Surgical instrument

Abstract

A surgical instrument, characterized in that the surgical instrument comprises an end tool comprising one or more jaws (jaw), in which any one of the one or more jaws comprises: a reciprocating assembly disposed inside the jaw and movable in a first direction, which is a length direction of the jaw, and a second reciprocating assembly disposed inside the jaw and movable in a second direction, which is a length direction of the jaw; a working member formed to be contactable with the reciprocating assembly so as to be formed to be advanceable by the reciprocating assembly in the first direction from a proximal end side of the jaw to a distal end side of the jaw; and a retreating wire disposed adjacent to the working member and movable in the first direction, in which the retreating wire includes one or more fasteners fixed to the retreating wire, and the fasteners can retreat the working member toward a proximal end side of the jaw.

Description

[0001] CROSS-REFERENCE TO RELATED APPLICATIONS

[0002] This application claims priority, based on 35 U.S.C. §119, to Korean Patent Application No. 10-2023-0153490 filed on November 8, 2023, in the Korean Intellectual Property Office, which is incorporated herein in its entirety. Technical Field

[0003] The present invention relates to a surgical instrument, and in particular to a surgical instrument, wherein the surgical instrument can be installed on a robot arm or can be manually operated for use in laparoscopic surgery or various other surgeries. Background Art

[0004] Recently, laparoscopic surgery has been actively used to reduce postoperative recovery time and complications through small incisions. Laparoscopic surgery is a method of drilling multiple small holes in the patient's abdomen and performing surgery while observing the inside of the abdominal cavity through these small holes. It is widely used in general surgery, etc.

[0005] When such laparoscopic surgery is performed, a suturing instrument inserted into the body is used to suturing a surgical site in the abdominal cavity, and as such a suturing instrument, a surgical stapler that suturing the surgical site with medical staples is used.

[0006] Generally speaking, a surgical stapler is a medical device widely used for cutting and anastomosis of organs in abdominal and thoracic organ surgeries. Such surgical staplers include open staplers used in thoracotomy or laparotomy, and endo staplers used in thoracoscopy and laparoscopy.

[0007] The advantage of surgical staplers is that they can not only shorten the operation time, but also achieve accurate suturing of the surgical site, since they can perform organ anastomosis while cutting the surgical site. In addition, surgical staplers are widely used in modern surgical operations because they have the advantages of faster recovery and less scarring when cutting and suturing tissues compared to using surgical sutures. In particular, surgical staplers are widely used in cancer surgery to cut cancerous tissues and suturing the cut site.

[0008] The above-mentioned background technology is the technical information possessed by the inventor in order to derive the present invention, or the technical information obtained in the process of deriving the present invention, and it should not be considered as necessarily the known technology disclosed to the public before applying for the present invention. Summary of the invention

[0009] An object of the present invention is to provide a surgical instrument, wherein the surgical instrument can be mounted on a robot arm or can be manually operated for use in laparoscopic surgery or various other surgeries, and includes a structure for preventing a working member from retreating during a stapling action and a retreat guide wire structure for retreating the working member after the stapling action.

[0010] Other aspects will be described in part below and in part will be obvious based on the description or may be learned by practicing embodiments of the invention.

[0011] One embodiment of the present invention provides a surgical instrument, characterized in that the surgical instrument includes an end tool, which includes one or more jaws and is formed to be rotatable along at least any direction, wherein any one of the one or more jaws includes: a reciprocating assembly, which is arranged inside the jaw and is movable relative to the jaw along a first direction which is the length direction of the jaw; a working member, which is formed on one side of the reciprocating assembly and is formed to be contactable with the reciprocating assembly, so as to be able to move forward from the proximal end side of the jaw to the distal end side of the jaw along the first direction through the reciprocating assembly; and a retreat wire, which is arranged adjacent to the working member and is movable along the first direction, wherein the retreat wire includes one or more fasteners fixed to the retreat wire, and the fastener can move the working member backward toward the proximal end side of the jaw by moving to the proximal end side of the jaw together with the retreat wire.

[0012] In one embodiment of the present invention, the jaws further include a back-up wire pulley formed at the distal end of the jaws, wherein a portion of the back-up wire contacts and is wound around the back-up wire pulley, and two branches of the wire released therefrom can extend toward the proximal end side.

[0013] In one embodiment of the present invention, the jaw further comprises an auxiliary pulley arranged adjacent to the retreat wire pulley, wherein the auxiliary pulley can arrange the retreat wire by adjusting the position or distance between two branches of the retreat wire.

[0014] In one embodiment of the present invention, in the retreating wire, when one of the two branches of the wire close to the working member is classified as an inner wire, and the other is classified as an outer wire, the fastener may be coupled to the outer wire.

[0015] In one embodiment of the present invention, the end tool may include: a jaw rotation axis, which is the rotation center of the jaw; and an annular pulley, which is coupled to the jaw rotation axis and a portion of the retracting wire is wound around the annular pulley.

[0016] In one embodiment of the present invention, the annular pulley is composed of two pulleys that can rotate independently of each other, and the two branches of the retreat wire can be wound around the annular pulley in different directions based on the jaw rotation axis.

[0017] In one embodiment of the present invention, a plurality of concave-convex portions are formed on at least one side of the reciprocating assembly, and the working component includes a ratchet component, a ratchet is formed on at least one side of the ratchet component, and the ratchet of the ratchet component can be formed to be contactable with the concave-convex portions of the reciprocating assembly.

[0018] In an embodiment of the present invention, the fastener may cause the working member to move backward toward the proximal end portion by contacting the ratchet member.

[0019] In an embodiment of the present invention, the ratchet member includes a protrusion protruding from a surface opposite to a surface on which the ratchet is formed, and the fastener may be in contact with the protrusion of the ratchet member.

[0020] In an embodiment of the present invention, the protrusion of the ratchet member forms a hollow, and the retreat wire can pass through the protrusion through the hollow.

[0021] In an embodiment of the present invention, the retreat guide wire and the fastener may be located at opposite sides of the reciprocating assembly based on the ratchet member.

[0022] In an embodiment of the present invention, the fastener may be arranged at the distal end side so as not to interfere with the working member until the working member is moved forward to the distal end side of the jaw.

[0023] In an embodiment of the present invention, when the working member moves forward toward the distal end portion, the fastener may move together in front of the working member while being spaced apart from the working member to ensure a free space.

[0024] One embodiment of the present invention provides a surgical instrument, characterized in that the surgical instrument includes an end tool, which includes one or more jaws and is formed to be rotatable along at least any direction, wherein any one of the one or more jaws includes: a reciprocating assembly, which is arranged inside the jaw and is movable relative to the jaw along a first direction which is the length direction of the jaw; a working member, which is formed on one side of the reciprocating assembly and is formed to be contactable with the reciprocating assembly, so as to be able to move forward from the proximal end side of the jaw to the distal end side of the jaw along the first direction through the reciprocating assembly; and a retreat wire, which is arranged adjacent to the working member and is movable along the first direction, wherein the retreat wire includes one or more fasteners fixed to the retreat wire, and when the reciprocating assembly moves toward the proximal end side of the jaw, the fastener prevents the working member from moving toward the proximal end side of the jaw by contacting the working member.

[0025] In an embodiment of the present invention, when the working member moves forward toward the distal end portion, the fastener may move together behind the working member while being spaced apart from the working member to ensure a free space.

[0026] In one embodiment of the present invention, when the working member moves forward toward the distal end portion, the fastener may move together behind the working member while applying force to the working member along the direction of the forward movement.

[0027] In an embodiment of the present invention, the working member includes a protrusion protruding toward the retreating wire side, and the fastener may be arranged behind the protrusion.

[0028] In one embodiment of the present invention, a plurality of concave-convex portions are formed on at least one side of the reciprocating assembly, and the working component includes a ratchet component, a ratchet is formed on at least one side of the ratchet component, and the ratchet of the ratchet component can be formed to be contactable with the concave-convex portions of the reciprocating assembly.

[0029] In an embodiment of the present invention, the fastener may be arranged behind the ratchet member.

[0030] In an embodiment of the present invention, the protrusion of the ratchet member forms a hollow, and the retreat wire can pass through the protrusion through the hollow.

[0031] In one embodiment of the present invention, in the retreating wire, when one of the two branches of the wire close to the working member is classified as an inner wire and the other is classified as an outer wire, the fastener may be coupled to the inner wire.

[0032] In one embodiment of the present invention, the retreat guide wire further includes a retreat fastener, and the retreat fastener can move the working member backward toward the proximal end portion while moving toward the proximal end portion together with the retreat guide wire.

[0033] In one embodiment of the present invention, in the retreat wire, when one of the two branches of the wire close to the working member is classified as an inner wire, and the other is classified as an outer wire, the retreat fastener and the fastener can only be combined with any one of the inner wire and the outer wire.

[0034] In one embodiment of the present invention, when the working member moves forward to the distal end side, the retreat fastener may move together in front of the working member while being spaced apart from the working member to ensure a free space.

[0035] One embodiment of the present invention provides a surgical instrument, characterized in that the surgical instrument includes an end tool, which includes one or more jaws and is formed to be rotatable along at least any direction, wherein any one of the one or more jaws includes: a reciprocating assembly, which is arranged inside the jaw and is movable relative to the jaw along a first direction which is the length direction of the jaw; and a working member, which is formed on one side of the reciprocating assembly and is formed to be contactable with the reciprocating assembly, so as to be able to move forward from the proximal end side of the jaw to the distal end side of the jaw along the first direction through the reciprocating assembly, wherein one or more concave-convex portions are formed on the inner side surface of the jaw in an area which can contact the working member, and a buckle which can contact the concave-convex portion is formed on the working member.

