CA1163890A - Surgical stapling instruments - Google Patents
Surgical stapling instrumentsInfo
- Publication number
- CA1163890A CA1163890A CA000369043A CA369043A CA1163890A CA 1163890 A CA1163890 A CA 1163890A CA 000369043 A CA000369043 A CA 000369043A CA 369043 A CA369043 A CA 369043A CA 1163890 A CA1163890 A CA 1163890A
- Authority
- CA
- Canada
- Prior art keywords
- jaws
- surgical stapling
- stapling instrument
- pusher
- shoes
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/2812—Surgical forceps with a single pivotal connection
- A61B17/282—Jaws
- A61B2017/2825—Inserts of different material in jaws
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Surgery (AREA)
- Heart & Thoracic Surgery (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Medical Informatics (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Surgical Instruments (AREA)
- Materials For Medical Uses (AREA)
Abstract
Improvements In Surgical Instruments Abstract A surgical stapling instrument has upper and lower elongate jaws for receiving a staple cartridge and an anvil respectively. A pusher bar and knife assembly including a pair of pusher bars and a central knife carrier moves longitudinally relative to the jaws to eject staples sequentially from the magazine and form laterally spaced staple rows in tissue gripped between the jaws while the knife cuts the tissue along a line between the staple rows. The instrument includes shoes for locally supporting the jaws in the region of the pusher bar cams and knife blade as these elements move along the jaws to resist forces created during staple ejection and shaping which tend to vertically separate and/or laterally distort the jaws.
Description
Description Improvements In Surgical Instruments Technical Field This invention relates to an instrument for use in applying surgical fasteners such as staples, clips and the like to living tissue. More particularly, the invention relates to a surgical stapling instrument for use in forming a plurality of laterally spaced rows of staples in an internal body organ. Typically, such an instrument comprises a pair of cooperatinq elongate jaw members, one of which in use carries a staple cartridge with at least two laterally spaced rows of staples and the other of which carries an anvil with staple-closing depressions aligned with the rows of staples in the cartridge. A pusher bar and knife assembly is provided which is movSd longitudinally along the jaws to sequentially eject staples from the cartridge by a camming action, throu~h the agency of staple pushers carried by the cartridge in association with the individual staples, and to close the staples against the anvil thereby forming laterally spaced lines of staples in tissue gripped between the jaws, while the knife, which trails the pusher bars, cuts the tissue along a line between the staple rows.
One instrument of this type is disclosed, for example, in Canadian Patent No. 888,867.
`'~
1 l63ssn Background Art With instruments of the above type, the staple cartridges and associated anvils, pusher bars and knife assemblies have commonly been made of disposable plastics and low cost metal stampings while the frames, namely the basic instruments have more generally been constructed for repeated usage necessitating continual sterilization of these elements between each use. In recent years, in order to obviate the need for such repeated steril-ization of instruments, the tendency in the surgical field has been towards the introduction of fully self-contained disposable instruments which are used for only a single operation and then discarded.
Obviously, therefore in the design of such dispos-able instruments, economics is a factor and it is desirable to design such instruments to utilize readily available economic materials of minimum material weight and to employ production techniques of optimum economy.
With stapling instruments of the type described, relatively large forces are involved in clamping the tissue to be fastened and in ejecting the individual staples, causing these to penetrate the gripped tissue and to be closed against the anvil. Such forces tend both to separate the jaws vertically and to laterally distort the jaws thereby hindering accurate stapling. This problem is of course accentuated if relatively light-weight dis-posable materials are to be used for manfacture ofthe jaw frames.
It is an object of the present invention to provide an instrument of the character described for applying surgical fasteners, in which optimum alignment and stabilization of the jaws is obtained during application and securing of the fasteners.
Another object of the invention is to provide a novel form of instrument for use in applying surgical fasteners to living tissue and which is particularly suited to use in surgical stapling procedures.
It is a further object of the invention to provide a surgical stapling or like fastening instru-ment having a design which allows the instrument to be manufactured in the main from relatively lightweight disposable materials while still providing proper align-ment and stablization of the jaws during stapling.
According to the present invention, there is provided a surgical stapling instrument having first and second cooperating frames each provided with an elongate jaw, one of the jaws being adapted to receive at least two laterally spaced longitudinal rows of staples, an elongate pusher bar and knife assembly slid-able longitudinally relative to the jaws for sequen-tially ejecting staples from said one of the jaws and shaping the staples against anvil means provided on the other of the jaws to form a pair of laterally spaced staple rows in tissue gripped between the jaws and for cutting the tissue along a line between the staple rows, the assembly including a pair of laterally spaced pusher bars each having a forward end portion including a pusher bar cam and a knife carrier having a knife blade Located between the pusher bars, and jaw support means carried by the pusher bar and knife assembly and cooperating with the jaws for locally supporting both of the jaws in the region of the pusher bar cams as the cams move along the jaws for resisting forces tending to deflect the jaws during ejection and shaping of the individual staple8 to provide for lateral alignment and vertical stabilization of the jaws during stapling, each jaw is formed with a longituidnal channel or passageway and the pusher bar and knife assembly carries the jaw support means, which comprise upper and lower support shoes which are accurately laterally aligned with one 1 ~638~0 another and which fit closely in the respective passage-ways when the jaws are closed, so that the shoes travel along the passageways when the pusher bar and knife blade assembly is operated.
The shoes are located on the pusher bar and knife blade assembly in the region of pusher bar cams and the knife blade and their effect is to provide localized support for the jaws in the region of these elements as they progress along the jaws, thereby pro-viding proper jaw alignment in the region of the indi-vidual staples as these are sequentially acted upon by the pusher bars. Further, the shoes are not only laterally but also vertically confined in the passage-ways and thereby serve to resist vertical jaw-opening forces during staple formation.
