Surgical anastomosis instrument and control system for such instrument

Abstract

Surgical stapling instruments and control systems for these instruments are provided herein. A surgical stapling instrument includes an elongate shaft and an end effector having an anvil on a first jaw and a staple cartridge coupled to a second jaw. The instrument further includes a first coupler for adjusting a distance between the distal end of the anvil and the distal end of the staple cartridge and a second coupler for adjusting a distance between the proximal end of the anvil and the proximal end of the staple cartridge. This allows a user to independently adjust these distances or gaps to cope with tissue thickness variations across the length of the jaws. The instruments and control systems are particularly useful for dissecting and stapling relatively long lengths of tissue, such as for dissecting and stapling the stomach or lung in sleeve gastrectomy and pneumotomy procedures.

Description

[0001] Cross-reference to related applications This application claims the benefit of U.S. Provisional Application Serial No. 63 / 458,510, filed April 11, 2023, the entire disclosure of which is incorporated herein by reference for all purposes. Background Technology

[0002] Minimally invasive medical techniques aim to reduce the amount of foreign tissue damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. For example, one benefit of minimally invasive surgery is reduced postoperative hospital stays. The average hospital stay for standard open surgery is generally significantly longer than that for similar minimally invasive surgeries (MIS). Therefore, increasing the use of MIS could save millions of dollars in hospitalization costs annually. While many surgical procedures performed in the United States each year could potentially be performed minimally invasively, only a portion of these procedures currently utilize these advantageous techniques due to the limitations of minimally invasive surgical instruments and the additional surgical training required to master them.

[0003] Improved surgical instruments, such as access, navigation, anatomical, and sealing instruments, have enabled minimally invasive surgical systems (MIS) to redefine the field of surgery. These instruments allow for surgical and diagnostic procedures with reduced patient trauma. A common form of minimally invasive surgery is endoscopy, and a common form of endoscopy is laparoscopy, which involves minimally invasive examinations and surgeries performed within the abdominal cavity. In standard laparoscopic surgery, the patient's abdomen is inflated with gas, and a trocar is inserted through a small incision (approximately half an inch or less) to provide an entry point for laparoscopic instruments.

[0004] An example of a laparoscopic procedure is sleeve gastrectomy. Sleeve gastrectomy is a surgical weight-loss procedure in which a large portion of the stomach is surgically removed along the greater curvature, reducing the stomach to approximately 15% of its original size. The result is a sleeve-like or tubular structure. This procedure permanently reduces the size of the stomach, although some expansion may occur later in life.

[0005] Sleeve gastrectomy involves a longitudinal resection of the stomach, beginning at the antrum approximately 5-6 cm from the pylorus and ending near the fundus close to the cardia. The remaining gastric sleeve is calibrated with a scoop. Most surgeons prefer to use a 36-40 Fr scoop for this procedure, and the ideal approximate remaining size of the stomach after the procedure is approximately 150 mL.

[0006] Although sleeve gastrectomy procedures have become more common, variations in surgical techniques (such as oversewing, probe size, and the distance between the staples and the pylorus) can lead to poor outcomes. In radiographically studied sleeve gastrectomies, less than 40% achieved the ideal tubular sleeve anatomy, resulting in variable patient outcomes, including reduced weight loss efficiency and gastroesophageal reflux. Therefore, recent efforts have focused on standardizing the procedure to improve patient outcomes, reduce operative time, and lower costs.

[0007] One method to improve the consistency of sleeve gastrectomy procedures is the single-shot obesity therapeutic anastomosis device, which dissects and anastomoses the entire length of the greater curvature of the stomach with a single staple loading. These single-shot anastomosis devices have jaws that are much longer than conventional anastomoses, allowing surgeons to dissect and anastomose the entire greater curvature by clamping the jaws from one end of the greater curvature to the other. The benefits of these novel anastomosis devices include reduced operative time, elimination of junctions in the staple lines, and elimination of angles between staple loadings. Without multiple intersecting staple lines, these single-shot anastomoses eliminate the need for surgeons to screen and remove migrated “crotch staples” that have been identified as having a risk of leakage.

[0008] While novel single-shot stapler devices show promise, they also have several drawbacks. One such drawback is that these staplers do not account for variations in tissue thickness across the length of the clamps. For example, if the thickness of the distal portion of the stomach tissue (relative to the instrument) differs significantly from (or vice versa) the thickness of the proximal portion of the stomach tissue, the stapler may not effectively clamp the entire length of the tissue. Alternatively, the stapler may be pushed by the stomach tissue to clamp in a direction deviating from or transverse to the desired direction, resulting in ineffective or suboptimal anatomical and stapling lines.

[0009] Another drawback of existing single-shot stapler devices is that the jaws are typically fixed relative to the instrument's axis. They lack any rotational movement relative to the axis that would mimic the natural movements of a surgeon's wrist. This inability to rotate the end effector relative to the axis presents a challenge for surgeons in positioning the jaws for optimal anatomical / stapler function—especially in laparoscopic procedures where the instruments have already been inserted into the abdominal cavity through a small access point.

[0010] Therefore, although novel obese therapeutic anastomosis devices have improved certain procedures involving dissections of relatively long tissue lengths, such as dissecting gastric tissue in sleeve gastrectomy procedures, further improvements will still be needed to overcome the drawbacks of these devices. The system and apparatus described in this paper address these and other needs. Summary of the Invention

[0011] The following is a simplified overview of the claimed subject matter to provide a basic understanding of some aspects of it. This overview is not a comprehensive summary of the claimed subject matter. It is neither intended to identify important or key elements of the claimed subject matter nor to outline its scope. Its sole purpose is to present some ideas of the claimed subject matter in a simplified form as a prelude to the more detailed description that follows.

[0012] This article provides surgical anastomosis instruments and control systems for these instruments. The instruments and control systems are particularly useful for dissecting and / or stapleing relatively long lengths of tissue, such as in sleeve gastrectomy and pulmonary resection procedures for dissecting and stapleing the stomach or lung.

[0013] On one hand, a surgical anastomosis instrument includes: an elongated shaft having a distal end and a proximal end; and an end effector coupled to the distal end of the shaft. The end effector includes: an anvil on a first jaw having a surface positionable on a first side of an anatomical structure; and a staple cartridge coupled to a second jaw and configured to receive a plurality of staples and having a surface positionable on a second side of the anatomical structure. The instrument further includes: a first connector movably coupling the distal end of the anvil to the distal end of the staple cartridge; and a second connector movably coupling the proximal end of the anvil to the proximal end of the staple cartridge.

[0014] In various embodiments, the first and second connectors are configured to adjust the distance or gap between the proximal and distal ends of the anvil and the proximal and distal ends of the staple cassette. The first and second connectors can be independent of each other. This allows the user to independently adjust the distance or gap between the proximal and distal ends of the anvil and the proximal and distal ends of the staple cassette to, for example, accommodate changes in tissue thickness across the length of the clamp jaws.

[0015] In some embodiments, the instrument further includes a drive member configured to translate through an end effector to drive staples in the staple cassette into deformable contact with the anvil. The drive member may also include a cutting element that passes through the forceps to dissect tissue. Simultaneously with tissue dissection, staples are driven into the tissue on either side of the anatomical line.

[0016] In various embodiments, the first connector limits the distance between the distal end of the anvil and the distal end of the staple cartridge to a range between a minimum and a maximum distance. The second connector may also limit the distance between the proximal end of the anvil and the proximal end of the staple cartridge to a range between a minimum and a maximum distance. These ranges may be set, for example, based on the maximum and minimum distances that would allow sufficient staple formation for a particular type of tissue once the staple has been driven against the anvil by the drive member.

[0017] The first and second connectors can be manually actuated and controlled via one or more user controls located proximally on the instrument (e.g., on the instrument handle or on the user interface in, for example, a robot control system). Alternatively, the first and second connectors can be automatically actuated and controlled via a control system (such as a robot control system).

[0018] In some embodiments, the user can manually actuate and control the connector within a range monitored and controlled by the control system. This range can be, for example, based on the range of torque and / or force applied to the components of the connector and / or the jaws as the jaws are adjusted relative to each other. The range of torque or force can be, for example, based on the force applied by the tissue positioned between the jaws (i.e., as the jaws move toward each other against the tissue). This allows the system to ensure a suitable clearance between the distal and proximal ends of the jaws to provide sufficient tissue load for good anastomosis when the drive member is translated through the end effector (i.e., “fired”) to dissect the tissue and apply the staples to either side of the anatomical line.

[0019] In one embodiment, the first or proximal connector includes a pulley and a belt having a flat first surface in contact with the pulley and a flat second surface opposite the first surface. The belt has a distal end coupled to the proximal end of the anvil, and a second portion of the belt is configured to move away from this distal end to adjust the distance between the proximal end of the anvil and the proximal end of the nail box. In various embodiments, the movement of the belt also causes the proximal end of the anvil to pivot relative to the proximal end of the nail box from an open position to a substantially closed position.

[0020] The second or distal connector may also include a pulley and a belt having a flat first surface in contact with the pulley and a flat second surface opposite the first surface. The belt has a distal end coupled to the distal end of the anvil, and a second portion of the belt is configured to move away from this distal end to adjust the distance between the distal end of the anvil and the distal end of the staple cartridge. In some embodiments, the instrument further includes a slot in the distal portion of the staple cartridge and / or lower jaws, and a pin slidable within the slot. The pin is coupled to the anvil to allow the distal end of the anvil to move toward and away from the distal end of the staple cartridge. In some embodiments, the slot extends in a direction substantially perpendicular to the longitudinal axis of the end effector. This allows the jaws to pivot about their distal end to open and close the proximal end while independently adjusting the gap between the distal and / or proximal ends of the anvil and staple cartridge.

[0021] In some embodiments, the instrument further includes a first spring that biases the distal end of the anvil and the distal end of the nail box away from each other, and / or a second spring that biases the proximal end of the anvil and the proximal end of the nail box away from each other. In this way, the distal and proximal ends of the anvil and the nail box are biased to the position with the largest gap between them (i.e., the fully open position). Tension can be applied to one or both of the bands by, for example, a proximal drive element to pull the bands proximally and reduce the gap or distance between either the proximal or distal ends of the jaws.

[0022] In another embodiment, the proximal connector includes a drive element having an angled slot and a slot pin configured to travel through the angled slot to adjust the distance between the proximal and distal ends of the anvil and the proximal and distal ends of the staple cartridge. The drive element may be located, for example, within the staple cartridge, one of the jaws of the end effector, or the axis of the instrument. The slot pin may be coupled to a movable jaw or anvil such that longitudinal movement of the drive element causes the movable jaw and / or anvil to open and close relative to another jaw or staple cartridge. In some embodiments, distal movement of the drive element causes the slot pin to travel proximally through the angled slot to close the proximal end of the jaw.

[0023] The surgical instrument may further include one or more drive elements configured to travel (i.e., push and / or pull) the belt and cause the drive member to translate distally through the end effector. One or more drive elements may include one or more control devices of the robotic surgical system.

[0024] On the other hand, a surgical anastomosis instrument includes: an elongated shaft having a distal end and a proximal end; and an end effector coupled to the distal end of the shaft. The end effector includes: an anvil on a first jaw, the anvil having a surface positionable on a first side of an anatomical structure; and a staple cartridge coupled to a second jaw and configured to receive a plurality of staples and having a surface positionable on a second side of the anatomical structure. The surgical anastomosis instrument further includes: a connector movably coupling the proximal end of the anvil to the proximal end of the staple cartridge; and a hinge element for rotating the end effector relative to the shaft.

[0025] In some embodiments, the articulating element is configured to allow the end effector to rotate about the longitudinal axis of the shaft (i.e., the "roll" axis). In other embodiments, the end effector can rotate about an axis substantially perpendicular to the longitudinal axis of the shaft (i.e., the "yaw" or "pitch" axis relative to the shaft). Providing at least one degree of rotational movement relative to the shaft allows the end effector to correspond to at least a portion of the natural movement of the surgeon's wrist, thereby facilitating the placement of the forceps in the optimal position for performing anatomical / stapling functions—especially in laparoscopic procedures where instruments have already been inserted into the abdominal cavity through a small access point.

[0026] In some embodiments, the instrument includes a second hinge element for rotating the end effector relative to the axis about a second axis perpendicular to both the first axis and the longitudinal axis. In this way, the end effector can rotate about both yaw and pitch axes and / or about a roll axis and a yaw or pitch axis. The instrument may include a third hinge element for rotating the end effector relative to the axis about the longitudinal axis (i.e., roll, pitch, and yaw).

[0027] In various embodiments, the articulating element(s) includes at least one belt extending through the end effector and having a flat first surface and a flat second surface opposite the first surface. The articulating element may also extend into a wrist member that pivotally couples the shaft to the end effector. The belt is configured to move laterally relative to the shaft within the wrist member when tension or pressure is applied to the belt from a proximal drive element, thereby causing the end effector to rotate relative to the shaft.

