SURGICAL STAPLER
20220395274 · 2022-12-15
Inventors
Cpc classification
A61B17/0644
HUMAN NECESSITIES
A61B2017/00004
HUMAN NECESSITIES
A61B2017/07264
HUMAN NECESSITIES
A61B2017/00911
HUMAN NECESSITIES
A61B2017/00853
HUMAN NECESSITIES
A61B17/1155
HUMAN NECESSITIES
International classification
Abstract
A surgical stapler is disclosed herein. The surgical stapler comprises a body having a distal end and a proximal end, and the body defines an interior space. A first knob and a second knob are configured adjacent the proximal end of the body. An anvil and trocar assembly is configured adjacent the distal end of the surgical stapler, wherein the anvil and trocar assembly is coupled to the first knob, and the first knob is configured to facilitate the extension and retraction of the anvil and trocar assembly at the distal end of the body. A staple and knife assembly is configured adjacent the anvil and trocar assembly within the body, wherein the staple and knife assembly is coupled to the second knob, and wherein the second knob is configured to facilitate firing of staples and actuation of a knife of the staple and knife assembly sequentially.
Claims
1. A surgical apparatus, comprising: (a) a body assembly, comprising: (i) a handle portion, and (ii) a shaft portion extending distally from the handle portion; (b) an end effector comprising a staple driver, wherein the staple driver is movable relative to the shaft portion of the body assembly between an unfired position and a fired position; (c) a staple firing actuator located on the handle portion of the body assembly; (d) a tissue cutting actuator located on the handle portion of the body assembly; (e) a staple containment housing that holds a plurality of unformed metal staples until the moment of dispensing the staples for forming in tissue; (f) an anvil assembly for receiving staple tips containing at least one contiguous uninterrupted staple-forming groove of at least the length of two unformed staple widths and which is substantially the same groove depth over its entire length, the at least one contiguous uninterrupted staple-forming groove configured for forming a plurality of staples during the same firing.
2. The surgical apparatus of claim 1, wherein the assembly comprises a circular-shaped distal end effector having at least one fully circular or arcuate groove, and wherein the at least one fully circular or arcuate groove is configured to form a plurality of staples during a single actuation, wherein the number of unformed (U-shaped) staples per linear centimeter of groove length is two or more.
3. The surgical apparatus of claim 1, wherein the anvil assembly comprises a linear distal end effector having at least one straight anvil groove, the at least one straight anvil groove oriented in a fixed or movable (articulable) mode, generally parallel with or up to an angle of 90 degrees to a shaft axis, and wherein the at least one straight anvil groove is configured to form a plurality of staples during a single actuation, wherein the number of unformed (U-shaped) staples per linear centimeter of groove length is two or more.
4. The surgical apparatus of claim 1, wherein the wherein the anvil assembly comprises an arcuate distal end effector having at least one circular or arcuate groove configured to form a plurality of staples during a single actuation, wherein the number of unformed (U-shaped) staples per linear centimeter of groove length is two or more.
5. A surgical apparatus, comprising: (a) a body assembly, comprising: (i) a handle portion, and (ii) a shaft portion extending distally from the handle portion; (b) an end effector comprising a staple driver, wherein the staple driver is movable relative to the shaft portion of the body assembly between an unfired position and a fired position; (c) a staple firing actuator located on the handle portion of the body assembly; (d) a tissue cutting actuator located on the handle portion of the body assembly; (e) a staple containment housing that holds a plurality of unformed metal staples until the moment of dispensing the staples for forming in tissue; (f) an anvil assembly for receiving staple tips containing at least one contiguous uninterrupted staple-forming groove of at least the length of two unformed staple widths and which is substantially the same groove depth over its entire length, the at least one contiguous uninterrupted staple-forming groove configured for forming a plurality of staples during the same firing; (g) a tissue release mechanism located within the handle portion of the body assembly, comprising; (i) a spring to store mechanical energy during closure of the anvil assembly; and (ii) a rotary knob operatively coupled to an elongated shaft and the anvil assembly; and (iii) a releasable shaft-engaging mechanism which operatively couples the rotary knob to the anvil during closure and the storage of mechanical energy; and (iii) a triggering mechanism to unleash the energy stored in the spring to allow a movable anvil of the anvil assembly to automatically move distally after completing the firing, enabling stapled tissue to easily be released.
6. The surgical apparatus of claim 2, further comprising: (h) a tissue compression limiter that is operatively connected to the movable anvil, and comprising at least one tension-limiting spring.
