as) United States
`a2) Patent Application Publication 10) Pub. No.: US 2006/0175375 Al
`(43) Pub. Date: Aug. 10, 2006
`
`Shelton, IV etal.
`
`US 20060175375A1
`
`(54) SURGICAL STAPLING INSTRUMENT
`INCORPORATING A MULTI-STROKE
`FIRING MECHANISM WITH RETURN
`SPRING ROTARY MANUAL RETRACTION
`SYSTEM
`
`(75)
`
`Inventors: Frederick E. Shelton IV, Hillsboro,
`OH (US); Kevin Ross Doll, Mason, OH
`(US); Douglas B. Hoffman, Harrison,
`OH (US); Michael Earl Setser,
`Burlington, KY (US); Jeffrey S.
`Swayze, Hamilton, OH (US)
`
`Correspondence Address:
`FROST BROWN TODD, LLC
`2200 PNC CENTER
`201 E. FIFTH STREET
`
`CINCINNATI, OH 45202 (US)
`
`(73) Assignee: Ethicon Endo-Surgery, Inc.
`
`(21) Appl. No.:
`
`11/052,387
`
`(22)
`
`Filed:
`
`Feb. 7, 2005
`
`Publication Classification
`
`(51)
`
`Int. CL
`(2006.01)
`AGIB 17/10
`(52) U.S. Ce ceccscccssesssecsssensseseseensten 227/176.1; 227/19
`
`(57)
`
`ABSTRACT
`
`A surgical stapling and severing instrument particularly
`suited to endoscopic procedures incorporates a handle that
`produces separate closing and firing motions to actuate an
`end effector. In particular,
`the handle produces multiple
`firing strokesin order to reduce the required amountof force
`required to fire (i.e., staple and sever) the end effector. A
`linked transmission reduces the required handle longitudinal
`length, yet achieves a rigid, strong configuration when
`straightened for firing. A traction biased firing mechanism
`avoids binding in driving this straightened linked rack in
`cooperation with an anti-backup mechanism, with a lockout
`mechanism that prevents releasing the closure trigger during
`firing. Furthermore, an external indicator gives feedback to
`the surgeon as to how far firing has progressed, as well as
`providing a manualretraction capability.
`
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`SURGICAL STAPLING INSTRUMENT
`INCORPORATING A MULTI-STROKE FIRING
`MECHANISM WITH RETURN SPRING ROTARY
`MANUAL RETRACTION SYSTEM
`
`CROSS REFERENCE TO RELATED
`APPLICATIONS
`
`[0001] The present application is related to commonly-
`
`owned U.S. patent application Ser. No.
`filed on even
`date herewith, entitled “SURGICAL STAPLING INSTRU-
`MENT INCORPORATING A MULTI-STROKE FIRING
`MECHANISM WITH AUTOMATIC END OF FIRING
`
`TRAVEL RETRACTION”, to Kevin Ross Doll, Jeffrey S.
`Swayze, Frederick E. Shelton IV, Douglas B. Hoffman, and
`Michael Earl Setser,
`the disclosure of which is hereby
`incorporated by reference in its entirety.
`
`FIELD OF THE INVENTION
`
`[0002] The present invention relates in general to surgical
`stapler instruments that are capable of applying lines of
`staples to tissue while cutting the tissue between those staple
`lines and, more particularly,
`to improvements relating to
`stapler instruments and improvements in processes for form-
`ing various components of such stapler instruments that
`accomplish firing with multiple strokes of a trigger.
`
`BACKGROUND OF THE INVENTION
`
`instruments are often pre-
`[0003] Endoscopic surgical
`ferred overtraditional open surgical devices since a smaller
`incision tends to reduce the post-operative recovery time and
`complications. Consequently, significant development has
`gone into a range of endoscopic surgical instruments that are
`suitable for precise placement of a distal end effector at a
`desired surgical site through a cannula of a trocar. These
`distal end effectors engage the tissue in a numberof waysto
`achieve a diagnostic or therapeutic effect (e.g., endocutter,
`grasper, cutter, staplers, clip applier, access device, drug/
`gene therapy delivery device, and energy device using
`ultrasound, RF, laser, etc.).
