WO2006085389A1 - Stapling instrument - Google Patents
Stapling instrument Download PDFInfo
- Publication number
- WO2006085389A1 WO2006085389A1 PCT/JP2005/002366 JP2005002366W WO2006085389A1 WO 2006085389 A1 WO2006085389 A1 WO 2006085389A1 JP 2005002366 W JP2005002366 W JP 2005002366W WO 2006085389 A1 WO2006085389 A1 WO 2006085389A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- release button
- stapling instrument
- jaw
- staple
- lever
- 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
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2932—Transmission of forces to jaw members
Definitions
- the present invention relates to a surgical instrument for use in surgical operations and, more particularly, to a stapling instrument for cutting and suturing body tissue by use of staples.
- stapling instruments of the type that comprise an elongated insert portion for insertion into patient body and a gun-grip-shaped operating portion connected to the base end of the insert portion: the insert portion is inserted into the patient body and the operating portion is actuated to drive plural rows of staples into body tissue and make an incision in the stapled body tissue linearly between the plural rows of staples by means of a knife.
- Fig. 11 shows, in perspective, an outward appearance of a conventional stapling instrument.
- the illustrated example is provided with a cartridge 5 for housing plural rows of staples and an anvil 6 having plural grooves for deforming the staples to curl their legs into desired form.
- the conventional instrument is adapted to drive staples from the cartridge 5 into body tissue clamped between the anvil 6 and the cartridge 5 and simultaneously cut the stapled body tissue between the plural rows of staples by a knife.
- each cam bar housed in a tubular insert portion 2 slides in a slot made in the bottom of the cartridge 5 toward the forward end thereof and abuts against staple holding members one after another to push them toward the anvil 6 to thereby drive staples into the body tissue, and then a cutter or the knife slides in slots made in the surfaces of the cartridge 5 and the anvil 6, cutting the stapled body tissue.
- Fig. 7 is an enlarged sectional view showing how the cam bar 21 slides in the slot and pushes the staple holding members 10 toward the anvil 6.
- the present invention is to provide, as a solution to the above- mentioned problem, a stapling instrument which ensures returning the cam bars and the staple firing lever to their initial positions.
- the stapling instrument according to an aspect of the present invention comprises: a body portion having an operating portion; an insert portion extending from the body portion lengthwise thereof; an openable/closable jaw portion attached to the forward end of the insert portion; a jaw actuating means for actuating the jaw portion to open and close; staple pusher means; knife actuating means for actuating a knife disposed in the insert portion; and pre-release means for actuating the jaw actuating means to bring the jaw portion from its fully-closed to half-open position and hold it in the latter position.
- the jaw portion comprises a staple cartridge, a cartridge holder carrying the cartridge, and an anvil pivotally mounted to the cartridge holder.
- the jaw actuating means comprises a closing pipe coupled to the anvil, and a closing lever coupled to the closing pipe.
- the pre-release means comprises a closing lever having first and second camming surfaces which are operatively associated with the anvil, a pre-release button configured to engage at its forward end with the first camming surface, and a release button configured to engage at one end thereof with the second camming surface.
- the pre-release button projects out from the body portion for actuation only when the jaw portion is in its fully closed position.
- the release button projects out from the body portion for actuation only when the jaw portion is in its half-open position.
- the first camming surface of the closing lever has a stepped portion inclined further inwardly of a circular arcuate locus of the forward end of the pre-release button pivotally mounted on the body portion.
- the stapling instrument is provided with a locking mechanism which allows operation of the knife actuating means and the staple pusher means only when the jaw portion is in its fully-closed position.
- the locking mechanism comprises: a lock lever disposed in the prerelease button of hollow configuration; a cam bar rack having a groove for engagement with the forward end of the lock lever; and a spring for biasing one end of the lock lever in the direction of the groove.
- the staple pusher means and the knife actuating means are provided with: cam bars each extending from the operating portion toward the jaw portion and a knife; staple holding members disposed in the vicinity of the staple housing portion in the cartridge; and a staple firing lever coupled to the cam bars and the knife via a rack member.
- the pre-release means is provided for actuating the jaw actuating means to bring the jaw portion from its fully-open to half-open position and hold it in the latter position, even when the body tissue to be fastened is thick, no tension will be applied to the staple pusher means — this ensures returning the staple pusher means and the knife to their initial positions.
- FIG. 1 is a perspective view of the stapling instrument according to Embodiment 1 of the present invention.
- Fig. 2 is a sectional view showing the state in which a jaw portion is in its fully opened position in the Fig. 1 embodiment.
- Fig. 3 is a sectional view showing the state in which the jaw portion is in its fully closed position prior to the operation of a staple firing lever in the Fig. 1 embodiment.
- Fig. 4 is a sectional view showing the state in which the jaw portion is in its fully closed position after the operation of the staple firing lever in the Fig. 1 embodiment.
- Fig. 5 is a sectional view showing the state in which the jaw portion is in its half open position.
- Fig. 6 is an enlarged diagram of the jaw portion held full-opened, with an anvil taken away therefrom in the Fig. 1 embodiment.
- Fig. 7 is an enlarged sectional view showing the state in which a cam bar is effecting stapling with the jaw portion held in its fully closed position in the Fig. 1 embodiment and a prior art example.
- Fig. 8 is an exploded perspective view showing the am bar, a knife and their associated parts in the Fig. 1 embodiment.
- Fig. 9 is an exploded perspective view of the body portion of the stapling instrument of the Fig. 1 embodiment.
- Fig. 10 is an enlarged sectional view showing the engagement between a first camming surface and a pre-release button in the Fig. 1 embodiment.
- Fig. 11 is a general perspective view of a conventional stapling instrument. Detailed Description of the Preferred Embodiment Embodiment 1
- Fig. 1 is a general perspective view of a stapling instrument according to Embodiment 1 of the present invention.
