Surgical fastener devices with geometric tubes

Abstract

An end effector for a surgical fastening device includes a fastener and a tube defining a longitudinal axis. The tube includes an outer surface and an inner surface. The inner surface defines a lumen that extends along the longitudinal axis. The tube defines depressions that may be arranged helically about the tube along the longitudinal axis. The end effector may include one or more ribs extending along the tube.

Claims

1. A surgical fastening device, comprising: a handle; a shaft extending from the handle; and an end effector supported on the shaft and configured to support at least one fastener, the end effector including: a tube defining a longitudinal axis and including an outer surface and an inner surface, the inner surface defining a lumen that extends along the longitudinal axis, the tube defining a proximal depression and a plurality of distal depressions, the proximal depression defined by segments having the same longitudinal alignment, the plurality of distal depressions arranged helically about the inner surface of the tube along the longitudinal axis to guide the at least one fastener through the lumen, the tube defining a tube length; and at least one rib continually extending in a plane substantially parallel to the longitudinal axis of the tube, the at least one rib extending continually along a length of the tube length, the length of the tube length defined by at least three of the depressions.

2. The surgical fastening device of claim 1, wherein at least one depression of the plurality of distal depressions is defined by recesses in the outer surface of the tube.

3. The surgical fastening device of claim 2, wherein at least a portion of the depressions of the plurality of distal depressions form grooves at predetermined locations along the tube.

4. The surgical fastening device of claim 3, wherein the grooves are disposed between inner ridges configured to contact the at least one fastener as the at least one fastener advances through the lumen.

5. The surgical fastening device of claim 1, further comprising a drive member supported within the tube, the drive member rotatable relative to the tube to distally advance the at least one fastener along the tube.

6. The surgical fastening device of claim 1, wherein the at least one rib interrupts adjacent depressions of the plurality of distal depressions along the tube.

7. The surgical fastening device of claim 6, wherein the at least one rib includes a plurality of ribs positioned along the tube at predetermined radial locations about the tube to increase stiffness of the tube.

8. The surgical fastening device of claim 7, wherein the plurality of ribs includes three ribs.

9. The surgical fastening device of claim 1, wherein at least some of the plurality of distal depressions are stamped in the tube.

10. An end effector comprising: a tube defining a longitudinal axis and including an outer surface and an inner surface, the inner surface defining a lumen that extends along the longitudinal axis and including a proximal inner ridge and distal inner ridges to guide at least one fastener through the lumen, the proximal inner ridge defined by segments disposed in longitudinal alignment with one another, the distal inner ridges disposed in a helical arrangement along the longitudinal axis and having an interrupted pattern, the tube defining a tube length; and at least one rib continually extending in a plane substantially parallel to the longitudinal axis of the tube, the at least one rib extending continually along a length of the tube length, the length of the tube length defined by at least three of the inner ridges.

11. The end effector of claim 10, wherein the proximal and distal inner ridges are formed by depressions defined in the outer surface of the tube.

12. The end effector of claim 10, further comprising a drive member supported within the tube, the drive member rotatable relative to the tube to distally advance the at least one fastener along the tube.

13. The end effector of claim 10, wherein the at least one rib extends longitudinally along the outer surface of the tube, the at least one rib creating the interrupted pattern by interrupting adjacent ridges of the proximal or distal ridges.

14. The end effector of claim 13, wherein the at least one rib includes a plurality of ribs supported at spaced apart locations around the tube.

15. An end effector for a surgical fastening device, the end effector comprising: a tube defining a longitudinal axis and including an outer surface and an inner surface, the inner surface defining a lumen that extends along the longitudinal axis, the inner surface of the tube defining a proximal depression and a plurality of distal depressions arranged about the tube along the longitudinal axis, the proximal depression defined by segments disposed at the same longitudinal location along the longitudinal axis, the proximal depressions configured to prevent proximal movement of a fastener through the lumen and at least one depression of the plurality of distal depressions configured to facilitate distal advancement of the fastener through the lumen, the tube defining a tube length; and at least one rib continually extending in a plane substantially parallel to the longitudinal axis of the tube, the at least one rib extending continually along a length of the tube length, the length of the tube length defined by at least three depressions of the plurality of distal depressions.

16. The end effector of claim 15, wherein at least some depressions of the plurality of distal depressions are defined by recesses in the outer surface of the tube.

17. The end effector of claim 16, wherein the plurality of distal depressions form inner grooves at predetermined locations along the inner surface of the tube.