`
`[0004] Known surgical staplers include an end effector
`that simultaneously makes a longitudinal incision in tissue
`and applieslines of staples on opposing sidesofthe incision.
`The endeffector includesa pair of cooperating jaw members
`that, if the instrumentis intended for endoscopic or laparo-
`scopic applications, are capable of passing through a can-
`nula passageway. One of the jaw membersreceives a staple
`cartridge having at least two laterally spaced rowsofstaples.
`The other jaw member defines an anvil having staple-
`forming pockets aligned with the rows of staples in the
`cartridge. The instrument includes a plurality of reciprocat-
`ing wedges which, whendriven distally, pass through open-
`ings in the staple cartridge and engage drivers supporting the
`staples to effect the firing of the staples toward the anvil.
`
`[0005] An example of a surgical stapler suitable for endo-
`scopic applications is described in U.S. Pat. No. 5,465,895,
`which advantageously provides distinct closing and firing
`actions. Thereby,a clinician is able to close the jaw members
`upon tissue to position the tissue prior to firing. Once the
`clinician has determined that the jaw membersare properly
`gripping tissue, the clinician can thenfire the surgical stapler
`with a single firing stroke, thereby severing and stapling the
`tissue. The simultaneous severing and stapling avoids com-
`
`plications that may arise when performing such actions
`sequentially with different surgical tools that respectively
`only sever or staple.
`[0006] One specific advantage of being able to close upon
`tissue before firing is that the clinician is able to verify via
`an endoscope that a desired location for the cut has been
`achieved, including a sufficient amount of tissue has been
`captured between opposing jaws. Otherwise, opposing jaws
`may be drawntoo close together, especially pinchingat their
`distal ends, and thus not effectively forming closed staples
`in the severed tissue. At the other extreme, an excessive
`amount of clamped tissue may cause binding and an incom-
`pletefiring.
`[0007] Generally, a single closing stroke followed by a
`single firing stroke is a convenient and eflicient way to
`perform severing and stapling. However, in someinstances,
`it would be desirable for multiple firing strokes to be
`required. For example, surgeons are able to select from a
`range of jaw sizes with a corresponding length of staple
`cartridge for the desired length of cut. Longer staple car-
`tridges require a longer firing stroke. Thus,
`to effect the
`firing, a hand-squeezed trigger is required to exert a larger
`force for these longer staple cartridges in order to sever more
`tissue and drive more staples as comparedto a shorter staple
`cartridge. It would be desirable for the amountof force to be
`lower so as not
`to exceed the hand strength of some
`surgeons. In addition, some surgeons, not familiar with the
`larger staple cartridges, may become concernedthat binding
`or other malfunction has occurred when an unexpectedly
`higher force is required.
`[0008] One approach for lowering the required force for a
`firing stroke is a ratcheting mechanism that allowsa firing
`trigger to be stroked multiple times, as described in U.S. Pat.
`Nos. 5,762,256 and 6,330,965. These knownsurgical sta-
`pling instruments with multiple-stroke firing mechanisms do
`not have the advantages of a separate closure and firing
`action. Moreover, the ratcheting mechanism relies upon a
`toothed rack and driving pawl to achieve the ratcheting
`motion, with the length of a handle encompassing these
`components thus increased to accommodate the toothed
`rack. This increased length is inconvenient given the close
`confines and increasing amount of equipment associated
`with a surgical procedure.
`[0009] While these multiple firing stroke mechanisms
`would have advantages, some features of a single firing
`stroke mechanism have advantages as well. For instance, a
`single-stroke firing trigger may be directly coupled to the
`firing mechanism even during release of the firing trigger.
