AUT TNOTATAUS 20070175959A1
`
`asy United States
`a2) Patent Application Publication co) Pub. No.: US 2007/0175959 Al
`Shelton, IV et al. Aug. 2, 2007 (43) Pub. Date:
`
`
`
`(52) US. C1. ce ceeeeeeeccesteeneeeneennee 227/178.1; 227/176.1
`
`(57)
`
`ABSTRACT
`
`(54) MOTOR-DRIVEN SURGICAL CUTTING AND
`FASTENING INSTRUMENT WITH
`ARTICULATABLE END EFFECTOR
`
`(76)
`
`.
`Inventors: Frederick E. Shelton IV, New Vienna,
`OH (US); Christoph L. Gillum,
`Liberty Township, OH (US)
`
`Correspondence Address:
`KIRKPATRICK & LOCKHART PRESTON
`GATES ELLIS LLP
`535 SMITHFIELD STREET
`PITTSBURGH, PA 15222 (US)
`(21) Appl. No.:
`11/343,562
`
`(22) Filed:
`
`Jan. 31, 2006
`.
`Publication Classification
`
`A surgical cutting and fastening instrument is disclosed.
`According to various embodiments, the instrument includes
`an end effector comprising a moveable cutting instrument.
`The instrumentalso includes a main drive shaft assemblyfor
`actuating the cutting, instrument in the end effector. The
`instrument also includes a handle comprising a gear drive
`train connected to the main drive shaft assembly, a motorfor
`actuating the gear drive train, a closure trigger for causing
`the end effector to clamp an object positioned m the end
`effector when the closure trigger is retracted, and a firing
`trigger separate from the closure trigger for actuating the
`motor when the firing trigger is retracted. The instrument
`
`
`further comprises means for articulating the end effector.
`
`
`
`(51)
`
`Int. Cl
`AGIB 17/10
`
`(2006.01)
`
`
`
`1
`41
`
`IS 1025
`Intuitive Surgical v. Ethicon
`IPR2019-00880
`
`IS 1025
`Intuitive Surgical v. Ethicon
`IPR2019-00880
`
`

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`Patent Application Publication Aug. 2,2007 Sheet 1 of 39
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`Patent Application Publication Aug. 2,2007 Sheet 24 of 39
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`Patent Application Publication Aug. 2, 2007 Sheet 25 of 39
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`Patent Application Publication Aug. 2,2007 Sheet 27 of 39
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`US 2007/0175959 Al
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`Aug. 2, 2007
`
`MOTOR-DRIVEN SURGICAL CUTTING AND
`FASTENING INSTRUMENT WITH
`ARTICULATABLE END EFFECTOR
`
`
`
`CROSS-RETERENCE TO RELATED
`
`APPLICATIONS
`
`
`
`[0001] The present application is related to the following
`concurrently-filed U.S. patent applications, which are incor-
`porated herein byreference:
`
`[0002] MOTOR-DRIVEN SURGICAL CUTTING AND
`FASTENING INSTRUMENT WITH USER FEEDBACK
`
`SYSTEM;
`Inventors: Frederick E. Shelton,
`IV,
`John
`T
`Ouwerkerk and Jerome R. Morgan (Atty. Docket No.
`
`050519/END5687USNP)
`
`
`
`ton, IV, Jeffrey S. Swayze, Mark 8. Ortiz, and Leslie M.
`
`Fugikawa (Atty. Docket No. 050701END5776USNP)
`
`
`[0013] ELECTRO-MECHANICAL SURGICAL CUT-
`
`TING AND FASTENING INSTRUMENT HAVING A
`ROTARYFIRING AND CLOSURE SYSTEM WITH PAR-
`ALLEL CLOSURE AND ANVIL ALIGNMENT COMPO-
`
`NENTS; Inventors: Frederick F. Shelton, TV, Stephen J.
`Balek and Eugene L. Timperman (Atty. Docket No. 050702/
`END5777USNP)
`
`
`
`
`[0014] DISPOSABLE STAPLE CARTRIDGE HAVING
`AN ANVIL WITH TISSUE LOCATOR FOR USE WITHA
`
`SURGICAL CUTTING AND FASTENING INSTRU-
`
`
`MENT AND MODULAR END LFTECTOR SYSTEM
`
`THEREFOR;Inventors: Frederick E. Shelton, IV, Michael
`S. Cropper, Joshua M. Broehl, Ryan S. Crisp, Jamison J.