Conveniently, the jaw passageways may be for-med towards the outside of the respecti~e jaws and the shoes may be carried on upper and lower extensions of the knife carrier which is made of relatively rigid material affording adequate lateral support to the shoes and hence to the jaws at the point of stapling as the shoes move therealong. To allow passage of the ver-tically extended knife carrler along the jaws, the staple cartridge and the anvil which are supported on the inner facing surfaces of the respective jaws are preferably each composed of two laterally spaced elongate members carried by the respective jaws so that the extended knife carrier can move through spaces formed between the respective elongate members.
By utilizing the aforementioned shoes locally to support the jaws and provide both lateral and ver-tical stabilization ln the region of the pusher bar cams and knife blade as these elements ride along the jaws, the adverse effects of the previously mentioned forces are substantially minimized and the jaws them-selves can therefore be made of lightweight construction so that an instrument designed in accordance with the invention lends itself to manufacture in disposable materials.
The invention will be more readily understood from the following description of a preferred embodi-ment thereof given by way of example with referenceto the drawings, in which:-Figure 1 is a side view of a surgical staplinginstrument in the assembl!ed and closed condition;
Figure 2 is a side view of the instrument in an open condition;
Figure ~ is an exploded view of the instrument;
Figure 4 is a side view of a pusher bar and knife assembly;
Figure 5 is an underneath plan view of the lS pusher bar and ~nife assembly;
Figure 6 i9 a section on line 6-6 o ~igure 1;
Figure 7 is a section on line 7-7 of Figure li with parts of the instrument removed;
Figure 8 is an underneath ~iew of a disposable staple cartridge;
Flgure 9 is a side view of the cartridge;
Figure 10 is a section on line 10-10 of Fig-ure 9;
Figure 11 is a top view of an elongate anvil member;
Figure 12 is a side view of the anvil member;
Figure 13 is a section on line 13-13 of Fig-ure 12; and Figure 14 is a section on line 14-14 of Fig-ure 1.
It is to be noted that the general construc-tion and principle of opexation of the illustrated in-strument is similar to the instrument described in Canadian Patent No. 888,867, previously referred to.
Accordingly, the following description will only deal in detail with modified features of the instrument.
1 ~63890 The present instrument, generally indicated by reference 10 includes an upper frame 12 and a lower frame 14. The forward end portion of upper frame 12 defines an elongate upper jaw 16 while the forward end portion of the lower frame 14 defines an elongate lower jaw 20. The portion of lower frame 14 rearward of jaw 20 fits into a channel-shaped handle member 22 having a pivot bar 24 at its rear end which is received in notches 28 at the rear end of upper frame member 12. Intermediate its length, upper frame member 12 has laterally projecting lugs 13 which fit in complimentary openings 15 formed in a bifurcated locking handle 26. The handle 26 can be used to open and close the frames about the pivot means 24, 28 between the open condition shown in Figure 2 and the locked condition shown in Figure 1.
To this end, handle 26 has slots 17 providing camming surfaces 19 which cooperate with laterally projecting lugs 21 on handle member 22. The instrument further includes a sliding pusher bar and knife assembly 30 comprising a central knife carrier 32 and laterally spaced pusher bars 34 and 36 on either side of the knife carrier, the pusher bars terminating at their forward ends in inclined pusher bar cams 38 and 40, respectively, and the knife carrier including an inclined knife 42 situated just to the rear of the pusher bar cams.
In use, a disposable staple cartridge 44, containing four laterally spaced longitudinal rows of staples, is inserted into the lower jaw 20 while two anvil members 72 having staple shaping depres-sions in their outer surfaces, complimentary to the positioning of the individual staples in the staple 1 ~38~0 cartridge, are placed on the upper jaw 16. The instrument is inserted into a patients body and manipulated such that tissue to be cut and sutured is inserted between the jaws, an incision to receive one of the jaws having previously been made in the tissue, if required. The jaws are then closed and locked by handle 26 to firmly grip the tissue between the opposing staple cartridge and anvil surfaces.
The pusher bar and knife assembly which is initially in a rearward position relative to the jaws, is then pushed forwardly causing the pusher bar cams to enter longitudinal slits in the staple cartridge, in which slits are accommodated rows of individual staple pushers. The pusher bar cams cooperate sequentially with camming surfaces on the individual staple pushers to force the staples successively from the cartridge, through the gripped tissue and into engagement with the anvil depressions which thereby, in conjunction with the cams, produce staple-closing forces. The design of the cartridge is such that each slit carries two mutually stag-gered rows of staples so that in all, four staple rows are formed in the gripped tissue. The knife 42 which trails the pusher bars cams slightly and rides in central longitudinal slits in the cartridge and anvil, cuts the gripped tissue along a line between the two pairs of staple rows.
To provide lateral support for the jaws and to resist forces tending to vertically open the jaws during stapling, each jaw is provided with a longitudinal passageway and the knife blade carrier 32 which is a relatively rigid member, preferably of metal, carries upper and lower laterally aligned shoes which ride in these passageways and provide the required local support to the jaws in the region 1 1~3890 of the pusher bar cams and knife blade as these elements travel along the staple cartridge.
Thus, it will be seen, particularly in Figures 6, 7 and 14 that the lower frame 14 is formed with a cartridge-receiving channel 46 and an outer longitudinal passageway 48 of generally T-shaped cross-section extending from the base of the channel 46. Upper frame 12 has inwardly directed longitudinally extending shoulders 50 for mounting the anvils as will be described, the construction of the upper frame being such that a longitudinally extending passageway 52 of generally rectangular section is formed ~bove the shoulders.
