 60.
Because the outer shaft 1920 surrounds the inner shaft, a portion (for example, an upper portion) contacts the proximal end of the open upper jaw, which is at a position proximal of the upper jaw pivot. As the outer shaft 1920 moves further distal, the upper jaw cannot translate distally because of the fixed pivot position, but can rotate about that pivot. Accordingly, the upper jaw closes upon the lower, longitudinally fixed jaw. Simply put, and as can be seen in the progression from FIG. 59 to FIG. 60, when the handle 1410 is moved towards the electric power assembly 1500, the slider 1430 moves in the longitudinal direction from the proximal position of FIG. 59 to the distal position of FIG. 60. This prior art jaw assembly is present on a linear stapler manufactured by Ethicon Endo-Surgery under the trade name Echelon Ec6o.
It is noted that this exemplary configuration of the end effector shaft assembly 1900 is opposite to the end effector actuation shown in family of co-pending patent applications mentioned above, including application serial no. 11/844,406, filed August 24, 2007. As shown in this application in FIGS. 39 and 40, as the lower jaw/staple cartridge holder 1030 is translated in the proximal direction over gap 1031, the upper anvil 1020 is caused to pivot downward because the proximal upper edge of the upper anvil 1020 is being pressed against the longitudinally fixed drum sleeve 1040.
Various prior art linear staplers, such as the Echelon EC60 mentioned above, use the same end effector and shaft Therefore, it is desirable to have those prior art end effector shaft assemblies be able to fit inside the device 1000 of the present invention. This is accomplished by configuring the left and right side frames 1010, 1020 as shown in FIGS. 61 to 62, for example, The frames 1010.
1020 are formed with one side the upper side) open as Shown in FIG. 62, In this configuration, the proximal end of the inner shaft 1910 prior art end effector shaft assembly can simply side in between respective tabs 1012, 1022 to longitudinally fix the inner shaft 1910 (and, thus, the entire assembly) JO therein and transversely fix the inner shaft 19.10 therebetween in all radial directions except for the direction in which the inner shaft 1910 was inserted into the opening between the frames 1010, 1020.
To close off this opening, a shaft plug 1930 is secured between the tabs 1012, 1022, for example, with a bolt, as shown in FIG. 61. In another alternative embodiment, the shaft plug 1930 can be entirely disregarded by extending the distal ends of the left and right frames 1010, 1020 and shaping them, in a clam-shell design, to be secured around the inner shaft 1910 when placed together.
The foregoing description and accompanying drawings illustrate the principles, preferred embodiments and modes of operation of the invention. More specifically, the optimized power supply, motor., and drive train according to the present invention has been described with respect to a surgical stapler. However, the invention should not be construed as being limited to the particular embodiments discussed above. Additional variations of the embodiments discussed above will be appreciated by those skilled in the art as well as for applications, unrelated to surgical devices, that require an advanced power or current output for short and limited durations with a power cell having a limited power or current output. As is shown and described, when optimized according to the present invention, a limited power supply can produce lifting, pushing, pulling, dragging, retaining, and other kinds of forces sufficient to move a substantial amount of weight, for example, over 82 kg.
The above-desciibed embodiments should be regarded as illustrative rather than restrictive.
Accordingly, it should be appreciated that variations to those embodiments can be made by those skilled in the art without departing from the scope of the invention as defined by the following
FIGS. 3 to 6 in Main et al.
show how the circular stapler 10 functions to join two pieces of tissue together. As the anvil 30 is moved closer to the head 20, interposed tissue is compressed therebetween, as particularly shown in FIGS. 5 and 6. If this tissue is overcompressed, the surgical stapling procedure might not succeed.
Thus, it is desirable to not exceed the maximum acceptable tissue compression force. The interposed tissue can be subject to a range of acceptable compressing force during surgery. This range is known and referred to as optimal tissue compression or OTC, and is dependent upon the .10 type of tissue being stapled. While the stapler shown in Main et al.
does have a bar indicator that displays to the user a safe staple-tiring distance between the anvil and the staple cartridge, it cannot indicate to the user any level of compressive force being imparted upon the tissue prior to stapling.
It would be desirable to provide such an indication so that over-compression of the tissue can be avoided.
Disclosure of Invention The invention overcomes the above-noted and other deficiencies of the prior art by providing a electrically self-powered surgical device that uses the self-power to effect a medical procedure.
For example, in a linear endocutter, the electric on-board power can position an anvil and stapler cartridge with respect to one another about tissue to be stapled and/or cut, and, after closing the anvil and stapler cartridge with respect to one another, firing and securing the staples at the tissue (and/or cutting the tissue). Further, the electrically self-powered surgical device can indicate to the user a user-pre-defined level of compressive force being imparted upon the tissue prior to firing the staples.
The present invention also provides methods for operating the electric surgical stapling device to staple when optimal tissue compression (OTC) exists. Further provided is a manual release device that allows recovery from a partial actuation or a jam.
An offset-axis configuration for the two anvil and staple firing sub-assemblies creates a device that can be sized to comfortably fit into a user's hand. It. also decreases manufacturin.g difficulty by removing previously required nested (co-axial) hollow shafts.
With the axis of the anvil sub-assembly being offset from the staple firing sub-assembly, the length of the threaded rod for extending and retracting the anvil can be decreased by approximately two inches, thereby saving in manufacturing cost and generating a shorter longitudinal profile.
An exemplary method for using the electric stapler includes a power-on feature that permits entry into a manual mode for testing purposes. in a surgical procedure, the stapler is a one-way device. In the test mode, however, the user has the ability to move the trocar back and forth as desired. This test mode can be disengaged and the stapler reset to the use mode for packaging and shipment. For packaging, it is desirable (but not necessary) to have. the anvil be at a distance from the staple cartridge. Therefore, a homing sequence can be programmed to place the anvil 1 cm (for example) away from the staple cartridge before powering down for pack-aging and shipment. Before use, the trocar is extended and the anvil is removed. Vibe stapler is being used to dissect a colon, for example, the trocar is retracted back into the handle and the handle is inserted trans-anally into the colon to downstream side of the dissection while the anvil is inserted through a laparoscopic incision to an upstream side of the dissection. The anvil is attached to the trocar and the two parts are retracted towards the handle until a staple ready condition occurs. The staple firing sequence is started, which can be aborted, to staple the dissection and simultaneously cut tissue at the center of the dissection to clear an opening in the middle of the circular ring of staples. The staple firing sequence includes an optimal tissue compression (OTC) measurement and feedback control mechanism that causes staples to be tired only when the compression is in a desired pressure range, referred to as the OTC range. This range or value is known beforehand based upon known characteristics of the tissue to be compressed between the anvil and staple cartridge.
Some exemplary procedures in which the electric stapler can be used include colon dissection and gastric bypass surgeries. There are many other uses for the electric stapler in various different technology areas.
'With the foregoing and other objects in view, there is provided, in accordance with the invention, an electrically operated surgical instrument, including a handle and a surgical end effector having an actuation assembly operable to effect a surgical procedure when actuated, a part of the actuation assembly operable to move between a start position and a fully actuated position. The handle is connected to the end effector for actuating the actuation assembly.
The handle has a self-contained power supply disposed entirely within the handle, a drive assembly disposed entirely within the handle and having an electrically powered motor and a controller electrically connected to the power supply and to the motor and selectively operating the motor, a transmission mechanically connecting the motor to the moving part and being operable to selectively displace the moving part anywhere between the start and fully extended positions when the motor is operated, and a manual release mechanically coupled to the transmission to selectively intetrupt the transmission and, during interruption, displace the moving part towards the start position independent of operation of the motor.
In accordance with another feature of the invention, the surgical end effector is surgical linear stapling endocutter and the moving part includes at least a staple-actuating and tissue-cutting slide.
In accordance with a further feature of the invention, the drive assembly and the transmission are operable to actuate a stapling-cutting feature of the endocutter.
In accordance with an added feature of the invention, the power supply is a removable battery pack containing at least one battety.
In accordance with an additional feature of the invention, the power supply is a series connection of between four and six CR123 or CR2 power cells.
In accordance with yet another feature of the invention, the controller includes a multi-state switch operable to cause rotation of the motor in a forward direction when the switch is in a first state and to cause rotation of the motor in a reverse direction when the switch is in a second state.
In accordance with yet a further feature of the invention, the transmission has a motor drive side and an actuation drive side and the manual release is coupled therebetween.
In accordance with yet an added feature of the invention, the manual release is mechanically disposed in the transmission.
In accordance with yet an additional feature of the invention, the motor drive side has a series of rotation-reducing gears including a last gear, the actuation drive side has at least one gear and a rack-and-pinion assembly coupled to the at least one gear and directly connected to at least a portion of the moving part, and the manual release is mechanically coupled between the at least one gear and the last gear.
In accordance with again another feature of the invention, the motor has an output gear and the series of gears has a first stage coupled to the output gear.
hi accordance with again a further feature of the invention, the series of gears includes first, second, and third stages, and a cross-over gear with a shaft crossing from said motor drive side to said actuation drive side and the cross-over gear is coupled to the third stage.
In accordance with again an added feature of the invention, the series of gears has a cross-over gear with a shaft crossing from the motor drive side to the actuation drive side, the cross-over gear is coupled to the series of gears, a castle gear is rotationally fixedly coupled about the cross-over shaft and longitudinally translatable thereon, the castle gear having ca.stellations extending towards the actuation drive side, the at least one gear of the actuation drive side includes a first pinion having castellation slots shaped to mate with the castellations, a bias device is disposed between the cross-over gear and the castle gear and imparts a bias upon the castle gear towards the actuation drive side to permit selective engagement of the castle gear with the first pinion and, 5 thereby, cause a corresponding rotation of the first pinion with rotation of the shaft when so engaged, and the manual release has a release part shaped and positioned to provide an opposing force to overcome the bias on the castle gear and disengage the castle gear from the first pinion when the manual release is at least partially actuated.
in accordance with again an additional feature of the invention, the at least one gear of the actuation drive side includes a second pinion stage having a second pinion shaft, a second pinion gear coupled to the first pinion and rotationally fixed to the second pinion shaft, and a third pinion rotationally fixed to the second pinion shaft, the third pinion being a pinion of the rack-and-pinion assembly and longitudinally moving a rack thereof when rotated.
In accordance with still another feature of the invention, the manual release has a rest state in which the release part provides the opposing force at a magnitude less than the bias to the castle gear, a first partially actuated state in which the release part provides the opposing force at a magnitude greater than the bias to the castle gear and move the castellatims out from the castellation slots, and a second partially actuated state in which the manual release rotates the pinion to move the rack longitudinally in a withdrawing direction.
hi accordance with still a further feature of the invention, the at least one gear of the actuation drive side includes at least one release gear and the first pinion is directly connected to the at least one release gear to rotate the at least one release gear when rotated.
In accordance with still an added feature of the invention, the at least one gear of the actuation drive side includes first and second stage release gears and the .first pinion is directly connected to the first stage release gear to rotate the first and second release gears when rotated.
In accordance with a concomitant feature of the invention, the manual release includes a manual release lever rotatably connected to the handle and having a one-way ratchet assembly, and the at least one release gear has an axle directly connected to the ratchet assembly to rotate in a corresponding manner with the lever when the lever is at least partially actuated and to rotate independent of the lever when the lever is not actuated.
With the objects of the invention in view, there is also provided a method for operating a surgical instrument, including the steps of mechanically coupling a manual release to a transmission of a surgical instrument having a self-contained power supply disposed entirely within a handle thereof, the transmission translating movement of an electrically powered motor inside the handle to movement of a part of a surgical end effector connected to the handle, the part being operable to move anywhere between a start position and a fully actuated position, and selectively interrupting the transmission with the manual release to move the part towards the start position independent of motor operation.
With the objects of the invention in view, there is also provided a surgical instrument, including a method for operating a surgical instrument, including the steps of providing a surgical end effector at a distal end of a surgical instrument handle, the end effector having an actuation assembly operable to effect a surgical procedure when actuated, the actuation assembly having a part operable to move between a start position and a fully actuated position, disposing a self-contained power supply and an electrically powered motor entirely within a handle and connecting a motor controller to the motor and to the power supply to selectively operate the motor with the controller, mechanically connecting the motor to the moving part through a transmission operable to selectively displace the moving part anywhere between the start and fully extended positions when the motor is operated, and mechanically coupling a manual release to the transmission to selectively interrupt the transmission and, during interruption, displace the moving part towards the start position independent of motor operation.
Although the invention is illustrated and described herein as embodied in an electrically self-powered surgical instrument with manual release, it is, nevertheless, not intended to be limited to the details shown because various modifications and structural changes may be made therein and the scope of the claims should not be limited by the preferred embodiments set forth in the examples, but should be given the broadest interpretation consistent with the description as a whole.
The construction and method of operation of the invention, however, together with additional objects and advantages thereof, will be best understood from the following description of specific embodiments when read in connection with the accompanying drawings.
Brief Description f Drawings Advantages of embodiments of the present invention will be apparent from the following detailed description of the preferred embodiments thereof, which description should be considered in conjunction with the accompanying drawings in which:
FIG. I is a perspective view from a side of an exemplary embodiment of an electric stapler according to the invention;
FIG. 2 is a fragmentary side devotional view of the stapler of FIG. 1 with a right half of a handle body and with a proximal backbone plate removed;
FIG, 3 is an exploded, perspective view of on anvil control assembly of the stapler of FIG. 1;
FIG, 4 is an enlarged, fragmentary, exploded, perspective view of the anvil control assembly of FIG. 3;
FIG. 5 is a fragmentary, perspective view of a staple firing control assembly of the stapler of FIG. 1 from a rear side thereof, FIG, 6 is an exploded, perspective view of the staple firing control assembly of the stapler of FIG.!;
FIG. 7 is an enlarged, fragmentary, exploded, perspective view of the staple firing control assembly of FIG. 6;
FIG. 8 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from below the handle body portion of the stapler of FIG. 1;
FIG. 9 is a fragmentary, enlarged, horizontally cross-sectional view from below a proximal portion of the anvil control assembly FIG. 8;
FIG, 10 is a fragmentary, enlarged, horizontally cross-sectional view from below an intermediate portion of the anvil control assembly of FIG. 8;
FIG. 11 is a fragmentary, enlarged, horizontally cross-sectional view from below a distal portion of the anvil control assembly of FIG. 8;
FIG. 12 is a fragmentary, vertically cross-sectional view from a right side of a handle body portion of the stapler of FIG. 1;
FIG. 13 is a fragmentary, enlarged, vertically cross-sectional view from the right side of a proximal handle body portion of the stapler of FIG. 12;
FIG. 14 is a fragmentary, enlarged, vertically cross-sectional view from the right side of an intermediate handle body portion of the stapler of FIG. 12;
FIG. 15 is a fragmentary, further enlarged, vertically cross-sectional view from the right side of the intermediate handle body portion of the stapler of FIG. 14;
FIG. 16 is a fragmentary, enlarged, vertically cross-sectional view from the right side of a distal handle body portion of the stapler of FIG. 12;
FIG. 17 is a perspective view of a portion of an anvil of the stapler of FIG.
I;
FIG. 18 is a fragmentary, cross-sectional view of a removable stapling assembly including the anvil, a stapler cartridge, a force switch, and a removable cartridge connecting assembly of the stapler of FIG. 1;
FIG. 19 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from above the handle body portion of the stapler of FIG. 1 with the anvil rod in a fully extended position;
FIG. 20 is a fragmentary, side elevational view of the handle body portion of the stapler of FIG 1 from a left side of the handle body portion with the left handle body and the circuit board removed and with the anvil rod in a fully extended position;
FIG. 21 is a fragmentary, side elevational view of the handle body portion of the stapler of FIG. 20 with the anvil rod in a 1-cm anvil closure position;
FIG. 22 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from above the handle body portion of the stapler of FIG. 1 with the anvil rod in a safe staple firing position;
FIG, 23 is a fragmentary, horizontally cross-sectional view of the anvil control assembly from above the handle body portion of the stapler of FIG, 1 with the anvil rod in a fully retracted position;
FIG. 24 is a fragmentary, horizontally cross-sectional view of the firing control assembly from above the handle body portion of the stapler of FIG. I;
FIG, 25 is a fragmentary, enlarged, horizontally cross-sectional view from above a proximal portion of the firing control assembly of FIG. 24;
FIG. 26 is a fragmentary, enlarged, horizontally cross-sectional view from above an intermediate portion of the firing control assembly of FIG. 24;
FIG. 27 is a fragmentary, enlarged, horizontally cross-sectional view from above a distal portion of the firing control assembly of FIG. 24;
FIGS. 28 and 29 are shaded, fragmentary, enlarged, partially transparent perspective views of a staple cartridge removal assembly of the stapler of FIG. 1;
FIG, 30 is a schematic circuit diagram of an exemplary encryption circuit for interchangeable parts of the medical device according to the invention;
FIG. 31 is a bar graph illustrating a speed that a pinion moves a rack shown in FIG. 32 for various loads;
FIG. 32 is a fragmentary, perspective view of a simplified, exemplary portion of a gear train according to the present invention between a gear box and a rack;
FIG. 33 is a fragmentary, vertically longitudinal, cross-sectional view of a distal end of an articulating portion of an exemplary embodiment of an end effector with the inner tube, the pushrod-blade support, the anvil, the closure ring, and the near half of the staple sled removed;
FIG. 34 is a schematic circuit diagram of an exemplary switching assembly for a power supply according to the invention;
FIG. 35 is a schematic circuit diagram of an exemplary switching assembly for forward and reverse control of a motor according to the invention;
FIG, 36 is a schematic circuit diagram of another exemplary switching assembly for the power supply and the forward and reverse control of the motor according to the invention;
FIG. 37 is a left side elevation& view of the device according, to the invention with the outer shell removed;
FIG. 38 is an enlarged left side elevational view of a portion the device of FIG. 37 with the left side frame removed;
FIG. 39 is a right side elevational view of the device of FIG. 37;
FIG. 40 is an enlarged right side elevational view of a portion the device of FIG. 38 with the right side frame removed;
FIG. 41 is a perspective view of the device portion of FIG. 40 from the right rear;
FIG. 42 is a rear elevational view of the device portion of FIG. 40;
FIG. 43 is a perspective view of the device portion of FIG. 40 from the left rear with the first to third stage cover removed;
FIG. 44 is a perspective view of the device portion of FIG. 40 from above the right side with the power supply removed;
FIG. 45 is a perspective view of the device portion of FIG. 44 with the manual release lever in a first intermediate position with the castle gear in the separated position;
FIG. 46 is a perspective view of the device portion of FIG. 45 with the manual release lever in a second intermediate position;
FIG. 47 is a top plan view of the device portion of FIG. 46 with the manual release lever in a third intermediate position;
FIG. 48 is an enlarged perspective view of the manual release assembly from the right side with the second stage release gear, two cam plates, and a pawl spring removed with the pawl in an 5 upper, unratcheting position;
FIG, 49 is a perspective view of the manual release lever from below a right front side;
FIG. 50 is a perspective view of the manual release lever from below a right rear side;
FIG-. 51 is a perspective view of the manual release lever from below aleft rear side;
FIG. 52 is a perspective view of a cam plate from a left side;
JO FIG. 53 is a perspective view of a castle gear from a right side;
FIG. 54 is a perspective view of a fourth stage pinion from the left side;
FIG. 55 is a perspective view of the device portion of FIG. 44 from above a front right side with a pawl against a pawl cam;
FIG, 56 is a perspective view of the device portion of FIG. 55 with the pawl off of the pawl cam and against a ratchet. gear and with the castle gear in the separated position;
FIG. 57 is a perspective view of the device portion of FIG. 44 from above a front left side with the manual release in an intermediate position;
FIG. 58 is a perspective view of the device portion of FIG. 57 with the manual release in another intermediate position;
FIG. 59 is an enlarged right side elevational view a a portion of the device of FIG. 40 with the end effector control handle in an unactuated position;
FIG. 60 is an enlarged right side elevational view of a the device portion of FIG. 59 with the end effector control handle in a partially actuated position;
FIG. 61 is an enlarged perspective view of a shaft connector portion of the device of FIG. 37 from above the front right side with a removable end effector shaft secured in a frame;
:FIG. 62 is an enlarged perspective view of the shaft connector portion of FIG. 61 with shaft securing device removed to permit removal of the end effector shaft from the frame;
FIG. 63 is an elevational view of the interior of a left half of the outer shell of the device of FIG. 37;
FIG. 64 is an elevational view of the interior of a right half of the outer shell of the device of FIG. 37;
, FIG. 65 is an elevational view of the exterior of the right half of the outer shell of the device of FIG. 37; and FIG. 66 is an elevational view of the exterior of the left half of the outer shell of the device of FIG. 37.
Best Mode for Carrying Out the Invention Aspects of the invention are disclosed in the following description and related drawings directed to specific embodiments of the invention. Additionally, well-known elements of exemplary embodiments of the invention will not be described in detail or will be omitted so as not to obscure the relevant details of the invention. The scope of the claims should not be limited by the preferred embodiments set forth in the examples, but should be given the broadest interpretation consistent with the description as a whole.
Before the present invention is disclosed and described, it is to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. It must be noted that, as used in the specification and the appended claims, the singular forms "a", "an", and "the" include plural references unless the context clearly dictates otherwise.
While the specification concludes with claims defining the features of the invention that are regarded as novel, it is believed that the invention will be better understood from a consideration of the following description in conjunction with the drawing figures, in which like reference numerals are carried forward. The figures of the drawings are not drawn to scale. Further, it is noted that the figures have been created using a computer-aided design computer program. This program at times removes certain structural lines and/or surfaces when switching from a shaded or colored view to a wireframe view. Accordingly, the drawings should be treated as approximations and be used as illustrative of the features of the present invention.
Referring now to the figures of the drawings in detail and first, particularly to FIGS. 1 to 2 thereof, there is shown an exemplary embodiment of an electric surgical circular stapler 1. The present application applies the electrically powered handle to a circular surgical staple head for ease of understanding only. The invention is not limited to circular staplers and can be applied to any surgical stapling head, such as a linear stapling device, for example. Such an exemplary embodiment is described, in particular, starting with FIG. 37.
The powered stapler 1 has a handle body 10 containing three switches: an anvil open switch 20, an anvil close switch 21, and a staple firing switch 22. Each of these switches is electrically connected to a circuit board 500 (see FIG. 12) having circuitry programmed to carry out the stapling fiinctions of the stapler 1. The circuit board 500 is electrically connected to a power supply 600 contained within the handle body 10. One exemplary embodiment utilizes 2 to 6 Lithium CR123 or CR2 cells as the power supply 600. Other power supply embodiments are possible, such as rechargeable batteries or a power converter that is connected to an electric mains (in the latter embodiment., the stapler would not be self-powered or self-contained). As used herein, the terms self-powered or self-contained when used with regard to the electric power supply (600) are interchangeable and mean that the power supply is a complete and independent unit in and of itself and can operate under its own power without the use of external power sources.
For example, a power supply having an electric cord that is plugged into an electric mains during use is not self-powered or self-contained, Insulated conductive wires or conductor tracks on the circuit board 500 connect all of the electronic parts of the stapler 1, such as an on/off switch 12, a tissue compression indicator 14, the anvil and firing switches 20, 21, 22, the circuit board 500, and the power supply 600, for example.
I 5 But these wires and conductors are not shown in the figures of the drawings for ease of understanding and clarity.
The distal end of the handle body 10 is connected to a proximal end of a rigid anvil neck 30.
Opposite this connection, at the distal end of the anvil neck 30, is a coupling device 40 for removably attaching a staple cartridge 50 and an anvil 60 thereto.
Alternatively, the staple cartridge 50 can be non-removable in a single-use configuration of the stapler 1. These connections will be described in further detail below.
= FIG. 2 shows the handle body 10 with the right half 13 of the handle body 10 and the circuit board 500 removed. As will be discussed below, a proximal backbone plate 70 is also removed from the view of HG. 210 allow viewing of the internal components inside the handle body 10 from the right side thereof. What can be seen from the view of FIG. 2 is that there exist two internal component axes within the handle body 10. A first of these axes is the staple control axis 80, which is relatively horizontal in the view of FIG. 2. The staple control axis 80 is the centerline on which lie the components for controlling staple actuation. The second of these axes is the anvil control axis 90 and is disposed at an angle to the staple control axis 80. The anvil control axis 90 is the centerline on which lie the components for controlling anvil actuation. It is this separation of axes 80, 90 that allows the electric stapler 1 to be powered using a handle body 10 that is small enough to fit in a physician's hand and that does not take up so much space that the physician becomes restricted from movement in all necessary directions and orientations.
Shown inside the handle body 10 is the on/off switch 12 (e.g., a grenade pin) for controlling power (e.g., battery power) to all of the electrical components and the tissue compression indicator 14. The tissue compression indicator 14 indicates to the physician that the tissue being compressed between the anvil 60 and the staple cartridge 50 has or has not been compressed with greater than a pre-set compressive force, which will be described in further detail below. This indicator 14 is associated with a force switch 400 that has been described in co-pending U.S. Patent Provisional Application Serial No. 60/801,989 filed May 19, 2006, and titled "Force Switch".
The components along the anvil control axis 90 make up the anvil control assembly 100. An anvil control frame 110 is aligned along the anvil control axis 90 to house and/or fix various part of the anvil control assembly 100 thereto. The anvil control frame 110 has a proximal mount 112, an intermediate mount 114, and a distal mount 116. Each of these mounts 112, 114, 116 can be attached to or integral with the control frame 110. In the exemplary embodiment, for ease of manufacturing, the proximal mount 112 has two halves and is separate from the frame 110 and the intermediate mount 114 is separate from the frame 110.
At the proximal end of the anvil control assembly 100 is an anvil motor 120.
The anvil motor 120 includes the drive motor and any gearbox that would be needed to convert the native motor revolution speed to a desired output axle revolution speed. In the present case, the drive motor has a native speed of approximately 10,000 rpm and the gearbox converts the speed down to between approximately 50 and 70 rpm at an axle 122 extending out from a distal end of the anvil motor 120. The anvil motor 120 is secured both longitudinally and rotationally inside the proximal mount 112.
A motor-shaft coupler 130 is rotationally fixed to the axle 122 so that rotation of the axle 122 translates into a corresponding rotation of the motor coupler 130.
Positioned distal of the coupler 130 is a rotating nut assembly 140. The nut assembly 140 is, in this embodiment, a two part device having a proximal nut half 141 and a distal nut half 142 rotationally and longitudinally fixed to the proximal nut half 141. It is noted that these nut halves 141, 142 can be integral if desired. Here, they are illustrated in two halves for ease of manufacturing. The proximal end of the nut assembly 140 is rotationally fixed to the distal end of the coupler 130. Longitudinal and rotational support throughout the length of these two connected parts is assisted by the intermediate 114 and distal 116 mounts.
A proximal nut bushing 150 (see FIG. 3) is interposed between the intermediate mount 114 and the proximal nut half 141 and a distal nut bushing 160 is interposed between the distal mount 116 and the distal nut half 142 to have these pans spin efficiently and substantially without friction within the handle body 10 and the anvil control frame 110. The bushings 150, 160 can be of any suitable bearing material, for example, they can be of metal such as bronze or a polymer such as nylon. To further decrease the longitudinal friction between the rotating nut assembly 140 and the coupler 130, a thrust washer 170 is disposed between the proximal bushing 150 and the proximal nut half 141.
Rotation of the coupler 130 and nut assembly 140 is used to advance or retract a threaded rod 180, which is the mechanism through which the anvil 60 is extended or retracted. The threaded rod 180 is shown in further detail in the exploded view of FIGS. 3 to 4 and is described in further detail below. A rod support 190 is attached to a distal end of the anvil control frame 110 for extending the supporting surfaces inside the nut assembly 140 that keep the rod 180 aligned along the anvil control axis 90. The rod support 190 has a smooth interior shape corresponding to an external shape of the portion of the rod 180 that passes therethrough. This mating of shapes allows the rod 180 to move proximally and distally through the support 190 substantially without friction. To improve frictionless movement of the rod 180 through the support 190, in the exemplary embodiment, a cylindrical rod bushing 192 is disposed between the support 190 and the rod 180. The rod bushing 192 is not visible in FIG. 2 because it rests inside the support 190. However, the rod bushing 192 is visible in the exploded view of :FIGS. 3 to 4. With the rod bushing 192 in place, the internal shape of the support 190 corresponds to the external shape of the rod bushing 192 and the internal shape of the rod bushing 192 corresponds to the external shape of the portion of the rod 180 that passes therethrough. The rod bushing 192 can be, for example, of metal such as bronze or a polymer such as nylon.
The components along the staple control axis 80 form the staple control assembly 200. The staple control assembly 200 is illustrated in Fla 5 viewed from a proximal upper and side perspective. The proximal end of the staple control assembly 200 includes a stapling motor 210.
The stapling motor 210 includes the drive motor and any gearbox that would be needed to convert the native motor revolution speed to a desired revolution speed. In the present case, the drive motor has a native speed of approximately 20,000 rpm and the gearbox converts the speed to approximately 200 rpm at an output axle 212 at the distal end of the gearbox.
The axle 212 cannot be seen in the view of FIG. 5 but can be seen in the exploded view of FIGS, 6 to 7.
The stapling motor 210 is rotationally and longitudinally fixed to a motor mount 220. Distal of the motor mount 220 is an intermediate coupling mount 230. This coupling mount 230 has a 5 distal plate 232 that is shown, for example in FM. 6. The distal plate 232 is removable from the coupling mount 230 so that a rotating screw 250 can be held therebetween. It is this rotating screw 250 that acts as the drive for ejecting the staples out of the staple cartridge 50. The efficiency in transferring the rotational movement of axle 212 to the rotating screw 250 is a factor that can substantially decrease the ability of the stapler 1 to deliver the necessary staple ejection longitudinal 10 force of up to 250 pounds. Thus, an exemplary embodiment of the screw 250 has an acme profile thread.
There are two exemplary ways described herein for efficiently coupling the rotation of the axle 212 to the screw 250. First, the stapling motor 210 can be housed "loosely" within a chamber defined by the handle body 10 so that it is rotationally stable but has play to move radially and so 15 that it is longitudinally stable but has play to move. In such a configuration, the stapling motor 210 will "find its own center" to align the axis of the axle 212 to the axis of the screw 250, which, in the exemplary embodiment, is also the staple control axis 80.
A second exemplary embodiment for aligning the axle 212 and the screw 250 is illustrated in FIGS. I to 5, for example. In this embodiment, a proximal end of a flexible coupling 240 is fixed (both rotationally and longitudinally) to the axle 212. This connection is formed by fitting the distal end of the axle 212 inside a proximal bore 241 of the flexible coupling 240.
See FIG. 12. The axle 212 is, then, secured therein with a proximal setscrew 213. The screw 250 has a proximal extension 251 that fits inside a distal bore 242 of the flexible coupling 240 and is secured therein by a distal setscrew 252. It is noted that the 'figures of the drawings show the flexible coupling 240 with ridges in the middle portion thereof. in an exemplary embodiment of the coupling 240, the part is of aluminum or molded plastic and has a spiral or helixed cut-out around the circumference of the center portion thereof. In such a configuration, one end of the coupling 240 can move in any radial direction (360 degrees) with respect to the other end (as in a gimbal), thus providing the desired flex to efficiently align the central axes of the axle 212 and the screw 250.
The proximal extension 251 of the screw 250 is substantially smaller in diameter than the diameter of the bore 231 that exists in and through the intermediate coupling mount 230. This bore 231 has two increasing steps in diameter on the distal side thereof. The first increasing step in diameter is sized to fit a proximal radius screw bushing 260, which is formed of a material that is softer than the intermediate coupling mount 230. The proximal radius screw bushing 260 only keeps the screw 250 axially aliened and does not absorb or transmit any of the longitudinal thrust. The second increasing step in diameter is sized to fit a proximal thrust bearing 270 for the screw 250. In an exemplary embodiment of the thrust bearing 270, proximal and distal plates sandwich a bearing ball retainer plate and bearing balls therebetween. This thrust bearing 270 absorbs all of the longitudinal thrust that is imparted towards the axle 212 while the up to 250 pounds of longitudinal force is being applied to eject the staples in the staple cartridge 50. The proximal extension 251 of the screw 250 has different sized diameters for each of the interiors of the screw bushing 260 and the thrust bearing 270. The motor mount 220 and the coupling mount 230, therefore, form the two devices that hold the flexible coupling 240 therebetween.