18. The end effector of claim 15, wherein the tube includes a proximal portion and a distal portion, the proximal portion having a first thickness and the distal portion having a second thickness, the first and second thicknesses being different.

19. The end effector of claim 15, wherein at least one of the proximal depression or one depression of the plurality of distal depressions is stamped in the tube.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

(1) The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description given below, serve to explain the principles of the disclosure, wherein:

(2) FIG. 1 is a perspective view of a surgical fastener for use in an endoscopic surgical device in accordance with the present disclosure;

(3) FIG. 2 is a side, elevational view of the surgical fastener of FIG. 1;

(4) FIG. 3 is a distal, end view of the surgical fastener of FIGS. 1 and 2;

(5) FIG. 4 is a side, elevational view, partially broken away, of the surgical fastener of FIGS. 1-3;

(6) FIG. 5 is a perspective view of an endoscopic surgical device having one embodiment of an end effector supported thereon in accordance with the present disclosure;

(7) FIG. 6A is an enlarged, perspective view of an outer tube of the end effector shown in FIG. 5;

(8) FIG. 6B is a top view of the outer tube of FIG. 6A;

(9) FIG. 6C is a cross-sectional view of the outer tube of FIGS. 6A and 6B, as taken along line 6C-6C shown in FIG. 6A;

(10) FIG. 6D is a cross-sectional view of the outer tube of FIGS. 6A and 6B, as taken along line 6D-6D shown in FIG. 6A;

(11) FIG. 6E is a proximal end view of the outer tube of FIGS. 6A and 6B;

(12) FIG. 6F is a distal end view of the outer tube of FIGS. 6A and 6B;

(13) FIG. 6G is an enlarged, perspective view of the indicated area of detail shown in FIG. 6A;

(14) FIG. 7 is a perspective view of an inner tube of the end effector of FIG. 5 with a plurality of surgical fasteners of FIGS. 1-4 shown separated therefrom;

(15) FIG. 8A-8C are progressive, cross-sectional views of a distal portion of the end effector of FIG. 5, illustrating the surgical fasteners of FIGS. 1-4 being advanced therethrough;

(16) FIG. 9 is a perspective illustration showing the anchoring and/or fixation of a surgical mesh to underlying tissue with a plurality of surgical fasteners of the endoscopic surgical device of FIG. 5;

(17) FIG. 10 is a perspective view of another embodiment of an end effector of the endoscopic surgical device of FIG. 5, the end effector having a shipping wedge secured thereto;

(18) FIG. 11A is a perspective view of the end effector of FIG. 10;

(19) FIG. 11B is a distal end view of the end effector of FIG. 11A;

(20) FIG. 12A is a perspective view of an outer tube of another embodiment of an end effector of the endoscopic surgical device of FIG. 5;

(21) FIG. 12B is an enlarged, perspective view of the indicated area of detail shown in FIG. 12A;

(22) FIG. 12C is a distal end view of the outer tube of FIG. 12A; and

(23) FIG. 13 is a schematic illustration of a medical work station and operating console in accordance with the present disclosure.

DETAILED DESCRIPTION

(24) Embodiments of endoscopic surgical devices and end effectors in accordance with the present disclosure are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term distal refers to that portion of the device that is farther from the user, while the term proximal refers to that portion of the device that is closer to the user. As commonly known, the term clinician refers to a doctor, a nurse or any other care provider, and may include support personnel. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.

(25) Non-limiting examples of endoscopic surgical devices according to the present disclosure include manual, mechanical and/or electromechanical surgical tack appliers (e.g., tackers) and the like.

(26) Referring initially to FIGS. 1-4, an illustrative embodiment of a surgical fastener or tack for use with the endoscopic surgical devices of the present disclosure is illustrated and generally designated as an anchor 100. As seen in FIGS. 1-4, the anchor 100 includes a head section 110, a mesh retention section 120, and a threaded tissue-snaring section 130. The head section 110 of the anchor 100 includes a pair of opposing threaded sections 112a, 112b having respective radially, outer, helical head threads 114a, 114b, and a pair of opposing open or slotted sections 116a, 116b. A distal surface of the head section 110 is formed onto or integral with a proximal end of the mesh retention section 120.

