阅读说明：本技术 具有弯曲砧座末端、成角度的钉仓末端和组织抓持特征部的外科缝合器 (Surgical stapling device with bending anvil block end, angled nail bin end and grasping tissue features ) 是由 J·L·哈里斯 D·L·巴伯 J·P·肖瓦尔特 G·J·巴克斯 F·E·谢尔顿四世 于 2018-02-13 设计创作，主要内容包括：本发明公开了一种外科器械,所述外科器械包括主体部分、轴和端部执行器,所述端部执行器能够操作以压缩、缝合和切割组织。所述端部执行器包括砧座和钉仓。所述砧座具有刚性弯曲末端,所述刚性弯曲末端被构造成能够接触所述钉仓的鼻部分的成角度的表面。所述钉仓包括沿着钉平台的抓持特征部,所述抓持特征部有助于在夹紧期间抓持组织。所述仓的所述钉平台可包括多个级。所述砧座进一步包括带有侧向部分的狭槽,所述侧向部分具有弯曲的端部,所述弯曲的端部用于接纳击发梁的部分以在切割和缝合动作期间引导所述击发梁。(The invention discloses a kind of surgical instruments, the surgical instruments includes main part, axis and end effector, and the end effector can be operated with compression, suture and cutting tissue.The end effector includes anvil block and nail bin.The anvil block has rigid curved end, and the rigid curved end is configured to contact the angled surface of the nasal portion of the nail bin.The nail bin includes the grasping features along nail platform, and the grasping features help to grasp tissue during clamping.The nail platform in the storehouse may include multiple grades.The anvil block further comprises the slit with lateral part, and the lateral part has curved end, and the curved end is used to receive the part of percussion beam to guide the percussion beam during cutting and suture act.)

1. a kind of equipment, comprising:

(a) main part；

(b) axis, the axis extend from the main part towards distal side；And

(c) end effector, the end effector are connected to the axis, wherein the end effector can be in open configuration It is moved between closed configuration, wherein the end effector can be operated with compression, suture and cutting tissue, and wherein institute Stating end effector includes:

(i) storehouse, the storehouse are configured to keep one or more nails, wherein the storehouse includes with angled surface Nasal portion,

(ii) anvil block, the anvil block include proximal body portion and the end that extends from the main part towards distal side, wherein institute Stating end includes curved configuration, and

(iii) multiple grasping features, the multiple grasping features are positioned along the nail platform in the storehouse, wherein the multiple Grasping features are configured to the contact when the end effector is in the closed configuration and are grasped in the end Tissue between actuator.

2. equipment according to claim 1, wherein the end including the curved configuration is rigid.

3. equipment according to claim 1, wherein the nasal portion in the storehouse includes curved downside.

4. equipment according to claim 1, wherein the nasal portion in the storehouse includes the first blunt end, and wherein institute The end for stating anvil block includes the second blunt end.

5. equipment according to claim 4, wherein when the end effector is in the closed configuration, described Two blunt ends and first blunt end are longitudinally-aligned.

6. equipment according to claim 1, wherein the end includes inner surface, wherein at the end effector When the closed configuration, the distal part of the inner surface is configured to when there is no tissues in the end effector When contact the storehouse the nasal portion the angled surface.

7. equipment according to claim 6, wherein the inner surface of the end has angled construction.

8. equipment according to claim 6, wherein when the end effector is in the closed configuration and the end When tissue being not present in actuator, the angled table of the nasal portion of the inner surface and storehouse of the end Face is configured to limit space between the two.

9. equipment according to claim 1, wherein the nail platform limits the first plane, wherein the end includes limit The inner surface of fixed second plane, and wherein the angled surface of the nasal portion limits third plane, wherein described Second plane and the third plane are non-coplanar.

10. equipment according to claim 9, wherein by the first cross-shaped portion of second plane and first plane The first angle of formation is greater than the second angle formed by the second cross-shaped portion of the third plane and first plane.

11. equipment according to claim 9, wherein compared with the angled surface of the nasal portion, the end The inner surface at end is steeper.

12. equipment according to claim 1, wherein the end of the anvil block includes the distal end portion in the end Protruding portion at portion.

13. equipment according to claim 12, wherein the protruding portion includes flat, and the flat is by structure Cause can to contact the angled surface of the nasal portion when the end effector is in the closed configuration.

14. equipment according to claim 12, wherein the protruding portion includes bulbous component.

15. equipment according to claim 14, wherein the angled surface of the nasal portion includes and the end The features of the bulbous members complementary at end.

16. equipment according to claim 1, wherein the nail platform in the storehouse includes multistage nail platform.

17. a kind of equipment, comprising:

(a) main part；

(b) axis, the axis extend from the main part towards distal side；And

(c) end effector, the end effector are connected to the axis, wherein the end effector can be in open configuration It is moved between closed configuration, wherein the end effector can be operated with compression, suture and cutting tissue, and wherein institute Stating end effector includes:

(i) storehouse, the storehouse are configured to keep one or more nails, wherein the storehouse includes nail platform and has angled Surface nasal portion, wherein the angled surface includes elastic cushion, and

(ii) rigid anvil block, the end that the rigidity anvil block includes proximal body portion and extends from the main part towards distal side End, wherein the end includes curved configuration, wherein the end further comprises protruding portion, the protruding portion is adapted to It is enough to contact the pad when the end effector is in the closed configuration and tissue is not present in the end effector.

18. equipment according to claim 17, wherein the end effector further comprises along described in the storehouse Multiple first graspings features of nail platform positioning, and along the nasal portion the angled surface positioning it is multiple Second grasping features, wherein the multiple first grasping features and the multiple second grasping features are configured to When the end effector is in the closed configuration, contact is grasped in the tissue between the end effector.

19. equipment according to claim 17, wherein the anvil block includes downside surface, and the downside surface includes more A nail shapes pit, wherein the downside surface further comprises at least one stepped portion.

20. a kind of equipment, comprising:

(a) main part；

(b) axis, the axis extend from the main part towards distal side；And

(c) end effector, the end effector are connected to the axis, wherein the end effector can be in open configuration It is moved between closed configuration, wherein the end effector can be operated with compression, suture and cutting tissue, and wherein institute Stating end effector includes:

(i) storehouse, the storehouse are configured to keep one or more nails, wherein the storehouse includes nail platform and nasal portion, Described in nasal portion include angled surface, and wherein the nail platform includes multiple grasping features, the multiple to grab Features are held to be configured to when the end effector is in the closed configuration contact and be grasped in the end to hold Tissue between row device, and

(ii) anvil block, the anvil block include proximal body portion and the end that extends from the main part towards distal side, wherein institute Stating end includes curved configuration, wherein the main part includes the longitudinal direction with lateral part with part " I " shape profile Slit, the lateral part have the curved end for the pin for being configured to receive percussion beam.

Background technique

In some environments, endoscopic surgical instrument is preferred for traditional open surgical device, Because lesser notch can reduce post-operative recovery time and complication.Therefore, some endoscopic surgical instruments may be adapted to pass through Distal end effector is placed on desired surgical site by the intubation of trochar.These distal end effector (examples Such as, endoscopic stapler, grasper, cutter, stitching unstrument, applicator, delivery apparatus and make into device, medicine/gene treatment With the energy delivery device of ultrasound, RF, laser etc.) tissue can be engaged in many ways, to achieve the effect that diagnosis or treatment.It is interior Sight glass type surgical instruments may include the axis between the handle portions positioned at end effector and by clinician's manipulation.Such axis can Make it possible to be inserted into desired depth and rotated around the longitudinal axis of axis, to be thus conducive to for end effector being located in Patient's body.It can be by including that one or more actuated articulation joints or features are further conducive to position end execution Device enables end effector selectively to carry out joint motions or inclined relative to the longitudinal axis of axis in other ways Turn.