`
`Float, Eugene L. Timperman (Atty. Docket No. 050703/
`ENDS5778USNP)
`
`
`[0015] SURGICAL INSTRUMENT HAVING A FEED-
`BACK SYSTEM; Inventors: l'rederick L'. Shelton, IV, Jer-
`ome R. Morgan, Kevin R. Doll, Jeffrey S. Swayze and
`Eugene
`Timperman
`(Atty. Docket No.
`050705/
`END5780USNP)
`
`BACKGROUND
`
`[0016] The present invention generally concerns surgical
`cutting and fastening instruments and, more particularly,
`motor-driven surgical cutting and fastening instruments.
`
`instruments are often pre-
`[0017] 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
`goneinto 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 lissue 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.).
`
`
`
`[0018] Known surgical staplers include an ond effector
`
`that simultaneously makes a longitudinal incision in tissue
`and applies lines ofstaples on opposingsidesoftheincision.
`The endeffector includesa 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 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 includesa plurality of reciprocat-
`ing wedges which, when driven 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.
`
`
`
`41
`41
`
`HAVING A
`INSTRUMENT
`SURGICAL
`[0010]
`REMOVABLE BATTERY; Inventors: I'rederick [. Shelton,
`V, Kevin R. Doll, Jeffrey S. Swayze and Eugene Timper-
`
`man (Atty. Docket No. 050699/END5774USNP)
`[0011] ELECTRONIC LOCKOU'TS AND SURGICAL
`
`
`NSTRUMENT INCLUDING SAME; Inventors: Jeffrey S.
`Swayze, Frederick E. Shelton,
`IV, Kevin R. Doll (Atty.
`Docket No. 050700/END5775USNP)
`
`
`
`
`
`[0019] An example ofa surgical stapler suitable for endo-
`scopic applications is described in U.S. Pat. No. 5,465,895,
`which discloses an endocutter with distinct closing and
`firing actions. A clinician using this device is able to close
`the jaw members upontissue to position the tissue prior to
`firing. Once the clinician has determined that the jaw mem-
`[0012] LNDOSCOPIC SURGICAL=INSTRUMENT
`
`WITH A HANDLE THAT CAN ARTICULATE WITH
`bers are properly gripping tissue, the clinician can thenfire
`
`
`RESPECT TO THE SHAFT;Inventors: Frederick E. Shel-
`the surgical stapler with a single firing stroke, or multiple
`
`[0003] MOTOR-DRIVEN SURGICAL CUTTING AND
`
`FASTENING INSTRUMENT WITH LOADING FORCE
`
`
`
`
`FEEDBACK;Inventors: Frederick E. Shelton, IV, John N.
`
`
`Ouwerkerk, Jerome R. Morgan, and Jeffrey S. Swayze (Atty.
`Docket No. 050516/END5692USNP)
`
`
`[0004] MOTOR-DRIVEN SURGICAL CUTTING AND
`
`
`FASTENING INSTRUMENT WITH TACTILE POSITION
`
`
`
`
`FEEDBACK;Inventors: Frederick E. Shelton, IV, John N.
`
`
`Ouwerkerk, Jerome R. Morgan, and Jeffrey S. Swayze (Atty.
`Docket No. 050515/END5693USNP)
`
`[0005] MOTOR-DRIVEN SURGICAL CUTTING AND
`
`
`FASTENING INSTRUMENT WITH ADAPTIVE USER
`
`
`
`FEEDBACK;Inventors: Frederick E. Shelton, IV, John N.
`Ouwerkerk, and Jerome R. Morgan (Atty. Docket No.
`050513/ENDS5694USNP)
`
`[0006] MOTOR-DRIVEN SURGICAL CUTTING AND
`FASTENING INSTRUMENT WITH MECHANICAL
`CLOSURE SYSTEM;Inventors: Frederick F. Shelton, TV
`and Christoph L. Gillum (Atty. Docket No. 050693/
`END5770USNP)
`
`
`
`
`
`
`
`T
`SURGICAL CUTTING AND [ASTENING
`[0007]
`
`NSTRUMENT WITH CLOSURE TRIGGER LOCKING
`
`MECHANISM; Inventors: Frederick E. Shelton, IV and
`Kevin R. Doll (Atty. Docket No. 050694/END5771USNP)
`
`[0008] GEARING SELECTOR FOR A POWERED SUR-
`
`GICAL CUTTING AND FASTENING STAPLING
`
`
`NSTRUMENT,;Inventors: Frederick E. Shelton, IV, Jeffrey
`S. Swayze, Eugene L. Timperman (Atty. Docket No.