[0036] In one embodiment of the present invention, when the reciprocating assembly moves toward the proximal end side of the jaws, the buckle may prevent the working member from moving toward the proximal end side of the jaws by contacting the concave-convex portion.

[0037] In an embodiment of the present invention, one end of the buckle is combined with the working member and may be formed to allow a certain degree of elastic deformation.

[0038] In one embodiment of the present invention, the concavoconvex portion is formed below the moving path of the working member, and one end of the buckle is coupled to the rear lower end of the working member, and the other end of the buckle can contact the concavoconvex portion.

[0039] In an embodiment of the present invention, the one or more concave-convex parts may include an inclined surface, and the inclined surface is formed so that the height of the distal end side of the jaw is higher than the height of the proximal end side.

[0040] In one embodiment of the present invention, the one or more concave-convex portions include a first inclined surface as a surface on the proximal end side and a second inclined surface as a surface on the distal end side, and the first inclined surface is formed to have a gentle inclination, and the second inclined surface can be formed to be nearly vertical.

[0041] In one embodiment of the present invention, when the working member moves forward toward the distal end side, the buckle climbs up the first inclined surface and moves toward the distal end side, and when the reciprocating assembly moves backward toward the proximal end side, the buckle interferes with the second inclined surface, thereby preventing the working member from moving backward toward the proximal end side.

[0042] In one embodiment of the present invention, it further includes a retreat wire, which can move the working component backward toward the proximal end side. When the working component moves backward toward the proximal end side through the retreat wire, the buckle undergoes plastic deformation, thereby losing its function of preventing the working component from moving backward.

[0043] Other aspects, features, and advantages in addition to those described above will become apparent from the following drawings, claims, and summary. BRIEF DESCRIPTION OF THE DRAWINGS

[0044] Figure 1 is a perspective view showing a surgical instrument according to a first embodiment of the present invention.

[0045] Figure 2 It is shown Figure 1 A perspective view of the end tool of a surgical instrument.

[0046] Figure 3 and Figure 4 1 is a plan view showing a first jaw of a distal end tool of a surgical instrument according to a first embodiment of the present invention.

[0047] Figure 5 1 is a perspective view showing a first jaw of a distal end tool of a surgical instrument according to a first embodiment of the present invention.

[0048] Figure 6 and Figure 7It is shown Figure 3 A perspective view of the groove portion of the reciprocating member and the suture staple pulley in FIG.

[0049] Figure 8 It is shown Figure 3 Perspective view of the staple pulley in FIG.

[0050] Fig. 9 It is shown Figure 1 A perspective view of the first jaw and nail magazine of the surgical instrument.

[0051] Fig.10 It is shown Fig. 9 An exploded perspective view of the nail magazine in FIG.

[0052] Fig.11 It is shown Fig. 9 Combination perspective view of the nail magazine in.

[0053] Fig.12 It is shown Fig. 9 Side view of the nail magazine in.

[0054] Fig.13 It is shown Fig. 9 A perspective cross-sectional view of the nail magazine in FIG.

[0055] Fig.14 It is shown Fig. 9 Side cross-sectional view of the nail magazine in.

[0056] Fig.15 and Fig.16 It is shown Fig. 9 A perspective view of the working components of the nail magazine in FIG.

[0057] Figures 17 to 20 It is shown Figure 1 A perspective view of the ratchet drive action of the end tool in FIG.

[0058] Fig.21 and Fig. 22 It is shown Figure 1 A plan view of the ratchet drive action of the end tool in FIG.

[0059] Fig.23A , Fig. 23B and Fig.23C The whole is shown Figure 1 Side cross-sectional view of the stapling action of the end tool in FIG.

[0060] Fig.24 It is shown Figure 4 A plan view of the distal end of the end tool.

[0061] Fig.25 It is shown Figure 3 A perspective view of the jaw rotation axis and pulley of the end tool in FIG.

[0062] Figure 26 to Figure 28 It is shown Figure 3 A perspective view of the working components in .

[0063] FIG. 29A to FIG. 32 It is a diagram for describing the retreat prevention structure of the surgical instrument according to the first embodiment of the present invention.

[0064] Fig.33 1 is a perspective view showing a working member of a surgical instrument according to a modified example of the first embodiment of the present invention.

[0065] Fig.34 It is shown Fig.33 Side cross-sectional view of the working component in.

[0066] Fig.35 It is shown Fig.33 A perspective view of the working components and retreating wire structure in FIG. DETAILED DESCRIPTION

[0067] Embodiments of the present invention will now be described in detail, examples of which are illustrated in the accompanying drawings, wherein like reference numerals refer to like elements. In this regard, embodiments of the present invention may have different forms and should not be construed as being limited to those described herein. Therefore, embodiments of the present invention are described below only by reference to the accompanying drawings to explain various aspects thereof. The term "and / or" as used herein includes any and all combinations of one or more of the related listed items. Expressions such as "at least one", when appearing before a list of elements, are modifications to the entire list of elements, rather than to a single element in the list.

[0068] Hereinafter, the following embodiments will be described in detail with reference to the accompanying drawings, and in the description with reference to the accompanying drawings, the same reference numerals will be given to the same or corresponding constituent elements, and a repeated description thereof will be omitted.

[0069] Since various modifications can be made to this embodiment, specific embodiments will be shown in the drawings and described in detail in the specific embodiments. The effects, features, and methods for implementing them of this embodiment will become clear by referring to the drawings and the following detailed description. However, this embodiment is not limited to the embodiments disclosed below and can be implemented in various forms.

[0070] In the case of describing the present invention, if it is determined that the detailed description of the related known art may obscure the gist of the present invention, the detailed description thereof will be omitted.

[0071] In the following embodiments, unless the context clearly states otherwise, singular expressions include plural expressions. Terms such as first and second can be used to describe various components, but the components should not be limited by the terms. The terms are only used to distinguish one component from other components.

[0072] In the following embodiments, the terms “including” or “having” and the like refer to the presence of features or constituent elements described in the specification, and do not preclude the possibility of adding one or more other features or constituent elements.

[0073] In the following embodiments, when a part of a unit, region, constituent element, etc. is described as being on or over another part, it not only refers to the case where it is directly on the other part but also includes the case where other units, regions, constituent elements, etc. are interposed therebetween.

[0074] In the following embodiments, terms such as “connected” or “coupled” do not necessarily mean a direct and / or fixed connection or coupling of two components, and do not mean to exclude the situation where another component is interposed between the two components, unless the context clearly indicates otherwise.

[0075] In the drawings, the size of the constituent elements may be enlarged or reduced for the convenience of description. For example, the size and thickness of each component shown in the drawings are arbitrarily shown for the convenience of description, and therefore the following embodiments are not necessarily limited to the contents of the drawings.

[0076] <First Embodiment of Surgical Instrument>

[0077] Figure 1 is a perspective view showing a surgical instrument according to a first embodiment of the present invention, Figure 2 It is shown Figure 1 A perspective view of the end tool of a surgical instrument. Figure 3 and Figure 4 1 is a plan view showing a first jaw of an end tool of a surgical instrument according to a first embodiment of the present invention, Figure 5 1 is a perspective view showing a first jaw of a distal end tool of a surgical instrument according to a first embodiment of the present invention.

[0078] First, see Figure 1 and Figure 2 , a surgical instrument 10 according to the first embodiment of the present invention includes an end tool 100 , an operating portion 200 , a power transmission portion (not shown), and a connecting portion 400 .

[0079] Here, the connecting part 400 is formed in a hollow shaft shape, and one or more wires and electric wires can be accommodated therein. The operating part 200 is coupled to one end of the connecting part 400, and the end tool 100 is coupled to the other end of the connecting part 400, so that the connecting part 400 can be used to connect the operating part 200 and the end tool 100.

[0080] The operating part 200 is formed at one end of the connecting part 400 and is provided with an interface that can be directly manipulated by the doctor, such as a clip-shaped, rod-shaped, and bar-shaped interface. When the doctor manipulates it, the end tool 100 connected to the interface and inserted into the surgical patient performs a predetermined action to perform surgery. Figure 1 As shown, the operating part 200 is formed into a gripping part wrapped by a palm and a rod shape pulled by fingers, but the concept of the present invention is not limited thereto, and operating parts of various shapes connected to the end tool 100 and capable of operating the end tool 100 are possible.

[0081] The end tool 100 is formed at the other end of the connection part 400 and is inserted into the surgical site to perform the required operation. As an example of the end tool 100 as described above, Figure 1 The end tool 100 is a pair of jaws 103 shown in the figure for gripping. However, the concept of the present invention is not limited thereto, and various devices used for surgery can also be used as the end tool 100. For example, a structure such as a single-arm cauterizer can also be used as the end tool. The end tool 100 as described above is connected to the operating part 200 through the power transmission part 300, and receives the driving force of the operating part 200 through the power transmission part 300, so as to perform the actions required for the operation, such as gripping, cutting and suturing actions.

[0082] Here, the end tool 100 of the surgical instrument 10 according to the first embodiment of the present invention is formed to be rotatable in at least one or more directions. For example, the end tool 100 can be formed to rotate around Figure 1 While the Y axis is pitching, Figure 1 The Z-axis performs yaw motion and actuation motion.

[0083] Here, pitch, yaw, and actuation actions used in the present invention are respectively defined as follows.