The rotating screw 250 is held inside the distal plate 232 with a distal radius screw bushing 280 similar to the proximal radius screw bushing 260. Thus, the screw 250 rotates freely within the distal plate 232. To translate the rotation of the screw 250 into a linear distal movement, the screw 250 is threaded within a moving nut 290. Movement of the nut 290 is limited to the amount of movement that is needed for complete actuation of the staples; in other words, the nut 290 only needs to move through a distance sufficient to form closed staples between the staple cartridge 50 and the anvil 60 and to extend the cutting blade, if any, within the staple cartridge 50, and then rebut the same. When the nut 290 is in the proximal-most position (see, e.g., FIG. 12), the staples are at rest and ready to be fired. When the nut 290 is in the distal-most position, the staples are stapled through and around the tissue interposed between the staple cartridge 50 and the anvil, and the knife, if any, is passed entirely through the tissue to be cut. The distal-mast position of the nut 290 is limited by the location of the distal plate 232. Thus, the longitudinal length of the threads of the screw 250 and the location of the distal plate 232 limit the distal movement of the nut 290.
Frictional losses between the screw 250 and the nut 290 contribute to a significant reduction in the total pounds of force that can be transmitted to the staple cartridge SO through the cartridge plunger 320. Therefore, it is desirable to select the materials of the screw 250 and the nut 290 and the pitch of the threads of the screw 250 in an optimized way it has been found that use of a low-friction polymer for manufacturing the nut 290 will decrease the friction enough to transmit the approximately 250 pounds of longitudinal force to the distal end of the cartridge plunger 320 ¨ the amount of force that is needed to effectively deploy the staples. Two particular exemplary materials provide the desired characteristics and are referred to in the art as DELRINO
AF Blend Acetal (a thermoplastic material combining TEFLON fibers uniformly dispersed in DELRINO
acetal resin) and RULONO (a compounded form of TEE fluorocarbon) or other similar low-friction polymers.
A nut coupling bracket 300 is longitudinally fixed to the nut 290 so that it moves along with the nut 290. The nut coupling bracket 300 provides support. for the relatively soft, lubricious nut material. In the exemplary embodiment shown, the bracket 300 has an interior cavity having a shape corresponding to the exterior shape of the nut 290. Thus, the nut 290 fits snugly into the coupling bracket 300 and movement of the nut 290 translates into a corresponding movement of the nut coupling bracket 300. The shape of the nut coupling bracket 300 is, in the exemplary embodiment, dictated by the components surrounding it and by the longitudinal forces that it has to bear. For example, there is an interior cavity 302 distal of the nut 290 that is shaped to receive the distal plate 232 therein. The nut coupling bracket 300 also has a distal housing 304 for receiving therein a stiffening rod 310. The stiffening rod 310 increases the longitudinal support and forms a portion of the connection between the nut 290 and a cartridge plunger 320 (see, i.e., EEG. 5), which is the last moving link between elements in the handle body 10 and the staple cartridge 50. A firing bracket 330, disposed between the distal end of the nut coupling bracket 300 and the stiffening rod 310, strengthens the connection between the nut coupling bracket 300 and the rod 310.
Various components of the stapler I are connected to one another to form a backbone or spine. This backbone is a frame providing multi-directional stability and is made up of four primary parts On order from proximal to distal): the anvil control frame 110, the proximal backbone plate 70 (shown in FIGS. 3 to 4 and 6 to 7), a distal backbone plate 340, and the anvil neck 30. Each of these four parts is longitudinally and rotationally fixed to one another in this order and forms the skeleton on which the remainder of the handle components is attached in some way.
Lateral support to the components is provided by contours on the inside surfaces of the handle body 10, which in an exemplary embodiment. is formed of two halves, a_ lefl. half II and a right half 13. Alternatively, support could be single frame, stamped., or incorporated into the handle halves 11, 13.
Functionality of the anvil control assembly 100 is described with regard to FIGS. 17 to 27.
To carry out a stapling procedure with the stapler 1, the anvil 60 is removed entirely from the stapler 1 as shown in FIG. 17. The anvil open switch 20 is depressed to extend the distal end of the trocar tip 410 housed within the staple cartridge and which is longitudinally fixedly connected to the screw 250. The point of the trocar tip 410 can, now, be passed through or punctured through tissue that is to be stapled. The user can, at this point, replace the anvil 60 onto the trocar tip 410 from the opposite side of the tissue (see FIG. 18) and, thereby, lock the anvil 60 thereon. The anvil closed switch 22 can be actuated to begin closing the anvil 60 against the staple cartridge 50 and pinch the tissue therebetween within an anvil-cartridge gap 62.
To describe how the trocar tip controlling movement of the anvil 60 occurs, reference is made to FIGS. 8 to 10, 1410 15, and 18. As shown in dashed lines in FIG. 15,a rod-guiding pin 143 is positioned within the central bore 144 of the distal nut half 142. As the threaded rod 180 is screwed into the rotating nut 140, 141, 142, the pin 143 catches the proximal end of the thread 182 to surround the pin 143 therein, Thus, rotation of the nut 140 with the pin 143 inside the thread 182 will cause proximal or distal movement of the rod 180, depending on the direction of nut rotation.
The thread 182 has a variable pitch, as shown in FIGS. 14 to 15, to move the anvil 60 at different longitudinal speeds. When the pin 143 is inside the longer (lower) pitched thread portion 183, the anvil 60 moves longitudinally faster. in comparison, when the pin 143 is inside the shorter (higher) pitched thread portion 184, the anvil 60 moves longitudinally slower. it is noted that the pin 143 is the only portion contacting the thread 182 when in the longer pitched thread portion 183. Thus, the pin 143 is exposed to the entire longitudinal force that is acting on the rod 180 at this point in time.
.15 The pin 143 is strong enough to bear such forces but may not be sufficient to withstand all longitudinal force that could occur with anvil 60 closure about interposed tissue.
As shown in FIG. 14, the rod 180 is provided with a shorter pitched thread portion 184 to engage in a corresponding internal thread 145 at the proximal end of the central bore 144 of the proximal nut half 141. When the shorter pitched thread portion 184 engages the internal thread 145, the entire transverse surface of the thread portion 184 contacts the internal thread 145. This surface contact is much larger than the contact between the pin 143 and any portion of the thread 182 and, therefore, can withstand all the longitudinal force that occurs with respect to anvil 60 closure, especially when the anvil 60 is closing about tissue during the staple tiring state. For example, in the exemplary embodiment, the pin 143 bears up to approximately 30 to 50 pounds of longitudinal force. This is compared to the threads, which can hold up to 400 pounds of longitudinal force ¨ an almost 10-to-1 difference.
An alternative exemplary embodiment of anvil control assembly 100 can entirely remove the complex threading of the rod 180. lin such a case, the rod 180 has a single thread pitch and the anvil motor 120 is driven (through corresponding programming in the circuit board 500) at different speeds dependent upon the longitudinal position of the single-thread rod 180.
In any embodiment for driving the motors 120, 210, the control programming can take many forms. In one exemplary embodiment, the microcontroller on the battery powered circuit board 508 can apply pulse modulation (e.g., pulse-width, pulse-frequency) to drive either or both of the motors.
Further, because the stapler 1 is a device that has a low duty cycle, or is a one-use device, components can be driven to exceed acceptable manufacturers' specifications.
For example, a gear box can be torqued beyond its specified rating. Also, a drive motor, for example, a 6 volt motor, can be overpowered, for example, with 12 volts.
Closure of the anvil 60 from an extended position to a position in which the tissue is not compressed or is just slightly compressed can occur rapidly without causing damage to the imetposed tissue. Thus, the longer-pitched thread portion 183 allows the user to quickly close the anvil 60 to the tissue in a tissue pre-compressing state. Thereafter, it is desirable to compress the tissue slowly so that the user has control to avoid over-compression of the tissue. As such, the shorter pitched thread portion 184 is used over this latter range of movement and provides the user with a greater degree of control. During such compression, the force switch 400 seen in FIG. 18 and described in co-pending U.S. Patent Provisional Application Serial No.
60/801,989 can be used to indicate to the user through the tissue compression indicator 14 (and/or to the control circuitry of the .15 circuit board 500) that the tissue is being compressed with a force that. is greater than the pre-load of the spring 420 inside the force switch 400. it is noted that FIG. 18 illustrates the force switch 400 embodiment in the normally-open configuration described as the first exemplary embodiment of U.S. Patent Provisional Application Serial No. 60/801,989. A strain gauge can also be used for measuring tissue compression.
FIGS. 19 to 23 illustrate movement of the rod 180 from an anvil-extended position (see FIGS, 19 to 20), to a 1-cm-closure-distance position (see FIG. 21), to a staple-tire-ready position (see FIG. 22), and, finally, to an anvil fully closed position (see FIG. 23).
Movement of the rod 180 is controlled electrically (via the circuit board 500) by contact between a portion of a cam surface actuator 185 on the rod 180 and actuating levers or buttons of a series of micro-switches positioned in the handle body 10.
A rod-fully-extended switch 610 (see FIG. 19) is positioned distal in the handle body 10 to have the actuator 185 compress the activation lever of the rod-fully-extended switch 610 when the rod 180 (and, thereby, the anvil 60) is in the fully extended position. A 1-cm switch 612 is positioned in an intermediate position within the handle body 10 (see FIGS. 20 to 21) to prevent a 1-cm cam surface portion 186 of the rod 180 from pressing the activation button of the 1-cm switch 612 when the rod 180 (and, thereby, the anvil 60) is within 1 cm of the fully closed position. After passing the I-cm closure distance, as shown in FIG. 22, the cam surface actuator 185 engages a staple-fire-ready switch 614. The lower end of the actuator 185 as viewed in FIGS, 22 to 23 has a bevel on both the forward and rear sides with respect to the button of the staple-fire-ready switch 614 and the distance between the portion on the two bevels that actuates the button (or, only the flat portion thereof) corresponds to the acceptable staple forming range (i.e., safe firing length) of the 5 staples in the staple cartridge 50. Thus, when the button of the staple-fire-ready switch 614 is depressed for the first time, the distance between the anvil 60 and the staple cartridge 50 is at the longest range for successfully firing and closing the staples. While the button is depressed, the separation distance 62 of the anvil 60 (see FIG. 18) remains within a safe staple-firing range_ However, when the button of the staple-fire-ready switch 614 is no longer depressed because the 10 actuator 185 is positioned proximally of the button, then staples will not fire because the distance is too short for therapeutic stapling. FIG. 23 show the rod 180 in the proximal-most position, which is indicated by the top end of the actuator 185 closing the lever of a rod fully-retracted switch 616.
When this switch 616 is actuated, the programming in the circuit board 500 prevents the motor 120 from turning in a rod-retraction direction; in other words, it is a stop switch for retracting the rod 180 15 in the proximal direction.
It is noted that FIGS. 2 to 3, 11 to 12, and 16 illustrate the distal end of the rod 180 not being connected to another device at its distal end (which would then contact the proximal end of the force switch 400). The connection band or bands between the distal end of the rod 180 and the proximal end of the force switch 400 are not shown in the drawings only for clarity purposes. In an exemplary 20 embodiment, the pull-bands are flat and flexible to traverse the curved underside of the cartridge plunger 320 through the anvil neck 30 and up to the proximal end of the force switch 400. Of course, if the force switch 400 is not present, the bands would be connected to the proximal end of the =trocar tip 410 that release* connects to the proximal end of the anvil 60.
Functionality of the staple control assembly 200 is described with regard to FIGS. 12 to 16 and 24 to 27, in particular, to FIG. 24. The stapling motor 210 is held between a motor bearing 222 and a motor shaft cover 224. The axle 2.12 of the stapling motor 210 is rotationally connected to the proximal end of the flexible coupling 240 and the distal end of the flexible coupling 240 is rotationally connected to the proximal end of the screw 250, which rotates on bearings 260, 270, 280 that are disposed within the intermediate coupling mount 230 and the distal plate 232. The longitudinally translating nut 290 is threaded onto the screw 250 between the coupling mount 230 and the distal plate 232. Therefore, rotation of the axle 212 translates into a corresponding rotation of the screw 250.
The nut coupling bracket 300 is longitudinally fixed to the nut 290 and to the stiffening rod 310 and the firing bracket 330. The firing bracket 330 is longitudinally fixed to the cartridge plunger 320, which extends (through a non-illustrated staple driver) up to the staple cartridge 50 (or to the staples). With such a connection, longitudinal movement of the nut 290 translates into a corresponding longitudinal movement of the cartridge plunger 320. Accordingly, when the staple tiring switch 22 is activated, the stapling motor 210 is caused to rotate a sufficient number of times so that the staples are completely fired from the staple cartridge 50 (and the cutting blade, if present, is extended to completely cut the tissue between the anvil 60 and the staple cartridge 50).
Programming in the circuitry, as described below, then causes the cartridge plunger 320 to retract after firing and remove an.y portion of the staple firing parts and/or the blade within the staple cartridge 50 from the anvil-cartridge gap 62.
Control of this stapling movement, again, occurs through micro-switches connected to the circuit board 500 through electrical connections, such as wires. A first of these control switches, the proximal staple switch 618, controls retraction of the staple control assembly 200 and defines the proximal-most position of this assembly 200. To actuate this switch, an actuation plate 306 is attached, in an adjustable manner, to a side of the nut coupling bracket 300.
See, e.g., FIGS, 6 and 24. As such, when the nut 290 moves proximally to cause the plate 306 on the nut coupling bracket 300 to activate the proximal staple switch 618, power to the stapling motor 210 is removed to stop tiother proximally directed movement of the staple control assembly 200.
A second of the switches for controlling movement of the staple control assembly 200 is located opposite a distal transverse surface of the stiffening rod 310. See, e.g. FIG. 27. At. this surface is disposed a longitudinally adjustable cam member 312 that contacts a distal staple switch 620. In an exemplary embodiment, the cam member 312 is a screw that is threaded into a distal bore of the stiffening rod 310. Accordingly, when the nut 290 moves distally to cause the cam member 312 of the stiffening rod 310 to activate the distal staple switch 620, power to the stapling motor 210 is removed to stop further distally directed movement of the staple control assembly 200.
FIGS. 28 and 29 illustrate a removable connection assembly to permit replacement of a different staple cartridge 60 on the distal end of the anvil 30.
The proximal-most chamber of the handle body 10 defines a. cavity for holding therein a power supply 600. This power supply 600 is connected through the circuit board 500 to the motors 120, 210 and to the other electrical components of the stapler 1.
The electronic components of the stapler 1 have been described in general with respect to control through the circuit board 500. The electric stapler 1 includes, as set forth above in an exemplary embodiment, two drive motors 120, 210 powered by batteries and controlled through pushbuttons 20, 21, 22. The ranges of travel of each motor 120, 210 are controlled by limit switches 610, 616, 618, 620 at the ends of travel and at intermediary locations 612, 614 along the travel. The logic by which the motors 120, 210 are controlled can be accomplished in several ways. For example, relay, or ladder logic, can be used to define the control algorithm for the motors 120, 210 and switches 610, 612, 614, 616, 618, 620. Such a configuration is a simple but limited control method. A more flexible method employs a microprocessor-based control system that senses switch inputs, locks switches out, activates indicator lights, records data, provides audible feedback, drives a visual display, queries identification devices (e.g., radio frequency identification devices (RFIDs) or cryptographic identification devices), senses forces, communicates with external devices, monitors battery life, etc. The microprocessor can be part of an integrated circuit constructed specifically for the purpose of interfacing with and controlling complex electro-mechanical systems.
.15 Examples of such chips include those offered by A tmel, such as the Mega 128, and by PIC, such as the PIC 16F684.
A software program is requited to provide control instructions to such a processor. Once fully developed, the program can be written to the processor and stored indefinitely. Such a system makes changes to the control algorithm relatively simple; changes to the software that are uploaded to the processor adjust the control and user interface without changing the wiring or mechanical layout of the device.
For a disposable device, a power-on event is a one time occurrence. In this case, the power-on can be accomplished by pulling a tab or a release that is permanently removed from the device.
The removal enables battery contact, thus powering on the device.
In any embodiment of the device, when the device is powered on, the control program begins to execute and, prior to enabling the device for use, goes through a routine that. ensures awareness of' actual positions of the extend/retract and firing sub-assemblies, referred to as a homing routine. The homing routine may be executed at the manufacturer prior to shipping to the user. In such a case, the homing routine is performed, the positions of the assemblies are set, and the device is shipped to the user in a ready-to-use condition. Upon power-up, the device verifies its positions and is ready to use.
Visual indicators (e.g., LEDs) are used to provide feedback to the user. In the case of the pushbutton switches 20, 21, 22, they can be lit (or backlit) when active and unlit when not active.
The indicators can blink to convey additional information to the user. In the case of a delayed response after a button press, a given light can blink at an ever-increasing rate as the response becomes imminent, for example. The indicators can also light with different colors to indicate various states.
Cams are used in various locations at the stapler 1 to activate limit switches that provide position information to the processor. By using linear cams of various lengths, position ranges can be set. Alternatively, encoders can be used instead of limit switches (absolute and incremental .10 positioning. Limit switches are binary: off or on. Instead of binary input, for position information, encoders (such as optical encoders) can be used to provide position information. Another way to provide position feedback includes mounting pulse generators on the end of the motors that drive the sub-assemblies. By counting pulses, and by knowing the ratio of motor turns to linear travel, absolute position can be derived.
Use of a processor creates the ability to store data. For example, vital, pre-loaded information, such as the device serial number and software revision can be stored. Memory can also be used to record data while the stapler 1 is in use. Every button press, every limit switch transition, every aborted tire, every completed fire, etc., can be stored for later retrieval and diagnosis. Data can be retrieved through a programming port or wirelessly. In an exemplary embodiment, the device can be put into diagnostic mode through a series of button presses. in this diagnostic mode, a technician can query the stapler I for certain data or to transmit/output certain data. Response from the stapler 1 to such a query can be in the form of blinking LEDs, or, in the case of a device with a display, visual character data, or can be electronic data. As set forth above, a strain gauge can be used for analog output and to provide an acceptable strain band.
Alternatively, addition of a second spring and support components can set this band mechanically.
An exemplaty control algorithm for a single tire stapler I can include the following steps:
o Power on.
o Verify home position and go to home position, if necessary/desired.
o Enable extend/retract buttons (lit) and disable (unlit) staple fire button.
o Enable staple fire button only after full extension (anvil removal) and subsequent retraction with extend/retract buttons remaining enabled.
o Upon actuation of staple fire button, retract anvil until force switch is activated.
o Begin countdown by blinking fire button LED and increase blink, rate as firing cycle becomes imminent. Continue monitoring of force switch and retract anvil so that force switch remains activated.
o During staple fire cycle, any button press aborts staple fire routine.
o If abort occurs before staple firing motor is activated, firing cycle stops, anvil is extended to home position, and staple fire button remains active and ready for a re-fire.
o Alternatively, if the abort occurs during movement of tiring motor, firing cycle stops, firing motor is retracted, anvil is returned to home position, and firing 0 button is rendered inactive. Accordingly, stapler (or that staple cartridge) cannot be used.
o After countdown to fire is complete, staple range limit switch is queried for position. If staple range limit switch is activated -- meaning that anvil is within an acceptable staple firing range -- then staple firing motor is activated and firing cycle proceeds. if staple range limit switch is not activated, then firing cycle is aborted, anvil is returned to home position, and staple firing button remains active ready for a re-fire attempt.
o After a completed staple firing, anvil remains in closed position and only the extend button remains active. Once anvil is extended to at least the home =,.() position, both extend and retract buttons are made active. Staple fire button remains inactive after a completed staple firing.
Throughout the above exemplary cycle, button presses, switch positions, aborts, and/or fires can be recorded.
In a surgical procedure, the stapler is a one-way device. In the test mode, however, the test user needs to have the ability to move the troc.ar 410 and anvil 60 back and forth as desired. The power-on feature permits entry by the user into a manual mode for testing purposes. This test mode can be disengaged and the stapler reset to the use mode for packaging and shipment.
For packaging, it is desirable (but not necessary) to have the anvil 60 be disposed at a distance from the staple cartridge 50. Therefore, a horning sequence can be programmed to place the anvil 60 one centimeter (for example) away from the staple cartridge 50 before powering down for packaging and shipment.
When the electric stapler is unpackaged and ready to be used for surgery, the user tums the stapler on (switch 12). Staples should not be allowed to fire at any time prior to being in a proper staple-firing position and a desired tissue compression state. Thus, the anvil/trocar extend/retract function is the only function that is enabled. In this stale, the extend and retract buttons 20, 21 are lit 5 and the staple firing switch 22 is not lit (i.e,, disabled).
Before use inside the patient, the trocar 410 is extended and the anvil 60 is removed. If the stapler is being used to anastomose a colon, for example, the trocar 410 is retracted back into the anvil neck 30 and the staple cartridge 50 and anvil neck 30 are inserted trans-anally into the colon to a downstream side of the dissection. The anvil 60, in contrast, is inserted through an upstream 10 laparoscopic incision and placed at the upstream side of the dissection.
The anvil 60 is attached to the trocar 410 and the two parts are retracted towards the staple cartridge 50 until a staple ready condition occurs. As set forth above, the anvil is moved to a distance that does not substantially compress and, specifically, does not desiccate, the tissue therebetween. At this point, staple firing can occur when desired.
15 The staple firing sequence is started by activating the staple fire switch 22. Staple firing can be aborted anytime during the firing sequence, whether prior to movement (during the blanching cycle) or during movement (whether the staples have started to form or not).
The software is programmed to begin a staple firing countdown sequence because it is understood that the tissue needs to be compressed and allowed to desiccate before staple tiring should occur. Thus, after the 20 staple firing switch 22 is activated, the anvil 60 closes upon the interposed tissue and begins to compress the tissue. The staple thing sequence includes an optimal tissue compression (OTC) measurement and a feedback control mechanism that causes staples to be fired only when the compression is in a desired pressure range, referred to as the OTC range, and a sufficient time period has elapsed to allow fluid removal from the compressed tissue. The OTC range is known 25 beforehand based upon known characteristics of the tissue that is to be compressed between the anvil 60 and the staple cartridge 50 (the force switch can be tuned for different tissue OTC ranges). It is the force switch 400 that provides the OTC measurement and supplies the microprocessor with information indicating that the OTC for that particular tissue has been reached. The OTC state can be indicated to the user with an LED, for example.
When the firing sequence begins, the staple fire switch 22 can be made to blink at a given rate and then proceed to blink faster and faster, for example, until firing occurs. If no abort is triggered during this wait time, the OTC state will remain for the preprogrammed desiccation duration and staple filing will occur after the countdown concludes. In the example of colon anastomosis with a circular stapler, stapling of the dissection occurs simultaneously with a cutting of tissue at the center of the dissection. This cutting guarantees a clear opening in the middle of the circular ring of staples sufficient to create an opening for normal colon behavior after the surgery is concluded.
As the liquid from the interposed compressed tissue is removed, the compressive force on the tissue naturally reduces. En some instances, this reduction can be outside the OTC range. Therefore, the program includes closed-loop anvil-compression control that is dependent upon continuous measurements provided by the force switch 400. With this feedback, the compressed tissue is kept within the OTC range throughout the procedure and even after being desiccated.
During the staple firing cycle, any actuation of a control switch by the user can be programmed to abort the staple fire routine. IT an abort occurs before the staple firing motor 210 is activated, the firing cycle stops, the anvil 60 is extended to a home position, and the staple fire switch 22 remains active and ready for a re-fire attempt, if desired.
Alternatively, if the abort occurs during movement, of the staple firing motor 210, the firing cycle stops and the staple firing motor 210 is caused to extend the anvil 60 to its home position. At this point, the staple firing switch 22 is rendered inactive_ Accordingly, the stapler (or that particular staple cartridge) can no longer be used (unless the staple cartridge is replaced).
It is noted that before a staple firing can occur, a staple range limit switch is queried for relative position of the staple cartridge 50 and anvil 60. If the staple range limit switch is activated ¨
meaning that anvil 60 is within an acceptable staple firing range -- then the staple firing motor 210 can be made active and the tiring cycle can be allowed to proceed. If the staple range limit switch is not activated, then the firing cycle is aborted, the anvil 60 is returned to the home position, and the staple firing switch 22 remains active and ready for a re-fire attempt.
Powering (also referred to as actuating, powering, controlling, or activating) of the motor and/or the drive train of any portion of the end effector (e.g.õ anvil or stapler/cutter) is described herein. It is to be understood that such powering need not, be limited to a single press of an actuation button by the user nor is the powering of a motor limited to a single energizing of the motor by the power supply. Control of any motor in the device can require the user to press an actuation button a number of times, for example, a first time to actuate a portion of the end effector for a first third of movement, a second time for a second third of movement, and a third time for a last third of movement. More specifically for a surgical stapler, a first exemplary actuation can move the staple sled or blade past the lock-out, a second exemplary actuation can move the part up to the tissue, and a third exemplary actuation can move the sled past all staples to the end of the staple cartridge.
Similarly, powering of a motor need not be constant, for example, where the motor is energized constantly from the time that the blade begins movement until it reaches the end point of its movement. Instead, the motor can be operated in a pulsed mode, a first example of which includes periodically switching on and off the power supplied by the power supply to the motor during actuation of an end effector function. More specifically for a stapler, the motor can be pulsed ten times/second as the stapl &cutter moves from its proximal/start position to its distal-most position.
This pulsing can be directly controlled or controlled by microprocessor, either of which can have an adjustable pulse rate. Alternatively, or additionally, the motor can be operated with a pulse modulation (pulse-width or pulse-frequency), with pulses occurring at very short time periods (e.g., tenths, hundredths, thousandths, or millionths of a second). Accordingly, when the power supply, the motor, and/or the drive train are described herein as being powered, any of these and other possible modes of operation are envisioned and included.
After a completed staple firing, the anvil 60 remains in the closed position and only the extend switch 20 remains active (all other switches are deactivated). Once the anvil 60 is extended to at least the home position, both the extend and retract switches 20, 21 are made active but the retraction switch 21 does not permit closure of the anvil 60 past the home position. The staple fire switch 22 remains inactive after a completed staple firing.
As set forth above, the anvil neck 30 houses a linear force switch 400 connected to the trocar 410. This switch 400 is calibrated to activate when a given tensile load is applied. The given load is set to correspond to a desired pressure that is to be applied to the particular tissue before stapling can occur. Interfacing this switch 400 with the processor can ensure that the firing of staples only occurs within the OTC range.
The following text is an exemplary embodiment of a program listing for carrying out the methods according to the invention as described herein. The text that follows is only submitted as exemplary and those of skill in the art can appreciate that programming the methods according to the invention can take many different forms to achieve the same functionality.
'Circular Stapler Program using the rev 3c board (cb280 chipset) V8.03 (C8-3c-080306.CUL) '8-3-06 'Modified program to abort with only fire button, added pbcotmt variable 'Added PNIIIM ramping '7-28-06 'final tweaks - stan is now an integer etc.
'7-17-06 This version written for the 3c board.
'7-14 DEBUGGING VERSION
= Program written for 3c board using the Cubloc 280 chipset Note: this program is a modified version of the ones noted below. All changes not related to the addition of the FIR limit switches 'apply. The programs below were written to deal with the "gray logic" of the 1 cm switch. This version uses 'a limit switch at either end of the extend/retract stage.
N6,20 Final Version of Gray Logic program as used in prototype 0, serial number 100 'V6.05 'modified the extend to cm 1 and retract to cm I routines to make sure that when they are called that they move the motor until the cm 'switch is closed; le: When the anvil is all the way out and the retract.
button is pressed, retract the anvil until the cm limit switch 'is closed regardless of whether the retract button is released before the cm switch is closed. Same change for when the anvil is 'extended from the 1 cm position.
'made changes to comments in the extend/retract routines 'V6.02 'added loop requiring the release of both buttons to exit jog routine, and a 1 second delay at the end of jog subroutine before 'going back to main routine 'reformatted datadump labels 'added variables for high and low speed pwm values 'added extend only capability at end of completed fire to prevent crushing stapled tissue 'NOT WORKING- REMOVED added checks To ensure 1 cm switch Is made when extending Or retracting from the I cm And fully extended positions respectively 1V6,01.
'All prior versions were made for testing the program on the Cubloc development board. All outputs were pulled LOW, The actual device 'requires all the outputs to be pulled high (+5V). This version is set-up to run on the actual device.
'limited the values of the EEPROM data to 255 max 'added delays before changes in motor direction, made program run smoother 'removed pwmoff commands. They were not allowing the motors to stay on when changing subroutines (for some reason) EVS.27 'added the recording ofjog routine button presses 'added the recording of datadump requests 'V5,26 'added the recording of Extend/Retract button presses 'added serial number field in eeprom 'the datadump routine now keeps running total of data as it is read from eeprom 'V5.25 (circular-stapler-5-25.cul) 'added code to allow storage of data each power on cycle in eeprom 'V5.24 works well, no known bugs (oircular-stapler-5-24.cul) %MS Medical LLC (c) 2006 'MAP
1)10 Extend Button ?II Retract Button 712 Fire Button 713 Extend Limit P14 Retract Limit T1 5 Fire Forward Limit 716 Fire Back Limit 717 1 cm Limit Switch 718 Staple Range Limit Switch P19 Force Switch P20 Extend Button LED
P21 Retract :Button LED
722 Fire Button LED
P23 Force LED (blue) 1P24 Not USED
P25 Not USED
P26 Not USED
1P27 Not. USED
1P28 Not USED
'P29 Staple Range LED (green) Const Device=cb280 'Comfl le Tech. Cubloc CB280 chipset Dim ver As String*7 ver="3C-8.03" 'set software version here Dim extendbutton As Byte Dim retractbutton As Byte Dim firebutton As Byte Dim &stout As Byte Dim firstback As Byte Dim cmstatus As Byte 11 cm limit switch status Dim srstatus As Byte 'staplerange limit switch status Dim x As Integer Dim powerons As Byte 'store in eeprom address 2 Dim cycnumfires As Byte 'store in eeprom (powerons*5) Dim cycabortfires As Byte 'store in eeprom (powerons*5)+1 Dim cycers As Byte 'store in eeprom, number of cycle extend/retract presses Dim cycjogs As Byte Dim arm As Byte Dim completefire As Byte Dim staplerangestatus As Byte Dim bail As Byte Dim ds As Integer 'eeprom data start location for individual cycle data writing Dim fast As Integer Dim slow As Integer Dim extendonly As Byte Dim extlimit As Byte Dim retlimit As Byte Dim speed As Integer 5 Dim dracula As Byte initalize outputs Out 20,0 'extend button LED
10 Out 21,0 'retract button led Out 22,0 The button led Out 23,0 'force led Out 29,0 'staple range led 15 'initialize variables firstout=0 firstback=0 completeftre=0 arm-0 20 bail.=0 cycnamfires---0 cycabort1ires-0 cycers=0 cycjogs-0 25 extendon1r0 'CHANGE PWM VALUES HERE
fast=60000 'highspeed pwm value slow=60000 lowspeed pwm value 30 speed-0 Output 5 'turns on pwm output for PINCH
Output 6 VirlIS on pwm output for FIRE
'read totals from eeprom powerons-Eeread(2,1) Incr poweronstincrement total power on number If powerons>,.-255 Then powerom.,-255 'limit number of recordtx1powerons to an integer of one byte max flewrite 2,powerons,1 'write total power on number to eeprom ds-powerons*5 '.10G and DATADUMP Check 'push any button within 2 (or so) seconds to go to jog routine 'hold all three buttons on at startup to dump the data For x-:1 To 50 If Keyir(l 0,20)=0 And Keyir(l 1,20)=0 And Keyin(12,20)=0 Then datadutnp 'write all stored data to the debug screen Exit For Elseif Keyin(I 0,20)=0 Or Keyin(11,20),---0 Or Keyin(12,20)4 Then 'either eir button or the tire button pressed jog Exit For End if Delay 20 Next ------ ----- --------. 'HOMING SEQUENCES
cmstatus=Keyin(17,20) 'read the status of the lent limit switch if cmstatus=0 Then homeretract Elseif =status-1 Then homeextend End If 'Return .fire motor to back position hotnefire 'this returns the fire motor to the full retracted condition (P6 limit switch) ********
'Main Loop ************************************************
********
Do Debug "Main Loop",Cr 'Delay 1000 cmstatusr---Keyin(17õ20) 'read the I cm switch istaplerangestatus-:Keyin(5,20) 'read the staplerange limit switch extendbutton¨Keyin(1 0,20) retractbuttorr.Keyi n(11,20) firebutton=Keyin(12,20) If cmstatus=0 And Keyin(13,20)<>0 Then Out 20,1 'turn extend led on Out 21,1 'turn retract. led on El self cmstattis=0 And Keyi n(I 3,20)-0 Then Out 20,0 'turn off extend led because extend limit met Out 21,1 'turn on retract limit Elseif emstatus=1 Then Out 20,1 Out 21,0 End If 'check firebutton led status If tirstout=1 And firstback=1 And arm=1 And c.ompletefire<>1 And cmstatus<>0 Then Out 22,1 'turn on tire button led Else Out 22,0 'turn off fire led End If 'check for extend retract button press If extendbutton=0 And cmstatus=0 Then extend Elseif cmstatus=1 And extendbutton=0 Then extend End If If retrac1button-0 And crnstatus=0 Then 'And extendonly=0 retract End If 'check for firebutton press If firebutton=0 And firstout=1 And firstback=1 And arm=1 And completefire<>1 And cmstatus<>0 Then initialfire Loop 'keep looping ti l powerdown End 'End of program SUBROUTINES
"
'HOME: retract to cm switch=not pressed ------------------Sub homeretractO 'retract until 1 cm switch is open 'Debug "Horneretract",Cr 'Delay 1000 PWIT1 0,slow,60000 Do Until Keyin(17,20)-1 'retract until 1 cm switch is open.
