ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
`Description
`CROSS REFERENCE TO RELATED APPLICATIONS
`The present application is a continuation in part of U.S. pat. appln Ser. No. 10/673,930 entitled
`“SURGICAL STAPLING INSTRUMENT INCORPORATING A FIRING MECHANISM
`HAVING A LINKED RACK TRANSMISSION”, to Jeffrey S. Swayze, Frederick E. Shelton
`IV, filed 29 Sep. 2003, the disclosure of which is hereby incorporated by reference in its entirety.
`The present application is related to commonly-owned U.S. Pat. Appln.patent application Ser.
`No. ______ filed on even date herewith, entitled “SURGICAL STAPLING INSTRUMENT
`INCORPORATING A MULTI-STROKE FIRING MECHANISM WITH RETURN SPRING
`ROTARY MANUALAUTOMATIC END OF FIRING TRAVEL RETRACTION SYSTEM”, to
`F.Kevin Ross Doll, Jeffrey S. Swayze, Frederick E. Shelton, K. Doll, D. Hoffinan, M. IV,
`Douglas B. Hoffman, and Michael Earl Setser, and J. Swayze, the disclosure of which is hereby
`incorporated by reference in its entirety.
`FIELD OF THE INVENTION
`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
`forming various components of such stapler instruments that accomplish firing with multiple
`strokes of a trigger.
`BACKGROUND OF THE INVENTION
`Endoscopic surgical instruments are often preferred over traditional 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 number of ways to 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.).
`Known surgical staplers include an end effector that simultaneously makes a longitudinal
`incision in tissue and applies lines of staples on opposing sides of the incision. The end effector
`includes a pair of cooperating jaw members that, if the instrument is intended for endoscopic or
`laparoscopic applications, are capable of passing through a cannula passageway. One of the jaw
`members receives a staple cartridge having at least two laterally spaced rows of staples. 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 reciprocating wedges which, when
`driven distally, pass through openings in the staple cartridge and engage drivers supporting the
`staples to effect the firing of the staples toward the anvil.
`
`IS 1009
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`1
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`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`An example of a surgical stapler suitable for endoscopic 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 members are properly gripping tissue, the clinician can
`then fire the surgical stapler with a single firing stroke, thereby severing and stapling the tissue.
`The simultaneous severing and stapling avoids complications that may arise when performing
`such actions sequentially with different surgical tools that respectively only sever or staple.
`One specific advantage of being able to close upon tissue before firing is that the clinician is able
`to verify via an endoscope that thea 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 drawn too close 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.
`Generally, a single closing stroke followed by a single firing stroke is a convenient and efficient
`way to perform severing and stapling. However, in some instances, it would be desirable for
`multiple firing strokes to be required. For example, surgeons are able to select afrom a range of
`jaw sizes with a corresponding length of staple cartridge for the desired length of cut from a
`range of jaw sizes. Longer staple 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 compared to a shorter staple cartridge. It
`would be desirable for the amount of 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 unexpectedly higher force is required.
`One approach for lowering the required force for a firing stroke is a ratcheting mechanism that
`allows a firing trigger to be stroked multiple times, as described in U.S. Pat. Nos. 5,762,256 and
`6,330,965. These known surgical stapling 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.
`While these multiple firing strokesstroke 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 outward to effect
`retraction since the firing trigger is directly coupled to the firing mechanism.
`
`2
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`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`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.
`However, instances occur when assistance is required to retract the firing mechanism. Otherwise,
`it may be difficult to release the end effector from clamped tissue 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 the multiple stroke firing trigger uncoupled during return strokes, another
`way to effect retraction of the firing mechanism is desirable. As another example, firing may
`have commenced partially, but the surgeon decides that firing must be stopped and the 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.
`Consequently, a significant need exists for a surgical stapling instrument having a multiple stroke
`firing mechanism thatwith automatically retractsretraction after full firing travel yet does not
`inadvertently retract between firing strokes.
`BRIEF SUMMARY OF THE INVENTION
`The invention overcomes the above-noted and other deficiencies of the prior art by providing a
`surgical stapling and severing instrument that advantageously incorporates a multiple firing
`stroke handle that actuates a long end effector without undue manual force required by a
`surgeon. A firing member that transfers the firing 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 when released by a firing mechanism. An anti-backup release
`mechanism consistent with aspects of the invention responds to full firing travel of the firing
`member by disabling the anti-backup release mechanism so that the firing member will
`retractincludes an end effector 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 attached to the end effector via a shaft. The handle
`produces a firing motion that is imparted by a firing mechanism through a rack to a firing
`member that is slidingly received in the shaft. A gear mechanism rotates with the rack to run a
`retraction member that is externally visible on the handle. Thereby, the user is able to manually
`assist in retracting the firing mechanism.
`In one aspect of the invention, a handle of the surgical instrument 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 severing of clamped tissue. A firing
`mechanism selectively engages a pawl into engagement with the firing member that is
`responsive to distally move the firing member in a seriesa plurality of firing strokes offrom a
`
`3
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`

