CA2126279A1 - Endoscopic surgical instrument with pivotable and rotatable staple cartridge - Google Patents

Abstract

ABSTRACT OF THE DISCLOSURE

A surgical instrument is provided which is insertable through an endoscopic tube to enable a surgeon to perform a surgical technique inside a body cavity. The surgical instrument includes a shaft with a pivotally mounted tip attached thereto, the shaft extending from a handle for gripping the instrument for insertion to the body cavity.
The tip of the shaft is adjustable to different angular orientations relative to the support shaft and is rotatable at any angular orientation of the tip. The support shaft may be rotatable about its longitudinal axis relative to the handle, or it may be fixed with respect to the handle, in which case the handle may be rotated to rotate the shaft inside the body cavity. In one embodiment, the surgical instrument comprises an endoscopic stapling device and the tip of the instrument comprises a staple cartridge which is rotatable 360° about its axes after the cartridge has been articulated with respect to the support shaft. An improved device for articulating the shaft tip is also provided in which a control knob is mounted to the support shaft for providing sweeping articulation of the shaft tip. Separate actuator mechanisms are provided on the handle to control the pivotal movement of the shaft tip, as well as the rotation of the shaft tip and the rotation of the support shaft.

Description

~ - 212~27~

ATTORNEY DOCKET NO. END-71 ~DOSCOPIC S~RGICAh I~STRnM~NT WIT~ PIVOTA~
AND ROTATABL~ ST~P~E CARTRIDG~
This application i8 a continuation-in-part of Serial ;
No. 959,184, filed October 9, 1992, entitled "Endoscopic Surgical Instrument with Pivotable and Rotatable Staple Cartridge", Attorney Docket No. END-26.

FIE~D OF THE INVENTION
This invention relates to surgical instruments having ',!, ~,,,.,.,~
an articulating end pivotally connected to a shaft, wherein~
the articulating end may be rotated about a longitudinal axis over a plurality of angles of articulation with '~
respect to the longitudinal axis of the shaft. More specifically, the present invention relates to endoscopic -instruments such as a sur~ical ~tapling instrument for applying surgical staples to internal body tissue and, more 0 particularIy, to a surgical stapler which can be used ;
endoscopically for the repair of herniag. Mogt p"".!~ ;1"~
specifically, this invention relates to an endoYcopic surgical stapling instrument including a staple cartridge which is pivotally and rotatably mounted to allow the ~ii ~L5 ~surgical staples to be applied to the internal body tissue in any desired orientation. Additionally, the present , invention relates to an improved mechanism for providing articulation to the articulating end of the instrument. ?"~";~ ;"
~ACRGROUND OP THE INVENTI~)N AND PRIOR ART
~0~ With the proliferation of endoscopic surgery, it has been realized that there are many ~procedures typically pexformed in open surgery which can be performed e~dosc~pically. In endoscopic surgery, a trocar, which is - ~ 2 ~ 2 ~ 2 7 9 .. "~ ~ .

a pointed piercing device, ic inserted in~:o the body with a cannula placed around the trocar. After the trocar pierce~ the body cavity walls, it is removed and the cannula remains in the body. Through this cannula, endo~copic procedures can be conducted. ~ Generally, the endoscopic procedures are performed under insufflation.
Some of the more typical endoscopic procedures have included gall bladder removal, tissue repair, and sterilization procedures such a~ occluding of fallopian tubes.
~ Surgeons realize that it may be possible to perfonm additional procedures endoscopically, once the proper materials and mechanisms become available for perfonming these procedures. One of che more basic, and quite logical extensions of current endoscopic procedures has been focused on the repair of hernias. It i~ realized that to have the capability of performing hernia repair endoscopically will benefit the medical community in many ways-. Specifically, it is realized that endoscopic hernia repair will allow the patient to recuperate more rapidly, and without the more than likely extensive physical therapy currently practiced as a result of a hernia repair performed by open surgery.
Moreover, it is realized that hernia repair procedures may contain aspects which are applicable in other procedures. For instance, if it i9 possible to cover, or reinforce and constrain a hernia, it may be possible to apply this procedure to other vessels or organs, in a similar manner. Also, it is realized that once a device becomes available wherein hernias can be repaired, many of the functional components of the hernia repair device will be useful in other devices capable of performing other '-. .

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procedures. Al~o, naturally, these mechanisms may be useful for procedures in which ope~ surgery is performed. ;.~
I~ re~pon~e to the above described need~, a number of '~' '~'~ ~ "'. ~'",''!
surgical in~truments have been developed for use in endoscopic stapling procedures. One such device, copending U.S. Patent Application Serial No. 759,014, filed :
September 12, 1991, Attorney Docket No. SEN-83, expressly - .
incorporated in its entirety by reference herein, di~clo~es a surgical stapler having a rigid, rotatable shaft O containing a stack of staples aligned in a horizontal plane :.. -::.;.
with respect to the shaft. This mechanism has proven quite ;- : -effective in performing endoscopic surgical procedures; it .-. .
does not, however, offer means for articulating the tip of ~'~',~''',','',~"G!~
the shaft containing the staples in lesponse ~o a surgeon's .5 need to alter the orientation of the device once it has been inseted into the patient. .:,.i 2.
Copending U.S. Patent Application Serial No. 959,184 .
(END-26), also expressly incorporated in its entirety by ~: reference herein,. di~clo~es an endoscopic surgical device .. i .`
:0 which includes an articulating tip allowing the surgeon to : ~"- ~ -.
articulate a staple cartridge after the device has been .
in~erted.into.. the patient. The.staple cartridge includes .
a stack of staples oriented in a vertical plane, which allows for a more efficient packing of staples in the Although the articulation device of the aforedescribed application i9~ effective in providing articulation of the tip of the shaft, it is limated to providing a ~'!''''.. ~,'~
: predetermined number of angles of articulation by use of a :10 ratchet mechanism. Occasionally, the ratchet mechanism may .. ~. ' bind and become difficult to operate smoothly. . .~.~ .`.
~: : It would, therefore, ~be useful to provide an endoscopic surgical instrument that i9 capable of having an - - 2~2~

articulatable tip that could be rotaLted about its longitudinal axi~ in a plurality of angles of articulation with re~pect to the shaft. Additionally, a significant advance in the art would be realized if a new articulation S device could be developed to better ~olve ~he aforementioned problems of ratchet-type articulation.
SUMMARY OF THE INVENTION
Accordingly, it is an object of the present invention to provide an endoscopic surgical stapler for applying staples to secure a hernia repair patch to internal body tissue.
Another object of the invention is to provide an endoscopic surgical stapler including a staple cartridge which is pivotally and rotatably mounted to allow ~he lS staples to be fastened to the tissue in any desired orientation.
It is also an object of the invention to provide an endoscopic surgical stapling instrument in which the pivotaL ~oveme~t and rotation-of- the staple ca~tridge ca~
be controlled from a remote actuator handle assembly.
It is another object of the invention to provide an endoscopic surgical stapling instrument whi~h facilitate~
manipulation by a surgeon to control the orientation and actuation of the etaple cartridge.
A further object of the invention is to provide a staple cartridge for use with a surgical stapling instrument which includes an improved staple forming mechanism for advancing the staples one at a time into engagement with an anvil about which the staple i9 formed to secure the staple to the tissue.
Yet another object of the invention is to provide an endoscopic surgical instrument having an articulatable tip, which tip may be rotated 360 about its axis after the tip . . ,, ~ . .

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,, .. ;., has been articulated with respect to the longitudinal axi0 of the ~haft to which it is pivotally co~nected.
It is still another object of the invention to provide a retrofittable device for use on existing articulatable endoscopic surgical instrument~ for providing the aforedescribed 360 rotation of the tip of the device after articulation.
It i9 still a further object of the invention to provide a mechanism for smooth~y articulating the tip of .0 the instrument in a sweeping, as opposed to a ratcheting, motion.
The aforedescribed objects are satisfied with the pre~ent invention, which includes a device for providing rotational motion to the di~tal end of any surgical .5 instrument having a shaft for introducing surgical apparatus to a patent. The shaft of the instrument includes an : articulatable tip which, as previously described, may be rotated about its axis after the tip ha been artic~lated with re~pect to the shaft long-itudinal '0 axis. Surgical apparatus which may be used in connection with the shaft include cannula~, cameras,~ staplers, ligation devices,. forceps, drills, suction devices, insulation devices, cutting devices, scalpel devices, clamps, absorption devices, injection devices, drainage ~5 devices, lasers~, cryogenic devices, sonic devices, illuminatio~ devices, and stitching devices. In the aforedescribed surgical in~truments, devices similar to those previously described are emp~oyed to provide the desired rotational movement of the articulatable tip of the surgical instrument shaft.
In another embodiment of the invention, the invention is adapted to provide rotational motion to a rotatable, . articulatable staple cartridge of a surgical stapling 2~627~
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instrument having a support ~haft suppor~,ing the staple cartridge. The stapling in~trument inc}udes a pivot for pivoting the staple cartridge relative to the support shaft, and the staple cartridge has a longitudinal axis forming an angle of a~ticulation relative to an axis passing longitudinally through the support shaft. The device of the inventi allows the staple cartridge to be rotated about its longitudinal axis over a plurality of angles of articulation of the staple cartridge after the staple cartridge has been articulated with respect to the ,,,,s,"up,port shaft. ,, ,, , In one preferred embodiment of the invention, the device includes a first external sleeve rotatably positioned on the support shaft and a second ex~ernal sleeve positioned on and engaging the staple cartridge.
The first external sleev~ hag a di~tal end terminating proximate the pivot and the second external sleeve has a proximal end terminating proximate the pivot. The distal and proxima~-slee~e ende of the first and second sleeves 0 engage one another for transferring rotational motion from the first external sleeve to the second external sleeve and to,the staple cartridge.
In another preferred embodiment of the invention, the distal and proximal sleeve ends compri~e interconnecting teeth positioned about the external sleeves. In another embodiment of the invention, the distal and proximal sleeve ends compri~e frictional annular flanges. In yet another embodiment of the invention, the first and second sleeves are connected with a series of flexible film strips that 0 are adhesively connected to the ends of the first and second sleeves.
In yet another preferred embodiment of the invention, a 3tapling instrument is provided having an improved ~: :., :

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articulation device that include~ a control knob rotatably `
mounted to the support Rhaft proximate the handle of the ,!''.'''~.~.'~i','~`~r;.'.'.
in~trument. The device ~urther include~ a mechanism for j~ ~ s tran~ferring rotational motion of the control knob to an -`-articulation driver in a longltudinal direction generally parallel to the longitudinal axis of the support shaft. ~ -i~
The device further includes a flexible cable sIidably positioned within the support shaft and connected at one --end to the articulation driver and connected at its other ;
end to the staple cartridge at a point spaced from the longitudinal axis of the staple car~id~e~ ", In yet another preferred embodiment of the invention, `~
the control knob includes a worm gear for transferring rotational motion about the axis of the control kncD to the articulation driver. j;~1`~-;
In another preferred embodiment of the invention, the articulation driver includes a sleeve rotatably positioned i ~ i on the support shaft, having an annular channel therein for slidably receiving a flange connected to the articulation ~.,'""'`.~` `'`'J.,`' driver. The channel is inclined with respect to the `~
longitudinal axis of the support shaft, thereby providing longitudinal motion of the flange and articulation driver as the sleeve is rotated by the worm gear.
The present invention further achieve~ an improved 25~ endo~copic surgical stapler which is adapted for insertion through an endoscopic tube or cannula into a body cavity to -apply one or more surgical staples to the internal body tissue. The surgical stapling instrument includes a staple cartridge which i9 pivotally mounted at the distal end of -a tubular support shaft extending from a handle which includes a staple actuator mechanism for actuating the ~taple cartridge to fasten the staples seriatim to the tissue. The staple cartridge is mounted for pivotal ` ~ `''' ;'.

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movement relative to the support shaft about an axis transver~e to the longitudinal axi~ of the support shaft to permit the angular orientation ~f the ~taple cartridge to be adjusted. Also, the staple cartridge is mounted for rotation relative to the support shaft to permit the rotational orientation of the staple cartridge to be adjusted. In addition, the support shaft i8 rotatable about its longitudinal axis relative to the handle. The~e feature~ of the stapling instrument allow the staple 0 cartridge to be precisely aligned with the desired region of the internal body tissue to which the staple is applied.
Separate actuator mechanisms are provided on the handle for controlling the rotation of the support shaft, the pivoting of the &taple cartridge relative to the support shaft, and the rotation of the staple cartridge relative to the support shaft. These actuator mechanisms facilitate manipulation of the stapling instrument by a surgeon to position the staple cartridge in a desired orientation.
- In accorda~ce with one aspect of the invention, t~e 0 surgical stapling instrument is provided with pivot means at the distal end of the support ~haft for mounting the staple cartridge for pivotal movement about an axis transverse to the longitudinal axis of the support shaft.
Actuator means i9 provided on the handle for pivoting the ~5 staple cartridge about the transverse axis to adju~t the angular position of the staple cartridge relative to the support shaft. The stapling instrument includes means for retaining thè- 3taple cartridge in different angular positions relative to the support shaft. The staple cartridge has a staple forming mechanism which can be actuated by the staple actuator mechanism with the staple cartridge oriented in any of its different angular position~

