阅读说明：本技术 具有可***远侧砧座末端的外科缝合器 (Surgical stapling device with pluggable distal anvil end ) 是由 J·L·哈里斯 R·布勒索伊 J·P·肖瓦尔特 G·J·巴克斯 F·E·谢尔顿四世 于 2018-02-12 设计创作，主要内容包括：本发明提供了一种外科器械,其包括主体、轴和端部执行器,该端部执行器能够操作以压缩、缝合并切割组织。该端部执行器包括砧座和仓。该砧座具有主体和与主体连接的模块化可释放弯曲末端。当组织被夹持在砧座和仓之间时,弯曲末端响应于施加在弯曲末端上的力而为能够弹性变形的。砧座的弯曲且能够变形的特征部为端部执行器提供改善的可视化和可操纵性,尤其是在涉及行进的手术期间。弯曲的砧座末端的模块化性质为端部执行器提供：允许由于磨损而进行的砧座末端更换或基于使用者偏好或手术的可互换性。(The present invention provides a kind of surgical instruments comprising main body, axis and end effector, the end effector can operate with compression, suture and cut tissue.The end effector includes anvil block and storehouse.The releasable bent back ends of modularization that the anvil block has main body and connect with main body.When tissue is clamped between anvil block and storehouse, bent back ends are in response to the power that is applied on bent back ends being capable of flexible deformation.The features that is bent and can deform of anvil block provide improved visualization and navigability for end effector, especially during the operation for being related to advancing.The modular nature of curved anvil block end provides for end effector: the anvil block end for allowing to carry out due to abrasion is replaced or the interchangeability based on user's preference or operation.)

1. a kind of equipment, comprising:

(a) main body；

(b) axis, the axis extend from the main body, wherein the axis limit longitudinal axis；And

(c) end effector being connected to the axis, wherein the end effector can be operated with compression, suture and cutting group It knits, wherein the end effector includes:

(i) lower arm, the lower arm are configured to keep nail bin,

(ii) anvil body, the anvil body can move between the open and the closed positions, and

(iii) curved anvil block end, wherein the curved anvil block end be configured to it is remote with the anvil body Side end is selectively fixed, wherein the curved anvil block end is capable of flexible deformation and is configured to respond In when the anvil body is moved towards the closed position capture between the curved anvil block end and the lower arm It organizes and bends.

2. equipment according to claim 1, wherein the anvil body includes longitudinal slit, wherein when described curved When being fixed to the anvil body to anvil block terminal selective, at least part of the curved anvil block end is accepted in institute It states in a part of longitudinal slit.

3. equipment according to claim 1, wherein the curved anvil block end includes operatively being configured to grab Hold one or more ridges of tissue.

4. equipment according to claim 1, wherein the curved anvil block end includes insertion piece, the insertion piece quilt It is constructed to be permeable to cooperate in the distal part for the longitudinal slit being formed in the anvil body.

5. equipment according to claim 4, wherein the insertion piece is taper.

6. equipment according to claim 4, wherein the insertion piece is configured in response to being applied to the insertion The pulling force of part and extend.

7. equipment according to claim 4, wherein the distal part of the longitudinal slit has T-shape, described T-shape has the horizontal component and vertical portion for intersecting to form the T-shape.

8. equipment according to claim 1, wherein the anvil body includes longitudinal slit, wherein the longitudinal slit Including at the distal end of the longitudinal slit first part, connect with the first part and from the first part The second part extended proximally and the third for connecting with the second part and being extended proximally from the second part Part.

9. equipment according to claim 8, wherein the first part of the longitudinal slit includes V-shaped part.

10. equipment according to claim 8, wherein the second part of the longitudinal slit includes cylindrical part.

11. equipment according to claim 8, wherein the curved anvil block end includes neck portion, plug and guidance Features.

12. equipment according to claim 11, wherein the neck portion of the curved anvil block end is configured to It can be accepted and be selectively retained in the first part of the longitudinal slit, wherein the plug is adapted to It is enough accepted and is selectively retained in the second part of the longitudinal slit, and wherein guide features portion quilt It is constructed to be permeable to be accepted and be selectively retained in the Part III of the longitudinal slit.

13. equipment according to claim 1, wherein the anvil body includes longitudinal slit, wherein the longitudinal slit Part including being configured to receive the cylindrical insert of the anvil block end.

14. equipment according to claim 13, wherein the cylindrical insert is flexible and is adapted to It is enough to be extended in response to being applied to the power of the cylindrical insert, and wherein the anvil body is constructed such that institute State that anvil block end and the anvil body are selectively fixed to be needed to extend the cylindrical insert with by the cylinder Insertion piece is placed in the part for being configured to receive the cylindrical insert of the longitudinal slit.

15. equipment according to claim 1, wherein the anvil body includes the first alignment feature, wherein described curved Bent anvil block end includes the second alignment feature, and wherein first alignment feature and second alignment feature Cooperation is the curved anvil block end to be aligned with the anvil body.

16. a kind of equipment, comprising:

(a) main body；

(b) axis, the axis extend from the main body, wherein the axis limit longitudinal axis；And

(c) end effector being connected to the axis, wherein the end effector can be operated with compression, suture and cutting group It knits, wherein the end effector includes:

(i) lower arm, the lower arm are configured to keep nail bin,

(ii) anvil body, the anvil body can move between the open and the closed positions, wherein the anvil block master Body includes longitudinal slit, and

(iii) curved anvil block end, wherein the curved anvil block end be configured to it is remote with the anvil body Side end is selectively fixed, wherein the curved anvil block end includes insertion piece, the insertion piece be configured to by It is received in the longitudinal slit of the anvil body, and wherein the curved anvil block end is to be capable of flexible deformation And it is configured to the chucking power in response to being applied to the curved anvil block end and bends.

17. equipment according to claim 16, wherein the anvil body further includes shoulder, and the wherein bending Anvil block end include latch, the latch is configured to be selectively engaged the shoulder with by the curved anvil block End is selectively fixed with the anvil body.

18. equipment according to claim 16, wherein the anvil body includes the first bottom surface, chamfering and second Bottom surface, wherein first bottom surface and second bottom surface offset each other.

19. a kind of equipment, comprising:

(a) main body；

(b) axis, the axis extend from the main body, wherein the axis limit longitudinal axis；And

(c) end effector being connected to the axis, wherein the end effector can be operated with compression, suture and cutting group It knits, wherein the end effector includes:

(i) lower arm, the lower arm are configured to keep nail bin,

(ii) anvil body, the anvil body can move between the open and the closed positions, wherein the anvil block master Body includes longitudinal slit,

(iii) curved anvil block end, wherein the curved anvil block end be configured to it is remote with the anvil body Side end is selectively fixed, wherein the curved anvil block end is capable of flexible deformation and is configured to respond It is bent in the chucking power for being applied to the curved anvil block end, and wherein the curved anvil block end includes from described The distal end of curved anvil block end extends to the opening of the proximal end of the curved anvil block end, and

(iv) taper gasket, the taper gasket are configured to be accepted in the opening of the curved anvil block end It is interior and extend through the opening, wherein the tapered pad piece is in a part of the longitudinal slit of the anvil body Further extend, and wherein the tapered pad piece is constructed such that the taper gasket and the described of the anvil body are indulged The curved anvil block end is selectively fixed with the anvil body to the engagement between slit.

20. equipment according to claim 19, wherein the curved anvil block end further includes extended element, described to prolong Component is stretched to extend proximally from the rear surface of the curved anvil block end, wherein

The extended element is configured to be accepted in the longitudinal slit of the anvil body, and wherein described Taper gasket be configured to when the taper gasket extends in the longitudinal slit to the extended element apply to Outer power.

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, inner cutter, 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.This 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 also be by including one or more actuated articulation joints or features are further conducive to position the end and hold Row device enables end effector selectively to carry out joint motions or otherwise inclined relative to the longitudinal axis of axis Turn.

The example of endoscopic surgical instrument includes surgical stapling device.Some such stitching unstruments can be operated to clamp 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 following United States Patent (USP): 1989 The U.S. of entitled " Pocket Configuration for Internal Organ Staplers " that 21 days 2 months year announced Patent 4,805,823；Entitled " the Surgical Stapler and Staple that May 16 nineteen ninety-five announces The United States Patent (USP) 5,415,334 of Cartridge "；Entitled " the Surgical Stapler that November 14 nineteen ninety-five announces The United States Patent (USP) 5,465,895 of Instrument "；Entitled " the Surgical Stapler that on January 28th, 1997 announces The United States Patent (USP) 5,597,107 of Instrument "；Entitled " the Surgical Instrument " that on May 27th, 1997 announces United States Patent (USP) 5,632,432；The United States Patent (USP) of entitled " Surgical Instrument " that on October 7th, 1997 announces 5,673,840；Entitled " the Articulation Assembly for Surgical that on January 6th, 1998 announces The United States Patent (USP) 5,704,534 of Instruments "；On September 29th, 1998 entitled " the Surgical Clamping announced The United States Patent (USP) 5,814,055 of Mechanism "；Entitled " the Surgical Stapling that on December 27th, 2005 announces The United States Patent (USP) 6,978,921 of Instrument Incorporating an E-Beam Firing Mechanism "；2006 Entitled " the Surgical Stapling Instrument Having Separate Distinct that 21 days 2 months year announced The United States Patent (USP) 7,000,818 of Closing and Firing Systems "；On December 5th, 2006 announces entitled “Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil” United States Patent (USP) 7,143,923；Entitled " the Surgical Stapling Instrument that on December 4th, 2007 announces The United States Patent (USP) of Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack " 7,303,108；Entitled " the Surgical Stapling Instrument Incorporating that on May 6th, 2008 announces The United States Patent (USP) 7,367 of a Multistroke Firing Mechanism Having a Rotary Transmission ", 485；Entitled " the Surgical Stapling Instrument Having a Single that on June 3rd, 2008 announces The United States Patent (USP) 7,380,695 of Lockout Mechanism for Prevention of Firing "；On June 3rd, 2008 public affairs Entitled " the Articulating Surgical Stapling Instrument Incorporating a Two- of cloth The United States Patent (USP) 7,380,696 of Piece E-Beam Firing Mechanism "；On July 29th, 2008 announces entitled The United States Patent (USP) 7,404,508 of " Surgical Stapling and Cutting Device "；On October 14th, 2008 announces Entitled " Surgical Stapling Instrument Having Multistroke Firing with Opening The United States Patent (USP) 7,434,715 of Lockout "；Entitled " the Disposable Cartridge that on May 25th, 2010 announces The United States Patent (USP) 7,721,930 of with Adhesive for Use with a Stapling Device "；October 21 in 2010 Entitled " the Surgical Stapling Instrument with An Articulatable End that day announces Announce 2010/0264193 in the U.S. of Effector "；And on September 20th, the 2012 entitled " Motor-Driven announced Surgical Cutting Instrument with Electric Actuator Directional Control Announce 2012/0239012 in the U.S. of Assembly ".Each of above-cited United States Patent (USP) and U.S. Patent Publication Disclosure be herein incorporated by reference.

