WO2006064491A1 - Tissue stapler - Google Patents
Tissue stapler Download PDFInfo
- Publication number
- WO2006064491A1 WO2006064491A1 PCT/IL2005/001179 IL2005001179W WO2006064491A1 WO 2006064491 A1 WO2006064491 A1 WO 2006064491A1 IL 2005001179 W IL2005001179 W IL 2005001179W WO 2006064491 A1 WO2006064491 A1 WO 2006064491A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- stapler
- staples
- cartridge assembly
- tissue
- anvil
- Prior art date
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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
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07228—Arrangement of the staples
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2919—Handles transmission of forces to actuating rod or piston details of linkages or pivot points
- A61B2017/2922—Handles transmission of forces to actuating rod or piston details of linkages or pivot points toggle linkages
-
- 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
- A61B17/2909—Handles
- A61B2017/2912—Handles transmission of forces to actuating rod or piston
- A61B2017/2923—Toothed members, e.g. rack and pinion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/06—Measuring instruments not otherwise provided for
- A61B2090/061—Measuring instruments not otherwise provided for for measuring dimensions, e.g. length
Definitions
- the present invention relates to staplers and a method for use thereof, particularly tissue staplers.
- the term “stapler” means a device which accomplishes stapling of tissue, and which may optionally also be provided with cutting or resection capabilities, by means of a blade or a knife.
- Surgical stapling devices for performing gastrointestinal surgery are known. Generally, these devices are categorized by their method of use and application. One type of device is designed for use under open surgery conditions, while a second type of device is designed for use in laparoscopic or endoscopic surgery. Included in the latter is the surgical method known as hand-assisted laparoscopic surgery (HALS).
- HALS hand-assisted laparoscopic surgery
- HALS is a bridge method between open and laparoscopic surgical methods.
- a special hand port is installed through a small (4-6 cm.) incision in the body.
- the hand port enables the surgeon to insert one hand into the abdominal cavity to assist with the laparoscopic procedure thereby retaining finger sensitivity which is lost in full laparoscopic procedures.
- HALS also enables the surgeon to insert hand operated palm size instruments through the hand port.
- Prior art open and laparoscopic surgical devices are based on a plurality of mechanisms. Each device includes one or more specific improvements, such as means for reducing the risk of using the device when the staple cartridge is empty.
- These open and laparoscopic surgical devices include instruments which may be mechanically, gas or electrically driven.
- Prior art laparoscopic instruments are generally similar to open surgery devices. However, they typically have an extended or elongated body with a pair of jaws connected to the distal end of the elongated portion. These jaws are pivotally mounted at the device's distal end for movement toward and away from each other while gripping body tissue. Many variations of this basic design exist with each device providing specific added features, such as articulation of the distal operating mechanism. As with open surgery devices, these instruments may be driven by various types of motive power sources. As noted above, surgical instruments for the surgical stapling and excising of tissue are well known in the art.
- Laparoscopic and endoscopic devices are disclosed in a number of patents. These include inter alia US Pat No 5,071,430 to de Salis, et al.; US Pat No 5,040,715 to Green, et al.; US Pat Nos 5,318,221, 5,413,268, 5,425,745 and 5,476,206, to Green, et al.; US Pat No 5,326,013 to Green, et al.; US Pat No 5,364,001 to Bryan; US Pat No 5,456,401 to Green, et al.; US Pat Nos 5,397,046 and 5,472,132 to Savage, et al.; US Pat No 5,482,197 to Green, et al.; US Pat No 6,250,532 to Green, et al.; US Pat No 5,487,499 to Sorrentino, et al.; US Pat Nos 5,476,206 and 5,431,322 to Green, et al.; US Pat Nos 5,507,426 and 5,657,921
- the device is suitable for open and laparoscopic surgery, including hand-assisted laparoscopic surgery (HALS). It is another object of the present invention to provide a stapler for surgical procedures which can be positioned and operated entirely within the body cavity.
- the stapler can be repositioned around the tissue to be stapled during the surgery by a series of single-hand operations.
- Another object of the present invention is to provide a method for stapling, and optionally cutting, tissue during surgical procedures wherein all the operations are effected using one hand of the user.
- the method also allows for the repositioning of the stapler around the tissue being stapled and resected during the stapling and optional cutting operations without removing the stapler from the body cavity.
- a further object of the present invention is to provide a stapler for surgical procedures wherein the staples remain substantially planar during and after stapling.
- the surgical device in accordance with embodiments of the present invention is a surgical stapler adapted for inserting two or more longitudinal rows of staples.
- the stapler may optionally include a blade element for making an incision in body tissue between rows of staples.
- the stapler may find particular use in removing all or a portion of an organ, such as the bowel, appendix, gallbladder, uterus, etc.
- a palm-size stapler for hand- assisted laparoscopic and open surgery.
- the device includes a chassis member and an anvil member.
- the chassis member supports at least the following elements: i) a cartridge assembly for containing two or more rows of staples and ii) a slider assembly operative to slidably move along a predetermined path with respect to the cartridge assembly, thereby providing a predetermined staple ejection force causing the ejection of staples from the cartridge assembly.
- the slider assembly includes one or more staple ejector elements aligned with the two or more rows of staples for causing ejection of the staples.
- the anvil member is operable in closed and open positions with respect to the cartridge assembly.
- the stapler When in a closed position, the anvil member is spaced from the cartridge assembly so that a portion of tissue is held between it and the cartridge assembly.
- the anvil member also allows closure of staples ejected from the cartridge assembly in response to the predetermined staple ejection force provided by the slider assembly.
- the stapler also includes a lever member mounted to the chassis member which is pivotably movable with respect to the cartridge assembly.
- the stapler further includes one or more selector elements disposed on the stapler, the one or more selector elements being operated while in the grip of a single hand of an operator. These elements act to select an operational mode of the stapler in response to the operator selected positioning of the one or more selector elements.
- the stapler also includes a locking linking mechanism operable in locked and unlocked positions.
- the linking mechanism is in operative association with the anvil member and also with the one or more selector elements.
- the mechanism is brought to its locked position when the lever member is brought down and presses on it.
- the linking mechanism is in its locked position the anvil member is brought to its closed position and held adjacent to the cartridge assembly. This allows closure of staples in the portion of tissue held between the cartridge assembly and the anvil member as the slider assembly advances step-wise incrementally, ejecting staples into the tissue with each step.
- the stapler further includes an incremental drive mechanism operative to selectively engage with and to provide a predetermined driving force to the slider assembly causing an incremental step-wise sliding motion of the slider assembly.
- the locking linking mechanism is in its unlocked position when the drive mechanism is operative.
- the incremental drive mechanism allows for interruption of the operation of the stapler during surgery and repositioning of the tissue being stapled. Interruption and repositioning is effected when the one or more selector elements are brought to an operational mode where the lever member is operative to release the anvil member from its closed position.
- a second palm-size stapler for hand-assisted laparoscopic and open surgery.
- the stapler includes a chassis member and an anvil member.
- the chassis member supports at least the following elements: i) a cartridge assembly for containing two or more rows of staples and ii) a slider assembly operative to slidably move along a predetermined path with respect to the cartridge assembly, thereby providing a predetermined staple ejection force causing the ejection of staples from the cartridge assembly.
- the slider assembly includes one or more staple ejector elements aligned with the two or more rows of staples for causing ejection thereof.
- the anvil member is operable in closed and open positions with respect to the cartridge assembly.