7. The surgical apparatus of claim 2, further comprising: (i) a high mechanical advantage staple firing mechanism comprising; (i) a slidable elongated driver shaft operatively connected to a staple driver, and containing a screw thread; (ii) an adjusting knob operatively connected to the slidable elongated driver shaft, and including a mating screw thread for engagement with the slidable elongated driver shaft;
8. The surgical apparatus of claim 2, further comprising: (j) a tactile feedback mechanism to emit a vibration and/or emit a clicking sound sufficient to be easily heard by a clinician, and wherein the tactile feedback mechanism is located on or within the handle portion, to alert the clinician of firing completion; and (k) a hardened stainless steel or ceramic knife sufficiently tough and sharp enough to cut through tissue and any of the softer metal staples from prior firings used to close tissues
9. The surgical apparatus of claim 2, wherein the anvil assembly further comprises: (l) an anvil mounted flat receiving substrate disc, wherein the anvil mounted flat receiving substrate disc is at least one of coating of polymer and rubber configured adjacent to the staple forming grooves, the anvil mounted flat receiving substrate disc configured to solidly back up the circular knife for effective cutting of the tissue and any prior staple lines encountered.
10. The surgical apparatus of claim 8, wherein the hardened stainless steel or ceramic knife imparts a rotational slicing action during tissue cutting.
11. The surgical apparatus of claim 2, wherein the movable anvil includes selectively serrated, machined, coated, or abrasive blasted surfaces, designed to grip tissue and prevent slippage during the stapling and/or cutting of tissues.
12. The surgical apparatus of claim 2, further comprising a clutching mechanism that effectively limits the torque which a clinician may input via turning the adjusting knob, and wherein the clutching mechanism is operatively connected to the slidable elongated shaft and anvil.
13. The surgical apparatus of claim 2, wherein the staple firing actuator and the tissue cutting actuator located on the handle portion of the body assembly are the same actuator operable in different operating modes.
14. The surgical apparatus of claim 1, wherein the staple firing actuator and the tissue cutting actuator located on the handle portion of the body assembly with both the staple firing and tissue cutting functions effectuated by the same actuator.
15. The surgical apparatus of claim 1, wherein: an anvil of the anvil assembly is constructed of at least one material selected from stainless steel and aluminum metal, wherein the at least one material is at least one of anodized, treated, oxidized, or tinted with colors; or the anvil of the anvil assembly is constructed of at least one metal selected from stainless steel or aluminum metal, wherein the at least one metal is coated or impregnated with at least one material selected from a group consisting of polytetrafluoroethylene (PTFE), stearate emulsions, or greases, wherein the at least one material, when interacting with the malleable metal staple, generates a coefficient of friction less than or equal to 0.5, whether static or sliding; or the anvil of the anvil assembly is constructed of a polymer and having a coating substantially hard enough to enable staples to form, wherein the coating is at least one of electro-plated coating of a metallic material.
16. The surgical apparatus of claims 1, further comprising unformed staples which include a pre-bend, to bias the buckling direction of the staple tips consistently toward each other during device actuation and staple forming, and to reduce the column strength of the staple legs to reduce the force required to form the staples.
17. The surgical apparatus of claim 1, wherein all the staples are fully formed prior to engagement of the knife to cut the tissue.
18. The surgical apparatus of claim 2, wherein an anvil shaft of the anvil assembly does not contain radial orientation means to provide radial positioning of the anvil to a plurality of cartridge pockets.
19. The surgical apparatus of claim 18, wherein the anvil shaft is configured to have an interference fit with a mating cartridge surface for at least a portion of shaft engagement with a mating surface of a staple cartridge.
20. The surgical apparatus of claims 1, wherein the staples are plated, coated or impregnated with at least one material selected from a group consisting of polytetrafluoroethylene (PTFE), stearate emulsions, and greases, wherein when the at least one material interacting with the malleable metal staple, generates a coefficient of friction less than or equal to 0.5, whether static or sliding.
Description
BRIEF DESCRIPTION OF THE DRAWINGS
[0038] The description of the illustrative embodiments can be read in conjunction with the accompanying figures. It will be appreciated that for simplicity and clarity of illustration, elements illustrated in the figures have not necessarily been drawn to scale. For example, the dimensions of some of the elements are exaggerated relative to other elements. Embodiments incorporating teachings of the present disclosure are shown and described with respect to the figures presented herein, in which:
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DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS
[0052] For clarity of disclosure, the terms “proximal” and “distal” are defined herein relative to a surgeon, or other operator, grasping a surgical instrument having a distal surgical end effector. The term “proximal” refers to the position of an element arranged closer to the surgeon, and the term “distal” refers to the position of an element arranged closer to the surgical end effector of the surgical instrument and further away from the surgeon.
