United States Patent
`[19]
`[11] Patent Number:
`5,485,952
`
`Fontayne
`[45] Date of Patent:
`Jan. 23, 1996
`
`US005485952A
`
`[54] APPARATUS FOR APPLYING SURGICAL
`FASTENERS
`
`[75]
`
`Inventor: Diego Fontayne, Norwalk, Conn.
`
`[73] Assignee: United States Surgical Corporation,
`Norwalk, Conn.
`
`[21] Appl. No.2 950,065
`
`[22]
`
`Filed:
`
`Sep. 23, 1992
`
`Int. Cl.6 ................................................... A61B 17/072
`[51]
`[52] US. Cl.
`..................................... 227/178.1; 227/180.1;
`227/19; 227/111
`[58] Field of Search .............................. 227/19, 175, 176,
`227/177, 178‘, 179, 180, 111; 606/139,
`142, 143, 219, 215
`
`[56]
`
`References Cited
`
`US PATENT DOCUMENTS
`
`4,715,520
`4,728,020
`4,763,669
`4’784’137
`
`~
`
`12/1987 Roehr, Jr. et 211-
`3/1988 Green et a1.
`.
`8/1988 Jaeger'
`....................................... 30/251
`11,1988 Kuhk et 31'
`‘
`(List continued on next page.)
`
`FOREIGN PATENT DOCUMENTS
`0369324
`5/1990 European Pat. 01f.
`.
`0505138
`9/1992 European Pat. OE.
`.
`2330182
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`”mad ngd‘”
`OTHER PUBLICATIONS
`
`Swain et 31., “An Endoscopic Sewing Machine”, Gas-
`trointestinal Endoscopy, vol. 32, No. 1, 1986.
`Swain, C. P., Brown, G. J. and Mills, T. N., “An Endoscopic
`Stapling Device: The Development of a New Flexible Endo-
`scopically Controlled Device for Placing Multiple Transmu-
`ral Staples in Gastrointestinal Tissue”, Gastrointestinal
`Endoscopy, 1989, vol. 35, No. 4, pp. 338—339.
`Primary Examiner—Rinaldi I. Rada
`
`[57]
`
`ABSTRACT
`
`Surgical apparatus is provided for placing lateral lines of
`surgical fasteners intobody tissue. The apparatus includes
`an endoscopic body having an elongated proximal portion
`and an articulating distal portion which moves relative to the
`proximal portion. A cartridge assembly and an anvil member
`are detachably mounted adjacent the articulating distal por-
`tion which move relative to one another between an open
`position and a closed position. A camming mechanism is
`associated with the articulating portion of the apparatus for
`moving the anvil member relative to the cartridge assembly,
`and a linkage system is provided for effectuating the articu-
`lation of the distal portion of the endoscopic body to increase
`the range of operability of the apparatus. In addition, a
`driving mechanism is provided for ejecting the surgical
`fasteners from the cartridge assembly.
`
`30 Claims, 11 Drawing Sheets
`
`.
`
`.
`
`.
`
`.
`
`8/1976 Noiles eta1..
`Re. 28,932
`5/1963 Bobrov et a1.
`3,079,606
`1/1970 Green et a1.
`,
`3,490,675
`3/1970 Green.
`3,499,591
`7/1971 Astafiev et a1,
`3,593,903
`7/1972 Bryan et a1.
`.
`3,675,688
`5/1973 Bryan et a1.
`.
`3,735,762
`6/1974 Noiles et a1.
`3,819,100
`4/1976 Green.
`3,949,924
`12/1977 Meredith.
`4,064,881
`5/1978 Green et al. .
`4,086,926
`9/1978 Vishnevsky et a1.
`4,111,206
`4,169,476 10/1979 Hiltebrandt.
`4,273,129
`6/1981 Boebel .
`4,325,377
`4/1982 Boebel .
`4,383,634
`5/1983 Green.
`4,429,695
`2/1984 Green.
`4,520,817
`6/1985 Green.
`4,566,620
`1/1986 Green et al.