[0028] In various embodiments, the hinge element(s) includes a plurality of straps, which may, for example, be laminated together. The straps are configured to twist relative to each other within the wrist member, thereby causing the end effector to rotate relative to the shaft about an axis perpendicular to the longitudinal axis.

[0029] In various embodiments, the instrument includes a second connector that movably couples the distal end of the anvil to the distal end of the nail box. The first connector can be independent of the second connector, allowing the distance or gap between the distal and proximal ends of the jaws to be adjusted independently.

[0030] On the other hand, systems and methods for controlling surgical anastomosis instruments are provided. The surgical anastomosis instrument has an elongated shaft and an end effector coupled to the distal end of the shaft. The end effector has an anvil and a staple cassette, the anvil and the staple cassette having proximal and distal ends movably coupled to each other. The system includes: a first controller configured to detect a first torque and / or force applied to the proximal end of the anvil and the proximal end of the staple cassette, and to maintain a distance between the proximal ends such that the first torque or force remains within a first range; and a second controller configured to detect a second torque and / or force applied to the distal end of the anvil and the distal end of the staple cassette, and to maintain a distance between the distal ends such that the second torque or force remains within a second range.

[0031] The first and second controllers can be separate from each other or part of the same controller. In some embodiments, the controller is part of a robot control system coupled to a surgical instrument.

[0032] In various embodiments, the first torque and the second torque are associated with one or more forces exerted on the anvil and staple cassette by tissue disposed between the anvil and staple cassette. One or more controllers may be configured to maintain the distance between the proximal and distal ends of the jaws within a range based on these forces. In one such embodiment, for example, the range may be based on a minimum distance representing a threshold force exerted by the tissue on the jaws such that the jaws do not overcompress the tissue and thus cannot effectively apply the staples thereto. The range may also be based on a maximum distance representing a threshold and / or zero amount of force exerted by the tissue on the jaws such that the jaws do not separate too far from each other and thus cannot effectively apply the staples to the tissue.

[0033] In various embodiments, the anastomosis device further includes a drive member configured to travel longitudinally relative to the staple cassette and anvil to drive the staples in the staple cassette into deformable contact with the anvil. The system further includes a third controller configured to block or prevent travel of the drive member when a first torque or a second torque is outside a first range and a second range, respectively. The third controller may be independent of the first controller and / or the second controller, or these controllers may cooperate with each other as part of a single control system.

[0034] In some embodiments, the system further includes a proximal connector configured to adjust the distance between the proximal end of the anvil and the proximal end of the nail box. A first controller is coupled to the proximal connector and configured to limit the range of motion of one or more components of the proximal connector relative to a first range based on a first torque.

[0035] The system may further include a distal connector for adjusting the distance between the distal end of the anvil and the distal end of the nail box. A second controller is coupled to the distal connector and configured to limit the range of motion of one or more components of the distal connector relative to a second range based on a second torque.

[0036] In various embodiments, the proximal connector and the distal connector each include a flexible member, such as a cable or strip, having a distal end coupled to a proximal end of the anvil and a proximal end coupled to a first controller. The system further includes a drive member for retracting at least a portion of the flexible member via an axis to move the proximal or distal end of the anvil toward the proximal or distal end of the nail box. The first and second controllers may be configured to detect torque and / or force applied to the flexible member and / or to the jaws when the flexible member is retracted.

[0037] On the other hand, a method for controlling a surgical anastomosis instrument is provided. The method includes detecting a first torque applied to the proximal ends of a first jaw and a second jaw of an end effector of the surgical anastomosis instrument, and detecting a second torque applied to the distal ends of the first jaw and the second jaw. The method further includes releasing a drive member to travel through the end effector when the first torque or the second torque is within a first range and a second range, respectively.

[0038] In various embodiments, the method further includes adjusting the distance or gap between the proximal end of the anvil and the proximal end of the nail box, and detecting a first torque while adjusting this gap. In one such embodiment, the flexible member is traveled relative to the end effector to adjust the gap between the proximal end of the anvil and the proximal end of the nail box, and further movement of the flexible member is constrained or prevented when the first torque reaches a threshold level.

[0039] In various embodiments, the method further includes adjusting the distance or gap between the distal end of the anvil and the distal end of the nail box, and detecting a second torque while adjusting this gap. In one such embodiment, a second flexible member is traveled relative to the end effector to adjust the distance between the distal end of the anvil and the distal end of the nail box, and further movement of the flexible member is constrained or prevented when the second torque reaches a threshold level.

[0040] The method may further include preventing or stopping the drive member from traveling through the end effector when the first torque or the second torque is below the threshold minimum or above the threshold maximum.

[0041] On the other hand, a surgical anastomosis system includes: an instrument having an elongated shaft, an end effector coupled to the distal end of the shaft, and a drive member configured to travel through the end effector. The end effector has an anvil on a first jaw and a staple cassette coupled to a second jaw. The anvil and the staple cassette have proximal and distal ends movably coupled to each other. The system further includes a first connector for adjusting the distance between the distal end of the anvil and the distal end of the staple cassette, a second connector for adjusting the distance between the proximal end of the anvil and the proximal end of the staple cassette, and a third actuator for causing the drive member to travel longitudinally relative to the anvil and the staple cassette.

[0042] In various embodiments, the system further includes a hinge mechanism for rotating the end effector about its longitudinal axis. This allows the surgeon to rotate the end effector without moving the axis, providing greater flexibility in positioning the jaws for optimal engagement of tissue—especially in endoscopic procedures where the axis extends through an access point in the patient's skin to reach cavities within the patient's body.

[0043] In various embodiments, the system further includes a second hinge mechanism for rotating the end effector relative to the shaft about an axis perpendicular to the longitudinal axis. In some embodiments, the second hinge mechanism is configured to rotate the end effector about a yaw axis of the shaft. In other embodiments, the second hinge mechanism is configured to rotate the end effector about a pitch axis of the shaft. In other embodiments, the second hinge mechanism rotates the shaft about both the pitch and yaw axes. In alternative embodiments, the system may include a third hinge mechanism that allows independent rotation about each of the yaw and pitch axes.

[0044] In various embodiments, the first and second connectors each include: a belt having a flat first surface and a flat second surface opposite to the first surface; and a gear disposed at a proximal portion of the shaft, wherein the gear is coupled to a rotating disk and configured to convert rotation of the disk into linear movement of the belt. In an exemplary embodiment, the system further includes a controller for rotating the disk. The controller may be part of a robot control system that allows remote control of the device.

[0045] In various embodiments, the first and second articulation mechanisms each include one or more belts extending through the end effector and into a wrist element that pivotally couples the end effector to the axis. These belts may, for example, be laminated together to form a composite belt with additional stiffness. In an exemplary embodiment, the belt is coupled to a proximal drive element and configured to twist within the wrist to allow rotational movement of the end effector relative to the axis. The proximal drive element may be part of a robot control system that allows for remote control of the device. Attached Figure Description

[0046] The above and other aspects, features, and advantages of the surgical instrument with a locking mechanism of the present invention will become more apparent when taken in conjunction with the accompanying drawings, in which: Figure 1 It is a perspective view of a representative surgical instrument with an end effector and actuation mechanism mounted on a slender shaft; Figure 1A This is a perspective view of a representative surgical instrument equipped with a robot-controlled back-end mechanism; Figure 2 This is a perspective view of the distal portion of a representative surgical instrument with its jaws in the open position. Figure 3 It is configured for Figure 1 An exploded view of the staple box for surgical instruments; Figure 4 This is a cross-sectional view of the jaws, showing the proximal connector and the distal connector; Figure 5 This is an enlarged view of the distal part of the jaws; Figure 6 This is a cross-sectional view of an alternative embodiment of the proximal connector for forceps jaws used in surgical instruments; Figure 7A and Figure 7B This is a cross-sectional view of another embodiment of the proximal connector of forceps jaws for surgical instruments; Figure 8 This is a cross-sectional view of another embodiment of the distal connector of the forceps jaws for surgical instruments; Figure 9 This is a cross-sectional view of another embodiment of the proximal connector of forceps jaws for surgical instruments; Figure 10 A is Figure 1 A perspective view of a representative drive component of a surgical instrument; Figure 10 B is an alternative embodiment of the drive component; Figure 11 yes Figure 10 A cross-sectional side view of a representative U-shaped connector (clevis) of the drive component of B; Figure 12A It is used for Figure 10 Cross-sectional perspective view of the actuation mechanism of the drive component of B; Figure 12B It is used for Figure 10 Cross-sectional side view of the actuation mechanism of the drive component of B; Figure 13 This is a cross-sectional view of the shaft of a surgical instrument, showing multiple articulated bands; Figure 14A yes Figure 13 A cross-sectional view of the band rotating within the wrist of a surgical instrument; Figure 14B yes Figure 13 Another cross-sectional view of the end effector band of an articulated surgical instrument; Figure 15 This is an enlarged view of a representative robot rear-end mechanism used for surgical instruments; Figure 16 The actuation mechanism of the articulated belt of the robot's rear end mechanism is shown; Figure 17 This is a schematic diagram of a control system used for surgical instruments; Figure 18 The anatomical structure of the stomach is described; Figure 19 The end effector of the surgical instrument described herein, positioned on the stomach, is shown; Figure 20 It shows the results after gastrectomy Figure 19 The end effector; Figure 21 This is an overhead view of an operating room equipped with a robotic surgical system; and Figure 22 A simplified side view of the robot arm assembly is shown. Detailed Implementation

[0047] Specific embodiments of the surgical instruments of the present invention are described below with reference to the accompanying drawings; however, it should be understood that the disclosed embodiments are merely examples of the present disclosure and may be embodied in various forms. Therefore, the specific structural and functional details disclosed herein should not be construed as limiting, but merely as the basis for the claims and as a representative basis for instructing those skilled in the art to use the present disclosure in various ways with virtually any suitable detailed structure. Well-known functions or constructions have not been described in detail to avoid obscuring the present disclosure with any unnecessary detail.

[0048] While the following description relates to a surgical anastomosis device and control system for anchoring and dissecting gastric tissue in a sleeve gastrectomy procedure for obesity treatment, it should be understood that the features of the surgical instruments and / or control systems described herein can be readily adapted to any type of surgical clamping, cutting, anchoring, ligating, dissecting, holding, cauterizing, suturing, and / or sealing instruments, regardless of whether fasteners are used on the surgical instruments. For example, the anastomosis device and control system described herein can be adapted to procedures involving anatomical structures, such as organs other than the stomach or soft tissues (e.g., lung tissue, liver tissue, etc.).

[0049] In another example, some features described in this invention can be used in electrosurgical instruments, wherein the jaws include electrodes for applying energy to tissue to treat (e.g., cauterize, ablate, fuse, or cut) the tissue. Furthermore, the features of the surgical instruments described in this invention can also be readily adapted to other types of surgical staplers, such as circular staplers, linear staplers, and / or purse-string staplers and / or the like.

[0050] The surgical anastomosis and cutting instruments described herein can be minimally invasive (e.g., laparoscopic) instruments or instruments for open surgery. Furthermore, the features of the surgical anastomosis instruments described herein can also be readily applied to surgical instruments activated using any technology within the capabilities of those skilled in the art, such as, for example, manually activated surgical instruments, powered surgical instruments (e.g., electromechanical powered instruments), robotic surgical instruments, and the like.

[0051] The device or certain components of the device described herein can also be incorporated into a variety of different surgical instruments, such as the following commonly assigned, co-existing U.S. Patent Applications Nos. 16 / 205,128, 16 / 427,427, 16 / 678,405, 16 / 904,482, 17 / 081,088, and 17 / 084,981, and International Patent Nos. PCT / US2019 / 107646, PCT / US2019 / 019501, PCT / US2019 / 062344, PCT / US2020 / 54568, PC The complete disclosure of the surgical instruments described in T / US2019 / 064861, PCT / US2019 / 062768, PCT / 2020 / 025655, PCT / US2020 / 056979, PCT / 2019 / 066513, PCT / US2020 / 020672, PCT / US2019 / 066530 and PCT / US2020 / 033481 is incorporated herein by reference in its entirety for all purposes as if it were copied and pasted into this document.

[0052] As used herein, the term "coupler" means any device, component, system, assembly, or other element that connects, combines, couples, joins, bonds, links, unites, or links together two or more parts or devices. The term "movably coupled" means any device, component, system, assembly, or other element that connects, combines, couples, joins, bonds, links, unites, or links together two or more parts or devices such that at least one of these parts can be moved, pivoted, rotated, translated, displaced, realigned, repositioned, or otherwise changed in position relative to at least one of the other parts.

[0053] Figure 1This is a perspective view of an exemplary surgical instrument 100 having a handle assembly 102 and an end effector 110 mounted on an elongated shaft 106. The end effector 110 includes a first jaw 111 and a second jaw 112. The handle assembly 102 includes a stationary handle 102a and a movable handle 102b, the movable handle 102b acting as an actuator of the surgical instrument 100.