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 abdominal and/or other non-endoscopic surgeries.Only by way of example, in thorax surgery In operation, surgical stapling device can be inserted by thoracotomy, and thus between patient's rib cage to reach one or more Organ, the thorax surgical operation do not use conduit of the trochar as stitching unstrument.Such operation may include being cut using stitching unstrument Disconnected and closure leads to the blood vessel of lung.For example, can be cut off and be closed logical by stitching unstrument before exteriorizing in thoracic cavity Organotropic blood vessel.Certainly, surgical stapling device can be used in various other situations and operation.

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 shows the perspective view of the exemplary surgery suturing appliance for carrying out joint motions；

Fig. 2 shows the side views of the instrument of Fig. 1；

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

Fig. 4 A shows 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 close Side position；

Fig. 4 B shows 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 shows the cross-sectional end view that the end effector of Fig. 3 is intercepted along the line 5-5 of Fig. 3；

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

Fig. 7 shows the perspective view of the end effector of Fig. 3, which is located at tissue and is organizing In be activated it is primary；

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

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

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

Figure 11 shows the amplification decomposition perspective view of the distal part of the alternative pattern of the anvil block of end effector, wherein anvil Seat tool has curved modular tip；

Figure 12 shows the amplification bottom view of the distal part of the anvil block of Figure 11, shows wherein modular tip and anvil block Main body separate；

Figure 13 shows the amplification bottom view of the distal part of the anvil block of Figure 11, shows wherein modular tip and is being inserted into First state is in when in the main body of anvil block；

Figure 14 shows the amplification bottom view of the distal part of the anvil block of Figure 11, shows wherein modular tip and is being inserted into The second state is in when in the main body of anvil block；

Figure 15 shows the amplification decomposition perspective view of the distal part of another alternative pattern of the anvil block of end effector, Wherein anvil block has curved modular tip；

Figure 16 shows the amplification decomposition perspective view of the distal part of another alternative pattern of the anvil block of end effector, Wherein anvil block has curved modular tip；

Figure 17 shows the enlarged perspectives of the distal part of another alternative pattern of the anvil block of end effector, wherein Anvil block has curved modular tip；And

Figure 18 shows the decomposition perspective view of the distal part of the anvil block of Figure 17, is illustrated in cross-section the main part of anvil block Divide to manifest longitudinal slit.

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 modes execute, 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.For following description, Other examples, feature, aspect, embodiment and advantage of the invention will become aobvious and easy to those skilled in the art See, description below carries out by way of example, this is one of best mode contemplated to realize the present invention mode. It arrives as will be appreciated, the present invention can have other different and apparent aspects, and all such aspects are all without departing from the present invention.Cause This, attached drawing and explanation should be considered as it is substantially illustrative and not restrictive.

I. exemplary surgical stitching unstrument

Fig. 1 to Fig. 7 shows exemplary surgical suture and cutting off apparatus 10, the shape of non-joint motions shown in Fig. 1 Under state, size is set to the surgical site of the intubation insertion patient across trochar, to execute surgical operation.Only with Example way, such trochar can be from the abdomens for being inserted into patient between two rib cages of patient or elsewhere.Some In the case of, instrument 10 is used in the case where trochar is not present.For example, instrument 10 can pass through thoracotomy or other types Notch is inserted directly into.This exemplary instrument 10 includes the handle portions 20 for being connected to axis 22.Axis 22 is being distally terminating in joint fortune In dynamic connector 11, which further couples with end effector 12.It should be appreciated that term used herein is all For the handle portions 20 of " nearside " and " distal side " referring to clinician's grasping instrument 10.Therefore, end effector 12 is opposite It is distally located in the handle portions 20 of more nearside.It is also understood that knot diagram use space is used herein for the sake of convenient and is clear Language such as "vertical" and "horizontal".It is used however, surgical instruments is middle in many orientations and positions, and these terms are not intended to It is restrictive and absolute.

In some patterns, at least some of teaching content that axis 22 is announced according to following U.S. teaching content carries out structure It makes: entitled " the Surgical Instrument with Multi-Diameter Shaft's " of announcement on August 28th, 2014 The U.S. announces 2014/0239038, and the disclosure of which is herein incorporated by reference.Only in such a way that another is exemplary, according to The beauty of entitled " Surgical Instrument Comprising a Sensor System " that on October 1st, 2015 announces State announces 2015/0272575 at least some of teaching content, and axis 22 can be removed from handle portions 20, the disclosure of which It is herein incorporated by reference.In some other patterns, axis 22 cannot be removed from handle portions 20.According to the teaching of this article Hold, other suitable configurations of axis 22 will be apparent for those of ordinary skills.

Once the cannula passage that actuated articulation joints 11 and end effector 12 pass through trochar is inserted into, actuated articulation joints 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 effector 12 can be deflected from the longitudinal axis L A of axis 22 with required angle [alpha].End effector 12 can be from required angle or due to it as a result, His reason reaches behind organ or close to tissue.In some forms, actuated articulation joints 11 can make end effector 12 It is deflected along single plane.In some other forms, actuated articulation joints 11 can make end effector along more than one Plane deflection.Actuated articulation joints 11 and joint motions control 13 can be according in any references in herein cited multiple references Teaching content construct.Alternatively, actuated articulation joints 11 and/or joint motions control 13 can have any other suitable Configuration.Only by way of example, joint motions control 13 is alternatively configured to knob, which surrounds perpendicular to the vertical of axis 22 It is rotated to the axis of axis LA.

In some patterns, actuated articulation joints 11 and/or joint motions control 13 are according to following U.S. Patent application At least some of teaching content teaching content is constructed and is operated: the title " Surgical that on November 17th, 2015 submits Instrument End Effector Articulation Drive with Pinion and Opposing Racks's " United States Patent (USP) 9,186,142, the disclosure of which is herein incorporated by reference.Actuated articulation joints 11 can also be according to following announcements At least some of teaching content teaching content constructed and operated: announce on August 28th, 2014 entitled The U.S. of " Surgical Instrument with Multi-Diameter Shaft " announces 2014/0239038, disclosure Content is herein incorporated by reference.In view of teaching herein content, actuated articulation joints 11 and joint control 13 can be adopted Various other suitable forms will be apparent for those of ordinary skills.

This exemplary end effector 12 includes lower jaw 16 and pivotable anvil block 18.In some patterns, lower jaw 16 At least some of the teaching content announced according to following U.S. teaching content is constructed: on August 28th, 2014 names announced Referred to as " Installation Features for Surgical Instrument End Effector Cartridge " The U.S. announces 2014/0239044, and the disclosure of which is herein incorporated by reference.In some patterns, anvil block 18 is according to following It is 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 various other suitable Form will be apparent for those of ordinary skills.

Handle portions 20 include pistol grip 24 and closure trigger 26.Closure trigger 26 can be towards pistol type Grip part 24 pivots, so that lower jaw 16 clamping or closure of the anvil block 18 towards end effector 12.The such of anvil block 18 closes Conjunction is provided by closed tube 32 and close ring 33, and the two is in response to closure trigger 26 relative to pistol grip 24 Pivot and longitudinally translated relative to handle portions 20.Closed tube 32 extends along the length of axis 22；And close ring 33 positions In the distal side of actuated articulation joints 11.Actuated articulation joints 11 can operate with by longitudinal movement from 32 transmission of closed tube/transmission To close ring 33.

Handle portions 20 also include firing trigger 28.Slender member (not shown) extends longitudinally through axis 22, and rings Longitudinal percussion movement should be transmitted from handle portions 20 to percussion beam 14 in the actuating of firing trigger 28.Fire this of beam 14 Distal translation makes the suture and cutting of the tissue clamped in end effector 12, as will be described in more detail.Then, Trigger 26,28 can be discharged to discharge the tissue from end effector 12.

Fig. 3 to Fig. 6 shows the percussion beam 14 using electron beam form to execute the end effector 12 of multiple functions.It answers Work as understanding, electron beam form is only illustrative example.Percussion beam 14 can take any other suitable form, including but not limited to Non-electrical beamlet form.As best in Fig. 4 A to Fig. 4 B as it can be seen that percussion beam 14 includes the upper pin 38 of horizontal orientation, percussion back lid 44, the middle pin 46 of horizontal orientation and the cutting edge 48 in distal side.Longitudinal anvil block that upper pin 38 is positioned in anvil block 18 is narrow In slot 42, and it can be translated in longitudinal anvil block slot.Percussion back lid 44 is by extending through down percussion beam 14 Jaw slot 45 (shown in Fig. 4 B) and the lower surface for slidably engaging lower jaw 16, lower jaw slot 45 are across the formation of lower jaw 16 's.Middle pin 46 engages the top surface of lower jaw 16 in a sliding manner, to cooperate with percussion back lid 44.Therefore, it fires The inevitable spaced end actuator 12 during percussion of beam 14.

The percussion beam 14 of some non-electrical beamlet forms can lack upper pin 38, middle pin 46, and/or percussion back lid 44. Some such forms of instrument 10 can be relied solely in close ring 33 or some other features, to be advanced to far in percussion beam 14 When side position, anvil block 18 is pivoted to closed position and anvil block 18 is maintained in closed position.Only by way of example, it fires Beam 14 and/or associated latching features can be carried out according at least some of the teaching content of following patents teaching content Construction and operation: on August 28th, 2014 entitled " the Lockout Feature for Movable Cutting announced The U.S. of Member of Surgical Instrument " announces 2014/0239041, and the disclosure of which is incorporated by reference Herein.Content according to the teaching of this article, ordinary skill of other the suitable forms that percussion beam 14 can use for this field Personnel will be apparent.