[0084] First, the pitch motion refers to the extension direction ( Figure 1 The X-axis direction in the vertical direction) is the movement of rotation around Figure 1 In other words, the pitch action refers to the movement of the end tool 100 rotating in the up-down direction around the Y-axis relative to the connection part 400, wherein the end tool 100 is moved from the connection part 400 to the extension direction of the connection part 400 ( Figure 1 The X-axis direction) is extended to form.

[0085] Next, the yaw motion refers to the extension direction ( Figure 1 The X-axis direction in the left and right directions (the X-axis direction in the right and left directions) is the rotation around Figure 1 In other words, the yaw motion refers to the motion of the end tool 100 rotating in the left-right direction around the Z axis relative to the connecting portion 400, wherein the end tool 100 moves from the connecting portion 400 to the extending direction of the connecting portion 400 ( Figure 1 That is, the yaw motion refers to the motion of two jaws 103 formed on the end tool 100 rotating in the same direction around the Z axis.

[0086] Meanwhile, the actuation action refers to the action of the end tool 100 rotating around the same rotation axis as the yaw action, but the two jaws 103 rotate in opposite directions to each other, and the jaws contract or open. That is, the actuation action refers to the movement of the two jaws 103 formed on the end tool 100 rotating around the Z axis in opposite directions to each other.

[0087] The power transmission part 300 connects the operation part 200 and the end tool 100 to transmit the driving force of the operation part 200 to the end tool 100 , and may include a plurality of wires, pulleys, links, joints, gears, and the like.

[0088] (Power transmission unit)

[0089] In the following, it will be described in more detail Figure 1 The power transmission part 300 of the surgical instrument 10.

[0090] See also Figures 1 to 6 Etc. According to an embodiment of the present invention, the power transmission part 300 of the surgical instrument 10 may include a plurality of wires, including a suture staple wire 307 , a suture staple wire 308 , and a back-off wire 309 .

[0091] Here, two wires can be used as a first jaw wire or a second jaw wire in pairs, and can also be used as a suture staple wire or a back-off wire. The suture staple wire and the back-off wire will be described in detail later.

[0092] In addition, the power transmission part 300 of the surgical instrument 10 according to an embodiment of the present invention may include a fastener (not shown) coupled to each end of each wire to couple the wire and the pulley. Here, each fastener may have various shapes, such as a ball shape or a tube shape, etc., as required.

[0093] As described above, the first jaw wire, the second jaw wire, the suture staple wire and the back wire are each formed by two separate wires, and these wires can be connected to each other by a fastener. Alternatively, a fastener can be inserted into the middle point of a single wire and fixed by crimping the fastener, and the wire can be divided into two branches with the fastener as the center.

[0094] In addition, the wire can be fixedly coupled to the pulley by coupling the fastener to the pulley, so that the pulley can rotate as the wire is pulled and released.

[0095] Meanwhile, the first jaw wire-operating part fastener may be coupled to the end portion of the wire of the end tool 100 opposite to the position where the fastener is fastened, that is, the operating part 200 side.

[0096] In addition, as described above, the first jaw wire-operating part fastener is coupled to the pulley of the operating part 200, so that the wire can be fixedly coupled to the pulley of the operating part 200. As a result, when the pulley of the operating part 200 is rotated by a motor or manpower, the wire is pulled and released, so that the pulley of the end tool 100 can be rotated.

[0097] In the same manner, the second jaw wire may connect the jaw pulley of the end tool 100 and the pulley (not shown) of the operating portion 200, and the staple wire 307 and the staple wire 308 may connect the staple pulley 167 and the staple pulley 168 of the end tool 100 and the pulley (not shown) of the operating portion 200. In addition, the back-off wire 309 may connect the back-off wire pulley 151 of the end tool 100 and the pulley (not shown) of the operating portion 200.

[0098] (End Tool)

[0099] In the following, it will be described in more detail Figure 1 The end tool 100 of the surgical instrument 10 is shown in FIG.

[0100] See also Figure 1 to Figure 2The end tool 100 of the first embodiment of the present invention is provided with a pair of jaws for performing a gripping action, namely a first jaw 101 and a second jaw 102. Here, each of the first jaw 101 and the second jaw 102 or a component including the first jaw 101 and the second jaw 102 may be referred to as a jaw 103.

[0101] In addition, the end tool 100 may include all structures related to the staple cartridge 500, the staple drive assembly 150, the back-off guide wire 309, and the back-off drive, which are described later.

[0102] In addition, the end tool 100 may include an end tool hub 180 . The rotation shaft 141 is inserted through one end of the end tool hub 180 , and the end tool hub 180 may be axially coupled to the first jaw 101 through the rotation shaft 141 .

[0103] Rotating shaft 141 is axially coupled to pulley 131 serving as a pitch pulley, staple pulleys 167 and 168 described later, reciprocating member 551 , and annular pulleys 153 and 154 , etc., and a portion of them can be accommodated inside first jaw 101 .

[0104] Here, although the drawings show that each pulley facing each other is formed in parallel with each other, the concept of the present invention is not limited thereto, and each pulley can be formed at various positions suitable for the configuration of the end tool and can also be formed into various sizes suitable for the configuration of the end tool.

[0105] (Staple drive components)

[0106] Figure 6 and Figure 7 It is shown Figure 3 A perspective view of the groove portion of the reciprocating member and the staple pulley in FIG. Figure 8 It is shown Figure 3 Perspective view of the staple pulley in FIG.

[0107] See also Figures 6 to 8 Etc. According to the first embodiment of the present invention, the first jaw 101 of the end tool 100 of the surgical instrument may include a reciprocating motion component 550, a working member 540, a suture staple driving component 150, a jaw rotating shaft 141, a suture staple pulley 167 and a suture staple pulley 168, a back-off wire 309, a back-off wire pulley 151, and an annular pulley 153 and an annular pulley 154, etc.

[0108] First, the staple drive assembly 150 and the reciprocating assembly 550 associated with the staple stapling action will be described in detail.

[0109] The staple drive assembly 150 of this embodiment may include two staple pulleys, namely 167 and 168. Here, the feature is that the staple drive assembly 150 is connected to the reciprocating assembly 550 described later, so that the rotational motion of the staple pulleys 167 and 168 is converted into the linear motion of the reciprocating assembly 550.

[0110] See again Figures 6 to 8 , the staple pulley 167 and the staple pulley 168 can be configured as a group. As an example, the staple pulley 167 and the staple pulley 168 can be arranged on both sides of the reciprocating member 551 across the reciprocating member 551, or arranged on any side of the reciprocating member 551. A through hole is formed in each center of the staple pulley 167 and the staple pulley 168, so that the rotating shaft 141 can be inserted therethrough. As shown in the figure, when the staple pulley 167 and the staple pulley 168 are both arranged on one side of the groove portion 551a of the reciprocating member 551, the staple pulley 167 and the staple pulley 168 can include a pin / slot structure so that the staple pulley 167 and the staple pulley 168 are both connected to the reciprocating member 551. That is, a structure is required to transfer the rotational motion of staple pulley 167 and staple pulley 168 to the linear motion of reciprocating member 551, and this structure will be described in detail below.

[0111] Specifically, among the staple pulleys, when the pulley more adjacent to the reciprocating member 551 side is referred to as the staple pulley 168 on the inner side, and the other pulley is referred to as the staple pulley 167 on the outer side, the staple pulley 168 on the inner side may be formed with a pulley pin 168a protruding toward the groove portion 551a side of the reciprocating member 551 described later. Such a pulley pin 168a may be formed on the inner side of the staple pulley 168 so as to be adjacent to or spaced apart from the rotation shaft 141 through which the staple pulley 168 is inserted. In addition, the pulley pin 168a may be inserted into the inside of the groove 551a1 of the reciprocating member 551.

[0112] In addition, in staple pulley 168, groove 168b may be formed on the other side opposite to the side on which pulley pin 168a is formed based on rotation axis 141. Groove 168b of staple pulley 168 may be a region through which pulley pin 167a of staple pulley 167 described later is inserted.

[0113] The staple pulley 167 on the outer side may be formed with a pulley pin 167a protruding toward the groove portion 551a side of the reciprocating member, and such pulley pin 167a may be inserted into the groove 551a1 of the reciprocating member by passing through the staple pulley 168 on the inner side. In other words, the pulley pin 167a of the staple pulley 167 may be inserted into the groove 551a1 of the reciprocating member by passing through the groove 168b of the staple pulley 168.

[0114] When the staple pulley 167 rotates about the rotation axis 141, since the pulley pin 167a rotates about the rotation axis 141, in order to prevent the pulley pin 167a from interfering with the staple pulley 168, the groove 168b of the staple pulley 168 can be formed to have a space to enable the pulley pin 167a to move freely.

[0115] Meanwhile, in a state where pulley pin 167a of staple pulley 167 is inserted into the inside of groove 168b of staple pulley 168, pulley pin 167a may be formed on the opposite side of pulley pin 168a of staple pulley 168 based on rotation shaft 141. In addition, pulley pin 167a and pulley pin 168a are connected to groove portion 551a of a reciprocating member described later, thereby being able to convert the rotational motion of staple pulley 167 and staple pulley 168 into the linear motion of the reciprocating member.

[0116] Hereinafter, the linear motion of the reciprocating member 551 according to the connection relationship between the reciprocating member 551 and the staple pulleys 167 and 168 will be described in detail.

[0117] The reciprocating member 551 is formed in a bar shape that is elongated in the length direction of the first jaw 101 , and a groove portion 551 a may be formed on a proximal end side connected to the staple pulleys 167 and 168 .