[0054] Figure 1A It shows that the back-end mechanism 102c is replaced Figure 1 The surgical instrument 100a is shown with a handle assembly. A rear-end mechanism 102c generally provides mechanical coupling between the instrument's drive tendon, belt, or cable and the motor shaft of the mechanical interface of the drive system. Further details of known rear-end mechanisms and surgical systems are described, for example, in U.S. Patent Nos. 8,597,280, 7,048,745, and 10,016,244. Each of these patents is incorporated herein by reference in its entirety.

[0055] The input connector can interface with and be driven by a corresponding output connector (not shown) of a remote surgical system such as the system disclosed in U.S. Publication No. 2014 / 0183244A1, the entire disclosure of which is incorporated herein by reference. The input connector is drivably coupled to one or more input members (not shown) disposed within instrument shaft 106. The input members are drivably coupled to end effector 110. Suitable input connectors are adaptable to mate with various types of motor assemblies (not shown), such as the stapler-specific motor assembly disclosed in U.S. Patent No. 8,912,746 or the general-purpose motor assembly disclosed in U.S. Patent No. 8,529,582, the disclosures of which are incorporated herein by reference in their entirety. Further details of known input connectors and surgical systems are described, for example, in U.S. Patent Nos. 8,597,280, 7,048,745, and 10,016,244. Each of these patents is incorporated herein by reference in its entirety for all purposes.

[0056] The actuation mechanism of the surgical instrument 100 may employ a drive cable, rod, or belt used in conjunction with a motor and pulley system. Powered surgical systems, including robotic surgical systems, are known to utilize drive cables or belts connected to motor and pulley systems to achieve various functions, including the opening and closing of jaws, and the movement and actuation of end effectors. Further details of known drive cable and belt surgical systems are described, for example, in U.S. Patent Nos. 7,666,191, 8,271,230, and 9,050,119 and Publication No. WO 2020 / 252184, all of which are incorporated herein by reference in their entirety. While this document describes instruments configured for use in robotic surgical systems, it should be understood that the actuation and drive components described herein may be incorporated into manually actuated instruments, electromechanical instruments, or instruments actuated in any other manner.

[0057] Figure 2 The distal portion of a surgical instrument 100 is shown, including an end effector 110 that defines a longitudinal axis X and has a first jaw 111, a second jaw 112, a clevis 140 for mounting the jaws 111, 112 to the instrument, and an articulation mechanism such as a wrist assembly 160. In some embodiments, the second jaw 112 is a movable jaw configured to move relative to the first jaw 111 from an open position to a closed position. In other embodiments, the first jaw 111 is a movable jaw configured to move relative to the second jaw 112 between an open position and a closed position. In yet another embodiment, both jaws 111, 112 are movable relative to each other.

[0058] In an exemplary embodiment, the first jaw 111 is a movable jaw 111 configured to move from an open position to a closed position relative to the stationary jaw 112. Specifically, the movable jaw 111 has a proximal portion 130 and a distal portion 132, and the second jaw 112 has a proximal portion 134 and a distal portion 136. This will be discussed in further detail below (see...). Figure 4 and Figure 5 The distal portions 132 and 136 of the jaws 111 and 112 are pivotally coupled to each other, such that the proximal portion 130 of the movable jaw 111 opens and closes relative to the proximal portion 134 of the jaw 112 (which also adjusts the distance between the proximal portions 130 and 134). Furthermore, the distance between the distal portions 132 and 136 can be adjusted independently of the opening and closing of the proximal portions 130 and 134.

[0059] The first jaw 111 includes an anvil 115 with staple forming recesses 116. In the open position, an unused staple cartridge 122 (sometimes referred to as a new or unfired reload) can be loaded into the second jaw 112, and tissue can be positioned between the jaws 111 and 112. In the closed position, the jaws 111 and 112 cooperate to grip the tissue, such that the staple cartridge 122 and the anvil 115 are tightly aligned. The staple forming recesses 116 are aligned with each other to cooperate, thereby deforming the first leg and the second leg of each staple 124 respectively (see...). Figure 3 Each forming recess 116 is designed to receive one leg of the staple 124 and to bend or deform the staple 124 such that the staple is formed into a suitable shape to secure the tissue held between the jaws 111, 112. Suitable shapes of the deformed staple include B-shape, D-shape, M-shape and the like.

[0060] In some embodiments, the end effector 110 can be used, for example, to create a straight sleeve gastrectomy bag within the patient's stomach. In these embodiments, the anvil 115 can be positioned anteriorly on the stomach, while the staple cassette 122 can be positioned posteriorly on the stomach (or vice versa). The lengths of the anvil 115 and staple cassette 122 can be sufficient to encircle the stomach. By way of example and not limitation, the length of each can be measured from about 35 mm to about 350 mm.

[0061] like Figure 3 As shown, the stapler cartridge 122 may include a plurality of staples 124 supported on corresponding staple drivers 126 and provided within corresponding staple holding openings or recesses 127 formed in the stapler cartridge 122. In one embodiment, the cartridge 122 includes a housing 129 having a receiving drive member 150 (in Figure 2 A central channel 131 (shown in the diagram and discussed in more detail below) and first and second staple receiving assemblies extending longitudinally on either side of the central channel 131. Each staple receiving assembly includes at least one linear row of staple recesses 127 for receiving staples 124. In some embodiments, the staple assembly includes two or more substantially parallel linear rows of staple recesses 127. In a representative embodiment, the staple box 122 includes three longitudinal rows of staple recesses 116, but it should be understood that the staple box 122 may include only one row, two rows, four rows, five rows, six rows, or more rows. For example, in one embodiment, the staple recesses may be arranged in six longitudinal rows, wherein three rows of staple recesses are positioned on a first side of the longitudinal axis of the staple box 122, and three rows of staple recesses are positioned on a second side of the longitudinal axis.

[0062] Now for reference Figure 4 and Figure 5An embodiment of a proximal connector and a distal connector for adjusting the distance between the proximal and distal ends of jaws 111 and 112 will now be described. In this embodiment, the distal connector 200 includes a tension band 202, a pulley 204, and a proximal drive member (hereinafter referred to) for moving the tension band 202 along the surface of the pulley 204. Figure 16 (Discussion). The tension band 202 includes a flat first surface 206 in contact with the pulley 204, a flat second surface 208 opposite the first surface 206, and a distal end 210 coupled to the distal portion 132 of the jaws 111 (or anvil 115). The tension band 202 extends through a channel in the jaws 112 or the staple holder 122, through the shaft 106 to the proximal end of the instrument 100 (reaching the rear end mechanism 102c or handle 102, see...). Figure 1 and Figure 1A ).

[0063] The jaws 111 further include a slot 212, and the anvil 115 includes a slot pin 214 (or vice versa), the slot pin 214 sliding through the slot 212 to allow the jaws 112 to move relative to the jaws 111, and to adjust the distance between the distal portions 132, 136 of the jaws 111, 112 from a fully open position (where the jaws 111, 112 define a maximum gap therebetween) to a substantially closed position (where the jaws 111, 112 define a minimum gap therebetween). The slot 212 extends transversely to the longitudinal axis XX. In a preferred embodiment, the slot 212 extends perpendicularly to the longitudinal axis XX, such that the slot pin 214 relative to its... Figure 5 The orientation moves vertically.

[0064] In various embodiments, the distal connector 200 limits the range of distance between the distal end of the anvil 115 and the distal end of the staple holder 122 to a minimum and a maximum distance. This range can be mechanically limited (i.e., by mechanically limiting the travel range of the band 202) or by a control system coupled to the distal connector 200 or the proximal drive member of the connector 200. This range can be set, for example, based on the maximum and minimum distances that would achieve sufficient staple formation through a particular type of tissue once the staple has been driven against the anvil 115 by the drive member 150.

[0065] The distal connector 200 may further include a spring (not shown) that can bias the jaws 111, 112 to an open or closed position. In an exemplary embodiment, the spring biases the jaws 111, 112 to the open position and applies tension to the tension band 202 to operate by pulling the jaws 111, 112 closer together to adjust the gap between them.

[0066] The device 100 further includes a proximal connector 220, which includes a tension band 222, a pulley 224, and a proximal drive member (discussed below) for moving the tension band 222 along the surface of the pulley 224. The tension band 222 includes a flat first surface 226 in contact with the pulley 224, a flat second surface 228 opposite to the first surface 226, and a distal end 230 coupled to a proximal portion 130 of the anvil 115. The tension band 222 extends through the proximal end 134 of the end effector 110, through the shaft 106, and reaches the proximal end of the device 100 (reaching the rear end mechanism 102c or handle 102, see below). Figure 1 and Figure 1A ).

[0067] In some embodiments, the distal portions 132, 136 of the jaws 111, 112 are pivotally coupled to each other by hinges or other suitable mechanisms, such that the proximal portions 130, 134 can pivot between a fully open position and a substantially closed position. In some embodiments, the jaws 111, 112 are substantially parallel to each other in the substantially closed position. In various embodiments, the proximal connector 200 limits the range of distance between the proximal end of the anvil 115 and the proximal end of the staple cartridge 122 to a minimum and a maximum distance. This range can be set, for example, based on the maximum and minimum distances that would achieve sufficient staple formation through a particular type of tissue once the staple is driven against the anvil 115 by the drive member 150.

[0068] The proximal connector 200 may further include a spring (not shown) that can bias the jaws to an open or closed position. In an exemplary embodiment, the spring biases the jaws 111, 112 to the open position and applies tension on the tension band 232 to operate by pulling the jaws 111, 112 closer together to pivot the jaws closed and adjust the gap between them.

[0069] Belts 202, 222 (and any belt described herein) can have any suitable shape. For example, although Figure 4 and Figure 5 Strips 202 and 222 are shown with a rectangular cross-sectional shape, but the strips can have other shapes, such as trapezoidal, triangular, curved, crown-shaped, and the like. Strips 202 and 222 can be constructed from any suitable material. In some embodiments, strips 202 and 222 form a single integral strip. In other embodiments, strips 202 and 22 can be constructed from a series of laminated materials bonded together (e.g., via an adhesive or any other suitable method). The laminated materials can include any suitable material, such as tungsten, steel, polymers, or the like.

[0070] In some embodiments, tension may be applied to belts 202, 222 such that belts 202, 222 travel substantially proximally through the end effector 110 and / or shaft 106 of the instrument. Since belts 202, 222 are in contact with pulleys 204, 224, the distal portion of each belt 202, 222 moves substantially perpendicular to the end effector to pull the distal portion 130 and / or proximal portion 132 of the anvil 115 toward the jaws 111. In some embodiments, pressure may be applied to belts 202, 222 to move them in opposite directions, thereby pushing the proximal portion 132 and the distal portion 136 away from each other. Alternatively, tension may be reduced or completely removed to allow springs to automatically push the distal portions 132, 136 away.

[0071] In some embodiments, the operation of tension bands 202, 222 can be entirely manual; that is, the proximal handle 102 or another user interface (not shown) coupled to the rear mechanism 102c may include one or more actuators that allow the user to apply tension to tension bands 202, 222 to manually adjust the distance between the distal and proximal portions of jaws 111, 112. In other embodiments (discussed in more detail below), the operation of tension bands 202, 222 can be automatically controlled by one or more controllers (not shown) coupled to tension bands 202, 222 in handle 102 or rear mechanism 102c. In these embodiments, the tension applied to bands 202, 222 can be adjusted based on, for example, the torque or force required to move bands 202, 222 and thus organize the torque or force applied to jaws 111, 112 when moving them closer together. In yet another embodiment, the operation of tension bands 111, 112 can be a combination of manual and automatic control. For example, the tension on belts 111 and 112 can be manually adjusted within a certain range of torque or force applied to jaws 111 and 112 by one or more controllers (discussed in more detail below).

[0072] For reference Figure 6Alternative embodiments of the proximal connector 240 for the device 100 will now be described. As shown, the proximal connector 240 includes a drive element 242 having a slot 244 extending at a transverse angle relative to the longitudinal axis of the end effector 110. The upper jaw 112 includes a slotted pin 246 that slides through the angled slot 244, such that distal movement of the drive element 242 causes the slotted pin 246 to slide downward through the angled slot 244, thereby causing the jaw 112 to move toward a closed position and reducing the gap between the proximal portions 130, 134 of the jaws 111, 112. Proximal movement of the drive element 242 causes the slotted pin 246 to slide upward through the angled slot 244, thereby causing the jaw 112 to move toward an open position and increasing the gap between the proximal portions 130, 134 of the jaws 111, 112.

[0073] The drive element 242 includes an elongated member 248 that extends proximally to the proximal end of the shaft 106 and is movable longitudinally within the shaft 106. In some embodiments, the drive element 242 may be coupled to the drive member 150 such that the drive element 242 moves distally when the drive member 150 is driven distally, thereby automatically closing the jaws 111, 112 as the drive member 150 moves distally past the end effector 110. In other embodiments, the drive element 242 is not coupled to the drive member 150 and can be actuated independently in a manner similar to that of the belts 202, 222.