The pusher bar and knife assembly 30, see particularly Figures 3, 4 and 5, has conventional-type laterally spaced pusher bars 34 and 36 terminat-ing in slightly offset inclined pusher bar cams 38 and 40. The central knife carrier 32, as indicated, has an inclined knife 42 just to the rear of the pusher bar cams and the knife carrier is extended vertically above and below the pusher bars. On upper and lower terminal portions of the knife carrier which project forwardly of the knife, are situated lower and upper shoes 54 and 56, respec-tively, the vertical spacing between the shoes cor-responding to the vertical spacing between the passageways 48 and 52 in the lower and upper frames when the frames are locked together. The lower shoe 54 has a substantially T-shaped cross section cor-responding to the cross-sectional shape of passageway 48 so that this shoe fits in passageway 48 with minimal clearance to allow substantially friction-free passage of the shoe along the passageway, and upper shoe 56 is likewise shaped to fit in passage-way 52 with minimal clearance to provide substantially 1 lfi3~
friction-free passage. It will be noted that the shoes 52 and 54 are longitudinally located in prox-imity to the pusher bar cams 38 and 40 so as to in use, provide support for the jaws 16 and 20 in the region of the cams substantially at points where the forces created by cooperation of the pusher bar cams and the individual staple pushers in the cartridge approach a maximum. Further, by locating the shoes both laterally and vertically in the respective passageways, both lateral alignment of the jaws and resistance to vertical jaw opening during stapling is obtained.
At the rear end of assembly 30, the pusher bars and knife carrier are mounted in known manner in a suitable carrying block 31 having an operating knob 33 or the like.
The staple cartridge 44 as shown in Figures 8, 9 and 10 is generally of similar character to the known type as described in the aforementioned Canadian Patent No. 888,867 insofar as the number of staple rows, and design and location of the individual staple pushers is concerned. For a fuller descrip-tion of these elements and the manner in which staple ejection is effected by interaction of the pusher bar cams and the individual staple pushers, reference may therefore be made to this patent. In the present case, the cartridge 44 has a solid nose portion 58 and a pair of longitudinal ribs 60 and 62 extending rearwardly from the nose portion and defining a slit 64 therebetween right through the cartridge for passage of the knife carrier 32. The inner facing surfaces of the ribs 60 and 62 again have bumps 66 to laterally locate the knife carrier and the ribs are themselves longitudinally slit to accommodate the staple pushers and the opposed, 1 16:~90 staggered rows of staples. Friction pieces 68 are again pxovided to inhibit inadvertent forward motion of the pusher bars. Thus, the significant difference between the present cartrid~e and that described in Canadian Patent No. 888,867 is that in the present case slit 64 extends right through the cartridge (to the rear of the nose portion) to allow passage of the vertically extended knife carrier. In use, as indicated, the cartridge 44 sits in the cartridge receiving channel 46 of the upper jaw with the nose portion 58 projecting forwardly of the jaw and positive longitudinal location of the cartridge being effected by means of a projecting cartridge lug 70 and a complimentary cut-out in one of the side walls of channel 46.
While the instrument has ~een herein described as utilizing a separate staple cartridge 44 in like manner to the instrument described in Canadian Patent No. 888,867, it is contemplated within the scope of the present invention, for the staple cartridge to be formed as an integral part of lower jaw 20.
The anvil means in the present instance, see Figures ll, 12 and 13, comprises a pair of like individual elongate anvils 72 which sit with a friction fit on the shoulders 50 of the upper jaw, as seen in Figures 1, 3 and 14, whereby a slit is provided between the anvils allowing passage for the vertically extended knife carrier. Each individual anvil comprises an anvil surface 76 with staple-shaping depressions 78, an outer wall 80 and a shorter inner wall 82. The inner and outer wall~
are slightly inwardly tapered to provide the friction fit on shoulders 50 and the outer walls each have depressions 51 aligning with complimentary depressions ~ ..~
1 ~63~0 in the side walls of the lower jaw for longitu-dinally locating the individual anvils and accurate-ly aligning the staple shaping depressions with the individual staples in cartridge 44.
While the instrument as described includes separate anvils 72 which fit on the shoulders 50 of upper jaw 16, it is also possible, particularly in the manufacture of a low-cost disposable instrument, to dispense with the anvils themselves and form the staple shaping depressions, directly in the under-surfaces of shoulders 50 of the upper jaw.
Assembly of the various components of the instrument is effected in the following manner with particular reference to Figures 1 to 3. Initially, with a cartridge 44 correctly positioned on jaw 20 of lower frame 14, the forward end of pusher assembly 30 is inserted from the back into lower frame 14, with lower shoe 54 fitting in passageway 48, and assembly 30 is moved forwardly along frame 14 until the pusher bars enter the lontitudinally slit ribs 60 and 62 of cartridge 44 and are arrested by the friction pieces 68. This position of pusher assembly 30 relative to frame 14 is shown in Figures 1 and 2.
Frame 14 with the inserted pusher assembly 30 is then fitted into handle member 22, suitable compli-mentary locating means (not shown~ being provided on the frame and handle member to longitudinally align these elements and prevent forward movement of frame 14 in member 22 during staple ejection.
Anvils 72 are fitted on jaw 16 and lugs 13 of frame 12 are fitted into openings 15 of handle 26. Then with handle 26 tilted upwardly, as shown in Figure 2, notches 28 are engaged with pivot bar 24 to complete the assembly of the instrument.
. , 1 163~9~
In use, the instrument in the assembled open condition, substantially as shown in Figure 2, is inserted into a body cavity, so that tissue to be stapled is accepted between jaws 16 and 20 and the instrument is then locked by manipulation of handle 26 and cooperation of camming surfaces 19 with lugs 21. It will be noted that openings 55 (see Figure 3) are provided in shoulders 50 o~ the upper frame 12 which allow shoes S6 to enter channel 52 as the instrument is closed. With tissue gripped between the jaws and the instrument in the condition as shown in Figure 1, stapling is effected in the manner described in the aforementioned patent by pushing forwarding on knob 33.