[0118] The groove portion 551a of the reciprocating member 551 may be formed as a plate-like member capable of contacting the rotating surface of the staple pulley 167 and the staple pulley 168, and may be formed as a member independent of the bar-shaped reciprocating member 551, or may be formed as a single unit with the reciprocating member 551. In addition, the groove portion 551a may be formed with a groove 551a1 through which the rotating shaft 141, the pulley pin 167a, and the pulley pin 168a pass.

[0119] Specifically, the groove 551a1 may be formed in the length direction of the reciprocating member 551 so that when the rotating shaft 141 is inserted into the groove 551a1, the groove portion 551a can perform a relative linear motion based on the rotating shaft 141. In other words, the groove 551a1 may be formed to enable the reciprocating member 551 to perform a linear motion away from or close to the rotating shaft 141.

[0120] In addition, the groove 551a1 may be formed as a whole with the groove 551a1 region through which the pulley pin 167a and the pulley pin 168a pass and the groove region through which the rotating shaft 141 is inserted. In addition, the groove portion 551a may be formed with the groove 551a1 and the groove 551a2 through which the rotating shaft 141, the pulley pin 167a and the pulley pin 168a pass. The groove 551a2 is a region for inserting the length member 552 described later, and like the groove 551a1, the groove 551a2 may be formed in the length direction parallel to the linear motion direction of the reciprocating member 551.

[0121] Meanwhile, since the rotating shaft 141 and the length member 552 are formed at a position fixed to the first jaw 101 and the groove portion 551a is not directly fixed to the first jaw 101, the groove portion 551a can move according to the rotation of the staple pulley 167 and the staple pulley 168. That is, the reciprocating member 551 combined with the groove portion 551a can move.

[0122] As described above, the grooves 551a1 and 551a2 are formed in the length direction corresponding to the length direction of the first jaw 101 , ie, the length direction of the reciprocating member 551 , and thus the reciprocating member 551 can move only in the length direction of the first jaw 101 .

[0123] Also, see again Figure 6 The suture staple wire connected to the suture staple pulley 167 can be formed as a wire 307a and a wire 307b combined by a fastener (not shown), or can be formed as a single wire. Here, for convenience, the suture staple wire is described separately as a wire 307a and a wire 307b.

[0124] Similarly, the staple wire connected to the staple pulley 168 can be formed as a wire 308a and a wire 308b combined by a fastener (not shown), or can be formed as a single wire. Here, for convenience, the staple wire is described separately as a wire 308a and a wire 308b.

[0125] When the staple wire is pulled and released, the staple pulley performs a rotational motion. Figure 6Based on the direction shown in the figure (i.e., the direction in which the distal end of the first jaw faces the right side), since the wire 307a is pulled toward the proximal end of the end tool and the wire 307b is released toward the distal end, the staple pulley 167 rotates in the clockwise direction, otherwise, it rotates in the counterclockwise direction. In addition, since the wire 308b is pulled toward the proximal end of the end tool and the wire 308a is released toward the distal end, the staple pulley 168 rotates in the clockwise direction, otherwise, it rotates in the counterclockwise direction.

[0126] See also Figure 7 Again, since pulley pin 167 a of staple pulley 167 and pulley pin 168 a of staple pulley 168 are coupled to groove portion 551 a of reciprocating member 551 , groove portion 551 a may perform the following actions according to the rotation of staple pulley 167 and staple pulley 168 .

[0127] When the suture staple pulley 168 rotates in the clockwise direction based on the direction shown in the accompanying drawing (i.e., the direction in which the distal end of the first jaw is toward the left), the pulley pin 168a located below the rotating shaft 141 pushes the groove 551a1 of the groove portion 551a toward the distal end portion side of the end tool, and the suture staple pulley 167 rotates in the counterclockwise direction, thereby enabling the pulley pin 167a located above the rotating shaft 141 to push the groove 551a1 of the groove portion 551a toward the distal end portion side of the end tool.

[0128] Conversely, when the suture staple pulley 168 rotates counterclockwise, the pulley pin 168a located below the rotating shaft 141 pulls the groove 551a1 of the groove portion 551a toward the proximal end portion of the end tool, and when the suture staple pulley 167 rotates clockwise, the pulley pin 167a located above the rotating shaft 141 can pull the groove 551a1 of the groove portion 551a toward the proximal end portion of the end tool.

[0129] At the same time, since staple pulley 167 and staple pulley 168 always rotate in opposite directions to each other, the rotational force transmitted to first jaw 101 by staple wire 307 and staple wire 308 can be offset.

[0130] Specifically, see again Figure 6 and Figure 7 , based on the direction in which the distal end of the first jaw 101 faces the right side, when the wire 308a is pulled, the staple pulley 168 rotates counterclockwise, and the reciprocating member 551 moves toward the proximal end of the end tool. At this time, due to the force of the wire 308a to rotate the staple pulley 168 counterclockwise, a force can be generated to rotate the reciprocating member 551 and the first jaw 101 counterclockwise relative to the rotation axis 141.

[0131] On the other hand, when the wire 307a is pulled, the staple pulley 167 rotates clockwise, and the reciprocating member 551 moves toward the proximal end of the end tool. At this time, due to the force of the wire 307a to rotate the staple pulley 167 clockwise, a force can be generated to rotate the reciprocating member 551 and the first jaw 101 clockwise relative to the rotating shaft 141.

[0132] As described above, since staple pulley 167 and staple pulley 168 always rotate in opposite directions to each other, the rotational force transmitted to first jaw 101 by staple wire 307 and staple wire 308 can be offset. In other words, since the rotation directions of staple pulley 167 and staple pulley 168 for causing reciprocating member 551 to perform linear motion in the same direction always rotate in opposite directions to each other (i.e., clockwise-counterclockwise, or counterclockwise-clockwise), the rotational force transmitted to first jaw 101 by staple wire 307 and staple wire 308 can be offset.

[0133] Meanwhile, the end tool 100 according to the embodiment of the present invention may further include a length member 553 formed at a distal end side of the end tool.

[0134] The length member 553 can be used to support the reciprocating member 551 together with the above-mentioned length member 552. In other words, it can be described as providing a device that can limit the movement of the reciprocating member 551 in the up-down direction (Z-axis direction) so that the reciprocating member 551 can only perform linear motion through the rotation of the staple pulley 167 and the staple pulley 168. Specifically, the length member 553 can be used as a member that prevents the end of the distal end side of the reciprocating member 551 from rising while not interfering with the linear motion of the reciprocating member 551 in the length direction of the first jaw 101.

[0135] (Nail Warehouse)

[0136] In the following, it will be described in more detail Figure 1 The nail magazine 500 of the surgical instrument 10.

[0137] Fig. 9 It is shown Figure 1 A perspective view of the first jaw and nail magazine of the surgical instrument. Fig.10 It is shown Fig. 9 An exploded perspective view of the nail magazine in FIG. Fig.11 It is shown Fig. 9 Combination perspective view of the nail bin in Fig.12 It is shown Fig. 9 Side view of the nail magazine in. Fig.13 It is shown Fig. 9 A perspective cross-sectional view of the nail magazine in FIG. Fig.14 It is shown Fig. 9 Side cross-sectional view of the nail magazine in. Fig.15 and Fig.16 It is shown Fig. 9 A perspective view of the working components of the nail magazine in FIG. Figures 17 to 20 It is shown Figure 1 A perspective view of the ratchet drive action of the end tool in FIG. Fig.21 and Fig. 22 It is shown Figure 1 A plan view of the ratchet drive action of the end tool in FIG. FIG. 23A to FIG. 23C The whole is shown Figure 1 Side cross-sectional view of the stapling action of the end tool in FIG.

[0138] See also Figures 9 to 23C The staple cartridge 500 is detachably formed in the first jaw 101 and includes a plurality of staples 530 and a blade 542 therein for suturing and cutting tissue. Here, the staple cartridge 500 may include a cover 510, a housing 520, staples 530, a lead-out member 535, a working member 540, and a reciprocating assembly 550.

[0139] The housing 520 constitutes the outer shape of the staple cartridge 500, and is generally formed in a shape in which one side (top surface) is removed from an empty box, so that the interior thereof can be formed to accommodate the reciprocating assembly 550, the working member 540, and the staples 530. Here, the cross section of the housing 520 is generally formed in a "U" shape.

[0140] The cover 510 is formed to cover the top of the housing 520. The cover 510 may be provided with a suture nail hole 511 that enables a plurality of suture nails 530 to be discharged to the outside. Before the suture nailing drive, the suture nails 530 accommodated in the housing 520 are pushed upward by the working member 540 when the suture nailing action is performed, and then pass through the suture nail hole 511 of the cover 510 to be led out of the nail magazine 500, and the suture nailing is performed.

[0141] Meanwhile, the slit 512 may be formed on the cover 510 along the length direction of the cover 510. The blade 542 of the working member 540 may protrude to the outside of the staple cartridge 500 through the slit 512. When the blade 542 of the working member 540 passes along the slit 512, the stapled tissue may be cut.

[0142] A plurality of suture staples 530 may be arranged inside the housing 520. As the working member 540 described later moves linearly in one direction, the plurality of suture staples 530 are sequentially pushed upward from the inside of the housing 520 to the outside, and suture is performed at the same time, that is, staple suture may be performed. Here, the material of the suture staples 530 may include titanium, stainless steel, etc.

[0143] Meanwhile, the lead-out member 535 may be further disposed between the housing 520 and the staples 530. In other words, it may be described that the staples 530 are disposed on top of the lead-out member 535. In this case, the working member 540 pushes the lead-out member 535 upward while performing a linear motion in one direction, and the lead-out member 535 may push each staple 530 upward.

