SURGICAL INSTRUMENT WITH DOUBLE CARTRIDGE AND ANVIL ASSEMBLIES
An end effector for use with a surgical instrument having a first cartridge assembly configured to deploy a first set of fasteners and a second cartridge assembly disposed distally of the first cartridge assembly. The second cartridge assembly is configured to move between an open position and an approximated position relative to clamp tissue. A central rod extends between the first cartridge assembly and the second cartridge assembly.
This application is a continuation of U.S. patent application Ser. No. 14/536,991 filed Nov. 10, 2014, which is a continuation of U.S. patent application Ser. No. 14/107,378 filed Dec. 16, 2013, now U.S. Pat. No. 8,905,286, which is a divisional of U.S. patent application Ser. No. 13/602,176 filed Sep. 2, 2012, now U.S. Pat. No. 8,631,993, which is a continuation of U.S. patent application Ser. No. 12/783,994 filed May 20, 2010, now U.S. Pat. No. 8,276,802, which claims benefit of U.S. Provisional Application No. 61/224,854 filed Jul. 11, 2009, and the disclosures of each of the above-identified applications are hereby incorporated by reference in their entirety
BACKGROUND1. Technical Field
The present disclosure relates generally to surgical instruments and methods for performing surgery. More specifically, the present disclosure relates to surgical instruments and methods for clamping, cutting, and/or joining tissue.
2. Background of Related Art
Certain surgical stapling instruments are used for applying rows of staples through compressed living tissue. These surgical stapling instruments are employed, for example, for fastening tissue or organs prior to transaction or resection or during anastomoses. In some cases, these surgical stapling instruments are utilized for occluding organs in thoracic and abdominal procedures.
Typically, such surgical stapling instruments include an anvil assembly, a cartridge assembly for supporting an array of surgical staples, an approximation mechanism for approximating the cartridge and anvil assemblies, and a firing mechanism for ejecting the surgical staples from the cartridge assembly.
In use, a surgeon initially approximates the anvil and cartridge assemblies. Next, the surgeon can fire the instrument to place staples in tissue. Optionally, the surgeon may use the same instrument or a separate device to cut the tissue adjacent or between the row(s) of staples.
SUMMARYThe present disclosure relates in one aspect to an end effector for use with a surgical instrument. The end effector includes a first cartridge assembly configured to deploy a first set of fasteners and a second cartridge assembly disposed distally of the first cartridge assembly. The second cartridge assembly is configured to move between an open position and an approximated position. A central rod extends between the first cartridge assembly and the second cartridge assembly.
The end effector preferably also includes a first anvil assembly disposed distally of the first cartridge assembly and a second anvil assembly disposed distally of the first anvil assembly.
Preferably, each of the first anvil assembly and second anvil assembly is mounted on the central rod for movement in response to movement of the central rod. The second cartridge assembly preferably includes a second set of fasteners and a fastener pusher adapted to move between a distal position and a proximal position to eject the second set of fasteners from the second cartridge.
In some embodiments, the second cartridge assembly includes a biasing member, biasing a cartridge housing against the fastener pusher. The first cartridge assembly can include a knife movable between a proximal position and a distal position.
In some embodiments, the end effector is removably mountable to a surgical instrument.
In some embodiments, the first anvil assembly includes a plurality of anvil pockets arranged in a substantially annular array and configured to deform the first set of fasteners arranged in a substantially annular array.
In another aspect, the present disclosure relates to a surgical instrument including a handle assembly and an elongated portion extending distally from the handle assembly. The elongated portion has a proximal portion and a distal portion. The surgical instrument further includes an end effector disposed adjacent the distal portion of the elongated portion. The end effector includes a first cartridge assembly configured to deploy a first set of fasteners, a first anvil assembly disposed distally of the first cartridge assembly, a second anvil assembly disposed distally of the first anvil assembly, and a second cartridge assembly disposed distally of the second anvil assembly. The second cartridge assembly is configured to move between an open position and an approximated position relative to the second anvil assembly. A central rod extends between the first cartridge assembly and the second cartridge assembly.
In some embodiments, the second cartridge assembly is configured to deploy a second set of fasteners once the second cartridge assembly has moved to the approximated position and includes a fastener pusher adapted to move between a distal position and a proximal position to eject the second set of fasteners. Preferably, each of the first anvil assembly and the second anvil assembly is mounted on the central rod for movement in response to movement of the central rod.
The first cartridge assembly may further include a knife movable between a proximal position and a distal position. The first and second sets of fasteners can be arranged in a substantially annular array.
