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Patentes

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Número de publicaciónWO1997034533 A1
Tipo de publicaciónSolicitud
Número de solicitudPCT/IL1997/000104
Fecha de publicación25 Sep 1997
Fecha de presentación20 Mar 1997
Fecha de prioridad21 Mar 1996
También publicado comoEP0844847A1, EP0844847A4
Número de publicaciónPCT/1997/104, PCT/IL/1997/000104, PCT/IL/1997/00104, PCT/IL/97/000104, PCT/IL/97/00104, PCT/IL1997/000104, PCT/IL1997/00104, PCT/IL1997000104, PCT/IL199700104, PCT/IL97/000104, PCT/IL97/00104, PCT/IL97000104, PCT/IL9700104, WO 1997/034533 A1, WO 1997034533 A1, WO 1997034533A1, WO 9734533 A1, WO 9734533A1, WO-A1-1997034533, WO-A1-9734533, WO1997/034533A1, WO1997034533 A1, WO1997034533A1, WO9734533 A1, WO9734533A1
InventoresSergey Popov
SolicitanteS.A. Development Of Advanced Medical Products Ltd.
Exportar citaBiBTeX, EndNote, RefMan
Enlaces externos:  Patentscope, Espacenet
Surgical stapler and method of surgical fastening
WO 1997034533 A1
Resumen
This invention is a suturing device (10) and a method of using the device (10), for providing anastomosis of first and second hollow organ portions (120, 122) each having an open end for suturing together with each other across a common interface (131), wherein the device (10) includes an elongated tubular housing (12) having a first free end (14), and a second end (16), the housing (12) being configured for insertion through the first hollow organ portion such that the second end is associated with the open end thereof; a suturing apparatus, associated with the second end of the tubular housing (12), for suturing together the open ends of the first and second organ portions (120, 122) by insertion of suture elements (40, 44, 48) therethrough along the entire length of the common interface (131) and thereacross; a suturing apparatus that includes an apparatus for inserting a single row of suture elements through the organ tissue along a portion of the common interface; and an apparatus for inserting a double row of suture elements through the organ tissue along the remainder of the common interface.
Reclamaciones  (El texto procesado por OCR puede contener errores)
1. A suturing device for providing anastomosis of first and second hollow organ portions each having an open end for suturing together with each other across a common interface, wherein said device comprises: an elongate tubular housing having a first free end, and a second end, said housing being configured for insertion through the first hollow organ portion such that said second end is associable with the open end thereof; and suturing means, associated with said second end of said tubular housing, for suturing together the open ends of the first and second organ portions by insertion of suture elements therethrough along the entire Iength of the common interface and thereacross, and wherein said suturing means comprises: means for inserting a single row of suture elements through the organ tissue along a portion of the common interface, and means for inserting a double row of suture elements through the organ tissue along the remainder of the common interface.
2. A suturing device according to claim 1 , wherein said means for inserting a single row of said suture elements comprises means for inserting through the organ tissue a first row of suture elements having a first predetermined spacing, and said means for inserting a double row of said suture elements comprises means for inserting a double row of said suture elements having other predetermined spacings, different from said first predetermined spacing, wherein said spacings are predetermined to apply to the suture tissue a varying force along the entire suture predetermined so as to facilitate adequate blood supply to the suture tissue while not preventing haemostasis, thereby to facilitate optimal healing of the tissue.
3. A suturing device according to claim 2, wherein said means for inserting a double row of suture elements comprises: means for inserting a second row of suture elements, having a second predetermined spacing, and means for inserting a third row of suture elements generally parallel to said second row, and having a third predetermined spacing, different from said first and second predetermined spacings.
4. A suturing device according to claim 3, wherein said first, second and third rows of suture elements comprise deformable suture elements.
5. A suturing device according to claim 1, wherein each said suture element is a deformable suture element which has a pair of legs extending generally parallel to the longitudinal axis of said housing, and arranged for transverse insertion through the organ tissue, each said suture element also having a transverse portion connecting said pair of legs, and wherein said suturing device further comprises: an anvil constructed for placement in the open end of the second hollow organ portion, and having formed on a rear face thereof a single row of recesses extending along a portion of the anvil periphery, and a double row of recesses extending along the remainder of the anvil periphery, for receiving and cooperating with said single and double rows of suture elements , respectively, after insertion thereof through the organ tissue; and means for selectably connecting said anvil to said housing.
6. A suturing device according to claim 5, wherein said means for inserting a single row of said suture elements comprises means for inserting through the organ tissue a first row of suture elements having a first predetermined leg Iength and a first predetermined spacing, and said means for inserting a double row of said suture elements comprises: means for inserting through the organ tissue a second row of suture elements having a second predetermined leg Iength and a second predetermined spacing, and means for inserting through the organ tissue a third row of suture elements, parallel to said second row, and having a third predetermined leg Iength and a third predetermined spacing, wherein said leg lengths and said spacings are predetermined to apply to the suture tissue a varying force along the entire suture predetermined so as to facilitate adequate blood supply to the suture tissue while not preventing haemostasis, thereby to facilitate optimal healing of the tissue.
7. A suturing device according to claim 5, wherein said means for selectably connecting also comprises means for aligning said anvil with said suturing means such that said single and double rows of said recesses are aligned in registration with said single and double rows of suture elements.
8. A suturing device according to claim 7, wherein said means for selectably connecting comprises: a rod member, also located within said tubular housing, and having a front end portion protruding from said second end of said housing; and a stem protruding rearwardly from said anvil and connected thereto and having a rear end portion; and means for fastening said front end portion of said rod member to said rear end portion of said stem.
9. A suturing device according to claim 5, and wherein said recesses are operative to receive and plastically deform said legs of said suture elements, thereby to bend said legs about and fasten them to the organ tissue.
10. A suturing device according to claim 1 , and also including means for cutting excess organ tissue from the open ends of the organ portions to be sutured together.
11. A suturing device according to claim 1, and also comprising means for activating said suturing means to insert said single and double rows of suture elements into the organ tissue.
12. A suturing device according to claim, 1 wherein said means for activating comprises a piston rod extending through said tubular housing, and said suturing means comprises a piston head, wherein said piston head has formed therein a plurality of pusher members for ejecting said suture elements from said second end of said tubular housing, thereby to insert said suture elements into the organ tissue.
13. A suturing device according to claim 1 , wherein said tubular housing has a curved configuration, thereby to ease placement thereof into the first organ portion.
14. A suturing device according to claim 13, wherein said tubular housing has a concave portion, and said means for inserting a double row of suture elements is located adjacent to said concave portion.
15. A suturing device according to claim 1 , wherein said means for inserting a single row of suture elements comprise means for inserting a single row of suture elements along a first portion of a predetermined geometric pattern, and said means for inserting a double row of suture elements comprise means for inserting a single row of suture elements along a second portion of said predetermined geometric pattern.
16. A suturing device according to claim 15, wherein said predetermined geometric pattern approximates to a circle.
17. A suturing device according to claim 15, wherein said geometric pattern is oval.
18. A method of surgical stapling of first and second hollow organ portions so as to provide anastomosis thereof, wherein each said organ portion has a first tissue portion and each said organ portion further has a second tissue portion, and wherein at least one of the organ portions to be connected has a mesentery and the first tissue portion of the at least one organ portion is distal from the mesentery and the second tissue portion of the at least one organ portion is adjacent to the mesentery, and wherein said method includes the following steps: holding together the ends of the organ portions sought to be stapled together; a first step of stapling, comprising stapling together the first tissue portions of the two organ portions under a first pressure that facilitates adequate blood supply, and which also facilitates haemostasis thereat; and a second step of stapling, comprising stapling together the second tissue portions under a second pressure, greater than said first pressure, that also facilitates adequate blood supply and facilitates haemostasis thereat.
19. A method according to claim 18, wherein said steps of stapling are performed simultaneously.
20. A method according to claim 18, wherein said first step of stapling comprises inserting through the first tissue portions a single row of suture elements, and said second step of stapling comprises inserting through the second tissue portions a double row of suture elements.
21. A method according to claim 20, wherein each suture element has a pair of legs arranged for transverse insertion through the organ tissue, and each said step of stapling comprises forcibly inserting the suture elements through the tissue and bending the legs down so as to cause them to become fastened to the tissue.
22. A method according to claim 21, wherein said first step of stapling comprises inserting through the first tissue portions a first row of suture elements having a first predetermined leg Iength and a first predetermined spacing, and said second step of stapling comprises: inserting through the second tissue portions a second row of suture elements having a second predetermined leg Iength and a second predetermined spacing, and inserting through the third tissue portions a third row of suture elements, parallel to the second row, and having a third predetermined leg Iength and a third predetermined spacing, and wherein said method further comprises the step of predetermining the required leg lengths and spacings so as to apply a varying force along the entire suture while facilitating adequate blood supply to the suture tissue while not preventing haemostasis, thereby to facilitate optimal healing of the tissue.
23. A method according to claim 20, and also comprising, prior to said first step of stapling, the following additional steps: placing a stapling head in the end of one of the organ portions so as to face the other organ portion, wherein the single and double rows of suture elements are held within the stapling head prior to said steps of stapling; placing an anvil in the end of the other organ portions so as to face the stapling head, wherein the anvil has having suture element receiving recesses formed in single and double rows for respectively receiving the single and double rows of suture element during said steps of stapling; fixating the anvil within the organ end such that the single and double rows of recesses are respectively located distally from and adjacent to the mesentery; and aligning the stapling head with the anvil such that the single and double rows of suture elements are positioned in registration with the single and double rows of recesses, respectively.
24. A method according to claim 23, wherein said step of fixating comprises: positioning the anvil within the organ end such that the single and double rows of recesses are respectively located distally from and adjacent to the mesentery; and attaching the anvil to the organ tissue by means of purse-string sutures.
25. A method according to claim 18, also including the step of cutting excess organ tissue from the open ends of the organ portions being sutured together.
Descripción  (El texto procesado por OCR puede contener errores)

SURGICAL STAPLER AND METHOD OF SURGICAL FASTENING

FIELD OF THE INVENTION The present invention relates to apparatus for surgically connecting two portions of a hollow organs of the digestive system.

BACKGROUND OF THE INVENTION

Surgical staplers, providing either one row, or two concentric rows, of sutures are known for achieving anastomosis - or connection - between two generally tubular portions of hollow organs of the digestive system.

By way of example, USSR Patent No. 264612 describes circular anastomosis by use of a single row staple suture, while US Patent No. 4198982 describes double row staple suturing.

Generally, surgical staplers of the sort which provide anastomosis of hollow organs are formed of a suturing head which is attached to an elongate body, and an anvil. The elongate body is inserted via an opening in one side of the hollow organ, and the anvil is placed in the other. The ends of the organ portions to be connected are placed together and positioned between the suturing head and the anvil. Anastomosis is provided by operating the suturing head such that the staples therein are ejected through the organ tissue and against the anvil, thereby to be plastically deformed and to provide a desired connection of the organ portions. The entire stapler, including the anvil, which is removably connected to the suturing head, is subsequently withdrawn from the hollow organ.

Hollow bowel organs are characterized by having a mesentery along one side. As known, the side of a bowel connected to the mesentery has a very high density of blood vessels compared to the blood vessel density in the distal side of the organ. It has been found, due to the non-uniform distribution of blood vessels in digestive system organs, that neither the single row stapler, nor the double row stapler, fulfills all the requirements of anastomosis of these organs.

Single row staple suturing is characterized by low traumatization to the sutured tissue, anastomosis that is sufficiently elastic so as to facilitate relatively easy extraction of the stapler from the organ, and by not significantly obstructing blood supply to the sutured tissue. It is also characterized, however, by applying insufficient pressure to organ tissue connected to the mesentery. Accordingly, due to the greater density of blood vessels in the organ tissue connected to the mesentery, the tissue to be connected is not fixated properly, and it is thus difficult to achieve anastomosis.