- the anvil member When in a closed position, the anvil member is spaced from the cartridge assembly so that a portion of tissue is held between the anvil and the cartridge assembly.
- the anvil member also allows closure of staples ejected from the cartridge assembly in response to the predetermined staple ejection force provided by the slider assembly.
- Included is one or more selector elements disposed on the stapler.
- the one or more selector elements are operated while in the grip of a single hand of an operator.
- the one or more selector elements select an operational mode of the stapler in response to operator selected positioning of the selector elements.
- the stapler also includes a lever member mounted to the chassis member, the lever member being pivotably movable with respect to the cartridge assembly.
- the stapler also includes an incremental drive mechanism in operational association with the slider assembly.
- the drive mechanism operates to selectably engage with and to provide a predetermined driving force to the slider assembly causing an incremental step-wise sliding motion of the slider assembly.
- the incremental drive mechanism also allows for interruption of the operation of the device during surgery and repositioning of the portion of tissue being stapled. Interruption occurs when the one or more selector elements are brought to an operational mode where the lever member operates to release the anvil member from its closed position.
- the stapler further includes a locking linking mechanism which operates in locked and unlocked positions.
- the linking mechanism is in operative association with the anvil member and also with the one or more selector elements.
- the locking linking mechanism is brought to its locked position when the lever member is brought down pressing on it. When in its locked position the locking linking member holds the anvil member in its closed position proximate to the cartridge assembly.
- the one or more selector elements are operable to select at least one of a plurality of operative modes.
- the one or more selector elements is operable to select any of a first, second and third operative mode, wherein a) in the first operative mode, the lever member is operative to move the anvil member into a position proximal to the cartridge assembly, thereby facilitating closure of staples ejected there against, b) in the second operative mode, the.
- the lever member is operative to transform a squeezing force, applied repetitively thereto, into the predetermined driving force of the incremental drive mechanism so as to slidably move the slider assembly with an incremental stepped action in the predetermined path relative to the chassis member, thereby to provide the predetermined staple ejection force; and c) in the third operative mode, the lever member is operative to release the anvil member from its closed position, where the anvil member is proximate to the cartridge assembly, to its open position where the anvil member is distant from the cartridge assembly.
- the staplers further include a release mechanism comprising a guiding pin attached to the incremental drive mechanism. The pin rides in a groove having two or more legs positioned in the chassis member.
- the guiding pin rides in one leg of the two or more legs when the anvil member is in its closed position and held proximate to the cartridge assembly and rides in another leg of the two or more legs when the anvil member is in its open position and held distant from the cartridge assembly.
- the pin moves from one leg to another as the incremental drive mechanism is selectively engaged with the slider assembly.
- the incremental drive mechanism is selected from a group of mechanisms consisting of a pusher-ratchet mechanism, a pulley mechanism and a gear mechanism.
- the mechanism includes a pusher and a ratchet mechanism where the pusher is positioned obliquely to the ratchet mechanism and the ratchet mechanism is part of the slider assembly.
- the pusher is operatively associated with a slidable tooth rack so as to incrementally move the slider assembly of the device along a predetermined path in a stepped fashion.
- the anvil member has proximal and distal surfaces with respect to the cartridge assembly and a plurality of recesses positioned on the proximal surface.
- the recesses are in registration with staples in a cartridge in the cartridge assembly and configured to hold the staples in a planar configuration during and subsequent to crimping of the staples.
- the recesses are funnel- shaped with each recess having a rounded end and a wide end.
- the funnel-shaped recesses may have one or more of the following characteristics when using staples of a given cross section formed from a wire with a given largest cross sectional dimension: a) the wide end of the recess ranges in size from about three to about six times the largest cross sectional dimension of the wire from which the staples are formed; and b) the rounded end of each of the recesses has a radius of curvature of from about half the largest cross sectional dimension to about the largest cross sectional dimension of the wire from which the staples are formed.
- the recesses may have a bottom surface and an angle formed between the bottom surface and the proximal surface of the anvil ranges from about 0 to about 5 degrees.
- the locking linking mechanism includes a plurality of links. In some of these embodiments the locking linking mechanism locks when the plurality of links are in a substantially linear configuration. In other embodiments, the locking linking mechanism locks when the plurality of links are in an over center position. In yet other embodiments, the locking linking mechanism locks when the plurality of links are in an under center position. In some embodiments, the locking linking mechanism locks when held in place by a latch.
- a tab is positioned on a link of the locking linking mechanism, the tab preventing the pusher from engaging with the slider assembly.
- the one or more selector elements are disposed on the lever member.
- the stapling device may include a blade element to selectively cut the held portion of tissue.
- the blade element may be attached to the slider assembly.
- the blade element may advance stepwise incrementally cutting through the held portion of stapled tissue as the slider assembly advances step-wise incrementally.
- a method for performing tissue stapling during hand-assisted laparoscopic or open surgery.
- the method includes the following steps: a) inserting a stapler through an incision in a body cavity b) positioning the stapler so that an anvil member and a cartridge assembly of the stapler are arranged about a preselected tissue section to be excised; c) closing and locking the stapler so as to hold a preselected tissue section between the anvil member and the cartridge assembly of the stapler; and d) repeatedly operating a lever member of the stapler so as to incrementally and in a stepped fashion move a slider assembly of the stapler along a predetermined path, thereby to staple the preselected tissue section at a predetermined position, wherein all of the above steps are performed by the operator while holding the device in one hand.
- the method further includes repeating the steps of positioning and closing at any point during the surgery so as to reposition the stapler about the tissue being stapled and then continuing with the step of repeatedly operating.
- the method further includes the steps of positioning, closing and repeatedly operating where the slider assembly moves along a second preselected path on the tissue so that a second stapling line can be formed along a second predetermined position.
- the step of repeatedly operating further includes the step of cutting the stapled preselected tissue, when the stapler additionally includes a blade element.
- the method further includes the steps of positioning, closing and repeatedly operating where the slider assembly moves along a second preselected path on the tissue so that a second cut can be effected along a second predetermined position, thereby totally severing the tissue, allowing for its withdrawal from the body cavity.
- the method further includes the step of anastomosing the two ends of tissue from which the severed tissue was detached.
- anastomosis may be performed using the same stapler as that used in the steps of positioning, closing and repeatedly operating. In other instances, anastomosis may be performed using a device other than the stapler used in the steps positioning, closing and repeatedly operating.
- the tissue being stapled and/or resected is bowel tissue and the body cavity is the abdominal cavity.
- the step of inserting is effected while the anvil member of the device is held proximal to the cartridge assembly.
- an anvil for use in a stapling device.
- the anvil has proximal and distal surfaces with respect to a staple cartridge containing a plurality of staples, and the proximal surface has a plurality of funnel-shaped recesses.
- Each recess has a wide end and a rounded end.
- the recesses are in registration with the staples in the cartridge and sized and configured for receiving staples during the crimping process so that the staple will retain a substantially planar shape after crimping.
- the anvil is for use in stapling body tissue.
- the recesses have at least one of the following characteristics when using staples of a given cross section formed from wire of a given largest cross sectional dimension: a) the wide end of the recess ranges in size from about three to about six times the largest cross sectional dimension of the wire from which the staples are formed; and b) the rounded end of each of the recesses has a radius of curvature of from about half the largest cross sectional dimension to about the largest cross sectional dimension of the wire from which the staples are formed.
- the largest cross sectional dimension is the diameter of the wire.
- each of the recesses has a bottom surface and an angle formed between the bottom surface and the proximal surface of the anvil ranges from about 0 to about 5 degrees.
