BUTTRESS ATTACHMENT FEATURES FOR SURGICAL STAPLING APPARATUS
20210085312 ยท 2021-03-25
Inventors
- Rahim R. Merchant (Hamden, CT, US)
- Gerald N. Hodgkinson (Killingworth, CT, US)
- Danny R. Berry (Cheshire, CT, US)
- Sally L. Carter (Nashua, NH, US)
Cpc classification
A61B17/07292
HUMAN NECESSITIES
A61B17/1155
HUMAN NECESSITIES
International classification
Abstract
An end effector assembly for use with a surgical stapler, comprising a staple cartridge having a tissue contacting surface, an anvil plate having a tissue contacting surface, a buttress material releasably disposed on the tissue contacting surfaces of each of the staple cartridge and the anvil plate, and an epoxy positioned onto the tissue contacting surfaces of each of the staple cartridge and anvil plate defining an attachment zone configured to retain the respective buttress material atop the respective tissue contacting surfaces.
Claims
1. (canceled)
2. An end effector assembly comprising: a staple cartridge; an anvil plate including first and second openings defined therein, and having a tissue contacting surface; a buttress material overlying the tissue contacting surface of the anvil plate; and first and second retaining members each including a pair of buttons linked together by a tether, the tether extending through the respective first and second openings of the anvil plate and through the buttress material, the pair of buttons sized larger than the first and second openings to releasably secure the buttress material to the anvil plate.
3. The end effector assembly according to claim 2, wherein the buttress material includes first and second holes in registration with the first and second openings, respectively, of the anvil plate, and the tether of the first and second retaining members extend through the respective first and second holes.
4. The end effector assembly according to claim 2, wherein the first and second openings of the anvil plate are defined through respective first and second side surfaces of the anvil plate, the first and second side surfaces disposed on opposed sides of the tissue contacting surface.
5. The end effector assembly according to claim 4, wherein the anvil plate is linear and the first and second side surfaces extend longitudinally along the opposed sides of the tissue contacting surface.
6. The end effector assembly according to claim 4, wherein the anvil plate is annular and defines a centrally located aperture therein, and the first and second side surfaces extend annularly around the opposed sides of the tissue contacting surface.
7. The end effector assembly according to claim 4, wherein the buttress material includes a body portion overlying the tissue contacting surface of the anvil plate and first and second flaps extending from the body portion and overlying the respective first and second side surfaces of the anvil plate, the tether of the first and second retaining members extending through the respective first and second flaps of the buttress material.
8. The end effector assembly according to claim 2, wherein a first button of the pair of buttons of each of the first and second retaining members is positioned adjacent to an outer surface of the buttress material and a second button of the pair of buttons is positioned adjacent to an inner surface of the anvil plate.
9. The end effector assembly according to claim 8, wherein the buttress material includes perforations aligned with the first buttons such that the first buttons break through the perforations when the buttress material is released from the anvil plate.
10. The end effector assembly according to claim 2, wherein the first and second retaining members are bioabsorbable.
11. The end effector assembly according to claim 2, wherein the first and second retaining members are dissolvable.
12. The end effector assembly according to claim 2, wherein the first and second openings defined in the anvil plate are one of a plurality of first and second openings, and the first and second retaining members are one of a plurality of first and second retaining members.
13. The end effector assembly according to claim 2, further including a second buttress material releasably disposed on the staple cartridge.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0053] Various embodiments of the presently disclosed interlocking buttress retention systems are disclosed herein with reference to the drawings, wherein:
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DETAILED DESCRIPTION OF THE EMBODIMENTS
[0086] Various exemplary embodiments of the present disclosure are discussed herein below in terms of buttresses for use with surgical stapling apparatus. The buttresses described herein may be used in sealing a wound by approximating the edges of wound tissue between a staple cartridge and an anvil plate of a surgical stapling apparatus which contains at least one buttress. The at least one buttress is joined to the surgical stapling apparatus by at least one attachment zone formed by an epoxy positioned between a tissue contacting surface of each of the staple cartridge and anvil plate and the least one buttress. Firing of the surgical stapling apparatus forces legs of at least one staple to pass through an opening on the staple cartridge, the tissue, and the openings on the anvil plate to secure the buttress to the tissue, to secure the adjoining tissue to one another, and to seal the tissue. Thus, the present disclosure describes surgical buttresses, surgical stapling apparatus supporting said surgical buttresses, and methods and mechanisms for using the same.