While double row suturing might be expected to overcome the above problems of single row suturing, the additional pressure provided at the tissue that is not adjacent to the mesentery causes the blood supply thereto to be blocked. This causes the formation of scar tissue thereat, leading to stenosis of the organ.

SUMMARY OF THE INVENTION

The present invention seeks to provide a novel method of surgical suturing of hollow organs to as to provide anastomosis thereof, and a novel surgical stapler for performing this method, which overcomes disadvantages of known art.

More particularly, the present invention seeks to provide reliable haemostasis and fixation of connected ends of sutured hollow organs, while also providing good conditions for tissue regeneration, minimal traumatization of sutured tissue, and a reduced probability of post-operative suture stenosis.

A further object of the invention is to optimize haemostasis of sutures while maintaining a sufficient blood supply to the sutured tissue.

Yet a further object of the present invention is to provide a method of suturing of hollow organs, and a means of performing the method of suturing, which take account of the varying cross-sectional shapes of these organs.

There is thus provided, in accordance with a preferred embodiment of the invention, a suturing device for providing anastomosis of first and second hollow organ portions each having an open end for suturing together with each other across a common interface, wherein the device includes: an elongate tubular housing having a first free end, and a second end, the housing being configured for insertion through the first hollow organ portion such that the second end is associable with the open end thereof; and suturing apparatus, associated with the second end of the tubular housing, for suturing together the open ends of the first and second organ portions by insertion of suture elements therethrough along the entire Iength of the common interface and thereacross, and wherein the suturing apparatus includes: apparatus for inserting a single row of suture elements through the organ tissue along a portion of the common interface, and apparatus for inserting a double row of suture elements through the organ tissue along the remainder of the common interface.

Additionally in accordance with a preferred embodiment of the invention, the apparatus for inserting a single row of the suture elements includes apparatus for inserting through the organ tissue a first row of suture elements having a first predetermined spacing, and the apparatus for inserting a double row of the suture elements includes apparatus for inserting a double row of the suture elements having other predetermined spacings, different from the first predetermined spacing, wherein the spacings are predetermined to apply to the suture tissue a varying force along the entire suture predetermined so as to facilitate adequate blood supply to the suture tissue while not preventing haemostasis, thereby to facilitate optimal healing of the tissue.

Further in accordance with a preferred embodiment of the invention, the apparatus for inserting a double row of suture elements includes apparatus for inserting a second row of suture elements, having a second predetermined spacing, and apparatus for inserting a third row of suture elements generally parallel to the second row, and having a third predetermined spacing, different from the first and second predetermined spacings.

Additionally in accordance with a preferred embodiment of the invention, the first, second and third rows of suture elements include deformable suture elements.

Further in accordance with a preferred embodiment of the invention, each suture element is a deformable suture element which has a pair of legs extending generally parallel to the longitudinal axis of the housing, and arranged for transverse insertion through the organ tissue. Each suture element also has a transverse portion connecting the pair of legs, and the suturing device further includes an anvil constructed for placement in the open end of the second hollow organ portion, and having formed on a rear face thereof a single row of recesses extending along a portion of the anvil periphery, and a double row of recesses extending along the remainder of the anvil periphery, for receiving and cooperating with the single and double rows of suture elements , respectively, after insertion thereof through the organ tissue; and apparatus for selectably connecting the anvil to the housing.

Additionally in accordance with a preferred embodiment of the invention, the apparatus for inserting a single row of the suture elements includes apparatus for inserting through the organ tissue a first row of suture elements having a first predetermined leg Iength and a first predetermined spacing, and the apparatus for inserting a double row of the suture elements includes: apparatus for inserting through the organ tissue a second row of suture elements having a second predetermined leg Iength and a second predetermined spacing, and apparatus for inserting through the organ tissue a third row of suture elements, parallel to the second row, and having a third predetermined leg Iength and a third predetermined spacing, wherein the leg lengths and the spacings are predetermined to apply to the suture tissue a varying force along the entire suture predetermined so as to facilitate adequate blood supply to the suture tissue while not preventing haemostasis, thereby to facilitate optimal healing of the tissue.

Further in accordance with a preferred embodiment of the invention, the apparatus for selectably connecting also includes apparatus for aligning the anvil with the suturing apparatus such that the single and double rows of the recesses are aligned in registration with the single and double rows of suture elements.

There is also provided, in accordance with a further preferred embodiment of the invention, a method of surgical stapling of first and second hollow organ portions so as to provide anastomosis thereof, wherein each organ portion has a first tissue portion and each organ portion further has a second tissue portion, and wherein at least one of the organ portions to be connected has a mesentery and the first tissue portion of the at least one organ portion is distal from the mesentery and the second tissue portion of the at least one organ portion is adjacent to the mesentery, and wherein the method includes the following steps: holding together the ends of the organ portions sought to be stapled together; a first step of stapling, including stapling together the first tissue portions of the two organ portions under a first pressure that facilitates adequate blood supply, and which also facilitates haemostasis thereat; and a second step of stapling, including stapling together the second tissue portions under a second pressure, greater than the first pressure, that also facilitates adequate blood supply and facilitates haemostasis thereat. These steps are preferably performed simultaneously. Additionally in accordance with the method of the invention, the first step of stapling includes inserting through the first tissue portions a single row of suture elements, and the second step of stapling includes inserting through the second tissue portions a double row of suture elements.

Further in accordance with the method of the invention, each suture element has a pair of legs arranged for transverse insertion through the organ tissue, and each step of stapling includes forcibly inserting the suture elements through the tissue and bending the legs down so as to cause them to become fastened to the tissue.

Additionally in accordance with the method of the invention, the first step of stapling includes inserting through the first tissue portions a first row of suture elements having a first predetermined leg Iength and a first predetermined spacing, and the second step of stapling includes: inserting through the second tissue portions a second row of suture elements having a second predetermined leg Iength and a second predetermined spacing, and inserting through the third tissue portions a third row of suture elements, parallel to the second row, and having a third predetermined leg Iength and a third predetermined spacing.

Preferably, the method further includes the step of predetermining the required leg lengths and spacings so as to apply a varying force along the entire suture while facilitating adequate blood supply to the suture tissue while not preventing haemostasis, thereby to facilitate optimal healing of the tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be more fully understood and appreciated form the following detailed description, taken in conjunction with the drawings, in which:

Fig. 1 is a side view of a suturing device, constructed and operative in accordance with a preferred embodiment of the present invention;

Fig. 2A is cross-sectional view of the head portion and anvil of the suturing device of

Fig. 1 ;

Fig. 2B is a side-sectional view of the rear end of the suturing device of Fig. 1;

Fig. 2C is a cross-sectional view of a portion of the device seen in Fig. 2B, at line C-C therein;

Fig. 3A is a perspective view of a piston head forming part of the head portion of Fig. 2A;

Fig. 3B is a diagrammatic view of the three sizes of suture element seen in Fig. 2A;

Fig. 4A is a cross-sectional view of the head portion of Fig 2A, taken along line A-A therein;

Fig. 4B is a part-sectional view of the anvil of Fig. 2A, taken along line B-B therein;

Fig. 5 is a view corresponding to that of Fig. 4B, but showing a construction according to an alternative embodiment of the invention;

Fig. 6 is a view corresponding to that of Fig. 3A, but showing a construction according to yet a further alternative embodiment of the invention; and

Figs. 7A, 7B and 7C are schematic side views showing the suturing device of the present invention in various stages of use.

DETAILED DESCRIPTION OF THE INVENTION

Reference is now made to Fig. 1, in which there is seen a suturing device, also known as a surgical stapler, referenced generally 10, constructed and operative in accordance with a preferred embodiment of the present invention. The terms "suturing device" and "surgical stapler" are used interchangeably throughout the description and claims. Stapler 10 has an elongated tubular housing, referenced 12, which has a front end 14, which is inserted into a hollow organ to be sutured, and a rear end 16. Typically, operation of the stapler is provided via a squeeze-type trigger handle 18, which causes ejection of suturing elements or staples from the front end 14 and embedding of the staples in organ tissue, thereby to provide suturing thereof in accordance with the present invention.

Referring now also to Fig. 2A, front end 14 of stapler 10 is formed of a staple ejection head 20, referred to also as a suture head, and an anvil 22. As will be appreciated form the following description, staple ejection head 20 and anvil 22 cooperate so as to provide optimal anastomosis of organ portions in accordance with the present invention.

Ejection head 20 has a cylindrical casing 24, which constitutes a widened end portion of tubular housing 12. As seen in Figs. 2A and 3A, an elongate, hollow piston rod 26 extends generally axially along housing 12, terminating in a hollow piston head 27. Piston head 27, which is also illustrated in Fig. 4A, defines a first, generally cylindrical, wall-shaped pusher member 28, and a second wall-shaped pusher member 30, which extends only along a predetermined angular sector. Casing 24 has formed therein inner and outer partitions 32 and 34. Inner partition 32 is generally cylindrical and, at a first portion thereof, forms, together with an inward facing surface 36 of casing 24, a first chamber 38 for a plurality of first suturing elements 40 (Fig. 2A), which are provided as a single row. Outer partition 34 is disposed between a major portion of casing 24 and inner partition 32. A second chamber 42 for a second plurality of suturing elements 44 is thus formed between the inner and outer partitions 32 and 34, and a third chamber 46 for a third plurality of suturing elements 48 is formed between outer partition 34 and casing 24. It will thus be appreciated that the second and third pluralities of suturing elements 44 and 48 are provided as a double row. A circular blade 50, is also mounted onto piston head 27, and is provided for automatically cutting excess organ tissue at the time of suturing.

Pusher members 28 and 30 are disposed, as seen, within the first, second and third chambers. Activation of the handle 18 of the device 10, described below in conjunction with Figs. 2B and 2C, is operative to cause piston rod 26 to project pusher members 28 and 30 forwardly with respect to casing 24, thereby to cause ejection of the suturing elements from the chambers.

Anvil 22 has a rear-facing surface, referenced 52, which, as seen in Figs. 2A and 4B, has a plurality of recesses formed therein. In accordance with the present embodiment of the invention, the recesses are provided as first, second and third pluralities, respectively referenced 40', 44' and 48', and are distributed so as to be in registration with the first, second and third pluralities of suture elements, and thereby to cooperate with them when the device is activated.

Referring now particularly to Fig. 2A, there is provided an activating rod 54, which is operatively connected to handle 18, and which extends through tubular housing 12 and ejection head 20. Rod 54 has a front end portion 56 which is constructed for a snap-type connection with a rear end portion 58 of a stem element 60 formed on rear surface 52 of anvil 22. In particular, front end portion 56 is shown in the drawings as a female connecting portion, having a pair of splayed arms 62 having inward-facing protrusions 64 formed at the free ends thereof. Rear end portion 58 of stem element 60 is shown as a male portion, having a thickened head portion 66, beyond which is a neck portion 68 which has formed therein elongate grooves 69 which are adapted for engagement by inward-facing protrusions 64 of the female connecting portion.

Due to the elongate grooves 69 and protrusions 64, connection of the rod 54 to anvil 22 is possible in a single, unique position, predetermined such that the chambers for the first, second and third pluralities of suture elements 40, 44 and 48 are in registration with the corresponding first, second and third pluralities of recesses 40', 44' and 48', formed on anvil 22. Prior to operation of the device 10, rod 54 is connected to anvil 22, as shown and described below in conjunction with Fig. 7B, via the described connector portions, thereby enabling rearward removal of the entire device 10, including the anvil 22, after suturing.