- Figure l is a side view of a stapler
- Figure 2 is a partial cross-sectional view of the operating mechanism of the stapler shown in Figure 1;
- Figure 3A is a partial perspective cross-sectional view of the cartridge assembly of the stapler shown in Figure 1 ;
- Figure 3B is a first exploded view of the cartridge assembly shown in Figure 3 A;
- Figure 3C is a second exploded view of the cartridge assembly shown in Figure 3A, but wherein the blade holder and blade element are seen in broken lines, indicating that the stapler may optionally be bladeless;
- Figure 4 is a perspective underside view of the cartridge assembly shown in Figure 3 A;
- Figure 5 is a side view of the cartridge assembly shown in Figure 3 A and a detailed view of the cartridge ratchet mechanism;
- Figure 6A is a detailed view of the anvil grooves used with the anvil of the stapler shown in Figures 1-2;
- Figures 6B-6D are views showing additional details of the staples, anvil recesses and recess configurations and their relative dimensions with Figures 6C and 6D showing top and side views of the recesses respectively;
- Figure 7 is a perspective bottom view of the stapler shown in Figure 1;
- Figures 8, 9 and 10 are top plan views of the stapler illustrating three operational mode positions of a selector element;
- Figure 11 is a cross-sectional view of the stapler with an anvil member in an open position
- Figure 12 is a partial cross-sectional view of the stapler in a closed position
- Figure 13 is a partial cross-sectional view of the stapler in a position where the anvil is closed and the lever is open;
- Figures 14, 15, 16 and 17 are partial cross-sectional views of the stapler in a stapling and cutting mode
- Figures 18 and 19 are partial cross-sectional views of the stapler with the selector mechanism in an open position prior to the release and opening of the anvil;
- Figure 20 is a partial cross-sectional view of the stapler with the anvil in a released open position after the stapling and cutting process
- Figure 21 is an enlarged view of V-shaped groove and guiding pin used in the stapler shown in Figs 1-20;
- Figure 22 is a partial perspective view of a portion of bowel indicating stapling and excision
- Figures 23A-23C are views of the under center, substantially linear, and over center positions respectively of the locking linking mechanism of the stapler of the present invention.
- Figure 24A is an isometric view of a latch mechanism for locking the stapler of the present invention.
- Figures 24B-24E are views of the different stages of operation of the latch mechanism shown in Figure 24A;
- Figures 25A-25B are two views of an incremental drive mechanism based on gears for the stapler of the present invention.
- Figures 26A-26B are two views of an incremental drive mechanism based on a pulley for the stapler of the present invention.
- palm-size is intended to indicate the general size of the device. Its size is about the size of the hand of a typical adult male or female and it is this size that allows for its one hand use.
- the present invention relates to a stapler for performing open and hand-assisted laparoscopic surgery (HALS).
- HALS is generally carried out employing a hand port, which provides entry into the patient's abdominal cavity and facilitates continuous inflation of the cavity.
- the surgeon grasps the generally palm-size stapler of the present invention with one hand and works directly within the cavity.
- the stapler of the present invention is useful in resecting various types of tissue, particularly bowel tissue.
- tissue particularly bowel tissue.
- the discussion herein below will describe the use of the stapler in resecting bowel tissue. It should readily be understood by one skilled in the art that such use is exemplary only and should not be deemed limiting as to other types of tissue.
- the stapler of the present invention allows for stapling and cutting tissue, while permitting interruption of the resection at any point during the surgery and repositioning the stapler with respect to the tissue to be excised.
- the surgeon can stop the stapling and cutting operation, open the stapler, rotate the device, re- clamp the tissue and continue stapling and cutting in the same or in a different direction.
- Stapling is effected by an incremental drive mechanism, including but not limited to, a step-like ratchet mechanism.
- the stapler includes a locking linking mechanism which locks an anvil member in a position proximate to a cartridge assembly.
- the mechanism uses the relatively small forces produced by a single hand and magnifies them sufficiently to ensure proper clamping of the tissue between the anvil and a cartridge assembly.
- An anvil member formed to include funnel-shaped recesses which guide the staple into a crimped B-shape while ensuring that the staple remains essentially in one plane during and after crimping.
- FIG. 1 and 2 a side view of a stapler 10 and a partial cross-sectional view of the operating mechanism of stapler 10, constructed according to an embodiment of the present invention, are shown.
- Figures 3A-3C and 4 a perspective view, two exploded perspective views and a side view of cartridge assembly 18, respectively, are shown.
- proximal relates to the side of the stapler or element of the stapler closest to the user
- distal refers to the side of the stapler or element of the stapler furthest from the user.
- element 18 in Figure 1 is positioned near the distal end of stapler 10 while element 19 is located near its proximal end.
- Stapler 10 includes a chassis member 12, to which are attached anvil member 14 and lever member 16. Both anvil 14 and lever 16 members are pivoting members as indicated by arrows 52B and 52 A respectively. Operatively associated with lever member 16 and disposed near its distal end 17, is a selector element 24.
- Figure 1 includes a chassis cover member 28, which obscures additional elements readily seen in Figure 2.
- chassis member 12 includes in addition to an elongated end which is readily seen in Figure 2, a second larger, non-elongated, shaped proximal end that is obscured by chassis cover 28 of Figure 1 and not shown in Figure 2. The entire chassis member 12 can best be seen in Figure 3B which will be discussed below.
- lever member 16 is mounted on main spring 114 and can pivot relative to chassis member 12, as indicated by arrow 52 A.
- Main spring 114 keeps lever member 16 open by providing a biasing tension thereto.
- selector mechanism 54 Disposed near the proximal end 19 of lever member 16 is a selector mechanism 54, which is operatively connected to selector element 24. During a surgical procedure, the user grasps stapler 10 in one hand and operates selector element 24 with a finger of that hand.
- Stapler 10 is operational in three modes, these modes being discussed in greater detail below.
- Selector element 24 determines in which of the three operational modes stapler 10 is to be operated. By moving selector element 24 to one of three different positions, the operational mode in which stapler 10 is to be operated is determined and may be varied.
- Locking linking mechanism 56 is comprised of locking front 88 and back 90 links joined at locking linking mechanism pin 92. Locking front link 88 is attached to anvil member 14 and when front 88 and back 90 links are extended so as to form a substantially linear configuration (as shown in Figures 12-17 which will be described below), anvil member 14 pivots as indicated by arrow 52B toward chassis member 12.
- chassis member 12 inter alia supports slider assembly 20 and cartridge assembly 18 which ride therein.
- Locking back link 90 is attached to locking linking mechanism spring 116.
- Locking linking mechanism spring 116 assists in controlling locking linking mechanism 56 so that anvil member 14 may be in its open or closed position as described herein.
- lever member 16 indicates that member 16 has rotated toward chassis member 12 as shown by arrow 52 A and is proximate to chassis member 12; “open” indicates that lever member 16 is in a position distant from chassis member 12 as shown in Figures 1 and 2.
- anvil member 14 indicates that it has rotated in a direction toward chassis member 12 as shown by arrow 52B and is held proximate to chassis member 12, while “open” indicates that anvil member 14 is in a position distant from chassis member 12 as shown in Figures 1 and 2.
- Selector element 24 is in mode transferring association with selector mechanism 54 through mode transfer element 120.
- Proximal end 122 of mode transfer element 120 has grooves which engage teeth on selector mechanism 54.