[0087] It should be understood that a variety of surgical stapling apparatus may be utilized with a surgical buttress of the present disclosure. For example, linear stapler configurations may be utilized, such as, for example those including Duet TRS reloads and staplers with Tri-Staple technology, available through Covidien, which maintain a principal place of business at 555 Long Wharf Drive, North Haven, Conn. 06511, and transverse anastomosis staplers, such as, for example, EEA, CEEA, GIA, EndoGIA, and TA surgical staplers, also available through Covidien. It should also be appreciated that the principles of the present disclosure are equally applicable to surgical staplers having alternate configurations, such as, for example, end-to-end anastomosis staplers having a circular cartridge and anvil (see, e.g., commonly owned U.S. Pat. No. 5,915,616, entitled Surgical Fastener Applying Apparatus, the entire content of which is incorporated herein by this reference); laparoscopic staplers (see, e.g., commonly owned U.S. Pat. Nos. 6,330,965 and 6,241,139, each entitled Surgical Stapling Apparatus, the entire contents of each of which being incorporated herein by this reference); and transverse anastomosis staplers (see, e.g., commonly owned U.S. Pat. Nos. 5,964,394 and 7,334,717, each entitled Surgical Fastener Applying Apparatus, the entire contents of each of which being incorporated herein by this reference).
[0088] Embodiments of the presently disclosed surgical buttress and surgical stapling apparatus will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. In the following discussion, the terms proximal and trailing may be employed interchangeably, and should be understood as referring to the portion of a structure that is closer to a clinician during proper use. The terms distal and leading may also be employed interchangeably, and should be understood as referring to the portion of a structure that is further from the clinician during proper use. As used herein, the term patient should be understood as referring to a human subject or other animal, and the term clinician should be understood as referring to a doctor, nurse, or other care provider and may include support personnel.
[0089] Referring now to
[0090] Surgical stapling apparatus 10 generally includes a handle 12 having an elongate tubular member 14 extending distally from handle 12. An end effector assembly 16 is mounted on a distal end 18 of elongate tubular member 14. End effector assembly 16 includes a staple cartridge 200 configured to receive a cartridge body 32 therein and an anvil plate 300. End effector assembly 16 may be permanently affixed to elongate tubular member 14 or may be detachable and thus replaceable with a new end effector assembly 16. Anvil plate 300 is movably mounted on distal end 18 of jaw assembly 16 and is movable between an open position spaced apart from staple cartridge 200 to a closed position substantially adjacent staple cartridge 200. Anvil plate 300 is fabricated from a metal material, including and not limited to stainless steel, titanium, titanium alloy, and the like. At least a tissue contacting surface of staple cartridge 200 is fabricated from a material other than metal, including and not limited to plastic, thermoplastic, resin, polycarbonate, and the like.
[0091] Surgical stapling apparatus 10 further includes a trigger 33, as seen in
[0092] A driver 36, as seen in
[0093] Reference may be made to commonly owned U.S. Pat. Nos. 5,915,616, 6,330,965 and 6,241,139, referenced above, for a detailed discussion of the construction and operation of an exemplary surgical stapling apparatus 10.
[0094] Staple cartridge 200 and/or anvil plate 300 may be provided with a surgical buttress 500. Surgical buttress 500 is provided to reinforce and seal the lines of staples applied to tissue by surgical stapling apparatus 10. Surgical buttress 500 may be configured into any shape, size, or dimension suitable to fit any surgical stapling, fastening, or firing apparatus.
[0095] Staple cartridge 200 is provided with a cartridge buttress 500a and anvil plate 300 is provided with an anvil buttress 500b in the manners described in more detail hereinbelow. The buttresses 500a, 500b may be made from any biocompatible natural or synthetic material. The material from which the buttresses 500a, 500b are formed may be bioabsorbable or non-bioabsorbable. It should be understood that any combination of natural, synthetic, bioabsorbable and non-bioabsorbable materials may be used to form the buttress material. The buttresses 500a, 500b may be porous or non-porous, combination of porous and non-porous layers. The non-porous buttresses 500a, 500b may be utilized to retard or prevent tissue ingrowth from surrounding tissues thereby acting as an adhesion barrier and preventing the formation of unwanted scar tissue.