`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`firing trigger. Automatically causing the rack and thus the firing member to advance down the
`shaft. A retraction is facilitated by an anti-backup release lever tipping to the perpendicular a
`locking plate ofspring biases the firing member proximally away from the shaft to assist in
`retraction. To prevent inadvertent retraction between firing strokes, an anti-backup mechanism
`that is biased to a nonperpendicular binding state againstbinds the firing member. The anti-
`backup release lever is cammed into this position in response to thea proximal movement
`thereof. After firing member approaching full firing travel., 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-way clutch to an externally accessible
`actuator. Thus, assistance may be given when the 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.
`These and other objects and advantages of the present invention shall be made apparent from the
`accompanying drawings and the description thereof.
`BRIEF DESCRIPTION OF THE FIGURES
`The accompanying drawings, which are incorporated 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.
`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.
`FIG. 2 is a left side elevation view taken along line 2-2 in the longitudinal cross section of an end
`effector at a distal portion of the surgical stapling instrument of FIG. 1.
`FIG. 3 is a front perspective view of the end effector of FIG. 2.
`FIG. 4 is a perspective, exploded view of an implement portion of the surgical stapling and
`severing instrument of FIG. 1.
`FIG. 5 depicts a left side elevation view in section of the end effector of FIG. 3 of the surgical
`instrument of 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.
`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 is a left side elevation view of the handle of the surgical stapling and severing instrument
`of FIG. 1 with a left handle housing removed.
`FIG. 8 is a perspective, exploded view of the handle of FIG. 7.
`
`4
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`

`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`FIG. 9 is a perspective view from an elevated, aft, left vantage point of the linked transmission
`firing mechanism of the handle of FIG. 7.
`FIG. 10 is a detail left side elevation view of the linked rack of the firing mechanism of FIG. 9.
`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.
`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.
`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.
`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.
`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.
`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.
`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.
`FIGS. 26-27 are perspective views from a top, left, distal vantage point of the surgical stapling
`and severing 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.
`FIG. 28 is perspective view of a surgical stapling and severing instrument in 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 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.
`
`5
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`

`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`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.
`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.
`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 awaycutaway and a right half shell of a handle housing
`removed to expose an automatic end-of-firing travel retraction mechanism and a manual firing
`retraction mechanism.
`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.
`FIG. 34 is right aft perspective view of the surgical stapling and severing instrument of 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.
`FIG. 35 is a right side view in elevation of the partially disassembled surgical stapling and
`severing instrument of FIG. 34.
`FIG. 36 is a right aft perspective view of the partially disassembled surgical stapling and
`severing instrument 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.
`FIG. 37 is a right aft perspective view of the partially disassembled surgical stapling and
`severing instrument of FIG. 35 with the side pawl firing mechanism disengaged and the distal
`link approaching automatic retraction.
`FIG. 38 is left side view in elevation of the partially disassembled surgical stapling and severing
`instrument of FIG. 35 in an initial state of an end effector open and a anti-backup mechanism
`engaged.
`FIG. 39 is a left side detail view of the right half shell and a first alternative anti-backup release
`lever (i.e., link triggered) of the handle portion of FIG. 38.
`FIG. 40 is a left side detail view in elevation of the disassembled surgical stapling and severing
`instrument of FIG. 31 with the closure trigger clamped, the firing trigger performing a final
`stroke and the distal link positioned to trip automatic retraction.
`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.
`
`6
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`

`

`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`FIG. 42 is a right disassembled perspective view of 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.
`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.
`FIG. 44 is a partially disassembled left side view in elevation of anthe 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/compression spring prior to actuation of the manual retraction lever of FIG. 42.
`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-backup release lever, aft
`gear, and manual firing release lever shown in phantom.
`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 linklinked rack.
`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 manual firing
`release lever disengaging the anti-backup mechanism.
`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.
`FIG. 49 is a left a perspective disassembled view of the second alternative anti-backup release
`lever (gear forward cammed), aft gear axle, and automatic retraction cam wheel of FIG. 48.
`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.
`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.
`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.
`FIG. 51A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel
`and a second link of FIG. 51.
`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.
`
`7
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`