Out 31,1 'ER motor reverse Loop Out 31,0 'er motor off Out 21,0 'turn retract led Off Out 20,1 'turn extend led On Pwmoff 0 'turn pwm off End Sub 'HOME: extend to cm switch=pressed Sub homeextendo 'extend until 1 cm switch is closed Debug "Homextend",Cr Delay 1000 Pwm 0,slow,60000 If Keyin(17,20)=1 Then Do Until Keyin(17,20)=0 'now the 1 cm switch is pressed Out 30,1 'ER motor forward DDD
Loop End If Out 30,0 'DDD
Pwmoff 0 Delay 300 homeretract 'once the switch is made, call homeretract End Sub 'Fire motor horning routine Sub hoinefireo Debug "Homefire",Cr 'Delay 1000 Pwm 1,slowõ60000 Do Until Keyin(16,20):::0 'retract firing stage until back switch is closed Out 33,1 Loop Out 33,0 Pwmoffi End Sub '10(1 Routine Sub jog() Out 20,1 Out 21,1 Do Delay 25 If Keyi n(10,20)=0 And Keyin(11,20)=0 Then Exit Do 'if both buttons pressed, exit jog routine and start horning routine after 1 second delay If Keyin(I 0,20)=0 And Keyin(11,20)<>0 And Keyin(12,20)<>0 Then Pwin 0,slow,60000 'Out 30,1 'extend motor forward Do Until Keyirt(10,20)<>0 Or Keyin(13,20)=0 Out 30,1 'extend motor on forward D:DD
Loop Out 30,0 'extend motor off forward DDD
Pwtnoff 0 incr cycjogs If cycjogS>=255 Then cycjogs=255 Eewrite ds+3,cycjogs,1 End If If Keyin(11,20)=0 And Keyin(10,20)<>0 And Keyin(12,20)<>0 Then Pwm 0,slow,60000 Do Until Keyin(11,20)<>0 Or Keyin(14,20)-0 Out 31,1 'extend motor reverse Loop Out 31,0 'extend motor off reverse :Pwmoff 0 Incr cycjogs If cycj ogs>=255 Then cycjogs=255 Eewrite ds-v3,c3rcjogs,1 End If If Keyirt(12,200 And Keyin(10,20)=0 Then jog the fire motor forward :Pwm 1,slow,60000 Do Until Keyin(10,20)<>0 Or Keyin(12,20)<>0 Or Keyin(15,20)=0 Out 32,1 'fire motor forward Loop Out 32,0 'fire motor off forward Pwmoff 1 bier cycjogs If cycjogs>=255 Then cycjogs=255 Eewrite ds+3,cycjogs,1 End If If Keyin(12,20).0 And Keyin(11,20)-0 Then 'jog the fire motor reverse Pwm 1,slow,60000 Do Until Keyin(11,20)<>0 Or Keyin(12,20)<>0 Or Keyin(16,20)=0 Out 33,1 'fire motor reverse Loop Out 33,0 Tire motor off reverse Pwmoff Incr cycjogs =
If cycjogs>=255 Then cycjogs=255 Eewrite ds+3õcycjogs,1 End If 5 Loop Do Until Keyin(10,20)=I And Keyin(1.1,20)=1 'let off both buttons before exiting jog routine Delay 10 Loop 10 Out 20,0 'turn on eir button Ieds Out 21,0 Delay 1000 End Sub 'Extend until extend limit is met Sub extend() Out 22,0 'turn off fire button led while extending Out 21,0 'turn off retract button led while extending Pwin 0,fast,60000 Do Until Keyin(10,20)=1 Or Keyin(13,20)=0 'extend until either the extend limit is closed or the extend button is released /5 Out 30,1 'ER motor forward DDD
Loop Out 30,0 'DDD
If firstout--.0 Then 'this will keep the extend motor going on the first extension until the anvil is all the way out Do Until Keyin(13,20--0 Out 30,1 DDD
Loop End If Out 30,0 'DDD
Pm:I-toff 0 Incr cycers If cycers>=255 Then cycers=255 Eemite ds+2,cycers, 1 If Keyin(13,20)=0 Then firstout-- I 'set the firstout flag to enable .fire button Out 20,0 'turn off extend led End If End Sub 'Retract: until cm switch is open Sub retract() Out 22,0 'turn off tire button led while retracting Out 20,0 'turn off extend button led while retracting Pwm 0,fast,60000 Do Until Keyin(11,20)=1 Or Keyin(17,20)1 'retract until either the lcm switch goes open or the extend button is released Out 313 'ER motor reverse Loop Out 31,0 Pwmoff Incr cycers If cycers>=255 Then cycers=255 &write ds+2,cycers,1 If Keyin(17,20)=2t Then firstback=1 Out 21,0 'turn retract led off End If If firstout-1 And firstback---1 Then arm-1 'set the ann flag to arm the tire button End Sub 'D.ATADUMP Routine Sub datadump() Dim chef As Byte Dim tf As Byte 'total fires Dim ta As Byte 'total aborts Dim ers As Integer Dim tj As Byte Dim tdd As Byte Dim stan As Integer Dim kyle As Byte Dim token As Byte Dim ike As Byte Dim kenny As Byte Dim sn As Byte tf-0 ta-0 ers-0 tj-0 td&O
Eewrite ds+4,1,1 'write 1 to the ds+4 eeprom register denoting that datadump was accessed Delay 1000 sn-Eeread(0,1) Debug "Circular Stapler Stored Data",Cr Debug "Version ",ver,Cr Debug "KN1S Medical ILLC",Cr Debug" .........................
Debug Cr Debug "Serial Number: ",Dec sn,Cr poweronvzSeread(2,1) If powerons>=255 Then powerons-255 Debug "Total Cycles: ",Dec powerons,Cr Debug Cr Debug "-------- ------- ----------",Cr Debug Cr For stan--5 To (powerons*5) Step 5 Debug "Cycle ",Dec (stan/5),Cr Debug" -------------------chef=Eeread(stan,l) tf=chef+tf Debug "Completed Fires: ",Dec chef,Cr ky le-Eeread(stan+1,1) taAyle+-ta Debug "Aborted Fires: ",Dec kyle,Cr toketr:::Eeread(stan+2,1) ers=token+ers Debug "Fills: ",Dec token,Cr ike.,Eeread(statr+-3,1) tj=ike-1 Debug "Jogs: ",Dec ike,Cr kenny=Eeread(stan+4,1) tdd---kenny tdd Debug "Datadumps: ",Dec kenny,Cr Debug Cr Next 'stan Debug" ......................... ",Cr Debug "Cycle Totals",Cr Debug Cr Debug "Completed Fires: ",Dec tf,Cr Debug "Aborted Fires: ",Dec ta,Cr Debug "FIR Presses: "Dec ers,Cr Debug "Jog Presses: ",Dec tj,Cr Debug "Datadumps: ",Dec tdd,Cr Debug Cr Delay 1000 For x=1 To If 'blink the number of completed firing cycles Out 22,1 Delay 500 Out 22,0 Delay 500 Next ex Do Until Adin(0)>800 And Keyin(3,20)=1 'wait until datadump buttons are released Loop End Sub 'Initial fire Sub initialfire0 Dim f As Integer Dim p As Integer Dim t As Integer Dim y As Integer Dim z As Integer Dim q As :Integer Dim jimmy As Integer Dim butter As Integer Dim numblinks As Integer Dim fbcount As Integer Debug cir,Cr 'turn off extend and retract buttons to show that they are not active for abort?
Out 20,0 'extend button Out 21,0 'retract button bail=0 t=15 'total blink time p-.3 'number of blink periods Pwm 0,fa.st,60000 'start blink and adjust pinch motor to force fr(t*1000)/p fbcount=0 If Keyi n(12,20)-1 Then tbcount-1 For y=1 Top numblinks" (t*y)/p For z-1 To numblinks timmy=finumblinks butter=timmy/50 'calibrate this to seconds If timmy---0 Then timtny=1 If Keyin(12,20)=0 And fbcount=1 Then bail"] 'set abortfue flag Exit For End If If Keyin(12,20)=1 Then fbcount=1 Do Until Keyin(19,20)----,0 Or Keyin(14,20).--0 'retract until force switch met or retract limit met Out 31,1 If Keyin(12,20),---0 And fbcount=1 Then bail=1 'set abortfire flag Exit Do End If If Keyin(12,20)=1 Then tbcount=1 Loop If bail=1 Then Exit For Out 31,0 Out 23,1 'force led Out 22,1 'fire button led For q=0 To butter Delay 10 If Keyin(12,20)=0 And tbcourxt= I Then bal1=1 'set abortfire flag Exit For End If if Keyin(12,20)..:1 Then fhcount-:1 If Keyin(19,20)=I Then Out 23,0 Next 'q If baiFl Then Exit For Do Until Keyin(19,20)=0 Or Keyin(14,20) 'retract until force switch met or retract limit met Out 31,1 If .Keyin(i 2,20)=0 And fbcount=1 Then ball.-1 'set abortilre flag Exit Do End If If Keyin(12,20)-1 Then .fficount-1 Loop Out 31,0 Out 23,1 if Keyin(12,20)=0 And fbcount;=-1 Then 'set abortflre flag Exit For End If if Keyin(12,20)=1 Then fbcount=1 Out 22,0 For cr0 To butter Delay 10 If Keyin(12,20):-0 And fbc,ount-.1 Then bail=1 'set abortfire flag Exit For End if If Keyin(12,20)= I Then tbcount=1 5 if Keyin(19,20)= I Then Out 23,0 Next 'q If bail= I Then Exit For Next 'z Debug Dec? tbcount,Cr 10 if bail=1 Then Exit For Next 'y PwinotT 0 If bail =1 Then 15 abortfire Else 'staplerangecheck finalfire End If 20 End Sub 'Staple Range Check Routine Sub staplerangecheck() srstatus=Keyin(29,20) 'read the staplerange limit switch If srstatus=0 Then finalfire Else abortilre End If End Sub ' 'Final Fire Routine Sub final-fire() Out 23,0 'turn force led off Out 20,0 'turn extend led off Out 21,0 'turn retract led off Out 22,1 'Turn on fire led to signify final fire abort ready Pwmoff 1 'Fwrn 1 fast,60000 'Out 32,1 Tire motor forward ODD
COM pletefire:" 1 Do Until Keyin(15,20)=0 'fire forward until forward limit is met If speed>=60000 Then speed=60000 If speed<60000 Then speed=speed+10000 End If Nan 1õspeed,60000 Out 32,1 Delay 50 If Keyin(12,20)-0 Then 'Or :Keyiri(10,20)..0 Or Keyin(11,20)-0 bai 1=1 Exit Do End If Loop Out 32,0 'fire motor fwd off DDD
speed=0 Delay 250 Do Until Keyin(16,20)=0 'retract fire motor If speed>-60000 Then speed'-60000 If speed<60000 Then speed=speed+10000 End If PwIn 1,speed,60000 Out 33,1 Delay 50 Loop speed,=0 Out 33,0 Pwmoff I
Out 22,0 'turn tire led off Out 21,0 'turn off retract led extendonly=1 iner cycnumfires If cycntunfires>255 Then cycnumfires=255 Eewrite ds,cycnumfires,1 'write the current cycle number of fires to the eeprorn Delay 200 End Sub 'return to the main routine 'Abort fire Sub abortfire() 'Debug "Fire aborted before firing! !",Cr Out 31,0 'turn retract motor off Out 32,0 'turn tire forward off DDD
Out 23,0 'turn force led off Pwm 1,fast,60000 Delay 250 Do Until Keyin(16,20)=0 'retract fire motor Out 33,1 Loop Out 33,0 Pwmoff 1 Out 22,0 'turn fire led off Incr cycabortfires If cycabortfires>=255 Then cycabortfires=255 Eewrite ds+1,cycabortfires,1 'write the current cycle abortfires to the eeprom Delay 200 homeextend 'extend to lcm End Sub Also mentioned above is the possibility of using identification devices with removable and/or interchangeable portions of the end effector. Such identification devices, for example, can be used to track usage and inventory.
One exemplary identification device employs radio-frequency and is referred to as an RF1D.
In an exemplary embodiment where a medical stapler uses re-loadable, interchangeable staple cartridges, such as the stapler I described herein, an RFID can be placed in the staple cartridge to ensure compatibility with the particular stapler and an RFID reader for sensing compatible staple cartridges can be associated with the handle. In such a configuration, the reader interrogates the RFID mounted in the cartridge. The RFID responds with a unique code that the stapler verifies. If the stapler cartridge is labeled as verified, the stapler becomes active and ready for use. If the cartridge is rejected, however, the stapler gives a rejected indication (e.g., a blinking LED, an audible cue, a visual indicator). To avoid accidental or improper reading of a nearby staple cartridge, the antenna of the RFID reader can be constructed to only read the RFID when the staple cartridge is installed in the stapler or is very nearby (optimally, at the distal end of the device). Use of the RFID can be combined with a mechanical lockout to ensure that only one fire cycle is allowed per staple cartridge. RFIDs have drawbacks because the readers are expensive, the antennas are required to be relatively large, and the distance for reading is relatively close, typically measured in centimeters.
Other wireless authentication measures can be employed. Active RFIDs can be used.
Similarly, infrared (ER) transmission devices can be used. However, both of these require the generation of power at the receiving end, which is a cost and size disadvantage.
Another exemplary identification device employs encryption. With encryption comes the need for processing numbers and, associated with such calculations, is use of processing chips (e.g., a microprocessor), one of which is to be placed on the interchangeable part, such as a staple cartridge or a replaceable end effector shaft. Such encryption chips have certain characteristics that can be analyzed for optimization with the surgical instrument of the present invention. First, a separate power source for the interchangeable part is not desired. Not only would such a power source add cost, it would also add undesirable weight and take up space that is needed for other features or is just not available. Thus, power supply to the part should come from the already existing power supply within the handle. Also, supply of power should be insured at all times.
Because the interchangeable part is relatively small, the encryption chip should be correspondingly small. Further, both the handle and the interchangeable pan are configured to be disposable, therefore, both encryption processors should have a cost that allows disposability. Finally, connections between the encryption device on the interchangeable part and the corresponding encryption device on the handle should be minimized. As will be discussed below, the encryption device according to the present invention provides all of these desirable characteristics and limits the undesirable ones.
Devices for encrypted identification are commercially available. One of such encryption devices is produced by Dallas Semiconductor and is referred to as the DS2432 chip. The DS2432 chip not only provides encrypted identification between a reader and a transponder, but it also has a memory that can be used to store device-specific information, which information and its uses will be described in further detail below. One beneficial characteristic of the DS2432 is that it is a 1-wire device. This means that the power and both of the input and output signals travel on the same line.
With a 1-wire device such as the DS2432, there is only the need for a single wire to traverse the distance from the handle body 10 through the anvil neck 30 to the interchangeable staple cartridge 50 in order to make a connection between the handle and the end effector. This configuration satisfies the characteristic of having a minimal amount of electrical connections and has a correspondingly reduced cost for manufacture. It is true that the DS2432 chip requires ground, however, the metallic anvil neck 30 is electrically conducting and is connected to ground of the device 1, therefore, an exemplary embodiment for the ground connection of the DS2432 chip is made by direct electrical contact through a lead to the neck 30 or by directly connecting the chip's ground to the neck 30.
One exemplary encryption circuit configuration places a first encryption chip on the interchangeable part (e.g., the staple cartridge). Ground for the first encryption chip is electrically connected to a metallic portion of the interchangeable part which, in turn, is electrically connected to ground of the device, for example, to the neck 30. The 1-wire connection of the DS2432 chip is electrically connected to a contact pad that is somewhere on the interchangeable part but is electrically disconnected from ground. For example, if the interchangeable part is a linear 60 mm staple cartridge, the DS2432 can be attached to or embedded within the electrically insulated distal end of the cartridge distal of the last staple set. The encryption chip can be embedded on a side of the cartridge opposite the staple ejection face so that it is neither exposed to the working surfaces nor to the exposed tissue when in use. The ground lead of the DS2432 chip can be electrically connected to the metallic outer frame of the staple cartridge, which is electrically connected to ground of the stapler. The 1-wire lead is electrically connected to a first conductive device (such as a pad, a lead, or a boss) that is electrically insulated from the metallic frame of the cartridge. A single electrically conductive but insulated wire is connected at the proximal end to the circuit board or to the appropriate control electronics within the handle of the device.
This wire is insulated from electrical contact with any other part of the stapler, especially the grounded frame, and travels from the handle, through the neck and up to the receiving chamber for the interchangeable part. At the distal end, the insulated wire is exposed and electrically connected to a second conductive device (such as a pad, a lead, or a boss) that is shaped to positively contact the first conductive device on the cartridge when the cartridge is locked into place in the end effector. In such a configuration, the two conductive devices form a direct electrical connection every time that the interchangeable part (e.g., the staple cartridge) is inserted within the end effector, in one particular embodiment, contact can be made only when the part is correctly inserted.
The DS2432 is also only a few square millimeters in area, making the chip easy to install on a small interchangeable part, such as a staple cartridge, while simultaneously satisfying the minimal size requirement. It is noted that the DS2432 chip is relatively inexpensive. To keep all communication with the DS2432 chip hidden from outside examination, a DS2460 (also manufactured by Dallas Semiconductor) can be used to perform a comparison of an encrypted transmission received from a DS2432 with an expected result calculated internally. The characteristics of both of these chips are explained, for example, by Dallas Semiconductors' Application Note 3675. The DS2460 chip costs significantly more than the DS2432 chip, but is still inexpensive enough to be disposed along with the handle. It is noted that the number of disposable interchangeable parts of medical devices (such as the surgical instrument of the present invention) typically outnumber the handle that receives the interchangeable parts by a significant amount.
Accordingly, if the 0S2432 chip is placed in the interchangeable part and the DS2460 chip is placed in the handle, the low cost 5 encryption characteristic is satisfied. There exists an alternative circuit configuration using two DS2432 chips that is explained in MG, 2 of Application Note 3675, which circuit eliminates the need of the more expensive DS2460 chip by performing the comparison with a local microprocessor (e.g., microprocessor 2000). In such a configuration, the cost for adding encryption into the device 1 is reduced, however, as explained, the configuration gives up some aspects of security by making 10 available to inspection both numbers that are to be compared.
The process for electronically verifying the identity of an interchangeable part on a medical device using encryption is described with an exemplary embodiment having one 0S2432 chip and one DS2460 chip. The exemplary control circuit for the encryption device is shown in FIG. 30, This exemplary embodiment is described using a linear stapler having a handle containing therein a 15 circuit board with a microprocessor 2000. One free I/O pin 2010 of the microprocessor 2000 is connected to a first lead 2110 of the .DS2460 and another pin 2020 is connected to a second lead 2120. Each interchangeable part 2200 is provided with a DS2432 chip and the 1-wire lead is connected to a third I/O pin 2030 of the microprocessor 2000.
To start the process, an interchangeable part 2200 is connected to the device, mating 20 electrical contact with ground and with the 1-wire lead. When the microprocessor 2000 detects that a new part 2200 has been connected to the device 1, it runs an authentication routine. First, the microprocessor 2000 initiates a random number request to the DS2460 over the first communication pin 2010. The DS2460 has a pre-programmed secret number that is the same as the pre-programmed secret numbers stored in each of the DS2432 chips contained on the interchangeable parts 2200.
25 Therefore, when the same random number is provided to both the 0S2432 and the 1DS2460 chips, the output result from each of the two chips will be identical. The DS2460 generates a random number and supplies it, via the second pin 2020, to the microprocessor 2000 for forwarding, via pin 2030, on to the DS2432 over the 1-wire lead. When the DS2432 receives the random number, it applies its SEA-1 algorithm (developed by the National Institute of Standards and Technology 30 (MST)) to cryptographically generate a hash code reply. This hash code reply is transmitted back over the 1-wire lead to the microprocessor 2000 and is forwarded, via either pin 2010 or 2.020 to the DS2460. During this period of time, the DS2460 is also calculating its own a hash code reply. First, the DS2460 internally applies the same random number sent to the DS2432 to its own SEA-1 algorithm and stores, internally, the generated hash code reply. The DS2460 also stores the hash code reply transmitted from the 0S2432 through the microprocessor 2000. Both of the hash code replies are compared and, if they are identical, the interchangeable part 2200 is confirmed as authenticated. If there is a difference between the hash code replies, then the part 2200 is rejected and the device is placed in a state where the part 2200 either cannot be used or can be used, but only after certain safeguards are met. For example, data regarding the time, date, environment, etc. and characteristics of the unauthenticated part can be stored for later or simultaneous transmission to the manufacturer Or its agent) to inform the manufacturer that the user is attempting to use or has used an unauthorized part 2200 with the device. If there was no encryption in the messages, the authentication messages could be intercepted and counterfeit, pirated, or unauthorized parts 2200 could be used without having to purchase the parts 2200 from an authorized distributor. hi the exem platy encryption embodiment described herein, the only information that is transmitted across lines that can be examined is a single random number and a single hash code reply. It is understood that it would take hundreds of years to decrypt this SRA4-generated reply, thus reducing any incentive for reverse engineering.
Because the chips used in this example each have secure memories that can only be accessed after authentication occurs, they can be programmed to employ multiple secret keys each stored within the memory. For example, if the DS2460 has multiple keys stored therein and the parts 2200 each have only one key selected from this stored set of multiple keys, the DS2460 can act as a "master" key to the "general" single keys of the parts 2200.
By authenticating the interchangeable part of the surgical instrument of the present invention, many positive results are obtained. First, the instrument manufacturer can prevent a user from using unauthorized parts, thereby insuring use of only authorized parts. Not only does this guarantee that the manufacturer can receive royalties from sales of the interchangeable part, but it also allows the manufacture to insure that the quality of the surgical parts remains high.
Having the encryption circuitry contain memory dramatically enhances the benefits provided by the present invention. For example, if a single end effector of a linear stapler can receive 30 mm, 60 mm, and 120 mm staple cartridges, for example, each size of the cartridges could be provided with an individualized key and the handle can be programmed to store and use each tat' these three keys. Upon receiving a hash code reply that corresponds to one, but not the other two internally calculated hash code replies, the handle would know what kind of cartridge has been inserted in the device. Each cartridge could also contain in its memory cartridge-specific parameters, such as staple sled movement length, that are different among the various sized cartridges and, therefore, cause the handle to behave differently dependent upon the cartridge detected. The parameters examined can also account for revision levels in the particular part. For example, a revision I cartridge could have certain parameters for use and, by detecting that particular cartridge, programming could cause the handle to not allow use of revision 1 cartridges but allow use of revision 2 cartridges, or vice-versa.
Having memory on the encryption chips can also allow the cartridge to keep track of other kinds of data. For example, the cartridge can store the identity of each handle to which it was connected, the identity of the handle that fired the cartridge, the time, date and other temporal data when use and/or connection occurred, how long it took to fire the cartridge, how many times the firing trigger was actuated during staple tiring, and many other similar parameters. One parameter in particular could record data when the cartridge misfires_ This would allow the manufacturer to determine if the cartridge was faulty or if user-error occurred, for example, the latter being investigated to assist the user with remedial measures or other training. By having memory available .15 at the handle, other handle-relevant parameters could be stored, for example, duration of each procedure, speed of each staple firing, torque generated at each tiring, and/or load experienced throughout each firing. The memory could be powered for years merely from the lithium-based power cells already present in the handle. Thus, longevity of handle data can be ensured. The memory can be used to store all uses of a particular handle, along with relevant calendar data. For example, if a handle is only certified for use in a single surgical procedure but the handle has data indicating that staple cartridges were fired days or weeks apart, then, when it was finally returned to the manufacturer for recycling, the manufacturer could detect that the user (hospital, doctor, clinic, etc.) was improperly and, possibly, unsafely, using the handle. Encrypted authentication can be used with removable battery packs as well. Moreover, sensors can be added to any portion of the device for communicating information to be stored within the memory of the encryption chips. For example, temperature sensors can transmit operating room temperature existing when the cartridge was fired. This temperature reading can be used to determine if later infection was caused by improper temperature control existing during the procedure (e.g., in countries where air-conditioning is not available).
In the unlikely event that the stapler becomes inoperable during use, a mechanical override or bail-out is provided to allow manual removal of the device from the patient.
All bailout uses can be recorded with the memory existing on these encryption chips. Furthermore, data that could indicate why bailout was necessary could be stored for later examination. For quality assurance, when bailout is detected, the handle can be programmed to indicate that a certified letter should be sent to the customer/user informing them of the bailout use.
As described above, the present invention is not limited to a circular stapler, which has been used as an exemplary embodiment above, and can be applied to any surgical stapling head, such as a linear stapling device, for example. Accordingly, a linear stapler is being used in the text that follows for various exemplary embodiment. However, use of a linear stapler in this context should not be considered as limited only thereto_ Described above are components that exist along the staple control axis 80 of linear and circular staplers and these components form the staple control assembly 200. As set forth therein, the required force for proper staple ejection and tissue cutting can be over 200 pounds and, possibly, up to 250 pounds. :ft has been determined that minimum requirements for carrying out the desired stapling and cutting functions with a linear electric surgical stapler for human tissue (such as colon tissue, for example) are:
delivering approximately 54.5 kg (120 pounds) of force over a stroke of about 60 mm (-2.4") in approximately 3 seconds; or 2) delivering approximately 82 kg (180 pounds) of force over a stroke of about 60 mm (-2.4") in approximately 8 seconds.
The electric-powered, hand-held linear surgical stapling device of the present invention can meet these requirements because it is optimized in a novel way as set forth below.
To generate the force necessary to meet the above-mentioned requirements, the maximum power (in watts) of the mechanical assembly needs to be calculated based upon the maximum limits of these requirements: 82 kg over 60 mm in 3 seconds. Mathematical conversion of these figures generates an approximate maximum of 16 Watts of mechanical power needed at the output of the drive train. Conversion of the electrical power into mechanical power is not 1:1 because the motor has less than 100% efficiency and because the drive train also has less than 100% efficiency. The product of these two efficiency ratings forms the overall efficiency. The electrical power required to produce the 16 Watts of mechanical power is greater than the 16 Watts by an inverse product of the overall efficiency. Once the required electrical power can be determined, an examination of available power supplies can be made to meet the minimum power requirements.
Thereafter, an examination and optimization of the different power supplies can be made. This analysis is described in detail in the following text.
Matching or optimizing the power source and the motor involves looking into the individual characteristics of both. When examining the characteristics of an electric motor, larger motors can perform a given amount work with greater efficiency than smaller motors. Also motors with rare-earth magnets or with careless construction can deliver the same power in a smaller size, but at higher cost. Further, in general, larger motors cost less than smaller motors if both are designed to deliver the same power over a given period of time. Larger motors, however, have an undesirable characteristic when used in surgical stapling devices because the handle in which they are to be placed is limited by the size of an operator's hand. Physicians desire to use devices that are smaller and lighter, not larger and heavier. Based upon these considerations, cost, size, and weight are factors that can be optimized for use in the surgical stapler handle of the present invention.
Available motors for use within a physician's hand include motors with relatively inexpensive ceramic magnets and motors with relatively expensive rare earth (i.e., neodymium) magnets. However, the power increase of the latter as compared to the former is not sufficiently large to warrant the substantial increase in cost of the latter. Thus, ceramic magnet motors can be selected for use in the handle. Exemplary motors come in standard sizes (diameter) of 27.5 mm or 24 mm, for example. These motors have a rated efficiency of approximately 60%
(which decreases to 30% or below depending upon the size of the load). Such motors operate at speeds of approximately 30,000 rpm (between 20,000 and 40,000 rpm) when unloaded.
Even though such conventional motors could be used, it would be desirable to reduce the size even fitrther. To that effect, the inventors have discovered that coreless, brush-type, DC motors produce similar power output but with a significant reduction in size. For example, a 17 mm diameter coreless motor can output approximately the same power as a standard 24 mm diameter motor. Unlike a standard motor, the coreless motor can have an efficiency of up to 80%. Coreless motors almost all use rare earth magnets.
With such a limited volume and mechanical power available, it. is desirable to select a mechanical gear train having the greatest efficiency. Placing a rack and pinion assembly as the final drive train control stage places a high-efficiency end stage in the drive train as compared to a screw drive because, in general, the rack and pinion has an approximate 95%
efficiency, and the screw drive has a maximum of about 80% efficiency. For the linear electric stapler, there is a 60 mm travel range for the stapling/cutting mechanism when the stapler has a 60 mm cartridge (cartridges ranging from 30 mm to 100 mm can be used but 60 mm is used in this example for illustrative purposes).
With this travel range, a 3-second, full travel duration places the rack and pinion extension rate at 0.8 inches per second. To accomplish this with a reasonably sized rack and pinion assembly, a gear train should reduce the motor output to approximately 60 rpm. With a motor output speed of approximately 30,000 rpm, the reduction in speed for the drive train becomes approximately 500:1.
To achieve this reduction with the motor, a 5-stage drive train is selected.
it is known that such 5 drive trains have an approximate 97% efficiency for each stage. Thus, combined with an approximate 95% efficiency of the rack and pinion, the overall efficiency of the drive train is (0.95X0.97)5 or 82%. Combining the 60% motor efficiency with the 82% drive train efficiency yields an overall electrical to final mechanical efficiency of approximately 49.2%. Knowing this overall efficiency rating, when determining the amount of electrical power required for operating the 10 stapler within the desired requirements, the actual electrical power needed is almost. twice the value that is calculated for producing the stapling/cutting force, To generate the force necessary to meet the above-mentioned requirements, the power (in watts) of the mechanical assembly can be calculated based upon the 82 kg over 60 mm in 3 seconds to be approximately 16 Watts. It is known that the overall mechanical efficiency is 49.2%, so 32,5 15 Watts is needed from the power supply (16 mech. watts 32.5 elec. Watts x 0.492 overall efficiency.). With this minimum requirement for electrical power, the kind of cells available to power the stapler can be identified, which, in this case, include high-power Lithium Primary cells. A
known characteristic of high-power Lithium cells (e.g., CRI 23 or (R.2 cells) is that they produce about 5 peak watts of power per cell. Thus, at least six cells in series will generate the required 20 approximate amount of 32.5 watts of electrical power, which translates into 16 watts of mechanical power. This does not end the optimization process because each type of high-power Lithium cell manufactured has different characteristics for delivering peak power and these characteristics differ for the load that is to be applied.
Various battery characteristics exist that differentiate one battery of a first manufacturer from 25 another battery of a second manufacturer. Significant battery characteristics to compare are those that limit the power that can be obtained from a battery, a few of which include:
= type or electrolyte in the cell;
= electrolyte concentration and chemistry;
= how the anode and cathode are manufactured (both in chemistry and in 30 mechanical construction); and = type and construction of the PTC (positive temperature coefficient of resistance) device.
Testing of one or more of these characteristics gives valuable information in the selection of the most desirable battery for use in the stapling device. It has been found that an examination of the last characteristic -- PTC device behavior -- allows an optimization of the type of battery to perform the desired work.
Most power sources are required to perform, with relative certainty and efficiency, many times throughout a long period of time. When designing and constructing a power source, it is not typical to select the power source for short-duration use combined with a low number of uses.
However, the power source of an electric stapling device is only used for a short duration and for a small number of times. In each use, the motor needs to be ready :for a peak load and needs to perform without error. This means that, for surgical staplers, the stapling/cutting feature will be carried out during only one medical procedure, which has cycle counts of between 10 and 20 uses at most, with each use needing to address a possible peak load of the device.
After the one procedure, the device is taken out of commission and discarded. Therefore, the power source for the present invention needs to be constructed unlike any other traditional power supply.
I 5 The device according to the present invention is constructed to have a limited useful life of a power cell as compared to an expected useful life of the power cell when not used in the device.
