Method of surgical stapling with end effector component having arcuate tip

Abstract

A method of surgical stapling using a surgical instrument operable to compress, staple, and cut tissue is disclosed. The instrument includes a body, a shaft, and an end effector having a pair of jaws. The placement tip extends distally from one of the jaws of the end effector. When clamping force is applied to the placing tail end, the placing tail end can elastically deform. In some cases, the placement tip includes an arcuate bend, while in other cases, the placement tip is straight. The placement tip may have various non-rectangular lateral cross-sectional shapes. In some cases, the placement tip is made of a material having a specified range of hardness and having a high color contrast. A distal end of the placement tip may change position based on a deflected state of the placement tip in response to the clamping force.

Description

[0001] This invention application is a divisional application of the invention patent application filed on July 12, 2019, with application number 201980060390.2 and invention name “Method for surgical suturing using an end actuator component with an arc-shaped end” (based on PCT international application No. PCT / IB2019 / 055984).

[0002] priority

[0003] This patent application is a continuation-in-part of U.S. non-provisional patent application serial number 15 / 435,573, entitled “SURGICAL STAPLER WITH ELASTICALLY DEFORMABLE TIP,” filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Background Art

[0004] 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.

[0005] 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 disclosure of each of the above-referenced U.S. patents and U.S. patent publications is incorporated herein by reference. ;

[0006] 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.

[0007] 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

[0008] 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.

[0009] Figure 1 shows a perspective view of an exemplary articulating surgical stapling instrument;

[0010] Figure 2 Shows Figure 1 A side view of the device;

[0011] Figure 3 Shows Figure 1 A perspective view of an end effector opened in an instrument;

[0012] 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;

[0013] 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;

[0014] Figure 5 Depicted Figure 3 The end effector along Figure 3 an end cross-sectional view taken along line 5-5 of ;

[0015] Figure 6 Depicted Figure 3 An exploded perspective view of an end effector;

[0016] Figure 7 Depicted Figure 3 A perspective view of an end effector positioned at tissue and having been actuated once in the tissue;

[0017] Figure 8 depicts a perspective view of an alternative version of an end effector having an angled anvil and an angled cartridge;

[0018] Fig. 9 Depicted Figure 8 An enlarged side view of an end effector;

[0019] Fig.10 Depicted Figure 8 An enlarged top view of the end effector;

[0020] Fig.11 shows a perspective view of an exemplary surgical stapling instrument having an end effector with a curved or angled elastically deformable end segment;

[0021] Fig. 12A Shows Fig.11 An enlarged side view of a distal portion of an end effector;

[0022] Fig. 12B Shows something like Fig.11 An enlarged side view of a distal portion of an alternative end effector of the end effector;

[0023] Fig.13 Shows Fig.11 a bottom view of a distal portion of an end effector of , wherein the cartridge is shown in phantom to illustrate an underside surface of an anvil;

[0024] Fig.14 Shown along Fig.13 The line 14-14 is intercepted Fig.11 a side cross-sectional view of a distal portion of an end effector of;

[0025] Fig.15 Shows Fig.11 The anvil of the end effector is along Fig.13 an end cross-sectional view taken along line 15-15 of ;

[0026] Fig.16 an enlarged side view of a distal portion of an alternative version of an end effector shown in an open position and having an upper jaw with a placement tip forming a first angle with a longitudinal axis of the upper jaw;

[0027] Fig.17 Shows Fig.16 an enlarged side view of a distal portion of an end effector of , shown in a closed position and having a placement tip forming a second angle with the longitudinal axis of the upper jaw;

[0028] Fig.18 an enlarged side view of a distal portion of an alternative version of an end effector shown in a closed and unloaded position and having an upper jaw with a placement tip forming a first angle with a nose portion of a lower jaw;

[0029] Fig.19 Shows Fig.18 an enlarged side view of a distal portion of an end effector of , shown in a closed and loaded position and having a placement tip forming a second angle with a nose portion of a lower jaw;

[0030] Fig. 20 An enlarged side view of a distal portion of an alternative version of an end effector is shown in a closed position with the distal end of the placement tip of the upper jaw positioned relative to the platform and distal end of the lower jaw;

[0031] Fig.21 An enlarged side view of a distal portion of an alternative version of an end effector is shown in a closed position and having a zone defined by a lower jaw with a distal end of a placement tip of an upper jaw located in a first zone;

[0032] Fig.22A An enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the placement tip of the upper jaw positioned as shown. Fig.21 In the third zone shown;

[0033] Fig. 22B An enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the arcuate placement tip of the upper jaw positioned as shown. Fig.21 In the third zone shown;

[0034] Fig. 22CAn enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the placement tip of the upper jaw positioned as shown. Fig.21 In the fourth zone shown;

[0035] Fig.22D An enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the arcuate placement tip of the upper jaw positioned as shown. Fig.21 In the fifth zone shown;

[0036] Fig.22E An enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the placement tip of the upper jaw positioned as shown. Fig.21 In the sixth zone shown;

[0037] Fig.22F An enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the multi-angle placement tip of the upper jaw positioned as shown. Fig.21 In the sixth zone shown;

[0038] Figure 22G An enlarged side view of the distal portion of an alternative version of an end effector is shown in a closed position and with the distal end of the placement tip of the upper jaw positioned as shown. Fig.21 In the third zone shown, and the placement tip is configured to have a profile of an underside surface corresponding to the tapered profile of the lower jaw nose portion;

[0039] Fig.23A shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with a rounded profile;

[0040] Fig. 23B shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with an angled and pointed profile;

[0041] Fig.23C shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with a toothed profile;

[0042] Fig.23D shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with a flared profile;

[0043] Fig.23E shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with a spherical profile;

[0044] Fig.23F shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with an asymmetrical profile;

[0045] Fig.24A shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a width with an angled profile;

[0046] Fig. 24B shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a width with a stepped profile;

[0047] Fig.24C shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a width with an asymmetrical profile;

[0048] Fig.24D shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a width with a centrally scalloped tip profile;

[0049] Fig.24E shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a width with a ridged profile;

[0050] Fig.25 shows an enlarged top view of an alternative version of a placement tip of an end effector, wherein the placement tip has a distal end with an angled and pointed profile, and wherein the placement tip has a width with an angled profile;

[0051] Fig.26A An enlarged side view of a distal portion of an alternative version of an end effector is shown in which the placement tip of the upper jaw has an underside surface having a flat profile parallel to the profile of the nose portion of the lower jaw;

[0052] Fig.26B An enlarged side view of a distal portion of an alternative version of an end effector is shown, wherein the placement tip of the upper jaw has an underside surface with a curved profile;

[0053] Fig.26C An enlarged side view of a distal portion of an alternative version of an end effector is shown in which the straight-lying tip of the upper jaw has an underside surface with a flat profile;

[0054] Fig.26D An enlarged side view of a distal portion of an alternative version of an end effector is shown, wherein the placement tip of the upper jaw has an underside surface with a multi-angle profile;

[0055] Fig.26EAn enlarged side view of a distal portion of an alternative version of an end effector is shown, wherein the placement tip of the upper jaw has an underside surface with an arcuate member and is shown with the placement tip in a dual position;

[0056] Fig.27A An enlarged side view of a distal portion of an alternative version of an end effector is shown showing a gap between a placement tip of the upper jaw and a nose portion of the lower jaw;

[0057] Fig.27B An enlarged side view of the distal portion of an alternative version of the end effector is shown, showing the Fig.27A a gap compared to a smaller gap between a distal end of the placement tip of the upper jaw and a nose portion of the lower jaw;

[0058] Fig.28 showing an enlarged perspective view of a distal portion of the jaws of an alternative version of the end effector;

[0059] Fig.29 Shows Fig.28 Top view of the jaws;

[0060] Fig. 30A Shows a section taken along line A-A Fig.29 A front cross-sectional view of the jaws;

[0061] Fig. 30B Shows a view taken along line B-B Fig.29 A front cross-sectional view of the jaws;

[0062] Fig.31A Shows something like Fig.29 A front cross-sectional view of an alternative jaw of the jaws and taken along line A-A;

[0063] Fig.31B Shown along Fig.29 The line B-B intercepts Fig.31A Another front cross-sectional view of an alternative jaw;

[0064] Fig.32A Shows a similar image taken along line A-A Fig.29 A front cross-sectional view of an alternative jaw type of jaws;

[0065] Fig.32B Shown along Fig.29 The line B-B intercepts Fig.32A Another front cross-sectional view of an alternative jaw;

[0066] Fig.33A Shows a similar image taken along line A-A Fig.29 A front cross-sectional view of an alternative jaw type of jaws;

[0067] Fig.33B Shown along Fig.29 The line B-B intercepts Fig.33A Another front cross-sectional view of an alternative jaw;

[0068] Fig.34A Shows a similar image taken along line A-A Fig.29 A front cross-sectional view of an alternative jaw type of jaws;

[0069] Fig.34B Shown along Fig.29 The line B-B intercepts Fig.34A Another front cross-sectional view of an alternative jaw;

[0070] Fig.35 an enlarged perspective view of a distal portion of the jaws of an alternative version of an end effector showing a high contrast placement tip;

[0071] Fig.36 shows an enlarged side view of a distal portion of an alternative form of an end effector having a straight placement tip;

[0072] Fig.37 shows an enlarged side view of a distal portion of an alternative form of an end effector having a straight placement tip with a tapered portion;

[0073] Fig.38 Shows that it is possible to Fig.36 and Fig.37 an enlarged top view of an anvil and a distal portion of a placement tip used with an end effector; and

[0074] Fig.39 Shows that it is possible to Fig.36 and Fig.37 An enlarged top view of another exemplary anvil and distal portion of the placement tip for use with an end effector.

[0075] 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

[0076] 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.

[0077] I. Exemplary Surgical Stapler

[0078] Figure 1-7 An exemplary surgical stapling and severing instrument (10) is depicted. Figure 1 In the non-articulated state depicted in FIG, the instrument (10) is sized to be inserted through a cannula of a trocar into a surgical site of a patient in order to perform a surgical procedure. By way of example only, such a trocar may 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) may be inserted directly 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 distally in an articulation joint (11), which is further coupled to an end effector (12). It should be understood that terms such as "proximal" and "distal" used herein refer to the handle portion (20) of the instrument (10) gripped by a clinician. 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, spatial terms such as "vertical", "horizontal", "upper" and "lower" are used herein relative to the accompanying drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

[0079] 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 Oct. 24, 2017, the disclosure of which is incorporated herein by reference. Other suitable configurations of shaft (22) will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0080] 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).

[0081] 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.

[0082] The end effector (12) of the present example includes a lower jaw (16) and a pivotable anvil (18). In the present example, the anvil (18) may also be considered as an upper jaw. In addition, in some versions, such as the present example, the upper jaw or anvil (18) pivots relative to the fixed lower jaw (16); however, in some other versions, the upper jaw or anvil (18) is fixed and the lower jaw (16) pivots. In some versions, the lower jaw (16) is constructed according to at least some of the teachings of the following U.S. patents: U.S. Patent No. 9,808,248, entitled "Installation Features for Surgical Instrument End Effector Cartridge", published 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 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 at least some of the teachings of U.S. Publication No. 2014 / 0239037, entitled "Staple Forming Features for Surgical Stapling Instrument," published on August 28, 2014, 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 view of the teachings herein.

[0083] 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).

[0084] 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).

[0085] Figure 3-6 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 Figures 4A-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.

[0086] 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.

[0087] Figure 3 The 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). Figure 5-6 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 6As 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 ).

[0088] 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, 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. 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, entitled “Installation Features for Surgical Instrument End Effector Cartridge,” published on November 7, 2017, 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 view of the teachings herein.

[0089] 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 4BThe 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 5 The anvil (18) is intentionally omitted from the view.

[0090] 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 ...

[0091] 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 7No 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.

[0092] In one form, 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 the following U.S. publication: 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 view of the teachings herein. It should also be understood that some other versions may provide manual drive 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.

[0093] 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.

[0094] 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.

[0095] 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.

[0096] 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 U.S. Patent 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. 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, 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. With reference 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.

[0097] II. Exemplary End Effectors with Visualization, Introduction, and Collection Features

[0098] 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).

[0099] 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).

[0100] 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).

[0101] 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 further distally in the longitudinal direction than the chamber (237). 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 at an angle. 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, such as a large blood vessel, toward the proximal side when the anvil (218) is closed toward the lower jaw (216) into the space between the anvil (218) and 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) with reference to the teachings of this article.

[0102] 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).

[0103] 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. A person of ordinary skill in the art can readily envision other suitable angles for the viewing angle (θ) with reference to 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).