The present disclosure relates in another aspect to a method for performing surgery. This method includes the steps of: (a) inserting an end effector inside a tubular organ, the end effector including a first cartridge assembly housing a first set of fasteners, a first anvil assembly disposed distally of the first cartridge assembly, a second anvil assembly disposed distally of the first anvil assembly, a second cartridge assembly disposed distally of the second anvil assembly, and configured to move between an open position and an approximated position relative to the second anvil assembly, and a central rod extending between the first cartridge assembly and the second cartridge assembly; (b) drawing a first tissue portion of the tubular organ toward the central rod and into a first area located between the second cartridge assembly and the second anvil assembly; (c) drawing a second tissue portion of the tubular organ toward the central rod and into a second area located between the first anvil assembly and the second anvil assembly; (d) drawing a third tissue portion of the tubular organ toward the central rod and into a third area located between the first anvil assembly and the first cartridge assembly; and (e) firing the end effector to fasten together sections of the first tissue portion and to fasten sections of the third tissue portion.
Embodiments of the presently disclosed surgical instrument are described in detail with reference to the drawings, wherein like reference numerals designate corresponding elements in each of the several views. In the description that follows, the term “proximal” refers to the end or portion of the surgical instrument closer to the user, whereas the term “distal” refers to the end or portion of the surgical instrument further away from the user.
Handle assembly 12 includes a stationary handle 18, a pivotable firing trigger 20, a rotatable approximation knob 22 and an indicator 24. In certain embodiments, stationary handle 18 is made of a thermoplastic, such as polycarbonate. In other embodiments, stationary handle 18 is formed of an elastomeric material. Stationary handle 18 may nevertheless be formed of any suitable material. In some embodiments, stationary handle 18 has a hollow body that houses internal components of handle assembly 12. U.S. Pat. No. 7,303,106, the entire contents of which have previously been incorporated by reference, describes in detail the internal components of handle assembly 12.
Handle assembly 12 further includes a trigger lock 26 for preventing or at least minimizing the risk of inadvertently firing surgical instrument 10 (e.g., prior to approximation of various portions of the end effector). In the embodiment depicted in
As seen in
With continued reference to
In addition, after end effector 16 has been fully assembled (either by the user or alternatively in manufacture and shipped and packaged assembled), first anvil assembly 34 is positioned proximally relative to second anvil assembly 36. First anvil assembly 34 includes a tubular portion 50 and disk 52 adjacent a distal end 54 of tubular portion 50. Tubular portion 50 defines a longitudinal opening 64 extending therethrough. Longitudinal opening 64 is configured to accommodate central rod 38. Anvil assembly 34 is slidably positioned on central rod 38. It is contemplated that tubular portion 50 may be made of a polymer, such as a plastic, or any other suitable material. Disk 52 may be formed of a metal, such as stainless steel, or any other suitable material. Disk 52 includes one or more anvil pockets or concavities 66 (
As seen in
As noted above, anvil assemblies 34 and 36 are slidably mounted on central rod 38. A detent mechanism can be provided to retain the anvil assemblies 34, 36 in an initial position. As shown, detent 59 on an inner surface of tubular portion 58 of anvil assembly 36 engages a groove 39 formed in central rod 38. A detent 51 on an inner surface of tubular portion 50 of anvil assembly 34 engages a groove 37 formed in central rod 38. In this manner, anvil assemblies 34 and 36 are held in position on the central rod 38 until the instrument is approximated to clamp tissue as described below.
With reference to
With continued reference to
As seen in
As shown in
With continued reference to
As depicted in
With continued reference to
As depicted in
A retainer ring 140 rests in groove 37 of center rod 38. Cartridge housing 102 of second cartridge 32 is biased by member 110 against a distal surface of fastener pusher 108. Biasing member 110 secures initial positioning relation of fasteners 80 and fastener pusher 108 to second cartridge 32 prior to clamping. Cartridge housing 102 includes housing cap 107 to prevent exposure of biasing member 110 and retainer ring 140 to body fluids and tissue.
Once end effector 16 is assembled, the clinician can clamp tissue, cut, and/or join tissue. In one exemplary embodiment, end effector 16 is inserted inside a tubular organ “O”, such as a bowel, through the patient's anus until end effector 16 reaches an area adjacent to the tumor or desired surgical site.