When so configured, the device is intended to work few times after this defined "life span." It is known that self-contained power supplies, such as batteries, have the ability to recover after some kind of use. For optimization with the present invention, the device is constructed within certain parameters that, for a defined procedure, will perform accordingly but will be limited or unable to continue performance if the time of use extends past the procedure. Even though the device might recover and possibly he used again in a different procedure, the device is designed to use the power cells such that they will most likely not be able to perform at the enhanced level much outside the range of intended single use periods or outside the range of aggregate use time. With this in mind, a useful life or clinical life of the power supply or of the device is defined, which life can also be described as an intended use. It is understood that this useful/clinical life does not include periods or occurrences of use during a testing period thereof to make sure that the device works as intended.
The life also does not include other times that the device is activated outside the intended procedure, i.e., when it is not activated in accordance with a surgical procedure.
Conventional batteries available in the market are designed to be used in two ways: (1) provide a significant amount of power for a short duration (such as in a high-drain digital device like cameras) or (2) provide a small amount of power over a long duration (such as a computer's clock =
backup). If either of these operations is not followed, then the battery begins to heat up. If left unchecked, the battery could heat to a point where the chemicals could cause significant damage, such as an explosion. As is apparent, battery explosion is to be avoided, These extremes are prevented in conventional batteries with the presence of the Pit device ¨ a device that is constructed to limit conduction of the battery as the battery increases in temperature (i.e,, a positive temperature coefficient of resistance), The FTC device protects batteries and/or circuits from overcurrent and overtemperature conditions. Significantly, the PVC device protects a battery from external short circuits while still allowing the battery to continue functioning after the short circuit. is removed. Some batteries provide short-circuit and/or overteruperature protection using a one-time fuse. However, an accidental short-circuit of such a fused battery causes the fuse to open, rendering the battery useless. PVC-protected batteries have an advantage over fused batteries because they are able to automatically "reset" when the short circuit is removed, allowing the battery to resume its normal operation. Understanding characteristics of the PVC device is particularly important in the present invention because the motor will be drawing several times greater current than would ever be seen in a typical high-drain application.
The 'PTC device is provided in series with the anode and cathode and is made of a partially conducting layer sandwiched between two conductive layers, for example. The device is in a low-resistance condition at a temperature during a normal operation (depending on circuit conditions in which the device is used, for example, from room temperature to 400 C.). On exposure to high temperature due to, for example, unusually large current resulting from the formation of a short circuit or excessive discharge (depending on circuit conditions in which the device is used, for example, from 60* to 1300 C), the PVC device switches into an extremely high-resistance mode.
Simply put, when a PTC device is included in a circuit and an abnormal current passes through the circuit, the device enters the higher temperature condition and, thereby, switches into the higher resistance condition to decrease the current passing through the circuit to a minimal level and, thus, protect electric elements of the circuit and the batteryiies. .At the minimal level (e.g., about 20% of peak current), the battery can cool off to a "safe" level at which time greater power can be supplied.
The partially conducting layer of the PTC. device is, for example, a composite of carbon powder and polyolefin plastic. Further description of such devices is unnecessary, as these devices are described and are well known in the art.
Because FTC circuits of different manufacturers operate with different characteristic behaviors, the present invention takes advantage of this feature and provides a process for optimizing the selection of a particular battery to match a particular motor and a particular use. An examination of the time When the PTC device switches to the higher resistance condition can be used as this indicator for optimizing a particular motor and drive train to a battery. It is desirable to know when the PIC device makes this switch so that, during normal stapler use, the PTC device does not make this change.
Exemplary batteries were loaded with various levels from approximately 3 amps to = approximately 8 amps. At the high end, the PTC device changed to the high-resistance state almost immediately, making This current level too high for standard CR123 cells. It was determined that, for between 4 and 6 amps, one manufacturer's cell had PTC activation sooner than another .10 manufacturer's cell. The longest PIC changeover duration for the second manufacturer was >3 minutes f.or 4 amps, approximately 2 minutes for 5 amps, and almost 50 seconds for 6 amps. Each of these durations was significantly greater than the 8-second peak load requirement. Accordingly, it was determined that the second manufacturer's cells would be optimal for use at peak amps as compared to the first manufacturer's cells.
Initially, it was surmised that higher amperes with lower or constant voltage would generate higher power out of the power cell(s). Based upon the configuration of 6 cells in series, the peak voltage could be 18 volts with a peak current of only 6 amps. Placing cells in parallel, in theory, should allow a higher peak amperage and a 3x2 configuration (two parallel set of three cells in series) could have a 9 volt peak with up to a 12 amp peak.
Different single cells were investigated and it was confirmed that a relatively low voltage (about 1,5 to 2 volts) and approximately 4 to 6 amperes produces the highest power in Watts. Two six-cell configurations were examined: a 6x1 series connection and a 3x2 parallel connection. The 3x2 configuration produced the greatest peak amperes of approximately 10 amps.
The 6x1 configuration produced about 6 amps peak and the single cell was able to peak at 5-6 amps beibre the PTC device changed state. This information indicated the state at which any single cell in the series group would be activating its Pit device and, thus, limiting current through the entire group of cells. Thus, the tentative conclusion of yielding peak amps at lower voltage with a 3x2 configuration was maintained.
Three different CR123 battery configurations were tested: 4x1, 6x1, and 3x2, to see how fast the pinion would move the rack (in inches per second ("IPS")) for the 120# and 180# loads and for a given typical gearing The results of this real world dynamic loading test are shown in the chart of FIG. 31, for both the 1201iload = the 4x1 battery pack was able to move the load at about 0,6 IPS at approximately 2.5 amps but at approximately 8 volts;
= the 6x1 battery pack was able to move the load at. about 0,9 IPS at approximately 2,5 amps but at approximately 13 volts; and = the 3x2 battery pack was able to move the load at about 0,4 IPS at approximately 2.5 amps but at approximately 6 volts;
and the 1804 load:
= the 4x1 battery pack was able to move the load at about 0.65 IPS at approximately 4 amps but at approximately 7.5 volts;
= the 6x1 battery pack was able to move the load at about. 0.9 IPS at approximately 4 amps but at approximately 12 volts; and = the 3x2 battery pack was able to move the load at about 0.4 IPS at approximately 4 amps but at approximately 7 volts.
Clearly, the peak current was limited and this limit was dependent upon the load. This experiment revealed that the motor drew a similar current regardless of the power supply for a given load but that the voltage changed depending upon the battery cell configuration. With respect_ to either load, the power output was the greatest in the 6x1 configuration and not in the 3x2 configuration, as was expected. From this, it was determined that the total power of the cell pack is driven by voltage and not by current and, therefore, the parallel configuration (3x2) was not the path to take in optimizing the power source.
Traditionally, when designing specifications for a motor, the windings of the motor are matched to the anticipated voltage at which the motor will be run. This matching takes into account the duration of individual cycles and the desired overall life of the product.
In a case of an electric stapling device the motor will only be used for very short cycles and for a very short life, traditional matching methods yield results that are below optimal. Manufacturers of the IMAMS give a voltage rating on a motor that corresponds to the number of turns of the windings. The lower the number of turns, the lower the rated voltage. Within a given size of motor winding, a lower number of' turns allows larger wire to be used, such that a lower number of turns results in a lower resistance in the windings, and a higher number of turns results in a higher resistance. These characteristics limit the maximum current that the motor will draw, which is what creates most of the heat and damage when the motor is overdriven. For the present invention, a desirable configuration will have the lowest winding resistance to draw the most current from the power supply (i.e., battery pack). By .ninning the motor at a voltage much higher than the motor rating, significantly greater power can be drawn from similarly sized motors. This trait was verified with testing of nearly identical coreless motors 5 that only varied in winding resistance (and, hence, the number of rums).
For example, 12-volt and 6-volt rated motors were run with 6 cells (i.e., at 19.2 volts). The motors rated for 12 volts output peak power of 4 Watts with the battery voltage only falling slightly to 18 volts when drawing 0.7 amps. In comparison, the motors rated for 6 volts output 15 Watts of power with the voltage dropping to 15 volts but drawing 2 amps of current. Therefore, the lower resistance windings were 10 selected to draw enough power out of the batteries. It is noted that the motor windings should be balanced to the particular battery pack so that, in a stall condition, the motor does not draw current from the cells sufficient to activate the PTC, which condition would impermissibly delay use of an electric surgical stapler during an operation.
The 6x1 power cell configuration appeared to be more than sufficient to meet the 15 requirements of the electric stapling device. Nonetheless, at this point, the power cell can be fiirther optimized to determine if six cells are necessary to perform the required work. Four cells were, then, tested and it was determined that, under the 1204 load, the motor/drive train could not move the rack over the 60 mm span within 3 seconds. Six cells were tested and it was determined that, under the 120# load, the motor/drive train could MONT the rack over the 60 mm span in 2.1 seconds ¨ much 20 faster than the 3-second requirement. it was further determined that, under the 1804 load, the motor/drive train could move the rack over the 60 mm span in less than 2.5 seconds ¨ much quicker than the 8-second requirement. At this point, it is desirable to optimize the power source and mechanical layout to make sure that there is no "runaway" stapling/cutting; in other words, if the load is significantly less than the required 1804 maximum, or even the 1204 maximum, then it would 25 not be desirable to have the rack move too fast.
The gear reduction ratio and the drive system need to be optimized to keep the motor near peak efficiency during the firing stroke. The desired stroke of 60 min in 3 seconds means a minimum rack velocity of 20 mm/sec (-0.8 inches/second). To reduce the number of variables in the optimization process, a basic reduction of 333:1 is set in the gear box.
This leaves the final 30 reduction to be performed by the gears present between the output shaft 214 of the gear box and the rack 217, which gears include, for example, a bevel gear 215 and the pinion 216 (which drives the rack), a simplified example of which is illustrated in FIG. 32.
These variables can be combined into the number of inches of rack travel with a single revolution of the output shaft 214 of the 333:1 gearbox. if the gearbox output (in rpm) never changed, it would be a simple function to match the inches of rack travel per output shaft. revolution ("[PR.") to the output rpm to get a desired velocity as follows:
(60 rpm 1 revolution/second (rps); I rps (i.P. 0.8 IPR. 3 0.8 in/sec).
In such an idealized case, if the IPR is plotted against velocity, a. straight line would be produced.
Velocity over a fixed distance can be further reduced to Firing Time. Thus, a plot of Firing Time versus IPR would also be a straight line in this idealized case. However, output of the motor (in rpm) and, therefore, of the gearbox, is not fixed because this speed varies with the load. The degree of load determines the amount of power the motor can put out. As the load increases, the tprns decrease and the efficiency changes. Based upon an examination of efficiency with differing loads, it has been determined that efficiency peaks at just over 60%. However, the corresponding voltage and amperes at this efficiency peak are not. the same as at the point of peak.
power. Power continues to increase as the load increases until the efficiency is falling faster than the power is increasing. As the IPR increases, an increase in velocity is expected, but. a corresponding increase in IPR lowers the mechanical advantage and., therefore, increases the load. This increasing load, with the corresponding decrease in efficiency at progressively higher loads, means that a point will exist when greater velocity out of the rack is no longer possible with greater IPR.
This behavior is reflected as a deviation from a predicted straight line in the plot of Firing Time (in sec) versus IPR.
Experimentation of the system of the present invention reveals that the boundary between unnecessary mechanical advantage and insufficient mechanical advantage occurs at approximately 0.4 IPR.
From this .T.PR value, it is possible to, now, select, the final gear ratio of the bevel gear 215 to be approximately three times greater (3:1) than the sprocket of the output shaft. This ratio translates into an approximate IPR of 0.4.
Now that the bevel gear 215 has been optimized, the battery pack can be reexamined to determine if six cells could be reduced to five or even four cells, which would save cost and . considerably decrease the volume needed for the power supply within the handle. A constant load of approximately 120# was used with the optimized motor, drive train, bevel gear, and rack and pinion and it was discovered that use of 4 cells resulted in an almost 5 second time period for moving the rack 60 mm. With 5 cells, the time was reduced to approximately 3.5 seconds.
With a 6-ce1l configuration, the time was 2.5 seconds. Thus, interpolating this curve resulted in a minimum cell configuration of 5.5 cells. Due to the fact that cells only can be supplied in integer amounts, it was discovered that the 6-cell configuration was needed to meet the requirements provided for the electric stapling device.
From this, the minimum power source volume could be calculated as a fixed value, unless different sized cells could be used that provided the same electrical power characteristics. Lithium cells referred as CR2s have similar electrical power characteristics as have CR123s but are smaller.
Therefore, using a 6-cell power supply of CR2s reduced the space requirement by more than 17%.
As set forth in detail above, the power source (i.e., batteries), drive train, and motor are optimized for total efficiency to deliver the desired output force within the required window of time .10 for completing the surgical procedure. The efficiency of each kind of power source, drive train, and motor was examined and, thereafter, the type of power source, drive train, and motor was selected based upon this examination to deliver the maximum power over the desired time period. In other words, the maximum-power condition (voltage and current) is examined that can exist for a given period of time without activating the PTC (e.g., approximately 15 seconds).
The present invention locates the voltage-current-power value that optimizes the way in which power is extracted from the cells to drive the motor. Even after such optimization, other changes can be made to improve upon the features of the electric stapler 1.
Another kind of power supply can be used and is referred to herein as a "hybrid" cell. In such a configuration, a rechargeable Lithium-ion or Lithium-polymer cell is connected to one or more of the optimized cells mentioned above (or perhaps another primary cell of smaller size but of a similar or higher voltage). In such a configuration, the Li-ion cell would power the stapling/cutting motor because the total energy contained within one CR2 cell is sufficient to recharge the Li ion cell many times, however, the primary cells are limited as to delivery. Li-ion and Li-Polymer cells have very low internal resistance and are capable of very high currents over short durations. To harness this beneficial behavior, a primary cell (e.g., CR123, CR2, or another cell) could take 10 to 30 seconds to charge up the secondary cell, which would form an additional power source for the motor during firing. An alternative embodiment of the Li-ion cell is the use of a capacitor; however, capacitors are volume inefficient. Even so, a super capacitor may be put into the motor powering system; it may be disconnected electrically therefrom until the operator determines that additional power is required. At such a time, the operator would connect the capacitor for an added "boost" of energy.
=
=
As mentioned above, if the load on the motor increases past a given point, the efficiency begins to decrease. In such a situation, a multi-ratio transmission can be used to change the delivered power over the desired time period. When the load becomes too great such that efficiency decreases, a multi-ratio transmission can be used to switch the gear ration to return the motor to the higher efficiency point, at which, for example, at least a 180# force can be supplied. It is noted, however, that the motor of the present invention needs to operate in both forward and reverse directions. In the latter operating mode, the motor must be able to disengage the stapling/cutting instrument from out of a "jammed" tissue clamping situation. Thus, it would be beneficial for the reverse gearing to generate more force than the forward gearing, With significantly varying loads, e.g., from low pounds up to 180 pounds, there is the possibility of the drive assembly being too powerfill in the lower end of the load range. Thus, the invention can include a speed governing device. Possible governing devices include dissipative (active) governors and passive governors. One exemplary passive governor is a flywheel, such as the energy storage element 56, 456 disclosed in U.S. Patent Application No.
2005/0277955 to Palmer et al. Another passive governor that can be used is a "fly"
paddlewheel. Such an assembly uses wind resistance to govern speed because it absorbs more force as it spins faster and, therefore, provides a speed governing characteristic when the motor is moving too fast.
Another kind of governor can be a compression spring that the motor compresses slowly to a compressed state.
When actuation is desired, the compressed spring is released, allowing all of the energy to be transferred to the drive in a relatively short amount of time. A further exemplary governor embodiment can include a multi-stage switch having stages that are connected respectively to various sub-sets of the battery cells. When low force is desired, a first switch or first part of a switch can be activated to place only a few of the cells in the power supply circuit.
As more power is desired, the user (or an automated computing device) can place successive additional cells into the power supply circuit. For example, in a 6-cell configuration, the first 4 cells can be connected to the power supply circuit: with a first position of a switch, the fifth cell can be connected with a second position of the switch, and the sixth cell can be connected with a third position of the switch.
Electric motors and the associated gear box produce a certain amount of noise when used, The stapler of the present invention isolates the motor and/or the motor drive train from the handle to decrease both the acoustic and vibration characteristics and, thereby, the, overall noise produced during operation. In a first embodiment, a dampening material is disposed between the handle body and both of motor and the drive train, The material can be foam, such as latex, polyester, plant-based, polyether, polyetherimide, polyimide, polyolefin, polypropylene, phenolic, polyisocyanates, polyurethane, silicone, vinyl, ethylene copolymer, expanded polyethylene, fluoropolymer, or styrofoam. The material can be an elastomer, such as silicone, polyurethane, chloroprene, butyl, polybutadiene, neoprene, natural rubber, or isoprene. The foam can be closed cellular, open cellular, flexible, reticular, or syntactic, for example. The material can be placed at given positions between the handle and motor/gear box or can entirely fill the chamber surrounding the motor/gear box, In a second embodiment, the motor and drive train are isolated within a nested box configuration, sometimes referred to as a "Chinese Box" or "Russian nesting doll." in such a.
configuration, the dampening material is placed around the motor/gear box and the two are placed within a first box I 0 with the gear box shaft protruding therefrom. Then, the first box is mounted within the "second box" -- the handle body and the dampening material is place between the first box and the handle interior.
The electric stapler of the present invention can be used in surgical applications. Most stapling devices are one-time use. They can be disposed after one medical procedure because the cost is relatively low. The electric surgical stapler, however, has a greater cost and it. may be desirable to use at least the handle for more than one medical procedure.
Accordingly, sterilization of the handle components after use becomes an issue. Sterilization before use is also significant.
Because the electric stapler includes electronic components that typically do not go through standard sterilization processes (i.e., steam or gamma radiation), the stapler needs to be sterilized by other, possibly more expensive, means such as ethylene-oxide gas. It would be desirable, however, to make the stapler available to gamma radiation sterilization to reduce the cost associated with gas sterilization. It is known that electronics are usable in space, which is an environment where such electronics are. exposed to gamma radiation. In such applications, however, the electronics need to work while being exposed. In contrast, the electric stapler does not need to work while being exposed to the gamma sterilization radiation. When semiconductors are employed, even if the power to the electronics is turned off, gamma radiation will adversely affect the stored memory.
These components only need to withstand such radiation and, only after exposure. ceases, need to be ready for use. Knowing this, there are various measures that can be taken to gamma-harden the electronic components within the handle. First, instead of use MOSFET memory, for example, 'Usable link memories can be used. For such memories, once the fuses are programmed burnt), the memory becomes permanent and resistant to the gamma sterilization. Second, the memory can be mask-programmed. if the memory is hard programmed using masks, gamma radiation at the level for medical sterilization will not adversely affect the programming.
Third, the sterilization can be performed while the volatile memory is empty and, after sterilization, the memory can be programmed through various measures, for example, a wireless link including infrared, radio, ultrasound, or Illuetooth communication can be used. Alternatively, or additionally, external 5 electrodes can be contacted in a clean environment and these conductors can program the memory.
Finally, a radiopaque shield (made from molybdenum or tungsten, for example) can be provided around the gamma radiation sensitive components to prevent exposure of these components to the potentially damaging radiation.
As set forth herein, characteristics of the battery, drive train, and motor are examined and .10 optimized for an electric stapling application. The particular design (i.e., chemistry and PIC) of a battery will determine the amount of current that can be supplied andlor the amount of power that can be generated over a period of time. It has been determined that standard alkaline cells do not have the ability to generate the high power needed over the short period of time to effect actuation of the electric stapling device. It was also determined that some lithium-manganese dioxide cells also 15 were unable to meet the needs for actuating the stapling device.
Therefore, characteristics of certain lithium-manganese dioxide cell configurations were examined, such as the electrolyte and the positive temperature coefficient device.
Lt is understood that conventional lithium-manganese dioxide cells (e.g., CR123 and CR2) are designed for loads over a long period of time. For example, SUREFIREft markets flashlights 20 and such cells and states that the cells will last for from 20 minutes to a few hours (3 to 6) at the maximum lumen output of the flashlight. Load upon the cells(s) during this period of time is not close to the power capacity of the battery(ies) and, therefore, the critical current rate of' the battery(ies) is not reached and there is no danger of overheating or explosion. If such use is not continuous, the batteries can last through many cycles (i.e., hundreds) at this same full power output.
25 Simply put, such batteries are not designed for loads over a period of 10 seconds or less, for example, five seconds, and are also not designed for a small number of uses, for example, ten to fifteen. What the present invention does is to configure the power supply, drive train, and motor to optimize the power supply (i.e., battery ) for a small number of uses with each use occurring over a period of less than ten seconds and at a load that. is significantly higher than rated.
30 All of the primary lithium cells that were examined possess a critical current rate defined by the respective Pit device andior the chemistry and internal construction. If used above the critical current rate for a period of time, the cells can overheat and, possibly, explode. When exposed to a =
very high power demand (close to the PTC threshold) with a low number of cycles, the voltage and amperage profiles do not behave the same as in prior art standard uses. It has been found that some cells have PTC devices that prevent generation of power required by the stapler of the present invention, but that other cells are able to generate the desired power (can supply the current an voltage) for powering the electric stapling device. This means that the critical current rate is different depending upon the particular chemistry, construction, and/or PTC of the cell.
The present invention configures the power supply to operate in a range above the critical current rate, referred to herein as the "Super-Critical Current Rate." It is noted within the definition of Super-Critical Current Rate also is an averaging of a modulated current supplied by the power supply that is above the critical current rate. Because the cells cannot last long while supplying power at the Super-Critical Current Rate, the time period of their use is shortened. This shortened time period where the cells are able to operate at the Super-Critical Current Rate is referred to herein as the "Super-Critical Pulse Discharge Period," whereas the entire time when the power supply is activated is referred to as a "Pulse Discharge Period." In other words, the Super-Critical Pulse Discharge Period is a time that is less than or equal to the Pulse Discharge Period, during which time the current rate is greater than the critical current rate of the cells. The Super-Critical Pulse Discharge Period for the present invention is less than about 16 seconds, in other words, in a range of about one-half to fifteen seconds, for example, between two and four seconds and, more particularly, at about three seconds. During the life of the stapling device, the power supply may be subjected to the Super-Critical Current Rate over the Pulse Discharge Period for at least one time and less than twenty times within the time of a clinical procedure, for example, between approximately five and fifteen times, in particular, between ten and fifteen times within a period of five minutes, Therefore, in comparison to the hours of use for standard applications of the power supply, the present invention will have an aggregate use, referred to as the Aggregate Pulse Time, of, at most, approximately 200 to 300 seconds, in particular, approximately 225 seconds. It is noted that, during an activation, the device may not be required to exceed or to always exceed the Super-Critical Current Rate in a given procedure because the load presented to the instrument is dependent upon the specific clinical application (i.e.: some tissue is denser than others and increased tissue density will increase load presented to device), :However, the. stapler is designed to be able to exceed the Super-Critical Current Rate for a number of times during the intended use of the surgical procedure. Acting in this Super-Critical Pulse Discharge Period, the device can operate a sufficient amount of times to complete the desired surgical procedure, but not many more because the power supply is asked to perform at. an increased current.
When performing in the increased range, the force generated by the device, e.g., the electric stapler 1, is significantly greater than existed in a hand-powered stapler. In fact, the force is so much greater that it could damage the stapler itself. In one exemplary use, the motor and drive assemblies can be operated to the detriment of the knife blade lock-out feature -- the safety that prevents the knife blade 1060 from advancing when there is no staple cartridge or a previously fired staple cartridge in the staple cartridge holder 1030. This feature is illustrated in FIG. 33. As discussed, the knife blade 1060 should be allowed to move distally only when the staple sled 102 is present at the firing-ready position, i.e., when the sled 102 is in the position illustrated in Fla 33. If the sled 102 is not present in this position, this can mean one of two things, either there is no staple cartridge in the holder 1030 or the sled 102 has already been moved distally ¨ in other words, a partial or full firing has already occurred with the loaded staple cartridge. Thus, the blade 1060 should not be allowed Co move, or should be restricted in its movement. Accordingly, to insure that the sled 102 can prop up the blade 1060 when in a firing state, the sled 102 is provided with a lock-out contact surface 104 and the blade 1060 is provided with a correspondingly shaped contact nose 1069. It is noted at this point that, the lower guide wings 1065 do not rest against a floor 1034 in the cartridge holder 1030 until the blade 1060 has moved distally past an edge 1035. With such a configuration, if the sled 102 is not present at the distal end of the blade 1060 to prop up the nose 1069, then the lower guide wings 1065 will follow the depression 1037 just proximal of the edge 1035 and, instead of advancing on the floor 1034, will hit the edge 1035 and prevent further forward movement of the blade 1060. To assist with such contact when the sled 102 is not present (referred to as a "lock our), the staple cartridge 1030 has a plate spring 1090 (attached thereto by at least one rivet 1036) for biasing the blade 1060. With the plate spring 1090 flexed upward and pressing downward against the flange 1067 (at least until the flange 1067 is distal of the distal end of the plate spring 1090), a downwardly directed force is imparted against the blade 1060 to press the wings 1065 down into the depression 1037. Thus, as the blade 1060 advances distally without the sled 102 being present, the wings 1065 follow the lower curve of the depression .1037 and are stopped from further distal movement when the distal edge of the wings 1065 hit the edge 1035.
This safety feature operates as described so long as the force transmitted by the knife blades 1062 to the blade 1060 is not great enough to tear off the lower guide wings1065 from the blade 1060. With the forces able to be generated by the power supply, motor and drive train of the present invention, the blade 1060 can be pushed distally so strongly that the wings 1065 are torn away. If this occurs, there is no way to prevent distal movement of the blade 1060 or the sled 102.
Accordingly, the present invention provides a way to lower the forces able to be imparted upon the wings 1065 prior to their passage past the edge 1035. In other words, the upper limit of force able to be applied to the blade 1060 is reduced in the first part of blade travel (past the edge 1035) and increases after the wings 1065 have cleared the edge 1035 and rest on the floor 1034. More specifically, a first exemplary embodiment of this two-part force generation limiter takes the form of a circuit in which only one or a few of the cells in the power supply are connected to the motor during the first part of the stapling/cutting stroke and, in the second part of the stapling/cutting stroke, most or all of the cells in the power supply are connected to the motor. A first exemplary form of such a circuit is illustrated in MG, 34. In this first embodiment, when the switch 1100 is in the "A" position, the motor (e.g., stapling motor 210) is only powered with one power cell 602 (of a possible four in this exemplary embodiment). However, when the switch 1100 is in the "B"
position, the motor is powered with all four of the cells 602 of the power supply 600, thereby increasing the amount of force that can be supplied to the blade 1060. Control of the switch 1100 between the A and B positions can occur by positioning a second switch somewhere along the blade control assembly or along the sled 102, the second switch sending a signal to a controller after the wings 1065 have passed the edge 1035. It is noted that this first embodiment of the control circuit is only exemplary and any similarly performing assembly can provide the lock-out protection for the device, see, for example, the second exemplary embodiment illustrated in FIG.
36.
A first exemplary form of a forward and reverse motor control circuit is illustrated in FIG, 35. This first exemplary embodiment uses a double-throw, double pole switch 1200. The switch 1200 is normally spring-biased to a center position in which both poles are off The motor M
illustrated can, for example, represent the stapling motor 210 of the present invention. As can be seen, the power-on switch 1210 must be closed to turn on the device. Of course, this switch is optional. When a forward movement of the motor M is desired, the switch 1200 is placed in the right position as viewed in FIG. 35, in which power is supplied to the motor to run the motor in a first direction, defined as the forward direction here because the "+" of the battery is connected to the "+" of the motor M. In this forward switching position, the motor M can power the blade 1060 in a distal direction. Placement of an appropriate sensor or switch to indicate the forward-most desired position athe blade 1060 or the sled 102 can be used to control a fiarward travel limit switch 1220 that interrupts power supply to the motor M and prevents further forward travel, at least as long as the switch 1220 remains open. Circuitry can be programmed to never allow this switch 1220 to close and complete the circuit or to only allow resetting of the switch 1220 when a new staple cartridge, for example, is loaded.
When a reverse movement of the motor M is desired, the switch 1200 is placed in the left position as viewed in FIG. 35, in which power is supplied to the motor to run the motor in a second direction, defined as the reverse direction here because the "-" of the battery is connected to the "+"
of the motor M. In this reverse switching position, the motor M can power the blade 1060 in a proximal direction. Placement of an appropriate sensor or switch to indicate the rearward-most desired position of the blade 1060 or the sled 102 can be used to control a rearward travel limit switch 1230 that interrupts power supply to the motor Ni and prevents further rearward travel, at least as long as the switch 1230 remains open. It is noted that other switches (indicated with dotted arrows) can be provided in the circuit to selectively prevent movement in either direction independent of the limit switches 1220, 1230.
It is noted that the motor can power the gear train with a significant amount of force, which translates into a high rotational inertia. As such, when any switch mentioned with respect to FIGS.
34 and 35 is used to turn off the motor, the gears may not just stop. Instead, the rotational inertia continues to propel, for example, the rack 217 in the direction it was traveling when power to the motor was terminated. Such movement can be disadvantageous for many reasons.
By configuring the power supply and motor appropriately, a circuit can be formed to substantially eliminate such post-termination movement, thereby giving the user more control over actuation.
FIG. 36 illustrates an exemplary embodiment where the motor (for example, stapling motor 210) is arrested from further rotation when forward or reverse control is terminated. FIG. 36 also illustrates alternative embodiments of the forward/reverse control and of the multi-stage power supply. The circuit of Fla 36 has a motor arrest sub-circuit utilizing a short-circuit property of an electrical motor. More specifically, the electrical motor M is placed into a short-circuit so that an electrically generated magnetic field is created in opposition to the permanent magnetic field., thus slowing the still-spinning motor at a rate that substantially prevents inertia-induced over-stroke. To explain how the circuit of FIG. 36 can brake the motor M, an explanation of the 'forward/reverse switch 1300 is provided. As can be seen, the forward/reverse switch 1300 has three positions, just 10 like the switch 1200 of FIG. 35. When placed in the right position, the motor Ni is actuated in a forward rotation direction. When placed in the left position, the motor M is actuated in a rearward rotation direction. When the switch 1300 is not actuated ¨ as shown in FIG. 36 the motor M is short circuited, This short circuit is diagrammatically illustrated by the upper portion of the switch 1300. It is noted that the switching processes in a braking switch is desired to take place in a time-delayed manner, which is also referred to as a break-before-make switching configuration. When switching over from operating the motor M to braking the motor M, the double-pole, double throw 5 portion of the forward/reverse switch 1300 is opened before the motor short circuit is effected.
Conversely, when switching over from braking the motor M to operating the motor M, the short circuit is opened before the switch 1300 can cause motor actuation. Therefore, in operation, when the user releases the 3-way switch 1300 from either the forward or reverse positions, the motor M is short-circuited and brakes quickly.
.10 Other features of the circuit in FIG, 36 have been explained with regard to FIG 35. For example, an on/off switch 1210 is provided. Also present is the power lock-out switch 1100 that only powers the motor with one power cell 602' in a given portion of the actuation (which can occur at the beginning or at any other desired part of the stroke) and powers the motor M with all of the power cells 602 (here, for example, six power cells) in another portion of the actuation.
IS A new feature of the reverse and forward limit switches 1320, 1330 prevents any further forward movement of the motor M after the forward limit switch 1320 is actuated. When this limit is reached, the forward limit switch 1320 is actuated and the switch moves to the second position. In this state, no power can get to the motor for forward movement but power can be delivered to the motor for reverse movement. The forward limit switch can be programmed to toggle or be a one-20 time use for a given staple cartridge. More specifically, the switch 1320 will remain in the second position until a reset occurs by replacing the staple cartridge with a new one. Thus, until the replacement occurs, the motor M can only be powered in the reverse direction.
lithe switch is merely a toggle, then power can be restored for additional further movement, only when the movement has retreated the part. away from actuating the switch 1320.
25 The reverse limit switch 1330 can be configured similarly. When the reverse limit is reached, the switch 1330 moves to the second position and stays there until a reset occurs. It is noted that, in this position, the motor M is in a short-circuit, which prevents motor movement in either direction, With such a configuration, the operation of the stapler can be limited to a single stroke up to the forward limit and a single retreat up to the rear limit. When both have occurred, the 30 motor M is disabled until the two switches 1320 are reset.
Referring now to the figures of the drawings in detail and first, particularly to FIGS. 37 to 40 thereof, there is shown an exemplary embodiment of an electric surgical device 1000 according to , -, the invention, which, in this embodiment, is an electric surgical linear stapler. FIG. 37 shows the left side of the device 1000 with the handle's outer shell 1001 and 1002 removed.
Similarly, FIG. 39 shows the right side of the device 1000 with the handle's outer shell removed.