- Fig. 2 is its sectional view showing the state in which the jaw portion is in its fully-opened position.
- the illustrated stapling instrument is made up of an elongated insert portion 2 for insertion into a patient body and a body portion 3 coupled to the base end of the insert portion 2 and having a gun- grip-like operating portion.
- the insert portion 2 has attached thereto a tubular closing block 4 whose sectional area gradually increases forwardly.
- Attached to the forward end of the insert portion 2 is an openable/closable jaw portion for clamping body tissue between its jaw members.
- the jaw portion is formed by a cartridge 5 and an anvil 6 pivotally secured thereto.
- Fig. 6 is an enlarged diagram of the jaw portion in the stapling instrument according to Embodiment 1 of the present invention, the jaw portion being full-open with the anvil taken away therefrom.
- Fig. 7 is an enlarged sectional view showing the state in which the jaw portion is fully closed and each cam bar 21 effects stapling.
- staple storage portions 8 in which plural rows of substantially U-shaped staples 7 made of a biocompatible metal material are stored with their both legs directed toward the anvil 6.
- four rows of staples 7 are stored in each staple storage portion 8 as depicted in Fig. 6.
- each staple 7 is supported by a staple holding member 10 underlying it.
- the underside of the staple holding member 10 has a sloping face for pushing out the staple 7 toward the anvil 6.
- the staple holding member 10 is supported in such a manner as to be slidable toward the anvil 6 while being held in contact with the staple 7.
- each staple holding member 10 holds two adjacent rows of staples disposed in substantially side-by-side relation.
- that surface of the anvil 6 facing the cartridge 5 there are formed grooves 11 for curling the legs of the staples 7 into desire form and a guide groove 9 for sliding movement of an edge portion of a knife 20 described later on.
- the rear end portion of the anvil 6 in the direction of the operating portion is pivotally secured by a pin 13 to the rear end portion of a cartridge holder 12.
- the anvil 6 has its intermediate portion coupled by a coupling member 14 to the forward end of a closing block 4.
- the cartridge holder 12 is substantially U-shaped in cross section, and detachably holds the cartridge 5.
- the cartridge holder 12 has formed in its forward end portion a pair of cartridge locking recesses.
- the cartridge 5 has a pair of projections protrusively provided on the forward end portion thereof for detachable engagement with the recesses of the cartridge holder 12.
- the knife 20 for cutting the body tissue clamped by the jaw portion and cam bars 21 each having its forward end portion sloped or tapered for pushing out the rows of staples 7 toward the anvil 6 one after another.
- FIG. 8 is an exploded perspective view showing the cam bar, the knife and their associated parts in Embodiment 1.
- the knife 20 has its forward end portion formed as a cutting edge
- the cam bar 21 has a cam bar adapter 23 on the side opposite from the cutting edge, that is, at the rear end in the direction of the body portion 3.
- the cam bar adapter 23 is connected to the knife 20 and the rear end portion of the cam bar 21 in the direction of the body portion 3.
- the rear end portion of the cam bar adapter 23 is connected to one end portion of a cam bar rack 24, which has a groove 15 cut in the other end portion for engagement with a lock lever 43 (see Figs. 2 to 5).
- the cam bar rack 24 is toothed in the underside surface of its intermediate portion for threaded engagement with a gear 25.
- Fig. 9 is an exploded perspective view of the body potion 3 of the stapling instrument according to Embodiment 1.
- the gear 25 has a smaller gear wheel which is coaxial and operatively associated therewith.
- the gear wheel meshes with teeth cut in one end portion of a closing rack 26.
- the closing rack 26 is toothed in the underside surface of its other end portion and meshes with a toothed portion of the staple firing lever 27.
- the staple firing lever 27 has a configuration that a lever portion extends downwardly from a substantially disk-like member journaled centrally thereof by a pivot pin on a casing 28 of the body portion.
- the disk-like member has the above- mentioned toothed portion.
- the staple firing lever 27 is always biased by a spring (not shown) disposed near the above-mentioned pivot pin in a direction in which to open the anvil 6.
- a tubular cap 31 is mounted on the boundary between the body portion 3 and the insert portion 2 in a manner to be rotatable relative to the casing 28.
- the closing block 4 coupled at the forward end to the coupling member 14 extends rearwardly through the cap 31 and into the body portion 3, wherein it is coupled to a slider 32.
- the slider 32 is always biased rearwardly, that is, toward the operating portion by a spring (not shown) stretched between the cap 31 and the slider 32.
- the rear end of the slider 32 is coupled by a pin 13 (not shown) to a link 34, which is, in turn, connected by a pin (not shown) at the other end to the closing lever 40.
- the closing lever 40 is pivotally mounted on a pivot pin on the casing 28 of the body portion 3.
- the closing lever 40 is axially aligned with but not directly connected to the staple firing lever 27; that is, the closing lever 40 and the staple firing lever 27 are pivotable independently of each other.
- the closing lever 40 is formed by a cam portion having first and second camming surfaces of different configurations but axially aligned in side-by- side relation, and an operating handle extending in a direction substantially diametrically opposite to the first and second camming surfaces.
- the first camming surface engages with the forward end of a pre-release button 41, whereas the second camming surface engages with the forward end of a release button 42.
- Fig. 10 is an enlarged sectional view showing the engagement between the first camming surface of the closing lever 40 and the pre-release button 41.
- the pre-release button 41 is pivotally mounted by a pivot pin on the casing 28.
- the forward end portion of the pre-release button 41 conforms generally to a stepped portion of the first camming surface of the closing lever 40.
- the forward end portion of the pre-release button 41 which abuts against the first camming surface, slopes at an angle less than 90 degrees as indicated by ⁇ in Fig. 10.