When stapling is completed, the pusher assembly 30 is retracted to the initial positon, allowing shoes 56 to be removed from channel 52 through openings 55, so that the instrument can be opened.
It will be appreciated, since the shoes 54 and 56 are accurately laterally aligned and carried by a relatively rigid member, that during stapling, as the shoes move along the passageways 48 and 52 with minimal clearance, they provide adequate localized support to the jaws in the region of operation of the pusher bar cams and the particular individual staple pushers being actuated. Due to the cross~sectional shape of the shoes and passage-ways, such support resists forces tending both laterally to distort the jaws and to open the jaws vertically and accordingly the present construction lends itself to manufacturing the jaws in relatively light weight disposable materials. It is to be understood however that the construction can also be used in instruments manufactured from more convention-al materials.
1 1~à339~3 While only a single preferred embodiment of the invention has been described in detail, it is to be understood that the invention is not limited to its specific features and modifications are possible within the scope of the attached claims.
Thus, while the invention has been particularly described in relation to its application in a surgical stapling instrument, the invention is not limited to this application. The invention may be applied to other fastening instruments having opposed jaws which re~uire stabilization while fastening means are applied to living tissue gripped between the jaws. For example, the invention may be applied to instruments for applying certain types of surgical clips or instruments for applying surgical fastening devices of the type set out in U.S. Patent No.
4,060,089.
One instrument of this type is disclosed, for example, in Canadian Patent No. 888,867.
`'~
1 l63ssn Background Art With instruments of the above type, the staple cartridges and associated anvils, pusher bars and knife assemblies have commonly been made of disposable plastics and low cost metal stampings while the frames, namely the basic instruments have more generally been constructed for repeated usage necessitating continual sterilization of these elements between each use. In recent years, in order to obviate the need for such repeated steril-ization of instruments, the tendency in the surgical field has been towards the introduction of fully self-contained disposable instruments which are used for only a single operation and then discarded.
Obviously, therefore in the design of such dispos-able instruments, economics is a factor and it is desirable to design such instruments to utilize readily available economic materials of minimum material weight and to employ production techniques of optimum economy.
With stapling instruments of the type described, relatively large forces are involved in clamping the tissue to be fastened and in ejecting the individual staples, causing these to penetrate the gripped tissue and to be closed against the anvil. Such forces tend both to separate the jaws vertically and to laterally distort the jaws thereby hindering accurate stapling. This problem is of course accentuated if relatively light-weight dis-posable materials are to be used for manfacture ofthe jaw frames.
It is an object of the present invention to provide an instrument of the character described for applying surgical fasteners, in which optimum alignment and stabilization of the jaws is obtained during application and securing of the fasteners.
Another object of the invention is to provide a novel form of instrument for use in applying surgical fasteners to living tissue and which is particularly suited to use in surgical stapling procedures.
It is a further object of the invention to provide a surgical stapling or like fastening instru-ment having a design which allows the instrument to be manufactured in the main from relatively lightweight disposable materials while still providing proper align-ment and stablization of the jaws during stapling.
According to the present invention, there is provided a surgical stapling instrument having first and second cooperating frames each provided with an elongate jaw, one of the jaws being adapted to receive at least two laterally spaced longitudinal rows of staples, an elongate pusher bar and knife assembly slid-able longitudinally relative to the jaws for sequen-tially ejecting staples from said one of the jaws and shaping the staples against anvil means provided on the other of the jaws to form a pair of laterally spaced staple rows in tissue gripped between the jaws and for cutting the tissue along a line between the staple rows, the assembly including a pair of laterally spaced pusher bars each having a forward end portion including a pusher bar cam and a knife carrier having a knife blade Located between the pusher bars, and jaw support means carried by the pusher bar and knife assembly and cooperating with the jaws for locally supporting both of the jaws in the region of the pusher bar cams as the cams move along the jaws for resisting forces tending to deflect the jaws during ejection and shaping of the individual staple8 to provide for lateral alignment and vertical stabilization of the jaws during stapling, each jaw is formed with a longituidnal channel or passageway and the pusher bar and knife assembly carries the jaw support means, which comprise upper and lower support shoes which are accurately laterally aligned with one 1 ~638~0 another and which fit closely in the respective passage-ways when the jaws are closed, so that the shoes travel along the passageways when the pusher bar and knife blade assembly is operated.
The shoes are located on the pusher bar and knife blade assembly in the region of pusher bar cams and the knife blade and their effect is to provide localized support for the jaws in the region of these elements as they progress along the jaws, thereby pro-viding proper jaw alignment in the region of the indi-vidual staples as these are sequentially acted upon by the pusher bars. Further, the shoes are not only laterally but also vertically confined in the passage-ways and thereby serve to resist vertical jaw-opening forces during staple formation.
Conveniently, the jaw passageways may be for-med towards the outside of the respecti~e jaws and the shoes may be carried on upper and lower extensions of the knife carrier which is made of relatively rigid material affording adequate lateral support to the shoes and hence to the jaws at the point of stapling as the shoes move therealong. To allow passage of the ver-tically extended knife carrler along the jaws, the staple cartridge and the anvil which are supported on the inner facing surfaces of the respective jaws are preferably each composed of two laterally spaced elongate members carried by the respective jaws so that the extended knife carrier can move through spaces formed between the respective elongate members.
By utilizing the aforementioned shoes locally to support the jaws and provide both lateral and ver-tical stabilization ln the region of the pusher bar cams and knife blade as these elements ride along the jaws, the adverse effects of the previously mentioned forces are substantially minimized and the jaws them-selves can therefore be made of lightweight construction so that an instrument designed in accordance with the invention lends itself to manufacture in disposable materials.