[0096] Additional exemplary materials for surgical buttresses 500a, 500b for use with the surgical stapling devices disclosed herein are set forth in commonly assigned U.S. Pat. Nos. 5,542,594; 5,908,427; 5,964,774; and 6,045,560, and commonly assigned U.S. Application Publication Nos. 2006/0085034, filed on Apr. 20, 2006; and 2006/0135992, filed on Jun. 22, 2006, the entire contents of each of being hereby incorporated herein by reference in their entirety.
[0097] As illustrated in the current embodiment and shown in
[0098] With reference to
[0099] Cartridge buttress 500a includes perforations 246 that allow cartridge buttress 500a to be released from the tissue contacting surface 220. Perforations 246 extend linearly in a direction perpendicular to the central longitudinal slot 238 near the proximal and distal attachment zones 240a, 240b. In particular, at the distal end 262 of staple cartridge 200, perforations 246a of the cartridge buttress 500a are disposed between the distal attachment zone 240a and the distal end of the central longitudinal slot 238. Further, at the proximal end 260 of staple cartridge 200, the perforations 246b of the cartridge buttress 500a are disposed distally of each proximal attachment zone 240b.
[0100] With reference to
[0101] Anvil buttress 500b includes perforations 346 similar to cartridge buttress 500a. Perforations 346 of anvil buttress 500b extend linearly in a direction perpendicular to the central longitudinal slot 338 near the proximal and distal attachment zones 340a, 340b from the first and second outer edges 348a, 348b. In particular, at the distal end 362 of anvil plate 300, the perforations 346a of the anvil buttress 500b are disposed between the distal attachment zone 340a and the distal end of the central longitudinal slot 338. Further, at the proximal end 360 of anvil plate 300, the perforations 346b of the anvil buttress 500b are disposed distally of each proximal attachment zone 340b. the perforations enable the buttresses 500a, 500b to be permanently attached to the anvil plate and staple cartridge while allowing the release of the buttresses after stapling has been performed.
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[0103] During assembly, epoxy 250, 350 is disposed at predetermined locations on tissue contacting surfaces 220, 320 of each of staple cartridge 200 and anvil plate 300 by known methods, such as spraying, dipping, blotting, dabbing, or similar known methods in the art. Once the buttresses 500a, 500b are placed onto each of the tissue contacting surfaces 220, 320 of staple cartridge 200 and anvil plate 300, respectively, an ultraviolet light is used to cure epoxy 250, 350 and bond buttresses 500a, 500b to the epoxy 250, 350 and thus to the tissue contacting surfaces 220, 320. In any of the embodiments disclosed herein, it is contemplated that the epoxy could be partially cured and then the buttress is adhered to the partially cured epoxy.
[0104] In any of the embodiments disclosed herein, the epoxy can be an epoxy that is cured using any electromagnetic radiation, including but not limited to ultraviolet light.
[0105] As illustrated in
[0106] As shown in
[0107] Surgical stapling apparatus 10 is initially actuated by movement of trigger 33 relative to handle 12 (
[0108] Upon full actuation of surgical stapling apparatus 10, a knife 30 associated with surgical stapling apparatus 10 and carried by driver 36 may be utilized to cut tissue T, as well as surgical buttresses 500a, 500b between the rows of now formed staples 50. Upon movement of anvil plate 300 to the open position spaced apart from staple cartridge 200, surgical buttresses 500a, 500b finish pulling away from tissue contacting surfaces 220, 320 from staple cartridge 200 and anvil plate 300 along the perforations 246, 346.
[0109] The resulting tissue T, divided and stapled closed with staples 50, is illustrated in
[0110] Referring now to
[0111] Staple cartridge 122 may be fixedly connected to the distal end of tubular body portion 114 or may be configured to concentrically fit within the distal end of tubular body portion 114. Staple cartridge 122 includes a staple pusher 164 including a proximal portion having a generally frusto-conical shape and a distal portion defining two concentric rings of peripherally spaced fingers (not shown), each one of which is received within a respective staple retaining slot 152.