(27) The mesh retention section 120 of the anchor 100 extends from and between a distal end or surface of the head section 110 of the anchor 100 and a proximal end of the tissue-snaring section 130 of the anchor 100. The mesh retention section 120 functions to lock, anchor or otherwise retain a surgical mesh M (FIG. 9) onto the anchor 100 when the anchor 100 is screwed into the surgical mesh M to a depth past a proximal-most segment 138 of the tissue-snaring thread 132 of the tissue-snaring section 130. This is achieved because there is no thread located in the mesh retention section 120 that would enable the anchor 100 to be unscrewed or backed out from the surgical mesh M.

(28) The mesh retention section 120 of the anchor 100 has a cylindrical or conical transverse cross-sectional profile. The mesh retention section 120 includes a transverse radial dimension, relative to a central longitudinal axis of the anchor 100, that is smaller than a transverse radial dimension of the head section 110 of the anchor 100, and smaller than a transverse radial dimension of the proximal-most segment 138 of the tissue-snaring thread 138 of the anchor 100.

(29) The threaded tissue-snaring section 130 of the anchor 100 includes helical threads 132 formed onto a tapered truncated body section 134. A distal point or tip 136 of the anchor 100 defines the terminus of the distal most tissue-snaring thread 132.

(30) As seen in FIG. 4, the body section 134 of the tissue-snaring section 130 is tapered, e.g., becoming smaller toward the distal end of the threaded tissue-snaring section 130. The body section 134 includes a concave taper. The tissue-snaring threads 132 of the anchor 100 terminate at the distal tip 136 of the anchor 100.

(31) The anchor 100 may be constructed from any suitable bioabsorbable material, such as, for example polylactide, polyglycolide, polylactide-co-glycolide or the like. In some embodiments, the anchor may be formed of a co-polymer. The anchor 100 may be formed of a solid, non-cannulated configuration.

(32) Turning now to FIG. 5, an endoscopic surgical device, in the form of an endoscopic surgical tack applier or tacker, is shown generally as 200. The tack applier 200 includes a handle assembly 210 and an endoscopic assembly 230 extending from the handle assembly 210 to an end effector 300. The tack applier 200 may be a reusable device which may be cleaned, sterilized and/or autoclaved for reuse following a surgical procedure, and which may be used with a plurality of end effectors 300 during a single surgical procedure. The end effector 300 of the endoscopic assembly 230 is a reload and may be in the form of a single use loading unit (SULU) or disposable loading unit (DLU). The tack applier 200 is configured to store and selectively dispense or fire the anchors 100 from the end effector 300 and into the surgical mesh M overlying tissue.

(33) As seen in FIG. 5, the handle assembly 210 of the tack applier 200 includes a handle housing 212 formed from a first half-section 212a and a second half section 212b joined to one another. The first half-section 212a and the second half section 212b of the handle housing 212 may be joined to one another using methods known by those with skill in the art, including and not limited to welding, mechanical press fit, fastening (e.g., with screws), and the like.

(34) The handle assembly 210 of the tack applier 200 includes a trigger 214 pivotably connected to the handle housing 212 at a location remote from the endoscopic assembly 230. The trigger 214 is movable from an extended or un-actuated position to a retracted or actuated position to fire the anchors 100 from the end effector 300. The trigger 214 may be spring-biased towards to the un-actuated position and operably coupled to a drive assembly 212c supported in the handle assembly 210 and the endoscopic assembly 230.

(35) The handle assembly 210 of the tack applier 200 includes a button 240 and a slider 244 supported on the handle housing 212. The slider 244 is configured to effectuate a loading/retention and/or a release/removal of the end effector 300 to/from the endoscopic assembly 230. The button 240 is configured to selectively enable and/or inhibit actuation of the trigger 214 of the handle assembly 210, so that a clinician can, for example, safely effectuate a loading/retention, and/or a release/removal, of an end effector 300 to/from the endoscopic assembly 230 of the tack applier 200.

(36) The handle assembly 210 further includes an articulation knob 246 rotatably supported on handle housing 212 and operably coupled to the anchor retaining/advancing assembly 230. Rotation of articulation knob 246 results in the articulating and/or straightening of the end effector 300 about an articulation joint 250 relative to the anchor retaining/advancing assembly 230.

(37) For a detailed description of the construction and operation of a similar endoscopic surgical devices having one or more of the same or similar components for use with one or more components of the presently described endoscopic surgical devices, reference may be made to U.S. Patent Application Publication No. 2015/0005748, the entire contents of which are incorporated by reference herein.