The anvil block 18 that Fig. 3 shows this exemplary percussion beam 14 proximally positioned and is pivoted to open position, to permit Perhaps unspent nail bin 37 is removably attached in the channel of lower jaw 16.As best finding, sheet are exemplary into Fig. 6 by Fig. 5 Nail bin 37 includes warehouse 70, which shows upper brace 72 and couple with lower part storehouse pallet 74.As seen in best in Fig. 3, Vertical slit 49 is formed through a part of nail bin 37.Best finding in same such as Fig. 3, three dog holes 51 are formed Upper brace 72 is passed through on the side of vertical slit 49, and another group of three dog holes 51 are formed in the another of vertical slit 49 Upper brace 72 is passed through on side.Certainly, it is possible to provide any other appropriate number of staple (for example, two rows of, four rows or other Quantity).Referring again to Fig. 4 A to Fig. 6, wedge-shaped slides 41 and multiple staple drivers 43 be trapped in warehouse 70 and pallet 74 it Between, wherein wedge-shaped slides 41 are located at 43 nearside of staple drivers.Wedge-shaped slides 41 can longitudinally move in nail bin 37；And Staple drivers 43 can vertically move in nail bin 37.Nail 47 is also positioned in warehouse 70, is located at corresponding staple drivers 43 tops.Specifically, each nail 47 is vertically driven in warehouse 70 by staple drivers 43, will follow closely 47 nail hole by being connected 51 drive out.As seen in best in Fig. 4 A to Fig. 4 B and Fig. 6, there are inclined cam surfaces for wedge-shaped slides 41, when wedge shape is slided When part 41 is driven distally through 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 is carried out 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 be according at least one in the teaching content of following U.S. Publication A little teaching content are constructed and are operated: on August 28th, 2014 entitled " the Installation Features for announced The U.S. of Surgical Instrument End Effector Cartridge " announces 2014/0239044, the disclosure of which It is herein incorporated by reference.With reference to teaching herein content, other the adoptable suitable forms of nail bin 37 are for this field Those of ordinary skill for will be apparent.

By promoting closed tube 32 and close ring 33 so that end effector 12 is closed as shown in Fig. 4 A to Fig. 4 B towards distal side In the case where conjunction, by making upper pin 38 enter longitudinal anvil block slot 42, percussion beam 14 is advanced into and is engaged with anvil block 18.Pushing block 80 (shown in Fig. 5) are located at the distal end of percussion beam 14, and are configured to engaged wedge sliding part 41, so that when hitting When hair trigger 28 is activated, in the case that percussion beam 14 is advanced through nail bin 37 towards distal side, pushing block 80 can push wedge towards distal side Shape sliding part 41.During such percussion, the cutting edge 48 of percussion beam 14 enters the vertical slit 49 of nail bin 37, to cut off folder Hold the tissue between nail bin 37 and anvil block 18.As shown in Fig. 4 A to Fig. 4 B, intermediate pin 46 and pushing block 80 are by entering nail bin 37 Activate nail bin 37 together in interior slit 49, by wedge-shaped slides 41 driving at staple drivers 43 occur upwards jack up connect Nail 47 is then driven across nail hole 51 outward and makes nail 47 and (Fig. 3 institute of nail shapes pit 53 on the inner surface of anvil block 18 by touching Show) form contact.Fig. 4 B shows the percussion beam 14 being translated to the far side completely after completing cutting and suture tissue.It should manage Solution, nail shapes pit 53 are purposely omitted in the view of Fig. 4 A to Fig. 4 B；But nail shapes pit 53 is illustrated in Fig. 3.Also answer Work as understanding, anvil block 18 is purposely omitted in Fig. 5.

Fig. 7, which is shown, is activated the end effector 12 across tissue 90 by single stroke.As shown, cutting edge 48 (being occluded in Fig. 7) have cut through tissue 90, while staple drivers 43 have driven three rows alternately to follow closely 47 across by cutting edge 48 Tissue 90 on every side of the cutting line of generation.In this example, nail 47 is all oriented substantially parallel with cutting line, but It should be appreciated that nail 47 can be with any suitable orientation positions.In this example, after the completion of first stroke, end effector 12 It is recalled from trochar, the nail bin 37 exhausted is replaced with new staple cartridge, then, end effector 12 is arrived again insertable into trochar is passed through Up to suture site further to be cut and be sutured.This process may be repeated, until have been provided desired amount notch and Nail 47.Anvil block 18 can need to be closed to be conducive to be inserted into and recall by trochar；And anvil block 18 can need to be opened with Be conducive to replace nail bin 37.

It should be appreciated that cutting edge 48 substantially can be driven through tissue simultaneously with nail 47 during each actuation stroke Cut off tissue.In this example, cutting edge 48 only slightly lags behind the driving of nail 47, so that nail 47 is just passed through in cutting edge 48 The same area of the tissue is driven through before tissue, it should be appreciated that this can sequentially be overturned or cutting edge 48 can be direct It is synchronous with adjacent nail.Although Fig. 7 shows the end effector 12 being activated in two layers 92,94 of tissue 90, answer Work as understanding, end effector 12 can be activated the more than two layer 92,94 of single layer or tissue across tissue 90.It should also manage Solution, the nail 47 adjacent with the cutting line generated by cutting edge 48 be shaped and located can substantially sealed cutting line tissue, Thus the bleeding at cutting line and/or the leakage of other body fluid are reduced or prevented.In addition, although Fig. 7 shows end effector 12 activate in two substantially flat opposite plane layers 92,94 of tissue, it is to be understood that, end effector 12 can also In the upper actuating such as a part of tubular structure blood vessel, gastrointestinal tract.Therefore, Fig. 7 should not be considered as to end effector 12 Imagine purposes and carries out any restrictions.With reference to teaching herein content, wherein the various suitable conditions and program of instrument 10 can be used It will be apparent for those of ordinary skill in the art.

In a kind of pattern, instrument 10, which provides, controls the motorization of percussion beam 14.It can be used for percussion 14 offer machine of beam The example components of dynamicization control show and describe in following application: on August 28th, the 2014 entitled " Distal announced The U.S. of Tip Features for End Effector of Surgical Instrument " announces 2014/0239043, The disclosure of which is herein incorporated by reference.In addition to the foregoing or foregoing teachings are replaced, motorization controls at least A part can be according to the U.S. of entitled " the Motor-Driven Surgical Instrument " issued on July 3rd, 2012 Patent 8,210, at least some of 411 teaching content teaching content are constructed and are operated, and the disclosure of which is with the side of reference Formula is incorporated herein.In addition to this it or as replacement above-mentioned, can operate to drive the features of percussion beam 14 can be according to the U.S. It announces at least some of the teaching content in 2012/0239012 teaching content to be constructed, the disclosure of which is by reference It is incorporated herein；And/or at least some of 2012/0239012 teaching content teaching content is announced according to the U.S. and is constructed, The disclosure of which is also herein incorporated by reference.In view of teaching herein content, for providing the motor-driven of percussion beam 14 Other suitable component, features and configurations will be apparent for those of ordinary skill in the art.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, beam is fired 14 can be caused according at least some of any other herein cited patent/announcement reference teaching content teaching content It is dynamic.

Instrument 10 may also include latch switch and locking indicator, as shown and described in following patent: August 28 in 2014 Entitled " the Distal Tip Features for End Effector of Surgical Instrument's " that day announces The U.S. announces 2014/0239043, and the disclosure of which is herein incorporated by reference.In addition, latch switch and/or locking instruction And associated components/functions can be constructed according at least some of the teaching content of following patents teaching content: Entitled " the Electronic Lockouts and Surgical Instrument that on January 12nd, 2010 announces The United States Patent (USP) 7 of Including Same ", 644,848, the disclosure of which is herein incorporated by reference.

Instrument 10 further includes manual Returning switch 116, is adapted to be enough in and serves as " emergency " features, so that behaviour Author quickly can proximally bounce back percussion beam 14 in firing schedule.In other words, manual Returning switch 116 can fire Beam 14 is actuated manually when only part is promoted towards distal side.The teaching content that manual Returning switch 116 can be announced according to the following U.S. At least some of teaching content further function: on August 28th, 2014 entitled " the Distal Tip announced is provided The U.S. of Features for End Effector of Surgical Instrument " announces 2014/0239043, public affairs Content is opened to be herein incorporated by reference.

In the operation of description instrument 10, use term " pivot " (and " pivot " with based on similar term) It is not to be read as necessarily requiring to be pivoted movement around fastening axis.In some forms, anvil block 18 is surrounded by pin (or class As features) limit axis pivot, the pin (or similar features) anvil block 18 towards lower jaw 16 move when, along thin Long slit or channel sliding.In such form, pivot axis is along the path shift limited by slit and channel, and anvil block 18 It is pivoted simultaneously around the axis.In addition to this or alternatively, pivot axis can slide first along slit/channel, then anvil block 18 slide into certain distance back wall along slit/channel in pivot axis pivots around the pivot axis.It should be appreciated that such Sliding/translation pivoting action is comprised in the terms such as " pivot ", " pivot ", " can pivot ".Certainly, Yi Xiexing Formula can provide anvil block 18 around the pivoting action etc. for the axis for keeping fastening and not translating in slit or channel.

It should be appreciated that instrument 10 can be carried out according to any teaching content in the teaching content of following United States Patent (USP) construction 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；United States Patent (USP) 2010/0264193；And/or 2012/0239012.As described above, this The disclosure of each of a little patents is herein incorporated by reference.It can provide and exemplary repaired for other of instrument 10 Changing will be described in more detail below.Following teaching content may be incorporated into the various suitable methods in instrument 10 for this field Those of ordinary skill will be apparent.Similarly, by following teaching content and the herein cited various religions of patent/announcement Leading the various suitable modes that content is combined will be apparent those skilled in the art.It is also understood that Following teaching content are not limited to instrument 10 or device taught in herein cited patent.Following teaching content can be easy to answer Use the instrument of various other types, the instrument includes that will not be classified as the instrument of surgical stapling device.With reference to the religion of this paper Content is led, wherein can be using hereafter various other suitable devices of teaching content and setting to those skilled in the art It will be apparent.

