CA1259875A - Two-piece tissue fastener with coinable leg staple and retaining receiver and instrument for applying same - Google Patents
Two-piece tissue fastener with coinable leg staple and retaining receiver and instrument for applying sameInfo
- Publication number
- CA1259875A CA1259875A CA000456803A CA456803A CA1259875A CA 1259875 A CA1259875 A CA 1259875A CA 000456803 A CA000456803 A CA 000456803A CA 456803 A CA456803 A CA 456803A CA 1259875 A CA1259875 A CA 1259875A
- Authority
- CA
- Canada
- Prior art keywords
- legs
- fastening member
- receiver
- fastener
- jaw
- 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
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/064—Surgical staples, i.e. penetrating the tissue
- A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
Abstract
Abstract of Disclosure A fastener is provided to hold together separated portions of mammalian tissue and includes an open loop fastening member and a receiver adapted to receive the legs of the fastening member. The legs of the fastening member are then deformed to effect engagement of the fastening member and receiver. An instrument is provided for holding the receiver on one side of the tissue portions and for inserting the fastening member through the tissue portions and into the receiver. The instrument also 1) deforms the legs of the fastening member to effect the engagement of the fastening member with the receiver and 2) severs the protruding portions of the legs.
Description
TWO-PIECE TIS5UE FASTENER WITH COIN~BLE LEG STAPLE
~N~ ~ETAI~ING RE OE IVER AND MET~OD AND INSTRUMENT
FOR APPLYING S~E
5 Technical Field This invention relates, in general~ to the fastening together of portions of t~ssue in surgical procedures and is especially advzlntageous in the ~ur~ical closure of internal organ tissue.
Back~ und of the ~nvention In various surgical procedure~, fasteners ~n the form of staples or the like are employed for holding tissue portions together t~ fa~ilitat~e healing of a wound or incision~ For example, a locking ~taple, hav1ng a tongue and groove structure by which the staple ~s locked, is disclosed in U.S.
Patent No. 2,881,762, A metal staple espe~ially adapted for ligating blood vessels is disclosed in U.S. Patent : No. 3~079,608. International Patent Application No. PCT/SU79/
00049, which is available to the public, discloses a variety of fastening devices and instruments for performing circular anastomoses on the l~rge intestlne. The a~orementioned dis~losures ~erve as e~amples of a wide variety of ~issue fastening devi~es and techniques that may be employed in general and/or specific 6urgical ~i~tua~ions.
One common type of ~a~tening device or joining or bolding together ~cfft ti~sue por~ion ls the generally ~Un-shaped staple which ~g typicall~
fabricated from a ~uf~table metal. Such ~taples, alth~ugh generally descr~hed as having tw3 legs ~oined ts:~ ~efine 2 ~ hape when unclinched" 21ay al~o be regarded ~s having ~ o~nfiguration of ~n "open~ loop when unclin~hed. The legs ~ee~ not 3S necessarily be paralle~ but ~re typically adap.ed for ~TH 548 f penetrating the tissue portions and for receiving between them some of the tissue material.
Other examples of U-shaped or open loop staples, as well as of methods and instruments for applying such staples to tissue, are disclosed in UrS~ Patent Nos. 3,252,643, 3,482,428, 3,692,224, 3,790,057, 3,795,034, 3,889,683, 4,198,982, 4,316,468 and 4,319,576.
Other tissue fastening devices have been pro-posed and differ from staples per se in that theseother devices may have a plurality of components and do not have to be clinched in the manner used to set a staple. One such device is disclosed in U.S. Patent No. 4,060,089 and includes a fastener s-trip provided with a plurality of longitudinally spaced, parallel prongs which are adapted to pene-trate two overlapped tissue portions from one side so that the distal ends of the prongs project from the other side of the tissue portions. 'rhe fastener device further includes a retainer strip which is adapted to be placed on the other side of the tissue portions opposite the fastener strip to engage the ends of the projecting fastener strip prongs and thus secure the tissue portions tightly between the fastener strip and the retainer strip. Such a fastening device may be fabricated from a biodegrad-able or absorbable material.
Yet another tissue fastening device having a plurality of components is known. The fasteners of that device are made from various polymeric materials and the legs of the U-shaped portion of the fastener have a taper to improve the penetration in the tissue.
~ :
~L~5~7~
Although n~any of the above-di scussed types of ti ssue fasJcening deYices and ~cechniques are ~atisfai:tory in various applications, there i8 a need 'co prov:Lde an improved fastening device, especially 5 one completely fabricated from absorbable materials.
Also, it would be d~sirable to provide an ~mproved fastening device fabricated from absorbable _.............. material~ that can provide primary zlpproximation of the tissue edges to insure that the tissue edges ar~
10 in oontinuous contact~ Further, ~;uah an ~mproved - ~astener should provide a desi red amount of hemostatic oompression to minimize bleeding, but allow ~ome collateral blood circulation to the wound or in~ision edges of the tissue to promote healing. In ~ddition, such an improved fastener should have the capability to accommodate varying tissue thicknesses and 8hould leave as little tissue cuff or margin as pos~ible in effecting ~he joining of the tis~ue.
~urther, it would be b~neficial if such an i~proved fastener had ~ oonfigur~tlon t~at ~ould enable the fa~tener to be fabri~ate~ with 1) as ~mall a size as p~ssible to mini~ize dosage and 2) wlth a minimum of sharp edges or protrusions. Also, another . desirable feature o~ such ~n l~proved fastener would be ~ fastener c~nfiguration that dld not form, or oontribute to the formation of, pockets o In~ec~ion in the ti~sue.
~ urther, ~uch ~n improved fastener ~uld desirably provide the 8urgeon ~1~h tactil~ ~e~dback and oompen~ating ~on~rol during the appli~ation of the fa~tener.
~ inally; ~uoh an improved ~2stener shoul~
have ~he eapability for ~aintaining the ti~gu~
p~rtions in ~ppro~i~a~ion and o~mpre3sion for a mi~imum of 21 days ETH-~8 It would also be advantageous to provide a ~imple yet effective method for joining tissue portions together w~ th such an improved fastener and to provide an instrument for applyinlg ~uch an S improved fastener according ~o such a mel:hod. It w~uld be desi rable 1 f the improved rnethod o~uld be effected with a variety of diffarenl: embodi~nen~s of ~uc:h an improved fastener by means of appropriate instruments .
Su~nmary of the Invention ~ ~mproved fas'cener is prc~vided to hold toge~cher ~epara~ed portions of mammalian tissue such as are defined by a wound or incision, to facilita'ce healing of the wound or ~ncision, The fastener comprises an open loop fastening member wh$ch has a pair of legs adapted to penetrate two overlapped tissue portions and which has a link connecting the legs. ~he l;nk is adapted to lie substantially against one of the tissue portions.
A receiver i~ provideB for ~eing ~isposed against ~he other of the tissue portions opposite ~he fastenirlg member and has means for r~ceiving the fastening ~nember legs after the legs have bees inserted through ~he ti~sue po~tlons.
At le~s'c a por~ion of each of the legs or at least a portion of the receiver consi~'cs of ~Dal:erial that is init1ally defor~able un~er the ~pplication of pressure via a tool or instr~nent to e~Efe~t engagement of the ~astening metnber leg~ and receiver after the tissue portlon~ h~ve been peretroted by the fastening ~e~nber legs and ~f~cer the l~gs ~sve been received in the receiver.
Ac~rd~ng to the ~nethod iEor iol~ ng ti El~ue portions wi~h the f~stener ~ the two ti~ue portions are fir~t approxim~ d in ~ generally face-to-face ET~'-548
~N~ ~ETAI~ING RE OE IVER AND MET~OD AND INSTRUMENT
FOR APPLYING S~E
5 Technical Field This invention relates, in general~ to the fastening together of portions of t~ssue in surgical procedures and is especially advzlntageous in the ~ur~ical closure of internal organ tissue.
Back~ und of the ~nvention In various surgical procedure~, fasteners ~n the form of staples or the like are employed for holding tissue portions together t~ fa~ilitat~e healing of a wound or incision~ For example, a locking ~taple, hav1ng a tongue and groove structure by which the staple ~s locked, is disclosed in U.S.
Patent No. 2,881,762, A metal staple espe~ially adapted for ligating blood vessels is disclosed in U.S. Patent : No. 3~079,608. International Patent Application No. PCT/SU79/
00049, which is available to the public, discloses a variety of fastening devices and instruments for performing circular anastomoses on the l~rge intestlne. The a~orementioned dis~losures ~erve as e~amples of a wide variety of ~issue fastening devi~es and techniques that may be employed in general and/or specific 6urgical ~i~tua~ions.
One common type of ~a~tening device or joining or bolding together ~cfft ti~sue por~ion ls the generally ~Un-shaped staple which ~g typicall~
fabricated from a ~uf~table metal. Such ~taples, alth~ugh generally descr~hed as having tw3 legs ~oined ts:~ ~efine 2 ~ hape when unclinched" 21ay al~o be regarded ~s having ~ o~nfiguration of ~n "open~ loop when unclin~hed. The legs ~ee~ not 3S necessarily be paralle~ but ~re typically adap.ed for ~TH 548 f penetrating the tissue portions and for receiving between them some of the tissue material.
Other examples of U-shaped or open loop staples, as well as of methods and instruments for applying such staples to tissue, are disclosed in UrS~ Patent Nos. 3,252,643, 3,482,428, 3,692,224, 3,790,057, 3,795,034, 3,889,683, 4,198,982, 4,316,468 and 4,319,576.
Other tissue fastening devices have been pro-posed and differ from staples per se in that theseother devices may have a plurality of components and do not have to be clinched in the manner used to set a staple. One such device is disclosed in U.S. Patent No. 4,060,089 and includes a fastener s-trip provided with a plurality of longitudinally spaced, parallel prongs which are adapted to pene-trate two overlapped tissue portions from one side so that the distal ends of the prongs project from the other side of the tissue portions. 'rhe fastener device further includes a retainer strip which is adapted to be placed on the other side of the tissue portions opposite the fastener strip to engage the ends of the projecting fastener strip prongs and thus secure the tissue portions tightly between the fastener strip and the retainer strip. Such a fastening device may be fabricated from a biodegrad-able or absorbable material.
Yet another tissue fastening device having a plurality of components is known. The fasteners of that device are made from various polymeric materials and the legs of the U-shaped portion of the fastener have a taper to improve the penetration in the tissue.
~ :
~L~5~7~
Although n~any of the above-di scussed types of ti ssue fasJcening deYices and ~cechniques are ~atisfai:tory in various applications, there i8 a need 'co prov:Lde an improved fastening device, especially 5 one completely fabricated from absorbable materials.
Also, it would be d~sirable to provide an ~mproved fastening device fabricated from absorbable _.............. material~ that can provide primary zlpproximation of the tissue edges to insure that the tissue edges ar~
10 in oontinuous contact~ Further, ~;uah an ~mproved - ~astener should provide a desi red amount of hemostatic oompression to minimize bleeding, but allow ~ome collateral blood circulation to the wound or in~ision edges of the tissue to promote healing. In ~ddition, such an improved fastener should have the capability to accommodate varying tissue thicknesses and 8hould leave as little tissue cuff or margin as pos~ible in effecting ~he joining of the tis~ue.
~urther, it would be b~neficial if such an i~proved fastener had ~ oonfigur~tlon t~at ~ould enable the fa~tener to be fabri~ate~ with 1) as ~mall a size as p~ssible to mini~ize dosage and 2) wlth a minimum of sharp edges or protrusions. Also, another . desirable feature o~ such ~n l~proved fastener would be ~ fastener c~nfiguration that dld not form, or oontribute to the formation of, pockets o In~ec~ion in the ti~sue.
~ urther, ~uch ~n improved fastener ~uld desirably provide the 8urgeon ~1~h tactil~ ~e~dback and oompen~ating ~on~rol during the appli~ation of the fa~tener.
~ inally; ~uoh an improved ~2stener shoul~
have ~he eapability for ~aintaining the ti~gu~
p~rtions in ~ppro~i~a~ion and o~mpre3sion for a mi~imum of 21 days ETH-~8 It would also be advantageous to provide a ~imple yet effective method for joining tissue portions together w~ th such an improved fastener and to provide an instrument for applyinlg ~uch an S improved fastener according ~o such a mel:hod. It w~uld be desi rable 1 f the improved rnethod o~uld be effected with a variety of diffarenl: embodi~nen~s of ~uc:h an improved fastener by means of appropriate instruments .
Su~nmary of the Invention ~ ~mproved fas'cener is prc~vided to hold toge~cher ~epara~ed portions of mammalian tissue such as are defined by a wound or incision, to facilita'ce healing of the wound or ~ncision, The fastener comprises an open loop fastening member wh$ch has a pair of legs adapted to penetrate two overlapped tissue portions and which has a link connecting the legs. ~he l;nk is adapted to lie substantially against one of the tissue portions.
A receiver i~ provideB for ~eing ~isposed against ~he other of the tissue portions opposite ~he fastenirlg member and has means for r~ceiving the fastening ~nember legs after the legs have bees inserted through ~he ti~sue po~tlons.
At le~s'c a por~ion of each of the legs or at least a portion of the receiver consi~'cs of ~Dal:erial that is init1ally defor~able un~er the ~pplication of pressure via a tool or instr~nent to e~Efe~t engagement of the ~astening metnber leg~ and receiver after the tissue portlon~ h~ve been peretroted by the fastening ~e~nber legs and ~f~cer the l~gs ~sve been received in the receiver.
Ac~rd~ng to the ~nethod iEor iol~ ng ti El~ue portions wi~h the f~stener ~ the two ti~ue portions are fir~t approxim~ d in ~ generally face-to-face ET~'-548
2~ ~7 ~
relationship. Next, the fastenin~ member is posi~ioned on one side o~ the ~issue portions ~ith the leqs orient~d at an appropriate angle to penetrate the tissue portions. The receiver is positioned on the other ~ide of ~he ti-~sue portions opposite the fastening member and generally in alignment with the fastening member legsO
Relative movement ls then effec~ed between ~he fas~ening member on ~he one hand and ~he ~is~ue portions and receiver on the other hand to oause penetration of the tissue portions by the fastening member legs and to cause a portion of each of the fastening member legs to be received within the reeeiver. The relative movement is effected until ~5 the link i8 disposed against the surface of one of the tissue portions and until the receiver is disposed against the other of the ~issue p~rtions.
Finally~ deformation of the ~astening m~mber legs or of the receiver or deformation of bo~h ~he ~0 receiver and the fastening me~ber legs is effected with a tool or instrument ~o as to provi~e engagement of the fastenin~ ~ember leg~ and receiver.
A tool or ins~rument for applying at leas~
one fastener to hold ~ogether..the separated portions of the mammalian tissue in acoordance w;th the above-d~scrlbed method preferably include~ a fir~t aW for holding the fa~tening ~ember on one ~ide of the ti~sue port~ons with the leg5 oriented in ~n appropr~ate ~ngle ~o penetrate the tis~ue p~rtions.
The in~trume~t al~o includes a ~ecDnd jaw for holding th~ re~eiver on ~he other ~lde o ~he ~13sue portions opposite the ast~ning ~e~ber and gèn~rally in ali~nment with the fa~tening ~e~ber legs.
The in~trument further includes ~ean for mov~ng the first and ~econd ~aws between 1) an open ET}~-5 4 ~
position for receiving the tissue portions between them and 2) a position in which the jaws are at least partially closed. Means are also provided on the instrument for moving the fastening member relative to the first jaw to penetrate the tissue portions with the legs of the fastening member and to locate at least portions of the legs of the Eastening member within the receiver in the second jaw.
Additionally, the instrument is provided with a deforming member movable relative to the second jaw for being urged against the fastening member legs, the receiver, or both so as to deform the fastening member legs, the receiver, or both for thus effecting an engagement of the fastening member legs and receiver. The deforming member i5 preferably moved by a suitable mechanism in response to movement of -the first and second jaws to at leas-t a partially closed position.
According to a further broad aspect of the present invention there is provided a fastener adapted to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision. The fastener comprises an open loop fastening member. The fastening member comprises a pair of legs adapted to penetrate the tissue portions and a link connects the legs that is adapted to lie substantially against one of the tissue portions. A receiver is adapted to be disposed against the other of the tissue portions opposite the fastening member. The receiver has means for receiving the fastening member legs after the legs have been inserted through the tissue portions. At leas-t a portion of each of the legs or at least a portion oE the receiver consistS f a material-that is initially deformable under the application of a predetermined~amount of pressure to effect engagement of the fastening-member legs and receiver after the tissue portions have been penetrated by the fastening member legs and after the legs have been received in the receiver.
~:25~
-6a-Acrording to a still further broad aspect of the present invention -there is provided an instrument for apply-ing at least one fastener to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision.
The fastener includes an open loop fastening member that comprises a pair of legs adapted to penetrate the tissue portions and a link connecting the legs that is adapted to lie substantially against one of the tissue portions. The fastener further includes a receiver adapted to be disposed against the other of the tissue portions opposi-te the fastening member and adapted to accept the legs of the fastening member. The instrument comprises a first jaw for Holding the fastening member on one side of the tissue portions with the legs oriented at an appropriate angle to penetra-te the tissue portions. A second jaw is provided for holding the receiver on the other side of the tissue por-tions opposite the fastening member and generally in alignment with the fastening member legs. Means is provided for moving the first and second jaws between an open position for receiving the tissue portions therebetween and an at least partially closed position. Means is provided for moving the fastening member relative to the first jaw to penetrate the tissue portions with the legs of the fastening member and to locate at least por-tions of the legs of the fastening member within the receiver in the second jaw. A
deforming member is movable relative to the second jaw member for being urged against the fastening member legs, the receiver, or both to deform the fastening member legs, the receiver, or both to thereby effect an engagement of the fastening member legs and receiver. Means is also provided for moving the deforming member to effect the deformation.
; ,~
1~25~
-6b-Nun~erous other features of 1) various embodiments of a novel -tissue fastener, 2) of methods for applying such embodiments of the tissue fastener~ and 3) of embodiments of an instrument for applying the tissue fastener in accordance with such methods will be apparent from the following detailed description and accompanying drawings.
Brief Description of the Drawings In the accompanying drawings forming part of the specification, and in which like numerals are employed to designate li.ke parts throughout the same, Figure 1 is a fragmentary perspective view of two portions of mammalian tissue defined by an incision or wound and being held together by a plurality of novel fasteners;
Figure 2 is a greatly enlarged, fragmentary, cross-sectional view taken generally along the plate 2-2 ~n Figure l;
.
Fi9UEe 3 i5 a fragmentaryv cross-sectional view taken generally along the plane 3~3 in Figure 2;
Figure 4 is an exploded, per~pective view of ~ first emb~iment of the fastensr E;hown in Figure l;
Figure 5 is a side view oi the fastening mem~er of the fas~ener illus~ratea in ~igure 4;
Figure 6 i~ an end ~iew ol. th~ astening member of the fastener lllu~trated in Figure 4;
Figure 7 is a top plane Yiew of the receiver of the fastener illustrated in Figure 47 ~ igure 8 is a cross-sectional view taken generally along the plane B-8 and Figure 7;
Figure 9 is a cross-sectional view taken generally along the plane g-9 in Figure 8;
Figure 10 is a si~e view of an instrument for applying the first embodiment of the fast~ener illustrated in ~igures 1-9;
Figure 11 is a grea~ly enlarged, fragmentary, front end view o~ the instrument illustrated in Figure 10;
Figure 12 is a greatly enlarged, fragmen~ary, ~op plane v~ew of the instrumen~ of Figure 10;
Figures 13-l6 are greatly enl~rged~
fragmentary, partial cros~-~ectional view~ of ~he instrument of Figure 10 illustrating the sequen~2 of opeEation of the in~trument;
~igure 17 ~s a greatly enlarged, fragmentary plane view of the instrument lower jaw t~ken along the pla~e 17-17 in Flgure 13;
. Fiyure 18 i a greatly enlarged, fragmentary, cros~-~ectional v~ew of the front end of the ~aws of the in~rument ~n the ~losed pos~ n ~hown ~n Figure 16;
~TH~548 ~5~
Figure lg is a fra~mentary, cross-sectional view similar to Figure 18 ~ut limited to the end of the lower jaw and showiny a modified form of the instrument;
Figure 20 is a fragment~ry, partial, cross-sectional view of a ~econd embodiment of the fastener shown in an orientati~n similar ~o that of the orientation of the firs~ embodi~nt of the fastener in Figure 2;
Figure 21 is a frag~entary, cros~-sectional - YieW taken generally along the plane 21-21 in Figure 20;
Figure 22 is a side Yiew of the receiver of the second embodiment of the fastener shown in Figures 20 and 21;
Figure 23 is a top plane view of ~he receiver of the se~ond embodiment of the fastener of Figures 20-22;
Figure 24 is a cros~-sectional view taken generally along the plane 24-24 in Figure 22;
Figure 25 is a fragmentary, partial, cross-sectional view of a third emhodimen~ of ~he : fastener ~hown in an ori~ntation ~i~ilar to that of the orientation of the first embodi~ent of the fastener in Figure 2;
Flgure 26 is a fragmen~ary, ~ross-~ectional view taken generally along the plane 26-26 in Figure 25;
Figure 27 is a ~i~e view of the receiver of the third embDdi~ent of the fastener of Fiqures 25 and 26;
Figure 28 is ~ ~op pl~ne view of ~he third fastener embodiment rec~iver of Figur~s 25-275 and Figure 29 i~ a ~ross-sectlonal v~ew tak~n generally along ~he pl~ne 2~ 29 in Figure 27O
Description of the_Pr~erre~ ~m~odiment
relationship. Next, the fastenin~ member is posi~ioned on one side o~ the ~issue portions ~ith the leqs orient~d at an appropriate angle to penetrate the tissue portions. The receiver is positioned on the other ~ide of ~he ti-~sue portions opposite the fastening member and generally in alignment with the fastening member legsO
Relative movement ls then effec~ed between ~he fas~ening member on ~he one hand and ~he ~is~ue portions and receiver on the other hand to oause penetration of the tissue portions by the fastening member legs and to cause a portion of each of the fastening member legs to be received within the reeeiver. The relative movement is effected until ~5 the link i8 disposed against the surface of one of the tissue portions and until the receiver is disposed against the other of the ~issue p~rtions.
Finally~ deformation of the ~astening m~mber legs or of the receiver or deformation of bo~h ~he ~0 receiver and the fastening me~ber legs is effected with a tool or instrument ~o as to provi~e engagement of the fastenin~ ~ember leg~ and receiver.
A tool or ins~rument for applying at leas~
one fastener to hold ~ogether..the separated portions of the mammalian tissue in acoordance w;th the above-d~scrlbed method preferably include~ a fir~t aW for holding the fa~tening ~ember on one ~ide of the ti~sue port~ons with the leg5 oriented in ~n appropr~ate ~ngle ~o penetrate the tis~ue p~rtions.