Referring now to Fig. 2B, it is seen that both piston rod 26 and activating rod 54 extend rearwardly into rear end portion 16 of the suturing device 10, whereat they are enclosed by rear housing 150. As seen in Fig. 2C, activating rod 54 has a non-circular, typically rectangular, configuration along most of its Iength, and is disposed within piston rod 26, such that rotation of the activating rod 54 within the piston rod 26 is not possible. A rear end portion 152, however, of activating rod 54, is disposed within an elongate nut member 154 having a front portion 156 having an inward-facing screw thread 158. Rear end portion 152 of the activating rod 54 has a generally rounded cross-sectional configuration, and has formed thereon an outward-facing screw thread 160, which is arranged for screwing engagement with screw thread 158. Nut member 154 terminates in a handle portion 162, via a narrowed neck portion 164 which is engaged by rear wall 166 of rear housing 150, thereby to be prevented from axial translation.

It will thus be appreciated that rotation of handle 162 is operative to cause a corresponding axial translation of activating rod 54 and thus of front end portion 56 (Fig. 2A) thereof, so as to facilitate engagement of rear end portion 58 of stem element 60 of anvil 22 by front end portion 56. Subsequently, the clearance between ejection head 20 and anvil 22 can be adjusted as desired by appropriate rotation of handle portion 162.

Handle 18 is mounted for rotation about an axis 168, and is formed with an inward-projecting tooth, referenced 170. Piston rod 26 has a recess 172, formed therein, and is arranged such that recess 172 is positioned in registration with tooth 170. Accordingly, depression of handle 18, achieved by squeezing it such that it rotates towards housing 150, as shown by arrow 174, causes a corresponding rotation of tooth 170 which, in turn, engages a rear-facing edge 176 of piston rod 26, thereby to causes a forward axial movement thereof, shown by arrow 178.

Referring now once again to Fig. 2A, stem element 60 preferably has a hook 61 formed thereon. Hook 61 is provided for fastening threads of a purse-string suture. An additional hook (not shown), for a similar purpose, is also provided adjacent to front end portion 56 of rod 54.

It is further seen that the respective axes 70 and 72 of rod 54 and blade 50, do not coincide. This is due to the fact that it is necessary to provide a greater pushing force to the second and third pluralities 44 and 48 of suture elements, than to the single, first plurality of suture elements 40.

As seen with reference to Figs. 2A and 4B, both the frequency and Iength of the suture elements are varied so as to take account of the suturing requirements of the different portions of tissue of the organ portions to be connected. In particular, it is seen that the lateral spacing between suture elements in the first, second and third pluralities varies directly with the distance between the portions of pusher members 28 and 30 in registration with the first, second and third pluralities of suture elements.

As stated above, the present invention provides suturing of hollow organs so as to provide optimal anastomosis of both the organ tissue adjacent the mesentery - which has a high density of blood vessels, - and of the tissue distal from the mesentery, which is less thick and which has a lower density of blood vessels. Accordingly, while the first plurality of suture elements 40 (Fig. 3B) are spaced apart and have legs 41 of Iength L2 so as to provide proper fixation, haemostasis, and thus proper anastomosis of the tissue distal from the mesentery, the second and third pluralities 44 and 48 of suture elements, which are provided in a double row, are of different lengths and spacing.

As seen in Fig. 3B, the suture elements in the third plurality 48 are required to provide, first and foremost, proper fixation of the tissue adjacent to the mesentery, while the second plurality of suture elements 44, located inwardly of the third plurality, primarily provides the required pressure so as to prevent bleeding, and thereby to allow haemostasis Accordingly, the suture elements 48 in the outside row have legs 49 which are relatively long, having a Iength L3, such that they can easily be inserted through the mesenteric tissue, and can provide the required fixation of this tissue, while the inner plurality of suture elements 44, while having shorter legs 45 of Iength L1, are more densely spaced, thereby to provide required sealing of the blood vessels

Referring once again to Fig. 1, it is seen that housing 12 has a generally bent configuration, and the second and third chambers 42 and 46 are provided on the concave side of the housing Preferably, housing 12 has provided thereon exterior markings along surface portions 80 and 82, including lines 84 and 86 These markings face towards the concave side of the housing 12, and, as the anvil 22 will already have been positioned such that the recesses for the second and third pluralities of suture elements face inwards, or towards the mesentery, the surface markings and lines provide a visual indication as to the orientation of the remainder of the device required so as to place the suture element pluralities in registration with their respective recesses Similar markings are also provided on surface portion 88 of the stem element 60

Refemng now to Fig. 5, it is seen that, in accordance with an alternative embodiment of the invention, the anvil 93, and thus the entire front end of the sutunng device of the invention, has a generally oval profile, and, further, has first, second and third pluralities of suture element recesses, respectively referenced 92, 94 and 96, which are, in part, rectilinear The function of rod 54 (Figs 1-4B) is provided by a pair of parallel rod members 98 and 100. Rod members 98 and 100 are disposed along a longitudinal axis 102 which is offset from the axis 103 which connects the geometπc centers of the semi-circular end portions, referenced generally 104 and 106, of the oval front end portion of the sutunng device.

Referring now to Fig. 6, it is seen that, in accordance with yet a further embodiment of the invention, the anvil 110, and thus the entire front end of the sutunng device of the invention, has a generally oval profile, and, further, has first, second and third pluralities of suture element recesses, respectively referenced 112, 114 and 116, which are, in part, rectilinear. The function of rod 54 (Figs. 1-4B) is provided by a single, generally flattened rod member 118.

Use of the suturing device of the present invention in suturing first and second bowel portions, respectively referenced 120 and 122, is now described in conjunction with Figs. 7A, 7B and 7C.

Referring now to Fig. 7A, prior to suturing of bowel portions 120 and 122, head portion 20 is inserted into first bowel portion 120, through an incision 124, such that the concave side, in general, of housing 12, and such that the markings 84 and 86 (Fig. 1), in particular, face towards the mesentery 126. Head portion 20 is further positioned such that front end 56 of rod 54 protrudes through an opening 128 of first bowel portion 120, thereby to be in axial registration with opening 130 of the second bowel portion 122. Anvil 22 is inserted through opening 130 into the second bowel portion 122, such that stem 60 protrudes rearwardly towards front end 56 of rod 54, and such that marking 88 (Fig. 2A) is in registration with the mesentery 126.

Referring now to Fig. 7B, the bowel ends 128' and 130' are partially closed about the suturing head 20 and anvil 22, respectively, by purse-string sutures, such that end portion 56 of rod 54 and stem 60 of anvil 22 remain protruding from the bowel portions. The ends of the threads are attached to their respective hooks, of which only one, namely, hook 61 , is seen in the drawing.

Subsequently, after adjusting nut member 154 (Fig. 2B) as required, as described above in conjunction with Fig. 2B, rod 54 and anvil 22 are connected, also as described above, such that the chambers for the first, second and third pluralities of suture elements 40, 44 and 48 are in registration with the corresponding first, second and third pluralities of recesses 40', 44' and 48', formed on anvil 22. It will be appreciated that the unique positioning of the anvil 22 relative to the rod member 54, and thus relative to the suturing head 20, is required due to the different pluralities of suture elements whose position is determined by their function in the suture.

Referring now to Fig. 7C, nut member 154 (Fig. 2B) is rotated so as to cause an axial retraction retract rod 54, thereby to bring head portion 20 and anvil 22 together, such that the bowel ends 128' and 130' are pressed therebetween, defining a common interface 131. Subsequently, handle 18 is rotated, as described above in conjunction with Fig. 2B, so as to extend piston rod 26 and thus pusher members 28 and 30, and blade 50 forwardly of casing 24. This causes the suture elements 40, 44 and 48 to be extended across interface 131, through the bowel tissue and into recesses 40', 44' and 48' on anvil 22, such that the legs of the suture elements are bent inwards, thereby to connect the two bowel portions together. The described extension of blade 50 is operative to cut off the excess tissue connected to device 10 by the purse- string sutures.

It will thus be appreciated that the double row of suturing elements, constituted by second and third pluralities 44 and 48, used to suture the bowel tissues adjoining the mesentery, provide good fixation of the tissue portions, and apply enough pressure so as to provide good haemostasis thereat. In particular, the pressure applied via the inner or second plurality of suture elements 44, is greater, due to the fact that the portion of pusher member 28 is relatively long, and the elements themselves are relatively short. This provides improved haemostasis thereby. The greater Iength of the outermost row of suture elements 48, ensures that the pressure applied to the sutured bowel tissue thereby, while being sufficient to fixate the tissue properly, does not overly reduce the blood supply to these tissue portions. Accordingly, the tissue is permitted to heal properly with sufficient haemostasis, but without stenosis ands thus undesired formation of scar tissue.

In the tissue portion distal from the portion adjacent to the mesentery, only a single row of suture elements, in the form of plurality 40, is used. As opposed to the prior art use of a double row suture, the single row suture of the present invention facilitates a desired elasticity of the anastomosis and of the bowel lumen, thereby facilitating extraction of the entire surgical stapler 10, and, in particular, of the anvil 22. Furthermore, suture traumatization and the possibility of post-operative suture stenosis, are reduced. In order to ensure the required haemostasis, healing and strength of the suture, the Iength of .the suture elements in first plurality 40 is selected to be between the Iength of the suture elements of the second and third pluralities 44 and 48, and the frequency of the first plurality 40 is selected to be greater than that of the third plurality of suture elements 48.

The various configurations of the suture elements shown in Figs. 4B, 5 and 6, are intended for suturing of predetermined types of hollow organ. For example, the generally circular arrangement of Figs. 4B and 5 is best suited for the connection of bowel portions, as described above in conjunction with Figs. 7A-7C. The various oval configurations shown in Figs. 5 and 6, however, are more suited to connection of the colon to the jejunum, or of a bowel portion to the stomach.

It will be appreciated by persons skilled in the art that the scope of the present invention is not limited by what has been shown and described above, merely by way of example. The scope of the invention is limited, rather, solely by the claims, which follow.