[0104] 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, the user can more easily push the end effector (212) through the 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. In view of the teachings herein, 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.

[0105] 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”, 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”, published on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Publication No. 2014 / 0239037, entitled “Staple Forming Features for Surgical Stapling Instrument”, published on August 28, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,795,379, entitled “Surgical Instrument with Multi-Diameter Shaft”, published 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”, published 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”, published on April 18, 2017, the disclosure of which is incorporated herein by reference; U.S. Publication No. 2014 / 0239037, entitled “Staple Forming Features for Surgical Stapling Instrument”, published on August 28, 2014, 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.

[0106] III. Exemplary End Effectors Having Curved or Angled Elastically Deformable Anvil Tips

[0107] 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.

[0108] 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).

[0109] 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 deflect away from the lower jaw in response to a sufficient load on the distal tip. In view of 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.

[0110] 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 U.S. Publication 2017 / 086823, entitled "Surgical Stapling Instrument with Shaft Release, Powered Firing, and Powered Articulation," published on March 30, 2017, the disclosure of which is incorporated herein by reference. In view of the teachings herein, 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. Furthermore, in view of the teachings herein, 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.

[0111] 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 capable of elastic deformation. 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).

[0112] 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 view of 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.

[0113] 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 capable of elastic deformation. 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 capable of elastic deformation. 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.

[0114] 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.

[0115] 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).

[0116] 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.

[0117] A. Overmolded anvil tip

[0118] Figures 13 to 15 An enlarged distal view of end effector (312) is shown to illustrate an exemplary configuration. Figures 13 to 15 The construction shown in also applies to Fig. 12B , except for the difference in length of the anvil (318) mentioned above. Fig.13 As shown in the top view of FIG. , the end effector (312) includes an anvil (318) wherein the distal end (319) includes a rigid portion (326) and a deflectable portion (328). In this example, the deflectable portion (328) is overmolded onto the rigid portion (326) to form the distal end (319) of the anvil (318). Fig.13In the illustrated example, the outline of the cartridge (37) is shown in dashed lines to show the underside surface (324) of the anvil (318). The rigid portion (326) of the distal end (319) extends from the body (330) of the anvil (318). In the present example, the body (330) is made of metal, and the rigid portion (326) is an extension of the metal body (330) into the distal end (319). In other embodiments, the body (330) and / or the rigid portion (326) may be made of materials other than metal, including but not limited to plastics, ceramics, combinations of metals and plastics or ceramics, and other suitable materials or combinations of materials, which are apparent to those of ordinary skill in the art in view of the teachings herein. Additionally, the rigid portion (326) is completely rigid in some embodiments, but in other embodiments, the degree of elasticity of the rigid portion (326) may be lower than that of the deflectable portion (328).

[0119] exist Fig.13 and Fig.14 In the illustrated embodiment of the present invention, the metal portion (326) includes a generally flat or planar lower side surface (332) and a similarly generally flat or planar top surface (334). The metal portion (326) also includes an opening (336) extending from the top surface (334) through the metal portion (326) to the lower side surface (332). Additionally, the metal portion (326) includes a neck region (338), a head region (340) extending distally from the neck region (338), and a shoulder (342) at the transition between the neck region (338) and the head region (340). In this example, the neck region (338) extends from the body (330) of the anvil (318). With this arrangement, the metal portion (326) provides securing features or interfaces, such as opening (336) and shoulder (342), wherein the elastomeric portion (328) may be connected to the metal portion (326) in a secure manner using an overmolding process.

[0120] Fig.15 A cross-sectional view of the anvil (318) is shown just proximal to the distal end (319). As shown, the anvil (318) includes a longitudinal slot (344) that divides the six rows of staple forming pockets (346) into two groups of three rows each. The slot (344) and staple forming pockets (346) are structurally and functionally similar to the slot (42) and staple forming pockets (53) described above with respect to the anvil (18). The slot (344) includes a "t" shaped cross section, such as Fig.15 As shown. Refer again Fig.13 and Fig.14, the opening (336) in the metal portion (326) is adjacent to the lateral extension of the slot (344). In view of the teachings herein, other ways of using the overmolding process to construct the metal portion (326) for suitable connection with the elastomeric portion (328) will be apparent to those of ordinary skill in the art.

[0121] The elastomeric portion (328) is molded onto the metal portion (326) and is given an angled configuration during the molding process so that the elastomeric portion (328) defines a plane that intersects and is not coplanar with a plane defined by the body (330) of the anvil (318). In this way, the elastomeric portion (328) is biased to maintain its angled configuration unless some other force is applied to the elastomeric portion (328), thereby causing it to deviate from its initial angled position. During the molding process, the elastomeric material flows through and fills the opening (336) in the metal portion (326). The elastomeric material also flows around and adjacent to the shoulder (342). In this way, the elastomeric portion (328) is firmly connected to the metal portion (326) during the overmolding process. The elastomeric portion (328) may comprise rubber, plastic, or any other suitable natural or synthetic material having the desired elastomeric properties that allows the distal tip (319) to deform when a force is applied, but allows the distal tip to elastically return to its initial angled state when the force is no longer applied or present. During the molding process, a stop member (not shown) may be inserted into a slot (349) formed distal to the slot (344) to prevent the elastomeric material from entering the slot (344). Other ways of configuring the elastomeric portion (328) for proper connection with the metal portion (326) using an overmolding process will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0122] Using the above and Fig.13 and Fig.14 In the configuration of the distal tip (319) shown, the extension of the metal portion (326) into the region of the distal tip (319) defines a deflection zone (348). The deflection zone (348) coincides with a rigid portion of the distal tip (319) located at the proximal end of the distal tip (319). This region of increased stiffness, for example, Fig. 12A As shown, distal tip (319) will deflect, with deflection zone (348) serving as a pivot point or location about which the remainder of distal tip (319) rotates during deflection. In view of the teachings herein, one of ordinary skill in the art will appreciate other ways to modify distal tip (319) to change, modify, or control deflection zone (348) so as to achieve a desired deflection of distal tip (319).

[0123] IV. Exemplary Configurations of End Effectors Having Elastically Deformable Placement Tips

[0124] With an end effector having a bent or angled elastically deformable end (also referred to as a placement end), such as those described above with respect to end effectors (312, 412), the deformable end can deflect during use. As described above, the elastically deformable end can be located on an anvil, such as anvil (318). In other versions, the elastically deformable end can be located on a cartridge. Additionally, while the above-described end effectors (12, 212, 312, 412) are discussed as including a lower jaw (16, 216) opposite anvil (18, 218, 318), in some versions, the end effector includes an upper jaw and a lower jaw, wherein the anvil can be located on either jaw, and the cartridge can be located on either jaw opposite the jaw having the anvil. In addition, either jaw can include an elastically deformable end that can be part of or associated with the anvil or cartridge. The following paragraphs describe several exemplary end effectors that may be used with instrument (10, 310) and other instruments, including a lower jaw, an upper jaw, and an elastically deformable tip or placement tip. These exemplary end effectors are shown and described in various ways, which are not intended to be mutually exclusive of one another. Rather, in many cases, features of one version are equally applicable to another version, as will be understood by one of ordinary skill in the art in view of the teachings herein.

[0125] In some versions to be shown and described, when comparing the state of the end effector in an open state to a closed state, the deflection of the deformable tip changes the angle of the deformable tip relative to the longitudinal axis defined by the jaws in which the deformable tip is located. In some versions to be shown and described, when the end effector is loaded or engaged with tissue, the deflection of the deformable tip changes the angle of the deformable tip relative to the nose of the chamber compared to when the end effector is not loaded or engaged with tissue. In some versions to be shown and described, when in a deflected state, the placement tip of one of the end effector jaws may assume certain positions relative to the other end effector jaw of the end effector jaws compared to when in a non-deflected state. In some versions to be shown and described, the end effector component is configured to have certain placement tip end and / or width profiles. Finally, in some versions to be shown and described, the end effector component is configured to have certain underside surface configurations and / or gaps.

[0126] The end effectors described below may each be configured to be used with the instruments (10, 310) described above. For example, it should be understood that each of the end effectors described below may be used in place of Figure 1 The end effector (12) shown, or in place of Fig.11The end effector (312) shown. In some versions, each of the end effectors described below may be formed integrally with the shaft (22), or alternatively, the end effectors may be formed separately and then assembled. In some versions, each of the end effectors described below may be provided for use in a robotic system. In such a robotic system, a modular shaft (322) having any of the end effectors described below 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, each of the end effectors described below may be suitable for use with a robotic system in a manner in which the end effectors described below are connected to the robotic system without having to connect the entire modular shaft (322). In view of the teachings of this document, other ways of incorporating each of the end effectors described below into a user-operated or robot-operated instrument will be apparent to those of ordinary skill in the art.

[0127] A. Example angles in open and closed states

[0128] See now Fig.16 and Fig.17 , showing an enlarged view of the end effector (512). The end effector (512) is configured to be used with the instrument (10, 310) and / or for robotic use, as described above. The end effector (512) includes an upper jaw (514) and a lower jaw (516). In this example, the upper jaw (514) includes a body (517) having a distal end or placement end (519) that is bent or angled and can be elastically deformed. In addition to the placement end (519), the body (517) defines a longitudinal axis (LA1). The placement end (519) defines another axis (A2). In this example, the longitudinal axis (LA1) extends parallel to the lower side surface (520) of the body (517) of the upper jaw (514). Similarly, the axis (A2) extends parallel to the lower side surface (522) of the placement end (519).

[0129] like Fig.16 As shown, the end effector (512) is in an open position or state, wherein no tissue or other object contacts the end effector (512). The first angle (θ3) is defined by the intersection of the longitudinal axis (LA1) of the body (517) and the axis (A2) of the placement tip (519). In other words, the first angle (θ3) is defined by the intersection of a plane extending along the underside surface (520) of the body (517) and a plane extending along the underside surface (522) of the placement tip (519).

[0130] like Fig.17As shown, the end effector (512) has been moved to a closed position and is still in an unloaded state, wherein tissue does not contact the end effector (512). However, in the closed position, the placement tip (519) of the upper jaw (514) contacts the lower jaw (516). With this contact and the elastically deformable nature of the placement tip (519), the placement tip (519) deflects from its position relative to the body (517), as shown. Fig.16 In this deflected position or state, the second angle (θ4) is defined by the intersection of the longitudinal axis (LA1) of the body (517) and the axis (A2) of the placement tip (519). In other words, the second angle (θ4) is defined by the intersection of a plane extending along the lower surface (520) of the body (517) and a plane extending along the lower surface (522) of the placement tip (519).

[0131] As the placement tip (519) is deflected, the second angle (θ4) is different from the first angle (θ3). Fig.17 3. The deflection shown, the lower jaw (516) contacts the underside of the placement end (519), causing the placement end (519) to pivot upward away from the lower jaw (516), so that the second angle (θ4) is greater than the first angle (θ3). In this example, the end actuator (512) defines a pivot point (524) about which the placement end (519) pivots relative to the body (517). More specifically, the pivot point (524) occurs at a location where the underside surface (520) of the body (517) intersects the underside surface (522) of the placement end (519). With this configuration, the end actuator (512) includes a placement end (519) extending from the distal end of the upper jaw (514). When the end actuator (512) is in an open position, the placement end (519) includes a first angle (θ3) relative to the axis or longitudinal axis (LA1) of the body (517) of the upper jaw (514). The placement tip (519) further includes a second angle (θ4) relative to the axis of the body (517) of the upper jaw (514) when the end effector (512) is in the closed position, and the second angle (θ4) is different from the first angle (θ3).

[0132] In view of the teachings herein, various ways to modify the deflection of the end effector (512) and the placement tip (519) to achieve other angles of the second angle (θ4) when the end effector (512) is in the closed position will be apparent to those of ordinary skill in the art. By way of example only and not limitation, one such modification would be to change the relationship of the contact of the placement tip (519) with the lower jaw (516) when the end effector (512) is closed. In this example, the lower jaw (516) includes a nose portion (526) located at the distal end of the lower jaw (516). In addition, the nose portion (526) includes a top surface (528) that defines a plane having a slope relative to the longitudinal axis (LA2) of the lower jaw (516). The slope can affect the deflection of the placement tip (519), thereby causing a change in the second angle (θ4). By way of another example only and not limitation, another such modification would be to include features on top surface (528) to guide and / or affect the deflection of placement tip (519), thereby causing a change in second angle (θ4).