[0053] Moreover, to the extent that spatial terms such as “top,” “bottom,” “upper,” “lower,” “vertical,” “horizontal,” are used herein with reference to the drawings, it will be appreciated that such terms are used for exemplary description purposes only and not intended to be limiting or absolute. In that regard, it will be understood that surgical instruments such as disclosed herein may be used in orientations and positions not limited to those shown and described herein.
[0054] In addition, the term “endoscopic” is used generally to refer to surgical procedures performed through a small incision or a cannula inserted into a patient's body including endoscopic, laparoscopic and arthroscopic surgical procedures. Finally, the term clinician is used generally to refer to medical personnel including doctors, nurses, and support personnel.
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[0057] Referring to
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[0061] Reference is now directed to
[0062] The variable threaded tube 112 defines a variable thread 112A along an inner surface thereof. The adjustable shuttle 114 is configured for insertion and movement along a longitudinal axis of the variable threaded tube 112, wherein the adjustable shuttle 114 is coupled to the variable threaded tube 112 via a pin 114A configured to engage with the variable thread 112A to facilitate the linear movement of the adjustable shuttle 114 within the variable threaded tube 112. More specifically, the pin 114A is in engagement with the variable thread 112A, and when the first knob 104 is rotated, the variable threaded tube 112 rotates as well. The rotation of the variable threaded tube 112 causes the pin 114A to follow the variable thread 112A in accordance with the direction of rotation of the first knob 104. In one embodiment, the clockwise rotation of the first knob 104 may facilitate the movement of the adjustable shuttle 114 towards the distal end of the body for facilitating the extension of the anvil and trocar assembly from the distal end of the body. Similarly, the counterclockwise rotation of the first knob 104 may facilitate the retraction of the anvil and trocar assembly. The closure rod 116 extends from the adjustable shuttle 114 up to the distal end of the body for facilitating the extension or retraction of the anvil and trocar assembly in accordance with the rotation of the first knob 104.
[0063] Referring to
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[0073] A disadvantageous aspect of the conventional circular relates to opening and removing the device smoothly from the patient and knowing the position that is safe to open the device. The difficulty of removing a device after firing it or opening it to a position inadequate for safe removal can cause inadvertent tearing and undetected disruption of a portion of the staple line due to inability of the knife to cut completely through tissue and previous staple lines, and also due to the knife being retracted immediately after firing, and allowing the tissue to fall axially inward, causing it to snag on the edges of the cartridge and anvil. The present invention solves this problem by leaving the knife 140 distal until opened further following withdrawal from the patient, and then retracting the knife 140 sequentially thereafter, to prevent exposure to the clinicians during tissue doughnut inspection. Further, the present invention utilizes a hardened knife to effectively cut through prior staple lines, and an automatically opening anvil to ensure the device is adequately opened to remove it safely without disrupting the anastomotic staple line.
[0074] It is to be noted that the surgical stapler further comprises a second biasing element 144 disposed between the trocar 128 and the closure rod 116 for providing a biasing force against the downward movement of the trocar 128 to limit the compressive forces acting on the tissues T held between the anvil 130 and the distal end 102A to prevent any unwanted tissue injury.
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[0078] It is to be noted that one disadvantageous aspect of the conventional circular staplers is the difficulty of firing the device due to the high force to squeeze the firing lever to form the staples, and cut the knife backing washer and tissue. To this end, an improved actuation mechanism including the first knob 104, the second knob 106, and the associated components have been described herein. The actuation mechanism uses a combination of improvements including the use of a high mechanical advantage firing system comprising a drive screw, low coefficient of friction components, and pre-bent staples with smaller wire diameters, all combined. More specifically, the use of knobs instead of levers makes it very convenient to fire the staples. Furthermore, the unique pre-bent profile of the staple 138 described herein, in combination with first and second knobs 104, 106, and the use of low coefficient of friction components or adequately lubricated components provides an ease of usage not found in the conventional circular staplers having an actuation lever.