Citas de patentes
Patente citada Fecha de presentación Fecha de publicación Solicitante Título
US4930503 *12 May 19895 Jun 1990Pruitt J CraytonStapling process and device for use on the mesenteries of the abdomen
US5027834 *1 May 19902 Jul 1991United States Surgical CorporationStapling process for use on the mesenteries of the abdomen
US5445644 *30 Mar 199429 Ago 1995Ethicon, Inc.Pyloroplasty/pylorectomy shield
Otras citas
Referencia
1 *See also references of EP0844847A4
Citada por
Patente citante Fecha de presentación Fecha de publicación Solicitante Título
WO2013103505A3 *17 Dic 201228 Nov 2013Ethicon Endo-Surgery, Inc.Tissue stapler anvil feature to prevent premature jaw opening
WO2017172589A1 *27 Mar 20175 Oct 2017Ethicon LlcSurgical stapling system comprising a jaw attachment lockout
CN101254123B28 Feb 200823 Oct 2013伊西康内外科公司Surgical stapling device with staple drivers of different height
EP1754445A3 *14 Ago 200611 Abr 2007Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
EP1915954A214 Ago 200630 Abr 2008Tyco Healthcare Group, LPSurgical stapling instruments including a cartridge having multiple staple sizes
EP1915954A3 *14 Ago 20067 May 2008Tyco Healthcare Group, LPSurgical stapling instruments including a cartridge having multiple staple sizes
EP1964528A3 *27 Feb 20083 Jun 2009Ethicon Endo-Surgery, Inc.Surgical stapling device with staple drivers of different height
EP1964529A127 Feb 20083 Sep 2008Ethicon Endo-Surgery, Inc.Surgical stapling devices that produce formed staples having different legths
EP2319423A3 *14 Ago 200620 Mar 2013Covidien LPSurgical stapling instruments including a cartridge having multiple staple sizes
EP2371298A1 *27 Feb 20085 Oct 2011Ethicon Endo-Surgery, Inc.Surgical stapling devices that produce formed staple having different lengths
EP2425788A3 *27 Feb 200812 Sep 2012Ethicon Endo-Surgery, Inc.Surgical stapling device with staple drivers of different height
EP3225193A3 *31 Mar 201711 Oct 2017Ethicon LLCSurgical stapling system comprising a jaw attachment lockout
US73989083 Nov 200615 Jul 2008Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US740172118 May 200622 Jul 2008Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US740707515 Ago 20055 Ago 2008Tyco Healthcare Group LpStaple cartridge having multiple staple sizes for a surgical stapling instrument
US745567615 Oct 200725 Nov 2008Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US747281625 Ene 20086 Ene 2009Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US748134915 Oct 200727 Ene 2009Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US758817424 Jul 200815 Sep 2009Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staples sizes
US765831110 Ene 20089 Feb 2010Ethicon Endo-Surgery, Inc.Surgical stapling instrument with a geared return mechanism
US766564729 Sep 200623 Feb 2010Ethicon Endo-Surgery, Inc.Surgical cutting and stapling device with closure apparatus for limiting maximum tissue compression force
US766974631 Ago 20052 Mar 2010Ethicon Endo-Surgery, Inc.Staple cartridges for forming staples having differing formed staple heights
US766974729 Jun 20072 Mar 2010Ethicon Endo-Surgery, Inc.Washer for use with a surgical stapling instrument
US767033410 Ene 20062 Mar 2010Ethicon Endo-Surgery, Inc.Surgical instrument having an articulating end effector
US76737809 Nov 20059 Mar 2010Ethicon Endo-Surgery, Inc.Articulation joint with improved moment arm extension for articulating an end effector of a surgical instrument
US767378128 Feb 20079 Mar 2010Ethicon Endo-Surgery, Inc.Surgical stapling device with staple driver that supports multiple wire diameter staples
US767378229 Jun 20079 Mar 2010Ethicon Endo-Surgery, Inc.Surgical stapling instrument having a releasable buttress material
US76737834 Nov 20059 Mar 2010Ethicon Endo-Surgery, Inc.Surgical stapling instruments structured for delivery of medical agents
US772193110 Ene 200725 May 2010Ethicon Endo-Surgery, Inc.Prevention of cartridge reuse in a surgical instrument
US772193430 May 200725 May 2010Ethicon Endo-Surgery, Inc.Articulatable drive shaft arrangements for surgical cutting and fastening instruments
US772193610 Ene 200725 May 2010Ethicon Endo-Surgery, Inc.Interlock and surgical instrument including same
US772653813 Mar 20081 Jun 2010Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US772653923 Feb 20091 Jun 2010Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US773107218 Jun 20078 Jun 2010Ethicon Endo-Surgery, Inc.Surgical stapling and cutting instrument with improved anvil opening features
US773570329 Jun 200715 Jun 2010Ethicon Endo-Surgery, Inc.Re-loadable surgical stapling instrument
US773897110 Ene 200715 Jun 2010Ethicon Endo-Surgery, Inc.Post-sterilization programming of surgical instruments
US77401592 Ago 200622 Jun 2010Ethicon Endo-Surgery, Inc.Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist
US775324522 Jun 200713 Jul 2010Ethicon Endo-Surgery, Inc.Surgical stapling instruments
US775390431 Ene 200613 Jul 2010Ethicon Endo-Surgery, Inc.Endoscopic surgical instrument with a handle that can articulate with respect to the shaft
US776620913 Feb 20083 Ago 2010Ethicon Endo-Surgery, Inc.Surgical stapling instrument with improved firing trigger arrangement
US776621031 Ene 20063 Ago 2010Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting and fastening instrument with user feedback system
US777077531 Ene 200610 Ago 2010Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting and fastening instrument with adaptive user feedback
US779381214 Feb 200814 Sep 2010Ethicon Endo-Surgery, Inc.Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US779447529 Sep 200614 Sep 2010Ethicon Endo-Surgery, Inc.Surgical staples having compressible or crushable members for securing tissue therein and stapling instruments for deploying the same
US779838614 Feb 200821 Sep 2010Ethicon Endo-Surgery, Inc.Surgical instrument articulation joint cover
US77990399 Nov 200521 Sep 2010Ethicon Endo-Surgery, Inc.Surgical instrument having a hydraulically actuated end effector
US781069214 Feb 200812 Oct 2010Ethicon Endo-Surgery, Inc.Disposable loading unit with firing indicator
US781069330 May 200712 Oct 2010Ethicon Endo-Surgery, Inc.Surgical stapling and cutting instrument with articulatable end effector
US781929614 Feb 200826 Oct 2010Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with retractable firing systems
US781929714 Feb 200826 Oct 2010Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with reprocessible handle assembly
US781929814 Feb 200826 Oct 2010Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with control features operable with one hand
US78192994 Jun 200726 Oct 2010Ethicon Endo-Surgery, Inc.Surgical instrument having a common trigger for actuating an end effector closing system and a staple firing system
US782818921 Jul 20089 Nov 2010Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US78324084 Jun 200716 Nov 2010Ethicon Endo-Surgery, Inc.Surgical instrument having a directional switching mechanism
US783261219 Sep 200816 Nov 2010Ethicon Endo-Surgery, Inc.Lockout arrangement for a surgical stapler
US783707929 Ago 200623 Nov 2010Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US783708018 Sep 200823 Nov 2010Ethicon Endo-Surgery, Inc.Surgical stapling instrument with device for indicating when the instrument has cut through tissue
US783708110 Sep 200923 Nov 2010Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US784553731 Ene 20067 Dic 2010Ethicon Endo-Surgery, Inc.Surgical instrument having recording capabilities
US785718514 Feb 200828 Dic 2010Ethicon Endo-Surgery, Inc.Disposable loading unit for surgical stapling apparatus
US785718619 Sep 200828 Dic 2010Ethicon Endo-Surgery, Inc.Surgical stapler having an intermediate closing position
US786190614 Feb 20084 Ene 2011Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with articulatable components
US786652714 Feb 200811 Ene 2011Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with interlockable firing system
US790080510 Ene 20078 Mar 2011Ethicon Endo-Surgery, Inc.Surgical instrument with enhanced battery performance
US79053804 Jun 200715 Mar 2011Ethicon Endo-Surgery, Inc.Surgical instrument having a multiple rate directional switching mechanism
US790538119 Sep 200815 Mar 2011Ethicon Endo-Surgery, Inc.Surgical stapling instrument with cutting member arrangement
US791389114 Feb 200829 Mar 2011Ethicon Endo-Surgery, Inc.Disposable loading unit with user feedback features and surgical instrument for use therewith
US791837716 Oct 20085 Abr 2011Ethicon Endo-Surgery, Inc.Surgical stapling instrument with apparatus for providing anvil position feedback
US792206121 May 200812 Abr 2011Ethicon Endo-Surgery, Inc.Surgical instrument with automatically reconfigurable articulating end effector
US793463028 Feb 20083 May 2011Ethicon Endo-Surgery, Inc.Staple cartridges for forming staples having differing formed staple heights
US795468210 Ene 20077 Jun 2011Ethicon Endo-Surgery, Inc.Surgical instrument with elements to communicate between control unit and end effector
US795468410 Ene 20087 Jun 2011Ehticon Endo-Surgery, Inc.Surgical stapling instrument with a firing member return mechanism
US795468619 Sep 20087 Jun 2011Ethicon Endo-Surgery, Inc.Surgical stapler with apparatus for adjusting staple height
US795905115 Feb 200814 Jun 2011Ethicon Endo-Surgery, Inc.Closure systems for a surgical cutting and stapling instrument
US796679929 Jun 200728 Jun 2011Ethicon Endo-Surgery, Inc.Method of manufacturing staples
US798044315 Feb 200819 Jul 2011Ethicon Endo-Surgery, Inc.End effectors for a surgical cutting and stapling instrument
US802074315 Oct 200820 Sep 2011Ethicon Endo-Surgery, Inc.Powered articulatable surgical cutting and fastening instrument with flexible drive member
US805678728 Mar 200715 Nov 2011Ethicon Endo-Surgery, Inc.Surgical stapling and cutting instrument with travel-indicating retraction member
US806616723 Mar 200929 Nov 2011Ethicon Endo-Surgery, Inc.Circular surgical stapling instrument with anvil locking system
US808312018 Sep 200827 Dic 2011Ethicon Endo-Surgery, Inc.End effector for use with a surgical cutting and stapling instrument
US811340615 Dic 200914 Feb 2012Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US81134071 Jun 201014 Feb 2012Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staples sizes
US81134109 Feb 201114 Feb 2012Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with control features
US81231003 Oct 200828 Feb 2012Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US813671210 Dic 200920 Mar 2012Ethicon Endo-Surgery, Inc.Surgical stapler with discrete staple height adjustment and tactile feedback
US814176219 Nov 200927 Mar 2012Ethicon Endo-Surgery, Inc.Surgical stapler comprising a staple pocket
US815714531 May 200717 Abr 2012Ethicon Endo-Surgery, Inc.Pneumatically powered surgical cutting and fastening instrument with electrical feedback
US81571534 Feb 201117 Abr 2012Ethicon Endo-Surgery, Inc.Surgical instrument with force-feedback capabilities
US816197723 Sep 200824 Abr 2012Ethicon Endo-Surgery, Inc.Accessing data stored in a memory of a surgical instrument
US816718518 Nov 20101 May 2012Ethicon Endo-Surgery, Inc.Surgical instrument having recording capabilities
US81721244 Feb 20118 May 2012Ethicon Endo-Surgery, Inc.Surgical instrument having recording capabilities