The two halves of the outer shell 1001 and 1002 are only shown in FIGS. 63 to 66 to allow for clear viewing of the internal assemblies. Also not shown in these and the subsequent figures is the end effector. An exemplary embodiment of a linear stapling end effector is described in detail in the family of co-owned and co-pending patent applications including U.S. Provisional Patent Application No.
60/702,643 filed July 26, 2005, 60/760,000 filed January 18, 2006, and 60/811,950 filed June 8, 2006, and U.S. Patent No.
8,579,176 issued November 12, 2013, U.S. Patent No. 7,404,508 issued July 29, 2008, U.S.
Published Application No. 20070073341 published March 29, 2007 and U.S. No.
Patent 7,419,080 issued September 2, 2008.
FIG. 38 shows the mechanical assembly of the device 1000 with the left-side frames 1010 removed. FIG. 40, in comparison, shows the mechanical assembly both the left-and right-side frames 1010, 1020 removed.
FIG. 37 shows the gear cover plate 1105, under which are the first-, second-, and third-stage gears 1110, 1120, 1130 of the motor transmission assembly. Also appearing in FIG. 37 is the end effector closing assembly 1400. This end effector closing assembly 1400 will be explained in greater detail with regard to FIGS. 59 to 60.
FIGS. 37 to 38 also show the electric power and power control assemblies. The electric power assembly 1500 in this exemplary embodiment is a removable battery pack containing one or more batteries 1510. As set forth above, one exemplary power supply is a series connection of between four and six CR123 or CR2 power cells. Here, there are six batteries 1510. One of these batteries 1510a, the one on the upper left in FIG. 37, is placed in an electrically disconnectable configuration so that power can be supplied selectively to the motor 1520 through either the single battery 1510a or the entire set of six batteries 1510. This is beneficial in applications where only a small amount of power is needed or where full torque is desired to be prohibited. One such prohibition is mentioned above with regard to moving the staple sled or blade past the lock-out. The exemplary circuit only connects this one cell 1510a to the motor 1520 during the first part of the stapling/cutting stroke and, in the second part of the stapling/cutting stroke, all of the cells 1510, 1510a in the power supply are connected to the motor 1520. See FIG. 34.
The power supply control assembly 1600 in the exemplary embodiment takes the form of a rocker switch 1610. In one actuated direction of the rocker switch 1610, the motor 1520 is caused to =
rotate in a first direction, for example, forward, and in the other actuated direction of the rocker switch 1610, the motor 1520 is caused to rotate in an opposite second direction, for example, reverse.
The electrically powered drive train in the exemplary embodiment is used to operate one feature of a linear cutter/stapler. Here, the drive train is being used to actuate the stapling/cutting feature. To do this, the drive train is connected to a linear actuator 1700, which, in the present embodiment, is in the form of a toothed rack that translates distally and proximally along a rack guide 1720. As shown in FIG. 38, the rack 1700 is in a relatively proximal position. To minimize the size of the shell 1001, 1002 at the proximal end (right side of FIG 38)., the rack 1700 has a pivoting portion 1710 that pivots freely in the downward direction (as viewed in FIG. 38) when the pivoting portion 1710 is not contained within the rack guide 1720. As the rack 1700 moves distally (to the left in FIG. 38), the bottom of the pivoting portion 1710 contacts the proximal end of the rack guide 1720 and is caused to pivot upward to a position that is substantially coaxial with the remainder of the rack 1700 due to the shape of the rack guide 1720. The proximal end of the rack guide 1720 is seen in FIG. 41.
The teeth 1702 of the rack 1700 are shaped to interact with a final stage of the drive train in a rack-and-pinion configuration. While various features of the drive train are visible in virtually all of FIGS. 37 to 47, the explanation of the drive train is easily seen with particular reference to FIGS. 43 and 46. It is noted here that some of the transmission stages shown in many of the figures have no teeth. This is because the gears are merely diagrammatic representations of a particular exemplary embodiment, Thus, the lack of teeth, or even the number or size of teeth present, should not be taken as limiting or fixed. Additionally, many of the gears illustrated are shown with a central band located inside the teeth. This band should not be considered as part of the device 1000 and is, merely, a limitation of the software used to create the figures of the instant application.
The explanation of the drive train starts from the motor 1520. An output gear 1522 of the motor '1520 is connected to the first, second, and third stages 111.0, 1120, 1130 of the transmission.
The third stage 1130 is coupled to the final gear present on the left side of the device 1000. This couple is difficult to view in all of the figures because of its interior location. FIGS. 55 to 56, however, show the coupling of the third stage 1130 to the fourth stage, cross-over gear 1140. As mentioned above, the output of the third stage 1130 is only diagrammatically illustrated -- as a cylinder without teeth. Continuing to refer to FIG. 46, the cross-over gear 1140 is rotationally coupled to a fourth stage shaft 1142, which shaft 1142 crosses over the rack 1700 from the left side of the device 1000 to the right side. The right side of the shaft 1142 is not directly coupled in a rotational manner to any of the gears on the right side. Instead, it rotates inside a shaft bearing 1144 that fits inside a corresponding pocket within the right side frame 1020, which frame 1020 is removed from the view of:FIG. 46 to allow viewing of the right side drive train.
A castle gear 1146 (shown by itself in FIG. 53) is positioned on the cross-over shaft 1142 to be rotationally fixed therewith but longitudinally translatable thereon. To permit such a connection, the shaft 1142 has a non-illustrated interior slot in which is disposed a non-illustrated pin that passes through two opposing ports 11462 of the castle gear 1146. By fixedly securing the pin to the castle gear 1146, rotation of the shaft 1142 will cause a corresponding rotation of the castle gear 1146 while still allowing the castle gear 1146 to freely translate along the longitudinal axis of the shaft 1142, at least to the extent of the slot in the shaft 1142. As can be seen in FIG. 46, the right-side castellations 11464 of the castle gear 1146 are shaped to fit between corresponding castellation slots 11482 on the left-side of a fourth stage pinion 1148, which is illustrated by itself in FIG. 54.
Because the castle gear 1146 is required to mate securely with the fourth stage pinion 1148, a right-side biasing force F is needed. To supply this bias, a non-illustrated compression spring, for example, can be provided to have one end contact the right face of the cross-over gear 1140 and the other opposing end contact the left face of a central flange 11468, which projects radially away from the outer cylindrical suiface of the castle gear 1146. (This flange 11468 will be described in more detail below with respect to the manual release feature of the device 1000.) Any other similarly functioning bias device can be used instead of the exemplary spring. Such a configuration allows the castle gear 1146 to be selectively rotationally engaged with the fourth stage pinion 1148. More specifically, when the castle gear 1146 is not acted upon by any force other than the force F of the bias device, the castellations 11464 will be mated with the castellation slots 11482 and any rotation of the shaft. 1142 will cause a corresponding rotation of the fourth stage pinion 1148. However, when a force opposing and overcoming the bias F is applied, the castellations 11464 exit the castellation slots 11482 and any rotation of the shaft 1142 has no effect on the fourth stage pinion 1148. It is this selective engagement that allows a manual release to occur.
Before such release is explained, the tight side drive train is described.
The fourth stage pinion 1148 is directly engaged with a fifth stage 1150 of the drive train, which has a fifth stage shaft 1152, a fifth stage input gear 1154 rotationally fixed to the fifth stage shaft 1152, and a fifth stage pinion 1156, also rotationally fixed to the fifth stage shaft 1152. The teeth of the fifth stage pinion 1156 are directly coupled to the teeth .1702 of the rack 1700. Thus, any rotation of the fifth stage input gear 1154 causes a corresponding rotation of the fifth stage pinion and a longitudinal movement of the rack 1700. As viewed in the exemplary embodiment of :FIG. 46, a clockwise rotation of the fifth stage input gear 1154 causes a proximally directed movement of the rack 1700 (retract) and a counter-clockwise rotation of the fifth stage input gear 1154 causes a distally directed movement of the rack 1700 (extend).
Based upon the above connection of the five stages of the drive train, rotation of the motor shaft in one direction will cause a longitudinal movement ot7the rack 1700, but only when the castle gear '1146 is engaged with the fourth stage pinion 1148. When the castle gear 1146 is not engaged with the fourth stage pinion 1148, rotation of the motor has no effect on the rack 1700. It is in this uncoupled state of the two gears 1146, 1148 that a manual. release of the rack 1700 becomes possible.
In operation of the device 1000, the rack 1700 moves distally (extends) to actuate some part of an end effector. In the embodiment of a linear surgical stapling/cutting device, when the rack.
1700 moves distally, the sled (carrying the stapling actuator and cutting blade) that causes both stapling and cutting to occur is moved distally to effect both stapling and cutting. Because the tissue placed between the jaws of the end effector is different in virtually every surgical procedure, a physician cannot anticipate times when the sled will be jammed or stuck for any reason. In a jammed case, the sled will need to be retracted distally without use of the motor. There also exists the possibility of a power loss or the possibility that the motor fails in a catastrophic fashion rendering the output shaft fixed. If this occurred when the sled was in a distal position, the jaws of the end effector would be held Shut on the tissue therebetween and, consequently, the sled would have to be moved proximally before the jaws could be opened and the tissue could be released. in such a case, the rack 1700 will need to be retracted distally without use of the motor. To effect this desired function, the invention is provided with a manual release assembly 1800.
in each of FIGS. 37 to 44, 55, 59 to 62, the manual release lever 1810 is in the un-actuated (e.g., down) position. In FIGS. 45 and 57, the manual release lever 1810 is in an intermediate position. And, in FIGS. 46, 47, 56, and 58, the manual release lever 1810 is approximately in a fully actuated (e.g., up) position.
When the manual release lever 1810 is in the un-actuated position, as can be seen in FIG. 44, the castle gear 1146 is engaged with the fourth stage pinion 1148. Thus, any rotation of the output gear 1522 of the motor 1520 causes movement of the rack 1700. The fourth stage pinion 1148 is not only directly connected to the -fifth stage input gear 1154, however. It is also directly connected to a first stage release gear 1820, which, in turn, is directly connected to a second stage release gear 1830. Thus, any rotation of the fourth stage pinion 1148 necessarily causes a rotation of the second stage release gear 1830 (the direction of which being dependent upon the number of gears therebetween). If the axle of this gear 1830 was directly connected to the manual release lever 1810, 5 the lever 1810 would rotate every time the fourth stage pinion 1148 rotated. And, if the fourth stage pinion 1148 rotated more than one revolution, the lever 1810 could possibly be caused to rotate through a full 360 degree revolution. As expected, this does not occur due to the presence of a one-way gear assembly coupling the manual release lever 1810 to the second stage release gear 1830 (see explanation of FIG. 48 below). it is noted that the first stage release gear 1820 has a toothed shaft 10 1822 extending coaxially therefrom. This toothed shaft 1822 is directly coupled to an indicator wheel 1840. As can he seen on the right surface of the wheel 1840, there is a curved shape linearly expanding about the axis of the wheel 1840 and having a different color from the remainder of the surface. When coupled with the window 1004 present on the right side shell 1002 (see FIGS. 64 to 65), the colored shape becomes more and more visible in a linear manner --corresponding to a linear 15 distance of the rack 1700 traveled from the fully proximal (e.g., retracted) position.
The one-way gear assembly coupling the manual release lever 1810 to the second stage release gear 1830 is shown in F1G. 48. This assembly is formed by providing a ratchet gear 1850 centered at a pivot point of the lever 1810 and extending an axle 1852 of the ratchet gear 1850 into and through a center bore 1832 of the second stage release gear 1830. With the axle 1852 fixed to 20 the bore 1832 of the second stage release gear 1830 in this way, any rotation of the second stage release gear 1830 causes a corresponding rotation of the ratchet gear 1850.
But, merely having this ratchet gear 1850 rotate with the second stage release gear 1830 does not, by itself, assist with a manual release of the rack 1700 when the motor 1520 is not powering the drive train.
To create the manual release function, two manual releasing items are present.
The first item 25 is a device that uncouples the right side gear train from the left side gear train and motor. This prevents the manual release from having to overcome the resistance offered by both the motor 1520 and the gears of the left side train when the manual release is actuated. The uncoupling occurs when the castle gear 1146 separates from the fourth stage pinion 1148. To cause this uncoupling, a cam plate 1860 is disposed between the ratchet gear 1850 and the second stage release gear 1830 and is 30 rotationally fixed to the axle 1852. The cam plate 1860 is shown by itself in FIG. 52. The cam plate 1860 is provided with a ramped cam surface 1862 that is positioned to interact with the central flange 11468 of the castle gear 1146. Interaction of the cam plate 1860 with the central flange 11468 can be seen in the progression of FIGS. 44 to 47 and in FIGS. 57 to 58.
In FIG. 44, the manual release lever 1810 is in an unactuated position, which means that it is desired to have the castle gear 1146 rotationally coupled with the fourth stage pinion 1148. In this way, any rotation of the motor 1520 will be translated into a rotation of the fourth stage pinion 1148 and a movement of the rack 1700. In FIGS. 45 to 47 and Site 58, the manual release lever 1810 is in one of a few actuated positions, each of which is illustrated as being sufficient to rotate the cam plate 1860 to have the ramped cam surface 1862 contact the central flange 11468 of the castle gear 1146 and force the castle gear 1146 towards the left side sufficient to separate the castellations 11464 from the castellation slots 11482 of the fourth stage pinion 1148. In this position, the castle gear 1146 is rotationally uncoupled from the fourth stage pinion 1148. Thus, any rotation of the motor 1520 (or the gears of the left side train) will be entirely independent from the right side gear train, thus preventing any movement of the rack 1700 based upon. rotation of the motor .1520_ After the right side gear train become rotationally independent from the right side motor and gear train, to have a manual rack release function, the rack 1700 needs to be moved in the proximal direction. To supply this movement, a second of the two above-mentioned manual releasing items is provided. This second item interacts with the teeth 1832 of the ratchet gear 1850 so that a counter-clockwise rotation of the manual release lever 1810 (when viewed from the right side of the device 1000) causes the ratchet gear 1850 to spin in a counter-clockwise direction ¨
this direction is desired in the illustrated embodiment because such rotation causes a clockwise rotation of the fifth stage pinion 1156 -- a rotation that corresponds to proximal movement (e.g., retraction) of the rack 1700.
To control the ratchet gear 1850 with this counter-clockwise lever 1810 movement, the invention provides a ratchet pawl 1870 that is rotatably mounted on a locking boss 1814 of the lever 1810, This configuration is best illustrated in FIG. 48. A non-illustrated leaf spring is secured in a spring channel 1816 of the lever 1810 to bias the pawl 1870 in a direction D towards the ratchet gear 1850.
It is noted that if the pawl 1870 were not restrained in some way, however, the pawl 1.870 would always contact the teeth 1852 of the ratchet gear 1850 and prevent any clockwise rotation of the gear 1850¨ which occurs in the present embodiment when the castle gear 1146 and the fourth stage pinion 1148 are engaged with one another (see, i.e., FIG, 44) and rotate together. To prevent this condition, as shown in FIGS, 44 and 55, the distal end of the pawl -1870 has a widened portion 1872 that extends out from the pawl cavity 1818 towards the second stage release gear 1830. With the presence of a second cam plate 1880 between the second stage release gear 1830 and the cam plate 1870, a pawl cam 1882 can be positioned to contact the bottom surface of the widened portion 1872 and retain the pawl 1870 in the pawl cavity 1818 (by providing a force in a direction opposite to direction D and against bias of the leaf spring) when the lever 1810 is in a home or unactuated position. This contact between the pawl 1870 and the pawl cam 1882 is shown in FIGS. 44 and 55.
Thus, when the lever 1810 is not actuated, the pawl 1870 has no contact with the teeth 1852 of the ratchet gear 1850. In contrast, when the manual release has rotated past a position sufficient to separate the ratchet gear 1850 from the fourth stage pinion 1148, the bottom surface of the pawl 1870 no longer contacts the pawl cam 1882 of the non-rotating second cam plate 1880 and is, there-time, free to move in the direction D (caused by the biasing force of the leaf spring) to engage the teeth 1852 of the ratchet gear 1850 when rotating counter-clockwise. Thus, when rotating clockwise, the pawl 1870 ratchets against the top surfaces of the teeth 1852.
After about fifteen degrees of travel of the lever 1810, for example, the pawl 1870 no longer is in contact with the pawl cam 1882 and the castellations 11464 of the castle gear 1.146 are no longer engaged with the castellation slots 11482 of the fourth stage pinion 1148. At this point, the pawl 1870 is permitted to move towards the axle 1852 and engages one of the teeth 1852 of the ratchet gear 1850. Further counter-clockwise movement of the lever 1810 turns the ratchet gear 1850 correspondingly, which causes a corresponding counter-clockwise rotation of the second stage release gear 1830. In turn, rotation of the second stage release gear 1830 causes clockwise rotation of the first stage release gear 1820, counter-clockwise rotation of the fourth stage pinion 1148, and clockwise rotation of the fifth stage input gear 1154, respectively. As indicated above, clockwise rotation of the fifth stage input gear 1154 causes proximal movement of the rack 1700 ¨ the desired direction of movement during a manual release of the end effector feature connected to the rack 1700. As the lever 1810 is released, a return bias 1890 forces the lever 1810 back to its unactuated position (see FIG. 44), which causes the pawl cam .1882 to return the pawl :1870 to its upper position in the pawl cavity 1818 where it is disengaged from the teeth 1852 of the ratchet gear 1850. It is noted that contact between the pawl cam 1882 and the lower surface of the widened portion 1872 is made smooth by shaping the respective top front and top rear surfaces of the pawl cam 1882 and bottom front and bottom rear surfaces of the widened portion 1872. It is further noted that the return bias 1890 is shown in FIGS. 46, 57, and 58, for example, as a coil spring, one end of which is wrapped around a bolt secured to the lever 1810 and the other opposing end being a shaft that is secured to a portion of the shell 1001, 1002, illustrated in FIGs. 63-66. The opposing shaft of the coil spring 1890 moves in the illustrations only due to the limitations of the drawing program. This movement does not occur in the invention.
As discussed above, one exemplary embodiment of the end effector for the device 1000 of the present invention includes a set of jaws that close down upon tissue disposed therebetween and a stapler/cutter to secure together each of two sides of the tissue as it is being cut. The manual release described above can be coupled to the stapler/cutter and the end effector closing assembly 1400 can be coupled to the jaws to close the jaws together when actuated. FIGS. 59 to 60 illustrate one exemplary embodiment of the couple between the jaws and the. end effector closing assembly 1400.
Here, the end effector closing assembly 1400 is comprised of a handle 1410 having a lever support 1412 and pivoting about a handle pivot .1414. The lever support 1412 is pivotally connected to a first end of a link 1420. A second opposing end of the link 1420 is pivotally connected to a slider shaft 1430. The end effector shaft assembly 1900 includes an outer shaft 1910 and an inner shaft 1920. The inner shaft 1910 is longitudinally fixed to the frames 1010, 1020 and to the lower jaw of the end effector and, therefore, is the longitudinally fixed component of the end effector. The outer shaft 1920 is connected about the inner shaft 1910 and longitudinally translates thereon. The upper jaw of the end effector pivots in relation to the lower jaw. To cause the pivoting, the outer shaft 1920 is extended from a proximal position, shown in FIG. 59, to a. distal position, shown in FIG. 60.
Because the outer shaft 1920 surrounds the inner shaft, a portion (for example, an upper portion) contacts the proximal end of the open upper jaw, which is at a position proximal of the upper jaw pivot. As the outer shaft 1920 moves further distal, the upper jaw cannot translate distally because of the fixed pivot position, but can rotate about that pivot. Accordingly, the upper jaw closes upon the lower, longitudinally fixed jaw. Simply put, and as can be seen in the progression from FIG. 59 to FIG. 60, when the handle 1410 is moved towards the electric power assembly 1500, the slider 1430 moves in the longitudinal direction from the proximal position of FIG. 59 to the distal position of FIG. 60. This prior art jaw assembly is present on a linear stapler manufactured by Ethicon Endo-Surgery under the trade name Echelon Ec6o.
It is noted that this exemplary configuration of the end effector shaft assembly 1900 is opposite to the end effector actuation shown in family of co-pending patent applications mentioned above, including application serial no. 11/844,406, filed August 24, 2007. As shown in this application in FIGS. 39 and 40, as the lower jaw/staple cartridge holder 1030 is translated in the proximal direction over gap 1031, the upper anvil 1020 is caused to pivot downward because the proximal upper edge of the upper anvil 1020 is being pressed against the longitudinally fixed drum sleeve 1040.
Various prior art linear staplers, such as the Echelon EC60 mentioned above, use the same end effector and shaft Therefore, it is desirable to have those prior art end effector shaft assemblies be able to fit inside the device 1000 of the present invention. This is accomplished by configuring the left and right side frames 1010, 1020 as shown in FIGS. 61 to 62, for example, The frames 1010.
1020 are formed with one side the upper side) open as Shown in FIG. 62, In this configuration, the proximal end of the inner shaft 1910 prior art end effector shaft assembly can simply side in between respective tabs 1012, 1022 to longitudinally fix the inner shaft 1910 (and, thus, the entire assembly) JO therein and transversely fix the inner shaft 19.10 therebetween in all radial directions except for the direction in which the inner shaft 1910 was inserted into the opening between the frames 1010, 1020.
To close off this opening, a shaft plug 1930 is secured between the tabs 1012, 1022, for example, with a bolt, as shown in FIG. 61. In another alternative embodiment, the shaft plug 1930 can be entirely disregarded by extending the distal ends of the left and right frames 1010, 1020 and shaping them, in a clam-shell design, to be secured around the inner shaft 1910 when placed together.
The foregoing description and accompanying drawings illustrate the principles, preferred embodiments and modes of operation of the invention. More specifically, the optimized power supply, motor., and drive train according to the present invention has been described with respect to a surgical stapler. However, the invention should not be construed as being limited to the particular embodiments discussed above. Additional variations of the embodiments discussed above will be appreciated by those skilled in the art as well as for applications, unrelated to surgical devices, that require an advanced power or current output for short and limited durations with a power cell having a limited power or current output. As is shown and described, when optimized according to the present invention, a limited power supply can produce lifting, pushing, pulling, dragging, retaining, and other kinds of forces sufficient to move a substantial amount of weight, for example, over 82 kg.
The above-desciibed embodiments should be regarded as illustrative rather than restrictive.
Accordingly, it should be appreciated that variations to those embodiments can be made by those skilled in the art without departing from the scope of the invention as defined by the following
Claims (20)
1. A surgical instrument, comprising:
a surgical end effector having a receiving portion for removably receiving therein an interchangeable part, the receiving portion having a communication connection;
a handle connected to the surgical end effector and having a controller, the controller being electrically connected to the communication connection and having a power supply; and an interchangeable part shaped to be removably connected to the receiving portion and having an encryption device electrically removably connected to the communication connection and powered by the power supply when at the receiving portion.
a surgical end effector having a receiving portion for removably receiving therein an interchangeable part, the receiving portion having a communication connection;
a handle connected to the surgical end effector and having a controller, the controller being electrically connected to the communication connection and having a power supply; and an interchangeable part shaped to be removably connected to the receiving portion and having an encryption device electrically removably connected to the communication connection and powered by the power supply when at the receiving portion.
2. The surgical instrument according to claim 1, wherein the handle is operable to actuate the end effector.
3. The surgical instrument according to claim 1, wherein the encryption device is programmed to authenticate the interchangeable part when the interchangeable part is at the receiving portion.
4. The surgical instrument according to claim 3, wherein the controller is operable to authenticate the interchangeable part.
5. The surgical instrument according to claim 1, wherein the encryption device has a microprocessor.
6. The surgical instrument according to claim 5, wherein:
one wire forms the electrical connection between the communication connection and the controller; and the encryption device is a 1-wire device:
powered by the power supply through the one wire; and receiving data from and transmitting data to the controller through the one wire.
one wire forms the electrical connection between the communication connection and the controller; and the encryption device is a 1-wire device:
powered by the power supply through the one wire; and receiving data from and transmitting data to the controller through the one wire.
7. The surgical instrument according to claim 6, wherein the encryption device and the controller share a common ground.
8. The surgical instrument according to claim 6, wherein the controller has a circuit board with a second microprocessor connected to the microprocessor through the one wire.
9. The surgical instrument according to claim 4, wherein:
the interchangeable part has a seated position in the receiving portion and an unseated position with respect to the receiving portion; and the electrical connection between the encryption device and the communication connection exists to allow authentication of the interchangeable part only when the interchangeable part is in the seated position.
the interchangeable part has a seated position in the receiving portion and an unseated position with respect to the receiving portion; and the electrical connection between the encryption device and the communication connection exists to allow authentication of the interchangeable part only when the interchangeable part is in the seated position.
10. A surgical instrument, comprising:
a surgical end effector having a receiving portion for removably receiving therein an interchangeable part, the receiving portion having a communication connection;
a handle connected to the surgical end effector and having a controller, the controller being electrically connected to the communication connection and having a power supply; and an interchangeable part shaped to be removably connected to the receiving portion and having a 1-wire encryption device electrically removably connected to the communication connection and powered by the power supply when at the receiving portion.
a surgical end effector having a receiving portion for removably receiving therein an interchangeable part, the receiving portion having a communication connection;
a handle connected to the surgical end effector and having a controller, the controller being electrically connected to the communication connection and having a power supply; and an interchangeable part shaped to be removably connected to the receiving portion and having a 1-wire encryption device electrically removably connected to the communication connection and powered by the power supply when at the receiving portion.
11. The surgical instrument according to claim 10, wherein the handle is operable to actuate the end effector.
12. The surgical instrument according to claim 10, wherein the 1-wire encryption device is programmed to authenticate the interchangeable part when the interchangeable part is at the receiving portion.
13. The surgical instrument according to claim 12, wherein the controller is operable to authenticate the interchangeable part.
14. The surgical instrument according to claim 10, wherein the 1-wire encryption device has a microprocessor.
15. The surgical instrument according to claim 14, wherein:
one wire forms the electrical connection between the communication connection and the controller; and the 1-wire encryption device is powered by the power supply through the one wire and receives data from and transmits data to the controller through the one wire.
one wire forms the electrical connection between the communication connection and the controller; and the 1-wire encryption device is powered by the power supply through the one wire and receives data from and transmits data to the controller through the one wire.
16. The surgical instrument according to claim 15, wherein the 1-wire encryption device and the controller share a common ground.
17. The surgical instrument according to claim 16, wherein the controller has a circuit board with a second microprocessor connected to the microprocessor through the one wire.
18. The surgical instrument according to claim 13, wherein:
the interchangeable part has a seated position in the receiving portion and an unseated position with respect to the receiving portion; and the electrical connection between the 1-wire encryption device and the communication connection exists to allow authentication of the interchangeable part only when the interchangeable part is in the seated position.
the interchangeable part has a seated position in the receiving portion and an unseated position with respect to the receiving portion; and the electrical connection between the 1-wire encryption device and the communication connection exists to allow authentication of the interchangeable part only when the interchangeable part is in the seated position.
19. A surgical instrument, comprising:
a surgical end effector having a receiving portion for removably receiving therein an interchangeable part, the receiving portion having a communication connection;
a handle connected to the surgical end effector and having a power supply and a controller, the controller having a first microprocessor electrically connected to the communication connection; and an interchangeable part shaped to be removably connected to the receiving portion and having an encryption device electrically removably connected to the communication connection and powered by the power supply when at the receiving portion, the encryption device having a second microprocessor programmed to cryptographically authenticate the interchangeable part with the first microprocessor when the interchangeable part is at the receiving portion.
a surgical end effector having a receiving portion for removably receiving therein an interchangeable part, the receiving portion having a communication connection;
a handle connected to the surgical end effector and having a power supply and a controller, the controller having a first microprocessor electrically connected to the communication connection; and an interchangeable part shaped to be removably connected to the receiving portion and having an encryption device electrically removably connected to the communication connection and powered by the power supply when at the receiving portion, the encryption device having a second microprocessor programmed to cryptographically authenticate the interchangeable part with the first microprocessor when the interchangeable part is at the receiving portion.
20. The surgical instrument according to claim 19, wherein:
one wire forms the electrical connection between the communication connection and the first microprocessor; and the encryption device is a 1-wire device:
powered by the power supply through the one wire; and receiving data from and transmitting data to the controller through the one wire.
one wire forms the electrical connection between the communication connection and the first microprocessor; and the encryption device is a 1-wire device:
powered by the power supply through the one wire; and receiving data from and transmitting data to the controller through the one wire.