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The ~urgical stapling instrument includes actuator means on ~he handle for rotating the support shaft about - its longitudiual axls to adjust the rotational orientation of the ~upport ahaft and the staple cartridge. Also, means is provided for retaining the suppor~ shaft in different rotational positions as the support shaft is rotated about its longitudinal axis.
In a preferred embodiment of the surgical stapling instrument, the staple cartridge i9 mounted for rotation about ita longitudinal axis relative to the support shaft.
Actuator means is provided on the handle for rotating the staple cartridge to adjust the rotational position of the ~taple cartridge relative to the support shaft. Al~o, mean~ is provided for ~retaining tne staple cartridge in IS different rotational pogitiong as the staple cartridge is rotated about its longitudinal axis relative to the support shaft.
In accordance with another aspect of the invention, a staple cartridge for use with-~ stapling instrument -for applying one or more surgical staples to tissue comprises a cartridge housing adapted to receive a plurality of staples in a row for longitudinal movement therethrough, an anvil mounted on the housing, means for advancing the forwardmost staple in the row into engagement with the anvil, mean~ for rotating the forwardmost staple from a transverse orientation into a longitudinal orientation as the staple is advanced toward the anvil, and means or forming thé forwardmost staple about the anvil to attach ~ the staple to the tissue. The staple advancing means comprises a staple holder slidably mounted within the cartridge housing for advancing the forwardmost staple from the row and clamping the staple against the anvil. The staple rotating means compri~es ramp mean~ on the cartridge . 2 ,~
housing for engaging and rotating the forwardmost staple into a longitudinal orientation a~ the staple is advanced by the staple holder. The staple forming means comprise3 a staple former slidably mounted within the cartridge housing for movement relative to the staple holder and adapted to form the forwardmost staple about the anvil.
Preferably, the staple holder includes an ejector arm for removing the forwardmost staple from the anvil after the staple is formed.
0 A preferred embodiment of the staple cartridge i8 adapted for use with a staple having a generally U-shaped body including a crown with a central offset portion and a pair of depending legs at opposite sides of the crown. The staple cartridge comprises an elongated hollow cylindrical S cartridge housing including a pair of spaced parallel guide rails therein for slidably supporting a stack of staple~
for longitudinal movement there along with the staple crowns resting on the guide rails and the staple legs oriented perpendicularly to the longitudinal axis of the 'O cartridge housing. A staple follower is slidably mounted on the guide rails for urging the staples forwardly on the guide rails toward the distal end ~f the cartridge housing.
An anvil is mounted adjacent to the distal end of the cartridge housing. A staple holder is slidably mounted ~5 between the guide rails for engaging the central offset portion of the~forwardmost staple to a~vance the staple from the stack into engagement with the anvil. Ramp means i9 provided on the cartridge housing for engaging the crown of the forwardmost staple advanced by the staple holder and rotating the staple into a }ongitudinal orientation with the staple legs oriented parallel to the longitudinal axis of the cartridge housing. A staple former is slidably mounted between the guide rails and movable relative to the 2~2~2~
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.~.. ,, ~ ,", staple holder for engaging the crown of the forwardmost ~taple to form the staple about the anvil to attach the staple to the ti~sue. ~ ""
In the preferred embodiment of the ~taple cartridge, ,';,'~
the staple former comprises an elongated channel-shaped ', member including upstanding side flanges extending along its opposite sides for engaging and forming the, staple. ''~
The staple holder comprises an elongated plate-like member slidably supported on the staple former and located between '''~',"'~',,'~,`;;
the side flanges. The staple holder includes a notch at . ~'j,;,"
its distal end for receiving the forwardmost staple to be, ,~
advanced. The staple holder also includes a pusher finger ;,;;,""`, at its distal end for engaging the forwardmost staple and ',; ~ '-cl~mping the staple against the anvil. In addition, the -"''' "h staple holder includes an ejector anm at its distal end for removing the formed istaple from the anvil when the staple ``='"-~;
holder is retracted.

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BRIBF D~SCRIPTION OF THE DRAWINGS
The foregoing and other object~, aspects and advantages will be better understood and more readily apparen~ to those of ordinary skill in the art, as the following detailed description of the preferred embodiments --~
of the invention proceeds, particularly with reference to the accompanying illustrative figures, in which~
Figure 1 ie an overall perspective view of an endoscopic surgical stapling instrument con~tructed in O accordance with a preferred embodiment of this invention;
Figure 2 is a partially cutaway side _view of the stapling instrument of Figure l; - ..
Figure 3 is an enlarged longitudinal section of the stapling head and cartridge asuembly of Figure 2;
.5 Figure 4 i8 an enlarged longitudinal section of the stapling head and cartridge assembly from the opposite ~ide .- `
of Figure 3; .
Figure 4a is a schematic plan view of a portion of the : ~irst-and second sleeves of a preferred embodiment of the -~0 invention, illustrating the interlocking teeth.
Figures 5 and 6 are exploded perspective views showing the compo~ents of.the stapling instrument of Figure 1; ~ 1r~7 Figure 7 is an enlarged partially cutaway horizontal section of a portion of the~stapling head as~embly and ~-5 support shaft:of Figure 2;
Figure 8 is an enlarged partially cutaway vertical ~ -;~
section of a portion of the stapling head assembly and ~- ~c~
support shaft of Figure~2;
Figure 9 is an enlarged, exploded perspective view ~0 showing the staple cartridge and the staple forming .
mechani~m of the stapling head assembly;
Figure 10 is an enlarged longitudinal section of the : ~ staple cartridge of Figure 9;

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Figure 11 i~ an enlaryed longitudinal section of the r~
staple cartridge along line 11-11 of Figure 10;
Figure 12 i9 an enlarged proximal e~d view of the sta~le cartridge;
Figure 13 i9 an enlarged distal end view of a portion of the stapling head assembly of Figure 3; Figure 14 is an enlarged fragmentary section of the staple cartridge taken along line 14-14 of Figure 11;
Figure 15 is a longitudinal section of a slide actuator for pivoting the stapling head assembly;
_ Figure 16 is_a proximal end view _f the slide actuator `;-~ ~:
of Figure 15 Figure 17 i9 an enlarged plan view o- a staple for u~3e with the surgical stapling instrument of this invention; ;.
Figure 18 illustrates a hernia repair patch fastened to tissue with staples applied by the surgical stapling instrument of thi~3 invention;
Figure 19 is an enlarged longitudinal section of the staple cartridge of Figure g showing. the staple forming .~ ;
mechanism in a retracted position;
Figure 20 i9 an enlarged longitudinal section of the ~ `.:;. ` .
staple.cartridge of Figure 9 showing the staple forming ;-;~ .
mechanism advanced to rotate a staple int:o a longitudinal orientation;
Figure 21 i8 an enlarged longitudinal section of the ;~
staple cartridge of Figure 9 showing the staple forming mechanism advanced to clamp the staple against an anvil of ~ 2~",~
the staple cartridge;
Figures 22-26 illustrate the operation of the staple ;~
: 30 forming mechanism in advancing and forming a ~taple;
Figures 27-31 are fragmentary view3 showing the operation of a precock ratchet mechanism in the actuator .
handle assembly;

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Figure 32 i9 an overall per~pective view of an alternative em~odiment of the ~urgical stapling in~trument .
con~tructed in accordance with this invention;
Figure 33 iB a partially cutaway side view of the stapling in~trument of Figure 32; .
Figure 34 is an enlarged longitudinal ~ection of the stapling head assembly from the opposite side of Figure 32;
Figure 35 is an enlarged cro~s section of the stapling .
instrument along line 35-35 of Figure 33; `~
!0 Figure 36 is an enlarged cross section of the stapling .; .:
instrument along line 36-36 of Figure 33; .`~
Figure 37 is a perspective view of another embodiment of a stapling head assembly for use with the surgical . ~
staplillg instrument of this invention; ~. :-.
LS Figure 38 i~ a side view of the stapling head assembly ., from the opposite side of Figure 37;
Figure 39 i8 a partially cutaway side view of the .-.
stapling head assembly of Figure 38; and ..
Eigure..4Q is~ ~-partially c~taway side-view of the ~0 stapling head assembly from the opposite side of Figure 39.
Figure 41 is an enlarged longitudinal section of the .
stapling head and cartridge assembly of th~ invention with ..
frictional annular flanges for transferring rotational ..
motion to the staple cartridge.
Figure 42 is an enlarged longitudinal section of the ....
stapling head and cartridge a~sembly of the invention with adhesive bands and film ~trips for transferring rotational motion to the staple cartridge.
Figure 43 is a plan view of the adhesive bands and film strips of Figure 42 as formed from a unitary piece of material .

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Figure 44 io a per~pective view of ar impr ~ed stapling instrument and articulation device of the presen~ n invention.
Fi ~ re 4~ is a cross sectlonal, top plan view of the -~
articulation device of Figure 44, taken along line 45-45.
Figure 46 i~ a cros~ sectional, elevational plan view ~ `s of the articulation device of Figure 44, taken along line - -~
46 46. r `
Figure 47 is a partial cross sectional, partial ~0 cutaway view of the encircled portion of the device of ;~
Figure 45. ~ `
Figure 48 is a further modification of the asse bly of ;;~
Figures 34-36.
Figure 49 i~ a cros6 sectional view taken along lines ~ -LS 49-49 of Fi ~ re 48.
Figure 50 is a cross sectional view taken along lines 50-50 of Pigure 48. ~ ` ~ `
Figure 51 i9 an exploded isometric view of the front -~
portion of a highly preferred stapling instr ~ ent of the 2~ invention. ~u~
Figure 51a i8 an isometric exploded view of the handle ;
portion of the instrument illustrated in Figure 51.
Figure 52 is a cross-sectional view of the e ~ odiment of the invention illustrated in Fig res 51 and 51a. ` ` -~
Figure 53 is a front, top, left and right side plan view of a stationary clevis useful in the e~ odiment of Fi ~ res 51, 51a and 52.
Figure 54 is a front, top, and;left side view of a ~ `
movable clevis useful in the e ~ odiment of Figures 51, 51a, -~
and 52.
Figure 55 is a side elevational view detailing the e ~ odiment of Figures 51, 51a, and 52 in an articulation - - -mode. ` ~ -`

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.. . ~ -Figure 56 i8 a plan view of the preferred articulating mechanism u~ed in the embodiment of Figures, 51, 51a, and 52.
Figure 57 is a front plan view of the device of Figure 56.
Figure 5B is a cross-sectional view of the device of Figure 56 taken along the lines A-A.
DETAILZ~D DESCRIPTION OF PREFBRRED EMBODIMENTS
Referring to~ Figure 1, the present invention- is embodied in, and/or retrofittable to, an~ articulating endosco~_c surgiçal_sta~ling_ina~rumen~_ g~nerallx 50, including a distal stapling head assembly 60 which- i9 pivotally connected to an elongated support:shaft, or tube 70 rotatably or non-rotatably mo~nted on a proximal actuator handle assembly generally 80. When a rotatable tube 70 is used, a xotatablé adjusting knob 82 may be mounted at the diZ3tal end of~the actuator handle assemZbly 80 for rotating the support tube 70 about~its longitudinal axis A1~
A saddle-shaped actuator 8¢ZZ is slidably mounted on the actuator handle a6sem:bly 80 for controlling the pivotal, or articulatable movement of the stapling head assembZly 60 relative to the~support tube 70 about an axis of :~ articulation A2 running perpendicular to the support~tube:
~25 ~ : longitudinal axis Al. The actuaeor handle assembly 80 : includes a depending handle grip 86 and a pivotally mounted staple actuating lever 88 for actuating a staple cartridge 100 on the stapling head assembly ;60. Preferably, the actuator handle assembly 80~ the adjusting knob:82, the saddle-shaped actuator 84 and the staple actuating lever 88 consist of plastic material.
As illustrated in Figure 1, the support tube 70 :~ preferably includes a sleeve 600 which slidably and ~ ~ 7 9 rotatably engages the shaft 70 such that the sleeve 600 may be slid toward or away from the stapling head assembly 60 .
and may be rotated about the ~haft longltudinal axis Al with re~pect to the stationery shaft 70.
As further illustrated in Figure 1, the stapling head .- . :
assembly 60 may be articulated about a pivot or :~
articulation axis A2, forming an angle of articulation with re~pect to the support tube axis A1. The stapling head assembly 60 has a longitudinal axis A3 that forms the angle of articulation with respect to the longitudinal ~:.
axis Al of.the_~uppor~...tube.ZO.,.a~..illustra~ed The stapling head assembly 60 may be rotated about its . ..... ~
axis A3 as will subsequently be described. In the past, . . ~.:
this rotation wa~ not possible once the stapling head a~embly 60 was placed inside the body. The present invention, however, allow~ rotation of the staple cartridge '~
100 about the axis A3 at any angle of articulation inside .
the body. This rotational motion is possible by virtue of .-~the firet sleeve--600, which~engages a-second sleeve 602 - ;
fa~tened to the cartridge 100. As best seen in Figure 4, ~ g.
the first sleeve 600 has a distal end 604 terminating .:.~;.. ~
proximate a pivot 236. The pivot 236 allows the staple i.
cartridge 100 and stapling head assembly 60 to be .. ;
:~ articulated about the axis of articulation A2 relative to .
the support tube 70. `- :
The second external sleeve 602 has a proximal end 606 also terminating proximate the pivot 236. The distal and . `.. ~
proximal ends 604 and 606 of the first and second sleeves ~!.
600 and 602, respectively, allow for the transfer of ~ ; 5 rotational motion from the first external ~leeve 600 to the : second external eleeve 602 to the stapling cartridge 100.
In the embodiment of the invention illustrated in ..
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~ Figures 1 and 4, the distal and proximal sleeve ends .~

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comprise a series of interconnecting teeth 608, preferably equally sized and shaped, separated by a plurality of notc~es, 609, al~o preferably equally ~ized and shaped, to complement the teeth 608. The teeth 608 ~f the distal end 604 are received by the notches 609, of the proximal end 606 and vise versa. h~en the distal end 604 of the fir~t sleeve 600 i9 aligned with the proximal end 606 of the second sleeve 602, such that equals 0, the teeth 608 and notches 609 of each sleeve preferably mate wit~ one another, with little or no gaps between them, as illustrated schematically in Pigure 4a. ~
As will now be appreciated to those of ordinary skill in the art, rotation of the staple cartridge 100 can be varied, in terms of ease of rotation, by varying the number and depth of teeth 608 and complementary notches 609 on the first and second sleçves. In one preferred embodiment of the invention, the~sleeves 600 and 602 each have 18 teeth 608 and notches 609.
: As.further illustrated in Figure 4, the.. second.sleeve 602 is rotatably positioned around the non-rotating portion, e.g., the clamshell sleeve 224, and clamshell halve~, 221, 222 (Figure 6) of the stapling head assembly 60, and is fastened at its end 610 to the staple cartridge ~: 100, which rotates, as will be subsequently described. The : 25 end 610 of the sleeve 602 may be fastened to the cartridge ~: ~ 100 in any number of ways, including the use of adhesives, pins, rivets, welding, etc. Although the distal end 604 of the first sleeve 600 may be withdrawn with respect to the second sleeve 602, is preferred that the second sleeve 602 be in a fixed position with respect to the cartridge 100 by being fastened thereto as previou~Iy described.
:~ In the embodiment of the invention illustrated in ~ Figure 1, the first ~leeve 600 preferably includes a stop 2 7 ~2 7~
., ., `"-, 601 at the end of the sleeve 600 proxirnate the handle assembly, generally 80, fastened to the support shaft 70.
The stop 601 assists the surgeon in determining that the ~ :
sleeve 600 has reached the handle 80 and has been stopped thereby, a~d may comprise an annular flange around the sleeve 600.
In another highly preferred embodiment of the invention, the first sleeve 600 i9 biased either toward or away from the handle asserobly 80, such as with a spring or `~ ;~
L0 other biasing means ~not shown).
_ In another preferred embodiment of_the invention, illustrated in Figure 41, the first sleeve distal end 604 and the second sleeve proximal end 606 comprise annular flanges 612 that engage each other with frictional surfaces LS 614. In the embodiment of Figure 41, the frictional i~
surfaces 614 may comprise an elastometeric mater~al, 9UC~ ~ i as natural or synthetic rubber, a stippled plastic or metallic surface, or a granulated surface, such as emery cloth or sandpaper, in addition to other frictional surfaces known to those skilIed in the art of frictional `~
surfaces. The annular flanges 612 may be arranged such - i c that the outside diameter of the flange 612 on~the first sleeve distal end 604 is smaller than the inside diameter of the flange 612 on the second sleeve proximal end 606. ~ ~,'.,;,~,,I.',',i,,, In still another embodiment of the invention, the teeth 608 or annular flanges 612 are replaced with bands of film, which may be adhesive film, connected by a series of strips. As illustrated in Figure 42, a first band of ----adhesive film 616 is fastened about the first sleeve 600 `-~ -; i;
proximate the pivot 236, and a second band of adhesive film 618 is fastened about the second sleeve 602, also proximate the pivot 236. The bands 616 and 618 are joined by a plurality of film strips 620 positioned about the pivot 236 2 ~ ~ ~ 2 7 ~