[0133] In some versions, the upper jaw (514) includes an anvil (518) similar to the anvils (18, 218, 318) described above. In this type of version, the anvil (518) includes a body (517) and a placement tip (519). Additionally, in this type of version, opposite the anvil (518), the lower jaw (516) includes a staple cartridge (537) having a nose portion (526). With this configuration, the end effector (512) includes a placement tip (519) extending from a distal end of the anvil (518). When the end effector (512) is in an open position, the placement tip (519) includes a first angle (θ3) relative to the anvil (518) axis or longitudinal axis (LA1). When the end effector (512) is in the closed position, the placement tip (519) further includes a second angle (θ4) relative to the anvil (518) axis or the longitudinal axis (LA1), and the second angle (θ4) is different from the first angle (θ3) described above. In some other versions, the positions of the anvil (518) and the cartridge (537) can be switched so that the lower jaw (516) includes the anvil (518) and the upper jaw (514) includes the staple cartridge (537).

[0134] B. Exemplary Angles of Tissue Deflection

[0135] See now Fig.18 and Fig.19, showing an enlarged view of the end effector (612). The end effector (612) is configured to be used with an instrument (10, 310) as described above and / or for robotic use. The end effector (612) includes an upper jaw (614) and a lower jaw (616). In this example, the upper jaw (614) includes a body (617) having a placement end (619) that is bent or angled and can be elastically deformed. In addition to the placement end (619), the body (617) defines a longitudinal axis (LA3) extending along the lower side surface (620) of the body (617). The placement end (619) defines another axis (A3) extending along the lower side surface (622) of the placement end (619). In addition, in this example, the lower jaw (616) includes a tapered nose portion (626) located at the distal end of the lower jaw (616). The nose portion (626) defines an axis (A4) extending along a top surface (628) of the nose portion (626).

[0136] like Fig.18 As shown, the end effector (612) is in an unloaded state, wherein there is no tissue or other object between the upper jaw (614) and the lower jaw (616). The third angle (θ5) is defined by the intersection of the longitudinal axis (LA3) of the body (617) and the axis (A3) of the placement tip (619). In other words, when the end effector (612) is in an unloaded state, the third angle (θ5) is defined by the intersection of a plane extending along the lower surface (620) of the body (617) and a plane extending along the lower surface (622) of the placement tip (619). Similarly, as Fig.18 As shown, when the end effector (612) is in an unloaded state and there is no tissue or other object between the upper jaw (614) and the lower jaw (616), the fifth angle (α1) is defined by the intersection of the axis (A3) of the placement tip (619) and the axis (A4) of the nose portion (626). In other words, when the end effector (612) is in an unloaded state, the fifth angle (α1) is defined by the intersection of a plane extending along the lower surface (622) of the placement tip (619) and a plane extending along the top surface (628) of the nose portion (626). Similarly, as shown in FIG. Fig.18 As shown in the present example, with the end actuator (612) closed and in an unloaded state, the end (630) of the placement tip (619) is located proximal to the end (632) of the nose portion (626).

[0137] like Fig.19As shown, the end effector (612) has been moved to a closed position and is in a loaded state, wherein tissue is located between the upper jaw (614) and the lower jaw (616) of the end effector (612). Utilizing the tissue between the jaws (614, 616) and the elastically deformable nature of the placement end (619), the placement end (619) is deflected from its position relative to the body (617). In this deflected position or state, the fourth angle (θ6) is defined by the intersection of the longitudinal axis (LA3) of the body (617) and the axis (A3) of the placement end (619). In other words, when the end effector (612) is in a loaded state, the fourth angle (θ6) is defined by the intersection of a plane extending along the lower surface (620) of the body (617) and a plane extending along the lower surface (622) of the placement end (619). Similarly, as Fig.19 As shown, when the end effector (612) is in a loaded state and tissue is located between the upper jaw (614) and the lower jaw (616), the sixth angle (α2) is defined by the intersection of the axis (A3) of the placement tip (619) and the axis (A4) of the nose portion (626). In other words, when the end effector (612) is in a loaded state, the sixth angle (α2) is defined by the intersection of a plane extending along the lower surface (622) of the placement tip (619) and a plane extending along the top surface (628) of the nose portion (626). Similarly, as shown in FIG. Fig.19 As shown in the present example, with the end effector (612) closed and in a loaded state, the end (630) of the placement tip (619) is located distal to the end (632) of the nose portion (626).

[0138] With the placement end (619) in Fig.19 Deflection under loading condition, relative to Fig.18 For the unloaded state, the fourth angle (θ6) is different from the third angle (θ5). Fig.19The deflection shown causes tissue to contact the underside of the placement tip (619), causing the placement tip (619) to pivot upward away from the lower jaw (616) such that the fourth angle (θ6) is greater than the third angle (θ5). In the present example, the end effector (612) defines a pivot point (624) about which the placement tip (619) pivots relative to the body (617). More specifically, the pivot point (624) occurs at a location where the underside surface (620) of the body (617) intersects the underside surface (622) of the placement tip (619). With this configuration, the end effector (612) includes a placement tip (619) extending from the distal end of the upper jaw (614). When the end effector (612) is in a closed and unloaded state, the placement tip (619) includes a third angle (θ5) relative to the axis or longitudinal axis (LA3) of the body (617) of the upper jaw (614). When the end effector (612) is in the closed position and the loaded state, the placement tip (619) also includes a fourth angle (θ6) relative to the axis of the body (617) of the upper jaw (614), and the fourth angle (θ6) is different from the third angle (θ5). Similar to this configuration, the end effector (612) includes a placement tip (619) having an undeflected state and a deflected state. In the undeflected state, the placement tip (619) and the nose portion (626) define a fifth angle (α1), and in the deflected state, the placement tip (619) and the nose portion (626) define a sixth angle (α2) that is different from the fifth angle (α1).

[0139] Various ways of modifying the deflection of the end effector (612) and the placement tip (619) to achieve other angles of the fourth angle (θ6) and the sixth angle (α2) when the end effector (612) is in a closed and loaded state will be apparent to those of ordinary skill in the art in view of the teachings herein. By way of example only and not limitation, one such modification would be to change the taper of the nose portion (626) so that the axis (A4) extending along the top surface (628) of the nose portion (626) is steeper or shallower. By way of another example only and not limitation, another such modification would be to include a feature on the top surface (628) that guides tissue held between the nose portion (626) and the placement tip (619) to change the force applied to the placement tip (619) when the end effector (612) is in a closed and loaded state, thereby changing the deflection of the placement tip (619) to cause changes in the fourth angle (θ6) and the sixth angle (α2).

[0140] In some versions, the upper jaw (614) includes an anvil (618) similar to the anvils (18, 218, 318) described above. In this type of version, the anvil (618) includes a body (617) and a placement tip (619). Additionally, in this type of version, opposite the anvil (618), the lower jaw (616) includes a staple cartridge (637) having a nose portion (626). With this configuration, the end effector (612) includes a placement tip (619) extending from a distal end of the anvil (618). When the end effector (612) is in a closed and unloaded state, the placement tip (619) includes a third angle (θ5) relative to the anvil (618) axis or longitudinal axis (LA3). When the end effector (612) is in a closed and loaded state, the placement end (619) also includes a fourth angle (θ6) relative to the anvil (618) axis or longitudinal axis (LA3), and the fourth angle (θ6) is different from the third angle (θ5) described above. Similar to this configuration, the end effector (612) includes a placement end (619) extending from the distal end of the anvil (618) and a nose portion (619) at the distal end of the cartridge (637), wherein the end effector (612) has an undeflected state and a deflected state. In the undeflected state, the placement end (619) of the anvil (618) and the nose portion (626) of the cartridge (637) define a fifth angle (α1). In the deflected state, the placement end (619) of the anvil (618) and the nose portion (626) of the cartridge (637) define a sixth angle (α2) that is different from the fifth angle (α1). In some other versions, the positions of anvil (618) and cartridge (637) may be switched such that lower jaw (616) includes anvil (618) and upper jaw (614) includes staple cartridge (637).

[0141] C. Exemplary End Positions in Deflected and Non-Deflected States

[0142] As above relative to Fig.18 and Fig.19 As described above, the placement tip (619) is configured to deflect when the end effector (612) is loaded, and such deflection occurs in a manner such that the end (630) of the placement tip (619) changes its relative placement or position relative to the end (632) of the nose portion (626) of the cartridge (637). Fig.18 and Fig.19 As shown, when the end effector (612) is unloaded, the end (630) is located proximal to the end (632) so that no tissue exists between the upper jaw (614) and the lower jaw (616). And when the end effector (612) is loaded with tissue between the upper jaw (614) and the lower jaw (616), the end (630) moves distally so that the end (630) is located distal to the end (632).

[0143] See now Fig. 20 , showing an enlarged view of the end effector (712). The end effector (712) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (712) includes an upper jaw (714) and a lower jaw (716). The lower jaw (716) includes a nose portion (726) and an end (732). The lower jaw (716) also includes a platform (772). The upper jaw (714) includes a body (717) and a placement end (719). The placement end (719) has a curved or angled configuration and is elastically deformable as described above. The placement end (719) includes an end (730) at its most distal portion.

[0144] like Fig. 20 As shown, a first reference plane (P1) is defined by platform (772) and extends generally parallel to the longitudinal axis of lower jaw (716). A second reference plane (P2) passes through end (732) of nose portion (726) such that second reference plane (P2) is orthogonal to first reference plane (P1). Fig. 20 As shown, the position or placement of the end (732) of the placement tip (719) can be shown and described relative to the first reference plane (P1) and the second reference plane (P2). In other words, the position or placement of the end (730) of the placement tip (719) can be described as being proximal, flush with, or distal to the end (732) of the nose portion (726) of the lower jaw (716), as shown in the second reference plane (P2). At the same time, the position or placement of the end (730) of the placement tip (719) can be described as being above, flush with, or below the platform (772) of the lower jaw (716), as shown in the first reference plane (P1).

[0145] See now Fig.21 , shows an enlarged view of another end effector (812), wherein reference numerals define a plurality of regions that may be used to describe the location or placement of the end of the placement tip of the exemplary end effector. The end effector (812) is configured to be usable with the instrument (10, 310) described above and / or for robotic use. Fig. 20 Same, Fig.21 The end effector (812) also includes a first reference plane (P1) and a second reference plane (P2). Additionally, a third reference plane (P3) is defined by and extends along a bottom surface (834) of the lower jaw (816). The third reference plane (P3) in this example is parallel to the first reference plane (P1) and is also orthogonal to the second reference plane (P2). With this configuration, as Fig.21As shown, six zones are defined by the intersection lines of the first reference plane (P1) and the third reference plane (P3) with the second reference plane (P2).

[0146] The first zone (Z1) is shown as an area above the platform (872) of the lower jaw (816) (corresponding to the first reference plane (P1)) and proximal to the end (832) of the nose portion (826) (corresponding to the second reference plane (P2)). The second zone (Z2) is shown as an area above the platform (872) of the lower jaw (816) (corresponding to the first reference plane (P1)) and distal to the end (832) of the nose portion (826) (corresponding to the second reference plane (P2)). The third zone (Z3) is shown as an area below the platform (872) of the lower jaw (816) (corresponding to the first reference plane (P1)) but above the bottom surface (834) of the lower jaw (816) (corresponding to the third reference plane (P3)) and proximal to the end (832) of the nose portion (826) (corresponding to the second reference plane (P2)). The fourth zone (Z4) is shown as an area below the platform (872) of the lower jaw (816) (corresponding to the first reference plane (P1)) but above the bottom surface (834) of the lower jaw (816) (corresponding to the third reference plane (P3)) and distal to the end (832) of the nose portion (826) (corresponding to the second reference plane (P2)). The fifth zone (Z5) is shown as an area below the bottom surface (834) of the lower jaw (816) (corresponding to the third reference plane (P3)) and proximal to the end (832) of the nose portion (826) (corresponding to the second reference plane (P2)). The sixth zone (Z6) is shown as an area below the bottom surface (834) of the lower jaw (816) (corresponding to the third reference plane (P3)) and distal to the end (832) of the nose portion (826) (corresponding to the second reference plane (P2)).

[0147] Using this reference system, several exemplary end effectors will now be described that illustrate various positions or placements of the end of the distal end when the end effector is in a closed and unloaded state. Fig.22A, showing an enlarged view of another end effector (912) in a closed and unloaded state. The end effector (912) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (912) includes an upper jaw (914) and a lower jaw (916). The upper jaw (914) includes a body (917) and a placement end (919). At its most distal portion, the placement end (919) includes an end (930). As shown, the placement end (919) has a curved or angled configuration. With the configuration shown, the placement end (919) extends through the first zone (Z1), and the position of the end (930) of the placement end (919) is in the third zone (Z3). In view of the teachings herein, it will be apparent to those of ordinary skill in the art that when end effector (912) is in the closed and loaded state, the position of end (930) of placement tip (919) can be deflected but maintained in third zone (Z3). However, in view of the teachings herein, it will also be apparent to those of ordinary skill in the art that placement tip (919) can be deflected such that end (930) of placement tip (919) changes its position in the closed and loaded state to another of the zones.