[0144] As described above, the situation where the working member 540 directly pushes the suture staples 530 upwards and the situation where the working member 540 pushes the lead-out member 535 upwards so that the lead-out member 535 pushes each suture staple 530 upwards (i.e., the working member 540 indirectly pushes the suture staples 530 upwards) can both be described as the working member 540 pushing the suture staples 530 upwards.

[0145] The reciprocating assembly 550 may be arranged below the interior of the housing 520. Alternatively, the reciprocating assembly 550 may be arranged between the housing 520 and the first jaw 101. The reciprocating assembly 550 may include one or more reciprocating members 551. In the present embodiment, although one reciprocating member 551 is shown, a plurality of reciprocating members 551 may also be provided.

[0146] In the present embodiment, the reciprocating member 551 may be a rack. The reciprocating member 551 may include a concave-convex portion 551b and a groove portion 551a. In detail, the reciprocating member 551 may be formed in the shape of a long bar, and a plurality of concave-convex portions 551b in a sawtooth shape may be formed on one surface thereof. The concave-convex portion 551b may be formed to be contactable with the working member 540 described later, in particular, to be contactable with the ratchet member 543 of the working member 540. In other words, the reciprocating member 551 may include a plurality of concave-convex portions 551b having a shape that meshes with the respective ratchet wheels 543a of the ratchet member 543.

[0147] Meanwhile, although not shown in the drawings, in addition to the shape of a rack, the reciprocating member 551 may be provided as a member of various shapes directly or indirectly connected to the staple pulleys 167 and 168 to be able to perform linear reciprocating motion according to the rotational motion of the staple pulleys 167 and 168. For example, the reciprocating member 551 may be in the shape of a clutch without a concave-convex portion.

[0148] Here, the reciprocating member 551 is not fixedly coupled to other components of the staple cartridge 500, and may be relatively movable relative to other components of the staple cartridge 500. That is, the reciprocating member 551 may reciprocate linearly relative to the housing 520 and the cover 510 coupled thereto.

[0149] Meanwhile, a groove 551a may be formed at the proximal end 501 adjacent to the rotation shaft 141 on the reciprocating member 551, and the rotation shaft 141 of the end tool 100 is inserted through to be combined with the groove 551a. Therefore, when the groove 551a performs reciprocating linear motion along the extension direction of the connecting portion 400 (i.e., the X-axis direction), the reciprocating member 551 combined therewith may also perform reciprocating linear motion along the extension direction of the connecting portion 400 (i.e., the X-axis direction). This will be described in more detail below.

[0150] The working member 540 may be disposed inside the housing 520. The working member 540 is formed to be contactable with the reciprocating member 551, thereby performing linear motion in one direction according to the reciprocating linear motion of the reciprocating member 551. In other words, the working member 540 interacts with the reciprocating member 551, thereby performing stapling and cutting while moving along the extending direction of the connecting portion 400.

[0151] The working member 540 may include a wedge 541 , a blade 542 , a ratchet member 543 , an elastic member 544 , and a body 545 .

[0152] The body 545 may be formed in a rectangular column shape, and forms a base of the working member 540 .

[0153] The wedge 541 is formed on at least one side of the main body 545 and may be formed to have a predetermined inclined surface. That is, the wedge 541 may be formed to be inclined to a certain extent in the extending direction of the connecting portion 400. In other words, the height of the proximal end portion 501 side of the staple cartridge 500 may be higher than the height of the distal end portion 502 side. Although the drawings show that two wedges 541 are formed on the left and right sides of the main body 545, respectively, the concept of the present invention is not limited thereto and may be formed in various numbers and shapes according to the shapes of the suture staples 530 or the lead-out member 535 contacting the wedge 541.

[0154] The wedge-shaped member 541 as described above is formed to sequentially contact the lead-out member 535 or the plurality of suture staples 530, thereby being used to sequentially push the suture staples 530 upward. FIG. 23A to FIG. 23C As shown in FIGS. 1 and 14 , when the working member 540 moves toward the distal end portion 502 , it can be used to push the suture staples 530 upward in sequence to lead them out of the staple cartridge 500 .

[0155] The blade 542 may be formed on one side of the wedge 541, more specifically, on the proximal end 501 side of the wedge 541. In one area of ​​the blade 542, a sharp edge portion 542a is formed to cut tissue. At least a portion of the edge portion 542a may be led out of the first jaw 101 and the staple cartridge 500, while cutting tissue arranged between the first jaw 101 and the second jaw 102. The edge portion 542a of the blade 542 may also be always led out of the first jaw 101. Alternatively, the edge portion 542a of the blade 542 may be usually accommodated inside the first jaw 101 or inside the staple cartridge 500, and only led out of the first jaw 101 when the working member 540 moves along the length direction.

[0156] The ratchet member 543 is formed on one side of the wedge 541, more specifically, below the wedge 541, and may be formed to face the reciprocating member 551 described later. The ratchet member 543 may be formed in a bar shape and may include a plurality of ratchets 543a on one surface thereof. The working member 540 moves only in one direction (i.e., the distal end direction) relative to the reciprocating member 551 by the ratchet member 543. The ratchet 543a of the ratchet member 543 may be formed to be contactable with the concave-convex portion 551b of the reciprocating member 551.

[0157] The elastic member 544 is formed on either side of the body 545 or the wedge 541 to apply a predetermined elastic force to the ratchet member 543. As an example, one area of ​​the elastic member 544 is connected to the wedge 541 or the body 545, and another area of ​​the elastic member 544 is connected to the ratchet member 543, so that the elastic member 544 can connect the wedge 541 or the body 545 to the ratchet member 543. Here, the elastic member 544 can apply an elastic force in a direction that closely contacts the ratchet member 543 and the reciprocating member 551. To this end, the elastic member 544 can be formed in the shape of a leaf spring, and further, it can be provided in various shapes that can provide a predetermined elastic force to the ratchet member 543, for example, a coil spring or a disc spring, etc.

[0158] Here, the first surface 543a1 of the ratchet 543a of the ratchet member 543 (specifically, the surface on the distal end 502 side) is formed to have a predetermined angle and a gentle inclination, and the second surface 543a2 (specifically, the surface on the proximal end 501 side) can be formed to be vertical or nearly vertical.

[0159] In addition, the first surface 551b1 (specifically, the surface on the proximal end 501 side) of the concave-convex portion 551b of the reciprocating member 551 is also formed to have a predetermined angle and a gentle inclination, and the second surface 551b2 (specifically, the surface on the distal end 502 side) can be formed to be vertical or nearly vertical so as to be able to engage with the ratchet 543a of the ratchet member 543.

[0160] In a state where the reciprocating member 551 and the ratchet member 543 are fastened to each other (or meshed, or in close contact), the first surface 543a1 inclined in the ratchet 543a and the first surface 551b1 inclined in the concave-convex portion 551b can be arranged to be opposite to each other (i.e., engage with each other). In addition, the second surface 543a2 vertical in the ratchet 543a and the second surface 551b2 vertical in the concave-convex portion 551b can be arranged to be opposite to each other (i.e., engage with each other).

[0161] With the above-described configuration, in a state where the ratchet 543a and the concave-convex portion 551b are fastened (or meshed) to each other, they can be used as a ratchet so as to be movable in only one direction.

[0162] As an example, assuming that the reciprocating member 551 is in a fixed state, the working member 540 can move in a direction in which the second surface 543a2 and the second surface 551b2 formed vertically are away from each other, but the second surface 543a2 and the second surface 551b2 cannot move in a direction close to each other while in contact.

[0163] To describe this from another perspective, when the reciprocating member 551 and the ratchet member 543 are fastened to each other (or meshed, or in close contact), when the reciprocating member 551 moves toward the distal end portion 502, the ratchet member 543 also moves toward the distal end portion 502 through the reciprocating member 551. That is, the vertical second surface 551b2 of the reciprocating member 551 pushes the vertical second surface 543a2 of the working member 540, so that the ratchet member 543 also moves toward the distal end portion 502 through the reciprocating member 551.

[0164] On the contrary, in a state where the reciprocating member 551 and the ratchet member 543 are fastened (or meshed, or in close contact) to each other, when the reciprocating member 551 moves toward the proximal end portion 501, in a state where the ratchet member 543 is fixed, only the reciprocating member 551 moves alone toward the proximal end portion 501. That is, in a state where the working member 540 is fixed, the inclined first surface 551b1 of the reciprocating member 551 moves along the inclined first surface 543a1 of the working member 540, so that only the reciprocating member 551 moves alone toward the proximal end portion 501.

[0165] See also Figures 19 to 22 ,exist Fig.19 and Fig.21 In the state shown, when the reciprocating member 551 moves toward the proximal end portion 501 ( Fig. 20 and Fig. 22 The ratchet member 543 moves in the direction of the arrow K1 in the figure. The inclined first surface 551b1 of the reciprocating member 551 moves along the inclined first surface 543a1 of the working member 540. Fig. 22 The arrow K2 direction in the figure is pressed while being pushed. In addition, at this time, the elastic member 544 also undergoes a certain degree of elastic deformation.

[0166] In this state, when the reciprocating member 551 further moves toward the proximal end portion 501, so that the inclined first surface 551b1 of the reciprocating member 551 passes the end of the inclined first surface 543a1 of the working member 540, the concave-convex portion 551b of the reciprocating member 551 meets the next ratchet 543a of the ratchet member 543. At this time, since the elastic member 544 applies elastic force in the direction in which the ratchet member 543 and the reciprocating member 551 are in close contact with each other, the reciprocating member 551 and the ratchet member 543 are in full-surface close contact again.