The in~trume~t al~o includes a ~ecDnd jaw for holding th~ re~eiver on ~he other ~lde o ~he ~13sue portions opposite the ast~ning ~e~ber and gèn~rally in ali~nment with the fa~tening ~e~ber legs.
The in~trument further includes ~ean for mov~ng the first and ~econd ~aws between 1) an open ET}~-5 4 ~
position for receiving the tissue portions between them and 2) a position in which the jaws are at least partially closed. Means are also provided on the instrument for moving the fastening member relative to the first jaw to penetrate the tissue portions with the legs of the fastening member and to locate at least portions of the legs of the Eastening member within the receiver in the second jaw.
Additionally, the instrument is provided with a deforming member movable relative to the second jaw for being urged against the fastening member legs, the receiver, or both so as to deform the fastening member legs, the receiver, or both for thus effecting an engagement of the fastening member legs and receiver. The deforming member i5 preferably moved by a suitable mechanism in response to movement of -the first and second jaws to at leas-t a partially closed position.
According to a further broad aspect of the present invention there is provided a fastener adapted to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision. The fastener comprises an open loop fastening member. The fastening member comprises a pair of legs adapted to penetrate the tissue portions and a link connects the legs that is adapted to lie substantially against one of the tissue portions. A receiver is adapted to be disposed against the other of the tissue portions opposite the fastening member. The receiver has means for receiving the fastening member legs after the legs have been inserted through the tissue portions. At leas-t a portion of each of the legs or at least a portion oE the receiver consistS f a material-that is initially deformable under the application of a predetermined~amount of pressure to effect engagement of the fastening-member legs and receiver after the tissue portions have been penetrated by the fastening member legs and after the legs have been received in the receiver.
~:25~
-6a-Acrording to a still further broad aspect of the present invention -there is provided an instrument for apply-ing at least one fastener to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision.
The fastener includes an open loop fastening member that comprises a pair of legs adapted to penetrate the tissue portions and a link connecting the legs that is adapted to lie substantially against one of the tissue portions. The fastener further includes a receiver adapted to be disposed against the other of the tissue portions opposi-te the fastening member and adapted to accept the legs of the fastening member. The instrument comprises a first jaw for Holding the fastening member on one side of the tissue portions with the legs oriented at an appropriate angle to penetra-te the tissue portions. A second jaw is provided for holding the receiver on the other side of the tissue por-tions opposite the fastening member and generally in alignment with the fastening member legs. Means is provided for moving the first and second jaws between an open position for receiving the tissue portions therebetween and an at least partially closed position. Means is provided for moving the fastening member relative to the first jaw to penetrate the tissue portions with the legs of the fastening member and to locate at least por-tions of the legs of the fastening member within the receiver in the second jaw. A
deforming member is movable relative to the second jaw member for being urged against the fastening member legs, the receiver, or both to deform the fastening member legs, the receiver, or both to thereby effect an engagement of the fastening member legs and receiver. Means is also provided for moving the deforming member to effect the deformation.
; ,~
1~25~
-6b-Nun~erous other features of 1) various embodiments of a novel -tissue fastener, 2) of methods for applying such embodiments of the tissue fastener~ and 3) of embodiments of an instrument for applying the tissue fastener in accordance with such methods will be apparent from the following detailed description and accompanying drawings.
Brief Description of the Drawings In the accompanying drawings forming part of the specification, and in which like numerals are employed to designate li.ke parts throughout the same, Figure 1 is a fragmentary perspective view of two portions of mammalian tissue defined by an incision or wound and being held together by a plurality of novel fasteners;
Figure 2 is a greatly enlarged, fragmentary, cross-sectional view taken generally along the plate 2-2 ~n Figure l;
.
Fi9UEe 3 i5 a fragmentaryv cross-sectional view taken generally along the plane 3~3 in Figure 2;
Figure 4 is an exploded, per~pective view of ~ first emb~iment of the fastensr E;hown in Figure l;
Figure 5 is a side view oi the fastening mem~er of the fas~ener illus~ratea in ~igure 4;
Figure 6 i~ an end ~iew ol. th~ astening member of the fastener lllu~trated in Figure 4;
Figure 7 is a top plane Yiew of the receiver of the fastener illustrated in Figure 47 ~ igure 8 is a cross-sectional view taken generally along the plane B-8 and Figure 7;
Figure 9 is a cross-sectional view taken generally along the plane g-9 in Figure 8;
Figure 10 is a si~e view of an instrument for applying the first embodiment of the fast~ener illustrated in ~igures 1-9;
Figure 11 is a grea~ly enlarged, fragmentary, front end view o~ the instrument illustrated in Figure 10;
Figure 12 is a greatly enlarged, fragmen~ary, ~op plane v~ew of the instrumen~ of Figure 10;
Figures 13-l6 are greatly enl~rged~
fragmentary, partial cros~-~ectional view~ of ~he instrument of Figure 10 illustrating the sequen~2 of opeEation of the in~trument;
~igure 17 ~s a greatly enlarged, fragmentary plane view of the instrument lower jaw t~ken along the pla~e 17-17 in Flgure 13;
. Fiyure 18 i a greatly enlarged, fragmentary, cros~-~ectional v~ew of the front end of the ~aws of the in~rument ~n the ~losed pos~ n ~hown ~n Figure 16;
~TH~548 ~5~
Figure lg is a fra~mentary, cross-sectional view similar to Figure 18 ~ut limited to the end of the lower jaw and showiny a modified form of the instrument;
Figure 20 is a fragment~ry, partial, cross-sectional view of a ~econd embodiment of the fastener shown in an orientati~n similar ~o that of the orientation of the firs~ embodi~nt of the fastener in Figure 2;
Figure 21 is a frag~entary, cros~-sectional - YieW taken generally along the plane 21-21 in Figure 20;
Figure 22 is a side Yiew of the receiver of the second embodiment of the fastener shown in Figures 20 and 21;
Figure 23 is a top plane view of ~he receiver of the se~ond embodiment of the fastener of Figures 20-22;
Figure 24 is a cros~-sectional view taken generally along the plane 24-24 in Figure 22;
Figure 25 is a fragmentary, partial, cross-sectional view of a third emhodimen~ of ~he : fastener ~hown in an ori~ntation ~i~ilar to that of the orientation of the first embodi~ent of the fastener in Figure 2;
Flgure 26 is a fragmen~ary, ~ross-~ectional view taken generally along the plane 26-26 in Figure 25;
Figure 27 is a ~i~e view of the receiver of the third embDdi~ent of the fastener of Fiqures 25 and 26;
Figure 28 is ~ ~op pl~ne view of ~he third fastener embodiment rec~iver of Figur~s 25-275 and Figure 29 i~ a ~ross-sectlonal v~ew tak~n generally along ~he pl~ne 2~ 29 in Figure 27O
Description of the_Pr~erre~ ~m~odiment
3~ ~his invention ~ay ~e u~ed ~n ~any ~ifferent forms. The specl~ic~tion ~nd the ~Dmp~nying dr~ing~
~TH-548 ~5~
_g _ disclose only a few specific forms as an example of the use of the invention. ~he precise shapes and ~ize~ of the compvnents herein des~ribed are not essential to ~he in~ention unless otherwi~e indicated. ~he inventlon 1~ not intended to be limited to the embodi~ents illustrated, and the aoope of the inventi~n will be p~inted out in the appended claims~
THE FASTENER ~IRST ~BODIMENT
A first embodiment of tbe fastener is illustrated in an assembled oonfiguration in Figures 1-4 and i~ generally indicate~ therein by reference numeral 50O Individual parts of the fastener are shown in Figures 5-9.
The plurality of such fasteners 50 are illustrated in Figure 1 as holding together separated portions 52 and 54 of mammalian tissue, such as are defined by a wound or incision, to fa~ilitate healing of the wound or incision.
The fastener includes tw~ ~omponents r a generally ~-shaped or open loop fas~enlng member 60 and a receiver 62 which are ~niti~lly ~eparated as illustrated in ~igure ~ whi~h are adapted to cooperate to oompress or hold bet~een them the tissue portions 52 and 54 as illustrated in Fiyur.es 1-3.
As is best illustrated in ~igure 4~ the fastening member 60 includes 1~ a pair of legs 66 adapted ~o penetra~e ~he tl~sue portion~ ~nd 2) a llnk 68 which is o~nne~ted to ~he leg~ 66 and which i5 adap~ed to lie ~ubst~ntially ~ga$n~t one of the ~is~ue 3C p~rtions (e-g- ? tiæsue p~rtion 54 ~n F19ure 2). The legs 66 of the astening ~ember are generally parallel ~o eaGh other a~a ~re gener~lly perpendiculær ~9 ~he link 68. Preferably, ~ach leg 66 has ~ ~olid, generally ~ylindrical o~nfigurat~n ~ith ~ conical end 3~ 70 (Figures 4 6) to f~cilitate or aid in the .
penetration of the tissue ~ortions. The link 68 may have the regul~r parallelpiped shape illustrat2d or may have any other suitable shape.
As best illustrated in Figures 7-9, the receiver 62 includes a central member 72 joining a pair of leg receiving members 74. Each leg receiving member 74 defines a~ least one p~sage 76 i.-or receiving one of the fastening ~ember legs 66 as best illustrated in Figure 39 If the fastening member legs 66 have a cylindrical configuration as illu~trated, then the receiving member passages 76 are preferably cylindrical bores o sufficient diameter to permit ~he legs 66 to be received ~loosely or in slid~ng engagement). Each receiving member 74 and the passage 76 defined therein lS cooperate as means for receiving and encompas~ing at least a portion of one of the fastening ~ember legs 66 after ~he leg has been in~erted through the ti~sue portions as best illustrated in ~igures 2 and 3.
Preferably, each receiving me~ber 7~ of ~he receiver 62 defines a first aperture 78 ~Figures 3 and 9) co~munica~ing from the exterior of the receiviny ~ember 74 wlth the interior of the passage 76. Also, a ~e~ond aper~ure 80 (Pigures 3 and 9) i~ provided in the receivin~ member 74 opposite the fir~t ap~rture 78 for ~ommunicating be~ween the exterior of the receiving ~ember 74 and the interior of the pa~sage 7~. ~t least one of these ~wo apertures 78 and 80 i8 intended to scoo~od~te the inser~ion of a r~m-like aember of a tool or instrumen~ for defor~ing ~he fa~tening ~ember leg 66 in a manner des~ribed in d~tail hereinaf~er.
The other of ~he aper~ures 78 and 80 ~ay ~unct$on ~o pos~t~ on the re~ei~er 62 ~hin ~he ~ns~rument in a manner Al~o de~cribed in detail her~inafter.
The fastening ~e~ber 60 and ~be receiver 62 may be formed from ~uitable ~a~er$al~, ~ueh a~
~25~
thermoplastic polymer m~terials that are absorbable by mammalian tissue. For example, the fastening member 60 has bee!n ~atisfactorily molded ronn a ~opolymer of lactide and glycolide. Preferablyl, the fastenîng member 60 is molded in a heated moLd, is pos~ scoured, and is annealed.
METHOD FOR APPLYING TEE FASTENER
--- According to the novel method of joining tissue portions with the above-described fastener 50, the tissue portions 52 an~ 54 ~igures 1~3) are approxi~ated in surface~to-~urface relationship. The fa~tening member 60 is then p~sitioned on one side of the ti~sue port~ons with the legs 66 oriented at an appropriate angle to penetrate the tissue portions.
is The receiver 62 is held on ~he other side of the tissue portions opposite the fastening member 60 and generally in alignment with the fastening member legs 66.
Specifically, the passages 76 are aligned ~ith ~he fastening member legs 66.
Next, relat~ve movement between the fastening member 60 and the receiver 62 is sffected to urge the fastening member and the receiver closer together to cause the fastening member legs 66 to penetrate the ~issue portions 52 and 54 and *o loc~te at Iea~
portions of the ~astening member legs 66 wi~hin the receiver 62. The relative ~ov~ment betwèen the fastening ~ember 60 ~nd the receiver 6?~ i8 t~rmin~ted when ~he ~astening member link 68 i8 ~t ~ de~ired ~i~tance from the receiver 62 to ~ecure the ~i~sue portions together. Preferably~ ~his ~ovement is tarminated after the ti~ue pDrtions hAvg ~een mpressed toge~her a de~ired amount.
At thi~ pDint, the di~t~l ends of ~he fastening ~e~ber leg~ 66 ~ ypically protrude from the receiver opp~si~e the ~ide of ~he r~ceiver tha~ is contaeting one of ~he tissue portions. ~n ~igures 1 2, the legs 66 are not shown protruding beyond the receivec 62 since, in accordance with a preferred further step of the method, the protruding p~rtions have been severed flu~h wi~h the xeceiver 62, An instrument for applying the fa~tener 50 and severi~g the legs 66 are described in detail hereina~ter.
_ Xowever, ln its broadest form, the method of applyin~
the ~asSener 50 to the tissue portions does not neces~arily require the ~everance of the protruding portions of the fastening ~ember legs 66.
Regardless of whether or not the protruding p~rtions of the fastening member legs 66 are severed~
the fastening member legs 66 and/or the receiver 62 are acted upon in a certain manner to effect an engagement of the legs 66 with the receiver 62 to hold the two tissue portions together. To this end, in a preferred form of the method, each fastenlng member leg 66 is deformed or coined to force a bulged out portion 79 of each fastenin~ member leg 66 ~nto engagemen~ with the receiver 62.
Specifically, as bes~ illustrated in Figures 2 and 3, a force may be applied by ~eans of a tool ~r instrument through one or both.of ~he apertures 78 and 80 ln the re~eiver 62 and against a port~on of each leg 66. The amount of or~e i~ such that the pre~sure on each leg 66 defor~ a port~on 79 of the le9 materlal outwardly into either end of one or bo~h ~f the apertur~s 78 and 80 as ~s best illustrated ~n Figure 2.
To acoom~odate this bulglng out of the 1~9 portion 79, the ~pertures 78 ~nd 80 have ~ ension (mea~ured normal ~o longitudinal ~xi`~ of the pa~age 76) that i~ greater than the ai~ension o~ ~he pa~sage 76 ~measur~d n~rmal to the longitudinal ~ of ~he passage). In ~he embodiment illu~trat~d in ~he ~gures ~5~
1-9, the apertures 78 and B0, when viewed from the ~ide, are seen to each have a generally right rectangular oonfiguration (with ~omewhat rounded corners) with a length greater than the diameker of the cylindrical bore passage 76. This aeoommoda~es tbe bulged out portion 79 of the fastening ~ember leg ~aterial and thus effects a ri~et-like engagement of the leg 66 ~ith the receiver 62.
It has been found that the above described method of applying the fastener 50 to the ti~sue portions results in a relatively strong retention structure ~omprising the fasteniny member 60 and engaged receiver 62. Further, one 8i ze fastener 50 may - be u~ed for a varie~y of different tissue thicknesses since the fas~ening member 60 can be in~ertea into th~
receiver 62 to the desired depth and the leg~ 66 can then be deformed ~o effect the engagement of the legs and recei~er with the desired amount of ti~ e compression. This deformation ~an take place at any point along the length of each leg 66, depending on tis~ue ~hickness. Such a fast~ner ~ru~ture and ~e~hod of applying the faste~er readily acoommodate applic~tion ~f ehe fa~tener 50 by ~e~ns of a ~uitable instrumen~ tha~ can be designed to apply a plurality of ~uch fa~teners simultaneously.
With the embodiment of the fasten~r 50 described above, th~ 1~9~ 66 ~re deformed ~nto engag~ment w~h the receiver 62. ~ow~ver~ lt 1~ ~o ~e under to~d th~t ~he leg~ 66 ~y be for~e~ with ~per~ures or no~ch~ ~no~ illu~tratea~ and ~h~
portions of the recelver 62 ~ay be defor~ed lnto the leg notches or ap~r~ures for ~f~eeting the ~ngagement between the receiver 62 and fasteninq ms~ber 60~
Further9 a o~mbination of both the ~eformation of the receiver 62 and ~he ~eform~tion of the legs ~6 ~y a1BO
ET~-548 7~
-~4-be used to effec~ engagemen~ of ~he receiver 62 and fastening ~ember 60.
With the ~bove-described method, the protruding portions of the astening member legs 66 may S be seveled during or after the step of deforming the legs 66 and/or re~eiver 62. Preferably, during the step of severing the protruding portions of the _ fastening member legs 66, ~he protruding portions of the ~astening ~ember l~gs are surrounded with a 6uitable oontainer for catching the leg protruding portions after they are s*vered so as to prevent the severed portions of legs from falling ~to ~he surrc~unding tissue or body cavity.
The material from which the fas~ening member legs 66 are formed is preferably selected to accommodate the de~orming action. To this end, oopolymers of lactid~ and glycolide have been found to work satisfactorily. If just the legs are to be de~ormed, ~he recelver 62 need not be fabricated from such a relatively ea~ily deformable matetialO On the other hand, the oopolymers of lactide and glycolide may be made relatively ~nelastic enough to ~unction well as a receiver als~s even if it i~ not lntended that the receiver be de~ormed.
Regardless of the 1Daterials selected ~or the fastening member 60 and receiver 62s it may be desirable to effec~ ~he method of de~o~ing the fa~tening leg~ 66 ~nd/or receiver 62 with the ~aid of heat to ~of~cen ~he material. Su~h heat may be provided by a suitable proc~e~ (e.g., eleetrical re6~Hnce heating). Such hea~ing would redu~e the ~agnit~de of the mechan$cal forc~s required to effec~ ~he ne~e~sary deforma~ion~
~TH-54B
FASTENER APPLIER INSTRU~ENT
A tool or ins~rument ~or alpplying ~he first embodiment of the fas~ener 50 ~s i].lu~tra~ed in Figures 10-19 and is designated generally by the reference S numeral 100. ~s is best illus~ra~e!d in Figures 10, 11, and 12, the instr~fflent in~l~de a fir~t ~aw 101 for holding the fas~ening ~ember 60 on one side of the ti~sue p~rtions w~th the fastening ~ember legs 66 orien~ed a~ an appropriate angle to penetrate the ti~sue portions 52 and 54. The in~trument 100 further includes a se~ond jaw 102 for holding the receiver 62 on the o~her side of the ti~sue portions opposite the fastening member 60 and generally ~n ~lignment with the fastening member legs 66.
The first ~aw 101 and second iaw 102 are pivotally mounted together about a pin 104. Also pivotally mounted to pin 104 i~ a fastening member driving frame lOfi which function~ as a means for moving the fastening member 60 relative to the first jaw 101 2a to penetrate the tissue portions 52 and 54 with the legs 6S of the fa~tening member and ~o ~ocate at least portions of the fa~tening member legs 66 within the receiver 62 held in the ~eoond jaw 102.
A first 8ci~80r8-typq handle lever 108 extends rearwardly from the driving fra~e 106. Therefore, the fastening member ~ovin~ means or drlving fr~e 106 can be regarded a~ being mounted to, and e~ending ~orwardly from, ~he flr~t hsndle l~ver 108. The first handle lever 108 defin~s ~ ~Y~ ~onf1gur~tion ~h~re it i~ joined to the dr~ving fra~e 106~ hi~ ~o~nt, the fron~ end of the handle l~Yer 108 de~ln~ an engaging ~urface 109 for engaging ~he lo~er ~terior ~r~ion of the s~cond j~w 102 when the ~a~s ~01 ~d 102 are clo~ed : ~Figure 16).
~5~3B7`-?
A second scissors-type handle 110 is pivotally mounted about ~ pin 112 to the upper rear portion of the seeond jaw 102. The se~ond j2W 102 can be alternatively regarded as being pivotally mou~ted to, S an~ extending from, the second handle leYer 110. Bo~h handle levers 108 an~ 110 are adap~ed for relative movement to~ard and away from each other.
As best illustrated in Figure 13, the second handle lever 110 is biased outwardly from the first handle leYer 108 by means of a helical ~ompressio~
spring 114 ~Figure 13). The ~pring 11~ is disp~sed - within a bore 116 in the upper rear portion of the ~econd jaw 102 and ~ears upwardly against an annular bearing ring or plate 118 which is secured to the unaerside of the second handle lever 110.
As best illustrated ~n Figure 13, ~he first jaw 101 is mounted to the pin 104 in the manner that perm~ts the first jaw 101 to move relative to both the fastening member driving frame 106 and the second ~aw 102. The first jaw 101 i~ adap~ed to oDoperate wi~h the astening member drivlng frame 106 a~ bæst lllustrated in Figures 12 and 14. Specifically, the front end of ~he jaw 101 defines a pas~ag~ in the form of a ~-shaped slot 120 ~or reoeiving ~he fastening 25 m~mber 60 for receiving a general~y T-shaped pu~her member 122.
As best illustr~ted in Figure~ 13 ~nd 14, the cros6wise portion of the ~-sh~ped ~lot~or passage 120 fun~tions as a ehannel ~or ~rictlonally receivlng the fas~ening member 60 and the croæ~ ~ar portion of the pusher member 122. The ba~e of ~he pusher ~ember 122 extends out of the ~lot 120 and i~ ~iidsbly dlsposed with1n an aperture 126 at ~he front of the f~tenlng member driving frame 106 as bes~ illus~rated ~n Fi~ure ~5 18. This moun~ing of the pusher me~ber 1~2 in the ~TH-54B
frame 106 facilitates entry of ~he pusher member 122 into the T-shaped slot 120 of the first jaw 101.
The pusher ~ember 122 pref.erably includes an upwardly projecting tab 123 (Figur~ 13) o retain the pusher ~ember 122 within the fastening member driving frame 106 when the frame 106 is ~il.ted upwardly in the orientation shown in Figure 13.
_ The second jaw 102 holds ~.he fastener receiver Ç2 in a ~lot 127 as best illustra~ed in Figure 14 and houses ~he fas~ening member leg deforming and severing mechanism as is next explained in detail. The lower ~aw 102 includes ~ generally cylindrical anvil member 130 slidably disp~sed within a cylindrical bore 132 and biaæed outwardly a predetermined amount by means of a helical ~pring 134. Tbe dist~l end of the anvil 130 has a curved or somewhat hemi~pherical configuration adapted to enter into one of the re~eiver apertures 78 or 80 (Figure 9) to vertically position the receiver 62 withi~ the second ~aw 102. Lateral positioning o the 20 receiver 62 in the ~econd jaw 10~ is effectea by the four walls defining the slot 127 in the lower ~aw 102.
To accommodate the insertion of the re~eiver 62 into the ~econd iaw 102, the bo~tom of the receiver 62 is preferably rounded ~o ~s. to t~ngentially es~gage 25 the hemispherical end of the anvil laember 13û and cause the anvil member 130 to be pu~hed rearwardly against the ~pring 134 until the receiver apert~res 78 ~nd Bû
are aligned with the anvil ~ember 130. At thl~ point, the anvil me~aber 130 ~ bi~sed outwardly into one of 3û the rece$ver apertures to fix the vertlcal po~ition of ~he re~eiver 62 in the second ~aw 102.