[0148] See now Fig. 22B , showing an enlarged view of another end effector (1012) in a closed and unloaded state. The end effector (1012) is configured to be used with the instrument (10,310) described above and / or for robotic use. The end effector (1012) includes an upper jaw (1014) and a lower jaw (1016). The upper jaw (1014) includes a body (1017) and a placement end (1019). At its most distal portion, the placement end (1019) includes an end (1030). As shown, the placement end (1019) has an arcuate configuration. With the configuration shown, the placement end (1019) extends through the first zone (Z1), and the position of the end (1030) of the placement end (1019) is in the third zone (Z3). In view of the teachings herein, it will be apparent to one of ordinary skill in the art that when end effector (1012) is in the closed and loaded state, the position of end (1030) of placement tip (1019) can be deflected but maintained in third zone (Z3). However, in view of the teachings herein, it will also be apparent to one of ordinary skill in the art that placement tip (1019) can be deflected such that end (1030) of placement tip (1019) changes its position in the closed and loaded state to another of the zones.

[0149] See now Fig. 22C, showing an enlarged view of another end effector (1112) in a closed and unloaded state. The end effector (1112) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (1112) includes an upper jaw (1114) and a lower jaw (1116). The upper jaw (1114) includes a body (1117) and a placement end (1119). At its most distal portion, the placement end (1119) includes an end (1130). As shown, the placement end (1119) has a curved or angled configuration. With the configuration shown, the placement end (1119) extends through the first zone (Z1) and the third zone (Z3), and the position of the end (1130) of the placement end (1119) is in the fourth zone (Z4). In view of the teachings herein, it will be apparent to one of ordinary skill in the art that when end effector (1112) is in the closed and loaded state, the position of end (1130) of placement tip (1119) can be deflected but maintained in fourth zone (Z4). However, in view of the teachings herein, it will also be apparent to one of ordinary skill in the art that placement tip (1119) can be deflected such that end (1130) of placement tip (1119) changes its position in the closed and loaded state to another of the zones.

[0150] See now Fig.22D, showing an enlarged view of another end effector (1212) in a closed and unloaded state. The end effector (1212) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (1212) includes an upper jaw (1214) and a lower jaw (1216). The upper jaw (1214) includes a body (1217) and a placement end (1219). At its most distal portion, the placement end (1219) includes an end (1230). As shown, the placement end (1219) has an arcuate configuration. With the configuration shown, the placement end (1219) extends through the first zone (Z1), the second zone (Z2), the third zone (Z3), the fourth zone (Z4) and the sixth zone (Z6), and the position of the end (1230) of the placement end (1219) is in the fifth zone (Z5). Of the six total zones, placement tip (1230) passes through all of them, although zone 3 (Z3) is substantially free of placement tip (1230). It will be apparent to one of ordinary skill in the art in view of the teachings herein that when end effector (1212) is in the closed and loaded state, the position of end (1230) of placement tip (1219) may deflect but remain in zone 5 (Z5). However, it will also be apparent to one of ordinary skill in the art in view of the teachings herein that placement tip (1219) may deflect such that end (1230) of placement tip (1219) changes its position in the closed and loaded state to another of the zones.

[0151] See now Fig.22E, showing an enlarged view of another end effector (1312) in a closed and unloaded state. The end effector (1312) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (1312) includes an upper jaw (1314) and a lower jaw (1316). The upper jaw (1314) includes a body (1317) and a placement end (1319). At its most distal portion, the placement end (1319) includes an end (1330). As shown, the placement end (1319) has a curved or angled configuration. With the configuration shown, the placement end (1319) extends through the first zone (Z1), the third zone (Z3) and the fourth zone (Z4), and the position of the end (1330) of the placement end (1319) is in the sixth zone (Z6). It will be apparent to one of ordinary skill in the art in view of the teachings herein that the position of end (1330) of placement tip (1319) may deflect but remain in zone six (Z6) when end effector (1312) is in the closed and loaded state. However, it will also be apparent to one of ordinary skill in the art in view of the teachings herein that placement tip (1319) may deflect such that end (1330) of placement tip (1319) changes its position in the closed and loaded state to another of the zones.

[0152] See now Fig.22F , showing an enlarged view of another end effector (1412) in a closed and unloaded state. The end effector (1412) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (1412) includes an upper jaw (1414) and a lower jaw (1416). The upper jaw (1414) includes a body (1417) and a placement end (1419). At its most distal portion, the placement end (1419) includes an end (1430). As shown, the placement end (1419) has a multi-angle configuration. With the configuration shown, the placement end (1419) extends through the first zone (Z1), the third zone (Z3) and the fourth zone (Z4), and the position of the end (1430) of the placement end (1419) is in the sixth zone (Z6). It will be apparent to one of ordinary skill in the art in view of the teachings herein that when end effector (1412) is in the closed and loaded state, the position of end (1430) of placement tip (1419) may deflect but remain in the sixth zone (Z6). However, it will also be apparent to one of ordinary skill in the art in view of the teachings herein that placement tip (1419) may deflect such that end (1430) of placement tip (1419) changes its position in the closed and loaded state to another of the zones.

[0153] See now Figure 22G , showing an enlarged view of another end effector (1512) in a closed and unloaded state. The end effector (1512) is configured to be used with the instrument (10, 310) described above and / or for robotic use. The end effector (1512) includes an upper jaw (1514) and a lower jaw (1516). The upper jaw (1514) includes a body (1517) and a placement end (1519). At its most distal portion, the placement end (1519) includes an end (1530). As shown, the placement end (1519) has a curved or angled configuration. At its proximal end, the placement end (1519) includes a step (1591) so that the body (1517) is offset from the step (1591) of the placement end (1519). With the configuration shown, placement tip (1519) extends through first zone (Z1), and the position of end (1530) of placement tip (1519) is in third zone (Z3). It will be apparent to one of ordinary skill in the art in view of the teachings herein that the position of end (1530) of placement tip (1519) can deflect but remain in third zone (Z3) when end effector (1512) is in the closed and loaded state. However, it will also be apparent to one of ordinary skill in the art in view of the teachings herein that placement tip (1519) can deflect such that end (1530) of placement tip (1519) changes its position in the closed and loaded state to another of the zones.

[0154] like Figure 22G As shown, the end effector (1512) defines a fourth reference plane (P4) based on the offset of the body (1517) from the step (1591) of the placement end (1519). In addition, the placement end (1519) includes a lower side surface (1522) that matches the profile of the top surface (1528) and the platform (1572) of the lower jaw (1516). The placement end (1519) defines a pivot point (1524), wherein the lower side surface (1522) transitions from matching the profile of the top surface (1528) of the lower jaw (1516) to matching the platform (1572) of the lower jaw (1516). As shown in the illustrated version, the end effector (1512) defines a first distance (D1) extending proximally from the pivot point (1524) to the most proximal end of the step (1591). First distance (D1) may be considered to represent the length of placement tip (1519) that overlaps platform (1572) of lower jaw (1516). Various ways of modifying or altering end effector (1512) and first distance (D1) to achieve greater or lesser overlap of placement tip (1519) with platform (1572) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0155] The above paragraphs describe a reference system in which various reference planes are used to define zones relative to an end effector. Specifically, the various reference planes are relative to the platform, distal-most end, and bottom surface of the lower jaw of the end effector. This reference system is applicable to other versions of the end effector shown and described herein, not to the above reference system. FIG. 22A to FIG. 22G For example, from Fig.17 It is clearly seen that the end effector (512) includes a placement tip (519) that presents its most distal end in the third zone (Z3). Fig.18 An end effector (612) is shown including a placement tip (619) that also presents its distal-most end in the third zone (Z3). Fig.17 and Fig.18 , both end effectors (512, 612) are shown in a closed and unloaded state. Fig.19 , end effector (612) is shown in a closed and loaded state. As shown, with end effector (612) in a closed and loaded state, placement tip (619) is deflected such that a majority of the distal end of placement tip (619) is located in the second zone (Z2) and a smaller portion is located in the fourth zone (Z4). Various ways of configuring an end effector to position the end of the placement tip in a desired position under various conditions (i.e., open / closed and loaded / unloaded) will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0156] D. Exemplary Shapes of Elastically Deformable Placement Tips

[0157] As described above, the placement tip of the end effector may have a curved or angled configuration as well as an arcuate configuration. FIG. 22A to FIG. 22G . In conjunction with these various options for the placement tip of the end effector, there are additional options for the shape of the placement tip. As described below, the placement tip can be configured to have various distal end profiles, width profiles, and underside surface geometries. It should be understood that the various shapes related to the distal end profile, width profile, and underside surface geometry described below can be combined in a single placement tip. For example, any of the distal end profiles shown and described can be used with a placement tip having any of the width profiles shown and described, and in addition, such a placement tip can have any of the underside surface geometries shown and described.

[0158] 1. Distal end contour

[0159] FIG. 23A to FIG. 23F An exemplary enlarged portion of a placement tip is shown showing various distal end profiles of the placement tip. Fig.23A , the end effector includes a placement end (1619). Fig.23A As shown in the top view of , placement tip (1619) includes a distal end (1630) having a rounded profile. Placement tip (1619) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, placement tip (1619) can be configured so that it can be part of an anvil or part of a staple cartridge. In view of the teachings herein, it will be apparent to one of ordinary skill in the art that such a rounded distal end profile of placement tip (1619) can be used with any of the placement tips of the end effectors described herein.

[0160] Fig. 23B An end effector is shown including a placement tip (1719). Fig. 23B As shown in the top view of , the placement tip (1719) includes a distal end (1730) having an angled and pointed profile. In this example, because the placement tip (1719) is composed of an elastomer and a deflectable material, the placement tip (1719) is still constructed as an atraumatic tip despite having a sharp profile. The placement tip (119) can be constructed so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (119) can be constructed so that it can be part of the anvil or part of the nail magazine. In view of the teachings of this article, it will be apparent to those of ordinary skill in the art that this angled and pointed distal end profile of the placement tip (119) can be used with any of the placement tips of the end effectors described herein.

[0161] Fig.23C An end effector is shown including a placement tip (1819). Fig.23C As shown in the top view of , placement tip (1819) includes a distal end (1830) having a toothed profile. Placement tip (1819) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, placement tip (1819) can be configured so that it can be part of an anvil or part of a staple cartridge. In view of the teachings herein, it will be apparent to one of ordinary skill in the art that such a toothed distal end profile of placement tip (1819) can be used with any of the placement tips of the end effectors described herein.

[0162] Fig.23D An end effector is shown including a placement tip (1919). Fig.23DAs shown in the top view of the , placement tip (1919) includes a distal end (1930) having an expanded profile. The placement tip (1919) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (1919) can be configured so that it can be part of the anvil or part of the staple cartridge. In view of the teachings herein, it will be apparent to those of ordinary skill in the art that such an expanded distal end profile of the placement tip (1919) can be used with any of the placement tips of the end effectors described herein.

[0163] Fig.23E An end effector is shown including a placement tip (2019). Fig.23E As shown in the top view of , the placement tip (2019) includes a distal end (2030) having a spherical profile. The placement tip (2019) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (2019) can be configured so that it can be part of the anvil or part of the staple cartridge. In view of the teachings herein, it will be apparent to a person of ordinary skill in the art that such a spherical distal end profile of the placement tip (2019) can be used with any of the placement tips of the end effectors described herein.

[0164] Fig.23F An end effector is shown including a placement tip (2119). Fig.23F As shown in the top view of , the placement tip (2119) includes a distal end (2130) having an asymmetric profile. In this way, the end (2130) extends distally longer on one side than on the other side, so that the end (2130) is angled. The placement tip (2119) can be constructed so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (2119) can be constructed so that it can be part of the anvil or part of the nail magazine. In view of the teachings of this article, it will be obvious to those of ordinary skill in the art that this asymmetric distal end profile of the placement tip (2119) can be used with any of the placement tips of the end effector described herein. Although several distal end profiles of the placement tip of the end effector have been shown and described above, other distal end profiles of the placement tip of the end effector will be obvious to those of ordinary skill in the art in view of the teachings of this article.