Priority Applications (1)
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CA3026522A CA3026522C (en) | 2007-10-04 | 2008-10-04 | Electrically self-powered surgical instrument with manual release |
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CA2699481A CA2699481C (en) | 2007-10-04 | 2008-10-04 | Electrically self-powered surgical instrument with manual release |
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CA2699481A Division CA2699481C (en) | 2007-10-04 | 2008-10-04 | Electrically self-powered surgical instrument with manual release |
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CA2925484A Active CA2925484C (en) | 2007-10-04 | 2008-10-04 | Electrically self-powered surgical instrument with manual release |
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CA2699481A Active CA2699481C (en) | 2007-10-04 | 2008-10-04 | Electrically self-powered surgical instrument with manual release |
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Families Citing this family (965)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US11229472B2 (en) | 2001-06-12 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with multiple magnetic position sensors |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US10041822B2 (en) | 2007-10-05 | 2018-08-07 | Covidien Lp | Methods to shorten calibration times for powered devices |
US9113880B2 (en) * | 2007-10-05 | 2015-08-25 | Covidien Lp | Internal backbone structural chassis for a surgical device |
US8182501B2 (en) | 2004-02-27 | 2012-05-22 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical shears and method for sealing a blood vessel using same |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US8905977B2 (en) | 2004-07-28 | 2014-12-09 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser |
PL1802245T3 (en) | 2004-10-08 | 2017-01-31 | Ethicon Endosurgery Llc | Ultrasonic surgical instrument |
US8028885B2 (en) | 2006-05-19 | 2011-10-04 | Ethicon Endo-Surgery, Inc. | Electric surgical instrument with optimized power supply and drive |
US7959050B2 (en) * | 2005-07-26 | 2011-06-14 | Ethicon Endo-Surgery, Inc | Electrically self-powered surgical instrument with manual release |
US8627995B2 (en) * | 2006-05-19 | 2014-01-14 | Ethicon Endo-Sugery, Inc. | Electrically self-powered surgical instrument with cryptographic identification of interchangeable part |
US10314583B2 (en) * | 2005-07-26 | 2019-06-11 | Ethicon Llc | Electrically self-powered surgical instrument with manual release |
US11751873B2 (en) * | 2005-07-26 | 2023-09-12 | Cilag Gmbh International | Electrically powered surgical instrument with manual release |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US8800838B2 (en) | 2005-08-31 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Robotically-controlled cable-based surgical end effectors |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US20070194079A1 (en) | 2005-08-31 | 2007-08-23 | Hueil Joseph C | Surgical stapling device with staple drivers of different height |
US7934630B2 (en) | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070191713A1 (en) | 2005-10-14 | 2007-08-16 | Eichmann Stephen E | Ultrasonic device for cutting and coagulating |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US7621930B2 (en) | 2006-01-20 | 2009-11-24 | Ethicon Endo-Surgery, Inc. | Ultrasound medical instrument having a medical ultrasonic blade |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US20110295295A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument having recording capabilities |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US20070225562A1 (en) | 2006-03-23 | 2007-09-27 | Ethicon Endo-Surgery, Inc. | Articulating endoscopic accessory channel |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
EP2018248B1 (en) | 2006-05-19 | 2015-11-04 | Applied Medical Resources Corporation | Surgical stapler |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US7740159B2 (en) | 2006-08-02 | 2010-06-22 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US7665647B2 (en) | 2006-09-29 | 2010-02-23 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling device with closure apparatus for limiting maximum tissue compression force |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8459520B2 (en) | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US7954682B2 (en) * | 2007-01-10 | 2011-06-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument with elements to communicate between control unit and end effector |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
US8540128B2 (en) | 2007-01-11 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with a curved end effector |
US7735703B2 (en) | 2007-03-15 | 2010-06-15 | Ethicon Endo-Surgery, Inc. | Re-loadable surgical stapling instrument |
US8057498B2 (en) | 2007-11-30 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument blades |
US20080234709A1 (en) | 2007-03-22 | 2008-09-25 | Houser Kevin L | Ultrasonic surgical instrument and cartilage and bone shaping blades therefor |
US8142461B2 (en) | 2007-03-22 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8226675B2 (en) | 2007-03-22 | 2012-07-24 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8911460B2 (en) | 2007-03-22 | 2014-12-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
US8157145B2 (en) | 2007-05-31 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with electrical feedback |
US8534528B2 (en) | 2007-06-04 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US7832408B2 (en) | 2007-06-04 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a directional switching mechanism |
US11857181B2 (en) | 2007-06-04 | 2024-01-02 | Cilag Gmbh International | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US8408439B2 (en) | 2007-06-22 | 2013-04-02 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US20090025982A1 (en) * | 2007-07-26 | 2009-01-29 | Hall David R | Stabilizer Assembly |
US8523889B2 (en) | 2007-07-27 | 2013-09-03 | Ethicon Endo-Surgery, Inc. | Ultrasonic end effectors with increased active length |
US8348967B2 (en) | 2007-07-27 | 2013-01-08 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8808319B2 (en) | 2007-07-27 | 2014-08-19 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8882791B2 (en) | 2007-07-27 | 2014-11-11 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8430898B2 (en) | 2007-07-31 | 2013-04-30 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8512365B2 (en) | 2007-07-31 | 2013-08-20 | Ethicon Endo-Surgery, Inc. | Surgical instruments |
US8252012B2 (en) | 2007-07-31 | 2012-08-28 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with modulator |
US9044261B2 (en) | 2007-07-31 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Temperature controlled ultrasonic surgical instruments |
US8012170B2 (en) | 2009-04-27 | 2011-09-06 | Tyco Healthcare Group Lp | Device and method for controlling compression of tissue |
US8960520B2 (en) * | 2007-10-05 | 2015-02-24 | Covidien Lp | Method and apparatus for determining parameters of linear motion in a surgical instrument |
US8967443B2 (en) * | 2007-10-05 | 2015-03-03 | Covidien Lp | Method and apparatus for determining parameters of linear motion in a surgical instrument |
JP2010540186A (en) | 2007-10-05 | 2010-12-24 | エシコン・エンド−サージェリィ・インコーポレイテッド | Ergonomic surgical instrument |
US20110022032A1 (en) * | 2007-10-05 | 2011-01-27 | Tyco Healthcare Group Lp | Battery ejection design for a surgical device |
US10271844B2 (en) * | 2009-04-27 | 2019-04-30 | Covidien Lp | Surgical stapling apparatus employing a predictive stapling algorithm |
US10010339B2 (en) | 2007-11-30 | 2018-07-03 | Ethicon Llc | Ultrasonic surgical blades |
US7901423B2 (en) | 2007-11-30 | 2011-03-08 | Ethicon Endo-Surgery, Inc. | Folded ultrasonic end effectors with increased active length |
US7766209B2 (en) | 2008-02-13 | 2010-08-03 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US8540133B2 (en) | 2008-09-19 | 2013-09-24 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US8453908B2 (en) | 2008-02-13 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with improved firing trigger arrangement |
US7905381B2 (en) * | 2008-09-19 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with cutting member arrangement |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
US8459525B2 (en) | 2008-02-14 | 2013-06-11 | Ethicon Endo-Sugery, Inc. | Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US7793812B2 (en) | 2008-02-14 | 2010-09-14 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US8584919B2 (en) | 2008-02-14 | 2013-11-19 | Ethicon Endo-Sugery, Inc. | Surgical stapling apparatus with load-sensitive firing mechanism |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
RU2493788C2 (en) | 2008-02-14 | 2013-09-27 | Этикон Эндо-Серджери, Инк. | Surgical cutting and fixing instrument, which has radio-frequency electrodes |
US8622274B2 (en) | 2008-02-14 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Motorized cutting and fastening instrument having control circuit for optimizing battery usage |
US7980443B2 (en) | 2008-02-15 | 2011-07-19 | Ethicon Endo-Surgery, Inc. | End effectors for a surgical cutting and stapling instrument |
US20130153641A1 (en) | 2008-02-15 | 2013-06-20 | Ethicon Endo-Surgery, Inc. | Releasable layer of material and surgical end effector having the same |
US20090206131A1 (en) | 2008-02-15 | 2009-08-20 | Ethicon Endo-Surgery, Inc. | End effector coupling arrangements for a surgical cutting and stapling instrument |
US8608044B2 (en) | 2008-02-15 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Feedback and lockout mechanism for surgical instrument |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US8371491B2 (en) * | 2008-02-15 | 2013-02-12 | Ethicon Endo-Surgery, Inc. | Surgical end effector having buttress retention features |
US8058771B2 (en) | 2008-08-06 | 2011-11-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic device for cutting and coagulating with stepped output |
US9089360B2 (en) | 2008-08-06 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US8083120B2 (en) * | 2008-09-18 | 2011-12-27 | Ethicon Endo-Surgery, Inc. | End effector for use with a surgical cutting and stapling instrument |
US20100069942A1 (en) * | 2008-09-18 | 2010-03-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with apparatus for measuring elapsed time between actions |
PL3476312T3 (en) | 2008-09-19 | 2024-03-11 | Ethicon Llc | Surgical stapler with apparatus for adjusting staple height |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US9050083B2 (en) | 2008-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8231042B2 (en) | 2008-11-06 | 2012-07-31 | Tyco Healthcare Group Lp | Surgical stapler |
US8281974B2 (en) | 2009-01-14 | 2012-10-09 | Tyco Healthcare, Group LP | Surgical stapler with suture locator |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8397971B2 (en) | 2009-02-05 | 2013-03-19 | Ethicon Endo-Surgery, Inc. | Sterilizable surgical instrument |
US8485413B2 (en) | 2009-02-05 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising an articulation joint |
US8414577B2 (en) | 2009-02-05 | 2013-04-09 | Ethicon Endo-Surgery, Inc. | Surgical instruments and components for use in sterile environments |
RU2525225C2 (en) * | 2009-02-06 | 2014-08-10 | Этикон Эндо-Серджери, Инк. | Improvement of drive surgical suturing instrument |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
US8453907B2 (en) | 2009-02-06 | 2013-06-04 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with cutting member reversing mechanism |
US8066167B2 (en) * | 2009-03-23 | 2011-11-29 | Ethicon Endo-Surgery, Inc. | Circular surgical stapling instrument with anvil locking system |
US9700339B2 (en) | 2009-05-20 | 2017-07-11 | Ethicon Endo-Surgery, Inc. | Coupling arrangements and methods for attaching tools to ultrasonic surgical instruments |
US8344596B2 (en) | 2009-06-24 | 2013-01-01 | Ethicon Endo-Surgery, Inc. | Transducer arrangements for ultrasonic surgical instruments |
US8146790B2 (en) | 2009-07-11 | 2012-04-03 | Tyco Healthcare Group Lp | Surgical instrument with safety mechanism |
US9017326B2 (en) | 2009-07-15 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Impedance monitoring apparatus, system, and method for ultrasonic surgical instruments |
US8663220B2 (en) | 2009-07-15 | 2014-03-04 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments |
US8461744B2 (en) | 2009-07-15 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Rotating transducer mount for ultrasonic surgical instruments |
US8141762B2 (en) | 2009-10-09 | 2012-03-27 | Ethicon Endo-Surgery, Inc. | Surgical stapler comprising a staple pocket |
US10172669B2 (en) | 2009-10-09 | 2019-01-08 | Ethicon Llc | Surgical instrument comprising an energy trigger lockout |
US11090104B2 (en) | 2009-10-09 | 2021-08-17 | Cilag Gmbh International | Surgical generator for ultrasonic and electrosurgical devices |
USRE47996E1 (en) | 2009-10-09 | 2020-05-19 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US10441345B2 (en) | 2009-10-09 | 2019-10-15 | Ethicon Llc | Surgical generator for ultrasonic and electrosurgical devices |
US9168054B2 (en) | 2009-10-09 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US8956349B2 (en) | 2009-10-09 | 2015-02-17 | Ethicon Endo-Surgery, Inc. | Surgical generator for ultrasonic and electrosurgical devices |
US8353438B2 (en) | 2009-11-19 | 2013-01-15 | Ethicon Endo-Surgery, Inc. | Circular stapler introducer with rigid cap assembly configured for easy removal |
US8136712B2 (en) | 2009-12-10 | 2012-03-20 | Ethicon Endo-Surgery, Inc. | Surgical stapler with discrete staple height adjustment and tactile feedback |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8267300B2 (en) | 2009-12-30 | 2012-09-18 | Ethicon Endo-Surgery, Inc. | Dampening device for endoscopic surgical stapler |
US8608046B2 (en) * | 2010-01-07 | 2013-12-17 | Ethicon Endo-Surgery, Inc. | Test device for a surgical tool |
US8469981B2 (en) | 2010-02-11 | 2013-06-25 | Ethicon Endo-Surgery, Inc. | Rotatable cutting implement arrangements for ultrasonic surgical instruments |
US8531064B2 (en) | 2010-02-11 | 2013-09-10 | Ethicon Endo-Surgery, Inc. | Ultrasonically powered surgical instruments with rotating cutting implement |
US8579928B2 (en) | 2010-02-11 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Outer sheath and blade arrangements for ultrasonic surgical instruments |
US8323302B2 (en) | 2010-02-11 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Methods of using ultrasonically powered surgical instruments with rotatable cutting implements |
US8951272B2 (en) | 2010-02-11 | 2015-02-10 | Ethicon Endo-Surgery, Inc. | Seal arrangements for ultrasonically powered surgical instruments |
US8961547B2 (en) | 2010-02-11 | 2015-02-24 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with moving cutting implement |
US8382782B2 (en) | 2010-02-11 | 2013-02-26 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with partially rotating blade and fixed pad arrangement |
US8486096B2 (en) | 2010-02-11 | 2013-07-16 | Ethicon Endo-Surgery, Inc. | Dual purpose surgical instrument for cutting and coagulating tissue |
US9259234B2 (en) | 2010-02-11 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with rotatable blade and hollow sheath arrangements |
US8419759B2 (en) | 2010-02-11 | 2013-04-16 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with comb-like tissue trimming device |
GB2480498A (en) | 2010-05-21 | 2011-11-23 | Ethicon Endo Surgery Inc | Medical device comprising RF circuitry |
US8795327B2 (en) | 2010-07-22 | 2014-08-05 | Ethicon Endo-Surgery, Inc. | Electrosurgical instrument with separate closure and cutting members |
US9192431B2 (en) | 2010-07-23 | 2015-11-24 | Ethicon Endo-Surgery, Inc. | Electrosurgical cutting and sealing instrument |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US8801735B2 (en) | 2010-07-30 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Surgical circular stapler with tissue retention arrangements |
US8789740B2 (en) | 2010-07-30 | 2014-07-29 | Ethicon Endo-Surgery, Inc. | Linear cutting and stapling device with selectively disengageable cutting member |
US8360296B2 (en) | 2010-09-09 | 2013-01-29 | Ethicon Endo-Surgery, Inc. | Surgical stapling head assembly with firing lockout for a surgical stapler |
US9289212B2 (en) | 2010-09-17 | 2016-03-22 | Ethicon Endo-Surgery, Inc. | Surgical instruments and batteries for surgical instruments |
US8632525B2 (en) | 2010-09-17 | 2014-01-21 | Ethicon Endo-Surgery, Inc. | Power control arrangements for surgical instruments and batteries |
US20120078244A1 (en) | 2010-09-24 | 2012-03-29 | Worrell Barry C | Control features for articulating surgical device |
US8733613B2 (en) | 2010-09-29 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US9480476B2 (en) | 2010-09-30 | 2016-11-01 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising resilient members |
US9232941B2 (en) | 2010-09-30 | 2016-01-12 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising a reservoir |
US9301752B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising a plurality of capsules |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US9241714B2 (en) | 2011-04-29 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator and method for making the same |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US9301753B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Expandable tissue thickness compensator |
US9168038B2 (en) | 2010-09-30 | 2015-10-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising a tissue thickness compensator |
AU2011308701B2 (en) | 2010-09-30 | 2013-11-14 | Ethicon Endo-Surgery, Inc. | Fastener system comprising a retention matrix and an alignment matrix |
US9861361B2 (en) | 2010-09-30 | 2018-01-09 | Ethicon Llc | Releasable tissue thickness compensator and fastener cartridge having the same |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US8783542B2 (en) | 2010-09-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Fasteners supported by a fastener cartridge support |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US9320523B2 (en) | 2012-03-28 | 2016-04-26 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising tissue ingrowth features |
US20120080498A1 (en) | 2010-09-30 | 2012-04-05 | Ethicon Endo-Surgery, Inc. | Curved end effector for a stapling instrument |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US8695866B2 (en) * | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
US10660695B2 (en) | 2010-11-05 | 2020-05-26 | Ethicon Llc | Sterile medical instrument charging device |
US9247986B2 (en) | 2010-11-05 | 2016-02-02 | Ethicon Endo-Surgery, Llc | Surgical instrument with ultrasonic transducer having integral switches |
US10085792B2 (en) | 2010-11-05 | 2018-10-02 | Ethicon Llc | Surgical instrument with motorized attachment feature |
US9161803B2 (en) | 2010-11-05 | 2015-10-20 | Ethicon Endo-Surgery, Inc. | Motor driven electrosurgical device with mechanical and electrical feedback |
US9017851B2 (en) | 2010-11-05 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Sterile housing for non-sterile medical device component |
US9510895B2 (en) | 2010-11-05 | 2016-12-06 | Ethicon Endo-Surgery, Llc | Surgical instrument with modular shaft and end effector |
US9526921B2 (en) * | 2010-11-05 | 2016-12-27 | Ethicon Endo-Surgery, Llc | User feedback through end effector of surgical instrument |
US9039720B2 (en) | 2010-11-05 | 2015-05-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with ratcheting rotatable shaft |
US9017849B2 (en) | 2010-11-05 | 2015-04-28 | Ethicon Endo-Surgery, Inc. | Power source management for medical device |
US9782214B2 (en) | 2010-11-05 | 2017-10-10 | Ethicon Llc | Surgical instrument with sensor and powered control |
US20120116381A1 (en) | 2010-11-05 | 2012-05-10 | Houser Kevin L | Surgical instrument with charging station and wireless communication |
US9072523B2 (en) | 2010-11-05 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Medical device with feature for sterile acceptance of non-sterile reusable component |
US9000720B2 (en) | 2010-11-05 | 2015-04-07 | Ethicon Endo-Surgery, Inc. | Medical device packaging with charging interface |
US10959769B2 (en) | 2010-11-05 | 2021-03-30 | Ethicon Llc | Surgical instrument with slip ring assembly to power ultrasonic transducer |
US9381058B2 (en) | 2010-11-05 | 2016-07-05 | Ethicon Endo-Surgery, Llc | Recharge system for medical devices |
US20120116265A1 (en) | 2010-11-05 | 2012-05-10 | Houser Kevin L | Surgical instrument with charging devices |
US9649150B2 (en) | 2010-11-05 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Selective activation of electronic components in medical device |
US9782215B2 (en) | 2010-11-05 | 2017-10-10 | Ethicon Endo-Surgery, Llc | Surgical instrument with ultrasonic transducer having integral switches |
US9011471B2 (en) | 2010-11-05 | 2015-04-21 | Ethicon Endo-Surgery, Inc. | Surgical instrument with pivoting coupling to modular shaft and end effector |
US9597143B2 (en) | 2010-11-05 | 2017-03-21 | Ethicon Endo-Surgery, Llc | Sterile medical instrument charging device |
US9421062B2 (en) | 2010-11-05 | 2016-08-23 | Ethicon Endo-Surgery, Llc | Surgical instrument shaft with resiliently biased coupling to handpiece |
US9089338B2 (en) | 2010-11-05 | 2015-07-28 | Ethicon Endo-Surgery, Inc. | Medical device packaging with window for insertion of reusable component |
US9375255B2 (en) | 2010-11-05 | 2016-06-28 | Ethicon Endo-Surgery, Llc | Surgical instrument handpiece with resiliently biased coupling to modular shaft and end effector |
US10881448B2 (en) | 2010-11-05 | 2021-01-05 | Ethicon Llc | Cam driven coupling between ultrasonic transducer and waveguide in surgical instrument |
JP2012130980A (en) * | 2010-12-21 | 2012-07-12 | Makita Corp | Cordless electric power tool |
US20120211542A1 (en) | 2011-02-23 | 2012-08-23 | Tyco Healthcare Group I.P | Controlled tissue compression systems and methods |
US9033204B2 (en) | 2011-03-14 | 2015-05-19 | Ethicon Endo-Surgery, Inc. | Circular stapling devices with tissue-puncturing anvil features |
US9044229B2 (en) | 2011-03-15 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical fastener instruments |
US8800841B2 (en) | 2011-03-15 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Surgical staple cartridges |
US8926598B2 (en) | 2011-03-15 | 2015-01-06 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulatable and rotatable end effector |
US8968293B2 (en) | 2011-04-12 | 2015-03-03 | Covidien Lp | Systems and methods for calibrating power measurements in an electrosurgical generator |
US9474527B1 (en) * | 2011-04-26 | 2016-10-25 | Bryan D. Knodel | Surgical instrument with discrete articulation |
US9566048B1 (en) * | 2011-04-26 | 2017-02-14 | Cardica, Inc. | Surgical instrument with discrete cammed articulation |
BR112013027794B1 (en) | 2011-04-29 | 2020-12-15 | Ethicon Endo-Surgery, Inc | CLAMP CARTRIDGE SET |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
EP2713927B1 (en) * | 2011-05-31 | 2022-07-20 | Intuitive Surgical Operations, Inc. | Surgical instrument with control for detected fault condition |
US9364288B2 (en) | 2011-07-06 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Sterile battery containment |
US9259265B2 (en) | 2011-07-22 | 2016-02-16 | Ethicon Endo-Surgery, Llc | Surgical instruments for tensioning tissue |
JP6009840B2 (en) | 2011-08-04 | 2016-10-19 | オリンパス株式会社 | Medical equipment |
JP6005950B2 (en) | 2011-08-04 | 2016-10-12 | オリンパス株式会社 | Surgery support apparatus and control method thereof |
JP5841451B2 (en) * | 2011-08-04 | 2016-01-13 | オリンパス株式会社 | Surgical instrument and control method thereof |
JP5931497B2 (en) | 2011-08-04 | 2016-06-08 | オリンパス株式会社 | Surgery support apparatus and assembly method thereof |
EP2740433B1 (en) | 2011-08-04 | 2016-04-27 | Olympus Corporation | Surgical implement and medical treatment manipulator |
EP2740434A4 (en) | 2011-08-04 | 2015-03-18 | Olympus Corp | Medical manipulator and method for controlling same |
JP5936914B2 (en) | 2011-08-04 | 2016-06-22 | オリンパス株式会社 | Operation input device and manipulator system including the same |
JP6021353B2 (en) | 2011-08-04 | 2016-11-09 | オリンパス株式会社 | Surgery support device |
JP6081061B2 (en) | 2011-08-04 | 2017-02-15 | オリンパス株式会社 | Surgery support device |
US9519341B2 (en) | 2011-08-04 | 2016-12-13 | Olympus Corporation | Medical manipulator and surgical support apparatus |
JP6000641B2 (en) | 2011-08-04 | 2016-10-05 | オリンパス株式会社 | Manipulator system |
JP5953058B2 (en) | 2011-08-04 | 2016-07-13 | オリンパス株式会社 | Surgery support device and method for attaching and detaching the same |
JP6021484B2 (en) | 2011-08-04 | 2016-11-09 | オリンパス株式会社 | Medical manipulator |
USD700967S1 (en) | 2011-08-23 | 2014-03-11 | Covidien Ag | Handle for portable surgical device |
US8956342B1 (en) | 2011-09-01 | 2015-02-17 | Microaire Surgical Instruments Llc | Method and device for ergonomically and ambidextrously operable surgical device |
US8789739B2 (en) | 2011-09-06 | 2014-07-29 | Ethicon Endo-Surgery, Inc. | Continuous stapling instrument |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
US9050125B2 (en) | 2011-10-10 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instrument with modular end effector |
US8734476B2 (en) | 2011-10-13 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Coupling for slip ring assembly and ultrasonic transducer in surgical instrument |
US8708212B2 (en) | 2011-10-18 | 2014-04-29 | Covidien Lp | Tilt top anvil with torsion spring |
USD687549S1 (en) | 2011-10-24 | 2013-08-06 | Ethicon Endo-Surgery, Inc. | Surgical instrument |
US9333025B2 (en) | 2011-10-24 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Battery initialization clip |
US9016547B2 (en) | 2011-10-26 | 2015-04-28 | Covidien Lp | EEA tilt top anvil with ratchet/locking mechanism |
AU2015201050B2 (en) * | 2011-10-27 | 2016-06-09 | Covidien Lp | System and method of using simulation reload to optimize staple formation |
US9364231B2 (en) | 2011-10-27 | 2016-06-14 | Covidien Lp | System and method of using simulation reload to optimize staple formation |
US9168042B2 (en) | 2012-01-12 | 2015-10-27 | Covidien Lp | Circular stapling instruments |
US9010605B2 (en) | 2012-01-12 | 2015-04-21 | Covidien Lp | Sliding sleeve for circular stapling instrument reloads |
DE102012100308A1 (en) * | 2012-01-13 | 2013-07-18 | Technische Universität Berlin | Device for applying an active substance to or in an organic tissue and method |
US9038882B2 (en) | 2012-02-03 | 2015-05-26 | Covidien Lp | Circular stapling instrument |
EP2811932B1 (en) | 2012-02-10 | 2019-06-26 | Ethicon LLC | Robotically controlled surgical instrument |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
US9022274B2 (en) | 2012-02-15 | 2015-05-05 | Covidien Lp | Circular stapler with increased lumen diameter |
US9078653B2 (en) | 2012-03-26 | 2015-07-14 | Ethicon Endo-Surgery, Inc. | Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge |
RU2014143258A (en) | 2012-03-28 | 2016-05-20 | Этикон Эндо-Серджери, Инк. | FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS |
RU2639857C2 (en) | 2012-03-28 | 2017-12-22 | Этикон Эндо-Серджери, Инк. | Tissue thickness compensator containing capsule for medium with low pressure |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
BR112014024194B1 (en) | 2012-03-28 | 2022-03-03 | Ethicon Endo-Surgery, Inc | STAPLER CARTRIDGE SET FOR A SURGICAL STAPLER |
US9237921B2 (en) | 2012-04-09 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Devices and techniques for cutting and coagulating tissue |
US9241731B2 (en) | 2012-04-09 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Rotatable electrical connection for ultrasonic surgical instruments |
US9439668B2 (en) | 2012-04-09 | 2016-09-13 | Ethicon Endo-Surgery, Llc | Switch arrangements for ultrasonic surgical instruments |
US9226766B2 (en) | 2012-04-09 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Serial communication protocol for medical device |
US9724118B2 (en) | 2012-04-09 | 2017-08-08 | Ethicon Endo-Surgery, Llc | Techniques for cutting and coagulating tissue for ultrasonic surgical instruments |
US9186141B2 (en) | 2012-04-12 | 2015-11-17 | Covidien Lp | Circular anastomosis stapling apparatus utilizing a two stroke firing sequence |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9351734B2 (en) | 2012-06-19 | 2016-05-31 | Covidien Lp | Spring loaded anvil retainer |
US9649111B2 (en) | 2012-06-28 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Replaceable clip cartridge for a clip applier |
US20140005705A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Surgical instruments with articulating shafts |
US9125662B2 (en) | 2012-06-28 | 2015-09-08 | Ethicon Endo-Surgery, Inc. | Multi-axis articulating and rotating surgical tools |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
US9028494B2 (en) | 2012-06-28 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Interchangeable end effector coupling arrangement |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
BR112014032740A2 (en) | 2012-06-28 | 2020-02-27 | Ethicon Endo Surgery Inc | empty clip cartridge lock |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
US11278284B2 (en) | 2012-06-28 | 2022-03-22 | Cilag Gmbh International | Rotary drive arrangements for surgical instruments |
US20140005718A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Multi-functional powered surgical device with external dissection features |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
US20140001234A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Coupling arrangements for attaching surgical end effectors to drive systems therefor |
US9408622B2 (en) | 2012-06-29 | 2016-08-09 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9198714B2 (en) | 2012-06-29 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Haptic feedback devices for surgical robot |
US9326788B2 (en) | 2012-06-29 | 2016-05-03 | Ethicon Endo-Surgery, Llc | Lockout mechanism for use with robotic electrosurgical device |
US9283045B2 (en) | 2012-06-29 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Surgical instruments with fluid management system |
US9351754B2 (en) | 2012-06-29 | 2016-05-31 | Ethicon Endo-Surgery, Llc | Ultrasonic surgical instruments with distally positioned jaw assemblies |
US9226767B2 (en) | 2012-06-29 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Closed feedback control for electrosurgical device |
US20140005702A1 (en) | 2012-06-29 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Ultrasonic surgical instruments with distally positioned transducers |
US9393037B2 (en) | 2012-06-29 | 2016-07-19 | Ethicon Endo-Surgery, Llc | Surgical instruments with articulating shafts |
US9820768B2 (en) | 2012-06-29 | 2017-11-21 | Ethicon Llc | Ultrasonic surgical instruments with control mechanisms |
US10213205B2 (en) | 2012-07-06 | 2019-02-26 | Covidien Lp | T-slot tilt anvil for circular stapling instrument |
US9347533B2 (en) * | 2012-07-25 | 2016-05-24 | Cook Medical Technologies Llc | Rotational drive system for a biopsy member |
CN104335386B (en) * | 2012-08-29 | 2016-08-17 | 捷锐士阿希迈公司(以奥林巴斯美国外科技术名义) | It is attached to the set of cells of cable |
US9692036B2 (en) | 2012-08-29 | 2017-06-27 | Gyrus Acmi, Inc. | Destructive battery closure |
BR112015007010B1 (en) | 2012-09-28 | 2022-05-31 | Ethicon Endo-Surgery, Inc | end actuator |
US9675359B2 (en) | 2012-10-10 | 2017-06-13 | Covidien Lp | Surgical instrument with preload assembly |
US9386985B2 (en) | 2012-10-15 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Surgical cutting instrument |
US9095367B2 (en) | 2012-10-22 | 2015-08-04 | Ethicon Endo-Surgery, Inc. | Flexible harmonic waveguides/blades for surgical instruments |
US10201365B2 (en) | 2012-10-22 | 2019-02-12 | Ethicon Llc | Surgeon feedback sensing and display methods |
US9572572B2 (en) | 2012-11-09 | 2017-02-21 | Covidien Lp | Circular stapler mechanical lockout |
US20140135804A1 (en) | 2012-11-15 | 2014-05-15 | Ethicon Endo-Surgery, Inc. | Ultrasonic and electrosurgical devices |
US9532783B2 (en) | 2012-12-17 | 2017-01-03 | Ethicon Endo-Surgery, Llc | Circular stapler with selectable motorized and manual control, including a control ring |
US9351724B2 (en) | 2013-01-11 | 2016-05-31 | Covidien Lp | Circular stapling instrument |
MX364730B (en) * | 2013-01-18 | 2019-05-06 | Ethicon Endo Surgery Inc | Motorized surgical instrument. |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
US10092292B2 (en) | 2013-02-28 | 2018-10-09 | Ethicon Llc | Staple forming features for surgical stapling instrument |
BR112015021098B1 (en) | 2013-03-01 | 2022-02-15 | Ethicon Endo-Surgery, Inc | COVERAGE FOR A JOINT JOINT AND SURGICAL INSTRUMENT |