`050697/END5772USNP)
`
`
`
`SURGICAL INSTRUMENT HAVING RECORD-
`[0009]
`
`NG CAPABILITIES; Inventors: Frederick E. Shelton, IV,
`John N. Ouwerkerk, and Eugene L. Timperman (Atty.
`Docket No. 050698/END5773USNP)
`
`
`
`
`

`

`US 2007/0175959 Al
`
`Aug. 2, 2007
`
`firing strokes, depending on the device. Firing the surgical
`stapler causes severing and stapling the tissue. The simul-
`taneoussevering and stapling avoids complications that may
`arise when performing such actions sequentially with dif-
`ferent surgical tools that respectively only sever andstaple.
`
`[0020] One specific advantage of being able to close upon
`tissue beforefiring is that the clinician is able to verify via
`an endoscopethat the desired location for the cut has been
`achieved, including a sufficient amount oftissue 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-
`plete firmg.
`
`[0021] Endoscopic staplers/cutters continue to increase in
`complexity and function with each generation. One of the
`main reasons for this is the quest for lower force-to-fire
`(TTT) to a level that all or a great majority of surgeons can
`handle. One knownsolution to lower FIF it use CO, or
`electrical motors. These devices have not faired much better
`than traditional hand-powered devices, but for a different
`reason. Surgeonstypically prefer to experience proportion-
`ate force distribution to that being experienced by the
`end-effector in the forming the staple to assure them that the
`cutting/stapling cycle is complete, with the upper limit
`within the capabilities of most surgeons (usually around
`15-30 Ibs). They also typically want to maintain control of
`deploying the staple and being able to stop at anytime if the
`forces felt in the handle of the device feel too great or for
`some other clinical reason. These user-feedback effects are
`not suitably realizable in present motor-driven endocutters.
`As a result, there is a general lack of acceptance by physi-
`cians of motor-drive endocutters where the cutting/stapling
`Operation is actuated by merely pressing a button.
`
`SUMMARY
`
`invention is
`the present
`In one general aspect,
`[0022]
`directed to a motorized surgical cutting and fastening instru-
`ment
`that provides feedback to the user regarding the
`position, force and/or deployment of the end effector. The
`instrument, in various embodiments, also allows the opera-
`tor to control the end effector, including being able to stop
`deployment if so desired. The instrument mayinclude two
`triggers in its handle—a closuretrigger and a firing trigger—
`with separate actuation motions. When an operator of the
`instrumentretracts the closure trigger, tissue positioned in
`the end effector may be clamped by the end effector. Then,
`when the operator retracts the firing trigger, a motor may
`power, via a gear drive train, a rotational main drive shaft
`assembly, which causes a culling instrument
`in the end
`effector to severe the clampedtissue.
`
`In various embodiments, the instrument may com-
`[0023]
`prise a powerassist system with loading force feedback and
`control to reduce the firing force required to be exerted by
`the operator in order to complete the cutting operation. In
`such embodiments, the firing trigger may be geared into the
`gear drive train of the main drive shaft assembly. Inthat way,
`the operator may experience feedback regarding, the force
`being applied to the cutting instrument. ‘That 1s, the loading
`force on thefiring trigger may berelated to the loading force
`experienced by the cutting instrument. Also in such embodi-
`
`ments, becausethefiring trigger is geared into the gear drive
`train, force applied by the operator may be addedto the force
`applied to the motor.
`
`[0024] According to various cmbodiments, whenthefiring
`trigger
`is
`retracted an appropriate amount
`(e.g.,
`five
`degrees), an on/off switch maybe actuated, which sends a
`signal to the motor to rotate at a specified rate, thus com-
`mencing actuation of the drive shaft assembly and end
`effector. According to other embodiments, a proportional
`sensor may be used. ‘lhe proportional sensor may send a
`signal to the motorto rotate at a rate proportional to the force
`applied to thefiring trigger by the operator. In that way, the
`
`rotational position ofthe firmg trigger is generally propor-
`
`
`
`tional to where the cutting instrumentis in the end effector
`(e.g., fully deployedorfully retracted). Further, the operator
`could stop retracting the firing trigger at some point in the
`stroke to stop the motor, and thereby stop the cutting motion.
