Surgical stapler with switchable distal tip

Abstract

The present invention discloses a surgical instrument end effector, the surgical instrument end effector comprises a first jaw and a second jaw, the first jaw is configured to receive a nail magazine, and the second jaw comprises an anvil having a plurality of nail forming recesses. The first jaw and the second jaw are operable to clamp and suturing tissue positioned between the first jaw and the second jaw. An end member is movably disposed at the distal end of the anvil and is configured to be switchable between a first discrete position and a second discrete position relative to the anvil. The end member is angularly oriented toward the first jaw when in the first discrete position, and is angularly oriented away from the first discrete position when in the second discrete position.

Description

[0001] priority

[0002] This application claims U.S. Provisional Patent Application No. 62 / 798,651, filed on January 30, 2019, entitled “Surgical Stapler with Adjustable Tip Angulation”; and U.S. Provisional Patent Application No. 62 / 840,602, filed on April 30, 2019, entitled “Surgical Stapler with Adjustable Tip Angulation”, the disclosures of which are incorporated herein by reference. Background Art

[0003] In some environments, endoscopic surgical instruments are preferred over traditional open surgical devices because smaller incisions can reduce postoperative recovery time and complications. Therefore, some endoscopic surgical instruments may be suitable for placing the distal end effector at the desired surgical site through the cannula of a trocar. These distal end effectors (e.g., internal cutters, graspers, cutters, staplers, clip appliers, access devices, drug / gene therapy delivery devices, and energy delivery devices using ultrasound, RF, lasers, etc.) can engage tissue in a variety of ways to achieve diagnostic or therapeutic effects. Endoscopic surgical instruments may include an axis between the end effector and the handle portion manipulated by a clinician. Such an axis may enable insertion into a desired depth and rotation around the longitudinal axis of the axis, so as to facilitate positioning the end effector in the patient's body. It may also be further advantageous to position the end effector by including one or more articulation joints or features so that the end effector can selectively articulate or otherwise deflect relative to the longitudinal axis of the axis.

[0004] Examples of endoscopic surgical instruments include surgical staplers. Some such staplers are operable to clamp tissue layers, cut through the clamped tissue layers, and drive staples through the tissue layers to substantially seal the severed tissue layers together near the severed ends of the tissue layers. Surgical staplers, for exemplary purposes only, are disclosed in the following U.S. patents: U.S. Patent 4,805,823, entitled "Pocket Configuration for Internal Organ Staplers," issued on February 21, 1989; U.S. Patent 5,415,334, entitled "Surgical Stapler and Staple Cartridge," issued on May 16, 1995; U.S. Patent 5,465,895, entitled "Surgical Stapler Instrument," issued on November 14, 1995; U.S. Patent 5,597,107, entitled "Surgical Stapler Instrument," issued on January 28, 1997; U.S. Patent 5,632,432, entitled "Surgical Instrument," issued on May 27, 1997; U.S. Patent 5,632,432, entitled "Surgical Instrument," issued on October 7, 1997; U.S. Patent 5,632,432, entitled "Surgical Stapler Instrument," issued on October 7, 1997; U.S. Patent 5,632,432, entitled "Surgical Stapler Instrument," issued on October 7, 1997; U.S. Patent 5,632,432, entitled "Surgical Stapler Instrument," issued on October 14 ... U.S. Patent No. 5,673,840, entitled "Instrument"; U.S. Patent No. 5,704,534, entitled "Articulation Assembly for Surgical Instruments", issued on January 6, 1998; U.S. Patent No. 5,814,055, entitled "Surgical Clamping Mechanism", issued on September 29, 1998; U.S. Patent No. 6,978,921, entitled "Surgical Stapling Instrument Incorporating an E-Beam Firing Mechanism", issued on December 27, 2005; U.S. Patent No. 7,000,818, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems", issued on February 21, 2006; U.S. Patent No. 7,143,923, entitled "Surgical Stapling Instrument Having a Firing Lockout for an Unclosed Anvil", issued on December 5, 2006;U.S. Patent No. 7,303,108, published on December 4, 2007, entitled “Surgical Stapling Instrument Incorporating a Multi-Stroke Firing Mechanism with a Flexible Rack”; U.S. Patent No. 7,367,485, published on May 6, 2008, entitled “Surgical Stapling Instrument Incorporatinga Multistroke Firing Mechanism Having a Rotary Transmission”; U.S. Patent No. 7,380,695, published on June 3, 2008, entitled “Surgical Stapling Instrument Having a SingleLockout Mechanism for Prevention of Firing”; U.S. Patent No. 7,380,696, published on June 3, 2008, entitled “Articulating Surgical Stapling Instrument Incorporating a Two-Piece E-Beam Firing Mechanism”; U.S. Patent No. 7,380,696, published on July 29, 2008, entitled “Surgical Stapling and Cutting Device”; U.S. Patent 7,404,508, entitled “Surgical Stapling Instrument Having Multistroke Firing with Opening Lockout”, published on October 14, 2008; U.S. Patent 7,721,930, entitled “Disposable Cartridgewith Adhesive for Use with a Stapling Device”, published on May 25, 2010; U.S. Patent 8,408,439, entitled “Surgical Stapling Instrument with An Articulatable End Effector”, published on April 2, 2013;and U.S. Patent No. 8,453,914, entitled "Motor-Driven Surgical Cutting Instrument with Electric Actuator Directional Control Assembly," issued on June 4, 2013. The disclosures of each of the above-referenced U.S. patents, U.S. patent publications, and U.S. patent applications are incorporated herein by reference. ;

[0005] Although the surgical stapler involved above is described as being used in endoscopic surgery, it should be understood that such surgical staplers can also be used in laparotomy and / or other non-endoscopic surgeries. By way of example only, in thoracic surgery, the surgical stapler can be inserted by thoracotomy, and thus be located between the patient's ribs to reach one or more organs, and the thoracic surgery does not use a trocar as the conduit of the stapler. Such surgery may include using a stapler to cut off and close the blood vessels leading to the lungs. For example, before removing an organ from the chest cavity, the blood vessels leading to the organ can be cut off and closed by a stapler. Of course, the surgical stapler can be used in various other situations and operations.

[0006] While various surgical stapling instruments and associated components have been made and used, it is believed that no one prior to the inventor has made or used the invention described in the appended claims. BRIEF DESCRIPTION OF THE DRAWINGS

[0007] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention.

[0008] Figure 1 shows a perspective view of an exemplary articulating surgical stapling instrument;

[0009] Figure 2 Shows Figure 1 A side view of the device;

[0010] Figure 3 Shows Figure 1 A perspective view of an end effector opened in an instrument;

[0011] Figure 4A Shows Figure 3 The end effector along Figure 3 A side cross-sectional view taken along line 4-4 of the embodiment of the present invention, wherein the firing beam is in a proximal position;

[0012] Figure 4B Shows Figure 3 The end effector along Figure 3A side cross-sectional view taken along line 4-4 of the embodiment of the present invention, wherein the firing beam is in a distal position;

[0013] Figure 5 Shows Figure 3 The end effector along Figure 3 an end cross-sectional view taken along line 5-5 of ;

[0014] Figure 6 Shows Figure 3 An exploded perspective view of an end effector;

[0015] Figure 7 Shows Figure 3 A perspective view of an end effector positioned at tissue and having been actuated once in the tissue;

[0016] Figure 8 shows a perspective view of an alternative version of an end effector having an angled anvil and an angled cartridge;

[0017] Fig. 9 Shows Figure 8 An enlarged side view of an end effector;

[0018] Fig.10 Shows Figure 8 An enlarged top view of the end effector;

[0019] Fig.11 shows a perspective view of an exemplary surgical stapling instrument having an end effector with a bent, elastically deformable end section;

[0020] Fig. 12A Shows Fig.11 An enlarged side view of a distal portion of an end effector;

[0021] Fig. 12B Shows something like Fig.11 An enlarged side view of a distal portion of an alternative end effector of the end effector;

[0022] Fig.13 shows a partial top view of an alternative anvil for an end effector for use with the surgical instruments described herein;

[0023] Fig.14A Shown along Fig.13 The line 14-14 is intercepted Fig.13 sectional side view of an anvil of and showing an end of the anvil in a first position;

[0024] Fig. 14B Shows Fig.14A An enlarged perspective view of an anvil of , wherein a portion of the anvil is shown in phantom;

[0025] Fig.15 Shows Fig.13 4. A side view of the anvil showing an end of rotation of the anvil to a second position;

[0026] Fig.16 shows a cross-sectional side view of an alternative anvil for use with the surgical instruments described herein, the anvil being similar to the anvil of FIG. 14 but having a plurality of rotatable end portions;

[0027] Fig.17 shows a perspective view of an alternative anvil for an end effector for use with the surgical instruments described herein;

[0028] Fig.18 Shows Fig.17 A cross-sectional side view of an anvil of , wherein the elastomeric overmold is shown in phantom and showing a pivot member capable of pivoting about a fulcrum feature;

[0029] Fig.19 A perspective view of an alternative tip of an anvil of an end effector for use with the surgical instruments described herein is shown, showing the tip in a first position;

[0030] Fig. 20 Shows Fig.19 A perspective view of the end of the embodiment of the present invention, showing the end in a second position;

[0031] Fig.21 A perspective view of an exemplary alternative end effector for use with the surgical instruments described herein is shown, showing a distal end of an anvil in a first position;

[0032] Fig. 22 Shows Fig.21 An enlarged side view of an end effector;

[0033] Fig.23 Shows Fig.21 An enlarged side view of the end effector of , showing a distal end of the anvil in a second position;

[0034] Fig.24 Shows Fig.21 an enlarged perspective view of an end effector of showing the elastomeric overmold in phantom to reveal the internal clamps and showing the distal end of the anvil in a first position;

[0035] Fig.25 Shows Fig.24 ' side view of the end effector showing the distal end of the anvil in a second position;

[0036] Fig.26 Shows Fig.24 A perspective view of an internal fixture of an end effector;

[0037] Fig. 27 Shows Fig.26 a perspective view of an inner clamp of FIG. 1 showing a pair of arms of the inner clamp prior to engaging their distal ends;

[0038] Fig.28 Shows Fig.21 An enlarged side view of the end effector of , showing the distal end of the anvil in an alternative second position;

[0039] Fig.29 Shows Fig.28 A side view of an end effector of , showing the elastomeric overmold in phantom to illustrate the internal clamp;

[0040] Fig.30 A perspective view of an exemplary alternative end effector for use with the surgical instruments described herein is shown, showing a distal end of an anvil in a first position;

[0041] Fig.31 Shows Fig.30 an enlarged perspective view of a distal end of an anvil of an end effector of the invention, showing an elastomeric overmold in phantom to reveal an internal clamp;

[0042] Fig.32 Shows Fig.31 A top view of the distal end of an anvil of an end effector;

[0043] Fig.33 shows a bottom view of an alternative anvil for an end effector for use with the surgical instruments described herein;

[0044] Fig.34 Shows Fig.33 an enlarged perspective view of a distal end of an anvil showing the distal end in a first position;

[0045] Fig.35 Shows Fig.33 an enlarged perspective view of a distal end of an anvil showing the distal end in a second position;

[0046] Fig.36 A plurality of alternative internal clamps are shown, each of which is usable within the tip of an anvil of an end effector for use with the surgical instruments described herein;

[0047] Fig.37 illustrates a perspective view of a distal portion of another exemplary end effector having an anvil with a selectively rotatable distal tip showing the distal tip in a first discrete position relative to anvil body;

[0048] Fig.38 Shows Fig.37 a perspective view of a body and distal tip of an anvil of , showing the distal tip rotated relative to the body between a first discrete position and a second discrete position;

[0049] Fig.39A Shows Fig.37 a side elevation view of a distal portion of an end effector of , showing the distal tip in a first discrete position relative to the body;

[0050] Fig.39B Shows Fig.37 a side elevation view of a distal portion of an end effector of , showing the distal tip in a second discrete position relative to the body;

[0051] Fig.40 showing a perspective view of a distal portion of another exemplary anvil having a body, a selectively rotatable distal tip, and a tip locking mechanism, showing the distal tip in a pre-completed assembly state and in a second discrete position relative to the body;

[0052] Fig.41 Shows Fig.40 a side cross-sectional view of a distal portion of an anvil of , showing the distal tip in a fully assembled state and in a first discrete position relative to the body;

[0053] Fig.42 A top plan view of a distal portion of another exemplary anvil having a body, a selectively rotatable distal tip, and a tip locking mechanism is shown, showing the distal tip in a first discrete position relative to the body;

[0054] Fig.43A A perspective view of a distal portion of another exemplary anvil having a body, a rotatable distal tip, and a tip locking mechanism is shown with the distal tip partially disengaged from the body and in a second discrete position relative to the body;

[0055] Fig.43B Shows Fig.43A an enlarged perspective view of a distal portion of an anvil showing the distal tip rotated relative to the body between a first discrete position and a second discrete position;

[0056] Fig.44A a perspective view of a distal portion of another exemplary anvil having a selectively rotatable distal tip and a tip locking mechanism, showing the distal tip in a second discrete position and shown in phantom to illustrate features of the tip locking mechanism;

[0057] Fig.44B Shows Fig.44Aan end view of a distal portion of an anvil showing the distal tip rotated relative to the connecting member between a second discrete position and a first discrete position;

[0058] Fig.45 shows a partial cutaway perspective view of a distal portion of another exemplary anvil having a selectively rotatable distal tip and a tip locking mechanism, with the distal tip shown in phantom to reveal internal features;

[0059] Fig.46 Shows that it is allowed Fig.45 A perspective view of an exemplary shaft for rotating the distal tip of an anvil;

[0060] Fig.47 shows a structure that can be relative to Fig.45 The distal tip and the connecting member are axially fixed Fig.46 A perspective view of an exemplary fixture for a shaft of

[0061] Fig.48 Shows Fig.46 an enlarged perspective view of a distal portion of a shaft of , showing an exemplary detent feature of an end locking mechanism of an anvil;

[0062] Fig.49 shows a perspective view of an exemplary end effector having an anvil with a switching distal tip pivotable about a transverse axis, showing the distal tip in a first discrete position relative to a body of the anvil;

[0063] Fig.50 Shows Fig.49 an exploded perspective view of a distal portion of an anvil showing an anvil body, a distal tip, a connecting member, a spring plate, and a retaining pin;

[0064] Fig.51 Shows Fig.49 A side cross-sectional view of an end effector of showing the distal tip releasably retained in a second discrete position relative to the anvil body;

[0065] Fig.52A Shows Fig.49 a perspective view of a distal portion of an end effector of , showing the distal tip in a second discrete position relative to the anvil body;

[0066] Fig.52B Shows Fig.49 a perspective view of a distal portion of an end effector of , showing the distal tip in a first discrete position relative to an anvil body;

[0067] Fig.53showing a perspective view of a distal portion of an anvil having a switching distal tip pivotable about a transverse axis, showing the distal tip in a first discrete position relative to a body of the anvil;

[0068] Fig.54 Shows Fig.53 an exploded perspective view of a distal portion of an anvil showing an anvil body, a distal tip, a connecting member, a spring plate, and a retaining pin;

[0069] Fig.55 Shows Fig.53 A proximal perspective view of the upper side of the distal end of the anvil;

[0070] Fig.56 Shows Fig.53 a proximal perspective view of an underside of a distal tip of an anvil;

[0071] Fig.57 Shows Fig.53 A proximal perspective view of a connecting member of an anvil;

[0072] Fig.58 Shows Fig.53 a distal perspective view of a connecting member of an anvil;

[0073] Fig.59 Shows Fig.53 A perspective view of a spring plate of an anvil;

[0074] Fig.60A Shows Fig.53 a side cross-sectional view of an anvil showing the distal tip in a first discrete position, wherein the distal tip is parallel to the anvil body;

[0075] Fig.60B Shows Fig.53 A side cross-sectional view of an anvil of FIG. 1 showing the distal tip in an intermediate position wherein the distal tip is moving from Fig.60A A first discrete position transitions toward a second discrete position;

[0076] Fig.60C Shows Fig.53 a side cross-sectional view of an anvil showing the distal tip in a first discrete position, wherein the distal tip is parallel to the anvil body;

[0077] Fig.61 shows a structured Fig.53 A schematic perspective view of another exemplary spring plate for use with an anvil of;

[0078] Fig.62 shows a structured Fig.53 A schematic perspective view of another exemplary spring plate for use with an anvil of;

[0079] Fig.63 shows a structured Fig.53 A schematic perspective view of another exemplary spring plate for use with an anvil of;

[0080] Fig.64 shows a structured Fig.53 A schematic perspective view of another exemplary spring plate for use with an anvil of;

[0081] Fig.65 shows a structured Fig.53 A schematic perspective view of another exemplary spring plate for use with an anvil of;

[0082] Fig.66 Shows Fig.65 Schematic side view of a spring plate showing the resultant force vector represented by Fig.53 a combination of a force exerted by the distal tip of the spring plate on the proximal spring arm of the spring plate and a reaction force exerted by the proximal spring arm on the distal tip;

[0083] Fig.67 shows a perspective view of another exemplary distal tip configured to be pivotally switchable relative to anvil body;

[0084] Fig.68 shows a perspective view of another exemplary distal tip configured to be pivotally switchable relative to anvil body;

[0085] Fig.69 A perspective view of an exemplary distal tip unit configured to be coupled to a distal end of an anvil body is shown, showing the distal tip unit in an assembled state;

[0086] Fig.70A Shown in pre-assembled state Fig.69 A perspective view of a distal tip unit of FIG. 1 showing an integrated living hinge of the distal tip unit; and

[0087] Fig.70B Shown in assembled state Fig.69 A side cross-sectional view of the distal tip of the , also showing the integrated living hinge.

[0088] The drawings are not intended to be limiting in any way, and it is contemplated that various embodiments of the invention may be performed in a variety of other ways, including those not necessarily shown in the drawings. The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several aspects of the invention and, together with the description, serve to explain the principles of the invention; however, it should be understood that the invention is not limited to the precise arrangements shown. DETAILED DESCRIPTION

[0089] The following description of some examples of the present invention should not be used to limit the scope of the present invention. According to the following description shown by way of example, other examples, features, aspects, embodiments and advantages of the present invention will be apparent to those skilled in the art, and a best mode is contemplated for implementing the present invention. As will be appreciated, the present invention can have other different and obvious aspects, all of which do not depart from the present invention. Therefore, the drawings and description should be considered as illustrative and non-restrictive in nature.

[0090] I. Exemplary Surgical Stapler

[0091] Figures 1 to 7 An exemplary surgical stapling and severing instrument (10) is depicted. Figure 1 In the non-articulated state depicted in the figure, the cannula is sized to be inserted into the surgical site of the patient through the trocar in order to perform the surgical procedure. By way of example only, such a trocar can be inserted into the patient's abdomen from between two ribs of the patient or elsewhere. In some cases, the instrument (10) is used in the absence of a trocar. For example, the instrument (10) can be directly inserted through a thoracotomy or other type of incision. The instrument (10) of this example includes a handle portion (20) connected to a shaft (22). The shaft (22) terminates in an articulation joint (11) at the distal end, which is further connected to the end effector (12). It should be understood that the terms used herein, such as "proximal" and "distal", refer to the handle portion (20) of the clinician grasping the instrument (10). Therefore, the end effector (12) is located distally relative to the more proximal handle portion (20). It should also be understood that for convenience and clarity, the spatial terms such as "vertical" and "horizontal" are used in the diagrams of this article. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

[0092] In some versions, shaft (22) is constructed in accordance with at least some of the teachings of U.S. Pat. No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft,” issued on Oct. 24, 2017, the disclosure of which is incorporated herein by reference. Other suitable configurations for shaft (22) will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0093] Once the articulation joint (11) and end effector (12) are inserted through the cannula channel of the trocar, the articulation joint (11) can be remotely articulated via the articulation control (13), such as Figure 1, so that the end effector (12) can be deflected from the longitudinal axis (LA) of the shaft (22) at a desired angle (α). As a result, the end effector (12) can reach the back of the organ or approach the tissue from a desired angle or for other reasons. In some versions, the articulation joint (11) is capable of deflecting the end effector (12) along a single plane. In some other versions, the articulation joint (11) is capable of deflecting the end effector along more than one plane. The articulation joint (11) and the articulation control (13) can be constructed according to the teachings of any of the multiple references cited herein. Alternatively, the articulation joint (11) and / or the articulation control (13) can have any other suitable configuration. By way of example only, the articulation control (13) can be alternatively constructed as a knob that rotates around an axis perpendicular to the longitudinal axis (LA) of the shaft (22).

[0094] In some versions, the articulation joint (11) and / or articulation control (13) are constructed and operated in accordance with at least some of the teachings of the following U.S. patent application: U.S. Patent No. 9,186,142, filed on November 17, 2015, entitled "Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks", the disclosure of which is incorporated herein by reference. The articulation joint (11) may also be constructed and operated in accordance with at least some of the teachings of the following U.S. patent application: U.S. Patent No. 9,795,379, published on October 24, 2017, entitled "Surgical Instrument with Multi-Diameter Shaft", the disclosure of which is incorporated herein by reference. In view of the teachings herein, various other suitable forms that the articulation joint (11) and articulation control (13) may take will be apparent to those of ordinary skill in the art.