[0165] 2. Width profile

[0166] FIG. 24A to FIG. 24E An exemplary enlarged portion of a placement tip is shown, showing various width profiles of the placement tip. Fig.24A , the end effector includes a placement end (2219). Fig.24A As shown in the top view of , the placement tip (2219) includes a distal edge (2229) leading to a distal end (2230), wherein the distal edge (2229) defines an angled width profile. The placement tip (2219) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (2219) can be configured so that it can be part of the anvil or part of the staple cartridge. In view of the teachings herein, it will be apparent to those of ordinary skill in the art that such an angled width profile of the placement tip (2219) can be used with any of the placement tips of the end effectors described herein.

[0167] Fig. 24B An end effector is shown including a placement tip (2319). Fig. 24B As shown in the top view of , placement tip (2319) includes a distal edge (2329) leading to a distal end (2330), wherein the distal edge (2329) defines a stepped width profile. The placement tip (2319) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (2319) can be configured so that it can be part of the anvil or part of the staple cartridge. In view of the teachings herein, it will be apparent to those of ordinary skill in the art that such a stepped width profile of the placement tip (2319) can be used with any of the placement tips of the end effectors described herein.

[0168] Fig.24C An end effector is shown including a placement tip (2419). Fig.24C As shown in the top view of , the placement tip (2419) includes a distal edge (2429) leading to a distal end (2430), wherein the distal edge (2429) defines an asymmetric width profile such that the distal edge (2429) is asymmetrically oriented, and in this case at different angles. The placement tip (2419) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (2419) can be configured so that it can be part of the anvil or part of the staple cartridge. In view of the teachings herein, it will be apparent to those of ordinary skill in the art that such an asymmetric width profile of the placement tip (2419) can be used with any of the placement tips of the end effectors described herein.

[0169] Fig.24D An end effector is shown including a placement tip (2519). Fig.24DAs shown in the top view of , the placement tip (2519) includes a distal edge (2529) leading to a distal end (2530), wherein the distal edge (2529) defines a width profile that is scalloped with the distal end (2530) centered along the longitudinal axis of the placement tip (2519). In this way, one of the distal edges (2529) has a concave curvature and the other distal edge has a convex curvature. The placement tip (2519) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. In addition, the placement tip (2519) can be configured so that it can be part of the anvil or part of the nail magazine. In view of the teachings of this article, it will be apparent to those of ordinary skill in the art that such a scalloped width profile of the placement tip (2519) can be used with any of the placement tips of the end effectors described herein.

[0170] Fig.24E An end effector is shown including a placement tip (2619). Fig.24E As shown in the top view of FIG. 2 , the placement tip (2619) includes a distal side edge (2629) leading to a distal end (2630), wherein the distal side edge (2629) defines a width profile having a ridge or lateral protrusion (2631) on each side edge. In the illustrated version, the jaws (2616) of the end effector opposite the placement tip (2619) are shown in phantom. As shown in this example, the ridges (2631) extend outwardly from the jaws (2616), and the remaining width of the placement tip (2619) is narrower than the width of the jaws (2616). However, in all versions, it is not required that the ridges (2631) extend outwardly from the width of the jaws (2616). In the event that the ridges (2631) do extend outwardly from the jaws (2616), the placement tip (2619) is configured to provide resistance when moving the instrument with the end effector and the placement tip (2619) into and out of the surgical site. Additionally, the protuberance (2631) is configured to expand a larger hole when the placement tip (2619) passes therethrough. The placement tip (2619) can be configured so that it can be positioned on the upper jaw or the lower jaw of the end effector. Furthermore, the placement tip (2619) can be configured so that it can be part of an anvil or part of a staple cartridge. In view of the teachings herein, it will be apparent to one of ordinary skill in the art that such a width profile of the placement tip (2619) having a protuberance (2631) on each side can be used with any of the placement tips of the end effectors described herein.

[0171] Fig.25An enlarged top view of a placement tip (2719) of an end effector is shown, wherein the placement tip (2719) has a distal end (2730) having an angled and pointed profile, and wherein the placement tip (2719) has a distal edge (2729) defining an angled width profile. As described above, the placement tip (2719) shows Fig. 23B The angled and pointed distal end profile of the tip (1719) is Fig.24A In view of the teachings herein, and as further illustrated by this example, various combinations of distal end profiles and width profiles will be apparent to those of ordinary skill in the art.

[0172] The placement tip (2719) further illustrates the relationship between the profile at the distal end (2730) and the width profile defined by the distal edge (2729). As described above with respect to other examples, the placement tip extends from the body of one of the upper jaw or the lower jaw of the end effector. In this example, the placement tip (2719) is understood to have a longitudinal dimension or length that is shorter than the body of the jaw from which the placement tip extends. As shown in the illustrated version, the placement tip (2719) can be understood to have a length characterized by the sum of a first length (L1) and a second length (L2). Although not shown to be drawn to scale based on the wavy fold line, indicating that the placement tip (2719) extends further proximally than shown, it should be understood that the first length (L1) is substantially greater than the second length (L2). When shown and described above in FIG. 23A to FIG. 23F as well as FIG. 24A to FIG. 24E When referring to the various distal end profiles and width profiles of the placement tip in the embodiment of the present invention, it should be understood that the distal end profile and the width profile defined by the distal edge are all included in the length of the placement tip that coincides with the second length (L2).

[0173] The placement tip (2719) further illustrates an example where a plane defined by one of the symmetrical distal edges (2729) combines with another plane defined by one of the proximal edges (2733) to form an angle (β1). In this example, as the width profile defined by the distal edge (2729) becomes more angular or steeper, the angle (β1) increases. As the width profile defined by the distal edge (2729) becomes less angular and thus closer to being parallel to the proximal edge (2733), the angle (β1) decreases.

[0174] The placement tip (2719) also shows an example where a plane defined tangent to the distal-most portion of the distal end (2730) combines with a plane defined by one of the sides (2735) of the distal end (2730) to form an angle (β2). In this example, as the sides (2735) of the distal end (2730) become more angular or steeper, the angle (β2) increases. As the sides (2735) of the distal end (2730) become less angular and thus the distal end (2730) becomes more blunt, the angle (β2) decreases.

[0175] 3. Lower surface

[0176] See now FIG. 26A to FIG. 26E , showing and describing various geometric shapes of the lower surface of the placement end. In some cases, the lower surface of the placement end may be referred to as the inner surface, and these terms should be understood to be interchangeable. Fig.26A An end effector (2812) is shown that includes an upper jaw (2814) and a lower jaw (2816). The upper jaw (2814) includes a body (2817) and a placement tip (2819) extending distally from the body (2817). The placement tip (2819) has a curved or angled configuration and includes a flat lower side surface (2822). In this example, the lower side surface (2822) is also parallel to the top surface (2828) on the nose portion (2826) of the lower jaw (2816). In this way, when the end effector (2812) is closed and unloaded, the lower side surface (2822) can contact the top surface (2828).

[0177] Fig.26B An end effector (2912) is shown that includes an upper jaw (2914) and a lower jaw (2916). The upper jaw (2914) includes a body (2917) and a placement tip (2919) extending distally from the body (2917). The placement tip (2919) has an arcuate configuration and includes an arcuate lower side surface (2922). In addition, the lower jaw (2916) includes a nose portion (2926) having a tapered top surface (2928). The curvature of the lower side surface (2922) combined with the tapered top surface (2928) of the nose portion (2926) provides point contact for the placement tip (2919) when the end effector (2912) is closed and unloaded, which is in contrast to the larger contact area of ​​the end effector (2812) shown and described above.

[0178] Fig.26CAn end effector (3012) is shown that includes an upper jaw (3014) and a lower jaw (3016). The upper jaw (3014) includes a body (3017) and a placement tip (3019) extending distally from the body (3017). The placement tip (3019) has a straight configuration and includes a straight lower side surface (3022). The placement tip (3019) is configured to be elastically deformable as described above. In this way, the lower side surface (3022) of the placement tip (3019) extends along the same plane as the lower side surface (3020) of the body (3017) of the upper jaw (3014). In addition, the lower jaw (3016) includes a nose portion (3026) having a tapered top surface (3028). The straight configuration of the lower side surface (3022) combined with the tapered top surface (3028) of the nose portion (3026) eliminates contact of the placement tip (3019) with the tapered top surface (3028) when the end effector (3012) is closed and unloaded.

[0179] Fig.26D An end effector (3112) is shown that includes an upper jaw (3114) and a lower jaw (3116). The upper jaw (3114) includes a body (3117) and a placement tip (3119) extending distally from the body (3117). The placement tip (3119) has an arcuate configuration and includes a multi-angle lower side surface (3122). The placement tip (3119) is configured to be elastically deformable as described above. In addition, the lower jaw (3116) includes a nose portion (3126) having a conical top surface (3128). The multi-angle nature of the lower side surface (3122) combined with the conical top surface (3128) of the nose portion (3126) provides point contact for the placement tip (3119) when the end effector (3112) is closed and unloaded, which is contrary to the larger contact area of ​​the end effector (3112) shown and described above.

[0180] Fig.26E An end effector (3212) is shown including an upper jaw (3214) and a lower jaw (3216) having a dual position. The upper jaw (3214) includes a body (3217) and a placement tip (3219) extending distally from the body (3217). When the end effector (3212) is in an open and unloaded position, the placement tip (3219) has a curved or angled configuration, such as Fig.26EThe placement end (3219) includes a lower surface (3222) including an arc-shaped protrusion (3231). The placement end (3219) is configured to be elastically deformable as described above. In addition, the lower jaw (3216) includes a nose portion (3226) having a conical top surface (3228) and a platform (3272). The arcuate protrusion (3231) on the lower surface (3222) of the placement tip (3219) is configured to act as a pivot structure such that the placement tip (3219) pivots from its curved or angled orientation shown in phantom to a straight, or at least less curved or angled, orientation in response to the arcuate protrusion (3231) contacting a structure such as the platform (3272) when the end effector (3212) is closed and there is no tissue between the jaws (3214, 3216), or contacting tissue when the end effector (3212) is closed and loaded with tissue between the jaws (3214, 3216).

[0181] E. Exemplary Gaps

[0182] The various end effectors described herein provide visualization and guidance features as described above. Additionally, the ability of the placement tip to deflect or elastically deform can provide a use benefit during a procedure where advancement may be required or beneficial. In addition to the ability of the placement tip to elastically deform, the presence or absence of a gap between the placement tip and the surface of the opposing jaws can affect visualization and advancement. For example, in some versions with minimal or no gap, the ability of the placement tip to elastically deform enables the end effector to be used during advancement.

[0183] Fig.27A and Fig.27B Portions of an end effector are shown showing exemplary gaps and configurations thereof. Fig.27A An enlarged side view of a distal portion of the end effector (3312) is shown, illustrating a gap (3340) between the placement tip (3319) of the upper jaw (3314) and the nose portion (3326) of the lower jaw (3316). In this example, the end effector (3312) is shown in a closed and unloaded state. The placement tip (3319) includes an underside surface (3322) that is generally parallel to the top surface (3320) of the nose portion (3326) of the lower jaw (3316). As such, the gap (3340) has a generally uniform size along the underside surface (3322) of the placement tip (3319) and the top surface (3320) of the nose portion (3326). Utilizing this configuration of gap (3340), and utilizing the elastically deformable nature of placement tip (3319), end effector (3312) is configured to be usable in procedures requiring advancement.

[0184] Fig.27BAn enlarged side view of the distal portion of the end effector (3412) is shown, showing a gap (3440) between the distal end (3430) of the placement tip (3419) of the upper jaw (3414) and the nose portion (3426) of the lower jaw (3416). The placement tip (3419) is bent or angled, and with the end effector (3412) in a closed and unloaded state as shown, the end (3430) contacts or nearly contacts the top surface (3420) of the nose portion (3426) of the lower jaw (3416). Thus, in this example, the gap (3440) is very small, or in the case where the jaws (3414, 3416) are in contact, the gap (3440) is not present at all. In the version where the gap (3440) is present, as shown, the size of the gap (3440) increases as the gap (3440) extends proximally. Utilizing this configuration, and utilizing the elastically deformable nature of placement tip (3419), end effector (3412) is configured to be usable in procedures requiring advancement. Other ways of constructing end effectors having various gaps to facilitate visualization, guidance, and advancement will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0185] F. Exemplary Arcuate Side Cross Sections

[0186] As above relative to Fig.26B and Fig.26D As described, some exemplary end effectors are configured to have a placement tip having an arcuate side cross-section. Where the placement tip is elastically deformable or deflectable, the curvature or degree of curvature of the placement tip changes based on the clamping force applied to the placement tip. As described above, having an end effector have an arcuate placement tip can provide benefits in terms of visualization and guidance of the end effector in use. In addition, having an end effector have an elastically deformable placement tip can provide benefits in surgeries where advancement is used or required. Combining the curvature of the placement tip with the deformability provides the end effector with desired visualization and guidance attributes in a configuration that can be used for advancement applications where a gap between the jaws of the end effector is not necessary or required.