The invention will be more readily understood from the following description of a preferred embodi-ment thereof given by way of example with referenceto the drawings, in which:-Figure 1 is a side view of a surgical staplinginstrument in the assembl!ed and closed condition;
Figure 2 is a side view of the instrument in an open condition;
Figure ~ is an exploded view of the instrument;
Figure 4 is a side view of a pusher bar and knife assembly;
Figure 5 is an underneath plan view of the lS pusher bar and ~nife assembly;
Figure 6 i9 a section on line 6-6 o ~igure 1;
Figure 7 is a section on line 7-7 of Figure li with parts of the instrument removed;
Figure 8 is an underneath ~iew of a disposable staple cartridge;
Flgure 9 is a side view of the cartridge;
Figure 10 is a section on line 10-10 of Fig-ure 9;
Figure 11 is a top view of an elongate anvil member;
Figure 12 is a side view of the anvil member;
Figure 13 is a section on line 13-13 of Fig-ure 12; and Figure 14 is a section on line 14-14 of Fig-ure 1.
It is to be noted that the general construc-tion and principle of opexation of the illustrated in-strument is similar to the instrument described in Canadian Patent No. 888,867, previously referred to.
Accordingly, the following description will only deal in detail with modified features of the instrument.
1 ~63890 The present instrument, generally indicated by reference 10 includes an upper frame 12 and a lower frame 14. The forward end portion of upper frame 12 defines an elongate upper jaw 16 while the forward end portion of the lower frame 14 defines an elongate lower jaw 20. The portion of lower frame 14 rearward of jaw 20 fits into a channel-shaped handle member 22 having a pivot bar 24 at its rear end which is received in notches 28 at the rear end of upper frame member 12. Intermediate its length, upper frame member 12 has laterally projecting lugs 13 which fit in complimentary openings 15 formed in a bifurcated locking handle 26. The handle 26 can be used to open and close the frames about the pivot means 24, 28 between the open condition shown in Figure 2 and the locked condition shown in Figure 1.
To this end, handle 26 has slots 17 providing camming surfaces 19 which cooperate with laterally projecting lugs 21 on handle member 22. The instrument further includes a sliding pusher bar and knife assembly 30 comprising a central knife carrier 32 and laterally spaced pusher bars 34 and 36 on either side of the knife carrier, the pusher bars terminating at their forward ends in inclined pusher bar cams 38 and 40, respectively, and the knife carrier including an inclined knife 42 situated just to the rear of the pusher bar cams.
In use, a disposable staple cartridge 44, containing four laterally spaced longitudinal rows of staples, is inserted into the lower jaw 20 while two anvil members 72 having staple shaping depres-sions in their outer surfaces, complimentary to the positioning of the individual staples in the staple 1 ~38~0 cartridge, are placed on the upper jaw 16. The instrument is inserted into a patients body and manipulated such that tissue to be cut and sutured is inserted between the jaws, an incision to receive one of the jaws having previously been made in the tissue, if required. The jaws are then closed and locked by handle 26 to firmly grip the tissue between the opposing staple cartridge and anvil surfaces.
The pusher bar and knife assembly which is initially in a rearward position relative to the jaws, is then pushed forwardly causing the pusher bar cams to enter longitudinal slits in the staple cartridge, in which slits are accommodated rows of individual staple pushers. The pusher bar cams cooperate sequentially with camming surfaces on the individual staple pushers to force the staples successively from the cartridge, through the gripped tissue and into engagement with the anvil depressions which thereby, in conjunction with the cams, produce staple-closing forces. The design of the cartridge is such that each slit carries two mutually stag-gered rows of staples so that in all, four staple rows are formed in the gripped tissue. The knife 42 which trails the pusher bars cams slightly and rides in central longitudinal slits in the cartridge and anvil, cuts the gripped tissue along a line between the two pairs of staple rows.
To provide lateral support for the jaws and to resist forces tending to vertically open the jaws during stapling, each jaw is provided with a longitudinal passageway and the knife blade carrier 32 which is a relatively rigid member, preferably of metal, carries upper and lower laterally aligned shoes which ride in these passageways and provide the required local support to the jaws in the region 1 1~3890 of the pusher bar cams and knife blade as these elements travel along the staple cartridge.
Thus, it will be seen, particularly in Figures 6, 7 and 14 that the lower frame 14 is formed with a cartridge-receiving channel 46 and an outer longitudinal passageway 48 of generally T-shaped cross-section extending from the base of the channel 46. Upper frame 12 has inwardly directed longitudinally extending shoulders 50 for mounting the anvils as will be described, the construction of the upper frame being such that a longitudinally extending passageway 52 of generally rectangular section is formed ~bove the shoulders.
The pusher bar and knife assembly 30, see particularly Figures 3, 4 and 5, has conventional-type laterally spaced pusher bars 34 and 36 terminat-ing in slightly offset inclined pusher bar cams 38 and 40. The central knife carrier 32, as indicated, has an inclined knife 42 just to the rear of the pusher bar cams and the knife carrier is extended vertically above and below the pusher bars. On upper and lower terminal portions of the knife carrier which project forwardly of the knife, are situated lower and upper shoes 54 and 56, respec-tively, the vertical spacing between the shoes cor-responding to the vertical spacing between the passageways 48 and 52 in the lower and upper frames when the frames are locked together. The lower shoe 54 has a substantially T-shaped cross section cor-responding to the cross-sectional shape of passageway 48 so that this shoe fits in passageway 48 with minimal clearance to allow substantially friction-free passage of the shoe along the passageway, and upper shoe 56 is likewise shaped to fit in passage-way 52 with minimal clearance to provide substantially 1 lfi3~
friction-free passage. It will be noted that the shoes 52 and 54 are longitudinally located in prox-imity to the pusher bar cams 38 and 40 so as to in use, provide support for the jaws 16 and 20 in the region of the cams substantially at points where the forces created by cooperation of the pusher bar cams and the individual staple pushers in the cartridge approach a maximum. Further, by locating the shoes both laterally and vertically in the respective passageways, both lateral alignment of the jaws and resistance to vertical jaw opening during stapling is obtained.