US818655531 Ene 200629 May 2012Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting and fastening instrument with mechanical closure system
US818656016 Oct 200929 May 2012Ethicon Endo-Surgery, Inc.Surgical stapling systems and staple cartridges for deploying surgical staples with tissue compression features
US819679513 Ago 201012 Jun 2012Ethicon Endo-Surgery, Inc.Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US81967963 Feb 201112 Jun 2012Ethicon Endo-Surgery, Inc.Shaft based rotary drive system for surgical instruments
US82057813 Jun 201126 Jun 2012Ethicon Endo-Surgery, Inc.Surgical stapler with apparatus for adjusting staple height
US821041123 Sep 20083 Jul 2012Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting instrument
US821553129 Ene 201010 Jul 2012Ethicon Endo-Surgery, Inc.Surgical stapling instrument having a medical substance dispenser
US822068824 Dic 200917 Jul 2012Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting instrument with electric actuator directional control assembly
US826730030 Dic 200918 Sep 2012Ethicon Endo-Surgery, Inc.Dampening device for endoscopic surgical stapler
US827255230 Ene 201225 Sep 2012Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US829214622 Abr 201023 Oct 2012Tyco Healthcare Group LpSurgical stapling instruments including a cartridge having multiple staple sizes
US82921552 Jun 201123 Oct 2012Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting and fastening instrument with tactile position feedback
US830804022 Abr 201013 Nov 2012Ethicon Endo-Surgery, Inc.Surgical stapling instrument with an articulatable end effector
US831707028 Feb 200727 Nov 2012Ethicon Endo-Surgery, Inc.Surgical stapling devices that produce formed staples having different lengths
US832245527 Jun 20064 Dic 2012Ethicon Endo-Surgery, Inc.Manually driven surgical cutting and fastening instrument
US83225892 Jul 20104 Dic 2012Ethicon Endo-Surgery, Inc.Surgical stapling instruments
US83333133 Jun 201118 Dic 2012Ethicon Endo-Surgery, Inc.Surgical stapling instrument with a firing member return mechanism
US834812919 Nov 20098 Ene 2013Ethicon Endo-Surgery, Inc.Surgical stapler having a closure mechanism
US834813129 Sep 20068 Ene 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument with mechanical indicator to show levels of tissue compression
US83534371 Feb 201015 Ene 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument with a geared return mechanism
US835343819 Nov 200915 Ene 2013Ethicon Endo-Surgery, Inc.Circular stapler introducer with rigid cap assembly configured for easy removal
US835343919 Nov 200915 Ene 2013Ethicon Endo-Surgery, Inc.Circular stapler introducer with radially-openable distal end portion
US83602969 Sep 201029 Ene 2013Ethicon Endo-Surgery, Inc.Surgical stapling head assembly with firing lockout for a surgical stapler
US836029729 Sep 200629 Ene 2013Ethicon Endo-Surgery, Inc.Surgical cutting and stapling instrument with self adjusting anvil
US836597629 Sep 20065 Feb 2013Ethicon Endo-Surgery, Inc.Surgical staples having dissolvable, bioabsorbable or biofragmentable portions and stapling instruments for deploying the same
US837149115 Feb 200812 Feb 2013Ethicon Endo-Surgery, Inc.Surgical end effector having buttress retention features
US839351430 Sep 201012 Mar 2013Ethicon Endo-Surgery, Inc.Selectively orientable implantable fastener cartridge
US83979715 Feb 200919 Mar 2013Ethicon Endo-Surgery, Inc.Sterilizable surgical instrument
US840843922 Abr 20102 Abr 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument with an articulatable end effector
US841457719 Nov 20099 Abr 2013Ethicon Endo-Surgery, Inc.Surgical instruments and components for use in sterile environments
US84247404 Nov 201023 Abr 2013Ethicon Endo-Surgery, Inc.Surgical instrument having a directional switching mechanism
US844403629 Jul 201021 May 2013Ethicon Endo-Surgery, Inc.Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
US845390729 Jul 20104 Jun 2013Ethicon Endo-Surgery, Inc.Motor driven surgical fastener device with cutting member reversing mechanism
US845390812 Ago 20104 Jun 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument with improved firing trigger arrangement
US845391429 May 20124 Jun 2013Ethicon Endo-Surgery, Inc.Motor-driven surgical cutting instrument with electric actuator directional control assembly
US845952010 Ene 200711 Jun 2013Ethicon Endo-Surgery, Inc.Surgical instrument with wireless communication between control unit and remote sensor
US845952514 Feb 200811 Jun 2013Ethicon Endo-Sugery, Inc.Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device
US846492328 Ene 201018 Jun 2013Ethicon Endo-Surgery, Inc.Surgical stapling devices for forming staples with different formed heights
US847467730 Sep 20102 Jul 2013Ethicon Endo-Surgery, Inc.Fastener system comprising a retention matrix and a cover
US84799699 Feb 20129 Jul 2013Ethicon Endo-Surgery, Inc.Drive interface for operably coupling a manipulatable surgical tool to a robot
US848541229 Sep 200616 Jul 2013Ethicon Endo-Surgery, Inc.Surgical staples having attached drivers and stapling instruments for deploying the same
US84854135 Feb 200916 Jul 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument comprising an articulation joint
US849999312 Jun 20126 Ago 2013Ethicon Endo-Surgery, Inc.Surgical staple cartridge
US85172395 Feb 200927 Ago 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument comprising a magnetic element driver
US851724314 Feb 201127 Ago 2013Ethicon Endo-Surgery, Inc.Surgical instrument with wireless communication between control unit and remote sensor
US85172449 Jul 201227 Ago 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument having a medical substance dispenser
US852960030 Sep 201010 Sep 2013Ethicon Endo-Surgery, Inc.Fastener system comprising a retention matrix
US85345281 Mar 201117 Sep 2013Ethicon Endo-Surgery, Inc.Surgical instrument having a multiple rate directional switching mechanism
US854012811 Ene 200724 Sep 2013Ethicon Endo-Surgery, Inc.Surgical stapling device with a curved end effector
US854012926 Jul 201024 Sep 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument with improved firing trigger arrangement
US85401308 Feb 201124 Sep 2013Ethicon Endo-Surgery, Inc.Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US854013115 Mar 201124 Sep 2013Ethicon Endo-Surgery, Inc.Surgical staple cartridges with tissue tethers for manipulating divided tissue and methods of using same
US854013317 Mar 201024 Sep 2013Ethicon Endo-Surgery, Inc.Staple cartridge
US856187028 Feb 201122 Oct 2013Ethicon Endo-Surgery, Inc.Surgical stapling instrument
US856765628 Mar 201129 Oct 2013Ethicon Endo-Surgery, Inc.Staple cartridges for forming staples having differing formed staple heights
US85734619 Feb 20125 Nov 2013Ethicon Endo-Surgery, Inc.Surgical stapling instruments with cam-driven staple deployment arrangements
US85734659 Feb 20125 Nov 2013Ethicon Endo-Surgery, Inc.Robotically-controlled surgical end effector system with rotary actuated closure systems
US858491914 Feb 200819 Nov 2013Ethicon Endo-Sugery, Inc.Surgical stapling apparatus with load-sensitive firing mechanism
US859076229 Jun 200726 Nov 2013Ethicon Endo-Surgery, Inc.Staple cartridge cavity configurations
US86022871 Jun 201210 Dic 2013Ethicon Endo-Surgery, Inc.Motor driven surgical cutting instrument
US86022889 Feb 201210 Dic 2013Ethicon Endo-Surgery. Inc.Robotically-controlled motorized surgical end effector system with rotary actuated closure systems having variable actuation speeds
US860804415 Feb 200817 Dic 2013Ethicon Endo-Surgery, Inc.Feedback and lockout mechanism for surgical instrument
US860804510 Oct 200817 Dic 2013Ethicon Endo-Sugery, Inc.Powered surgical cutting and stapling apparatus with manually retractable firing system
US86080467 Ene 201017 Dic 2013Ethicon Endo-Surgery, Inc.Test device for a surgical tool
US86164319 Feb 201231 Dic 2013Ethicon Endo-Surgery, Inc.Shiftable drive interface for robotically-controlled surgical tool
US862227414 Feb 20087 Ene 2014Ethicon Endo-Surgery, Inc.Motorized cutting and fastening instrument having control circuit for optimizing battery usage
US862227519 Nov 20097 Ene 2014Ethicon Endo-Surgery, Inc.Circular stapler introducer with rigid distal end portion
US863198717 May 201021 Ene 2014Ethicon Endo-Surgery, Inc.Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist
US863246213 Jul 201121 Ene 2014Ethicon Endo-Surgery, Inc.Trans-rectum universal ports
US863252517 Sep 201021 Ene 2014Ethicon Endo-Surgery, Inc.Power control arrangements for surgical instruments and batteries
US86325353 Jun 201021 Ene 2014Ethicon Endo-Surgery, Inc.Interlock and surgical instrument including same
US86361873 Feb 201128 Ene 2014Ethicon Endo-Surgery, Inc.Surgical stapling systems that produce formed staples having different lengths
US863673614 Feb 200828 Ene 2014Ethicon Endo-Surgery, Inc.Motorized surgical cutting and fastening instrument
US865212010 Ene 200718 Feb 2014Ethicon Endo-Surgery, Inc.Surgical instrument with wireless communication between control unit and sensor transponders
US865717414 Feb 200825 Feb 2014Ethicon Endo-Surgery, Inc.Motorized surgical cutting and fastening instrument having handle based power source
US865717629 Abr 201125 Feb 2014Ethicon Endo-Surgery, Inc.Tissue thickness compensator for a surgical stapler
US86571789 Ene 201325 Feb 2014Ethicon Endo-Surgery, Inc.Surgical stapling apparatus
US866813024 May 201211 Mar 2014Ethicon Endo-Surgery, Inc.Surgical stapling systems and staple cartridges for deploying surgical staples with tissue compression features
US867220730 Jul 201018 Mar 2014Ethicon Endo-Surgery, Inc.Transwall visualization arrangements and methods for surgical circular staplers
US86722085 Mar 201018 Mar 2014Ethicon Endo-Surgery, Inc.Surgical stapling instrument having a releasable buttress material
US868425327 May 20111 Abr 2014Ethicon Endo-Surgery, Inc.Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US86958661 Oct 201015 Abr 2014Ethicon Endo-Surgery, Inc.Surgical instrument having a power control circuit
US872076629 Sep 200613 May 2014Ethicon Endo-Surgery, Inc.Surgical stapling instruments and staples
US872719729 Jun 200720 May 2014Ethicon Endo-Surgery, Inc.Staple cartridge cavity configuration with cooperative surgical staple
US873361329 Sep 201027 May 2014Ethicon Endo-Surgery, Inc.Staple cartridge
US873447813 Jul 201127 May 2014Ethicon Endo-Surgery, Inc.Rectal manipulation devices
US874003430 Sep 20103 Jun 2014Ethicon Endo-Surgery, Inc.Surgical stapling instrument with interchangeable staple cartridge arrangements
US874003730 Sep 20103 Jun 2014Ethicon Endo-Surgery, Inc.Compressible fastener cartridge
US874003829 Abr 20113 Jun 2014Ethicon Endo-Surgery, Inc.Staple cartridge comprising a releasable portion
US87465292 Dic 201110 Jun 2014Ethicon Endo-Surgery, Inc.Accessing data stored in a memory of a surgical instrument
US874653028 Sep 201210 Jun 2014Ethicon Endo-Surgery, Inc.Surgical instrument with wireless communication between control unit and remote sensor
US874653529 Abr 201110 Jun 2014Ethicon Endo-Surgery, Inc.Tissue thickness compensator comprising detachable portions
US874723828 Jun 201210 Jun 2014Ethicon Endo-Surgery, Inc.Rotary drive shaft assemblies for surgical instruments with articulatable end effectors