[0187] Now see again Fig.26B , Fig.26BAn end effector (2912) is shown that includes an upper jaw (2914) and a lower jaw (2916). The upper jaw (2914) includes a body (2917) and a placement tip (2919) extending distally from the body (2917). The placement tip (2919) has an arcuate configuration and includes an arcuate lower side surface (2922). In addition, the lower jaw (2916) includes a nose portion (2926) having a tapered top surface (2928). The curvature of the lower side surface (2922) combined with the tapered top surface (2928) of the nose portion (2926) provides point contact for the placement tip (2919) when the end effector (2912) is closed and unloaded. In this way, when the end effector (2912) is closed and unloaded, there is no gap between the upper jaw (2914) and the lower jaw (2916).

[0188] In some cases, the arcuate placement tip may be achieved by using angled underside surfaces. Fig.26D Such an end effector is shown having an end effector (3112) that includes an upper jaw (3114) and a lower jaw (3116). The upper jaw (3114) includes a body (3117) and a placement end (3119) extending distally from the body (3117). The placement end (3119) has an arcuate configuration and includes a multi-angle lower side surface (3122). The placement end (3119) is configured to be elastically deformable as described above. In addition, the lower jaw (3116) includes a nose portion (3126) having a conical top surface (3128). The multi-angle nature of the lower side surface (3122) combined with the conical top surface (3128) of the nose portion (3126) provides point contact for the placement end (3119) when the end effector (3112) is closed and unloaded. As such, when end effector (3112) is closed and unloaded, there is no gap between upper jaw (3114) and lower jaw (3116).Other ways of providing an end effector with jaws having a placement tip having arcuate sides when viewed in cross-section will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0189] G. Exemplary Stepped or Toothed End Shapes

[0190] As described above, the placement tip of the end effector can be configured to have a variety of shapes, including having a variety of width profiles. One such placement tip is Fig. 24B 23 is shown as having a placement tip (2319) having a stepped or toothed shape. Fig. 24BAs shown in the top view of , the placement tip (2319) includes a distal edge (2329) leading to a distal end (2330), wherein the distal edge (2329) defines a stepped width profile. In the present example, the placement tip (2319) extends distally from the anvil of the end effector. However, the placement tip (2319) can be constructed so that it can be part of the anvil or part of the nail magazine. In addition, the placement tip (2319) can be constructed so that it can be positioned on the upper jaw or the lower jaw of the end effector. In view of the teachings of this document, it will be apparent to a person of ordinary skill in the art that such a stepped width profile of the placement tip (2319) can be used with any of the placement tips of the end effectors described herein.

[0191] As shown in the illustrated version, the side (2329) of the placement tip (2319) defines a plurality of regions (2331, 2333, 2335) of the placement tip (2319), and each of the regions (2331, 2333, 2335) includes a different width (W1, W2, W3), as shown. In addition, for the stepped configuration, each width (W1, W2, W3) remains generally the same within its associated region (2331, 2333, 2335). In addition, when moving from the proximal end of the placement tip (2319) to the distal end (2330) of the placement tip (2319), the width (W1, W2, W3) of each region (2331, 2333, 2335) is less than or lower than the width of the immediately proximal positioning region.

[0192] exist Fig. 24B In the illustrated example, placement tip (2319) includes three distinct regions (2331, 2333, 2335). In other versions, placement tip (2319) may be configured to have more or fewer regions, as will be apparent to one of ordinary skill in the art in view of the teachings herein. Fig. 24B As shown, side (2329) further includes an angled portion (2337) where one region transitions to an adjacent region. In some other versions, angled portion (2337) may be orthogonal to an adjacent portion of side (2329) rather than angled. Other ways of configuring and placing end (2319) and side (2329) to define multiple regions having different widths will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0193] H. Exemplary Non-Rectangular Cross-Sections

[0194] One of the various other ways of placing the tip of the end effector can be configured to involve a lateral cross-sectional profile of the placement tip. As discussed above, the surgical instrument (10, 310) described herein includes an end effector at the distal end of an elongated shaft (22, 322). The end effector includes an upper jaw and a lower jaw, wherein one of the jaws includes an anvil. In at least some versions, the placement tip extends from the distal end of the anvil.

[0195] Fig.28 An exemplary jaw (3514) is shown that can be used with one or more of the end effectors described herein. In the illustrated example, the jaw (3514) includes an anvil (3518) and a placement tip (3519) extending from the distal end of the anvil (3518). The placement tip (3519) is configured to have a bend (3520) distal to where the placement tip (3519) is attached to the anvil (3518) and proximal to the distal end (3530) of the placement tip (3519).

[0196] See also Fig.29 In the illustrated version, the placement tip (3519) tapers as the placement tip (3519) extends distally. Various configurations of the distal end (3530) of the placement tip (3519) may be used as described above. The anvil (3518) defines a longitudinal axis, and the placement tip (3519) defines a lateral cross-section that may be taken at various locations along its length. Fig.29 In the illustrated example, the first lateral cross-section coincides with a position just proximal to the bend (3520), and Fig.29 The second lateral cross-section coincides with a position distal to the bend (3520) and proximal to the distal end (3530), and is Fig.29 Other locations for placing the lateral cross-section of tip (3519) will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0197] FIG. 30A to FIG. 34B Various cross-sectional profiles of placement tips (3519) or similar placement tips are shown. In addition, many of the illustrated cross-sectional profiles represent non-rectangular cross-sectional profiles. For example, Fig. 30A and Fig. 30B An exemplary inverted U-shaped cross-sectional profile is shown. Fig. 30A It coincides with the position of the placement end (3519) along the line A-A, such as Fig.29 As shown, Fig. 30BCoincident with the position along line B-B on the placement tip (3519). In this regard, the shapes of the cross-sectional profiles match, both being inverted U-shaped. However, the taper of the placement tip (3519) provides a smaller width or lateral dimension along a more distal position of the placement tip (3519) than a more proximal position of the placement tip (3519). Additionally, in this version, the inverted U-shaped cross-sectional profile is defined by the lower side surface (3522) having five connected orthogonally oriented surfaces. Thus, the U-shaped cross-sectional profile defines a void or space having a rectangular shape.

[0198] Fig.31A and Fig.31B Shown with Fig.28 and Fig.29 Various cross-sectional profiles of another placement tip (3619) that is identical to the placement tip (3519) shown. Fig.28 and Fig.29 The description of placement tip (3519) also applies to placement tip (3619). Fig.31A and Fig.31B An exemplary inverted U-shaped cross-sectional profile is shown, wherein the U-shape is defined by a curved underside surface (3622). Fig.31A It coincides with the position of the placement end (3619) along the line A-A, such as Fig.29 As shown, Fig.31B Coincident with the location along line B-B on the placement tip (3619). In this regard, the shapes of the cross-sectional profiles match, both being inverted U-shaped. However, the taper of the placement tip (3619) provides a smaller width or lateral dimension along a more distal location of the placement tip (3619) than a more proximal location of the placement tip (3619). Additionally, in this version, the inverted U-shaped cross-sectional profile is defined by the lower side surface (3622) having an arcuate surface as mentioned. Thus, the U-shaped cross-sectional profile defines a void or space having a semicircular shape.

[0199] Fig.32A and Fig.32B Shown with Fig.28 and Fig.29 Various cross-sectional profiles of another placement tip (3719) that is identical to the placement tip (3519) shown, except in the region proximal to the bend (3520). For the placement tip (3719), as will be shown by the cross-section, the region proximal to the bend includes a convex side (3702) such that the cross-sectional profile is not flat or straight across the top surface, as will be shown with respect to Fig.32A In addition to this difference between the placement end (3519) and the placement end (3719), relative to Fig.28 and Fig.29The description of placement tip (3519) also applies to placement tip (3719). Fig.32A An exemplary H-shaped cross-sectional profile is shown, while Fig.32B An exemplary U-shaped cross-sectional profile is shown. Fig.32A It coincides with the position of the placement end (3719) along the line A-A, such as Fig.29 As shown, Fig.32B Coincident with the position along line B-B on the placement end (3719). In this regard, the shape of the cross-sectional profile is different from the examples discussed above. In addition, the taper of the placement end (3719) provides a smaller width or lateral dimension along the more distal position of the placement end (3719) compared to the more proximal position of the placement end (3719). Additionally, in this version, the bottom portion of the H-shaped cross-sectional profile is defined by an inverted U-shape having five connected orthogonally oriented surfaces on the lower side surface (3722). In this way, these portions of the cross-sectional profile define a void or space having a rectangular shape.

[0200] Fig.33A and Fig.33B Shown with Fig.28 and Fig.29 Various cross-sectional profiles of another placement tip (3819) that is identical to the placement tip (3519) shown. Fig.28 and Fig.29 The description of placement tip (3519) also applies to placement tip (3819). Fig.33A An exemplary inverted V-shaped cross-sectional profile is shown, while Fig.33B An exemplary rectangular shape outline is shown. Fig.33A It coincides with the position along the line A-A on the placement end (3819), such as Fig.29 As shown, Fig.33B Coincident with the position along line B-B on the placement end (3819). In this regard, the shape of the cross-sectional profile is different. In addition, the taper of the placement end (3819) provides a smaller width or lateral dimension along the more distal position of the placement end (3819) compared to the more proximal position of the placement end (3819). Additionally, at the more proximal region of the placement end (3819), the inverted V-shaped cross-sectional profile is defined by the lower side surface (3822) having two connected angled surfaces. At the more distal region of the placement end (3819), the rectangular cross-sectional profile is defined by the flat or straight lower side surface (3822). In this way, the V-shaped cross-sectional profile defines a gap or space having a triangular shape, while the rectangular cross-sectional profile does not define any such gap or space.

[0201] Fig.34A and Fig.34B Shown with Fig.28 and Fig.29The placement tip (3519) is shown as a different cross-sectional profile than another placement tip (3919) that is identical to the placement tip (3519), except that the sides of the placement tip (3919) are rounded. This affects the cross-sectional profile as will be shown and described. In addition to this difference between the placement tip (3519) and the placement tip (3919), relative to Fig.28 and Fig.29 The description of placement tip (3519) also applies to placement tip (3919). Fig.34A and Fig.34B An exemplary elliptical cross-sectional profile is shown. Fig.34A It coincides with the position of the placement end (3919) along the line A-A, such as Fig.29 As shown, Fig.34B Coincident with the location along line B-B on the placement tip (3919). In this regard, the shapes of the cross-sectional profiles are of the same broad category, namely, two ovals, but the shapes differ in that the appearance of the oval shape is different at each profile. The taper of the placement tip (3919) provides a smaller width, diameter, or lateral dimension along a more distal location of the placement tip (3919) than at a more proximal location of the placement tip (3919). Additionally, in this version, the elliptical cross-sectional profile is defined by the lower side surface (3922) having an arcuate surface as mentioned. As such, the elliptical cross-sectional profile does not define a void or space because the curvature of the lower side surface (3922) is consistent with the placement tip (3919). FIG. 31A to FIG. 31B The curvature of the lower surface (3622) shown is different. Fig.34B In some other versions, along Fig.29 The shape of the cross-sectional profile taken along line B-B is circular rather than elliptical. Various modifications to the elliptical and circular configurations of the cross-sectional profile of the placement tip (3919) will be apparent to those of ordinary skill in the art in view of the teachings herein.

[0202] In this example, the placement end (3519, 3619, 3719, 3819, 3919) is configured to be elastically deformable or deflectable. As discussed above, this allows the placement end (3519, 3619, 3719, 3819, 3919) to deflect when subjected to a force such as a clamping force. The various lateral cross-sectional profiles shown and described above can be used to manipulate or control the nature and degree of deflection that the placement end (3519, 3619, 3719, 3819, 3919) can experience when subjected to a clamping force. In other versions, the placement end (3519, 3619, 3719, 3819, 3919) does not need to be configured to be elastically deformable or deflectable. In view of the teachings of this article, various ways of constructing and modifying the placement end of the end actuator as described herein (including ways of modifying the construction and lateral cross-sectional profile) will be apparent to those of ordinary skill in the art.