At the rear end of assembly 30, the pusher bars and knife carrier are mounted in known manner in a suitable carrying block 31 having an operating knob 33 or the like.
The staple cartridge 44 as shown in Figures 8, 9 and 10 is generally of similar character to the known type as described in the aforementioned Canadian Patent No. 888,867 insofar as the number of staple rows, and design and location of the individual staple pushers is concerned. For a fuller descrip-tion of these elements and the manner in which staple ejection is effected by interaction of the pusher bar cams and the individual staple pushers, reference may therefore be made to this patent. In the present case, the cartridge 44 has a solid nose portion 58 and a pair of longitudinal ribs 60 and 62 extending rearwardly from the nose portion and defining a slit 64 therebetween right through the cartridge for passage of the knife carrier 32. The inner facing surfaces of the ribs 60 and 62 again have bumps 66 to laterally locate the knife carrier and the ribs are themselves longitudinally slit to accommodate the staple pushers and the opposed, 1 16:~90 staggered rows of staples. Friction pieces 68 are again pxovided to inhibit inadvertent forward motion of the pusher bars. Thus, the significant difference between the present cartrid~e and that described in Canadian Patent No. 888,867 is that in the present case slit 64 extends right through the cartridge (to the rear of the nose portion) to allow passage of the vertically extended knife carrier. In use, as indicated, the cartridge 44 sits in the cartridge receiving channel 46 of the upper jaw with the nose portion 58 projecting forwardly of the jaw and positive longitudinal location of the cartridge being effected by means of a projecting cartridge lug 70 and a complimentary cut-out in one of the side walls of channel 46.
While the instrument has ~een herein described as utilizing a separate staple cartridge 44 in like manner to the instrument described in Canadian Patent No. 888,867, it is contemplated within the scope of the present invention, for the staple cartridge to be formed as an integral part of lower jaw 20.
The anvil means in the present instance, see Figures ll, 12 and 13, comprises a pair of like individual elongate anvils 72 which sit with a friction fit on the shoulders 50 of the upper jaw, as seen in Figures 1, 3 and 14, whereby a slit is provided between the anvils allowing passage for the vertically extended knife carrier. Each individual anvil comprises an anvil surface 76 with staple-shaping depressions 78, an outer wall 80 and a shorter inner wall 82. The inner and outer wall~
are slightly inwardly tapered to provide the friction fit on shoulders 50 and the outer walls each have depressions 51 aligning with complimentary depressions ~ ..~
1 ~63~0 in the side walls of the lower jaw for longitu-dinally locating the individual anvils and accurate-ly aligning the staple shaping depressions with the individual staples in cartridge 44.
While the instrument as described includes separate anvils 72 which fit on the shoulders 50 of upper jaw 16, it is also possible, particularly in the manufacture of a low-cost disposable instrument, to dispense with the anvils themselves and form the staple shaping depressions, directly in the under-surfaces of shoulders 50 of the upper jaw.
Assembly of the various components of the instrument is effected in the following manner with particular reference to Figures 1 to 3. Initially, with a cartridge 44 correctly positioned on jaw 20 of lower frame 14, the forward end of pusher assembly 30 is inserted from the back into lower frame 14, with lower shoe 54 fitting in passageway 48, and assembly 30 is moved forwardly along frame 14 until the pusher bars enter the lontitudinally slit ribs 60 and 62 of cartridge 44 and are arrested by the friction pieces 68. This position of pusher assembly 30 relative to frame 14 is shown in Figures 1 and 2.
Frame 14 with the inserted pusher assembly 30 is then fitted into handle member 22, suitable compli-mentary locating means (not shown~ being provided on the frame and handle member to longitudinally align these elements and prevent forward movement of frame 14 in member 22 during staple ejection.
Anvils 72 are fitted on jaw 16 and lugs 13 of frame 12 are fitted into openings 15 of handle 26. Then with handle 26 tilted upwardly, as shown in Figure 2, notches 28 are engaged with pivot bar 24 to complete the assembly of the instrument.
. , 1 163~9~
In use, the instrument in the assembled open condition, substantially as shown in Figure 2, is inserted into a body cavity, so that tissue to be stapled is accepted between jaws 16 and 20 and the instrument is then locked by manipulation of handle 26 and cooperation of camming surfaces 19 with lugs 21. It will be noted that openings 55 (see Figure 3) are provided in shoulders 50 o~ the upper frame 12 which allow shoes S6 to enter channel 52 as the instrument is closed. With tissue gripped between the jaws and the instrument in the condition as shown in Figure 1, stapling is effected in the manner described in the aforementioned patent by pushing forwarding on knob 33.
When stapling is completed, the pusher assembly 30 is retracted to the initial positon, allowing shoes 56 to be removed from channel 52 through openings 55, so that the instrument can be opened.
It will be appreciated, since the shoes 54 and 56 are accurately laterally aligned and carried by a relatively rigid member, that during stapling, as the shoes move along the passageways 48 and 52 with minimal clearance, they provide adequate localized support to the jaws in the region of operation of the pusher bar cams and the particular individual staple pushers being actuated. Due to the cross~sectional shape of the shoes and passage-ways, such support resists forces tending both laterally to distort the jaws and to open the jaws vertically and accordingly the present construction lends itself to manufacturing the jaws in relatively light weight disposable materials. It is to be understood however that the construction can also be used in instruments manufactured from more convention-al materials.