[0167] As a result, the staple cartridge 500 is accommodated in the staple cartridge accommodating portion 101a of the first jaw 101, and at this time, the groove portion 551a of the reciprocating member 551 of the staple cartridge 500 is engaged with the staple pulleys 167 and 168 of the end tool 100. Therefore, the rotational motion of the staple pulleys 167 and 168 of the end tool 100 is converted into the linear motion of the reciprocating member 551 through the groove portion 551a.

[0168] At this time, because the groove 551a of the reciprocating member 551 is connected with the staple pulley 167 and the staple pulley 168 by the pulley pin 168a and the pulley pin 167a, therefore, when the staple pulley 167 and the staple pulley 168 rotate alternately along the clockwise direction / counterclockwise direction, the reciprocating member 551 can repeat the forward movement and the backward movement. In addition, when the reciprocating member 551 moves forward, the working member 540 moves forward together with the reciprocating member 551, and when the reciprocating member 551 moves backward, only the reciprocating member 551 moves backward and the working member 540 can be stationary in the original position. When repeating this process, the working member 540 moves forward, and when the staple 530 is stapled by the wedge 541, the blade 542 can cut the tissue stapled.

[0169] Hereinafter, the stapling action of the surgical instrument 10 according to the first embodiment of the present invention will be described.

[0170] FIG. 23A to FIG. 23C It is shown Fig.14 A perspective view of the end tool performing the stapling action in various parts.

[0171] See also FIG. 23A to FIG. 23C ,exist Fig.23A In the state shown, when the working member 540 moves along Fig. 23B When moving in the direction of arrow A1 in FIG. 1 , the wedge 541 of the working member 540 pushes the lead-out member 535 upward, and the lead-out member 535 pushes the lower side of the suture staple 530 upward. In addition, the suture staple 530 is discharged to the outside of the first jaw 101 and the staple cartridge 500.

[0172] In this state, when the working member 540 moves along Fig.23C When the middle arrow A2 direction moves further, the ejected suture staple 530 is further pushed upward by the working member 540 while in contact with the anvil (not shown) of the second jaw 102, so that the two ends of the suture staple 530 are bent to perform staple suturing.

[0173] While the above-mentioned operation is continuously performed, staple suturing is performed sequentially from the suture staples 530 on the proximal end portion 501 side to the suture staples 530 on the distal end portion 502 side among the plurality of suture staples 530 .

[0174] (Backward wire structure)

[0175] The surgical instrument 10 according to the first embodiment of the present invention is characterized in that it includes a backoff guide wire 309 and various structures related thereto.

[0176] Figure 3 and Figure 4 1 is a plan view showing a first jaw of a distal end tool of a surgical instrument according to a first embodiment of the present invention. Fig.24 It is shown Figure 4 A plan view of the distal end of the end tool, Fig.25 It is shown Figure 3 A perspective view of the jaw rotation axis and pulley of the end tool in FIG. Figure 26 to Figure 28 It is shown Figure 3 A perspective view of the working components in .

[0177] See again Figure 3 to Figure 4 as well as Figure 24 to Figure 25 The tip tool 100 according to the first embodiment of the present invention may include a retracting guide wire structure for retracting the working member 540 that has advanced toward the distal end portion toward the proximal end portion.

[0178] Various methods can be devised to retract the working member 540, and the working member 540 can be retracted by pulling the wire toward the proximal end portion by directly fixing the wire to the working member 540. However, if the wire is fixed to the working member 540, the wire may interfere with the forward movement of the working member 540. Therefore, a structure is required that can retract the working member 540 by retracting the wire while not being fixed to the working member 540.

[0179] Therefore, the surgical instrument 10 according to the first embodiment of the present invention is characterized in that the backoff guide wire 309 is an independent structure that is not fixed to the working member 540 and can be formed inside the first jaw 101 .

[0180] Here, the wire used to retract the working member 540 is referred to as a retraction wire 309. The retraction wire may be arranged parallel to the length direction of the first jaw 101 (i.e., the forward and backward direction of the working member 540). In order to achieve the arrangement of the retraction wire 309 as described above, the retraction wire pulley 151 may be located at the distal end side of the first jaw 101.

[0181] The back-off wire 309 may be formed to extend from the proximal end side of the end tool 100 to the back-off wire pulley 151, so as to be wound around the back-off wire pulley 151 and change direction by 180 degrees, and then be directed toward the proximal end side of the end tool 100. That is, it can be described that the two branches of the back-off wire 309 are arranged in the length direction of the first jaw 101. Here, for the convenience of description, the back-off wire closer to the working member 540 is classified as the inner wire 309a, and the other is classified as the outer wire 309b.

[0182] At the same time, the backward wire 309a and the backward wire 309b, which are wound around the backward wire pulley 151 and extend in two branches, can be spaced apart by about the diameter of the pulley 151. Fig.24 As shown, the auxiliary pulley 152 may be disposed at a position close to the backward wire pulley 151, so that the inner wire 309a can be arranged as close to the outer wire 309b as possible.

[0183] That is, the auxiliary pulley 152 is coupled to a rotation axis parallel to the rotation axis of the backward wire pulley 151 and rotates on the same plane as the backward wire pulley 151, and while the auxiliary pulley 152 is arranged close to the backward wire pulley 151, the inner wire 309a is contacted and passed by a part of the auxiliary pulley 152, so that the path of the inner wire 309a can be changed to be close to the outer wire 309b. However, the idea of ​​the present invention is not limited thereto, and the auxiliary pulley 152 may be arranged by setting the path of the outer wire 309b close to the inner wire 309a, and the size and arrangement of each pulley may be changed.

[0184] The retracted guide wire 309 of the end tool 100 according to the first embodiment of the present invention may include a fastener 310. Here, the fastener 310 is crimped and fixed in a state where the guide wire is inserted, so as to be combined with the guide wire.

[0185] As described above, the fastener 310 has a protruding shape fixed to a portion of the back-off guide wire 309 , and can advance or retreat in the length direction of the first jaw 101 according to the movement of the back-off guide wire 309 .

[0186] Therefore, the retreat wire 309 combined with the fastener 310 is moved to the proximal end side, and when the fastener 310 interferes with a portion of the working member 540, the working member 540 can be pushed to the proximal end side and retreated. Hereinafter, the principle that the fastener 310 retreats the working member 540 by contacting the working member 540 will be described in detail.

[0187] Meanwhile, when the working member 540 is advanced toward the distal end side of the end tool 100 , the fastener 310 does not move, but when the working member 540 is to be retracted, the fastener 310 may be moved to the proximal end side.

[0188] Here, the fastener 310 may be arranged at the distal end side of the end tool 100 so that the fastener 310 does not interfere with the working member 540 until the working member 540 is moved forward all the way to the distal end side.

[0189] See also Fig.25 The surgical instrument 10 according to the first embodiment of the present invention may further include an annular pulley 153 and an annular pulley 154 coupled to the jaw rotation shaft 141 of the end tool 100 .

[0190] Here, in addition to the annular pulleys 153 and 154, the pitch pulley 131 and the staple pulleys 167 and 168 may be coupled to the rotating shaft 141, and these pulleys may be divided and arranged on both sides based on one end of the end tool center 180. As an example, based on one end of the end tool center 180, the annular pulleys 153 and 154 and the pitch pulley 131 may be arranged on one side, and the staple pulleys 167 and 168 may be arranged on the other side.

[0191] The annular pulley 153 and the annular pulley 154 may be pulleys having the same diameter and capable of rotating independently of each other. The inner wire 309a as one of the two branches of the backward wire 309 may be connected to the annular pulley 153, and the outer wire 309b may be connected to the annular pulley 154.

[0192] In addition, the inner wire 309a and the outer wire 309b can be wound around the pulley in different directions based on the jaw rotation axis 141. As an example, the inner wire 309a is arranged to pass above the pulley 153 based on the jaw rotation axis 141, and the outer wire 309b is arranged to pass below the pulley 154 based on the jaw rotation axis 141. Of course, it is also possible to arrange them in a manner opposite to each other.

[0193] As described above, by connecting the back-up wire 309 from the back-up wire pulley 151 to the annular pulley 153 and the annular pulley 154 on the proximal end side to form a loop, it is possible to apply pre-tension to the back-up wire 309. That is, it is possible to prevent the back-up wire 309 from being separated from the pulley at the joint where the end tool 100 rotates.

[0194] In addition, when the first jaw 101 of the end tool 100 rotates around the jaw rotation axis 141, the retraction wire 309 must be wound or released when the angle of the first jaw 101 changes, so the retraction wire 309 passing through the rotation axis 141 can automatically compensate for the length change of the retraction wire 309.

[0195] In other words, since the back-up wire 309 is configured to be wound in the opposite direction to the annular pulley 153 and the annular pulley 154, the other wire can be wound as much as one wire is released, thereby being able to maintain pre-tension. However, when the first jaw 101 rotates around the rotation axis 141, as the back-up wire 309 moves, the fastener 310 fixed to the back-up wire 309 also moves, so the fastener 310 can be arranged to ensure a free space so as not to interfere with the working member 540.

[0196] Hereinafter, a principle in which the fastener 310 retracts the working member 540 by coming into contact with the working member 540 will be described.

[0197] First, regarding the working member 540 , the working member 540 according to the first embodiment of the present invention may include a ratchet member 543 .