`4,573,468
`3/1986 Conta et a1.
`4,573,622
`3/1986 Green et a1.
`4,580,712
`4/1986 Green.
`4,606,343
`8/1986 Conta et al. .
`4,610,383
`9/1986 Rothfuss et al. .
`4,633,874
`1/1987 Chow et a1.
`.
`4,714,187
`12/1987 Green.
`
`.............................. 227/19
`
`.
`.
`
`
`
`1
`
`IS 1022
`Ethicon
`Intuitive Surgical v.
`|PR2019-00880
`
`IS 1022
`Intuitive Surgical v. Ethicon
`IPR2019-00880
`
`

`

`5,485,952
` Page 2
`
`7/1990 Pruitt .
`
`.
`
`4,941,623
`.
`4
`”1990 Odd?” em
`’944’443
`4,964,559 10/1990 Dcmcga ct a1.
`049
`4
`1
`v978=
`2/1990 Green-
`.
`.
`5,040,715
`8/1991 Green et al.
`5,042,707
`8/1991 Taheri
`................................. 227/179X
`5,071,430 12/1991
`d6 Salis et a1.
`.
`
`5,099,827
`3/1992 Melzcr et a1.
`
`........................ 227/178
`
`606/142X
`
`U.S. PATENT DOCUMENTS
`
`4,819,853
`4,821,942
`4,841,888
`4,848,637
`4,858,608
`4,869,414
`4,880,015
`
`4/1989 Green.
`.
`4/1989 R1chards et a].
`6/1989 Mills 61211..
`7/1989 Pruitt .
`8/1989 McQuilkin.
`9/1989 Green et -a1.
`11/1989 Nierman.
`
`,
`
`.............................. 227/19
`
`2
`
`

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`US. Patent
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`1
`APPARATUS FOR APPLYING SURGICAL
`FASTENERS
`
`BACKGROUND OF THE INVENTION
`
`5,485,952
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`2
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`flexible fiberoptic bronchoscope. The biopsy forceps
`includes a handle connected to a thin elongated flexible shaft
`with a distal portion thereof hinged to the shaft. A grasping
`tool or biopsy forceps is attached to the distal hinged
`portion. Control wires extend from the handle through the
`distal portion to the shaft for controlling the angular rotation
`of the distal portion of the instrument to increase its range of
`operability.
`In accordance with these and other principles, it is an
`object of the present invention to provide a surgical appa-
`ratus for driving surgical fasteners into body tissue which
`apparatus may be operated from a location remote from the
`surgical site.
`It is another object of the present invention to provide a
`surgical apparatus insertable through a small incision or
`narrow tube for driving surgical fasteners into body tissue
`and cutting the body tissue between the rows of staples.
`It is another object of the present invention to provide a
`surgical apparatus for driving surgical fasteners into body
`tissue which apparatus has an increased range of operability.
`It is still another object of the present invention to provide
`a surgical apparatus having sealing structure for inhibiting
`the escape of insufilation gas through the apparatus.
`Yet another object of the present invention to provide a
`surgical apparatus for driving staples which is adapted for
`mounting a replaceable cartridge assembly.
`
`SUMMARY OF THE INVENTION
`
`The surgical instrument in accordance with an embodi-
`ment of the present invention is a surgical stapling apparatus
`adapted for placing one or more longitudinal rows of staples
`in body tissue. This apparatus may include a knife for
`making an incision in the body tissue between the rows of
`staples. The latter configuration may find particular use in
`joining two hollow organs or in removing an organ, such as
`the appendix or gallbladder.
`In a preferred embodiment of the subject invention, the
`endoscopic stapler comprises a tubular body having an
`elongated proximal portion and an articulating distal portion
`adapted for detachably mounting a cartridge assembly. A
`linkage mechanism is associated with the tubular body of the
`instrument for efiectuating the articulation of the distal
`portion of the tubular body relative to the proximal portion
`thereof and includes a pair of elongated rod members
`extending through the endoscopic body and actuated from a
`location remote from the distal end portion of the apparatus.