[0079] Another advantageous aspect of the stapler 100 is the simple configuration of the stapler. More specifically, the design of the stapler 100, in accordance with the present subject matter, includes very few components as compared to the designs of the conventional circular staplers, which is achieved by replacing the firing lever with a high mechanical advantage rotary firing mechanism and by combining multiple components into fewer components where sensible and were possible to accomplish this without sacrificing function. The reduced number of components also have an added advantage in terms being economical for manufacturing. It is important to note that the present invention is not limited to circular staplers, but can be included in various surgical staplers, e.g. linear or curved staplers, both open and laparoscopic, and whether or not they contain a cutter to subsequently transect tissue following the stapling. The reduced number of components also has an added advantage of ensuring that the surgical stapler 100 has a simple operation. Furthermore, the presence of a single rotary actuator for stapling, tissue cutting, as well as retraction of the trocar makes the stapler 100 intuitive and easy to use, while reducing the time required by the practitioner to familiarize himself with the stapler 100.
[0080] Yet another advantageous aspect of the stapler 100, in accordance with an embodiment of the present subject matter, is its sequential operation. Sequential operation refers to the feature of the stapler 100 in which the knife of the stapler is actuated only after the staples have been fired to join the required tissues. This means that knife of the stapler 100 is actuated only after the tissues that are required to be joined are stapled together. Such a feature eliminates the possibility of accidentally cutting the tissues that are required to be joined before they are stapled together.
[0081] Another advantageous aspect of the stapler 100, in accordance with the present subject matter, is that incomplete firing of the staples is eliminated due to the sequential firing of the staples as well as the simple and easy to use design of the stapler 100. Therefore, the conditions occurring from such incomplete firing such as poor hemostasis, leaky anastomosis, patient harm or death, are substantially prevented using the stapler 100, in accordance with an embodiment of the present subject matter.
[0082] A typical problem with the conventional staplers is that the clinicians don't open the device consistently to the same level prior to removal, which may result in the disruption of the anastomosis upon device removal and may cause immense harm or even death to the patient. The stapler 100, in accordance with an embodiment of the present subject matter, includes a specifically designed release mechanism that includes the auto-open button 126 and other components associated thereto to ensure fast, easy, and uniform opening of the stapler 100 prior to the removal of the stapler 100 from the patient's body.
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[0085] It is to be noted that configuration of the anvil having plurality of staple forming grooves is a novel feature of the anvil that simplifies the process of design as well as manufacturing the anvil, regardless of the shape of the anvil. The anvil may be circular, linear, or curved or arcuate. More specifically, the provision of the staple forming grooves eliminates the need of anvil having staple forming pockets. An advantageous aspect of the staple forming grooves over staple forming pockets is that the staple forming grooves even if the staples do get misaligned with respect to the staple forming grooves due to some reason, the staples will still deform as required subsequent to the firing. More specifically, in conventional surgical staplers, misalignment of the staple forming pockets with respect to the incoming staples may have disastrous implications, which are completely eliminated by the configuration of the staple forming grooves in the anvil, in accordance with the embodiments of the present subject matter.
[0086] In various embodiments, the anvil and trocar may be fabricated from, for example, 300 & 400 Series, 17-4 & 17-7 stainless steel, aluminum, or titanium.
[0087] The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
[0088] Preferably, the invention described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK (DuPont de Nemours, Inc., Wilmington, Del.) bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.
[0089] The foregoing description of the specific embodiments have been described herein above that a person having ordinary skill in the art can apply the current knowledge, readily modify, or adapt for various applications such specific embodiments without departing from the generic concept. All such adaptations and modifications are intended to be comprehended within the meaning and range of equivalents of the disclosed embodiments.
[0090] Further, it is to be understood that the terminology employed herein is for the purpose of description and not of limitation. Therefore, while the embodiments herein have been described in terms of preferred embodiments, a person having ordinary skill in the art will readily recognize that the embodiments herein can be practiced with modification within the spirit and scope of the embodiments as described herein.
[0091] While the disclosure has been described with reference to exemplary embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the disclosure. In addition, many modifications may be made to adapt a particular system, device or component thereof to the teachings of the disclosure without departing from the essential scope thereof. Therefore, it is intended that the disclosure is not limited to the particular embodiments disclosed for carrying out this disclosure, but that the disclosure will include all embodiments falling within the scope of the appended claims. Moreover, the use of the terms first, second, etc. do not denote any order or importance, but rather the terms first, second, etc. are used to distinguish one element from another.
[0092] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the disclosure. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof.
[0093] The description of the present disclosure has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to the disclosure in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope of the disclosure. The described embodiments were chosen and described in order to best explain the principles of the disclosure and the practical application, and to enable others of ordinary skill in the art to understand the disclosure for various embodiments with various modifications as are suited to the particular use contemplated.