(38) Turning now to FIGS. 5-7, the end effector 300 is selectively connectable to a distal portion of the endoscopic assembly 230 and may be in the form of a reload. In some embodiments, end effector 300 may be disposable, autoclavable/sterilizable and/or reusable. The end effector 300 includes an outer tube 302 and an inner tube 304 rotatably supported within the outer tube 302. The inner tube 304 supports the surgical anchors 100 therein and is rotatable relative to the outer tube 302 to axially advance the surgical anchors 100 through the outer tube 302.

(39) With reference to FIG. 6A, the outer tube 302 of the end effector 300 defines a longitudinal axis L that extends between a proximal end portion 302a of the outer tube 302 and a distal end portion 302b of the outer tube 302. The proximal end portion 302a defines a key slot 306 for engagement with a complementary key (not shown) formed on a distal end portion of the endoscopic assembly 230 to align the end effector 300 and the endoscopic assembly 230 with one another. The outer tube 302 further includes an outer surface 302c and an inner surface 302d. The inner surface 302d of the outer tube 302 defines a lumen 302e that extends through the outer tube 302 along the longitudinal axis L. The outer tube 302 further includes a proximal portion 308 and a distal portion 310 that extends distally from the proximal portion 308. The proximal portion 308 extends distally to features (e.g., tabs) 308a, 308b that project inwardly toward the lumen 302e and prevents the inner tube 304 from translating proximally. The proximal portion 308 may further define a wedge opening 308c transversely therethrough to support a shipping wedge (see FIG. 10). The distal portion 210 extends distally from the proximal portion 308 to a distal end opening 302f of the outer tube 302 that is in registration with the lumen 302e of the outer tube 302.

(40) Referring to FIGS. 6B-6G, the distal portion 310 of the outer tube 302 includes a proximal depression 312 that may extend circumferentially about the outer tube 302 at a single longitudinal location along the longitudinal axis L. The proximal depression 312 functions as a constraining feature or constraining diameter to limit distal movement of the inner tube 304 relative to the outer tube 302. The distal portion 310 further includes distal depressions 314 arranged along the longitudinal axis L and spaced apart from the proximal depression 312. The distal depressions 314 may be helically arranged about the outer tube 302. Each of the distal depressions 314 may have an identical arc length as one or more of the other distal depressions 314. The proximal and distal depressions 312, 314 may be depressed (e.g., rolled, stamped, crimped, deposited on a mandrel or plate, or otherwise formed etc.) into the outer surface 302c such that the proximal and distal depressions 312, 314 are recessed into the outer surface 302c and project radially inwardly from the inner surface 302d to form a plurality of inner ridges 313 extending into the lumen 302e of the outer tube 302. The inner ridges 313 may be a trough of the respective depressions 312, 314.

(41) Disposed adjacent to the depressions 312, 314, on the outer surface 302c of the outer tube 302, are outer ridges 315 that may be formed by virtue of the formation of the depressions 312, 314. The inner ridges 313 define a plurality of inner grooves 311 on the inner surface 302d of the outer tube 302, which are positioned to enable the anchors 100 to be axially advanced through the outer tube 302 upon rotation of the anchors 100 through the inner grooves 311.

(42) The proximal and distal depressions 312, 314 of the distal portion 310 of the outer tube 302 are separated (e.g., interrupted) by one or more stiffness members or ribs 316a, 316b that extend longitudinally along the distal portion 310 of the outer tube 302 and function to increase the structural stiffness and limit deflection of the outer tube 302. The ribs 316a, 316b (and so on, depending on the number of ribs) separate the proximal depression 312 into segments (depicted as a first segment 312a and a second segment 312b for a two-rib design), and the distal depressions 314 into segments (depicted as a first and second segments 314a, 314b for a two-rib design) such that each depression 312, 314 has an interrupted profile. With this interrupted profile, each of the depressions 312, 314 is discontinuous, with ends of continuous segments of respective depressions 312, 314 spaced apart along an arc length corresponding to a width of the respective ribs 316a, 316b (and so on, depending on the number of ribs). This interrupted profile may provide each depression of the proximal and distal depressions 312, 314 with a first end 318a and a second end 318b, as seen in FIGS. 6E and 6F. With the ribs 316a, 316b (and so on, depending on the number of ribs) separating each of the depressions 312, 314, each of the depressions 312, 314 has an arc length less than 360 degrees.

(43) The distal depressions 314 of the distal portion 310 further include a distal-most segment 314c that may circumscribe a different arc length about the circumference of the outer tube 302 (e.g., circumscribes a shorter or longer arc length about the circumference of the outer tube 302) than the arc lengths of one or more of the other segments 314a, 314b (and so on, depending on the number of ribs) of the distal depressions 314 to effectuate proper release of the anchors 100 through the distal end opening 302f of the outer tube 302 as the anchors 100 are dispensed out of the outer tube 302.