RU2669463C2 (en) | 2013-03-01 | 2018-10-11 | Этикон Эндо-Серджери, Инк. | Surgical instrument with soft stop |
US9358003B2 (en) | 2013-03-01 | 2016-06-07 | Ethicon Endo-Surgery, Llc | Electromechanical surgical device with signal relay arrangement |
US20140263552A1 (en) | 2013-03-13 | 2014-09-18 | Ethicon Endo-Surgery, Inc. | Staple cartridge tissue thickness sensor system |
WO2014152912A1 (en) | 2013-03-14 | 2014-09-25 | Applied Medical Resources Corporation | Surgical stapler with partial pockets |
US9592056B2 (en) | 2013-03-14 | 2017-03-14 | Covidien Lp | Powered stapling apparatus |
US9883860B2 (en) | 2013-03-14 | 2018-02-06 | Ethicon Llc | Interchangeable shaft assemblies for use with a surgical instrument |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US10226273B2 (en) | 2013-03-14 | 2019-03-12 | Ethicon Llc | Mechanical fasteners for use with surgical energy devices |
WO2014144411A1 (en) | 2013-03-15 | 2014-09-18 | Applied Medical Resources Corporation | Surgical stapler having actuation mechanism with rotatable shaft |
KR102254476B1 (en) | 2013-03-15 | 2021-05-21 | 어플라이드 메디컬 리소시스 코포레이션 | Surgical stapler with expandable jaw |
CN104042292A (en) | 2013-03-15 | 2014-09-17 | 柯惠Lp公司 | Surgical anastomosis device comprising assemblies capable of being repeatedly utilized |
US9241728B2 (en) | 2013-03-15 | 2016-01-26 | Ethicon Endo-Surgery, Inc. | Surgical instrument with multiple clamping mechanisms |
US9795384B2 (en) | 2013-03-27 | 2017-10-24 | Ethicon Llc | Fastener cartridge comprising a tissue thickness compensator and a gap setting element |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
US9332984B2 (en) | 2013-03-27 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Fastener cartridge assemblies |
US9844368B2 (en) | 2013-04-16 | 2017-12-19 | Ethicon Llc | Surgical system comprising first and second drive systems |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
AT513482B1 (en) * | 2013-04-22 | 2014-05-15 | Dominik Kovács | Device for producing anastomoses |
US9574644B2 (en) | 2013-05-30 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Power module for use with a surgical instrument |
US9532780B2 (en) | 2013-06-12 | 2017-01-03 | Covidien Lp | EEA anvil snap ring activator |
US9668740B2 (en) | 2013-06-14 | 2017-06-06 | Covidien Lp | Anvil assembly with sliding sleeve |
US10271843B2 (en) | 2013-06-17 | 2019-04-30 | Covidien Lp | Surgical instrument with lockout mechanism |
US9750503B2 (en) * | 2013-07-11 | 2017-09-05 | Covidien Lp | Methods and devices for performing a surgical anastomosis |
US10811816B2 (en) | 2013-08-16 | 2020-10-20 | Covidien Lp | Chip assembly for reusable surgical instruments |
US9833235B2 (en) * | 2013-08-16 | 2017-12-05 | Covidien Lp | Chip assembly for reusable surgical instruments |
BR112016003537B1 (en) | 2013-08-23 | 2023-01-17 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT, EQUIPPED WITH A MOTOR, WITH SECONDARY BATTERY PROVISIONS |
MX369362B (en) * | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Firing member retraction devices for powered surgical instruments. |
US9283054B2 (en) | 2013-08-23 | 2016-03-15 | Ethicon Endo-Surgery, Llc | Interactive displays |
US9693773B2 (en) | 2013-09-11 | 2017-07-04 | Covidien Lp | Anvil assembly with sliding sleeve |
US9814514B2 (en) | 2013-09-13 | 2017-11-14 | Ethicon Llc | Electrosurgical (RF) medical instruments for cutting and coagulating tissue |
US20140171986A1 (en) | 2013-09-13 | 2014-06-19 | Ethicon Endo-Surgery, Inc. | Surgical Clip Having Comliant Portion |
US9936949B2 (en) * | 2013-09-23 | 2018-04-10 | Ethicon Llc | Surgical stapling instrument with drive assembly having toggle features |
US9713469B2 (en) | 2013-09-23 | 2017-07-25 | Ethicon Llc | Surgical stapler with rotary cam drive |
US10709452B2 (en) | 2013-09-23 | 2020-07-14 | Ethicon Llc | Methods and systems for performing circular stapling |
US20150083772A1 (en) * | 2013-09-23 | 2015-03-26 | Ethicon Endo-Surgery, Inc. | Surgical stapler with rotary cam drive and return |
US10463365B2 (en) * | 2013-10-17 | 2019-11-05 | Covidien Lp | Chip assembly for surgical instruments |
US9265926B2 (en) | 2013-11-08 | 2016-02-23 | Ethicon Endo-Surgery, Llc | Electrosurgical devices |
US9554802B2 (en) | 2013-11-13 | 2017-01-31 | Covidien Lp | Anvil assembly with frangible retaining member |
US9517070B2 (en) | 2013-11-13 | 2016-12-13 | Covidien Lp | Anvil assembly and delivery system |
GB2521228A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
GB2521229A (en) | 2013-12-16 | 2015-06-17 | Ethicon Endo Surgery Inc | Medical device |
CA2932285C (en) | 2013-12-17 | 2019-10-08 | Standard Bariatrics, Inc. | Resection line guide for a medical procedure and method of using same |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US9681870B2 (en) | 2013-12-23 | 2017-06-20 | Ethicon Llc | Articulatable surgical instruments with separate and distinct closing and firing systems |
US9549735B2 (en) | 2013-12-23 | 2017-01-24 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a firing member including fastener transfer surfaces |
US9642620B2 (en) | 2013-12-23 | 2017-05-09 | Ethicon Endo-Surgery, Llc | Surgical cutting and stapling instruments with articulatable end effectors |
US9795436B2 (en) | 2014-01-07 | 2017-10-24 | Ethicon Llc | Harvesting energy from a surgical generator |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
BR112016019387B1 (en) | 2014-02-24 | 2022-11-29 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT SYSTEM AND FASTENER CARTRIDGE FOR USE WITH A SURGICAL FIXING INSTRUMENT |
US9775608B2 (en) | 2014-02-24 | 2017-10-03 | Ethicon Llc | Fastening system comprising a firing member lockout |
US9554854B2 (en) | 2014-03-18 | 2017-01-31 | Ethicon Endo-Surgery, Llc | Detecting short circuits in electrosurgical medical devices |
US20150272557A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Modular surgical instrument system |
US9913642B2 (en) | 2014-03-26 | 2018-03-13 | Ethicon Llc | Surgical instrument comprising a sensor system |
CN106456167B (en) * | 2014-03-26 | 2019-05-14 | 伊西康内外科有限责任公司 | The feedback algorithm of manual-operated emergent system for surgical instruments |
US9750499B2 (en) | 2014-03-26 | 2017-09-05 | Ethicon Llc | Surgical stapling instrument system |
US10013049B2 (en) | 2014-03-26 | 2018-07-03 | Ethicon Llc | Power management through sleep options of segmented circuit and wake up control |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US10463421B2 (en) | 2014-03-27 | 2019-11-05 | Ethicon Llc | Two stage trigger, clamp and cut bipolar vessel sealer |
US10092310B2 (en) | 2014-03-27 | 2018-10-09 | Ethicon Llc | Electrosurgical devices |
CA2944329C (en) | 2014-03-29 | 2019-08-20 | Standard Bariatrics, Inc. | End effectors, surgical stapling devices, and methods of using same |
AU2015241193B2 (en) | 2014-03-29 | 2020-01-02 | Standard Bariatrics, Inc. | End effectors surgical stapling devices, and methods of using same |
US9737355B2 (en) | 2014-03-31 | 2017-08-22 | Ethicon Llc | Controlling impedance rise in electrosurgical medical devices |
US9913680B2 (en) | 2014-04-15 | 2018-03-13 | Ethicon Llc | Software algorithms for electrosurgical instruments |
CN106456159B (en) | 2014-04-16 | 2019-03-08 | 伊西康内外科有限责任公司 | Fastener cartridge assembly and nail retainer lid arragement construction |
JP6612256B2 (en) | 2014-04-16 | 2019-11-27 | エシコン エルエルシー | Fastener cartridge with non-uniform fastener |
US20150297225A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US10542988B2 (en) | 2014-04-16 | 2020-01-28 | Ethicon Llc | End effector comprising an anvil including projections extending therefrom |
BR112016023698B1 (en) | 2014-04-16 | 2022-07-26 | Ethicon Endo-Surgery, Llc | FASTENER CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US9801627B2 (en) | 2014-09-26 | 2017-10-31 | Ethicon Llc | Fastener cartridge for creating a flexible staple line |
US9913643B2 (en) | 2014-05-09 | 2018-03-13 | Covidien Lp | Interlock assemblies for replaceable loading unit |
ES2861258T3 (en) | 2014-06-11 | 2021-10-06 | Applied Med Resources | Circumferential Shot Surgical Stapler |
AU2014397432A1 (en) | 2014-06-12 | 2016-12-01 | Covidien Lp | Surgical stapling apparatus |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
US9867619B2 (en) | 2014-06-24 | 2018-01-16 | Covidien Lp | System for delivering an anvil assembly to a surgical site |
US9861367B2 (en) | 2014-06-24 | 2018-01-09 | Covidien Lp | Anvil assembly delivery systems |
CN106659502B (en) | 2014-07-04 | 2019-03-01 | 柯惠有限合伙公司 | The load units with shipment component for surgical stapling device |
US9757133B2 (en) | 2014-07-09 | 2017-09-12 | Covidien Lp | Methods and devices for performing a surgical anastomosis |
US10285724B2 (en) | 2014-07-31 | 2019-05-14 | Ethicon Llc | Actuation mechanisms and load adjustment assemblies for surgical instruments |
US10743960B2 (en) | 2014-09-04 | 2020-08-18 | AtaCor Medical, Inc. | Cardiac arrhythmia treatment devices and delivery |
US10328268B2 (en) | 2014-09-04 | 2019-06-25 | AtaCor Medical, Inc. | Cardiac pacing |
EP3188791A4 (en) * | 2014-09-04 | 2018-03-28 | Atacor Medical, Inc. | Cardiac pacing lead delivery system |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
US10111679B2 (en) | 2014-09-05 | 2018-10-30 | Ethicon Llc | Circuitry and sensors for powered medical device |
US10470911B2 (en) | 2014-09-05 | 2019-11-12 | Standard Bariatrics, Inc. | Sleeve gastrectomy calibration tube and method of using same |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
AU2015318095B2 (en) | 2014-09-15 | 2020-02-20 | Applied Medical Resources Corporation | Surgical stapler with self-adjusting staple height |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
BR112017005981B1 (en) | 2014-09-26 | 2022-09-06 | Ethicon, Llc | ANCHOR MATERIAL FOR USE WITH A SURGICAL STAPLE CARTRIDGE AND SURGICAL STAPLE CARTRIDGE FOR USE WITH A SURGICAL INSTRUMENT |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US10136938B2 (en) | 2014-10-29 | 2018-11-27 | Ethicon Llc | Electrosurgical instrument with sensor |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US11097109B2 (en) | 2014-11-24 | 2021-08-24 | AtaCor Medical, Inc. | Cardiac pacing sensing and control |
US10085744B2 (en) | 2014-12-08 | 2018-10-02 | Covidien Lp | Loading unit attachment band for surgical stapling instrument |
US10639092B2 (en) | 2014-12-08 | 2020-05-05 | Ethicon Llc | Electrode configurations for surgical instruments |
US9855045B2 (en) | 2014-12-09 | 2018-01-02 | Covidien Lp | Anvil assembly delivery system |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US10772627B2 (en) | 2014-12-11 | 2020-09-15 | Covidien Lp | Stapler with auto-matic lockout mechanism |
US10499916B2 (en) | 2014-12-11 | 2019-12-10 | Covidien Lp | Surgical stapling loading unit |
JP6518766B2 (en) | 2014-12-17 | 2019-05-22 | コヴィディエン リミテッド パートナーシップ | Surgical stapling device with firing indicator |
MX2017008108A (en) | 2014-12-18 | 2018-03-06 | Ethicon Llc | Surgical instrument with an anvil that is selectively movable about a discrete non-movable axis relative to a staple cartridge. |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US10004501B2 (en) | 2014-12-18 | 2018-06-26 | Ethicon Llc | Surgical instruments with improved closure arrangements |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US10159524B2 (en) | 2014-12-22 | 2018-12-25 | Ethicon Llc | High power battery powered RF amplifier topology |
US10117656B2 (en) | 2015-01-07 | 2018-11-06 | Covidien Lp | Loading unit locking collar |
US10039549B2 (en) | 2015-01-07 | 2018-08-07 | Covidien Lp | Loading unit retention clip for surgical stapling instrument |
US10022126B2 (en) | 2015-01-07 | 2018-07-17 | Covidien Lp | Loading unit locking collar |
US10245095B2 (en) | 2015-02-06 | 2019-04-02 | Ethicon Llc | Electrosurgical instrument with rotation and articulation mechanisms |
CN107249479B (en) | 2015-02-15 | 2020-05-08 | 柯惠有限合伙公司 | Surgical stapling device including firing indicator having unitary construction |
US10285698B2 (en) * | 2015-02-26 | 2019-05-14 | Covidien Lp | Surgical apparatus |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US9931118B2 (en) | 2015-02-27 | 2018-04-03 | Ethicon Endo-Surgery, Llc | Reinforced battery for a surgical instrument |
US10226250B2 (en) | 2015-02-27 | 2019-03-12 | Ethicon Llc | Modular stapling assembly |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10190888B2 (en) * | 2015-03-11 | 2019-01-29 | Covidien Lp | Surgical stapling instruments with linear position assembly |
US10342602B2 (en) | 2015-03-17 | 2019-07-09 | Ethicon Llc | Managing tissue treatment |
US10321950B2 (en) | 2015-03-17 | 2019-06-18 | Ethicon Llc | Managing tissue treatment |
US10595929B2 (en) | 2015-03-24 | 2020-03-24 | Ethicon Llc | Surgical instruments with firing system overload protection mechanisms |
US10433844B2 (en) | 2015-03-31 | 2019-10-08 | Ethicon Llc | Surgical instrument with selectively disengageable threaded drive systems |
US10314638B2 (en) | 2015-04-07 | 2019-06-11 | Ethicon Llc | Articulating radio frequency (RF) tissue seal with articulating state sensing |
US10881408B2 (en) | 2015-04-22 | 2021-01-05 | Covidien Lp | Interlock assembly for replaceable loading units |
US10426480B2 (en) | 2015-04-29 | 2019-10-01 | Covidien Lp | Cutting ring assembly with rigid cutting member |
US9987001B2 (en) | 2015-06-12 | 2018-06-05 | Covidien Lp | Surgical anastomosis apparatus |
US10034684B2 (en) | 2015-06-15 | 2018-07-31 | Ethicon Llc | Apparatus and method for dissecting and coagulating tissue |
US11020140B2 (en) | 2015-06-17 | 2021-06-01 | Cilag Gmbh International | Ultrasonic surgical blade for use with ultrasonic surgical instruments |
US10178992B2 (en) | 2015-06-18 | 2019-01-15 | Ethicon Llc | Push/pull articulation drive systems for articulatable surgical instruments |
US10265066B2 (en) * | 2015-06-26 | 2019-04-23 | Ethicon Llc | Surgical stapler with incomplete firing indicator |
US10517602B2 (en) | 2015-06-26 | 2019-12-31 | Ethicon Llc | Surgical stapler with reversible polarity |
US10456134B2 (en) * | 2015-06-26 | 2019-10-29 | Ethicon Llc | Surgical stapler with reversible motor |
US10405855B2 (en) * | 2015-06-26 | 2019-09-10 | Ethicon Llc | Firing circuit for surgical stapler |
US10188386B2 (en) * | 2015-06-26 | 2019-01-29 | Ethicon Llc | Surgical stapler with anvil state indicator |
US10357303B2 (en) | 2015-06-30 | 2019-07-23 | Ethicon Llc | Translatable outer tube for sealing using shielded lap chole dissector |
US10898256B2 (en) | 2015-06-30 | 2021-01-26 | Ethicon Llc | Surgical system with user adaptable techniques based on tissue impedance |
US10034704B2 (en) | 2015-06-30 | 2018-07-31 | Ethicon Llc | Surgical instrument with user adaptable algorithms |
US11051873B2 (en) | 2015-06-30 | 2021-07-06 | Cilag Gmbh International | Surgical system with user adaptable techniques employing multiple energy modalities based on tissue parameters |
US11129669B2 (en) | 2015-06-30 | 2021-09-28 | Cilag Gmbh International | Surgical system with user adaptable techniques based on tissue type |
US11141213B2 (en) | 2015-06-30 | 2021-10-12 | Cilag Gmbh International | Surgical instrument with user adaptable techniques |
US10154852B2 (en) | 2015-07-01 | 2018-12-18 | Ethicon Llc | Ultrasonic surgical blade with improved cutting and coagulation features |
US9974536B2 (en) | 2015-07-02 | 2018-05-22 | Covidien Lp | Anvil assemblies and delivery systems |
US10111668B2 (en) | 2015-07-02 | 2018-10-30 | Covidien Lp | Anvil assembly with snap backup ring |
US10117655B2 (en) | 2015-07-22 | 2018-11-06 | Covidien Lp | Loading unit locking band for surgical stapling instrument |
US10085756B2 (en) | 2015-07-24 | 2018-10-02 | Covidien Lp | Anvil assembly and anvil assembly delivery system |
US10117675B2 (en) | 2015-07-28 | 2018-11-06 | Covidien Lp | Trocar tip protector |
JP7079194B2 (en) | 2015-08-06 | 2022-06-01 | アプライド メディカル リソーシーズ コーポレイション | Surgical stapler with lock joints |
US10835249B2 (en) | 2015-08-17 | 2020-11-17 | Ethicon Llc | Implantable layers for a surgical instrument |
US10390829B2 (en) | 2015-08-26 | 2019-08-27 | Ethicon Llc | Staples comprising a cover |
JP6828018B2 (en) | 2015-08-26 | 2021-02-10 | エシコン エルエルシーEthicon LLC | Surgical staple strips that allow you to change the characteristics of staples and facilitate filling into cartridges |
MX2022006189A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10314587B2 (en) | 2015-09-02 | 2019-06-11 | Ethicon Llc | Surgical staple cartridge with improved staple driver configurations |
US10285837B1 (en) | 2015-09-16 | 2019-05-14 | Standard Bariatrics, Inc. | Systems and methods for measuring volume of potential sleeve in a sleeve gastrectomy |
US9980730B2 (en) | 2015-09-21 | 2018-05-29 | Covidien Lp | Loading unit locking collar with rotational actuated release |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10111684B2 (en) | 2015-09-25 | 2018-10-30 | Covidien Lp | Adapter assembly including a removable trocar assembly |
US10687884B2 (en) | 2015-09-30 | 2020-06-23 | Ethicon Llc | Circuits for supplying isolated direct current (DC) voltage to surgical instruments |
US20170086829A1 (en) | 2015-09-30 | 2017-03-30 | Ethicon Endo-Surgery, Llc | Compressible adjunct with intermediate supporting structures |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US11690623B2 (en) | 2015-09-30 | 2023-07-04 | Cilag Gmbh International | Method for applying an implantable layer to a fastener cartridge |
US10959771B2 (en) | 2015-10-16 | 2021-03-30 | Ethicon Llc | Suction and irrigation sealing grasper |
US10595930B2 (en) | 2015-10-16 | 2020-03-24 | Ethicon Llc | Electrode wiping surgical device |
US10542992B2 (en) | 2015-10-19 | 2020-01-28 | Covidien Lp | Loading unit with stretchable bushing |
CN108348256B (en) | 2015-10-20 | 2020-08-28 | 柯惠有限合伙公司 | Circular stapler with tissue gap indicator assembly |
CN108135616B (en) | 2015-10-21 | 2022-04-15 | 柯惠有限合伙公司 | Annular knife for surgical stapler |
US10512466B2 (en) | 2015-11-05 | 2019-12-24 | Covidien Lp | Adapter assembly for surgical device |
WO2017079970A1 (en) | 2015-11-13 | 2017-05-18 | Covidien Lp | Circular stapler with audible indicator mechanism |
CN108289684B (en) | 2015-12-07 | 2021-08-31 | 柯惠有限合伙公司 | Anvil assembly and delivery system |
US10390835B2 (en) | 2015-12-10 | 2019-08-27 | Covidien Lp | Surgical fastener apparatus with linear position sensor |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
US10179022B2 (en) | 2015-12-30 | 2019-01-15 | Ethicon Llc | Jaw position impedance limiter for electrosurgical instrument |
US10959806B2 (en) | 2015-12-30 | 2021-03-30 | Ethicon Llc | Energized medical device with reusable handle |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10575892B2 (en) | 2015-12-31 | 2020-03-03 | Ethicon Llc | Adapter for electrical surgical instruments |
FR3046543B1 (en) * | 2016-01-07 | 2018-02-02 | Robocath | ROBOTISABLE MODULE FOR DRIVING AN ELONGATED SOFT MEDICAL DEVICE, MEDICAL ROBOT AND SYSTEM COMPRISING SUCH A MODULE |
US10524797B2 (en) | 2016-01-13 | 2020-01-07 | Covidien Lp | Adapter assembly including a removable trocar assembly |
US10709469B2 (en) | 2016-01-15 | 2020-07-14 | Ethicon Llc | Modular battery powered handheld surgical instrument with energy conservation techniques |
US10716615B2 (en) | 2016-01-15 | 2020-07-21 | Ethicon Llc | Modular battery powered handheld surgical instrument with curved end effectors having asymmetric engagement between jaw and blade |
US11129670B2 (en) | 2016-01-15 | 2021-09-28 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on button displacement, intensity, or local tissue characterization |
US11229471B2 (en) | 2016-01-15 | 2022-01-25 | Cilag Gmbh International | Modular battery powered handheld surgical instrument with selective application of energy based on tissue characterization |
WO2017132932A1 (en) | 2016-02-04 | 2017-08-10 | Covidien Lp | Circular stapler with visual indicator mechanism |
JP6911054B2 (en) | 2016-02-09 | 2021-07-28 | エシコン エルエルシーEthicon LLC | Surgical instruments with asymmetric joint composition |
US10245030B2 (en) | 2016-02-09 | 2019-04-02 | Ethicon Llc | Surgical instruments with tensioning arrangements for cable driven articulation systems |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10398439B2 (en) | 2016-02-10 | 2019-09-03 | Covidien Lp | Adapter, extension, and connector assemblies for surgical devices |
US10603042B2 (en) | 2016-02-10 | 2020-03-31 | Covidien Lp | Flexible circular stapler |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10555769B2 (en) | 2016-02-22 | 2020-02-11 | Ethicon Llc | Flexible circuits for electrosurgical instrument |
JP6938533B2 (en) * | 2016-04-01 | 2021-09-22 | エシコン エルエルシーEthicon LLC | Surgical staple fastening system |
US10675021B2 (en) | 2016-04-01 | 2020-06-09 | Ethicon Llc | Circular stapling system comprising rotary firing system |
US10307159B2 (en) | 2016-04-01 | 2019-06-04 | Ethicon Llc | Surgical instrument handle assembly with reconfigurable grip portion |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US11284890B2 (en) | 2016-04-01 | 2022-03-29 | Cilag Gmbh International | Circular stapling system comprising an incisable tissue support |
US10376263B2 (en) | 2016-04-01 | 2019-08-13 | Ethicon Llc | Anvil modification members for surgical staplers |
ES2882141T3 (en) | 2016-04-12 | 2021-12-01 | Applied Med Resources | Refill Stem Assembly for Surgical Stapler |
KR20240038159A (en) * | 2016-04-12 | 2024-03-22 | 어플라이드 메디컬 리소시스 코포레이션 | Surgical stapler having a powered handle |
ES2878152T3 (en) | 2016-04-12 | 2021-11-18 | Applied Med Resources | Articulating Mechanism Surgical Stapler |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10363037B2 (en) | 2016-04-18 | 2019-07-30 | Ethicon Llc | Surgical instrument system comprising a magnetic lockout |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
US10856934B2 (en) | 2016-04-29 | 2020-12-08 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting and tissue engaging members |
US10987156B2 (en) | 2016-04-29 | 2021-04-27 | Ethicon Llc | Electrosurgical instrument with electrically conductive gap setting member and electrically insulative tissue engaging members |
US10702329B2 (en) | 2016-04-29 | 2020-07-07 | Ethicon Llc | Jaw structure with distal post for electrosurgical instruments |
US10646269B2 (en) | 2016-04-29 | 2020-05-12 | Ethicon Llc | Non-linear jaw gap for electrosurgical instruments |
US10485607B2 (en) | 2016-04-29 | 2019-11-26 | Ethicon Llc | Jaw structure with distal closure for electrosurgical instruments |
US10456193B2 (en) | 2016-05-03 | 2019-10-29 | Ethicon Llc | Medical device with a bilateral jaw configuration for nerve stimulation |
US10595871B2 (en) | 2016-05-10 | 2020-03-24 | Covidien Lp | Insertion instrument, adapter assemblies and protector assemblies for a flexible circular stapler |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
USD822206S1 (en) | 2016-06-24 | 2018-07-03 | Ethicon Llc | Surgical fastener |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
US11000278B2 (en) | 2016-06-24 | 2021-05-11 | Ethicon Llc | Staple cartridge comprising wire staples and stamped staples |
CN109310431B (en) | 2016-06-24 | 2022-03-04 | 伊西康有限责任公司 | Staple cartridge comprising wire staples and punch staples |
US11141162B2 (en) | 2016-07-08 | 2021-10-12 | Covidien Lp | Loading unit locking collar with linearly actuated release |
US10245064B2 (en) | 2016-07-12 | 2019-04-02 | Ethicon Llc | Ultrasonic surgical instrument with piezoelectric central lumen transducer |
US10893883B2 (en) | 2016-07-13 | 2021-01-19 | Ethicon Llc | Ultrasonic assembly for use with ultrasonic surgical instruments |
US10842522B2 (en) | 2016-07-15 | 2020-11-24 | Ethicon Llc | Ultrasonic surgical instruments having offset blades |
US10383631B2 (en) | 2016-08-04 | 2019-08-20 | Covidien Lp | Variable speed control of powered surgical device |
US10376305B2 (en) | 2016-08-05 | 2019-08-13 | Ethicon Llc | Methods and systems for advanced harmonic energy |
US10285723B2 (en) | 2016-08-09 | 2019-05-14 | Ethicon Llc | Ultrasonic surgical blade with improved heel portion |
US11452522B2 (en) | 2016-08-15 | 2022-09-27 | Covidien Lp | Circular stapling device with articulating anvil retainer assembly |
USD847990S1 (en) | 2016-08-16 | 2019-05-07 | Ethicon Llc | Surgical instrument |
US10952759B2 (en) | 2016-08-25 | 2021-03-23 | Ethicon Llc | Tissue loading of a surgical instrument |
US10828056B2 (en) | 2016-08-25 | 2020-11-10 | Ethicon Llc | Ultrasonic transducer to waveguide acoustic coupling, connections, and configurations |
US10751117B2 (en) | 2016-09-23 | 2020-08-25 | Ethicon Llc | Electrosurgical instrument with fluid diverter |
US10499922B2 (en) | 2016-11-04 | 2019-12-10 | Covidien Lp | Stapling device with self-releasing knife carrier pusher |
US10426470B2 (en) | 2016-11-04 | 2019-10-01 | Covidien Lp | Stapling device with releasable knife carrier |
US10603064B2 (en) | 2016-11-28 | 2020-03-31 | Ethicon Llc | Ultrasonic transducer |
US11266430B2 (en) | 2016-11-29 | 2022-03-08 | Cilag Gmbh International | End effector control and calibration |
US10405932B2 (en) | 2016-12-20 | 2019-09-10 | Ethicon Llc | Robotic endocutter drivetrain with bailout and manual opening |
US10398460B2 (en) | 2016-12-20 | 2019-09-03 | Ethicon Llc | Robotic endocutter drivetrain with bailout and manual opening |
US10893864B2 (en) | 2016-12-21 | 2021-01-19 | Ethicon | Staple cartridges and arrangements of staples and staple cavities therein |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
JP2020501779A (en) | 2016-12-21 | 2020-01-23 | エシコン エルエルシーEthicon LLC | Surgical stapling system |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US10448950B2 (en) | 2016-12-21 | 2019-10-22 | Ethicon Llc | Surgical staplers with independently actuatable closing and firing systems |
US10537324B2 (en) | 2016-12-21 | 2020-01-21 | Ethicon Llc | Stepped staple cartridge with asymmetrical staples |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
US10588630B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical tool assemblies with closure stroke reduction features |
US10588632B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical end effectors and firing members thereof |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
US10524789B2 (en) | 2016-12-21 | 2020-01-07 | Ethicon Llc | Laterally actuatable articulation lock arrangements for locking an end effector of a surgical instrument in an articulated configuration |
US10675026B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Methods of stapling tissue |
US10856868B2 (en) | 2016-12-21 | 2020-12-08 | Ethicon Llc | Firing member pin configurations |
US10682138B2 (en) | 2016-12-21 | 2020-06-16 | Ethicon Llc | Bilaterally asymmetric staple forming pocket pairs |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
JP6983893B2 (en) | 2016-12-21 | 2021-12-17 | エシコン エルエルシーEthicon LLC | Lockout configuration for surgical end effectors and replaceable tool assemblies |
US10426471B2 (en) * | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US10881401B2 (en) | 2016-12-21 | 2021-01-05 | Ethicon Llc | Staple firing member comprising a missing cartridge and/or spent cartridge lockout |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10835245B2 (en) | 2016-12-21 | 2020-11-17 | Ethicon Llc | Method for attaching a shaft assembly to a surgical instrument and, alternatively, to a surgical robot |
US11241232B2 (en) | 2017-01-24 | 2022-02-08 | Covidien Lp | Surgical stapling device with resettable anvil assembly |
US11678885B2 (en) | 2017-01-25 | 2023-06-20 | Covidien Lp | Circular stapling device and method of use |
US11020171B2 (en) | 2017-02-01 | 2021-06-01 | Ethicon Llc | Electrosurgical instrument with passive articulation and thermal insulation |
US11033325B2 (en) | 2017-02-16 | 2021-06-15 | Cilag Gmbh International | Electrosurgical instrument with telescoping suction port and debris cleaner |
US10542993B2 (en) | 2017-02-24 | 2020-01-28 | Covidien Lp | Anvil assembly of circular stapling device including alignment splines |
AU2017403146A1 (en) | 2017-03-09 | 2019-08-01 | Covidien Lp | Surgical stapling device with audible indicator mechanism |
CN110381852B (en) | 2017-03-09 | 2022-12-27 | 柯惠有限合伙公司 | End effector assembly for circular stapler apparatus |
US10799284B2 (en) | 2017-03-15 | 2020-10-13 | Ethicon Llc | Electrosurgical instrument with textured jaws |
US10342534B2 (en) | 2017-03-23 | 2019-07-09 | Covidien Lp | Surgical stapling device with releasable knife carrier |
ES2924630T3 (en) | 2017-03-23 | 2022-10-10 | Covidien Lp | Circular stapling device with alignment serrations |
US11497546B2 (en) | 2017-03-31 | 2022-11-15 | Cilag Gmbh International | Area ratios of patterned coatings on RF electrodes to reduce sticking |
US10881409B2 (en) | 2017-05-02 | 2021-01-05 | Covidien Lp | Rotation assembly for a surgical device |
AU2018202813A1 (en) * | 2017-05-03 | 2018-11-22 | Covidien Lp | Surgical stapling apparatus employing a predictive stapling algorithm |
US11596400B2 (en) | 2017-06-09 | 2023-03-07 | Covidien Lp | Handheld electromechanical surgical system |
US10932784B2 (en) | 2017-06-09 | 2021-03-02 | Covidien Lp | Handheld electromechanical surgical system |
US11045199B2 (en) | 2017-06-09 | 2021-06-29 | Covidien Lp | Handheld electromechanical surgical system |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
US10987103B2 (en) * | 2017-06-27 | 2021-04-27 | Ethicon Llc | Powered surgical instrument with latching feature preventing removal of battery pack |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US10631859B2 (en) | 2017-06-27 | 2020-04-28 | Ethicon Llc | Articulation systems for surgical instruments |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US10786253B2 (en) | 2017-06-28 | 2020-09-29 | Ethicon Llc | Surgical end effectors with improved jaw aperture arrangements |
US10603117B2 (en) | 2017-06-28 | 2020-03-31 | Ethicon Llc | Articulation state detection mechanisms |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
US11000279B2 (en) | 2017-06-28 | 2021-05-11 | Ethicon Llc | Surgical instrument comprising an articulation system ratio |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US10987107B2 (en) | 2017-07-05 | 2021-04-27 | Covidien Lp | Surgical stapling device |
US10820920B2 (en) | 2017-07-05 | 2020-11-03 | Ethicon Llc | Reusable ultrasonic medical devices and methods of their use |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11090054B2 (en) | 2017-08-07 | 2021-08-17 | Covidien Lp | Stapling device with resettable tilt anvil assembly |
US10828026B2 (en) | 2017-08-08 | 2020-11-10 | Covidien Lp | Tiltable anvil assembly |
WO2019036490A1 (en) | 2017-08-14 | 2019-02-21 | Standard Bariatrics, Inc. | End effectors, surgical stapling devices, and methods of using same |
US10695069B2 (en) | 2017-08-23 | 2020-06-30 | Covidien Lp | Circular stapling device with offset spline tip |
EP3675748A4 (en) | 2017-09-01 | 2021-01-20 | Covidien LP | Circular stapling device with position ribs |
US10966720B2 (en) | 2017-09-01 | 2021-04-06 | RevMedica, Inc. | Surgical stapler with removable power pack |
US11331099B2 (en) | 2017-09-01 | 2022-05-17 | Rev Medica, Inc. | Surgical stapler with removable power pack and interchangeable battery pack |
US10695060B2 (en) | 2017-09-01 | 2020-06-30 | RevMedica, Inc. | Loadable power pack for surgical instruments |
US10835256B2 (en) * | 2017-09-27 | 2020-11-17 | Ethicon Llc | Circular stapling instrument with firing trigger having integral resilient features |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
US11484358B2 (en) | 2017-09-29 | 2022-11-01 | Cilag Gmbh International | Flexible electrosurgical instrument |
US11490951B2 (en) | 2017-09-29 | 2022-11-08 | Cilag Gmbh International | Saline contact with electrodes |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
US11033323B2 (en) | 2017-09-29 | 2021-06-15 | Cilag Gmbh International | Systems and methods for managing fluid and suction in electrosurgical systems |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US11324507B2 (en) | 2017-11-03 | 2022-05-10 | Covidien Lp | Device and method for attachment of a stomal sleeve |
JP2021502172A (en) * | 2017-11-10 | 2021-01-28 | エシコン エルエルシーEthicon LLC | Laparoscopic stapler with flip-up staple housing assembly and flip-up anvil assembly |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
US10682134B2 (en) | 2017-12-21 | 2020-06-16 | Ethicon Llc | Continuous use self-propelled stapling instrument |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
KR20200126409A (en) | 2018-02-27 | 2020-11-06 | 어플라이드 메디컬 리소시스 코포레이션 | Surgical stapler with electric handle |
US11497501B2 (en) | 2018-03-26 | 2022-11-15 | Covidien Lp | Circular stapling device with A-frame splines |