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, user exists After end effector 12 is inserted into surgical site, the axis 22 of instrument 10 may be rotated during operation.End effector 12 thus also rotate.When end effector 12 rotates, user may want to see surgical site.For example, user It may wish to see the contact surface between tissue 90 and end effector 12 or contact point.Because end effector 12 can be around vertical It is rotated to axis LA relative to handle portions 20, so user when observing surgical site, may see that end executes The lower jaw 16 of device, rather than anvil block 18.Alternatively, end effector 12 can be rotated into so that when user is in observation end When actuator 12, user can see anvil block 18.User may expect 10 Shi Suoneng of instrument it can be seen that than using Fig. 1 The bigger range of the surgical site range seen.For example, user using equipment do it is some be related to cutting stitch again In the case where the surgical operation for closing the vascular for thering is body fluid and blood to flow through, it may be desirable to visually confirm anvil block 18 and lower jaw 16 Vascular to be cut is completely covered, therefore ensures that actuating primary equipment can cut completely and suture this vascular.In other words It says, user may want to the situation for avoiding cutting and suturing only a part of vascular.Accordingly, it may be desirable to some visual monitorings And/or feedback device, so that user will be appreciated by end effector 12 and be properly positioned in surgical site, so as to anvil block 18 and lower jaw 16 completely clamping blood vessel.It is a kind of it is feasible monitoring surgical site mode may include improve with lower jaw 16 With the visibility of the distal end adjacent area of anvil block 18.In addition, can not only it is expected that the distal end of end effector 12 is visual, But also can it is expected to construct end effector 12, so that the distal end of anvil block 18 is configured in anvil block 18 towards lower jaw Tissue (for example, big blood vessel) is proximally pushed into the space between anvil block 18 and lower jaw 16 when 16 closure.

Fig. 8 shows the exemplary end effector 212 including anvil block 218 and lower jaw 216.It should be appreciated that end is held The end effector 12 that row device 212 may replace instrument 10 uses.End effector 212 can or conduct integrally formed with instrument 10 Another option can be exchanged with the end effector 12 of instrument 10.

Anvil block 218 is operable to pivot relative to lower jaw 216.Anvil block 218 and lower jaw 216 can be similar to by scheming Clamping that anvil block 18 shown in 1 and lower jaw 16 execute clamps tissue 90.End effector 212 further include with it is shown in Fig. 3 The similar storehouse 237 in storehouse 37, storehouse 237 can be operated to be placed in lower jaw 216.

Visible anvil block 218 has the shape of elongation in Fig. 8 into Figure 10, and wherein the distal part of anvil block 218 is towards storehouse 237 It is angled.The distal part of anvil block 218 is angled so that storehouse is compared in the farthest side end 219 of anvil block 218 in the longitudinal direction towards storehouse 237 237 further extend towards distal side.However, distal end 219 may extend to is equal to storehouse 237 in the longitudinal direction in some patterns Distance, or extend to the nearside relative to the farthest side point on storehouse 237.In addition, anvil block 218 passes through gentle incline towards storehouse 237 is angled.Such as the best finding of Figure 10, anvil block 218 includes the side tapered when it is close to the farthest side end 219 of anvil block 218 Face 241.Only by way of example, anvil block 218 is similar to inverted skis end in fig. 8 and is shaped.With angled shape The anvil block 218 of shape can make end effector 212 be easier to be inserted into surgical site.For example, having flat grade or reversing The anvil block 218 of skis end shape contacting tissue or when moving across tissue, anvil block 218 can provide noninvasive injured tissue and scratch Curved surface.Such noninvasive injured tissue flexure may include when anvil block 218 is closed towards lower jaw 216, by tissue (for example, big blood vessel) It is proximally pushed into the space between anvil block 218 and lower jaw 216.Once being placed into surgical site, the angulation of anvil block 218 Degree shape also can provide end effector 212 better navigability and end effector 212 distal end relative to The more preferable visibility of anatomical structure at surgical site.Those skilled in the art refer to teaching herein content energy Easily imagine the anvil block 218 of other suitable forms.

Storehouse 237 can be operated to keep and follow closely 47 similar nails shown in Fig. 4 A to drive in tissue.Such as Fig. 9 institute Show, the distal end in storehouse 237 has triangular-shaped profile.Specifically, the distal end in storehouse 237 includes 239 He of upper taper surface Lower tapering surface 238.In addition, the distal end in storehouse 237 includes tapered side surface 243 on each side.In this example, storehouse The taper that 237 each tapered side surface 243 is substantially presented with the side 241 of anvil block 218 is aligned.Therefore, as shown in Figure 10, storehouse 237 side surface 243 will not extend outward past the side 241 of anvil block 218 from the longitudinal axis L A of end effector 212.On Portion's conical surface 239 and lower tapering surface 238 lead to the farthest side end in storehouse 237.Lower tapering surface 238 limits collimation line 240, so that once end effector 212 is inserted into surgical site, user can see along collimation line 240.Depending on Directrix 240 extends along the edge of lower tapering surface 238.It should be appreciated that the even shape of lower tapering surface 238 can be grasped Make to allow user to visualize and/or almost visualize the distal end 219 of anvil block 218.Specifically, collimation line 240 and vertical View angle theta is intersected to form to the longitudinal axis L A for extending through end effector 212.

View angle theta can establish user to the luminosity coefficient of distal end 219.Specifically, user may be at distal side end 219 front of end passes through any bar point of view distal side end of collimation line 240 and the intersection point of longitudinal axis L A along view angle theta End 219.For example, user has proximally vantage point to close to the region in 219 front of distal end when view angle theta increases Bigger visibility；However, proximally vantage point has the region in 219 front of distal end to user when view angle theta reduces There is smaller visibility.In some forms, view angle theta limits the angle bigger than 90 degree.In addition, in some forms, view angle theta limit Surely angle bigger than 135 degree.Content according to the teaching of this article, other suitable angles of view angle theta are for ordinary skill It will be apparent for personnel.In the pattern of illustration, user is usually along collimation line 240 or along view angle theta Some other point of view, therefore, user is not only it is observed that along the region of collimation line, moreover it is possible to observe within the scope of view angle theta Arbitrary region.The downside of distal end 219 can also slightly justify, to facilitate the intersection point to longitudinal axis L A and collimation line 240 Visibility.

When tissue 90 is clamped between closure storehouse 237 and anvil block 218, user can be along collimation line 240 or in view angle theta Other positions observation in range, such as it can be clearly seen that anvil block 218 clamps tissue 90 in what position.In addition, user will It can determine whether tissue is clamped between anvil block 218 and storehouse 237 completely, only determine that tissue is clamped completely, it could really Protect the end that tissue does not spill over end effector 212.It is also possible to anvil block 218 and storehouse 237 clamping the degree of tissue 90 visually It is presented to user.It should be appreciated that in some instances, can first rotary end effector 212 clamp tissue 90 again, rotating Tissue 90 is clamped while end effector 212, or first clamps rotary end effector 212 again of tissue 90.Therefore, anvil block 218 Conical by its shape user can also be allowed to be easier to observe distal end 219, or the region substantially adjacent with distal end 219.Cone The anvil block 218 of shape can further promote end effector 212 in a manner of hurtless measure together with the lower tapering surface 238 in storehouse 237 It is easily inserted in tissue.Further, since end effector 212 has tapered end, user can be more easily by end Portion's actuator 212, which passes through trochar or can operate, is pushed to surgical operation for the other equipment of leading end actuator 212 In position.For example, once distal end 219 is packed into trochar, the anvil block 218 of lower tapering surface 238 and taper by user It can be used as leading-in end, the rest part sleeve pipe needle of leading end actuator 212.Content according to the teaching of this article, ability The those of ordinary skill in domain will be further understood that, can pass through the taper of each side 243 of the side 241 and storehouse 237 of anvil block 218 Design is to enhance visibility and navigability.

In addition to the foregoing, the pattern of end effector 212 and the instrument 10 for being incorporated to end effector 212 can be according to following beauty At least some of the teaching content that state announces 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；On August 28th, 2014 names announced The referred to as U.S. of " Lockout Feature for Movable Cutting Member of Surgical Instrument " Patent 2014/0239041, the disclosure of which is herein incorporated by reference；On December 13rd, 2016 announces entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical The United States Patent (USP) 9 of Stapler ", 517,065, the disclosure of which is herein incorporated by reference；On August 28th, 2014 The beauty of entitled " the Jaw Closure Feature for End Effector of Surgical Instrument " that announces State's patent 2014/0239036, the disclosure of which is herein incorporated by reference；It announces on August 28th, 2014 entitled The United States Patent (USP) 2014/ 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 The United States Patent (USP) 2014/0239037 of Features for Surgical Stapling Instrument ", the public affairs of above-mentioned announcement Content is opened to be herein incorporated by reference；On August 28th, 2014 entitled " the Surgical Instrument with announced The United States Patent (USP) 2014/0239038 of Multi-Diameter Shaft ", the disclosure of which is herein incorporated by reference；With/ Or on August 28th, 2014 entitled " the Installation Features for Surgical Instrument End announced The United States Patent (USP) 2014/0239044 of Effector Cartridge ", the disclosure of the announcement are herein incorporated by reference. The other modification that can be coupled in end effector 212 will describe in greater detail below.

III. it is used for the curved anvil block end of modularization of end effector

In some operations, it may be necessary to be cut along organizing or passing through tissue, wherein more than one cutting sequence is needed It completes operation-in other words, carries out sequence cutting along continuous path.In such operation, this sequence cutting technique can define For " traveling ".For the operation for being related to advancing, instrument 10 can be placed at surgical site, be activated to cut and stitch It closes, then removes from surgical site with for installing new storehouse 37, and be then put back into surgical site again, with The same paths of primary cutting and suture circulation are cut and are sutured next time before occurring.This process is repeated until cutting It is completed with suture operation.As in Fig. 4 A to Fig. 4 B and Fig. 7 as it can be seen that the distal end configuration of end effector 12 is in anvil block 18 Gap is provided between distal end and the distal end in storehouse 37.The gap can by group be woven in when each traveling step starts into The distal end for entering end effector 12 provides hurtless measure space to be conducive to advance.