1 1~à339~3 While only a single preferred embodiment of the invention has been described in detail, it is to be understood that the invention is not limited to its specific features and modifications are possible within the scope of the attached claims.
Thus, while the invention has been particularly described in relation to its application in a surgical stapling instrument, the invention is not limited to this application. The invention may be applied to other fastening instruments having opposed jaws which re~uire stabilization while fastening means are applied to living tissue gripped between the jaws. For example, the invention may be applied to instruments for applying certain types of surgical clips or instruments for applying surgical fastening devices of the type set out in U.S. Patent No.
4,060,089.
Claims (19)
1. A surgical stapling instrument having first and second cooperating frames each provided with an elongate jaw, one of said jaws being adapted to receive at least two laterally spaced longitudinal rows of staples, an elongate pusher bar and knife assembly slidable longitudinally relative to said jaws for sequentially ejecting staples from said one of said jaws and shaping the staples against anvil means pro-vided on the other of said jaws to form a pair of laterally spaced staple rows in tissue gripped between said jaws and for cutting the tissue along a line be-tween said staple rows, said assembly including a pair of laterally spaced pusher bars each having a forward end portion including a pusher bar cam and a knife carrier having a knife blade located between said pusher bars, and jaw support means carried by said pusher bar and knife assembly and cooperating with said jaws for locally supporting both of said jaws in the region of said pusher bar cams as said cams move along said jaws for resisting forces tending to deflect said jaws during ejection and shaping of the individual staples.
2. A surgical stapling instrument as claimed in claim 1 wherein said support means includes means for resisting forces tending to laterally distort said jaws.
3. A surgical stapling instrument as claimed in claim 1 wherein said support means includes means for resisting forces tending to vertically separate said jaws.
4. A surgical stapling instrument as claimed in claim 1 wherein said support means includes means for resisting forces tending to laterally distort said jaws and forces tending to vertically separate said jaws.
5. A surgical stapling instrument as claimed in claim 1 wherein each of said jaws has a longitudinal passageway defined therein and wherein said support means includes upper and lower shoes carried by said pusher bar and knife assembly in the region of said pusher bar cams, said shoes fitting in said passage-ways and travelling therealong during longitudinal movement of said assembly to provide said local support for said jaws.
6. A surgical stapling instrument as claimed in claim 5 wherein said passageways and shoes have complementary cross-sectional shapes resisting localized lateral misalignment of the jaws and resisting vertical separation of the jaws.
7. A surgical stapling instrument as claimed in claim 6 wherein at least one of said shoes and the corresponding jaw passageway have complementary sub-stantially T-shaped cross-sectional profiles.
8. A surgical stapling instrument as claimed in claim 5 wherein said knife carrier includes upper and lower portions projecting forwardly of said knife and wherein said shoes are disposed on the projecting portions above and below the level of said pusher bar cams, respectively.
9. A surgical stapling instrument as claimed in claim 1 wherein said jaws are made of lightweight disposable plastics material and said knife carrier is made of relatively rigid material, whereby said shoes provide support to said jaws resisting said jaw deflecting forces.
10. A surgical stapling instrument as claimed in claim 1 including a staple cartridge for mounting on said one of said jaws to provide said rows of staples, said cartridge comprising a pair of longitudinally extending staple-carrying elements defining a slit therebetween for passage of said knife carrier when said cartridge is mounted on said one of said jaws.
11. A surgical stapling instrument as claimed in claim 10 wherein said cartridge has a common nose portion and said staple-carrying elements each extend rearwardly from said nose portion.
12. A surgical stapling instrument as claimed in claim 1 including anvil means comprising a pair of elongate anvil members and means for mounting said anvil members on the other of said jaws to define a slit therebetween for passage of said knife carrier.
13. A surgical stapling instrument as claimed in claim 12 wherein each of said anvil members is sub-stantially channel-shaped in cross-section and said other of said jaws includes opposed inwardly directed longitudinal shoulders defining said anvil mounting means, said anvil members seating on said shoulders with a friction fit.
14. A surgical stapling instrument as claimed in claim 1 including means for pivotally connecting said frames together at the rear ends of said frames and a locking handle means pivotally connected to one of said frames and cooperating with locking formation associated with the other of said frames for moving said jaws between open and closed conditions.
15. A surgical stapling instrument as claimed in claim 1 wherein said jaw support means is disposed at least partially between said jaws.
16. A surgical instrument for use in fastening living tissue comprising upper and lower cooperating elongated jaws movable between open and closed posi-tions, whereby tissue to be fastened may be gripped between said jaws when said jaws are in the closed position, means associated with one of said jaws for mounting a tissue fastening means, a pusher means movable longitudinally relative to said jaws when said jaws are in said closed position for forcibly expel-ling said fastening means for said one jaw and causing said fastening means to penetrate tissue gripped be-tween said jaws, and jaw support means carried by said pusher means, said jaw support means cooperating with said jaws during movement of said pusher means along said jaws for resisting forces tending to separate said jaws during expulsion of said fastening means.
17. A surgical instrument as defined in claim 16 wherein said jaw support means includes means for resisting forces tending to laterally separate said jaws during expulsion of said fastening means.
18. A surgical instrument as defined in claim 16 or claim 17 wherein said jaw support means includes means for resisting forces tending to vertically separate said jaws during expulsion of said fastening means.
19. A surgical instrument as defined in claim 16 wherein said jaw support means includes upper and lower support shoes carried by said pusher means and wherein each of said jaws includes a longitudinal passageway for receiving a respective one of said shoes, said shoes travelling in said passageways during move-ment of said pusher means along said jaws and locally supporting said jaws in the region of said respective shoes.