~ s bes~ illu6tr~ted in Figure~ 13, 17, ~nd 18, a pair of deformin~ me~bers 150 are ~ounted ~or movement within the ~eoDnd i~w 102. Pref~rably, as best illustrated in Figures 13-17, the defor~lng ~T~-548 members 150 are part of a uni~ary reciprocative actuating member 15~ which is slidably disposed irl a receiving cavity 156 (Figures 16 and 18) in the second ~aw 102.
Also unitary with the reciprocative actuating member 154 are two cutting b,lades 160 which are spaced below, and in ali~nment with, the deforming members 150.
. A novel means is provided for ~oving the deforming member~ 150 and the cutting blades 160 forwardly into the fastener. Specifically, the reciprocative actuating member 154 includes a flexible drive member 170 extending rearwardly in ~n arcuate channel 172 in the second ~aw 1~2. ~he flexibl~ drive member 170 includes a disk 174 at its distal end which 15 is received in a cylindrical bore 176 defined in the sec~nd handle lever 110.
Normally ~ when the handle lever~ 108 and 110 are in the unactuateA, open position illus~rated in Figure 13, the spring 114 biases the handle levers 108 2û and 110 apart so that the annular ring 118 ~ecured to the se~ond handle lever 110 pulls up on the di~k 174, and hence pulls the attached flexible drive ~mber 170 upwardly and rearwardly relative to the front of the instr~nent. This causes the recipro~ative actuating member 154 to be pulled rearw~rdly ln it~ recei~ing ~vity 156 1:o ~he fully retr~cted position illu~'crated in Figure 13. *-On the other han2, when th2 handle le~ ers 10û
and llû are closed in the orient~ n I llustr~ted in 3Q Figure 16, di~k 174 i~ ~oved do~nwardly by the ~econd handle lever 110 to force the drive me~ 170, and hence the a~tua~ g ~ember 154, f~rwardly to the extended position lllustrated in Figures 16 ~nd 18.
The re~ultirlg action of the deforaning member~ 150 and blad~s 160 on the fastener i~ described ln de'cail hereinaft~r ~ETH-548 ~19-A~ best illustrated in Piqure 13, the second handle lever 110 is prefer~bly provided with a pair of depending skirts 177 (one of which i~ visible in Figure 10 and the other of which is visib]Le in Figure 13) to inhibit access to the flexible drive member 17D and spring 114. A15Q~ as best iilustrated in ~igure 13, the upper rear p~rtion of the ~econd jaw 102 defines a flat abutment surface 180 between the ~kirts 177 for ec~operatin~ with the undersiae of t~e ~econd handle 10 lever 110 to limit the movement of the second handle lever 110 relative to the ~ec~nd jaw 102 and, hence, relative ~o the first handle le~er 108. ~his, of course, limlts the forward travel of the rec:Lprocative actuating member 154 to the positon illustr3~ed in Figure 16.
In ope~ation, the tool is initially oriented as illustrated in Figure 13 with the first jaw 101 and the second jaw 102 tempQrarily held apart to permit ~he insertion of the receiver 62 into the ~lot 127 of the lower jaw 102. ~hen properly inserted, the receiver is engaged as described above by the anvil ~ember 1309 ~ext, the fas~ening member 60 is inserted in ~he drivins frame channel 120 ~s illus~ra~ed ln ~igures 13 and 14. Then, as illustr~ed in Figure 14, the fir~t jaw 101 and the ~eo~nd jaw 102 are d~sp~ed on either side of the tissue p~rtions 52 and ~4 that have been approxi~a~ed in ~urface-to-~urface~relationship.
The first handle lever 103 i8 pulled toward the ~ond handle lever 110 to bring the pusher ~ember 122 o~ 40p of ~he fasteninq ~ember 50 ~nd in~o the chann~l 120.
Initially, the ~econd h~ndl~ lev~r 110 doe~ not pivot rel~tive to the ~e~nd jaw 102 becau~e the force ~pplied to the hændle lever 110 i~ ~ot qreat enough ~o overo~me the for~e of ~pring 11~. Con~quently, rela~ive movement occur~ between ~he ~riv~ng ~r~me 106 -20~
and the seco~d jaw 1~2 so tha~ the pusher member 122 forces tvhe ~astening mem~er 60 through the ~issue portions, 52 and 54 and into ~he receiver 62.
In the instrument embodi~ent illustrated in ~igures 13-16, the downward movement of the pusher member 122 terminates when the driving frame 106 pivots to the orientation illustra~ed in ~igure 15. A~ this _ point, the engaging ~urface 109 of the first handle lever 108 engages the bottom exterior ~urface o~ the ~e~nd jaw 102 and prevents ~ further pivoting of the frame 106 and second jaw 102 about the pin 104. This precludes undue compressi~n of the t~ssue portions 52 and 54. However, it ls to be realized that the engagement of the ~econd jaw 102 by the first handle lever 1~8 may not be necessary in ~ome situations and that no limitation of the downward movement of the pusher member 122 need neces~arily be provide~l.
If the eng~glng ~urface 109 is provided on the handle 108 for engaging the ~econd ~aw 102, then further movemen-t of the fir~t handle lever lOR ~owards the second handle lever 110 is prohibited when the first handle lever 108 reaches the orientation illus~rated i~ ~igure 15~ At this point, any further force applied to squee~e ~he ~o ~ogether handle levers 108 and 110 acts to overcvme the force of ~prin9 114 and to cause the ~eoDnd handle lever 110 to pivot about the pin 112. Thi~ drives ~he reciproca~ive actuating member 154 forwar~ to the po~i~ion illustrated in Figure 16.
When ~he ~eoond handle lever 110 engages the top ~urfa~e 180 ~f the rear pDr~ion of the ~eoQnd jaw 102, further orward m~v~m~nt of the re~iproaative actuating me~ber 154 is nece~sarily prevented. At this poin~; the defor~ing ~ember~ 150 have be~ome positioned :
wlthin the ~pertur~ (7B or 80 in Figure 9~ of ~be ~TH-548 -21;
receiving member b2 and have deformed a portion of each of the fastening member legs 66 to ~hereby effect an engagem.ent of the fastening ~ember legs 66 and receiver 62 in the manner described in detail above with respect to Figures 1-9.
Similarily, when the actuating ~em~er 154 is in the extend~d position as illustrated in Figure 16, the ~paced-apart cutting blades 160 have ~oved acros5 the bottom of the receiver 62 to ~ever the protruding 1~ por~ions o~ ~he legs 66 from the ~actening member ~0 at substantially the same time the legs are being deformed into engagement with the receiver 62 by ~embers :L50 .
Preferably, the cutting blades 160 are arranged to sever the protruding portions of the legs flush with the bottom of the receiver ~o as to eliminate the possiblity of protrusions that oould injure surrounding tissue.
Even if the engagement surace 109 is not provided as part of the fir~t handle lever 108 and 20 associated frame 106, the instrument 100 will function in the same manner as jus~ described. Specifically, even ~hough the downward ~ovement of the pusher ~ember 122 is not terminatea by mechani~al engage~ent of interacting parts of the in~tr~nent; the force required 25 to compress the ti~sue portion~ 52 and S4 bet~een the fa~3tening member l~nk 68 and the econd jaw 102 eventually becoines 80 great ~cha~ the spring 114 i~
overcome and the ~econd handle 110 piYotE; ~:0 the position il7ustr~ted in Figur~ 16 ~o ~ffect ~che deformat~o~ of ~he g~ten~ng me~ber legs 66 and ~he ~everance of the protruding po~t~n~ of tbe leg~.
If desire~, t~e instru~en~ 100 ~y be provided with ~eans for heating the deforming me~ber5 150.
Although n~t illu~trat~d, ~uch ~e~ting me~n~ o~uld ~n~lude elec~ri~al r~si~ance hea~ing element~ pDwered by a suitable ba~tery. ~ea~ing of ~he deforming members 150 would reduce the amount of force required to ~ause deormation of the fastener leg material.
After the fa~tener 50 has been applied as illustrated in Figure 18, the handle levers 108 and 110 are opened. The ~econd jaw 102 can be disenyaged from the receiver 62 by pulling the seoond jaw 102 away from the receiver 62 5which is now secured to the ti~sue with the fastening ~ember 60). It is possible to 10 disenqage the ~econd ~aw 102 from the receiver 62 because the curved distal end of the anvil 130 in the ~eoond jaw 102 will be forced further into the receiving cavity 132 and out of ~he rPceiver aperture as the second jaw 102 is pulled downwardly past the 15 bottom of the receiver 62.
Figure 19 illustrates a ~nodification of the instrument 100 shown in ~igure~ 10-18. Specifically, a cage, housing, or container 192 is provided at the bottom of the second jaw 102 for receiving the severed portions of ~he fastening member legs 66. This prevents the severed portions of the legs from fall~ng into the body ~avity. ~he housing 192 can be designed so it is readily movable from the ~econ~ ~aw 102 when desi red for di ~posing of the ~e~ered leg portions.
Although the $nstr~nent 100 has been illustrated as being des~gned to deform th~ ~asten$ng member legs into engagement ~th the r~eiver ~ubstantially ~i~ult~neously with the step o~ ~vering the protrud~ng en~ of the leg~, it i~ to be realized ~hat ~he ~tep of severing ~he leg~ ~ay be effect~d before or after t~ defor~ation ~tepO
Furth~r, although the in~trument 100 preferably include~ the cutting bl~es 160 for ~e~ering thQ proiecting pbrtions of the legs 66 ~s de~cribed above, in ~ome appl16ations ~t ~ay not be desir~ to ~TH-548 ~ 23-sever the legs. In sueh applications t the cutting blades 160 may, of ~D~rseg be omittea from the instrumelllt i de~ired.
Although the ~nstrument 100 has been i11UBtrated as designed for applying one fastener at a time, it is to b2 realiged t~at the in~trument may be ~od~fied ~o apply a p~urality of fasteners _ ~imultaneously. ~or example, the jaws oould be ~ade ~onsiderably wider and ~ould be provided with a plurality of cavities 132 and passages 120 for holding th~ receivers 62 and fastening members 60, respectively, and with a plurality of pusher members 122.
HE FASTENER: SECOND EMBODIMENT
The seoond embodiment of the fastener is illustrated in Figures 20-24 and is designated generally by the reference numeral 50A. The elements of the second embodiment 50A that are identical or ~nct~onally analogous to those of ~he first embodi~ent 50 are designated by reference numerals ldentical to those used for the first embodiment with the exception that the second emb~diment refer~nce numerals are fo~lowed by ~he upper ~ase letter A whereas the first ~mbDdiment r~ference numerals are not ~ollowed by any letter.
~ ~he fa6tener 50A ha an open loop or U-shaped : . 25 fastening member 60A with legs 66A ~ubstantially identical to the fa~en~ng member 6~ of the first embodiment descr~bed above with r~fer~nce to Figures 1-9.
~ he a~tener 50A ~18Q lnclu~s a recei~er 62A
w~ich is ~i~ilar t~ ~he receiv~r 62 of the firs~
embodi~ent of the fa~tener 50 describe~ abo~e with reference ~o Figur~s 1-9. ~he recei~er C2A has central ~ember 72A ~oining ~ pair of leg re~eiv~nq member~ 74A. ~ach leg receiv~ng m~mber 74~ defines a generally cyl~ndrical bore 76A for r~ceiving one of 3~ the fastening me~ber leg~ 66A.
ETH-~8 Further, esch receiving member 74A defines one aperture 78A communicating between the exterior of the receiving member and the interior of the bore 76A. Unlike the receiver 62 of the first embDdi~enk of ~he fa~tener 50 described aboYe wi~h reference to Figures 1-9, the receiver 62A does not have a second aperture opposi~e the aperture 78~. The aperture 78A
_~. functions to a*mi~ a deforming ~emher of a suitable instrument tha~ is used in ~pplying the ~as~aner 50A
to tissue portions. ~he deforming ~ember of the instrument would pass through the ~perture 78A and deform the leg 66A to produce a bulged out portion 79A (Figure 20). To accommodate the bulged out por~ion 7gA, the aperture 78A has a dimension ~as measured in the direction normal to the longitudinal axis of the fa~tening member leg) which is larger than the diameter of the leg re~eiving bore 76A.
Thus~ ~he bulged out por~ion 79~ ~c~s to retain the ~astening member 60A ln ~he receiver 62A.
The second embodimen~ of the fastening rnember 50~ may be applied with a suitable irlstrument similar to the instrument 100 described abo~e with reference ~o Figures 10-19. ~owever, su~h an inst:rument would not require t~e ~pring bia~ed anvil (anvil 130 illustrated ~n Figure 18). Other ~ui~able ~eans for temporarily ali~ning the receiver 62A
vert$~ally wlthin the instrumen~ low~r ~ w would be providedO
THE FASTENER: THIRD ~MBODIMENT
A third e~bod1~ant of the ~ en~r is illust~ate~ 1n Figure~ 25 29 ~herein ~he fast~ner i~
~e~igna~ed generally by reference numeral 50Bc ~he element~ of the third emb~ai~ent o~ the ~ast~ner 5Q~
that are ~denticaL or fun~tion~lly anaglous to those of the fir5t ~mbDdiment of the f~s~en~r 50 are designated by re~erence numerals identiGal ~o those used for the first embodiment with the exception that the third embodiment reference numerals are followed by the upper case letter B whereas no letter ~ollows ~.he first embodiment reference numerals~
The third embodiment of the fastening member 5QB includes a generally ~-shaped fastenins member 60B that is substantially identical, ~n the unappl~ed condition, ~o the fastening member 60 of the firs~ embodiment of ~he fa~tener 50 described above with reference to Figures 1-9. The ~hird embodiment of ~he fastener 50B also ~ncludes a receiver 62B that includes a ce~ral member 72B
joining a pair of le~ receiving member~ 74B. Each lS leg receiving m~mber 74B de~ines at least one passage, such as a cylind,rical bore 76, or receiving one of the fas~ening me~.,ber legs 66B.
` ~he height of ea~h leg receiving member 74B
i5 less than the height of each leg receiving m~mber 74 of thc firfit emb~iment of the fa~tener S0 described ~bove w~th reference to Figures 1-9.
Further, n~ apertures ~such as aperturçs 78 ~d 80 $n the rec~ver 62 of the first embodiment of the faste~er 50 illu~trated in Figures 1-4) are prov~ded~ Rather, the legs 66B ~re deformed, a~ by produoing ~ bulge 79B (Figure 25), adja~ent the ~ide o~ the re~e~ver 62B that faces a~ay fro~ the tis~ue r~ortion 52 and 54.
The deforrnation of the astening membe~
legs 66~ may be e~fected with a instru~ent ~milar to the instrument 100 describ~d ab~ve ~ith re erence to F$gures 10-19. ~owever, the spring biasea ~nvll 130 of the instrument lU0 (Fi~ure 18) n~ed not be provided~ ~ather~ a fixed ~nYil ~y be pro~ided in ~uch an instrument ~mmediately below the bDtto~ of the receiver. In addition, the cutter blades ~such as cutter blades 160 of the instrument 100 illustrated in Figure 18) would be spaced below the bottom of the receiver 62B by an amount sufficient to accommodate the deformed por~ion 7gB of the fastening - member legs.
THE FASTENER: FOURTH EMBODIMENT
- Although not illustrated, the fastener design may also include an interferenc2 fit or friction fit feature. For example, the fastening ~ember legs may be pr~vided with protrusions for engaging suitable portions of the receiverO The friction fit would provide a retention restraint in addition to the restraint provided by the permanent deformation of the legs ~nd/or receiver.
ALTERNATIVE DESIGN FEATURES
In the figures, the two legs of the fastening member are connected by a portion of the fastening member (e.g., the link or clamping member) which is illustrated as being generally straight and - extending perpendicular to the two legs. ~he structure need not be limited to such a shape however. Instead, all or a portion of the length of the fastening member between the two legs may be arched or arcuate or may include an arcuate portion (e.g., an inverted U-shaped configuration)O This would function to initially provide a fre~ space between ~he upper tissue por~ion and the top of the fastening member to allow for ~ome expansion ~f the tissue.
However, in those situation~ where increased initial tissue compression is desired, a modified receiver structure may be provided to co~perate with the above-des~ribed arcuate fas~ening member. Specifically, the re~eiver need not have a ETH~548 flat upper surface as illustrated, Rather, the upper surface of the receiver may be arcuate (e.g., convex) so as to ~Fenerally match or correspond with the arcuate sh.ape of the fastening member. This can result in an increased compression of the two tissue portions between the receiver and fastening member.
From the foregoing, it will be observed that numerous variations and moaifications may be effected without departing from the true spirt and scope of the novel concept of the invention. It is to be understood that no limitation with respect to the specific articles, instruments, and methods illustrated herein is intended or should be inferred. It is, of course, intended to cover by the appended claims all such modifications as fall within the scope of the claims.
~TH-548 ~5~
_g _ disclose only a few specific forms as an example of the use of the invention. ~he precise shapes and ~ize~ of the compvnents herein des~ribed are not essential to ~he in~ention unless otherwi~e indicated. ~he inventlon 1~ not intended to be limited to the embodi~ents illustrated, and the aoope of the inventi~n will be p~inted out in the appended claims~
THE FASTENER ~IRST ~BODIMENT
A first embodiment of tbe fastener is illustrated in an assembled oonfiguration in Figures 1-4 and i~ generally indicate~ therein by reference numeral 50O Individual parts of the fastener are shown in Figures 5-9.
The plurality of such fasteners 50 are illustrated in Figure 1 as holding together separated portions 52 and 54 of mammalian tissue, such as are defined by a wound or incision, to fa~ilitate healing of the wound or incision.
The fastener includes tw~ ~omponents r a generally ~-shaped or open loop fas~enlng member 60 and a receiver 62 which are ~niti~lly ~eparated as illustrated in ~igure ~ whi~h are adapted to cooperate to oompress or hold bet~een them the tissue portions 52 and 54 as illustrated in Fiyur.es 1-3.
As is best illustrated in ~igure 4~ the fastening member 60 includes 1~ a pair of legs 66 adapted ~o penetra~e ~he tl~sue portion~ ~nd 2) a llnk 68 which is o~nne~ted to ~he leg~ 66 and which i5 adap~ed to lie ~ubst~ntially ~ga$n~t one of the ~is~ue 3C p~rtions (e-g- ? tiæsue p~rtion 54 ~n F19ure 2). The legs 66 of the astening ~ember are generally parallel ~o eaGh other a~a ~re gener~lly perpendiculær ~9 ~he link 68. Preferably, ~ach leg 66 has ~ ~olid, generally ~ylindrical o~nfigurat~n ~ith ~ conical end 3~ 70 (Figures 4 6) to f~cilitate or aid in the .
penetration of the tissue ~ortions. The link 68 may have the regul~r parallelpiped shape illustrat2d or may have any other suitable shape.
As best illustrated in Figures 7-9, the receiver 62 includes a central member 72 joining a pair of leg receiving members 74. Each leg receiving member 74 defines a~ least one p~sage 76 i.-or receiving one of the fastening ~ember legs 66 as best illustrated in Figure 39 If the fastening member legs 66 have a cylindrical configuration as illu~trated, then the receiving member passages 76 are preferably cylindrical bores o sufficient diameter to permit ~he legs 66 to be received ~loosely or in slid~ng engagement). Each receiving member 74 and the passage 76 defined therein lS cooperate as means for receiving and encompas~ing at least a portion of one of the fastening ~ember legs 66 after ~he leg has been in~erted through the ti~sue portions as best illustrated in ~igures 2 and 3.
Preferably, each receiving me~ber 7~ of ~he receiver 62 defines a first aperture 78 ~Figures 3 and 9) co~munica~ing from the exterior of the receiviny ~ember 74 wlth the interior of the passage 76. Also, a ~e~ond aper~ure 80 (Pigures 3 and 9) i~ provided in the receivin~ member 74 opposite the fir~t ap~rture 78 for ~ommunicating be~ween the exterior of the receiving ~ember 74 and the interior of the pa~sage 7~. ~t least one of these ~wo apertures 78 and 80 i8 intended to scoo~od~te the inser~ion of a r~m-like aember of a tool or instrumen~ for defor~ing ~he fa~tening ~ember leg 66 in a manner des~ribed in d~tail hereinaf~er.
The other of ~he aper~ures 78 and 80 ~ay ~unct$on ~o pos~t~ on the re~ei~er 62 ~hin ~he ~ns~rument in a manner Al~o de~cribed in detail her~inafter.
The fastening ~e~ber 60 and ~be receiver 62 may be formed from ~uitable ~a~er$al~, ~ueh a~
~25~
thermoplastic polymer m~terials that are absorbable by mammalian tissue. For example, the fastening member 60 has bee!n ~atisfactorily molded ronn a ~opolymer of lactide and glycolide. Preferablyl, the fastenîng member 60 is molded in a heated moLd, is pos~ scoured, and is annealed.
METHOD FOR APPLYING TEE FASTENER
--- According to the novel method of joining tissue portions with the above-described fastener 50, the tissue portions 52 an~ 54 ~igures 1~3) are approxi~ated in surface~to-~urface relationship. The fa~tening member 60 is then p~sitioned on one side of the ti~sue port~ons with the legs 66 oriented at an appropriate angle to penetrate the tissue portions.
is The receiver 62 is held on ~he other side of the tissue portions opposite the fastening member 60 and generally in alignment with the fastening member legs 66.
Specifically, the passages 76 are aligned ~ith ~he fastening member legs 66.
Next, relat~ve movement between the fastening member 60 and the receiver 62 is sffected to urge the fastening member and the receiver closer together to cause the fastening member legs 66 to penetrate the ~issue portions 52 and 54 and *o loc~te at Iea~
portions of the ~astening member legs 66 wi~hin the receiver 62. The relative ~ov~ment betwèen the fastening ~ember 60 ~nd the receiver 6?~ i8 t~rmin~ted when ~he ~astening member link 68 i8 ~t ~ de~ired ~i~tance from the receiver 62 to ~ecure the ~i~sue portions together. Preferably~ ~his ~ovement is tarminated after the ti~ue pDrtions hAvg ~een mpressed toge~her a de~ired amount.
At thi~ pDint, the di~t~l ends of ~he fastening ~e~ber leg~ 66 ~ ypically protrude from the receiver opp~si~e the ~ide of ~he r~ceiver tha~ is contaeting one of ~he tissue portions. ~n ~igures 1 2, the legs 66 are not shown protruding beyond the receivec 62 since, in accordance with a preferred further step of the method, the protruding p~rtions have been severed flu~h wi~h the xeceiver 62, An instrument for applying the fa~tener 50 and severi~g the legs 66 are described in detail hereina~ter.