The example of endoscopic surgical instrument includes surgical stapling device.Some such stitching unstruments can be operated with grip tissue Layer, cut through the organized layer of clamping, and nail is driven across organized layer, near the cutting end of organized layer by the group of cutting Tissue layer is substantially sealed together.Only surgical stapling device as exemplary purposes is disclosed in the following: on 2 21st, 1989 The United States Patent (USP) 4 of entitled " the Pocket Configuration for Internal Organ Staplers " that announces, 805,823；The beauty of entitled " Surgical Stapler and Staple Cartridge " that May 16 nineteen ninety-five announces State's patent 5,415,334；The U.S. of entitled " Surgical Stapler Instrument " that November 14 nineteen ninety-five announces Patent 5,465,895；The U.S. of entitled " Surgical Stapler Instrument " that on January 28th, 1997 announces is special Benefit 5,597,107；The United States Patent (USP) 5,632 of entitled " Surgical Instrument " that on May 27th, 1997 announces, 432；The United States Patent (USP) 5,673,840 of entitled " Surgical Instrument " that on October 7th, 1997 announces；1998 1 The United States Patent (USP) 5 of entitled " Articulation Assembly for Surgical Instruments " that the moon 6 was announced, 704,534；The United States Patent (USP) 5 of on September 29th, 1998 entitled " the Surgical Clamping Mechanism " announced, 814,055；Entitled " the Surgical Stapling Instrument Incorporating that on December 27th, 2005 announces The United States Patent (USP) 6,978,921 of an E-Beam Firing Mechanism "；It announces on 2 21st, 2006 entitled “Surgical Stapling Instrument Having Separate Distinct Closing and Firing The United States Patent (USP) 7,000,818 of Systems "；Entitled " the Surgical Stapling that on December 5th, 2006 announces The United States Patent (USP) 7,143,923 of Instrument Having a Firing Lockout for an Unclosed Anvil "； Entitled " the Surgical Stapling Instrument Incorporating a Multi- that on December 4th, 2007 announces The United States Patent (USP) 7,303,108 of Stroke Firing Mechanism with a Flexible Rack "；On May 6th, 2008 Entitled " the Surgical Stapling Instrument Incorporating a Multistroke Firing announced The United States Patent (USP) 7,367,485 of Mechanism Having a Rotary Transmission "；What on June 3rd, 2008 announced Entitled " Surgical Stapling Instrument Having a Single Lockout Mechanism for The United States Patent (USP) 7,380,695 of Prevention of Firing "；On June 3rd, 2008 announces entitled “Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam The United States Patent (USP) 7,380,696 of Firing Mechanism "；Entitled " the Surgical that on July 29th, 2008 announces The United States Patent (USP) 7,404,508 of Stapling and Cutting Device "；On October 14th, 2008 announces entitled “Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout” United States Patent (USP) 7,434,715；Entitled " the Disposable Cartridge with that on May 25th, 2010 announces The United States Patent (USP) 7,721,930 of Adhesive for Use with a Stapling Device "；On October 21st, 2010 public affairs Entitled " the Surgical Stapling Instrument with An Articulatable End Effector's " of cloth Announce 2010/0264193 in the U.S.；Entitled " the Motor-Driven Surgical Cutting of 20 day header of September in 2012 It announces in the U.S. of Instrument with Electric Actuator Directional Control Assembly " 2012/0239012.The disclosure of each of above-cited United States Patent (USP) and U.S. Patent Publication is by reference It is incorporated herein.

Although surgical stapling device referred to above is described in endoscopic surgery, it is to be understood that, it is such Surgical stapling device can also be used in open surgery and/or other non-endoscopic surgeries.Only by way of example, outside thorax In section's operation, surgical stapling device can be inserted by thoracotomy, and thus between patient's rib cage to reach one or more A organ, the thorax surgical operation do not use conduit of the trochar as stitching unstrument.Such operation may include being come using stitching unstrument Cutting and closure lead to the blood vessel of lung.For example, can cut off and be closed by stitching unstrument before exteriorizing in thoracic cavity Lead to organotropic blood vessel.Certainly, surgical stapling device can be used in various other situations and program.

Although having manufactured and used various surgery suturing appliances and associated component, it is believed that before the present inventor also Nobody makes or uses described invention in the following claims.

Detailed description of the invention

It is incorporated to the attached drawing in this specification and formed part of this specification and shows embodiment of the present invention, and It is used to explain this hair together with the detailed description of general description of the invention given above and embodiment given below Bright principle.

Fig. 1 depicts the perspective view of the exemplary surgery suturing appliance for carrying out joint motions；

Fig. 2 depicts the side view of the instrument of Fig. 1；

Fig. 3 depicts the perspective view of the end effector of the opening in Fig. 1 instrument；

Fig. 4 A depicts the sectional side view that the end effector of Fig. 3 is intercepted along the line 4-4 of Fig. 3, wherein percussion beam is in close Side position；

Fig. 4 B depicts the sectional view that the end effector of Fig. 3 is intercepted along the line 4-4 of Fig. 3, wherein percussion beam is in remote Side position；

Fig. 5 depicts the cross-sectional end view that the end effector of Fig. 3 is intercepted along the line 5-5 of Fig. 3；

Fig. 6 depicts the decomposition perspective view of the end effector of Fig. 3；

Fig. 7 depicts the perspective view of the end effector of Fig. 3, which is located at tissue and in group It is activated in knitting primary；

Fig. 8 depicts the perspective view of the alternative pattern of the end effector with angled anvil block and angled storehouse；

Fig. 9 depicts the enlarged side view of the end effector of Fig. 8；

Figure 10 depicts the amplification vertical view of the end effector of Fig. 8；

Figure 11 depicts the distal part of another alternative pattern of the end effector with curved anvil block end Perspective view is illustrated at open configuration；

Figure 12 depicts the side view of the end effector of Figure 11；

Figure 13 has drawn the side view of the end effector of Figure 11, but is illustrated at closed configuration；

Figure 14 depicts the enlarged side view of the distal part of the end effector of Figure 13；

Figure 15 depicts the cross-sectional view that the anvil block of the end effector of Figure 11 is intercepted along the line 15-15 of Figure 12；

Figure 16 depicts the alternative pattern of the anvil block of the end effector of Figure 11 along view similar with the line 15-15 of Figure 12 The cross-sectional view of transversal upper thread interception；

Figure 17 depicts the local perspective view of the alternative pattern of the anvil block of the end effector of Figure 11；

Figure 18 depicts the local perspective view of another alternative pattern of the anvil block of the end effector of Figure 11；

Figure 19 depicts the alternative pattern of the end effector of rigid anvil block end and storehouse End features portion with cooperation Distal part enlarged side view；

Figure 20 is depicted is incorporated to additional grasping features and together with the anvil block with rigid curved end on storehouse The enlarged side view of the distal part of the alternative pattern of the end effector used；

Figure 21 depicts the enlarged perspective of the distal part in the storehouse of the end effector of Figure 20；And

Figure 22 depicts the perspective view of the distal part of the alternative pattern of the end effector with curved anvil block end, It is illustrated at open configuration.

Attached drawing is not intended to be limited in any way, and is contemplated that various embodiments of the present invention can be more Kind of other way executes, the mode that may not be shown in the accompanying drawings including those.It is incorporated in this specification and constitutes part of it Attached drawing show several aspects of the invention, and be used to explain the principle of the present invention together with specification；However, should manage Solution, the present invention is not limited to shown clear arrangements.

Specific embodiment

Certain exemplary following explanations of the invention are not applied to limit the scope of the invention.According to showing by way of example Following explanation out, other examples of the invention, feature, aspect, embodiment and advantage for those skilled in the art and Speech it will be evident that, a kind of best mode is contemplated for implementing the present invention.Arrive as will be appreciated, the present invention can have it is other not Same and apparent aspect, all such aspects are all without departing from the present invention.Therefore, attached drawing and explanation should be considered as substantially illustrating Property and not restrictive.

I. exemplary surgical stitching unstrument

Fig. 1 to Fig. 7 depicts exemplary surgical suture and cutting off apparatus (10), the non-joint motions described in Fig. 1 Under state, size is set to the operative site of the intubation insertion patient across trochar, to execute surgical operation.Only to lift The mode of example, such trochar can be between two rib cages of patient or in the abdomens of other place insertion patients.In some feelings Under condition, instrument (10) are used in the case where trochar is not present.For example, instrument (10) can pass through thoracotomy or other classes Type notch is inserted directly into.This exemplary instrument (10) includes the handle portions (20) for being connected to axis (22).Axis (22) is at distal side end It terminates in actuated articulation joints (11), which further couples with end effector (12).It should be appreciated that herein Used in for term such as " nearside " and " distal side " grasp the handle portions (20) of instrument (10) referring to clinician.Cause This, end effector (12) is distally located relative to the handle portions (20) of more nearside.It is also understood that for convenient and clear See, herein in conjunction with attached drawing use space term such as "vertical" and "horizontal".However, surgical instruments in many orientations and positions in It uses, and these terms are not intended to be restrictive and absolute.

In some patterns, at least some of teaching content that axis (22) is announced according to following U.S. teaching content is carried out Construction: on August 28th, 2014 entitled " the Surgical Instrument with Multi-Diameter Shaft " announced The U.S. announce 2014/0239038, the disclosure of which is herein incorporated by reference.Only by way of example, according to 2015 It announces in the U.S. of entitled " Surgical Instrument Comprising a Sensor System " that October 1 announced At least some of 2015/0272575 teaching content teaching content, axis (22), which can be, to be dismantled from handle portions (20) , which announces disclosure and is herein incorporated by reference.In some other patterns, axis (22) can not be from shank portion Divide (20) disassembly.Content according to the teaching of this article, other suitable constructions of axis (22) are for those of ordinary skill in the art For it will be evident that.

Once actuated articulation joints (11) and end effector (12) are inserted by the cannula passage of trochar, joint motions Connector (11) can carry out long-range joint motions by joint motions control (13), discribed with the virtual image as shown in figure 1, so that end Portion's actuator (12) can be deflected from the longitudinal axis (LA) of axis (22) with required angle (α).End effector (12) can be from as a result, Required angle is reached behind organ due to other or close to tissue.In some patterns, actuated articulation joints (11) end effector (12) can be made to deflect along single plane.In some other patterns, actuated articulation joints (11) energy Deflect end effector along more than one plane.Actuated articulation joints (11) and joint motions control (13) can be according to these The teaching content of any bibliography in multiple bibliography of text reference constructs.Alternatively, actuated articulation joints (11) And/or joint motions control (13) can have any other suitable construction.Only by way of example, joint motions control (13) It is alternatively configured to knob, which surrounds the axis rotation perpendicular to the longitudinal axis (LA) of axis (22).