`Thus, any spring bias on the single-stroke firing trigger
`assists in retracting the knife from the end effector. If
`binding occurs,
`the surgeon may urge the firing trigger
`outwardto effect retraction sincethe firing triggeris directly
`coupled to the firing mechanism.
`[0010] By contrast,
`the multiple-stroke firing trigger is
`uncoupled from the firing mechanism during return strokes.
`While a retraction bias force is advantageously incorporated
`to retract the knife from the staple applying assembly, this
`retraction force thus needs to be prevented from performing
`retraction of the knife before full firing travel is achieved.
`Thus, the retraction force is desirably moderated so as to not
`increase the manual
`loads felt at
`the firing trigger.
`In
`addition, the retraction force is moderated as well so as to
`not over power an anti-backup mechanism.
`
`46
`
`46
`
`

`

`US 2006/0175375 Al
`
`Aug. 10, 2006
`
`instances occur when assistance is
`[0011] However,
`required to retract the firing mechanism. Otherwise, it may
`be difficult to release the end effector from clampedtissue to
`complete the surgical procedure. For instance, tissue may
`cause binding in the instrument. As another example, a
`malfunction may occur that increases binding within the
`instrument or otherwise reduces the retraction force. With
`
`[0017] FIG. 1 is a right side elevation view of a surgical
`stapling and severing instrument(traction biased pawl) in an
`open (start) condition, with a shaft partially cut away to
`expose a closure tube andfiring rod.
`
`FIG.2 isa left side elevation view taken alongline
`[0018]
`2-2 in the longitudinal cross section of an end effector at a
`distal portion of the surgical stapling instrument of FIG.1.
`
`[0019] FIG. 3 is a front perspective view of the end
`effector of FIG. 2.
`
`[0020] FIG. 4 is a perspective, exploded view of an
`implement portion of the surgical stapling and severing
`instrument of FIG.1.
`
`the multiple stroke firing trigger uncoupled during return
`strokes, another way to effect retraction of the firmg mecha-
`nism is desirable. As another example, firing may have
`commenced partially, but the surgeon decides that firing
`must be stopped andthe end effector opened. This may occur
`if an expended staple cartridge was in the end effector and
`partial firing occurred until the instrument locked out further
`firing.
`[0021] FIG.5depicts a left side elevation view in section
`of the end effector of FIG. 3 of the surgical instrument of
`[0012] Consequently, a significant need exists for a sur-
`FIG.1, the section generally taken along lines 5-5 of FIG.
`gical stapling instrument having a multiple stroke firing
`3 to expose portions of a staple cartridge but also depicting
`mechanism with automatically retraction after full firing
`travel.
`the firing bar along the longitudinal centerline.
`
`BRIEF SUMMARY OF THE INVENTION
`
`[0013] The invention overcomes the above-noted and
`other deficiencies of the prior art by providing a surgical
`stapling and severing instrumentthat includes an endeffec-
`tor responsive to a longitudinal firing motion to perform a
`surgical operation. This end effector is positioned through a
`body opening (e.g., cannula of a trocar) by externally
`manipulating a handle that is attachedto the end effector via
`a shaft. The handle producesa firing motion that is imparted
`by a firing mechanism througha rack to a firing memberthat
`is slidingly received in the shaft. A gear mechanism rotates
`with the rack to run a retraction memberthat is externally
`visible on the handle. Thereby, the user is able to manually
`assist in retracting the firing mechanism.
`
`FIG.6 depicts a left side elevation view in section
`[0022]
`of the end effector of FIG. 5 after the firing bar has fully
`fired.
`
`FIG.7 isa left side elevation view of the handle of
`[0023]
`the surgical stapling and severing instrument of FIG. 1 with
`a left handle housing removed.
`
`[0024] FIG. 8 is a perspective, exploded view of the
`handle of FIG.7.
`
`FIG.9 is a perspective view from an elevated, aft,
`[0025]
`left vantage point of the linked transmission firing mecha-
`nism of the handle of FIG. 7.