- selector mechanism 54 which is spring loaded by selector spring 118, turns in a counter-clockwise direction (as viewed when facing the plane of Figure 2).
- selector spring 118 is attached to pusher 62; spring 118 pushes pusher 62 down to engage with teeth 68 on tooth rack 66 of slider assembly 20, the latter element best seen in Figures 3A-3C. This engagement is necessary for pushing slider assembly 20 and moving it towards the distal end 22 of cartridge assembly 18 during the stapling and cutting operations.
- Each squeeze of lever member 16 advances pusher 62 a predetermined distance while engaging tooth 68 on tooth rack 66 causing slider assembly 20 to advance incrementally one "step” within cartridge chassis member 42.
- pusher 62 retracts and moves to the next successive tooth.
- selector mechanism 54 When selector element 24 is moved in the distal direction to its release position, selector mechanism 54 turns in a clockwise direction (as viewed when facing the plane of Figure 2). Pusher 62 moves upward due to the force exerted by selector spring 118 and it disengages from tooth rack 66 of slider assembly 20 ( Figure 3) as described in more detail in conjunction with Figures 18-20 below.
- FIGS 1 and 2 show stapler 10 in its neutral position.
- proximal end 126 of pusher 62 is restrained by restraining surface 124 of proximal end 122 of mode transfer element 120.
- front 88 and back 90 links of locking linking mechanism 56 are in a "bent" non-extended configuration forming a "knee” 142 as shown.
- lever element 16 is squeezed, locking leg 86 descends and presses on knee 142.
- front 88 and back 90 links extend and form a substantially linear configuration as shown in, for example, Figures 12-17 to be discussed below.
- This substantially linear configuration locks anvil member 14 in its "closed” position proximate to cartridge assembly 18.
- locking linking mechanism pin 92 moves down and is restrained against the edge of chassis member 12.
- pusher 62 is positioned obliquely with respect to slider assembly 20. As is readily evident, the obliqueness changes during the various stages in the stapler's 10 operation. The angle also depends on the point pusher 62 has reached in cartridge assembly 18.
- a cartridge step 106 and a locking step 108 are included on cartridge assembly 18 and anvil member 14 respectively.
- the engagement of these steps shown for example in Figures 12-17 below, prevents relative motion between anvil member 14 and cartridge assembly 18.
- stapler 10 includes safety tab 130 which is part of back link 90. Its purpose is to prevent pusher 62 from engaging one of teeth 68 of tooth rack 66 when anvil member 14 is not yet in its closed position, i.e. not proximate to cartridge assembly 18, and when selector element 24 is in its stapling and cutting mode position.
- Stapler 10 is constructed so as to allow stapling and cutting of, for example, a large diameter bowel section. Even if the bowel is larger than the distance between tissue stop 100 and the distal end 22 of cartridge assembly 18, stapling and excision of the bowel may be effected. This may be achieved by stapling and cutting a first portion of the bowel. After completing the stapling and cutting of the first bowel portion, the procedure is interrupted and, if required, a fresh cartridge inserted into stapler 10. The stapling and cutting procedure is then resumed where it was interrupted until the entire bowel is severed. If necessary before resuming the stapling and cutting operation, the user may reposition the stapler with respect to the bowel section being resected. The user may then continue stapling and cutting along the same or in a different direction.
- Cartridge assembly 18 has a proximal 40 and a distal end 22 and includes a cartridge 21 and a slider assembly 20.
- Slider assembly 20 includes a slider assembly cover 23.
- Cartridge assembly 18 contains a plurality of rows 34, typically, but without being limiting, four or six rows, of staples 50 in cartridge 21. These staples 50 are ejected in response to an ejection force conveyed by two rows of staple lifters 36 which are aligned with the rows 34 of staples 50.
- Cartridge 21 and slider assembly 20 typically are both constructed of plastic and are positioned on cartridge chassis member 42, typically constructed of metal. They may however be made of other materials as well.
- Slider assembly 20 includes a series of teeth 68, the first of which is distal tooth 98, on tooth rack 66. Slider assembly 20 is initially disposed on the proximal side of cartridge assembly 18 as seen in Figure 3 A. Slider assembly 20 is further comprised of a blade holder 44, a blade element 46 positioned on blade holder 44, and stapler ejector wedges 48, the latter disposed on each side of blade element 46 and aligned with a row of staples 34 contained in cartridge 21.
- FIG 3B shows chassis member 12 in its entirety.
- Cartridge assembly 18 and slider 20 sit in and are supported by chassis member 12. Additionally, the entire locking linking mechanism 56 and the pusher 62 shown in Figure 2 are positioned within the larger, non- elongated, shaped proximal end of chassis member 12. Groove 134 necessary for the release mechanism discussed in conjunction with Figure 21 below is also shown.
- FIG 3C is a second exploded view of the cartridge assembly shown in Figure 3A.
- the blade holder and blade element are seen in broken lines, indicating that the stapler may optionally be bladeless.
- FIG. 4 a perspective underside view of cartridge assembly 18 of Figure 3 A is shown.
- a series of position indicator windows 58 on the underside 60 of cartridge chassis member 42 is shown.
- the position of slider assembly 20, which includes blade element 46 and stapler ejector wedges 48, in relation to cartridge 21 of cartridge assembly 18, is observable through these windows during the stapling and cutting operation.
- Cartridge locking groove 102 is also shown in Figure 4. Groove 102 prevents undesired movement of cartridge chassis member 42 when a force is applied in the distal direction by a user on cartridge assembly 18. Groove 102 is locked by cartridge locking snap 104 as described below in conjunction with Figure 7.
- ratchet tooth 38 which engages with ratchet grooves 39 ( Figure 5) on the bottom of slider assembly 20 during the pushing effected by pusher 62.
- Ratchet tooth 38 prevents slider assembly 20 from moving in a proximal direction.
- blade holder 44 and blade 46 are clearly shown as are individual teeth 68.
- ratchet tooth 38 and ratchet groove 39 As has been discussed in conjunction with Figure 2 above and will be discussed in more detail below, pusher 62, shown in Figure 2 and elsewhere, engages teeth 68 of tooth rack 66 thereby pushing slider assembly 20 in the distal direction of cartridge assembly 18. As lever member 16 is squeezed while stapler 10 is in its stapling and cutting mode, pusher 62 pushes slider assembly 20 forward toward the distal end 22 of cartridge assembly 18. Slider assembly 20 advances incrementally step-wise as pusher 62 advances one tooth per squeeze of lever member 16.
- blade 46, blade holder 44 and stapler ejection wedges 48 advance in a stepped fashion.
- an additional set of staples 50 typically but without being limiting, four or six staples, are ejected by stapler ejector wedges 48. Staples 50 pass through tissue clamped between anvil member 14 and cartridge assembly 18 ( Figure 2) and then advancing blade element 46 cuts further into the clamped tissue. This stapling and cutting process is described in more detail below. #
- an exhausted cartridge assembly 18 of stapler 10 is detached and replaced with a fully loaded staple cartridge 21.
- the cartridge 21 is replaced with a new supply of staples and the blade 46 is also replaced.
- cartridge assembly 18, including blade element 46 are not replaceable.
- Figure 6A shows the anvil face 113 proximate to cartridge assembly 18 ( Figures 3A-3C).
- Anvil face 113 when positioned adjacent to cartridge assembly 18 and with the bowel portion to be excised positioned therebetween, acts as the crimping, i.e. closing, surface for the ejected staples.