`The cartridge assembly comprise a cartridge housing for
`supporting a cartridge which contains a plurality of surgical
`staples slidably mounted therein, and has a tissue engaging
`surface formed thereon. An anvil member is mounted adja-
`cent the cartridge housing and is provided with a staple
`forming surface against which staples ejected from the
`cartridge are driven. The anvil member is movable between
`an open position and a closed position wherein the staple
`forming surface is in close cooperative alignment with the
`tissue engaging surface of the cartridge.
`The apparatus includes carrmiing means which are asso-
`ciated with the cartridge assembly for moving the anvil
`member between the open position and the closed position.
`The camrning means comprises a cam tube having a carn-
`ming surface disposed around at least a portion of the anvil
`member and movable between a first position wherein the
`camming surface is located proximal to a carnming portion
`of the anvil member, corresponding to the anvil member
`being open, and a second position wherein the carnming
`
`1. Field of the Invention
`
`This invention relates to surgical stapling apparatus, and
`more particularly to surgical apparatus for performing
`sequential operations such as tissue clamping, staple form-
`ing and/or tissue cutting.
`2. Description of Related Art
`Surgical stapling apparatus is known wherein tissue is
`first grasped or clamped between opposing jaw structure and
`then fastened by means of fasteners. In some instruments a
`knife is provided to cut tissue which has been joined. The
`fasteners are typically in the form of surgical staples how-
`ever, two part polymeric type fasteners are also known.
`Instruments for this purpose can comprise two elongated
`members which are respectively used to capture or clamp
`tissue. Typically, one of the members carries a disposable
`cartridge housing wherein a. plurality of staples are arranged
`in at least two lateral rows while the other member defines
`an anvil for forming the staple legs into a hook-like con—
`figuration as they are driven against the anvil. The stapling
`operation is effected by a pusher which travels longitudi-
`nally along the cartridge carrying member, acting upon the
`staples so as to place them in lateral rows in the body tissue.
`Aknife may be optionally positioned in such a manner so as
`to operate immediately behind the pusher, and laterally
`positioned between the staple rows to longitudinally cut
`and/or open the stapled tissue between the rows of staples.
`Such instruments are disclosed for example in Bobrov et al.
`(U.S. Pat. No. 3,079,606) and Green (U.S. Pat. No. 3,490,
`675). These instruments comprise apparatus for simulta-
`neously making a longitudinal incision and applying a row
`of staples on both sides of the incision.
`A later development disclosed in Green (U.S. Pat. No.
`3,499,591) applies a double row of staples on each side of
`the incision. This is accomplished by a cartridge assembly
`having a cam member which moves within a guide path
`between two sets of staggered staple carrying grooves.
`Staple drive members are located within the grooves for
`being contacted by the longitudinally moving cam member
`as it is driven along the groove to effect ejection of the
`staples.
`The instruments described above were all designed to be
`used in surgical procedures in which surgeons have direct
`manual access to the operation site. However, in endoscopic
`or laparoscopic procedures surgery is performed from a
`location remote from the operative site through a small
`incision or through narrow cannulae inserted through small
`entrance wounds in the skin. In order to address the specific
`needs of endoscopic and/or laparoscopic surgical proce-
`dures, an endoscopic surgical stapling apparatus such as that
`which is shown in Green et at. (U.S. Pat. No. 5,040,715) has
`been developed. This apparatus is well suited for such
`procedures and incorporates a distal end having an anvil and
`staple cartridge assembly and a manually operated handle
`assembly interconnected by an endoscopic portion which
`permits the instrument to be inserted into a cannula and be
`remotely operated by the surgeon.
`Many of the instruments described above are limited in
`their range of operability. Improvements have been made in
`the art of surgical instruments to increase their range of
`operability. For example, Niennan (U.S. Pat. No. 4,880,015)
`discloses a biopsy forceps designed for use through a
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`5,485,952
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`surface is located distal to the camming portion of the anvil
`member, corresponding to the anvil member being closed.