Priority Applications (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
CA000421367A CA1162814A (en) | 1980-02-05 | 1983-02-10 | Surgical instruments |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US11866480A | 1980-02-05 | 1980-02-05 | |
US118,664 | 1987-11-09 |
Publications (1)
Publication Number | Publication Date |
---|---|
CA1163890A true CA1163890A (en) | 1984-03-20 |
Family
ID=22379998
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA000369043A Expired CA1163890A (en) | 1980-02-05 | 1981-01-22 | Surgical stapling instruments |
Country Status (9)
Country | Link |
---|---|
US (1) | US4520817A (en) |
EP (1) | EP0033548B1 (en) |
JP (1) | JPS56119239A (en) |
AT (1) | ATE19729T1 (en) |
AU (1) | AU534210B2 (en) |
CA (1) | CA1163890A (en) |
DE (1) | DE3103976C2 (en) |
GB (2) | GB2078594B (en) |
HK (2) | HK99885A (en) |
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FR1278616A (en) * | 1959-09-28 | 1961-12-15 | Apparatus for suturing hollow organs | |
US3079606A (en) * | 1960-01-04 | 1963-03-05 | Bobrov Boris Sergeevich | Instrument for placing lateral gastrointestinal anastomoses |
CH375481A (en) * | 1960-02-04 | 1964-02-29 | S Bobrov Boris | Surgical instrument for performing lateral gastrointestinal anastomoses |
US3137192A (en) * | 1962-12-21 | 1964-06-16 | Robert M Mcneill | Material cutting device |
US3252643A (en) * | 1962-12-24 | 1966-05-24 | Strekopytov Alexey Alexcevich | Instrument for suturing living tissue |
US3317105A (en) * | 1964-03-25 | 1967-05-02 | Niiex Khirurgicheskoi Apparatu | Instrument for placing lateral intestinal anastomoses |
US3275211A (en) * | 1965-05-10 | 1966-09-27 | United States Surgical Corp | Surgical stapler with replaceable cartridge |
US3315863A (en) * | 1965-07-06 | 1967-04-25 | United States Surgical Corp | Medical instrument |
GB1158112A (en) * | 1965-07-06 | 1969-07-16 | Us Surgical Corp 62 1158111 | Surgical Stapling Instruments |
GB1210524A (en) * | 1966-10-10 | 1970-10-28 | United States Surgical Corp | Staple cartridge for surgical stapling instruments |
US3494533A (en) * | 1966-10-10 | 1970-02-10 | United States Surgical Corp | Surgical stapler for stitching body organs |
US3490675A (en) * | 1966-10-10 | 1970-01-20 | United States Surgical Corp | Instrument for placing lateral gastrointestinal anastomoses |
US3499591A (en) * | 1967-06-23 | 1970-03-10 | United States Surgical Corp | Instrument for placing lateral gastro-intestinal anastomoses |
SU566574A1 (en) * | 1975-05-04 | 1977-07-30 | Всесоюзный научно-исследовательский и испытательный институт медицинской техники | Apparatus for applying linear agraffe suture on organs and tissue |
US4060089A (en) * | 1975-09-03 | 1977-11-29 | United States Surgical Corporation | Surgical fastening method and device therefor |
US4241861A (en) * | 1977-12-20 | 1980-12-30 | Fleischer Harry N | Scissor-type surgical stapler |
US4207898A (en) * | 1978-03-27 | 1980-06-17 | Senco Products, Inc. | Intralumenal anastomosis surgical stapling instrument |
DE7909218U1 (en) * | 1978-03-31 | 1979-08-16 | Vsesojuznyj Nautschno-Issledovatelskij I Ispytatelnyj Institut Medicinskoj Techniki Ssr, Moskau | Surgical sewing device for suturing organs |
US4210043A (en) * | 1978-11-09 | 1980-07-01 | Scott Paper Company | Cutting assembly |
-
1980
- 1980-09-01 AU AU61927/80A patent/AU534210B2/en not_active Expired
-
1981
- 1981-01-22 CA CA000369043A patent/CA1163890A/en not_active Expired
- 1981-02-02 GB GB8120470A patent/GB2078594B/en not_active Expired
- 1981-02-02 GB GB8103084A patent/GB2068817B/en not_active Expired
- 1981-02-03 JP JP1490581A patent/JPS56119239A/en active Granted
- 1981-02-05 AT AT81100826T patent/ATE19729T1/en not_active IP Right Cessation
- 1981-02-05 DE DE3103976A patent/DE3103976C2/en not_active Expired
- 1981-02-05 EP EP81100826A patent/EP0033548B1/en not_active Expired
-
1982
- 1982-03-08 US US06/356,247 patent/US4520817A/en not_active Expired - Lifetime
-
1985
- 1985-12-12 HK HK998/85A patent/HK99885A/en not_active IP Right Cessation
- 1985-12-12 HK HK995/85A patent/HK99585A/en not_active IP Right Cessation
Also Published As
Publication number | Publication date |
---|---|
EP0033548A2 (en) | 1981-08-12 |
HK99885A (en) | 1985-12-20 |
DE3103976C2 (en) | 1982-10-14 |
DE3103976A1 (en) | 1982-01-07 |
JPH0359693B2 (en) | 1991-09-11 |
ATE19729T1 (en) | 1986-05-15 |
AU534210B2 (en) | 1984-01-12 |
GB2078594B (en) | 1984-02-01 |
AU6192780A (en) | 1981-08-13 |
GB2078594A (en) | 1982-01-13 |
GB2068817B (en) | 1983-11-23 |
GB2068817A (en) | 1981-08-19 |
HK99585A (en) | 1985-12-20 |
EP0033548B1 (en) | 1986-05-14 |
JPS56119239A (en) | 1981-09-18 |
EP0033548A3 (en) | 1982-03-31 |
US4520817A (en) | 1985-06-04 |
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Legal Events
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MKEX | Expiry |