- the stepped portion of the first camming surface is inclined further inwardly than a circularly arcuate locus of the forward end of the pre-release button 41.
- the pre-release button 41 is adapted to turn to protrude its rear end portion from out the casing 28 to be pressed by a user as required.
- the release button 42 is pivotally mounted by the pivot pin common to the pre-release button 41. Though mounted by the same pivot pin, the pre-release button 41 and the release button 42 are pivotable independently of each other.
- the forward end portion of the release button 42 is configured to engage with the closing lever 40 and conforms generally to a recess cut in the second camming surface of the closing lever 40.
- the closing lever 40 is also adapted to turn to protrude its rear end portion from the casing 28 to be pressed by the user as required.
- the second camming surface of the closing lever 40 is concave, and when the forward end of the release button
- the release button 42 40 engages in the concave camming surface centrally thereof, the release button 42 turns to protrude its rear end portion from the casing 28.
- the closing lever turns to right or left to disengage the forward end of the release button 42 from the concave camming surface, the rear end portion of the release button 42 is retracted into the casing 28.
- the lock lever 43 is disposed in the pre-release button 41 of partially hollow configuration and pivotally mounted on the casing 48 by the same pivotal pin as that by which the pre-release button 41 is pivotally mounted.
- the lock lever 43 though disposed in the pre-release button 41, is pivotable independently of the latter.
- the lock lever 43 has at its one end a projection for engagement with the groove 15 of the cam bar rack 24, whereas the other end of the lock lever 43 is configured to abut against the inner surface of the pre-release button 41 at one end thereof.
- a plate spring (not shown), by which the lock lever
- Fig. 10 schematically shows the state of the pre-release button 41 immediately before the jaw portion is completely closed.
- the pre-release button 41 turns to right and an upward projection of the lock lever 43 abuts against the inner surface of the pre-release button 41, with the result that the lock lever 43 also turns to right and hence disengages from the groove 15.
- the casing 28 is provided with a grip 46.
- the grip 46, the closing lever 40, and the staple firing lever 27 are arranged in this order toward the insert portion 2.
- the closing lever 40 and the staple firing lever 27 are in the direction away from the grip 46.
- the insert portion of the instrument is inserted into patient body while keeping the instrument in this state.
- the instrument is oriented to bring the jaw portion to the affected area desired to cut, and the closing lever 40 is manually pulled toward the grip 46.
- the closing lever 40 turns about he pivot pin fixed to the casing 28.
- the link 34 pivotally secured by a pin to the closing lever 40 is pushed toward the insert portion 2.
- Fig. 3 is a sectional view showing the state in which the jaw portion is in its fully closed position prior to the operation of the staple firing lever 27.
- the pre-release button 41 moves rearward and its pointed forward end snaps into engagement with the first camming surface of the closing lever 40 along its stepped portion to give a tactile and audio feedback since the stepped portion of the first camming surface of the closing lever 40 tilts and overhangs inwardly of the arcuate locus of the forward end of the pre-release button 41 as referred to previously.
- the pre-release button 41 moves in the direction in which to project out of the casing 38, then the inner surface of the hollow closing lever 40 pushes the end portion of the lock lever 43 on the side opposite from its projection engaged with the groove 15 of the closing rack 24.
- the projection of the lock lever 43 disengages from the groove 15 of the closing rack 26, enabling the staple firing lever 27 to be operated.
- Fig. 3 shows the state in which when the closing lever 40 is pulled toward the grip 46 to place the jaw portion in its fully closed position, the prerelease button 41 projects out of the casing 28 but the release button 42 does not project out therefrom and the lock lever 43 does not lock the staple firing lever 27.
- Fig. 4 shows the state in which the staple firing lever 27 has just been operated with the jaw portion held in its fully closed position, that is, in which stapling has just been completed and the knife 20 and the cam bar 21 are in their foremost positions.
- the staples 7 are not urged hard against the anvil 6, in which case, on releasing the staple firing lever 27, the knife 20 and the cam bar 21 will readily return to their initial positions even without the need for pressing the pre-release button 41.
- the body tissue to be fastened is thick, however, there arises the same problem as encountered in the prior art.
- the metal-made, elastic staples each act as a spring and apply tension between the staple holding member in the cartridge and the anvil because each staple has an arc-shaped portion. Then, the tension acts on each cam bar which slides in the slot, and when the tension becomes larger than the force of the coiled spring disposed near the staple firing lever, the cam bar and the staple firing lever will not return to their initial positions.
- the jaw portion Upon pressing the pre-release button 41 when the staple firing lever 27 does not return to its initial position, the jaw portion assumes its half-open position, that is, the anvil 6 turns a little away from the cartridge 5 to prevent the staples 7 from applying tension to the cam bar 21 through the staple holding members 10 even if the body tissue to be fastened is too thick.
- pressing the pre-release button 41 disengages its forward end from the first camming surface of the closing lever 40, allowing the closing lever 40 to turn in the direction away from the grip 46 to the position where the second camming surface engages the forward end portion of the release button 42. In this instance, no tension is applied to the cam bar 21; hence, the cam bar 21 , the knife 20 and the staple firing lever 27 return to their initial positions.
- the prerelease button 41 moves in the direction in which to project out of the casing 28, and the inner surface of the hollow closing lever 40 abuts against the rear end portion of the lock lever 43 to disengage its forward end projection from the groove 15 of the cam bar rack 24, and hence the staple firing lever 27 is operable.
- the pre-release button 41 upon the pre-release button 41 being pressed, it turns and the closing lever 40 no longer pushes the rear end of the lock lever 43, and consequently, the lock lever 43 biased by the plate spring moves to the position where to engage the groove 15 of the cam bar rack 24, locking the staple firing lever 27. Since the staple firing lever is inoperable, the knife 20 will not be advanced forwardly in the direction of the insert portion 2.