`The apparatus further includes means for ejecting the
`surgical staples from the cartridge in such a manner so as to
`cause the staples to form against the staple forming surface
`of the anvil member. The means for ejecting the surgical
`fasteners comprises a plurality of pusher elements in abut-
`ment with the surgical fasteners, and a cam plate for actu-
`ating the pusher elements. The cam plate is mounted for
`translation within the cartridge assembly and is operatively
`connected to a plunger member extending through the
`tubular body of the apparatus and actuated from a location
`remote from the cartridge assembly.
`The surgical apparatus of the subject invention further
`comprises sealing means associated with the tubular body
`portion of the instrument for inhibiting the egress of insuf-
`flation gas therethrough during surgical procedures. Prefer-
`ably, the sealing means includes a first annular seal member
`disposed adjacent the proximal end of the tubular body and
`a second annular seal member disposed at the distal end of
`the tubular body adjacent the articulating portion thereof.
`Further features of the invention, its nature, and various
`advantages will become more apparent from the accompa-
`nying drawing and the following detailed description of the
`invention.
`
`BRIEF DESCRIPTION OF THE DRAWINGS
`
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`Preferred embodiments of the subject invention will be
`described hereinbelow with reference to the drawings
`wherein:
`
`30
`
`FIG. 1 is a perspective view of an apparatus for driving
`surgical fasteners in accordance with a preferred embodi-
`ment of the subject invention;
`FIG. 2 is an exploded perspective view of the surgical
`apparatus of FIG. 1;
`FIG. 3 is an enlarged perspective view, partially broken
`away, of the articulating portion of the apparatus of FIG. 1;
`FIG. 4 is an exploded perspective view of the cartridge
`assembly of the apparatus of FIG. 1;
`FIG. 5 is a rear elevational View of the articulating portion
`of the apparatus of FIG. 1, showing the internal structure
`defined therein;
`FIG. 6 is a top plan view of a linkage of the apparatus of
`FIG. 1, illustrating the relative movement of the members
`thereof;
`FIG. 7 is a perspective View of the surgical apparatus of
`FIG. 1, with the cartridge assembly thereof in an open
`position;
`FIG. 8 is a perspective view of the surgical apparatus of
`FIG. 1 in an articulated condition, wherein the cartridge
`assembly thereof is in an open position;
`FIG. 9 is an enlarged perspective view of the articulating
`portion of the apparatus of FIG. 1;
`FIG. 10 is a perspective view of the surgical apparatus of
`FIG. 1 in an articulated condition, with the cartridge assem-
`bly thereof in a closed position;
`FIG. 11 is a perspective view of the surgical apparatus of
`FIG. 1, illustrating the actuation of the staple driving mecha—
`nism thereof;
`FIGS. 12—14 are side elevational views, partially broken
`away, of the cartridge assembly of the apparatus of FIG. 1
`during a staple driving sequence wherein:
`FIG. 12 illustrates the cartridge assembly before the
`apparatus of FIG. 1 has been fired;
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`FIG. 13 illustrates the cartridge assembly as the apparatus
`of FIG. 1 is being fired; and
`FIG. 14 illustrates the cartridge assembly after the appa-
`ratus of FIG. 1 has been fired.
`
`DETAILED DESCRIPTION OF THE
`PREFERRED EMBODIMENTS
`
`Because endoscopic procedures are more common than
`laparoscopic procedures, the present invention shall be dis-
`cussed in terms of endoscopic procedures and apparatus.
`However, use herein of terms such as “endoscopic,” “endo—
`scopically” and “endoscopic portion”, among others, should
`not be construed to limit the present invention to a stapling
`and cutting apparatus for use only in conjunction with an
`endoscopic tube. To the contrary, it is believed that the
`present invention may find use in procedures where access
`is limited to a small incision including but not limited to
`laparoscopic procedures. Also, as used herein the terms
`“fasteners” and “staples” shall be treated equivalently.