[0074] In some embodiments, the device 100 may include a proximal connector 240 and a distal connector 200 (e.g., Figure 4 and Figure 5 (As shown) to allow independent adjustment of the distance or gap between the proximal and distal ends of the jaws. In other embodiments, the device 100 may include only the proximal connector 240, and the distal ends of the jaws 111, 112 will be pivotally coupled to each other to allow the jaws to open and close.

[0075] For reference Figure 7A and Figure 7B Another embodiment of the proximal connector will now be described. As shown, the connector includes a generally flat band 252 extending through shaft 106 to the proximal ends of jaws 111, 112. Band 252 has a distal end attached to an anvil 115 and in contact with the surface of pulley 254. As in the previous embodiment, the proximal end of band 252 is coupled to a drive element configured to push / pull band 252 in the longitudinal direction to adjust the distance between the proximal ends of the jaws.

[0076] In this embodiment, the articulated assembly further includes a drive member 256 having a tapered distal surface 258. The drive member 256 may be the same element as the drive member 150 that operates the firing stud (discussed below), or it may be a separate element driven independently of the drive member 150. In some embodiments, the tapered distal surface 258 of the drive member 256 is configured to engage the surface of the pulley 254 to rotate the pulley and travel the belt 252. For example, distal movement of the drive member 256 may rotate the pulley, causing the belt 252 to move proximally, thereby moving the proximal end of the jaws 111 toward the jaws 112. In other embodiments, the proximal drive element may be operable to move the drive member 256 distally while the belt 252 moves proximally. In both embodiments, as the drive member 256 moves distally, its engaging jaws 111, 112 ensure that the jaws 111, 112 are substantially parallel to each other before the stapling (discussed below) is fired.

[0077] For reference Figure 8 Another embodiment of the distal connector will now be described. As shown, the distal connector includes a linkage assembly 260 having a first link 262 coupled to the distal end 130 of jaws 111 and a second link 264 coupled to the distal end 136 of jaws 112. The first link 262 and the second link 264 are coupled to each other at a pivot point or central portion 166 of the linkage assembly 260. In various embodiments, links 262, 264 may be pivotally coupled to each other such that longitudinal movement of the central portion 166 causes links 262, 264 to pivot and open and close jaws 111, 112. In other embodiments, links 262, 264 are rigidly coupled to each other at the central portion 266 such that longitudinal movement of portion 266 causes the entire linkage assembly 260 to move in a proximal or distal direction to open and close the distal ends 130, 136 of the jaws.

[0078] For reference Figure 9 Another embodiment of the proximal connector will now be described. As shown, the linkage includes a drive member 270, which may be the same element as the drive member 150 that operates for firing the stapling (discussed below), or it may be a separate element driven independently of the drive member 150. The drive member 270 is coupled to the link assembly 272.

[0079] For reference Figure 10A. The surgical instrument 100 may further include a drive member 150 configured to translate through the end effector 110. The drive member 150 may be any structure capable of actuating at least one of the shuttle or scalpel of the surgical anastomosis instrument with the necessary force to effectively cut or staple human tissue. The drive member 150 may be an I-beam, an E-beam, or any other type of drive member capable of performing a similar function. The drive member 150 is movably supported on the surgical anastomosis instrument 100 such that when the surgical anastomosis instrument is fired (e.g., actuated), the drive member 150 may travel through the staple cartridge 122 and the upper jaw 111 and lower jaw 112.

[0080] exist Figure 10 In embodiment A, the instrument will also include a shuttle (not shown) separate from the drive member 150. The shuttle may be included, for example, as a separate component within the stapler cartridge 122, and includes one or more inclined portions that act sequentially on the stapler actuator 126 as the drive member 150 moves distally or proximally (see, for example...). Figure 10 (The inclined portion 125 on the integral shuttle 123 shown in B).

[0081] In a representative embodiment, the drive member 150 may include an upper protrusion or shoe 152, a lower protrusion or shoe 154, and a central portion 156 connecting the upper shoe 152 and the lower shoe 154. The upper shoe 152 of the drive member 150 is substantially aligned with and translates through a channel (not shown) in the jaws 111, while the lower shoe 154 of the drive member 150 is substantially aligned with and translates through a channel (not shown) below the jaws 112. A hole 158 is formed through the central portion 156 to receive a drive cable 171 (see [link to relevant documentation]). Figure 12A This will be described in more detail below. The proximal surface of the drive member 150 is configured to be driven by the coil 120 of the actuation assembly (see below). Figure 12A The coil 120 engages, allowing it to apply force to the drive member 150, causing the drive member 150 to move distally (i.e., along the...). Figure 12B (In the direction of the middle arrow "A") travels. The blade 128 can be formed on the drive member 150 along the distal edge between the upper base plate 152 and the central portion 156.

[0082] When the surgical instruments are activated, the drive member 150 is advanced distally through the end effector 110 to advance the shuttle 123 and blade 128 distally through the staple cartridge 122, thereby securing and cutting tissue clamped between the jaws 111, 112. In an alternative embodiment, the drive member 150 may be advanced proximally from the distal end of the end effector 110 to advance the shuttle 123 and blade 128 proximally through the staple cartridge 122.

[0083] In some embodiments, the drive member 150 may cooperate with the proximal and distal connectors discussed above to move the jaws 111, 112 from an open position to a closed position. In other embodiments, the jaws 111, 112 may have already moved to a closed or substantially closed position before the drive member 150 is actuated to move distally. In some embodiments, the proximal and distal connectors are actuated first to move the jaws 111, 112 to an optimal position relative to the thickness of the tissue therebetween. Thereafter, distal translation of the drive member 150 may further compress the jaws 111, 112 together to clamp the tissue during stapling and dissection operations.

[0084] It should be noted that the instrument is not limited to the configuration in which the drive member 150 translates distally upon being "fired" to act on the staple driver 126 and move the staple 124 into deformable contact with the anvil 115. In some embodiments, the drive member 150 may be located within the proximal portion of the end effector 110 and configured to translate proximally upon being "fired" to act on the staple driver 126 and move the staple 124 into deformable contact with the anvil 115.

[0085] Figure 10 B illustrates another embodiment of a drive member 150A including a shuttle 123 integrally formed thereon. The shuttle 123 includes an inclined distal or proximal portion 125 that, as the drive member 150A moves distally or proximally, successively acts on a staple driver 126, causing the staple driver 126 to be cam-driven upwards, thereby moving the staple 124 into deformable contact with the anvil 115. In some embodiments, the shuttle 123 may be included as a separate component within the staple holder 122.

[0086] In a representative embodiment, the drive member 150A may include an upper protrusion or base plate 152, a lower protrusion or base plate 154, and a central portion 156 connecting the upper base plate 152 and the lower base plate 154. The upper base plate 152 of the drive member 150A is substantially aligned with and translates through a channel (not shown) in the jaws 111, while the lower base plate 154 of the drive member 150A is substantially aligned with and translates through a channel (not shown) below the jaws 112. A hole 158 is formed through the upper base plate 152 to receive a drive cable 171 (see [link to documentation]). Figure 12A This will be described in more detail below. The proximal surface 153 of the upper base plate 152 is configured to be driven by the coil 120 of the actuation assembly (see below). Figure 12A The coil 120 is engaged so that it can apply a force to the upper base plate 152 to drive the drive member 150 distally (i.e., along the...). Figure 12B(In the direction of the middle arrow "A") travels. The blade 128 may be formed on the drive member 150A along the distal edge between the upper base plate 152 and the central portion 156. In various embodiments, the inclined distal portion 125 may be formed on either side of the drive member 150A.

[0087] For reference Figure 11 The clamps 111 and 112 can be attached to the surgical instrument 100 via a U-shaped connector 140 or other suitable connecting element. Designed to... Figure 10 In a representative embodiment where the drive member 150A in B works together, the U-shaped clamp 140 includes a proximal surface 140a and a distal surface 140b. The U-shaped connector 140 further includes an upper U-shaped connector portion 142 and a lower U-shaped connector portion 141, which cooperate to form a protrusion during assembly. This protrusion is configured to engage tabs of the jaws 111 to securely mount the jaws 111 to a fixed position on the instrument 100. The lower U-shaped connector portion 141 includes a pair of distally extending arms 147 to support the movable jaws 112. The arms 147 include openings 149 for receiving a pivot pin (not shown) that defines a pivot axis about which the jaws 112 pivot, as described in more detail below.

[0088] The lower U-shaped connector portion 141 also includes a groove 144 configured to guide the actuation coil 120 exposed from the wrist portion 160 (see...). Figure 12A Part of the U-shaped connector 142. The upper U-shaped connector portion 142 includes a complementary groove 146 that cooperates with the groove 144 of the lower U-shaped connector portion 141 to form a closed channel 180, which guides the coil 120 as it is slowly jogged upward from the wrist 160 toward the distal surface 157 of the upper base plate 152 of the drive member 150A. In various embodiments, the channel 180 may include a first end 181 at the central portion of the proximal surface 140a and a second end 182 at the peripheral portion of the distal surface 140b. In various embodiments, the closed channel 180 may be substantially “S”-shaped. Although shown as a two-part U-shaped connector, it should be understood that the U-shaped connector may be an integral structure formed, for example, by molding, machining, 3D printing, or similar means.

[0089] For reference Figure 12A and Figure 12B A representative drive assembly of drive member 150A includes a drive cable 171, a coil 120, a sheath 121 surrounding the coil 120, and a drive rod 175. The drive cable 171 includes an extended distal end 173. The upper base plate 152 of drive member 150A includes a hole 158 into which the drive cable 171 is routed (note that in...). Figure 10In embodiment A, the hole 158 is positioned within the central portion 156.

[0090] When assembling the exemplary surgical instrument 100, the coil 120 and the protective sheath 121 slide past the free end of the drive cable 171. The free end of the drive cable 171 is attached to the drive rod 175, thereby securing the coil 120 and the protective sheath 121 between the drive member 150 and the drive rod 175, as shown. Figure 12B As shown. Sheath 121 serves to promote stable and smooth movement and prevent buckling during actuation of surgical instrument 100. Sheath 121 can be made of polyimide or any other suitable material with the necessary strength requirements, such as various reinforced plastics, such as NITINOL. TM Nickel-titanium alloys, such as KEVLAR available from DuPont TM It is made of poly(p-phenylene terephthalamide) material. Other suitable materials will be apparent to those skilled in the art.

[0091] The enlarged distal end 173 of the drive cable 171 is located within the enlarged distal portion 159 of the hole 158 in the upper base plate 152 of the body 150, such that the proximal side 157 of the enlarged distal end 173 can be positioned proximal (i.e., along) Figure 12B When the drive cable 171 is pulled (in the direction of the middle arrow "B"), a retraction force is applied to the upper base plate 152. The drive rod 175 is operably connected to an actuator (e.g., a movable handle 102b), which allows the actuation assembly 190 to translate distally and retract proximally. Those skilled in the art will recognize that in manually actuated instruments, the actuator can be a movable handle, such as... Figure 1 The movable handle 102b shown; in a power device, the actuator may be a button (not shown) that actuates a motor onto a drive rod; and in a robotic system, the actuator may be a control device, such as those described below. Figures 13-16 The control device described. Any suitable rear-end actuation mechanism for driving the components of the surgical anastomosis instrument can be used. For further details relating to exemplary actuation mechanisms using push / pull drive cables, see, for example, the jointly owned international application WO2018 / 049217, the disclosure of which is incorporated herein by reference in its entirety.

[0092] During actuation of the exemplary surgical instrument 100, the drive rod 175 applies a force to the coil 120, thereby causing the coil 120 to apply a force to the upper base plate 152 (or central portion 156) of the drive member 150, pushing it distally (i.e., along...). Figure 12BThe instrument translates (in the direction of the middle arrow "A"), causing the jaws 111 and 112 to initially close, and then the staple 124 is ejected from the staple cartridge 122 to staple the tissue. After stapleping is complete, the drive rod 175 applies force in the proximal direction to retract the drive member. During retraction, the enlarged distal end 173 of the drive cable 171 is obstructed by the wall 157 of the enlarged portion 159 of the hole 158, causing the drive cable 171 to apply force to the upper base plate 152 (or central portion 156) of the drive member, thereby causing the drive member to translate in the proximal direction. In some embodiments, the surgical instrument may be designed such that the drive member 150 does not retract in the proximal direction after the staple has been fired. Those skilled in the art will understand that the drive member 150, drive cable 171, and drive rod 175 all move in unison and remain in the same relative position to each other.

[0093] In various embodiments, the surgical instrument may alternatively include a switch designed to engage by an inclined distal portion of the actuating member for engaging a locking assembly, providing reload identification, or both, as described in International Patent Applications Nos. PCT / US2019 / 66513 and PCT / / US2019 / 66530, both filed December 16, 2019 (the entire disclosure of which is incorporated herein by reference).