[0198] In the ratchet member 543 , the ratchet 543 a may be formed on a surface that contacts the reciprocating member 551 , and as described above, the ratchet 543 a may be a portion that meshes with the concavo-convex portion 551 b of the reciprocating member 551 .

[0199] In addition, in the ratchet member 543, the protrusion 543b may be formed on a surface opposite to a surface on which the ratchet 543a is formed. That is, the protrusion 543b may be formed in a direction away from the reciprocating member 551 based on the ratchet member 543. In addition, the protrusion 543b may be formed close to the rotation axis 544a which is the rotation center of the ratchet member 543.

[0200] In addition, the back-off guide wire 309 and the fastener 310 may be located on opposite sides of the reciprocating assembly 550 based on the ratchet member 543. That is, the back-off guide wire 309 and the fastener 310 may be arranged close to the protrusion 543b of the ratchet member 543.

[0201] Meanwhile, as described above, when the retreat wire 309 moves so that the fastener 310 moves from the distal end side to the proximal end side and contacts the working member 540, the fastener 310 may contact the protrusion 543b of the ratchet member 543. At this time, when the retreat wire 309 further moves so that the fastener 310 pushes the protrusion 543b to the proximal end side, a rotational force may be applied, thereby enabling the ratchet member 543 to rotate around the rotation axis 544a of the ratchet member 543, and finally the ratchet member 543 may move in a direction away from the reciprocating member 551. Thereafter, since the concave-convex portion 551b of the reciprocating member 551 is spaced apart from the ratchet 543a of the ratchet member 543, the working member 540 including the ratchet member 543 may retreat to the proximal end side without being interfered by the reciprocating member 551.

[0202] In addition, the protrusion 543b of the ratchet member 543 may form a hollow 543c at the center thereof. Specifically, the protrusion 543b may be formed with a hollow 543c that passes along a direction parallel to the path of the linear motion of the working member 540 in the first jaw 101. In addition, the retreat wire 309 may pass through the hollow 543c. However, it may be formed so that when the retreat wire 309 moves, the fastener 310 fixed to the retreat wire 309 does not pass through the hollow 543c and interfere with the protrusion 543b.

[0203] Therefore, the fastener 310 can press the protrusion 543b along the proximal end side as the guide wire 309 moves backward. That is, as described above, since the ratchet 543a of the ratchet member 543 is spaced apart from the reciprocating member 551, the working member 540 including the ratchet member 543 can be retracted toward the proximal end side without being interfered by the reciprocating member 551.

[0204] Here, at least one of the inner wire 309a or the outer wire 309b of the retreat wire 309 may be formed to pass through the inside of the hollow 543c. Alternatively, both the inner wire 309a and the outer wire 309b may be formed to pass through the inside of the hollow 543c. At this time, the fastener 310 may be coupled to the outer wire 309b. When the fastener 310 is coupled to the outer wire 309b to press the protrusion 543b, a greater rotational force may be applied to the ratchet member 543 rotating around the rotation axis 544a.

[0205] Meanwhile, the fastener 310 may be formed to stay on the distal end side of the end tool, but as Fig.29A As shown, when the working member 540 advances toward the distal end side of the end tool, the fastener 310 may also be formed to move forward together from the front of the working member 540. However, in order to prevent the fastener 310 from interfering with the forward movement of the working member 540, the fastener 310 may be formed to be spaced apart from the working member 540 to ensure free space and move forward together. (See Fig.29B )

[0206] As described above, when the fastener 310 is configured to move forward together from the front of the working member 540, the fastener 310 can quickly contact the working member 540 to start retreating. For example, when the working member 540 is not moved to the end of the distal end side of the end tool, and the advancement is stopped and it is retreated, when the fastener 310 is moved to the vicinity of the working member 540, the retreat action can be started more quickly than when the fastener 310 is left on the distal end side.

[0207] In addition, when the fastener 310 is configured to move from the front of the working member 540 together with the working member 540, a back-off prevention structure described later can be simultaneously implemented.

[0208] Meanwhile, when the reciprocating member 551 advances toward the distal end and then retreats toward the proximal end, the operating member 540 may retreat unintentionally due to the frictional force generated between the concave-convex portion 551 b of the reciprocating member 551 and the ratchet 543 a of the ratchet member 543 .

[0209] Hereinafter, a retreat prevention structure of the working member 540 for preventing this will be described.

[0210] FIG. 29A to FIG. 32 It is a diagram for describing the retreat prevention structure of the surgical instrument according to the first embodiment of the present invention.

[0211] See also Fig.30 The body 545 of the working member 540 may include a protrusion 546 protruding toward the side of the retreating wire 309 .

[0212] The protrusion 546 of the body 545 does not interfere with the movement of the retreat wire 309, but may be formed to contact the fastener 311 coupled to the retreat wire 309. That is, the retreat wire 309 is spaced apart from the protrusion 546, but a portion of the fastener 311 and a portion of the protrusion 546 may be formed to contact each other. In addition, when the working member 540 attempts to partially retreat, the fastener 311 in contact with the protrusion 546 may prevent the working member 540 from moving toward the proximal end side.

[0213] For this purpose, the fastener 311 must be arranged behind the protrusion 546. At this time, when the working member 540 moves forward to the distal end side, the fastener 311 can move together behind the working member 540 and can be spaced apart from the working member 540 to ensure a free space.

[0214] Alternatively, when the working member 540 moves forward toward the distal end portion, the fastener 311 may move together with the working member 540 behind the working member 540, and may apply force to the working member 540 in the direction of the forward movement. That is, when the working member 540 moves forward toward the distal end portion of the end tool by the back-and-forth reciprocating linear motion of the reciprocating member 551, the fastener 311 of the retreat wire 309 also advances together with the working member 540, and the fastener 311 slightly pushes the protrusion 546 from behind the protrusion 546, but when the working member 540 tries to retreat due to the friction force with the reciprocating member 551, the fastener 311 may apply strong resistance to the protrusion 546.

[0215] Meanwhile, the fastener 311 coupled to the retreat wire 309 to prevent retreat may be arranged behind the protrusion 543b of the ratchet member 543. In addition, as described above, the retreat wire 309 may be formed to pass through the hollow 543c formed in the protrusion 543b of the ratchet member 543, and the fastener 311 may be formed to be unable to pass through the hollow 543c. As described above, the fastener 311 is formed to interfere with the protrusion 543b of the ratchet member 543, so that when the working member 540 attempts to retreat, the fastener 311 can prevent the retreat movement of the working member 540.

[0216] Meanwhile, the fastener 311 coupled to the retreating wire 309 to prevent retreat may be coupled to the inner wire 309a or the outer wire 309b. Preferably, the fastener 311 may be coupled to the inner wire 309a.

[0217] The surgical instrument 10 according to the first embodiment of the present invention includes a structure for preventing the back-off of the working member 540 using the back-off guide wire 309. In this case, the fastener 310 for making the working member 540 back-off and the fastener 311 for preventing the working member 540 from back-off may be included. Here, the fastener 310 and the fastener 311 are combined with the inner guide wire 309a or the outer guide wire 309b, but all must be combined with the same guide wire. In other words, the fastener 310 for making the working member 540 back-off and the fastener 311 for preventing the working member 540 from back-off must be able to move in the same direction.

[0218] Specifically, the fastener 310 is arranged to move together from the front of the working member 540 when the working member 540 advances toward the distal end side of the end tool, and the fastener 311 can be arranged to move together from behind the protrusion 546 of the working member 540 or behind the protrusion 543b of the ratchet member 543.

[0219] Thus, the surgical instrument 10 according to the first embodiment of the present invention can prevent the working member 540 from unintentionally retreating, and can retreat the working member 540 when necessary.

[0220] Meanwhile, in the present embodiment, the linear motion of the reciprocating member 551 and the forward motion of the working member 540 caused by the interaction between the reciprocating member 551 including the groove portion 551 a and the staple pulleys 167 and 168 have been described, but the technical idea of ​​the retreat guide wire structure of the first embodiment of the present invention is not limited thereto and can be applied to various methods for staple suturing actions.

[0221] <Modification of the First Embodiment>

[0222] Hereinafter, a surgical instrument end tool 100 according to a modified example of the first embodiment of the present invention will be described. Here, the surgical instrument end tool 100 according to the modified example of the first embodiment of the present invention is different from the above-mentioned surgical instrument end tool according to the first embodiment of the present invention (see Figure 1 Compared with 100 in the embodiment, the constitution of the back-off prevention structure of the working member 540 is different in features. As described above, hereinafter, the constitution different from the first embodiment will be described in detail.

[0223] Fig.33 1 is a perspective view showing the first jaw 101 including a working member 640 of a surgical instrument according to a modified example of the first embodiment of the present invention. Fig.34 It is shown Fig.33 A side cross-sectional view of the working member 640 in FIG. Fig.35 It is shown Fig.33 A perspective view of the working member 640 and the retreating wire structure in FIG.

[0224] See also Figure 33 to Figure 35 The first jaw 101 according to the modified example of the first embodiment of the present invention may include a reciprocating member 651 and a working member 640 of a reciprocating assembly (not shown). In addition, although not shown in the drawings, a nail magazine 600 accommodated in a receiving portion of the first jaw 101, a cover 610 of the nail magazine, a housing 620, etc. may be included.

[0225] Here, the reciprocating assembly (not shown) is substantially the same as the reciprocating assembly 550 according to the first embodiment of the present invention, and thus a detailed description will be omitted.