[0095] The end effector (12) of the present example includes a lower jaw (16) and an upper jaw in the form of a pivotable anvil (18). In some versions, the lower jaw (16) is constructed in accordance with at least some of the teachings of the following U.S. Patent: U.S. Patent 9,808,248, entitled "Installation Features for Surgical Instrument End Effector Cartridge", issued on November 7, 2017, the disclosure of which is incorporated herein by reference. The anvil (18) may be constructed in accordance with at least some of the teachings of the following U.S. patent applications: U.S. Patent No. 9,517,065, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," published on December 13, 2016, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,839,421, entitled "Jaw Closure Feature for End Effector of Surgical Instrument," published on December 12, 2017, the disclosure of which is incorporated herein by reference. And / or U.S. Patent No. 10,092,292, entitled "Staple Forming Features for Surgical Stapling Instrument," published on October 9, 2018, the disclosure of which is incorporated herein by reference. Various other suitable forms that the lower jaw (16) and anvil (18) may take will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0096] The handle portion (20) includes a pistol grip (24) and a closure trigger (26). The closure trigger (26) is capable of pivoting toward the pistol grip (24) so ​​that the anvil (18) is clamped or closed toward the lower jaw (16) of the end effector (12). Such closure of the anvil (18) is provided by a closure tube (32) and a closure ring (33), both of which are longitudinally translated relative to the handle portion (20) in response to pivoting of the closure trigger (26) relative to the pistol grip (24). The closure tube (32) extends along the length of the shaft (22); and the closure ring (33) is positioned distally of the articulation joint (11). The articulation joint (11) is operable to transmit / transmit longitudinal motion from the closure tube (32) to the closure ring (33).

[0097] The handle portion (20) also includes a firing trigger (28). An elongated member (not shown) extends longitudinally through the shaft (22) and transmits a longitudinal firing motion from the handle portion (20) to the firing beam (14) in response to actuation of the firing trigger (28). This distal translation of the firing beam (14) causes the tissue clamped in the end effector (12) to be stapled and severed, as will be described in more detail below. The trigger (26, 28) is then released to release the tissue from the end effector (12).

[0098] Figures 3 to 6 The end effector (12) is shown to use a firing beam (14) in the form of an electron beam to perform various functions. It should be understood that the electron beam form is merely an illustrative example. The firing beam (14) may take any other suitable form, including but not limited to non-electron beam forms. As best seen in FIG. 4A to FIG. 4B The firing beam (14) includes a transversely oriented upper pin (38), a firing beam cap (44), a transversely oriented middle pin (46), and a distally located cutting edge (48). The upper pin (38) is positioned in a longitudinal anvil slot (42) of the anvil (18) and is capable of translating in the longitudinal anvil slot. The firing beam cap (44) is formed by extending the firing beam (14) through the lower jaw slot (45) ( Figure 4B The lower jaw slot (45) is formed through the lower jaw (16) and slidably engages the lower surface of the lower jaw (16). The middle pin (46) slidably engages the top surface of the lower jaw (16) to cooperate with the firing beam top cover (44). Therefore, the firing beam (14) is necessarily spaced apart from the end effector (12) during firing.

[0099] Some non-electron beam versions of the firing beam (14) may lack the upper pin (38), the middle pin (46), and / or the firing beam cap (44). Some such versions of the instrument (10) may rely solely on the closed ring (33) or some other feature structure to pivot the anvil (18) to the closed position and maintain the anvil (18) in the closed position when the firing beam (14) is advanced to the distal position. By way of example only, the firing beam (14) and / or associated lockout features may be constructed and operated in accordance with at least some of the teachings of the following U.S. Patents: U.S. Patent No. 9,717,497, entitled “Lockout Feature for Movable Cutting Member of Surgical Instrument,” published on August 1, 2017, the disclosure of which is incorporated herein by reference. Other suitable forms that the firing beam (14) may take will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0100] Figure 3The present example is shown with the firing beam (14) positioned proximally and the anvil (18) pivoted to an open position, thereby allowing an unspent staple cartridge (37) to be removably installed into the channel of the lower jaw (16). Figures 5 and 6 The staple cartridge (37) of this example includes a cartridge body (70) having an upper platform (72) and connected to a lower cartridge tray (74). Figure 3 As best shown in FIG. 1 , a vertical slot (49) is formed through a portion of the staple cartridge (37). Figure 3 As best shown in FIG. 1 , three rows of nail holes (51) are formed through the upper platform (72) on one side of the vertical slot (49), and another set of three rows of nail holes (51) are formed through the upper platform (72) on the other side of the vertical slot (49). Of course, any other suitable number of nail rows (e.g., two rows, four rows, or other numbers) may be provided. See again FIG. 4A to FIG. 6 , a wedge-shaped slide (41) and a plurality of nail drivers (43) are captured between the magazine body (70) and the tray (74), wherein the wedge-shaped slide (41) is located proximal to the nail driver (43). The wedge-shaped slide (41) is capable of moving longitudinally within the nail magazine (37); and the nail driver (43) is capable of moving vertically within the nail magazine (37). The nails (47) are also positioned within the magazine body (70), above the corresponding nail drivers (43). Specifically, each nail (47) is driven vertically within the magazine body (70) by the nail driver (43) to drive the nail (47) out through the associated nail hole (51). As shown FIG. 4A to FIG. 4B and Figure 6 As best shown in FIG. 4 , wedge sled ( 41 ) presents an inclined cam surface that pushes the staple drivers ( 43 ) upwardly as the wedge sled ( 41 ) is driven distally through the staple cartridge ( 37 ).

[0101] In some versions, staple cartridge (37) is constructed and operated in accordance with at least some of the teachings of U.S. Patent No. 9,517,065, issued December 13, 2016, entitled "Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler," the disclosure of which is incorporated herein by reference. Additionally or alternatively, staple cartridge (37) may be constructed and operated in accordance with at least some of the teachings of U.S. Patent No. 9,808,248, issued November 7, 2017, entitled "Installation Features for Surgical Instrument End Effector Cartridge," the disclosure of which is incorporated herein by reference. Other suitable forms that staple cartridge (37) may take will be apparent to one of ordinary skill in the art in light of the teachings herein.

[0102] By advancing the closure tube (32) and the closure ring (33) distally so that the end effector (12) is FIG. 4A to FIG. 4B In the closed position shown, the firing beam (14) is advanced into engagement with the anvil (18) by allowing the upper pin (38) to enter the longitudinal anvil slot (42). Figure 5 ) is located at the distal end of the firing beam (14) and is configured to engage the wedge slide (41) so that when the firing trigger (28) is actuated, the push block (80) pushes the wedge slide (41) distally as the firing beam (14) is advanced distally through the staple cartridge (37). During such firing, the cutting edge (48) of the firing beam (14) enters the vertical slot (49) of the staple cartridge (37), thereby severing the tissue clamped between the staple cartridge (37) and the anvil (18). FIG. 4A to FIG. 4B As shown, the intermediate pin (46) and the push block (80) actuate the nail magazine (37) together by entering the narrow slot (49) in the nail magazine (37) to drive the wedge-shaped sliding member (41) into upward lifting contact with the nail driver (43), thereby driving the nail (47) outward through the nail hole (51) and causing the nail to engage with the nail forming recess (53) on the inner surface of the anvil (18) ( Figure 3 ) to form contact. Figure 4B The firing beam (14) is shown fully translated distally after severing and stapling tissue. FIG. 4A to FIG. 4B The nail forming recess (53) is intentionally omitted in the view in FIG. Figure 3 It should also be understood that Figure 5The anvil (18) is intentionally omitted from the view.

[0103] Figure 7 The end effector (12) is shown having been actuated through tissue (90) in a single stroke. As shown, the cutting edge (48) ( Figure 7 4 and 5. In one embodiment, the staples (47) of the present invention are arranged such that the staples (47) of the present invention are arranged in a manner that is consistent with the present invention. The ...

[0104] It will be appreciated that during each actuation stroke, cutting blade (48) may sever tissue substantially simultaneously with the staples (47) being driven through the tissue. In the present example, cutting blade (48) lags only slightly behind the driving of staples (47) such that staples (47) are driven through the same area of ​​tissue just before cutting blade (48) is driven through the tissue, but it will be appreciated that this sequence may be reversed or cutting blade (48) may be synchronized directly with an adjacent staple. Although Figure 7 The end effector (12) is shown being actuated in two layers (92, 94) of tissue (90), but it should be understood that the end effector (12) may be actuated through a single layer of tissue (90) or more than two layers (92, 94) of tissue. It should also be understood that the formation and positioning of the staples (47) adjacent to the cut line created by the cutting edge (48) may substantially seal the tissue at the cut line, thereby reducing or preventing bleeding and / or leakage of other body fluids at the cut line. Furthermore, although Figure 7 The end effector (12) is shown actuating in two substantially flat opposing planar layers (92, 94) of tissue, but it should be understood that the end effector (12) may also be actuated on tubular structures such as blood vessels, portions of the gastrointestinal tract, etc. Therefore, it should not be construed as Figure 7 No limitations are to be construed as to the contemplated uses of end effector (12). Various suitable situations and procedures in which instrument (10) may be used will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0105] In one version, the instrument (10) provides motorized control of the firing beam (14). Exemplary components that may be used to provide motorized control of the firing beam (14) are shown and described in U.S. Patent No. 9,622,746, entitled "Distal Tip Features for End Effector of Surgical Instrument," published on April 18, 2017, the disclosure of which is incorporated herein by reference. In addition to or in lieu of the foregoing, at least a portion of the motorized control may be constructed in accordance with at least some of the teachings of U.S. Patent Publication No. 8,210,411, entitled "Motor-Driven Surgical Instrument," published on July 3, 2012, the disclosure of which is incorporated herein by reference. In addition to or in lieu of the foregoing, features operable to drive the firing beam (14) may be constructed in accordance with at least some of the teachings of U.S. Pat. No. 8,453,914, the disclosure of which is incorporated herein by reference; and / or constructed in accordance with at least some of the teachings of U.S. Pat. No. 8,453,914, the disclosure of which is incorporated herein by reference. Other suitable components, features, and configurations for providing motorization of the firing beam (14) will be apparent to one of ordinary skill in the art in light of the teachings herein. It will also be appreciated that some other versions may provide for manual actuation of the firing beam (14) such that a motor may be omitted. By way of example only, the firing beam (14) may be actuated in accordance with at least some of the teachings of any other patent / publication reference cited herein.

[0106] The instrument (10) may also include a lockout switch and a lockout indicator, as shown and described in U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument,” issued on April 18, 2017, the disclosure of which is incorporated herein by reference. Additionally, the lockout switch and / or lockout indicator and associated components / functionality may be constructed in accordance with at least some of the teachings of U.S. Patent No. 7,644,848, entitled “Electronic Lockouts and Surgical Instrument Including Same,” issued on January 12, 2010, the disclosure of which is incorporated herein by reference.

[0107] The instrument (10) also includes a manual return switch (116) that is configured to act as a "panic" feature, allowing an operator to quickly retract the firing beam (14) proximally during the firing stroke. In other words, the manual return switch (116) can be manually actuated when the firing beam (14) is only partially advanced distally. The manual return switch (116) can provide additional functionality in accordance with at least some of the teachings of U.S. Patent No. 9,622,746, entitled "Distal Tip Features for End Effector of Surgical Instrument," published on April 18, 2017, the disclosure of which is incorporated herein by reference.

[0108] When describing the operation of the instrument (10), the use of the term "pivot" (and similar terms to the underlying "pivot") should not be interpreted as necessarily requiring pivotal movement about a fixed axis. In some versions, the anvil (18) pivots about an axis defined by a pin (or similar feature) that slides along an elongated slot or channel as the anvil (18) moves toward the lower jaw (16). In this type of version, the pivot axis translates along a path defined by the slot and channel while the anvil (18) simultaneously pivots about the axis. In addition or as an alternative, the pivot axis may first slide along the slot / channel and then the anvil (18) pivots about the pivot axis after the pivot axis has slid a certain distance along the slot / channel. It should be understood that such sliding / translational pivoting movement is included in terms such as "pivot", "pivoting", "pivotable", etc. Of course, some versions may provide for pivotal movement of anvil (18) about an axis that remains fixed and does not translate within the slot or channel, etc.

[0109] It will be appreciated that the apparatus (10) may be constructed and operated in accordance with the teachings of the following U.S. Patents: U.S. Patent 4,805,823; U.S. Patent 5,415,334; U.S. Patent 5,465,895; U.S. Patent 5,597,107; U.S. Patent 5,632,432; U.S. Patent 5,673,840; U.S. Patent 5,704,534; U.S. Patent 5,814,055; U.S. Patent 6,978,921; U.S. Patent 7,000,818; U.S. Patent 7,143,923; U.S. Patent 7,303,108; U.S. Patent 7,367,485; U.S. Patent 7,380,695; U.S. Patent 7,380,696; U.S. Patent 7,404,508; U.S. Patent 7,434,715; U.S. Patent 7,721,930; U.S. Patent 8,408,439; and / or 8,453,914. As mentioned above, the disclosure of each of these patents is incorporated herein by reference. Other exemplary modifications that may be provided for the apparatus (10) will be described in more detail below. The various suitable ways in which the following teachings may be incorporated into the apparatus (10) will be apparent to one of ordinary skill in the art. Similarly, the various suitable ways in which the following teachings may be combined with the various teachings of the patents / publications cited herein will be apparent to one of ordinary skill in the art. It should also be understood that the following teachings are not limited to the apparatus (10) or devices taught in the patents cited herein. The following teachings may be easily applied to various other types of apparatus, including apparatus that will not be classified as surgical staplers. According to the teachings herein, various other suitable devices and situations in which the following teachings may be applied will be apparent to one of ordinary skill in the art.

[0110] II. Exemplary End Effectors with Visualization, Introduction, and Collection Features

[0111] In some cases, it may be desirable to provide the user with a clearer view of the end effector 12. Specifically, after the user inserts the end effector (12) into the surgical site, the user may rotate the shaft (22) of the instrument (10) during the operation. The end effector (12) thereby also rotates. As the end effector (12) rotates, the user may wish to see the surgical site. For example, the user may want to see the contact surface or contact point between the tissue (90) and the end effector (12). Because the end effector (12) can be rotated about the longitudinal axis (LA) relative to the handle portion (20), the user may see the lower jaw (16) of the end effector instead of the anvil (18) when observing the surgical site. Alternatively, the end effector (12) can be rotated to a position such that the user can see the anvil (18) when observing the end effector (12). The user may desire to be able to see more of the surgical site than when using a handheld device. Figure 1The range of the surgical site that can be seen when the instrument (10) is used is large. For example, in the case where the user uses the device to perform some surgical procedures involving cutting and then suturing a vessel through which body fluids flow, it may be desirable to visually determine that the anvil (18) and the lower jaw (16) have completely covered the vessel to be cut, thereby ensuring that the vessel can be completely cut and sutured with a single actuation of the device. In other words, the user may want to avoid a situation where only a portion of the vessel is cut and sutured. Therefore, it may be desirable to take some visual monitoring and / or feedback measures to let the user know that the end effector (12) is properly positioned in the surgical site, and then the user can manipulate the end effector to allow the anvil (18) and the lower jaw (16) to fully clamp the vessel. A possible way to monitor the surgical site may include improving the visibility of the area adjacent to the distal end of the lower jaw (16) and the anvil (18). Furthermore, not only may visualization of the distal end of the end effector (12) be desired, but it may also be desired to construct the end effector (12) so that the distal end of the anvil (18) is configured to be capable of pushing tissue (e.g., a large blood vessel) proximally into the space between the anvil (18) and the lower jaw (16) when the anvil (18) is closed toward the lower jaw (16).

[0112] Figure 8 An exemplary end effector (212) is shown including an anvil (218) and a lower jaw (216). It should be understood that end effector (212) may be used in place of end effector (12) of instrument (10). End effector (212) may be integrally formed with instrument (10) or, alternatively, may be interchangeable with end effector (12) of instrument (10).

[0113] The anvil (218) is operable to pivot relative to the lower jaw (216). The anvil (218) and the lower jaw (216) may be similar to those of Figure 1 The anvil (18) and lower jaw (16) are shown to clamp tissue (90). The end effector (212) also includes a cartridge (237) that is coupled to the end effector (212). Figure 3 The illustrated cartridge (37) is similarly operable to be placed within lower jaw (216).

[0114] If available Figures 8 to 10The anvil (218) seen in the drawings has an elongated shape, wherein the distal portion of the anvil (218) approaches the chamber (237) at a certain angle. The distal portion of the anvil (218) approaches the chamber (237) at an angle such that the distal-most end (219) of the anvil (218) extends distally beyond the chamber (237) in the longitudinal direction. However, in some versions, the distal end (219) may extend longitudinally to be vertically flush with the chamber (237), or to a position proximal to the distal-most point of the chamber (237). In addition, the anvil (218) approaches the chamber (237) at a gentle slope. As shown in FIG. Fig.10 As best shown in FIG. 1 , the anvil (218) includes a side surface (241) that tapers toward the distal end (219) of the anvil (218). For example, the anvil (218) may be tapered toward the distal end (219) of the anvil (218). Figure 8 The anvil (218) is shaped like an inverted ski top. An anvil (218) having an angled shape can make it easier to insert the end effector (212) into the surgical site. For example, an anvil (218) having a gentle slope or an inverted ski top shape can provide an atraumatic tissue deflection surface when contacting or moving through tissue. This atraumatic tissue deflection can include pushing tissue (e.g., a large blood vessel) proximally into the space between the anvil (218) and the lower jaw (216) when the anvil (218) is closed toward the lower jaw (216). Once placed at the surgical site, the angled shape of the anvil (218) can also provide better maneuverability of the end effector (212) and better visibility of the distal end of the end effector (212) relative to the anatomical structure at the surgical site. A person of ordinary skill in the art can easily conceive of other suitable forms of anvils (218) based on the teachings of this article.

[0115] The bin (237) is operable to hold Figure 4A A staple similar to the staple (47) shown in FIG. 1 is used to drive into tissue. Fig. 9 As shown, the distal end of the cartridge (237) has a triangular profile. Specifically, the distal end of the cartridge (237) includes an upper tapered surface (239) and a lower tapered surface (238). Additionally, the distal end of the cartridge (237) includes a tapered side surface (243) on each side. In this example, each tapered side surface (243) of the cartridge (237) is generally aligned with the taper presented by the side (241) of the anvil (218). Thus, as shown in FIG. Fig.10As shown, the side surface (243) of the cartridge (237) does not extend outward from the longitudinal axis (LA) of the end effector (212) beyond the side (241) of the anvil (218). The upper tapered surface (239) and the lower tapered surface (238) are closed at the distal end of the cartridge (237). The lower tapered surface (238) defines a sight line (240) so that once the user inserts the end effector (212) into the surgical site, the sight line (240) can be observed. The sight line (240) extends along the edge of the lower tapered surface (238). It should be understood that the lower tapered surface (238) is operated to have a planar shape to allow the user to see and / or roughly see the distal end (219) of the anvil (218). Specifically, the sight line (240) intersects with the longitudinal axis (LA) extending longitudinally through the end effector (212) to form a viewing angle (θ).

[0116] The viewing angle (θ) may determine the user's relative visibility of the distal tip (219). Specifically, the user may be in front of the distal tip (219) along any line of sight that passes through the intersection of the sight line (240) and the longitudinal axis (LA) within the viewing angle (θ). For example, as the viewing angle (θ) increases, the user may have greater visibility of the area directly in front of the distal tip (219) from a proximal vantage point; however, as the viewing angle (θ) decreases, the user may have less visibility of the area in front of the distal tip (219) from a proximal vantage point. In some embodiments, the viewing angle (θ) defines an angle greater than 90 degrees. Additionally, in some embodiments, the viewing angle (θ) defines an angle greater than 135 degrees. Other suitable angles for the viewing angle (θ) can be readily envisioned by a person of ordinary skill in the art based on the teachings herein. In the illustrated version, the user typically views along the sight line (240) or along some other line of sight within the viewing angle (θ), so that the user can view not only the area along the sight line, but also any area within the viewing angle (θ). The underside of the distal tip (219) may also be slightly rounded to help the user see the intersection of the longitudinal axis (LA) and the sight line (240).

[0117] When the tissue (90) is clamped between the closed bin (237) and the anvil (218), the user can observe along the sight line (240) or at other positions within the viewing angle (θ), for example, clearly see where the anvil (218) clamps the tissue (90). In addition, the user will be able to determine whether the tissue is completely clamped between the anvil (218) and the bin (237). Only by determining that the tissue is completely clamped can the tissue be ensured not to overflow the end of the end effector (212). It is also possible to visually present to the user the extent to which the anvil (218) and the bin (237) clamp the tissue (90). It should be understood that in some cases, the end effector (212) can be rotated before, during, or after clamping the tissue (90). Therefore, the tapered shape of the anvil (218) also allows the user to more easily observe the distal end (219), or the area generally adjacent to the distal end (219). The tapered anvil (218) together with the lower tapered surface (238) of the cartridge (237) can further facilitate the easy insertion of the end effector (212) into the tissue in an atraumatic manner. In addition, because the end effector (212) has a tapered end, it is easier to push the end effector (212) through a trocar or other device operable to guide the end effector (212) into the surgical site. For example, once the user loads the distal end (219) into the trocar, the lower tapered surface (238) and the tapered anvil (218) can be used as an introduction end to guide the rest of the end effector (212) into the trocar. According to the teachings of this article, a person of ordinary skill in the art will further understand that the tapered design of the two sides (241) of the anvil (218) and each side (243) of the cartridge (237) can enhance visibility and maneuverability.