`In addition, sensors may be used to detect the beginning of
`the stroke of the end elector (e.g.. fully retracted position)
`and the end. ofthe stroke (e.g., fully deployed position).
`
`respectively. Consequently,
`
`the sensors may provide an
`
`
`adaptive control system for controlling end effector deploy-
`ment that is outside ofthe closed loop system ofthe motor,
`gear drive train, and end effector.
`
`
`
`In other embodiments, the firing trigger may not be
`[0025]
`
`directly geared into the gear drive train used to actuate the
`
`end effector. In such embodiments, a second motor may be
`used to apply forces to the firing trigger to simulate the
`deploymentof the cutting instrument in the end effector. The
`second motor may be controlled based on incremental
`rotations of the main drive shaft assembly, which may be
`measured by a rolary encoder. In such embodiment,
`the
`position of the rotational position ofthe firing trigger may be
`related to the position of the cutting instrument in the end
`effector. Additionally, an on/off switch or a proportional
`switch may be used to control the main motor(i.e., the motor
`that powers the main drive shaft).
`
`In various implementations, the end effector may
`[0026]
`use a helical drive screw in the base ofthe end effector to
`drive the cutting instrument (c.g., knife). Also,
`the end
`effector may include a staple cartridge for stapling the
`severed tissue. According to other embodiments, other
`means for fastening (or sealing) the severed tissue may be
`used, including RF energy and adhesives.
`
`the instrument may include a mechanical
`[0027] Also,
`closure system. The mechanical closure system may include
`an clongate channel having a clamping member, such as an
`anvil, pivotably connected to the channel to clamp tissue
`positioned in the end effector. The user may activate the
`clamping action of the end effector by retracting the closer
`trigger, which, through a mechanical closure system, causes
`the clamping action of the end effector. Once the clamping
`memberis locked in place, the operator may activate the
`cutting operation by retracting the separate firing trigger.
`This may cause the cutting instrument to travel longitudi-
`nally along the channelin order to cut tissue clamped bythe
`end effector.
`
`the instrument may
`In various implementations,
`[0028]
`include a rotational main drive shaft assembly for actuating
`the end effector. l'urther, the main drive shaft may comprise
`an articulating joint such that
`the end effector may be
`articulated. The articulation joint may comprise,
`for
`
`42
`42
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`US 2007/0175959 Al
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`Aug. 2, 2007
`
`Qe
`
`example, a bevel gear assembly, a universal joint, or a
`flexible torsion cable capable of transmitting torsion force to
`the end effector.
`
`[0029] Otheraspects of the present invention are directed
`to various mechanisms for locking the closure trigger to a
`lower, pistol-grip portion of the handle. Such embodiments
`free up space in the handle directly above and behind the
`triggers for other components of the instrument, including
`components of the gear drive train and the mechanical
`closure system.
`
`DRAWINGS
`
`[0045] FIGS. 41-42 illustrate a proportional sensor that
`may be used according to various embodiments of the
`present invention.
`
`
`DETAILED DESCRIPTION
`
`
`[0046] FIGS. 1 and 2 depict a surgical cutting and fasten-
`ing instrument 10 according to various embodiments of the
`present imvention. The illustrated embodiment is an endo-
`scopic instrument and, in general, the embodiments of the
`instrument 10 described herein are endoscopic surgical
`cutting and fastening instruments. It should be noted, how-
`ever, that according to other embodiments of the present
`invention, the instrument maybe a non-endoscopic surgical
`culling and fastening instrument, such as a laparoscopic
`instrument.
`
`[0047] The surgical instrument 10 depicted in FIGS. 1 and
`2 comprises a handle 6, a shafl 8, and an articulating end
`effector 12 pivotally connected to the shaft 8 at an articu-
`lation pivot 14. An articulation control 16 may be provided
`adjacent to the handle 6 to effect rotationof the end efector
`12 about the articulation pivot 14. Inthe illustrated embodi-
`ment, the end effector 12 is configured to act as an endocut-
`
`ter for clamping, severing and stapling tissue, although, in
`
`
`
`other embodiments, different types of end effectors may be
`used, such as end effectors for other types of surgical
`devices, such as graspers, cutters, staplers, clip appliers.
`access devices, drug/gene therapy devices, ultrasound, RF or
`laser devices, etc.