`
`[0026] FIG. 10 is a detail left side elevation view of the
`linked rack of the firing mechanism of FIG.9.
`
`In one aspect of the invention, a handle of the
`[0014]
`[0027] FIGS. 11-14 are left side elevation views in cross
`surgical instrumenthasa firing mechanism that is responsive
`section generally along the longitudinal axis of the ramped
`to a plurality of firing strokes from a firing trigger causing
`central track of the linked rack and the pawl of the firing
`the rack and thus the firing member to advance down the
`mechanism, and additionally showing the firing trigger,
`shaft. A retraction spring biases the firing member proxi-
`biasing wheel and ramp ofthe traction biasing mechanism,
`mally away from the shaft to assist in retraction. To prevent
`depicting a sequence duringafiring stroke.
`inadvertent retraction betweenfiring strokes, an anti-backup
`mechanism binds the firing member in response to a proxi-
`mal movementthereof. After firing, an anti-backup release
`mechanism disengages the anti-backup mechanism for
`retraction. Advantageously, a manual retraction mechanism
`has a transmission gear coupled by a one-wayclutch to an
`externally accessible actuator. Thus, assistance may be given
`whenthe automatic retraction is incapable of retraction. This
`avoids situations where the end effector may otherwise
`remain in a closed and clamped condition onto stapled and
`severed tissue.
`
`[0028] FIG. 15 is a right-side elevation view partially
`disassembled to expose a distal portion of an anti-backup
`mechanism (lateral kick-out type) in a locked condition in
`the surgical stapling and severing instrument of FIG.1.
`
`[0029] FIG. 16 is a perspective view from a top, aft, right
`vantage point of the anti-backup mechanism of FIG. 15 with
`the anti-backup cam tube removed.
`
`[0015] These and other objects and advantages of the
`present invention shall be made apparent from the accom-
`panying drawings and the description thereof.
`
`DESCRIPTION OF THE FIGURES
`
`[0016] The accompanying drawings, which are incorpo-
`rated in and constitute a part of this specification, illustrate
`embodiments of the invention, and, together with the general
`description of the invention given above, and the detailed
`description of the embodiments given below, serve to
`explain the principles of the present invention.
`
`[0030] FIG. 17 is a right-side elevation view partially
`disassembled to expose a distal portion of an anti-backup
`mechanism in an unlocked condition in the surgical stapling
`and severing instrument of FIG. 1.
`
`[0031] FIG. 18 is a right-side elevation view partially
`disassembled to expose a distal portion of an anti-backup
`mechanism in an unlocked condition in the surgical stapling
`and severing instrument of FIG. 1.
`
`[0032] FIG. 19 is a rear elevation view of the surgical
`stapling and severing instrument of FIG. 1 with the right
`half shell of the handle housing removed to expose the
`anti-backup release lever in phantom in a locking condition
`and in an unlocked condition.
`
`47
`
`47
`
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`

`US 2006/0175375 Al
`
`Aug. 10, 2006
`
`[0033] FIGS. 20-25 are detail views of the anti-backup
`release lever of FIG. 18 depicting respectively a firing
`sequence of unfired, one firing stroke, two firing strokes,
`three firing strokes, returning or release button pushed, and
`fully returned.
`
`[0045] FIG. 38 is left side view in elevation of the
`partially disassembled surgical stapling and severing instru-
`ment of FIG.35 in an initial state of an end effector open and
`a anti-backup mechanism engaged.
`
`[0046] FIG. 39 is a left side detail view of the right half
`[0034] FIGS. 26-27 are perspective views fromatop,left,
`shell and a first alternative anti-backup release lever (i.e.,
`distal vantage point of the surgical stapling and severing
`link triggered) of the handle portion of FIG. 38.