In some patterns, actuated articulation joints (11) and/or joint motions control (13) are according to following United States Patent (USP) At least some of teaching content teaching content is constructed and operated: on November 17th, 2015 announces entitled “Surgical Instrument End Effector Articulation Drive with Pinion and Opposing The United States Patent (USP) 9 of Racks ", 186,142, the disclosure of which is herein incorporated by reference.Actuated articulation joints (11) can also root At least some teaching content for the teaching content for descending the U.S. to announce accordingly are constructed and are operated: being announced on August 28th, 2014 The U.S. of entitled " Surgical Instrument with Multi-Diameter Shaft " announces 2014/0239038, The disclosure of which is herein incorporated by reference.In view of teaching herein content, actuated articulation joints (11) and joint motions Other suitable forms that control (13) can use will be evident for the ordinary skill in the art.

This exemplary end effector (12) includes lower jaw (16) and pivotable anvil block (18).In some patterns, under At least some of the teaching content that jaw (16) is announced according to following U.S. teaching content is constructed: on August 28th, 2014 Entitled " the Installation Features for Surgical Instrument End Effector announced The U.S. of Cartridge " announces 2014/0239044, and the disclosure of which is herein incorporated by reference.Anvil block (18) according to It is lower to be constructed: on August 28th, 2014 entitled " the Integrated Tissue Positioning and Jaw announced It announces in 2014/0239042 teaching content in the U.S. of Alignment Features for Surgical Stapler " At least some teaching content, the disclosure of which are herein incorporated by reference；On August 28th, the 2014 entitled " Jaw announced Announce 2014/ in the U.S. of Closure Feature for End Effector of Surgical Instrument " At least some of 0239036 teaching content teaching content, the disclosure of which are herein incorporated by reference；And/or 2014 Entitled " the Staple Forming Features for Surgical Stapling that on August 28, announced U.S. of Instrument " announces at least some of 2014/0239037 teaching content teaching content, the disclosure of which with Way of reference is incorporated herein.In view of teaching herein content, lower jaw (16) and anvil block (18) can be used other suitable Form will be evident for the ordinary skill in the art.

Handle portions (20) include pistol grip (24) and closure trigger (26).The closure trigger (26) being capable of court Pistol grip (24) pivot so that anvil block (18) towards end effector (12) lower jaw (16) clamp or closure. Such closure of anvil block (18) is provided by closed tube (32) and close ring (33), and the two is in response to closure trigger (26) it is longitudinally translated relative to the pivot of pistol grip (24) relative to handle portions (20).Closed tube (32) is along axis (22) length extends；And close ring (33) is located in the distal side of actuated articulation joints (11).Actuated articulation joints (11) energy Enough operations are to transmit/be transferred to close ring (33) from closed tube (32) for longitudinal movement.

Handle portions (20) also include firing trigger (28).Slender member (not shown) extends longitudinally through axis (22), And in response to the actuating of firing trigger (28), longitudinal percussion movement is transmitted to percussion beam (14) from handle portions (20).It hits This distal translation of hair beam (14) makes the tissue clamped in end effector (12) be sewn and cut off, it is as follows will more in detail Carefully describe.Then, trigger (26,28) are discharged to discharge the tissue from end effector (12).

Fig. 3 to Fig. 6 depicts the end effector of percussion beam (14) Lai Zhihang multiple functions using electron beam form (12).It should be appreciated that electron beam form is only exemplary example.Percussion beam (14) can take any other suitable form, including But it is not limited to non-electrical beamlet form.Such as best seen in Fig. 4 A to 4B, fires beam (14) and include the upper pin (38) of horizontal orientation, hit Send out back lid (44), the middle pin (46) of horizontal orientation and the cutting edge (48) in distal side.Upper pin (38) is positioned in anvil In longitudinal anvil block slot (42) of seat (18), and it can be translated in longitudinal anvil block slot.Percussion back lid (44) is by making Percussion beam (14) extends through lower jaw slot (45) (shown in Fig. 4 B) and slidably engages the lower surfaces of lower jaw (16), under this Jaw slot (45) is formed across lower jaw (16).Middle pin (46) is slidably engaged the top surface of lower jaw (16), thus with Fire back lid (44) cooperation.Therefore, percussion beam (14) inevitable spaced end actuator (12) during percussion.

The percussion beam (14) of some non-electrical beamlet forms can lack upper pin (38), middle pin (46) and/or percussion back It covers (44).Some such patterns of instrument (10) can be relied solely in close ring (33) or some other feature portions, to fire When beam (14) is advanced to distal position, anvil block (18) is pivoted to closed position and anvil block (18) is maintained in closed position. Only by way of example, firing beam (14) and/or associated latching features can be in the teaching content according to following announcement At least some constructed and operated: on August 28th, 2014 entitled " the Lockout Feature for announced U.S. of Movable Cutting Member of Surgical Instrument " announces 2014/0239041, it is open in Appearance is herein incorporated by reference.In view of teaching herein content, other suitable forms that beam (14) can use are fired For those of ordinary skill in the art it will be evident that.

Fig. 3 shows this exemplary percussion beam (14) proximally positioned and the anvil block (18) for being pivoted to open position, thus Unspent nail bin (37) is allowed to be removably attached in the channel of lower jaw (16).Such as best seen in Fig. 5 to Fig. 6, originally show The nail bin (37) of example includes warehouse (70), which shows upper brace (72) and couple with lower part storehouse pallet (74). Such as best seen in Fig. 3, vertical slit (49) is formed through a part of nail bin (37).Equally such as best seen in Fig. 3, three rows Nail hole (51) is formed to pass through upper brace (72) on the side of vertical slit (49), and another group of three dog holes (51) is by shape Upper brace (72) are passed through as on the other side of vertical slit (49).Certainly, it is possible to provide any other appropriate number of nail It arranges (for example, two rows, four rows, any other quantity).Referring again to Fig. 4 A to Fig. 6, wedge-shaped slides (41) and the driving of multiple nails Device (43) is trapped between warehouse (70) and pallet (74), and wherein wedge-shaped slides (41) are located at staple drivers (43) nearside. Wedge-shaped slides (41) can be in nail bin (37) interior longitudinal movement；And staple drivers (43) can vertically be transported in nail bin (37) It is dynamic.Nail (47) is also positioned in warehouse (70), is located above corresponding staple drivers (43).Specifically, each nail (47) It is vertically driven in warehouse (70) by staple drivers (43), (47) will be followed closely and driven out by associated nail hole (51).Such as Best seen in Fig. 4 A to 4B and Fig. 6, there are inclined cam surfaces for wedge-shaped slides (41), when wedge-shaped slides (41) are driven towards distal side When moving across nail bin (37), inclined cam surface presses upwards on staple drivers (43).

In some patterns, at least some of teaching content that nail bin (37) is announced according to following U.S. teaching content into Row construction and operation: on August 28th, 2014 entitled " the Integrated Tissue Positioning and Jaw announced The U.S. of Alignment Features for Surgical Stapler " announces 2014/0239042, and the disclosure of which is to draw It is incorporated herein with mode.In addition to this or alternatively, nail bin (37) can according to the following U.S. announce teaching content at least Some teaching content are constructed and are operated: on August 28th, 2014 entitled " the Installation Features announced The U.S. of for Surgical Instrument End Effector Cartridge " announces 2014/0239044, disclosure Content is herein incorporated by reference.In view of teaching herein content, the adoptable other suitable forms pair of nail bin (37) It will be evident for those skilled in the art.

By promote closed tube (32) and close ring (33) towards distal side so that end effector (12) as shown in figs. 4 a-4b In the case where closure, by making upper pin (38) to enter longitudinal anvil block slot (42), percussion beam (14) is advanced into and anvil block (18) it engages.Pushing block (80) (shown in Fig. 5) is located at the distal end of percussion beam (14), and is configured as engaged wedge sliding part (41), so that when firing trigger (28) is activated, the case where beam (14) are advanced through nail bin (37) towards distal side is fired Under, pushing block (80) pushes wedge-shaped slides (41) towards distal side.During such percussion, the cutting edge (48) of percussion beam (14) enters The vertical slit (49) of nail bin (37), so that cutting is clamped in the tissue between nail bin (37) and anvil block (18).Such as Fig. 4 A-4B institute Show, middle pin (46) and pushing block (80) by activating nail bin (37) together in the vertical slit (49) that enters in nail bin (37), Wedge-shaped slides (41) driving at jack-up contacts upwards with staple drivers (43) generation, then to be worn the outside driving of nail (47) It crosses nail hole (51) and is contacted with nail shapes pit (53) (shown in Fig. 3) formation on the inner surface of anvil block (18).Fig. 4 B is depicted The percussion beam (14) being translated to the far side completely after completing cutting and suture tissue.It should be appreciated that the view from Fig. 4 A-4B In intentionally omit nail shapes pit (53)；But nail shapes pit (53) is shown in FIG. 3.It is also understood that the view from Fig. 5 Anvil block (18) are intentionally omitted in figure.