Y'-. .: . , . -.

and transferring rotational forces from the first sleeve 600 to the second sleeve 602 to the staple cartridge 100.
As illu~trated, the film strips 620 are aligned substantially paralleI to the longitudinal ~ is Al of the support shaft 70.
As best seen in Figure 43, the bands 616, 617 and the films strips 620 preferably comprise a unitary piece of generally rectangular adhesive film, generally 615, having ~lits 622 forming the strip~ 620, as illustrated. In the e ~ odiment of Figure 43, the unitary piece of film ~y be f~hr~a~ sf ~y_~teri~l-suitahl~- for t~ ~.oge, including, by way of example, but not limitation, nylon, polyethylene, Teflon~, Ultem~, and polypropylene.
Additionally, the film strips 520 may be coated ~n their internal ~urfaces with a friction reducing material, kno ~
to those skilled in the art, for reducing friction of the strips 520 with respect to the pivot 236. Such materials include, by way of example, but not limitation, Teflon~
silic~ne,--a~ polyethyl~ ~
Referring to Figure 14, a staple 65 adapted for use with the surgical stapling instr ~ent 50 of the present ~n~ention-- c ~ rises a wire-like body of circular cross section which is bent in a generally U-shaped configuration. Preferably, the staple 65 consista of titani ~ or stainless steel. The staple 65 includes a top portion or crown 66 provided with a central dimpled portion 67 which is offset downwardly from the crown 66 by an amount approximately equal to the-diameter of the circul~r cross section of the staple 65. The opposite sides of the staple 65 are bent downwardly to provide a pair of depending legs 68 which are substantially perpendicular to the crown 66. Each leg 68 has a beveled end 69 which is ; beveled at an angle of approxi~ tely 45 degrees. ~ en the 2 ~

staple 65 is closed by operation of the ~urgical stapling inctrument 50, the staple leg~ 6~5 overlap each other a~
~hown by phantom l~nes in Figure 14 to secure the staple to the.tissue.
A~ shown in Figures 1 and 5, the handle assembly 80 includes a pair of hollow handle sections 91 and 92 which are adapted to snap fit together. The handle sections 91 and 92 include distally extending elongated, semi-cylindrical neck portions 93 and 94 which receive the proximal end of the support tube 70 therebetween and mount t~u~_s~pport.t~be~_10. fc~. r5tation. about its lo~gi ~
axis relative to the handle as~5emb51y 80. Alternatively, the support tube 70 may be fixed, rather than rotatable, with respect to the handle assemk51y 80, in which case the surgeon rotates the entire handle assemble 80 to rotate the support tube 70 inside the cannula and/or the body cavity.
Each of the handle sections 91~and 92 includes an internal annular flange 95 (one shown) for engaging a radially projecting flange 72 at the proximal end of the support tube 70 to retain the support tube 70 within the handle assembly 80. The staple actuating lever 88 is pivotally mounted-on the actuator handle assembly 80 by a pivot pin 96 extending through a pivot hole 90 in the lever 88. The pivot pin 96 i9 received in a pair of hollow cylindrical support stems 97 (one shown~ formed on the inside of thé handle sections 91 and 92.
As shown in Figures 1 and 5, the adjusting knob 82 comprises a pair of elongated hollow, tapered sleeve-like sections 101 and 102 which fit together over the neck portions 93 and 94 of the handle sections 91 and 92, respectively. Each of the sleeve-like knob sections 101 : and 102 has an inwardly projecting prong 103 adjacent toits distal end. The prongs 103 are received in a pair of 2 ~ 2 fi ~ 7 v~
:' '' ''~ -' holes 74 ~one shown) formed on opposite side~ of the support tube 70 to secure the knob ~ections 101 and 102 to the support tube 70. Each of the knob sections 101 and 102 includes a semi-circular ratchet 104 on its inner wall for S engaging a pair of detentes 105 mounted on resilient arms 106 formed on each of the handle sections 91 and 92. The semi-circular ratchets 104 and the detentes 105 provide a ratchet mechanism for retaining the ~upport tube 70 in different rotational positions as the support tube 70 is ~O rotated about its longitudinal axis. For example, each ~atchet_104_ is ~rov-ided with~eight _ra ~h~t teeth which allow the support tube to be rotated in sixteen equal angular increments of 22-1/2 degrees. Each of the knob sections 101 and 102 has an enlarged rear section 107 provided with alternating longitudinal ridges 108 and finger-receiving grooves 109 which facilitate the rotation of the adjusting knob 82 and the support tube 70 by the surgeon.
- The support tube-70 i8 an elongated, thin-walled rigid metal tube, e.g., stainless steel. Inside the support tube 70 are mounted an elongated staple driver 76 and an elongated articulation driver 78 which are - slidable longitudinally relative to the support tube 70 and relative to each other. The articulation driver 78 pivots the stapling head assembly 60 in response to movement of the saddle-shaped actuator 84 along the actuator handle assem~ly 80. The staple driver 76 actuates the staple forming mechanism within the staple cartridge 62 when the staple actuating lever 88 is operated. Preferably, the staple driver 76 and the articulation driver 78 consist of stainless steel.
AS shown in Figures 5 and 6, the staple driver 76 comprises an elongated thin flat rod including a pair of ,Ç~

2 ~ 2 ~ ~ 7 ~
.~,. . . ~ :. ,:
,, . ,~ ~ . :.

~paced parallel flanges 110 which extend longitudi~lly along its top and bottom edge~. The ~taple driver 76 ha~
a pivot hole 111 ~Flgure 6) ad~acent to it~ di~tal end and ;.
a longitudinal 910t 112 ~Figure S) adjacent to itq pro ~ al end. The articulation driver 78 co~ ri~es an elongated .
thin flat rod which i8 elidably mounted adjacent to the ~...... - .
staple driver 76 and is slidably received between the .`. .~
flanges 110. The articulation driver 78 has an enlarged .~... : .
distal portion 113 ~Figure 6) with a laterally projecting ...
guide pin 114 formed adjacent to its distal end. ~ ;~
~ ae ~ y .h~l P 11 ~_~.igure.5L.;.q f~ a~j?~nt .to the ``
proximal end of the articulation driver 78. A~driver gu~de member 116 of generally cylindricaI shape i~ mounted within .
the proximal end of the support tube 70. Th~ driver ~uide .
.. . ~ . . . ~ .
me ~ er 116 has a pair of opposed, outwardly extending pogts .....
117 which are received in a pair of corresponding holes 118 formed adjacent to the proximal end of the support tube 70. ...
The driver guide 116 has a rectangular slot 119 extending therethrough for slidably receiving the staple driver 76 . and the articulation driver 78. - ~ .' As shown in Figures 2 and 5, a driver coupling member ...
120, preferably ~ de of plastic ~ terial, includes an .
opening 122 extending longitudinally therethrough for receiving the proximal ends of the staple driver 76 and the . ~ "'".".~.,,,1,,:!,~
2S articulation driver 78. The driver coupling me ~ er 120 is `.
secured to the articulation driver 78 by a coupling pin 124 .`
which is received in the hole 115 in the articulation driver 78 and extends through a pair of apertures 126 fo ~ ed on opposite sides of the coupling me ~ er 120. ~ e .
coupling pin 124 is slidably received in the longitudinal ~.. ...-~
slot 112 of the staple driver 76 to allow the articulation -`...... - -.
driver 78 to slide longitudinally relative to the staple .9 ~ .
driver 76. A pair of spaced annular flanges 12~ and 130 ..

2~62~

are provided at the proximal end of the coupling member 120 for connection to an articulation control mechanism on the actuator handle assembly 80, The ~addle-shaped actuator 84 operates a slide member 132 which is coupled to the driver coupling member 120 to operate the articulation driver 78. The saddle slide member 132 is a generally flat metal plate with an elongated neck 134 projecting distally and having a pair of curved depending arms 136 provided with inwardly projecting 0 fingers 138 which are received between the annular flanges 12Q~n~ 1~0. nn th~ dr;ver_c~upling membeI~12Q_ ~rh annular flanges 128 and 130 capture the fingers 138 therebetween and connect the coupling me~ber 120 to the saddle slide mem~er 132 for longitudinal movement therewith. The annular flanges 138 allow the coupling member 120 to rotate about its longitudinal axis relative to the saddle slide member 132 when the support shaft 70 is rotated by the adjusting knob 82.
- The--saddle slide member 132 i`9- slidably mffunted onTa 0 pair of horizontal support ledges 140 (one shown) formed on the interior of the handle sections 91 and 92. Each support ledge 140 includes a s~ries o~ uniformly spaced notches 142 arranged in a longitudinal row. The saddle slide member 132 i~ formed with a transverse notch 144 for ~5 receiving a ratchet pin 146 which is biased downwardly into the notch 144 by a coil spring 148 mounted on an inclined post 149 formed on the inside of the saddle-shaped actuator 84. A pair of inclined fingers 150 ~Figures 15 and 16) is formed on the inside of the saddle-shaped actuator 84 and spaced from oppo~ite sides of the post 149. The ratchet pin 146 extends transversely between the fingers 150 and is slidably received in an inclined slot 151 ~ormed in each of the fingers lS0.

`, :.' `:" ' `."
. ~ -: - . .: --` - 2 ~ 2 ~ ~ 7 ~

The opposite ends of the ratchet pin 146 are received in the notches 142 formed in the ~upport :Ledge~ 140. The notches 142 and ratchet pin 146 provide a ratchet mecha~i~m for controlling the angular orientation of the stapling head a~sembly 60 relative to the longitud:inal axi9 of the support tube 70. The notches 142 provide a series of stop positions which corre~pond to angular orientations preferably of 0, 15, 30, 45 and 60 degrees relative to the longitudinal axis of the support tube 70.
L0 The Raddle-shaped actuator 84 includes a pair of outwardly~pro~.ectin~ r~ hq . a5.which seLve ~R finger grips.to facilitate the longitudinal movement of the saddle-shaped actuator 84 along the handle assembly 60. The saddle~
shaped actuator 84 includes a pair of inwardly projecting guides 87 (Figures 15 and 16) formed on each of its opposite sides which are snap-fit and ~lidably received into a pair of longitudinally extending channels 89 (one shown) formed on the exterior of the handle sections 91 and Referring to Figures 2 and 5, the staple actuating mecha~ism includes a driver link assembly 152 which is coupled to the etaple driver 76 and actuated by the staple actuating lever 88. The driver link assembly 152 comprises a block-shaped slide member 154, preferably of plastic material, including a pair of vertically ~paced flanges 156 extending from it~ opposite sides. Each of the handle ~ections 91 and 92 includes a horizontal support ledge 158 which is received between one pair of the side flange~ 156 to slidably support the driver link assembly 152 on the actuator handle assembly 80. A cylindrical connector pin 160 projecting distally from the front of the slide block 154 includes an annular rim 162 for connecting the drive link assembly 152 to the staple driver 76. The connector . . .
`~,~'`, 2:~2627~

pin 160 i8 inserted into a buckle-like connector 164 at the proximal end of the staple driver 76. The buckle-like connector 164 has a pair of longitudinally ~paced bands 166 and 168 which are curved outwardly in opposite direction~
and capture the annular flange 162 therebetween to couple the staple driver 76 and the driver li~k as~embly 152 together for mo~ement along the longitudinal axi8 of the :
support tube 70. Also, the buckle-like connector 164 i~
free to rotate about the axis of the connector pin 160 to I0 allow the staple driver 76 and the articulation dri~er 78 ~ :~
.t ~ rotate.~hen the Yupport ~ube-70 ~ rntated_about its longitudinal axis. ~:
As shown in Figures 2 and 5, the staple actuating lever 88 includes a pair of upright fingers 170 which are spaced apart to receive a rearwardly projecti~g lug 172 formed on the slide member 154. The lug 172 i8 connected .~
to a return coil spring 174 which i9 anchored to a post 176 . .~. ;.~.
on the handle section 92. The return spring 174 normally urges-the ~l-ide -~4--rearwardly into engagement- with- the ,~
upright arms 170 to retain the staple actuating le~er 88 in the unactuated position (Figure 2).
The driver- link- assembly 152 include~ a rearwardly ~.. -.. s projecting metal leaf spring 178 which is curved downwardly .
at its proximal end and provided with a pair of spring arms 180 projecting laterally from its opposite sides for engaging a pair of ratchets 182 (one shown) formed on the - -~
handle sections 91 and 92. The spring arm~ 180 and the ratchets 182 provide a ratchet mechanism which retains the .~
driver link assembly 152 at different stages of advancement ~.. -~.. -.::
as the staple actuating lever 88 is actuated. Once the .. ~
spring arms 180 are engaged with the ratchets 182, the ... ~.. ~.
driver link assembly 152 cannot return to its unactuated "~

,~-. ~"",. .....