`instrument with the right half shell of the handle housing
`removed to expose a closure release lockout mechanism,
`respectively in an initial position with lockout removed and
`closure release button depressed, and then a lockout being
`activated during initial firing.
`
`FIG.40 is a left side detail view in elevation of the
`[0047]
`disassembled surgical stapling and severing instrument of
`FIG.31 with the closure trigger clamped, the firing trigger
`performing a final stroke andthe distal link positionedto trip
`automatic retraction.
`
`[0035] FIG. 28 is perspective view of a surgical stapling
`and severing instrumentin an open condition similar to FIG.
`1 but incorporating a top-accessible retraction lever.
`
`FIG.29 is a left side elevation view of the surgical
`[0036]
`stapling and severing instrument of FIG. 28 with the left
`half shell of the handle housing removed to expose an
`intermittently toothed indicator gear presenting a first dwell
`area to the idler gear.
`
`FIG.30 is a left side elevation view of the surgical
`[0037]
`stapling and severing instrument of FIG. 28 with the left
`half shell of the handle housing removed to expose an
`intermittently toothed indicator gear presenting a second
`dwell area to the idler gear.
`
`[0038] FIG. 31 is a left front perspective view of an
`alternate surgical stapling and severing instrument (spring
`biased side pawl) with an alternate handle portion including
`a first alternative (link triggered) automatic retraction and an
`alternative (ratcheting) manual retraction mechanism.
`
`[0039] FIG. 32 is a right aft perspective view of the
`surgical stapling and severing instrument of FIG. 31 with a
`portion of an elongate shaft cutaway anda righthalf shell of
`a handle housing removed to expose an automatic end-of-
`firing travel retraction mechanism and a manual
`firing
`retraction mechanism.
`
`[0040] FIG. 33 is a right aft perspective disassembled
`view of the handle portion and an elongate shaft of the
`surgical stapling and severing instrument of FIG.31.
`
`[0041] FIG. 34 is right aft perspective view ofthe surgical
`stapling and severing instrumentof FIG. 31 with a right half
`shell and outer portions of the implement portion removed
`to expose the closure and firing mechanisms in an initial
`state.
`
`[0042] FIG. 35 is a right side view in elevation of the
`partially disassembled surgical stapling and severing instru-
`ment of FIG. 34.
`
`[0048] FIG. 41 is a left side detail in elevation of the
`disassembled surgical stapling and severing instrument of
`FIG. 40 immediately after the distal link has actuated and
`locked forward the anti-backup release lever allowing the
`linked rack to retract.
`
`FIG.42 isa right disassembled perspective view of
`[0049]
`the idler and aft gears and manual retraction lever and
`ratcheting pawl of a manual retraction mechanism of the
`alternative (spring-biased side pawl) surgical stapling and
`severing instrument of FIG.31.
`
`[0050] FIG. 43 is a right perspective view of the manual
`retraction mechanism of FIG. 42 with the manual retraction
`
`lever partially cut away to expose a smaller diameter ratchet
`gear on the aft gear engaging the ratcheting pawl.
`
`[0051] FIG. 44 is a partially disassembled left side view
`in elevation of the alternative surgical stapling and severing
`instrument (spring-biased side pawl) of FIG. 31 with the
`anti-backup mechanism engaged to the fully fired linked
`rack that is disconnected from a combination tension/com-
`
`pression spring prior to actuation of the manual retraction
`lever of FIG. 42.
`
`[0052] FIG. 45 is a partially disassembled left side view
`in elevation of the alternative surgical stapling and severing
`instrument of FIG. 44 with hidden portions of the anti-
`backuprelease lever, aft gear, and manualfiring release lever
`shown in phantom.
`
`[0053] FIG. 46 is a partially disassembled left side view
`in elevation of the alternative surgical stapling and severing
`instrument of FIG. 45 after actuation of the manualfiring
`release lever has manually retracted the linked rack.
