as) United States
`a2) Patent Application Publication 0) Pub. No.: US 2005/0178813 Al
`(43) Pub. Date: Aug. 18, 2005
`
`Swayzeetal.
`
`US 20050178813A1
`
`(54) SURGICAL STAPLING INSTRUMENT
`INCORPORATING A MULTI-STROKE
`FIRING MECHANISM WITH AUTOMATIC
`END OF FIRING TRAVEL RETRACTION
`
`(76)
`
`Inventors: Jeffrey S. Swayze, Hamilton, OH (US);
`Frederick E. Shelton IV, Hillsboro,
`OH (US); Kevin Ross Doll, Mason, OH
`(US); Douglas B. Hoffman, Harrison,
`OH (US)
`
`Correspondence Address:
`J&J Docketing Department
`Johnson and Johnson Law Department
`P.O. Box 1222
`
`New Brunswick, NJ 08903 (US)
`
`(21) Appl. No.:
`
`11/052,632
`
`(22)
`
`Filed:
`
`Feb. 7, 2005
`
`Related U.S. Application Data
`
`(63) Continuation-in-part of application No. 10/673,930,
`filed on Sep. 29, 2003, now Pat. No. 6,905,057.
`
`Publication Classification
`
`(SL) Ute C07 cacccssssssssssnssssssssttnesnsstn A61B 17/04
`(52) US. Ch.
`cecescsssssssscnsssesnssnsennssee 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 strokes in 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 manual retraction capability.
`
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`US 2005/0178813 Al
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`Aug. 18, 2005
`
`SURGICAL STAPLING INSTRUMENT
`INCORPORATING A MULTI-STROKE FIRING
`MECHANISM WITH AUTOMATIC END OF
`FIRING TRAVEL RETRACTION
`
`CROSS REFERENCE TO RELATED
`APPLICATIONS
`
`[0001] The present application is a continuation in part of
`US. pat. appln Ser. No. 10/673,930 entitled “SURGICAL
`STAPLING INSTRUMENTINCORPORATINGA 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.
`
`[0002] The present application is related to commonly-
`
`owned U.S. Pat. Appin. Ser. No.
`filed on even date
`herewith, entitled “SURGICAL STAPLING INSTRU-
`MENT INCORPORATING A MULTI-STROKE FIRING
`MECHANISM WITH RETURN SPRING ROTARY
`MANUAL RETRACTION SYSTEM”,
`to F. Shelton, K.
`Doll, D. Hoffinan, M. Setser, and J. Swayze, the disclosure
`of which is hereby incorporated by referencein its entirety.
`
`FIELD OF THE INVENTION
`
`[0003] 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-
`[0004] 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.).
`
`[0005] Known surgical staplers include an end effector
`that simultaneously makes a longitudinal incision in tissue
`and applies lines of staples on opposingsides of the incision.
`The end effector includes a pair of cooperating jaw members
`that, if the instrument is intended for endoscopic or laparo-
`scopic applications, are capable of passing through a can-
`nula passageway. One of the jaw membersreceivesa staple
`cartridge havingatleast 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, when drivendistally, pass through open-
`ings in the staple cartridge and engage drivers supporting the
`staples to effect the firing of the staples toward the anvil.
`
`[0006] 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 clinicianis 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.
`
`[0007] One specific advantage of being able to close upon
`tissue before firing is that the clinician is able to verify via
`an endoscope that the desired location for the cut has been
`achieved, including that a sufficient amount of tissue has
`been captured between opposing jaws. Otherwise, opposing
`jaws may be drawntooclose together, especially pinching at
`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 incomplete firing.
`
`[0008] Generally, a single closing stroke followed by a
`single firing stroke is a convenient and efficient 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 a length
`of staple cartridge for the desired length of cut from a range
`of jaw sizes. Longerstaple cartridges 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 and comparable
`to shorter cartridges so as not to exceed the hand strength of
`some surgeons. In addition, some surgeons, not familiar with
`the larger staple cartridges, may become concerned that
`binding or other malfunction has occurred when an unex-
`pectedly higher force is required.
`
`[0009] 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 known surgical 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.
`
`[0010] While these multiple firing strokes would have
`advantages, some features of a single firing stroke 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 outward to effect retraction since the
`firing trigger is directly coupled to the firing mechanism.
`
`the multiple-stroke firing trigger is
`[0011] By contrast,
`uncoupled from the firing mechanism during return strokes.
`While a retraction bias force is advantageously incorporated
`
`46
`
`46
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`