_ Xowever, ln its broadest form, the method of applyin~
the ~asSener 50 to the tissue portions does not neces~arily require the ~everance of the protruding portions of the fastening ~ember legs 66.
Regardless of whether or not the protruding p~rtions of the fastening member legs 66 are severed~
the fastening member legs 66 and/or the receiver 62 are acted upon in a certain manner to effect an engagement of the legs 66 with the receiver 62 to hold the two tissue portions together. To this end, in a preferred form of the method, each fastenlng member leg 66 is deformed or coined to force a bulged out portion 79 of each fastenin~ member leg 66 ~nto engagemen~ with the receiver 62.
Specifically, as bes~ illustrated in Figures 2 and 3, a force may be applied by ~eans of a tool ~r instrument through one or both.of ~he apertures 78 and 80 ln the re~eiver 62 and against a port~on of each leg 66. The amount of or~e i~ such that the pre~sure on each leg 66 defor~ a port~on 79 of the le9 materlal outwardly into either end of one or bo~h ~f the apertur~s 78 and 80 as ~s best illustrated ~n Figure 2.
To acoom~odate this bulglng out of the 1~9 portion 79, the ~pertures 78 ~nd 80 have ~ ension (mea~ured normal ~o longitudinal ~xi`~ of the pa~age 76) that i~ greater than the ai~ension o~ ~he pa~sage 76 ~measur~d n~rmal to the longitudinal ~ of ~he passage). In ~he embodiment illu~trat~d in ~he ~gures ~5~
1-9, the apertures 78 and B0, when viewed from the ~ide, are seen to each have a generally right rectangular oonfiguration (with ~omewhat rounded corners) with a length greater than the diameker of the cylindrical bore passage 76. This aeoommoda~es tbe bulged out portion 79 of the fastening ~ember leg ~aterial and thus effects a ri~et-like engagement of the leg 66 ~ith the receiver 62.
It has been found that the above described method of applying the fastener 50 to the ti~sue portions results in a relatively strong retention structure ~omprising the fasteniny member 60 and engaged receiver 62. Further, one 8i ze fastener 50 may - be u~ed for a varie~y of different tissue thicknesses since the fas~ening member 60 can be in~ertea into th~
receiver 62 to the desired depth and the leg~ 66 can then be deformed ~o effect the engagement of the legs and recei~er with the desired amount of ti~ e compression. This deformation ~an take place at any point along the length of each leg 66, depending on tis~ue ~hickness. Such a fast~ner ~ru~ture and ~e~hod of applying the faste~er readily acoommodate applic~tion ~f ehe fa~tener 50 by ~e~ns of a ~uitable instrumen~ tha~ can be designed to apply a plurality of ~uch fa~teners simultaneously.
With the embodiment of the fasten~r 50 described above, th~ 1~9~ 66 ~re deformed ~nto engag~ment w~h the receiver 62. ~ow~ver~ lt 1~ ~o ~e under to~d th~t ~he leg~ 66 ~y be for~e~ with ~per~ures or no~ch~ ~no~ illu~tratea~ and ~h~
portions of the recelver 62 ~ay be defor~ed lnto the leg notches or ap~r~ures for ~f~eeting the ~ngagement between the receiver 62 and fasteninq ms~ber 60~
Further9 a o~mbination of both the ~eformation of the receiver 62 and ~he ~eform~tion of the legs ~6 ~y a1BO
ET~-548 7~
-~4-be used to effec~ engagemen~ of ~he receiver 62 and fastening ~ember 60.
With the ~bove-described method, the protruding portions of the astening member legs 66 may S be seveled during or after the step of deforming the legs 66 and/or re~eiver 62. Preferably, during the step of severing the protruding portions of the _ fastening member legs 66, ~he protruding portions of the ~astening ~ember l~gs are surrounded with a 6uitable oontainer for catching the leg protruding portions after they are s*vered so as to prevent the severed portions of legs from falling ~to ~he surrc~unding tissue or body cavity.
The material from which the fas~ening member legs 66 are formed is preferably selected to accommodate the de~orming action. To this end, oopolymers of lactid~ and glycolide have been found to work satisfactorily. If just the legs are to be de~ormed, ~he recelver 62 need not be fabricated from such a relatively ea~ily deformable matetialO On the other hand, the oopolymers of lactide and glycolide may be made relatively ~nelastic enough to ~unction well as a receiver als~s even if it i~ not lntended that the receiver be de~ormed.
Regardless of the 1Daterials selected ~or the fastening member 60 and receiver 62s it may be desirable to effec~ ~he method of de~o~ing the fa~tening leg~ 66 ~nd/or receiver 62 with the ~aid of heat to ~of~cen ~he material. Su~h heat may be provided by a suitable proc~e~ (e.g., eleetrical re6~Hnce heating). Such hea~ing would redu~e the ~agnit~de of the mechan$cal forc~s required to effec~ ~he ne~e~sary deforma~ion~
~TH-54B
FASTENER APPLIER INSTRU~ENT
A tool or ins~rument ~or alpplying ~he first embodiment of the fas~ener 50 ~s i].lu~tra~ed in Figures 10-19 and is designated generally by the reference S numeral 100. ~s is best illus~ra~e!d in Figures 10, 11, and 12, the instr~fflent in~l~de a fir~t ~aw 101 for holding the fas~ening ~ember 60 on one side of the ti~sue p~rtions w~th the fastening ~ember legs 66 orien~ed a~ an appropriate angle to penetrate the ti~sue portions 52 and 54. The in~trument 100 further includes a se~ond jaw 102 for holding the receiver 62 on the o~her side of the ti~sue portions opposite the fastening member 60 and generally ~n ~lignment with the fastening member legs 66.
The first ~aw 101 and second iaw 102 are pivotally mounted together about a pin 104. Also pivotally mounted to pin 104 i~ a fastening member driving frame lOfi which function~ as a means for moving the fastening member 60 relative to the first jaw 101 2a to penetrate the tissue portions 52 and 54 with the legs 6S of the fa~tening member and ~o ~ocate at least portions of the fa~tening member legs 66 within the receiver 62 held in the ~eoond jaw 102.
A first 8ci~80r8-typq handle lever 108 extends rearwardly from the driving fra~e 106. Therefore, the fastening member ~ovin~ means or drlving fr~e 106 can be regarded a~ being mounted to, and e~ending ~orwardly from, ~he flr~t hsndle l~ver 108. The first handle lever 108 defin~s ~ ~Y~ ~onf1gur~tion ~h~re it i~ joined to the dr~ving fra~e 106~ hi~ ~o~nt, the fron~ end of the handle l~Yer 108 de~ln~ an engaging ~urface 109 for engaging ~he lo~er ~terior ~r~ion of the s~cond j~w 102 when the ~a~s ~01 ~d 102 are clo~ed : ~Figure 16).
~5~3B7`-?
A second scissors-type handle 110 is pivotally mounted about ~ pin 112 to the upper rear portion of the seeond jaw 102. The se~ond j2W 102 can be alternatively regarded as being pivotally mou~ted to, S an~ extending from, the second handle leYer 110. Bo~h handle levers 108 an~ 110 are adap~ed for relative movement to~ard and away from each other.
As best illustrated in Figure 13, the second handle lever 110 is biased outwardly from the first handle leYer 108 by means of a helical ~ompressio~
spring 114 ~Figure 13). The ~pring 11~ is disp~sed - within a bore 116 in the upper rear portion of the ~econd jaw 102 and ~ears upwardly against an annular bearing ring or plate 118 which is secured to the unaerside of the second handle lever 110.
As best illustrated ~n Figure 13, ~he first jaw 101 is mounted to the pin 104 in the manner that perm~ts the first jaw 101 to move relative to both the fastening member driving frame 106 and the second ~aw 102. The first jaw 101 i~ adap~ed to oDoperate wi~h the astening member drivlng frame 106 a~ bæst lllustrated in Figures 12 and 14. Specifically, the front end of ~he jaw 101 defines a pas~ag~ in the form of a ~-shaped slot 120 ~or reoeiving ~he fastening 25 m~mber 60 for receiving a general~y T-shaped pu~her member 122.
As best illustr~ted in Figure~ 13 ~nd 14, the cros6wise portion of the ~-sh~ped ~lot~or passage 120 fun~tions as a ehannel ~or ~rictlonally receivlng the fas~ening member 60 and the croæ~ ~ar portion of the pusher member 122. The ba~e of ~he pusher ~ember 122 extends out of the ~lot 120 and i~ ~iidsbly dlsposed with1n an aperture 126 at ~he front of the f~tenlng member driving frame 106 as bes~ illus~rated ~n Fi~ure ~5 18. This moun~ing of the pusher me~ber 1~2 in the ~TH-54B
frame 106 facilitates entry of ~he pusher member 122 into the T-shaped slot 120 of the first jaw 101.
The pusher ~ember 122 pref.erably includes an upwardly projecting tab 123 (Figur~ 13) o retain the pusher ~ember 122 within the fastening member driving frame 106 when the frame 106 is ~il.ted upwardly in the orientation shown in Figure 13.
_ The second jaw 102 holds ~.he fastener receiver Ç2 in a ~lot 127 as best illustra~ed in Figure 14 and houses ~he fas~ening member leg deforming and severing mechanism as is next explained in detail. The lower ~aw 102 includes ~ generally cylindrical anvil member 130 slidably disp~sed within a cylindrical bore 132 and biaæed outwardly a predetermined amount by means of a helical ~pring 134. Tbe dist~l end of the anvil 130 has a curved or somewhat hemi~pherical configuration adapted to enter into one of the re~eiver apertures 78 or 80 (Figure 9) to vertically position the receiver 62 withi~ the second ~aw 102. Lateral positioning o the 20 receiver 62 in the ~econd jaw 10~ is effectea by the four walls defining the slot 127 in the lower ~aw 102.
To accommodate the insertion of the re~eiver 62 into the ~econd iaw 102, the bo~tom of the receiver 62 is preferably rounded ~o ~s. to t~ngentially es~gage 25 the hemispherical end of the anvil laember 13û and cause the anvil member 130 to be pu~hed rearwardly against the ~pring 134 until the receiver apert~res 78 ~nd Bû
are aligned with the anvil ~ember 130. At thl~ point, the anvil me~aber 130 ~ bi~sed outwardly into one of 3û the rece$ver apertures to fix the vertlcal po~ition of ~he re~eiver 62 in the second ~aw 102.
~ s bes~ illu6tr~ted in Figure~ 13, 17, ~nd 18, a pair of deformin~ me~bers 150 are ~ounted ~or movement within the ~eoDnd i~w 102. Pref~rably, as best illustrated in Figures 13-17, the defor~lng ~T~-548 members 150 are part of a uni~ary reciprocative actuating member 15~ which is slidably disposed irl a receiving cavity 156 (Figures 16 and 18) in the second ~aw 102.
Also unitary with the reciprocative actuating member 154 are two cutting b,lades 160 which are spaced below, and in ali~nment with, the deforming members 150.
. A novel means is provided for ~oving the deforming member~ 150 and the cutting blades 160 forwardly into the fastener. Specifically, the reciprocative actuating member 154 includes a flexible drive member 170 extending rearwardly in ~n arcuate channel 172 in the second ~aw 1~2. ~he flexibl~ drive member 170 includes a disk 174 at its distal end which 15 is received in a cylindrical bore 176 defined in the sec~nd handle lever 110.
Normally ~ when the handle lever~ 108 and 110 are in the unactuateA, open position illus~rated in Figure 13, the spring 114 biases the handle levers 108 2û and 110 apart so that the annular ring 118 ~ecured to the se~ond handle lever 110 pulls up on the di~k 174, and hence pulls the attached flexible drive ~mber 170 upwardly and rearwardly relative to the front of the instr~nent. This causes the recipro~ative actuating member 154 to be pulled rearw~rdly ln it~ recei~ing ~vity 156 1:o ~he fully retr~cted position illu~'crated in Figure 13. *-On the other han2, when th2 handle le~ ers 10û
and llû are closed in the orient~ n I llustr~ted in 3Q Figure 16, di~k 174 i~ ~oved do~nwardly by the ~econd handle lever 110 to force the drive me~ 170, and hence the a~tua~ g ~ember 154, f~rwardly to the extended position lllustrated in Figures 16 ~nd 18.
The re~ultirlg action of the deforaning member~ 150 and blad~s 160 on the fastener i~ described ln de'cail hereinaft~r ~ETH-548 ~19-A~ best illustrated in Piqure 13, the second handle lever 110 is prefer~bly provided with a pair of depending skirts 177 (one of which i~ visible in Figure 10 and the other of which is visib]Le in Figure 13) to inhibit access to the flexible drive member 17D and spring 114. A15Q~ as best iilustrated in ~igure 13, the upper rear p~rtion of the ~econd jaw 102 defines a flat abutment surface 180 between the ~kirts 177 for ec~operatin~ with the undersiae of t~e ~econd handle 10 lever 110 to limit the movement of the second handle lever 110 relative to the ~ec~nd jaw 102 and, hence, relative ~o the first handle le~er 108. ~his, of course, limlts the forward travel of the rec:Lprocative actuating member 154 to the positon illustr3~ed in Figure 16.
In ope~ation, the tool is initially oriented as illustrated in Figure 13 with the first jaw 101 and the second jaw 102 tempQrarily held apart to permit ~he insertion of the receiver 62 into the ~lot 127 of the lower jaw 102. ~hen properly inserted, the receiver is engaged as described above by the anvil ~ember 1309 ~ext, the fas~ening member 60 is inserted in ~he drivins frame channel 120 ~s illus~ra~ed ln ~igures 13 and 14. Then, as illustr~ed in Figure 14, the fir~t jaw 101 and the ~eo~nd jaw 102 are d~sp~ed on either side of the tissue p~rtions 52 and ~4 that have been approxi~a~ed in ~urface-to-~urface~relationship.
The first handle lever 103 i8 pulled toward the ~ond handle lever 110 to bring the pusher ~ember 122 o~ 40p of ~he fasteninq ~ember 50 ~nd in~o the chann~l 120.
Initially, the ~econd h~ndl~ lev~r 110 doe~ not pivot rel~tive to the ~e~nd jaw 102 becau~e the force ~pplied to the hændle lever 110 i~ ~ot qreat enough ~o overo~me the for~e of ~pring 11~. Con~quently, rela~ive movement occur~ between ~he ~riv~ng ~r~me 106 -20~
and the seco~d jaw 1~2 so tha~ the pusher member 122 forces tvhe ~astening mem~er 60 through the ~issue portions, 52 and 54 and into ~he receiver 62.
In the instrument embodi~ent illustrated in ~igures 13-16, the downward movement of the pusher member 122 terminates when the driving frame 106 pivots to the orientation illustra~ed in ~igure 15. A~ this _ point, the engaging ~urface 109 of the first handle lever 108 engages the bottom exterior ~urface o~ the ~e~nd jaw 102 and prevents ~ further pivoting of the frame 106 and second jaw 102 about the pin 104. This precludes undue compressi~n of the t~ssue portions 52 and 54. However, it ls to be realized that the engagement of the ~econd jaw 102 by the first handle lever 1~8 may not be necessary in ~ome situations and that no limitation of the downward movement of the pusher member 122 need neces~arily be provide~l.
If the eng~glng ~urface 109 is provided on the handle 108 for engaging the ~econd ~aw 102, then further movemen-t of the fir~t handle lever lOR ~owards the second handle lever 110 is prohibited when the first handle lever 108 reaches the orientation illus~rated i~ ~igure 15~ At this point, any further force applied to squee~e ~he ~o ~ogether handle levers 108 and 110 acts to overcvme the force of ~prin9 114 and to cause the ~eoDnd handle lever 110 to pivot about the pin 112. Thi~ drives ~he reciproca~ive actuating member 154 forwar~ to the po~i~ion illustrated in Figure 16.
When ~he ~eoond handle lever 110 engages the top ~urfa~e 180 ~f the rear pDr~ion of the ~eoQnd jaw 102, further orward m~v~m~nt of the re~iproaative actuating me~ber 154 is nece~sarily prevented. At this poin~; the defor~ing ~ember~ 150 have be~ome positioned :
wlthin the ~pertur~ (7B or 80 in Figure 9~ of ~be ~TH-548 -21;
receiving member b2 and have deformed a portion of each of the fastening member legs 66 to ~hereby effect an engagem.ent of the fastening ~ember legs 66 and receiver 62 in the manner described in detail above with respect to Figures 1-9.
Similarily, when the actuating ~em~er 154 is in the extend~d position as illustrated in Figure 16, the ~paced-apart cutting blades 160 have ~oved acros5 the bottom of the receiver 62 to ~ever the protruding 1~ por~ions o~ ~he legs 66 from the ~actening member ~0 at substantially the same time the legs are being deformed into engagement with the receiver 62 by ~embers :L50 .
Preferably, the cutting blades 160 are arranged to sever the protruding portions of the legs flush with the bottom of the receiver ~o as to eliminate the possiblity of protrusions that oould injure surrounding tissue.
Even if the engagement surace 109 is not provided as part of the fir~t handle lever 108 and 20 associated frame 106, the instrument 100 will function in the same manner as jus~ described. Specifically, even ~hough the downward ~ovement of the pusher ~ember 122 is not terminatea by mechani~al engage~ent of interacting parts of the in~tr~nent; the force required 25 to compress the ti~sue portion~ 52 and S4 bet~een the fa~3tening member l~nk 68 and the econd jaw 102 eventually becoines 80 great ~cha~ the spring 114 i~
overcome and the ~econd handle 110 piYotE; ~:0 the position il7ustr~ted in Figur~ 16 ~o ~ffect ~che deformat~o~ of ~he g~ten~ng me~ber legs 66 and ~he ~everance of the protruding po~t~n~ of tbe leg~.
If desire~, t~e instru~en~ 100 ~y be provided with ~eans for heating the deforming me~ber5 150.
Although n~t illu~trat~d, ~uch ~e~ting me~n~ o~uld ~n~lude elec~ri~al r~si~ance hea~ing element~ pDwered by a suitable ba~tery. ~ea~ing of ~he deforming members 150 would reduce the amount of force required to ~ause deormation of the fastener leg material.
After the fa~tener 50 has been applied as illustrated in Figure 18, the handle levers 108 and 110 are opened. The ~econd jaw 102 can be disenyaged from the receiver 62 by pulling the seoond jaw 102 away from the receiver 62 5which is now secured to the ti~sue with the fastening ~ember 60). It is possible to 10 disenqage the ~econd ~aw 102 from the receiver 62 because the curved distal end of the anvil 130 in the ~eoond jaw 102 will be forced further into the receiving cavity 132 and out of ~he rPceiver aperture as the second jaw 102 is pulled downwardly past the 15 bottom of the receiver 62.
Figure 19 illustrates a ~nodification of the instrument 100 shown in ~igure~ 10-18. Specifically, a cage, housing, or container 192 is provided at the bottom of the second jaw 102 for receiving the severed portions of ~he fastening member legs 66. This prevents the severed portions of the legs from fall~ng into the body ~avity. ~he housing 192 can be designed so it is readily movable from the ~econ~ ~aw 102 when desi red for di ~posing of the ~e~ered leg portions.
Although the $nstr~nent 100 has been illustrated as being des~gned to deform th~ ~asten$ng member legs into engagement ~th the r~eiver ~ubstantially ~i~ult~neously with the step o~ ~vering the protrud~ng en~ of the leg~, it i~ to be realized ~hat ~he ~tep of severing ~he leg~ ~ay be effect~d before or after t~ defor~ation ~tepO
Furth~r, although the in~trument 100 preferably include~ the cutting bl~es 160 for ~e~ering thQ proiecting pbrtions of the legs 66 ~s de~cribed above, in ~ome appl16ations ~t ~ay not be desir~ to ~TH-548 ~ 23-sever the legs. In sueh applications t the cutting blades 160 may, of ~D~rseg be omittea from the instrumelllt i de~ired.
Although the ~nstrument 100 has been i11UBtrated as designed for applying one fastener at a time, it is to b2 realiged t~at the in~trument may be ~od~fied ~o apply a p~urality of fasteners _ ~imultaneously. ~or example, the jaws oould be ~ade ~onsiderably wider and ~ould be provided with a plurality of cavities 132 and passages 120 for holding th~ receivers 62 and fastening members 60, respectively, and with a plurality of pusher members 122.
HE FASTENER: SECOND EMBODIMENT
The seoond embodiment of the fastener is illustrated in Figures 20-24 and is designated generally by the reference numeral 50A. The elements of the second embodiment 50A that are identical or ~nct~onally analogous to those of ~he first embodi~ent 50 are designated by reference numerals ldentical to those used for the first embodiment with the exception that the second emb~diment refer~nce numerals are fo~lowed by ~he upper ~ase letter A whereas the first ~mbDdiment r~ference numerals are not ~ollowed by any letter.
~ ~he fa6tener 50A ha an open loop or U-shaped : . 25 fastening member 60A with legs 66A ~ubstantially identical to the fa~en~ng member 6~ of the first embodiment descr~bed above with r~fer~nce to Figures 1-9.
~ he a~tener 50A ~18Q lnclu~s a recei~er 62A
w~ich is ~i~ilar t~ ~he receiv~r 62 of the firs~
embodi~ent of the fa~tener 50 describe~ abo~e with reference ~o Figur~s 1-9. ~he recei~er C2A has central ~ember 72A ~oining ~ pair of leg re~eiv~nq member~ 74A. ~ach leg receiv~ng m~mber 74~ defines a generally cyl~ndrical bore 76A for r~ceiving one of 3~ the fastening me~ber leg~ 66A.
ETH-~8 Further, esch receiving member 74A defines one aperture 78A communicating between the exterior of the receiving member and the interior of the bore 76A. Unlike the receiver 62 of the first embDdi~enk of ~he fa~tener 50 described aboYe wi~h reference to Figures 1-9, the receiver 62A does not have a second aperture opposi~e the aperture 78~. The aperture 78A
_~. functions to a*mi~ a deforming ~emher of a suitable instrument tha~ is used in ~pplying the ~as~aner 50A
to tissue portions. ~he deforming ~ember of the instrument would pass through the ~perture 78A and deform the leg 66A to produce a bulged out portion 79A (Figure 20). To accommodate the bulged out por~ion 7gA, the aperture 78A has a dimension ~as measured in the direction normal to the longitudinal axis of the fa~tening member leg) which is larger than the diameter of the leg re~eiving bore 76A.
Thus~ ~he bulged out por~ion 79~ ~c~s to retain the ~astening member 60A ln ~he receiver 62A.