`
`[0054] FIG. 47 is a partially disassembled left side view
`in elevation of the alternative surgical stapling and severing
`instrument of FIG.46 with the linked rack omitted depicting
`the manualfiring release lever disengaging the anti-backup
`mechanism.
`
`[0043] FIG. 36 is a right aft perspective view of the
`[0055] FIG. 48 is a left side detail view of a second
`partially disassembled surgical stapling and severing instru-
`alternative anti-backup release lever (gear forward cammed)
`ment of FIG. 34 with a closure mechanism closed and
`and handle housing for the surgical stapling and severing
`clamped and side paw! firing mechanism completingafirst
`instrument (spring biased side pawl) of FIG. 31.
`stroke and with a manual retraction mechanism removed to
`exposea distal link of the linked rack that triggers automatic
`retraction of the firing mechanism.
`
`FIG.49 is left a perspective disassembled view of
`[0056]
`the second alternative anti-backup release lever (gear for-
`ward cammed), aft gear axle, and automatic retraction cam
`wheel of FIG. 48.
`
`[0044] FIG. 37 is a right aft perspective view of the
`partially disassembled surgical stapling and severing instru-
`ment of FIG. 35 with the side pawl firing mechanism
`disengaged andthedistal link approaching automaticretrac-
`tion.
`
`[0057] FIG. 50 is a right side view in elevation of the
`second alternative anti-backup release mechanism of FIG.
`48 with the linked rack in a retracted position and the
`
`48
`
`48
`
`

`

`US 2006/0175375 Al
`
`Aug. 10, 2006
`
`anti-backup release lever proximally positioned with the
`anti-backup plate engagedto the firing rod.
`
`[0058] FIG. 50A is a right detail side view in elevation of
`the aft gear, automatic retraction cam wheel and distal-most
`link of FIG. 50.
`
`[0059] FIG. 51 is a right side view in elevation of the
`second alternative anti-backup release mechanism of FIG.
`50 after a first firing stroke.
`
`[0060] FIG. 514Ais a right detail side view in elevation of
`the aft gear, automatic retraction cam wheel and a second
`link of FIG. 51.
`
`[0061] FIG. 52 is a right side view in elevation of the
`second alternative anti-backup release mechanism of FIG.
`51 after a secondfiring stroke.
`
`[0062] FIG. 52A is a right detail side view in elevation of
`the aft gear, automatic retraction cam wheel andthird link of
`FIG. 52.
`
`[0063] FIG. 53 is a right detail side view in elevation of
`the second alternative anti-backup release mechanism of
`FIG. 52 after a third firing and final stroke.
`
`[0064] FIG. 53Ais a right detail side view in elevation of
`the aft gear, automatic retraction cam wheel and proximal-
`most fourth link of FIG. 53.
`
`[0065] FIG. 54 is a right side view in elevation of the
`second alternative automatic release mechanism of FIG. 53
`
`after a further firing stroke causes the automatic retraction
`cam wheelto distally slide and lock the second alternative
`anti-backup release lever disengaging the anti-backup
`mechanism.
`
`DETAILED DESCRIPTION OF THE
`INVENTION
`
`stapling and severing instrument,
`[0066] A surgical
`whether with a conventional solid or linked rack as advan-
`tageously depicted for a shorter handle,
`incorporates a
`multiplefiring stroke capability allowing greaterfiring travel
`without an excessive amount of force required to squeeze a
`firing trigger. Betweenfiring strokes, an anti-backup mecha-
`nism is incorporated so that a firing retraction bias does
`inadvertently cause firing retraction.