[0118] In addition to the foregoing, the end effector (212) and the type of instrument (10) incorporating the end effector (212) may be constructed and operated in accordance with at least some of the teachings of the following: U.S. Patent No. 9,186,142, entitled “Surgical Instrument End Effector Articulation Drive with Pinion and Opposing Racks,” issued on November 17, 2015, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,717,497, entitled “Lockout Feature for Movable Cutting Member of Surgical Instrument,” issued on August 1, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,517,065, entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler,” issued on December 13, 2016, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,517,065, entitled “Integrated Tissue Positioning and Jaw Alignment Features for Surgical Stapler,” issued on December 12, 2017, the disclosure of which is incorporated herein by reference; and / or U.S. Patent No. 9,839,421, entitled “Closure Feature for End Effector of Surgical Instrument”, issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument”, issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 10,092,292, entitled “Staple Forming Features for Surgical Stapling Instrument”, issued on October 9, 2018, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft”, issued on October 24, 2017, the disclosure of which is incorporated herein by reference; and / or U.S. Patent No. 9,839,421, entitled “Closure Feature for End Effector of Surgical Instrument”, issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,622,746, entitled “Distal Tip Features for End Effector of Surgical Instrument”, issued on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Patent No. 10,092,292, entitled “Staple Forming Features for Surgical Stapling Instrument”, issued on October 9, 2018, the disclosure of which is incorporated herein by reference; Cartridge", the disclosure of which is incorporated herein by reference.Additional modifications that may be incorporated into end effector (212) are described in greater detail below.

[0119] III. End Effector with Angled Elastically Deformable Anvil Tip

[0120] In some procedures, it may be necessary to cut along or through tissue where more than one cutting sequence is required to complete the procedure - in other words, sequential cuts are made along a continuous path. In such procedures, this sequential cutting technique may be defined as "marching". For procedures involving marching, the instrument (10) may be placed at the surgical site, activated to cut and suture, then removed from the surgical site for installation of a new cartridge (37), and then placed back at the surgical site again to make the next cut and suture along the same path where the previous cutting and suturing cycle occurred. This process is repeated until the cutting and suturing procedure is complete. FIG. 4A to FIG. 4B and Figure 7 As can be seen in the figure, the distal end configuration of the end effector (12) provides a gap between the distal end of the anvil (18) and the distal end of the cartridge (37). This gap can facilitate advancement by providing tissue with an atraumatic space for access to the distal end of the end effector (12) at the beginning of each advancement step.

[0121] As described above, the distal end configuration of the end effector (212) is different from the distal end configuration of the end effector (12); wherein the different configurations of the end effector (212) provide different potential advantages. Specifically, the distal end configuration of the end effector (212) can improve maneuverability and improve visibility of the relationship between the distal end of the end effector (212) and adjacent anatomical structures. In addition, the distal end configuration of the end effector (212) can provide a tissue harvesting effect by pushing tissue proximally into the space between the anvil (218) and the lower jaw (216) when the anvil (218) is closed toward the lower jaw (216). However, in a version in which all structures of the end effector (212) are rigid, the curved configuration of the distal tip (219) of the anvil (218) may not be suitable for advancing operations because the distal tip (219) may traumatize tissue that is not collected in the space between the anvil (218) and the lower jaw (216) when the anvil (218) is closed toward the lower jaw (216). Therefore, in a version in which all structures of the end effector (212) are rigid, the end effector (212) may be most suitable for cutting and stapling operations (e.g., vessel transection) in which all tissue to be cut and stapled is collected proximal to the distal tip (219).

[0122] In view of the foregoing, it may be desirable to provide a variation of an end effector (12, 212) that provides travel capabilities of the end effector (12), improved visibility associated with the end effector (212), and tissue acquisition capabilities of the end effector (212) without increasing the risk of trauma that may otherwise be associated with a completely rigid version of the end effector (212). Several merely illustrative examples of such variations of the end effector (12, 212) are described below. In the following examples, the anvil has a distal tip that is resiliently biased to present a curved or angled configuration similar to the distal tip (219); however, the resiliently biased distal tip can be deflected away from the lower jaw in response to a sufficient load on the distal tip. Based on the teachings herein, it should be understood that providing an anvil having an angled distal tip portion that is resiliently deformable can provide an additional level of maneuverability benefit in navigating through tissue to a surgical site. In this manner, the deformable distal tip portion can be deflected or deformed to facilitate smooth and atraumatic movement of the end effector through tissue, particularly during advancement operations. Additionally, with the anvil having a bias to an angled position when not in a loaded state or in contact with surrounding tissue, enhanced visualization during tissue capture and cutting can be achieved compared to using an end effector with a straight or non-angled anvil. Furthermore, an anvil with a distal tip biased to an angled position can provide a degree of tissue collection effect until a load point associated with advancement is reached, rather than being associated with simply collecting relatively small tissue structures between the anvil and the lower jaw.

[0123] Fig.11Another exemplary instrument (310) configured as a surgical stapler is shown. The instrument (310) includes a handle portion (320) and a shaft (322). The instrument (310) has a modular configuration so that the shaft (322) can be selectively removed from the handle portion (320) and can be attached to the handle portion. The instrument (310) is constructed similarly to the instrument (10) so that the operability and use of the instrument (310) are the same as those described above for the instrument (10), wherein an additional feature of the instrument (310) is a modular configuration. Through its modular configuration, the instrument (310) provides a method for replacing an end effector. Such changes can be made in the end effector to replace an otherwise worn end effector, or to provide different end effector configurations based on the procedure or user preference. In addition to or in lieu of the foregoing, features operable to provide a modular configuration of the apparatus (310) may be constructed in accordance with at least some of the teachings of the following U.S. Patent No. 10,182,813, entitled "Surgical Stapling Instrument with Shaft Release, Powered Firing, and Powered Articulation," issued on January 22, 2019, the disclosure of which is incorporated herein by reference. Other suitable components, features, and configurations for providing an apparatus (310) having a modular configuration will be apparent to one of ordinary skill in the art in light of the teachings herein. Furthermore, one of ordinary skill in the art will appreciate that the apparatus (10) may be modified to incorporate a modular configuration, as shown and described with respect to the apparatus (310) or other apparatus incorporated herein by reference, in light of the teachings herein.

[0124] exist Fig.11 In the example shown in FIG. 3 , the instrument ( 310 ) includes an end effector ( 312 ) having an anvil ( 318 ) having an angled distal end ( 319 ). In addition, the distal end ( 319 ) of the anvil ( 318 ) is elastically deformable. In this manner, and as Fig. 12A and Fig. 12BAs best shown in , the angled distal tip (319) is operable to elastically deform from a first angled position to a second position. The second position of the angled distal tip (319) may be substantially straight in some versions, but may be angled to a certain degree (e.g., slightly above or slightly below the longitudinal axis (A1)) in other versions. It should be understood that the second position of the angled distal tip (319) may be defined by the characteristics (e.g., thickness, density, etc.) of the tissue captured between the anvil (318) and the lower jaw (16). In the present example, the end effector (312) is disposed on a shaft (322) that is removable from the handle portion (320). By way of example only, shaft (322) may be detachable from handle portion (320) in accordance with at least some of the teachings of U.S. Patent 9,913,642, entitled “Surgical Instrument Comprising a Sensor System,” which issued on Mar. 13, 2018, the disclosure of which is incorporated herein by reference. In some other versions, shaft (322) may not be detachable from handle portion (320).

[0125] It should be understood that the end effector (312) may be used instead of Figure 1 . In some versions, the end effector (312) may be integrally formed with the shaft (22), or alternatively, the end effector may be formed separately and then assembled. In some versions, the end effector (312) may be provided for use in a robotic system. In such a robotic system, a modular shaft (322) having an end effector (312) can be attached to a portion of the robotic system for use, so that the handle portion (320) is replaced by a component of the robotic system. Still in other examples, the end effector (312) may be adapted for use with a robotic system in a manner in which the end effector (312) is connected to the robotic system without having to connect the entire modular shaft (322). In accordance with the teachings herein, other ways of incorporating an end effector having an angled, elastically deformable anvil tip into a user-operated or robot-operated instrument will be apparent to one of ordinary skill in the art.

[0126] Fig. 12AAn enlarged side view of the distal end of the end effector (312) is shown. The end effector (312) includes an anvil (318) and a lower jaw (16) which receives a cartridge (37) as described above with respect to the instrument (10). As described above with respect to the instrument (10), the anvil (318) is pivotally rotatable toward the lower jaw (16) in the same manner as the anvil (18). In this configuration, the end effector (312) is similar to the end effector (12), however, the anvil (318) includes an angled distal tip (319) that is elastically deformable. As Fig. 12A As shown, the tip (319) is biased to an angled position that is Fig.11 is shown in and Fig. 12A When the end effector (312) is not clamping tissue and is open, the tip (319) adopts this angled position, as shown in dashed lines. Fig.11 as shown; or closed without clamping the tissue, as Fig. 12A 312 is shown as a dotted line in FIG. 31. With end effector (312) in this angled state or position, end effector (312) may be considered unloaded or in an unloaded state or position. Conversely, when end effector (312) is clamping tissue, end effector (312) may be considered loaded or in a loaded state or position.

[0127] When closed and not clamping tissue between the anvil (318) and the lower jaw (16), the end (319) contacts the cartridge (37). In this position, the lower side surface (324) of the end (319) defines a plane that intersects the longitudinal axis (A1) defined by the shaft (322) to form an angle (θ1). When closed and clamping tissue (90) between the anvil (318) and the lower jaw (16), the lower side surface (324) of the end (319) contacts the tissue (90). In this position, the lower side surface (324) of the end (319) defines a plane that intersects the longitudinal axis (A1) to form an angle (θ2). Fig. 12AIn the illustrated example, the angles (θ1, θ2) are relative to the longitudinal axis (A1), and the sum of the angles (θ1, θ2) represents the range of movement experienced by the distal tip (319). By way of example only and not limitation, in some examples, in the downward direction from the longitudinal axis (A1) toward the bin (37), the angle (θ1) is between about 20 and about 70 degrees, or more specifically between about 30 and about 50 degrees. By way of example only and not limitation, in some examples, in the upward direction away from the longitudinal axis (A1) from the bin (37), the angle (θ2) is between about 0 and about 90 degrees. By way of example only and not limitation, in some examples, the range of movement experienced by the tip (319) is between about 20 and about 110 degrees. The angles described for angles (θ1, θ2) are exemplary only and not limiting. Other suitable angles will be apparent to one of ordinary skill in the art based on the teachings herein.

[0128] Additionally, in some cases, the longitudinal axis (A1) represents a zero degree reference and the angle relative to it can be positive or negative. For example, in the case where the angle is in a downward direction from the longitudinal axis (A1) toward the bin (37), the angle can be characterized as a negative angle. Similarly, in the case where the angle is in an upward direction away from the longitudinal axis (A1) away from the bin (37), the angle can be characterized as a positive angle. When using these provisions, the range of movement of the distal tip (319) due to deformation can be understood as the sum of the absolute value of the angle when the distal tip (319) is in a position to contact the bin (37) and the angle when the distal tip (319) is in a deformed state (when clamping tissue).

[0129] Fig. 12B Shown with Fig. 12A 1 and 12. With respect to the end effector (312), when the anvil (318) is in its angled and undeformed state (e.g., in Fig. 12A When the anvil (318) is deformed so that it deflects upward, the end of the distal tip (319) extends to the far side of the far end of the cartridge (37). Fig. 12B As shown, when the anvil (318) is in its angled and undeformed state (e.g., in Fig. 12B318) extends to a point flush with or close to the most distal end of the cartridge (37). When the anvil (318) is deformed so that it deflects upward, the end of the distal tip (319) of the anvil (318) extends to a point flush with or close to the most distal end of the cartridge (37). In this way, when the anvil (318) is in its angled state or deformed state, the anvil (318) of the end actuator (412) is flush with or close to the most distal end of the cartridge (37), so that whether the anvil (318) is in an angled and undeformed state or in a deformed state, the anvil (318) does not extend beyond the most distal end of the cartridge (37). In some cases, this can be achieved by modifying the anvil (318) so that the length of the distal tip (319) of the anvil is shortened. In other cases, instrument (10, 310) may be modified to provide slight proximal retraction of anvil (318) when clamping.Other ways to modify end effector (412) as it relates to controlling the position of anvil (318) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0130] IV. Exemplary End Effectors with Discrete Position Pivoting Tips

[0131] In some cases, it may be desirable to provide a user with a universal end effector having a tip that can be configured differently for different applications. For example, it may be desirable or beneficial for a user to use an end effector having an angled (or "bent") tip to obtain visualization and placement benefits as described above. In addition, not only visualization of the distal end of the end effector may be desired, but also the end effector may be constructed so that the distal end of the anvil is configured to be able to push tissue (e.g., a large blood vessel) toward the proximal side into the space between the anvil and the lower jaw when the anvil is closed toward the lower jaw. In addition, in other cases, it may be desirable or beneficial for a user to use an end effector having a straight or expanded tip so that the end effector is better adapted to procedures involving advancement as also described above. In addition, it may be desirable or beneficial for a user to be able to switch the end of the end effector to move away from the tissue when the user is concerned about pressure on the tissue under the tip of the end effector during use.

[0132] It should be understood that, as used herein in conjunction with the various exemplary anvil tips disclosed, the terms "angled" and "curved" encompass tip configurations in which the tip defines a flat, planar outer surface that extends angularly in a distal direction from the distal end of the anvil body; and tip configurations in which the tip defines a bent outer surface that extends arcuately in a distal direction from the distal end of the anvil body (e.g., wherein the tip is referred to as being in a "bent" configuration). In both types of configurations, the distal end of the anvil tip is perpendicularly offset from the longitudinal axis of the anvil body along an axis that extends transverse to the longitudinal axis of the anvil body and passes through the corresponding staple cartridge, such that the tip is "angled" or "curved" relative to the anvil body as a whole.

[0133] A. Exemplary End Effector Pinned Pivot Tip with Pawl

[0134] Figures 13 to 16 Exemplary anvils (518, 118) that can be used with the end effectors and other end effectors described herein are shown. For example, the anvils (518, 118) can be interchangeable or used to replace the anvils (18, 218, 318) of the corresponding end effectors (12, 212, 312, 412) described above. It should be understood that the end effectors (12, 212, 312, 412) in combination with any of the anvils (518, 118) can be used with the instrument (10, 310) and other surgical instruments described herein. In this regard, the end effectors (12, 212, 312, 412) in combination with any of the anvils (518, 118) can be integrally formed with the instrument (10, 310) and other surgical instruments described herein, or alternatively can be interchangeable end effectors of the instrument (10, 310) and other surgical instruments described herein.

[0135] As part of any of the end effectors (12, 212, 312, 412), the anvil (518, 118) is operable to pivot relative to the lower jaw (16, 216). The anvil (518, 118) and the lower jaw (16, 216) may be similar to those of Figure 7 The anvil (18) and lower jaw (16) shown are used to clamp tissue (90). The anvil (518, 118) and lower jaw (16, 216) can also be similar to those of Figure 7 The cutting and suturing performed by the anvil (18) and the lower jaw (16) shown are used to cut and suturing the clamped tissue (90). As described above, in order to achieve cutting and suturing, the end actuator (12,212,312,412) in conjunction with any one of the anvils (518,118) also includes a cartridge (37,237) containing staples, wherein the cartridge (37,237) is operable to be placed in the lower jaw (16,216).

[0136] 1. Single section pinned pivot end

[0137] The anvil (518) includes a body (520) and a distal end (519) extending distally from the body (520). On the proximal side of the distal end (519), the anvil (518) includes an extension (502) on the body (520). The anvil (518) also includes a pair of spaced-apart pawls (504). A portion of the pawl (504) located on the extension (502) is configured as a raised portion or protrusion (510), as shown in the illustrated embodiment. Another portion of the pawl (504) is located on the distal end (519) and is configured as a recessed portion (523), as will be further described below. The anvil (518) also includes an aperture (506) extending through the side of the body (520) of the anvil (518), and the aperture (506) is configured to receive the pin (508). As will be discussed further below, pin (508) defines an axis of rotation about which tip (519) is rotatable.

[0138] The end (519) includes an aperture (521) extending through the side of the end (519), and the aperture (521) is configured to also receive the pin (508). In this way, the end (519) can be operated to rotate around the pin (508), and thus rotate relative to the longitudinal axis (A2) of the anvil (518). The apertures (506, 521) have a circular shape, but have an elongated shape in other examples. In some cases, the elongated shape of the apertures (506, 521) provides or helps the end (519) to present different discrete positions, as further discussed below. As described above, the end (519) includes a pair of recessed portions (523) configured to selectively engage with the raised portion or protrusion (510) of the pawl (504). At the proximal portion of the end (519), the end (519) includes a pair of slots (525) extending longitudinally and defining an elastic portion (527). In this example, the elastic portion (527) includes a recess (523) along the underside of the elastic portion (527).

[0139] Reference now Fig.14A and Fig.15 , the anvil (518) is configured to have a tip (519) that is movable into discrete positions. The pawl (504) provides selective engagement between a raised portion (510) of the pawl (504) and a recessed portion (523) of the pawl (504), which allows the tip (519) to move into different discrete positions. Fig.14A The tip (519) is shown in a first position in which the tip (519) is in a straight orientation such that the longitudinal axis of the tip (519) is generally parallel to or coincident with the longitudinal axis (A2) of the anvil (518). Fig.15The tip (519) is shown in a second position in which the tip (519) is in an angled orientation such that the longitudinal axis of the tip (519) forms an angle of less than about 180 degrees with the longitudinal axis (A2) of the anvil (518).

[0140] As mentioned above and Figures 13 to 15 As shown, the slot (525) defines a resilient portion (527) such that the resilient portion (527) acts as a spring, thereby allowing the end (519) to change position by engaging the protruding portion (510) in different ways via the recess (523). Fig.14A When in the straight orientation shown, the most proximal recessed portion (523) engages with the most proximal raised portion (510). Similarly, in this straight orientation, the most distal recessed portion (523) engages with the most distal raised portion (510). Fig.15 In the angled orientation shown, the most proximal recess (523) engages with the most distal protrusion (510). In addition, in this angled orientation, the most distal recess (523) does not engage with any protrusion (510). However, the anvil (518) includes a stop feature (500) that is configured to contact the proximal end of the end (519) and prevent the end (519) from moving to an even further angled position. In the case of engagement between one or more recesses (523) and one or more protrusions (510) of each in a straight orientation, the end (519) can be adjusted or positioned in discrete positions rather than having a continuous orientation. Therefore, the end (519) is configured to take discrete positions, wherein the end (519) remains in one of the discrete positions until it is subjected to a force sufficient to overcome the interference connection established between the recess (523) and the protrusion (510) of the pawl (504).

[0141] refer to Fig.15 , when tip (519) is rotated or pivoted to the angled orientation shown, in some versions there may be a gap (529). An optional sleeve (not shown) may be added to anvil (518) to cover gap (529) or extend over the gap to eliminate the possibility that gap (529) may provide a compression point for surrounding tissue. In some examples, such a sleeve may extend to reach the end of tip (519) and return to a position as far as the suture line of anvil (518), although this is not required in all versions.

[0142] In one version of anvil (518), anvil (518) is constructed of a single material, such as stainless steel, although other materials may be used in place of stainless steel in other versions. Additionally, in some other versions, anvil (518) may be coated with another material to provide visualization, sliding, or other material characteristics or properties, as would be apparent to one of ordinary skill in the art in light of the teachings herein.

[0143] In other examples of the anvil (518), three pawls (504) may be used so that three discrete positions of the end (519) can be defined. In this type of configuration with three pawls (504), the end (519) can be configured to be able to take a straight orientation, an angled orientation (which can form a bent configuration), or an expanded or open orientation in which the end (519) is bent upward away from the lower jaw (16, 216). In addition, in other examples of the anvil (518), the pawls (504) may be located on the side of the end (519) and the body (520) of the anvil (518) instead of the top. However, in some other examples, the position of the feature of the pawl (504) can be opposite. For example, instead of the raised portion (510) being located on the body (520) of the anvil (518), the raised portion is located on the end (519). In such examples, instead of slot (525) and resilient portion (527) with recess (523) being located on tip (519), slot (525) and resilient portion (527) with recess (523) are located on body (520) of anvil (518). In such examples, these features still cooperate in the same manner as described above to provide discrete positioning of tip (519). Other ways of constructing anvil (518) and pawl (504) to achieve multiple discrete positions of tip (519) will be apparent to those of ordinary skill in the art in view of the teachings herein. 2. Multiple sections pinned to pivot ends

[0144] Fig.16 Another exemplary anvil (118) that can be used with the end effectors and other end effectors described herein is shown. Except for the differences mentioned below, anvil (118) is similar to anvil (518) described above. Therefore, the above description of anvil (518) also applies to anvil (118).

[0145] The anvil (118) includes a body (520) and a terminal end (119) extending distally from the body (520). The features and functions of the anvil (518) are also applicable to the anvil (118), including the features and functions of the terminal end (519) are also applicable to the terminal end (119). However, the terminal end (119) includes additional features and functions. Specifically, the terminal end (119) includes a distal portion (131) and a proximal portion (133). In addition, the terminal end (119) is configured so that not only the proximal portion (133) can be rotated to a discrete position relative to the body (520) of the anvil (118), as described above with respect to the anvil (118), but also the distal portion (131) can be rotated to a discrete position relative to the proximal portion (133) of the terminal end (119).

[0146] Furthermore, in the illustrated version, rotatability of distal portion (131) relative to proximal portion (133) occurs in the same manner as rotatability of proximal portion (133) relative to body (520) of anvil (118). Fig.16 As shown, a pin (135) extends through and connects the distal portion (131) and the proximal portion (133). And an additional pin (135) provides and defines an axis of rotation about which the distal portion (131) can rotate. In this way, the tip (119) is composed of multiple pinned parts or sections. This configuration allows for greater angles and, in some versions, also allows the overall curvature-like shape to be achieved using an originally straight but angled section of the tip (119).