As described above, the distal end configuration of end effector 212 is different from the distal end configuration of end effector 12； The various configuration of its end effector 212 provides different potential advantages.Specifically, the distal end of end effector 212 Configuration can provide the relationship between improved navigability and the distal end and adjacent anatomical structures of end effector 212 Improved visibility.In addition, the distal end configuration of end effector 212 can lead to when anvil block 218 is closed towards lower jaw 216 It crosses and tissue is proximally pushed into the space between anvil block 218 and lower jaw 216 and provides tissue sampling effect.However, at it All structures of end effector 212 are in the pattern of rigidity, and the bending configuration of the distal end 219 of anvil block 218 can be insufficient So that its own carries out traveling operation well, because distal end 219 can Xiang Wei when anvil block 218 is closed towards lower jaw 216 The tissue collected in the space between anvil block 218 and lower jaw 216 assigns wound.Therefore, in wherein end effector 212 All structures are in the pattern of rigidity, and end effector 212 can be most suitable for cutting and suturing operation (for example, blood vessel is crosscutting), It is middle by cut and sutured be collected in a organized way in the nearside of distal end 219.

In view of the foregoing, it may be desirable to provide the variations of end effector 12,212, which provides end The traveling ability of portion's actuator 12, the group of improved visibility associated with end effector 212 and end effector 212 Acquisition capacity is knitted, it otherwise may increased wound associated with the perfect rigidity pattern of end effector 212 without providing Risk.The following describe several only exemplary examples of such modification of end effector 12,212.In the following example, anvil Seat tool has distal end, which is resiliently biased so that the bending for being similar to distal end 219 or angled structure is presented Type；However, the distal end by fexible bias pressure is bent in response to enough loads in distal end far from lower jaw.According to this The teaching content of text, it should be understood that providing, there is the anvil block for the angled distal tip section for capableing of flexible deformation can pass through Tissue provides in addition horizontal navigability benefit in terms of navigating to surgical site.In this way, deformable distal tip section Deflection or deformation are to promote end effector smooth and hurtless measure moves across tissue, especially during operation of advancing.Separately Outside, in the case where anvil block is biased into angle position when being not in load condition or being contacted by surrounding tissue, have with using There is the end effector of straight or non-angled anvil block to compare, the visualization of enhancing can be achieved during tissue capture and cutting. In addition, there is the anvil block for the distal end for being biased into angle position can provide a degree of tissue sampling effect, until arriving Up to will be associated with traveling, rather than it is associated with relatively small institutional framework between anvil block and lower jaw is simply acquired Load point.

A. with the end of elastic plug

Figure 11 shows showing of being suitable for being used together with any one of end effector as described herein and surgical instruments Example property anvil block 318.Anvil block 318 includes end 319 and main body 320.End 319 can be selectively connected with main body 320, so that End 319 is configured to modularization and release tip.In the pattern of the illustration of Figure 11 to Figure 14, end 319 be it is curved, So that end 319 extends from main body 320 towards distal side in a curved fashion, wherein end 319 is vertical far from being limited downwards by main body 320 To axis or in the side of the nail bin towards end effector that is as shown in the figure and as described above and being used together with anvil block 318 It is bent upwards or bends.Although being shown as in the pattern of illustration curved, in some other patterns, end 319 can Think it is straight so that it extends along the longitudinal axis that is limited by main body 320.As used herein, when reference end effector When the distal end configuration of component, term " angled " and " curved " should be understood it is synonymous each other.In other words, Term " curved " (and its variations) may include the relationship between common two straight features for limiting angle, so that art Language " curved " (and its variations) is understood not to require component that must extend along camber line.

End 319 includes distal end 322 and proximal end 324.It is last that distal end 322 is configured to working as end 319 End 319 is maintained at the exterior section in 320 outside of main body when connecting with main body 320.Proximal end 324 is configured to end 319 The interior section being located in when end 319 is connect with main body 320 in main body 320.The distal end 322 of end 319 further includes Top surface 326 and bottom surface 328.Bottom surface 328 is operationally configured to connect when end effector clamps tissue Touch the contact surface of tissue.

End 319 further includes the ridge 330 in bottom surface 328.Ridge 330 is operationally configured to tissue grasp spy Sign portion, with facilitate end effector it is in the close position to clamp tissue when grasp tissue.In this example, ridge 330 Farthest side section close to distal end 322 positions, and ridge 330 extends laterally across distal end 322, so that ridge 330 is big Body is upwardly extended in the side perpendicular to the longitudinal axis limited by the main body 320 of anvil block 318.

End 319 further includes one or more grooves 332.In the pattern of illustration, end 319 has there are two groove 332, But in other patterns, end 319 can have more or fewer grooves 332.In the distally located end 322 of groove 332 simultaneously And it is positioned such that they are aligned with the correspondence protrusion 334 in main body 320.In this way, when end 319 is connected to main body 320 When, protrusion 334 can be located in groove 332 so that end 319 is aligned with main body 320.Therefore, in this example, groove 332 and protrusion 334 be operationally configured to alignment feature.

It is plug 336 at the proximal end 324 of end 319.Plug 336 is including wherein intracardiac notch 338 and at it The guide features portion 340 of recent side end.Plug 336 is connect by the neck portion 341 of end 319 with distal end 322.In In this example, plug 336 is made of elastic material such as elastomeric material.As described further below, the bullet of plug 336 Performance is enough to deform plug 336 when applying enough power to plug 336, its initial structure is then restored to when power is removed Type.As Figure 11 is best as it can be seen that guide features portion 340 includes two lateral parts 344 separated by central part 346.

The main body 320 of anvil block 318 includes being configured to cooperate the protrusion 334 in the groove 332 of end 319, As described above.Main body 320 further includes multiple nail shapes pits 353, is structurally and functionally similar to nail forming described above Pit 53.Main body 320 further includes longitudinal anvil block slot 342.Along the portions of proximal of main body 320, longitudinal anvil block slot 342 has Similar to the T-shape part 354 of longitudinal anvil block slot 42 as seen in Figure 3.However, being indulged close to the distal end of main body 320 It include the cylindrical part 348 for being configured to receive cannon plug 336 to anvil block slot 342.In addition closer to main body 320 distal end, longitudinal anvil block slot 342 include the V-shaped part 350 for being configured to receive V-arrangement neck portion 341.

Figure 12 to Figure 14, which is shown, shows a series of views that end 319 is connect with main body 320.Since Figure 12, end 319 and main body 320 be positioned to spaced apart, but be substantially aligned with each other.Tool with column 352 is by being inserted into plug 336 for column 352 Notch 338 in and use.Then, the tool with column 352 is promoted towards main body 320, so that it pulls end towards main body 320 319.When end 319 promotes or moves towards main body 320, guide features portion 340 is slided in longitudinal anvil block slot 342.In this way, Guide features portion 340 initially enters the V-shaped part 350 of longitudinal anvil block slot 342, and end 319 in a proximal direction after In the case where continuous drawing, guide features portion 340 passes through V-shaped part 350 and enters cylindrical part 348.

In the case where guide features portion 340 is by V-shaped part 350, the V-arrangement of the present longitudinal anvil block slot 342 of plug 336 Enter main body 320 at part 350.In this example, plug 336 is configured with cylindrical.The V of longitudinal anvil block slot 342 Shape part 350 narrows when it is extended proximally.Plug 336 is big in the wide end portion of V-shaped part 350 with initially cooperating It is small.However, proximally further extending along V-shaped part 350, the size of plug 336, which is set so that, has a diameter larger than V-arrangement The width of part 350.As described above, plug 336 is flexible, and apply continuous force to plug 336 in a proximal direction When, plug 336 is by stretching and the deformation that narrows, as shown in figure 13.This deformation of plug 336 enables plug 336 to pass through V-arrangement Part 350 and the cylindrical part 348 for entering longitudinal anvil block slot 342.In other words, the elongation of plug 336 is worn with final sliding It crosses V-shaped part 350 and enters in cylindrical part 348.In addition, when this happens, guide features portion 340 continues court Proximal movement, by the T-shape part 354 of cylindrical part 348 and the longitudinal anvil block slot 342 of entrance.

With reference to Figure 14, when plug 336 is located in the cylindrical part 348 of longitudinal anvil block slot 342 of main body 320, The column 352 of tool can be removed from the center cut 338 of plug 336.This removal of column 352 will be previously applied to plug 336 with The proximal force for extending plug 336 removes.In the case where power is removed, plug 336 is back to its original undeformed state, wherein Plug 336 no longer extends, and is therefore back to its cylindrical, so as to be fitted securely into longitudinal anvil block narrow for plug 336 In the cylindrical part 348 of slot 342.In some instances, by column 352 before the removal of notch 338, by proximal force from tool It removes, so that plug 336 is back to its initial static or loose shape before the removal of the notch 338 of plug 336 in column 352 State.

In the case where connection in main body 320 is inserted into end 319 or with main body 320, as shown in figure 14, protrusion 334 is matched It closes in groove 332, guide features portion 340 cooperates in the T-shape part 354 of longitudinal anvil block slot 342, and plug 336 is matched It closes in the cylindrical part 348 of longitudinal anvil block slot 342, and the cooperation of neck portion 341 is in the V of longitudinal anvil block slot 342 In shape part 350.In addition, water of the cooperation of lateral part 344 in guide features portion 340 in the T-shape part 354 of slit 342 In flat or side extensions.In addition, the central part 346 in guide features portion 340 cooperates in the vertical of T-shape part 354 In extension, so that the cooperation of central part 346 is in the slit 342 near the bottom surface 356 of main body 320.Originally showing In example, guide features portion 340 is constructed such that its nearest side position in T-shape part 354 is maintained at as described above Percussion beam 14 farthest side shift length distal side.

Using above-mentioned configuration, end 319 and main body 320 include multiple holding features, and multiple holding features can be grasped It is configured to selectively fix end 319 and main body 320 with making.In this way, keeping features includes that above-mentioned complementation connects One or more of mouthful.It is connect for example, one in protrusion 334 cooperation will indicate complementary in one in groove 332 Mouthful and therefore indicate it is multiple holding features in one.Similarly, cylindrical part of the cooperation of plug 336 in slit 342 It will be that another keeps features in 348.Although there are the multiple holdings for being configured to fixation ends 319 in this example Features, but in other patterns, keep the exact magnitude of features can be more or less.In some variations, As shown in figure 14, when end 319 is fully seated in main body 320, rigid pins (not shown) or other holding members are inserted into In notch 338.This pin or other holding members can prevent plug 336 from unexpectedly collapsing during using anvil block 318, thus anti- Only end 319 is not intended to be detached from main body 320 during using anvil block 318.In addition, plug 336, protrusion 334, groove 332, neck Part 341, notch 338, the accurate shape and configuration of guide features portion 340 and slit 342 are exemplary only.According to this paper's Teaching content, the other shapes of these features and to the modifications of these features for the ordinary skill in the art It will be apparent.