- FIGs. 1 and 5 show the state in which the pre-release button 41 is pressed, the jaw portion is half open and the release button 42 projects out of the casing 28.
- the wording "half open” in the specification and the claims should be construed as referring also to “slightly open” since the jaw portion needs only to open to such an extent as to ensure returning the cam bars and the staple firing lever to their initial position after stapling a thick body tissue.
- the lock lever 43 is mounted coaxially with the pre-release button 41 and the release button 42 and configured to turn in the pre-release button 41 of the hollow configuration as referred to previously. And, since the lock lever 43 is always pushed by the plate spring toward the closing rack 24, the forward end portion of the lock lever 43 will surely engage the groove of the clock rack 24 retracting on the pre-release button 41 being pressed after the operation of the staple firing lever 27. That is, the staple firing lever 27 cannot be operated unless the jaw portion is fully closed.
- the stepped portion of the first camming surface of the closing lever is inclined to overhang inwardly of the circularly arcuate locus of the forward end of the pre-release button 41 so that when the jaw portion is fully closed, the forward end portion of the prerelease button snaps into engagement with the first camming surface, giving a tactile and audio feedback.
- the stapling instrument of Embodiment 1 is provided with the locking mechanism which permits operation of the knife actuating means and the staple pusher means only when the jaw portion is fully closed — this excludes the possibility of misoperation by the user.
- the stapling instrument of Embodiment is provided with the locking mechanism composed of the lock lever disposed in the hollow pre-release button, the closing rack having a groove for engagement with the forward end of the lock lever and the spring for biasing the forward end of the lock lever toward the groove, the forward end of the lock lever engages the groove of the closing rack without fail, preventing malfunction of the locking mechanism.
Abstract
To provide a stapling instrument for cutting and suturing body tissue, configured to ensure returning cam bars and a staple firing lever to their initial position. The stapling instrument is provided with: a body portion 3 having an operating portion 40 having a closing lever 40, a staple firing lever 27, a pre-release button 41 and a release button 42; an insert portion 2 extending from the body portion 3; and a jaw portion attached to the forward end of the insert portion. The closing lever 40 is to fully close the jaw portion. The staple firing lever 27 is to effect stapling and make an incision in body tissue by a knife 20. The pre-release button 41 is to bring the jaw portion from its fully-closed to half-open position and hold it in the latter position.
Description
DESCRIPTION STAPLING INSTRUMENT
Technical Field
The present invention relates to a surgical instrument for use in surgical operations and, more particularly, to a stapling instrument for cutting and suturing body tissue by use of staples.
Background Art
In the field of surgical operations there are now widely used stapling instruments of the type that comprise an elongated insert portion for insertion into patient body and a gun-grip-shaped operating portion connected to the base end of the insert portion: the insert portion is inserted into the patient body and the operating portion is actuated to drive plural rows of staples into body tissue and make an incision in the stapled body tissue linearly between the plural rows of staples by means of a knife.
Fig. 11 shows, in perspective, an outward appearance of a conventional stapling instrument. The illustrated example is provided with a cartridge 5 for housing plural rows of staples and an anvil 6 having plural grooves for deforming the staples to curl their legs into desired form. The conventional instrument is adapted to drive staples from the cartridge 5 into body tissue clamped between the anvil 6 and the cartridge 5 and simultaneously cut the stapled body tissue between the plural rows of staples by a knife.
The operation of the above prior art example will be described in brief. The actuation of a closing lever 40 will cause the anvil 6 to turn toward the cartridge 5 to clamp therebetween body tissue.
Then, upon actuating a staple firing lever 27, each cam bar housed in a
tubular insert portion 2 slides in a slot made in the bottom of the cartridge 5 toward the forward end thereof and abuts against staple holding members one after another to push them toward the anvil 6 to thereby drive staples into the body tissue, and then a cutter or the knife slides in slots made in the surfaces of the cartridge 5 and the anvil 6, cutting the stapled body tissue. Fig. 7 is an enlarged sectional view showing how the cam bar 21 slides in the slot and pushes the staple holding members 10 toward the anvil 6.
Releasing the staple firing lever 27, the cam bar 21 and the knife slide in the slots back to their initial positions by the force of a coiled spring disposed near the staple firing lever 27. Then, pressing a release button 42 mounted on the back of an operating portion, a jaw portion becomes full- open.
There are published patent documents 1 to 3 that disclose stapling instruments provided with closing means and staple firing means as mentioned above.
Disclosure of Invention
With the above-mentioned conventional instrument, when the body tissue to be fastened is too thick, the staples are pressed hard against the anvil. On this account, when the staple firing lever is released and hence each cam bar is allowed to slide in the slot back toward its initial position, the metal- made, elastic staples each act as a spring and apply tension between the staple holding member in the cartridge and the anvil because each staple has an arc- shaped portion. Then, the tension acts on each cam bar which slides in the slot, and when the tension becomes larger than the force of the coiled spring disposed near the staple firing lever, the cam bar and the staple firing lever will not
return to their initial positions.
The present invention is to provide, as a solution to the above- mentioned problem, a stapling instrument which ensures returning the cam bars and the staple firing lever to their initial positions. The stapling instrument according to an aspect of the present invention comprises: a body portion having an operating portion; an insert portion extending from the body portion lengthwise thereof; an openable/closable jaw portion attached to the forward end of the insert portion; a jaw actuating means for actuating the jaw portion to open and close; staple pusher means; knife actuating means for actuating a knife disposed in the insert portion; and pre-release means for actuating the jaw actuating means to bring the jaw portion from its fully-closed to half-open position and hold it in the latter position.
According to another aspect of the present invention, the jaw portion comprises a staple cartridge, a cartridge holder carrying the cartridge, and an anvil pivotally mounted to the cartridge holder.