Fig. 7 shows the end effector (12) being activated by single stroke across tissue (90).As shown, cutting It cuts sword (48) (being occluded in Fig. 7) to have cut through tissue (90), while staple drivers (43) have driven three rows alternately to follow closely (47) to wear Cross the tissue (90) on every side of the cutting line generated by cutting edge (48).In this example, (47) whole and cutting line are followed closely It is oriented substantially parallel, it is to be understood that, nail (47) can be with any suitable orientation positions.In this example, in the first row After the completion of journey, end effector (12) is recalled from trochar, exhausts nail bin (37), then, end effector with new staple cartridge replacement (12) suture site is reached further to be cut and be sutured again insertable into trochar is passed through.This process repeat into Row, notch and nail (47) until desired amount has been provided.Anvil block (18) can need to be closed to be conducive to be inserted by trochar With recall；And anvil block (18) can need to be opened to be conducive to replace nail bin (37).

It should be appreciated that cutting edge (48) substantially can be driven through tissue with nail (47) during each actuation stroke Simultaneously cut off tissue.In this example, cutting edge (48) only slightly lags behind the driving of nail (47), so that nail (47) just exists Cutting edge (48) is driven through the same area of the tissue before passing through tissue, it should be appreciated that and this can sequentially be overturned, or Cutting edge (48) can be directly synchronous with adjacent nail.It is activated in two layers (92,94) of tissue (90) although Fig. 7 is shown End effector (12), it is to be understood that, end effector (12) can be activated single layer or tissue across tissue (90) More than two layer (92,94).It is also understood that the forming of the nail (47) adjacent with the cutting line that cutting edge (48) generate and determines Position can tissue at substantially sealed cutting line, thus reduce or prevent the bleeding at cutting line and/or the leakage of other body fluid. Although being caused in two substantially flat opposite plane layers (92,94) of tissue in addition, Fig. 7 shows end effector (12) It is dynamic, it is to be understood that, end effector (12) can also be activated across tubular structure blood vessel, a part of gastrointestinal tract etc.. Therefore, Fig. 7 should not be considered as and any restrictions is carried out to the imagination purposes of end effector (12).In view of in teaching herein Hold, wherein the various suitable conditions of instrument (10) and program can be used to will be evident for those of ordinary skill in the art.

In a kind of pattern, instrument (10) provides the motorization to percussion beam (14) and controls.It can be used for providing percussion beam (14) example components of motorization control are announced in the following U.S. to be shown and describes: on August 28th, 2014 titles announced It is announced for the U.S. of " Distal Tip Features for End Effector of Surgical Instrument " 2014/0239043, the disclosure of which is herein incorporated by reference.In addition to the foregoing or foregoing teachings are replaced, it is motor-driven At least part for changing control can be configured according at least some of the teaching content of following United States Patent (USP) teaching content: The United States Patent (USP) 8,210 of entitled " Motor-Driven Surgical Instrument " that on July 3rd, 2012 announces, 411, the disclosure of which is herein incorporated by reference.In addition to the foregoing or foregoing teachings are replaced, can be used to drive The features of dynamic percussion beam (14) can be configured according to following: in the teaching content of U.S.'s announcement 2012/0239012 at least Some teaching content, the disclosure of which are herein incorporated by reference；And/or the U.S. announces 2012/0239012 teaching content At least some of teaching content, the disclosure of which be herein incorporated by reference.In view of teaching herein content, for mentioning Motor-driven other suitable components, features and construction for firing beam (14) will be shown for those of ordinary skill in the art And it is clear to.It is also understood that some other patterns can provide the manual actuation to percussion beam (14), so that motor can be omitted. Only by way of example, percussion beam (14) can be according in herein cited any other patent/announcement reference teaching content At least some teaching content are activated.

Instrument (10) may also include latch switch and locking indicator, as shown and described in following: on August 28th, 2014 The beauty of entitled " the Distal Tip Features for End Effector of Surgical Instrument " that announces State announces 2014/0239043, and the disclosure of which is herein incorporated by reference.Additionally, latch switch and/or locking instruction Device and associated components/functions can be configured according at least some of teaching content below teaching content: 2010 1 Entitled " the Electronic Lockouts and Surgical Instrument Including that the moon 12 was announced The United States Patent (USP) 7 of Same ", 644,848, the disclosure of which is herein incorporated by reference.

Instrument (10) further includes manual Returning switch (116), which is configured to serve as " emergency " Features allow the operator to that quickly percussion beam (14) proximally bounces back during firing schedule.In other words, it returns manually Switch (116) can be actuated manually firing beam (14) when only part is promoted towards distal side.Manual Returning switch (116) can according to At least some of the teaching content that the lower U.S. announces teaching content provides other function: on August 28th, 2014 names announced Referred to as the U.S. of " Distal Tip Features for End Effector of Surgical Instrument " announces 2014/0239043, the disclosure of which is herein incorporated by reference.

In the operation of description instrument (10), term " pivot " (and the art that " pivot " with based on is similar is used Language) it is not to be read as necessarily requiring to be pivoted movement around fixed axis.In some patterns, anvil block (18) is surrounded by pin The axis that (or similar features) limit pivots, which transports in anvil block (18) towards lower jaw (16) When dynamic, slided along elongated slot or channel.In this type formula, pivot axis is put down along the path limited by slit and channel It moves, and anvil block (18) is pivoted around the axis simultaneously.Additionally or alternatively, pivot axis first can be along The sliding of slit/channel, then anvil block (18) pivot axis along slit/channel slided it is a certain apart from back wall around the pivot Shaft axis pivots.It should be appreciated that such sliding/translation pivoting action covered in such as " pivot ", " pivot ", " being capable of pivot Turn " etc. in terms.Certainly, some patterns, which can provide anvil block (18) and surround, is kept fixed and does not translate in slit or channel The pivoting action etc. of axis.

It should be appreciated that instrument (10) can be carried out according to any content in the teaching content in following United States Patent (USP) configuration and Operation: United States Patent (USP) 4,805,823；United States Patent (USP) 5,415,334；United States Patent (USP) 5,465,895；United States Patent (USP) 5,597,107； United States Patent (USP) 5,632,432；United States Patent (USP) 5,673,840；United States Patent (USP) 5,704,534；United States Patent (USP) 5,814,055；The U.S. Patent 6,978,921；United States Patent (USP) 7,000,818；United States Patent (USP) 7,143,923；United States Patent (USP) 7,303,108；United States Patent (USP) 7,367,485；United States Patent (USP) 7,380,695；United States Patent (USP) 7,380,696；United States Patent (USP) 7,404,508；United States Patent (USP) 7, 434,715；United States Patent (USP) 7,721,930；Announce 2010/0264193 in the U.S.；And/or 2012/0239012.As described above, this The disclosure of each of a little patent and publications is herein incorporated by reference.It can provide for the attached of instrument (10) Exemplary modification is added to will be described in more detail below.Following teaching content may be incorporated into the various suitable methods in instrument (10) For those of ordinary skill in the art it will be evident that.Similarly, by hereafter teaching content and herein cited patent/publication The various suitable modes that the various teaching content of object are combined will be evident those skilled in the art.Should also Understand, hereafter teaching content is not limited to instrument taught in herein cited patent (10) or device.Hereafter teaching content It can be easy to the instrument for being applied to various other types, the instrument includes that will not be classified as the instrument of surgical stapling device.Consider To teaching herein content, wherein can be using the hereafter various other suitable devices of teaching content and situation to the general of this field Logical technical staff will be evident.

II. there is the exemplary end effector of visualization, leading-in end and acquisition characteristics portion

In some cases, it can be possible to it is expected that user is made to be more clearly visible that end effector (12).Specifically, in end When actuator (12) is inserted into operative site, user can rotate the axis (22) of instrument (10) during operation.It holds end Row device (12) thus also rotates.When end effector (12) rotation, user may expect to obtain the vision to operative site Path.For example, user may wish to see the contact surface between tissue (90) and end effector (12) or contact point.Because End effector (12) can be rotated around longitudinal axis (LA) relative to handle portions (20), so user checks operation When position, the lower jaw (16) of end effector may be seen, rather than anvil block (18).Alternatively, rotatable end effector (12), so that user sees anvil block (18) when user checks end effector (12).It may be desirable to being mentioned to user For being more than the visibility to operative site for the visibility that can be provided in the instrument (10) of Fig. 1.For example, wherein cutting and In the case where some surgical operations for being sewed with the vascular that body fluid flows through, it may be desirable to visual confirmation anvil block (18) and lower jaw (16) vascular to be cut is completely covered, so that can cut completely in a single actuation and suture vascular.Change sentence Words say that user may want to avoid only to cut and suture a part of vascular.Accordingly, it may be desirable to be to take some visual prisons Depending on and/or feedback means, allow user to be able to know that end effector (12) has been properly located in operative site, thus anvil Seat (18) and lower jaw (16) clamp vascular completely.It is a kind of it is feasible monitoring operative site mode may include improvement and lower jaw (16) and the visualization of the distal end adjacent area of anvil block (18).In addition, can not only it is expected the distal side of end effector (12) The visualization of end, and may expect construction end effector (12), so that the distal end of anvil block (18) is adapted to Enough when anvil block (18) is close towards lower jaw (16), tissue (for example, big vascular) is proximally pushed into anvil block (18) and lower pincers In space between mouth (16).