US875269930 Sep 201017 Jun 2014Ethicon Endo-Surgery, Inc.Implantable fastener cartridge comprising bioabsorbable layers
US875274720 Mar 201217 Jun 2014Ethicon Endo-Surgery, Inc.Surgical instrument having recording capabilities
US875274927 May 201117 Jun 2014Ethicon Endo-Surgery, Inc.Robotically-controlled disposable motor-driven loading unit
US875746530 Sep 201024 Jun 2014Ethicon Endo-Surgery, Inc.Fastener system comprising a retention matrix and an alignment matrix
US875839114 Feb 200824 Jun 2014Ethicon Endo-Surgery, Inc.Interchangeable tools for surgical instruments
US87638756 Mar 20131 Jul 2014Ethicon Endo-Surgery, Inc.End effector for use with a surgical fastening instrument
US876387730 Sep 20101 Jul 2014Ethicon Endo-Surgery, Inc.Surgical instruments with reconfigurable shaft segments
US87638791 Mar 20111 Jul 2014Ethicon Endo-Surgery, Inc.Accessing data stored in a memory of surgical instrument
US877700429 Abr 201115 Jul 2014Ethicon Endo-Surgery, Inc.Compressible staple cartridge comprising alignment members
US87835419 Feb 201222 Jul 2014Frederick E. Shelton, IVRobotically-controlled surgical end effector system
US878354230 Sep 201022 Jul 2014Ethicon Endo-Surgery, Inc.Fasteners supported by a fastener cartridge support
US878354330 Jul 201022 Jul 2014Ethicon Endo-Surgery, Inc.Tissue acquisition arrangements and methods for surgical stapling devices
US87897396 Sep 201129 Jul 2014Ethicon Endo-Surgery, Inc.Continuous stapling instrument
US878974030 Jul 201029 Jul 2014Ethicon Endo-Surgery, Inc.Linear cutting and stapling device with selectively disengageable cutting member
US878974123 Sep 201129 Jul 2014Ethicon Endo-Surgery, Inc.Surgical instrument with trigger assembly for generating multiple actuation motions
US879449718 Dic 20125 Ago 2014Ethicon Endo-Surgery, Inc.Surgical stapling head assembly with firing lockout for a surgical stapler
US88008389 Feb 201212 Ago 2014Ethicon Endo-Surgery, Inc.Robotically-controlled cable-based surgical end effectors
US880084115 Mar 201112 Ago 2014Ethicon Endo-Surgery, Inc.Surgical staple cartridges
US880173430 Jul 201012 Ago 2014Ethicon Endo-Surgery, Inc.Circular stapling instruments with secondary cutting arrangements and methods of using same
US880173530 Jul 201012 Ago 2014Ethicon Endo-Surgery, Inc.Surgical circular stapler with tissue retention arrangements
US881402430 Sep 201026 Ago 2014Ethicon Endo-Surgery, Inc.Fastener system comprising a plurality of connected retention matrix elements
US88206031 Mar 20112 Sep 2014Ethicon Endo-Surgery, Inc.Accessing data stored in a memory of a surgical instrument
US88206059 Feb 20122 Sep 2014Ethicon Endo-Surgery, Inc.Robotically-controlled surgical instruments
US882713311 Ene 20079 Sep 2014Ethicon Endo-Surgery, Inc.Surgical stapling device having supports for a flexible drive mechanism
US882790313 Jul 20119 Sep 2014Ethicon Endo-Surgery, Inc.Modular tool heads for use with circular surgical instruments
US88336326 Sep 201116 Sep 2014Ethicon Endo-Surgery, Inc.Firing member displacement system for a stapling instrument
US884000330 Sep 201023 Sep 2014Ethicon Endo-Surgery, Inc.Surgical stapling instrument with compact articulation control arrangement
US88400045 Nov 201323 Sep 2014Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US88406033 Jun 201023 Sep 2014Ethicon Endo-Surgery, Inc.Surgical instrument with wireless communication between control unit and sensor transponders
US88447899 Feb 201230 Sep 2014Ethicon Endo-Surgery, Inc.Automated end effector component reloading system for use with a robotic system
US885135424 Dic 20097 Oct 2014Ethicon Endo-Surgery, Inc.Surgical cutting instrument that analyzes tissue thickness
US885769315 Mar 201114 Oct 2014Ethicon Endo-Surgery, Inc.Surgical instruments with lockable articulating end effector
US885769429 Abr 201114 Oct 2014Ethicon Endo-Surgery, Inc.Staple cartridge loading assembly
US885857125 Mar 201014 Oct 2014Ethicon Endo-Surgery, Inc.Hydraulically and electrically actuated articulation joints for surgical instruments
US885859013 Jul 201114 Oct 2014Ethicon Endo-Surgery, Inc.Tissue manipulation devices
US886400730 Sep 201021 Oct 2014Ethicon Endo-Surgery, Inc.Implantable fastener cartridge having a non-uniform arrangement
US886400929 Abr 201121 Oct 2014Ethicon Endo-Surgery, Inc.Tissue thickness compensator for a surgical stapler comprising an adjustable anvil
US88759711 Dic 20104 Nov 2014Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with interlockable firing system
US887597215 Feb 20114 Nov 2014Ethicon Endo-Surgery, Inc.End effector coupling arrangements for a surgical cutting and stapling instrument
US889394628 Mar 200725 Nov 2014Ethicon Endo-Surgery, Inc.Laparoscopic tissue thickness and clamp load measuring devices
US889394923 Sep 201125 Nov 2014Ethicon Endo-Surgery, Inc.Surgical stapler with floating anvil
US889946330 Sep 20102 Dic 2014Ethicon Endo-Surgery, Inc.Surgical staple cartridges supporting non-linearly arranged staples and surgical stapling instruments with common staple-forming pockets
US88994655 Mar 20132 Dic 2014Ethicon Endo-Surgery, Inc.Staple cartridge comprising drivers for deploying a plurality of staples
US889946619 Nov 20092 Dic 2014Ethicon Endo-Surgery, Inc.Devices and methods for introducing a surgical circular stapling instrument into a patient
US89059771 Jun 20059 Dic 2014Ethicon Endo-Surgery, Inc.Surgical stapling instrument having an electroactive polymer actuated medical substance dispenser
US891147114 Sep 201216 Dic 2014Ethicon Endo-Surgery, Inc.Articulatable surgical device
US892578230 Sep 20106 Ene 2015Ethicon Endo-Surgery, Inc.Implantable fastener cartridge comprising multiple layers
US892578514 Nov 20136 Ene 2015Covidien LpSurgical stapling instruments including a cartridge having multiple staple sizes
US892578610 Abr 20146 Ene 2015Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US89257883 Mar 20146 Ene 2015Ethicon Endo-Surgery, Inc.End effectors for surgical stapling instruments
US892659815 Mar 20116 Ene 2015Ethicon Endo-Surgery, Inc.Surgical instruments with articulatable and rotatable end effector
US893168227 May 201113 Ene 2015Ethicon Endo-Surgery, Inc.Robotically-controlled shaft based rotary drive systems for surgical instruments
US896744622 Abr 20093 Mar 2015Covidien LpVariable compression surgical fastener cartridge
US89738039 Sep 201010 Mar 2015Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with control features operable with one hand
US897380418 Mar 201410 Mar 2015Ethicon Endo-Surgery, Inc.Cartridge assembly having a buttressing member
US897895429 Abr 201117 Mar 2015Ethicon Endo-Surgery, Inc.Staple cartridge comprising an adjustable distal portion
US897895513 Jul 201117 Mar 2015Ethicon Endo-Surgery, Inc.Anvil assemblies with collapsible frames for circular staplers
US897895630 Sep 201017 Mar 2015Ethicon Endo-Surgery, Inc.Jaw closure arrangements for surgical instruments
US899167629 Jun 200731 Mar 2015Ethicon Endo-Surgery, Inc.Surgical staple having a slidable crown
US899167721 May 201431 Mar 2015Ethicon Endo-Surgery, Inc.Detachable motor powered surgical instrument
US899242227 May 201131 Mar 2015Ethicon Endo-Surgery, Inc.Robotically-controlled endoscopic accessory channel
US899805820 May 20147 Abr 2015Ethicon Endo-Surgery, Inc.Detachable motor powered surgical instrument
US900523018 Ene 201314 Abr 2015Ethicon Endo-Surgery, Inc.Motorized surgical instrument
US901654122 Abr 200928 Abr 2015Covidien LpVarying tissue compression with an anvil configuration
US901654229 Abr 201128 Abr 2015Ethicon Endo-Surgery, Inc.Staple cartridge comprising compressible distortion resistant components
US902849428 Jun 201212 May 2015Ethicon Endo-Surgery, Inc.Interchangeable end effector coupling arrangement
US90285197 Feb 201112 May 2015Ethicon Endo-Surgery, Inc.Motorized surgical instrument
US903320330 Sep 201019 May 2015Ethicon Endo-Surgery, Inc.Fastening instrument for deploying a fastener system comprising a retention matrix
US903320413 Jul 201119 May 2015Ethicon Endo-Surgery, Inc.Circular stapling devices with tissue-puncturing anvil features
US904422730 Sep 20102 Jun 2015Ethicon Endo-Surgery, Inc.Collapsible fastener cartridge
US904422830 Sep 20102 Jun 2015Ethicon Endo-Surgery, Inc.Fastener system comprising a plurality of fastener cartridges
US904422915 Mar 20112 Jun 2015Ethicon Endo-Surgery, Inc.Surgical fastener instruments
US904423013 Feb 20122 Jun 2015Ethicon Endo-Surgery, Inc.Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
US905008323 Sep 20089 Jun 2015Ethicon Endo-Surgery, Inc.Motorized surgical instrument
US905008423 Sep 20119 Jun 2015Ethicon Endo-Surgery, Inc.Staple cartridge including collapsible deck arrangement
US905594123 Sep 201116 Jun 2015Ethicon Endo-Surgery, Inc.Staple cartridge including collapsible deck
US906077027 May 201123 Jun 2015Ethicon Endo-Surgery, Inc.Robotically-driven surgical instrument with E-beam driver
US907251525 Jun 20147 Jul 2015Ethicon Endo-Surgery, Inc.Surgical stapling apparatus
US907253527 May 20117 Jul 2015Ethicon Endo-Surgery, Inc.Surgical stapling instruments with rotatable staple deployment arrangements
US907253628 Jun 20127 Jul 2015Ethicon Endo-Surgery, Inc.Differential locking arrangements for rotary powered surgical instruments
US907865326 Mar 201214 Jul 2015Ethicon Endo-Surgery, Inc.Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge
US908460115 Mar 201321 Jul 2015Ethicon Endo-Surgery, Inc.Detachable motor powered surgical instrument
US908933013 Jul 201128 Jul 2015Ethicon Endo-Surgery, Inc.Surgical bowel retractor devices
US909533919 May 20144 Ago 2015Ethicon Endo-Surgery, Inc.Detachable motor powered surgical instrument
US910135815 Jun 201211 Ago 2015Ethicon Endo-Surgery, Inc.Articulatable surgical instrument comprising a firing drive
US910138528 Jun 201211 Ago 2015Ethicon Endo-Surgery, Inc.Electrode connections for rotary driven surgical tools
US91076636 Sep 201118 Ago 2015Ethicon Endo-Surgery, Inc.Stapling instrument comprising resettable staple drivers
US911386230 Sep 201025 Ago 2015Ethicon Endo-Surgery, Inc.Surgical stapling instrument with a variable staple forming system
US911386430 Sep 201025 Ago 2015Ethicon Endo-Surgery, Inc.Surgical cutting and fastening instruments with separate and distinct fastener deployment and tissue cutting systems
US911386529 Abr 201125 Ago 2015Ethicon Endo-Surgery, Inc.Staple cartridge comprising a layer
US911387030 Nov 201225 Ago 2015Covidien LpVariable compression surgical fastener apparatus
US911387424 Jun 201425 Ago 2015Ethicon Endo-Surgery, Inc.Surgical instrument system
US911388313 Jul 201125 Ago 2015Ethicon Endo-Surgery, Inc.Collapsible anvil plate assemblies for circular surgical stapling devices
US911388413 Jul 201125 Ago 2015Ethicon Endo-Surgery, Inc.Modular surgical tool systems
US911965728 Jun 20121 Sep 2015Ethicon Endo-Surgery, Inc.Rotary actuatable closure arrangement for surgical end effector
US912565413 Jul 20118 Sep 2015Ethicon Endo-Surgery, Inc.Multiple part anvil assemblies for circular surgical stapling devices
US912566228 Jun 20128 Sep 2015Ethicon Endo-Surgery, Inc.Multi-axis articulating and rotating surgical tools
US913194021 Feb 201315 Sep 2015Ethicon Endo-Surgery, Inc.Staple cartridge
US913822526 Feb 201322 Sep 2015Ethicon Endo-Surgery, Inc.Surgical stapling instrument with an articulatable end effector
US914927417 Feb 20116 Oct 2015Ethicon Endo-Surgery, Inc.Articulating endoscopic accessory channel