End 319 can also be removed from main body 320, so that end 319 can be due to wearing or tearing, or for different ends End configuration is replaced for any other reason.In order to remove end 319, column 352 is inserted into notch 338.In column 352 In the case where in notch 338, user can firmly grasp the distal end 322 of end 319 and pull end 319 far towards distal side From main body 320.Meanwhile column 352 can be kept fixed, and be drawn so that the resilient nature of plug 336 applies distal side in response to terminad 319 Power and promote plug 336 extend and narrow.This allows the constriction at its distalmost end of plug 336, so that it can cooperate in slit 342 Cylindrical part 348 in and from cylindrical part 348 be transferred to V-shaped part 350.In a similar way, guide features portion 340 be also flexible, so that it is similar to the elongation of plug 336, this makes guide features portion 340 that can also pass through cylindrical part 348 are transferred to V-shaped part 350.

Remove end 319 some other examples in, can omit column 352 without the use of.In such example, it is applied to Enough distal forces of end 319 connect plug 336 in the cylindrical part 348 of slit 342 and the intersection of V-shaped part 350 Touch the internal side wall of main body 320.The power of application transfers to plug 336 and causes plug 336 to become by extending or narrowing Shape enables plug 336 to be transferred to V-shaped part 350 from cylindrical part 348.As described above, guide features portion 340 will be sent out Raw identical deformation and elongation.This will then allow to remove end 319 without using the tool with column 352.According to this The teaching content of text, the other modes for removing end 319 will be obvious to those of ordinary skill in the art.

In this example, end 319 is to be capable of flexible deformation, last so that in use, such as during clamp tissue End 319 can bend or be bent to straight or more unbending state from bending state.Only by way of example, end 319 can be from Longitudinal axis is bent towards storehouse in a downward direction between about 20 degree and about 70 degree；From longitudinal axis towards storehouse 37 in upward direction Upper flexure is between about 0 degree and about 90 degree.Degree of flexibility can be by the thickness for the tissue being compressed between anvil block 318 and storehouse 37 And/or Effects of Density.As described above, by this method, end 319 is operationally configured to make in the operation using traveling With.Therefore, end 319 is to be capable of flexible deformation, and similar to anvil block end shown and described in following patent: the application is same The U.S. of entitled " Surgical Stapler with Elastically Deformable Tip " that one date submitted is special Benefit application [attorney number END8115USNP.0641880], the disclosure of which is herein incorporated by reference.Show at other In example, end 319 can be rigid, but except plug 336 as described above.

B. with the end of taper insert

Figure 15 shows showing of being suitable for being used together with any one of end effector as described herein and surgical instruments Example property anvil block 418.Anvil block 418 includes end 419 and main body 420.End 419 can be selectively connected with main body 420, so that End 419 is configured to modularization and release tip.In the pattern of the illustration of Figure 15, end 419 be it is curved so that last End 419 extends from main body 420 towards distal side in a curved fashion, and wherein end 419 is far from the longitudinal axis limited downwards by main body 420 Or it is bent up in the side of the nail bin towards end effector that is as shown in the figure and as described above and being used together with anvil block 418 Bent or bending.Although being shown as in the pattern of illustration curved, in some other patterns, end 419 can be straight , so that it extends along the longitudinal axis limited by main body 420.

End 419 includes distal end 422 and proximal end 424.It is last that distal end 422 is configured to working as end 419 End 419 is maintained at the exterior section in 420 outside of main body when connecting with main body 420.Proximal end 424, which has, is configured to end The part of 419 interior section being located in when end 419 is connect with main body 420 in main body 420.The distal end portion of end 419 Portion 422 further includes top surface 426 and bottom surface 428.Bottom surface 428 extends through proximal end 424 and forms nearside A part of end 424.Bottom surface 428 is operationally configured to contact connecing for tissue when end effector clamps tissue Touch surface.

End 419 further includes the ridge 430 in bottom surface 428.Ridge 430 is operationally configured to tissue grasp spy Sign portion, with facilitate end effector it is in the close position to clamp tissue when grasp tissue.In this example, ridge 430 Farthest side section close to distal end 422 positions, and ridge 430 extends laterally across distal end 422, so that ridge 430 is big Body is upwardly extended in the side perpendicular to the longitudinal axis limited by the main body 420 of anvil block 418.Although this example shows two ridges 430, but in other patterns, the quantity of ridge 430 can more or less or ridge 430 can be completely omitted.

End 419 further includes latch 432, has a latch on every side of end 419.In the pattern of illustration, There are two latches 432 for the tool of end 419, but in other patterns, end 419 can have more or fewer latches 432.Latch 432 are located in proximal end 424 and a part of the outer periphery of end 419 are limited in proximal end 424.Latch 432 It is extended proximally towards main body 420.As described in more detail below, latch 432 is operationally configured to and is formed in Shoulder 434 in main body 420 engages, and such engagement provides or facilitates end 419 and main body 420 is selectively solid It is fixed.In addition, this engagement also provides the mode for being directed at end 419 with main body 420.

Slit 436 is adjacent with each latch 432 in proximal end 424.Slit 436 is from the most proximal end of end 419 close Extend in side end 424 towards distal side.Slit 436 limits the central part of corresponding latch 432 and the proximal end 424 of end 419 Additional space between 438.Using this configuration, latch 432 is operationally configured in response to along latch 432 Power that side region applies and be deflected outward far from central part 438.Latch 432 can also be downward towards the storehouse of end effector or lower arm Deflection, rather than be deflected outward or in addition to being deflected outward.When not by deflecting force, latch 432 is biased to return to it Initial position, as shown in figure 15.

End 419 further includes the insertion piece 440 of a part for being formed as end 419.Insertion piece includes main body 441.At this In example, insertion piece 440 is formed in the proximal end 424 of end 419 and extends the length of proximal end 424.Insertion Part 440 includes the upper fins 446 at its distalmost end, and wherein fin 446 upwardly extends, so that working as end 419 and main body Fin 446 extends towards main body 420 when 420 connection.Insertion piece 440 include conical by its shape, minimum dimension insertion piece 440 most Proximal end, and its full-size is at the distalmost end of insertion piece 440.In this example, the main body 441 of insertion piece 440 includes Crooked outer surface 444, but in other patterns, outer surface 444 does not need to be bent.Insertion piece 440 further includes extending downwardly down Portion's fin 445, so that fin 445 extends towards the storehouse for the end effector being used together with anvil block 418 or lower arm.

Main body 420 includes multiple nail shapes pits 453, is structurally and functionally similar to nail shapes pit described above 53.Main body 420 further includes longitudinal anvil block slot 442.Along the portions of proximal of main body 420, longitudinal anvil block slot 442 has similar In the T-shape part 454 of longitudinal anvil block slot 42 as seen in Figure 3.However, along the distal part of main body 420, longitudinal anvil Seat slit 442 includes the T-shape part 450 of modification.The T-shape part 450 of modification includes horizontal component 452, and perpendicular Intersect straight part 456.It is angled surface 458 along the bottom of horizontal component 452 or lower part.Utilize this configuration, the T of modification Shape shape 450 is configured to receive the insertion piece 440 of end 419.When end 419 is connect with main body 420, modification The vertical portion 456 of T-shape part 450 receive lower fins 445 and upper fins 446, and horizontal component 452 is received and is inserted Enter the main body 441 of part 440.In addition, the size and conical by its shape of insertion piece 440 and the size and shape quilt of horizontal component 452 It is configured so that when insertion piece 440 is accepted in the T-shape part 450 of modification, the restriction level part of anvil block 418 452 side wall is by the outer surface 444 of contact insert 440, so that end 419 is remained to main body 420.Using this configuration, Lower fins 445 and upper fins 446 serve as guide features during end 419 and main body 420 assemble together with vertical portion 456 Portion.

Main body 420 further includes shoulder 434, as described above.Shoulder 434 is configured to cubic shaped, wherein shoulder 434 in main body 420 formed based on 420 concave portion.Shoulder 434 is further configured to by latch as described above 432 engagements, and such engagement provides or helps selectively to fix end 419 and main body 420.When by end 419 with When main body 420 connects, insertion piece 440 of the side of the distal part of main body 420 in end 419 is inserted in the T-shape of modification Latch 432 is deflected in part 450 and when proximally promoting.When insertion piece 440 is in the T-shape part 450 of modification When enough nearsides, latch 432 is adjacent with shoulder 434 and returns to their bias state, thus from its be deflected outward state to Inside it is moved back to.In this way, corresponding latch 432 firmly grasps the corresponding shoulder 434 on every side of main body 420, wherein shoulder 434 is accepted In the overhead 460 and bottom member 462 of each corresponding latch 432.

In order to be conducive to make as described above latch 432 to deflect, in this example, the distal part of main body 420 is slightly at cone Shape narrows.When end 419 to be aligned with main body 420, this taper of main body 420 makes it easy to be aligned.When end 419 exists When proximally promoting during assembling, the distal part of main body 420 becomes wider, to contact latch 432 and finally make latch 432 It is deflected outward, as described above.

Compared with the rest part of main body 420, the distal part of main body 420 is also formed with compared with low height.For example, main body 420 distal part includes limiting the bottom surface 448 of plane.In addition, the rest part of main body 420 includes also limiting plane Bottom surface 464.In this example, these planes are not coplanar, but their general parallel orientations.It is inclined between the two planes Set the difference in height indicated between the distal part of main body 420 and the rest part of main body 420.In addition, working as end 419 and main body When 420 connection, the bottom surface 428 of end 419 is aligned with the bottom surface 464 of main body 420.Main body 420 further includes chamfering 466, chamfering 466 when end 419 and main body 420 are fully connected on every side of the proximal end 424 of end 419 with chamfering 468 are aligned and contact chamfering 468.By this method, chamfering 466,468 serves as stop part.

When end 419 is inserted into main body 420 or is connect with main body 420, latch 432 firmly grasps shoulder 434, insertion piece 440 Main body 441 cooperate and the lower part wing of insertion piece 440 in the T-shape part 450 of the modification of longitudinal anvil block slot 442 Piece 445 and the cooperation of upper fins 446 are in the vertical portion 456 of the T-shape part 450 of the modification of longitudinal anvil block slot 442. In this example, insertion piece 440 is constructed such that its nearest side position in the T-shape part 450 of modification is maintained at The distal side of the farthest side shift length of percussion beam 14 as described above.