The second embodimen~ of the fastening rnember 50~ may be applied with a suitable irlstrument similar to the instrument 100 described abo~e with reference ~o Figures 10-19. ~owever, su~h an inst:rument would not require t~e ~pring bia~ed anvil (anvil 130 illustrated ~n Figure 18). Other ~ui~able ~eans for temporarily ali~ning the receiver 62A
vert$~ally wlthin the instrumen~ low~r ~ w would be providedO
THE FASTENER: THIRD ~MBODIMENT
A third e~bod1~ant of the ~ en~r is illust~ate~ 1n Figure~ 25 29 ~herein ~he fast~ner i~
~e~igna~ed generally by reference numeral 50Bc ~he element~ of the third emb~ai~ent o~ the ~ast~ner 5Q~
that are ~denticaL or fun~tion~lly anaglous to those of the fir5t ~mbDdiment of the f~s~en~r 50 are designated by re~erence numerals identiGal ~o those used for the first embodiment with the exception that the third embodiment reference numerals are followed by the upper case letter B whereas no letter ~ollows ~.he first embodiment reference numerals~
The third embodiment of the fastening member 5QB includes a generally ~-shaped fastenins member 60B that is substantially identical, ~n the unappl~ed condition, ~o the fastening member 60 of the firs~ embodiment of ~he fa~tener 50 described above with reference to Figures 1-9. The ~hird embodiment of ~he fastener 50B also ~ncludes a receiver 62B that includes a ce~ral member 72B
joining a pair of le~ receiving member~ 74B. Each lS leg receiving m~mber 74B de~ines at least one passage, such as a cylind,rical bore 76, or receiving one of the fas~ening me~.,ber legs 66B.
` ~he height of ea~h leg receiving member 74B
i5 less than the height of each leg receiving m~mber 74 of thc firfit emb~iment of the fa~tener S0 described ~bove w~th reference to Figures 1-9.
Further, n~ apertures ~such as aperturçs 78 ~d 80 $n the rec~ver 62 of the first embodiment of the faste~er 50 illu~trated in Figures 1-4) are prov~ded~ Rather, the legs 66B ~re deformed, a~ by produoing ~ bulge 79B (Figure 25), adja~ent the ~ide o~ the re~e~ver 62B that faces a~ay fro~ the tis~ue r~ortion 52 and 54.
The deforrnation of the astening membe~
legs 66~ may be e~fected with a instru~ent ~milar to the instrument 100 describ~d ab~ve ~ith re erence to F$gures 10-19. ~owever, the spring biasea ~nvll 130 of the instrument lU0 (Fi~ure 18) n~ed not be provided~ ~ather~ a fixed ~nYil ~y be pro~ided in ~uch an instrument ~mmediately below the bDtto~ of the receiver. In addition, the cutter blades ~such as cutter blades 160 of the instrument 100 illustrated in Figure 18) would be spaced below the bottom of the receiver 62B by an amount sufficient to accommodate the deformed por~ion 7gB of the fastening - member legs.
THE FASTENER: FOURTH EMBODIMENT
- Although not illustrated, the fastener design may also include an interferenc2 fit or friction fit feature. For example, the fastening ~ember legs may be pr~vided with protrusions for engaging suitable portions of the receiverO The friction fit would provide a retention restraint in addition to the restraint provided by the permanent deformation of the legs ~nd/or receiver.
ALTERNATIVE DESIGN FEATURES
In the figures, the two legs of the fastening member are connected by a portion of the fastening member (e.g., the link or clamping member) which is illustrated as being generally straight and - extending perpendicular to the two legs. ~he structure need not be limited to such a shape however. Instead, all or a portion of the length of the fastening member between the two legs may be arched or arcuate or may include an arcuate portion (e.g., an inverted U-shaped configuration)O This would function to initially provide a fre~ space between ~he upper tissue por~ion and the top of the fastening member to allow for ~ome expansion ~f the tissue.
However, in those situation~ where increased initial tissue compression is desired, a modified receiver structure may be provided to co~perate with the above-des~ribed arcuate fas~ening member. Specifically, the re~eiver need not have a ETH~548 flat upper surface as illustrated, Rather, the upper surface of the receiver may be arcuate (e.g., convex) so as to ~Fenerally match or correspond with the arcuate sh.ape of the fastening member. This can result in an increased compression of the two tissue portions between the receiver and fastening member.
From the foregoing, it will be observed that numerous variations and moaifications may be effected without departing from the true spirt and scope of the novel concept of the invention. It is to be understood that no limitation with respect to the specific articles, instruments, and methods illustrated herein is intended or should be inferred. It is, of course, intended to cover by the appended claims all such modifications as fall within the scope of the claims.
Claims (18)
1. A fastener adapted to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision, said fastener comprising:
an open loop fastening member, said fastening member comprising a pair of legs adapted to penetrate said tissue portions and a link connecting said legs that is adapted to lie substantially against one of said tissue portions;
a receiver adapted to be disposed against the other of said tissue portions opposite said fastening member, said receiver having means for receiving said fastening member legs after said legs have been inserted through said tissue portions;
at least a portion of each of said legs or at least a portion of said receiver consisting of a material that is initially deformable under the application of a predetermined amount of pressure to effect engagement of the fastening member legs and receiver after the tissue portions have been penetrated by said fastening member legs and after said legs have been received in said receiver.
an open loop fastening member, said fastening member comprising a pair of legs adapted to penetrate said tissue portions and a link connecting said legs that is adapted to lie substantially against one of said tissue portions;
a receiver adapted to be disposed against the other of said tissue portions opposite said fastening member, said receiver having means for receiving said fastening member legs after said legs have been inserted through said tissue portions;
at least a portion of each of said legs or at least a portion of said receiver consisting of a material that is initially deformable under the application of a predetermined amount of pressure to effect engagement of the fastening member legs and receiver after the tissue portions have been penetrated by said fastening member legs and after said legs have been received in said receiver.
2. The fastener in accordance with claim 1 in which said fastening member is a generally U-shaped member, in which each of said legs has a generally solid cylindrical shape, and in which the end of each leg opposite said link has a generally conical configuration to aid in tissue penetration.
3. The fastener in accordance with claim 1 in which said legs are generally parallel to each other and are generally perpendicular to said link.
4. The fastener in accordance with claim 1 in which said fastening member is molded from a thermoplastic polymer and in which said receiver is molded from a thermoplastic polymer.
5. The fastener in accordance with claim 4 in which said receiver is molded from nylon.
6. The fastener in accordance with claim 1 in which said fastening member is molded from a thermoplastic polymer in a heated mold, in which said fastening member is post-scoured, and in which said fastening member is annealed.
7. The fastener in accordance with claim 1 in which said receiver includes a central member joining a pair of leg receiving members.
8. The fastener in accordance with claim 7 in which each said leg receiving member defines at least one passage for receiving one of said fastening member legs.
9. The fastener in accordance with claim 8 in which each said passage is a generally cylindrical bore.
10. The fastener in accordance with claim 8 in which each said receiving member defines a first aperture communi-cating from the exterior of the receiving member with the interior of said passage and a second aperture opposite the first aperture communicating from the exterior of said receiving member with the interior of said passage.
11. The fastener in accordance with claim 10 in which each said aperture has a generally right rectangular configuration.
12. A fastener adapted to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision, said fastener comprising a fastening member having a pair of legs adapted to penetrate said tissue portions and a link connecting said legs that is adapted to lie substantially against one of said tissue portions; said fastener further comprising a receiver adapted to be disposed against the other of said tissue portions opposite said fastening member, said receiver having receiving means for receiving and encompassing a portion of each of said fastening member legs after said legs have been inserted through said tissue portions, at least a portion of each of said legs consisting of a material that is initially deformable under the applica-tion of a predetermined amount of pressure exerted by a tool or instrument to deform said material against portions of said receiver adjacent said receiver receiving means to thereby effect engagement of the fastening member legs and the receiver after the tissue portions have been penetrated by said fastening member legs and after said legs have been received in said receiver receiving means.
13. An instrument for applying at least one fastener to hold together separated portions of mammalian tissue, such as are defined by a wound or incision, to facilitate healing of the wound or incision, said fastener including an open loop fastening member that comprises a pair of legs adapted to penetrate said tissue portions and a link connect-ing said legs that is adapted to lie substantially against one of said tissue portions, said fastener further including a receiver adapted to be disposed against the other of said tissue portions opposite said fastening member and adapted to accept the legs of the fastening member, said instrument comprising:
a first jaw for holding said fastening member on one side of said tissue portions with said legs oriented at an appropriate angle to penetrate said tissue portions;
a second jaw for holding said receiver on said other side of said tissue portions opposite said fastening member and generally in alignment with said fastening member legs;
means for moving said first and second jaws between an open position for receiving said tissue portions therebetween and an at least partially closed position;
means for moving said fastening member relative to said first jaw to penetrate said tissue portions with the legs of said fastening member and to locate at least portions of said legs of said fastening member within said receiver in said second jaw;
a deforming member movable relative to said second jaw member for being urged against the fastening member legs, the receiver, or both to deform the fastening member legs, the receiver, or both to thereby effect an engagement of the fastening member legs and receiver; and means for moving said deforming member to effect said deformation.
a first jaw for holding said fastening member on one side of said tissue portions with said legs oriented at an appropriate angle to penetrate said tissue portions;
a second jaw for holding said receiver on said other side of said tissue portions opposite said fastening member and generally in alignment with said fastening member legs;
means for moving said first and second jaws between an open position for receiving said tissue portions therebetween and an at least partially closed position;
means for moving said fastening member relative to said first jaw to penetrate said tissue portions with the legs of said fastening member and to locate at least portions of said legs of said fastening member within said receiver in said second jaw;
a deforming member movable relative to said second jaw member for being urged against the fastening member legs, the receiver, or both to deform the fastening member legs, the receiver, or both to thereby effect an engagement of the fastening member legs and receiver; and means for moving said deforming member to effect said deformation.
14. The instrument in accordance with claim 13 further including first and second handle levers connected for relative movement toward and away from each other, said fastening member moving means being mounted to and extending from said first handle lever, said second jaw being mounted to and extending from said second handle lever, and said first jaw being mounted to said instrument for movement relative to both said fastening member moving means and said second jaw.
15. The instrument in accordance with claim 14 in which the first jaw includes channel for frictionally receiv-ing said fastening member and in which said fastening member moving means includes a pusher member for engaging said fastening member and being received in said first jaw channel adjacent said fastening member.
16. The instrument in accordance with claim 13 further including a movable anvil member in said second jaw for engaging a portion of said receiver and said fastening member legs and further including means for biasing said anvil member into engagement with said receiver and said fastening member legs.
17. The instrument in accordance with claim 13 further including a cutting blade associated with said second jaw and further including means for moving said blade relative to said second jaw adjacent said receiver to cut off portions of said fastening member legs extending beyond said receiver when said jaws are in said at least partially closed position
18. The instrument in accordance with claim 17 in which said instrument is adapted to apply one fastener at a time and in which said instrument includes a reciprocative actuating member slidably disposed within said second jaw;
in which said deforming member and said cutting blade are unitary with said reciprocative actuating member; in which said instrument includes a handle lever pivotally mounted to said second jaw; in which said instrument further includes handle lever biasing means for biasing said handle lever into a first position relative to said second jaw; and in which said actuating member includes a drive member adapted to be engaged by said handle lever when sufficient force is applied to said handle lever to overcome said handle lever biasing means and move said handle lever relative to said second jaw away from said open position for engaging said drive member to thereby move said actuating member relative to said second jaw to effect the deformation with said deforming member and the cutting off of said fastening member legs with said cutting blade.
in which said deforming member and said cutting blade are unitary with said reciprocative actuating member; in which said instrument includes a handle lever pivotally mounted to said second jaw; in which said instrument further includes handle lever biasing means for biasing said handle lever into a first position relative to said second jaw; and in which said actuating member includes a drive member adapted to be engaged by said handle lever when sufficient force is applied to said handle lever to overcome said handle lever biasing means and move said handle lever relative to said second jaw away from said open position for engaging said drive member to thereby move said actuating member relative to said second jaw to effect the deformation with said deforming member and the cutting off of said fastening member legs with said cutting blade.
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US06/506,151 US4573469A (en) | 1983-06-20 | 1983-06-20 | Two-piece tissue fastener with coinable leg staple and retaining receiver and method and instrument for applying same |
US506,151 | 1983-06-20 |
Publications (1)
Publication Number | Publication Date |
---|---|
CA1259875A true CA1259875A (en) | 1989-09-26 |
Family
ID=24013406
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
CA000456803A Expired CA1259875A (en) | 1983-06-20 | 1984-06-18 | Two-piece tissue fastener with coinable leg staple and retaining receiver and instrument for applying same |
Country Status (9)
Country | Link |
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US (1) | US4573469A (en) |
EP (1) | EP0129441B1 (en) |
JP (1) | JPS6012046A (en) |
AU (1) | AU565190B2 (en) |
BR (1) | BR8403004A (en) |
CA (1) | CA1259875A (en) |
DE (1) | DE3467501D1 (en) |
GR (1) | GR81918B (en) |
ZA (1) | ZA844641B (en) |
Families Citing this family (563)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
IN165375B (en) * | 1984-07-16 | 1989-10-07 | Ethicon Inc | |
US4741336A (en) * | 1984-07-16 | 1988-05-03 | Ethicon, Inc. | Shaped staples and slotted receivers (case VII) |
US4671280A (en) * | 1985-05-13 | 1987-06-09 | Ethicon, Inc. | Surgical fastening device and method for manufacture |
US5100418A (en) | 1987-05-14 | 1992-03-31 | Inbae Yoon | Suture tie device system and applicator therefor |
US4932962A (en) * | 1989-05-16 | 1990-06-12 | Inbae Yoon | Suture devices particularly useful in endoscopic surgery and methods of suturing |
US5222976A (en) * | 1989-05-16 | 1993-06-29 | Inbae Yoon | Suture devices particularly useful in endoscopic surgery |
US5053047A (en) * | 1989-05-16 | 1991-10-01 | Inbae Yoon | Suture devices particularly useful in endoscopic surgery and methods of suturing |
US5395391A (en) * | 1993-06-07 | 1995-03-07 | Essig; Mitchell N. | Method for closing ressected uterine tissues |
US5391173A (en) * | 1994-02-10 | 1995-02-21 | Wilk; Peter J. | Laparoscopic suturing technique and associated device |
US5904697A (en) * | 1995-02-24 | 1999-05-18 | Heartport, Inc. | Devices and methods for performing a vascular anastomosis |
US6149658A (en) * | 1997-01-09 | 2000-11-21 | Coalescent Surgical, Inc. | Sutured staple surgical fasteners, instruments and methods for minimally invasive vascular and endoscopic surgery |
US6551328B2 (en) * | 1997-11-03 | 2003-04-22 | Symbiosis Corporation | Surgical instrument for invagination and fundoplication |
US6086600A (en) | 1997-11-03 | 2000-07-11 | Symbiosis Corporation | Flexible endoscopic surgical instrument for invagination and fundoplication |
US6641593B1 (en) | 1998-06-03 | 2003-11-04 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US6945980B2 (en) | 1998-06-03 | 2005-09-20 | Medtronic, Inc. | Multiple loop tissue connector apparatus and methods |
US6613059B2 (en) | 1999-03-01 | 2003-09-02 | Coalescent Surgical, Inc. | Tissue connector apparatus and methods |
US8118822B2 (en) | 1999-03-01 | 2012-02-21 | Medtronic, Inc. | Bridge clip tissue connector apparatus and methods |
US6981983B1 (en) | 1999-03-31 | 2006-01-03 | Rosenblatt Peter L | System and methods for soft tissue reconstruction |
US20050283189A1 (en) * | 1999-03-31 | 2005-12-22 | Rosenblatt Peter L | Systems and methods for soft tissue reconstruction |
US6695859B1 (en) | 1999-04-05 | 2004-02-24 | Coalescent Surgical, Inc. | Apparatus and methods for anastomosis |
US7846180B2 (en) | 1999-06-22 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Tissue fixation devices and methods of fixing tissue |
US8287554B2 (en) * | 1999-06-22 | 2012-10-16 | Ethicon Endo-Surgery, Inc. | Method and devices for tissue reconfiguration |
US6663639B1 (en) | 1999-06-22 | 2003-12-16 | Ndo Surgical, Inc. | Methods and devices for tissue reconfiguration |
US6494888B1 (en) * | 1999-06-22 | 2002-12-17 | Ndo Surgical, Inc. | Tissue reconfiguration |
US6821285B2 (en) * | 1999-06-22 | 2004-11-23 | Ndo Surgical, Inc. | Tissue reconfiguration |
US6835200B2 (en) | 1999-06-22 | 2004-12-28 | Ndo Surgical. Inc. | Method and devices for tissue reconfiguration |
US8529583B1 (en) | 1999-09-03 | 2013-09-10 | Medtronic, Inc. | Surgical clip removal apparatus |
US6926730B1 (en) | 2000-10-10 | 2005-08-09 | Medtronic, Inc. | Minimally invasive valve repair procedure and apparatus |
US6551332B1 (en) | 2000-03-31 | 2003-04-22 | Coalescent Surgical, Inc. | Multiple bias surgical fastener |
US6305891B1 (en) * | 2000-05-15 | 2001-10-23 | Mark S. Burlingame | Fastening device and a spacer, and a method of using the same |
US6438924B1 (en) * | 2000-08-22 | 2002-08-27 | Edward N. Martin | Slot forming tool for wall construction |
US6503259B2 (en) * | 2000-12-27 | 2003-01-07 | Ethicon, Inc. | Expandable anastomotic device |
US20040126201A1 (en) * | 2002-08-09 | 2004-07-01 | Brian Kobylinski | Color-coded staples |
US8066724B2 (en) | 2002-09-12 | 2011-11-29 | Medtronic, Inc. | Anastomosis apparatus and methods |
US8105345B2 (en) | 2002-10-04 | 2012-01-31 | Medtronic, Inc. | Anastomosis apparatus and methods |
US9060770B2 (en) | 2003-05-20 | 2015-06-23 | Ethicon Endo-Surgery, Inc. | Robotically-driven surgical instrument with E-beam driver |
US20070084897A1 (en) | 2003-05-20 | 2007-04-19 | Shelton Frederick E Iv | Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism |
US7182769B2 (en) | 2003-07-25 | 2007-02-27 | Medtronic, Inc. | Sealing clip, delivery systems, and methods |
US20050043749A1 (en) | 2003-08-22 | 2005-02-24 | Coalescent Surgical, Inc. | Eversion apparatus and methods |
US8394114B2 (en) | 2003-09-26 | 2013-03-12 | Medtronic, Inc. | Surgical connection apparatus and methods |
US7118318B2 (en) * | 2003-11-20 | 2006-10-10 | Bellsouth Intellectual Property Corporation | Wire protector and retainer |
US7128761B2 (en) * | 2003-12-10 | 2006-10-31 | Axiomed Spine Corporation | Method and apparatus for replacing a damaged spinal disc |
US7879047B2 (en) | 2003-12-10 | 2011-02-01 | Medtronic, Inc. | Surgical connection apparatus and methods |
US20060015144A1 (en) * | 2004-07-19 | 2006-01-19 | Vascular Control Systems, Inc. | Uterine artery occlusion staple |
US8215531B2 (en) | 2004-07-28 | 2012-07-10 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument having a medical substance dispenser |
US11896225B2 (en) | 2004-07-28 | 2024-02-13 | Cilag Gmbh International | Staple cartridge comprising a pan |
CA2549224A1 (en) * | 2005-06-02 | 2006-12-02 | Tyco Healthcare Group Lp | Expandable backspan staple |
US7722610B2 (en) * | 2005-06-02 | 2010-05-25 | Tyco Healthcare Group Lp | Multiple coil staple and staple applier |
US9237891B2 (en) | 2005-08-31 | 2016-01-19 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical stapling devices that produce formed staples having different lengths |