(44) With reference to FIG. 7, the inner tube 304 of the end effector 300 is rotatably disposed within the outer tube 302 of the end effector 300. The inner tube 304 includes a proximal end portion 304a and a distal end portion 304b. The proximal end portion 304a is configured to couple to the drive assembly 212c of the tack applier 200 (FIG. 5). The inner tube 304 includes retention tabs 304c projecting radially outward therefrom. In some embodiments, the inner tube 304 includes three retention tabs 304c disposed about a circumference at offset locations about the circumference. The retention tabs 304c are axially fixed and rotatably seated in a slot 302f (FIG. 6C) defined by the outer tube 302 between a proximal surface of the depression 312 of the outer tube 302 and a distal surface of the features (e.g., tabs) 308a, 308b of the outer tube 302. In some embodiments, the retention tabs 304c may be in the form of one or more annular rings circumscribing the inner tube 304.

(45) When the inner and outer tubes 304, 302 are assembled together, the inner tube 304 may be advanced through the proximal end of the outer tube 302 such that the tabs 308a, 308b of the outer tube 302 are deflected radially outwardly from an initial position by the insertion of the inner tube 304 into the outer tube 302 until after the retention tabs 304c are advanced distally past the tabs 308a, 308b of the outer tube 302. After the retention tabs 304c of the inner tube 304 are advanced distally past the tabs 308a, 308b of the outer tube 302, the tabs 308a, 308b of the outer tube 302, which may be formed of resilient material, deflect or bias radially inwardly back to their initial position. With the inner and outer tubes 304, 302 assembled together, the tabs 308a, 308b of the outer tube 302 prevent the inner tube 304 from moving proximally relative to the outer tube 302 and the proximal surface of the depression 312 prevents the inner tube 304 from moving distally relative to the outer tube 302 such that the inner tube 304 is axially fixed relative to the outer tube 302. While the inner tube 304 is axially fixed relative to the outer tube 302, the inner tube 304 can rotate relative to the outer tube 302 with the retention tabs 302c rotatable through the slot 302f of the outer tube 302.

(46) The distal end portion 304b of the inner tube 304 defines a pair of tines 304d, 304e separated by channels 304f, 304g that extend into a central lumen 304h of the inner tube 304. The distal end portion 304b of the inner tube 304 is configured to receive and support a plurality of anchors 100 within the central lumen 304h of the inner tube 304. In particular, the anchors 100 are loaded into the end effector 300 such that the pair of opposing threaded sections 112a, 112b of the anchors 100 extend through the respective channels 304f, 304g of the distal end portion 304b of the inner tube 304 and are rotatably disposed within the inner grooves 311 of the outer tube 311. The pair of tines 304d, 304e of the distal end portion 304b of the inner tube 304 are disposed within the pair of slotted sections 116a, 116b of the anchors 100 to rotatably drive the anchors 100 through the inner grooves 311 of the outer tube 302 and axially along the longitudinal axis L and the central lumen 304h of the inner tube 304. Each anchor 100 is loaded into the end effector 300 such that adjacent anchors 100 are not in contact with one another so as to not damage the distal tips 136 of the anchors 100.

(47) In use, actuation of the trigger 214 of the tack applier 200 causes the drive assembly 212c to transmit rotation to the inner tube 304 of the end effector 300. As inner tube 304 is rotated, as indicated by arrows A, about longitudinal axis L (see FIGS. 8A-8C), and with respect to the inner grooves 311 of the outer tube 302, the tines 304d, 304e of inner tube 304 transmit the rotation to the anchors 100 (only one anchor 100 shown) and advance the anchors 100 distally, as indicated by arrows B, owing to the head threads 114a, 114b of the anchors 100 engaging with the inner grooves 311 and inner ridges 313 of the outer tube 302. Although only a single anchor 100 is shown in FIGS. 8A-8C for illustrative purposes, the inner tube 304 can transmit rotation to an entire stack of anchors 100 and simultaneously advance the entire stack of anchors 100 distally in response to rotation of the inner tube 304 relative to the outer tube 302 as described above.

(48) One or more components of the tack applier 200 and anchors 100 may be configured such that a single complete and full actuation of the trigger 214 may result in a firing of a single anchor 100 (e.g., the distal-most anchor of the stack of anchors 100 loaded in end effector 300) from the end effector 300.