US916803829 Abr 201127 Oct 2015Ethicon Endo-Surgery, Inc.Staple cartridge comprising a tissue thickness compensator
US917991123 May 201410 Nov 2015Ethicon Endo-Surgery, Inc.End effector for use with a surgical fastening instrument
US917991227 May 201110 Nov 2015Ethicon Endo-Surgery, Inc.Robotically-controlled motorized surgical cutting and fastening instrument
US918614325 Jun 201417 Nov 2015Ethicon Endo-Surgery, Inc.Robotically-controlled shaft based rotary drive systems for surgical instruments
US91861485 Ene 201217 Nov 2015Ethicon Endo-Surgery, Inc.Tissue stapler anvil feature to prevent premature jaw opening
US919238712 Ago 201524 Nov 2015Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US91986616 Sep 20111 Dic 2015Ethicon Endo-Surgery, Inc.Stapling instrument comprising a plurality of staple cartridges stored therein
US919866226 Jun 20121 Dic 2015Ethicon Endo-Surgery, Inc.Tissue thickness compensator having improved visibility
US920487814 Ago 20148 Dic 2015Ethicon Endo-Surgery, Inc.Surgical stapling apparatus with interlockable firing system
US920487928 Jun 20128 Dic 2015Ethicon Endo-Surgery, Inc.Flexible drive member
US920488028 Mar 20128 Dic 2015Ethicon Endo-Surgery, Inc.Tissue thickness compensator comprising capsules defining a low pressure environment
US921112028 Mar 201215 Dic 2015Ethicon Endo-Surgery, Inc.Tissue thickness compensator comprising a plurality of medicaments
US921112113 Ene 201515 Dic 2015Ethicon Endo-Surgery, Inc.Surgical stapling apparatus
US921112213 Jul 201115 Dic 2015Ethicon Endo-Surgery, Inc.Surgical access devices with anvil introduction and specimen retrieval structures
US921601923 Sep 201122 Dic 2015Ethicon Endo-Surgery, Inc.Surgical stapler with stationary staple drivers
US922050028 Mar 201229 Dic 2015Ethicon Endo-Surgery, Inc.Tissue thickness compensator comprising structure to produce a resilient load
US922050128 Mar 201229 Dic 2015Ethicon Endo-Surgery, Inc.Tissue thickness compensators
US922675128 Jun 20125 Ene 2016Ethicon Endo-Surgery, Inc.Surgical instrument system including replaceable end effectors
US923294128 Mar 201212 Ene 2016Ethicon Endo-Surgery, Inc.Tissue thickness compensator comprising a reservoir
US92329457 Jul 201412 Ene 2016Ethicon Endo-Surgery, Inc.Surgical stapling head assembly with firing lockout for a surgical stapler
US923789127 May 201119 Ene 2016Ethicon Endo-Surgery, Inc.Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US924171428 Mar 201226 Ene 2016Ethicon Endo-Surgery, Inc.Tissue thickness compensator and method for making the same
US92541316 Dic 20129 Feb 2016Covidien LpSurgical staple with augmented compression area
US927179925 Jun 20141 Mar 2016Ethicon Endo-Surgery, LlcRobotic surgical system with removable motor housing
US92724068 Feb 20131 Mar 2016Ethicon Endo-Surgery, LlcFastener cartridge comprising a cutting member for releasing a tissue thickness compensator
US927791928 Mar 20128 Mar 2016Ethicon Endo-Surgery, LlcTissue thickness compensator comprising fibers to produce a resilient load
US92829628 Feb 201315 Mar 2016Ethicon Endo-Surgery, LlcAdhesive film laminate
US92829667 Feb 201415 Mar 2016Ethicon Endo-Surgery, Inc.Surgical stapling instrument
US928297428 Jun 201215 Mar 2016Ethicon Endo-Surgery, LlcEmpty clip cartridge lockout
US928305423 Ago 201315 Mar 2016Ethicon Endo-Surgery, LlcInteractive displays
US928920615 Dic 201422 Mar 2016Ethicon Endo-Surgery, LlcLateral securement members for surgical staple cartridges
US928921021 May 201222 Mar 2016Ethicon Endo-Surgery, LlcSurgical stapler with apparatus for adjusting staple height
US928921217 Sep 201022 Mar 2016Ethicon Endo-Surgery, Inc.Surgical instruments and batteries for surgical instruments
US928922522 Jun 201022 Mar 2016Ethicon Endo-Surgery, LlcEndoscopic surgical instrument with a handle that can articulate with respect to the shaft
US928925628 Jun 201222 Mar 2016Ethicon Endo-Surgery, LlcSurgical end effectors having angled tissue-contacting surfaces
US929546429 Abr 201129 Mar 2016Ethicon Endo-Surgery, Inc.Surgical stapler anvil comprising a plurality of forming pockets
US930175228 Mar 20125 Abr 2016Ethicon Endo-Surgery, LlcTissue thickness compensator comprising a plurality of capsules
US930175328 Mar 20125 Abr 2016Ethicon Endo-Surgery, LlcExpandable tissue thickness compensator
US930175529 Abr 20115 Abr 2016Ethicon Endo-Surgery, LlcCompressible staple cartridge assembly
US93017599 Feb 20125 Abr 2016Ethicon Endo-Surgery, LlcRobotically-controlled surgical instrument with selectively articulatable end effector
US930796525 Jun 201212 Abr 2016Ethicon Endo-Surgery, LlcTissue stapler having a thickness compensator incorporating an anti-microbial agent
US93079861 Mar 201312 Abr 2016Ethicon Endo-Surgery, LlcSurgical instrument soft stop
US930798725 Sep 201412 Abr 2016Ethicon Endo-Surgery, LlcSurgical cutting instrument that analyzes tissue thickness
US930798828 Oct 201312 Abr 2016Ethicon Endo-Surgery, LlcStaple cartridges for forming staples having differing formed staple heights
US930798926 Jun 201212 Abr 2016Ethicon Endo-Surgery, LlcTissue stapler having a thickness compensator incorportating a hydrophobic agent
US931424625 Jun 201219 Abr 2016Ethicon Endo-Surgery, LlcTissue stapler having a thickness compensator incorporating an anti-inflammatory agent
US931424726 Jun 201219 Abr 2016Ethicon Endo-Surgery, LlcTissue stapler having a thickness compensator incorporating a hydrophilic agent
US932051825 Jun 201226 Abr 2016Ethicon Endo-Surgery, LlcTissue stapler having a thickness compensator incorporating an oxygen generating agent
US932052019 Ago 201526 Abr 2016Ethicon Endo-Surgery, Inc.Surgical instrument system
US932052129 Oct 201226 Abr 2016Ethicon Endo-Surgery, LlcSurgical instrument
US932052328 Mar 201226 Abr 2016Ethicon Endo-Surgery, LlcTissue thickness compensator comprising tissue ingrowth features
US93267671 Mar 20133 May 2016Ethicon Endo-Surgery, LlcJoystick switch assemblies for surgical instruments
US932676812 Mar 20133 May 2016Ethicon Endo-Surgery, LlcStaple cartridges for forming staples having differing formed staple heights
US93267696 Mar 20133 May 2016Ethicon Endo-Surgery, LlcSurgical instrument
US93267706 Mar 20133 May 2016Ethicon Endo-Surgery, LlcSurgical instrument
US93267714 Mar 20113 May 2016Ethicon Endo-Surgery, LlcStaple cartridge
US933297428 Mar 201210 May 2016Ethicon Endo-Surgery, LlcLayered tissue thickness compensator
US933298427 Mar 201310 May 2016Ethicon Endo-Surgery, LlcFastener cartridge assemblies
US933298714 Mar 201310 May 2016Ethicon Endo-Surgery, LlcControl arrangements for a drive member of a surgical instrument
US934547725 Jun 201224 May 2016Ethicon Endo-Surgery, LlcTissue stapler having a thickness compensator comprising incorporating a hemostatic agent
US934548113 Mar 201324 May 2016Ethicon Endo-Surgery, LlcStaple cartridge tissue thickness sensor system
US935172614 Mar 201331 May 2016Ethicon Endo-Surgery, LlcArticulation control system for articulatable surgical instruments
US935172714 Mar 201331 May 2016Ethicon Endo-Surgery, LlcDrive train control arrangements for modular surgical instruments
US935173028 Mar 201231 May 2016Ethicon Endo-Surgery, LlcTissue thickness compensator comprising channels
US93580031 Mar 20137 Jun 2016Ethicon Endo-Surgery, LlcElectromechanical surgical device with signal relay arrangement
US935800522 Jun 20157 Jun 2016Ethicon Endo-Surgery, LlcEnd effector layer including holding features
US936422515 Jul 201314 Jun 2016Covidien LpCartridge for applying varying amounts of tissue compression
US936423028 Jun 201214 Jun 2016Ethicon Endo-Surgery, LlcSurgical stapling instruments with rotary joint assemblies
US936423328 Mar 201214 Jun 2016Ethicon Endo-Surgery, LlcTissue thickness compensators for circular surgical staplers
US937035819 Oct 201221 Jun 2016Ethicon Endo-Surgery, LlcMotor-driven surgical cutting and fastening instrument with tactile position feedback
US93703645 Mar 201321 Jun 2016Ethicon Endo-Surgery, LlcPowered surgical cutting and stapling apparatus with manually retractable firing system
US937036519 Sep 201421 Jun 2016Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US938698327 May 201112 Jul 2016Ethicon Endo-Surgery, LlcRobotically-controlled motorized surgical instrument
US93869848 Feb 201312 Jul 2016Ethicon Endo-Surgery, LlcStaple cartridge comprising a releasable cover
US938698515 Oct 201212 Jul 2016Ethicon Endo-Surgery, LlcSurgical cutting instrument
US938698828 Mar 201212 Jul 2016Ethicon End-Surgery, LLCRetainer assembly including a tissue thickness compensator
US939301510 May 201319 Jul 2016Ethicon Endo-Surgery, LlcMotor driven surgical fastener device with cutting member reversing mechanism
US93989111 Mar 201326 Jul 2016Ethicon Endo-Surgery, LlcRotary powered surgical instruments with multiple degrees of freedom
US940262618 Jul 20122 Ago 2016Ethicon Endo-Surgery, LlcRotary actuatable surgical fastener and cutter
US940860428 Feb 20149 Ago 2016Ethicon Endo-Surgery, LlcSurgical instrument comprising a firing system including a compliant portion
US940860628 Jun 20129 Ago 2016Ethicon Endo-Surgery, LlcRobotically powered surgical device with manually-actuatable reversing system
US941483828 Mar 201216 Ago 2016Ethicon Endo-Surgery, LlcTissue thickness compensator comprised of a plurality of materials
US943341928 Mar 20126 Sep 2016Ethicon Endo-Surgery, Inc.Tissue thickness compensator comprising a plurality of layers
US943964912 Dic 201213 Sep 2016Ethicon Endo-Surgery, LlcSurgical instrument having force feedback capabilities
US944581323 Ago 201320 Sep 2016Ethicon Endo-Surgery, LlcClosure indicator systems for surgical instruments
US94519585 Ago 201327 Sep 2016Ethicon Endo-Surgery, LlcSurgical instrument with firing actuator lockout
US946301726 Abr 201311 Oct 2016Covidien LpVariable compression surgical fastener cartridge
US94684381 Mar 201318 Oct 2016Eticon Endo-Surgery, LLCSensor straightened end effector during removal through trocar
US948047628 Mar 20121 Nov 2016Ethicon Endo-Surgery, LlcTissue thickness compensator comprising resilient members
US948621420 May 20138 Nov 2016Ethicon Endo-Surgery, LlcMotor driven surgical fastener device with switching system configured to prevent firing initiation until activated
US949216714 Mar 201315 Nov 2016Ethicon Endo-Surgery, LlcArticulatable surgical device with rotary driven cutting member
US949821930 Jun 201522 Nov 2016Ethicon Endo-Surgery, LlcDetachable motor powered surgical instrument
US951082823 Ago 20136 Dic 2016Ethicon Endo-Surgery, LlcConductor arrangements for electrically powered surgical instruments with rotatable end effectors
US951083023 Oct 20146 Dic 2016Ethicon Endo-Surgery, LlcStaple cartridge
US951706328 Mar 201213 Dic 2016Ethicon Endo-Surgery, LlcMovable member for use with a tissue thickness compensator
US95170685 Ago 201313 Dic 2016Ethicon Endo-Surgery, LlcSurgical instrument with automatically-returned firing member
US952202912 Mar 201320 Dic 2016Ethicon Endo-Surgery, LlcMotorized surgical cutting and fastening instrument having handle based power source
US95497325 Mar 201324 Ene 2017Ethicon Endo-Surgery, LlcMotor-driven surgical cutting instrument
US954973523 Dic 201324 Ene 2017Ethicon Endo-Surgery, LlcFastener cartridge comprising a firing member including fastener transfer surfaces