`Unless otherwise stated, the term “cartridge assembly” shall
`include at least the cartridge itself and staples or fasteners
`and staple drive members disclosed therein.
`In the drawings and the description which follows, the
`term “proximal” refers to the end of the apparatus which is
`closest to the operator, while the term “distal” will refer to
`the end which is furthest from the operator.
`A surgical stapling apparatus in accordance with a pre-
`ferred embodiment of the subject invention is illustrated in
`FIG. 1 and is designated generally by reference numeral 10.
`Surgical apparatus 10 comprises a tubular endoscopic body
`including an elongated proximal portion 12, and an articu—
`lating distal portion 14 which is mounted for movement
`relative to the longitudinal axis of proximal portion 12. A
`cartridge assembly is detachably mounted adjacent the distal
`end of articulating portion 14 which includes a cartridge
`housing 16 containing a plurality of surgical fasteners and an
`anvil member 18 against which the surgical fasteners are
`driven as they are ejected from the cartridge assembly. Anvil
`member 18 is movable relative to cartridge housing 16
`between a normally open position and a closed position by
`means of a camming mechanism which includes a cam tube
`assembly 20 associated with the articulating portion 14 of
`proximal portion 12 and configured for actuation by means
`of a reciprocating plunger assembly which extends longitu-
`dinally through proximal portion 12 from a location remote
`from the surgical site.
`The movement of the articulating portion 14 of surgical
`apparatus 10 is efi'ectuated by a linkage assembly which is
`disposed within the proximal portion 12 and which is
`operated through remote manipulation of a pivoting handle
`22 which is operatively connected to the linkage assembly.
`Once the distal portion 14 of the apparatus 10 has been
`articulated to a desired position, and body tissue has been
`engaged between the anvil member 18 and the cartridge
`housing 16, surgical apparatus 10 may be fired so as to drive
`a plurality of surgical fasteners from the cartridge assembly
`by remote operation of a plunger assembly 24 which extends
`longitudinally through the proximal portion 12 of surgical
`apparatus 10.
`Referring to FIG. 2, the proximal portion 12 of surgical
`apparatus 10 includes an elongated support tube 30 which
`houses a pair of elongated tube inserts 32 and 34. Tube insert
`32 is provided with a longitudinal central channel 36 the
`distal end portion 37 of which has a diameter which is
`slightly larger than the remainder thereof, and opposed
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`5,485,952
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`lateral grooves 38 and 40 formed on either side of central
`channel 36. Opposed anchor pins 42 and 44 extend from the
`opposed proximal and distal ends of tube insert 32, respec-
`tively, for anchoring tube insert 32 within the proximal
`portion 12 of apparatus 10. Tube insert 34 has structure
`corresponding to that of tube insert 32 including a longitu-
`dinal central channel 46 having an enlarged distal end
`portion 47, opposed lateral grooves 48 and 50, and anchor
`pins 52 and 54. When tube inserts 32 and 34 are arranged
`within support tube 30, central channels 36 and 46 define an
`elongated central passageway for a clamp rod 56, and lateral
`grooves 38 and 48, and 40 and 50 respectively define lateral
`passageways for articulator rods 58 and 60 which intercon—
`nect with the linkage mechanism for moving the articulating
`portion 14 of relative to the proximal portion 12 thereof. A
`pair of annular sealing members 65 and 75 are provided in
`proximal portion 12 for inhibiting the egress of insufflation
`gas therethrough. In particular, sealing member 65 is dis-
`posed adjacent the proximal end of proximal portion 16
`while sealing member 75 is disposed in the distal end of
`proximal portion 16 adjacent proximal pivot member 154.
`A clamp yoke 62 is mounted rigidly at the distal end of
`clamp rod 56 and is dimensioned for being maintained
`within the distal end portions 37 and 47 of the central
`passageway defined by channels 36 and 46. Clamp yoke 62
`is formed with a pair of opposed flange portions 64 and 66
`each having an aperture 68 and 70, respectively, for mount-
`ing a pivoting gear 72 which is adapted to pivot about an axis
`which is perpendicular to the longitudinal axis of the elon—
`gated clamp rod 56. Diametrically opposed toothed portions
`74 and 76 are formed on the circumference of gear 72 for
`operatively meshing with a pair of flexible links 78 and 80.