Using above-mentioned configuration, end 419 and main body 420 include multiple holding features, and multiple holding features can be grasped It is configured to selectively fix end 419 and main body 420 with making.In this way, keeping features includes that above-mentioned complementation connects One or more of mouthful.For example, one in shoulder 434 cooperation will indicate complementary interface in one in latch 332 And therefore indicate one in multiple holding features.Similarly, the cooperation of main body 441 of insertion piece 440 is narrow in longitudinal anvil block It will be that another keeps features in the horizontal component 452 of the T-shape part 450 of the modification of slot 442.Although in this example In the presence of being configured to multiple holding features of fixation ends 419, but in other patterns, keep the accurate of features Quantity can be more or less.In addition, shoulder 434, latch 432, insertion piece 440 and slit 442 accurate shape and configuration only It is exemplary.Content according to the teaching of this article, the other shapes of these features and to the modifications of these features for this The those of ordinary skill in field will be apparent.

End 419 can also be removed from main body 420, so that end 419 can be due to wearing or tearing, or for different ends Configuration is replaced for any other reason.In order to remove end 419, latch 432 can be deflected outward to release from shoulder 434 It puts or latch 432 can be deflected down to discharge from shoulder 434.In the case where latch 432 is disengaged from shoulder 434, make User can firmly grasp the distal end 422 of end 419 and pull end 419 far from main body 420 towards distal side.It is acted by this, Insertion piece 440 is removed out of longitudinal anvil block slot 442, and end 419 separates with main body 420 or removes from main body 420.When from When main body 420 removes end 419, in some patterns, tool or other instruments can be used for assisting by latch 432 from shoulder 434 It is disengaged.In other patterns, when removing end 419 from main body 420, tool or other instruments are not necessarily to, and only remote The downward or distal side guiding force of terminad 419 on side end 422 will cause latch 432 to be disengaged with shoulder 434.According to this The teaching content of text, the other modes for removing end 419 will be obvious to those of ordinary skill in the art.

In this example, end 419 is to be capable of flexible deformation, last so that in use, such as during clamp tissue End 419 can bend or be bent to straight or more unbending state from bending state.Only by way of example, end 419 can be from Longitudinal axis is bent towards storehouse in a downward direction between about 20 degree and about 70 degree；From longitudinal axis towards storehouse 37 in upward direction Upper flexure is between about 0 degree and about 90 degree.Degree of flexibility can be by the thickness for the tissue being compressed between anvil block 318 and storehouse 37 And/or Effects of Density.As described above, by this method, end 419 is operationally configured to make in the operation using traveling With.Therefore, end 419 is to be capable of flexible deformation, and similar to anvil block end shown and described in following patent: the application is same The U.S. of entitled " Surgical Stapler with Elastically Deformable Tip " that one date submitted is special Benefit application [attorney number END8115USNP.0641880], the disclosure of which is herein incorporated by reference.Show at other In example, end 419 can be rigid, but except latch 432 as described above.

C. with the end of independent taper gasket

Figure 16 shows showing of being suitable for being used together with any one of end effector as described herein and surgical instruments Example property anvil block 518.Anvil block 518 includes end 519, main body 520 and gasket 540.End 519 is able to use gasket 540 and main body 520 are selectively connected, so that end 519 is configured to modularization and release tip.In the pattern of the illustration of Figure 16, end End 519 is curved, so that end 519 extends from main body 520 towards distal side in a curved fashion, wherein end 519 is far from by main body 520 longitudinal axis limited downwards or towards as shown in the figure and as described above and the end that can be used together with anvil block 518 The side of the nail bin of actuator is bent upwards or bends.Although be shown as in the pattern of illustration it is curved, some other In pattern, end 519 can be straight, so that it is along the longitudinal axis extension limited by main body 520.

In the example of illustration, end 519 includes having triangle side 522, rear surface 524, top surface 426 and bottom The inclination or ramp shaped on portion surface 528.Bottom surface 528 is operationally configured to connect when end effector clamps tissue Touch the contact surface of tissue.End 519 includes extending through end 519 and being configured to receive the opening of gasket 540 532.End 519 further includes the ridge 530 in bottom surface 528.Ridge 530 is operationally configured to tissue grasp feature Portion, with facilitate end effector it is in the close position to clamp tissue when grasp tissue.In this example, ridge 530 leans on The farthest side section of proximal end 519 positions, and ridge 530 extends laterally across end 519 so that ridge 530 substantially perpendicular to The side of the longitudinal axis limited by the main body 520 of anvil block 518 upwardly extends.Although this example shows two ridges 530, at other In pattern, the quantity of ridge 530 can more or less or ridge 530 can be completely omitted.

Main body 520 includes multiple nail shapes pits 553, is structurally and functionally similar to nail shapes pit described above 53.Main body 520 further includes longitudinal anvil block slot 542.Longitudinal anvil block slot 542, which has, is similar to longitudinal anvil block as seen in Figure 3 The T-shape profile of slit 42.Slit 542 includes horizontal component 552 and the vertical component 556 intersected to form T-shape.Benefit With this configuration, slit 542 is configured to receive gasket 540.Main body 520 further includes front surface 534.Front surface 534 is Angled, so that the longitudinal axis of the plane limited by front surface 534 and main body 520 intersects to form acute angle.Rear surface 524 With matched angle, so that being limited when end 519 and main body 520 are installed to form matched acute angle by rear surface 524 Plane intersects with the longitudinal axis of main body 520.Utilize this configuration, when end 519 is fully connected with main body 520, end 519 Rear surface 524 contact main body 520 front surface 534.

As described above, the opening 532 in end 519 is configured to receive gasket 540.In opening 532 is resistance Only limited features portion of the gasket 540 from side to the other side freely integrally through opening 532.In one example, with gasket 540 maximum width is compared, this limited features portion include for be open 532 smaller width.Content according to the teaching of this article, Other limited features portions will be obvious to those of ordinary skill in the art.

The slit 542 of main body 520 is further configured to receive gasket 540.In this example, gasket 540 is included in often Lateral part 544 on side and the central part between lateral part 544 546.When gasket 540 is inserted into slit 542, Lateral part 544 is accepted in the horizontal component 552 of slit 542, and central part 546 is accepted in the vertical of slit 542 In part 556.In this example, gasket 540 is constructed such that its nearest side position in longitudinal anvil block slot 542 is kept In the distal side of the farthest side shift length of percussion beam 14 as described above.

In this example, for the ease of assembling and in order to which end 519 is remained to main body 520, gasket 540 has taper Configuration, wherein gasket 540 from its distal end it is wider from be tapered to the relatively narrow place of its proximal end.Gasket 540 is wider at it It is sized and configured at distal end so that gasket 540 contacts main body 520 when gasket 540 is fully inserted into slit 542 Form the internal side wall of slit 542.This contact generates between gasket 540 and main body 520 hits or interferes.In gasket 540 In the case where extending through opening 532 in end 519 and then passing through slit 542, between gasket 540 and main body 520 It hits or end 519 to be selectively maintained in main body 520 by touch operation.In some patterns, gasket 540 is by compressible But flexible elastomeric material is constituted.In this type formula, gasket 540 can be compressed certain when being inserted into slit 542 Degree, and such compression can promote selectivity of the gasket 540 in slit 542 and firmly hold.

Gasket 540 further includes the groove 548 at its distal end.Groove 548 is configured to receive driver work Tool, the actuator tool can be used for by gasket 540 pass through opening 532 positioning and be placed in end 519 and finally positioning and It is placed into the slit 542 of main body 520.532 positioning of opening is passed through in gasket 540 and in the case where in slit 542, driving Device tool can be used for proximally promoting gasket 540, until the rear surface 524 of end 519 contacts the front surface 534 of main body 520 simultaneously And gasket 540 is firmly seated in slit 542.In some other patterns or application, the placement and/or insertion of gasket 540 It can occur in the case where not using actuator tool.In some such examples, groove 548 also be can be omitted.According to herein Teaching content, using modularization release tip (such as end 519) or attach it to anvil body (such as anvil block 518 Main body 520) other modes will be obvious to those of ordinary skill in the art.

End 519 can also be removed from main body 520, so that end 519 can be due to wearing or tearing, or for different ends End configuration is replaced for any other reason.In order to remove end 519, end effector is moved into open position, So that accessible longitudinal direction anvil block slot 542.Actuator tool or other blunt instruments can be inserted into slit 542 in the nearside of gasket 540 Portions of proximal in.It then can be towards distal side driving tool or instrument with the end of contact pins 540, and by the tool or instrument court Distal side is promoted to remove gasket 540 from slit 542.In the case where removing gasket 540 from slit 542, end 519 is no longer fixed To main body 520, and if desired, it can be removed and replace end 519.Content according to the teaching of this article removes end 519 its He will be obvious to those of ordinary skill in the art mode.

In this example, end 519 is to be capable of flexible deformation, last so that in use, such as during clamp tissue End 519 can bend or be bent to straight or more unbending state from bending state.As described above, by this method, end 519 can It is operatively configured to use in the operation using traveling.Therefore, end 519 be capable of flexible deformation, be similar to Anvil block end shown and described in lower patent: entitled " the Surgical Stapler with that the application same date submits The U.S. Patent application [attorney number END8115USNP.0641880] of Elastically Deformable Tip ", Disclosure is herein incorporated by reference.In other examples, end 519 can be rigid.

Figure 17 and Figure 18, which is shown, to be suitable for making together with any one of end effector as described herein and surgical instruments Exemplary anvil 618.Anvil block 618 includes end 619, main body 620 and gasket 640.End 619 is able to use gasket 640 It is selectively connected with main body 620, so that end 619 is configured to modularization and release tip.In the pattern of illustration, end End 619 is curved, so that end 619 extends from main body 620 towards distal side in a curved fashion, wherein end 619 is far from by main body 620 longitudinal axis limited downwards or towards as shown in the figure and as described above and the end that can be used together with anvil block 618 The side of the nail bin of actuator is bent upwards or bends.Although be shown as in the pattern of illustration it is curved, some other In pattern, end 619 can be straight, so that it is along the longitudinal axis extension limited by main body 620.