According to another aspect of the present invention, the jaw actuating means comprises a closing pipe coupled to the anvil, and a closing lever coupled to the closing pipe. According to another aspect of the present invention, the pre-release means comprises a closing lever having first and second camming surfaces which are operatively associated with the anvil, a pre-release button configured to engage at its forward end with the first camming surface, and a release button configured to engage at one end thereof with the second camming surface.
The pre-release button projects out from the body portion for actuation only when the jaw portion is in its fully closed position.
According to another aspect of the present invention, the release button projects out from the body portion for actuation only when the jaw portion is in its half-open position.
The first camming surface of the closing lever has a stepped portion inclined further inwardly of a circular arcuate locus of the forward end of the pre-release button pivotally mounted on the body portion.
According to another aspect of the present invention, the stapling instrument is provided with a locking mechanism which allows operation of the knife actuating means and the staple pusher means only when the jaw portion is in its fully-closed position.
The locking mechanism comprises: a lock lever disposed in the prerelease button of hollow configuration; a cam bar rack having a groove for engagement with the forward end of the lock lever; and a spring for biasing one end of the lock lever in the direction of the groove. The staple pusher means and the knife actuating means are provided with: cam bars each extending from the operating portion toward the jaw portion and a knife; staple holding members disposed in the vicinity of the staple housing portion in the cartridge; and a staple firing lever coupled to the cam bars and the knife via a rack member. According to the present invention, since the pre-release means is provided for actuating the jaw actuating means to bring the jaw portion from its fully-open to half-open position and hold it in the latter position, even when the body tissue to be fastened is thick, no tension will be applied to the staple pusher means — this ensures returning the staple pusher means and the knife to their initial positions.
Brief Description of the Drawings
Fig. 1 is a perspective view of the stapling instrument according to Embodiment 1 of the present invention.
Fig. 2 is a sectional view showing the state in which a jaw portion is in its fully opened position in the Fig. 1 embodiment. Fig. 3 is a sectional view showing the state in which the jaw portion is in its fully closed position prior to the operation of a staple firing lever in the Fig. 1 embodiment.
Fig. 4 is a sectional view showing the state in which the jaw portion is in its fully closed position after the operation of the staple firing lever in the Fig. 1 embodiment.
Fig. 5 is a sectional view showing the state in which the jaw portion is in its half open position.
Fig. 6 is an enlarged diagram of the jaw portion held full-opened, with an anvil taken away therefrom in the Fig. 1 embodiment. Fig. 7 is an enlarged sectional view showing the state in which a cam bar is effecting stapling with the jaw portion held in its fully closed position in the Fig. 1 embodiment and a prior art example.
Fig. 8 is an exploded perspective view showing the am bar, a knife and their associated parts in the Fig. 1 embodiment. Fig. 9 is an exploded perspective view of the body portion of the stapling instrument of the Fig. 1 embodiment.
Fig. 10 is an enlarged sectional view showing the engagement between a first camming surface and a pre-release button in the Fig. 1 embodiment. Fig. 11 is a general perspective view of a conventional stapling instrument.
Detailed Description of the Preferred Embodiment Embodiment 1
Fig. 1 is a general perspective view of a stapling instrument according to Embodiment 1 of the present invention. Fig. 2 is its sectional view showing the state in which the jaw portion is in its fully-opened position.
The illustrated stapling instrument, denoted generally by 1 , is made up of an elongated insert portion 2 for insertion into a patient body and a body portion 3 coupled to the base end of the insert portion 2 and having a gun- grip-like operating portion. The insert portion 2 has attached thereto a tubular closing block 4 whose sectional area gradually increases forwardly. Attached to the forward end of the insert portion 2 is an openable/closable jaw portion for clamping body tissue between its jaw members. The jaw portion is formed by a cartridge 5 and an anvil 6 pivotally secured thereto. Fig. 6 is an enlarged diagram of the jaw portion in the stapling instrument according to Embodiment 1 of the present invention, the jaw portion being full-open with the anvil taken away therefrom. Fig. 7 is an enlarged sectional view showing the state in which the jaw portion is fully closed and each cam bar 21 effects stapling. In the forward portion of the cartridge 5 there are formed staple storage portions 8 in which plural rows of substantially U-shaped staples 7 made of a biocompatible metal material are stored with their both legs directed toward the anvil 6. In this embodiment four rows of staples 7 are stored in each staple storage portion 8 as depicted in Fig. 6. In the staple storage portion, 8 each staple 7 is supported by a staple holding member 10 underlying it. The underside of the staple holding member 10 has a sloping face for pushing out the staple 7 toward the anvil 6.
Incidentally, the staple holding member 10 is supported in such a manner as to be slidable toward the anvil 6 while being held in contact with the staple 7.
In this embodiment each staple holding member 10 holds two adjacent rows of staples disposed in substantially side-by-side relation. In that surface of the anvil 6 facing the cartridge 5 there are formed grooves 11 for curling the legs of the staples 7 into desire form and a guide groove 9 for sliding movement of an edge portion of a knife 20 described later on. As depicted in Fig. 2, the rear end portion of the anvil 6 in the direction of the operating portion is pivotally secured by a pin 13 to the rear end portion of a cartridge holder 12. The anvil 6 has its intermediate portion coupled by a coupling member 14 to the forward end of a closing block 4.
The cartridge holder 12 is substantially U-shaped in cross section, and detachably holds the cartridge 5. The cartridge holder 12 has formed in its forward end portion a pair of cartridge locking recesses. Correspondingly, the cartridge 5 has a pair of projections protrusively provided on the forward end portion thereof for detachable engagement with the recesses of the cartridge holder 12.
At the rear end of the cartridge holder 12 in the direction of the operating portion, there are disposed the knife 20 for cutting the body tissue clamped by the jaw portion and cam bars 21 each having its forward end portion sloped or tapered for pushing out the rows of staples 7 toward the anvil 6 one after another.