US11246590B2 (en) | 2005-08-31 | 2022-02-15 | Cilag Gmbh International | Staple cartridge including staple drivers having different unfired heights |
US11484312B2 (en) | 2005-08-31 | 2022-11-01 | Cilag Gmbh International | Staple cartridge comprising a staple driver arrangement |
US10159482B2 (en) | 2005-08-31 | 2018-12-25 | Ethicon Llc | Fastener cartridge assembly comprising a fixed anvil and different staple heights |
US8800838B2 (en) | 2005-08-31 | 2014-08-12 | Ethicon Endo-Surgery, Inc. | Robotically-controlled cable-based surgical end effectors |
US7934630B2 (en) * | 2005-08-31 | 2011-05-03 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070194082A1 (en) | 2005-08-31 | 2007-08-23 | Morgan Jerome R | Surgical stapling device with anvil having staple forming pockets of varying depths |
US7669746B2 (en) | 2005-08-31 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Staple cartridges for forming staples having differing formed staple heights |
US20070106317A1 (en) | 2005-11-09 | 2007-05-10 | Shelton Frederick E Iv | Hydraulically and electrically actuated articulation joints for surgical instruments |
US20070181756A1 (en) * | 2006-01-18 | 2007-08-09 | Gelfond-Holtz Alicia K | Transparent mounting strip |
US11793518B2 (en) | 2006-01-31 | 2023-10-24 | Cilag Gmbh International | Powered surgical instruments with firing system lockout arrangements |
US20110006101A1 (en) | 2009-02-06 | 2011-01-13 | EthiconEndo-Surgery, Inc. | Motor driven surgical fastener device with cutting member lockout arrangements |
US20120292367A1 (en) | 2006-01-31 | 2012-11-22 | Ethicon Endo-Surgery, Inc. | Robotically-controlled end effector |
US8186555B2 (en) | 2006-01-31 | 2012-05-29 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting and fastening instrument with mechanical closure system |
US20110024477A1 (en) | 2009-02-06 | 2011-02-03 | Hall Steven G | Driven Surgical Stapler Improvements |
US9861359B2 (en) | 2006-01-31 | 2018-01-09 | Ethicon Llc | Powered surgical instruments with firing system lockout arrangements |
US8763879B2 (en) | 2006-01-31 | 2014-07-01 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of surgical instrument |
US7845537B2 (en) | 2006-01-31 | 2010-12-07 | Ethicon Endo-Surgery, Inc. | Surgical instrument having recording capabilities |
US8161977B2 (en) | 2006-01-31 | 2012-04-24 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US20110295295A1 (en) | 2006-01-31 | 2011-12-01 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical instrument having recording capabilities |
US8708213B2 (en) | 2006-01-31 | 2014-04-29 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a feedback system |
US8820603B2 (en) | 2006-01-31 | 2014-09-02 | Ethicon Endo-Surgery, Inc. | Accessing data stored in a memory of a surgical instrument |
US7753904B2 (en) | 2006-01-31 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Endoscopic surgical instrument with a handle that can articulate with respect to the shaft |
US11224427B2 (en) | 2006-01-31 | 2022-01-18 | Cilag Gmbh International | Surgical stapling system including a console and retraction assembly |
US11278279B2 (en) | 2006-01-31 | 2022-03-22 | Cilag Gmbh International | Surgical instrument assembly |
US8992422B2 (en) | 2006-03-23 | 2015-03-31 | Ethicon Endo-Surgery, Inc. | Robotically-controlled endoscopic accessory channel |
US20070225562A1 (en) | 2006-03-23 | 2007-09-27 | Ethicon Endo-Surgery, Inc. | Articulating endoscopic accessory channel |
US8322455B2 (en) | 2006-06-27 | 2012-12-04 | Ethicon Endo-Surgery, Inc. | Manually driven surgical cutting and fastening instrument |
US10130359B2 (en) | 2006-09-29 | 2018-11-20 | Ethicon Llc | Method for forming a staple |
US10568652B2 (en) | 2006-09-29 | 2020-02-25 | Ethicon Llc | Surgical staples having attached drivers of different heights and stapling instruments for deploying the same |
US7506791B2 (en) | 2006-09-29 | 2009-03-24 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with mechanical mechanism for limiting maximum tissue compression |
US8459520B2 (en) | 2007-01-10 | 2013-06-11 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and remote sensor |
US11291441B2 (en) | 2007-01-10 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with wireless communication between control unit and remote sensor |
US8684253B2 (en) | 2007-01-10 | 2014-04-01 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor |
US8652120B2 (en) | 2007-01-10 | 2014-02-18 | Ethicon Endo-Surgery, Inc. | Surgical instrument with wireless communication between control unit and sensor transponders |
US8701958B2 (en) | 2007-01-11 | 2014-04-22 | Ethicon Endo-Surgery, Inc. | Curved end effector for a surgical stapling device |
US11039836B2 (en) | 2007-01-11 | 2021-06-22 | Cilag Gmbh International | Staple cartridge for use with a surgical stapling instrument |
RU2440150C2 (en) * | 2007-02-20 | 2012-01-20 | КейСиАй Лайсензинг Инк. | System and method of differentiating state of leak and state of reservoir disconnection in system of processing with lower pressure |
US7669747B2 (en) | 2007-03-15 | 2010-03-02 | Ethicon Endo-Surgery, Inc. | Washer for use with a surgical stapling instrument |
US20080234703A1 (en) * | 2007-03-23 | 2008-09-25 | Ethicon Endo-Surgery, Inc. | Tissue approximation system |
US8852216B2 (en) | 2007-03-23 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Tissue approximation methods |
US8893946B2 (en) | 2007-03-28 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Laparoscopic tissue thickness and clamp load measuring devices |
WO2008137833A2 (en) * | 2007-05-07 | 2008-11-13 | Tyco Healthcare Group Lp | Variable size-uniform compression staple assembly |
US8534528B2 (en) | 2007-06-04 | 2013-09-17 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US11564682B2 (en) | 2007-06-04 | 2023-01-31 | Cilag Gmbh International | Surgical stapler device |
US8931682B2 (en) | 2007-06-04 | 2015-01-13 | Ethicon Endo-Surgery, Inc. | Robotically-controlled shaft based rotary drive systems for surgical instruments |
US7832408B2 (en) | 2007-06-04 | 2010-11-16 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a directional switching mechanism |
US7905380B2 (en) | 2007-06-04 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a multiple rate directional switching mechanism |
US8308040B2 (en) | 2007-06-22 | 2012-11-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with an articulatable end effector |
US7753245B2 (en) | 2007-06-22 | 2010-07-13 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments |
US11849941B2 (en) | 2007-06-29 | 2023-12-26 | Cilag Gmbh International | Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis |
US8348972B2 (en) * | 2007-07-11 | 2013-01-08 | Covidien Lp | Surgical staple with augmented compression area |
US8561870B2 (en) | 2008-02-13 | 2013-10-22 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument |
US7905381B2 (en) | 2008-09-19 | 2011-03-15 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with cutting member arrangement |
US8636736B2 (en) | 2008-02-14 | 2014-01-28 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument |
JP5410110B2 (en) | 2008-02-14 | 2014-02-05 | エシコン・エンド−サージェリィ・インコーポレイテッド | Surgical cutting / fixing instrument with RF electrode |
US7866527B2 (en) | 2008-02-14 | 2011-01-11 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with interlockable firing system |
US8573465B2 (en) | 2008-02-14 | 2013-11-05 | Ethicon Endo-Surgery, Inc. | Robotically-controlled surgical end effector system with rotary actuated closure systems |
US8758391B2 (en) | 2008-02-14 | 2014-06-24 | Ethicon Endo-Surgery, Inc. | Interchangeable tools for surgical instruments |
US8752749B2 (en) | 2008-02-14 | 2014-06-17 | Ethicon Endo-Surgery, Inc. | Robotically-controlled disposable motor-driven loading unit |
US8584919B2 (en) | 2008-02-14 | 2013-11-19 | Ethicon Endo-Sugery, Inc. | Surgical stapling apparatus with load-sensitive firing mechanism |
US7793812B2 (en) | 2008-02-14 | 2010-09-14 | Ethicon Endo-Surgery, Inc. | Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus |
US8657174B2 (en) | 2008-02-14 | 2014-02-25 | Ethicon Endo-Surgery, Inc. | Motorized surgical cutting and fastening instrument having handle based power source |
US7819298B2 (en) | 2008-02-14 | 2010-10-26 | Ethicon Endo-Surgery, Inc. | Surgical stapling apparatus with control features operable with one hand |
US9179912B2 (en) | 2008-02-14 | 2015-11-10 | Ethicon Endo-Surgery, Inc. | Robotically-controlled motorized surgical cutting and fastening instrument |
US8459525B2 (en) | 2008-02-14 | 2013-06-11 | Ethicon Endo-Sugery, Inc. | Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device |
US8622274B2 (en) | 2008-02-14 | 2014-01-07 | Ethicon Endo-Surgery, Inc. | Motorized cutting and fastening instrument having control circuit for optimizing battery usage |
US11272927B2 (en) | 2008-02-15 | 2022-03-15 | Cilag Gmbh International | Layer arrangements for surgical staple cartridges |
US20130153641A1 (en) | 2008-02-15 | 2013-06-20 | Ethicon Endo-Surgery, Inc. | Releasable layer of material and surgical end effector having the same |
US8177836B2 (en) | 2008-03-10 | 2012-05-15 | Medtronic, Inc. | Apparatus and methods for minimally invasive valve repair |
US8231040B2 (en) * | 2008-04-14 | 2012-07-31 | Tyco Healthcare Group Lp | Variable compression surgical fastener cartridge |
US7926691B2 (en) | 2008-04-14 | 2011-04-19 | Tyco Healthcare Group, L.P. | Variable compression surgical fastener cartridge |
US8100310B2 (en) * | 2008-04-14 | 2012-01-24 | Tyco Healthcare Group Lp | Variable compression surgical fastener apparatus |
US20090255974A1 (en) * | 2008-04-14 | 2009-10-15 | Tyco Healthcare Group Lp | Single loop surgical fastener apparatus for applying variable compression |
US8231041B2 (en) * | 2008-04-14 | 2012-07-31 | Tyco Healthcare Group Lp | Variable compression surgical fastener cartridge |
US8277160B1 (en) * | 2008-04-29 | 2012-10-02 | Strauel Theodore A | Protective wire fastening apparatus |
US8967446B2 (en) | 2008-05-09 | 2015-03-03 | Covidien Lp | Variable compression surgical fastener cartridge |
US8091756B2 (en) | 2008-05-09 | 2012-01-10 | Tyco Healthcare Group Lp | Varying tissue compression using take-up component |
US9016541B2 (en) | 2008-05-09 | 2015-04-28 | Covidien Lp | Varying tissue compression with an anvil configuration |
US8464922B2 (en) | 2008-05-09 | 2013-06-18 | Covidien Lp | Variable compression surgical fastener cartridge |
US8186556B2 (en) | 2008-05-09 | 2012-05-29 | Tyco Healthcare Group Lp | Variable compression surgical fastener apparatus |
PL3476312T3 (en) | 2008-09-19 | 2024-03-11 | Ethicon Llc | Surgical stapler with apparatus for adjusting staple height |
US11648005B2 (en) | 2008-09-23 | 2023-05-16 | Cilag Gmbh International | Robotically-controlled motorized surgical instrument with an end effector |
US9386983B2 (en) | 2008-09-23 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Robotically-controlled motorized surgical instrument |
US9050083B2 (en) | 2008-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8210411B2 (en) | 2008-09-23 | 2012-07-03 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument |
US9005230B2 (en) | 2008-09-23 | 2015-04-14 | Ethicon Endo-Surgery, Inc. | Motorized surgical instrument |
US8608045B2 (en) | 2008-10-10 | 2013-12-17 | Ethicon Endo-Sugery, Inc. | Powered surgical cutting and stapling apparatus with manually retractable firing system |
US8381961B2 (en) * | 2009-01-14 | 2013-02-26 | Covidien Lp | Surgical stapling apparatus including staple with plate |
US8397971B2 (en) | 2009-02-05 | 2013-03-19 | Ethicon Endo-Surgery, Inc. | Sterilizable surgical instrument |
US8517239B2 (en) | 2009-02-05 | 2013-08-27 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument comprising a magnetic element driver |
US8414577B2 (en) | 2009-02-05 | 2013-04-09 | Ethicon Endo-Surgery, Inc. | Surgical instruments and components for use in sterile environments |
US8444036B2 (en) | 2009-02-06 | 2013-05-21 | Ethicon Endo-Surgery, Inc. | Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector |
EP2393430A1 (en) | 2009-02-06 | 2011-12-14 | Ethicon Endo-Surgery, Inc. | Driven surgical stapler improvements |
US8518060B2 (en) | 2009-04-09 | 2013-08-27 | Medtronic, Inc. | Medical clip with radial tines, system and method of using same |
US8292154B2 (en) * | 2009-04-16 | 2012-10-23 | Tyco Healthcare Group Lp | Surgical apparatus for applying tissue fasteners |
US8668704B2 (en) | 2009-04-24 | 2014-03-11 | Medtronic, Inc. | Medical clip with tines, system and method of using same |
US8851354B2 (en) | 2009-12-24 | 2014-10-07 | Ethicon Endo-Surgery, Inc. | Surgical cutting instrument that analyzes tissue thickness |
US8220688B2 (en) | 2009-12-24 | 2012-07-17 | Ethicon Endo-Surgery, Inc. | Motor-driven surgical cutting instrument with electric actuator directional control assembly |
US8783543B2 (en) | 2010-07-30 | 2014-07-22 | Ethicon Endo-Surgery, Inc. | Tissue acquisition arrangements and methods for surgical stapling devices |
US9877720B2 (en) | 2010-09-24 | 2018-01-30 | Ethicon Llc | Control features for articulating surgical device |
US8733613B2 (en) | 2010-09-29 | 2014-05-27 | Ethicon Endo-Surgery, Inc. | Staple cartridge |
US9301753B2 (en) | 2010-09-30 | 2016-04-05 | Ethicon Endo-Surgery, Llc | Expandable tissue thickness compensator |
US9277919B2 (en) | 2010-09-30 | 2016-03-08 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprising fibers to produce a resilient load |
US11849952B2 (en) | 2010-09-30 | 2023-12-26 | Cilag Gmbh International | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9216019B2 (en) | 2011-09-23 | 2015-12-22 | Ethicon Endo-Surgery, Inc. | Surgical stapler with stationary staple drivers |
US10945731B2 (en) | 2010-09-30 | 2021-03-16 | Ethicon Llc | Tissue thickness compensator comprising controlled release and expansion |
US8840003B2 (en) | 2010-09-30 | 2014-09-23 | Ethicon Endo-Surgery, Inc. | Surgical stapling instrument with compact articulation control arrangement |
US9220501B2 (en) | 2010-09-30 | 2015-12-29 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensators |
US11812965B2 (en) | 2010-09-30 | 2023-11-14 | Cilag Gmbh International | Layer of material for a surgical end effector |
US11298125B2 (en) | 2010-09-30 | 2022-04-12 | Cilag Gmbh International | Tissue stapler having a thickness compensator |
US9629814B2 (en) | 2010-09-30 | 2017-04-25 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator configured to redistribute compressive forces |
US9386988B2 (en) | 2010-09-30 | 2016-07-12 | Ethicon End-Surgery, LLC | Retainer assembly including a tissue thickness compensator |
US8893949B2 (en) | 2010-09-30 | 2014-11-25 | Ethicon Endo-Surgery, Inc. | Surgical stapler with floating anvil |
US8746535B2 (en) | 2010-09-30 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator comprising detachable portions |
US9517063B2 (en) | 2012-03-28 | 2016-12-13 | Ethicon Endo-Surgery, Llc | Movable member for use with a tissue thickness compensator |
US9566061B2 (en) | 2010-09-30 | 2017-02-14 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a releasably attached tissue thickness compensator |
US9307989B2 (en) | 2012-03-28 | 2016-04-12 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorportating a hydrophobic agent |
US9332974B2 (en) | 2010-09-30 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Layered tissue thickness compensator |
US9314246B2 (en) | 2010-09-30 | 2016-04-19 | Ethicon Endo-Surgery, Llc | Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent |
US9414838B2 (en) | 2012-03-28 | 2016-08-16 | Ethicon Endo-Surgery, Llc | Tissue thickness compensator comprised of a plurality of materials |
US9839420B2 (en) | 2010-09-30 | 2017-12-12 | Ethicon Llc | Tissue thickness compensator comprising at least one medicament |
US9364233B2 (en) | 2010-09-30 | 2016-06-14 | Ethicon Endo-Surgery, Llc | Tissue thickness compensators for circular surgical staplers |
EP2621356B1 (en) | 2010-09-30 | 2018-03-07 | Ethicon LLC | Fastener system comprising a retention matrix and an alignment matrix |
US8695866B2 (en) | 2010-10-01 | 2014-04-15 | Ethicon Endo-Surgery, Inc. | Surgical instrument having a power control circuit |
DE102012100086A1 (en) * | 2011-01-07 | 2012-08-02 | Z-Medical Gmbh & Co. Kg | Surgical instrument |
US10398445B2 (en) | 2011-01-11 | 2019-09-03 | Amsel Medical Corporation | Method and apparatus for clamping tissue layers and occluding tubular body structures |
US10820895B2 (en) | 2011-01-11 | 2020-11-03 | Amsel Medical Corporation | Methods and apparatus for fastening and clamping tissue |
US20120260489A1 (en) * | 2011-04-18 | 2012-10-18 | Hamilton Elaine T | Button repair system and method |
AU2012250197B2 (en) | 2011-04-29 | 2017-08-10 | Ethicon Endo-Surgery, Inc. | Staple cartridge comprising staples positioned within a compressible portion thereof |
US9072535B2 (en) | 2011-05-27 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Surgical stapling instruments with rotatable staple deployment arrangements |
US11207064B2 (en) | 2011-05-27 | 2021-12-28 | Cilag Gmbh International | Automated end effector component reloading system for use with a robotic system |
JP5372192B2 (en) * | 2011-06-18 | 2013-12-18 | 須藤 二三男 | Wall mounting tool using plate-like pins |
ES2633746T3 (en) * | 2011-07-18 | 2017-09-25 | Woodwelding Ag | Implant to stabilize each other separate bone portions |
US9050084B2 (en) | 2011-09-23 | 2015-06-09 | Ethicon Endo-Surgery, Inc. | Staple cartridge including collapsible deck arrangement |
US9044230B2 (en) | 2012-02-13 | 2015-06-02 | Ethicon Endo-Surgery, Inc. | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
US9198662B2 (en) | 2012-03-28 | 2015-12-01 | Ethicon Endo-Surgery, Inc. | Tissue thickness compensator having improved visibility |
RU2644272C2 (en) | 2012-03-28 | 2018-02-08 | Этикон Эндо-Серджери, Инк. | Limitation node with tissue thickness compensator |
RU2639857C2 (en) | 2012-03-28 | 2017-12-22 | Этикон Эндо-Серджери, Инк. | Tissue thickness compensator containing capsule for medium with low pressure |
MX358135B (en) | 2012-03-28 | 2018-08-06 | Ethicon Endo Surgery Inc | Tissue thickness compensator comprising a plurality of layers. |
US9101358B2 (en) | 2012-06-15 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Articulatable surgical instrument comprising a firing drive |
US9072536B2 (en) | 2012-06-28 | 2015-07-07 | Ethicon Endo-Surgery, Inc. | Differential locking arrangements for rotary powered surgical instruments |
US20140001231A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Firing system lockout arrangements for surgical instruments |
US8747238B2 (en) | 2012-06-28 | 2014-06-10 | Ethicon Endo-Surgery, Inc. | Rotary drive shaft assemblies for surgical instruments with articulatable end effectors |
US9125662B2 (en) | 2012-06-28 | 2015-09-08 | Ethicon Endo-Surgery, Inc. | Multi-axis articulating and rotating surgical tools |
US9561038B2 (en) | 2012-06-28 | 2017-02-07 | Ethicon Endo-Surgery, Llc | Interchangeable clip applier |
US9649111B2 (en) | 2012-06-28 | 2017-05-16 | Ethicon Endo-Surgery, Llc | Replaceable clip cartridge for a clip applier |
US9226751B2 (en) | 2012-06-28 | 2016-01-05 | Ethicon Endo-Surgery, Inc. | Surgical instrument system including replaceable end effectors |
BR112014032776B1 (en) | 2012-06-28 | 2021-09-08 | Ethicon Endo-Surgery, Inc | SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM |
EP2866686A1 (en) | 2012-06-28 | 2015-05-06 | Ethicon Endo-Surgery, Inc. | Empty clip cartridge lockout |
US9119657B2 (en) | 2012-06-28 | 2015-09-01 | Ethicon Endo-Surgery, Inc. | Rotary actuatable closure arrangement for surgical end effector |
US9028494B2 (en) | 2012-06-28 | 2015-05-12 | Ethicon Endo-Surgery, Inc. | Interchangeable end effector coupling arrangement |
US11202631B2 (en) | 2012-06-28 | 2021-12-21 | Cilag Gmbh International | Stapling assembly comprising a firing lockout |
US9289256B2 (en) | 2012-06-28 | 2016-03-22 | Ethicon Endo-Surgery, Llc | Surgical end effectors having angled tissue-contacting surfaces |
US9101385B2 (en) | 2012-06-28 | 2015-08-11 | Ethicon Endo-Surgery, Inc. | Electrode connections for rotary driven surgical tools |
US20140005718A1 (en) | 2012-06-28 | 2014-01-02 | Ethicon Endo-Surgery, Inc. | Multi-functional powered surgical device with external dissection features |
US9386984B2 (en) | 2013-02-08 | 2016-07-12 | Ethicon Endo-Surgery, Llc | Staple cartridge comprising a releasable cover |
US10092292B2 (en) | 2013-02-28 | 2018-10-09 | Ethicon Llc | Staple forming features for surgical stapling instrument |
RU2669463C2 (en) | 2013-03-01 | 2018-10-11 | Этикон Эндо-Серджери, Инк. | Surgical instrument with soft stop |
RU2672520C2 (en) | 2013-03-01 | 2018-11-15 | Этикон Эндо-Серджери, Инк. | Hingedly turnable surgical instruments with conducting ways for signal transfer |
US9358003B2 (en) | 2013-03-01 | 2016-06-07 | Ethicon Endo-Surgery, Llc | Electromechanical surgical device with signal relay arrangement |
US9345481B2 (en) | 2013-03-13 | 2016-05-24 | Ethicon Endo-Surgery, Llc | Staple cartridge tissue thickness sensor system |
US9629629B2 (en) | 2013-03-14 | 2017-04-25 | Ethicon Endo-Surgey, LLC | Control systems for surgical instruments |
US9332987B2 (en) | 2013-03-14 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Control arrangements for a drive member of a surgical instrument |
US9332984B2 (en) | 2013-03-27 | 2016-05-10 | Ethicon Endo-Surgery, Llc | Fastener cartridge assemblies |
US9795384B2 (en) | 2013-03-27 | 2017-10-24 | Ethicon Llc | Fastener cartridge comprising a tissue thickness compensator and a gap setting element |
US9572577B2 (en) | 2013-03-27 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Fastener cartridge comprising a tissue thickness compensator including openings therein |
US9867612B2 (en) | 2013-04-16 | 2018-01-16 | Ethicon Llc | Powered surgical stapler |
BR112015026109B1 (en) | 2013-04-16 | 2022-02-22 | Ethicon Endo-Surgery, Inc | surgical instrument |
CN105358074A (en) | 2013-05-07 | 2016-02-24 | 阿姆泽尔医药公司 | Method and apparatus for occluding a blood vessel and/or securing two objects together |
US9574644B2 (en) | 2013-05-30 | 2017-02-21 | Ethicon Endo-Surgery, Llc | Power module for use with a surgical instrument |
MX369362B (en) | 2013-08-23 | 2019-11-06 | Ethicon Endo Surgery Llc | Firing member retraction devices for powered surgical instruments. |
US9775609B2 (en) | 2013-08-23 | 2017-10-03 | Ethicon Llc | Tamper proof circuit for surgical instrument battery pack |