[0147] As mentioned, the same or similar configuration of pawl (504) may be used with the distal and proximal portions (131, 133) of tip (119) to achieve rotation to discrete positions. For example, in one version, the first discrete position of distal portion (131) is a straight orientation relative to proximal portion (133), such as Fig.16 As shown. The second discrete position of the distal portion (131) is an angled or bent orientation relative to the proximal portion (133), wherein the distal portion (131) is bent or angled downward toward the lower jaw (16, 216) of the associated end effector. Of course, in some other versions, the second discrete position of the distal portion (131) may be expanded or bent upward relative to the proximal portion (133). In view of the teachings herein, other configurations and methods for achieving such a configuration of the tip (119) having multiple rotatable pinned sections will be apparent to those of ordinary skill in the art.

[0148] B. Exemplary End Effector Pivot Tip Having Fulcrum Features

[0149] Fig.17 and Fig.18A portion of an exemplary anvil (618) that can be used with the end effectors and other end effectors described herein is shown. For example, the anvil (618) can be interchangeable or used to replace the anvil (18, 218, 318) of the corresponding end effectors (12, 212, 312, 412) described above. It should be understood that the end effector (12, 212, 312, 412) in combination with the anvil (618) can be used with the instrument (10, 310) and other surgical instruments described herein. In this regard, the end effector (12, 212, 312, 412) in combination with the anvil (618) can be integrally formed with the instrument (10, 310) and other surgical instruments described herein, or alternatively can be an interchangeable end effector of the instrument (10, 310) and other surgical instruments described herein.

[0150] As part of any of the end effectors (12, 212, 312, 412), the anvil (618) is operable to pivot relative to the lower jaw (16, 216). The anvil (618) and the lower jaw (16, 216) may be similar to those of Figure 7 The anvil (18) and lower jaw (16) shown are used to clamp tissue (90). The anvil (618) and lower jaw (16, 216) can also be similar to the clamping performed by Figure 7 The cutting and suturing performed by the anvil (18) and the lower jaw (16) shown are used to cut and suturing the clamped tissue (90). As described above, in order to achieve cutting and suturing, the end actuator (12,212,312,412) in conjunction with the anvil (618) also includes a cartridge (37,237) containing staples, wherein the cartridge (37,237) is operable to be placed in the lower jaw (16,216).

[0151] The anvil (618) includes a body (620), a tip (619), and a connecting member (621). The tip (619) includes a polymer or metal covering (shown as an elastomeric overmold (623)) and a pivot member 625, such as Fig.18 Best seen. The connecting member (621) is configured to be attached to the body (620). In one version, the connecting member (621) includes a metal stamping that is configured to be welded to the body (620) of the anvil (618). In another version, the connecting member (621) is configured to be press-fit or snap-fit ​​to the body (620). In this type of version, the connecting member (621) may include a feature that engages with a slot (627) of the body (620). In view of the teachings herein, other ways of attaching the connecting member (621) to the body (620) of the anvil (618) will be apparent to one of ordinary skill in the art.

[0152] The connecting member (621) includes arms (629) extending distally. The arms (629) each include an aperture (631) configured to receive a projection (633) of the pivot member (625). In this manner, the aperture (631) provides a pivot axis or rotation axis for the end (619). The connecting member (621) also includes a bent lip (635) that functions like a fulcrum feature. The bent lip (635) projects distally and is configured to interact with a proximal end (637) of the pivot member (625) of the end (619).

[0153] The pivot member (625) can be connected to the connecting member (621) as described above, wherein the protrusion (633) is received within the aperture (631) of the connecting member (621). With this configuration, the pivot member (625) can be rotationally adjusted relative to the connecting member (621) and the body (620) of the anvil (618). When the protrusion (633) is located within the aperture (631), the proximal end (637) of the pivot member (625) is positioned in a slightly overlapping orientation relative to the bent lip (635). The remainder of the pivot member (625) extends distally from the connecting member (621). Fig.18 As shown, an elastomeric overmold (623) (shown in phantom to illustrate internal components) covers the pivot member (625) and the connecting member (621).

[0154] With the above-described configuration of anvil (618), tip (619) is configured to be rotatable or pivotable about a pivot axis defined by aperture (631), whereby proximal end (637) of pivot member (625) can assume discrete positions relative to bent lip (635), such that tip (619) assumes discrete positions relative to body (620). For example, Fig.18 As shown by the solid lines in the figure, in the first position, the pivot member (625) can have an angled orientation. In the illustrated version, this corresponds to the situation where the proximal end (637) of the pivot member (625) is above the bent lip (635). Fig.18 As shown by the dotted lines in the figure, in the second position, the pivot member (625) can have a straight or slightly expanded orientation. In the illustrated version, this corresponds to the situation where the proximal end (637) of the pivot member (625) is below the bent lip (635).

[0155] In this example, the elastomeric overmold (623) acts as a spring that holds the pivot member (625) in position on either side of the bent lip (635) until sufficient force is applied to the tip (619) to overcome the bias provided by the elastomeric overmold (623) and the contact between the proximal end (637) and the bent lip (635). For example, when in an angled or bent orientation, when sufficient upward force is applied to the tip (619), the proximal end (637) of the pivot member (625) will rotate downward and snap past the bent lip (635), thereby allowing the tip (619) to assume another discrete position. Similarly, when in a straight or expanded orientation, when sufficient downward force is applied to the tip (619), the proximal end (637) of the pivot member (625) will rotate upward and snap past the bent lip (635), thereby allowing the tip (619) to assume another discrete position.

[0156] In this example, the proximal end (637) is rounded and toleranced so that it snaps past the bent lip (635) that acts as a fulcrum feature. In some other versions, the bent lip (635) may be combined with a rounded and toleranced distal end to facilitate movement of the proximal end (637) from one side of the bent lip (635) to the other side of the bent lip (635). Also, as mentioned, once on either side of the bent lip (635) or other fulcrum feature, the tip (619) will remain in place because the elastomeric overmold (623) acts as a spring to hold the pivot member (625) in place.

[0157] In one version of anvil (618), tuning for force feedback or acoustic feedback may be achieved by configuring the fulcrum feature to have a deformable dome-type geometry through which the proximal end (637) moves when changing discrete positions. In other words, greater or lesser deformations may be used with the fulcrum feature so that the user obtains tactile and / or audible feedback confirming that the tip (619) has changed position. Other ways of modifying the anvil (618), connecting member (621), and tip (619) to achieve a pivoting tip that assumes discrete positions will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0158] C. Exemplary End Effector Pivoting Tip Having Triangular Pivot Member

[0159] Fig.19 and Fig. 20A portion of an exemplary anvil (718) that can be used with the end effectors and other end effectors described herein is shown. For example, the anvil (718) can be interchangeable or used to replace the anvil (18, 218, 318) of the corresponding end effectors (12, 212, 312, 412) described above. It should be understood that the end effector (12, 212, 312, 412) in combination with the anvil (718) can be used with the instrument (10, 310) and other surgical instruments described herein. In this regard, the end effector (12, 212, 312, 412) in combination with the anvil (718) can be integrally formed with the instrument (10, 310) and other surgical instruments described herein, or alternatively can be an interchangeable end effector of the instrument (10, 310) and other surgical instruments described herein.

[0160] As part of any of the end effectors (12, 212, 312, 412), the anvil (718) is operable to pivot relative to the lower jaw (16, 216). The anvil (718) and the lower jaw (16, 216) may be similar to those of Figure 7 The anvil (18) and lower jaw (16) shown are used to clamp tissue (90). The anvil (718) and lower jaw (16, 216) can also be similar to those of Figure 7 The cutting and suturing performed by the anvil (18) and the lower jaw (16) shown are used to cut and suturing the clamped tissue (90). As described above, in order to achieve cutting and suturing, the end actuator (12,212,312,412) in conjunction with the anvil (718) also includes a cartridge (37,237) containing staples, wherein the cartridge (37,237) is operable to be placed in the lower jaw (16,216).

[0161] The anvil (718) includes a body (720), an end (719), and a connecting member (721). The end (719) includes a polymer or metal covering (shown as an elastomeric overmold (723)) and a pivot member 725. The connecting member (721) is configured to be attached to the body (720). In one embodiment, the connecting member (721) includes a metal stamping configured to be welded to the body (720) of the anvil (718). In another embodiment, the connecting member (721) is configured to be press-fit or snap-fit ​​to the body (720). In this type of embodiment, the connecting member (721) may include a feature that engages with a slot (similar to the slot (627) of the body (620)) of the body (720). In view of the teachings of this article, other ways of attaching the connecting member (721) to the body (720) of the anvil (718) will be apparent to those of ordinary skill in the art.

[0162] The connecting member (721) includes a distally extending double lug feature (735). As shown in the illustrated version, the connecting member (721) also includes a space or gap (739) between the lugs of the double lug feature (735). In this example, but not necessarily in all versions, the double lug feature (735) is rigid. The pivot member (725) includes a triangular body (741) and an elongated member (743) connected to the triangular body (741) and extending distally from the triangular body. In this example, but not necessarily in all versions, the pivot member (725) includes a metal structure.

[0163] In this example, the double lug feature (735) is sized and toleranced to interact with the triangular body (741) of the pivot member (725). For example, the double lug feature (735) defines base corners (745, 747) and the triangular body (741) defines vertices (749, 751). Fig.19 As shown, when the tip (719) is in a first discrete position in which the tip (719) has a downwardly angled orientation, the apex (749) is biased into the base corner (745). At the same time, the apex (751) is pivoted away from the base corner (747) and instead approaches the distal end of the double lug feature (735). Fig. 20 As shown, when the tip (719) is in a second discrete position in which the tip (719) has a straight or upwardly angled orientation, the apex (751) is biased into the base corner (747). At the same time, the apex (749) is pivoted away from the base corner (745) and close to the distal end of the double lug feature (735).

[0164] In this example, the elastomeric overmold (723) biases the triangular body (741) proximally. Thus, the elastomeric overmold (723) acts as a spring to hold the triangular body (741) of the pivot member (725) in position against the double lug features (735). However, when sufficient force is applied to the distal end (719) to overcome the proximal bias applied by the elastomeric overmold (723), the triangular body (741) pivots between the double lug features (735), as shown in FIG. Fig.19 and Fig. 20 For example, when in an angled or bent orientation, as shown in FIG. Fig.19As shown, when sufficient upward and / or distally directed force is applied to the tip (719), the vertex (749) of the triangular body (741) moves distally along the lower lug of the double lug feature (735). At the same time, the vertex (751) of the triangular body (741) of the pivot member (725) moves proximally along the upper lug of the double lug feature (735) until it locks into the base corner (747). Similarly, when in Fig. 20 When sufficient downwardly and / or distally directed force is applied to the tip (719) in the straight or upwardly curved orientation shown, the vertex (749) of the triangular body (741) travels proximally along the lower lug of the double lug feature (735) until locking into the base corner (745). At the same time, the vertex (751) of the triangular body (741) of the pivot member (725) travels distally along the upper lug of the double lug feature (735). In one version, switching the position of the tip (719) may involve a user squeezing and pulling distally on the tip (719) to temporarily deform the elastomeric overmold (723) while repositioning the tip (719). In other versions, switching the position of the tip (719) may involve a user pushing upward or downward so that a force is applied substantially orthogonally to the longitudinal axis of the anvil (718).

[0165] D. Exemplary End Effector Elastomeric Tip with Internal Snap-Fit Clamp

[0166] Figure 21 to Figure 29 and Figure 30 to Figure 32 An exemplary end effector (812, 912) with a corresponding anvil (818, 918) is shown. The end effector (812, 912) may be interchangeable or used in place of the end effectors (12, 212, 312, 412) described above. It should be understood that the end effector (812, 912) may be used with the instrument (10, 310) and other surgical instruments described herein. In this regard, the end effector (812, 912) with a corresponding anvil (818, 918) may be integrally formed with the instrument (10, 310) and other surgical instruments described herein, or alternatively may be an interchangeable end effector of the instrument (10, 310) and other surgical instruments described herein.

[0167] The end effectors (812, 912) are operable to clamp tissue (90), similar to the Figure 7 The end effector (812, 912) is further operable to cut and staple the clamped tissue (90), similar to the method performed by the end effector (12). Figure 7 The end effector (12) shown performs cutting and suturing.

[0168] 1. Internal snap-on clamp with distal rivet connection

[0169] Figure 21 to Figure 23 An exemplary end effector (812) is shown that includes an anvil (818), a lower jaw (16), and a staple cartridge (37) positioned within the lower jaw (16). The lower jaw (16) and cartridge (37) are described above with respect to other end effectors, and these descriptions apply equally here to the end effector (812). The anvil (818) includes a tip (819). The tip (819) includes a flexible, deformable member that enables the tip (819) to move relative to the anvil (818) between a first discrete position and a second discrete position. For example, the first discrete position is Fig.21 and Fig. 22 , where the tip (819) has an angled or bent orientation relative to the longitudinal axis (A3) of the anvil (818) until the deformable member is subjected to an external input force. Fig.23 A second discrete position is shown in which the tip (819) has a straight orientation relative to the longitudinal axis (A3) until the deformable member is subjected to an external input force. In the case of the straight orientation, the tip (819) is generally aligned with the remainder of the anvil (818), and the tip (819) extends parallel to the longitudinal axis (A3). In the case of the angled orientation, the tip (819) is angled relative to the longitudinal axis (A3) so that the tip (819) extends toward the lower jaw (16) and the cartridge (37). In some embodiments, the angled orientation can form a bent orientation.

[0170] When using the end effector (812), the user can select a desired discrete position for the end (819). This can be done, for example, when a new bin (37) is reloaded onto the end effector (812). When the user attempts to position and navigate the anvil (818) around tissues such as blood vessels and other tubular structures, the user can select an angled orientation of the end (819). When the user attempts to pass through tissue, the user can select a straight orientation of the end (819) because the straight orientation of the end (819) provides a larger hole than the angled orientation of the end (819). When the user performs a procedure involving advancement as described above, the user can also select a straight orientation of the end (819).

[0171] The deformable member may include a polymer or metal covering and an internal support structure. Fig.24 An enlarged perspective view of the distal end of end effector (812) is shown, wherein the polymer or metal covering of tip (819) (shown as elastomeric overmold (823)) is shown transparently to show the internal components of tip (819). The deformable member of tip (819) may include an internal support structure (in Fig.24819 is shown as an internal fixture (821) so that the end (819) remains in a desired discrete position until subjected to an external input force. Although the internal fixture (821) shows a suitable support structure of this type, other support structures of various shapes and sizes are also conceivable. In the illustrated embodiment, the internal fixture (821) is connected to the body (820) of the anvil (818) and extends distally from the body. The internal fixture (821) includes a base (825) and a pair of arms (827) extending distally from the base (825). The arms (827) converge when they extend distally, and the arms (827) are joined at their respective distal ends by rivets (829), as shown in this example. The internal fixture (821) also includes a space (831) located between the arms (827), and in this example, the space (831) has a triangular shape.

[0172] The inner clamp (821) is configured as an eccentric snap-fit ​​clamp having two discrete positions corresponding to the angled orientation and the straight orientation of the tip (819) as described above. In addition, the inner clamp (821) can be overmolded with an elastomeric material such that the tip (819) includes an elastomeric overmold (823), as described above. In still other versions, the inner clamp (821) can be inserted into an otherwise formed flexible tip such that the inner clamp (821) does not need to be overmolded to be surrounded by an elastomeric material.

[0173] When using end effector (812) having anvil (818) and end (819) to switch or transform the discrete positions of end (819), the user will apply force to end (819) in the direction the user wants end (819) to move. Fig.24 In the case of the first discrete position shown having an angled orientation, by opening the end actuator (812) and applying an upward force from the underside of the end (819), the internal clamp (821) will snap into its straight orientation associated with the second discrete position as described above. Fig.25 The tip (819) is shown in a straight orientation, and the elastomeric overmold (823) is shown as transparent to show the internal clamp (821) in this state or position. Similarly, the deformable member at the tip (819) is in a straight orientation as shown. Fig.25In the case of the second discrete position with a straight orientation shown, when sufficient downward force is applied from the top side of the end (819), the internal clamp (821) will snap into its angled (e.g., bent or curved) orientation associated with the first discrete position as described above. In this manner, the internal clamp (821) is deflectable and includes a bias to assume the first position associated with the angled orientation of the end (819), or the second discrete position associated with the straight orientation of the end (819).

[0174] Fig.26 and Fig. 27 The internal clamp (821) and its additional features are shown. As shown, the rivet (829) is Fig.26 and Fig. 27 827, arms (827) are shown each including an aperture (833) at a distal end thereof. Apertures (833) are each configured and sized to receive rivet (829), thereby engaging arms (827). Fig.26 The inner clamp (821) is shown in its assembled or formed form, wherein the arms (827) have been forced toward each other to align the apertures (833) of each arm to ultimately receive the rivet (829). Fig. 27 The inner clamp (821) is shown in its unassembled or stamped form, with the arms (827) not converging and the apertures (833) not aligned. Fig.26 and Fig. 27 In the illustrated version of FIG. 8 , the inner clamp ( 821 ) comprises a stamped metal structure. However, in other examples, other materials besides metal may be used to construct the inner clamp ( 821 ).

[0175] refer to Fig.26 In some embodiments, the proximal extension (835) of the inner clamp (821) is configured to be received by and connected to the body (820) of the anvil (818). In this manner, the inner clamp (821) is secured to the anvil (818). In some versions, the inner clamp (821) may be welded to the body (820) of the anvil (818), for example, by welding the proximal extension (835) to the body (820). Various other ways of connecting the inner clamp (821) to the anvil (818) will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0176] Fig.28 and Fig.29 Another version of the end effector 812 is shown, wherein the internal clamp (821) is configured to have a bias to assume a first discrete position associated with a bent orientation of the distal end (819), as described above with respect to Fig.21 , Fig. 22 and Fig.24As shown and described, or presenting a second discrete position associated with the expanded orientation of the tip (819), such as Fig.28 and Fig.29 As shown. In some examples, the expanded orientation may also be referred to as an arched orientation. In the expanded orientation, the tip (819) is angled upward relative to the longitudinal axis (A3) of the anvil (818). Compared to the straight orientation of the tip (819) shown and described above, the expanded orientation provides an even larger hole, which may be useful when attempting to penetrate tissue and / or when performing procedures involving advancement. In addition to changing the second discrete position from straight to expanded, as shown Fig.28 and Fig.29 The remaining features and functions of the illustrated end effector (812) are similar to those described above with respect to Figure 21 to Figure 27 Same as shown and described.

[0177] In some examples, the geometry and material of both the elastomeric overmold (823) and / or the internal fixture (821) can contribute to the discrete position of the end (819). For example, in one example, changing the elastomeric overmold (823) to a more flexible elastomer can allow the internal fixture (821) to change position to a greater extent. In one version, this is a way to change the configuration of the end (819) from having an angled and straight orientation to having an angled and expanded orientation on the contrary. In another example, the internal fixture (821) can be made stiffer by increasing the mass of the internal fixture (821), changing its material, or changing the geometry of the internal fixture (821). Such an increase in stiffness can overcome the reaction force or bias applied to the end (819) by the elastomeric overmold (823). This can be another way to change the configuration of the end (819) from having an angled and straight orientation to having an angled and expanded orientation on the contrary. However, in some versions of end effector (812) having anvil (818), tip (819) may be configured to provide angled, straight, and expanded orientations, and thus tip (819) will have three discrete positions available to a user. Various other ways to configure components of tip (819) to achieve the desired discrete positions of tip (819) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0178] 2. Internal snap-fit ​​clamp pinned proximally

[0179] Figure 30 to Figure 32An exemplary end effector (912) is shown that includes an anvil (918), a lower jaw (16), and a staple cartridge (37) positioned within the lower jaw (16). The lower jaw (16) and cartridge (37) are described above with respect to other end effectors, and these descriptions apply equally here to the end effector (912). The anvil (918) includes a tip (919). The tip (919) includes a flexible, deformable member that enables the tip (919) to move relative to the anvil (918) between a first discrete position and a second discrete position. For example, the first discrete position is Fig.30 and Fig. 22 , where the tip (919) has an angled (eg, bent) or curved orientation relative to the longitudinal axis (A3) of the anvil (918) until the deformable member is subjected to an external input force. Fig.23 A second discrete position is shown in which the tip (919) has a straight orientation relative to the longitudinal axis (A3) until the deformable member is subjected to an external input force. In the case of the straight orientation, the tip (919) is generally aligned with the remainder of the anvil (918), and the tip (919) extends parallel to the longitudinal axis (A3). In the case of the angled orientation, the tip (919) is angled relative to the longitudinal axis (A3) so that the tip (919) extends toward the lower jaw (16) and the cartridge (37). In some embodiments, the angled orientation can form a bent orientation, as described above.

[0180] When using the end effector (912), the user can select a desired discrete position for the end (919). This can be done, for example, when a new cartridge (37) is reloaded onto the end effector (912). When the user attempts to position and navigate the anvil (918) around tissues such as blood vessels and other tubular structures, the user can select an angled orientation of the end (919). When the user attempts to penetrate tissue, the user can select a straight orientation of the end (919) because the straight orientation of the end (919) provides a larger hole than the angled orientation of the end (919). The user can also select a straight orientation of the end (919) when the user performs a procedure involving advancement as described above.