2 ~ 2 6 2 ~
. . . ~ . .~

"
27 ;~
po~ition until the stapling head as~em~ly 60 is completely fired by operating the staple actuating lever 8~
Referring to Figuree 1 and 6, the ~tapling head as3embly 60 is pivotally mounted at the dil3tal end of the suppor~ tube 70 for pivotal movement about an axi3 transverse to the longitudinal axi~ of the ~upport tube 70. .~ :
The stapling head assembly 60 i9 pivotally mounted on the ~i s support tube 70 by a pivot connection, generally 200, including a pair of pivot housings 201 and 202 of generally 0 semi-cylindrical shape which are fit together and. are :~
ser.te into the_dis~al end.. of_She_suppo~t tllh~ lQ.. ~rhe ..
pivot housings 201 and 202 are generally shaped as hollow .. ~:
semi-cylindrical sleeves for slidably receiving the staple driver 76 and the articulation driver 78. Adjacent to the .
.5 proximal end of each of the pivot hou~ings 201 and 202 i9 a semi-circular groove 204 which receives an 0-ring 206 for .
engaging the interior of the support tube 70. The 0-ring .
206 helps to vent the staple cartridge 100 at the insufflation pres~ures of the abdomina~ cavity.
'O A~ shown in Figure 5, each of the pivot housing3 201 and 202 includes a side opening 208 formed therein adjacent ~`.. .
to the groove 204. When the pivot housing~ ~01 and 202 are ag8embled, 8ilicone i9 in~ected into the side openings 208 about the staple driver 76 and the articulation driver 78.
~s With the pivot housings 201 and 202 inserted into the .. ~
distal end of the support tube 70, a pair of dimples 210 ~ . `-.. -(Figure 7) i5 fonmed on opposite sides o~ the support tube .
70 to deform the tube material into the side openings 208 to fasten the pivot housings 201 and 202. Alternatively, .. . ~:
in place of the injected silicone material, a hollow .
cylindrical silicone plug 209 (Figure 5) can be inserted - -~
into the proximal ends of the pivot housings 201 and 202. ~--.. .. -The silicone plug 209 inc~udes a pair of distally : '' '` ""~.
- . ' ~.' '' ' .
~ ' ' ":
~ .:

2 ~ 2 ~ 2 7 ~
:, ~

projecting flange~q 211 which slidably engage the outer ~urface~ of the ~taple driver 76 and the articulation driver 7~. ~ach of the pivot housings 201 ~nd 202 includea a dis~ally projecti~g ta~g 212 which i9 provided with a pivot hole 21~. The pivot hou~ing~ 201 and 202 include front semi-circular flanges 216 which engage the di~tal end of the support tube 70.
The pivot connection 200 includes a pair of clamshell members 221 and 222 which are generally semi-cylindrical in ~hape and fit together inside a tubular clam~hell sleeYe '7~A _ ThP ~l~m.qh~ll m~ber-q 221 ~nd-222-ea~h include a front semi-circular flange 226 which engages the distal edge of the clamshell sleeve 224. The front flanges 226 each include an interior semi-circular groove 228. Fach of the pivot housing~q 221 and 222 include~ a detent arm 230 projecting inwardly through a side opening 232. Also, each pivot housing 221 and 222 includes a rearwardly extending tang 234 provided with an outwardly projecting pivot pin 236. -The-pivot-pins-23~ on-the=~amshell members-221- ~d ~0 222 are pi~otally recei~ed in the pivot holes 214 on the pivot housings 201 and 202. As- shown in Figure 4, the pivot housing 221 has an arc-shaped groove 238 formed on its interior surface for receiving the guide pin 114 on the articulation driver 78. The arc-shaped groove 238 and the guide pi~ 114 convert longitudinal movement of the articulation driver 7~ into pivotal movement of the stapling head assembly 60. Preferably, the pivot housings 201 and 202 and the clamshell members 221 and 222 conslst of plastic material.
Referring to Figure 6, the staple cartridge 100 of the stapling head assembly 60 has a hollow cylindrical housing 240 which is tapered at its distal end. Preferably, the staple cartridge housing 240 is a one-piece molded plas~ic .', .~'~ ., ,~'i ' ....

~ 1 2 ~

member. A hollow, generally cylindrical cartridge retainer 242 i~ insertad into the open proximal end of the staple cartridge hou~ing 240. The cartridge ret,ainer 242 has a pair of ~pring-like latch arms 244 located at diametrically opposed positions at the front of the retainer 242. The latch arms 244 are snap-fitted into a pair of diametrically opposed openings 245 adjacent to the proximal end of the cartridge hou~ing 240 to hold the cartridge housing 240 a~d the retainer 242 together. The retainer 242 includes an .0 annular flange 246 which i9 received in the annular grooves ;~
_22fL_Q~ 5~ clamsh~lJL_memk~rs 2~L_a~d~ ~ allow the staple cartridge 100 to rotate about its longitudinal ax:is relative to the support tube 70 and to the piYot connection 200. A set of twelve uniformly spaced circumferential L5 teeth 24a is formed at the proximal end of the retainer 242. ~ e teeth 248 are engaged by the detent arms 230 on the clamshell me ~ ers 221 and 222. The detent arm~ 230 and teeth 248 provide a ratchet mechanism which allows the rot-a~i ~ al orie~tat-ion--~f t ~- staple ~rtridg~ 1~0 to ~e ~-~0 adjusted in increments of 30 degrees.
I~side the staple cartridge 100 is mounted a staple forming mechani~m comprising an anvil-250, a staple holder 252 and a staple former 254 which are preferably made of stainles~ steel. The staple former 254 is channel-shaped in configuration for slidably receiving the stap}e holder 252 therein. The staple former 254 has an elongated central 810t 256 with a depending prong 258 at the proximal ~ y end of the slot 256. The staple holder 252 includes a `~
depending prong 260 which is slidably received in the slot 256 and is bia~ed away from the prong 258 by a compre3sion coil spring 262. A feeder shoe 264 is slidably mounted - ~ `
within the staple cartridge 100 for urging a series of staples 65 toward the distal end of the cartridge 100. ~ e .. '~` ~ `.
', ~.

' ~

21~2~

feeder shoe 264 i9 biased in the distal direction by a compre0~ion coil spring 266 which i~ mount~ed on a di~tally projecting prong 268 on the cartridge retainer 242.
The ~taple driver 76 is connected to the stap}e former 254 by a plunger 270 which i9 slidably mounted between the clamshell members 221 and 222. The plunger 270 is a generally flat metal plate, e.g. aluminum, and include~ a longitudinally extending side flange 272 slidably received in a longitudinal groove 274 formed in the clamshell member 222. The plunger 270 has a pivot hole 276 ad~acent to its .{~YUCh~lL end_~ _~ pivot_ link__~7a._includesL ~ _.p~ir_.of laterally projecting pivot pins 280 and 282 which are pivotally received in the pivot holes 111 and 276, respectively, to attach the staple driver 76 to the plunger 270. The pivot link 278 transfers the longitudinal movement of the staple driver 76 into longitudinal movement of the plunger 270. Also, the pivot link 278 permits the plunger 270 to pivot relative to the staple driver 76. At -t-he-dista-l end of-~he plunger 270, a-sm21-ler diameter fro~t disk 284 is spaced from a larger diameter rear disk 286.
The front di~k 284 is inserted between a pair of inwardly projecting fingers 288 at the proximal end of the staple former 254 to transfer the longitudinal movement of the plunger 270 into longitudinal movement of the staple former 254. The front disk 284 and the inwardly projecting fingers 288 permit the staple former 254 to rotate relative to the plunger 270.
Referring to Figure 9, the staple cartridge housing 240 ha~ an elongated hollow cylindrical wall 290 which preferably con3ists of transparent plastic material.
Extending longitudinally inside the staple cartridge housing 240 is a first pair of elongated upstanding flanges 292 which are spaced apart and extend parallel to the 2 ~27~
; -lonyitudinal axis of the cylindrical wall 290. The elongated flanges 292 provide a set of c~ide rail~ for slidably ~upporting the ~taple3 65 for longitudinal movement relative to the ~taple cartridge housing 240.
~ach flange or guide rail 292 has a ledge 293 (Figure 10) which is inclined at an angle to the axis of the cartridge housing 240 and terminates in an extension 294 of the guide rail 29~ at the open distal end of the cartridge housing 240. Each of the flanges 292 is spaced inwardly from the 0 cylindrical wall 290 to provide a pair of elongated side ~h~nn~l~ 2q5_.(Fig~re 12~ for re~P~v;ng the .depen~ng le~
68 of the staples 65. The cartridge housing 240 includes a ~econd pair of depending flanges 296 which are spaced apart and extend parallel to the longitudinal axis of the outer cylindrical wall 290. The upper flanges 296 terminate above the lower flanges 292 to provide a sufficient clearance therebetween to receive the crowns 66 of the staples 65. On the inside of each lower flange 292 i9 an elonga~ed ledge 298 which slidably supports the staple fonmer 254.
The stap}e.cartridge housing.240 has a tapered nose 300 at its dis~al end including an internal horizontal ledge 302 provided with a longitudinal channel 304 for receiving the anvil 250 of the ~tapling head assembly 100.
The ledge 302 has a rearwardly projecting post 306 to which the anvil 250 i9 secuxed. The tapered nose 300 has a central depending tab 308 located above the ledge 302 and provided with a downwardly sloped rear edge 309 which serves as a guide for the dimpled portion 67 of the staple 65 advanced by the staple forming mechanism. A180, the tapered no~e 300 includes a pair of ~loped ramps 310 (Figure 11) on opposite sides of the central tab 308 for engaging the crown 66 of the staple 65 which i~ advanced by -. ~, ., . . , : : :

, 2 ~ ~ S 2 7 ~

:' .., -', the ~taple forming mechanism to pivot the st:aple 65 into an orientation parallel to the longitudina:L axis of the cartridge housing 240. Bach of the ramps 310 terminatec at a ledge 312 located adjacent to one of the exten3ions . 294 of the guide rails 292. A window 314 i~3 formed on each ~ide of the cartridge housing 240 adjacent: to one of the ramps 310 as a result of the molding proce~s u~ed to fonm the cartridge housing 240.
A~ ~hown in Figure 9, the ~3taple former-254 i9 a~
.0 elongated, channel-shaped member provided with upstanding de_flan~es _~20 extending.along it3 opposite sides. The staple holder 252 i9 an elongated plate-like member wh~ch i9 slidably supported on the staple former 254 and located between the side flanges 320. rhe comp~e3sion coil spring L5 262 normally biases the staple holder 252 distally relative to the staple former 254 with the depending prong 260 biased against the distal end of the elongated central slot 256. The ~taple holder 252 and the staple 254 are inserted into the ~tap~e cartridge 240 between-the-lower upstan~ing flahges 292. The staple former 254 i9 slidably supported on the ledges 293 formed on the inside of the flanges 292.
A~ ejector arm 322 extending from the distal end of the staple holder 252 has a notch 324 for receiving the dimpled portion 67 of the staple 65. A pusher finger 326 projects forwardly into the notch 324 at the di~tal end of the staple holder 252 for engaging the dimpled portion 67 of the staple 65 ag the staple holder 2S2 i~ advanced to move the staple 65 into engagement with the anvil 250. The distal end of the ejector anm 322 i3 slanted away from the le~el of the pusher finger 326 and serves to disengage the staple 65 from the anvil 250 as the staple holder 252 i9 retracted after the staple 65 is formed. A pair of fingexs 328 at the tip of the ejector arm 322 are spaced apart to . ~'':.'' 2~2~79 ~ ~-- : --33 ~ - .
receive the depending tab 30~ of the cartridge housing 320 therebetween. -~.
The anvil 250 includes a pair of :laterally ~paced pro~gs 330 at its distal end which allow the ejector arm 322 to pass therebetween when the staple holder 252 i~
advanced. I3ach prong 330 includes an incl:ined ramp 332 for guiding the crown 66 of the staple 65 into engagement with the proximal ~ide of the prong 330.
The staple follower 264 is channel-shaped and includes .~
a generally flat top portion 340 which is ~lidably received .. ~.~. . .
be~wPPn ~.lower .fl~nges..292 .and. thQ up~r flAnS~es ~9.6 The staple follower 264 also has a pair of depending side flanges 342 on its opposite sides which are received in the chAnnel~ 294 adjacent to ~he lower flanges 292. The etaple follower 264 includes a rearwardly projecting post 344 . ~
which i~ inserted into the distal end of the compression ... `.
coil spring 266.
Referring to Figures 9 and 19, a stack of staples 65 is mounted in the staple cartridge housing 240 with the staple crowns 66 resting on and slidably supported by the elongated flanges or guide rails 292. The dimpled portions 67 of the staples 65 re~3t on top of the staple holder 252.
The row of staples 65 i9 urged forwardly toward the dis~cal end of the cartridge 240 by the staple follower 264 and the compres~ion coil spring 266. The staple former 254 i8 .
biased rearwardly by the return spring 174 tFigure 2) in the actuator handle assembly 80 to urge the depending prong ~ .
258 again~t the front of the retainer 242. The staple ~ :
holder 252 is biased forwardly by the compression coil spring 262 which urges the depending prong 260 against the front edge of the slot 256 in the staple former 254. The ejector arm 322 at the distal end of the staple holder 252 :-'-:, ~` `~' 2 ~ 2 6 2 ~

i9 located adjacent to the guide tab 308 at the fro~t of the tapered nose 300 of the staple cartridge 24V.
As ~how~ in Figure 19, the offset or dimpled portiorL
67 of the forwardmost ~taple 65 i9 locaLted at a level different from the remaining staple~ 65 in the stack. TkLe dimpled portion 67 of the forwardmost staple 65 i~ received in the notch 324 in front of the pusher finger 326. When the staple holder 252 i9 advanced, the dimpled portion 67 of the forwardmost ~taple 65 i9 advanced along the s'oped .0 surface 309 and adjacent to the guide tab 308 by the p-lsher fing~r...326. The top portion or..cr~wlL66..of_th~ ~or~arimo~t gtaple 65 i8 advanced along a path between the inc:ined ramps 310 (Figure 14~ and the inclined ledges 293 Oc the guide rails 292 to rotate the staple 65 by 90 degrees about it~ dimpled portion 67.
As shown in Figure 20, with the staple h~lder par~ially advanced, the forwardmo~t staple 65 i9 rc:ated into a longitudinal orientation with its staple le-s 68 parallel to the longi~udinal axi~ of th~-staple caL ~ idge 'O housing 240. Thereafter, a9 ~hown in Figure 21, whe~ the staple holder 252 is fully advanced, the forwardmost 6_aple 65 travels along the extensions 294 of the ~uide rail3 292 and is clamped against the anvil prongs 330 with the ~ aple legs 68 projecting distally from the front of the staple cartridge housing 240. The remaining staples 65 i~ the 3tack are restrained by the top of the staple holde~ 252 which engages the dimpled portion~ 67 of the staples 65.
The staple forminy mechanism of the staple cartridge 100 i9 actuated by squeezing the staple actuating lever 88 toward the handle yrip 86. A~ a result, the s~aple actuating lever 88 i9 pivoted about the pivot pin c~ and the upright fingers 170 advance the ~lide member 154 :~ the distal direction. The slide member 154 advances the staple ':; ''''' ~