`

`US 2005/0178813 Al
`
`Aug. 18, 2005
`
`to retract the knife from the staple applying assembly, this
`retraction force needs to be prevented from performing
`retraction of the knife before full firing travel is achieved.
`
`FIG.1, the section generally taken along lines 5-5 of FIG.
`3 to expose portions of a staple cartridge but also depicting
`the firing bar along the longitudinal centerline.
`
`Inone aspectof the invention, a surgical instrument
`[0014]
`has an end effector that includes jaws of an elongate channel
`and a pivotally attached anvil that hold a staple cartridge and
`clamp tissue. The firing member causes stapling and sever-
`ing of clamped tissue. A firing mechanism selectively
`engages a pawl into engagement with the firing member to
`distally move the firing memberin a series of firing strokes
`[0029] FIG. 16 is a perspective view fromatop, aft, right
`of a firing trigger. Automatically retraction is facilitated by
`vantage pointof the anti-backup mechanism of FIG. 15 with
`an anti-backup release lever tipping to the perpendicular a
`the anti-backup cam tube removed.
`locking plate of an anti-backup mechanism that is biased to
`a nonperpendicular binding state against the firing member.
`The anti-backup release lever is cammedinto this position in
`response to the firing member approachingfull firing travel.
`
`[0022] FIG. 6 depicts a left side elevation view in section
`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.
`
`[0025] FIG. 9 is a perspective view from an elevated,aft,
`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.
`
`[0027] FIGS. 11-14 are left side elevation views in cross
`section generally along the longitudinal axis of the ramped
`central track of the linked rack and the pawl of the firing
`mechanism, and additionally showing the firing trigger,
`biasing wheel and ramp of the traction biasing mechanism,
`depicting a sequence during a firing stroke.
`
`[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.
`
`[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.
`
`[0012] Consequently, a significant need exists for a sur-
`gical stapling instrument having a multiple stroke firing
`mechanism that automatically retracts after full firing travel
`yet does not inadvertently retract between firing strokes.
`
`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 instrument that advantageously incor-
`porates a multiple firing stroke handle that actuates a long
`end effector without undue manual force required by a
`surgeon. A firing memberthat transfers thefiring force to the
`end effector is proximally biased to assist in retraction. To
`avoid retraction between firing strokes, an anti-backup
`mechanism binds the firing member whenreleased by a
`firing mechanism. An anti-backup release mechanism con-
`sistent with aspects of the invention respondsto full firing
`travel of the firing member by disabling the anti-backup
`release mechanism so that the firing memberwill retract.
`
`[0015] These and other objects and advantages of the
`present invention shall be made apparent from the accom-
`panying drawings and the description thereof.
`
`BRIEF DESCRIPTION OF THE FIGURES
`
`[0016] The accompanying drawings, which are incorpo-
`rated in and constitute a part of this specification, illustrate
`embodimentsof 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.
`
`[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 and firing rod.
`
`[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.
`
`[0021] FIG. 5 depicts a left side elevation view in section
`of the end effector of FIG. 3 of the surgical instrument of
`
`[0018] FIG. 2 isa left side elevation view taken alongline
`[0034] FIGS. 26-27 are perspective views fromatop, left,
`2-2 in longitudinal cross section of an end effectorat a distal
`distal vantage point of the surgical stapling and severing
`portion of the surgical stapling instrument of FIG. 1.
`instrument with the right half shell of the handle housing
`removed to expose a closure release lockout mechanism,
`respectively in an initial position with the lockout removed
`and the closure release button depressed, and then a lockout
`being activated during initial firing.
`
`[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.
`
`[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.
`
`47
`
`47
`
`