[0181] The deformable member may include a polymer or metal covering and an internal support structure. Fig.31An enlarged perspective view of the distal end of the anvil (918) of the end effector (912) is shown, wherein the polymer or metal covering (shown as an elastomeric overmold (923)) of the end (919) and the body (920) of the anvil (918) is transparently shown to show the internal components. The deformable member of the end (919) may include an internal support structure (shown as an internal clamp (921)) connected to the body (920) of the anvil (918) and extending distally from the body. The internal clamp (921) includes a tip portion (925) and a pair of arms (927) extending proximally from the tip portion (925). The arms (927) initially diverge as they extend proximally and then converge as they approach their respective proximal ends. The arms (927) are joined at their respective proximal ends by pins (929) within the body (920) of the anvil (918), which extend through respective alignment apertures (933) of the arms (927), as shown in this example. In some versions, the pins (929) may be replaced with rivets or screw pins. The internal clamp (921) also includes a space (931) between the arms (927), and in this example, the space (931) has a triangular shape.

[0182] The inner clamp (921) is configured as an eccentric snap-fit ​​clamp having two discrete positions corresponding to the angled orientation and the straight orientation of the tip (919) as described above. In addition, the inner clamp (921) can be overmolded with an elastomeric material such that the tip (919) includes an elastomeric overmold (923), as described above. In still other versions, the inner clamp (921) can be inserted into an otherwise formed flexible tip such that the inner clamp (921) does not need to be overmolded to be surrounded by an elastomeric material.

[0183] When using an end effector (912) having an anvil (918) and a distal end (919) to switch or convert the discrete positions of the distal end (919), the user will apply a force to the distal end (919) in the direction in which the user wants the distal end (919) to move. Fig.30 In the case of the first position having an angled orientation as shown, by opening the end effector (912) and applying an upward force from the underside of the tip (919), the inner clamp (921) will snap into its straight orientation associated with the second discrete position as described above. Fig.23In the case of the second discrete position with a straight orientation shown, when sufficient downward force is applied from the top side of the end (919), the internal clamp (921) will snap into its bent or curved orientation associated with the first discrete position as described above. In this manner, the internal clamp (921) is deflectable and includes a bias to assume the first position associated with the angled orientation of the end (919), or the second discrete position associated with the straight orientation of the end (919).

[0184] Fig.32 A top view of the internal clamp (921) and its additional features is shown. As shown, the pin (929) extends orthogonally relative to the longitudinal axis of the body (920) of the anvil (918). The arms (927) are positioned to align with the apertures (933) such that the apertures (933) are each configured and sized to receive the pin (929) and thereby engage the arms (927). Fig.32 As shown, the internal fixture (921) is in its assembled or formed form, wherein the arms (927) have been forced toward each other to align the orifices (933) of each arm, thereby ultimately receiving the pin (929). Similar to the internal fixture (821) described above, the internal fixture (921) also has an unassembled or stamped form, wherein the arms (927) do not converge and the orifices (933) are initially misaligned. In one version, the internal fixture (921) includes a stamped metal structure. However, in other examples, other materials besides metal can be used to construct the internal fixture (921). In view of the teachings herein, various other ways of connecting the internal fixture (921) to the anvil (918) will be apparent to those of ordinary skill in the art.

[0185] Fig.28 Another version of the end effector 912 is shown in which the internal clamp (921) is configured to have a bias to assume a first discrete position associated with a bent orientation of the distal end (919), as described above with respect to Fig.30 As shown and described, or presenting a second discrete position associated with the expanded orientation of the tip (919), such as Fig.28 In some examples, the expanded orientation may also be referred to as an arched orientation. In the expanded orientation, the tip (919) is angled upward relative to the longitudinal axis (A3) of the anvil (918). Compared to the straight orientation of the tip (919) shown and described above, the expanded orientation provides an even larger hole, which may be useful when attempting to penetrate tissue and / or when performing procedures involving advancement. In addition to changing the second discrete position from straight to expanded, as Fig.28 The remaining features and functions of the illustrated end effector (912) are similar to those described above with respect to Figure 30 to Figure 32 Same as shown and described.

[0186] In order to change the discrete positions that the internal fixture (921) can adopt, in some examples, the geometry and material of both the elastomeric overmold (923) and / or the internal fixture (921) can contribute to the discrete positions that the end (919) will adopt. For example, in one example, changing the elastomeric overmold (923) to a more flexible elastomer can allow the internal fixture (921) to change positions to a greater extent. In one version, this is a way to change the configuration of the end (919) from having a bent and straight orientation to having a bent and expanded orientation in contrast. In another example, the internal fixture (921) can be made stiffer by increasing its mass, changing its material, and / or changing its geometry. Such an increase in stiffness can overcome the reaction force or bias applied by the elastomeric overmold (923) on the end (919). This can be another way to change the configuration of the end (919) from having a bent and straight orientation to having a bent and expanded orientation in contrast. However, in some versions of end effector (912) having anvil (918), tip (919) may be configured to provide a bent, straight, and expanded orientation, and thus tip (919) will have three discrete positions available to a user. Various other ways to configure components of tip (919) to achieve the desired discrete positions of tip (919) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0187] Another consideration of the end (919) in terms of configuring the discrete positions relates to the proximal portion of the arm (927) that ultimately engages the pin (929). More specifically, the freedom of movement of the proximal portion of the arm (927) relative to the pin (929) affects the position that the internal fixture (921) will take when changing from a first discrete position to a second discrete position. For example, when the internal fixture (921) is snapped from one discrete position to another discrete position, the orifice (933) of the arm (927) may travel to a certain extent along the pin (929). In one example, when the internal fixture (921) is snapped from one discrete position to another discrete position, a larger travel length of the orifice (933) of the arm (927) along the pin (929) is equivalent to a larger position difference from the first discrete position to the second discrete position. Furthermore, where the pin (929) is located within the body (920) of the anvil (918), the body (920) may be configured to allow greater or lesser freedom of movement of the orifice (933) along the pin (929), depending on the available space for the orifice (933) to travel along the pin (929). Similarly, having the connection of the arm (927) within the body (920) of the anvil (918) rather than within the elastomeric overmold (923) may facilitate greater freedom of movement of the arm (927) along the pin (929). Additionally, the diameter of the pin (929) may affect the friction between the pin (929) and the orifice (933), and therefore the freedom of movement of the arm (927) relative to the pin (929).

[0188] refer to Fig.32Another feature that helps control the lateral movement of the arm (927) and thus the discrete positions taken by the end (919) is the geometry of the slot in the body (920) of the anvil (918). For example, in the illustrated embodiment, the anvil (918) includes a slot (935) in the body (920), wherein the slot (935) is defined as a space between two walls (937) extending in the body (920). As shown, the proximal portions of the arm (927) move close enough to each other to fit in the slot (935) and ultimately connect with the pin (929). With this configuration, the size of the slot (935) defined by the wall (937) is used to limit the ability of the arm (927) to move laterally. When the internal clamp (921) is snapped from its first discrete position to its second discrete position, this limited lateral movement affects the degree of change in position. Thus, varying the width of the slot (935) can provide another way to control the range of motion of the inner clamp (921). Additionally, the height of the slot (935) can affect the range that the motion arm (927) must travel along the pin (929). For example, a small height can be more restrictive and thereby prevent the arm (927) from traveling along the pin (929) when the tip (919) moves from a first discrete position to a second discrete position. Similarly, a larger height can have a less restrictive nature and allow the arm (927) to travel further along the pin (929) when the tip (919) is switched.

[0189] 3. Bind the elastomer end to the cut window

[0190] Figure 33 to Figure 35 An exemplary anvil (1018) is shown that can be used with the end effectors and other end effectors described herein. For example, the anvil (1018) can be interchangeable or used to replace the anvil (18, 218, 318) of the corresponding end effectors (12, 212, 312, 412) described above. It should be understood that the end effector (12, 212, 312, 412) in combination with the anvil (1018) can be used with the instrument (10, 310) and other surgical instruments described herein. In this regard, the end effector (12, 212, 312, 412) in combination with the anvil (1018) can be integrally formed with the instrument (10, 310) and other surgical instruments described herein, or alternatively can be an interchangeable end effector of the instrument (10, 310) and other surgical instruments described herein.

[0191] As part of any of the end effectors (12, 212, 312, 412), the anvil (1018) is operable to pivot relative to the lower jaw (16, 216). The anvil (618) and the lower jaw (16, 216) may be similar to those of Figure 7The anvil (18) and lower jaw (16) shown are used to clamp tissue (90). The anvil (1018) and lower jaw (16, 216) can also be similar to the clamping performed by Figure 7 The cutting and suturing performed by the anvil (18) and the lower jaw (16) shown are used to cut and suturing the clamped tissue (90). As described above, in order to achieve cutting and suturing, the end actuator (12,212,312,412) in conjunction with the anvil (1018) also includes a cartridge (37,237) containing staples, wherein the cartridge (37,237) is operable to be placed in the lower jaw (16,216).

[0192] Still reference Figure 33 to Figure 35 , the anvil (1018) includes a body (1020) and a tip (1019). The tip (1019) is connected to the body (1020) and extends distally from the body. The tip (1019) includes a support structure (shown in phantom as an internal clamp (1021)) and a polymer or metal covering (shown as an elastomeric overmold (1023)). As with the previous anvil tip, the tip (1019) is configured so that the internal clamp (1021) can be moved by applying an external input force from a Fig.34 The first discrete position of the angled orientation shown is switched to a position having a Fig.35 A second discrete position of a straight orientation is shown.

[0193] The inner clamp (1021) includes arms (1027) and a space (1031) located between the arms (1027). In addition, the elastomeric overmold (1023) includes an opening (1033) extending through the end (1019). The opening (1033) is aligned with the space (1031) of the inner clamp (1021). By changing the size and shape of the opening (1033) and the space (1031), the deflection of the end (1019) to discrete positions can be controlled to achieve a desired bend and a straight or expanded orientation. In view of the teachings herein, other ways of controlling the discrete positions of the inner clamp (1021) will be apparent to those of ordinary skill in the art. 4. Internal clamp with center deflection rib

[0194] Fig.36A plurality of alternative internal clamps (1121) are shown, each of which is capable of being used within the end of an anvil of an end effector used with the surgical instruments described herein. For example, the internal clamp (1121) can be used to replace the internal clamps (821, 921, 1021). The internal clamp (1121) includes a resilient intermediate rib (1122) extending longitudinally between a pair of arms (1127) of the internal clamp (1121). The intermediate rib (1122) is deflectable and includes a bias to adopt discrete positions. In this example, the internal clamp (1121) is configured as a hairpin clamp. As described above, in the case where the internal clamp (1121) replaces the internal clamp (821, 921, 1021), the internal clamp (1121) can be overmolded with an elastomeric overmold, as described above. Additionally, various ways of controlling the discrete positions of inner clamp (1121), and thereby controlling the discrete positions of the tip using inner clamp (1121), will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0195] E. Exemplary Elastomeric Overmolding Configurations

[0196] Relative to the above-mentioned anvil end in combination with an elastomeric overmold, the various properties of the elastomeric overmold can be configured to provide various functional parameters. In addition, as described above, the elastomeric overmold can work as a system or assembly with certain internal fixtures, pivot members or other internal features to provide multiple discrete end positions. The end can be switched or adjusted between these discrete positions by applying an external force (i.e., by the user, the user's hand tool, the robotic manipulator or the patient's anatomical structure). In this way, modifications to the various configurations and designs of the elastomeric overmold can affect the ease or difficulty of moving or switching the end from one discrete position to another discrete position. As described above, one example thereof involves the use of an elastomer with different stiffnesses. Another example mentioned above involves changing the quality and / or geometry of the elastomer, for example, by including an opening, such as the opening (1033) described above.

[0197] In addition, there are other considerations and ways to configure the elastomeric overmold to be able to work with internal clamps and / or pivot members to provide a desired range of terminal functions. In one version, the terminal described herein includes an elastomeric overmold that can surround all structures of the terminal and can be coupled to all structures of the terminal. However, in other versions of the terminal described herein with an elastomeric overmold, the overmold is configured to not surround and / or be coupled to all structures of the terminal. Below are some additional exemplary configurations of the elastomeric overmold of the terminal. Among other things, these configurations may also be applicable to any of the terminals having the elastomeric overmold described herein, which include at least the terminal (219, 319, 619, 719, 819, 919, 1019) and at least the elastomeric overmold (623, 723, 823, 923, 1023).

[0198] In one example, the elastomeric overmold (623, 723, 823, 923, 1023) of the tip (219, 319, 619, 719, 819, 919, 1019) is directly bonded to the anvil (218, 318, 618, 718, 818, 918, 1018), or directly bonded to an intermediate connector such as a connecting member (621, 721) so that it forms a continuous smooth surface without openings or gaps when the tip is deformed. In such examples, bonding to certain locations allows the elastomer to have a spring bias and act as a spring, and therefore act as a source of tension, which can help provide discrete positions for the tip.

[0199] In another example, the elastomeric overmold (623, 723, 823, 923, 1023) of the tip (219, 319, 619, 719, 819, 919, 1019) may be specifically prevented from bonding to certain locations. By way of example only and not limitation, for a tip having a pivot member (625, 725) or an internal clamp (821, 921, 1021, 1121), bonding of the elastomeric overmold (623, 723, 823, 923, 1023) is partially or completely prevented such that the pivot member (625, 725) or the internal clamp (821, 921, 1021, 1121) does not bond to the elastomeric overmold (623, 723, 823, 923, 1023). In this way, the dynamics of the switch can be changed by allowing relative sliding between the pivot member (625, 725) or the internal clamp (821, 921, 1021, 1121) and the elastomeric overmold (623, 723, 823, 923, 1023). For example, one way to prevent binding in this manner is to dip the pivot member (625, 725) or the internal clamp (821, 921, 1021, 1121) in wax or another coating so that the elastomer does not bind to the pivot member or internal clamp, thereby allowing relative sliding.

[0200] refer to Fig.17 and Fig.26 , the pivot member (625) includes a coating (628), and the internal fixture (821) includes a coating (828). In this example, the coating (628, 828) comprises wax, but other coating materials may also be used. In addition, in some versions, the coating (628, 828) may be applied to the entire pivot member (625) and the internal fixture (821). However, in other versions, the coating (628, 828) may be applied to portions of the pivot member (625) and the internal fixture (821). For example, relative to the internal fixture (821), in one example, the coating (828) is only applied to a pair of arms (827). However, in other examples of the pivot member (625) and the internal fixture (821), the coating (628, 828) is omitted entirely. In view of the teachings herein, other ways to prevent the elastomeric overmold from being combined with certain structures of the end will be apparent to those of ordinary skill in the art.

[0201] In another example, the elastomeric overmold (623, 723, 823, 923, 1023) of the end (219, 319, 619, 719, 819, 919, 1019) of some portions of the pivot member (625, 725) or internal clamp (821, 921, 1021, 1121) may not be covered by elastomeric material at all. In such examples, this represents an opportunity to reduce or decrease the size of the end and allow the pivot member (625, 725) or internal clamp (821, 921, 1021, 1121) to have a stronger or more powerful detenting switch. By way of example only and not limitation, in one version, a base or proximal portion of the tip (619, 719, 819, 919, 1019) is covered, while an original or partially original pivot member (625, 725) or inner clamp (821, 921, 1021, 1121) extends distally. As used herein, the terms "original" or "partially original" should be understood to mean that such portions of the pivot member (625, 725) or inner clamp (821, 921, 1021, 1121) are not covered by an elastomeric overmold or otherwise exposed to the surrounding environment.

[0202] F. Exemplary Switching or Detent Mechanisms

[0203] With respect to the internal clamp (821, 921, 1021, 1121), in one example, such internal clamp (821, 921, 1021, 1121) is described as being configured with a hairpin design so that the internal clamp (821, 921, 1021, 1121) contains elastic energy after being riveted. In this way, the internal clamp (821, 921, 1021, 1121) may have stored elastic energy. After being assembled and connected with the main body of the anvil, an external force is applied. For example, the external force may be applied by a user, a hand tool of the user, a robotic manipulator, or an anatomical structure of the patient. During the application of the external force, the arm of the internal clamp (821, 921, 1021, 1121) is elastically deformed and a reaction force accumulates until it reaches a state instability. If the force continues in the same direction, the arm of the inner clamp (821, 921, 1021, 1121) will cross or pass through the instability region to reach another lower energy state. Therefore, in this way, the inner clamp (821, 921, 1021, 1121) has bistability in some cases and even multistability in other cases. In the case of bistability, the inner clamp (821, 921, 1021, 1121) includes two positions with low energy states, wherein the inner clamp will maintain its shape and position without applying external forces to the inner clamp (821, 921, 1021, 1121). In the case of multistability, the inner clamp (821, 921, 1021, 1121) includes more than two positions with low energy states, wherein the inner clamp will maintain its shape and position without applying external forces to the inner clamp (821, 921, 1021, 1121). In some examples of bi-stability and multi-stability, the internal clamp (821, 921, 1021, 1121) can be described as including the ability to twist, bend, or flex from one state or position to another state or position. In view of the teachings herein, various ways to modify and control the stability and positioning of the internal clamp (821, 921, 1021, 1121) will be apparent to those of ordinary skill in the art.

[0204] G. Exemplary Anvil with Rotating Tip

[0205] In some cases, it may be desirable to provide a selectively adjustable distal tip for an anvil of a surgical stapler end effector, the distal tip being configured to be able to transition between a first discrete position and a second discrete position via rotation about a longitudinal axis. Such a configuration may provide benefits different from other configurations, in which the distal tip is selectively adjustable via rotation about a longitudinal axis. Figures 13 to 20 The upward pivoting and downward pivoting about the transverse axis or the above combination Figures 21 to 36The flexure is transformed between a first discrete position and a second discrete position. Advantageously, in this type of formula, the anvil tip can be configured to have a rigid structure, an elastically deformable structure, or any suitable combination thereof, while still being able to selectively transform between a first discrete position and a second discrete position exhibiting the above-mentioned advantages. In addition, in some cases, it may be desirable to rotatably couple the anvil tip to the anvil body so that the tip can rotate around an axis extending in a vertical plane that contains the longitudinal axis of the anvil body and the relative lower jaws of the end effector. In this type of formula, the anvil tip is said to rotatably "rotate" relative to the anvil body between a first discrete position and a second discrete position.

[0206] Figures 37 to 45 Exemplary anvils (1218, 1318, 1418, 1518, 1618, 1718, 1818) are shown having distal tips (1222, 1322, 1422, 1522, 1622, 1722, 1822) that are selectively rotatable relative to a corresponding anvil body such that the tips (1222, 1322, 1422, 1522, 1622, 1722, 1822) are configured to rotate relative to the anvil body between a first discrete position and a second discrete position. Anvils (1218, 1318, 1418, 1518, 1618, 1718, 1818) and their corresponding end effectors described below are interchangeable with any of the exemplary anvils (18, 218, 318, 518, 618, 718, 818, 918, 1018) and end effectors (12, 212, 312, 412, 812, 912) described above and may be used with surgical instrument (10, 310) and other exemplary surgical instruments described herein. It should be understood that the anvils (1218, 1318, 1418, 1518, 1618, 1718, 1818) are similar to the above-mentioned anvils (18, 218, 318, 518, 618, 718, 818, 918, 1018) in that the anvils (1218, 1318, 1418, 1518, 1618, 1718, 1818) are capable of being operated to clamp tissue (90) against a staple cartridge supported in the lower jaw of a corresponding end actuator, such as a staple cartridge (37) supported in the above-mentioned lower jaw (16), and are also capable of being operated to form staples ejected from the staple cartridge into the clamped tissue. As described below, the anvil (1218, 1318, 1418, 1518, 1618, 1718, 1818) may be provided with a tip locking mechanism operable to releasably retain the anvil tip within a discrete position, thereby preventing the anvil tip from being accidentally rotated out of the discrete position.

[0207] It should be understood that any of the exemplary anvil tips (1222, 1322, 1422, 1522, 1622, 1722, 1822) described below can be formed of one or more materials as desired, and the one or more materials can include a rigid material, an elastically deformable material, or a combination thereof. For example, in some versions, the anvil tip (1222) can include a core or proximal base portion formed of a rigid material such as a metal, and an elastomeric body portion coupled to or otherwise overmolded around the rigid core or proximal base portion.

[0208] 1. Overview of an Exemplary Anvil with a Rotating Tip

[0209] Figures 37 to 39B An exemplary end effector (1212) is shown, which includes an anvil (1218) pivotally coupled to a lower jaw (16) and a staple cartridge (37) positioned within the lower jaw (16). The anvil (1218) includes an elongated anvil body (1220) having a plurality of staple forming recesses (not shown) similar to the recesses (53) of the anvil (18) arranged along its length. A tapered distal anvil tip (1222) is rotatably coupled to the distal end of the anvil body (1220) and is configured to selectively rotate relative to the anvil body (1220) between a first discrete position and a second discrete position in response to an external rotational force applied to the tip (1222) by a user or by an adjacent anatomical structure. As Fig.37 and Fig.39A As shown, anvil tip (1222) is angled relative to anvil body (1220) when in the first discrete position such that the distal end of anvil tip (1222) extends toward staple cartridge (37) and is configured to contact the distal end of staple cartridge (37) to clamp tissue between the anvil tip and the staple cartridge when anvil (1218) is closed. Fig.39BAs shown, the anvil tip (1222) is oriented straight relative to the anvil body (1220) when in the second discrete position, so that when the end effector (1212) is in a closed state, the anvil tip (1222) extends generally parallel to the lower jaw (16) and the staple cartridge (37), and the distal end of the anvil tip (1222) is thus spaced apart from the distal end of the staple cartridge (37) to define a gap therebetween. Thus, the anvil tip (1222) is configured to provide the end effector (1212) with a distal opening aperture throughout its entire clamping range when in the straight position, the distal opening aperture being larger than a corresponding aperture exhibited by the end effector (1212) when the anvil tip (1222) is in an angled position. Thus, similar to the other exemplary embodiments described above, the anvil tip (1222) is appropriately oriented to pull tissue proximally between the anvil (1218) and the staple cartridge (37) when in the angled position and facilitate visualization of target tissue during closure of the end effector (1212). Additionally, the anvil tip (1222) is appropriately oriented to facilitate advancement during a suture procedure when in the straight position, as also described above. Thus, the user may select an angled position or a straight position of the anvil tip (1222) as desired to best facilitate the particular procedure being performed.