As shown in Fig. 6, in that surface of the cartridge 5 facing the anvil 6 there is formed a slot for sliding movement of the knife 20 to pass between the rows of staples. In the underside of the cartridge 5 there are formed slots for guiding the cam bars 21 so that they go under the rows of staples one after another.
Fig. 8 is an exploded perspective view showing the cam bar, the knife and their associated parts in Embodiment 1. As depicted, the knife 20 has its forward end portion formed as a cutting edge, and the cam bar 21 has a cam bar adapter 23 on the side opposite from the cutting edge, that is, at the rear end in the direction of the body portion 3. The cam bar adapter 23 is connected to the knife 20 and the rear end portion of the cam bar 21 in the direction of the body portion 3. The rear end portion of the cam bar adapter 23 is connected to one end portion of a cam bar rack 24, which has a groove 15 cut in the other end portion for engagement with a lock lever 43 (see Figs. 2 to 5). The cam bar rack 24 is toothed in the underside surface of its intermediate portion for threaded engagement with a gear 25.
Fig. 9 is an exploded perspective view of the body potion 3 of the stapling instrument according to Embodiment 1. The gear 25 has a smaller gear wheel which is coaxial and operatively associated therewith. The gear wheel meshes with teeth cut in one end portion of a closing rack 26. The closing rack 26 is toothed in the underside surface of its other end portion and meshes with a toothed portion of the staple firing lever 27. The staple firing lever 27 has a configuration that a lever portion extends downwardly from a substantially disk-like member journaled centrally thereof by a pivot pin on a casing 28 of the body portion. The disk-like member has the above- mentioned toothed portion. The staple firing lever 27 is always biased by a spring (not shown) disposed near the above-mentioned pivot pin in a direction in which to open the anvil 6.
A tubular cap 31 is mounted on the boundary between the body portion 3 and the insert portion 2 in a manner to be rotatable relative to the casing 28. The closing block 4 coupled at the forward end to the coupling member 14 extends rearwardly through the cap 31 and into the body portion 3,
wherein it is coupled to a slider 32. The slider 32 is always biased rearwardly, that is, toward the operating portion by a spring (not shown) stretched between the cap 31 and the slider 32. The rear end of the slider 32 is coupled by a pin 13 (not shown) to a link 34, which is, in turn, connected by a pin (not shown) at the other end to the closing lever 40.
The closing lever 40 is pivotally mounted on a pivot pin on the casing 28 of the body portion 3. The closing lever 40 is axially aligned with but not directly connected to the staple firing lever 27; that is, the closing lever 40 and the staple firing lever 27 are pivotable independently of each other. The closing lever 40 is formed by a cam portion having first and second camming surfaces of different configurations but axially aligned in side-by- side relation, and an operating handle extending in a direction substantially diametrically opposite to the first and second camming surfaces. The first camming surface engages with the forward end of a pre-release button 41, whereas the second camming surface engages with the forward end of a release button 42. Fig. 10 is an enlarged sectional view showing the engagement between the first camming surface of the closing lever 40 and the pre-release button 41.
Intermediately of its ends the pre-release button 41 is pivotally mounted by a pivot pin on the casing 28. The forward end portion of the pre-release button 41 conforms generally to a stepped portion of the first camming surface of the closing lever 40. The forward end portion of the pre-release button 41, which abuts against the first camming surface, slopes at an angle less than 90 degrees as indicated by θ in Fig. 10. The stepped portion of the first camming surface is inclined further inwardly than a circularly arcuate locus of the forward end of the pre-release button 41. The pre-release button 41 is adapted to turn to protrude its rear end portion from
out the casing 28 to be pressed by a user as required.
Intermediately of its ends the release button 42 is pivotally mounted by the pivot pin common to the pre-release button 41. Though mounted by the same pivot pin, the pre-release button 41 and the release button 42 are pivotable independently of each other. The forward end portion of the release button 42 is configured to engage with the closing lever 40 and conforms generally to a recess cut in the second camming surface of the closing lever 40. As is the case with the pre-release button 41, the closing lever 40 is also adapted to turn to protrude its rear end portion from the casing 28 to be pressed by the user as required. The second camming surface of the closing lever 40 is concave, and when the forward end of the release button
42 40 engages in the concave camming surface centrally thereof, the release button 42 turns to protrude its rear end portion from the casing 28. When the closing lever turns to right or left to disengage the forward end of the release button 42 from the concave camming surface, the rear end portion of the release button 42 is retracted into the casing 28.
The lock lever 43 is disposed in the pre-release button 41 of partially hollow configuration and pivotally mounted on the casing 48 by the same pivotal pin as that by which the pre-release button 41 is pivotally mounted. The lock lever 43, though disposed in the pre-release button 41, is pivotable independently of the latter. The lock lever 43 has at its one end a projection for engagement with the groove 15 of the cam bar rack 24, whereas the other end of the lock lever 43 is configured to abut against the inner surface of the pre-release button 41 at one end thereof. Between the casing 28 and the lock lever 43 there is disposed a plate spring (not shown), by which the lock lever
43 is biased toward the groove 15 of the cam bar rack 24. When the prerelease button 41 projects out of the casing 28 and remains in its operable
position, the other end of the closing lever 40 is in contact with the inner surface of the pre-release button 41 at one side thereof, keeping the lock lever 43 out of engagement with the groove 15.
Fig. 10 schematically shows the state of the pre-release button 41 immediately before the jaw portion is completely closed. When the jaw portion is completely closed, the pre-release button 41 turns to right and an upward projection of the lock lever 43 abuts against the inner surface of the pre-release button 41, with the result that the lock lever 43 also turns to right and hence disengages from the groove 15. The casing 28 is provided with a grip 46. The grip 46, the closing lever 40, and the staple firing lever 27 are arranged in this order toward the insert portion 2.