`In particular, the proximal end portion of link 78 is provided
`with a plurality of spaced apart apertures 82 for meshing
`with toothed portion 74 on gear 72, and link 80 is similarly
`provided at the proximal end thereof with a plurality of
`spaced apart apertures 84 for operatively meshing with the
`toothed portion 76 of gear 72. As best seen in FIGS. 6 and
`9, pivotal movement of gear 72 about the perpendicular axis
`thereof will cause corresponding longitudinal translation of
`links 78 and 80 in opposed longitudinal directions. The
`flexible links 78 and 80 may be formed from stainless steel
`or a similar material. Preferably, however, the flexible links
`78 and 80 are formed from a shape memory alloy compris—
`ing nickel and titanium such as that which is disclosed in
`US. Pat. No. 4,665,906 to Jervis. In doing so, the links 78
`and 80 will not acquire an undesirable set when the distal
`portion 14 of surgical apparatus 10 is articulated.
`The distal end portions of links 78 and 80 are associated
`with cam tube assembly 20 and, in particular, are respec—
`tively connected to a collar tube 90 by a plurality of collar
`pins 92 which extend through apertures 94 in the distal end
`portion of collar link 78 and apertures'96 in the distal end
`portion of link 80 for being received in mounting ports 95 in
`collar tube 90. Collar tube 90 is disposed within a cover tube
`98 and functions as a cam member for operatively moving
`anvil member 18 between a normally open position and a
`closed position relative to cartridge housing 16.
`As discussed hereinabove, the articulation of the distal
`end portion 14 relative to the proximal portion 12 is eflec-
`tuating by means of a linkage mechanism which includes
`articulator rods 58 and 60. The proximal end portions of
`articulator rods 58 and 60 are respectively provided with pin
`portions 102 and 104 for receiving rod adapters 106 and 108,
`respectively. Rod adapters 106 and 108 extend through a
`pair of corresponding longitudinal bore holes 110 and 112
`which are provided in an elongated cylindrical handle sup-
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`port 114. Rod adapters 106 and 108 operatively contact
`respective transverse rod pins 116 and 118 which extend
`through slots 117 and 119 to associate with an articulator
`link assembly which includes a pair of generally U-shaped
`articulator links 120 and 122. Articular links 120 and 122 are
`connected to one another by link pins 124 and 126 and is
`pivotable about a transverse axis or a cylindrical support pin
`128. Opposed spherical articulator handles 130 and 132 are
`mounted to articulator links 120 and 122. In addition, a pair
`of opposed apertures 131 and 133 are defined in support
`handle 114 for receiving anchor pins 44 and 54, respectively.
`A center bore 135 extends through handle support 114 for
`receiving collar rod 56. A handle clamp 137 is also provided
`for mounting at the proximal end of collar rod 56. Rotation
`of the articulator link assembly about pivot pin 128 will
`cause corresponding longitudinal movement of articulator
`rods 58 and 60 in opposed longitudinal directions with
`respect to the proximal portion 12.
`The distal end portions of articulator rod members 58 and
`60 are engaged in substantially C-shaped adapter links 134
`and 136, respectively. Adapter link 134 is independently
`connected to upper and lower joint links 138 and 140 by
`adapter pins 142 and 144. Joint pins 146 and 148 connect
`joint links 138 and 140 to a distal joint member 150 which
`is pivotably connected by a transverse pivot pin 152 having
`a perpendicular bore 153 for receiving a flexible actuator
`link 155, to a proximal pivot member 154 which comprises
`a section of the articulating portion 14 of surgical apparatus
`10. Similarly, adapter link 136 is operatively connected to a
`pair of upper and lower joint links 158 and 160 by adapter
`pins 162 and 164 and joint pins 166 and 168 operatively
`connect articulator link 136 to the distal joint member 150.