`
`
`
`[0048] The handle 6 of the instrument 10 may include a
`closure trigger 18 and a firing trigger 20 for actuating the end
`effector 12. It will be appreciated that instruments having
`end effectors directed to different surgical tasks may have
`
`different numbers or types of triggers or other suitable
`
`controls for operating the end effector 12. The end effector
`12 is shown separated from the handle 6 bya preferably
`elongate shaft 8. In one embodiment, a clinician or operator
`of the instrument 10 may articulate the end effector 12
`relative to the shaft 8 by utilizing the articulation contra! 16,
`as described in more detail in pending U.S. patent applica-
`tion Ser. No. 11/329,020, filed Jan. 10, 2006, entitled “Sur-
`gical Instrument llaving An Articulating Lind Liffector,” by
`Geoffrey C. Hucil ct al., which is incorporated herein by
`reference.
`
`
`
`‘lhe end effector 12 includes in this example,
`[0049]
`among other things, a staple channel 22 and a pivotally
`translatable clamping member, such as an anvil 24, which
`are maintained at a spacing that assures effective stapling
`and severing of tissue clamped in the end effector 12. The
`handle 6 includes a pistol grip 26 towards which a closure
`trigger 18 is pivotally drawn by the clinician to cause
`
`clamping or closing of the anvil 24 toward the staple channel
`
`22 of the end effector 12 to thereby clamptissue positioned
`between the anvil 24 and channel 22. The firing trigger 20
`is farther outboard of the closure trigger 18. Once the closure
`trigger 18 is
`locked in the closure position as further
`described below, the firing trigger 20 mayrotate slightly
`toward the pistol grip 26 so that it can be reached by the
`operator using one hand. Then the operator may pivotally
`draw the firing trigger 20 toward the pistol grip 12 to cause
`the stapling and severing of clamped tissue in the end
`effector 12. In other embodiments, different types of clamp-
`ing membersbesidesthe anvil 24 could be used, such as,for
`example, an opposing jaw,etc.
`
`43
`43
`
`
`
`[0030] Various embodiments of the present invention are
`described herein by way of example in conjunction with the
`following figures, wherein
`
`FIGS. 1 and 2 are perspective views of a surgical
`[0031]
`cutting and fastening instrument according to various
`embodiments of the present invention;
`
`FIGS. 3-5 are exploded views of an end effector
`[0032]
`and shaft of the instrument according to various embodi-
`ments of the present invention;
`
`FIG.6 is a side view of the end effector according
`[0033]
`to various embodiments of the present invention;
`
`TIG. 7 is an exploded view of the handle of the
`[0034]
`instrument according to various embodiments of the present
`invention;
`
`FIGS. 8 and 9 are partial perspective views of the
`[0035]
`handle according to various embodiments of the present
`invention;3
`
`FIG. 10 is a side view of the handle according to
`[0036]
`various embodiments of the present invention;
`
`FIG. 11 is a schematic diagram of a circuit used in
`[0037]
`the instrument according to various embodiments of the
`present invention;
`
`FIGS. 12-13 are side viewsof the handle according
`[0038]
`to other embodiments ofthe present invention;
`
`FIGS. 14-22 illustrate different mechanisms for
`[0039]
`locking the closure trigger according to various embodi-
`ments of the present invention;
`
`FIGS. 23A-B show a universal joint (“u-joint”) that
`[0040]
`may be employedat the articulation point of the instrument
`according to various embodiments ofthe present invention;
`
`FIGS. 24A-B showsa torsion cable that may be
`[0041]
`employedat the articulation point of the instrument accord-
`ing to various embodiments of the present invention;
`
`FIGS. 25-31 illustrate a surgical cutting and fas-
`[0042]
`tening instrument with power assist according to another
`embodiment ofthe present invention;
`
`FIGS. 32-36 illustrate a surgical cutting and fas-
`[0043]
`tening instrument with powerassist according to yet another
`embodiment of the present invention;
`
`L'IGS. 37-40 illustrate a surgical cutting and. fas-
`[0044]
`tening instrument with tactile feedback to embodiments of
`the present invention; and
`
`

`

`US 2007/0175959 Al
`
`Aug. 2, 2007
`
`It will be appreciated that the terms “proximal” and
`[0050]
`
`“distal” are used herein with referenceto a clinician gripping
`
`
`
`the handle 6 of an instrument 10. Thus, the end effector 12
`is distal with respect to the more proximal handle 6. 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 manyoricntations and positions, and
`these terms are not intended to be limiting and absolute.