[0203] I. Exemplary Hardness Ranges and Visual Contrast

[0204] Fig.35 Another exemplary jaw (4014) is shown that can be used with one or more of the end effectors described herein. In the illustrated example, the jaw (4014) includes an anvil (4018) and a placement tip (4019) extending from the distal end of the anvil (4018). In the illustrated version, the placement tip (4019) is configured to have an arc or curved configuration. However, such an arc or curved configuration is not required in all cases, and in other versions, the placement tip (4019) may have a straight configuration. Returning to the illustrated version, the placement tip (4019) is further configured to be elastically deformable or deflectable. This allows the placement tip (4019) to deflect when subjected to a force such as a clamping force.

[0205] The placement tip (4019) is constructed of a material having a specific hardness range. For example, in the present example, the placement tip (4019) is constructed of a material having a hardness between about Shore 40A and about Shore 40D. However, this range should not be considered limiting or required in all versions, and other suitable hardness ranges will be apparent to one of ordinary skill in the art in view of the teachings herein.

[0206] Additionally, the placement tip (4019) is constructed of a material having a high contrast color. By having a high contrast color compared to the other materials of the surgical instrument and compared to the environment in which the surgical instrument is used, the placement tip (4019) can provide enhanced visualization for placement during use. In this example, the placement tip (4019) is constructed of a material having a neon green color. In some cases, this color can be described as iridescent green or fluorescent green or highlight green. In this example, the placement tip (4019) is further constructed to have a slot (4021) that can provide additional color contrast relative to the material of the placement tip (4019). However, the slot (4021) is not required in all versions. And in addition, in some versions, the slot (4021) is completely omitted or replaced with a region or area having another contrasting color with the rest of the placement tip (4019). In view of the teachings herein, other high contrast colors and / or color patterns used with the placement tip (4019) will be apparent to those of ordinary skill in the art.

[0207] J. Exemplary Deflectable Straight Tip Extending Beyond Cartridge

[0208] While many of the resiliently deformable placement tips shown and described above are arcuate or curved, in other versions, the end effector may incorporate a placement tip that extends distally from one of the jaws in a straight manner. Figure 36 to Figure 39 1 and 2 show views of exemplary end effectors (4112, 4212), each of which includes a straight placement tip (4119, 4219) that is elastically deformable or deflectable. Fig.36 Initially, the end effector (4112) includes an upper jaw (4114) and a lower jaw (4116). One or both of the jaws (4114, 4116) are operable to move relative to one another so as to open and close the end effector (4112). The end effector (4112) also includes an anvil (4118) and a bin (4137) that is the same or similar to the bin (37) described above. The bin (4137) includes a nail configured to strike or contact the anvil (4118) during use, as described and shown above with respect to the instrument (10, 310). In the present example, the upper jaw (4114) includes the anvil (4118), and the lower jaw (4116) includes the bin (4137). Furthermore, in the present example, placement tip (4119) extends distally from anvil (4118) and is not angled with cartridge (4137) toward lower jaw (4116), but remains flat. Additionally, placement tip (4119) extends distally beyond cartridge (4137) of lower jaw (4116).

[0209] Fig.37An end effector (4212) is shown, which includes an upper jaw (4214) and a lower jaw (4216). One or both jaws of the jaws (4214, 4216) are operable to move relative to one another so as to open and close the end effector (4212). The end effector (4212) also includes an anvil (4218) and a bin (4237), which is the same or similar to the above-mentioned bin (37). The bin (4237) includes a nail configured to strike or contact the anvil (4218) during use, as described and shown above with respect to the instrument (10, 310). In this example, the upper jaw (4214) includes the anvil (4218), and the lower jaw (4216) includes the bin (4237). Moreover, in the present example, placement tip (4219) extends distally from anvil (4218) and is not angled with cartridge (4237) toward lower jaw (4216), but rather is angled with cartridge (4237) away from lower jaw (4216). Thus, placement tip (4219) includes an upwardly angled surface (4222) proximate its distal end. Additionally, placement tip (4219) extends distally beyond cartridge (4237) of lower jaw (4216).

[0210] Fig.38 and Fig.39 A top view of the upper jaws (4114, 4214) of the end effectors (4112, 4212) is shown. It should be understood that Fig.38 The top view of is applicable to the two upper jaws (4114, 4214) of the end effector (4112, 4212) in a slightly different manner. Similarly, Fig.39 The top view of FIG. 4 is applicable to the two upper jaws (4114, 4214) of the end actuator (4112, 4212) in a slightly different manner.

[0211] for Fig.36 The end effector (4112) of the present invention, in one form, an upper jaw (4114) having an anvil (4118) and a placement tip (4119) has a placement tip (4119) that is flat and rounded at its distal end, such as Fig.38 Additionally, Fig.38 As shown, the placement tip (4119) comprises the same width as the anvil (4118). In another version of the end effector (4112), the upper jaw (4114) having the anvil (4118) and the placement tip (4119) has a placement tip (4119) that is tapered with a more pointed but slightly rounded distal end, such as Fig.39 Additionally, Fig.39As shown, although the placement tip (4119) tapers as it extends distally, at its proximal attachment point to the anvil (4118), the placement tip has the same width as the anvil (4118).

[0212] for Fig.37 The end effector (4212) of the present invention, in one version, an upper jaw (4214) having an anvil (4218) and a placement tip (4219) has a placement tip (4219) that is flat and rounded at its distal end, such as Fig.38 Additionally, Fig.38 As shown, the placement tip (4219) comprises the same width as the anvil (4218). In another version of the end effector (4212), the upper jaw (4214) having the anvil (4218) and the placement tip (4219) has a placement tip (4219) that is tapered with a more pointed but slightly rounded distal end, such as Fig.39 Additionally, Fig.39 As shown, although the placement tip (4219) tapers as it extends distally, at its proximal attachment point to the anvil (4218), the placement tip has the same width as the anvil (4218).

[0213] With respect to end effectors (4112, 4212), the upper jaws (4114, 4214) having anvils (4118, 4218) and placement ends (4119, 4219) have been described above as being straight relative to the longitudinal axis of the respective anvils (4118, 4218), but capable of deflection when subjected to forces such as clamping forces. In addition, placement ends (4119, 4219) have been described as having various configurations, including flat and round, angled and round, flat and tapered, and angled and tapered configurations. In view of the teachings herein, various modifications to the deflectable and straight placement ends of the end effectors extending beyond the bin will be apparent to those of ordinary skill in the art. By way of example only and not limitation, some such modifications may relate to the shape of the distal end or other regions of the placement end, including lateral and longitudinal cross-sectional profiles.

[0214] V. Exemplary Combinations

[0215] 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 as 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.

[0216] Example 1

[0217] A method for surgical suturing, the method using a device including a body, a shaft extending from the body, and an end effector connected to the shaft. The method includes (a) positioning the end effector at a desired location for surgical suturing. The end effector includes: (i) a pair of jaws, (ii) a bin configured to hold one or more staples, wherein the bin is selectively connected to a first jaw of the pair of jaws, (iii) an anvil configured to be contacted by the one or more staples of the bin, wherein the second jaw of the pair of jaws includes the anvil, and (iv) a placement end that is elastically deformable. The placement end extends distally from the second jaw, wherein the placement end includes an arcuate bend relative to the longitudinal axis of the anvil. The method also includes: (b) controlling one or more of the jaws of the end actuator to place the end actuator in an open position, wherein in the open position there is a gap between the jaws; (c) positioning the end actuator with the end actuator in the open position so that tissue is located between the jaws; (d) clamping the tissue between the jaws by moving at least one of the jaws toward the other jaw, wherein clamping the tissue places the end actuator in a loaded state, wherein in the loaded state the placement end of the second jaw is deflected away from the first jaw; and (e) advancing a firing beam of the device from a proximal position to a distal position, wherein advancing the firing beam causes the tissue to be cut by the cutting edge of the firing beam, and wherein advancing the firing beam also causes the tissue to be sutured by ejecting the one or more staples from the cartridge.

[0218] Example 2

[0219] A method according to Example 1, wherein the placement tip extends distally from the anvil.

[0220] Example 3

[0221] A method according to any one or more of embodiments 1 to 2, wherein the second jaw is capable of moving relative to the first jaw.

[0222] Example 4

[0223] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes an arcuate longitudinal cross-sectional profile.

[0224] Example 5

[0225] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes a multi-angle longitudinal cross-sectional profile.

[0226] Example 6

[0227] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes a non-rectangular lateral cross-sectional profile.

[0228] Example 7

[0229] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes an inverted U-shaped lateral cross-sectional profile.

[0230] Example 8

[0231] A method as in Example 7, wherein the inverted U-shaped lateral cross-sectional profile includes a curve extending along the lower side surface across the width of the placement tip.

[0232] Example 9

[0233] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes an inverted V-shaped lateral cross-sectional profile.

[0234] Example 10

[0235] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes an H-shaped lateral cross-sectional profile.

[0236] Embodiment 11

[0237] A method as described in any one or more of embodiments 1 to 3, wherein the placement tip includes an elliptical lateral cross-sectional profile.

[0238] Example 12

[0239] The method according to any one or more of embodiments 1 to 11, wherein the placement tip includes a proximal lateral cross-sectional profile and a distal lateral cross-sectional profile, wherein the proximal lateral cross-sectional profile and the distal lateral cross-sectional profile have matching shapes.

[0240] Embodiment 13

[0241] A method according to any one or more of embodiments 1 to 11, wherein the placement tip includes a proximal lateral cross-sectional profile and a distal lateral cross-sectional profile, wherein the proximal lateral cross-sectional profile and the distal lateral cross-sectional profile have different shapes.

[0242] Embodiment 14

[0243] A method according to Example 13, wherein the proximal lateral cross-sectional profile includes an H-shape, and wherein the distal lateral cross-sectional profile includes an inverted U-shape.

[0244] Embodiment 15

[0245]

[00136] The method according to Example 13, wherein the proximal lateral cross-sectional profile comprises an inverted V-shape, and wherein the distal lateral cross-sectional profile comprises a rectangular shape.

[0246] Example 16

[0247] A method as in any one or more of embodiments 1-15, wherein the placement tip comprises a material having a hardness ranging from about Shore 40A to about Shore 40D.

[0248] Embodiment 17

[0249] A method according to any one or more of embodiments 1-16, wherein the placement tip comprises a high contrast color relative to other components of the end effector.

[0250] Embodiment 18

[0251] A method for surgical suturing, the method using an apparatus including a body, a shaft extending from the body, and an end effector in communication with the shaft. The method includes (a) positioning the end effector at a desired location for surgical suturing. The end effector includes: (i) a pair of jaws, (ii) a cartridge configured to hold one or more staples, wherein the cartridge is selectively connected to a first jaw of the pair of jaws, (iii) an anvil configured to be contacted by the one or more staples of the cartridge, wherein a second jaw of the pair of jaws includes the anvil, and (iv) a placement end that is elastically deformable and extends distally from the second jaw. The placement end includes a pair of sides defining a plurality of different regions, each of the plurality of different regions having a width, wherein as the pair of sides extend distally, each width of the different regions is less than the width of the different regions positioned immediately adjacent to the side. The method also includes: (b) controlling one or more of the jaws of the end actuator to place the end actuator in an open position, wherein in the open position there is a gap between the jaws; (c) positioning the end actuator with the end actuator in the open position so that tissue is located between the jaws; (d) clamping the tissue between the jaws by moving at least one of the jaws toward the other jaw, wherein clamping the tissue places the end actuator in a loaded state, wherein in the loaded state the placement end of the second jaw is deflected away from the first jaw; and (e) advancing a firing beam of the device from a proximal position to a distal position, wherein advancing the firing beam causes the tissue to be cut by the cutting edge of the firing beam, and wherein advancing the firing beam also causes the tissue to be sutured by ejecting the one or more staples from the cartridge.

[0252] Embodiment 19

[0253] A method according to Example 18, wherein the placement tip includes an arcuate bend relative to a longitudinal axis of the anvil.

[0254] Embodiment 20

[0255] A method of surgical suturing, the method using an apparatus including a body, a shaft extending from the body, and an end effector in communication with the shaft. The method includes: (a) positioning the end effector at a desired location for surgical suturing, wherein the end effector includes: (i) a pair of jaws, (ii) a cartridge configured to hold one or more staples, wherein the cartridge is selectively connected to a first jaw of the pair of jaws, (iii) an anvil configured to be contacted by the one or more staples of the cartridge, wherein a second jaw of the pair of jaws includes the anvil, and (iv) a placement tip that is elastically deformable and extends distally from the second jaw and extends distally beyond the cartridge. The placement tip extends in a straight manner along a longitudinal axis defined by the anvil. The method also includes: (b) controlling one or more of the jaws of the end actuator to place the end actuator in an open position, wherein in the open position there is a gap between the jaws; (c) positioning the end actuator with the end actuator in the open position so that tissue is located between the jaws; (d) clamping the tissue between the jaws by moving at least one of the jaws toward the other jaw, wherein clamping the tissue places the end actuator in a loaded state, wherein in the loaded state the placement end of the second jaw is deflected away from the first jaw; and (e) advancing a firing beam of the device from a proximal position to a distal position, wherein advancing the firing beam causes the tissue to be cut by the cutting edge of the firing beam, and wherein advancing the firing beam also causes the tissue to be sutured by ejecting the one or more staples from the end of the cartridge.