[0210] like Fig.38 As shown, the anvil body (1220) extends along a longitudinal body axis (A1), and the anvil tip (1222) is configured to be rotatable about a rotation axis (A2) that intersects the body axis (A1) and is angled relative to the body axis while still extending in a generally proximal to distal direction. Thus, the axes (A1, A2) define and are contained by a vertical plane (P) that extends along the longitudinal centerline of the end effector (1212) so as to also contain the longitudinal axis (not shown) of the lower jaw (16). In other words, each axis (A1, A2) is within and extends along the vertical plane (P). The rotation axis (A2) of the anvil tip (1222) is defined by a rotation member (not shown), which may be similar to the one described below in conjunction with the embodiment of the present invention. Figures 40 to 48 The exemplary anvils (1318, 1518, 1618, 1718) of the present invention are in the form of any of the shafts (1324, 1524, 1634, 1740) described herein. In this version, the rotating member is suitably configured such that the rotation axis (A2) extends obliquely relative to the longitudinal axis of the anvil tip (1222).

[0211] like Figures 38 to 39BAs shown, the anvil (1218) includes an angled joint (1230) defined by an angled distal side (1232) of the anvil body (1220) and an angled proximal side (1234) of the anvil tip (1222). The angled surfaces (1232, 1234) are configured to engage with each other in a first mating configuration and a second mating configuration to define a first discrete position and a second discrete position of the anvil tip (1222). Fig.39A and Fig.39B As shown, angled surfaces (1232, 1234) are obliquely angled relative to the longitudinal axis of anvil body (1220) and anvil tip (1222). Fig.39A As shown, when the anvil tip (1222) is in a first rotational orientation relative to the anvil body (1220), the angles of inclination of the angled joint (1230) are added, thereby obliquely orienting the longitudinal axis of the anvil tip (1222) relative to the longitudinal axis (A1) of the anvil body (1220) to provide the anvil tip (1222) in an angled position. The anvil tip (1222) includes first and second opposing surfaces (1236, 1238) shown as being generally arcuate. Fig.23 In the first rotational orientation of A, the first surface (1236) is an exterior surface and the first surface (1238) is an interior surface relative to the staple cartridge (37).

[0212] The second rotational orientation may be obtained by rotating the anvil tip (1222) 180 degrees relative to the first rotational orientation. Fig.39B As shown, the angled angles of the angled joint (1230) are configured to offset each other when the anvil tip (1222) is in a second rotational orientation relative to the anvil body (1220), thereby coaxially aligning the longitudinal axes of the anvil body (1220) and the anvil tip (1222) so that the anvil tip (1222) extends straight distally from the anvil body (1220). In other words, the angled surfaces (1232, 1234) are arranged in a second rotational orientation relative to the anvil body (1220). Fig.39B The anvil tip (1222) is oriented relative to each other in the second discrete position shown so that the angled surfaces (1232, 1234) define supplementary angles that together define an angle of 180 degrees. In other versions, the angled surfaces (1232, 1234) may alternatively be configured to define an angle greater than 180 degrees when the anvil tip (1222) is in the second discrete position. In this type of version, the anvil tip (1222) is expanded upward away from the distal end of the staple cartridge (37) and the anvil body axis (A1) when in the second discrete position, for example similar to the above combined Fig.29 The configuration of the anvil (818) in FIG. Fig.23 In the second rotational orientation of B, the second surface (1238) is an outer surface and the first surface (1236) is an inner surface relative to the nail magazine (37).

[0213] Although not shown, the anvil (1218) may also include an end locking mechanism that is operable to releasably hold the anvil end (1222) in a first discrete position and a second discrete position, thereby preventing the end (1222) from being inadvertently rotated away from the selected position. With reference to the teachings herein, such end locking mechanisms may include various types of one or more detent features, protrusions, recesses, resilient members, interference features, etc. that will be apparent to one of ordinary skill in the art. For example, the anvil (1218) may include any one or more of the exemplary end locking mechanisms described below in conjunction with the anvils (1318, 1418, 1518, 1618, 1718, 1818), such as a detent protrusion (1340) and a detent recess (1342). In addition, although not shown, the anvil (1218) may also include a connecting member rigidly fixed to the distal end of the anvil body (1220), and the anvil end (1222) is rotatably coupled to the connecting member. Such a connection member may be similar to any of the exemplary connection members (1330, 1430, 1530, 1630, 1730, 1830) described below. Additionally, anvil tip (1222) may be axially fixed relative to anvil body (1220) using any of the exemplary methods described below.

[0214] 2. Anvil with a rotating end having an end locking mechanism with a detent lug

[0215] Figure 40 to Figure 41 A distal portion of another exemplary anvil (1318) suitable for use with any of the above-described exemplary end effectors is shown. Anvil (1318) is similar to anvil (1218) described above, except as described further below. Similar to anvil (1218), anvil (1318) includes an elongated anvil body (1320) having a plurality of staple forming recesses (not shown) arranged along its underside, and a tapered distal tip (1322) rotatably disposed at the distal end of anvil body (1320). Similar to anvil tip (1222), anvil tip (1322) is configured to be rotatable relative to anvil body (1320) about an axis of rotation, the axis of rotation being disposed in a plane containing the longitudinal axis of anvil body (1320) and the longitudinal centerline of a corresponding end effector having a lower jaw (16). Specifically, the anvil tip (1322) is configured to be rotatable about a rotational axis between a first discrete position and a second discrete position, wherein the anvil tip (1322) is angled relative to the anvil body (1320) in a direction toward the lower jaw (16), and wherein the anvil tip (1322) extends straight distally from the anvil body (1320) so as to be oriented away from the lower jaw (16).

[0216] Anvil (1318) further includes a connecting member (1330) that is rigidly secured to the distal end of anvil body (1320) and that rotatably supports anvil tip (1322). Fig.41 As shown, the connecting member (1330) includes a proximal plug (1332) securely received (e.g., via an interference fit) in the open distal end of the longitudinal anvil slot (1321) of the anvil body (1320), and the longitudinal anvil slot (1321) can be similar to the longitudinal anvil slot (42) of the anvil (18) described above. The connecting member (1330) also includes an internal aperture (1334) that extends obliquely relative to the longitudinal axis of the anvil body (1320) and the connecting member (1330) and is configured to rotatably receive the proximally extending shaft (1324) of the anvil end (1322). The shaft (1324) can be integrally formed with the body of the anvil end (1322) and extend obliquely relative to its longitudinal axis. The aperture (1334) and the shaft (1324) cooperate to define an axis of rotation (A2) of the anvil tip (1322) that is obliquely angled relative to the longitudinal axis of the anvil body (1320) and the anvil tip (1322). The anvil tip (1322) and the connecting member (1330) include angled end faces that adjustably cooperate with each other to define an angled joint (1336) that provides an angled orientation and a straight orientation of the anvil tip (1322) relative to the anvil body (1320) in a first discrete position and a second discrete position, similar to the angled joint (1230) of the anvil (1218) described above.

[0217] The proximal end of the anvil tip shaft (1324) of the present version of the anvil tip (1322) includes a retaining feature (1326) that is configured to engage an inner shoulder of the aperture (1334) to retain the shaft (1324) axially within the aperture (1334) while still allowing the shaft (1324) to rotate therein to enable the anvil tip (1322) to rotate between a straight position and an angled position. The retaining feature (1326) of the present example is configured to engage an inner shoulder of the aperture (1334) to retain the shaft (1324) axially within the aperture (1334) while still allowing the shaft (1324) to rotate therein to enable the anvil tip (1322) to rotate between a straight position and an angled position. Fig.41 1334, which may be formed by deformation (e.g., thermal deformation or "heat fusion") of the proximal end of the shaft after the shaft (1324) is inserted into the aperture (1334) during initial assembly of the anvil (1318). In this regard, Fig.40 Anvil (1318) is shown in a pre-finished assembled state prior to forming rounded protrusion (1326), and Fig.41Anvil (1318) is shown in a fully assembled state after rounded protrusion (1326) has been deformed. Various other suitable types of retention features that may be provided integrally with shaft (1324) or independently of the shaft will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0218] like Fig.41 As shown, the anvil tip (1322) of the present example also includes an optional rigid member (1328) embedded therein and extending proximally through the shaft (1324) and extending distally through at least a portion of the body of the anvil tip (1322). The rigid member (1328) may be formed of a material having a greater rigidity than the body of the anvil tip (1322), such that the most distal portion of the anvil tip (1322) through which the rigid member (1328) does not extend has greater flexibility than the proximal portion of the anvil tip (1322) including the shaft (1324). In some versions, the body of the anvil tip (1322) may be formed of a flexible elastomeric material, while the rigid member (1328) is formed of a more rigid material that is bendable. In some versions, the material of the rigid member (1328) may be compatible with a magnetic resonance imaging (MRI) device and / or may be configured to be used as a marker for fluoroscopic identification. In the present version, the proximal end of the rigid member (1328) is engaged within an inner core element of the retaining feature (1326) thereby enabling the retaining feature (1326) to remain engaged with the inner shoulder of the orifice (1334) when an axial load is applied to the shaft (1324), such as during rotation of the anvil tip (1322).

[0219] like Fig.40As best shown, the anvil (1318) also includes an end locking mechanism that is configured to releasably hold the anvil end (1322) in a first discrete position and a second discrete position. The end locking mechanism of this example is shown in the form of a ratchet feature disposed at the angled joint (1336) of the anvil end (1322) and the connecting member (1330). Specifically, a pair of ratchet protrusions (1340) are disposed on the angled proximal side of the anvil end (1322), and a corresponding pair of ratchet recesses (1342) are disposed in the angled distal side of the connecting member (1330). When the anvil end (1322) is in the first discrete position or the second discrete position, the ratchet protrusion (1340) is configured to be fully seated in the ratchet recess (1342). As the anvil tip (1322) rotates between discrete positions, the detent projection (1340) and / or the shaft (1324) may be elastically deformed to allow the detent projection (1340) to temporarily disengage the detent recess (1342). When the anvil tip (1322) reaches one of the first discrete position or the second discrete position relative to the anvil body (1320), the detent projection (1340) then quickly retracts into the corresponding detent recess (1342), thereby providing the user with tactile confirmation that the anvil tip (1322) has fully assumed the selected end position. In lieu of or in addition to the detent projection (1340) and / or the detent recess (1342), the anvil (1318) may include various other suitable types of end locking mechanisms, such as those described below.

[0220] 3. Anvil with a rotating end having an end locking mechanism with a ratchet arm

[0221] Fig.42A distal portion of another exemplary anvil (1418) suitable for use with any of the above-described exemplary end effectors is shown. The anvil (1418) is similar to the above-described anvil (1318), except that the difference is described in addition below. Similar to the anvil (1318), the anvil (1418) includes an elongated anvil body (1420) having a plurality of nail forming recesses (not shown) arranged along its underside, a connecting member (1430) fixed to the distal end of the anvil body (1420), and a tapered distal end (1422) rotatably connected to the connecting member (1430). Similar to the anvil end (1322), the anvil end (1422) is configured to be able to rotate relative to the connecting member (1430) and the anvil body (1420) about a rotation axis, which is arranged in a plane containing the longitudinal axis of the anvil body (1420) and the longitudinal centerline of the corresponding end effector having the lower jaw (16). Specifically, the anvil tip (1422) is configured to be rotatable about a rotational axis between a first discrete position in which the anvil tip (1422) is angled relative to the anvil body (1420) in a direction toward the lower jaw (16), and a second discrete position in which the anvil tip (1422) extends straight distally from the anvil body (1420) so as to be oriented away from the lower jaw (16). The connecting member (1430) and the anvil tip (1422) define an angled joint (1432) therebetween that provides for angular reorientation of the anvil tip (1322) relative to the longitudinal axis of the anvil body (1420) during rotation of the anvil tip (1422) between the first discrete position and the second discrete position.

[0222] The anvil (1418) of this example also includes an end locking mechanism, which is arranged at the angled joint (1432) and is configured to releasably retain the anvil end (1422) in each of the first discrete position and the second discrete position relative to the anvil body (1420). The end locking mechanism of the present invention is shown in the form of a pair of resilient pawl arms (1440) extending laterally from the angled proximal end of the anvil end (1422) and a corresponding pair of pawl recesses (1442) arranged on the angled distal side of the connecting member (1430). When the anvil end (1422) is in the first discrete position or the second discrete position, the pawl arm (1440) is configured to be seated in the pawl recess (1442). When the anvil end (1422) rotates relative to the anvil body (1420), the pawl arm (1440) is elastically deflected toward the distal side, thereby disengaging the pawl recess (1442). When anvil tip (1422) reaches one of the first discrete position or the second discrete position, detent arm (1440) quickly retracts into the corresponding detent recess (1442), thereby providing the user with tactile confirmation that anvil tip (1422) has fully assumed the selected end position.

[0223] 4. Anvil with a rotating tip having a tip locking mechanism with an annular wavy feature

[0224] FIG. 43A to FIG. 43BA distal portion of another exemplary anvil (1518) suitable for use with any of the above-described exemplary end effectors is shown. Anvil (1518) is similar to anvils (1318, 1418) described above, except as described further below. Similar to anvils (1318, 1418), anvil (1518) includes an elongated anvil body (1520) having a plurality of staple forming recesses (not shown) arranged along its underside, a connecting member (1530) fixed to the distal end of the anvil body (1520), and a tapered distal end (1522) rotatably coupled to the connecting member (1530). Similar to anvil tips (1322, 1422), anvil tip (1522) is configured to be rotatable relative to connecting member (1530) and anvil body (1520) about an axis of rotation, the axis of rotation being disposed within a plane containing a longitudinal axis of anvil body (1520) and a longitudinal centerline of a corresponding end effector having lower jaw (16). Specifically, anvil tip (1522) is configured to be rotatable about the axis of rotation between a first discrete position and a second discrete position, in which the anvil tip (1522) is angled relative to the anvil body (1520) in a direction toward the lower jaw (16), and in which the anvil tip (1522) extends straight distally from the anvil body (1520) so as to be oriented away from the lower jaw (16). The connecting member (1530) and the anvil end (1522) define an angled joint (1432) therebetween that provides for angular reorientation of the anvil end (1522) relative to the longitudinal axis of the anvil body (1520) during rotation of the anvil end (1522) between a first discrete position and a second discrete position.

[0225] The anvil (1518) of the present example further includes a tip locking mechanism disposed at the angled joint (1532) and configured to releasably retain the anvil tip (1522) in each of the first discrete position and the second discrete position relative to the anvil body (1520). Fig.43A As best shown in the exploded view of FIG, the end locking mechanism of the present invention is shown in the form of an annular undulating protrusion (1540) disposed at the base of the shaft (1524) on the angled proximal side (1526) of the anvil end (1522); and a corresponding annular undulating recess (1542) formed at the opening of the aperture (1534) on the angled distal side (1536) of the connecting member (1530). Although not shown, the shaft (1524) can be axially retained in the aperture (1534) by a retaining feature similar to the rounded protrusion (1326) described above.

[0226] When the anvil end (1522) is rotatably oriented Fig.43A Angled position as shown or similar Fig.40 In the straight position shown, the axially raised portion of the annular undulating protrusion (1540) is configured to be received by the corresponding axially recessed portion of the annular undulating recessed portion (1542), and vice versa. In any intermediate position therebetween, the raised portion of the annular undulating protrusion (1540) and the recessed portion of the annular undulating recessed portion (1542) engage and axially drive against each other, thereby generating tension in the shaft (1524). This tension generated in the shaft (1524) rotationally pushes the anvil tip (1522) toward the nearest straight position or angled position, thereby defining these positions as discrete positions.

[0227] 5. Anvil with a rotating tip having a tip locking mechanism with a rotational interference feature

[0228] FIG. 44A to FIG. 44B A distal portion of another exemplary anvil (1618) suitable for use with any of the above-described exemplary end effectors is shown. Anvil (1618) is similar to anvils (1318, 1418, 1518) described above, except that the differences are described in addition below. Similar to anvils (1318, 1418, 1518), anvil (1618) includes an elongated anvil body (not shown) having a plurality of nail forming recesses arranged along its underside, a connecting member (1630) fixed to the distal end of the anvil body, and a tapered distal end (1622) rotatably connected to the connecting member (1630). Similar to anvil ends (1322, 1422, 1522), anvil ends (1622) are configured to be able to rotate relative to connecting member (1630) about an axis of rotation, the axis of rotation being disposed in a plane containing the longitudinal axis of the anvil body and the longitudinal centerline of the corresponding end effector having a lower jaw (16). Specifically, the anvil tip (1622) is configured to be rotatable about a rotational axis between a first discrete position in which the anvil tip (1622) is angled relative to the anvil body in a direction toward the lower jaw (16) and a second discrete position in which the anvil tip (1622) extends straight distally from the anvil body so as to be oriented away from the lower jaw (16). The connecting member (1630) and the anvil tip (1622) define an angled joint (1632) therebetween that provides for angular reorientation of the anvil tip (1622) relative to the longitudinal axis of the anvil body during rotation of the anvil tip (1622) between the first discrete position and the second discrete position.

[0229] In the present version, connecting member (1630) includes a shaft (1634) that extends distally from its angled distal surface and is rotatably received within a corresponding aperture (1624) formed within anvil tip (1622). Shaft (1634) and aperture (1624) thus cooperate to define an axis about which anvil tip (1622) rotates relative to connecting member (1630) between a first discrete position and a second discrete position. Fig.44A As best shown, the shaft (1634) includes a cylindrical proximal portion and a distal cover (1636) having a non-circular cross-sectional shape. The shaft (1634) and the orifice (1624) also cooperate to define an end locking mechanism that is configured to releasably retain the anvil end (1522) in each of a first discrete position and a second discrete position relative to the connecting member (1630). Specifically, the shaft cover (1636) and the orifice (1624) are appropriately shaped to contact each other through interference engagement when the anvil end (1622) rotates between an angular position and a straight position. This interference engagement causes elastic deflection of the shaft cover (1636) and / or the anvil end (1622), which forces the anvil end (1622) toward the nearest straight position or angled position.

[0230] 6. Anvil with rotating end and independently captured shaft

[0231] Fig.45A distal portion of another exemplary anvil (1718) suitable for use with any of the above-described exemplary end effectors is shown. Anvil (1718) is similar to anvils (1318, 1418, 1518, 1618) described above, except that the differences are described in addition below. Similar to anvils (1318, 1418, 1518, 1618), anvil (1718) includes an elongated anvil body (not shown) having a plurality of staple forming recesses arranged along its underside, a connecting member (1730) fixed to the distal end of the anvil body, and a tapered distal end (1722) rotatably coupled to the connecting member (1730). Similar to anvil tips (1322, 1422, 1522, 1622), anvil tip (1722) is configured to be rotatable relative to connecting member (1730) about an axis of rotation, the axis of rotation being disposed within a plane containing the longitudinal axis of the anvil body and the longitudinal centerline of a corresponding end effector having lower jaw (16). Specifically, anvil tip (1722) is configured to be rotatable about the axis of rotation between a first discrete position and a second discrete position, in which the anvil tip (1722) is angled relative to the anvil body in a direction toward the lower jaw (16), and in which the anvil tip (1722) extends straight distally from the anvil body so as to be oriented away from the lower jaw (16). The connecting member (1730) and the anvil tip (1722) define an angled joint (1732) therebetween that provides for angular reorientation of the anvil tip (1722) relative to the longitudinal axis of the anvil body during rotation of the anvil tip (1722) between a first discrete position and a second discrete position.

[0232] like Fig.45 As shown, the connecting member includes a first aperture (1734) extending obliquely relative to the longitudinal axis of the connecting member (1730) and the anvil body, and the anvil end (1722) includes a second aperture (1736) coaxially aligned with the first aperture (1734). An axis (1740) provided independently of the anvil end (1722) and the connecting member (1730) is disposed within the first aperture and the second aperture (1734, 1736) and enables the anvil end (1722) to rotate relative to the connecting member (1730) between a first discrete position and a second discrete position. Fig.46As shown, the proximal end of the shaft (1740) includes a radially enlarged head (1742), and the distal end of the shaft (1740) includes an annular groove (1744). The shaft (1740) is configured to be received within the first and second apertures (1734, 1736) such that the proximal head (1742) seats against an internal stop shoulder (not shown) of the first aperture (1734) and such that the annular groove (1744) is exposed through the distal end of the second aperture (1736), such that Fig.47 A C-shaped clamp (1746) as shown in Figure 1 can be applied to the annular groove (1744). The proximal portion of the shaft (1740) can be received by the first aperture (1734) in a press fit engagement, while the distal portion of the shaft (1740) is received in the second aperture (1736) in a sliding fit engagement, thereby allowing the anvil tip (1722) to rotate about the anvil axis (1740) while the anvil tip (1722) is axially retained on the shaft (1740) by the C-shaped clamp (1746).