~ 1 2 6 2 ~
.: .~., :,-. . ~. . .

driver 76 in the distal dlrection which, in turn, advances the plunger 270 to actuate the staple ho].der 252 and the ~taple former 254. After the ~taple holder 252 and the ~taple former 254 are fully advanced to form one of the ~taples 65, the staple actuating lever 88 i~ released and returned to its original position by the return coil spring 174, which retracts the slide block 154 and the staple driver 76.
The operation of the -staple forming mechanism i9 illustrated in Figures 22-26 which, for clarity, show only one staple.~5. Figure 22.shows the s~aple...65 positiQned.in the notch 324 in front oE the pusher finger 326 at the 3tart of the staple forming cycle which corresponds to the position of the staple holder 25~ and staple former 254 shown in Figure 19. Initially~ when the staple actuating lever 88 is actuated, the ~taple holder 252 and the staple former 254 are advanced simultaneously to advance the staple 65 toward the prongs 330 of the anvil 250. AS the staple 65 is--advance~ toward the anvil prongs 330, the staple 65 is rotated by 90 degrees into a longitudinal orientation ~Figure 20) with the staple legs 68 pointing distally.
Figure 23 shows the staple holder 252 and the staple former 254 advanced to a staple clamping position corresponding to Figure 21 in which the staple crown 66 i8 clamped between the pusher finger 326 and the prongs 330 of the anvil 2S0. Thereafter, as the staple actuating lever 88 is actuated, only the staple former 254 is ad~anced while the staple holder 252 remains stationary with the staple 65 clamped against the anvil prongs 330.
Figure 24 shows the initial movement of the staple former 254 relative to the staple holder 252 to form the staple 65 about the anvil prongs 330. The initial contact .... .
: ~ ~

2 1 2 ~

..: ~ ....--..-.~

of the former flanges 320 with the staple 65 results i~ a slight bending of the ~taple crown 66 with the staple legs 68 angled toward each other.
Figure 25 shows an intermediate stage of the staple forming cycle in which the former flanges 320 are further advanced to bend the staple crown 66 around the anvil prongs 330 to bring the staple legs 68 closer together.
Figure 26 shows the final stage of the staple forming cycle in which the former flanges 320 are fully advanced to bend the staple legs 68 into an overlapping configuration to secure the 3taple 65 to the tissue.
After the staple 65 i9 completely formed, the staple actuating lever 88 i9 released and the staple former 254 i8 moved rearwardly relative to the staple holder 252 by the compression coil spring 262. When the depending lug 260 is engaged by the front edge of the slot 256, the staple holder 252 and the staple former 254 are retracted together by the return spring 174 in the actuator handle assembly 80. The ejector arm 322 lifts the formed staple 65 from the anvil prongs 330 a~ the staple holder 252 is retracted.
The staple holder 252 and the staple former 254 are returned to the start position ~hown in Figure 19 where the next staple 65 i8 received in the notch 324 in front of the pusher finger 326. Then, the staple forming cycle is repeated to form the next staple 65.
The actuator handle as~embly 80 includes a precock ratchet mechanism comprising the ratchet 3pring 178 and the ratchets 182 which prevents the retraction of the staple forming mechanism until the staple 65 is completely formed.
The operation of the ratchet mechanism is illustrated in Figures 27-31 which show the various ratchet positions corresponding to the stages of the staple forming cycle shown in Figures 22-26, respectively.

' " ' '' 2 ~ 2 ~ ~ 7 9 As shown in Flgure ~7, each spring arm 180 of the ratchet spring 178 i~ initially dise~gaged from each ratchet 182 with the ~taple holder 252 and the staple former 254 located in the retracted position (Figure 22).
A~ shown in Figure 28, each spring arm 180 of the ratchet spring 178 i8 engaged in the first notch of each ratchet 182 with the staple holder 252 and the staple former 254 in the advanced position (Figure 23) in which the staple 65 i9 clamped against the anvil prongs 330. Thereafter, the 0 engagement of the ratchet spring arms 180 with the ratchets 182 prevents the staple holder 252 and the staple former 254 from being retracted until the staple forming cycle is completed.
A~ shown in Figure 29, each spring arm 180 of the ratchet spring 178 i8 engaged in the second notch of each ratchet 182 with the flanges 320 of the staple former 254 initially engaged with the staple crown 66 to begin the forming of the staple 65 (Figure 24). As shown in Figure 30, each spring arm 180 of the ratchet spring 178 i~
~0 engaged in the third notch of each r~tchet 182 with the ~ormer flange3 320 advanced to the intermediate stage of the staple forming cycle (Figure 25) in which the staple legs 68 are partially closed.
As shown in Figure 31, each spring arm 180 of the ratchet spring 178 i8 disengaged from each ratchet 182 with the former flanges 320 fully advanced (Figure 26) to bend the staple legs 68 into an overlapping relationship. Each ~prin~ arm 180 travels rearwardly adjacent to the unnotched side of the corresponding ratchet 182 to allow the ratchet spring 178 to return to its retracted position (Figure 27) when the staple actuating lever 88 is released.
In performing a hernia repair procedure, the endoscopic surgical stapling instrument 50 is inserted in-o ''''````'`'' 2 ~ 2 6 r~ 7 ~ ~
,~

a body cavity through a trocar tube or cannula installed in a body wall. Initially, the ~urgical stapling instrument 50 i~ introduced into the body cavity in its non~
articulated mode, i.e., with the staple cartridge 100 aligned with the longitudinal axis of the support tube 70.
An endoscope may be inserted into the body cavity through a separate trocar tube or cannula for observation of the surgical site. The stapling cartridge 100 i~ positioned in the desired orientation over the surgical site by operating the rotatable adjusting knob 82 and the saddle-shaped actuator 84 to adjust the rotational orientation of the support tube 70 and the angular orientation of the staple cartridge 100. The staple cartridge 100 can be articulated to angles of 15, 30, 45 and 60 degrees relative to the support tube 70 by retracting the saddle-shaped actuator 84.
If it is desired to change the rotational orientation of the staple cartridge 100 on its axis, the staple cartridge 100 i9 returned to the non-articulated mode by ;~
sliding the saddle-shaped actuator 84 forwardly. The surgical ~tapling instrument 50 i9 withdrawn from the ~ ~ .
trocar tube or cannula and the staple cartridge 100 i9 rotated manually relative to the support tube 70. Then, the surgical stapling instrument 50 i9 reintroduced into ;~
the body cavity in it~ non-articula~ed mode and the orientation of the staple cartridge 100 is adjusted by operating the rotatable adjusting knob 82 and the saddle-shaped ac~uator 8~
With the staple cartridge 100 adjusted to the desired orientatio;n, the staple actuator lever 88 is squeezed to actuate the staple forming mechanism in the staple cartridge 100 to fasten one of the staples 65 to the tissue at the surgical 3ite. Thereafter, the staple cartridge lQ0 -:, . - . ,-',. .:
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:

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is shifted to another location and the operation i9 repeated to fa~ten another staple 65 to the tis~ue. When the staple actua~or le~er 88 i9 released, the formed ~taple 65 i9 disengaged from the anvil 250 of the 13taple cartridge . 100.
Referring to Figure 1~, the surgical stapling instrument 50 can be used to secure a hernia patch 62 at a desired ~urgical site. The hernia patch 62 i~ attached to internal body tissu~ 64 by applying a series of staples 65 L0 to the edges of the hernia patch 62. The staple cartridge 100 is readily adjustable into the different orientations to apply the staples 65 at various locations along the edges of the hernia patch 62.
Figures 32 and 33 illu~trate an alt~rnative embodiment of the ~urgical stapling instrument, generally 350, including a distal stapling head assembly 360 which is pivotally connected to an elongated support tube 370 rotatably mounted on a proximal actuator handle assembly 330. A rotatable adjusting knob 382 is mounted at the distal end of the actuator handle assembly 380 for rotatiny the support tube 370 about its longitudinal axis. A
saddle-shaped actuator 384 is slidably mounted on the actuator handle assembly 380 for controlling the pivotal moveme~t of the stapling head assembly 360 relative to the support tube 370. The actuator handle a~sembly 380 has a depending handle grip 386 and a pivotally mounted ~taple actuating lever 388 for actuating the stapling head asaembly 360. The internal components of the stapling head assembly 360, the support shaft 370 and the actuator handle as~embly 380 are substantially identical to the corresponding components of the surgical stapling instrument 50 deecribed above. Accordingly, no detailed description of the internal components of the surgical ~,' -`~
:

, . . : ~

2121~.?~

'.'~ '-- ' '' '.'' stapling instrument 350 i9 nece3sary, and it will be understood by persQn~ skilled in the art that the previous description of ~he internal components of the 3urgical ~tapling instrument 50 i~ applicable to the internal components of the surgical ~tapling instrument 350, unle~s otherwise described.
The stapling head assembly 360 includes a rotatably mounted staple cartridge 400 which i9 ~ubstantially $denticaI~ in construction to the stapling cartridge 100 O de~cribed above. The stapling head a~sembly 360 iq pi~otall~_ mounted on the support t~be ~lQ_~hy a pi~ot connection 390 which is substantially identical to the pivot connection 200 described above.
As shown in Figure 33, the handle assembly 3~0 S includes a pair of hollow handle sections 392 which are adapted to snap fit together. Each of the handle sections 392 includes a distally extending elongated, semi~
cylindrical neck portion 394 in which the proximal end of the-support tube-370 i8 received and mounted ~or rotat-ion 0 about its longitudinal axis relati~e to the handle assembly 380. Each af the handle sections 392 includes an internal ~nnular fl~nge 3~5 (one shown) for en~aging a radially projecting ~lange 372 at the proximal end of the support tube 370 to retain the support tube 370 within the handle '5 assembly 380. The staple actuating lever 3~38 is pivotally mounted on the actuator handle assembly 380 by a pivot pin 396.
As shown in Figures 32 and 33, the adjusting knob 382 comprises a pair of elongated, hollow tapered sleeve-like sections 402 which fit together over the neck portion~ 394 of the handle sections 392. Each of the sleeve-like knob sections 402 has an inwardly projecting prong 403 adjacent to its di~tal end. The prongs 403 are received in a pair ;: ~!,. ~ ' ' , . : - - ' '.' . ' . " . - . . ' '. :

21~27~ ~

of holes formed on opposite ~ideB of the 3upport tube 370 to ~ecure the knob eections 402 to the ~upport tube 370.
The actuator handle assembly 3~0 and the adju~ting knob 382 include the 3ame ratchet mecha~ism, described above in connection with the stapling instrument 50~ which allow~
the adjusting knob 382 to rotate the support shaft 370 about its longitudinal axis in sixteen equal intervals of 22-1/2 degrees. Each of the knob sections 402 has an enlarged rear section 407 provided with alternating longitudinal ridges 408 and finger receiving groove.q 409 whi~h - faL~ tate thQ ~otation of.,.the.ad~u t;ng knnh 382.and the support tube 370 by the surgeon.
The actuator handle assembly 380 includes a rotatable control knob 410 for controlling the rotation of the stdple cartridge 400 about its longitudinal axis relati-ve to the support ~haft 3'~0. The control knob 410 inc}udes an elongated hollow, conically tapered portion 412 which is rotatably received between the sleeve-like sections 402 of the adjust~ng--~n~ 382 and the cylindrical neck portiohs 394 of the handle sections 392. A hollow cylindrical, internally toothed geneva gear wheel 414 is secured within the distal en~ o~ the co~ically tapered body---412 for rotation with the control knob 410. A first pinion gear 416 which i8 rotatably mounted on the in~ide of the ~upport tube 370 extend~ through a window 372 tFigure 35~ formed in the side of the ~upport tube 370 and engages the internal teeth on the geneva gear wheel 414. The pinion gear 416 i9 attached to a ' flexible cable 418 which extends longitudinally through the support shaft 370 and the pivot connection 390. The di3tal end of the flexible cable 418 i~ connected to a second pinion gear 420 rotatably supported in a bushing 422 tFigure 34) mounted on the in~ide of one of the clamshell member~ 424 forming part of 2 ~ 9 7 ~

the pivot connection 390. The flexible cable 418 i~ formed of conventional materials such as steel alloys. The staple cartridge 400 i~ mounted on a cylindrical retainer 426 which is rotatably ~upported by the clamshell members 424 of the pivot connection 390. The cartridge retainer 422 has an internally toothed geneva gear wheel 428 (Figure 36) at its proximal end which engages the pinion gear 420.
In the operation of the ~urgical stapling instrument 350, the control knob 410 is used to control t-~e rotational .0 orientation of the staple cartridge 400 re}ative to the support_ sha~ 370 and the pivot_ connection 390. The rotation of the control knob 410 i9 transmitted via the flexible cable 41~ to the cartridge retainer 422 which rotates the staple cartridge 400 about its axis. ~9 a result, the rotational orientation of the staple cartridge 400 relative to the support shaft 370 ia adjustable by the rotation of the control knob 410.
Except for the control knob 410 which rotates the staple-cartri~ge ~OO, the-surgical stapling instrument 350 ~0 operates in substantially the same manner as the stapling instrument 50 described above. The rotatable adjusting knob 38~ sed to rotate the support shaft 370 relative to the actuator hand}e assembly 380. The saddle-shaped actuator 384 is slidable longitudinally along the actuator handle assembly 380 to pivot the stapling head assembly 360 about an axis transverse to the longitudinal axis of the support shaft 370. The staple actuating lever 388 is pivoted to actuate the Ytaple forming mechanism of the staple cartridge 400 in substantially the same manner as described above.
Figures 48-50 show an embodiment which combines the rotating and articulating features of the embodiment of ~igures 2 and 33, wherein these features are accomplished '~-' '' '`'~