KR102437288B1 (en) * | 2018-04-09 | 2022-08-29 | 콘메드 코포레이션 | Pencil-grip wire driver operated with distally located actuator |
US10905416B2 (en) | 2018-04-23 | 2021-02-02 | Covidien Lp | Over-molded connector for surgical instruments |
US10952734B2 (en) | 2018-04-23 | 2021-03-23 | Covidien Lp | Stapling device with cut ring biasing member |
US11197676B2 (en) | 2018-06-28 | 2021-12-14 | Covidien Lp | Tie-down method for anvil assembly delivery system |
US11241234B2 (en) | 2018-08-14 | 2022-02-08 | Covidien Lp | Anvil assembly with self-retaining backup member |
US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11324501B2 (en) | 2018-08-20 | 2022-05-10 | Cilag Gmbh International | Surgical stapling devices with improved closure members |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11564691B2 (en) | 2018-08-24 | 2023-01-31 | Covidien Lp | Powered circular stapling device |
US10973544B2 (en) | 2018-10-02 | 2021-04-13 | Covidien Lp | Retaining mechanism for trocar assembly |
US11141163B2 (en) | 2018-10-04 | 2021-10-12 | Covidien Lp | Circular stapling device with anvil rotation locking structure |
US11571214B2 (en) | 2018-10-16 | 2023-02-07 | Covidien Lp | Surgical stapling device with powered handle assembly |
US11065005B2 (en) | 2018-11-07 | 2021-07-20 | Covidien Lp | Reload assembly for a circular stapling device |
US11147561B2 (en) | 2018-11-28 | 2021-10-19 | Covidien Lp | Reload assembly for a circular stapling device |
US11389263B2 (en) | 2018-12-13 | 2022-07-19 | Covidien Lp | Lockout mechanisms for surgical instruments |
US11166728B2 (en) | 2019-02-08 | 2021-11-09 | Covidien Lp | Reload assembly for a circular stapling device |
US11547411B2 (en) | 2019-02-22 | 2023-01-10 | Covidien Lp | Anastomosis wound protector |
US11529144B2 (en) | 2019-02-22 | 2022-12-20 | Covidien Lp | Encapsulated plug assembly for electromechanical surgical devices |
EP3930588A1 (en) | 2019-02-27 | 2022-01-05 | Applied Medical Resources Corporation | Surgical stapling instrument having a two-position lockout mechanism |
US11331782B2 (en) | 2019-03-01 | 2022-05-17 | Covidien Lp | Reload assembly for a circular stapling device |
US11337701B2 (en) | 2019-03-01 | 2022-05-24 | Covidien Lp | Devices and methods for assembling adapter assemblies |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147551B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11457921B2 (en) | 2019-03-26 | 2022-10-04 | Covidien Lp | Anvil assembly for surgical stapling instrument |
JP2022527154A (en) | 2019-03-29 | 2022-05-31 | アプライド メディカル リソーシーズ コーポレイション | Reload cover for surgical staple fastening system |
US11534164B2 (en) | 2019-04-05 | 2022-12-27 | Covidien Lp | Strain gauge stabilization in a surgical device |
US11596410B2 (en) * | 2019-04-05 | 2023-03-07 | Covidien Lp | Surgical stapling device |
US11660116B2 (en) | 2019-04-16 | 2023-05-30 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11344330B2 (en) | 2019-04-16 | 2022-05-31 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11317945B2 (en) | 2019-04-16 | 2022-05-03 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11419631B2 (en) | 2019-04-16 | 2022-08-23 | Covidien Lp | Trocar assemblies for adapter assemblies for surgical stapling instruments |
US11839378B2 (en) | 2019-04-19 | 2023-12-12 | Covidien Lp | Circular stapling instruments |
US11399838B2 (en) | 2019-04-22 | 2022-08-02 | Covidien Lp | Reload assembly for circular stapling devices |
US11246599B2 (en) | 2019-04-25 | 2022-02-15 | Covidien Lp | End effector for circular stapling instrument |
US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11426251B2 (en) | 2019-04-30 | 2022-08-30 | Cilag Gmbh International | Articulation directional lights on a surgical instrument |
US11471157B2 (en) | 2019-04-30 | 2022-10-18 | Cilag Gmbh International | Articulation control mapping for a surgical instrument |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
US11903581B2 (en) * | 2019-04-30 | 2024-02-20 | Cilag Gmbh International | Methods for stapling tissue using a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
US11253254B2 (en) | 2019-04-30 | 2022-02-22 | Cilag Gmbh International | Shaft rotation actuator on a surgical instrument |
WO2020221357A1 (en) * | 2019-05-01 | 2020-11-05 | 江苏风和医疗器材股份有限公司 | Drive device and surgical instrument |
US20200398044A1 (en) | 2019-05-29 | 2020-12-24 | AtaCor Medical, Inc. | Implantable electrical leads and electrodes |
AU2019448247A1 (en) | 2019-05-31 | 2021-12-16 | Covidien Lp | Circular stapling device |
CN110293407B (en) * | 2019-06-12 | 2021-03-09 | 叶玉芳 | Automatic processing equipment for mass production threaded rod |
US11690624B2 (en) * | 2019-06-21 | 2023-07-04 | Covidien Lp | Reload assembly injection molded strain gauge |
US11446035B2 (en) | 2019-06-24 | 2022-09-20 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11123101B2 (en) | 2019-07-05 | 2021-09-21 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US20200405306A1 (en) * | 2019-06-28 | 2020-12-31 | Ethicon Llc | Surgical instrument including a firing system bailout |
US20200405307A1 (en) * | 2019-06-28 | 2020-12-31 | Ethicon Llc | Control circuit comprising a coating |
US11224497B2 (en) * | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11771419B2 (en) * | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11298132B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Inlernational | Staple cartridge including a honeycomb extension |
US11853835B2 (en) * | 2019-06-28 | 2023-12-26 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11426167B2 (en) * | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11229437B2 (en) | 2019-06-28 | 2022-01-25 | Cilag Gmbh International | Method for authenticating the compatibility of a staple cartridge with a surgical instrument |
US11478241B2 (en) | 2019-06-28 | 2022-10-25 | Cilag Gmbh International | Staple cartridge including projections |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US20200405302A1 (en) | 2019-06-28 | 2020-12-31 | Ethicon Llc | Surgical stapling system having an information decryption protocol |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11259803B2 (en) * | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11246678B2 (en) * | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
US11660163B2 (en) | 2019-06-28 | 2023-05-30 | Cilag Gmbh International | Surgical system with RFID tags for updating motor assembly parameters |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11638587B2 (en) * | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11361176B2 (en) | 2019-06-28 | 2022-06-14 | Cilag Gmbh International | Surgical RFID assemblies for compatibility detection |
US11357509B2 (en) | 2019-07-11 | 2022-06-14 | Covidien Lp | Reload assembly for a circular stapling device |
US11192227B2 (en) | 2019-07-16 | 2021-12-07 | Covidien Lp | Reload assembly for circular stapling devices |
WO2021016006A1 (en) | 2019-07-19 | 2021-01-28 | RevMedica, Inc. | Surgical stapler with removable power pack |
US11464510B2 (en) | 2019-07-26 | 2022-10-11 | Covidien Lp | Reload assembly with knife carrier lockout |
US11253255B2 (en) | 2019-07-26 | 2022-02-22 | Covidien Lp | Knife lockout wedge |
JP7417704B2 (en) | 2019-07-31 | 2024-01-18 | コヴィディエン リミテッド パートナーシップ | handheld electromechanical surgical instrument |
US11399825B2 (en) | 2019-10-28 | 2022-08-02 | Covidien Lp | Reload assembly with knife carrier lockout |
CN114641265A (en) | 2019-11-04 | 2022-06-17 | 标准肥胖病研究公司 | Systems and methods for performing surgery using Laplace's Laplacian tension retraction during surgery |
US11553918B2 (en) | 2019-12-16 | 2023-01-17 | Covidien Lp | Reload assembly with knife carrier lockout |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11779387B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Clamp arm jaw to minimize tissue sticking and improve tissue control |
US20210196359A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instruments with electrodes having energy focusing features |
US11911063B2 (en) | 2019-12-30 | 2024-02-27 | Cilag Gmbh International | Techniques for detecting ultrasonic blade to electrode contact and reducing power to ultrasonic blade |
US20210196363A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with electrodes operable in bipolar and monopolar modes |
US11696776B2 (en) | 2019-12-30 | 2023-07-11 | Cilag Gmbh International | Articulatable surgical instrument |
US11660089B2 (en) | 2019-12-30 | 2023-05-30 | Cilag Gmbh International | Surgical instrument comprising a sensing system |
US11779329B2 (en) | 2019-12-30 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a flex circuit including a sensor system |
US11812957B2 (en) | 2019-12-30 | 2023-11-14 | Cilag Gmbh International | Surgical instrument comprising a signal interference resolution system |
US20210196349A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Electrosurgical instrument with flexible wiring assemblies |
US11944366B2 (en) | 2019-12-30 | 2024-04-02 | Cilag Gmbh International | Asymmetric segmented ultrasonic support pad for cooperative engagement with a movable RF electrode |
US11786291B2 (en) | 2019-12-30 | 2023-10-17 | Cilag Gmbh International | Deflectable support of RF energy electrode with respect to opposing ultrasonic blade |
US11684412B2 (en) | 2019-12-30 | 2023-06-27 | Cilag Gmbh International | Surgical instrument with rotatable and articulatable surgical end effector |
US11950797B2 (en) | 2019-12-30 | 2024-04-09 | Cilag Gmbh International | Deflectable electrode with higher distal bias relative to proximal bias |
US11937863B2 (en) | 2019-12-30 | 2024-03-26 | Cilag Gmbh International | Deflectable electrode with variable compression bias along the length of the deflectable electrode |
US20210196344A1 (en) | 2019-12-30 | 2021-07-01 | Ethicon Llc | Surgical system communication pathways |
US11452525B2 (en) | 2019-12-30 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising an adjustment system |
US11730481B2 (en) | 2020-01-06 | 2023-08-22 | Covidien Lp | Assemblies for retaining a trocar assembly |
US11517317B2 (en) | 2020-01-06 | 2022-12-06 | Covidien Lp | Trocar release assemblies for a surgical stapler |
US11911038B2 (en) | 2020-01-13 | 2024-02-27 | Covidien Lp | Cut optimization for excessive tissue conditions |
US11523828B2 (en) | 2020-01-28 | 2022-12-13 | Covidien Lp | Sealed reload assembly for stapling device |
US11622767B2 (en) | 2020-02-19 | 2023-04-11 | Covidien Lp | Sealed trocar assembly for stapling device |
US11547438B2 (en) | 2020-02-24 | 2023-01-10 | Covidien Lp | Tip protector for ensuring trocar insertion |
US11382630B2 (en) | 2020-02-25 | 2022-07-12 | Covidien Lp | Surgical stapling device with two part knife assembly |
US11779343B2 (en) | 2020-02-26 | 2023-10-10 | Covidien Lp | Staple reload assembly with releasable knife |
US11298152B2 (en) | 2020-02-28 | 2022-04-12 | Covidien Lp | Trocar retaining mechanism including band support |
US11272998B2 (en) | 2020-03-04 | 2022-03-15 | Covidien Lp | Strain gage fixation in tension |
US11426170B2 (en) | 2020-03-24 | 2022-08-30 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11350939B2 (en) | 2020-03-24 | 2022-06-07 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11426169B2 (en) | 2020-03-24 | 2022-08-30 | Covidien Lp | Retaining mechanisms for trocar assemblies |
US11690694B2 (en) | 2020-05-19 | 2023-07-04 | Covidien Lp | Powered surgical instruments and methods of identifying tissue types therewith |
US11653925B2 (en) | 2020-05-21 | 2023-05-23 | Covidien Lp | Tissue relaxation monitoring for optimized tissue stapling |
US11547405B2 (en) | 2020-05-22 | 2023-01-10 | Covidien Lp | Surgical stapling device |
US11666771B2 (en) | 2020-05-29 | 2023-06-06 | AtaCor Medical, Inc. | Implantable electrical leads and associated delivery systems |
USD966512S1 (en) | 2020-06-02 | 2022-10-11 | Cilag Gmbh International | Staple cartridge |
USD976401S1 (en) | 2020-06-02 | 2023-01-24 | Cilag Gmbh International | Staple cartridge |
USD975278S1 (en) | 2020-06-02 | 2023-01-10 | Cilag Gmbh International | Staple cartridge |
USD975850S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
USD967421S1 (en) | 2020-06-02 | 2022-10-18 | Cilag Gmbh International | Staple cartridge |
USD975851S1 (en) | 2020-06-02 | 2023-01-17 | Cilag Gmbh International | Staple cartridge |
US11553921B2 (en) | 2020-07-15 | 2023-01-17 | Covidien Lp | Surgical stapling device with flexible shaft |
US11547412B2 (en) | 2020-07-22 | 2023-01-10 | Covidien Lp | Surgical instruments and methods of assembly |
US11864756B2 (en) | 2020-07-28 | 2024-01-09 | Cilag Gmbh International | Surgical instruments with flexible ball chain drive arrangements |
US11877744B2 (en) | 2020-08-14 | 2024-01-23 | Covidien Lp | Low-cost powered stapler with end stop selection |
US11627966B2 (en) | 2020-08-26 | 2023-04-18 | Covidien Lp | Surgical stapling device |
US11801054B2 (en) | 2020-09-22 | 2023-10-31 | Covidien Lp | Surgical stapler with oval tool assembly |
US11712509B2 (en) | 2020-10-02 | 2023-08-01 | Covidien Lp | Seal assembly for circular stapling instrument |
US11896217B2 (en) | 2020-10-29 | 2024-02-13 | Cilag Gmbh International | Surgical instrument comprising an articulation lock |
USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
US11534259B2 (en) | 2020-10-29 | 2022-12-27 | Cilag Gmbh International | Surgical instrument comprising an articulation indicator |
US11517390B2 (en) | 2020-10-29 | 2022-12-06 | Cilag Gmbh International | Surgical instrument comprising a limited travel switch |
USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
US11931025B2 (en) | 2020-10-29 | 2024-03-19 | Cilag Gmbh International | Surgical instrument comprising a releasable closure drive lock |
US11717289B2 (en) | 2020-10-29 | 2023-08-08 | Cilag Gmbh International | Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable |
US11617577B2 (en) | 2020-10-29 | 2023-04-04 | Cilag Gmbh International | Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable |
CA3195757A1 (en) | 2020-10-29 | 2022-05-05 | Jonathan VON STEIN | Actuation shaft retention mechanism for surgical stapler |
US11844518B2 (en) | 2020-10-29 | 2023-12-19 | Cilag Gmbh International | Method for operating a surgical instrument |
US11452526B2 (en) | 2020-10-29 | 2022-09-27 | Cilag Gmbh International | Surgical instrument comprising a staged voltage regulation start-up system |
US11779330B2 (en) | 2020-10-29 | 2023-10-10 | Cilag Gmbh International | Surgical instrument comprising a jaw alignment system |
EP4236821A1 (en) | 2020-10-29 | 2023-09-06 | Applied Medical Resources Corporation | Surgical stapler having a powered handle |
US11627967B2 (en) | 2020-11-23 | 2023-04-18 | Covidien Lp | Trans-anastomotic insertion device |
US11944296B2 (en) | 2020-12-02 | 2024-04-02 | Cilag Gmbh International | Powered surgical instruments with external connectors |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
US11653915B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Surgical instruments with sled location detection and adjustment features |
US11849943B2 (en) | 2020-12-02 | 2023-12-26 | Cilag Gmbh International | Surgical instrument with cartridge release mechanisms |
US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
US11653920B2 (en) | 2020-12-02 | 2023-05-23 | Cilag Gmbh International | Powered surgical instruments with communication interfaces through sterile barrier |
US11877750B2 (en) | 2021-01-21 | 2024-01-23 | Covidien Lp | Surgical stapler with powered and manual functions |
US11786241B2 (en) | 2021-02-16 | 2023-10-17 | Covidien Lp | Surgical stapling device including a hydraulic staple formation mechanism |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11793514B2 (en) | 2021-02-26 | 2023-10-24 | Cilag Gmbh International | Staple cartridge comprising sensor array which may be embedded in cartridge body |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
WO2022204078A1 (en) | 2021-03-23 | 2022-09-29 | Standard Bariatrics, Inc. | Systems and methods for preventing tissue migration in surgical staplers |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11931063B2 (en) | 2021-03-24 | 2024-03-19 | Medtronic Vascular, Inc. | Tissue-removing catheter with torque control |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11553920B2 (en) | 2021-05-03 | 2023-01-17 | Covidien Lp | Trocar retainer assembly for surgical stapler |
US11490894B1 (en) | 2021-05-12 | 2022-11-08 | Covidien Lp | Surgical device with grease filter |
US11642131B2 (en) | 2021-05-17 | 2023-05-09 | Covidien Lp | Devices and methods for shortening a rectal stump during a lower anterior resection procedure |
US11612400B2 (en) | 2021-05-24 | 2023-03-28 | Covidien Lp | Trocar assembly with bearing assembly for load sharing |
US20220378424A1 (en) | 2021-05-28 | 2022-12-01 | Cilag Gmbh International | Stapling instrument comprising a firing lockout |
US11819208B2 (en) | 2021-08-05 | 2023-11-21 | Covidien Lp | Handheld electromechanical surgical device with strain gauge drift detection |
US11737759B2 (en) | 2021-08-05 | 2023-08-29 | Covidien Lp | Surgical stapling device accommodating prolapsed tissue |
US11744592B2 (en) | 2021-08-05 | 2023-09-05 | Covidien Lp | Handheld electromechanical stapler with tissue thickness detection |
US11883028B2 (en) | 2021-09-08 | 2024-01-30 | Covidien Lp | Systems and methods for post-operative anastomotic leak detection |
US11717299B2 (en) | 2021-10-12 | 2023-08-08 | Covidien Lp | Surgical stapling device with probiotics |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
US11957342B2 (en) | 2021-11-01 | 2024-04-16 | Cilag Gmbh International | Devices, systems, and methods for detecting tissue and foreign objects during a surgical operation |
US20230293172A1 (en) * | 2022-03-15 | 2023-09-21 | Cilag Gmbh International | Surgical stapler cartridge with integrated rfid feature |
WO2023223254A1 (en) * | 2022-05-18 | 2023-11-23 | Covidien Lp | Surgical system including a cordless surgical instrument, communication hub, and one or more connected devices |
WO2023225866A1 (en) * | 2022-05-24 | 2023-11-30 | Covidien Lp | Powered stapling device with manual override mechanism |
Family Cites Families (116)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US2588006A (en) * | 1947-04-21 | 1952-03-04 | Fred M Hufnagel | Dental and surgical percussion tool |
US2770694A (en) * | 1952-07-12 | 1956-11-13 | Mercier Jean | Pressure switch |
US2770964A (en) * | 1953-10-19 | 1956-11-20 | American Hardware Corp | Adapter housing for door locks |
US4255698A (en) * | 1979-01-26 | 1981-03-10 | Raychem Corporation | Protection of batteries |
US4278091A (en) * | 1980-02-01 | 1981-07-14 | Howmedica, Inc. | Soft tissue retainer for use with bone implants, especially bone staples |
US4475679A (en) * | 1981-08-07 | 1984-10-09 | Fleury Jr George J | Multi-staple cartridge for surgical staplers |
DE3480971D1 (en) * | 1983-08-16 | 1990-02-08 | Omron Tateisi Electronics Co | ELECTRIC SWITCH. |
US4857818A (en) * | 1988-05-03 | 1989-08-15 | Hobbs Taz D | Electric motor brake |
US4979497A (en) * | 1989-06-06 | 1990-12-25 | Olympus Optical Co., Ltd. | Endoscope |
EP0438827A1 (en) | 1990-01-19 | 1991-07-31 | Koninklijke Philips Electronics N.V. | Apparatus comprising an electric motor having a variable motor power |
US5431645A (en) * | 1990-05-10 | 1995-07-11 | Symbiosis Corporation | Remotely activated endoscopic tools such as endoscopic biopsy forceps |
US5104025A (en) * | 1990-09-28 | 1992-04-14 | Ethicon, Inc. | Intraluminal anastomotic surgical stapler with detached anvil |
US5268622A (en) * | 1991-06-27 | 1993-12-07 | Stryker Corporation | DC powered surgical handpiece having a motor control circuit |
US5350104A (en) * | 1991-08-23 | 1994-09-27 | Ethicon, Inc. | Sealing means for endoscopic surgical anastomosis stapling instrument |
GR920100358A (en) * | 1991-08-23 | 1993-06-07 | Ethicon Inc | Surgical anastomosis stapling instrument. |
US5433721A (en) | 1992-01-17 | 1995-07-18 | Ethicon, Inc. | Endoscopic instrument having a torsionally stiff drive shaft for applying fasteners to tissue |
US5383880A (en) | 1992-01-17 | 1995-01-24 | Ethicon, Inc. | Endoscopic surgical system with sensing means |
US5626595A (en) * | 1992-02-14 | 1997-05-06 | Automated Medical Instruments, Inc. | Automated surgical instrument |
US5255698A (en) * | 1992-04-13 | 1993-10-26 | Orville Riley | Collapsible tent frame |
US5467911A (en) * | 1993-04-27 | 1995-11-21 | Olympus Optical Co., Ltd. | Surgical device for stapling and fastening body tissues |
JPH06304174A (en) * | 1993-04-27 | 1994-11-01 | Olympus Optical Co Ltd | Suturing and ligating device |
US5792165A (en) * | 1993-07-21 | 1998-08-11 | Charles H. Klieman | Endoscopic instrument with detachable end effector |
US5709680A (en) | 1993-07-22 | 1998-01-20 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic device |
US5810811A (en) * | 1993-07-22 | 1998-09-22 | Ethicon Endo-Surgery, Inc. | Electrosurgical hemostatic device |
US5503320A (en) * | 1993-08-19 | 1996-04-02 | United States Surgical Corporation | Surgical apparatus with indicator |
US5779623A (en) * | 1993-10-08 | 1998-07-14 | Leonard Medical, Inc. | Positioner for medical instruments |
US5472427A (en) * | 1993-10-22 | 1995-12-05 | Rammler; David H. | Trocar device |
US5743456A (en) * | 1993-12-16 | 1998-04-28 | Stryker Corporation | Hand actuable surgical handpiece |
JP2762033B2 (en) * | 1994-01-28 | 1998-06-04 | 株式会社キッツ | Manual operation device for valve actuator |
US5465895A (en) * | 1994-02-03 | 1995-11-14 | Ethicon Endo-Surgery, Inc. | Surgical stapler instrument |
CA2148667A1 (en) * | 1994-05-05 | 1995-11-06 | Carlo A. Mililli | Self-contained powered surgical apparatus |
US5779130A (en) | 1994-08-05 | 1998-07-14 | United States Surgical Corporation | Self-contained powered surgical apparatus |
EP0705571A1 (en) * | 1994-10-07 | 1996-04-10 | United States Surgical Corporation | Self-contained powered surgical apparatus |
US5868760A (en) * | 1994-12-07 | 1999-02-09 | Mcguckin, Jr.; James F. | Method and apparatus for endolumenally resectioning tissue |
US5575799A (en) | 1995-03-30 | 1996-11-19 | United States Surgical Corporation | Articulating surgical apparatus |
DE69632687T2 (en) * | 1995-08-07 | 2005-06-09 | Tyco Electronics Raychem K.K., Kawasaki | PTC DEVICE AND BATTERY SET USING THIS |
EP0762521B1 (en) * | 1995-09-06 | 1999-03-10 | Fuji Photo Film Co., Ltd. | Lithium ion secondary battery |
US5796188A (en) * | 1995-10-05 | 1998-08-18 | Xomed Surgical Products, Inc. | Battery-powered medical instrument with power booster |
US5747953A (en) * | 1996-03-29 | 1998-05-05 | Stryker Corporation | Cordless, battery operated surical tool |
US6338737B1 (en) * | 1997-07-17 | 2002-01-15 | Haviv Toledano | Flexible annular stapler for closed surgery of hollow organs |
JPH1154110A (en) * | 1997-07-31 | 1999-02-26 | N Ii C Mori Energ Kk | Battery protective device having positive characteristic temperature element |
US6434507B1 (en) * | 1997-09-05 | 2002-08-13 | Surgical Navigation Technologies, Inc. | Medical instrument and method for use with computer-assisted image guided surgery |
US6165173A (en) * | 1997-10-06 | 2000-12-26 | Somnus Medical Technologies, Inc. | Memory for regulating device utilization and behavior |
US8075570B2 (en) * | 2001-11-28 | 2011-12-13 | Aptus Endosystems, Inc. | Intraluminal prosthesis attachment systems and methods |
US6126058A (en) * | 1998-06-19 | 2000-10-03 | Scimed Life Systems, Inc. | Method and device for full thickness resectioning of an organ |
US6084366A (en) * | 1998-08-20 | 2000-07-04 | Nuell, Inc. | DC powered hand tools with automatic braking system |
US6076018A (en) * | 1998-09-04 | 2000-06-13 | Woodside Biomedical, Inc | Method and apparatus for low power regulated output in battery powered electrotherapy devices |
JP2002526911A (en) * | 1998-09-25 | 2002-08-20 | ブアンズ・インコーポレイテッド | A two-stage method for producing positive temperature coefficient polymeric materials |
US20010047183A1 (en) * | 2000-04-05 | 2001-11-29 | Salvatore Privitera | Surgical device for the collection of soft tissue |
US6887244B1 (en) * | 1998-12-16 | 2005-05-03 | Medtronic, Inc. | Cordless surgical handpiece with disposable battery; and method |
US6127811A (en) * | 1999-01-12 | 2000-10-03 | Vlsi Technology, Inc. | Micro-electromechanical system and voltage shifter, method of synchronizing an electronic system and a micromechanical system of a micro-electromechanical system |
JP2005243652A (en) | 1999-04-23 | 2005-09-08 | Sony Chem Corp | Overcurrent protective device |
US6264087B1 (en) * | 1999-07-12 | 2001-07-24 | Powermed, Inc. | Expanding parallel jaw device for use with an electromechanical driver device |
US6981941B2 (en) * | 1999-06-02 | 2006-01-03 | Power Medical Interventions | Electro-mechanical surgical device |
US6793652B1 (en) * | 1999-06-02 | 2004-09-21 | Power Medical Interventions, Inc. | Electro-mechanical surgical device |
US6517565B1 (en) * | 1999-06-02 | 2003-02-11 | Power Medical Interventions, Inc. | Carriage assembly for controlling a steering wire steering mechanism within a flexible shaft |
US20050154406A1 (en) * | 1999-07-28 | 2005-07-14 | Cardica, Inc. | Method for anastomosing vessels |
US6676600B1 (en) * | 1999-09-03 | 2004-01-13 | Tensys Medical, Inc. | Smart physiologic parameter sensor and method |
US6340878B1 (en) * | 1999-10-22 | 2002-01-22 | Motorola, Inc. | Silicon equivalent PTC circuit |
EP2305138B1 (en) * | 2000-02-22 | 2013-08-14 | Covidien LP | An electromechanical driver and remote surgical instrument attachment having computer assisted control capabilities |
US6533157B1 (en) * | 2000-02-22 | 2003-03-18 | Power Medical Interventions, Inc. | Tissue stapling attachment for use with an electromechanical driver device |
DE10029133A1 (en) * | 2000-06-14 | 2002-01-03 | Hilti Ag | Electric hand tool device with tool |
US6679899B2 (en) | 2000-10-20 | 2004-01-20 | Ethicon Endo-Surgery, Inc. | Method for detecting transverse vibrations in an ultrasonic hand piece |
US6908472B2 (en) | 2000-10-20 | 2005-06-21 | Ethicon Endo-Surgery, Inc. | Apparatus and method for altering generator functions in an ultrasonic surgical system |
US7273483B2 (en) * | 2000-10-20 | 2007-09-25 | Ethicon Endo-Surgery, Inc. | Apparatus and method for alerting generator functions in an ultrasonic surgical system |
US6645663B2 (en) * | 2001-03-28 | 2003-11-11 | Hewlett-Packard Development Company, L.P. | Life extending battery adapter for multi-chemistry battery systems |
JP2003024336A (en) * | 2001-07-16 | 2003-01-28 | Hitachi Ltd | Operation instrument |
US20030093103A1 (en) * | 2001-08-08 | 2003-05-15 | Don Malackowski | Surgical tool system with components that perform inductive data transfer |
DE10147145C2 (en) * | 2001-09-25 | 2003-12-18 | Kunz Reiner | Multi-function instrument for micro-invasive surgery |
US7464847B2 (en) * | 2005-06-03 | 2008-12-16 | Tyco Healthcare Group Lp | Surgical stapler with timer and feedback display |
US20030092364A1 (en) * | 2001-11-09 | 2003-05-15 | International Business Machines Corporation | Abrasive fluid jet cutting composition, method and apparatus |
US20050277956A1 (en) | 2004-06-14 | 2005-12-15 | Francese Jose L | Clip storage for endoscopic clip applier |
JP4078518B2 (en) | 2001-12-11 | 2008-04-23 | 株式会社コーナン・メディカル | Medical microscope |
US20050131390A1 (en) * | 2002-04-25 | 2005-06-16 | Russell Heinrich | Surgical instruments including mems devices |
US7967839B2 (en) * | 2002-05-20 | 2011-06-28 | Rocky Mountain Biosystems, Inc. | Electromagnetic treatment of tissues and cells |
JP3830433B2 (en) * | 2002-07-16 | 2006-10-04 | ジヤトコ株式会社 | Gear transmission for automatic transmission |
US7887559B2 (en) * | 2002-08-08 | 2011-02-15 | Stryker Corporation | Surgical cutting accessory with encapsulated RFID chip |
GB0220460D0 (en) | 2002-09-03 | 2002-10-09 | Acrobot Company The Ltd | Robot head |
EP2401969B1 (en) * | 2002-10-04 | 2013-04-03 | Covidien LP | Pneumatic powered surgical stapling device |
US7023159B2 (en) * | 2002-10-18 | 2006-04-04 | Black & Decker Inc. | Method and device for braking a motor |
US7075257B2 (en) * | 2002-10-18 | 2006-07-11 | Black & Decker Inc. | Method and device for braking a motor |
AU2003299831A1 (en) * | 2002-12-17 | 2004-07-14 | Medconx, Inc. | A mechanical limiter switch |
JP2004260980A (en) | 2003-02-28 | 2004-09-16 | Hitachi Printing Solutions Ltd | Method for detecting abnormality in constant voltage stepping motor drive circuit |
JP2004274928A (en) | 2003-03-11 | 2004-09-30 | Asmo Co Ltd | Controlling equipment of actuators |
AU2004226371B2 (en) * | 2003-03-26 | 2009-10-29 | Covidien Lp | Energy stored in spring with controlled release |
US7044352B2 (en) | 2003-05-20 | 2006-05-16 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a single lockout mechanism for prevention of firing |
US7140528B2 (en) * | 2003-05-20 | 2006-11-28 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having an electroactive polymer actuated single lockout mechanism for prevention of firing |
US7168604B2 (en) * | 2003-06-20 | 2007-01-30 | Tyco Healthcare Group Lp | Surgical stapling device |
JP2005094128A (en) | 2003-09-12 | 2005-04-07 | Matsushita Electric Ind Co Ltd | Authentication system |
GB0403020D0 (en) | 2004-02-11 | 2004-03-17 | Pa Consulting Services | Portable charging device |
US7143926B2 (en) * | 2005-02-07 | 2006-12-05 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument incorporating a multi-stroke firing mechanism with return spring rotary manual retraction system |
US7487899B2 (en) * | 2004-07-28 | 2009-02-10 | Ethicon Endo-Surgery, Inc. | Surgical instrument incorporating EAP complete firing system lockout mechanism |
US8317074B2 (en) * | 2004-07-28 | 2012-11-27 | Ethicon Endo-Surgery, Inc. | Electroactive polymer-based articulation mechanism for circular stapler |
US7143925B2 (en) * | 2004-07-28 | 2006-12-05 | Ethicon Endo-Surgery, Inc. | Surgical instrument incorporating EAP blocking lockout mechanism |
US7128254B2 (en) * | 2004-09-07 | 2006-10-31 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument incorporating a multistroke firing mechanism having a rotary slip-clutch transmission |
US20060095096A1 (en) * | 2004-09-09 | 2006-05-04 | Debenedictis Leonard C | Interchangeable tips for medical laser treatments and methods for using same |
EP1807922A4 (en) * | 2004-11-01 | 2009-09-23 | Superior Tool Corp | Powered hand held devices |
US7784663B2 (en) * | 2005-03-17 | 2010-08-31 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having load sensing control circuitry |
US20060282084A1 (en) * | 2005-06-03 | 2006-12-14 | Ken Blier | System and method for sealing tissue |
US7717312B2 (en) | 2005-06-03 | 2010-05-18 | Tyco Healthcare Group Lp | Surgical instruments employing sensors |
EP3738521B1 (en) * | 2005-06-03 | 2023-10-18 | Covidien LP | Surgical stapler with timer and feedback display |
US8627995B2 (en) * | 2006-05-19 | 2014-01-14 | Ethicon Endo-Sugery, Inc. | Electrically self-powered surgical instrument with cryptographic identification of interchangeable part |
US8579176B2 (en) * | 2005-07-26 | 2013-11-12 | Ethicon Endo-Surgery, Inc. | Surgical stapling and cutting device and method for using the device |
US7479608B2 (en) * | 2006-05-19 | 2009-01-20 | Ethicon Endo-Surgery, Inc. | Force switch |
US7959050B2 (en) * | 2005-07-26 | 2011-06-14 | Ethicon Endo-Surgery, Inc | Electrically self-powered surgical instrument with manual release |
US8096459B2 (en) * | 2005-10-11 | 2012-01-17 | Ethicon Endo-Surgery, Inc. | Surgical stapler with an end effector support |
US7246734B2 (en) * | 2005-12-05 | 2007-07-24 | Ethicon Endo-Surgery, Inc. | Rotary hydraulic pump actuated multi-stroke surgical instrument |
US7644848B2 (en) * | 2006-01-31 | 2010-01-12 | Ethicon Endo-Surgery, Inc. | Electronic lockouts and surgical instrument including same |
US7845537B2 (en) * | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8062236B2 (en) * | 2006-02-02 | 2011-11-22 | Tyco Healthcare Group, Lp | Method and system to determine an optimal tissue compression time to implant a surgical element |
US20070213692A1 (en) * | 2006-03-09 | 2007-09-13 | Timo Neubauer | Force action feedback in surgical instruments |
JP5085996B2 (en) * | 2006-10-25 | 2012-11-28 | テルモ株式会社 | Manipulator system |
US8459520B2 (en) * | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US7862627B2 (en) * | 2007-04-27 | 2011-01-04 | Front Edge Technology, Inc. | Thin film battery substrate cutting and fabrication process |
US8157145B2 (en) | 2007-05-31 | 2012-04-17 | Ethicon Endo-Surgery, Inc. | Pneumatically powered surgical cutting and fastening instrument with electrical feedback |
US8012170B2 (en) * | 2009-04-27 | 2011-09-06 | Tyco Healthcare Group Lp | Device and method for controlling compression of tissue |
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