[0233] Anvil (1718) may further include an end locking mechanism operable to releasably retain anvil end (1722) in a first discrete position and a second discrete position relative to connecting member (1730) and anvil body. Fig.48 The detent recess (1748) is shown disposed in an annular groove (1744) on the distal portion of the shaft (1740) and is configured to engage a corresponding detent protrusion (not shown) fixed to the anvil end (1722). In other versions, a reverse configuration may be provided, wherein the shaft (1740) is fixed to the anvil end (1722) and rotatably disposed within the first aperture (1734) of the connecting member (1730), wherein the proximal portion of the shaft (1740) provides the first detent feature and the connecting member (1730) provides the second detent feature. In addition, it should be understood that various other types of end locking mechanisms may be employed.

[0234] H. Exemplary Anvil with Switching Tip Pivotable About a Transverse Axis

[0235] As above combined Figures 37 to 48 As described above, in some cases, it may be desirable to rotatably mount the adjustable anvil tip relative to the anvil body so that the tip can rotate between discrete positions about an axis contained in a vertical plane and extending parallel to the length of the end effector. In other cases, it may be desirable to alternatively mount the adjustable anvil tip relative to the anvil body so that the tip can pivot between discrete positions about a transverse axis extending transverse to the length of the end effector; for example, in conjunction with the above Figures 13 to 16 The pivot configuration is similar in manner, but has the following combination Figure 53 to Figure 71 The unique features and functions of the switching end are described.

[0236] It should be understood that the following Figure 53 to Figure 7 The exemplary features described herein may be combined with any of the other exemplary features described herein. In this regard, the exemplary tips and related features described below may be substituted for similar components of any of the exemplary surgical instruments described herein to achieve desired performance characteristics in various types of surgical suturing procedures.

[0237] 1. Switching end and connecting member with ratchet recess

[0238] Figures 49 to 52B An exemplary end effector (1812) is shown, which includes an anvil (1818) pivotally coupled to a lower jaw (16) and a staple cartridge (37) positioned within the lower jaw (16). The anvil (1818) is similar to the anvils (1318, 1418, 1518, 1618, 1718) described above, except as further described below. Similar to the anvils (1318, 1418, 1518, 1618, 1718), the anvil (1818) includes an elongated anvil body (1820) having a plurality of staple forming recesses arranged along its underside, a connecting member (1830) fixed to the distal end of the anvil body (1820) with a retaining pin (1850), and a tapered distal end (1822) movably coupled to the connecting member (1730). Unlike anvil tips (1322, 1422, 1522, 1622, 1722), anvil tip (1822) is configured to pivot relative to connecting member (1830) about a transverse axis that extends transversely to the longitudinal axis of anvil body (1820) and the longitudinal centerline of end effector (1812). Fig.52A and Fig.52B As shown, the anvil tip (1822) is configured to be pivotally switchable about the transverse axis between a first discrete position and a second discrete position, in which the anvil tip (1822) is angled relative to the anvil body (1820) in a direction toward the lower jaw (16) (see FIG. Fig.52A ); in the second discrete position, the anvil tip (1822) extends straight distally from the anvil body (1820) so as to be oriented away from the lower jaw (16) (see Fig.49 and Fig.52B ). The user may select an angled position or a straight position of the anvil tip (1822) as desired to best facilitate the particular procedure being performed.

[0239] like Fig.50 and Fig.51As shown, the proximal end (also referred to as the "base") of the connecting member (1830) includes a plug (1832) that is securely received in the longitudinal slot (1821) of the anvil body (1820). The plug (1832) includes a feature that provides it with a generally t-shaped profile, which is configured to match the t-shaped profile of the longitudinal slot (1821). The connecting member (1830) also includes an axially extending internal channel (1834) that communicates with the open proximal end of the connecting member (1830) and is configured to receive the proximal end of the spring plate (1840) (also referred to as the "hinge plate") therein. A retaining pin (1850) extends vertically through an opening formed in the distal end of the anvil body (1820), the connecting member plug (1832) and the proximal end of the spring plate (1840), thereby axially fixing the connecting member (1830) and the spring plate (1840) relative to the anvil body (1820).

[0240] The proximal end of the anvil tip (1822) includes a tapered protrusion (1824) that extends proximally into the internal passage (1834) of the connecting member (1830) through the open proximal end. The tapered protrusion (1824) serves as a detent feature that is configured to releasably engage the upper and lower detent recesses (1836, 1838) and an intermediate surface formed within the internal passage (1834) disposed between the upper and lower detent recesses. The tapered protrusion (1824) includes a lower knuckle (1826) that covers a cavity (1828) formed in the underside of the proximal end of the anvil tip (1822). The distal lip (1842) of the spring plate (1840) arcuately wraps over the lower knuckle (1826) and upwardly into the tip cavity (1828), thereby retaining the tapered protrusion (1824) of the anvil tip (1822) proximally within the open proximal end of the connecting member (1830) and engaging the detent recesses (1836, 1838). The distal lip (1842) also defines a transverse hinge axis about which the anvil tip (1822) articulates relative to the anvil body (1820).

[0241] The contact between the spring plate (1840) and the tapered protrusion (1824) defines a transversely extending axis about which the anvil tip (1822) is configured to be pivotally switchable between a first discrete position and a second discrete position relative to the connecting member (1830) and the anvil body (1820). Specifically, when the tapered protrusion (1824) is seated in the upper pawl recess (1836), the anvil tip (1822) exhibits a Fig.51 and Fig.52AIn contrast, when the conical protrusion (1824) is seated in the lower detent recess (1838), the anvil end (1822) exhibits a first angular discrete position. Fig.49 and Fig.52B The second straight discrete position shown. Fig.51 As shown, in this example, the lower pawl recess (1838) is recessed toward the proximal side of the upper pawl recess (1836). In addition, in some examples, Fig.51 The intermediate surface shown separating upper detent recess (1836) from lower detent recess (1838) may protrude slightly distally.

[0242] The spring plate (1840) of the present example is resilient in construction and is configured to resiliently bias the anvil tip (1822) toward a first discrete position and a second discrete position away from an intermediate position. When pivoting between the first discrete position and the second discrete position, the conical protrusion (1824) of the tip (1822) frictionally engages an intermediate inner surface of the connecting member (1830) defined between the upper and lower detent recesses (1836, 1838). This contact forces the lower knuckle (1826) to abut against the distal lip (1842) of the spring plate (1840) distally, thereby forcing the spring plate (1840) to resiliently deflect. Subsequently, the distal lip (1842) exerts a proximally directed resilient biasing force on the lower knuckle (1826), thereby pushing the conical protrusion (1824) toward one of the detent recesses (1836, 1838). Due to this resilient bias imparted by spring plate (1840), anvil tip (1822) may "snap" into place when assuming one of the first discrete position or the second discrete position.

[0243] It will be appreciated that the resilient bias imparted by spring plate (1840) is strong enough to prevent accidental switching of anvil tip (1822) during a surgical procedure, and weak enough to be easily overcome by a user when selectively adjusting anvil tip (1822). In some versions, the input "switching force" required to switch anvil tip (1822) between its discrete positions may be, for example, about 2 pounds of force. Thus, the engagement of tapered protrusion (1824) with detent recesses (1836, 1838) serves as a tip locking mechanism operable to releasably retain anvil tip (1822) in a first discrete position and a second discrete position relative to anvil body (1820).

[0244] Although the above-described retaining pin (1850) is shown as having a solid configuration, in other versions, the retaining pin (1850) may be provided with a hollow spring pin configuration. During switching of the anvil tip (1822), such a spring pin may be resiliently compressed in a radial direction, thereby allowing the spring plate (1840) to translate slightly distally relative to the connecting member (1830), and thus requiring less deflection of the distal lip (1842) of the spring plate (1840) than when using a solid spring pin (1850). The stiffness of such a spring pin may be selected to adjust the input switching force required to transition the anvil tip (1822) between the first discrete position and the second discrete position. Specifically, a spring pin of greater stiffness may produce a higher input switching force, while a spring pin of less stiffness may produce a lower input switching force.

[0245] 2. Switch end and spring plate with spring arm

[0246] As described above, the tapered proximal protrusion (1824) of the distal anvil tip (1822) is configured to contact a rigid structure defined by the inner surface of the connecting member (1830) when the tip (1822) transitions between a first discrete position and a second discrete position. Thus, the resilient biasing force applied to the anvil tip (1822) for pushing the tip (1822) toward the first discrete position and the second discrete position is applied by the distal lip (1842) of the spring plate (1840) via the lower knuckle (1826) at the distal end of the tapered protrusion (1824). In some cases, it may be desirable to reconfigure the switching assembly so that the resilient biasing force is applied at the proximal end of the tapered proximal protrusion (1824). The switching assembly described below Figures 53 to 60C An exemplary version of this configuration is shown.

[0247] Figures 53 to 60C Another exemplary anvil (1900) is shown having a tapered distal tip (1920) that is configured to be pivotally switchable between a first discrete position and a second discrete position about a transverse axis. Anvil (1900) is similar to anvil (1818) described above, except as further described below. In addition, anvil (1900) is configured for use with any of the exemplary end effectors and surgical instruments described herein. Figure 53 to Figure 54 As shown, the anvil (1900) includes a slender anvil body (1910), a connecting member (1940) fixedly connected to the distal end of the anvil body (1910), a spring plate (1970) accommodated in the connecting member (1940), a retaining pin (1916) fixing the connecting member (1940) and the spring plate (1970) relative to the anvil body (1910), and a tapered distal end (1920) movably connected to the connecting member (1940) via the spring plate (1970).

[0248] like Figure 55 to Figure 56 As shown, the anvil tip (1920) of this type has a distally tapered shape having a rounded distal end (1922), a generally convex upper surface (1924), and a generally concave lower surface (1926). The proximal end of the anvil tip (1920) includes a plurality of features that enable the tip (1920) to be coupled to the connecting member (1940) and the spring plate (1970) in the manner described below. Specifically, the proximal end of the anvil tip (1920) includes a hinge structure (1928) that is recessed below the convex upper surface (1924). A conical protrusion (1930) extends from the hinge structure (1928) in a downwardly angled direction proximally toward the concave lower surface (1926). As shown Fig.56 As shown, the proximal end of the underside of the anvil tip (1920) includes a cavity (1932) that extends upwardly at an angle through the underside of the hinge structure (1928) and toward the convex upper surface (1924). In this version, the conical protrusion (1930) and cavity (1932) are arranged along the longitudinal centerline of the anvil tip (1920). Fig.55 As shown, opening (1934) is formed in the rounded upper surface of hinge structure (1928) and communicates with cavity (1932).

[0249] like Figure 57 to Figure 58 As shown, the connecting member (1940) of this version is formed to have a cross-sectional profile that generally matches the profile of the anvil body (1910). Specifically, the connecting member (1940) includes a convex upper surface (1942) and a generally flat lower surface (1944). Fig.57 As shown, the plug (1948) protrudes proximally from the proximal side (1946) of the connecting member (1940) and includes a pair of side arms (1950) that provide the plug (1948) with a generally T-shaped profile that matches the T-shaped profile of the longitudinal knife slot (1912) of the anvil body (1910). Thus, the plug (1948) is configured to be received within the open distal end of the longitudinal slot (1912) of the anvil body (1910), such as by friction fit. The retaining post (1952) protrudes upward from the upper side of the plug (1948) and is configured to anchor the proximal tab (1976) of the spring plate (1970) to the plug (1948), as described below. In this version, the distal side of the retaining post (1952) includes a bevel that facilitates engagement of the spring plate (1970) with the post (1952) during assembly.

[0250] like Fig.58As shown, the connecting member (1940) includes an internal passage (1954) leading to a distal side (1956) of the connecting member (1940). The internal passage (1954) is configured to receive a spring plate (1970) therein, as described below. FIG. 60A to FIG. 60C As shown. Fig.57 As shown, the proximal side (1946) of the connecting member (1940) includes a window (1958) that communicates with the internal passage (1954) and is configured to receive a proximal tab (1976) of the spring plate (1970) therethrough so that the proximal tab (1976) can be coupled to the post (1952). Fig.58 As best shown, the internal channel (1954) includes a generally rectangular internal cavity (1960) configured to receive the base portion (1972) of the spring plate (1970) and is bounded by a flat support surface (1962) extending through the proximal window (1958) and configured to support the base portion (1972) thereon. The internal channel (1954) also includes a lower recess (1964) formed at the distal end of the support surface (1962) and an upper recess (1966) positioned directly above the lower recess (1964). The upper and lower recesses (1964, 1966) are configured to accommodate and define upper and lower limits of vertical movement of the proximal conical protrusion (1930) of the anvil tip (1920) within the internal channel (1954) when the anvil tip (1920) pivots between a first discrete position and a second discrete position relative to the connecting member (1940).

[0251] like Fig.59As shown, the spring plate (1970) of this version includes a base portion (1972) having a pair of laterally opposed side tabs (1974) and a proximal tab (1976) having an opening (1978). The opening (1978) is configured to receive a retaining post (1952) of the connecting member plug (1948) extending upward therethrough, thereby longitudinally fixing the spring plate (1970) relative to the connecting member (1940). The opening (1978) may also be configured to receive a lower end of a retaining pin (1916) extending downward therethrough, thereby more securely longitudinally fixing the connecting member (1940) and the spring plate (1970) relative to the anvil body (1910). The spring plate (1970) also includes a proximal spring arm (1980) that protrudes upward from a middle portion of the base portion (1972) and away from a central opening (1981) in the base portion (1972). The proximal spring arm (1980) includes a base arm section (1982) extending parallel to the base portion (1972), an intermediate arm section (1984) extending upward at an angle from the base arm section (1982), and an upper arm section (1986) extending vertically upward from the intermediate arm section (1984). As described below, the proximal spring arm (1980) is configured to be resiliently deflectable relative to the base portion (1972) to resiliently bias the proximal conical protrusion (1930) at the end of the anvil (1900) toward each of the first discrete position and the second discrete position.

[0252] Likewise Fig.59 As shown, the distal end of the spring plate (1970) includes an arcuate hinge lip (1988) bent upward from the base portion (1972). The upper end of the hinge lip (1988) includes a finger (1990) aligned with the proximal spring arm (1980) along the centerline of the spring plate (1970), and a pair of pivot guide tabs (1992) disposed along the lateral sides of the finger (1990). FIG. 60A to FIG. 60C As shown, hinge lip (1988) is configured to pivotably capture hinge structure (1928) such that finger (1990) wraps circumferentially around the distal side of hinge structure (1928) within tip cavity (1932) and extends upwardly and proximally through opening (1934). Anvil tip (1920) is thus pivotally coupled to spring plate (1970), and thus to connecting member (1940) and anvil body (1910), while being longitudinally constrained relative to anvil body (1910) by spring plate (1970).

[0253] The hinge structure (1928) of the anvil tip (1920) and the hinge lip (1988) of the spring plate (1970) extend transversely, thereby defining a hinge axis that is transverse to the longitudinal axis of the anvil body (1910). The anvil tip (1920) is configured to pivot between a first discrete position and a second discrete position about the hinge axis. In addition, the hinge lip (1988) is configured to be able to flex elastically in the proximal and distal directions and in the upward and downward directions, thereby allowing, in addition to the above-mentioned pivoting, minimal translation (or "displacement") of the anvil tip (1920) relative to the connecting member (1940) while transitioning between the first discrete position and the second discrete position.

[0254] FIG. 60A to FIG. 60C An exemplary progression of anvil tip (1920) pivoting about a transverse axis between an exemplary first discrete position and an exemplary second discrete position is shown. Fig.60A ), the anvil tip (1920) is "straight" and extends parallel to the longitudinal axis of the anvil body (1910). Fig.60C ), the anvil tip (1920) is "angled" or "bent" relative to the anvil body (1910) and extends downwardly at an angle toward a staple cartridge (not shown) opposite the end effector jaws (not shown). As described above, the straight configuration can be used to "advance" the end effector across tissue structures in a sequential stapling and cutting sequence (or "firing"), while the angled configuration can be used to collect tissue at the distal end of the end effector for a single firing of the end effector.

[0255] like Fig.60A As shown, the anvil tip (1920) is in a straight discrete position so that the proximal end of the tapered protrusion (1930) engages the lower end of the intermediate arm section (1984) of the proximal spring arm (1980). The spring arm (1980) applies a resilient biasing force against the tapered protrusion (1930) in a downwardly angled direction, thereby maintaining the anvil tip (1920) in a straight discrete position. When an external input force sufficient to overcome the biasing force is applied to the anvil tip (1920) in a downward direction, the anvil tip (1920) begins to pivot downward relative to the spring plate (1970), the connecting member (1940) and the anvil body (1910). When the anvil (1900) is outside the patient's body, the external input force can be applied by an operator, or when the anvil (1900) is inside the patient's body during a surgical procedure, by an operator against the tissue structure against which the anvil tip (1920) is positioned.

[0256] Fig.60BA tapered protrusion (1930) is shown which reaches a sharp bend between the upper arm section (1986) and the middle arm section (1984). The sharp bend acts as a "snap point" so that when going down over the joint tapered protrusion (1930), the sharp bend is pulled toward the tapered protrusion (1930) under the action of the resilient biasing force applied by the middle arm section (1984) against the tapered protrusion (1930). Fig.60C The anvil tip (1920) may be "snapped" downwardly from the position shown, thereby providing the anvil tip (1920) in a downward (or "bent") discrete position. In addition to visual observation, this snapping effect may also provide the user with an audible and / or tactile indication that the anvil tip (1920) has assumed the downwardly angled discrete position. It should be understood that a similar snapping effect may occur when the anvil tip (1920) is actuated upwardly by an external input force to transition from the downwardly angled discrete position to the straight discrete position. Upon reaching Fig.60C When in the discrete downwardly angled position shown, the upper arm section (1986) of the spring arm (1980) applies a resilient biasing force in an upward angled direction against the underside of the conical protrusion (1930), thereby maintaining the anvil tip (1920) in the discrete downwardly angled position.

[0257] like FIG. 60A to FIG. 60C As shown, the joint between the conical protrusion (1930) of the anvil tip (1920) and the spring arm (1980) of the spring plate (1970) is proximal to the transverse pivot axis defined by the proximal hinge structure (1928) and the distal hinge lip (1988). Therefore, pushing the conical protrusion (1930) upward within the internal channel (1954) of the connecting member (1940) produces a downward bias of the distal end (1922) of the anvil tip (1920) relative to the anvil body (1910). Similarly, pushing the conical protrusion (1930) upward within the internal channel (1954) produces an upward bias of the distal end (1922) of the anvil tip (1920) relative to the anvil body (1910).

[0258] The present version of the spring arm (1980) includes two upwardly extending arm segments (1984, 1986) separated by a single sharp bend, thereby defining two discrete positions of the anvil tip (1920) relative to the anvil body (1910) separated by a single "snap point" transition. The spring arm (1980) may be appropriately configured to position the "snap point" transition along the vertical dimension of the spring arm (1980) to optimize the stress in the spring plate (1970) and to adjust the kinematics of the resulting transition of the anvil tip (1920) between the first discrete position and the second discrete position. In addition, it should be understood that the spring arm (1980) may alternatively be configured in other versions having various other numbers and configurations of upwardly extending segments, each segment separated by a corresponding sharp bend that serves as a "snap point" transition, to achieve any desired number of discrete positions of the anvil tip (1920) relative to the anvil body (1910). Furthermore, the shape and stiffness of spring arms (1980) may be selected to provide a "snap-fit" of anvil tip (1920) between adjacent discrete positions in response to a predetermined external input force.

[0259] 3. Exemplary Alternative Spring Plates

[0260] In some circumstances, it may be desirable to alternatively construct one or more features of the spring plate (1970) described above to adjust various performance characteristics of the spring plate (1970); for example, to provide a unique and advantageous stress distribution within the spring plate (1970) during elastic deflection of the spring plate for a particular application. Figure 61 to Figure 66 Several exemplary alternative spring plate configurations are shown, each of which is configured for use with anvils ( 1818 , 1900 ) described above and is similar to spring plate ( 1970 ) unless otherwise noted below.

[0261] Fig.61 An exemplary spring plate (2000) is shown, comprising a base portion (2002) having a pair of side tabs (2004) and a proximal tab (2006) with an opening (2008), a proximal spring arm (2010), and a distal hinge lip (2012). In this version, the side tabs (2004) have been provided with an increased surface area relative to the spring plate (1970), the proximal tabs (2006) have been rounded, and the longitudinal side cutouts (2014) at the base of the spring arms (2010) have been lengthened in the proximal direction to promote more favorable stress distribution within the spring plate (2000) during deflection thereof. In other versions, the proximal opening (2008) may be omitted and the spring plate (2000) may be secured to the connecting member (1940) in a variety of other suitable ways that would be apparent to one of ordinary skill in the art in view of the teachings herein.

[0262] Fig.62 Another exemplary spring plate (2020) is shown, which includes a base portion (2022) having a pair of side tabs (2024) and a rounded proximal end portion (2026) with an opening (2028), a proximal spring arm (2030), and a distal hinge lip (2032). In this version, each side tab (2024) includes a fold (2034) extending transversely across the side tab (2024). The fold (2034) is configured to be elastically extendable in the longitudinal direction of the spring plate (2020), thereby enabling the spring plate (2020) to elastically extend during actuation of the anvil tip (1920) relative to the anvil body (1910), while the spring arm (2030) is also elastically deflected relative to the base portion (2022), thereby redistributing stress within the spring plate (2020).

[0263] Fig.63 Another exemplary spring plate (2040) is shown, which includes a base portion (2042), a proximal spring arm (2048), and a distal hinge lip (2050), wherein the base portion has a pair of side tabs (2044) and a rounded proximal end portion (2046). Similar to the spring plate (2020), each side tab (2044) of the spring plate (2040) includes an elastic pleat (2052), but the pleats (2052) are taller than the pleats (2034) of the spring plate (2020).