US20150082601A1 (en) * | 2013-09-25 | 2015-03-26 | Srinivas Dutt | Crimping apparatus |
US9839428B2 (en) | 2013-12-23 | 2017-12-12 | Ethicon Llc | Surgical cutting and stapling instruments with independent jaw control features |
US20150173756A1 (en) | 2013-12-23 | 2015-06-25 | Ethicon Endo-Surgery, Inc. | Surgical cutting and stapling methods |
US9724092B2 (en) | 2013-12-23 | 2017-08-08 | Ethicon Llc | Modular surgical instruments |
US9763662B2 (en) | 2013-12-23 | 2017-09-19 | Ethicon Llc | Fastener cartridge comprising a firing member configured to directly engage and eject fasteners from the fastener cartridge |
US9962161B2 (en) | 2014-02-12 | 2018-05-08 | Ethicon Llc | Deliverable surgical instrument |
US20140166725A1 (en) | 2014-02-24 | 2014-06-19 | Ethicon Endo-Surgery, Inc. | Staple cartridge including a barbed staple. |
JP6462004B2 (en) | 2014-02-24 | 2019-01-30 | エシコン エルエルシー | Fastening system with launcher lockout |
BR112016021943B1 (en) | 2014-03-26 | 2022-06-14 | Ethicon Endo-Surgery, Llc | SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE |
US10028761B2 (en) | 2014-03-26 | 2018-07-24 | Ethicon Llc | Feedback algorithms for manual bailout systems for surgical instruments |
US9826977B2 (en) | 2014-03-26 | 2017-11-28 | Ethicon Llc | Sterilization verification circuit |
US9913642B2 (en) | 2014-03-26 | 2018-03-13 | Ethicon Llc | Surgical instrument comprising a sensor system |
US20150272557A1 (en) | 2014-03-26 | 2015-10-01 | Ethicon Endo-Surgery, Inc. | Modular surgical instrument system |
JP6612256B2 (en) | 2014-04-16 | 2019-11-27 | エシコン エルエルシー | Fastener cartridge with non-uniform fastener |
CN106456176B (en) | 2014-04-16 | 2019-06-28 | 伊西康内外科有限责任公司 | Fastener cartridge including the extension with various configuration |
US9844369B2 (en) | 2014-04-16 | 2017-12-19 | Ethicon Llc | Surgical end effectors with firing element monitoring arrangements |
US10206677B2 (en) | 2014-09-26 | 2019-02-19 | Ethicon Llc | Surgical staple and driver arrangements for staple cartridges |
JP6532889B2 (en) | 2014-04-16 | 2019-06-19 | エシコン エルエルシーEthicon LLC | Fastener cartridge assembly and staple holder cover arrangement |
US20150297223A1 (en) | 2014-04-16 | 2015-10-22 | Ethicon Endo-Surgery, Inc. | Fastener cartridges including extensions having different configurations |
US10045781B2 (en) | 2014-06-13 | 2018-08-14 | Ethicon Llc | Closure lockout systems for surgical instruments |
BR112017004361B1 (en) | 2014-09-05 | 2023-04-11 | Ethicon Llc | ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT |
US20160066913A1 (en) | 2014-09-05 | 2016-03-10 | Ethicon Endo-Surgery, Inc. | Local display of tissue parameter stabilization |
US11311294B2 (en) | 2014-09-05 | 2022-04-26 | Cilag Gmbh International | Powered medical device including measurement of closure state of jaws |
US10105142B2 (en) | 2014-09-18 | 2018-10-23 | Ethicon Llc | Surgical stapler with plurality of cutting elements |
US11523821B2 (en) | 2014-09-26 | 2022-12-13 | Cilag Gmbh International | Method for creating a flexible staple line |
JP6648119B2 (en) | 2014-09-26 | 2020-02-14 | エシコン エルエルシーEthicon LLC | Surgical stapling buttress and accessory materials |
US10076325B2 (en) | 2014-10-13 | 2018-09-18 | Ethicon Llc | Surgical stapling apparatus comprising a tissue stop |
US9924944B2 (en) | 2014-10-16 | 2018-03-27 | Ethicon Llc | Staple cartridge comprising an adjunct material |
US11141153B2 (en) | 2014-10-29 | 2021-10-12 | Cilag Gmbh International | Staple cartridges comprising driver arrangements |
US10517594B2 (en) | 2014-10-29 | 2019-12-31 | Ethicon Llc | Cartridge assemblies for surgical staplers |
US9844376B2 (en) | 2014-11-06 | 2017-12-19 | Ethicon Llc | Staple cartridge comprising a releasable adjunct material |
US10736636B2 (en) | 2014-12-10 | 2020-08-11 | Ethicon Llc | Articulatable surgical instrument system |
US9987000B2 (en) | 2014-12-18 | 2018-06-05 | Ethicon Llc | Surgical instrument assembly comprising a flexible articulation system |
US10188385B2 (en) | 2014-12-18 | 2019-01-29 | Ethicon Llc | Surgical instrument system comprising lockable systems |
US9844375B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Drive arrangements for articulatable surgical instruments |
US10085748B2 (en) | 2014-12-18 | 2018-10-02 | Ethicon Llc | Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors |
US9844374B2 (en) | 2014-12-18 | 2017-12-19 | Ethicon Llc | Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member |
RU2703684C2 (en) | 2014-12-18 | 2019-10-21 | ЭТИКОН ЭНДО-СЕРДЖЕРИ, ЭлЭлСи | Surgical instrument with anvil which is selectively movable relative to staple cartridge around discrete fixed axis |
US10004501B2 (en) | 2014-12-18 | 2018-06-26 | Ethicon Llc | Surgical instruments with improved closure arrangements |
US10117649B2 (en) | 2014-12-18 | 2018-11-06 | Ethicon Llc | Surgical instrument assembly comprising a lockable articulation system |
US20160249910A1 (en) | 2015-02-27 | 2016-09-01 | Ethicon Endo-Surgery, Llc | Surgical charging system that charges and/or conditions one or more batteries |
US10180463B2 (en) | 2015-02-27 | 2019-01-15 | Ethicon Llc | Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band |
US11154301B2 (en) | 2015-02-27 | 2021-10-26 | Cilag Gmbh International | Modular stapling assembly |
US10226250B2 (en) | 2015-02-27 | 2019-03-12 | Ethicon Llc | Modular stapling assembly |
US9901342B2 (en) | 2015-03-06 | 2018-02-27 | Ethicon Endo-Surgery, Llc | Signal and power communication system positioned on a rotatable shaft |
US10045776B2 (en) | 2015-03-06 | 2018-08-14 | Ethicon Llc | Control techniques and sub-processor contained within modular shaft with select control processing from handle |
US9993248B2 (en) | 2015-03-06 | 2018-06-12 | Ethicon Endo-Surgery, Llc | Smart sensors with local signal processing |
US9924961B2 (en) | 2015-03-06 | 2018-03-27 | Ethicon Endo-Surgery, Llc | Interactive feedback system for powered surgical instruments |
US10617412B2 (en) | 2015-03-06 | 2020-04-14 | Ethicon Llc | System for detecting the mis-insertion of a staple cartridge into a surgical stapler |
US9895148B2 (en) | 2015-03-06 | 2018-02-20 | Ethicon Endo-Surgery, Llc | Monitoring speed control and precision incrementing of motor for powered surgical instruments |
US10687806B2 (en) | 2015-03-06 | 2020-06-23 | Ethicon Llc | Adaptive tissue compression techniques to adjust closure rates for multiple tissue types |
US10245033B2 (en) | 2015-03-06 | 2019-04-02 | Ethicon Llc | Surgical instrument comprising a lockable battery housing |
JP2020121162A (en) | 2015-03-06 | 2020-08-13 | エシコン エルエルシーEthicon LLC | Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement |
US10052044B2 (en) | 2015-03-06 | 2018-08-21 | Ethicon Llc | Time dependent evaluation of sensor data to determine stability, creep, and viscoelastic elements of measures |
US10441279B2 (en) | 2015-03-06 | 2019-10-15 | Ethicon Llc | Multiple level thresholds to modify operation of powered surgical instruments |
US9808246B2 (en) | 2015-03-06 | 2017-11-07 | Ethicon Endo-Surgery, Llc | Method of operating a powered surgical instrument |
US10433844B2 (en) | 2015-03-31 | 2019-10-08 | Ethicon Llc | Surgical instrument with selectively disengageable threaded drive systems |
US10368861B2 (en) | 2015-06-18 | 2019-08-06 | Ethicon Llc | Dual articulation drive system arrangements for articulatable surgical instruments |
US10835249B2 (en) | 2015-08-17 | 2020-11-17 | Ethicon Llc | Implantable layers for a surgical instrument |
MX2022009705A (en) | 2015-08-26 | 2022-11-07 | Ethicon Llc | Surgical staples comprising hardness variations for improved fastening of tissue. |
BR112018003693B1 (en) | 2015-08-26 | 2022-11-22 | Ethicon Llc | SURGICAL STAPLE CARTRIDGE FOR USE WITH A SURGICAL STAPPING INSTRUMENT |
US10357251B2 (en) | 2015-08-26 | 2019-07-23 | Ethicon Llc | Surgical staples comprising hardness variations for improved fastening of tissue |
MX2022006189A (en) | 2015-09-02 | 2022-06-16 | Ethicon Llc | Surgical staple configurations with camming surfaces located between portions supporting surgical staples. |
US10251648B2 (en) | 2015-09-02 | 2019-04-09 | Ethicon Llc | Surgical staple cartridge staple drivers with central support features |
US10363036B2 (en) | 2015-09-23 | 2019-07-30 | Ethicon Llc | Surgical stapler having force-based motor control |
US10076326B2 (en) | 2015-09-23 | 2018-09-18 | Ethicon Llc | Surgical stapler having current mirror-based motor control |
US10105139B2 (en) | 2015-09-23 | 2018-10-23 | Ethicon Llc | Surgical stapler having downstream current-based motor control |
US10085751B2 (en) | 2015-09-23 | 2018-10-02 | Ethicon Llc | Surgical stapler having temperature-based motor control |
US10327769B2 (en) | 2015-09-23 | 2019-06-25 | Ethicon Llc | Surgical stapler having motor control based on a drive system component |
US10238386B2 (en) | 2015-09-23 | 2019-03-26 | Ethicon Llc | Surgical stapler having motor control based on an electrical parameter related to a motor current |
US10299878B2 (en) | 2015-09-25 | 2019-05-28 | Ethicon Llc | Implantable adjunct systems for determining adjunct skew |
US10603039B2 (en) | 2015-09-30 | 2020-03-31 | Ethicon Llc | Progressively releasable implantable adjunct for use with a surgical stapling instrument |
US10271849B2 (en) | 2015-09-30 | 2019-04-30 | Ethicon Llc | Woven constructs with interlocked standing fibers |
US11890015B2 (en) | 2015-09-30 | 2024-02-06 | Cilag Gmbh International | Compressible adjunct with crossing spacer fibers |
US10980539B2 (en) | 2015-09-30 | 2021-04-20 | Ethicon Llc | Implantable adjunct comprising bonded layers |
US10022216B2 (en) * | 2015-12-07 | 2018-07-17 | Cable Fix LLC | Soft-tissue fixation device |
US10433891B2 (en) | 2015-12-07 | 2019-10-08 | Cable Fix LLC | Apparatus, system, and method for anchoring cable to bone |
US10327825B2 (en) | 2015-12-07 | 2019-06-25 | Cable Fix LLC | System and method for reducing and stabilizing fractures in bone, subluxations, or dislocations |
US20170156774A1 (en) | 2015-12-07 | 2017-06-08 | Cable Fix LLC | Washer for supporting cable relative to bone |
US10349996B2 (en) | 2015-12-07 | 2019-07-16 | Cable Fix LLC | Apparatus, system, and method for securing a tensioned cable through or around bone |
US10231769B2 (en) | 2015-12-07 | 2019-03-19 | Cable Fix LLC | Apparatus, system, and method for passing cable through a pass-through hole in bone |
US10368865B2 (en) | 2015-12-30 | 2019-08-06 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10265068B2 (en) | 2015-12-30 | 2019-04-23 | Ethicon Llc | Surgical instruments with separable motors and motor control circuits |
US10292704B2 (en) | 2015-12-30 | 2019-05-21 | Ethicon Llc | Mechanisms for compensating for battery pack failure in powered surgical instruments |
BR112018016098B1 (en) | 2016-02-09 | 2023-02-23 | Ethicon Llc | SURGICAL INSTRUMENT |
US11213293B2 (en) | 2016-02-09 | 2022-01-04 | Cilag Gmbh International | Articulatable surgical instruments with single articulation link arrangements |
US10433837B2 (en) | 2016-02-09 | 2019-10-08 | Ethicon Llc | Surgical instruments with multiple link articulation arrangements |
US10448948B2 (en) | 2016-02-12 | 2019-10-22 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10258331B2 (en) | 2016-02-12 | 2019-04-16 | Ethicon Llc | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US11224426B2 (en) | 2016-02-12 | 2022-01-18 | Cilag Gmbh International | Mechanisms for compensating for drivetrain failure in powered surgical instruments |
US10314582B2 (en) | 2016-04-01 | 2019-06-11 | Ethicon Llc | Surgical instrument comprising a shifting mechanism |
US10617413B2 (en) | 2016-04-01 | 2020-04-14 | Ethicon Llc | Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts |
US10357247B2 (en) | 2016-04-15 | 2019-07-23 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US11179150B2 (en) | 2016-04-15 | 2021-11-23 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US11607239B2 (en) | 2016-04-15 | 2023-03-21 | Cilag Gmbh International | Systems and methods for controlling a surgical stapling and cutting instrument |
US10405859B2 (en) | 2016-04-15 | 2019-09-10 | Ethicon Llc | Surgical instrument with adjustable stop/start control during a firing motion |
US10335145B2 (en) | 2016-04-15 | 2019-07-02 | Ethicon Llc | Modular surgical instrument with configurable operating mode |
US10492783B2 (en) | 2016-04-15 | 2019-12-03 | Ethicon, Llc | Surgical instrument with improved stop/start control during a firing motion |
US10456137B2 (en) | 2016-04-15 | 2019-10-29 | Ethicon Llc | Staple formation detection mechanisms |
US10828028B2 (en) | 2016-04-15 | 2020-11-10 | Ethicon Llc | Surgical instrument with multiple program responses during a firing motion |
US10426467B2 (en) | 2016-04-15 | 2019-10-01 | Ethicon Llc | Surgical instrument with detection sensors |
US11317917B2 (en) | 2016-04-18 | 2022-05-03 | Cilag Gmbh International | Surgical stapling system comprising a lockable firing assembly |
US10426469B2 (en) | 2016-04-18 | 2019-10-01 | Ethicon Llc | Surgical instrument comprising a primary firing lockout and a secondary firing lockout |
US20170296173A1 (en) | 2016-04-18 | 2017-10-19 | Ethicon Endo-Surgery, Llc | Method for operating a surgical instrument |
USD850617S1 (en) | 2016-06-24 | 2019-06-04 | Ethicon Llc | Surgical fastener cartridge |
CN109310431B (en) | 2016-06-24 | 2022-03-04 | 伊西康有限责任公司 | Staple cartridge comprising wire staples and punch staples |
USD847989S1 (en) | 2016-06-24 | 2019-05-07 | Ethicon Llc | Surgical fastener cartridge |
US11000278B2 (en) | 2016-06-24 | 2021-05-11 | Ethicon Llc | Staple cartridge comprising wire staples and stamped staples |
USD826405S1 (en) | 2016-06-24 | 2018-08-21 | Ethicon Llc | Surgical fastener |
US10213240B2 (en) | 2016-08-30 | 2019-02-26 | Cable Fix LLC | Deployable anchor for bone fixation |
US20180168648A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Durability features for end effectors and firing assemblies of surgical stapling instruments |
US11090048B2 (en) | 2016-12-21 | 2021-08-17 | Cilag Gmbh International | Method for resetting a fuse of a surgical instrument shaft |
US10888322B2 (en) | 2016-12-21 | 2021-01-12 | Ethicon Llc | Surgical instrument comprising a cutting member |
US10675025B2 (en) | 2016-12-21 | 2020-06-09 | Ethicon Llc | Shaft assembly comprising separately actuatable and retractable systems |
JP7010956B2 (en) | 2016-12-21 | 2022-01-26 | エシコン エルエルシー | How to staple tissue |
US10568625B2 (en) | 2016-12-21 | 2020-02-25 | Ethicon Llc | Staple cartridges and arrangements of staples and staple cavities therein |
US10856868B2 (en) | 2016-12-21 | 2020-12-08 | Ethicon Llc | Firing member pin configurations |
US20180168625A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Surgical stapling instruments with smart staple cartridges |
US10588630B2 (en) | 2016-12-21 | 2020-03-17 | Ethicon Llc | Surgical tool assemblies with closure stroke reduction features |
US10568624B2 (en) | 2016-12-21 | 2020-02-25 | Ethicon Llc | Surgical instruments with jaws that are pivotable about a fixed axis and include separate and distinct closure and firing systems |
US10426471B2 (en) | 2016-12-21 | 2019-10-01 | Ethicon Llc | Surgical instrument with multiple failure response modes |
US10610224B2 (en) | 2016-12-21 | 2020-04-07 | Ethicon Llc | Lockout arrangements for surgical end effectors and replaceable tool assemblies |
US11419606B2 (en) | 2016-12-21 | 2022-08-23 | Cilag Gmbh International | Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems |
US10695055B2 (en) | 2016-12-21 | 2020-06-30 | Ethicon Llc | Firing assembly comprising a lockout |
US20180168615A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument |
US11191540B2 (en) | 2016-12-21 | 2021-12-07 | Cilag Gmbh International | Protective cover arrangements for a joint interface between a movable jaw and actuator shaft of a surgical instrument |
US10945727B2 (en) | 2016-12-21 | 2021-03-16 | Ethicon Llc | Staple cartridge with deformable driver retention features |
US11684367B2 (en) | 2016-12-21 | 2023-06-27 | Cilag Gmbh International | Stepped assembly having and end-of-life indicator |
US11134942B2 (en) | 2016-12-21 | 2021-10-05 | Cilag Gmbh International | Surgical stapling instruments and staple-forming anvils |
US10687810B2 (en) | 2016-12-21 | 2020-06-23 | Ethicon Llc | Stepped staple cartridge with tissue retention and gap setting features |
US10993715B2 (en) | 2016-12-21 | 2021-05-04 | Ethicon Llc | Staple cartridge comprising staples with different clamping breadths |
MX2019007311A (en) | 2016-12-21 | 2019-11-18 | Ethicon Llc | Surgical stapling systems. |
JP6983893B2 (en) | 2016-12-21 | 2021-12-17 | エシコン エルエルシーEthicon LLC | Lockout configuration for surgical end effectors and replaceable tool assemblies |
US20180168598A1 (en) | 2016-12-21 | 2018-06-21 | Ethicon Endo-Surgery, Llc | Staple forming pocket arrangements comprising zoned forming surface grooves |
US11071554B2 (en) | 2017-06-20 | 2021-07-27 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements |
US10779820B2 (en) | 2017-06-20 | 2020-09-22 | Ethicon Llc | Systems and methods for controlling motor speed according to user input for a surgical instrument |
US10646220B2 (en) | 2017-06-20 | 2020-05-12 | Ethicon Llc | Systems and methods for controlling displacement member velocity for a surgical instrument |
US10881399B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument |
US10327767B2 (en) | 2017-06-20 | 2019-06-25 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
USD890784S1 (en) | 2017-06-20 | 2020-07-21 | Ethicon Llc | Display panel with changeable graphical user interface |
US10624633B2 (en) | 2017-06-20 | 2020-04-21 | Ethicon Llc | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument |
US10390841B2 (en) | 2017-06-20 | 2019-08-27 | Ethicon Llc | Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation |
US10307170B2 (en) | 2017-06-20 | 2019-06-04 | Ethicon Llc | Method for closed loop control of motor velocity of a surgical stapling and cutting instrument |
US10368864B2 (en) | 2017-06-20 | 2019-08-06 | Ethicon Llc | Systems and methods for controlling displaying motor velocity for a surgical instrument |
USD879808S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with graphical user interface |
US11090046B2 (en) | 2017-06-20 | 2021-08-17 | Cilag Gmbh International | Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument |
US10881396B2 (en) | 2017-06-20 | 2021-01-05 | Ethicon Llc | Surgical instrument with variable duration trigger arrangement |
US11517325B2 (en) | 2017-06-20 | 2022-12-06 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval |
US11653914B2 (en) | 2017-06-20 | 2023-05-23 | Cilag Gmbh International | Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector |
US10813639B2 (en) | 2017-06-20 | 2020-10-27 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions |
USD879809S1 (en) | 2017-06-20 | 2020-03-31 | Ethicon Llc | Display panel with changeable graphical user interface |
US10888321B2 (en) | 2017-06-20 | 2021-01-12 | Ethicon Llc | Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument |
US10980537B2 (en) | 2017-06-20 | 2021-04-20 | Ethicon Llc | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations |
US11382638B2 (en) | 2017-06-20 | 2022-07-12 | Cilag Gmbh International | Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance |
US11324503B2 (en) | 2017-06-27 | 2022-05-10 | Cilag Gmbh International | Surgical firing member arrangements |
US10856869B2 (en) | 2017-06-27 | 2020-12-08 | Ethicon Llc | Surgical anvil arrangements |
US10631859B2 (en) | 2017-06-27 | 2020-04-28 | Ethicon Llc | Articulation systems for surgical instruments |
US10772629B2 (en) | 2017-06-27 | 2020-09-15 | Ethicon Llc | Surgical anvil arrangements |
US10993716B2 (en) | 2017-06-27 | 2021-05-04 | Ethicon Llc | Surgical anvil arrangements |
US11266405B2 (en) | 2017-06-27 | 2022-03-08 | Cilag Gmbh International | Surgical anvil manufacturing methods |
USD851762S1 (en) | 2017-06-28 | 2019-06-18 | Ethicon Llc | Anvil |
US11259805B2 (en) | 2017-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical instrument comprising firing member supports |
US10903685B2 (en) | 2017-06-28 | 2021-01-26 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies forming capacitive channels |
US10211586B2 (en) | 2017-06-28 | 2019-02-19 | Ethicon Llc | Surgical shaft assemblies with watertight housings |
US11564686B2 (en) | 2017-06-28 | 2023-01-31 | Cilag Gmbh International | Surgical shaft assemblies with flexible interfaces |
US11246592B2 (en) | 2017-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical instrument comprising an articulation system lockable to a frame |
US10765427B2 (en) | 2017-06-28 | 2020-09-08 | Ethicon Llc | Method for articulating a surgical instrument |
US20190000461A1 (en) | 2017-06-28 | 2019-01-03 | Ethicon Llc | Surgical cutting and fastening devices with pivotable anvil with a tissue locating arrangement in close proximity to an anvil pivot axis |
USD854151S1 (en) | 2017-06-28 | 2019-07-16 | Ethicon Llc | Surgical instrument shaft |
US11678880B2 (en) | 2017-06-28 | 2023-06-20 | Cilag Gmbh International | Surgical instrument comprising a shaft including a housing arrangement |
US10716614B2 (en) | 2017-06-28 | 2020-07-21 | Ethicon Llc | Surgical shaft assemblies with slip ring assemblies with increased contact pressure |
EP4070740A1 (en) | 2017-06-28 | 2022-10-12 | Cilag GmbH International | Surgical instrument comprising selectively actuatable rotatable couplers |
USD869655S1 (en) | 2017-06-28 | 2019-12-10 | Ethicon Llc | Surgical fastener cartridge |
USD906355S1 (en) | 2017-06-28 | 2020-12-29 | Ethicon Llc | Display screen or portion thereof with a graphical user interface for a surgical instrument |
US10932772B2 (en) | 2017-06-29 | 2021-03-02 | Ethicon Llc | Methods for closed loop velocity control for robotic surgical instrument |
US10258418B2 (en) | 2017-06-29 | 2019-04-16 | Ethicon Llc | System for controlling articulation forces |
US10398434B2 (en) | 2017-06-29 | 2019-09-03 | Ethicon Llc | Closed loop velocity control of closure member for robotic surgical instrument |
US11007022B2 (en) | 2017-06-29 | 2021-05-18 | Ethicon Llc | Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument |
US10898183B2 (en) | 2017-06-29 | 2021-01-26 | Ethicon Llc | Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing |
US11471155B2 (en) | 2017-08-03 | 2022-10-18 | Cilag Gmbh International | Surgical system bailout |
US11944300B2 (en) | 2017-08-03 | 2024-04-02 | Cilag Gmbh International | Method for operating a surgical system bailout |