Fig. 8 depicts the exemplary end effector (212) including anvil block (218) and lower jaw (216).It should be appreciated that End effector (212) can replace the end effector (12) of instrument (10) to use.End effector (212) can be with instrument (10) It is integrally formed, or alternatively, can be exchanged with the end effector (12) of instrument (10).

Anvil block (218) can be operated to pivot relative to lower jaw (216).Anvil block (218) and lower jaw (216) can clamp It organizes (90), the clamping carried out similar to anvil block shown in FIG. 1 (18) and lower jaw (16).End effector (212) is into one Step includes the storehouse (237) that can be operated to be placed in lower jaw (216), is similar to storehouse shown in Fig. 3 (37).

If into Figure 10, visible anvil block (218) has elongated shape to Fig. 8, wherein the distal part of anvil block (218) is towards storehouse (237) it is at an angle of.The distal part of anvil block (218) is angled towards storehouse (237), so that the farthest side end (219) of anvil block (218) Storehouse (237) are extended beyond towards distal side in the longitudinal direction.But in some patterns, distal end (219) be may extend into the longitudinal direction With storehouse (237) it is equal at a distance from, or extend to the position relative to the farthest side point nearside on storehouse (237).In addition, anvil block (218) angled towards storehouse (237) with flat grade.As shown best in figure 10, anvil block (218) includes side (241), the side (241) tapered when it is close to farthest side end (219) of anvil block (218).By way of example, anvil block (218) class in fig. 8 It is similar to inverted skis end forming.The angled shape of anvil block (218) can make end effector (212) to be easier to be inserted into In operative site.For example, when anvil block (218) contact tissue or move across tissue, the flat grade or inversion of anvil block (218) Skis terminal end shape can provide the deflector surface of hurtless measure.The tissue deflection of such hurtless measure may include in anvil block (218) When close towards lower jaw (216), tissue (for example, big vascular) is proximally pushed between anvil block (218) and lower jaw (216) Space in.Once being placed into operative site, the angled shape of anvil block (218) also can provide end effector (212) Better navigability and end effector (212) distal end relative to surgical site anatomical structure it is more preferable Visibility.In view of teaching herein content, the anvil block (218) of other suitable types will to those skilled in the art Obviously.

Storehouse (237) can be operated to keep being similar to the nail for following closely (47) shown in Fig. 4 A, to drive into tissue.Such as Fig. 9 Shown, the distal end of storehouse (237) has triangular-shaped profile.Specifically, the distal end of storehouse (237) includes upper taper surface (239) and lower tapering surface (238).In addition, the distal end of storehouse (237) includes tapered side surface (243) on each side. In this example, the taper pair that each tapered side surface (243) of storehouse (237) is substantially presented with the side (241) of anvil block (218) It is quasi-.Therefore, as shown in Figure 10, the side surface (243) of storehouse (237) not from the longitudinal axis (LA) of end effector 212 (212) to The side (241) of anvil block (218) is extended past outside.Upper taper surface (239) and lower tapering surface (238) are to storehouse (237) Farthest side end close up.Lower tapering surface 238 limits collimation line (240), once so that end effector (212) is inserted into In operative site, user can observe along collimation line (240).Collimation line (240) along lower tapering surface (238) side Edge extends.It should be appreciated that the flat shape of lower tapering surface (238) can be operated to allow user to see and/or substantially See the distal end (219) of anvil block (218).Specifically, collimation line (240) and end effector (212) are extended longitudinally through Longitudinal axis (LA) be crossed to form visual angle (θ).

Visual angle (θ) can determine user to the relative visibility of distal end (219).Specifically, user may be remote In front of side end (219), regarded along in visual angle (θ) range across any bar of collimation line (240) and longitudinal axis (LA) intersection point Line observation.For example, when visual angle (θ) increases, user by proximally advantage point close to area in front of distal end (219) The visibility in domain is larger；However, when visual angle (θ) reduce when, user to the distal end (219) of proximally advantage point in front of The visibility in region is smaller.In some patterns, visual angle (θ) limits the angle bigger than 90 degree.In addition, in some patterns, depending on Angle (θ) limits the angle bigger than 135 degree.In view of teaching herein content, other proper angles of visual angle (θ) are to this field It will be evident for those of ordinary skill.In diagram pattern, user is generally along collimation line (240) or along visual angle Some other point of view in (θ) range, therefore, user have appointing along collimation line and in visual angle (θ) range The visibility in what region.The downside of distal end (219) can also slightly justify, to facilitate longitudinal axis (LA) and collimation line (240) visibility of intersection point.

When tissue (90) is clamped between closure storehouse (237) and anvil block (218), user can be along collimation line 240 Or in visual angle (θ) range other positions observation, such as it can be clearly seen that anvil block (218) in what position grip tissue (90). In addition, user will determine whether tissue is clamped in completely between anvil block (218) and storehouse (237), so that tissue does not overflow The end of end effector (212) out.User may also be able to see the matter of anvil block (218) and storehouse (237) grip tissue (90) Amount.

It should be understood that, in some cases it may the rotary end effector before, during or after grip tissue (90) (212).Therefore, the conical by its shape of anvil block (218), which can also be provided, is easier to check to distal end (219) or substantially adjacent to remote Side end (219).The taper of anvil block (218) combines with the lower tapering surface (238) of storehouse (237) can further promote end Portion's actuator (212) is easily inserted in tissue in a manner of hurtless measure.Further, since the tapered end of end effector (212), Can more easily end effector (212) be fitted through trochar or can be used to leading end actuator (212) and arrived Its device in operative site.For example, once distal end (219) is loaded into trochar, lower tapering surface (238) and anvil The taper of seat (218) just can provide leading-in end, the rest part sleeve pipe needle of leading end actuator (212).In view of this The teaching content of text, those skilled in the art will be further understood that, can pass through the two sides (241) of anvil block (218) and storehouse (237) conical design of every side (243) enhances visibility and navigability.

In addition to the foregoing, end effector (212) and be incorporated to end effector (212) instrument (10) pattern Configuration and operation: the mark that on November 17th, 2015 announces can be carried out according at least some of teaching content below teaching content Entitled " Surgical Instrument End Effector Articulation Drive with Pinion and The United States Patent (USP) 9 of Opposing Racks ", 186,142, the disclosure of which is herein incorporated by reference；On August 28th, 2014 Entitled " the Lockout Feature for Movable Cutting Member of Surgical announced The U.S. of Instrument " announces 2014/0239041, and the disclosure of which is herein incorporated by reference；On December 13rd, 2016 Entitled " the Integrated Tissue Positioning and Jaw Alignment Features for announced The United States Patent (USP) 9 of Surgical Stapler ", 517,065, the disclosure of which is herein incorporated by reference；August 28 in 2014 Entitled " the Jaw Closure Feature for End Effector of Surgical Instrument's " that day announces The U.S. announces 2014/0239036, and the disclosure of which is herein incorporated by reference；It announces on August 28th, 2014 entitled Announce 2014/ in the U.S. of " Distal Tip Features for End Effector of Surgical Instrument " 0239043, the disclosure of which is herein incorporated by reference；On August 28th, 2014 entitled " the Staple Forming announced U.S. of Features for Surgical Stapling Instrument " announces 2014/0239037, the disclosure of which with Way of reference is incorporated herein；On August 28th, 2014 entitled " the Surgical Instrument with Multi- announced The U.S. of Diameter Shaft " announces 2014/0239038, and the disclosure of which is herein incorporated by reference；And/or 2014 Entitled " the Installation Features for Surgical Instrument End that on August 28, announced The U.S. of Effector Cartridge " announces 2014/0239044, and the disclosure of which is herein incorporated by reference.It will be under The other modification that may be incorporated into end effector (212) is more fully described in text.

III. with the exemplary end effector of rigid curved anvil block end

As described above, the distal end construction of end effector (212) is different from the distal end of end effector (12) Construction；The different configuration of its end effector (212) provides different potential advantages.Specifically, end effector (212) Distal end construction can provide improved navigability and the distal end of improved end effector (212) and adjacent anatomical knot The visibility of relationship between structure.In addition, when anvil block (218) is close towards lower jaw (216), end effector (212) Distal end construction can provide group by the way that tissue to be proximally pushed into the space between anvil block (218) and lower jaw (216) Knit acquisition effect.In some cases, it can be possible to be intended to provide such end effector, which, which has, is similar to anvil The anvil block bending distal end construction of seat (218)；The distal end structure in storehouse (37) is also configured similarly to distal end simultaneously The storehouse made.There is the mixing end effector of the anvil block similar to anvil block (218) and the storehouse similar to storehouse (37), anvil by providing The bending distal part of seat can have relatively steep bending angle, this can further promote tissue sampling as described herein to imitate It answers.Following description provides the configuration aspects and other structures feature of the configuration aspects for combining anvil block (218) and storehouse (37) The example of end effector.