- Anvil face 113 includes stapling recesses 110 constructed to have a funnel shape 112 at one end. Part of anvil face 113 is cut away 111 so that side views of stapling recesses 110 are visible.
- Prior art anvils include recesses that are typically square, rectangular or even hour-glass in shape.
- the present invention has funnel-shaped recesses 110 which are better able to keep staples 50 in one plane during the crimping/closing process even when the staples are distorted from their original planar shape as a result of their penetrating the tissue being stapled.
- the crimped staple 50 forms a "B" shape.
- Each stapling recess 110 is large where the staple meets the anvil to allow for greater tolerances.
- the recess is gathered to a rounded corner at one end to ensure that the two ends of the staple will remain in the same plane and to ensure a better B-like shape.
- the wide end of the stapling recess 110 meets the staple leg and guides it into the narrow rounded part of the funnel-shaped recess shaping it into a flat, i.e. planar, crimped B-like shape.
- FIGS 6B-6D give typical relative dimensions of the staples, anvil recesses and recess configurations.
- three staples are shown.
- the wire diameter of each staple is Dl
- the width of the staple is Ll
- the staples are spaced as shown at a distance of L2.
- the distance between adjacent wide ends of the recesses as shown in Fig 6C may range in length from between about Dl to about 4Dl .
- the recesses repeat at a uniform distance of L2.
- the wide end of the recess may range in size between about 3 to about 6 times Dl.
- the distance Z between the adjacent rounded ends of two recesses ranges between about the size of the wire diameter (Dl), up to about three times the wire diameter (3Dl).
- the length of the recess is larger than about half the staple width (L3>L1 :2) to compensate for any misalignment of the staple position in the anvil recesses.
- Figure 6D shows a cross sectional view of the recesses 110 on anvil member 14. It shows the penetration radius of curvature X of the anvil groove, i.e. the first surface the staple meets as it enters the recesses and starts to bend. It should be noted that the staple enters the recess from below in the presentation of Figure 6D. Only one end of the staple enters a recess. After bending begins, the staple is guided in a plane Y that can be inclined or perpendicular to the direction of staple movement, that is inclined or parallel to the surface S of the anvil in Figure 6D. The angle U of plane Y with respect to the anvil surface S is typically from about 0 to about 5 degrees. After bending, the staple encounters an exit radius of curvature W that guides the staple out of the recess, generating the closed planar B-like shape.
- FIG. 7 shows a perspective generally underside view of stapler 10. Additionally, there is a detailed cut away view of proximal end 30 of chassis member 12. The cut away view has been inverted from the general underside view.
- cartridge locking groove 102 and cartridge locking snap 104 engage, they hold cartridge assembly 18 firmly in place when the user applies a pulling force in the distal direction.
- cartridge release snap 128 is pressed, cartridge chassis member 42 is released.
- Cartridge assembly 18 ( Figure 3A) can then be removed from stapler 10 and a new cartridge assembly 18 can be inserted.
- FIGs 8, 9, and 10 top plan views of stapler 10 illustrate the three operational mode positions of selector element 24.
- the Figures include cut button 25, anvil member 14, lever member 16 and cartridge assembly 18.
- selector element 24 is shown in its neutral and closing mode position 80.
- selector element 24 is shown in its releasing mode position 84, while in Figure 10, it appears in its stapling and cutting mode position 82.
- the releasing mode position 84 and the stapling and cutting mode position 82 are sometimes also referred to herein as the selector element's 24 distal and proximal positions, respectively.
- the neutral and closing mode position is used when the stapler is inactive and when clamping tissue between anvil member 14 and chassis member 12. Clamping is effected when lever member 16 is squeezed causing anvil member 14 to pivot toward chassis member 12.
- the proximal stapling and cutting mode position 82 of Figure 10 is the mode position used when stapling and cutting tissue.
- Releasing mode position 84 of Figure 9 is used to release anvil member 14 and allow it to pivot away from chassis member 12 after stapling and cutting has been completed. It is also used if the first clamping attempt has been unsuccessful and the tissue to be excised has not been properly positioned. In such cases, the device must be opened by moving selector element 24 to the releasing mode position.
- selector element 24 Another attempt at positioning and clamping the tissue for excision is effected by first returning selector element 24 to its neutral and closing mode position 80. Changing the position of selector element 24 may be carried out regardless of the disposition of lever member 16. However, each new mode position becomes operatively effective only after lever member 16 is returned to its fully open configuration.
- selector element 24 of stapler 10 is shown therein in its neutral and closing position described in conjunction with Figure 8 above.
- anvil member 14 is brought into close operational association with cartridge assembly 18 by locking linking mechanism 56.
- a bowel portion (not shown) is disposed between anvil member 14 and cartridge assembly 18 and held tightly therebetween.
- Anvil member 14 remains in close locked operational association with cartridge assembly 18, locking being effected by locking linking mechanism 56.
- lever member 16 transforms an applied squeezing force into a predetermined driving force to slidably move slider assembly 20 in the distal direction along cartridge chassis member 42.
- pusher 62 pushes slider assembly 20 along cartridge chassis member 42.
- distal end 64 of pusher 62 engages tooth rack 66, which is part of slider assembly 20.
- successive individual teeth 68 of tooth rack 66 are operatively engaged by distal end 64 of pusher 62, thereby providing the pushing force and incremental step-like movement to slider assembly 20 along cartridge chassis member 42. It should be noted that prior to and throughout its operation pusher 62 is positioned obliquely with respect to slider assembly 20.
- FIGS 11-20 are cross sectional views of stapler 10 which show in detail the positions of the major members and elements of the stapler during various stages of its operation.
- FIG 11 shows stapler 10 in its neutral and closing mode similar to that shown in Figures 1 and 2 above.
- Figure 12 shows stapler 10 in the same mode where tissue is clamped and held between anvil member 14 and cartridge assembly 18.
- lever member 16 is squeezed and held in its closed position.
- Figure 13 shows stapler 10 in its neutral and closing mode with tissue being clamped and held between anvil member 14 and cartridge assembly 18 but with lever member 16 in its open position.
- Figures 14, 15, 16 and 17 are partial cross-sectional views of stapler 10 while the device operates in its stapling and cutting mode.
- Figure 14 shows stapler 10 in this mode with lever member 16 in its open position prior to the first squeeze of lever member 16.
- Figure 15 shows the stapler in the same mode with lever member 16 closed after the initial squeeze in a series of repetitive squeezing operations.
- Figure 16 shows the stapler with lever member 16 up after the first squeeze and prior to a series of further squeezes.
- Figure 17 shows stapler 10 in its stapling and cutting mode after the final squeeze in a series of squeezes and with lever member 16 still being held in its closed position.
- Figure 18 shows stapler 10 in its releasing mode after completing the stapling and cutting operation but before opening anvil member 14.
- Figure 19 shows stapler 10 in releasing mode with anvil member 14 still closed but with lever member 16 released and in its up or open position.
- Figure 20 is a partial cross-sectional view of stapler 10 with lever member 16 pressed and before complete release of locking linking mechanism 56.
- anvil member 14 is shown as beginning to open and pivot away from chassis member 12.
- FIG 11 to which reference is now made shows a cross sectional view of stapler 10 in its open position in neutral and closing mode as shown in Figures 1 and 2.
- selector element 24 is disposed at neutral and closing mode position 80 as in Figure 8 discussed above.
- Lever member 16 is disposed in a fully open configuration.
- anvil member 14 is fully open and locking linking mechanism 56 is in its raised “bent” “disengaged” configuration.