2 7 .9 ~ --. .

by the same mechanism. All elements of Figure 48 corresponding to those of Figure 2 are ~imilarly numbered and, except a~ hereinafter provided, function identically to the corresponding element~ as de~cribed in reference to Figure.2. Now, the gears and flexible cable contained in the embodiment of Figure 33 have been replaced by a centrally dispo~ed metal band 1418. This metal band 1418 is preferably formed of a memory metal, such a3 nitinol, which is able to both operate the staple driver and .0 articulate and rotate the cartridge 1400.
~ . _The...hand.1418 passes..through a hole 14~0..1~ the_ce~t~r of a plate 1422 within the staple cartridge 1400. The band 1418 is connected at its distal end to a staple driver 1476. The band 1418 i~ connected at its proximal end to the articula~ion caddle 1384. The band 1418 is also connected at its proximal end to the handle 1386 via a spring 1374 and pin 1376 in handle 1386.
In the range of articulation of the staple cartridge 1400, band l41~ ~as-~n-el~sti~ memory. Thu~j- dependent-oa '0 the relative slidable positioning of the band 1418 with respect to the staple cartridge 1400, the elastic memory of the band 1418 will cause the .stap}e cartridge 1400 to articulate about the pivot 1236 with respect to the shaft 1370. However, the shaft 1370 i9 rigid enough that the band 1418 has little or no effect on its relative radical po~ition in the shaft 1370. The band 1418 iB long enough to be operable in a handle 1386 at any distal positioning of the band 1418 by the saddle 1384. Of course, rotation of Rhaft 1370 and cartridge 1400 together is possible, as explained above.
In the embodiment of Figure 48, the staple cartridge 1400 preferably includes a series of detents, not illustrated, as previously described, for limiting th~

~ ~ ,? ~ 1~ 7 ~

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rotation of the staple cartridge 1400 to specific increments. This rotation i~ accomplish~d by use of a circular knob, generally 1500, that, ~imilar to the knob 410 in the Figure 33 embodiment, enable~ the rotation of the staple cartridge through rotation of a collar 1502 which is attached to the support tube 1370. The support tube 1370 in turn contains a plate 1504, illu~trated in Figure 49, having a rectangular-shaped hole 1506 therein for slidably receiving the memory metal band 1418 O therethrough. Thus, when the knob 1500 is rotated, the suppox~_tllhP ~Q_and plate 1504 are alsD rota~d. thcxe~y rotating the metal band 1418, which in turn rotates the plate 1422 in the staple cartridge, which in turn rotates the staple cartridge 1400. This, of course, is an optional method of rotating the cartridge 1400 since the external sleeve~ 601 and 60~ could accomplish the ~ame function, if they were used. Although these sleeves 601 and 602 are shown in the embodiment of Figure 48, they could optionally be removed~ ~iew--of--t-h~ k~ 540 and it-s associated 0 components for rotating the cartridge 1400.
The memory metal rod 1418 also cooperates with the staple driver- mechanism ~476 sub~tantially a~ described previously with respect to the embodiment of Figure 2 for actuating the staple driving mechanism of the staple cartridge.
In operation, the band 141~ causes articulation (via its memory and operation of the saddle 1384) of the staple cartridge and operation (via its rigidity and operation of the handle 1386) of the staple driving function. Thus, in 0 this embodiment, the one component, the band 1418, has substituted m~ny moving parts in the instrument of Figures 2 and 33.

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' '' ' ''`' 2 7 ~
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Figures 37-40 ~how an alternative ~embodiment of a stapling head assembly, generally 460, whLich can be used with the surgical ~tapling i~trument 50 described above.
The stapling head as~embly 460 i9 pivotally mounted at the distal end of the support tube 70 by a pivot connection 470 including a tubular pivot housing 472 secured to the support tube 70 and a tubular cartridge support member 474 pivotally connected to the pivot housing 472 by a pair of ~ -h pivot pin. 476-extending later~l-ly from-opposite ides of ~ .. f:~
0 the cartridge support member 474. An inclined ~lot 478 i8 formed on one.side.of the cartridge.support.member 474~
A staple cartridge 600 i9 mounted at the distal end of the cartridge support member 474. The staple cartridge 600 is generally cylindrical in shape and is adapted to be L5 received in the open distal end of the cartridge support member 474. The staple cartridge 600 has a pair of latch pins 602 projecting radially outward its opposite sides.
The latch pins 602 are received and latched in a pair of slots 604 extending~longitudinally-from the ~iista~ end of ~ --~0 the cartridge support member 474. The latch pins 602 and :
slots 604 allow the staple cartridge 600 to be disengaged ~- :
from the cartridge support member 474 when it is desired to replace the staple cartridge 600. ~.
As shown Figure 40, an articulation control member 480 is slidably mounted in the pivot housing 472 and is : .. ~.
connected to the articulation driver 78. A lateral}y ~.
projecting guide pin 482 is located adjacent to the distal ~:-end of the articulation control member 4Bn and is slidably received in the inclined slot 478 of the cartridge support ~ :~
member 474. The inclined slot 47B and the guide pin 4~2 . .
convert longitudinal movement of the articulation driver 78 into pivotal movement of the stapling head assembly 460 about the pivot pins 476.

' ' .:. ~ -2 ~ 2 7`~

As shown in Figure 39, a plunger 490 i8 glidably mounted for longitudinal movement in the cartridge support member 474. The plunger 490 includes an elongated laterally projecting side flange 492 which is ~lidably S received in a longi~udinal 810t ~94 (Figure 38) formed on the eide of the cartridge support member 474. The plunger 490 has a semi-circular rear edge 495 which i9 engaged by an inclined cam surface 496 on a drive member 498 mounted at the distal end of the staple driver 76. The front end L0 of the plunger 490 is engaged with the staple forming .~chanism_inside.the..staple cartridge 600.
~hen the staple driver 76 i9 advanced in the distal direction, the plunger 490 is advanced to actuate the staple forming mechanism of the staple cartridge 600 which operates in substantially the ~ame manner as described above. The semi-circular rear edge 496 of the plunger 90 and the inclined cam surface 498 at the distal end of the staple driver 76 allow the staple forming mechanism to be -a~tuat~d-in any angul-ar orsentation of the staple ~artridge 600.
Another highly preferred embodiment of the invention is illu~trated in Figures 44-47. In~this embodiment, an improved device, generally 700, for pivoting, or articulating the staple cartridge 100 with respect to the ~upport tube 70 is illustrated. The device includes a control knob 702 rotatably mounted on the support shaft 70 proximate the handle a~sembly 80. The control knob 702 i~
preferably mounted to the support shaft 70 and rotates about an axis A4 generally perpendicular to the longitudinal axi~ Al of the ~upport shaft 70.
The control knob 702 i8 adapted for transferring rotational motion of the control knob to an articulation driver a~sembly, generally 704, in a longitudinal direction :~;. :, :
~ .

2 ~ 7 ~

generally parallel to the longitudinal axi9 A1 of the support ~haft 70. Preferably, the art-Lculation driver as~embly comprises a ~leeve 705 rotatably ~o~itioned on the support shaft 70. The ~leeve 705 has an annular channel 706 therein. As illustrated in Figures 44-47, the shaft 70 slidably receives a pair of rods 707. ~ach of the rod~ 707 has a flange 707a extending perpendicularly from the proximal end of the rod 707. Each flange 707a in turn passes through and rides along a pair of ~lots 708 on either side of the shaft 70, the slots 708 preferably being oriented generally parallel to and cQpl~nAr w, th ~he axis A1 of the shaft 70. The flanges 707a also ride within the annular channel 706 of the sleeve 705. As illustrated in Figure~ 44-47, each of the rods 707 may slidably ride within a guide 730 inside the tube 70 for maintaining spacing between the rods 707 and walls of the tube 70.
Referring again to Figure 44, the control knob 702 preferably includes a worm gear 712 about the control knob axes -A4- for tran~ferring -rotational- ~otion- about the control knob axis A4 to rotational motion about the suppor~
shaft longitudinal axis A1. This i9 preferably accomplished with an annular gea~ 713 fastened to the sleeve 705.
As further illustrated in Figure 46, the annular channel 706 of the sleeve 705 ha~ in inclined orientation with respect to the longitudinal axi3 A1 of the support shaft 70. Thi~ inclined orientation converts the rotational motion of the sleeve 705 and annular channel 706 to the longitudinal motion of the flange 707a within the slot 708 when the sleeve 705 is rotated.
As best seen in Figure 47, each rod 707 has connected to its distal end 707b a flexible cable 709 which may be pushed and pulled by the rod 707 as its flange 707a slides ,' '~.' .` ~' ~

~2~273 ; - ~

~ . .~. .

in the 810t 708 and a~ the rod 707 slidel3 in the ~upport tube 70. Preferably, each rod end 707b has a blind hole 720, ~hich receive~ the cabla 709 as illustrated in Pigure 47. A~ illustrated, the cable 709 i~ ~lipped into the blind hole 720 and secured to the rod 707, for example, with a crimp or an adhesive material 722. Each flexible cable 709 i8 connected at ite distal end to the ~tapling head as embly 60 a~ illustrated. In making this connec~lo~, the c~ble 709 is fed through-the hollow support 0 tube 70, through the pivot connection 200 and attached to the stapler head assembly 60 at a-point in the plane fonmed by the intersection of the axes and A1 and A3, but at a poi~t spaced from the axis A3. Preferably, this connection be~ween the cable 709 and the stapler head assembly 60 iq L5 achieved by passing the cable 709 into a hole or bore in the stapler head a~sembly 60, and fastening the end of the cable to the assembly 60 with an adhesive or any other acceptable fastening method.
ln -a-~ighly preferred -embodiment--o~ th~ inventio~
illustrated in Figure ~7, the flexible cables 709 are s~idably received within a flexible sleeve 710, which provides reduced friction as the cable~709 is pushed and/or pulled through the support tube 70. Preferably, the flexible ~leeves 710 are fixed with respect to the support tube 70, allowing slidable motion of the cable~ 709 therein, for example, by attaching the ends of the flexible sleeve~ 710 to the support tube 70. The flexible ~leeves 710''are preferably fabrica~ed''of fiberglass reinforced or steel rein~orced nylon, TeflonX, polyethylene, among other equivalent materials known in the art.
The embodiment illustrated in Figures 44-47 is a "push/pull" sy~tem. That is, when one of the cables 709 is in compres~ion, the other cable 709 is in tension as `.''~`'''.-..'`

', -: `: ' ' ~ '~,:
`~

21~2~
'~ ' ~''"`' dictated by the rotation of the sleeva 705. A~ illustrated in Figure 44, the le~gth of the cable 705~ i~ relatively short with re~pect to the length of the support shaft 70 and rods 707, enabling each cable 709 to be pushed without buckling sub~tantially. Buckling i9 further avoided by the use of the flexible sleeves 710.
In àddition to a npush/pull~ Yystem, it would also be possible to arranse the embodiment of Figures 44-47 in either a ~pull/pull~ or a npush/push~ system, whereby both 0 cables are simultaneously pulled or pushed, respectively.
. The flexible cables 709 may be fabricated of any materials suited for the purpose including, by way of example, but not limitation, steel, nitinol, nylon, and fiberglass, manufac~ured by Hoechest Celanese. The flexible cable 709 preferably is flexible and retain~ good flexing memory.
The articulation asse~bly 700 of the invention offers several advantages with respect to prior articulation devices. - The ~ssambly -700 -allows a complete-~weep-of 0 articulation over the entire range of articulation (generally 0-60), rather than the more limited fixed angles of articulation provided with the prior ratchetting mechanism. Additionally, because of the use of the worm gear mechanism, with its advantageous gear ratios, S preferably greater than 2:1 to prevent back-driving, the degree of articulation i9 both precisely and ea~ily controlled with the turn of the control knob 702.
The devices for providing articuIation and rotation to the tip of a shaft previou~ly de~cribad can be employed in O a wide variety of surgical in~truments other than stap}ing devices. For example, since the support tube 70 is hollow, it may contain a number of other surgical apparatu~, including cameras, illumination devices, `.'' ;;-~'. . `'''~''.

: .., ` '`. ,' :"

ligation devices, forcep~, drilling de~vice9, 8uction device~, insufflation devices, cutting devices, scalpel~
clamps, absorption devices, injection devices, drainage devices, la~ers, cryogenic devices, ~onic devices, e.g., for providing sonar detection of blood vessels, illumixlation devices, such as fiber optic cable, and ~urgical stitching devices. The device of the present invention allows such surgical apparatu9 to be in~erted into a patient through a cannula, 9UC~- -a8 previou~ly L0 described, and articulated and/or rotated to the point of interest within the patient.
Referring now to Figures 51, 51a, and 52, there is illustrated yet another highly preferred embodimen~ of the invention. As illustrated in thi~ embodiment, a staple L5 cartridge 2001 includes an anvil 2002, a staple holder 2005, and a staple ~ormer 2004 preferably made of stainle~s steel and functioning as previously described. A
compre~sion coil spring 2003 biases the staple holder 2005 away from the staple fonmer 2004, al30 as previously-described. A feeder shoe 2007 is slideably mounted within the staple cartridge 2001 for urging a series of staples 2~06 ~oward the distal end of the cartridge 2001. The feeder shoe 2007 is biased in the distal direction by a compression coil spring 2008 which is mounted on a cartridge retainer 2010 substantially as previously described.
In the embodiment of Figure 51, the staple3 2006 are d~iven with a ~odified staple driver comprising a rod 2028 having fastened at its distal end 2028c a flexible member 2029. This flexible member 2029 in turn is fastened at its distal end to the staple fonmer 2004, for example, by being crimped at location 2004a in the staple former 2004. In forming the staples 2006, the staple driver rod 2028 is : ` . `.- .

~-.: .' ;`:.