[0094] The end effector 110 may be hinged in multiple directions by one or more hinge assemblies. In some embodiments, the hinge assembly may include a hinge element in the wrist 160, but other hinge mechanisms are also contemplated. In some embodiments, the end effector 110 may be hinged to rotate about a longitudinal axis of shaft 106. In other embodiments, the end effector 110 may be hinged to rotate about one or more axes substantially perpendicular to shaft 106. In one such embodiment, the end effector 110 may rotate about a yaw axis and / or a pitch axis relative to shaft 106.

[0095] For reference Figure 13 , Figure 14A and Figure 14B An embodiment of the articulated assembly 260 will now be described. As shown, the articulated assembly 260 includes a plurality of straps 262 extending through an internal channel 264 in the shaft 106 and having a proximal end coupled to a suitable drive element (not shown). The internal channel 262 is preferably housed within an outer sheath 270 and an outer tube 272 of the shaft 106. In some embodiments, the straps 262 may be coupled to a portion of the drive member 150. This configuration provides the straps 262 with additional stiffness to, for example, prevent buckling in the direction of actuation.

[0096] Each of the strips 262 includes a first flat surface 266 and a second flat surface 268 opposite to the first surface 266. In an exemplary embodiment, the strip 260 is oriented such that surfaces 266, 268 are substantially perpendicular to the longitudinal axis of shaft 106. The strip 262 may be constructed from a series of laminated materials bonded together (e.g., via an adhesive or any other suitable method). The laminated materials may include any suitable material, such as tungsten, steel, polymer, or similar materials.

[0097] like Figure 14A and Figure 14B As shown, the belt 262 within the wrist 160 is twisted at least about 45 degrees, preferably about 90 degrees, relative to its direction within the shaft 106. A proximal drive element (not shown) is configured to push / pull the belt 262 within the shaft 106, which causes the portion of the belt 262 within the wrist 160 to rotate the end effector 110 relative to the shaft 106. In some embodiments, the belt 262 is designed to rotate the end effector 110 about an axis substantially perpendicular to the longitudinal axis 274 of the shaft 106. In other embodiments, the belt 262 can rotate the end effector about two different axes (i.e., the yaw axis and the pitch axis) that are substantially perpendicular to the longitudinal axis of the shaft 106 and substantially perpendicular to each other.

[0098] Other articulation mechanisms that are within the capabilities of those skilled in the art can replace the strap 262 and / or the wrist 160. A suitable articulation mechanism is described, for example, in U.S. Publication No. 2015 / 0250530 (the disclosure of which is incorporated herein by reference in its entirety).

[0099] For reference Figure 15 An embodiment of a representative rear-end mechanism 500 of the instrument 100 will now be described. The rear-end mechanism 500 includes a housing 501 and a series of rotary inputs 502, 504, 506, and 508 for controlling the movement of the aforementioned belt to manipulate the end effector of the instrument. In addition, the rear-end mechanism includes a rotary input 510 for actuating the drive member 150 to provide dissection and stapling functions of the instrument.

[0100] In one embodiment, rotary inputs 502, 504 generate bands 202, 222 ( Figure 4 and Figure 5 The movement of the anvil controls the distance or gap between the proximal and distal ends of the anvil and the proximal and distal ends of the staple cartridge. Rotary inputs 506 and 508 control the band 262 to produce the desired movement (pitch, yaw, and / or roll) at the wrist assembly. Rotary input 510 controls the drive member 150 to travel through the end effector 110 to drive the staple against the anvil and dissect tissue (as discussed above).

[0101] Specifically, the rear-end mechanism 500 includes components and controls for moving belts 202, 222 in a proximal direction (i.e., pulling belts 202, 222) to reduce the gap between the proximal ends and the distal ends of the jaws. These components and controls can also enable distal movement of belts 202, 222 (i.e., release or "unwind") to allow springs in the articulated assemblies 200, 220 to force the belts to move in a distal direction, thereby increasing the gap between the proximal ends and the distal ends of the jaws. Similarly, the rear-end mechanism 500 includes components and controls for moving belt 262 in both proximal and distal directions to rotate the end effector 110 about the longitudinal axis of shaft 106 (i.e., roll) and / or about one or more axes perpendicular to shaft 106 (i.e., pitch and / or yaw).

[0102] The rear-end mechanism may include, for example, a universal joint, a lever, or any other suitable mechanism to directly pull (or release) the proximal portion of any of the belts. For example, in some embodiments, the rear-end mechanism 500 may include a rear-end component or part described in U.S. Patent Application Publication No. 2015 / 0047454, filed August 15, 2014, or U.S. Patent No. 6,817,942, filed June 28, 2001, each of which is incorporated herein by reference in its entirety for all purposes. In other embodiments, the rear-end mechanism 500 may include a winch or other motor-driven roller that rotates or “winds” a portion of any of the belts to produce a desired belt movement. For example, in some embodiments, the rear-end mechanism 500 may include any rear-end component or part described in U.S. Patent No. 9,204,923, filed July 16, 2008, which is incorporated herein by reference in its entirety for all purposes.

[0103] Figure 16 An embodiment of a proximal drive assembly 550 within a rear-end mechanism 500 for generating movement of a belt 552 within the instrument is shown. As shown, the drive assembly 550 includes a rotary input 554, which can be manually activated by a user or remotely activated via a robot control system. The rotary input 554 is coupled to a first gear 556 via a shaft 558. The first gear 556 is coupled to a second gear 560, which is in turn coupled to a lever 562. Rotation of the input 554 causes rotation of the shaft 558 and the first gear 556. The first gear 556 causes the second gear 560 and the lever 562 to rotate. As shown, the belt 552 is coupled to the lever 562 and configured to either coil up (i.e., move toward the lever 562) or "unwind" (i.e., move away from the lever 562) as the lever 562 rotates.

[0104] The surgical instruments described herein can be coupled to a proximal control system that monitors and controls connectors for adjusting the gap between the distal and proximal ends of the jaws, drive members for firing staples and anatomical tissue, and / or articulation mechanisms for rotating the end effector relative to the axis of the instrument. This control system can be a manual control system equipped with a user interface allowing the user to control each function of the instrument, or it can be an automatic control system that monitors and controls these functions. In some embodiments, the control system is a combination of manual and automatic, allowing the user to adjust or control certain functions while automatically limiting those functions within certain ranges or parameters.

[0105] Figure 17 A control system 600 is schematically illustrated for detecting the position of surgical instrument 100 and using this information to assist in surgical procedures. The control system 600 includes a first controller 602 configured to detect torque and / or force applied to the proximal end of the anvil and the proximal end of the cassette and / or to a proximal connector that adjusts the gap between these proximal ends. The first controller 602 may be coupled to one or more sensors (not shown) located within an end effector for detecting torque and / or force applied thereto. The first controller 602 is coupled to a drive assembly 604, such as one described herein, configured to adjust the distance between the proximal end of the anvil and the proximal end of the cassette. The first controller 602 controls the drive assembly 604 such that the torque or force is maintained within a first range. The drive assembly 604 may be located within a rear end assembly 500 of the surgical instrument 100.

[0106] In various embodiments, torque and / or force are associated with one or more forces exerted by tissue disposed between the anvil and the staple cartridge on the anvil and staple cartridge. Controller 602 may be configured to maintain the distance between the proximal and distal ends of the jaws 111, 112 within a range based on these forces or torques. In one such embodiment, for example, these ranges may be based on a minimum distance representing a threshold force exerted by the tissue on the jaws such that the jaws do not over-press the tissue and thus cannot effectively apply the staples thereto. These ranges may also be based on a maximum distance representing a threshold and / or zero amount of force exerted by the tissue on the jaws such that the jaws do not separate too far from each other and thus cannot effectively apply the staples to the tissue.

[0107] In some embodiments, the first controller 602 is configured to restrict the operation of the drive assembly 604 such that the proximal ends of the anvil and the nail box cannot move to a position that generates torque or force outside a predetermined range. In other embodiments, the first controller is configured to control the drive assembly 604 to move the proximal ends of the anvil and the nail box to a position that generates torque or force within a predetermined range.

[0108] The control system 600 includes a second controller 606 configured to detect torque and / or force applied to the distal end of the anvil and the distal end of the nail box. The second controller 606 may be coupled to one or more sensors (not shown) on the end effector for detecting torque and / or force applied thereto. The second controller 606 is coupled to a drive assembly 608, such as one of the drive assemblies described herein, configured to adjust the distance between the distal ends. The second controller 606 controls the drive assembly 608 such that the torque or force is maintained within a first range and may be located within the rear assembly 500.

[0109] In some embodiments, the second controller 606 is configured to restrict the operation of the drive assembly 608 such that the distal ends of the anvil and the nail box cannot move to a position that generates torque or force outside a specified range. In other embodiments, the second controller 606 is configured to control the drive assembly 608 to move the distal ends of the anvil and the nail box to a position that generates torque or force within a specified range.

[0110] The first controller 602 and the second controller 606 may be separate from each other or part of the same controller. In some embodiments, controllers 602 and 606 are part of a robot control system coupled to surgical instruments.

[0111] System 600 may include a third controller 610, which is coupled to actuator 612 for firing drive member 150 (see [link]). Figure 2 The third controller 610 is configured to block or prevent the drive member 150 from traveling when the first torque or the second torque is outside the first range and the second range, respectively. The third controller 610 may be independent of the first controller 602 and / or the second controller 606, or these controllers may cooperate with each other as part of a single control system.

[0112] The first controller 602, the second controller 606, and the third controller 610 may include one or more processors (e.g., microprocessors, microchips, or application-specific integrated circuits), one or more storage devices (e.g., random access memory and / or read-only memory), and I / O interfaces and / or communication interfaces. These processors may include one or more software applications that can read storage devices and / or store program instructions that allow (one or more) processors to compare detected torque or force with a specified range. The I / O devices may include one or more devices (e.g., user interfaces) that enable a user to interact with the system. The I / O devices may include, for example, a touchscreen display, a keypad, one or more selectors, and one or more indicators.

[0113] Although described as processors, it should be understood that controllers 602, 606, and 610 can be implemented in practice through any combination of hardware, software, and firmware. Furthermore, the functions described herein can be performed by a single unit or divided among different components, each of which can be implemented sequentially by any combination of hardware, software, and firmware.

[0114] The sensor may include any suitable sensor for detecting force and / or torque. In one embodiment, the sensor includes an optical fiber bending sensor, such as a fiber Bragg grating (FBG), for providing strain measurements in other components of clamps, tension bands, and / or surgical instruments. Various systems and methods for monitoring the shape and relative position of optical fibers in three dimensions are described in U.S. Patent Application Publication No. 2006 / 0013523, filed July 13, 2005, and U.S. Patent No. 6,389,187, filed June 17, 1998 (the entire disclosure of which is incorporated herein by reference for all purposes).

[0115] Figures 18-20 A method for using the surgical anastomosis device and control system described herein for a vertical sleeve gastrectomy procedure is illustrated. Figure 18 The anatomy of the stomach 620 used in vertical sleeve gastrectomy and the anatomical line 622 are shown. From an instrumental perspective, the stomach 620 generally comprises a proximal end 624, a distal end 626, a greater curvature 634, and a lesser curvature 640. The fundus 632 and the segment of the stomach 620 defined by the greater curvature 634 are the portions of the stomach 620 typically removed during the vertical gastrectomy procedure. The remaining pouch is typically defined by the lesser curvature 640 and the anatomical line 622. The desired location of the anatomical line 622 is approximately 0.5 cm to approximately 2.0 cm from the gastroesophageal junction 642 and approximately 2.0 cm to approximately 10.0 cm from the pylorus 644.

[0116] Now for reference Figure 19 The surgeon first introduces the end effector 110 of the instrument 100 and a portion of the shaft 106 into the abdominal cavity through a suitable inlet or entry point (not shown). The end effector 110 of the surgical instrument 100 is then positioned around the stomach 620, such that the jaws 111, 112 are positioned on either side of the anatomical line 622. As discussed above, the end effector 110 can be hinged relative to the shaft 106 during this procedure to facilitate optimal positioning of the end effector 110. Specifically, the end effector 110 can rotate about the longitudinal axis XX of the instrument 100, or it can rotate about one or more axes perpendicular to the longitudinal axis. These hinges can be achieved via push / pull straps 262 (…). Figure 14A and Figure 14BThis can be achieved by a proximal actuator that rotates the end effector 110 at the wrist 160, or they can be articulated by other suitable means known in the art. In some embodiments, these articulations can be controlled by a control system 600.

[0117] Now for reference Figure 20 Once in the proper position, the surgeon adjusts the gaps between the distal ends 132 and 136 of the forceps 111 and 112 and between the proximal ends 130 and 134 until a suitable gap exists for dissecting and assembling the gastric tissue. In some cases, the thickness of the gastric tissue may vary along the anatomical line 622. In these cases, the gap between the distal ends 132 and 136 may differ from the gap between the proximal ends 130 and 134.