A. exemplary anvil and storehouse orientation

Figure 11 to Figure 13 depicts the exemplary end effector (312) including anvil block (318) and lower jaw (316).It answers Work as understanding, end effector (312) can replace the end effector (12) of instrument (10) to use.End effector (312) can be with Instrument (10) is integrally formed, or alternatively, can exchange with the end effector (12) of instrument (10).Anvil block (318) it can operate with opposite lower jaw (316) pivot.Anvil block (318) and lower jaw (316) can grip tissue (90), it is similar The clamping performed by anvil block shown in FIG. 1 (18) and lower jaw (16).End effector (312) further comprises that can operate With the storehouse (337) being placed in lower jaw (316), it is similar to storehouse shown in Fig. 3 (37).

Anvil block (318) includes nail shapes pit (353), is similar to the nail shapes pit (53) of anvil block (18).Anvil block (318) further comprise anvil block slot (342), be similar to the anvil block slot (42) of anvil block (18).Anvil block (318) is different from anvil Seat (18), the difference is that anvil block (318) includes bent back ends (319) in its distal end.As used herein, when being related to holding When the distal end construction of the component of portion's actuator, such as the term of " bending ", " angled " and " curved " should be read as Synonym for each other.In other words, term " bending " and " curved " (and its modification) may include common two straight lines for limiting angle Relationship between features, so that term " bending " and " curved " (and its modification) are not to be read as requiring component must edge Camber line extend.In this example, end (319) are on-deflectables, therefore end (319) keep its shape.In other words, End (319) in this example is rigid.In this example, anvil block (318) and associated end (319) are by metal structure It makes, but considers teaching herein content, other materials plastics, ceramics etc. can be used, this common skill for this field It will be evident for art personnel.

End (319) includes the outer surface (320) with blunt end (321).Adjacent end (319), anvil block (318) include with The main part (322) that linear fashion extends.In the example presented in the figure, main part (322) forms the major part of anvil block (318), So that the major part of anvil block (318) is straight.Referring to Figure 12, anvil block (318) further comprises the inner surface along end (319) (324) and along main part (322) downside surface (326), nail shapes pit (353) is located in the downside surface.At this In example, in the case where end (319) have curved configuration or angled construction, outer surface (320) and inner surface (324) Straight main part (322) and downside surface (326) relative to anvil block (318) is angled.

The storehouse (337) of end effector (312) includes distal end (339).End (339) includes angled surface (341), blunt end (343) and curved downside (344).As shown in Figs. 13 and 14, when end effector (312) are closed, blunt end (321) with the blunt end (343) of storehouse (337) longitudinally uniform location.In this way, blunt end (321) and blunt end (343) terminate at (for example, blunt end (321) and blunt end (343) is made to terminate at and extend vertically through end effector at identical lengthwise position (312) at the same plane of longitudinal axis).In view of teaching herein content, for those of ordinary skill in the art will It is readily apparent that in other examples, when end effector (312) closure, blunt end (321) can be relative to storehouse (337) Blunt end (343) proximally positions.Similarly, in some other examples, end effector (312) be configured to so that When end effector (312) closure, the blunt end (321) of anvil block (318) prolongs relative to the blunt end (343) of storehouse (337) towards distal side It stretches.Furthermore, it is contemplated that teaching herein content, it is evident that, shows for those of ordinary skill in the art other In example, one or two of blunt end (321,343) can be modified such that they do not have blunt construction or they and can not have There is blunt construction and can be protected by blunt lid or shield.

Figure 14 shows the enlarged view of the distal end of end effector (312), is illustrated at closed position.Such as figure Shown, in closed position, inner surface (324) partly contacts angled at the distal end of end effector (312) Surface (341).When end effector (312) closure, along inner surface (324) and the further court in surface (341) being at an angle of Nearside, there are gap or space (345) between inner surface (324) and angled surface (341).As shown in figure 11, storehouse (337) Including upper mounting plate (372).As shown in figure 14, upper mounting plate (372) limits plane (P1).Similarly, inner surface (324) limits plane (P2), and angled surface (341) limits plane (P3).In addition as shown in 14 figures, the distal end portion of end effector (312) Portion limits vertical axis (VA).Vertical axis (VA) is usually orthogonal with plane (P1) limited by upper mounting plate (372).

Referring to Figure 14, in configuration described above, wherein inner surface (324) portion when end effector (312) closure The surface (341) for dividing ground contact angled, relative to vertical axis (VA), inner surface (324) and angled surface (341) phase It is steeper than more.For example, this is shown by the angle (a4) formed in the intersection of plane (P2) and vertical axis (VA), the angle (a4) with smaller or lower compared with the angle (a3) that the intersection of vertical axis (VA) is formed in plane (P3).This and angulation The surface (341) of degree is compared to steeper orientation associated with inner surface (324) also by plane (P2) and plane (P1) The angle (a1) that intersection is formed is shown, the angle which forms with the intersection at plane (P3) and plane (P1) (a2) compared to smaller or lower.

In this example, inner surface (324) and plane (P1) form about 35 degree of angle (a1), which is as above The plane limited by upper mounting plate (372).In contrast, angled surface (341) and plane (P1) form about 25 degree Angle (a2).Therefore, in this example, inner surface (324) and plane (P1) are formed or are limited angle (a1), the angle (a1) ratio About 10 degree of angle (a2) for being formed or being limited by angled surface (341) and plane (P1).On the contrary, this is it can be said that angulation The surface (341) of degree and plane (P1) are formed or are limited angle (a2), and angle (a2) ratio is by inner surface (324) and plane (P1) The angle (a1) for being formed or being limited is about 10 degree small.

In addition in this example, inner surface (324) and vertical axis (VA) form about 55 degree of angle (a4), the vertical axes Line (VA) is the axis limited by the distal end of end effector as described above (312).In contrast, angled surface (341) about 65 degree of angle (a3) is formed with vertical axis (VA).Therefore, in this example, inner surface (324) and vertical axis (VA) it is formed or limits angle (a4), the angle (a4) is than being formed or being limited by angled surface (341) and vertical axis (VA) Fixed angle (a3) is about 10 degree small.On the contrary, this is it can be said that angled surface (341) and vertical axis (VA) forms or limit Angle (a3), the angle (a3) compare about 10 degree of angle (a4) for being formed or being limited by inner surface (324) and vertical axis (VA). In view of teaching herein content, for modifying the various modifications to end (319,339) of above-mentioned angle for this field It will be evident for those of ordinary skill.

B. exemplary anvil longitudinal slit and downside surface

In some cases, in the case where the anvil block with bent back ends, can slit to anvil block and downside surface into The certain modifications of row are to provide the possible enhancing to cutting and suture.The anvil block of some such modifications or modification will be retouched hereinafter It states, and considers teaching herein content, others will be evident those of ordinary skill in the art.

Figure 15 depicts the cross-sectional view of anvil block (318), shows anvil block slot (342).As shown, slit (342) In It include part " I " shape in cross section.In this way, slit (342) includes lateral part (347) and top cap part (355). Percussion beam (314) (it is similar to above-mentioned percussion beam (14)) can be positioned on slit (42) with percussion beam (14) as described above Interior identical mode is located in slit (342).As shown in Figure 15 shown in example, upper pin (338) includes rectangular profile, is made Obtaining upper pin (338) can be positioned in the lateral part (347) of slit (342).In addition, percussion beam (314) is in top cap part (355) extend to inner part.Percussion beam (314) and end effector (312) can be operated relative to end effector (12) Cutting and suture movement are completed with percussion beam (14) identical mode described herein above.

As shown in Figure 15 seen in example, anvil block (318) further comprises along each outside of anvil block (318) and longitudinal The stepped portion (349) of extension.In this example, each stepped portion (349) includes a nail forming pit (353). Stepped portion (349) be configured to so that the downside surface (326) of anvil block (318) include stepped portion (349) with And low portion (351).As shown in figure 15, low portion (351) is deposited along every side of the anvil block slot (342) longitudinally extended , and low portion (351) respectively includes two rows of nail shapes pits (353).In the above described manner, stepped portion (349) from Low portion (351) offset of vertical of the downside surface (326) of anvil block (318) and the downside surface for being parallel to anvil block (318) (326) low portion (351).In view of teaching herein content, the downside surface (326) of anvil block (318), specifically ladder Other constructions of formula part (349) and low portion (351) will be evident for the ordinary skill in the art.Example Such as, in some instances, the construction of downside surface (326) is complementary with the construction of upper mounting plate (372) of storehouse (337).For example, storehouse (337) there can be multistage upper mounting plate (372), wherein convex portion is overlapped with the stepped portion (349) of offset of vertical.

Figure 16 depicts the sectional view for another exemplary anvil (418) being used together with end effector (312).Anvil Seat (418) is similar with anvil block (318) in all respects in addition to its cross section, as described herein.In this way, anvil block (318) can quilt It is modified as to embody the cross section of anvil block described below (418) rather than cross section shown in figure 15.Anvil block (418) includes anvil Seat slit (442).As shown, slit (442) includes part " I " shape in cross-section.Part " I " shape of slit (442) Shape is modified compared with the shape shown in anvil block slot (342) in Figure 15.For anvil block slot (442), slit (442) Including lateral part (447) and top cap part (455).Although lateral part (347) has on profile has straight end Rectangular shape, but lateral part (447) have curved end.Fire beam (414) (it is similar to above-mentioned percussion beam (14)) Identical mode in slit (42) can be can be positioned on percussion beam (14) as described above to be located in slit (442).Such as figure Shown in 16 diagram example, upper pin (438) includes lateral part (447) matched profile with slit (442), so that top Pin (438) can be positioned in the lateral part (447) of slit (442).In addition, percussion beam (414) extends in part in top cap Partially in (455), but the degree extended compared with the percussion beam (314) of Figure 15 as described above and top cap part (355) is smaller. Percussion beam (414) and end effector (312) can operate with relative to end effector (12) and fire beam (14) with above The identical mode completes cutting and suture movement.