As seen in
Thereafter, the clinician rotates approximation knob 22 relative to stationary handle 18 in the direction indicated by arrow “A” (see
After clamping and compression of tissue between second cartridge 32 and second anvil 36, center rod 38 with attached fastener pusher 108 approximates further in the direction indicated by arrows “D” (
To eject fasteners 78 housed in first cartridge assembly 32, the clinician actuates handle assembly 12 by moving firing trigger 20 toward stationary handle 18 in the direction indicated by arrow “E” (
Thereafter, a circular anastomosis instrument can be inserted through the lower tissue portion and into the tubular organ O. The instrument is clamped to approximate the two portions (since a tissue portion in between has been removed) and then staples are fired to join the portions.
Thus, as can be appreciated, one use of the instrument is in a lower anterior resection procedure. Clamping of the tissue organ O above the intended resection area enables wash out (cleaning out) of the area below the clamping, with stapling occurring below the clamping. This is achieved with access through the anus of the patient.
While the above description contains many specifics, these specifics should not be construed as limitations on the scope of the present disclosure, but merely as illustrations of various embodiments thereof. Therefore, the above description should not be construed as limiting, but merely as exemplifications of various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the disclosure.
Claims
1. (canceled)
2. An end effector for use with a surgical instrument, comprising:
- a first cartridge assembly including a plurality of first fastener slots, each slot of the plurality of first fastener slots receiving a first fastener;
- a first anvil assembly disposed distally of the first cartridge assembly, the first anvil assembly including a plurality of first anvil pockets each configured to receive one first fastener deployed from the first cartridge assembly;
- a second cartridge assembly disposed distally of the first anvil, the second cartridge assembly including a plurality of second fastener slots, each slot of the plurality of second fastener slots receiving a second fastener;
- a second anvil assembly disposed between the second cartridge assembly and the first anvil assembly, the second anvil assembly including a plurality of second anvil pockets each configured to receive one second fastener deployed from the second cartridge assembly; and
- a central rod extending between the first cartridge assembly and the second cartridge assembly, the central rod including at least one longitudinal key adapted to rotatably fix the first anvil assembly and the second anvil assembly relative to the central rod such that each slot of the plurality of first fastener slots is axially aligned with a corresponding pocket of the plurality of first anvil pockets of the first anvil assembly, and such that each slot of the plurality of second fastener slots is axially aligned with a corresponding pocket of the plurality of second anvil pockets of the second anvil assembly.
3. The end effector according to claim 2, wherein the first anvil assembly and the second anvil assembly each include at least one key slot adapted to receive the at least one longitudinal key of the central rod.
4. The end effector according to claim 3, wherein each of the first anvil assembly and the second anvil assembly is mounted on the central rod for movement in relation to the central rod in response to movement of the central rod.
5. The end effector according to claim 4, wherein the at least one longitudinal key of the central rod extends along a length of the central rod between the first cartridge assembly and the second cartridge assembly and the at least one key slot of each of the first anvil assembly and the second anvil assembly are adapted to receive the at least one longitudinal key of the central rod to prevent rotation of the first anvil assembly and the second anvil assembly relative to the central rod as the first anvil assembly and the second anvil assembly move in relation to the central rod along the length of the central rod.
6. The end effector according to claim 5, wherein the central rod has a circular cross-section and the at least one longitudinal key of the central rod includes a radial array of longitudinal keys extending along the length of the central rod.
7. The end effector according to claim 6, wherein the at least one key slot of the first anvil assembly defines a first radial array of key slots, the first radial array of key slots adapted to receive the radial array of longitudinal keys of the central rod and the at least one key slot of the second anvil assembly defines a second radial array of key slots, the second radial array of key slots adapted to receive the radial array of longitudinal keys of the central rod.
8. The end effector according to claim 2, wherein the first cartridge assembly further comprises a knife that is movable between a proximal position and a distal position, and the first anvil assembly includes a weakened portion, the weakened portion being configured to be broken by the knife as the knife moves towards the distal position.
9. The end effector according to claim 8, wherein the first cartridge assembly includes a plurality of first fastener pushers, each of the plurality of first fastener pushers being movable to eject one first fastener of the plurality of first fasteners from the first cartridge assembly, the plurality of first fastener pushers operatively coupled to the knife such that distal movement of the plurality of first fastener pushers moves the knife between the proximal position and the distal position.
10. The end effector according to claim 2, wherein the second cartridge assembly includes a plurality of second fastener pushers, each of the plurality of fastener pushers being movable to eject one second fastener of the plurality of second fasteners from the second cartridge assembly.
Type: Application
Filed: Feb 7, 2017
Publication Date: Jun 29, 2017
Inventor: Stanislaw Kostrzewski (Newtown, CT)
Application Number: 15/426,148