[0118] As the surgeon adjusts the gap between the proximal and distal ends of the forceps 111, 112, the control system 600 monitors the torque or force applied to the proximal and distal ends of the forceps 111, 112. In some embodiments, the control system 600 may include a user interface equipped with one or more indicators that provide indications that these torques or forces are within a prescribed range for optimal tissue anatomy and staple application. In one embodiment, for example, this range may be based on a minimum distance representing a threshold force exerted by the stomach tissue 620 on the forceps 111, 112 such that the forceps do not over-compress the tissue and thus cannot effectively apply the staple thereto. The range may also be based on a maximum distance representing a threshold and / or zero amount of force exerted by the tissue on the forceps such that the forceps do not separate too far from each other and thus cannot effectively apply the staple to the tissue.

[0119] Once the ends of the jaws 111 and 112 are positioned within the specified range, the control system 600 will allow the surgeon to advance the drive member 150 to "fire" the device. In one embodiment, when the first torque or the second torque is outside the first and second ranges, respectively, the third controller 610 blocks or prevents the drive member 150 from advancing. The drive member 150 can be actuated by the rotary input 510 (see...). Figure 15 The rotary input 510 acts as a rear-end mechanism 500 to operate a suitable drive mechanism, which causes the drive member 150 to travel through the end effector 110. The drive member 150 is moved distally through the end effector 110 to move the shuttle 123 and cutter 128 distally through the staple holder 122, thereby stapled and cut the tissue between the jaws 111, 112. In an alternative embodiment, the drive member 150 may be moved proximally from the distal end of the end effector 110 to move the shuttle 123 and cutter 128 proximally through the staple holder 122. Figure 20 As shown, the drive member 150 travels substantially along the anatomical line 622 to remove a portion 650 of the stomach.

[0120] Figure 21 A top view of an operating room employing a robotic surgical system is shown as an example. In this case, the robotic surgical system is robotic surgical system 300, which includes a console ("C") used by a surgeon ("S") while performing minimally invasive diagnostic or surgical procedures on a patient ("P") lying on an operating table ("O"), typically assisted by one or more assistants ("A").

[0121] Servo mechanisms used in remote surgery typically accept input from two master controllers (one in each hand of the surgeon) and may include two or more robotic arms. Surgical instruments are mounted on each robotic arm. Operable communication between the master controllers and the associated robotic arms and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor that relays input commands from the autonomous controllers to the associated robotic arms and instrument assemblies, and returns them in cases such as force feedback. An example of a robotic surgical system is the DA VINCI™ system, commercially available from Intuitive Surgical, Inc., Sunnyvale, California.

[0122] Various structural arrangements have been used to support surgical instruments at the surgical site during robotic surgery. Slave connectors, or “slave devices,” are commonly referred to as robotic surgical manipulators, and exemplary connector arrangements used as robotic surgical manipulators during minimally invasive robotic surgery are described in U.S. Patent Nos. 7,594,912, 6,758,843, 6,246,200, and 5,800,423, the entire disclosure of which is incorporated herein by reference for all purposes. These connectors typically manipulate instrument holders on which instruments with axes are mounted. Such manipulator structures can include parallelogram-shaped connector portions that generate movement of the instrument holder restricted to rotation about a pitch axis intersecting a telemanipulation center located along the length of the instrument axis. Such manipulator structures can also include yaw joints that generate movement of the instrument holder restricted to rotation about a yaw axis perpendicular to the pitch axis and also intersecting the telemanipulation center. By aligning the remote manipulation center with the internal surgical site through an incision point (e.g., using a trocar or cannula at the abdominal wall during laparoscopic surgery), the end effector of a surgical instrument can be safely positioned using the proximal end of the manipulator connector's moving axis without applying potentially dangerous forces to the abdominal wall. Alternative manipulator configurations are described, for example, in U.S. Patent Nos. 6,702,805, 6,676,669, 5,855,583, 5,808,665, 5,445,166, and 5,184,601, the entire disclosure of which is incorporated herein by reference for all purposes.

[0123] During surgical procedures, remote surgical systems can provide mechanical actuation and control of a variety of surgical instruments or tools with end effectors. These end effectors, in response to manipulation by a master input device, perform various functions for the surgeon, such as grasping or driving needles, seizing blood vessels, dissecting tissue, or similar functions. Manipulating and controlling these end effectors is a particularly beneficial aspect of robotic surgical systems. For this reason, it is desirable to provide surgical tools that include mechanisms that provide two or three rotational degrees of motion for the end effector to mimic the natural movements of the surgeon's wrist. Such mechanisms should be appropriately sized for minimally invasive procedures and relatively simple in design to reduce potential points of failure. Furthermore, such mechanisms should provide sufficient range of motion to allow manipulation of the end effector in a variety of positions.

[0124] The console includes a monitor 304 for displaying images of the surgical site to the surgeon, left and right control devices 308 and 309, a foot pedal 305, and a processor 302. Control devices 308 and 309 may include one or more of various input devices such as joysticks, gloves, trigger guns, manually operated controllers, or similar input devices. The processor 302 may be a dedicated computer, which may be integrated into the console or positioned adjacent to it.

[0125] The surgeon performs minimally invasive surgical procedures by manipulating control devices 308 and 309 (also referred to herein as “master manipulators”), such that processor 302 causes their respective associated robotic arm assemblies 328 and 329 (also referred to herein as “slave manipulators”) to correspondingly manipulate their respective detachably coupled surgical instruments 338 and 339 (also referred to herein as “tools”), while the surgeon views the surgical site in 3D on console monitor 304 when captured by stereoscopic endoscope 340.

[0126] Each of the tools 338 and 339 and the endoscope 340 can be inserted into the patient via a cannula or other tool guide (not shown) to extend downwards to the surgical site through a corresponding minimally invasive incision, such as incision 366. Typically, each of the robotic arms is formed by links such as link 362, which are coupled together and manipulated by motor-controlled or active joints such as joint 363.

[0127] The number of surgical instruments used at one time, and therefore the number of robotic arms used in system 300, will typically depend on other factors such as diagnostic or surgical procedures and space constraints within the operating room. If it is necessary to change one or more instruments in use during the procedure, the assistant can remove the unused instrument from their robotic arm and replace it with another instrument 331 in the operating room tray (“T”).

[0128] Monitor 304 can be positioned near the surgeon's hand so that it displays a projected image oriented so that the surgeon feels he or she is actually looking down at the surgical site. For this purpose, the images from tools 338 and 339 may appear to be positioned substantially where the surgeon's hand is.

[0129] The processor 302 performs various functions within the system 300. One of its functions is to convert and transmit the mechanical movements of the control devices 308 and 309 to their respective robotic arms 328 and 329 via control signals on the bus 310, enabling the surgeon to effectively manipulate their respective tools 338 and 339. Another important function is to implement the various control system processes described herein.

[0130] Although described as a processor, it should be understood that processor 302 can be implemented in practice through any combination of hardware, software, and firmware. Furthermore, the functions described herein can be performed by a single unit or divided among different components, each of which can be implemented sequentially by any combination of hardware, software, and firmware.

[0131] Robotic surgical systems and methods are further described in the following patents: U.S. Patent No. 5,797,900, filed May 16, 1997, and granted August 25, 1998; U.S. Patent No. 6,132,368, filed November 21, 1997, and granted October 17, 2000; U.S. Patent No. 6,331,181, filed October 15, 1999, and granted December 18, 2001; and U.S. Patent No. 6,331,181, filed April 3, 2001, and granted August 2002. U.S. Patent No. 6,441,577, issued on January 27, 2004; U.S. Patent No. 6,902,560, filed January 6, 2004, and issued June 7, 2005; U.S. Patent No. 6,936,042, filed April 16, 2002, and issued August 30, 2005; and U.S. Patent No. 6,994,703, filed December 4, 2002, and issued February 7, 2006, are all patents whose entire disclosures are incorporated herein by reference for all purposes. A suitable robotic surgical system currently in use is the da Vinci S surgical system from Intuitive Surgical, Inc.

[0132] Figure 22 A simplified (not necessarily scaled-up or complete) exemplary robotic arm assembly 400 (representing robotic arm assemblies 328 and 329) is shown as an example, holding surgical instruments 450 (representing tools 338 and 339) for performing surgical procedures. The surgical instruments 450 are detachably held in a tool holder 440. The arm assembly 400 is mechanically supported by a base 401, which may be part of a patient-side movable trolley or attached to an operating table or ceiling. It includes links 402 and 403 coupled together and coupled to the base 401 via mounting joints 404 and 405.

[0133] In this example, mounting joints 404 and 405 are passive joints that allow manual positioning of arm 400 when their brakes are released. For example, mounting joint 404 allows link 402 to be manually rotated about axis 406, while mounting joint 405 allows link 403 to be manually rotated about axis 407.

[0134] Although only two links and two mounting joints are shown in this example, various links and mounting joints, more or less, can be appropriately used in this robotic arm assembly described herein and other robotic arm assemblies. For example, while mounting joints 404 and 405 are useful for the horizontal positioning of arm 400, additional mounting joints may be included and useful for the limited vertical and angular positioning of arm 400. However, for the primary vertical positioning of arm 400, arm 400 can also slide along the vertical axis of base 401 and lock in place.

[0135] The robotic arm assembly 400 also includes three motor-driven active joints. A yaw joint 410 allows arm segment 430 to rotate about axis 461, while a pitch joint 420 allows arm segment 430 to rotate about an axis perpendicular to axis 461 and orthogonal to the plane of the figures. Arm segments 430 are configured such that segments 431 and 432 are always parallel to each other when the pitch joint 420 rotates via its motor. As a result, the instrument 450 can be controllably moved by driving the yaw and pitch motors to pivot about a pivot point 462, which is typically positioned by manual placement of mounting joints 404 and 405 to place it at the patient's incision point. Additionally, an insertion gear 445 can be coupled to a linear drive mechanism (not shown) to extend or retract the instrument 450 along its axis 463.

[0136] Although each of the yaw, pitch, and insertion joints or gears 410, 420, and 445 is controlled by a separate joint or gear controller, these three controllers are controlled by a common master / slave control system, which allows the robotic arm assembly 400 (also referred to herein as the “slave manipulator”) to be controlled by a user (e.g., a surgeon) through manipulation of its associated master manipulator.

[0137] In some embodiments, the system may include other device control inputs (such as foot pedals and the like) to provide additional control input to the surgical instruments and / or endoscopes used in the procedure. In some embodiments, the pedals are color-coded, typically indicating cauterization (blue) and cutting (yellow) actions of bipolar instruments. Sometimes these actions are instrument-specific. For example, a surgical stapler performs a clamping step (blue) followed by a firing step (yellow). These colors generally have the same meaning: blue indicates a low-risk or reversible action, while yellow indicates a high-risk, irreversible action.

[0138] For minimally invasive surgery, instruments must remain substantially stationary relative to their position within the patient's body (at the incision site or natural opening) to avoid unnecessary tissue damage. Therefore, the yaw and pitch movements of each instrument axis should be concentrated at a single location in space that remains relatively stationary on the manipulator assembly's roll axis or instrument insertion axis. This location is referred to as the remote center of motion. As described in more detail below, surgical instruments are mounted on and driven by the robotic arm of each surgical instrument manipulator or manipulator assembly. Instruments are detachably mounted, allowing various instruments to be interchangeably mounted on specific instrument manipulators. In a representative embodiment, one instrument manipulator is configured to actuate a camera instrument, and three instrument manipulators are configured to actuate various other interchangeable surgical instruments to perform surgical and / or diagnostic work at the surgical site. More or fewer instrument manipulators may be used. In some operational configurations, one or more manipulators may be without an associated surgical instrument during part or all of the surgical procedure.

[0139] Each joint in the robotic arm and support structure may include a joint brake, which can be manually set (or automatically set by a control system) to prevent movement about a particular joint. The base may include a passive, uncontrolled "mounting" portion and an actively controlled "manipulator" portion. In one example, the mounting portion includes two passive rotary "mounting" joints (not shown) that allow manual positioning of the robotic arm when the joint brake (not shown) is released. Passive prismatic mounting joints (not shown) may be used to allow for significant vertical adjustment. Alternatively, some of these mounting joints may be actively controlled, and more or fewer mounting joints may be used in various configurations. The mounting joints and links allow a person to position the robotic manipulator portion of the arm in various positions and orientations in Cartesian x, y, z space. The remote center of motion is the location where the yaw, pitch, and roll axes intersect (i.e., the location where the kinematic chain remains effectively stationary as the joint moves through its range of motion). As described in more detail below, some of these actively controlled joints are robotic manipulators associated with a DOF (Domain of Flight) controlling individual surgical instruments, while others are associated with a DOF controlling individual components of these robotic manipulators. The active joints and links are movable by motors or other actuators and receive motion control signals associated with the movement of the master arm at the surgeon's console. The active joints and manipulator platform move in conjunction and / or independently, such that after a remote center of motion has been established by the passively mounted arm and joints, the surgical instrument (or component) moves around the remote center of motion at the access port. Therefore, the passively mounted joints and links can be used to correctly position the remote center of motion relative to the patient. Once the remote center of motion is correctly positioned, an actuator at each joint is configured to prevent movement of the mounted portion of the arm.