`Longitudinal translation of articular rods 58 and 60 Will
`cause corresponding articulation of adapter links 134 and
`136 causing distal joint member 150 to pivot relative to
`proximal pivot member 154 about transverse pivot pin 152.
`Referring to FIG. 3, the proximal pivot member 154
`which is operatively associated with the articulating portion
`14 of surgical apparatus 10 comprises a generally cylindrical
`body portion 170 which includes a proximal engaging
`section 172 mountable within the distal end of support tube
`30. A pair of opposed mounting flanges 174 and 176 extend
`distally from cylindrical body portion 170 each having an
`aperture 178 and 180, respectively, for receiving pivot pin
`152 which joins proximal pivot member 154 to distal joint
`member 150. A plurality of longitudinal chambers are
`defined within the proximal pivot member 154 for main-
`taining various elements of the apparatus 10 of the subject
`invention. In particular, referring to FIG. 5, a pair of opposed
`generally C—shaped lateral chambers 182 and 184 are pro-
`vided therein for maintaining the C-shaped adapter links 134
`and 136, respectively. In addition, substantially rectangular
`channels 188 and 190 are defined in pivot member 154
`adjacent C-shaped channels 182 and 184 respectively, for
`receiving and maintaining links 78 and 80, respectively. A
`rectangular channel 186 is defined in the center of proximal
`pivot member 154 which is dimensioned for receiving gear
`member 72 and permitting its rotational movement when
`closing anvil member 18 through translation of the cam tube
`assembly 20. An internal chamber 196 having a generally
`rectangular cross-section and defining upper and lower
`tracks 198 and 200 extends longitudinally through proximal
`pivot member 154 for supporting the flexible actuator link
`155. A pair of opposed bores 206 and 208 are provided in
`pivot member 154 for receiving anchor pins 42 and 52,
`respectively.
`A cylindrical yoke member 210 is also associated with the
`proximal pivot member 154 and the distal joint member 150.
`
`16
`16
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`5,485,952
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`7
`Yoke member 210 has an elongated central bore 212 for
`receiving pivot pin 152, and a cylindrical barrel shaped body
`portion 214 which functions as a bearing surface for the
`flexible links 78 and 80 as they are flexed during articulation
`of distal end portion 14. A rectangular passageway 215
`extends through body portion 214 for accommodating flex-
`ible actuator link 155.
`
`The distal joint member 150 has a generally cylindrical
`body portion 220 which defines an engaging section 222 at
`the proximal end thereof for receiving the joint pins from
`joint links 138 and 140, and, in addition, for inter—engaging
`pivot pin 152 through aperture 225. Body portion 220 is
`provided with a pair of opposed lateral slots 224 and 226
`within which links 78 and 80 respectively travel
`in a
`longitudinal direction in response to movement of clamp rod
`56. A generally rectangular channel 230 extends longitudi—
`nally through the body portion 220 of distal joint member
`154 wherein a joint insert 232 (see FIG. 2) is positioned for
`releasably engaging anvil member 18 and cartridge assem—
`bly 16. In particular, a lower chamber 235 ofjoint insert 232
`is provided for receiving a mounting portion of cartridge
`housing member 16 and an upper chamber portion 234 of
`insert 232 is provided for releasably mounting a portion of
`anvil member 18. Furthermore, a pair of opposed generally
`rectangular slots 236 and 238 are provided in the walls of
`body portion 220 for permitting transverse movement of
`anvil member 18 relative to cartridge assembly 16 to eflcc-
`tuate the engagement of body tissue. A leaf spring member
`240 (see FIG. 2) is also associated with the distal joint
`member 150 for cooperating with cartridge member 16.
`Turning to FIG. 4, cartridge housing 16 of the cartridge
`assembly of surgical apparatus 10 comprises a channel
`portion 250 defined by opposed lateral walls 252 and 254
`and a bottom wall 256. A cartridge mounting portion 258
`extends proxirnally from channel portion 250 and is eng—
`agable in the pivot insert 232 which is disposed in the
`rectangular channel 230 formed in distal joint member 150.