[0226] Meanwhile, the housing 620 constitutes the outer shape of the staple cartridge 600, and is generally formed in a shape in which one side (top side) is removed from an empty box, so that the interior thereof can be formed to accommodate a reciprocating moving assembly (not shown), a working member 640, and staples (see Fig.10 Here, the cross section of the housing 620 is generally formed into a "U" shape.

[0227] One or more concavo-convex parts 621 may be formed in a region on the inner side surface of the housing 620 that may contact the working member 640. Alternatively, one or more concavo-convex parts 621 may be formed in a region on the inner side surface of the first jaw 101 that may contact the working member 640. Alternatively, it can be described that the concavo-convex parts 621 are formed below the moving path of the working member 640.

[0228] One or more concave-convex parts 621 can be formed into a wedge shape. From another perspective, it can be described that one or more concave-convex parts 621 include an inclined surface, and the inclined surface is formed so that the height of the distal end side of the nail magazine 600 is higher than the height of the proximal end side.

[0229] Here, one or more concave-convex portions include a first inclined surface 621a as a surface on the proximal end side and a second inclined surface 621b as a surface on the distal end side, and the first inclined surface 621a is formed to have a gentle inclination, and the second inclined surface 621b can be formed to be nearly vertical.

[0230] The concave-convex portion 621 as described above is formed to be contactable with the buckle 647 of the working member 640, thereby preventing the working member 640 from retreating (ie, moving toward the proximal end). This will be described in more detail below.

[0231] The working member 640 according to the modified example of the first embodiment of the present invention may include a body 645, a blade 642, a ratchet member 643, and a buckle 647. In addition, although not shown in the drawings, the working member 540 according to the first embodiment may include a wedge 641.

[0232] The body 645, blade 642, ratchet member 643 and wedge 641 of the working member 640 according to the modified example of the first embodiment of the present invention are substantially the same as the body 545, blade 542, ratchet member 543 and wedge 541 of the working member 540 according to the first embodiment of the present invention, so a detailed description will be omitted here.

[0233] Meanwhile, the buckle 647 may be formed to protrude from any one side of the body 645 or the wedge 641. In addition, the buckle 647 is formed as a plate-shaped member, and may be formed to contact the inner side surface of the housing 620 or the inner side surface of the first jaw 101. Specifically, one end 647a of the buckle 647 is coupled to the rear lower end of the working member 640, and the other end 647b of the buckle 647 may contact the concave-convex portion 621.

[0234] At this time, the buckle 647 may be formed to engage with the concave-convex portion 621 of the housing 620 or the first jaw 101. When the buckle 647 is engaged with the concave-convex portion 621, the buckle 647 and the concave-convex portion 621 may prevent the working member 640 from retreating (ie, moving toward the proximal end).

[0235] Here, the buckle 647 can be formed to allow a certain degree of elastic deformation. That is, it can be used as a leaf spring. Therefore, when the buckle 647 moves along the inclined surface of the concave-convex part 621, the buckle 647 can be elastically deformed to a certain extent toward the body 645. In addition, when the buckle 647 exceeds the inclined surface of the concave-convex part 621 and contacts the next concave-convex part 621, the buckle 647 can restore elasticity in the direction of the housing 620.

[0236] Specifically, when the working member 640 moves forward toward the distal end side, the buckle 647 climbs up the first inclined surface 621a and moves toward the distal end side, and when the reciprocating assembly (not shown) moves backward toward the proximal end side, the buckle 647 interferes with the second inclined surface 621b, thereby preventing the working member 640 from moving backward toward the proximal end side.

[0237] Here, when the reciprocating member 651 retreats, only the reciprocating member 651 retreats, and the working member 640 can be more reliably stopped in place. That is, the working member 640 can be more reliably prevented from moving toward the proximal end side of the end tool 100 by the buckle 647 and the concave-convex portion 621.

[0238] Meanwhile, similar to the surgical instrument according to the first embodiment of the present invention, the surgical instrument according to the modified example of the first embodiment of the present invention may include a retreat structure including a retreat guide wire 309 .

[0239] See also Fig.35The fastener 310 coupled to the outer wire 309 b is formed to be contactable with the protrusion 643 b of the ratchet member 643 , and can move the working member 640 to the proximal end side according to the movement of the retreat wire 309 .

[0240] Here, when the working member 640 moves backward toward the proximal end side through the backward guide wire 309, the buckle 647 may be plastically deformed, thereby losing its function of preventing the working member 640 from moving backward. That is, during the linear reciprocation of the reciprocating member 651 and the resulting forward movement of the working member 640, in order to prevent the working member 640 from unintentionally moving backward, the buckle 647 interferes with the concave-convex portion 621 so that the working member 640 cannot move backward, but during the backward operation of moving the working member 640 to the proximal end side, a strong backward force is transmitted through the fastener 310 of the backward guide wire 309, causing the buckle 647 to be plastically deformed, and eventually may lose its function of preventing backward movement.

[0241] So far, for the present invention, mainly preferred embodiments have been described. It will be appreciated by those skilled in the art that the present invention may be implemented in a modified form without departing from the essential features of the present invention. Therefore, the disclosed embodiments should be considered from an illustrative rather than a restrictive perspective. The scope of the present invention is indicated in the claims rather than in the foregoing description, and all differences within the equivalent range should be interpreted as being included in the present invention.

[0242] The surgical instrument according to the present invention includes a structure for preventing the working member from retreating during the stapling action and a retreat guide wire structure for retreating the working member after stapling, thereby facilitating the stapling action and improving the usability of the surgical instrument.

[0243] It should be understood that the embodiments described herein should be considered only as illustrative and not for limiting purposes. The description of features or aspects in each embodiment should generally be considered as other similar features or aspects that can be used in other embodiments. Although one or more embodiments have been described with reference to the accompanying drawings, it will be understood by those skilled in the art that various modifications may be made to the form and details thereof without departing from the spirit and scope defined by the claims.

[0244] [Description of Reference Numerals]

[0245] 10: Surgical instruments

[0246] 100: end tool

[0247] 200: Operation Department

[0248] 540, 640: working components

Claims

1. A surgical instrument, characterized in that: The surgical instrument comprises a distal tool, which comprises one or more jaws and is rotatable in at least any direction, wherein: Any one of the one or more jaws comprises: a reciprocating assembly disposed inside the jaws and movable relative to the jaws along a first direction that is a length direction of the jaws; a working member disposed at one side of the reciprocating assembly, the working member being contactable with the reciprocating assembly so as to be movable along the first direction from the proximal end side of the jaw to the distal end side of the jaw by the reciprocating assembly; and a retreat wire, which is arranged adjacent to the working member, and the retreat wire is movable along the first direction, wherein, The retreat guide wire includes one or more fasteners fixed to the retreat guide wire, and the one or more fasteners retreat the working member toward the proximal end side of the jaw by moving together with the retreat guide wire to the proximal end side of the jaw.

2. The surgical instrument according to claim 1, characterized in that: The jaws further include: A retract wire pulley is arranged at the distal end of the jaws, wherein A portion of the back-off wire contacts the back-off wire pulley and is wound thereon, and the back-off wire has two branches extending toward the proximal end side of the jaws.

3. The surgical instrument according to claim 2, characterized in that: The jaws further include: an auxiliary pulley arranged adjacent to the retreat wire pulley, wherein The auxiliary pulley is configured to arrange the backward wire by adjusting the position or distance between two branches of the backward wire.

4. The surgical instrument according to claim 2, characterized in that: The two branches of the retreat wire have an inner wire and an outer wire, the inner wire is the one close to the working member, and the outer wire is the other one, The one or more fasteners are coupled to the outer conductor.

5. The surgical instrument according to claim 2, wherein: The end tool comprises: a jaw rotation axis, which is the center of rotation of the jaws; and An annular pulley is coupled to the jaw rotating shaft, wherein a portion of the retreat wire is wound around the annular pulley.

6. The surgical instrument according to claim 5, characterized in that: The annular pulley includes two pulleys that are rotatable independently of each other, wherein the two branches of the retreat wire are respectively wound around the two pulleys of the annular pulley in different directions based on the jaw rotation axis.

7. The surgical instrument according to claim 2, characterized in that: The reciprocating component has a plurality of concave-convex parts, and the plurality of concave-convex parts are defined on at least one side of the reciprocating component. The working member includes a ratchet member having a ratchet wheel, wherein the ratchet wheel is defined on at least one side of the ratchet member, and The ratchet of the ratchet member is configured to be contactable with each of the plurality of concave and convex portions of the reciprocating assembly.

8. The surgical instrument according to claim 7, wherein: The one or more fasteners are configured to contact the ratchet member to cause the working member to move backward toward the proximal end side of the jaw.

9. The surgical instrument according to claim 8, characterized in that: The ratchet member includes a protrusion protruding from a surface opposite to at least one surface defining the ratchet, and the fastener is configured to contact the protrusion of the ratchet member.

10. The surgical instrument according to claim 9, characterized in that: The protrusion of the ratchet member forms a hollow, and the retreat wire is configured to pass through the protrusion through the hollow.

11. The surgical instrument according to claim 7, characterized in that: The back-off wire and the one or more fasteners are located on opposite sides of the reciprocating assembly based on the ratchet member.

12. The surgical instrument according to claim 1, wherein: The one or more fasteners are configured to be arranged on the distal end side of the jaw so as not to interfere with the working member until the working member is advanced all the way to the distal end side of the jaw.

13. The surgical instrument according to claim 2, wherein: When the working member moves forward toward the distal end portion, the one or more fasteners are configured to move together in front of the working member while being spaced apart from the working member to ensure a free space.

Images