`

`US 2005/0178813 Al
`
`Aug. 18, 2005
`
`[0036] FIG. 29 is a left side elevation view of the surgical
`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.
`
`[0037] FIG. 30 is a left side elevation view of the surgical
`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 cut away and a right half shell
`of a handle housing removed to expose an automatic end-
`of-firing travel retraction mechanism and a manualfiring
`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 of the 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-
`mentof FIG.34.
`
`[0043] FIG. 36 is a right aft perspective view of the
`partially disassembled surgical stapling and severing instru-
`ment of FIG. 34 with a closure mechanism closed and
`
`clamped and the side pawl firing mechanism completing a
`first stroke and with a manual
`retraction mechanism
`
`removed to expose a distal link of the linked rack that
`triggers automatic retraction of the firing mechanism.
`
`[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 andthe distal link approaching automatic retrac-
`tion.
`
`[0045] FIG. 38 is left side view in elevation of the
`partially disassembled surgical stapling and severing instru-
`mentof FIG. 35 in an initial state of end effector open and
`anti-backup mechanism engaged.
`
`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 manualretraction
`
`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 an alternative surgical stapling and severing
`instrument (spring-biased side pawl) of FIG. 31 with the
`anti-backup mechanism engaged to fully fired linked rack
`that is disconnected from a combination tension/compres-
`sion spring prior to actuation of the manualretraction 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 manual firing
`release lever has manually retracted the link 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.
`
`[0055] FIG. 48 is a left side detail view of a second
`alternative anti-backup release lever (gear forward cammed)
`and handle housing for the surgical stapling and severing
`instrument(spring-biased side pawl) of FIG. 31.
`
`[0056] FIG. 49is a left perspective disassembled view of
`the second alternative anti-backup release lever (gear for-
`ward cammed), aft gear axle, and automatic retraction cam
`wheel of FIG. 48.
`
`[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
`anti-backup release lever proximally positioned with the
`anti-backup plate engaged to the firing rod.
`
`[0058] FIG. 50Ais a right detail side view in elevation of
`the aft gear, automatic retraction cam wheel and distal-most
`link of FIG. 50.
`[0046] FIG. 39 isaleft side detail view of the right half
`shell and a first alternative anti-backup release lever (i.e.,
`[0059] FIG. 51 is a right side view in elevation of the
`link triggered) of the handle portion of FIG. 38.
`second alternative anti-backup release mechanism of FIG.
`50 after a first firing stroke.
`
`[0047] FIG. 40 is a left side detail view in elevation of the
`[0060] FIG. 51Ais a rightdetail side view in elevation of
`disassembled surgical stapling and severing instrument of
`FIG. 31 with the closure trigger clamped, the firing trigger
`the aft gear, automatic retraction cam wheel and a second
`link of FIG. 51.
`performingafinal stroke andthe distal link positioned to trip
`automatic retraction.
`
`[0048] FIG. 41 is a left side detail in elevation of the
`disassembled surgical stapling and severing instrument of
`
`48
`
`[0061] FIG. 52 is a right side view in elevation of the
`second alternative anti-backup release mechanism of FIG.
`51 after a second firing stroke.
`
`48
`
`

`

`US 2005/0178813 Al
`
`Aug. 18, 2005
`
`[0062] FIG. 52Ais a right detail side view in elevation of
`the aft gear, automatic retraction cam wheel and third 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-
`
`incorporates a
`tageously depicted for a shorter handle,
`multiple firing stroke capability allowing greater firing 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 automaticretrac-
`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 means of a frictionally
`biased top pawl. The second version of the surgical stapling
`and severing instrument of FIGS. 31-54 couples the firing
`motion of a firing trigger to a linked rack transmission by
`meansofa spring biased side pawl. 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.
`
`[0068] 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 implement portion 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 or ill-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
`[0069]
`coupled between a closure trigger 26 (FIG. 1) andthe 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-
`[0070]
`tion 22 is inserted into a patient to access a surgicalsite, a
`surgeon refers to an endoscopic or other diagnostic imaging
`device to position tissue between the anvil 14 and elongate
`channel 16. Grasping the closure trigger 26 and pistol grip
`36, the surgeon may repeatedly grasp and position thetissue.
`Oncesatisfied as to the location of the tissue relative to the
`end effector 12 and the amountoftissue therein, the surgeon
`depresses the closure trigger 26 fully toward the pistol grip
`36, clamping the tissue in the end effector 12 and locking the
`closure trigger 26 in this clamped (closed) position. If not
`satisfied with this position,
`the surgeon may release the
`closure trigger 26 by depressing a closure release button 38
`and thereafter repeat the procedure to clamptissue.
`[0071]
`Ifthe clampingis correct, the surgeon may proceed
`with firing the surgical stapling and severing instrument 10.
`Specifically,
`the surgeon grasps the firing trigger 34 and
`pistol grip 36, depressing the firing trigger 34 a predeter-
`mined number of times. The number of firing strokes
`necessary is ergonomically determined based on a maximum
`hand size, maximum amountof force to be imparted to the
`instrument during each firing stroke, and the longitudinal
`distance and force neededto be transferred throughthe firing
`ro