In the example of illustration, end 619 includes having triangle side 622, rear surface 624, top surface 626 and bottom The inclination or ramp shaped on portion surface 628.Bottom surface 628 is operationally configured to connect when end effector clamps tissue Touch the contact surface of tissue.End 619 further includes the ridge 630 in bottom surface 628.Ridge 630 is operationally configured to Tissue grasp features, with facilitate end effector it is in the close position to clamp tissue when grasp tissue.Originally showing In example, ridge 630 is positioned by the farthest side section of proximal end 619, and ridge 630 extends laterally across end 619, so that ridge 630 Substantially upwardly extended in the side perpendicular to the longitudinal axis limited by the main body 620 of anvil block 618.Although this example shows two ridges 630, but in other patterns, the quantity of ridge 630 can more or less or ridge 630 can be completely omitted.

End 619 includes extending through end 619 and being configured to receive the opening 632 of gasket 640.Opening It is slit 636 in 632, one of slit 636 extends along every side of opening 632.Slit 636 is configured to receive pad The lateral part 644 of piece 640.Limiting member 638 also in opening 632 and is configured to stop part, so that preventing gasket 640 Pass completely through opening 632.For example, gasket 640 includes head portion 650 and tail portion 654, tail portion 654 is from head 650 proximal side is divided to extend proximally.Head portion 650 is wider than tail portion 654, so that when gasket 640 is fully inserted into out When in mouth 632, the proximal face of head portion 650 contacts limiting member 638.

With reference to Figure 18, the rear surface 624 of end 619 includes into angle part 658 and straight portion 660.From at angle part 658 towards close What side extended is extended element 662.Extended element 662 is configured to be accepted in T-shape longitudinal direction anvil block slot 642 It is interior.Between extended element 662 be open 632 proximal side.In this example, extended element 662 is by fexible bias pressure, so that They may be in response to apply outside power to extended element 662 and be deflected outward far from opening 632.For example, when gasket 640 is inserted into Across be open 632 when, the lateral part 644 of gasket 640 be guided through slit 636 and extend through opening 632 nearside side Portion, wherein the lateral part 644 of gasket 640 contacts extended element 662.When gasket 640 is proximally pushed further into, gasket 640 lateral part 644 pushes out extended element 662, this causes extended element 662 to be flexibly deflected outward.

In this example, gasket 640 is taper, so that when the tail portion 654 of gasket 640 extends proximally, tail The width dimensions and height dimension of portion part 654 become smaller.Therefore, the most wide and highest part of tail portion 654 is located at tail At the distalmost end of portion part 654, wherein tail portion 654 is connect with head portion 650.The tapered feature portion of gasket 640 can fill Work as alignment feature, to help them to be positioned before end 619, gasket 640 and main body 620 are fixed together and make it Be aligned.As described above, the tail portion 654 of gasket 640 includes lateral part 644.In addition, tail portion 654 includes center Part 646, central part 646 extend in vertical direction, so that central part 646 includes being configured to be accepted in longitudinal direction Upper component 664 and lower member 668 in the vertical portion 656 of anvil block slot 642.

Gasket 640 further includes the groove 648 at its distal end.Groove 648 is configured to receive driver work Tool 670, the actuator tool can be used for passing through on gasket 640 632 positioning of opening and be placed in end 619 and finally position With in the slit 642 for being placed into main body 620.632 positioning of opening is passed through in gasket 640 and in the case where in slit 642, drive Dynamic device tool can be used for proximally promoting gasket 640, until the rear surface 624 of end 619 contacts the front surface 634 of main body 620 And gasket 640 is firmly seated in slit 642.Some other patterns or application in, the placement of gasket 640 and/or insert Entering can occur without using actuator tool.In some such examples, groove 648 also be can be omitted.According to this The teaching content of text (such as end 619 or attaches it to anvil body (such as anvil block 618 using modularization release tip The other modes of main body 620 will be obvious to those of ordinary skill in the art.

Main body 620 includes multiple nail shapes pit (not shown), is structurally and functionally similar to nail forming described above Pit 53.Main body 620 further includes longitudinal anvil block slot 642 as described above.Longitudinal anvil block slot 642, which has, is similar to such as Fig. 3 The T-shape profile of seen longitudinal direction anvil block slot 42.Slit 642 including horizontal component 652 and intersects vertical as described above The vertical component 656 of part 656, horizontal component 652 and intersection forms T-shape.Using this configuration, slit 642 is constructed At gasket 640 can be received, as described above.Main body 620 further includes front surface 634, as described above.Similar to the front surface of Figure 16 534, front surface 634 is angled, so that the plane limited by front surface 634 intersects with the longitudinal axis of main body 620 with shape It is at an acute angle.The rear surface 624 of end 619 has matched angle, is matched so that installing when end 619 with main body 620 with being formed Acute angle when, the plane limited by rear surface 624 intersects with the longitudinal axis of main body 620.Using this configuration, when end 619 When being fully connected with main body 620, the rear surface 624 of end 619 contacts the front surface 634 of main body 620.

Main body 620 is further similar to the main body 420 of the anvil block 418 of Figure 15, and 620 bottom surface (is not shown because based on Distal part out) is slightly concaved.Therefore, when end 619 is connect with main body 620, the straight portion 660 of end 619 is accepted in In the recessed area of the bottom surface of main body 620, so that the bottom surface 628 of end 619 is along straight portion 660 and not recessed master The remaining bottom surface of body 620 flushes.In this way, there is smooth transition along bottom surface when end 619 is connect with main body 620.

When assembling anvil block 618, in an illustrative methods, extended element 662 is inserted into T-shape longitudinal direction anvil block slot In 642.Gasket 640 is inserted into across opening 632 and proximally promotes, the limit in 650 contact openings 632 of head portion Component 638 processed.Tail portion 654 is extended out from opening 632, and the wherein contact of lateral part 644 is located in longitudinal slit 642 Extended element 662.The central part 646 of gasket 640 is accepted in the vertical portion of slit 642.Utilize the taper of gasket 640 Configuration, when gasket 640 further proximally promotes, gasket 640 pushes extended element 662, and extended element 662 is then inclined outward Turn and push the side wall of the longitudinal anvil block slot 642 of restriction of anvil block 618.In a similar way, upper component 664 and lower member 668 push the side wall of the vertical portion 656 of the restriction slit 642 of anvil block 618.Due to the conical configuration of gasket 640, by gasket 640 power applied increase as gasket 640 further proximally drives or promotes.It is fully inserted into or disposes in gasket 640 In the case where in end 619 and main body 620, end 619 is selectively firmly attached with main body 620.In this example, it pads Piece 640 is constructed such that its nearest side position in longitudinal anvil block slot 642 is maintained at percussion beam 14 as described above The distal side of farthest side shift length.

In some patterns, gasket 640 can be made of compressible but flexible elastomeric material.In this type formula, Gasket 640 can be compressed to a certain extent when being inserted into slit 642, and such compression can further promote gasket 640 to exist It selectivity in slit 642 and firmlys hold.In some other illustrative methods for end 619 to be connect with main body 620 In, gasket 640 can be connect with end 619 first, and then the end 619 then combined and gasket 640 are connect with main body 620 Or attachment.Content according to the teaching of this article assembles the other modes of end 619 and main body 620 for this field using gasket 640 Those of ordinary skill for will be apparent.

End 619 can also be removed from main body 620, so that end 619 can be due to wearing or tearing, or for different ends End configuration is replaced for any other reason.In order to remove end 619, end effector is moved into open position, So that accessible longitudinal direction anvil block slot 642.Actuator tool or other blunt instruments can be inserted into slit 642 in the nearside of gasket 640 Portions of proximal in.It then can be towards distal side driving tool or instrument with the end of contact pins 640, and by the tool or instrument court Distal side is promoted to remove gasket 640 from slit 642.In the case where removing gasket 640 from slit 642, end 619 is no longer fixed To main body 620, and if desired, it can be removed and replace end 619.Content according to the teaching of this article removes end 619 its He will be obvious to those of ordinary skill in the art mode.

In this example, end 619 is to be capable of flexible deformation, last so that in use, such as during clamp tissue End 619 can bend or be bent to straight or more unbending state from bending state.Only by way of example, end 619 can be from Longitudinal axis is bent towards storehouse in a downward direction between about 20 degree and about 70 degree；From longitudinal axis towards storehouse 37 in upward direction Upper flexure is between about 0 degree and about 90 degree.Degree of flexibility can be by the thickness for the tissue being compressed between anvil block 318 and storehouse 37 And/or Effects of Density.As described above, by this method, end 619 is operationally configured to make in the operation using traveling With.Therefore, end 619 is to be capable of flexible deformation, and similar to anvil block end shown and described in following patent: the application is same The U.S. of entitled " Surgical Stapler with Elastically Deformable Tip " that one date submitted is special Benefit application [attorney number END8115USNP.0641880], the disclosure of which is herein incorporated by reference.Show at other In example, end 619 can be rigid.

Several examples of modular tip shown and described herein are rendered as connecting for the anvil block with end effector Modular tip.In these examples, anvil block is the moving jaw part of end effector, and storehouse is the tight of end effector Solid or inactive associated jaw portion.Therefore, modular tip shown and described herein can be with the adjustable clamp of end effector Oral area point attachment or connection.However, modular tip as described herein may be adapted to or be revised as end execution in other patterns The storehouse of device or the end of inactive associated jaw portion.Content according to the teaching of this article, end and storehouse or lower pincers to end effector Such modification of mouth will be apparent for those of ordinary skill in the art.It is also understood that in some of instrument 10 In variations, anvil block can be kept fixed relative to shaft assembly, while keep the associated jaw portion of nail towards fastening anvil block and far from tight Gu anvil block pivots.

In some patterns of end shown and described herein, specific purpose tool or storehouse may be adapted to for assisting insert end And remove end.In some cases, tool or storehouse can be configured to only be inserted into and/or remove the end of anvil block, and In the case of other, tool or storehouse can also be configured to be inserted into and/or remove both end and nail bin of anvil block.For being inserted into And/or some exemplary such tools or storehouse in removal anvil block end and lower arm storehouse show and describe in following patent: with this Apply for entitled " the Surgical Stapler with Cooperating Distal Tip of same date submission U.S. Patent application [the attorney number of Features on Anvil and Staple Cartridge " END8117USNP.0641884], the disclosure of which is herein incorporated by reference.

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 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.