[0112] A knife 130, substantially in the form of an open cup with the rim thereof defining a knife blade 131, is disposed within staple cartridge 122 and mounted to a distal surface of a staple pusher 164. The knife 130 is disposed radially inward of the pair of annular arrays of staples 150. Accordingly, in use, as the staple pusher 164 is advanced, the knife 130 is also advanced axially outward.
[0113] As seen in
[0114] It is envisioned that the surgical buttress 124 may be additionally or alternatively attached or adhered to tissue contacting surface of anvil plate 121 in a manner similar to the surgical buttress 124 attached to staple cartridge 122.
[0115] As shown in
[0116] Surgical stapling apparatus 110 and detachable anvil assembly 120 are used in an anastomosis procedure to effect joining of intestinal sections 50 and 52. The anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. At the point in the procedure shown in
[0117] Thereafter, the clinician maneuvers anvil assembly 120 until the proximal end of shaft 123 is inserted into the distal end of tubular body portion 114 of surgical stapling apparatus 110, wherein the mounting structure (not shown) within the distal end of tubular body portion 114 engages shaft 123 to effect the mounting. Anvil assembly 120 and tubular body portion 114 are then approximated to approximate intestinal sections 50, 52. Surgical stapling apparatus 110 is then fired. A knife (not shown) cuts the portion of tissue and surgical buttress 124 disposed radially inward of the knife, to complete the anastomosis. The anvil assembly 120 and staple cartridge 122 are opened, with surgical buttress 124 stapled to intestinal sections 50 and 52. Surgical buttress 124 tears away from the deposits of epoxy 150, along perforations 146.
[0118] With reference now to
[0119] Buttress material 1000 is disposed on the tissue contacting surface 2200 of staple cartridge 2000 over the openings 2380a of retention slots 2380. Buttress material 1000 includes a pair of flaps 1020 positioned adjacent side surfaces 2320 of staple cartridge 2000 and includes at least one hole 1040 extending through each of flaps 1020. Each hole 1040 is longitudinally spaced apart from the next along the length of a respective flap 1020. Staple cartridge 2000 further includes at least one opening 2480 in each of side surfaces 2320 where each opening 2480 corresponds to a respective one of the holes 1040 of buttress material 1000. In one embodiment, when buttress material 1000 is disposed on tissue contacting surface 2200, holes 1040 of buttress material 1000 substantially align or are in registration with the corresponding openings 2480 of staple cartridge 2000.
[0120] With reference now to
[0121] Retaining members 1060 may be formed of a bio-compatible or bio absorbable material. In one embodiment, retaining members 1060 may be configured to be brittle and absorbable such that, upon firing of surgical stapling apparatus 10, retaining members 1060 are fractured to release buttress material 1000 from staple cartridge 2000. In another embodiment, retaining members 1060 may be dissolvable upon application of a subsequent fluid by the surgeon or by a surgical instrument, e.g. a saline fluid, during use in order to release buttress material 1000 from staple cartridge 2000. Retaining members 1060 may also or alternatively be dissolvable by body fluids in order to release buttress material 1000. In another embodiment, retaining members 1060 may be formed of an absorbable polymer or other similar low melt temperature material that is configured to melt or soften at body temperature, e.g., about 37 C., to release buttress material 1000 from staple cartridge 2000. In any of the embodiments disclosed herein, retaining members that are integrally formed with the buttress material may be used to attach the buttress to the anvil or staple cartridge of a stapling apparatus.
[0122] With reference now to
[0123] With reference now to
[0124] It is contemplated that a buttress material 1000 or 2100 may also or alternatively be disposed on anvil assembly in the same manner as described above with regard to the attachment of buttress materials 1000 and 2100 to staple cartridge 2000.
[0125] With reference now to
[0126] Buttress material 4000 is sized such that when buttress material 4000 is positioned over tissue contacting surface 3360 of staple cartridge 3200, buttress material 4000 extends radially beyond inner surface 3200a and outer surface 3200b of staple cartridge 3200 such that inner portion 4020 and outer portion 4060 of buttress material 4000 may be folded over to abut or engage inner and outer surfaces 3200a, 3200b, respectively.