`
`In FIGS. 1-30, a first version of the surgical
`[0067]
`stapling and severing instrumentincorporates a side moving
`anti-backup release mechanism that causes automatic retrac-
`tion at the end offiring travel. This version also includes a
`first version of a manual retraction assistance capability to
`overcome binding. In FIGS. 31-54, a second version of a
`surgical
`stapling and severing instrument mechanism
`includes two more anti-backup release mechanisms for
`automatic retraction at the end offiring travel. Further, the
`first version of the surgical stapling and severing instrument
`of FIGS. 1-30 couplesthe firing motion from a firing trigger
`to a linked rack transmission by meansof a frictionally
`biased top pawl, and is further described in U.S. patent
`application Ser. No. 10/673,930 entitled “SURGICAL STA-
`PLING INSTRUMENT INCORPORATING A FIRING
`MECHANISM HAVING A LINKED RACK TRANSMIS-
`
`SION”, to Jeffrey S. Swayze, Frederick E. Shelton IV, filed
`29 Sep. 2003, the disclosure of which is hereby incorporated
`by reference in its entirety.
`
`[0068] The second version of the surgical stapling and
`severing instrument of FIGS. 31-54 couples the firing
`motion ofa firing trigger to a linked rack transmission by
`meansofa spring-biased side paw]. Furthermore, the second
`version of the surgical stapling and severing instrument in
`FIGS. 32-41 depicts a rack-triggered automatic retraction
`capability with a ratcheting manual retraction mechanism as
`an alternative to the kick-out, anti-backup release lever of
`FIGS. 1-30. In FIGS. 42-47, a ratcheting manualretraction
`mechanism is depicted in more detail, corresponding to what
`is generally depicted in FIGS. 32-41. FIGS. 48-54 depict a
`gear driven automatic retraction feature built into the indi-
`cation and ratcheting manual retraction mechanism as a
`further alternative to the kick-out anti-backup release lever
`of FIGS. 1-30 and the rack-triggered anti-backup release
`lever of FIGS. 31-47.
`
`[0069] Turning to the Drawings, wherein like numerals
`denote like components throughoutthe several views, FIGS.
`1 and 2 depict a surgical stapling and severing instrument 10
`that
`is capable of practicing the unique benefits of the
`present invention. The surgical stapling and severing instru-
`ment 10 incorporates an end effector 12 having an anvil 14
`pivotally attached to an elongate channel 16, forming oppos-
`ing jaws for clamping tissue to be severed and stapled. The
`end effector 12 is coupled by a shaft 18 to a handle 20 (FIG.
`1). An implementportion 22, formed by the end effector 12
`and shaft 18, is advantageously sized for insertion through
`a trocar or small laparoscopic opening to perform an endo-
`scopic surgical procedure while being controlled by a sur-
`geon grasping the handle 20. The handle 20 advantageously
`includes features that allow separate closure motion and
`firing motion, lockouts to prevent inadvertent orill-advised
`firing of the end effector, as well as enabling multiple firing
`strokes to effect firing (i.e., severing and stapling) of the end
`effector 12 while indicating the degree of firing to the
`surgeon.
`
`To these ends, a closure tube 24 of the shaft 18 is
`[0070]
`coupled between a closure trigger 26 (FIG. 1) and the anvil
`14 to cause closure of the end effector 12. Within the closure
`
`tube 24, a frame 28 is coupled between the elongate channel
`16 and the handle 20 to longitudinally position and support
`the end effector 12. A rotation knob 30 is coupled with the
`frame 28, and both elements are rotatably coupled to the
`handle 20 with respect to a rotational movement about a
`longitudinalaxis of the shaft 18. Thus, the surgeon can rotate
`the end effector 12 by turning the rotation knob 30. The
`closure tube 24 is also rotated by the rotation knob 30 but
`retains a degree of longitudinal movementrelative thereto to
`cause the closure of the end effector 12. Within the frame 28,
`a firing rod 32 is positioned for longitudinal movement and
`coupled between the anvil 14 of the end effector 12 and a
`multiple-stroke firing trigger 34. The closure trigger 26 is
`distal to a pistol grip 36 of the handle 20 with the firing
`trigger 34 distal to both the pistol grip 36 and closure trigger
`26.
`
`In endoscopic operation, once the implement por-
`[0071]
`tion 22 is inserted into