In the case where anvil block (418) and slit (442), the gap of top cap part (455) is by top cap part (455) from side It is indicated to the distance of part (447) extension.In the case where anvil block (418) and slit (442), between top cap part (455) Gap is smaller compared with the gap of top cap part (355).The lateral part (347) of anvil block (318) and the lateral part of anvil block (418) (447) between another difference is that lateral part (347) width be greater than lateral part (447) width.Lateral part This width of (347,447) defines the path in lateral part (337,447), and the path is for receiving and keeping institute as above The respective pins (338,438) stated.

Anvil block (418) is also different from anvil block (318), as shown in Figure 15 and Figure 16, the difference is that anvil block (418) does not have There is the stepped portion (349) being similar in anvil block (318).On the contrary, anvil block (418) includes the downside surface of uniform planar (426), wherein downside surface (426) is divided into two sides by slit (442), and every side has three nail forming pits (453). In addition, anvil block (418) includes slightly thin profile compared with anvil block (318), wherein compared with the same distance of anvil block (318), anvil The distance of top surface to the downside surface (426) of seat (418) is smaller.In view of teaching herein content, for the general of this field Logical technical staff is evident that, in other patterns, anvil block (418) can be modified and/or changed in terms of size Downside surface (426) is to include stepped portion (349) same or similar stepped portion with anvil block (318).

C. exemplary anvil end

In some cases, it can modify to the end of anvil block to provide possible other tissue and capture benefit.One The anvil block end of a little such modifications or modification will be described below, and consider teaching herein content, other for this Field those of ordinary skill will be evident.

Figure 17 shows another exemplary anvils that can be used together with end effector (312) instead of anvil block (318) (518).Anvil block (518) includes bent back ends (519), is similar to bent back ends as described above (319).End (519) packet Inner surface (524) are included, are similar to above-mentioned inner surface (324).However, bent back ends (519) further comprise in its distal end portion Protruding portion (521) at portion.Protruding portion (521) extends outwardly away from inner surface (524) towards storehouse (337) when in use.Protruding portion It (521) include flat surfaces (523), which is configured to contact when end effector (312) are closed The angled surface (341) of the end (339) in storehouse (337).Protruding portion (521) further comprises antelabium (525).The antelabium (525) the entire width across end (519) is extended transversely with.

When end effector (312) closure when, protruding portion (521) can operate with promote tissue to capture and prevent tissue from The distal end of end effector (312) removes.By way of example, protruding portion (521) provides end (519) and storehouse (337) End (339) between direct contact, but provide the gap or space (345) of neighbouring contact area as described above simultaneously. Space (345) provides a region, and tissue can be collected in this region, so as not to understand from the distal side of end effector (312) End is squeezed out towards distal side.Using have protruding portion (521) anvil block (518) example in, with do not have protruding portion (521) example of the end of anvil block is compared, and gap or space (345) can be bigger.In other words, in some instances, but not Centainly require in all examples, when end effector (312) closure, by being contacted with end (339), protruding portion (521) it is configured to reduce the plane limited by inner surface (524) and the plane (P1) limited by upper mounting plate (372) is formed Angle.Therefore, compared to storehouse (337) angled surface (341) relative to upper mounting plate (372), inner surface (524) is opposite It is steeper in upper mounting plate (372).

End (519) is optionally further configured as the insertion piece of the main part (522) of anvil block (518).Originally showing In example, longitudinal slit (542) terminates at opening (527), which is configured to receive the nearside of end (519) Component, so that end (519) are the rigid insert of the main part (522) of anvil block (518).With pluggable anvil body portion Some additional exemplary end effectors of curved anvil block end in point are described in following: U.S. Patent application [agency People's file number END8116USNP.0641882], entitled " Surgical Stapler with Insertable Distal Anvil Tip " is submitted on the same day with the application, and the disclosure of which is herein incorporated by reference；And U.S. Patent application [attorney number END8117USNP.0641884], entitled " Surgical Stapler with Cooperating Distal Tip Features on Anvil and Staple Cartridge ", is submitted on the same day with the application, and it is public Content is opened to be herein incorporated by reference.Certainly, in other patterns, end (519) and anvil block (518) are integrally formed, without It is created as insertion piece.In such cases, opening (527) can be omitted.

Figure 18 shows another exemplary anvil that can be used together with end effector (312) instead of anvil block (318) (618).Anvil block (618) includes bent back ends (619), is similar to bent back ends as described above (319).End (619) packet Inner surface (624) are included, are similar to above-mentioned inner surface (324).However, bent back ends (619) further comprise in its distal end portion Protruding portion (621) at portion.Protruding portion (621) extends outwardly away from inner surface (624) towards storehouse (337) when in use.Protruding portion (621) Including bulbous convex surface (623), which is configured to close in end effector (312) The angled surface (341) of the end (339) of storehouse (337) is contacted when conjunction.

When end effector (312) closure when, protruding portion (621) can operate with promote tissue to capture and prevent tissue from The distal end of end effector (312) removes.By way of example, protruding portion (621) provides end (619) and storehouse (337) End (339) between direct contact, but provide the gap or space (345) of neighbouring contact area as described above simultaneously. Space (345) provides a region, and tissue can be collected in this region, so as not to understand from the distal side of end effector (312) End is squeezed out towards distal side.In the example using the anvil block (618) that there are protruding portion (621) to provide, protruded with not having The example of the end of the anvil block in portion (621) is compared, and gap or space (345) can be bigger.In other words, in some instances, but Not necessarily require in all examples, when end effector (312) closure, by being contacted with end (339), protruding portion (621) it is configured to reduce the plane limited by inner surface (624) and the plane (P1) limited by upper mounting plate (372) is formed Angle.Therefore, compared to storehouse (337) angled surface (341) relative to upper mounting plate (372), inner surface (624) is opposite It is steeper in upper mounting plate (372).

End (619) is optionally further configured as the insertion piece of the main part (622) of anvil block (618).Originally showing In example, longitudinal slit (642) terminates at opening (627), which is configured to receive the nearside of end (619) Component, so that end (619) are the rigid insert of the main part (622) of anvil block (618).With pluggable anvil body portion Some additional exemplary end effectors of curved anvil block end in point are described in following: U.S. Patent application [agency People's file number END8116USNP.0641882], entitled " Surgical Stapler with Insertable Distal Anvil Tip " is submitted on the same day with the application, and the disclosure of which is herein incorporated by reference；And U.S. Patent application [attorney number END8117USNP.0641884], entitled " Surgical Stapler with Cooperating Distal Tip Features on Anvil and Staple Cartridge ", is submitted on the same day with the application, and it is public Content is opened to be herein incorporated by reference.Certainly, in other patterns, end (619) and anvil block (618) are integrally formed, without It is created as insertion piece.In such cases, opening (627) can be omitted.

In view of teaching herein content, the end (319,519,619) of corresponding anvil block (318,518,618) is modified to mention For those of ordinary skill in the art for the other way of uniform flat surface or one or more protruding portions as described above It will be evident that.As by content understanding according to the teaching of this article, angle associated with the bent back ends of anvil block and/or similar The additional features of above-mentioned protruding portion can help to tissue capture, this is also beneficial to application of advancing as described above.

D. exemplary storehouse option

It is as described further below, for and have the end effector of rigid curved anvil block end, can be used has The end effector of anvil block end and the storehouse nose with cooperation feature portion realizes the grasping tissue of enhancing.Such cooperation features It can provide locking or tissue block piece, the locking or tissue block piece prevent the group clamped to be woven in court during cutting and suture movement Distal movement leaves the distal end of end effector.Such cooperation features also act as tactile feedback feature portion, to pass through Feel that cooperation feature portion is engaged or contacted to indicate their complete grip tissue, vascular or pipes to user in distal end Shape structure.In application of advancing, such cooperation features can serve as feedback characteristic portion or structure similarly to indicate to user They are in the end of tissue pathway, such as by engagement at the distal end or the cooperation feature portion contacted (with each contact tissue Corresponding cooperation feature portion it is opposite) proved.In addition, in some cases, storehouse upper mounting plate can be constructed modify with Possible enhancing in cutting and suture is provided.The storehouse of some such modifications or modification will be described below, and in view of herein Teaching content, others those of ordinary skill in the art will be evident.

Figure 19 depicts another exemplary end effector including anvil block (718), lower jaw (716) and storehouse (737) (712) distal part.It should be appreciated that end effector (712) can replace the end effector (12) of instrument (10) to use.End Portion's actuator (712) can be integrally formed with instrument (10), or alternatively, can be with the end effector of instrument (10) (12) it exchanges.Anvil block (718) can be operated with opposite lower jaw (716) pivot.Anvil block (718) and lower jaw (716) can clamp It organizes (90), the clamping carried out similar to anvil block shown in FIG. 1 (18) and lower jaw (16).Storehouse (737) can be operated to put It sets in lower jaw (716), is similar to storehouse shown in Fig. 3 (37).