`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`FIG. 52A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel
`and third link of FIG. 52.
`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.
`FIG. 53A is a right detail side view in elevation of the aft gear, automatic retraction cam wheel
`and proximal-most fourth link of FIG. 53.
`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 wheel to distally slide
`and lock the second alternative anti-backup release lever, disengaging the anti-backup
`mechanism.
`DETAILED DESCRIPTION OF THE INVENTION
`A surgical stapling and severing instrument, whether with a conventional solid or linked rack as
`advantageously depicted for a shorter handle, incorporates a multiple firing stroke capability
`allowing greater firing travel without an excessive amount of force required to squeeze a firing
`trigger. Between firing strokes, an anti-backup mechanism is incorporated so that a firing
`retraction bias does inadvertently cause firing retraction.
`In FIGS. 1-30, a first version of the surgical stapling and severing instrument incorporates a side
`moving anti-backup release mechanism that causes automatic retraction at the end of firing
`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 of firing travel. Further, the first version of the surgical stapling and severing
`instrument of FIGS. 1-30 couples the firing motion from a firing trigger to a linked rack
`transmission by means of a frictionally biased top pawl, and is further described in U.S. patent
`application Ser. No. 10/673,930 entitled “SURGICAL STAPLING INSTRUMENT
`INCORPORATING A FIRING MECHANISM HAVING A LINKED RACK
`TRANSMISSION”, to Jeffrey S. Swayze, Frederick E. Shelton IV, filed 29 Sep. 2003, the
`disclosure of which is hereby incorporated by reference in its entirety.
`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 means of a 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 manual retraction 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 indication 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.
`
`8
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`

`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`Turning to the Drawings, wherein like numerals denote like components throughout the 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
`instrument 10 incorporates an end effector 12 having an anvil 14 pivotally attached to an
`elongate channel 16, forming opposing 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 endoscopic surgical procedure while being
`controlled by a surgeon 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 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 longitudinal
`axis 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 movement relative 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 portion 22 is inserted into a patient to access a
`surgical site, 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 the tissue. Once satisfied as to the
`location of the tissue relative to the end effector 12 and the amount of tissue 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 clamp tissue.
`If the clamping is 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 predetermined number of times. The number of firing strokes necessary is
`ergonomically determined based on a maximum hand size, maximum amount of force to be
`imparted to the instrument during each firing stroke, and the longitudinal distance and force
`needed to be transferred through the firing rod 32 to the end effector 12 during firing. As will be
`appreciated in the discussion below, individual surgeons may choose to cycle the firing trigger
`
`9
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`ELECTRONIC COMPARISON OF WRITTEN DESCRIPTION OF
`SWAYZE (US 2005/0178813; ORIGINAL) TO
`SHELTON II (US 2006/0175375; UNDERLINE/STRIKETHROUGH)
`
` 
`34 a different angular range of motion, and thus increase or decrease the number of firing
`strokes, yet the handle 20 still effects firing without binding.
`During these strokes, the surgeon may reference an indicator, depicted as an indicating retraction
`knob 40, that positionally rotates in response to the multiple firing strokes. Additionally, the
`position of the retraction knob 40 may confirm that full firing has occurred when encountering
`resistance to further cycling of the firing trigger 34. It should be appreciated that various indicia
`and instructions may be added to the handle 20 to enhance the indication provided by the rotation
`of the indicating retraction knob 40. Upon full travel of the firing rod 32 and when the firing
`trigger 34 is released, the handle 20 automatically retracts the firing rod 32. Alternatively, the
`surgeon, with knowledge that the surgical stapling and severing instrument 10 has not fully fired
`as depicted by the indicating retraction knob 40, may depress an anti-backup release button 42
`and release the firing trigger 34. Both of these actions allow the handle 20 to automatically
`retract the firing rod 32.
`It will be appreciated that the terms “proximal” and “distal” are used herein with reference to a
`clinician gripping a handle of an instrument. Thus, the end effector 12 is distal with respect to the
`more proximal handle 20. Analogous terms such as “front” and “back” similarly correspond
`respectively to distal and proximal. It will be further appreciated that for convenience and clarity,
`spatial terms such as “vertical” and “horizontal” are used herein with respect to the drawings.
`However, surgical instruments are used in many orientations and positions, and these terms are
`not intended to be limiting and absolute.
`The present invention is being discussed in terms of endoscopic procedures and apparatus.
`However, use herein of terms such as “endoscopic”, should not be construed to limit the present
`invention to a surgical stapling and severing instrument for use only in conjunction with an
`endoscopic tube (i.e., trocar). On the contrary, it is believed that the present invention may find
`use in any procedure where access is limited to a small incision, including but not limited to
`laparoscopic procedures, as well as open procedures.
`E-Beam End Effector.
`The advantages of a handle 20, which is capable of providing multiple-stroke firing motion, has
`application to a number of instruments, with one such end effector 12 being depicted in FIGS. 2-
`6. With particular reference to FIG. 4, the end effector 12 responds to the closure motion from
`the handle 20 (not depicted in FIGS. 2-6) first by including an anvil face 50 (FIGS. 2, 4, 6)
`connecting to an anvil proximal end 52 that includes a pair of laterally projecting anvil pivot pins
`54 that are proximal to a vertically projecting anvil feature 56 (FIG. 4). The anvil pivot pins 54
`translate within kidney shaped openings 58 in the elongate channel 16 to open and close anv