(49) The tack applier 200 may be repeatedly fired to fire the anchors 100 from the end effector 300, for example, into the surgical mesh M as seen in FIG. 9, until the surgical procedure is complete or until the end effector 300 is spent of the anchors 100. If end effector 300 is spent of the anchors 100, and if additional anchors 100 are required to complete the surgical procedure, the spent end effector 300 may be replaced with a new (e.g., loaded with anchors 100) end effector 300.

(50) Turning now to FIGS. 10, 11A, and 11B, another embodiment of an end effector, generally referred to as end effector 400, is substantially similar to end effector 300 and therefore is only described herein to the extent necessary to explain the differences in construction and operation of the end effector 400. The end effector 400 includes an outer tube 402 and an inner tube 404 that releasably support one or more anchors 100.

(51) The outer tube 402 includes three spaced-apart ribs 406a, 406b, and 406c to increase rigidity/stiffness. Such increased rigidity and/or structural stiffness may be provided in multiple planes, directions, and/or angles. By comparison, the outer tube 302 of the end effector 300 only has two ribs 316a, 316b, which provides relatively less stiffness than embodiments with more ribs, but also provides greater flexibility than embodiments with more ribs, such as the outer tube 402 of the end effector 400. Accordingly, although the outer tube 402 has relatively more stiffness, and therefore relatively greater rigidity than the outer tube 302 of the end effector 300, the outer tube 302 of the end effector 300 has relatively greater contact with the anchors 100 (e.g., each rib interrupts the inner groove/ridge profile of the respective embodiment of the outer tube), and therefore, depending on relative geometries, has relatively increased fastener guidance through the end effector 300.

(52) In embodiments, the ribs of the present disclosure may be positioned at relatively spaced-apart locations about the circumference of the presently disclosed outer tubes such that the pair of opposing threaded sections 112a, 112b of the anchor 100 do not simultaneously engage (in some embodiments fully engaged, in other embodiments, partially engaged) two diametrically opposed ribs (e.g., ribs exactly 180 degrees apart and/or ribs approximately 180 degrees apart) as the anchor 100 rotates through the outer tube. Advantageously, such positioning of the ribs prevents the anchor 100 from misfiring and/or misaligning as the anchor 100 rotates relative to the outer tube. For example, in an embodiment with three ribs, the three ribs can be annularly spaced apart such that no two of the three ribs are diametrically opposed, whereby only one of the thread sections 112a, 112b of the anchor 100 is engaged with the ribs (e.g., one of the three ribs) at a time. In embodiments with more ribs, for instance five or more ribs, both threaded sections 112a, 112b of the anchor 100 may be at least partially engaged with two different ribs, but such ribs will not be diametrically opposed, thereby preventing misfire and/or misalignment of an anchor 100.

(53) As seen in FIG. 10, a shipping wedge 500 may be provided with any of the disclosed embodiments of end effectors. The shipping wedge 500 is configured to releasably connect to one of the presently disclosed end effectors. For example, the shipping wedge 500 may include a pin 502 that extends through the end effector 400 and wings 504 that capture the end effector 400 to secure the shipping wedge 500 to the end effector 400. While the shipping wedge 500 is coupled to the end effector 400, the pin 502 of the shipping wedge 500 inhibits premature rotation of the inner tube 404 of the end effector 400 and helps to facilitate loading/unloading of the end effector 400 to/from the tack applier 200. The shipping wedge 500 further includes a handle portion 506 to facilitate gripping thereof.

(54) Turning now to FIGS. 12A-12C, yet another embodiment of an outer tube, generally referred to as outer tube 602, is substantially similar to outer tubes 302, 402 and therefore is only described herein to the extent necessary to explain the differences in construction and operation of the outer tube 602. While the outer tube 602 is similar to outer tubes 302, 402, the outer tube 602 does not include any ribs to increase flexibility/deflectability of the outer tube 602 so that respective depressions, grooves, and inner/outer ridges thereof may have continuous or substantially continuous arrangements about the outer tube 602. For example, depressions 604 of the outer tube 602 may have a single continuous helical arrangement about the outer tube 602 along the longitudinal axis L thereof.

(55) In certain embodiments of the outer tube, instead of forming inner ridges by depression, the outer tube may include inner ridges that are in the form of threads and may be, formed by cutting away material, not displacing material by depression.