[0127] Each of inner portion 4020 and outer portion 4060 includes an annular array of holes 4412, 4416, respectively, and inner and outer surfaces 3200a and 3200b include corresponding openings 3240, 3260, respectively for the reception of retaining members 1060 therethrough. For example, when buttress 4000 is positioned on tissue contacting surface 3360 with inner and outer portions 4020, 4060 folded over to abut inner and outer surfaces 3200a, 3200b, respectively, the holes 4120, 4160 and the corresponding openings 3240, 3260 may be substantially radially aligned or in registration.
[0128] With reference now to
[0129] With reference now to
[0130] With reference now to
[0131] One of retaining members 1060 extends through each hole 5100 of inner portion 5020 and through the corresponding openings 3500 of flange 3480 to secure buttress material 5000 to staple cartridge 3200. For example, the tether 1100 of a respective retaining member 1060 extends through one of openings 3500 of flange 3480 and through the corresponding hole 5100 of inner portion 5020 of buttress material 5000 such that the first button 1080a is disposed adjacent a proximal surface 3480a of flange 3480 and the second button 1080b is disposed adjacent a distal surface 5020a of inner portion 5020 of buttress material 5000. Each button 1080 is sized to be larger than a respective opening 3500 or hole 5100 to inhibit removal of the retaining member 106 from the opening 3500 or hole 5100 during use.
[0132] With reference now to
[0133] One of retaining members 1060 extends through each hole 5100 of inner portion 5020 of buttress material 5000 and through the corresponding openings 3540 of the distal portion 3520a of the inner surface 3520 of staple cartridge 3200 to secure buttress material 5000 to staple cartridge 3200. For example, the tether 1100 of a respective retaining member 1060 extends through one of openings 3540 of the distal portion 3520a of inner surface 3520 of staple cartridge 3200 and through the corresponding hole 5100 of inner portion 5020 of buttress material 5000 such that the first button 1080a is disposed proximal of the opening 3540 in distal portion 3520a and the second button 1080b is disposed adjacent a distal surface 5020a of inner portion 5020 of buttress material 5000. Each button 1080 is sized to be larger than a respective opening 3540 or hole 5100 to inhibit removal of the retaining member 1060 from the opening 3540 or hole 5080 during use.
[0134] Referring now to
[0135] Referring now to
[0136] In one embodiment, retaining members 1060 may be formed during assembly of the surgical stapling apparatus or placement of buttress material to the surgical stapling apparatus 10, 110 during the manufacture or assembly thereof. In a method of attaching the buttress material to a surgical stapling apparatus, the polymer is deposited onto the buttress material, the polymer material having a melting temperature lower than the melting temperature of the buttress material. The polymer can be deposited by injection molding, spraying, dipping, or other methods. In this way, the polymer material can be melted without disrupting the physical properties of the buttress material. In an embodiment of the present disclosure, the degradable polymer material for the attachment features is the polymer used in making Caprosyn sutures, also known as L25, which has a melt temperature of about 125 to about 145 degrees Celsius, while the buttress material is L41 or L21, which have melting temperatures of about 210 to about 220 degrees Celsius and about 185 to about 200 degrees Celsius respectively. The L21 polymer is used to make Maxon sutures. The polymer L41 is similar to L21, but has a different chemical structure, and has a greater degree of crystallinity and a higher glass transition temperature and melting temperature. Both L21 and L41 are a copolymer of glycolide and trimethylene carbonate.
[0137] In certain embodiments, the top of the driver 36 mechanically disrupts the interlocking features of the bonding polymer and may shear off a portion of the polymer material. In certain embodiments, the knife severs off a portion of the polymer material that attaches the buttress material to the apparatus. In certain embodiments, small pushers are provided in the staple cartridge, which are actuated along with the staple firing pushers, to release the buttress material from the apparatus. In further embodiments, additional cutting assemblies can be provided in the anvil, staple cartridge, or both.
[0138] In any of the embodiments disclosed herein, the buttress material or the polymer of the attachment zone or attachment feature can be made from glycolic acid, glycolide, lactic acid, lactide, dioxanone, epsilon-caprolactone, trimethylene carbonate, etc., as is known in the art.
[0139] Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, it is envisioned that the elements and features illustrated or described in connection with one exemplary embodiment may be combined with the elements and features of another exemplary embodiment without departing from the scope of the present disclosure, and that such modifications and variations are also intended to be included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.