US11304695B2 (en) | 2017-08-03 | 2022-04-19 | Cilag Gmbh International | Surgical system shaft interconnection |
US10743872B2 (en) | 2017-09-29 | 2020-08-18 | Ethicon Llc | System and methods for controlling a display of a surgical instrument |
US10765429B2 (en) | 2017-09-29 | 2020-09-08 | Ethicon Llc | Systems and methods for providing alerts according to the operational state of a surgical instrument |
USD907648S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD907647S1 (en) | 2017-09-29 | 2021-01-12 | Ethicon Llc | Display screen or portion thereof with animated graphical user interface |
USD917500S1 (en) | 2017-09-29 | 2021-04-27 | Ethicon Llc | Display screen or portion thereof with graphical user interface |
US11399829B2 (en) | 2017-09-29 | 2022-08-02 | Cilag Gmbh International | Systems and methods of initiating a power shutdown mode for a surgical instrument |
US10796471B2 (en) | 2017-09-29 | 2020-10-06 | Ethicon Llc | Systems and methods of displaying a knife position for a surgical instrument |
US10729501B2 (en) | 2017-09-29 | 2020-08-04 | Ethicon Llc | Systems and methods for language selection of a surgical instrument |
US11134944B2 (en) | 2017-10-30 | 2021-10-05 | Cilag Gmbh International | Surgical stapler knife motion controls |
US11090075B2 (en) | 2017-10-30 | 2021-08-17 | Cilag Gmbh International | Articulation features for surgical end effector |
US10842490B2 (en) | 2017-10-31 | 2020-11-24 | Ethicon Llc | Cartridge body design with force reduction based on firing completion |
US10779903B2 (en) | 2017-10-31 | 2020-09-22 | Ethicon Llc | Positive shaft rotation lock activated by jaw closure |
US10687813B2 (en) | 2017-12-15 | 2020-06-23 | Ethicon Llc | Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments |
US10779826B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Methods of operating surgical end effectors |
US11071543B2 (en) | 2017-12-15 | 2021-07-27 | Cilag Gmbh International | Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges |
US11197670B2 (en) | 2017-12-15 | 2021-12-14 | Cilag Gmbh International | Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed |
US11006955B2 (en) | 2017-12-15 | 2021-05-18 | Ethicon Llc | End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments |
US10779825B2 (en) | 2017-12-15 | 2020-09-22 | Ethicon Llc | Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments |
US10869666B2 (en) | 2017-12-15 | 2020-12-22 | Ethicon Llc | Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument |
US10743874B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Sealed adapters for use with electromechanical surgical instruments |
US10743875B2 (en) | 2017-12-15 | 2020-08-18 | Ethicon Llc | Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member |
US10966718B2 (en) | 2017-12-15 | 2021-04-06 | Ethicon Llc | Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments |
US10828033B2 (en) | 2017-12-15 | 2020-11-10 | Ethicon Llc | Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto |
US11033267B2 (en) | 2017-12-15 | 2021-06-15 | Ethicon Llc | Systems and methods of controlling a clamping member firing rate of a surgical instrument |
US10835330B2 (en) | 2017-12-19 | 2020-11-17 | Ethicon Llc | Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly |
USD910847S1 (en) | 2017-12-19 | 2021-02-16 | Ethicon Llc | Surgical instrument assembly |
US11045270B2 (en) | 2017-12-19 | 2021-06-29 | Cilag Gmbh International | Robotic attachment comprising exterior drive actuator |
US10729509B2 (en) | 2017-12-19 | 2020-08-04 | Ethicon Llc | Surgical instrument comprising closure and firing locking mechanism |
US11020112B2 (en) | 2017-12-19 | 2021-06-01 | Ethicon Llc | Surgical tools configured for interchangeable use with different controller interfaces |
US10716565B2 (en) | 2017-12-19 | 2020-07-21 | Ethicon Llc | Surgical instruments with dual articulation drivers |
US11129680B2 (en) | 2017-12-21 | 2021-09-28 | Cilag Gmbh International | Surgical instrument comprising a projector |
US11076853B2 (en) | 2017-12-21 | 2021-08-03 | Cilag Gmbh International | Systems and methods of displaying a knife position during transection for a surgical instrument |
US11337691B2 (en) | 2017-12-21 | 2022-05-24 | Cilag Gmbh International | Surgical instrument configured to determine firing path |
US11311290B2 (en) | 2017-12-21 | 2022-04-26 | Cilag Gmbh International | Surgical instrument comprising an end effector dampener |
US10779821B2 (en) | 2018-08-20 | 2020-09-22 | Ethicon Llc | Surgical stapler anvils with tissue stop features configured to avoid tissue pinch |
US11039834B2 (en) | 2018-08-20 | 2021-06-22 | Cilag Gmbh International | Surgical stapler anvils with staple directing protrusions and tissue stability features |
US11253256B2 (en) | 2018-08-20 | 2022-02-22 | Cilag Gmbh International | Articulatable motor powered surgical instruments with dedicated articulation motor arrangements |
US11045192B2 (en) | 2018-08-20 | 2021-06-29 | Cilag Gmbh International | Fabricating techniques for surgical stapler anvils |
US11083458B2 (en) | 2018-08-20 | 2021-08-10 | Cilag Gmbh International | Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions |
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US11291440B2 (en) | 2018-08-20 | 2022-04-05 | Cilag Gmbh International | Method for operating a powered articulatable surgical instrument |
USD914878S1 (en) | 2018-08-20 | 2021-03-30 | Ethicon Llc | Surgical instrument anvil |
US10842492B2 (en) | 2018-08-20 | 2020-11-24 | Ethicon Llc | Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system |
US10912559B2 (en) | 2018-08-20 | 2021-02-09 | Ethicon Llc | Reinforced deformable anvil tip for surgical stapler anvil |
US10856870B2 (en) | 2018-08-20 | 2020-12-08 | Ethicon Llc | Switching arrangements for motor powered articulatable surgical instruments |
US11207065B2 (en) | 2018-08-20 | 2021-12-28 | Cilag Gmbh International | Method for fabricating surgical stapler anvils |
US11344297B2 (en) * | 2019-02-28 | 2022-05-31 | Covidien Lp | Surgical stapling device with independently movable jaws |
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US11172929B2 (en) | 2019-03-25 | 2021-11-16 | Cilag Gmbh International | Articulation drive arrangements for surgical systems |
US11696761B2 (en) | 2019-03-25 | 2023-07-11 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11147553B2 (en) | 2019-03-25 | 2021-10-19 | Cilag Gmbh International | Firing drive arrangements for surgical systems |
US11432816B2 (en) | 2019-04-30 | 2022-09-06 | Cilag Gmbh International | Articulation pin for a surgical instrument |
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US11648009B2 (en) | 2019-04-30 | 2023-05-16 | Cilag Gmbh International | Rotatable jaw tip for a surgical instrument |
US11452528B2 (en) | 2019-04-30 | 2022-09-27 | Cilag Gmbh International | Articulation actuators for a surgical instrument |
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US11638587B2 (en) | 2019-06-28 | 2023-05-02 | Cilag Gmbh International | RFID identification systems for surgical instruments |
US11298127B2 (en) | 2019-06-28 | 2022-04-12 | Cilag GmbH Interational | Surgical stapling system having a lockout mechanism for an incompatible cartridge |
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US11497492B2 (en) | 2019-06-28 | 2022-11-15 | Cilag Gmbh International | Surgical instrument including an articulation lock |
US11426167B2 (en) | 2019-06-28 | 2022-08-30 | Cilag Gmbh International | Mechanisms for proper anvil attachment surgical stapling head assembly |
US11376098B2 (en) | 2019-06-28 | 2022-07-05 | Cilag Gmbh International | Surgical instrument system comprising an RFID system |
US11771419B2 (en) | 2019-06-28 | 2023-10-03 | Cilag Gmbh International | Packaging for a replaceable component of a surgical stapling system |
US11399837B2 (en) | 2019-06-28 | 2022-08-02 | Cilag Gmbh International | Mechanisms for motor control adjustments of a motorized surgical instrument |
US11051807B2 (en) | 2019-06-28 | 2021-07-06 | Cilag Gmbh International | Packaging assembly including a particulate trap |
US11224497B2 (en) | 2019-06-28 | 2022-01-18 | Cilag Gmbh International | Surgical systems with multiple RFID tags |
US11291451B2 (en) | 2019-06-28 | 2022-04-05 | Cilag Gmbh International | Surgical instrument with battery compatibility verification functionality |
US11246678B2 (en) | 2019-06-28 | 2022-02-15 | Cilag Gmbh International | Surgical stapling system having a frangible RFID tag |
US11553971B2 (en) | 2019-06-28 | 2023-01-17 | Cilag Gmbh International | Surgical RFID assemblies for display and communication |
US11219455B2 (en) | 2019-06-28 | 2022-01-11 | Cilag Gmbh International | Surgical instrument including a lockout key |
US11464601B2 (en) | 2019-06-28 | 2022-10-11 | Cilag Gmbh International | Surgical instrument comprising an RFID system for tracking a movable component |
US11627959B2 (en) | 2019-06-28 | 2023-04-18 | Cilag Gmbh International | Surgical instruments including manual and powered system lockouts |
US11523822B2 (en) | 2019-06-28 | 2022-12-13 | Cilag Gmbh International | Battery pack including a circuit interrupter |
US11241235B2 (en) | 2019-06-28 | 2022-02-08 | Cilag Gmbh International | Method of using multiple RFID chips with a surgical assembly |
US11259803B2 (en) | 2019-06-28 | 2022-03-01 | Cilag Gmbh International | Surgical stapling system having an information encryption protocol |
US11684434B2 (en) | 2019-06-28 | 2023-06-27 | Cilag Gmbh International | Surgical RFID assemblies for instrument operational setting control |
US11607219B2 (en) | 2019-12-19 | 2023-03-21 | Cilag Gmbh International | Staple cartridge comprising a detachable tissue cutting knife |
US11291447B2 (en) | 2019-12-19 | 2022-04-05 | Cilag Gmbh International | Stapling instrument comprising independent jaw closing and staple firing systems |
US11701111B2 (en) | 2019-12-19 | 2023-07-18 | Cilag Gmbh International | Method for operating a surgical stapling instrument |
US11911032B2 (en) | 2019-12-19 | 2024-02-27 | Cilag Gmbh International | Staple cartridge comprising a seating cam |
US11504122B2 (en) | 2019-12-19 | 2022-11-22 | Cilag Gmbh International | Surgical instrument comprising a nested firing member |
US11931033B2 (en) | 2019-12-19 | 2024-03-19 | Cilag Gmbh International | Staple cartridge comprising a latch lockout |
US11844520B2 (en) | 2019-12-19 | 2023-12-19 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11234698B2 (en) | 2019-12-19 | 2022-02-01 | Cilag Gmbh International | Stapling system comprising a clamp lockout and a firing lockout |
US11529139B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Motor driven surgical instrument |
US11464512B2 (en) | 2019-12-19 | 2022-10-11 | Cilag Gmbh International | Staple cartridge comprising a curved deck surface |
US11304696B2 (en) | 2019-12-19 | 2022-04-19 | Cilag Gmbh International | Surgical instrument comprising a powered articulation system |
US11446029B2 (en) | 2019-12-19 | 2022-09-20 | Cilag Gmbh International | Staple cartridge comprising projections extending from a curved deck surface |
US11529137B2 (en) | 2019-12-19 | 2022-12-20 | Cilag Gmbh International | Staple cartridge comprising driver retention members |
US11576672B2 (en) | 2019-12-19 | 2023-02-14 | Cilag Gmbh International | Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw |
US11559304B2 (en) | 2019-12-19 | 2023-01-24 | Cilag Gmbh International | Surgical instrument comprising a rapid closure mechanism |
EP4158207A1 (en) | 2020-05-28 | 2023-04-05 | Milwaukee Electric Tool Corporation | Insulated staple and staple collation |
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USD974560S1 (en) | 2020-06-02 | 2023-01-03 | Cilag Gmbh International | Staple cartridge |
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USD980051S1 (en) * | 2020-10-15 | 2023-03-07 | Milwaukee Electric Tool Corporation | Staple |
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USD980425S1 (en) | 2020-10-29 | 2023-03-07 | Cilag Gmbh International | Surgical instrument assembly |
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USD1013170S1 (en) | 2020-10-29 | 2024-01-30 | Cilag Gmbh International | Surgical instrument assembly |
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US11737751B2 (en) | 2020-12-02 | 2023-08-29 | Cilag Gmbh International | Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings |
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US11678882B2 (en) | 2020-12-02 | 2023-06-20 | Cilag Gmbh International | Surgical instruments with interactive features to remedy incidental sled movements |
US11744581B2 (en) | 2020-12-02 | 2023-09-05 | Cilag Gmbh International | Powered surgical instruments with multi-phase tissue treatment |
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US11627960B2 (en) | 2020-12-02 | 2023-04-18 | Cilag Gmbh International | Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections |
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US11890010B2 (en) | 2020-12-02 | 2024-02-06 | Cllag GmbH International | Dual-sided reinforced reload for surgical instruments |
US11730473B2 (en) | 2021-02-26 | 2023-08-22 | Cilag Gmbh International | Monitoring of manufacturing life-cycle |
US11749877B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Stapling instrument comprising a signal antenna |
US11751869B2 (en) | 2021-02-26 | 2023-09-12 | Cilag Gmbh International | Monitoring of multiple sensors over time to detect moving characteristics of tissue |
US11696757B2 (en) | 2021-02-26 | 2023-07-11 | Cilag Gmbh International | Monitoring of internal systems to detect and track cartridge motion status |
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US11925349B2 (en) | 2021-02-26 | 2024-03-12 | Cilag Gmbh International | Adjustment to transfer parameters to improve available power |
US11812964B2 (en) | 2021-02-26 | 2023-11-14 | Cilag Gmbh International | Staple cartridge comprising a power management circuit |
US11950777B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Staple cartridge comprising an information access control system |
US11723657B2 (en) | 2021-02-26 | 2023-08-15 | Cilag Gmbh International | Adjustable communication based on available bandwidth and power capacity |
US11950779B2 (en) | 2021-02-26 | 2024-04-09 | Cilag Gmbh International | Method of powering and communicating with a staple cartridge |
US11701113B2 (en) | 2021-02-26 | 2023-07-18 | Cilag Gmbh International | Stapling instrument comprising a separate power antenna and a data transfer antenna |
US11744583B2 (en) | 2021-02-26 | 2023-09-05 | Cilag Gmbh International | Distal communication array to tune frequency of RF systems |
US11826012B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising a pulsed motor-driven firing rack |
US11723658B2 (en) | 2021-03-22 | 2023-08-15 | Cilag Gmbh International | Staple cartridge comprising a firing lockout |
US11737749B2 (en) | 2021-03-22 | 2023-08-29 | Cilag Gmbh International | Surgical stapling instrument comprising a retraction system |
US11826042B2 (en) | 2021-03-22 | 2023-11-28 | Cilag Gmbh International | Surgical instrument comprising a firing drive including a selectable leverage mechanism |
US11806011B2 (en) | 2021-03-22 | 2023-11-07 | Cilag Gmbh International | Stapling instrument comprising tissue compression systems |
US11717291B2 (en) | 2021-03-22 | 2023-08-08 | Cilag Gmbh International | Staple cartridge comprising staples configured to apply different tissue compression |
US11759202B2 (en) | 2021-03-22 | 2023-09-19 | Cilag Gmbh International | Staple cartridge comprising an implantable layer |
US11896218B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Method of using a powered stapling device |
US11786243B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Firing members having flexible portions for adapting to a load during a surgical firing stroke |
US11832816B2 (en) | 2021-03-24 | 2023-12-05 | Cilag Gmbh International | Surgical stapling assembly comprising nonplanar staples and planar staples |
US11744603B2 (en) | 2021-03-24 | 2023-09-05 | Cilag Gmbh International | Multi-axis pivot joints for surgical instruments and methods for manufacturing same |
US11857183B2 (en) | 2021-03-24 | 2024-01-02 | Cilag Gmbh International | Stapling assembly components having metal substrates and plastic bodies |
US11896219B2 (en) | 2021-03-24 | 2024-02-13 | Cilag Gmbh International | Mating features between drivers and underside of a cartridge deck |
US11903582B2 (en) | 2021-03-24 | 2024-02-20 | Cilag Gmbh International | Leveraging surfaces for cartridge installation |
US11849945B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Rotary-driven surgical stapling assembly comprising eccentrically driven firing member |
US11849944B2 (en) | 2021-03-24 | 2023-12-26 | Cilag Gmbh International | Drivers for fastener cartridge assemblies having rotary drive screws |
US11786239B2 (en) | 2021-03-24 | 2023-10-17 | Cilag Gmbh International | Surgical instrument articulation joint arrangements comprising multiple moving linkage features |
US11793516B2 (en) | 2021-03-24 | 2023-10-24 | Cilag Gmbh International | Surgical staple cartridge comprising longitudinal support beam |
US11944336B2 (en) | 2021-03-24 | 2024-04-02 | Cilag Gmbh International | Joint arrangements for multi-planar alignment and support of operational drive shafts in articulatable surgical instruments |
US11826047B2 (en) | 2021-05-28 | 2023-11-28 | Cilag Gmbh International | Stapling instrument comprising jaw mounts |
US11877745B2 (en) | 2021-10-18 | 2024-01-23 | Cilag Gmbh International | Surgical stapling assembly having longitudinally-repeating staple leg clusters |
US11957337B2 (en) | 2021-10-18 | 2024-04-16 | Cilag Gmbh International | Surgical stapling assembly with offset ramped drive surfaces |
US11937816B2 (en) | 2021-10-28 | 2024-03-26 | Cilag Gmbh International | Electrical lead arrangements for surgical instruments |
Family Cites Families (42)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US579831A (en) * | 1897-03-30 | Button | ||
US389660A (en) * | 1888-09-18 | Metallic fastener | ||
US27391A (en) * | 1860-03-06 | Washing-machine | ||
US306479A (en) * | 1884-10-14 | Chables y | ||
CH82738A (en) * | 1919-01-23 | 1919-10-16 | Marius Piguet | Tools for marking livestock |
FR743282A (en) * | 1932-09-21 | 1933-03-25 | ||
US1988233A (en) * | 1933-08-09 | 1935-01-15 | Berendt Alfred | Button fastener |
US2794981A (en) * | 1953-03-19 | 1957-06-11 | Ind Dev Corp | Machine for applying eye fasteners |
US2897561A (en) * | 1954-11-10 | 1959-08-04 | Megibow Charles | Fastener |
US2881762A (en) * | 1955-02-09 | 1959-04-14 | Robert J Lowrie | Surgical staple and stapler |
US2900696A (en) * | 1956-02-27 | 1959-08-25 | John H Bacon | Dog collar or the like |
US3009852A (en) * | 1960-01-22 | 1961-11-21 | Walter L Gruner | Plastic tag and applying tongs therefor |
GB972731A (en) * | 1961-05-31 | 1964-10-14 | Mihaly Gerendas | Improvements in or relating to artery clamps |
US3166072A (en) * | 1962-10-22 | 1965-01-19 | Jr John T Sullivan | Barbed clips |
FR1385691A (en) * | 1963-12-19 | 1965-01-15 | Animal identification mark | |
US3326217A (en) * | 1964-04-27 | 1967-06-20 | Kerr Harry Sydney | Hemostatic clamp |
US3210820A (en) * | 1964-05-26 | 1965-10-12 | Scovill Manufacturing Co | One-way snap fastener combination |
US3357296A (en) * | 1965-05-14 | 1967-12-12 | Keuneth W Lefever | Staple fastener |
US3494006A (en) * | 1968-01-12 | 1970-02-10 | George C Brumlik | Self-gripping fastening device |
US3570497A (en) * | 1969-01-16 | 1971-03-16 | Gerald M Lemole | Suture apparatus and methods |
US3577601A (en) * | 1969-03-12 | 1971-05-04 | Thomas & Betts Corp | Article fastening device |
US3744495A (en) * | 1970-01-02 | 1973-07-10 | M Johnson | Method of securing prolapsed vagina in cattle |
FR2084475A5 (en) * | 1970-03-16 | 1971-12-17 | Brumlik George | |
US3683927A (en) * | 1970-08-18 | 1972-08-15 | United States Surgical Corp | Method and cartridge for ligating organic tubular structures |
USRE27391E (en) | 1970-10-12 | 1972-06-20 | Connector for holding articles together | |
US3802438A (en) * | 1972-03-31 | 1974-04-09 | Technibiotics | Surgical instrument |
US3875648A (en) * | 1973-04-04 | 1975-04-08 | Dennison Mfg Co | Fastener attachment apparatus and method |
US3857396A (en) * | 1973-08-22 | 1974-12-31 | C Hardwick | Suture clamp |
US3879783A (en) * | 1974-02-11 | 1975-04-29 | Minnesota Mining & Mfg | Paper binding machine |
US4038725A (en) * | 1975-03-20 | 1977-08-02 | Monarch Marking Systems, Inc. | Fastener and method of using same |
US4006747A (en) * | 1975-04-23 | 1977-02-08 | Ethicon, Inc. | Surgical method |
US4060089A (en) * | 1975-09-03 | 1977-11-29 | United States Surgical Corporation | Surgical fastening method and device therefor |
JPS541115A (en) * | 1977-06-03 | 1979-01-06 | Takeo Aoki | Delivered transparent adhesive tape printer |
US4294255A (en) * | 1978-04-17 | 1981-10-13 | Andre Geroc | Intraluminal anastomosis |
US4235238A (en) * | 1978-05-11 | 1980-11-25 | Olympus Optical Co., Ltd. | Apparatus for suturing coeliac tissues |
JPS5542626A (en) * | 1978-09-20 | 1980-03-26 | Olympus Optical Co | Blocking device of coelom inside tubular portion |
US4259959A (en) * | 1978-12-20 | 1981-04-07 | Walker Wesley W | Suturing element |
CA1097171A (en) * | 1979-02-07 | 1981-03-10 | Frank Judickas | Ear piercing tool, method and insert |
US4400833A (en) * | 1981-06-10 | 1983-08-30 | Kurland Kenneth Z | Means and method of implanting bioprosthetics |
AU548370B2 (en) * | 1981-10-08 | 1985-12-05 | United States Surgical Corporation | Surgical fastener |
US4513746A (en) * | 1981-10-09 | 1985-04-30 | United States Surgical Corp. | Instrument for applying plastic-like surgical fastening devices |
US4454875A (en) * | 1982-04-15 | 1984-06-19 | Techmedica, Inc. | Osteal medical staple |
-
1983
- 1983-06-20 US US06/506,151 patent/US4573469A/en not_active Expired - Lifetime
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1984
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- 1984-06-18 JP JP59123886A patent/JPS6012046A/en active Granted
- 1984-06-19 ZA ZA844641A patent/ZA844641B/en unknown
- 1984-06-19 EP EP84304132A patent/EP0129441B1/en not_active Expired
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JPH0380018B2 (en) | 1991-12-20 |
DE3467501D1 (en) | 1987-12-23 |
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BR8403004A (en) | 1985-05-28 |
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