212~2~3 :

pushed through the support tube 2026, thereby driving the flexible member, 2029, which is stiff enough to drive the ~taple former 200~ toward the di~tal en~ of the ~taple cartridge 2001, fonming the ataples around the anvil 2002.
This staple forming procedure i8 sub~tantially the same a~
previously described herein with ~he exception of the modified staple driver 2028, 2029, 2004. This modified staple driver replaces the plunger 270 and staple driver 76 previously described. ~ ``
~0 In order to actuate the ~taple driver rod 2028, the rod preferably is actuated by a trigger mechanism 2037 pivotally supported on a handle 2036 with a pin 2038 as illustrated in Figure 51a and 52. The trigger mechanism 2037 ~9 bia~ed in an open or di~engaged position by a coil L5 spring 2035 in tension. This trigger mechanism 2037, spring 2035, and handle 2036 are assembled in substantially the same way as like components illustrated in Figure 52.
The-staple driver rod 202B i9 rotatably captured--~ a ~0 link 2033 in combination with a series of washers 2032 and snap rings 2031 as illustrated. The snap rings 2031 snap into annula~ g~ooves-2028a on th~ staple driver rod 2028-.
The link 2033 i8 retained by the spring 2035 and driven by the trigger 2037 as previously described.
As the trigger 2037 is pulled toward the handle 2036, the link 2033 forces the ~taple driver rod 2028 toward the distal end of the staple cartridge 2001, thereby driving the staple 2006. Figure 52 illustrates the link 2033 in both the retracted and firing positions. The driver link 2033 further include~ a projecting metal leaf spring 2034 curved downwardly at its proximal end for engaging a series of ratchets 2034a as previously described. The leaf spring 2034 and ratchet~ 2034a prevent the driver rod 2028 from .. .. ...... .

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rever~ing direction ~i.e., toward the proximal end of the stapling instrument) until the stapling mechanism has gone through a complete ~tapling cycle by firing and forming a sta~le. This is accomplished with a rcu~p 2034b which allows the metal leaf spring 2034 to return to the beginning of the series of ratchets as the trigger 2037 is release~ and again biased in the open position by the spring 2035 after a complete fire of the staple 2006.
~ - The~-staple ~river rod---2028 also opèrates as a torque O transmission mechanism for rotating the staple cartridge 2001 at any angle of articulation, as will now be described.
The rod 2028 is rotatably positioned within the support shaft 2C26, and i9 preferably supported by a spacer 2027 and/or a guide 2030 ~o maintain a space between the rod 2028 and the inner walls of the support tube 2026. The guide 2030 preferably is trapped within a series of grooved flanges 2030a within the handle 2036 or support shaft 2026.
~he rod^2028 incl~des at--its pro~imal end a ~lang~
" ,~, ~
~0 2028b, which may simply be a ~J-hook" bend in the rod 2028, which i9 captured by a knob 2040, which i9 externally and rotatably- posit-ioned on the handle ap~a-ratus 2036. This knob 2040 may comprise two clam shell halves, each of which may include a shelf 2040a on which the flange 2028b rides.
!5 Each side of the clam 3hell-type knob 2040 preferably includes one or more capturing flanges 2040b which trap the J-hook 2028b and allow the rod 2028 to be rotated when torque i3 applied to the external knob 2040. The 3helf 2040a and capture flanges 2040b also al1ow the rod 2028 and ~0 J-hook 2028b to slide back and forth in response to a staple driving cycle, while retaining the J-hook 2028b within the space defined by the shelf 2040a and capture flanges 204Ob.

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The knob 20~0 al~o preferably inclucle0 detents 2040c which allow the knob 2040 to provide incremental rotation to the staple cartridge 2001, in a manner ~ub~tantially the same a~ previoucly deecribed.
Accordingly, when the knob 2040 i9 rotated, the rod 202~ rotate~ in the same direction as does the flexible member 2029, which in turn rotates the ~taple former 2004, which in turn rotates the cartridge retainer 2010 and the staple cartridge 200~. The staple cartridge-retainer 2010 0 i8 rotatably connected to a forward clevis 2011 of a clevis ,,, :
assembly 2011/2012 via channeled clam shell members 2009 which are captured by a sleeve 2000. These clam shell member3 2009 rotate about an annular flange 2011a of the forward clevis 2011. The clevis member 201i/2012 does not, however, rotate upon rotation of the rod 2028. .. -.-The flexible member 2029 is flexible enough to allow the staple cartridge 2001 to be articulated, via the clevis 2011/2012, about an axis of articulation, A2, yet stiff enough to-al-low th~ staple-driver rod 2~2d to drive the staple former 2004, at any angle of articulation. The flexible attachment member 2029 is also capable of traLsferr~ng.torque from, a~d.-.initiated at, the external knob 2040 to the rotatable staple cartridge 2001.
Preferably, the flexible member 2029 compri3es flexible cable, including wire, rod, chain, flex shaft, and true multi-strand cable. Thi~ flexible cable may be fabricated of any suitable material, including by way of example, but not limitation, steel, nitinol, nylon, and fiberglass. The flexible cable 2029 is preferably ~ecured within the rod 2028 at its distal end 2028c, for example, by adhering the cable 2029 within a blind hole in the rod 2028 as previously described. The embodiment of Figureq 51 and 52 offer3 significant advantages over previously described ..~ ,.., ," ~ . ,~, ....
'`"`'`' ~ ." ~` ''~`' "
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embodiments, in the that it allows one component, the rod 2028 and associated components to fu~ction a~ both a torque transfer mechanism, i.e. for rotating the ~3taple cartridge 2001, a~ well as a staple driver device.
In a highly preferred embodiment of the invention, the flexible attachment member 2029 is slideably po~itioned within a flexible conduit attached to the inatrument, e.g., at the clevis 2011 and/or 2012. This flexible conduit may be fabricated from any acceptable conduit material, 0 including by way of example, but not limitation, woven, braided, bowden, extruded, and braided/extruded conduit.
The flexible conduit i~ highly desireable, because it provide~ support to the flexible attachment member 2029, especially when that member has been bent into an ang e of articulation by the clevis 2011/2012 as will subsequently be described.
The preferred embodiment of Figures 51, 51a, and 52 also includes a mechanism for articulating the staple cartridge 2001 about a~ a~is of artic~lation A2. This 0 mechanism preEerably includes devices for pro~iding pushing and/or pulling force~ in a direction generally parallel to the su~port shaft 2026 and for directing those forces around the clevis 2011/2012 for pivoting the staple cartridge 2001 about the axis of articulation A2. In the embodiment illustrated in Figure 51, thi~ mechanism includes one or more articulation driver rods 2014, which are slideably positioned within the support shaft 2026 and spaced from the torque transfer/staple driver rod 2028.
This spacing may be maintained, for example, by use of a 0 spacer member 2027 having a series of spaced holes and/or grooves therein for maintaining a spaced orientation of the respective rods 2028 and 2014.
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21~627~

Most preferably, the articulation driver assembly includes a rigid section compri~ing a rigidl rod 2014 having at its distal end a flexible eection 2015, which flexible section provide~ both ~iufficie~t flexibility for bending about the axiY of articulation, A2, while providing sufficient stiffness for transferring pushi.ng forces around the clevis 2011/2012 without buck;Ling. This flexible member 2015 may comprise a flexible cable similar to that previously discussed with respect to the flexible memher 0 2029. This flexible member 2015 may also be attached to the articulation driver rod 2014 as previously described with respect to flexible member 2029.
Depending on whether a push/pull, push/push, or pull/pull ~rrangement i8 desired, the flexible member~ 2015 L5 are attached ~o the staple cartridge 2001 in a number of ways, such as wa~ preYiously described with respect to the embodiment illustrated in Figures 44-47.
AS previously described with respect to Figures 44-47, the embodiment of Figures 51, 51a, and 52 also includes ~0 a control mechanism for transferring motion to the articulation driver assembly in a longitudinal direction generally parallel to the longitudinal axis, Al, of the support shaft 2026. This control apparatus preferably includes a control knob 2020 rotatably mounted on the support shaft, for example, with an axle 2021 and a mounting bracket 2024. The axle 2021 preferably includes a worm 2022 that drives a worm gear 2019 that ii3 attached via one or more pins 2018 to a slee~e 2017 which rides within an outer sleeve 2016 that i3 pinned to the sleeve 2017. The sleeve 2017 preferably comprises two hal~es 2017a and 2017b, each half having an inclined edge forming an inclined annular channel such as 706 previously '''~"''"'~"`'i'' - .~ . . .

, .. .~

described with respect to Figure 44. The sleeves Z017 and 2016 may be hou~ed wi.hin a cover 2025.
The a~nular chan~el in the sleeves 2017 ~apture~
flanges, which may comprise ~-hooked ends 2014a of the S articulation driver rods 2014, which ends extend through one or more longitudinal 810t8 2026a in the support shaft 2026. These flange~ 2014a therefore slideably ride within the slots 2026a and are each driven along that slot(s~ by ~he-s1~eeve-2017 as that sleeve i8 rotate~. - -As discussed previously with respect to the embodiment of Figure 44, it is preferred to include two or more articulation driver members 2014/2015 for articulating the staple cartridge 2001 about the clevis 2011/2012. As illu~trated in Figure 51, the rearward clevis 2012 preferably includes one or more grooves or slots 2012a having a thickness slightly greater than that of the cable 2015, which slides within and is guided by, the groove or slot 2012a. As also illustrated in Figure 51, the clevi~
includes oae o~-more pins 2013.which function-to pivot the clevis about its pivot point, which corresponds to the axis A2 of articulation.
Refer~ing.now. to.Figures 5~.-58, there..is illustrated in greater detail the clevis member 2011/2012. As illustrated in Figure 53ta) the rear or stationary clevis 2012 include~ an annular flange 2101 which is secured within the support tube 2026. This annular flange 2101 includes a number of bored holes 2102, 2103, 2104. As best seen in Figure 57, the bored holes 2102 -and 2104 ~lideably receive the flexible members 2015 and the bored hole 2103 slideably r2ceives the flexible member 2029. Each of these flexible members in turn pas~es through the slot 2012(a) as previously described. The stationary clevis 2012 further include3 a pair of planar flanges 2105, 2106, which define - 2-~ 2 7 ~

57 ;~
the slot 2012(a). Each flange 2105 and 2106 has a hole 2107, 2108 respectively, therethrough, for receiving the ~ .
pins 2013 a~ previously described. The pin~ 2013 do no~
however, penetrate the slot 2012(a). .
Referring now to Figure 54, there i8 illustrated the forward or moveable clevis, 2011, which includes an annular fla~ge 2110 having a set of bored holes 2112, 2113, 21~4 for receiving the respective flexible members from their ; ~ `.-. .
counterpart bore~- holes 2102, 2103, 2104, respectively in the stationary clevis 2012. Preferably, the bored holes 2112 and 2114 are "blind" holes, in which the flexible :.
members 2015 may be secured, for example, by an adhesive or crimping. The moveable clevis 2011 also includes a pair of . . . .
planar flanges 2115, 2116, each of which includes a bored ...... ..
hole 2117, 2118 respectively, for receiving the pins 2013. :m ~
The flanges 2115 and 2116 are separated by a space 2120, i:
which i9 wide enough to accept the flanges 2105, 2106 of .. . .
the stationary clevis 2012 as illustrated in Fig. 56.
.. In.~-highly.preferred-embodiment-o~--the-invsntion, the . ~
drivers 2014 operate in a push/pull mode, wherein as one ... .. i driver 2014 i9 pushing the staple cartridge 2001 such that it articulates. about the... axi~, A2, ~ia. the clevis 2011/2012, the other driver 2014 is pulling from the opposi~e side of the staple cartridge 2001. This is preferably achieved by affixing the cables 2015 to the m : .-forward clevis 2011, for example, by securing each of the ~ :-.. -cables 2015 within a blind hole, 2120 in the clevis 2011, as illustrated in Pigures 57, 58. The forward clevis 20~
is attached via the cartridge retainer 2010 to the staple cartridge 2001, with each cable being placed on the center line, i.e., diameter, of the cle~is 2011 and spaced apart from the axis, A1, of the cartridge and the clevis 2011 and 21~

. - - - . .

~. ~
on opposite ~ides of the center line with respect to that axi~, a~ illustrated in Figures 52 and 54(c).
Pigure 55 illu3trate~ the articulation of the embodiment of Figure~ 51 and 52. A~ illu~trated, as the lower articulation driver rod 2014 ie pu~hed in the direction of the arrow "An, and the upper articulation driver rod 2014 i~ pulled in the direction of the arrow "Bn, the moveable clevis 2011 is rotated about the pivot point, pin 2~13, in the direction o~ arrow ~C~. ~This,- in turn, articulates the staple cartridge 2001, which is fastened via the cartridge retainer 2010 to the moveable clevis 2011 as previously described.
Of course, it would be possible to impart a "push~pu~h" an~/or ~pull/pull n mode of operation to the instrument, for example, by maintaining both cables 2015 in equal compression or tension, and providing means to vary the relative compression or tension, thereby inducing a net fo~ce for articulating the cartridge 2001. In the "pullfpull" mode, for example, both articulation driver rods 2014 would be biased forwardly, placing each of the flexible members 2015 in equal compression. A device for placing the biasing forces acting on the two rods 2014 in imbalance, such as a hand lever or toggle, would be u~ed to cause a net force for articulating the cartridge in the direction of the net force. A ~imilar arrangement would be used for the "pull/pull" mode, except that both rods 201~
would be biased rearwardly, such that the flexible members 2015 were in equal- tension.
The invention in its broader aspect~ is not limited to the specific details of the preferred embodiments shown and described, and those skilled in the art will recognize that the invention can be practiced with modification within the spirit and scope of the appended claims, including any ', ~' " ' .'-:

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and all equivalent~ thereof. Additiol~ally, although certain preferred embodiments of the invention described herein satisfy one or more ob~ecte and pro1vide one or more advantage~ a~ d~scussed above, it i~ expre~ly contemplated that the invention may be practiced in spirit ~rithout utilizing all of the object~ and advantages, and that accordingly, ~he object~ and advantages of the invention form no part thereof, except a~ such may be embodied by the ful~ scope of the following clain~
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Claims (72)

1. Means for providing rotational motion to an articulatable staple cartridge of a surgical stapling instrument having a support shaft supporting said staple cartridge, said stapling instrument including pivot means for pivoting said staple cartridge relative to said support shaft, said staple cartridge having a longitudinal axis forming an angle of articulation relative to an axis passing longitudinally through said support shaft, said rotational motion of said staple cartridge being obtainable about said longitudinal axis at a plurality of angles of articulation of said staple cartridge.

2. The means for providing rotational motion of Claim 1 wherein said means includes means engaging said support shaft for transferring rotational motion about said support shaft axis to means engaging said staple cartridge for providing rotational motion to said staple cartridge about said longitudinal staple cartridge axis.

3. The means for providing rotational motion of Claim 1 wherein said angles of articulation are from about 0° to about 60°.