Anvil block (718) includes bent back ends (719), is similar to above-mentioned end (619), wherein end (719) include ball Root shape convex surface (723).Storehouse (737) includes being shaped as the spherical notch or groove (725) complementary with surface (723).In In this example, the rigid bulbous surface (723) of end (719) and groove (725) are to be configured to promote tissue capture Cooperation feature portion.In a kind of pattern, end effector (712) is configured to so that when end effector (712) are closed When conjunction, the rigid anvil block end (719) with bulbous surface (723) does not contact storehouse (737).In such cases, when being expert at Into when grip tissue, tissue 90 can be pushed into groove (725) by the bulbous surface (723) of anvil block end (719) in application, and Tissue (90) is remained there under compression, to provide the tissue capture of safety during cutting and suturing operation.In addition exist In other patterns, end effector (712) is configured to so that bulbous surface (723) contact groove when clamping (725).In such cases, when the grip tissue in application of advancing, bulbous surface (723) and recessed is detected in tactile Contact between slot (725) may act as feedback characteristic, for detecting final otch in operation as described above of advancing.Consider To teaching herein content, except bulbous surface (723), the shape in addition to spherical notch (725) can be used for providing similar function Can, and consider teaching herein content, such other shapes or modification for the ordinary skill in the art will Obviously.

Figure 20 depicts as described above including the exemplary end execution of another of anvil block (718) and lower jaw (716) The distal part of device (812).End effector (812) further comprises storehouse (837).It should be appreciated that end effector (812) can It is used instead of the end effector (12) of instrument (10).End effector (812) can be integrally formed with instrument (10), or as another A kind of outer selection can be exchanged with the end effector (12) of instrument (10).Anvil block (718) can be operated with opposite lower jaw (716) it pivots.Anvil block (718) and lower jaw (716) can grip tissue (90), be similar to anvil block shown in FIG. 1 (18) and lower pincers The clamping that mouth (16) is carried out.Storehouse (837) can be operated to be placed in lower jaw (716), be similar to storehouse shown in Fig. 3 (37)。

Anvil block (718) includes bent back ends (719), is similar to above-mentioned end (619), wherein end (719) include ball Root shape surface (723).Storehouse (837) includes the pad (825) being made of flexible elastomer, so that pad (825) has elasticity.Originally showing In example, the rigid bulbous surface (723) of end (719) and pad (825) are the cooperation for being configured to promote tissue capture Features.In a kind of pattern there is no tissue, or when the tissue clamped is merely positioned the straight of end effector (812) When in part, end effector (812) is configured to have bulbous table so that when end effector (812) closure The rigid anvil block end (719) in face (723) contacts storehouse (837), and specifically, bulbous surface (723) engagement pad (825), As shown in figure 20.In other cases, when the grip tissue in application of advancing, the bulbous surface of anvil block end (719) (723) tissue (90) can be compressed against pad (825), to provide the tissue capture of safety during cutting and suturing operation.Herein Class advance application in, when the end in tissue cut line, user can feel bulbous surface (723) and pad (825) it Between contact so that these structures may act as feedback characteristic portion, for detecting most egress in operation as described above of advancing Mouthful.In addition in other patterns, end effector (812) is configured to so that when clamping with the presence or absence of tissue, ball Root shape surface (723) not engagement pad (825).In view of teaching herein content, shape in addition to bulbous surface (723) and Features in addition to pad (825) can be used for providing similar function, and consider teaching herein content, such other shapes Shape, features or modification will be evident for those of ordinary skill in the art.

Figure 21 depicts the closer view in storehouse (837).As shown in this shown in pattern, storehouse (837) include being located at storehouse (837) Nasal portion (829) on multiple protruding features portions (827).In this example, nasal portion (829) includes the distal side of storehouse (837) End (839), the distal end (839) and lower platform part (831) are angled, on the lower platform part (831) and storehouse (837) Platform (872) extends in parallel.Protruding features portion (827) usually covers the top surface of nasal portion (829) and is evenly spaced. In this example, protruding features portion (827) be rigidity and including cylindrical member outstanding；However, in other patterns, Protruding features portion (827) can swell for rigid projections or have the top surface from nasal portion (829) outstanding any other suitable Shape.As shown in figure 21, protruding features portion (827) generally about pad (825), which is flexible as described above.Separately In external some other patterns, nose can be assigned by having multiple grooves or etching painting in the surface of nasal portion (829) Divide (829) surface texture.

Storehouse (837) further comprises multiple protruding features portions (833) on the upper mounting plate (872) of storehouse (837).Protrusion Features (833) extend along two sliding parts of vertical slit (849).In this example, protruding features portion (833) are rigid And provide the grasping tissue of enhancing.It should be appreciated that two protruding features portions (827,833) are referred to alternatively as grasping features.It is convex It plays features (833) and is configured as U-shaped component pair in diagram pattern, wherein each of component is towards another.Consider To teaching herein content, the other shapes and construction of protruding features portion (833) are for the ordinary skill in the art It will be evident that.In addition, although storehouse (837) are shown as tool there are two protruding features portion (827,833), other by this example In pattern, storehouse (837) only can have protruding features portion (827).In addition in other patterns, storehouse (837) can only have protrusion special Sign portion (833).However, storehouse (837) can not have protruding features portion (827,833), such as similar to storehouse in other patterns (37)。

Figure 22 depicts another exemplary end effector including anvil block (918), lower jaw (916) and storehouse (937) (912).It should be appreciated that end effector (912) can replace the end effector (12) of instrument (10) to use.End effector (912) can be integrally formed with instrument (10), or alternatively, it can be mutual with the end effector (12) of instrument (10) It changes.Anvil block (918) can be operated with opposite lower jaw (916) pivot.Anvil block (918) and lower jaw (916) can grip tissues (90), it is similar to clamping performed by anvil block shown in FIG. 1 (18) and lower jaw (16).Storehouse (937) can be operated to be placed on In lower jaw (916), it is similar to storehouse shown in Fig. 3 (37).Alternatively, end effector (912) from instrument (10) remaining In some patterns that part removes, storehouse (937) can be permanently attached in lower jaw (916).

As shown in figure 22, end effector (912) will have the anvil block (918) and storehouse (937) group of bent back ends (919) It closes, which has the angled surface (941) of the distal end (939) along storehouse (937), is similar to above-mentioned end The construction of actuator (312).In this example, end effector (912) includes other features, and specifically includes storehouse (937) multistage nail platform (972).In diagram pattern, multistage nail platform (972) includes along the every of vertical slit (949) Three grades of one side positioning, the vertical slit (949) longitudinally divide storehouse (937) equally.External level (973) on every side include along The dog holes (951) that the surface longitudinal in storehouse (937) extends.Inside rank (975) on every side includes the table along storehouse (937) The dog holes (951) that face longitudinally extends.Finally, the intergrade on every side between external level (973) and internal level (975) It (977) include the dog holes (951) extended along the surface longitudinal of storehouse (937).As shown, multistage nail platform (972) External level (973) is deviated from intergrade (977).The intergrade (977) of multistage nail platform (972) is deviated from internal level (975).In In this example, the offset of grade is configured with cascading fashion, wherein as grade is close to vertical slit (949), from a grade step Formula rises to next grade.In view of teaching herein content, the other way of multistage nail platform (972) is configured for this field Those of ordinary skill for it will be evident that.

In this example, the multistage nail platform (972) of storehouse (937) includes multiple protruding features portions (953), the multiple convex It is constructively identical as protruding features portion (833) described above relative to end effector (812) to play features.Institute as above It states, protruding features portion (953) are configured to provide improved tissue capture and grasping.Although storehouse (937) in this example Including protruding features portion (953), but in other patterns, protruding features portion (953) can be omitted, so that multistage nail platform (972) Including the flat surfaces along every level-one.In addition, in this example, angled surface (941) be shown as it is flat, but In other patterns, angled surface (941) may include protruding features portion (827) as described above.In view of teaching herein The other way of content, configuration end effector (912) will be evident for the ordinary skill in the art.

IV. example combinations

Following embodiment is related to the various non-exclusive modes that teaching herein content can be combined or apply.It should manage Solution, following embodiment be not intended to limit can present patent application or present patent application it is subsequent present a paper in any time The coverage area of any claim provided.It is not intended to carry out disclaimer.Following embodiment is provided merely for the sake of illustration Property purpose.It is expected that the various teaching content of this paper can be arranged and apply in a number of other ways.It is contemplated that arriving, some modifications Certain features mentioned in following embodiment can be omitted in.Therefore, any one of aspect or feature mentioned below be not Should be considered as conclusive, unless in addition for example by inventor or pay close attention to inventor successor the date later clearly indicate as This.If present patent application or any claim of subsequent middle proposition of presenting a paper relevant to present patent application include hereafter Those of refer to the supplementary features except feature, then these supplementary features should not be assumed because of any original relevant to patentability Thus it is added.