US95547941 Mar 201331 Ene 2017Ethicon Endo-Surgery, LlcMultiple processor motor control for modular surgical instruments
US956103213 Ago 20137 Feb 2017Ethicon Endo-Surgery, LlcStaple cartridge comprising a staple driver arrangement
US956103828 Jun 20127 Feb 2017Ethicon Endo-Surgery, LlcInterchangeable clip applier
US95660618 Feb 201314 Feb 2017Ethicon Endo-Surgery, LlcFastener cartridge comprising a releasably attached tissue thickness compensator
US957257422 Jun 201521 Feb 2017Ethicon Endo-Surgery, LlcTissue thickness compensators comprising therapeutic agents
US957257727 Mar 201321 Feb 2017Ethicon Endo-Surgery, LlcFastener cartridge comprising a tissue thickness compensator including openings therein
US957464430 May 201321 Feb 2017Ethicon Endo-Surgery, LlcPower module for use with a surgical instrument
US957910213 Sep 201628 Feb 2017Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US95856578 Feb 20137 Mar 2017Ethicon Endo-Surgery, LlcActuator for releasing a layer of material from a surgical end effector
US95856587 Abr 20167 Mar 2017Ethicon Endo-Surgery, LlcStapling systems
US958566011 Nov 20137 Mar 2017Ethicon Endo-Surgery, LlcMethod for testing a surgical tool
US958566223 Dic 20137 Mar 2017Ethicon Endo-Surgery, LlcFastener cartridge comprising an extendable firing member
US95856638 Mar 20167 Mar 2017Ethicon Endo-Surgery, LlcSurgical stapling instrument configured to apply a compressive pressure to tissue
US95920508 Feb 201314 Mar 2017Ethicon Endo-Surgery, LlcEnd effector comprising a distal tissue abutment member
US959205212 Mar 201414 Mar 2017Ethicon Endo-Surgery, LlcStapling assembly for forming different formed staple heights
US959205322 May 201414 Mar 2017Ethicon Endo-Surgery, LlcStaple cartridge comprising multiple regions
US95920544 Nov 201514 Mar 2017Ethicon Endo-Surgery, LlcSurgical stapler with stationary staple drivers
US959707327 Feb 201321 Mar 2017Covidien LpApparatus for forming variable height surgical fasteners
US95970759 Jun 201421 Mar 2017Ethicon Endo-Surgery, Inc.Tissue acquisition arrangements and methods for surgical stapling devices
US960359528 Feb 201428 Mar 2017Ethicon Endo-Surgery, LlcSurgical instrument comprising an adjustable system configured to accommodate different jaw heights
US960359830 Ago 201328 Mar 2017Ethicon Endo-Surgery, LlcSurgical stapling device with a curved end effector
US960399129 Jul 201328 Mar 2017Ethicon Endo-Surgery, LlcSurgical stapling instrument having a medical substance dispenser
US96158268 Feb 201311 Abr 2017Ethicon Endo-Surgery, LlcMultiple thickness implantable layers for surgical stapling devices
US962962314 Mar 201325 Abr 2017Ethicon Endo-Surgery, LlcDrive system lockout arrangements for modular surgical instruments
US96296297 Mar 201425 Abr 2017Ethicon Endo-Surgey, LLCControl systems for surgical instruments
US962981420 Mar 201425 Abr 2017Ethicon Endo-Surgery, LlcTissue thickness compensator configured to redistribute compressive forces
US96361115 May 20082 May 2017Covidien LpMethod of stapling tissues with a staple assembly
US964262023 Dic 20139 May 2017Ethicon Endo-Surgery, LlcSurgical cutting and stapling instruments with articulatable end effectors
US96491109 Abr 201416 May 2017Ethicon LlcSurgical instrument comprising a closing drive and a firing drive operated from the same rotatable output
US964911128 Jun 201216 May 2017Ethicon Endo-Surgery, LlcReplaceable clip cartridge for a clip applier
US965561411 Mar 201323 May 2017Ethicon Endo-Surgery, LlcRobotically-controlled motorized surgical instrument with an end effector
US965562430 Ago 201323 May 2017Ethicon LlcSurgical stapling device with a curved end effector
US966211015 Sep 201530 May 2017Ethicon Endo-Surgery, LlcSurgical stapling instrument with an articulatable end effector
US966211120 May 201630 May 2017Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US96687369 Ago 20166 Jun 2017Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US967534917 Oct 201613 Jun 2017Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US967535017 Oct 201613 Jun 2017Covidien LpSurgical stapling instruments including a cartridge having multiple staples sizes
US967535530 Ago 201313 Jun 2017Ethicon LlcSurgical stapling device with a curved end effector
US967537224 May 201313 Jun 2017Ethicon LlcMotor-driven surgical cutting instrument with electric actuator directional control assembly
US968187023 Dic 201320 Jun 2017Ethicon LlcArticulatable surgical instruments with separate and distinct closing and firing systems
US968723014 Mar 201327 Jun 2017Ethicon LlcArticulatable surgical instrument comprising a firing drive
US968723121 Oct 201327 Jun 2017Ethicon LlcSurgical stapling instrument
US968723624 Feb 201427 Jun 2017Ethicon Endo-Surgery, Inc.Surgical instrument having a power control circuit
US96872378 Jun 201527 Jun 2017Ethicon Endo-Surgery, LlcStaple cartridge including collapsible deck arrangement
US969036226 Mar 201427 Jun 2017Ethicon LlcSurgical instrument control circuit having a safety processor
US96937719 Oct 20134 Jul 2017Covidien LpMethod of forming a staple for use in surgical procedures
US969377724 Feb 20144 Jul 2017Ethicon LlcImplantable layers comprising a pressed region
US97003091 Mar 201311 Jul 2017Ethicon LlcArticulatable surgical instruments with conductive pathways for signal communication
US970031023 Ago 201311 Jul 2017Ethicon LlcFiring member retraction devices for powered surgical instruments
US97003178 Feb 201311 Jul 2017Ethicon Endo-Surgery, LlcFastener cartridge comprising a releasable tissue thickness compensator
US970032128 May 201411 Jul 2017Ethicon LlcSurgical stapling device having supports for a flexible drive mechanism
US970699119 Feb 201418 Jul 2017Ethicon Endo-Surgery, Inc.Staple cartridge comprising staples including a lateral base
US972409129 Ago 20138 Ago 2017Ethicon LlcSurgical stapling device
US972409223 Dic 20138 Ago 2017Ethicon LlcModular surgical instruments
US97240945 Sep 20148 Ago 2017Ethicon LlcAdjunct with integrated sensors to quantify tissue compression
US972409813 Nov 20148 Ago 2017Ethicon Endo-Surgery, LlcStaple cartridge comprising an implantable layer
US973069212 Mar 201315 Ago 2017Ethicon LlcSurgical stapling device with a curved staple cartridge
US973069517 Sep 201515 Ago 2017Ethicon Endo-Surgery, LlcPower management through segmented circuit
US973069723 Abr 201515 Ago 2017Ethicon Endo-Surgery, LlcSurgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
US973366326 Mar 201415 Ago 2017Ethicon LlcPower management through segmented circuit and variable voltage protection
US97373015 Sep 201422 Ago 2017Ethicon LlcMonitoring device degradation based on component evaluation
US97373028 Mar 201622 Ago 2017Ethicon LlcSurgical stapling instrument having a restraining member
US973730310 Sep 201522 Ago 2017Ethicon LlcArticulating surgical stapling instrument incorporating a two-piece E-beam firing mechanism
US974392825 Mar 201429 Ago 2017Ethicon Endo-Surgery, Inc.Surgical instrument having a feedback system
US974392926 Mar 201429 Ago 2017Ethicon LlcModular powered surgical instrument with detachable shaft assemblies
US975049828 Sep 20155 Sep 2017Ethicon Endo Surgery, LlcDrive systems for surgical instruments
US975049926 Mar 20145 Sep 2017Ethicon LlcSurgical stapling instrument system
US975050124 May 20165 Sep 2017Ethicon Endo-Surgery, LlcSurgical stapling devices having laterally movable anvils
US97571237 Mar 201312 Sep 2017Ethicon LlcPowered surgical instrument having a transmission system
US975712424 Feb 201412 Sep 2017Ethicon LlcImplantable layer assemblies
US97571285 Sep 201412 Sep 2017Ethicon LlcMultiple sensors with one sensor affecting a second sensor's output or interpretation
US975713012 Mar 201412 Sep 2017Ethicon LlcStapling assembly for forming different formed staple heights
US976366223 Dic 201319 Sep 2017Ethicon LlcFastener cartridge comprising a firing member configured to directly engage and eject fasteners from the fastener cartridge
US97702458 Feb 201326 Sep 2017Ethicon LlcLayer arrangements for surgical staple cartridges
US977560824 Feb 20143 Oct 2017Ethicon LlcFastening system comprising a firing member lockout
US977560923 Ago 20133 Oct 2017Ethicon LlcTamper proof circuit for surgical instrument battery pack
US977561330 Ago 20133 Oct 2017Ethicon LlcSurgical stapling device with a curved end effector
US977561425 Ene 20163 Oct 2017Ethicon Endo-Surgery, LlcSurgical stapling instruments with rotatable staple deployment arrangements
US97821691 Mar 201310 Oct 2017Ethicon LlcRotary powered articulation joints for surgical instruments
US97888348 Feb 201317 Oct 2017Ethicon LlcLayer comprising deployable attachment members
US97888365 Sep 201417 Oct 2017Ethicon LlcMultiple motor control for powered medical device
US97953817 Abr 201624 Oct 2017Ethicon Endo-Surgery, LlcRobotically-controlled shaft based rotary drive systems for surgical instruments
US979538220 Ago 201324 Oct 2017Ethicon LlcFastener cartridge assembly comprising a cam and driver arrangement
US979538322 Sep 201624 Oct 2017Ethicon LlcTissue thickness compensator comprising resilient members
US979538427 Mar 201324 Oct 2017Ethicon LlcFastener cartridge comprising a tissue thickness compensator and a gap setting element
US98016269 Abr 201431 Oct 2017Ethicon LlcModular motor driven surgical instruments with alignment features for aligning rotary drive shafts with surgical end effector shafts
US980162726 Sep 201431 Oct 2017Ethicon LlcFastener cartridge for creating a flexible staple line
US980162826 Sep 201431 Oct 2017Ethicon LlcSurgical staple and driver arrangements for staple cartridges
US980163420 Oct 201431 Oct 2017Ethicon LlcTissue thickness compensator for a surgical stapler
US980461826 Mar 201431 Oct 2017Ethicon LlcSystems and methods for controlling a segmented circuit
US980824414 Mar 20137 Nov 2017Ethicon LlcSensor arrangements for absolute positioning system for surgical instruments
US98082466 Mar 20157 Nov 2017Ethicon Endo-Surgery, LlcMethod of operating a powered surgical instrument
US980824730 Jun 20157 Nov 2017Ethicon LlcStapling system comprising implantable layers
US980824923 Ago 20137 Nov 2017Ethicon LlcAttachment portions for surgical instrument assemblies
US98144609 Abr 201414 Nov 2017Ethicon LlcModular motor driven surgical instruments with status indication arrangements
US981446223 Jun 201414 Nov 2017Ethicon LlcAssembly for fastening tissue comprising a compressible layer
US982073826 Mar 201421 Nov 2017Ethicon LlcSurgical instrument comprising interactive systems
US983942224 Feb 201412 Dic 2017Ethicon LlcImplantable layers and methods for altering implantable layers for use with surgical fastening instruments
US983942324 Feb 201412 Dic 2017Ethicon LlcImplantable layers and methods for modifying the shape of the implantable layers for use with a surgical fastening instrument
US984887320 Ago 201326 Dic 2017Ethicon LlcFastener cartridge assembly comprising a driver and staple cavity arrangement
US98488758 Feb 201326 Dic 2017Ethicon LlcAnvil layer attached to a proximal end of an end effector
USD6500741 Oct 20106 Dic 2011Ethicon Endo-Surgery, Inc.Surgical instrument
Clasificaciones
Clasificación internacionalA61B17/115, A61B17/11, A61B17/28
Clasificación cooperativaA61B17/1114, A61B2017/2905, A61B17/11, A61B2017/07235, A61B17/115, A61B17/1155
Clasificación europeaA61B17/115
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