`A detent member 260, which is mounted on a resilient leaf
`spring 262, is associated with the cartridge mounting portion
`258 of cartridge housing 16 for detachable engagement with
`the leaf spring 240 associated with the distal joint member
`150. A cartridge adapter 264 is disposed Within the channel
`portion 250 of cartridge housing 16 which includes a plat-
`form structure 266 having a longitudinal track 268 defined
`therein, and a slotted structure 270 having a longitudinal
`groove 272 formed therein. A plurality of slots 274 are
`provided in slotted structure 270 for receiving a cam plate
`276 which is configured for ejecting staples from the car-
`tridge assembly during stapling procedures. A support bar
`278 is configured to be mounted within longitudinal groove
`272 for defining a passageway within which a surgical knife
`member 265 travels as it traverses the cartridge housing 16
`cutting tissue as staples are ejected from the cartridge
`assembly. In particular, winged tabs 275 are provided in the
`proximal portion of support bar 278 for engagement in a
`corresponding winged slit 285 in platform 266. Surgical
`knife 265 comprises an elongated shank portion 280 having
`a cross-section which is dimensioned and configured for
`travel within the internal chamber 196 of proximal pivot
`member 154 and the longitudinal
`track 268 defined in
`cartridge adapter 264. A V—shaped notch 282 is provided in
`the proximal end of shank portion 280 for engaging a hook
`284 formed on the distal end of elongated flexible actuator
`link 155 which is attached to an actuator rod 286 extending
`through a tracked passageway 285 provided in collar rod 56.
`Actuator rod 286 is mounted to an actuator handle 288 (see
`FIG. 2) for remotely driving staples. Actuator link 155 is
`
`10
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`15
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`20
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`25
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`30
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`35
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`40
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`8
`also dimensioned and configured for travel Within the lon-
`gitudinal track 268 of cartridge adaptor 264 and the internal
`chamber 196 of pivot member 154. A wing—like structure
`289 is formed at the distal end of surgical knife 265 for
`engaging the cam plate 276.
`Cam plate 276 is formed with a pair of dual plates 290 and
`292 of triangular configuration which are disposed in stag-
`gered fashion for promoting more effective ejection of the
`staples from the cartridge assembly. The dual cam plates 290
`and 292 are dimensioned for traversing corresponding dual
`slots 294 and 296 which are formed in a cartridge element
`300 mounted within the channel portion 250 of cartridge
`housing 16 and containing a plurality of surgical fasteners
`302. A longitudinal groove 305 is also defined in cartridge
`element 300 for accommodating surgical knife 265. As the
`dual plates 290 and 292 of cam plate 276 traverse their
`respective dual slots 294 and 296 and knife 265 travels
`within groove 305, pusher elements 304 are driven upwardly
`within corresponding cavities 306 defined in cartridge ele-
`ment 300 for ejecting the staples 02 therefrom, driving them
`against a staple forming surface defined on anvil member 18.
`Anvil member 18 comprises a staple forming portion 310
`which extends from a shroud portion 312 having opposed
`lateral walls 314 and 316 for mounting anvil member 18
`adjacent cartridge housing 16 and an anvil mounting portion
`318 having a cam surface 320 which cooperates with the
`collar tube 90 for camming anvil member 18 between the
`open and closed positions, and an engagement head 322
`which includes opposed tabs 324 for engagement in opposed
`slots 236 and 238 in the walls of the distal joint member 150.
`An anvil spring 326 is associated with the anvil mounting
`portion 318 for biasing the anvil member 18 in an open
`position.
`Referring to FIGS. 8~11, in use the surgical apparatus 10
`is introduced into the abdominal cavity of a patient through
`a trocar or carmula extending through a small incision or
`entrance wound device whereupon the camming mechanism
`20 of the instrument is in its proximal most position per~
`mitting the anvil member 18 to be in an open position