Next, a description will be given of the operation of the stapling instrument of Embodiment 1. As shown in Fig. 2, when the jaw portion is in its fully open position, the closing lever 40 and the staple firing lever 27 are in the direction away from the grip 46. In use, the insert portion of the instrument is inserted into patient body while keeping the instrument in this state. After the affected area is recognized as by an endoscope, the instrument is oriented to bring the jaw portion to the affected area desired to cut, and the closing lever 40 is manually pulled toward the grip 46. Then the closing lever 40 turns about he pivot pin fixed to the casing 28. The link 34 pivotally secured by a pin to the closing lever 40 is pushed toward the insert portion 2. The closing block 4 coupled via the slider 32 to the link 34 is correspondingly pushed in the direction of the insert portion 2. The anvil 6, connected by the coupling member 14 to the forward end of the closing block 4 and journaled at one end to the cartridge holder 12, turns toward the cartridge holder 12 down to the position where the jaw portion is completely
closed. Fig. 3 is a sectional view showing the state in which the jaw portion is in its fully closed position prior to the operation of the staple firing lever 27.
As the closing lever 40 is operated to turn, its first and second camming surfaces also turn accordingly. As the jaw portion becomes fully closed, the pre-release button 41 moves rearward and its pointed forward end snaps into engagement with the first camming surface of the closing lever 40 along its stepped portion to give a tactile and audio feedback since the stepped portion of the first camming surface of the closing lever 40 tilts and overhangs inwardly of the arcuate locus of the forward end of the pre-release button 41 as referred to previously. As the jaw portion is fully closed, the pre-release button 41 moves in the direction in which to project out of the casing 38, then the inner surface of the hollow closing lever 40 pushes the end portion of the lock lever 43 on the side opposite from its projection engaged with the groove 15 of the closing rack 24. As a result, the projection of the lock lever 43 disengages from the groove 15 of the closing rack 26, enabling the staple firing lever 27 to be operated.
Fig. 3 shows the state in which when the closing lever 40 is pulled toward the grip 46 to place the jaw portion in its fully closed position, the prerelease button 41 projects out of the casing 28 but the release button 42 does not project out therefrom and the lock lever 43 does not lock the staple firing lever 27.
In the state of Fig. 3, after it is recognized that the jaw portion lies in the position where to cut the body tissue of the affected area, the staple firing lever 27 is pulled toward the grip 46. The teeth of the closing lever 27 mesh with the teeth cut in one end portion of the closing rack 26 to bring the latter toward the insert portion 2. Then, the teeth cut in the other end portion of the clocking rack 26 come to mesh with the small gear of the gear wheel 25 to
drive it. The teeth cut in the outer peripheral portion of the gear 25 mesh with the teeth of the cam bar rack 24 to drive it toward the insert portion 2.
Since the forward end of the cam bar rack 24 is coupled to one end of the cam bar adapter 23 connected at the other end to the cam bar 21 and the knife 20, the cam bar 21 and the knife 20 are also driven forwardly toward the insert portion 2.
When the tapered forward end portion of the cam bar 21 pushes up the staple holding members 10 toward the anvil 6 as the cam bar 21 moves in the slot cut in the cartridge 5, the staples 7 are pushed through the body tissue against the grooves cut in the surface of the anvil 6, whereby the body tissue is stapled. The staples 7 are ejected from the cartridge holder 12 one after another by the tapered forward end portion of the cam bar 21 urged forwardly in the direction from the operating portion to the insert portion 2, and then the knife 20 is guided by the groove 19 of the anvil 6 to cut the stapled body tissue by the cutting edge of the knife 20.
Fig. 4 shows the state in which the staple firing lever 27 has just been operated with the jaw portion held in its fully closed position, that is, in which stapling has just been completed and the knife 20 and the cam bar 21 are in their foremost positions. In Fig. 4, when the body tissue to be fastened is not thick, the staples 7 are not urged hard against the anvil 6, in which case, on releasing the staple firing lever 27, the knife 20 and the cam bar 21 will readily return to their initial positions even without the need for pressing the pre-release button 41. When the body tissue to be fastened is thick, however, there arises the same problem as encountered in the prior art. That is, when the staple firing lever 27 is released for returning to its initial position after the stapling operation, the metal-made, elastic staples each act as a spring and apply tension between
the staple holding member in the cartridge and the anvil because each staple has an arc-shaped portion. Then, the tension acts on each cam bar which slides in the slot, and when the tension becomes larger than the force of the coiled spring disposed near the staple firing lever, the cam bar and the staple firing lever will not return to their initial positions.