[0140] The system can be configured to generate a general target operating position around the surgical site or operation point (OP), where instruments will be used in a specific procedure within the patient's body. The system also generates a central target position or point, which is the center of the OP. In one embodiment, the center of the OP is located at the remote center of motion of the endoscopic cannula. The robotic arm is then constrained to move beyond a certain distance from the center of the OP to provide maximum range of motion (ROM) at the center of the surgical space during the procedure and to limit the risk of instrument collision. In some embodiments, the manipulator assembly includes one or more actuators to prevent the manipulator arm from moving a certain distance away from the OP.

[0141] Although several embodiments are shown in the accompanying drawings, this disclosure is not intended to be limited thereto, as it is intended to make the scope of this disclosure as broad as would be permitted in the art, and similarly, to be read in the specification. For example, the apparatus disclosed herein is not limited to the mechanism described herein for identifying and / or deactivating stapler cassettes. Other suitable apparatuses or mechanisms are described in co-existing and co-owned International Patent Application No. PCT / US 19 / 66513, filed December 16, 2019, entitled “SURGICAL INSTRUMENTS WITH SWITCHES FOR DEACTIVATING AND / OR IDENTIFYINGSTAPLER CARTRIDGES” (the entire disclosure of which is incorporated herein by reference in its entirety for all purposes). Therefore, the above description should not be construed as limiting, but merely as examples of embodiments of the invention disclosed herein. Consequently, the scope of these embodiments should be determined by the appended claims and their legal equivalents, and not by the examples given.

[0142] Those skilled in the art will understand that the apparatuses and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. Features shown or described in connection with one exemplary embodiment may be combined with features of other embodiments. Various alternatives and modifications can be devised by those skilled in the art without departing from this disclosure.

[0143] For example, in a first aspect, a first embodiment is a surgical anastomosis instrument comprising: an elongated shaft having a distal end and a proximal end; and an end effector coupled to the distal end of the shaft and defining a longitudinal axis. The end effector includes: an anvil having a proximal end, a distal end, and a surface positionable on a first side of an anatomical structure; and a staple cartridge configured to receive a plurality of staples and having a proximal end, a distal end, and a surface positionable on a second side of the anatomical structure. The instrument further includes: a first connector movably coupling the proximal end of the anvil to the proximal end of the staple cartridge; and a second connector movably coupling the distal end of the anvil to the distal end of the staple cartridge.

[0144] The second embodiment is a first embodiment in which the first connector is configured to adjust the distance between the proximal end of the anvil and the proximal end of the nail box.

[0145] The third embodiment is any combination of the first two embodiments, wherein the second connector is configured to adjust the distance between the distal end of the anvil and the distal end of the nail box.

[0146] The fourth embodiment is any combination of the first three embodiments, wherein the first connector is independent of the second connector.

[0147] The fifth embodiment is any combination of the first four embodiments, wherein the first connector comprises: a belt having a flat first surface and a flat second surface opposite to the first surface, the belt having a distal end coupled to the proximal end of the anvil; and a pulley, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the proximal end of the anvil and the proximal end of the nail box.

[0148] The sixth embodiment is any combination of the first five embodiments, wherein the first connector pivots the proximal end of the anvil from an open position to a substantially closed position relative to the proximal end of the nail box.

[0149] The seventh embodiment is any combination of the first six embodiments, wherein the second connector comprises: a belt having a flat first surface and a flat second surface opposite to the first surface, the belt having a distal end coupled to a distal end of the anvil; and a pulley, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the distal end of the anvil and the distal end of the nail box.

[0150] The eighth embodiment is any combination of the first seven embodiments, and further includes a slot in the distal portion of the nail box and a pin slidable within the slot, wherein the pin is coupled to the anvil to allow the distal end of the anvil to move toward and away from the distal end of the nail box.

[0151] The ninth embodiment is any combination of the first eight embodiments, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the distal end of the anvil and the distal end of the nail box.

[0152] The tenth embodiment is any combination of the first nine embodiments, and further includes a first spring that biases the distal end of the anvil and the distal end of the nail box away from each other.

[0153] The eleventh embodiment is any combination of the preceding ten embodiments, and further includes a second spring that biases the proximal end of the anvil and the proximal end of the nail box away from each other.

[0154] The twelfth embodiment is any combination of the first eleven embodiments, wherein the first connector limits the distance between the proximal end of the anvil and the proximal end of the nail box to a range between a minimum distance and a maximum distance.

[0155] The thirteenth embodiment is any combination of the first 12 embodiments, wherein the second connector limits the distance between the distal end of the anvil and the distal end of the nail box to a range between a minimum distance and a maximum distance.

[0156] The fourteenth embodiment is any combination of the preceding 13 embodiments, wherein the first connector includes an angled slot and a slot pin, wherein the slot pin is coupled to the anvil or the nail box and configured to travel through the angled slot to adjust the distance between the proximal and distal ends of the anvil and the proximal and distal ends of the nail box.

[0157] The fifteenth embodiment is any combination of the first five embodiments, and further includes a closing member configured to travel through the end effector in a distal direction, wherein the slot is disposed on the closing member such that when the closing member is moved distally, the slot pin travels proximally through the slot.

[0158] The sixteenth embodiment is any combination of the preceding 15 embodiments, and further includes a drive member configured to travel longitudinally through the anvil and the nail box.

[0159] On the other hand, a first embodiment is a surgical anastomosis instrument comprising: an elongated shaft having a distal end and a proximal end; and an end effector coupled to the distal end of the shaft and defining a longitudinal axis. The end effector includes: an anvil having a proximal end, a distal end, and a surface positionable on a first side of an anatomical structure; and a staple cassette configured to receive a plurality of staples and having a proximal end, a distal end, and a surface positionable on a second side of the anatomical structure. The instrument further includes a connector that movably couples the proximal end of the anvil to the proximal end of the staple cassette. The connector includes a band having a first flat surface and a second flat surface opposite the first flat surface.

[0160] The second embodiment is a first embodiment in which the belt has a distal end coupled to the anvil and a proximal end extending through the elongated shaft, the connector further including a pulley, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the proximal end of the anvil and the proximal end of the nail box.

[0161] The third embodiment is any combination of the first two embodiments, wherein the belt further includes a third portion extending between the distal end of the belt and the pulley, wherein the third portion extends substantially perpendicular to the longitudinal axis.

[0162] The fourth embodiment is any combination of the first three embodiments, and further includes a second connector that movably couples the distal end of the anvil to the distal end of the nail box, the second connector including a band having a flat first surface and a flat second surface opposite to the first surface.

[0163] The fifth embodiment is any combination of the first four embodiments, wherein the belt has a distal end coupled to the anvil and a proximal end extending through the elongated shaft, the second connector further includes a pulley, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the distal end of the anvil and the distal end of the nail box.

[0164] The sixth embodiment is any combination of the first five embodiments, wherein the belt further includes a third portion extending between the distal end of the belt and the pulley surface, wherein the third portion extends substantially perpendicular to the longitudinal axis.

[0165] On the other hand, a first embodiment is a surgical anastomosis instrument comprising: an elongated shaft having a distal end and a proximal end; and an end effector coupled to the distal end of the shaft and defining a longitudinal axis. The end effector includes: an anvil having a proximal end, a distal end, and a surface positionable on a first side of an anatomical structure; and a staple cartridge configured to receive a plurality of staples and having a proximal end, a distal end, and a surface positionable on a second side of the anatomical structure. The instrument further includes a connector movably coupling the proximal end of the anvil to the proximal end of the staple cartridge; and a hinge element for rotating the end effector relative to the shaft about an axis perpendicular to the longitudinal axis.

[0166] The second embodiment is a first embodiment that further includes a second hinge element for rotating the end effector relative to the shaft about a second axis perpendicular to the first axis and perpendicular to the longitudinal axis.

[0167] The third embodiment is any combination of the first two embodiments, and further includes a third hinge element for rotating the end effector about the longitudinal axis relative to the shaft.

[0168] The fourth embodiment is any combination of the first three embodiments, wherein the hinge element includes at least one strip having a flat first surface and a flat second surface opposite to the first surface.

[0169] The fifth embodiment is any combination of the first four embodiments, wherein the hinge element includes a plurality of strips extending longitudinally through the shaft.

[0170] The sixth embodiment is any combination of the first five embodiments, and further includes a wrist member that pivotally couples the shaft to the end effector, wherein the plurality of belts are twisted relative to each other within the wrist member such that longitudinal movement of the belts within the shaft causes the end effector to rotate relative to the shaft about an axis perpendicular to the longitudinal axis.

[0171] The seventh embodiment is any combination of the first six embodiments, and further includes a second connector that movably couples the distal end of the anvil to the distal end of the nail box, wherein the first engagement element is independent of the second engagement element.

[0172] On the other hand, a first embodiment is a system for controlling a surgical anastomosis instrument having an elongated shaft and an end effector coupled to the distal end of the shaft. The end effector has an anvil and a staple cartridge, the anvil and the staple cartridge having proximal and distal ends movably coupled to each other. The system includes: a first controller configured to detect a first torque applied to the proximal end of the anvil and the proximal end of the staple cartridge, and to maintain a distance between the proximal ends such that the first torque remains within a first range; and a second controller configured to detect a second torque applied to the distal end of the anvil and the distal end of the staple cartridge, and to maintain a distance between the distal ends such that the second torque remains within a second range.

[0173] The second embodiment is a first embodiment, wherein the anastomosis instrument further includes a drive member configured to travel in a longitudinal direction relative to the staple box and the anvil, and the system further includes a third controller configured to block or prevent the drive member from traveling when the first torque or the second torque is outside the first range and the second range, respectively.

[0174] The third embodiment is any combination of the first two embodiments, wherein the first torque and the second torque are associated with one or more forces applied to the anvil and the nail box by tissue disposed between the anvil and the nail box.

[0175] The fourth embodiment is any combination of the first three embodiments, and further includes a first connector for adjusting the distance between the proximal end of the anvil and the proximal end of the nail box, wherein the first controller is coupled to the first connector and configured to limit the range of motion of the first connector relative to the first range based on the first torque.

[0176] The fifth embodiment is any combination of the first four embodiments, and further includes a second connector for adjusting the distance between the distal end of the anvil and the distal end of the nail box, wherein the second controller is coupled to the second connector and configured to limit the range of motion of the second connector relative to the second range based on the second torque.

[0177] The sixth embodiment is any combination of the first five embodiments, wherein the first connector includes a flexible member having a distal end coupled to a proximal end of the anvil and a proximal end coupled to the first controller, the system further including a drive member for retracting at least a portion of the flexible member via the shaft to move the proximal end of the anvil toward the proximal end of the nail box, wherein the first controller is configured to detect torque applied to the flexible member when the flexible member is retracted.

[0178] The seventh embodiment is any combination of the first six embodiments, wherein the second connector includes a flexible member having a distal end coupled to the distal end of the anvil and a proximal end coupled to the second controller, the system further including a drive member for retracting at least a portion of the flexible member via the shaft to move the distal end of the anvil toward the distal end of the nail box, wherein the second controller is configured to detect torque applied to the flexible member when the flexible member is retracted.

[0179] On the other hand, a first embodiment is a method for controlling a surgical anastomosis instrument having an elongated shaft and an end effector coupled to the distal end of the shaft, the end effector having an anvil and a staple cartridge, the anvil and the staple cartridge having proximal and distal ends movably coupled to each other. The method includes: detecting a first torque applied to the proximal end of the anvil and the proximal end of the staple cartridge; detecting a second torque applied to the distal end of the anvil and the distal end of the staple cartridge; and releasing a drive member to travel through the end effector when the first torque or the second torque is within a first range and a second range, respectively.

[0180] The second embodiment is a first embodiment that further includes adjusting the distance between the proximal end of the anvil and the proximal end of the nail box and detecting the first torque.

[0181] The third embodiment is any combination of the first two embodiments, and further includes adjusting the distance between the distal end of the anvil and the distal end of the nail box and detecting the second torque.

[0182] The fourth embodiment is any combination of the first three embodiments, and further includes: moving the flexible member relative to the end effector to adjust the distance between the proximal end of the anvil and the proximal end of the nail box; and preventing the flexible member from moving further when the first torque reaches a threshold level.

[0183] The fifth embodiment is any combination of the first four embodiments, and further includes: moving the flexible member relative to the end effector to adjust the distance between the distal end of the anvil and the distal end of the nail box; and preventing the flexible member from moving further when the second torque reaches a threshold level.

[0184] The sixth embodiment is any combination of the first five embodiments, and further includes preventing the drive member from traveling past the end effector when the first torque or the second torque is below the minimum threshold or above the maximum threshold.

[0185] On the other hand, a first embodiment is a surgical anastomosis system comprising: an instrument having an elongated shaft and an end effector coupled to a distal end of the shaft, the end effector having an anvil and a staple cartridge having proximal and distal ends movably coupled to each other; and a drive member configured for longitudinal travel through the end effector. The system includes: a first connector for adjusting the distance between the distal end of the anvil and the distal end of the staple cartridge; a second connector for adjusting the distance between the proximal end of the anvil and the proximal end of the staple cartridge; and an actuator for causing the drive member to travel longitudinally relative to the anvil and the staple cartridge.