- Slider assembly 20 is disposed at proximal end 30 of chassis member 12.
- FIG. 11 Included in Figure 11 is an inset close-up view of distal end 64 of pusher 62 positioned above slider assembly 20. Also shown are teeth 68 and first distal tooth 98 and their relation to distal end 64 when stapler 10 is in its neutral and closing mode position. Pusher member 62 is in raised disengaged position relative to tooth rack 66. Distal end 64 does not enter first distal tooth 98 since pushing is not, and can not be, effected in the stapler's neutral and closing mode.
- stapler 10 is shown in its neutral clamping position. In this position the user clamps a portion of tissue, typically, but without being limiting, the bowel, between anvil member 14 and cartridge assembly 18. This can be effected by squeezing (also herein sometimes described as “pumping” or “pressing") against spring mounted lever member 16 into its closed position while selector element 24 is in its neutral and closing mode position 80 as in Figure 8. As a result of squeezing lever member 16, anvil member 14 moves to a closed position against cartridge assembly 18. Distal end 64 of pusher 62 still does not engage teeth 68 of tooth rack 66. Proximal end 126 of pusher 62 has dropped away from restraining surface 124 of mode transfer element 120.
- Locking linking mechanism 56 locks after links 88 and 90 reach a substantially extended linear configuration. Locking occurs after locking leg 86 is pushed down against locking linking mechanism pin 92 as lever member 16 is squeezed and moves downward. Locking linking mechanism 56 and locking links 88 and 90 remain locked under tension from locking linking mechanism spring 116; anvil member 14 remains in a closed clamping position proximate to cartridge assembly 18. They remain locked even after lever member 16 reverts to its open raised position as in Figure 13.
- FIG 13 shows stapler 10 with selector element 24 still in its neutral and closing mode position, anvil member 14 in its closed, i.e. clamping, position and lever member 16 in its open position.
- the locking linking mechanism remains in its substantially linear extended position but pusher 62 returns to its restrained position where its proximal end 126 is again held against restraining surface 124.
- This reversion of lever member 16 to its open position can be effected by main spring 114.
- Moving selector element 24 to its release position and then squeezing lever member 16 opens anvil member 14 from its closed locked position as will be described herein below. After opening locked anvil member 14, it is possible to reposition the clamped tissue. This is effected by returning selector element 24 to its neutral and closing mode position and squeezing lever member 16. This operation closes anvil member 14 against cartridge assembly 18, again clamping the tissue as described in conjunction with Figure 12.
- Figures 14-17 show cross-sectional views of stapler 10 while the device is being operated in its stapling and cutting mode.
- selector element 24 and selector mechanism 54 are positioned and operative to provide incremental "stepped" motion of slider assembly 20 in the distal direction by application of a predetermined pushing force.
- selector element 24 is moved distally to its stapling and cutting mode position 82, as indicated in Figure 10.
- lever member 16 With lever member 16 in a fully open configuration, distal end 64 of pusher member 62 operationally engages tooth rack 66 of slider assembly 20 at first distal tooth 98 allowing for a pushing force to be applied to assembly 20.
- Figure 14 shows stapler 10 in its stapling mode after selector element 24 has been moved to its stapling and cutting mode position 82 by pressing cut button 25.
- cut button 25 when cut button 25 is pressed it moves cut button spring 27 proximally in the direction of the proximal end 19 of device 10.
- neutral mode spring 29 which holds selector element 24 in its neutral and closing mode is disengaged from element 24.
- Selector element 24 is then free to move to its stapling and cutting mode position 82.
- Selector element 24 moves distally as a result of the force exerted by selector spring 118 on selector mechanism 54 which tries to move mode transfer element 120 distally.
- stapler 10 is shown in its stapling and cutting position with lever member 16 down after being squeezed once.
- Engaged pusher 62 shown in the insert in Figure 14, pushes on slider assembly 20 moving it one step forward towards the distal end 22 of cartridge assembly 18.
- stapler ejector wedge 48 pushes up on lifter row 36 causing the ejection of one series of staples 50.
- blade 46 (not shown) positioned in blade holder 44 moves forward, cutting the tissue clamped between anvil member 14 and cartridge assembly 18.
- lever member 16 returned to its up or open position after the first squeeze shown in Figure 15.
- Anvil member 14 is still in its down, clamping position held in place by locking linking mechanism 56, still in its extended substantially linear configuration.
- Figure 16 is essentially the same as in Figure 14 but the distal end 64 of pusher 62 has engaged the second tooth in the tooth rack 66 in Figure 16 and is ready to advance slider assembly 20 one additional step after lever member 16 is again squeezed.
- lever member 16 is repeatedly squeezed and released, causing pusher 62 to operationally engage the successive teeth 68 of tooth rack 66 while causing advance of tooth rack 66 in the distal direction.
- Incremental advance of tooth rack 66 in the distal direction causes slider assembly 20 to step-wise traverse its predetermined path along the length of chassis member 12.
- stapler ejector wedges 48 push on staple lifters 36, thereby sequentially ejecting staples 50 from cartridge 21 and successively crimping them against anvil member 14.
- Crimping is effected after staple 50 has passed through the engaged bowel portion (not shown) in Figures 14-17.
- the total number of repeated incremental movements required will depend inter alia on the bowel size and on the predetermined geometry of stapler 10.
- Release mechanism 94 remains disengaged while stapler 10 is in its stapling and cutting mode. Guiding pin 96 is retained within and slides proximally in the lower leg 140 of V-shaped groove 134, discussed more fully below in conjunction with Figure 21.
- Figure 17 shows the last squeezing position of lever member 16 in the stapling and cutting mode.
- Distal end 64 of pusher 62 is engaged to the last tooth 68 of tooth rack 66.
- Slider assembly 20 has reached the distal end 22 of cartridge assembly 18 as has blade 46 (not shown). Additional squeezing of lever member 16 will not move slider assembly 20 any further.
- pusher 62 in the stapling and cutting mode ( Figures 14-17), pusher 62 is in a position that allows for engagement of the distal end 64 of pusher 62 with teeth 68 in tooth rack 66 thereby slidably pushing slider assembly 20. This is to be contrasted with the neutral and closing mode where proximal end 126 of pusher 62 abuts restraining surface 124 of mode transfer element 120.
- Stapling and cutting may be stopped at anytime by bringing selector element 24 to its distal releasing mode position and squeezing lever member 16.
- FIG 18 shows a partial cross-sectional view of stapler 10 with its selector mechanism 54 positioned prior to the release and opening of anvil member 14.
- Selector element 24 has been moved to its releasing mode position 84 as in Figure 9.
- Selector mechanism 54 which is in operative association with selector element 24 through mode transfer element 120, turns clockwise, thereby disengaging pusher 62 from tooth rack 66. Guiding pin 96 remains in the lower leg 140 of V-shaped groove 134, the latter shown enlarged in Figure 21 and discussed below in conjunction therewith.
- selector mechanism 54 turns clockwise, selector mechanism spring 118 pushes guiding pin 96 toward the upper leg 138 of V- shaped groove 134.
- Lever member 16 is shown in its squeezed position.
- Figure 19 shows open lever member 16 after the lever has been released with selector element 24 in its releasing mode position 84.
- mode transfer element 120 moves selector mechanism 54 to the right.
- selector mechanism spring 118 Figure 2 brings pusher 62 to a more upright, but still oblique position, with respect to slider assembly 20.