(56) In some embodiments of the outer tube, one or more of the presently disclosed ribs may be discontinuous along one or more portions of a length of the respective ribs, whereby such ribs define a plurality of spaced-apart longitudinal segments. Such ribs may define one or more depressions having one or more varying arc lengths along the length of the longitudinal axis X. In some embodiments of the outer tube, one or more of the depressions of the outer tube may cross over one or more ribs of the outer tube.

(57) In certain embodiments, one or more of the depressions can be formed in the outer tube with one or more stamping forming dies (not shown) that are configured to form the one or more ribs. The depressions or ridges may also be formed by rolling, piercing and forming, cold forming, etc. The depression forming tooling may include both inner and outer contact/forming tools. The outer forming tools may include one or more stamping/forming dies, and will define the depression and/or rib geometry imparted to outer surface 402 of outer tube 402. The inner forming tool may be an arbor that will define the geometry imparted to an inner surface of outer tube 402. In general, the arbor geometry will closely resemble the negative of the outer forming die geometry. Depending on configuration, the arbor tool may be removed from finished part by rotation (unscrewed) or by use of collapsible tool technology.

(58) In embodiments, the ribs do not interrupt the inner surface of the presently disclosed outer tube. In some embodiments, the ribs extend only along the outer surface of the presently disclosed outer tube. In certain embodiments, to further increase guidance of tissue along the ribs or insertion of the outer tube into tissue, a secondary set of inner ridges may be formed on the inner surface of the presently disclosed outer tube along the ribs thereof so as to align (e.g., helically) with a primary set of inner ridges as defined by the depressions of the presently disclosed outer tube detailed above.

(59) Although some of the embodiments of the outer tube are shown with two or three ribs, the presently disclosed outer tubes can include any number of ribs (e.g., 0, 1, 2, 3, 4, 5, 6 . . . n). Such ribs may be spaced apart at any suitable annular angle between 0 and 360 degrees relative to one another. For instance, in some embodiments, adjacent ribs may be annularly spaced apart less or equal to than about 180 degrees relative to one another, while in certain embodiments, adjacent ribs may be annularly spaced apart less than or equal to about 90 degrees relative to one another. In an embodiment, adjacent ribs may be annularly spaced apart by about 120 degrees relative to one another. The presently disclosed ribs can be provided in any suitable configuration such as splines, coils, tabs, shafts, rods, tubes, cables, wires, etc. and/or combinations thereof. In certain embodiments, one or more the ribs may include nonlinear (e.g., curved and/or arcuate, such as c and/or s-shaped) and/or linear profiles.

(60) The presently disclosed outer tubes, or portions thereof (e.g., one or more of the ribs), may have any suitable dimension. For example, embodiments of the outer tube may have a length between about 2 inches and about 4 inches, and/or a thickness that ranges between about 0.005 inches and about 0.02 inches, particularly between about 0.009 inches and about 0.015 inches, and more particularly between about 0.011 and about 0.013 inches. In some embodiments, the presently disclosed outer tubes, or portions thereof, may have variable thicknesses along the length thereof that are configured to optimize deflection and/or structural stiffness properties. For instance, the proximal end portion of the outer tube, or portions thereof, may include a first thickness that is different from a distal end portion of the outer tube, or portions thereof. Or, in certain embodiments, the thickness of the outer tube may have a predetermined gradient, or multiple gradients, along a length, or portions of the length thereof.

(61) The presently disclosed outer tubes, or portions thereof, can be formed of, or provided with, any suitable material. In some embodiments, the presently disclosed outer tubes, or portions thereof, may be formed of different materials. Suitable materials include, and are not limited to, stainless steel, titanium, and nickel-titanium (also known as Nitinol) for shape-memory properties.

(62) With reference to Table 1 below, the following data was compiled using finite element analysis to compare tip deflection of different outer tube designs under identical bending load applied to distal end.

(63) TABLE-US-00001 TABLE 1 Distal Tip Deflection of a Compared to Baseline Simplified 1 Unit [higher value means less Tubes Length Tube (in) stiffness; less rigidity] Tube 1: Smooth Tube (Baseline) 0.006 1.0X Tube 2: 2-rib (load applied inline with ribs) 0.016 2.7X (0.035 rib) Tube 3: 2-rib (load applied off-ribs) 0.127 21.2X Tube 4: 3-rib (.013 rib) 0.029 4.8X Tube 5: 3-rib (.026 rib) 0.022 3.7X Tube 6: 3-rib (.035 rib) 0.02 3.3X Tube 7: 3-rib (.035 rib)( (.0568 pitch, 0.018 3.0X thread termination at rib) Tube 8: 3-rib (.040 rib) 0.017 2.8X Tube 9: 3-rib (.050 rib) 0.015 2.5X Tube 10: Zero-rib (continuous thread 0.115 19.2X w/o interruption)

(64) The finite element analysis for the data compiled with respect to Table 1 above included the following inputs for relative deflections: Modelsimplified 1 length (from the distal end of the outer tube); Material305 SS; Constraintsfully constrained bottom proximal face of 1 sample length Loads 10 lbf applied normal to tube axis on the distal end face and in-line with the rib.