Upon pressing the pre-release button 41 when the staple firing lever 27 does not return to its initial position, the jaw portion assumes its half-open position, that is, the anvil 6 turns a little away from the cartridge 5 to prevent the staples 7 from applying tension to the cam bar 21 through the staple holding members 10 even if the body tissue to be fastened is too thick. In other words, pressing the pre-release button 41 disengages its forward end from the first camming surface of the closing lever 40, allowing the closing lever 40 to turn in the direction away from the grip 46 to the position where the second camming surface engages the forward end portion of the release button 42. In this instance, no tension is applied to the cam bar 21; hence, the cam bar 21 , the knife 20 and the staple firing lever 27 return to their initial positions. As the jaw portion comes near its fully closed position, the prerelease button 41 moves in the direction in which to project out of the casing 28, and the inner surface of the hollow closing lever 40 abuts against the rear end portion of the lock lever 43 to disengage its forward end projection from the groove 15 of the cam bar rack 24, and hence the staple firing lever 27 is operable. However, upon the pre-release button 41 being pressed, it turns and the closing lever 40 no longer pushes the rear end of the lock lever 43, and consequently, the lock lever 43 biased by the plate spring moves to the position where to engage the groove 15 of the cam bar rack 24, locking the staple firing lever 27. Since the staple firing lever is inoperable, the knife 20 will not be advanced forwardly in the direction of the insert portion 2. That
is, there is no fear of making an unnecessary cut in the body tissue by inadvertent actuation of the staple firing lever 27. Figs. 1 and 5 show the state in which the pre-release button 41 is pressed, the jaw portion is half open and the release button 42 projects out of the casing 28. Incidentally, the wording "half open" in the specification and the claims should be construed as referring also to "slightly open" since the jaw portion needs only to open to such an extent as to ensure returning the cam bars and the staple firing lever to their initial position after stapling a thick body tissue. In the case where the knife 20 returns to its initial position when the jaw portion is full open, since the knife 20 moves with the body tissue 44 held apart from the anvil 6, there is the possibility of the knife 20 making unnecessary contact with an area of the body tissue different from the incision when the knife 20 returns to its initial position. According to the present invention, however, since the knife 20 returns to its initial position with the jaw portion held half open, the knife passes the same area of the body tissue 44 when it advances and retracts — this eliminates the possibility of unnecessarily cutting body tissues.
The lock lever 43 is mounted coaxially with the pre-release button 41 and the release button 42 and configured to turn in the pre-release button 41 of the hollow configuration as referred to previously. And, since the lock lever 43 is always pushed by the plate spring toward the closing rack 24, the forward end portion of the lock lever 43 will surely engage the groove of the clock rack 24 retracting on the pre-release button 41 being pressed after the operation of the staple firing lever 27. That is, the staple firing lever 27 cannot be operated unless the jaw portion is fully closed.
In the states shown in Figs. 1 and 5, upon pressing the pre-release
button 41, the jaw portion becomes full open and hence it completely unclamps the body tissue, enabling the insert portion 2 to be pulled out of the patient body.
According to Embodiment 1, since the pre-release button projects out of the body portion only when the jaw portion is in its fully closed position, it is possible to prevent a user from misoperation.
Further, according to Embodiment 1 , the stepped portion of the first camming surface of the closing lever is inclined to overhang inwardly of the circularly arcuate locus of the forward end of the pre-release button 41 so that when the jaw portion is fully closed, the forward end portion of the prerelease button snaps into engagement with the first camming surface, giving a tactile and audio feedback.
The stapling instrument of Embodiment 1 is provided with the locking mechanism which permits operation of the knife actuating means and the staple pusher means only when the jaw portion is fully closed — this excludes the possibility of misoperation by the user.
Further, since the stapling instrument of Embodiment is provided with the locking mechanism composed of the lock lever disposed in the hollow pre-release button, the closing rack having a groove for engagement with the forward end of the lock lever and the spring for biasing the forward end of the lock lever toward the groove, the forward end of the lock lever engages the groove of the closing rack without fail, preventing malfunction of the locking mechanism.
Claims
1. A stapling instrument comprising: a body portion having an operating portion; an insert portion extending from said body portion lengthwise thereof; openable/closable jaw portion attached to the forward end of said insert portion; a jaw actuating means for actuating said jaw portion to open and close; staple pusher means; knife actuating means for actuating a knife housed in said insert portion; and pre-release means for actuating said jaw actuating means to bring said jaw portion from its fully-closed to half- open position and hold said jaw portion in said half-open position.
2. The stapling instrument of claim 1, characterized in that said jaw portion comprises: a staple cartridge; a cartridge holder for holding said staple cartridge; and an anvil pivotally secured to said cartridge holder.
3. The stapling instrument of claim 2, characterized in that said jaw actuating means comprises a closing pipe coupled to said anvil and a closing lever coupled to said closing pipe.
4. The stapling instrument of any one of claims 1 to 3, characterized in that said pre-release means comprises: a closing lever having first and second camming surfaces which are operatively associated with said anvil; a pre-release button which engages at one end with said first camming surface; and a release button which engages at one end with said second camming surface.
5. The stapling instrument of claim 4, characterized in that said pre-release button projects out of said body portion for operation only when said pre-release means is operated with said jaw portion held in its fully closed position.
6. The stapling instrument of claim 5, characterized in that said release button projects out of said body portion for operation only when said jaw portion is held in its half-open position.
7. The stapling instrument of any one of claims 1 to 6, characterized in that said first camming surface has a stepped portion which is inclined further inwardly than a circularly arcuate locus of a forward end of said pre-release button pivotally mounted on said body portion.
8. The stapling instrument of any one of claims 1 to 7, characterized by the provision of a locking mechanism which allows operation of said knife actuating means and said staple pusher means only when said jaw portion is held in its fully-closed position.
9. The stapling instrument of claim 8, characterized in that said locking mechanism comprises: a lock lever disposed in said pre-release button of hollow configuration; a cam bar rack having a groove for engagement with the forward end of said lock lever; and a spring for biasing one end of said lock lever in the direction of said groove.
10. The stapling instrument of any one of claims 1 to 9, characterized in that said staple pusher means and said knife actuating means comprise: cam bars and a knife extending from said operating portion toward said jaw portion; staple holding portions provided in the vicinity of a staple storage portion in said staple cartridge and a staple firing lever coupled via a rack member to said cam bars and said knife.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/JP2005/002366 WO2006085389A1 (en) | 2005-02-09 | 2005-02-09 | Stapling instrument |
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
PCT/JP2005/002366 WO2006085389A1 (en) | 2005-02-09 | 2005-02-09 | Stapling instrument |
Publications (1)
Publication Number | Publication Date |
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WO2006085389A1 true WO2006085389A1 (en) | 2006-08-17 |
Family
ID=36792965
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/JP2005/002366 WO2006085389A1 (en) | 2005-02-09 | 2005-02-09 | Stapling instrument |
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