[0186] The second embodiment is a first embodiment that further includes a first hinge mechanism for rotating the end effector about its longitudinal axis.

[0187] The third embodiment is any combination of the first three embodiments, and further includes a second hinge mechanism for rotating the end effector relative to the shaft about an axis perpendicular to the longitudinal axis.

[0188] The fourth embodiment is any combination of the first three embodiments, wherein the second hinge mechanism is configured to rotate the end effector about the yaw axis of the shaft.

[0189] The fifth embodiment is any combination of the first four embodiments, wherein the second hinge mechanism is configured to rotate the end effector about the pitch axis of the shaft.

[0190] The sixth embodiment is any combination of the first five embodiments, wherein the first connector and the second connector each include a belt having a flat first surface and a flat second surface opposite to the first surface, and a gear disposed at the proximal portion of the shaft, wherein the gear is coupled to a rotating disk and configured to convert the rotation of the disk into linear movement of the belt.

[0191] The seventh embodiment is any combination of the first six embodiments, and further includes a robotic surgical control system coupled to the rotary disk.

[0192] Therefore, this disclosure is intended to cover all such alternatives, modifications, and variations. Similarly, based on the embodiments described above, those skilled in the art will understand other features and advantages of this disclosure. Therefore, this disclosure is not limited to what has been specifically shown and described, except as indicated by the appended claims.

Claims

1. A surgical anastomosis instrument, comprising: A slender shaft having a distal end and a proximal end; An end effector coupled to the distal end of the shaft and defining a longitudinal axis, the end effector including an anvil and a staple cassette, the anvil having a proximal end, a distal end and a surface capable of being positioned on a first side of the anatomical structure, the staple cassette being configured to receive a plurality of staples and having a proximal end, a distal end and a surface capable of being positioned on a second side of the anatomical structure; A first connector movably couples the proximal end of the anvil to the proximal end of the nail box; and A second connector movably couples the distal end of the anvil to the distal end of the nail box.

2. The anastomosis device of claim 1, wherein the first connector is configured to adjust the distance between the proximal end of the anvil and the proximal end of the staple cassette.

3. The anastomosis device of claim 1, wherein the second connector is configured to adjust the distance between the distal end of the anvil and the distal end of the staple cassette.

4. The anastomosis device according to claim 1, wherein the first connector is independent of the second connector.

5. The anastomosis device according to claim 1, wherein the first connector comprises: A strip having a flat first surface and a flat second surface opposite to the first surface, the strip having a distal end coupled to the proximal end of the anvil; and A pulley, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the proximal end of the anvil and the proximal end of the nail box.

6. The anastomosis device of claim 1, wherein the first connector pivots the proximal end of the anvil from an open position to a substantially closed position relative to the proximal end of the staple cassette.

7. The anastomosis device according to claim 1, wherein the second connector comprises: A strip having a flat first surface and a flat second surface opposite to the first surface, the strip having a distal end coupled to the distal end of the anvil; and A pulley, wherein a first portion of the belt contacts the pulley, and a second portion of the belt is configured to move in a substantially longitudinal direction to adjust the distance between the distal end of the anvil and the distal end of the nail box.

8. The anastomosis device of claim 7, further comprising a slot in the distal portion of the staple cassette and a slidable pin within the slot, wherein the pin is coupled to the anvil to allow the distal end of the anvil to move toward and away from the distal end of the staple cassette.

9. The anastomosis device of claim 1, further comprising a first spring that biases the distal end of the anvil and the distal end of the staple cassette away from each other.

10. The anastomosis device of claim 9, further comprising a second spring that biases the proximal end of the anvil and the proximal end of the staple cassette away from each other.

11. The anastomosis device of claim 1, wherein the first connector limits the distance between the proximal end of the anvil and the proximal end of the staple cassette to a range between a minimum distance and a maximum distance.

12. The anastomosis device of claim 1, wherein the second connector limits the distance between the distal end of the anvil and the distal end of the staple cassette to a range between a minimum distance and a maximum distance.

13. The anastomosis device of claim 1, wherein the first connector includes an angled slot and a slot pin, wherein the slot pin is coupled to the anvil or the staple cassette and configured to travel through the angled slot to adjust the distance between the proximal and distal ends of the anvil and the proximal and distal ends of the staple cassette.

14. The anastomosis device of claim 13, further comprising a closure member configured to travel distally through the end effector, wherein the slot is disposed on the closure member such that when the closure member is moved distally, the slot pin travels proximally through the slot.

15. The anastomosis device of claim 1, further comprising a drive member configured to travel longitudinally through the anvil and the staple cassette.

16. A surgical anastomosis instrument comprising: A slender shaft having a distal end and a proximal end; and An end effector coupled to the distal end of the shaft and defining a longitudinal axis, the end effector comprising: An anvil, having a proximal end, a distal end, and a surface capable of being positioned on a first side of an anatomical structure; A staple box, configured to accommodate multiple staples and having a proximal end, a distal end, and a surface capable of being positioned on a second side of the anatomical structure; A connector that movably couples the proximal end of the anvil to the proximal end of the nail box, the connector comprising a band having a first flat surface and a second flat surface opposite the first flat surface.

17. The anastomosis device of claim 16, wherein the band has a distal end coupled to the anvil and a proximal end extending through the elongated shaft, the connector further comprising a pulley, wherein a first portion of the band contacts the pulley, and a second portion of the band is configured to move in a substantially longitudinal direction to adjust the distance between the proximal end of the anvil and the proximal end of the staple cassette.

18. The anastomosis device of claim 17, wherein the band further comprises a third portion extending between the distal end of the band and the pulley, wherein the third portion extends substantially perpendicular to the longitudinal axis.

19. The anastomosis device of claim 16, further comprising a second connector movably coupling the distal end of the anvil to the distal end of the staple cassette, the second connector comprising a band having a flat first surface and a flat second surface opposite the first surface.

20. The anastomosis device of claim 19, wherein the band has a distal end coupled to the anvil and a proximal end extending through the elongated shaft, the second connector further comprising a pulley, wherein a first portion of the band contacts the pulley, and a second portion of the band is configured to move in a substantially longitudinal direction to adjust the distance between the distal end of the anvil and the distal end of the staple cassette.

21. The anastomosis device of claim 20, wherein the band further comprises a third portion extending between the distal end of the band and the pulley surface, wherein the third portion extends substantially perpendicular to the longitudinal axis.

22. A surgical anastomosis instrument comprising: A slender shaft having a distal end and a proximal end; and An end effector coupled to the distal end of the shaft and defining a longitudinal axis, the end effector comprising: An anvil, having a proximal end, a distal end, and a surface capable of being positioned on a first side of an anatomical structure; A staple box, configured to accommodate multiple staples and having a proximal end, a distal end, and a surface capable of being positioned on a second side of the anatomical structure; A connector that movably couples the proximal end of the anvil to the proximal end of the nail box; and A hinge element for rotating the end effector relative to the shaft about an axis perpendicular to the longitudinal axis.

23. The anastomosis device of claim 22, further comprising a second hinge element for rotating the end effector relative to the axis about a second axis perpendicular to the first axis and perpendicular to the longitudinal axis.

24. The anastomosis device of claim 23, further comprising a third hinge element for rotating the end effector about the longitudinal axis relative to the shaft.

25. The anastomosis device of claim 22, wherein the hinge element comprises at least one band having a flat first surface and a flat second surface opposite to the first surface.

26. The anastomosis device of claim 25, wherein the hinge element comprises a plurality of straps extending longitudinally through the shaft.

27. The anastomosis device of claim 26, further comprising a wrist member pivotally coupled to the shaft and the end effector, wherein the plurality of straps are twisted relative to each other within the wrist member such that longitudinal movement of the straps within the shaft causes the end effector to rotate relative to the shaft about an axis perpendicular to the longitudinal axis.

28. The anastomosis device of claim 22, further comprising a second connector movably coupling the distal end of the anvil to the distal end of the staple cassette, wherein the first engagement element is independent of the second engagement element.

29. A system for controlling a surgical anastomosis instrument, the surgical anastomosis instrument having an elongated shaft and an end effector coupled to the distal end of the shaft, the end effector having an anvil and a staple cartridge, the anvil and the staple cartridge having proximal and distal ends movably coupled to each other, the system comprising: A first controller is configured to detect a first torque applied to the proximal end of the anvil and the proximal end of the nail box, and to maintain a distance between the proximal ends such that the first torque remains within a first range; and A second controller is configured to detect a second torque applied to the distal end of the anvil and the distal end of the nail box, and to maintain the distance between the distal ends such that the second torque remains within a second range.

30. The system of claim 29, wherein the anastomosis instrument further includes a drive member configured to travel in a longitudinal direction relative to the staple cassette and the anvil, and the system further includes a third controller configured to block or prevent the drive member from traveling when the first torque or the second torque is outside the first range and the second range, respectively.

31. The system of claim 29, wherein the first torque and the second torque are associated with one or more forces applied to the anvil and the nail box by tissue disposed between the anvil and the nail box.

32. The system of claim 29, further comprising a first connector for adjusting the distance between the proximal end of the anvil and the proximal end of the nail box, wherein the first controller is coupled to the first connector and configured to limit the range of motion of the first connector relative to the first range based on the first torque.

33. The system of claim 32, further comprising a second connector for adjusting the distance between the distal end of the anvil and the distal end of the nail box, wherein the second controller is coupled to the second connector and configured to limit the range of motion of the second connector relative to the second range based on the second torque.

34. The system of claim 31, wherein the first connector includes a flexible member having a distal end coupled to the proximal end of the anvil and a proximal end coupled to the first controller, the system further including a drive member for retracting at least a portion of the flexible member via the axis to move the proximal end of the anvil toward the proximal end of the nail box, wherein the first controller is configured to detect torque applied to the flexible member when the flexible member is retracted.

35. The system of claim 33, wherein the second connector includes a flexible member having a distal end coupled to the distal end of the anvil and a proximal end coupled to the second controller, the system further including a drive member for retracting at least a portion of the flexible member via the axis to move the distal end of the anvil toward the distal end of the nail box, wherein the second controller is configured to detect torque applied to the flexible member when the flexible member is retracted.

36. A method for controlling a surgical anastomosis instrument, the surgical anastomosis instrument having an elongated shaft and an end effector coupled to a distal end of the shaft, the end effector having an anvil and a staple cartridge, the anvil and the staple cartridge having proximal and distal ends movably coupled to each other, the method comprising: Detect a first torque applied to the proximal end of the anvil and the proximal end of the nail box; Detect a second torque applied to the distal end of the anvil and the distal end of the nail box; and When the first torque or the second torque is within a first range and a second range, respectively, the release drive member travels through the end effector.

37. The method of claim 36, further comprising adjusting the distance between the proximal end of the anvil and the proximal end of the nail box and detecting the first torque.

38. The method of claim 36, further comprising adjusting the distance between the distal end of the anvil and the distal end of the nail box and detecting the second torque.

39. The method of claim 36, further comprising: The flexible member is moved relative to the end effector to adjust the distance between the proximal end of the anvil and the proximal end of the nail box; and When the first torque reaches a threshold level, the flexible member is prevented from moving further.

40. The method of claim 37, further comprising: The flexible member is moved relative to the end effector to adjust the distance between the distal end of the anvil and the distal end of the nail box; and When the second torque reaches a threshold level, it prevents the flexible member from moving further.

41. The method of claim 36, further comprising preventing the drive member from traveling past the end effector when the first torque or the second torque is below a threshold minimum or above a threshold maximum.

42. A surgical anastomosis system comprising: An instrument having an elongated shaft and an end effector coupled to the distal end of the shaft, the end effector having an anvil and a nail box having proximal and distal ends movably coupled to each other, and a drive member configured for longitudinal travel through the end effector, the system comprising: A first connector is used to adjust the distance between the distal end of the anvil and the distal end of the nail box; A second connector is used to adjust the distance between the proximal end of the anvil and the proximal end of the nail box; and An actuator for causing the drive member to travel longitudinally relative to the anvil and the nail box.

43. The system of claim 42, further comprising a first hinge mechanism for rotating the end effector about its longitudinal axis.

44. The system of claim 42, further comprising a second hinge mechanism for rotating the end effector relative to the shaft about an axis perpendicular to the longitudinal axis.

45. The system of claim 44, wherein the second articulation mechanism is configured to rotate the end effector about the yaw axis of the shaft.

46. ​​The system of claim 44, wherein the second hinge mechanism is configured to rotate the end effector about the pitch axis of the shaft.

47. The system of claim 42, wherein the first connector and the second connector each comprise a belt having a flat first surface and a flat second surface opposite to the first surface, and a gear disposed at a proximal portion of the shaft, wherein the gear is coupled to a rotating disk and configured to convert rotation of the disk into linear movement of the belt.

48. The system of claim 47, further comprising a robotic surgical control system coupled to the rotary disk.

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