4. The means for providing rotational motion of Claim 2 wherein said means engaging said support shaft comprises a first external sleeve rotatably positionable on said support shaft, and said means engaging said staple cartridge comprises a second external sleeve, said first external sleeve having a distal end terminating proximate said pivot means for articulating said staple cartridge relative to said support shaft, said second external sleeve having a proximal end terminating proximate said pivot means, said distal and proximal sleeve ends engaging one another for transferring rotational motion from said first external sleeve to said second external, sleeve to said staple cartridge.

5. The means for providing rotational motion of Claim 4 wherein said distal and proximal sleeve ends comprise interconnecting teeth positioned about said first and second external sleeves, respectively.

6. The means for providing rotational motion of Claim 4 wherein said distal and proximal sleeve ends comprise frictional annular flanges.

7. The means for providing rotational motion of Claim 4 wherein said distal end of said first sleeve includes a first band of adhesive film fastened about said first sleeve proximate said pivot means, wherein said proximal end of said second sleeve includes a second band of adhesive film fastened about said second sleeve proximate said pivot means, and said means for providing rotational motion further includes a plurality of film strips joining said first band and second band, said film strips positioned about said pivot means and transferring rotational forces. from said first sleeve to said second sleeve to said staple cartridge.

8. The means for providing rotational motion of Claim 7 wherein said film strips are aligned substantially parallel to said longitudinal axis of said support shaft.

9. The means for providing rotational motion of claim 8 wherein said bands and film strips comprise a unitary piece of generally rectangular adhesive film.

10. The means for providing rotational motion of claim 4 wherein said means is retrofittable to an existing surgical stapling instrument.

11. A surgical stapling instrument for applying one or more surgical staples to tissue, comprising:
a handle including a staple actuator mechanism;

a tubular support shaft having a longitudinal axis and extending from said handle;
a staple cartridge mounted on said support shaft and connected to said staple actuator mechanism for applying one or more staples to the tissue;
said staple cartridge being mounted for articulatable movement relative to said support shaft about an axis of articulation, said axis of articulation being transverse to said longitudinal axis of said support shaft;
and said support shaft being either rotatable about its longitudinal axis or fixed relative to said handle, said staple cartridge being rotatable about a second longitudinal axis of said staple cartridge after said staple cartridge has been articulated about said axis of articulation thereby forming an angle of articulation relative to said longitudinal axis of said support shaft.

12. The stapling instrument of Claim 11, which includes:
first means for articulating said staple cartridge about said axis of articulation.

13. The stapling instrument of Claim 12 which includes:
second means for rotating said support shaft about its longitudinal axis.

14. The stapling instrument of Claim 13 which includes:
means for rotating said staple cartridge about its longitudinal axis at any angle of articulation of said staple cartridge relative to said support shaft.

15. An endoscopic surgical stapling instrument for applying one or more surgical staples to tissue, comprising:

a handle including a staple actuator mechanism;
a tubular support shaft having a longitudinal axis and extending from said handle;
a staple cartridge mounted on said support shaft and connected to said staple actuator mechanism for applying one or more staples to the tissue;
said staple cartridge being mounted for rotation relative to said support shaft to permit the rotational orientation of said staple cartridge to be adjusted;
pivot means for articulating said staple cartridge relative to said support shaft;
means for retaining said staple cartridge in different rotational orientations as said staple cartridge is rotated;
means for retaining said staple cartridge in different articulated orientations as said staple cartridge is articulated;
first control means proximate said handle for rotating said staple cartridge relative to said support shaft;
second control means proximate said handle for articulating said staple cartridge relative to said support shaft;
first external sleeve means rotatably positioned on said tubular support shaft; and second external sleeve means engaging said staple cartridge, said first external sleeve means having a distal end terminating proximate said pivot means, said second external sleeve means having a proximal end terminating proximate said pivot means, said distal and proximal sleeve ends engaging one another for transferring rotational movement from said first external sleeve to said second external sleeve and to said staple cartridge.

16. The endoscopic stapling instrument of Claim 15 wherein said distal and proximal sleeve ends comprise interconnecting teeth positioned about said first and second external sleeves.

17. The endoscopic stapling instrument of Claim 15 wherein said distal and proximal sleeve ends comprise frictional annular flanges.

18. The endoscopic stapling instrument of Claim 15 wherein said distal end of said first cleeve includes a first band of adhesive film fastened about said first sleeve proximate said pivot means, wherein said proximal end of said second sleeve includes a second band of adhesive film fastened about said second sleeve proximate said pivot means, and said stapling instrument further includes a plurality of film strips joining said first band and second band, said film strips positioned about said pivot means and transferring rotational forces from said first sleeve to said second sleeve to said second staple cartridge.

19. The endoscopic stapling instrument of Claim 18 wherein said film strips are aligned substantially parallel to said longitudinal axis of said support tube.

20. The endoscopic stapling instrument of Claim 19 wherein said bands and film strips comprise a unitary piece of generally rectangular adhesive film.

21. The endoscopic stapling instrument of Claim 15, which further includes:
staple driver means for coupling said staple actuator mechanism to a staple forming mechanism and actuating said staple forming mechanism in any angular position of said staple cartridge.

22. The endoscopic stapling instrument of Claim 21, wherein said staple driver means comprises:

a staple driver slidably mounted for longitudinal movement in said support shaft and coupled to said staple actuator mechanism; and a plunger slidably mounted on said pivot means and actuated by the longitudinal movement of said staple driver for actuating the staple forming mechanism when said staple actuator mechanism is operated.

23. The endoscopic stapling instrument of Claim 15, which further includes:
an articulation driver slidably mounted for longitudinal movement in said support shaft for connecting said actuator means to said pivot means to pivot said staple cartridge relative to said support shaft.

24. The endoscopic stapling instrument of Claim 23 wherein:
said articulation driver includes a guide pin at its distal end received in an arcuate groove in said pivot means for converting the longitudinal movement of said articulation driver into pivotal movement of said staple cartridge relative to said support shaft.

25. The means for providing rotational motion of Claim 4 wherein said first external sleeve includes stop means at the end of said sleeve proximate a handle fastened to said support shaft.

26. The means for providing rotational motion of Claim 25 wherein said first external sleeve includes biasing means for biasing said sleeve toward or away from said handle.

27. A surgical instrument including a shaft for introducing surgical apparatus to a patient, said shaft comprising a distal end pivotally coupled to a proximal end, said instrument including means for articulating said distal end with respect to said proximal end about a pivot axis, said instrument further including means for rotating said distal end about a plurality of longitudinal axes passing through said distal end, said instrument further including means for rotating said proximal end of said shaft about a longitudinal axis passing through said proximal end.

28. The surgical instrument of Claim 27 wherein said plurality of longitudinal axes of said distal end forms an angle of from about 0° to 60° with respect to said longitudinal axis of said proximal end.

29. The surgical instrument of claim 27 wherein said surgical apparatus is selected from the group consisting of cannula means, stapling means, ligation means, forcep means, suction means, cutting means, scalpel means, clamp means, absorption means, sonic means, illumination means, and stitching means.

30. The surgical instrument of claim 27, said shaft proximal end including means engaging said shaft proximal end for transferring rotational motion about said longitudinal axis of said shaft proximal end to means engaging said shaft distal end for providing rotational motion to said shaft distal end about said plurality of distal end longitudinal axes.

31. The surgical instrument of Claim 30, wherein said means engaging said shaft proximal end comprises a first external sleeve rotatably positionable on said shaft proximal end, and said means engaging said shaft distal end comprises a second external sleeve, said first external sleeve having a distal end terminating proximate said pivot axis, said second external sleeve having a proximal end terminating proximate said pivot axis, said distal and proximal sleeve ends engaging one another for transferring rotational motion from said first external sleeve to said second external sleeve to said shaft distal end.

32. The surgical instrument of Claim 31 wherein said distal and proximal sleeve ends comprise interconnecting teeth positioned about said first and second external sleeves.

33. The surgical instrument of Claim 31 wherein said distal and proximal sleeve ends comprise frictional annular flanges.

34. The surgical instrument of Claim 31 wherein said distal end of said first sleeve includes a first band of adhesive film fastened about said first sleeve proximate said pivot axis, wherein said proximal end of such second sleeve includes a second band of adhesive film fastened about said second sleeve proximate said pivot axis, and said surgical instrument further includes a plurality of film strips joining said first band and second band, said film strips positioned about said pivot axis and transferring rotational forces from said first sleeve to said second sleeve to said shaft distal end.

35. The surgical instrument of Claim 34 wherein said film strips are aligned substantially parallel to said shaft proximal end longitudinal axis.

36. The surgical instrument of Claim 35 wherein said bands and film strips comprise a unitary piece of generally rectangular adhesive film.

37. The surgical instrument of claim 31 wherein said first external sleeve includes stop means at the end of said sleeve proximate a handle fastened to the proximal end of said shaft.

38. The surgical instrument of claim 37 wherein said first external sleeve includes biasing means for biasing said sleeve toward or away from said handle.

39. The means for providing rotational motion of Claim 1 wherein said means for providing rotational motion also comprises a means for providing staple driving force to said staple cartridge to drive staples contained in said staple cartridge.

40. The means for providing rotational motion of Claim 39 wherein said means passes through the center of said staple cartridge.

41. The means for providing rotational motion of Claim 40 wherein said means comprises a memory metal.

42. The stapling instrument of Claim 12 wherein said first means also comprises a means for providing staple driving force to said staple cartridge to drive staples contained in said staple cartridge.

43. The stapling instrument of Claim 42 wherein said first means is formed from a memory metal.

44. The stapling instrument of Claim 43 wherein said first means comprises a memory metal band having a permanent bend in one end thereof for articulating said staple cartridge as said band is slid with respect to said staple cartridge.

45. The means for providing rotational motion of claim 1, said means including torque transfer means rotatably positioned within said support shaft, said torque transfer means being fastened at its distal end to said rotatable staple cartridge via flexible attachment means, said torque transfer means being attached at its proximal end to external torque transfer means.

46. The means for providing rotational motion of claim 45, said flexible attachment means comprising flexible cable means adapted for flexing through any said angle of articulation of said staple cartridge and for transferring torque from, and initiated at, said external torque transfer means to said rotatable staple cartridge.

47. The means for providing rotational motion of claim 46, wherein said flexible cable means is fabricated from material selected from the group consisting of wire, rod, chain, flex shaft, and multi-strand cable.

48. The means for providing rotational motion of claim 46, wherein said flexible cable means is fastened at its distal end to said rotatable staple cartridge and fastened at its proximal end to a rigid portion of said torque transfer means.

49. The means of providing rotational motion of claim 48, wherein said rigid portion comprises a rod rotatably disposed within said support shaft.

50. The means for providing rotational motion of

claim 51, wherein said support shaft includes spacer means for maintaining spacing between said rod and said support shaft.
51. The means for providing rotational motion of claim 45, wherein said external torque transfer means comprises a knob rotatably positioned with respect to the proximal end of said support shaft, said knob transferring rotational motion thereof to said torque transfer means.

52. The surgical stapling instrument of claim 11, wherein said stapling instrument includes means for providing rotational motion of said staple cartridge, comprising torque transfer means rotatably positioned within said support shaft, said torque transfer means being fastened at its distal end to said rotatable staple cartridge via flexible attachment means, said torque transfer means being attached at its proximal end to external torque transfer means.

53. The surgical stapling instrument of claim 52, said flexible attachment means comprising flexible cable means adapted for flexing through any said angle of articulation of said staple cartridge and for transferring torque from, and initiated at, said external torque transfer means to said rotatable staple cartridge.

54. The surgical stapling instrument of claim 53, wherein said flexible cable means is fabricated from material selected from the group consisting of wire, rod, chain, flex shaft, and multi-strand cable.

55. The surgical stapling instrument of claim 52, wherein said flexible cable means is fastened at its distal end to said rotatable staple cartridge and fastened at its proximal end to a rigid portion of said torque transfer means.

56. The surgical stapling instrument of claim 55, wherein said rigid portion comprises a rod rotatably disposed within said support shaft.

57. The surgical stapling instrument of claim 56, wherein said rigid portion comprises a rod rotatably disposed within said support shaft.

58. The surgical stapling instrument of claim 52, wherein said external torque transfer means comprises a knob rotatably positioned with respect to the proximal end of said support shaft, said knob transferring rotational motion thereof to said torque transfer means.

59. The surgical stapling instrument of claim 58, wherein said torque transfer means includes a rigid rod, the proximal end of said rigid rod engaging said knob.

60. The surgical stapling instrument of claim 58, wherein said knob include means for providing incremental rotational motion to said rotatable staple cartridge.

61. The surgical stapling instrument of claim 60, wherein said means for providing incremental rotational motion comprises detent means.

62. The surgical stapling instrument of claim 52, wherein said torque transfer means further comprises staple driver means.

63. The surgical stapling instrument of claim 52, further including means for articulating said staple cartridge about said axis of articulation.

64. The surgical stapling instrument of claim 63, wherein said means for articulating said staple cartridge comprises means for providing pushing and/or pulling forces in a direction generally parallel to said support shaft and for directing said forces around clevis means for pivoting said staple cartridge about said axis of articulation.

65. The surgical stapling instrument of claim 64, wherein said means for articulating said staple cartridge comprises an articulation driver means slidably positioned in said support shaft and spaced from said torque transfer means.

66. The surgical stapling instrument of claim 65 further including spacer means for maintaining spacing between said torque transfer means and said articulation driver means.

67. The surgical stapling instrument of claim 65, wherein said articulation driver means comprises a rigid section having fastened to its distal end a flexible member, said flexible member providing both sufficient flexibility for bending about said axis of articulation and sufficient stiffness and tensile strength for transferring pushing and pulling forces, respectively, around said clevis means.

68. The surgical stapling instrument of claim 67, wherein said flexible member comprises a flexible cable.

69. The surgical stapling instrument of claim 68, wherein said flexible cable is fabricated from material selected form the group consisting of wire, rod, chain, flex shaft, and multi-strand cable.

70. The surgical stapling instrument of claim 68, wherein said flexible cable is fabricated from material selected from the group consisting of steel, nitinol, nylon, and fiberglass.

71. The surgical stapling instrument of claim 67, wherein said instrument further includes:
a control means mounted externally on said support shaft proximate said handle for transferring motion to said articulation driver means in a longitudinal direction generally parallel to the longitudinal axis of said support shaft.

72. The surgical stapling instrument of claim 53, wherein said flexible cable is slidably positioned within a flexible conduit.