(65) With reference to Table 2 below, the following data was also compiled using finite element analysis to compare tip deflection and max stress of different outer tube designs.

(66) TABLE-US-00002 TABLE 2 Tubes Distal Tip Deflection (in) Max Stress (ksi) Tube A: .110 437 Smooth Tube (Baseline) Tube B: .310 992 3-rib (.030 rib) with circular retention feature Tube C: .262 807 3-rib (.030 rib) with interrupted circular retention feature Tube D: .227 646 3-rib (.040 rib) with interrupted circular retention feature Tube E: .202 602 3-rib (.050 rib) with interrupted circular retention feature Tube F: .307 1101 3-rib (.035 rib) with no retention feature

(67) The finite element analysis for the data compiled with respect to Table 2 above included the following inputs for relative deflections: Modelfull-length production style tube that includes typical production features (e.g., holes, cuts, etc.) that exist for purposes such as attachment to device 230, assembly of shipping wedge, etc.; Material301 SS; Constraintsfully constrained volume regions were created in the proximal end of the tube to represent the actual contact areas when the tube 300 is assembled on the device 200. Loads 10 lbf applied normal to tube axis on the distal end face and in-line with the rib.

(68) As can be appreciated, securement of any of the components of the presently disclosed devices can be effectuated using known fastening techniques such welding, crimping, gluing, etc.

(69) In accordance with the present disclosure, a kit may be provided including a tack applier 200, an end effector 300, and a set of instructions for using tack applier 200 in combination with end effector 300. In another embodiment, the kit may include at least one tack applier 200, a plurality of end effectors 300, and a set of instructions for using a tack applier 200 in combination with at least one of the plurality of end effectors 300.

(70) The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as Telesurgery. Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.

(71) The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of clinicians may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another clinician (or group of clinicians) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled clinician may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.

(72) The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the clinician to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the clinician. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).

(73) The master handles may include various sensors to provide feedback to the clinician relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the clinician with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the clinician's ability to mimic actual operating conditions.

(74) Referring also to FIG. 13, a medical work station is shown generally as work station 1000 and generally may include a plurality of robot arms 1002, 1003; a control device 1004; and an operating console 1005 coupled with the control device 1004. The operating console 1005 may include a display device 1006, which may be set up in particular to display three-dimensional images; and manual input devices 1007, 1008, by means of which a person (not shown), for example a clinician, may be able to telemanipulate the robot arms 1002, 1003 in a first operating mode.

(75) Each of the robot arms 1002, 1003 may include a plurality of members, which are connected through joints, and an attaching device 1009, 1011, to which may be attached, for example, a surgical tool ST supporting an end effector 1100 (e.g., a pair of jaw members) in accordance with any one of several embodiments disclosed herein, as will be described in greater detail below.

(76) The robot arms 1002, 1003 may be driven by electric drives (not shown) that are connected to the control device 1004. The control device 1004 (e.g., a computer) may be set up to activate the drives, in particular by means of a computer program, in such a way that the robot arms 1002, 1003, their attaching devices 1009, 1011 and thus the surgical tool (including the end effector 1100) execute a desired movement according to a movement defined by means of the manual input devices 1007, 1008. The control device 1004 may also be set up in such a way that it regulates the movement of the robot arms 1002, 1003 and/or of the drives.

(77) The medical work station 1000 may be configured for use on a patient P lying on a patient table 1012 to be treated in a minimally invasive manner by means of the end effector 1100. The medical work station 1000 may also include more than two robot arms 1002, 1003, the additional robot arms likewise connected to the control device 1004 and telemanipulatable by means of the operating console 1005. A surgical system, such as the presently disclosed surgical system, may also be attached to the additional robot arm. The medical work station 1000 may include a database 1014 coupled with the control device 1004. In some embodiments, pre-operative data from patient/living being P and/or anatomical atlases may be stored in the database 1014.

(78) Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as 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, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variations are also included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.