`
`‘lhe closure trigger 18 maybe actuated first. Once
`[0051]
`the clinician is satisfied with the positioning of the end
`effector 12, the clinician may draw back the closure trigger
`18 to its fully closed, locked position proximateto the pistol
`grip 26. The firing trigger 20 may then be actuated. The
`firing trigger 20 returns to the open position (shown in FIGS.
`1 and 2) whenthe clinician removes pressure, as described
`more fully below. A release button on the handle 6, when
`depressed may release the locked closure trigger 18. The
`release bullon maybe implementedin various formssuch as,
`for example, as a slide release button 160 shown in l'IG. 14,
`and/or button 172 shown in FIG. 16.
`
`
`
`
`FIG. 3 is an exploded view of the end effector 12
`[0052]
`according to various embodiments. As shownin the illus-
`trated embodiment,
`the end effector 12 may include,
`in
`addition to the previously-mentioned channel 22 and anvil
`24, a culling instrument 32, a sled 33, a staple cartridge 34
`that is removably seated in the channel 22, and a helical
`screw shaft 36. The cutting instrument 32 may be, for
`example, a knife. The anvil 24 may be pivotably opened and
`closed at a pivot point 25 connected to the proximate end of
`the channel 22. The anvil 24 may also include a tab 27 at its
`proximate end that
`is inserted into a component of the
`mechanical closure system (described further below) to open
`and close the anvil 24. When the closure trigger 18 is
`actuated, that is, drawn in by a user of the instrument 10, the
`anvil 24 maypivot aboutthe pivot point 25 into the clamped
`or closed position. If clamping of the end effector 12 is
`satisfactory, the operator may actuate the firing trigger 20,
`which,as explained in moredetail below, causes the knife 32
`
`and sled 33 to travel longitudinally along the channel 22,
`
`
`
`therebycutting tissue clamped within the end effector 12.
`The movementof the sled 33 along the channel 22 causes
`the staples of the staple cartridge 34 to be driven throughthe
`severed tissue and against the closed anvil 24, which turns
`the staples to fasten the severed tissue. In various embodi-
`ments,
`the sled 33 maybe an integral component of the
`cartridge 34. U.S. Pat. No. 6,978,921, entitled “Surgical
`stapling instrument incorporating an E-bcam firing mecha-
`nism,” which is incorporated herein byreference, provides
`more details about such two-stroke cutting and fastening
`instruments. The sled 33 maybe part of the cartridge 34,
`such that when the knife 32 retracts following the cutting
`operation, the sled 33 does notretract.
`
`It should be noted that although the embodiments
`[0053]
`ofthe instrument 10 described herein employan endeffector
`12 that staples the severed tissue,
`in other embodiments
`different techniques for fastening or sealing the severed
`tissue may be used. For example, end effectors that use RF
`
`energy or adhesives to fasten the severed tissue mayalso be
`used, U.S. Pat. No. 5,709,680 entitled “ELECTROSURGI-
`CAL LIEMOSTATIC DLEVICL”to Yateset al., and U.S. Pat.
`No. 5,688,270 entitled “ELECTROSURGICAL HEMO-
`
`STATIC DEVICE WITH RECESSED AND/OR OFFSET
`
`
`
`
`
`ELECTRODES”to Yates et al., which are incorporated
`herein by reference, disclose an endoscopic cutting instru-
`ment that uses RF energy to seal the severed tissue. U.S.
`patent application Ser. No. 11/267,811 to Jerome R. Morgan.
`et. al, and U.S. patent application Ser. No. 11/267,383 to
`Frederick E. Shelton, IV, et. al., which are also incorporated
`herein by reference, disclose an endoscopic cutting instru-
`ment
`that uscs adhesives to fasten the scvered tissuc.
`Accordingly, although the description herein refers to cut-
`ting/stapling operations and the like below,
`it should be
`recognized that this is an exemplary embodiment andis not
`meant to be limiting. Other tissue-fastening techniques may
`also be used.