[0264] Fig.64 Another exemplary spring plate (2060) is shown, which includes a base portion (2062) having a pair of side tabs (2064) and a rounded proximal end portion (2066). Similar to the spring plate (2040), each side tab (2064) of the spring plate (2060) includes a resilient pleat (2070) of increased height relative to the pleats (2034) of the spring plate (2020). Each pleat (2070) also includes a flat top surface (2072). The proximal spring arm is omitted from the spring plate (2060), and the tapered proximal protrusion (1930) of the anvil tip (1920) is instead configured to frictionally engage one or more inner surfaces of the connecting member (1940) to present a first discrete position and a second discrete position, such as a configuration similar to that described above in conjunction with the anvil (1818).

[0265] Fig.65Another exemplary spring plate (2080) is shown, which includes a base portion (2082) having a pair of side tabs (2084) and a proximal tab (2086) with an opening (2088), a proximal spring arm (2090), and a distal hinge lip (2092). In this version, the base portion (2080) has been extended relative to the base portion (1972) of the spring plate (1970). As shown in FIG. Fig.66 As shown in the schematic diagram of , this extension of the base portion (2082) separates the distal hinge lip (2092) from the spring arm (2090) by a greater distal distance. This configuration enables the distal hinge lip (2092) to be slightly flexed upward relative to the base portion (2082) and the proximal end of the spring arm (2090). Therefore, compared to the corresponding relationship of the spring plate (1970), during the transition of the terminal position along the vector (V) that is more parallel to the longitudinal axis of the base portion (2082) and the anvil body (1910), the tapered protrusion (1930) of the spring arm (2090) and the anvil end (1920) exerts an interaction force on each other. Such a configuration can promote a more favorable stress distribution within the spring arm (2090).

[0266] 4. Exemplary Additional Features for Switching Tips

[0267]

[00106] In some circumstances, it may be desirable to provide anvil tip (1920) with exemplary alternative features that improve various aspects of its use during a surgical procedure. Fig.67 An anvil body (1910) and a connecting member (1940) equipped with an exemplary alternative distal end (2100) are shown. The anvil end (2100) is similar to the anvil end (1920) described above, except that the anvil end (2100) has a proximal corner (2102) that is positioned adjacent to and directly facing the distal side of the connecting member (1940). Therefore, this configuration minimizes the size of the longitudinal gap between the proximal end of the anvil end (2100) and the distal end of the connecting member (1940). Advantageously, this gap minimization reduces the risk of tissue being stuck in the gap during the switching of the anvil end (2100) relative to the connecting member (1940), which may otherwise cause undesirable trauma to the tissue during surgery.

[0268] Fig.68Another exemplary alternative anvil tip (2110) is shown that is configured for use with anvil (1900) in place of anvil tip (1920). Anvil tip (2110) is similar to anvil tip (1920), except that anvil tip (2110) includes an inner core member (2112) and a polymer jacket (2114) overmolded on the inner core member (2112) to define the same general shape as anvil tip (1920). The polymer jacket (2114) may be formed of, for example, silicone, and may provide enhanced flexibility to tip (2100) and a resulting more atraumatic configuration relative to anvil tip (1920).

[0269] 5. Switchable end unit with integrated living hinge

[0270] In some circumstances, it may be desirable to form the anvil tip (1920) and connecting member (1940) as a single integral component attachable to the anvil body (1910) while still enabling the anvil tip (1920) to pivot relative to the connecting member (1940) between a first discrete position and a second discrete position. Figures 69 to 70B An exemplary switching terminal unit (2200) showing such a configuration is shown. Specifically, the terminal unit (2200) includes a proximal connection portion (2210) and a distal terminal portion (2220) configured to be pivotable relative to the proximal connection portion (2210) via a living hinge (2202) integrally formed between the proximal connection portion and the distal terminal portion.

[0271] Fig.70A The end unit (2200) is shown in a pre-assembled state, wherein the first section (2212) of the connecting portion (2210) is located in the same plane as the second section (2214) of the connecting portion (2210) to which the first section (2212) is hingedly connected. FIG. 70A to FIG. 70BAs shown, the first section (2212) is flipped over the hinge connection to cooperate with the top side of the second section (2214) to capture the upward projection (2222) formed at the proximal end of the terminal portion (2220) in the cavity (2230) formed between the first and second connection sections (2212, 2214). The terminal portion (2220) is then able to selectively pivot between a first discrete position and a second discrete position about the living hinge (2202) relative to the connection portion (2210). Specifically, the top wall of the cavity (2230) defined by the first section (2212) includes a proximal detent recess (2232) and a distal detent recess (2234) that are configured to releasably capture the upward projection (2222) of the terminal portion (2220) therein. Positioning the upward projection (2222) within the proximal detent recess (2232) provides the end portion (2220) in a straight configuration relative to the connecting portion (2210). Positioning the upward projection (2222) within the distal detent recess (2232) provides the end portion (2220) in a downwardly angled position, such as Fig.69 and Fig.70B shown.

[0272] V. Exemplary Combinations

[0273] The following examples relate to various non-exhaustive ways in which the teachings herein may be combined or applied. It should be understood that the following examples are not intended to limit the coverage of any claims that may be provided at any time in this patent application or in the subsequent submissions of this patent application. It is not intended to make a disclaimer. The following examples are provided only for illustrative purposes. It is expected that the various teachings herein may be arranged and applied in a variety of other ways. It is also contemplated that some variations may omit certain features mentioned in the following examples. Therefore, any of the aspects or features mentioned below should not be considered decisive, unless otherwise, for example, by the inventor or the successor of the inventor concerned clearly indicates so at a later date. If any claim proposed in this patent application or in the subsequent submissions related to this patent application includes additional features other than those mentioned below, these additional features should not be assumed to be added for any reason related to patentability.

[0274] Example 1

[0275] A surgical instrument end effector comprises: (a) a first jaw, which is configured to receive a nail magazine; (b) a second jaw, which includes an anvil having a plurality of nail forming recesses, wherein the first jaw and the second jaw are operable to clamp and suturing tissue positioned between the first jaw and the second jaw; and (c) an end member, which is movably disposed at a distal end of the anvil, wherein the end member is configured to be switchable between a first discrete position and a second discrete position relative to the anvil, wherein the end member is angularly oriented toward the first jaw when in the first discrete position, and wherein the end member is angularly oriented away from the first discrete position when in the second discrete position.

[0276] Example 2

[0277] An end effector of a surgical instrument according to Example 1, wherein the anvil defines a longitudinal axis, and wherein the end member is configured to extend parallel to the longitudinal axis at the second discrete position.

[0278] Example 3

[0279] A surgical instrument end effector according to any of the preceding embodiments, wherein the tip member is movable relative to the anvil about a transverse axis between the first discrete position and the second discrete position.

[0280] Example 4

[0281] A surgical instrument end effector according to any of the aforementioned embodiments, wherein the end member is configured to be maintained in each of the first discrete position and the second discrete position independently of an external input force.

[0282] Example 5

[0283] A surgical instrument end effector according to any of the aforementioned embodiments, wherein the proximal end of the end member includes a tapered protrusion, wherein the tapered protrusion is capable of moving between the first discrete position and the second discrete position relative to the anvil.

[0284] Example 6

[0285] The surgical instrument end effector according to any of the aforementioned embodiments further includes an elastic member configured to bias the end member toward each of the first discrete position and the second discrete position.

[0286] Example 7

[0287] An end effector of a surgical instrument according to Example 6, wherein the elastic member is configured to longitudinally constrain the end member relative to the anvil while allowing the end member to move between the first discrete position and the second discrete position relative to the anvil.

[0288] Example 8

[0289] An end effector of a surgical instrument according to any one of embodiments 6 to 7, wherein the end member is pivotally connected to the distal end of the elastic member, wherein the end member is capable of pivoting relative to the elastic member between the first discrete position and the second discrete position.

[0290] Example 9

[0291] A surgical instrument end effector according to any one of embodiments 6 to 8, wherein the end member includes a cavity, wherein the distal end of the elastic member is received in the cavity.

[0292] Example 10

[0293] A surgical instrument end effector according to any one of embodiments 6 to 9, wherein the elastic member includes a spring arm, and wherein the proximal end of the end member is configured to engage a first portion of the spring arm when in the first discrete position and to engage a second portion of the spring arm when in the second discrete position.

[0294] Embodiment 11

[0295] An end effector of a surgical instrument according to any one of embodiments 6 to 10, wherein the proximal end of the elastic member is longitudinally fixed relative to the anvil.

[0296] Example 12

[0297] The surgical instrument end effector according to any one of embodiments 6 to 11 also includes a connecting member, which connects the end member to the anvil body, wherein the elastic member is at least partially accommodated in the connecting member.

[0298] Embodiment 13

[0299] A surgical instrument end effector according to Example 12, wherein the connecting member includes an internal channel, wherein the proximal end of the terminal member is movably received in the internal channel.

[0300] Embodiment 14

[0301] The surgical instrument end effector according to any of the aforementioned embodiments further includes a connecting member, which connects the end member to the anvil body, wherein the connecting member includes an internal channel, which movably receives the proximal end of the end member therein.

[0302] Embodiment 15

[0303] A surgical instrument comprises: (a) a body; (b) a shaft extending distally from the body; and (c) an end actuator according to any one of the aforementioned embodiments, wherein the end actuator is disposed at the distal end of the shaft.

[0304] Example 16

[0305] A surgical instrument end effector comprises: (a) a first jaw, which is configured to receive a nail magazine; (b) a second jaw, which includes an anvil having a plurality of nail forming recesses, wherein the first jaw and the second jaw are operable to clamp and suturing tissue positioned between the first jaw and the second jaw; and (c) an end member, which is movably disposed at the distal end of the anvil, wherein the end member is capable of moving between a first discrete position and a second discrete position around a transverse axis relative to the anvil, wherein the end member is configured to remain in the first discrete position when in the first discrete position until acted upon by an external input force, and wherein the end member is configured to remain in the second discrete position when in the second discrete position until acted upon by an external input force.

[0306] Embodiment 17

[0307] A surgical instrument end effector according to Example 16, wherein the proximal end of the terminal member includes a protrusion, wherein the protrusion is capable of moving between the first discrete position and the second discrete position relative to the anvil.

[0308] Embodiment 18

[0309] The surgical instrument end effector according to any one of embodiments 16 to 17 also includes an elastic member, which is configured to bias the end member toward each of the first discrete position and the second discrete position.

[0310] Embodiment 19

[0311] An anvil constructed for use with an end effector of a surgical instrument comprises: (a) an anvil body; (b) a plurality of nail forming recesses disposed on the anvil body; (c) an end member movably connected to a distal end of the anvil body, wherein the end member is capable of moving between a first discrete position and a second discrete position relative to the anvil body; and (d) an elastic member, wherein the elastic member is constructed to be capable of releasably holding the end member in the first discrete position when the end member is in the first discrete position, and to releasably hold the end member in the second discrete position when the end member is in the second discrete position.

[0312] Embodiment 20

[0313] The anvil according to Example 19, wherein the resilient member is configured to at least partially longitudinally constrain the end member relative to the anvil body while allowing the end member to pivot relative to the anvil body.

[0314] VI. Miscellaneous

[0315] It should be understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein may be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Therefore, the above teachings, expressions, embodiments, examples, etc. should not be considered isolated from each other. Various suitable ways in which the teachings herein can be combined will be apparent to those of ordinary skill in the art based on the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.

[0316] In addition, any one or more of the teachings herein may be combined with any one or more of the teachings disclosed in the following patent applications: U.S. Patent Application [Agent Docket No. END9103USNP1], entitled "Surgical Stapler with Deflectable Distal Tip," filed on the same date as the present application; and / or U.S. Patent Application [Agent Docket No. END9103USNP2], entitled "Surgical Stapler with Rotatable Distal Tip," filed on the same date as the present application. The disclosures of each of these U.S. patent applications are incorporated herein by reference.

[0317] It should also be understood that the teachings herein can be readily combined with the various teachings of the following U.S. patent applications: U.S. Patent D836,198, published on December 18, 2018, entitled “Surgical Stapler End Effector with Varying Deck Height and Tissue Gripping Features”; U.S. Patent D833,010, published on November 6, 2018, entitled “Circular Surgical Stapler End Effector with Varying Deck Height and Tissue Gripping Features”; U.S. Patent Publication 2018 / 0235610, published on August 23, 2018, entitled “Surgical Stapler with Insertable Distal Anvil Tip”; U.S. Patent Publication 2018 / 0235611, published on August 23, 2018, entitled “Surgical Stapler with Cooperating DistalTip Features on Anvil and Staple Cartridge”; U.S. Patent Publication 2018 / 0235612, published on December 18, 2018, entitled “Surgical Stapler U.S. Patent No. D836,199 entitled “Surgical Stapler with Bent Anvil Tip and Angled Staple Cartridge Tip”; U.S. Publication No. 2018 / 0235619 entitled “Surgical Stapler with Bent Anvil Tip, Angled Staple Cartridge Tip, and Tissue Gripping Features” published on August 23, 2018; U.S. Patent Publication No. 2019 / 0000481 entitled “Method of Surgical Stapling with End Effector Component Having a Curved Tip” published on January 3, 2019; U.S. Patent Application No. 16 / 235,617 entitled “Method of Applying Buttresses to Surgically Cut and Stapled Sites” filed on December 28, 2018;U.S. Patent Application No. 16 / 035,872, filed on July 16, 2018, entitled “Permanent Attachment Means for Curved Tip of Component of Surgical Stapling Instrument”; U.S. Patent Application No. 16 / 035,803, filed on July 16, 2018, entitled “Surgical Stapling End Effector Component with Deformable Tip Having Void”; U.S. Patent Application No. 16 / 035,821, filed on July 16, 2018, entitled “Surgical Stapling End Effector Component with Deformable Tip Skewing in Multiple Planes”; U.S. Patent Application No. 16 / 035,825, filed on July 16, 2018, entitled “Surgical Stapling End Effector Componentwith Articulation and Asymmetric Deformable Tip”; U.S. Patent Application No. 16 / 035,830, filed on July 16, 2018, entitled “Surgical Stapling End Effector Componentwith Articulation and Asymmetric Deformable Tip”; U.S. Patent Application No. 16 / 035,873, filed on July 16, 2018, entitled “Permanent Attachment Means for Curved Tip of Component of Surgical Stapling U.S. Patent Application No. 16 / 035,831, entitled “Instrument”; U.S. Patent Application No. 16 / 035,834, entitled “Buttress Applier Cartridge for Surgical Stapler Having End Effector with Deflectable Curved Tip”, filed on July 16, 2018. Various suitable ways in which the teachings herein can be combined with the teachings of the above-mentioned U.S. patents, U.S. patent publications, and U.S. patent applications will be apparent to those of ordinary skill in the art. The disclosures of each of the above-cited U.S. patents, U.S. patent publications, and U.S. patent applications are incorporated herein by reference.;

[0318] It should be understood that any patent, patent publication, or other public material, whether in whole or in part, allegedly incorporated herein by reference is incorporated herein only to the extent that the incorporated material does not conflict with existing definitions, statements, or other public materials described in the present disclosure. Therefore, and to the extent necessary, the disclosure explicitly listed herein supersedes any conflicting material incorporated herein by reference. Any material or portion thereof allegedly incorporated herein but conflicting with existing definitions, statements, or other public materials listed herein will be incorporated only to the extent that there is no conflict between the incorporated material and the existing public materials.

[0319] The above-described device versions may be used in conventional medical treatments and surgeries performed by medical professionals, as well as robotic-assisted medical treatments and surgeries. By way of example only, the various teachings herein may be readily incorporated into a robotic surgical system, such as the DAVINCI® by Intuitive Surgical, Inc. (Sunnyvale, California). TM system.

[0320] The devices of the types described above can be designed to be discarded after a single use, or they can be designed to be reusable. In either case or both, these types can be repaired to be reused after at least one use. Repair can include any combination of the following steps: disassembling the device, then cleaning or replacing specific parts and subsequently reassembling. Specifically, some types of devices can be disassembled, and any number of specific parts or parts of the device can be selectively replaced or removed in any combination. When cleaning and / or replacing specific parts, some types of the device can be reassembled at a repair facility or reassembled by the user before surgery is about to be performed for subsequent use. Those skilled in the art will appreciate that the repair of the device can be disassembled, cleaned / replaced, and reassembled using a variety of techniques. The use of such technology and the resulting repair device are all within the scope of the present application.

[0321] By way of example only, the types described herein may be sterilized before and / or after surgery. In one sterilization technique, the device is placed in a closed and sealed container such as a plastic bag or a TYVEK bag. The container and device may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation may kill bacteria on the device and in the container. The sterilized device may then be stored in a sterile container for later use. The device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.

[0322] Various embodiments of the present invention have been shown and described, and further improvements of the methods and systems described herein may be achieved by appropriate modifications by those of ordinary skill in the art without departing from the scope of the present invention. Several such possible modifications have been mentioned, and other modifications will be apparent to those of skill in the art. For example, the embodiments, embodiments, geometries, materials, dimensions, ratios, steps, etc. discussed above are illustrative and not required. Therefore, the scope of the present invention should be considered in light of the following claims, and should be understood not to be limited to the details of the structure and operation shown and described in the specification and drawings.

Claims

1. A surgical instrument end effector, comprising: (a) a first jaw configured to receive a staple cartridge; (b) a second jaw comprising an anvil body having a plurality of staple forming pockets, wherein the first jaw and the second jaw are operable to clamp and staple tissue positioned between the first jaw and the second jaw; as well as (c) an end member movably disposed distally of a distal end of the anvil body, wherein the end member is configured to be pivotally switchable between a first discrete position and a second discrete position about a transverse axis relative to the anvil so that a conical protrusion disposed at a proximal end of the end member is movable relative to the distal end of the anvil body while the end member is maintained longitudinally constrained relative to the anvil body, wherein the end member is angularly oriented toward the first jaw when in the first discrete position, Wherein the end member is oriented away from the first discrete position when in the second discrete position.

2. The surgical instrument end effector according to claim 1, wherein: The anvil body defines a longitudinal axis, wherein the tip member is configured to extend parallel to the longitudinal axis at the second discrete position.

3. The surgical instrument end effector according to claim 1, wherein: The end member is configured to be retainable in each of the first discrete position and the second discrete position independent of an external input force.

4. The surgical instrument end effector according to claim 1 further includes an elastic member configured to exert a biasing force on the end member, thereby biasing the end member toward each of the first discrete position and the second discrete position.

5. The surgical instrument end effector according to claim 4, wherein: The resilient member is configured to longitudinally constrain the tip member relative to the anvil body while allowing the tip member to move relative to the anvil body between the first discrete position and the second discrete position.

6. The surgical instrument end effector according to claim 4, wherein: The tip member is pivotably coupled to a distal end of the resilient member, wherein the tip member is pivotable relative to the resilient member between the first discrete position and the second discrete position.

7. The surgical instrument end effector according to claim 4, wherein: The tip member includes a lumen, wherein a distal end of the resilient member is received within the lumen.

8. The surgical instrument end effector according to claim 4, wherein: The resilient member includes a spring arm, wherein the proximal end of the tip member is configured to engage a first portion of the spring arm when in the first discrete position and to engage a second portion of the spring arm when in the second discrete position.

9. The surgical instrument end effector according to claim 4, wherein: The proximal end of the resilient member is longitudinally fixed relative to the anvil body.

10. The end effector of a surgical instrument according to claim 4, further comprising a connecting member, which connects the end member to the anvil body, wherein the elastic member is at least partially accommodated in the connecting member, and wherein the connecting member includes an internal channel for movably receiving the conical protrusion of the end member.

11. A surgical instrument comprising: (a) the subject; (b) a shaft extending distally from the body; as well as (c) An end effector according to claim 1, wherein the end effector is disposed at the distal end of the shaft.

12. A surgical instrument end effector, comprising: (a) a first jaw configured to receive a staple cartridge; (b) a second jaw comprising an anvil body having a plurality of staple forming pockets, wherein the first jaw and the second jaw are operable to clamp and staple tissue positioned between the first jaw and the second jaw; (c) a structure located distal to the plurality of staple forming recesses and defining an interior space; as well as (d) an end member pivotably disposed distally of the anvil body, wherein the end member is pivotable relative to the anvil body about a transverse axis between a first discrete position and a second discrete position such that a protrusion at a proximal end of the end member is movably positioned within the interior space, wherein the end member is configured to be able to remain in the first discrete position when in the first discrete position until subjected to an external input force, The end member is configured to be able to remain in the second discrete position when in the second discrete position until being acted upon by an external input force.

13. The surgical instrument end effector of claim 12, further comprising a resilient member configured to bias the tip member toward each of the first discrete position and the second discrete position.

14. An anvil configured for use with an end effector of a surgical instrument, comprising: (a) anvil body; (b) a plurality of nail forming recesses, the plurality of nail forming recesses being disposed on the anvil body; (c) an end member movably coupled to a distal end of the anvil body, wherein the end member is movable relative to the anvil body between a first discrete position and a second discrete position; as well as (d) an elastic member separate from the end member and configured to apply a biasing force on the end member, wherein the elastic member is configured to releasably hold the end member in the first discrete position when the end member is in the first discrete position, and to releasably hold the end member in the second discrete position when the end member is in the second discrete position.

15. An anvil according to claim 14, wherein: The resilient member is configured to at least partially longitudinally constrain the tip member relative to the anvil body while allowing the tip member to pivot relative to the anvil body.

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