[0256] VI. Miscellaneous

[0257] 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. With reference to the teachings herein, various suitable ways in which the teachings herein can be combined will be apparent to those of ordinary skill in the art. Such modifications and variations are intended to be included within the scope of the claims.

[0258] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. Patent Application 29 / 594,332, entitled "Surgical Stapler End Effector with Varying Deck Height and Tissue Gripping Features", filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application 29 / 594,332 will be apparent to those of ordinary skill in the art.

[0259] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. Patent Application 29 / 594,335, entitled "Circular Surgical Stapler End Effector with Varying Deck Height and Tissue Gripping Features", filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application 29 / 594,335 will be apparent to those of ordinary skill in the art.

[0260] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. Patent Application 15 / 435,607, entitled "Surgical Stapler with Insertable DistalAnvil Tip", filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application 15 / 435,607 will be apparent to those of ordinary skill in the art.

[0261] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. Patent Application No. 15 / 435,618, entitled "Surgical Stapler with Cooperating Distal Tip Features on Anvil and Staple Cartridge", filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application No. 15 / 435,618 will be apparent to those of ordinary skill in the art.

[0262] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. Patent Application 29 / 594,340, entitled "Surgical Stapler with Bent Anvil Tip and Angled Staple Cartridge Tip", filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application 29 / 594,340 will be apparent to those of ordinary skill in the art.

[0263] It should also be understood that the teachings herein can be readily combined with various teachings in the following U.S. patent application: U.S. Patent Application No. 15 / 435,631, entitled "Surgical Stapler with Bent Anvil Tip, Angled Staple Cartridge Tip, and Tissue Gripping Features", filed on February 17, 2017, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application No. 15 / 435,631 will be apparent to those of ordinary skill in the art.

[0264] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8115USCIP2.0659204], entitled "Surgical Stapling End Effector Jaw with Tip Deflecting Toward Other Jaw", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8115USCIP2.0659204] will be apparent to those of ordinary skill in the art.

[0265] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8115USCIP3.0659198], entitled "Method of Surgical Stapling with End Effector Component Having a Curved Tip", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8115USCIP3.0659198] will be apparent to those of ordinary skill in the art.

[0266] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8578USNP.0658213], entitled "Permanent Attachment Means for Curved Tip of Component of Surgical Stapling Instrument", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8578USNP.0658213] will be apparent to those of ordinary skill in the art.

[0267] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8593USNP.0659208], entitled "Surgical Stapling End Effector Component with Deformable Tip Having Void", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8593USNP.0659208] will be apparent to those of ordinary skill in the art.

[0268] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8594USNP.0659212], entitled "Surgical Stapling End Effector Component with Deformable Tip Skewing in Multiple Planes", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8594USNP.0659212] will be apparent to those of ordinary skill in the art.

[0269] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8595USNP.0659215], entitled "Surgical Stapling End Effector Component with Articulation and Asymmetric Deformable Tip", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8595USNP.0659215] will be apparent to those of ordinary skill in the art.

[0270] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8596USNP.0659218], entitled "Surgical Stapling End Effector Component with Deformable Tip Having Thick Distal End", filed on the same date as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8596USNP.0659218] will be apparent to those of ordinary skill in the art.

[0271] It should also be understood that the teachings herein can be easily combined with various teachings in the following U.S. patent application: U.S. Patent Application [Attorney Docket No. END8597USNP.0659221], entitled "Buttress ApplierCartridge for Surgical Stapler Having End Effector with Deformable CurvedTip", filed on the same day as the present application, the disclosure of which is incorporated herein by reference. Various suitable ways in which the teachings herein can be combined with the teachings of U.S. Patent Application [Attorney Docket No. END8597USNP.0659221] will be apparent to those of ordinary skill in the art.

[0272] 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 disclosures explicitly listed herein supersede 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.

[0273] 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). TMSimilarly, one of ordinary skill in the art will recognize that the various teachings herein may be readily combined with the various teachings of any of the following U.S. patents: U.S. Patent No. 5,792,135, entitled “Articulated Surgical Instrument For Performing Minimally Invasive Surgery With Enhanced Dexterity and Sensitivity,” issued on August 11, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent No. 5,817,084, entitled “Remote Center Positioning Device with Flexible Drive,” issued on October 6, 1998, the disclosure of which is incorporated herein by reference; U.S. Patent No. 5,878,193, entitled “Automated Endoscope System for Optimal Positioning,” issued on March 2, 1999, the disclosure of which is incorporated herein by reference; U.S. Patent No. 5,878,193, entitled “Automated Endoscope System for Optimal Positioning,” issued on May 15, 2001, the disclosure of which is incorporated herein by reference; No. 6,231,565, entitled “Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument”, issued on August 31, 2004, the disclosure of which is incorporated herein by reference; No. 6,783,524, entitled “Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument”, issued on April 2, 2002, the disclosure of which is incorporated herein by reference; No. 6,364,888, entitled “Alignment of Master and Slave in a Minimally Invasive Surgical Apparatus”, issued on April 28, 2009, the disclosure of which is incorporated herein by reference; No. 7,524,320, entitled “Mechanical Actuator Interface System for Robotic Surgical Tools”, issued on April 28, 2009, the disclosure of which is incorporated herein by reference; No. 7,691,098, entitled “Platform Link Wrist Mechanism”, issued on April 6, 2010, the disclosure of which is incorporated herein by reference;U.S. Patent No. 7,806,891, entitled “Repositioning and Reorientation of Master / Slave Relationship in Minimally Invasive Telesurgery”, issued on October 5, 2010, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,844,789, entitled “Automated End Effector Component Reloading System for Use with a Robotic System”, issued on September 30, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,820,605, entitled “Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities”, issued on September 2, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,820,605, entitled “Robotically-Controlled Surgical Instrument with Force-Feedback Capabilities”, issued on December 31, 2013, the disclosure of which is incorporated herein by reference; Tool”, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,616,431, entitled “Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements”, issued on November 5, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,573,461, entitled “Surgical Stapling Instruments with Cam-Driven Staple Deployment Arrangements”, issued on December 10, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,602,288, entitled “Robotically-Controlled Motorized Surgical End Effector System with Rotary Actuated Closure Systems Having Variable Actuation Speeds”, issued on December 10, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 9,301,759, entitled “Robotically-Controlled Surgical Instrument with Selectively Articulatable End Effector”, issued on April 5, 2016, the disclosure of which is incorporated herein by reference;U.S. Patent No. 8,783,541, entitled “Robotically-Controlled Surgical End Effector System,” issued on July 22, 2014, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,479,969, entitled “Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot,” issued on July 9, 2013, the disclosure of which is incorporated herein by reference; U.S. Patent No. 8,800,838, entitled “Robotically-Controlled Cable-Based Surgical End Effectors,” issued on August 12, 2014, the disclosure of which is incorporated herein by reference; and / or U.S. Patent No. 8,573,465, entitled “Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems,” issued on November 5, 2013, the disclosure of which is incorporated herein by reference. ;

[0274] 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.

[0275] 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.

[0276] 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 device comprising: (a) a first jaw having a plurality of nail holes for accommodating a plurality of nails; (b) a second jaw having a plurality of staple forming recesses configured to form the staples, wherein the first jaw and the second jaw are configured to cooperate to clamp tissue and suturing the tissue via the staples; as well as (c) an end member, wherein the end member is coupled to a selected jaw defined by one of the first jaw or the second jaw such that a proximal end of the end member is longitudinally constrained relative to the selected jaw, wherein the end member is configured to extend along a portion of an opposing jaw defined by the other of the first jaw or the second jaw, wherein the tip member is configured to transition between a first configuration and a second configuration relative to the selected jaw, wherein in at least one of the first configuration or the second configuration, a distal portion of the tip member does not extend parallel to a longitudinal axis of the selected jaw, Wherein the distal end of the tip member is configured to be able to extend distally beyond the distal ends of the opposing jaws in at least one of the first configuration or the second configuration.

2. The device according to claim 1, wherein: The selected jaw includes a jaw body, wherein a proximal end of the tip member is secured to a distal end of the jaw body.

3. The device according to claim 1, wherein: The end member is coupled to the second jaw.

4. The device according to claim 1, wherein: In the first configuration, the distal end of the tip member is positioned at a first distance from the distal ends of the opposing jaws, wherein in the second configuration, the distal end of the tip member is positioned at a second distance from the distal ends of the opposing jaws.

5. The device according to claim 1, wherein: The tip member is configured to transition from the first configuration to the second configuration in response to closing of the first jaw and the second jaw onto tissue.

6. The device according to claim 1, wherein: The end member is configured to be elastically deformable to transition from the first configuration to the second configuration.

7. The device according to claim 1, wherein: In the first configuration, the distal portion of the tip member does not extend parallel to the longitudinal axis of the selected jaw.

8. The device according to claim 7, wherein: The distal portion of the tip member is linear and configured to extend at an angle relative to the longitudinal axis when the tip member is in the first configuration.

9. The device according to claim 7, wherein: The distal portion of the tip member is curved and configured to extend along an arcuate path when the tip member is in the first configuration.

10. The device according to claim 1, wherein: The end member includes an underside surface and the opposing jaw includes a distal nose having an angled nose surface, wherein the underside surface is configured to remain spaced apart from the angled nose surface in each of the first configuration and the second configuration when the first jaw and the second jaw are closed.

11. The device according to claim 1, wherein: The end member includes an underside surface defining a void.

12. The device according to claim 11, wherein The underside surface includes at least one of a flat surface portion or a curved surface portion defining the void.

13. The apparatus according to claim 1, wherein: The first jaw and the second jaw are pivotable relative to each other between an open position for receiving tissue and a closed position for clamping tissue.

14. The apparatus according to claim 1, wherein: The end member includes a rigid portion and a resiliently deflectable portion.

15. A device comprising: (a) a first jaw having a plurality of nail holes for accommodating a plurality of nails; (b) a second jaw having a plurality of staple forming recesses configured to form the staples, wherein the first jaw and the second jaw are configured to transition from an open state to a closed state to clamp tissue and suturing the tissue through the staples; (c) a tip member coupled to a selected jaw defined by one of the first jaw or the second jaw such that a proximal end of the tip member is longitudinally constrained relative to the selected jaw; and (d) a distal nose defined by the other of the first jaw or the second jaw, wherein the distal nose includes an angled nose surface facing the terminal member, wherein the tip member is configured to transition between a first configuration and a second configuration relative to the selected jaw, wherein in at least one of the first configuration or the second configuration, a distal portion of the tip member does not extend parallel to a longitudinal axis of the selected jaw, The underside surface of the end member is configured to be spaced apart from the angled nose surface so as to define a gap between the underside surface and the angled nose surface in each of the first configuration and the second configuration when the first jaw and the second jaw are in the closed state.

16. The device according to claim 15, wherein: The underside surface and the angled nose surface are configured to remain spaced apart from each other in the closed state even in the absence of tissue between the underside surface and the angled nose surface.

17. The apparatus according to claim 15, wherein: The distal nose is tapered such that the angled nose surface is angled relative to a longitudinal axis of the other of the first jaw or the second jaw.

18. The apparatus according to claim 15, wherein: The end member is configured to be elastically deformable to transition between the first configuration and the second configuration.

19. A device comprising: (a) a first jaw having a plurality of nail holes for accommodating a plurality of nails; (b) a second jaw having a plurality of staple forming recesses configured to form the staples, wherein the first jaw and the second jaw are configured to cooperate to clamp tissue and suturing the tissue via the staples; as well as (c) a tip member, wherein the tip member is coupled to a selected jaw defined by one of the first jaw or the second jaw such that a proximal end of the tip member is longitudinally constrained relative to the selected jaw, wherein the tip member is configured to extend along a portion of an opposing jaw defined by the other of the first jaw or the second jaw, wherein the tip member is configured to be elastically deformable from a neutral state to a deflected state in response to closing of the first jaw and the second jaw onto tissue, The end member is configured to extend arcuately along a curved path at least in the neutral state.

20. The apparatus of claim 19, wherein: The opposing jaws include a distal nose having an angled surface facing the tip member, wherein the tip member curves toward the angled surface.

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