`
`[0054] FIGS. 4 and 5 arc exploded views and FIG.6 is a
`side view of the end effector 12 and shaft 8 according to
`various embodiments. As shownin the illustrated embodi-
`ment, the shaft 8 may include a proximate closure tube 40
`and a distal closure tube 42 pivotably linked by a pivot links
`44, The distal closure tube 42 includes an opening 45 into
`which the tab 27 on the anvil 24 is inserted in order to open
`and close the anvil 24, as further described below. Disposed
`inside the closure tubes 40, 42 may be a proximate spine
`tube 46. Disposed inside the proximate spine tube 46 maybe
`a main rotational (or proximate) drive shaft 48 that com-
`municates with a secondary (or distal) drive shaft 50 via a
`bevel gear assembly 52. The secondary drive shaft 50 is
`connected to a drive gear 54 that engages a proximate drive
`gear 56 ofthe helical screw shaft 36. The vertical bevel gear
`525 maysit and pivot in an opening 57 in the distal end of
`the proximate spine tube 46. A distal spine tube 58 may be
`used to enclose the secondary drive shaft 50 and the drive
`gears 54, 56. Collectively,
`the main drive shaft 48, the
`secondary drive shaft 50, and thearticulation assembly (e.g.,
`the bevel gear assembly 52a-c) are sometimes referred to
`herein as the “main drive shaft assembly.”
`
`[0055] A bearing 38, positioned at a distal end of the staple
`channel 22, receives the helical drive screw 36, allowing the
`helical drive screw 36 to freely rotate with respect to the
`channel 22. The helical screw shaft 36 may interface a
`threaded opening (not shown) of the knife 32 such that
`rotation of the shaft 36 causes the knife 32 to translate
`distally or proximately (depending on the direction of the
`rotation) through the staple channel 22. Accordingly, when
`the maindrive shaft 48 is caused to rotate by actuation ofthe
`firing trigger 20 (as explained in more detail below), the
`bevel gear assembly 52a-c causes the secondary drive shaft
`50 to rotate, whichin turn, because ofthe engagementofthe
`drive gears 54, 56, causesthe helical screw shaft 36 to rotate,
`which causes the knife driving member 32 to travel longi-
`tudinally along the channel 22 to cut anytissue clamped
`within the end effector. The sled 33 may be made of, for
`example, plastic, and may have a sloped distal surface. As
`the sled 33 traverse the channel 22,
`the sloped forward
`surface may push up or drive the staples in the staple
`cartridge through the clamped tissue and against the anvil
`24. The anvil 24 turns the staples,
`thereby stapling the
`severed tissue. Whenthe knife 32 is retracted, the knife 32
`and sled 33 may become disengaged, thereby leaving the
`sled 33 at the distal end of the channel 22.
`
`[0056] As described above, because of the lack of user
`feedback for the cutting/stapling operation, there 1s a general
`lack of acceptance among physicians of motor-driven
`endocutters where the cutting/stapling operation is actuated
`
`44
`44
`
`

`

`US 2007/0175959 Al
`
`Aug. 2, 2007
`
`
`
`by merely pressing a button. In contrast, embodiments of the
`present invention provide a motor-driven endocutter with
`user-feedback of the deployment, force, and/or position of
`he cutting instrument in the end effector.
`
`FIGS. 7-10 illustrate an exemplary embodiment of
`[0057]
`a motor-driven endocutter, and in particular the handle
`hereof, that provides user-feedhack regarding the deploy-
`ment and loading force of the cutting instrument in the end
`effector. In addition, the embodiment may use power pro-
`vided by the user in retracting thefiring trigger 20 to power
`he device (a so-called “powerassist” mode). As shown in
`he illustrated embodiment, the handle 6 includes exterior
`ower side pieces 59, 60 and exterior upper side pieces 61,
`62 that fit together to form, in general, the exterior of the
`handle 6. A battery 64, such as a Li ion battery, may be
`provided in the pistol grip portion 26 of the handle 6. The
`battery 64 powers a motor 65 disposed in an upper portion
`of the pistol grip portion 26 of the handle 6. According to
`various embodiments, the motor 65 may be a DC brushed
`driving motor having a maximum rotation of, approxi-
`mately, 5000 RPM. The motor 64 maydrive a 90° bevel gear
`assembly 66 comprising a first bevel gear 68 and a second
`bevel gear 70. The bevel gear assembly 66 may drive a
`planetary gear assembly 72. The planetary gear assembly 72
`may include a pinion gear 74 connected to a drive shaft 76.
`The pinion gear 74 maydrive a mating ring gear 78 that