- guiding pin 96 is guided into the upper leg 138 of V-shaped groove 134, to be described below in conjunction with Figure 21.
- Figure 20 shows the direction that anvil member 14 pivots (arrow 52B) when anvil member 14 opens after selector element 24 has been moved to its releasing mode position, and after lever member 16 has been squeezed.
- Anvil member 14 opens because locking links 88 and 90 have pivoted around locking linking mechanism pin 92 from their substantially linear configuration to their "bent” configuration.
- lever member 16 is squeezed and guiding pin 96 is guided to the upper leg 138 of V-shaped groove 134 pushing pusher 62 up. Unlocking surface 132 of pusher 62 pushes against locking linking mechanism pin 92 causing it to move from its substantially extended linear configuration to its "bent” configuration. This causes anvil member 14 to open by pivoting as shown by arrow 52B.
- V-shaped groove 134 is guiding pin 96 which is connected firmly to pusher 62.
- V-shaped groove 134 and guiding pin 96 constitute release mechanism 94.
- V-shaped groove 134, part of chassis member 12, contains upper 138 and lower 140 legs.
- selector element 24 is in neutral and closing mode position ( Figure 8) or stapling and cutting mode position ( Figure 9)
- guiding pin 96 is in the lower leg 140 of groove 134.
- selector element 24 is in releasing mode position ( Figure 10)
- guiding pin 96 moves to upper leg 138.
- groove 134 is not readily seen. Groove 134 is cut out of chassis member 12 and obscured by pusher 62 as presented in the other Figures. It should be noted that chassis member 12 includes in addition to an elongated end a second end that is obscured by chassis cover 28 shown in Figure 1. In Figure 21 part of the pusher is cut away revealing groove 134 in its entirety which is cut out of the larger, non- elongated, shaped proximal portion (not shown) of chassis member 12. Cut-out groove 134 can best be seen in Figure 3B discussed above where the complete chassis member 12 is shown.
- Stapler 10 is disengaged from the cut bowel portion and withdrawn from the abdominal cavity, through the incision or through the hand port.
- stapler 10 can be withdrawn either directly or lever member 16 may first be squeezed close with selector element 24 in the neutral and closing mode position. In such a case, anvil member 14 would again be brought proximate to cartridge assembly 18 resulting in a reduced profile allowing for easy withdrawal of the stapler.
- Figure 22 there is seen a bowel portion 70 having ends 78 subjected to stapling and cutting performed according to the series of operations discussed in conjunction with Figures 11-20.
- blade element 46 ( Figures 3A-3C for example) advances in the distal direction of cartridge assembly 18, cutting bowel 70 along excision line 76 between the two or more rows 74 of inserted staples 50.
- a second stapling and cutting procedure similar to the one described immediately above, is required.
- This second stapling and cutting procedure provides a second cut to the diseased portion of bowel 70 which effects the total severance of that portion and allows for its removal from the abdominal cavity.
- ends 72 of bowel 70 are joined by an anastomosis procedure, and continuity of bowel 70 is restored.
- Anastomosis can be effected using a separate anastomosis device or the stapler of the present invention.
- a third stapling and cutting procedure is required.
- the two stumps are positioned side-to-side either in the same or in opposite directions.
- Two close enterotomies are made, one in each lumen.
- the anvil and the cartridge assembly are introduced simultaneously all the way through each one of the enterotomies.
- the anvil When positioned the anvil is closed over the cartridge assembly, clamping the adjacent walls of the two lumens to each other. In this position, the lever is pressed and stapling and cutting occurs in between the previously stapled lines.
- the stapling process is completed, the device is opened and removed from the lumens with the enterotomies closed either by stapling or suturing.
- locking linking mechanism 56 acts as a toggle mechanism.
- the mechanism includes two links which are brought into substantially extended linear configuration and self-lock in that configuration.
- Anvil member 14 is closed when links 88 and 90 of locking linking mechanism 56 are in a substantially extended linear configuration; anvil member 14 is opened when locking linking mechanism 56 reverts back to its original "bent" configuration as shown, for example, in Figure 2.
- the extended substantially linear configuration may, and usually does, exceed a linear configuration with the angle centered on pin 92 between locking links 88 and 90 being somewhat greater than 180°. This latter case may also be described herein as the "over center" position. Alternatively, the angle may be somewhat less than 180°.
- Figures 23A-23C show the "under center”, “substantially linear” and “over center” relationship respectively of links 88 and 90 in the locking linking mechanism 56 of the present invention. This is best seen by viewing hatched line 152 in the Figures.
- line 152 represents the substantially linear position with a substantially straight line running through locking linking mechanism pin 92, the line being formed by fully extended links 88 and 90.
- Pin 92 may be in an under or over center position as shown in Figures 23A and 23C respectively; typically, the present invention is constructed to operate in the latter configuration.
- Figures 24A-24E represent one possible latch mechanism for locking the locking linking mechanism 556 when the linking mechanism 556 is locked in an "under center” position.
- Figures 24A-24E emphasis the novel aspects of the latch mechanism and do not include those elements, such as the pusher-ratchet mechanism, described in conjunction with Figures 1-21 above. In the embodiment of Figures 24A-24E, these operate in a manner similar to that discussed previously. Accordingly, no additional description will be provided relating to previously described elements.
- elements identical to those in the embodiment of Figures 1-21 have been given identical numbers but with a prefix "5". Only some of the previously identified parts will be labeled.
- Figure 24 A is an isometric partial sectional view of stapler 510 including latch mechanism 644.
- An inset in Figure 24 A shows the detailed construction of latch mechanism 644.
- Mechanism 644 includes latch legs 646, latch protrusion 648, and a latch arm 650 extending from latch bridge 651.
- Latch mechanism 644 is rotatably attached to back link 590 with a screw (not shown) and is spring (also not shown) loaded.
- Figure 24B shows the open position of stapler 510 as well as the position of latch mechanism 644 when stapler 510 is in that position.
- Figure 24C shows the locking linking mechanism as it begins to close. Latch mechanism 644 slides on an incline 654 of latch receiving groove 652 towards its engaged position therein.
- Figure 24D shows latch mechanism 644 in its locked position. It should be noted that links 588 and 590 do not form a linear configuration but remain slightly bent at locking mechanism pin 592 in an "under center” position. The two links remain in this configuration because latch protrusion 648 is held in latch receiving groove 652, preventing bending of the locking linking mechanism 556.
- Figure 24E shows the release of latch mechanism 644, the release being actuated only after pushing selector element 524 distally.
- latch mechanism 644 moves downward together with back link 590 and rotates slightly as it meets incline 654 until it reaches latch receiving groove 652.
- latch protrusion 648 enters the groove, thereby retaining links 588 and 590 in a locked, "under center” position while holding anvil member 514 proximate to cartridge assembly 518.
- Latch protrusion 648 of latch mechanism 644 moves outward from receiving groove 652 when selector element 524 is moved distally to its open position. This outward movement unlocks the locking linking mechanism 556 formed, in part, by links 588 and 590.
- Using a latch mechanism 644 as in Figures 24A-24E allows the stapler's 510 locking linking mechanism to be locked in an "under center" configuration that is at an angle formed around pin 592 of less than 180°. This angle is best seen in Figure 24A and Figure 23 A as the angle is obscured in Figures 24B-24E.
- latch mechanism 644 may be attached to the chassis and not to back link 590. In such an embodiment, the latch can engage with locking linking mechanism pin 92 when holding locking linking mechanism 556 in its locked position.
- Incremental drive mechanisms other than the pusher-ratchet mechanism discussed above may be used in other embodiments of staplers constructed according to the present invention.
- the incremental drive mechanism may be a gear mechanism.
- a stapler 710 containing a gear mechanism 858 is shown in Figures 25A- 25B.
- Figure 25A shows stapler 710 in its open position while Figure 25B shows stapler 710 in its closed operative position.
- Parts similar in construction and/or operation to those discussed previously have been given the same numerals but with a prefix of "7" and will not be discussed in conjunction with Figures 25A-25B.
- many elements have remained unnumbered as they have been discussed above in conjunction with Figures 1-21 and do not relate directly to the new feature, gear mechanism 858, discussed here. Only the new features of the drive will be described in this additional embodiment.
- Gear mechanism 858 includes a large gear 860 which is engaged with a small gear 862. The latter during operation further engages with gear rack 864.
- Large gear 860 is operated by gear pusher 866 which is engagable with the teeth of gear 860.
- gear pusher 866 is disengaged from large gear 860.
- gear pusher 866 moves downward and engages with large gear 860 turning and advancing small gear 862 one tooth in gear rack 864 causing rack 854 to advance one "step”.
- gear rack 864 advances incrementally in a step-wise fashion one tooth at a time.
- staple wedges and a blade element are staple wedges and a blade element, very similar to those shown inter alia in Figs 2-3 C.
- the former lifts staple lifters much as do the wedges in the slider assembly associated with the pusher-ratchet mechanism described in conjunction with Figures 1-21.
- Stapling and cutting proceeds in the fashion described previously in the embodiment of Figures 1-21.
- the control of the operational mode of stapler 710 is effected by selector element 724 which is operative much the same as described previously with previous embodiments. It should be noted that the locking linking mechanism shown in Figures 25A-25B is also operative as in previously described embodiments and its description will not be repeated here.
- FIG. 26A shows stapler 210 in its open position while Figure 26B shows stapler 210 in its closed position.
- Figure 26A shows stapler 210 in its open position
- Figure 26B shows stapler 210 in its closed position.
- Parts similar in construction and/or operation to those discussed previously in conjunction with Figures 1-21 are given the same numerals as in those Figures but with a prefix of "2" and will not be discussed further. Only the new features of the pulley mechanism will be described here. Additionally, many elements have remained unnumbered as they have been discussed elsewhere and will not be discussed again.
- the operative novel feature here is the pulley which includes a rotating drum 346 to which wire 348 is attached and around which wire 348 is wound. Near the end of cartridge assembly 218 is a wire axis pin 350 around which wire 348 is positioned and then attached to slider assembly 220.
- Rotating drum 346 is constructed to have teeth along its periphery. In engagement with the teeth of rotating drum 346 is drum pusher 262.
- a ratchet mechanism (not shown) permits rotation of the drum only in the clockwise direction.
- lever member 216 When lever member 216 is brought from its open to its closed position as from its position in Figure 26A to Figure 26B, drum pusher 262 engages with and pushes on the teeth of drum 346 in a step-wise fashion.
- rotating drum 346 rotates clockwise incrementally, winding wire 348 around drum 346. This winding action pulls on and moves wire 348 in a step-wise fashion.
- lever member 216 is repeatedly squeezed causing step- wise incremental rotational movement of drum 346.
- step-wise incremental linear motion is imparted to the slider assembly 220 as it is pulled along its predetermined path in the chassis member 212.
- the second end of the wire is attached to slider assembly 220.
- the slider assembly 220 As the wire is wound step-wise around drum 346, the slider assembly 220 is pulled and moves distally in the direction of wire axis pin 350. As slider assembly 220 moves, it staples and cuts tissue held between anvil member 214 and cartridge assembly 218 as described in previous embodiments. Staples are ejected and crimped as described previously; slider assembly 220 includes staple wedges (not shown) which lift staple lifters of cartridge assembly 218. Cutting is effected by a cutting blade (not shown). Selector element 224 selects between the operational modes as discussed above in conjunction with the embodiment of Figures 1-21. Similarly, locking linking mechanism 256 operates as discussed above.
- Repeatedly releasing and squeezing lever member 216 causes slider assembly 220 to traverse the length of chassis member 212 in the distal direction and to successively eject all staples from cartridge assembly 218.
- the number of repeated releasing and squeezing movements depends on the bowel size and the predetermined geometry of stapler 210.
- drum 346 is released from the ratchet mechanism (not shown) to allow free rotation of drum 346. This permits unrolling wire 348 from about drum 346 while pulling blade assembly 246 to its extreme proximal position in chassis member 212.
- Replacement cartridge assembly 218 and replacement blade assembly 246 are fixed in position relative to chassis member 212. Stapler 210 is then again ready for use.
- the wire can be configured to wind around the rotating drum and the pusher can be configured vis-a-vis the teeth on the drum so that the slider assembly may be made to move in the proximal direction instead of the distal.
- This may be accompanied by appropriate modification of the ratchet mechanism in association with the drum.
- anvil shown and discussed herein with its funnel-shaped recesses may be used with any stapling device to ensure proper crimping of the staples.
- Stapling devices which can use such an anvil include other linear, curved and circular staplers.
- the selector element has been shown positioned on the lever element. However in other embodiments the selector element can be positioned at other locations of the stapler, such as on the chassis. In all cases, the selector element must be capable of selecting the operative mode of the stapler and be in operative association with the locking linking mechanism and the release mechanism. Similarly, it should be operable by the user with one hand.
- the stapler may employ two or more selector elements. Each of these selector elements would select between at least two operational modes of the stapler and each of the elements should be operable by the user with one hand.
- the selector element has been described as selecting between three operative modes. It is readily understood that the one or more selector elements of the stapler may be operative to choose between a plurality of operative modes where the number of operative modes is at least two.
- the stapler has been described as being used in bowel resections. It should be evident to one skilled in the art that other organs can also be resected using the stapler of the present invention with little or no modification. Such organs include, but are not limited to, the uterus, esophagus and lungs.
- the device and method of the present invention can be used to excise tissue of animals as well as humans particularly, but without being limiting, other mammalian species.
Abstract
Description
Claims
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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US11/010,866 US7121446B2 (en) | 2004-12-13 | 2004-12-13 | Palm-size surgical stapler for single hand operation |
US11/010,866 | 2004-12-13 |
Publications (1)
Publication Number | Publication Date |
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WO2006064491A1 true WO2006064491A1 (en) | 2006-06-22 |
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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PCT/IL2005/001179 WO2006064491A1 (en) | 2004-12-13 | 2005-11-10 | Tissue stapler |
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US (1) | US7121446B2 (en) |
TW (1) | TW200618769A (en) |
WO (1) | WO2006064491A1 (en) |
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- 2005-12-09 TW TW094143646A patent/TW200618769A/en unknown
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US5480089A (en) * | 1994-08-19 | 1996-01-02 | United States Surgical Corporation | Surgical stapler apparatus with improved staple pockets |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
WO2011089294A1 (en) * | 2010-01-20 | 2011-07-28 | Fundación Marqués De Valdecilla | Surgical stapling device |
ES2397143A1 (en) * | 2010-01-20 | 2013-03-05 | Fundación Marqués De Valdecilla | Surgical stapling device |
Also Published As
Publication number | Publication date |
---|---|
US20060124689A1 (en) | 2006-06-15 |
US7121446B2 (en) | 2006-10-17 |
TW200618769A (en) | 2006-06-16 |
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