Circular anastomosis system and apparatus

Abstract

Systems, devices, and methods are provided for introducing a collapsible buttress into a target site in a patient, such as a proximal bowel tube during a colon resection procedure, and removing the collapsible buttress from the target site. A delivery instrument for a circular stapler having a buttress includes an elongated shaft having first and second jaws movable between an open position and a closed position, and a driver extending through the shaft. The driver has an engagement mechanism for engaging the buttress and moving the buttress between a collapsed configuration and an expanded configuration. The instrument allows a surgeon to introduce a buttress in a collapsed state through a percutaneous puncture point, such as a trocar, in a patient, and subsequently expand the buttress within a target site in a proximal bowel tube for a stapling operation. Further, the instrument allows a surgeon to collapse the buttress to facilitate removal of the buttress and reduce stress on the staple line.

Description

[0001] Cross-reference to related applications This application claims the benefit of U.S. Provisional Application Serial Nos. 63 / 621,462 and 63 / 621,490, filed January 16, 2024, the entire disclosure of which is incorporated herein by reference for all purposes. Technical Field

[0002] This specification generally relates to endoscopic surgical instruments for dissecting, occluding and / or sealing tissues, and more specifically to endoscopic circular stapler devices particularly suitable for connecting tubular tissue structures together, and instruments and systems for deploying such circular stapler devices. Background Technology

[0003] In certain types of surgical procedures, the use of surgical staples has become the preferred method for connecting tissues, and therefore, surgical staplers with special constructions have been developed for different applications. For example, intraluminal or circular staplers have been developed for connecting two tubular structures together, such as in surgical procedures involving the lower colon, where two separated regions of the lower colon are connected at the anastomosis after the target area has been removed.

[0004] A circular stapler typically comprises an elongated shaft with a proximal actuation mechanism and a distal stapler mechanism mounted on the shaft. The distal stapler mechanism typically includes a staple cartridge housing multiple staples arranged in a concentric circular array. An annular cutter is concentrically mounted with the staples within the cartridge or end actuator of the instrument, enabling axial movement relative to the cartridge. A movable cannula or capture spike extends axially from the center of the instrument to detachably couple an anvil to the stapler mechanism. The anvil is configured to shape the end of the staple as it is driven into the anvil. The distance between the distal surface of the staple cartridge and the staple anvil is typically controlled by an adjustment mechanism mounted proximal to the stapler shaft that controls the axial movement of the capture spike.

[0005] When performing procedures on the low colon using a circular stapler, surgeons typically use a standard linear stapler, placing two rows of staples on each side of the lesion to be removed and anastomosed. As adjacent ends are anastomosed, the target area is simultaneously cut. After removal of the affected area, the surgeon usually inserts the anvil of the circular stapler proximally into the lumen. This is done by inserting the head of the anvil into an opening that the surgeon has already made in the proximal lumen. Sometimes, the anvil can be placed transanally by placing the head of the anvil distally and inserting the instrument through the rectum. The proximal end of the intestine is then ligated to the anvil axis using purse-string sutures or other standard ligation devices, and the proximal and distal ends of the intestine are tightened within the gap between the anvil and the staple cartridge by closing the gap. The circular stapler is then actuated, thereby connecting the ends and forming a tubular channel by driving and shaping the annular multi-row staples through and shaping the two ends of the intestine. While driving and shaping the anastomotic staples, concentric circular blades are driven through the end of the intestinal tissue, thereby cutting the end of the anastomotic staples adjacent to the inner row.

[0006] After the proximal and distal ends of the intestine have been connected, the anvil must be removed from the proximal bowel. However, the diameter of the anvil is usually larger than the diameter of the anastomosis suture. Therefore, the operation of withdrawing the anvil through the anastomosis suture to remove it from the patient will apply stress to the anastomosis suture, which poses a risk of tearing the anastomosis array and subsequently causing anastomotic leakage.

[0007] To overcome these shortcomings, collapsible anvils have been developed, configured to fold or collapse into a smaller diameter configuration for easy removal via the anastomosis suture. These collapsible anvils must be introduced into the patient in a collapsed state and subsequently expanded and manipulated to the target site proximal to the end of the intestine. Furthermore, these anvils must maintain their expanded shape during the anastomosis procedure and then re-collapse when removal is necessary.

[0008] Therefore, there is a need for a delivery device and system for introducing and removing collapsible anchors into and from a target site in a patient’s body (such as the proximal intestinal tract). Summary of the Invention

[0009] The following is a simplified outline of the claimed subject matter to provide a preliminary understanding of some aspects thereof. This outline is not a comprehensive overview of the claimed subject matter. It is neither intended to identify key or essential elements of the claimed subject matter nor to define its scope. Its sole purpose is to present some concepts of the claimed subject matter in a simplified form as a prelude to a more detailed description later.

[0010] On one hand, a delivery device for a circular anastomosis device with an anvil is provided. The device includes an elongated shaft and a driver extending through the shaft, the shaft having a first jaw and a second jaw movable between an open position and a closed position. The driver has an engagement mechanism for engaging the anvil and moving the anvil between a collapsed configuration and an expanded configuration. This device allows a surgeon to introduce an anvil in a collapsed state into the patient through a percutaneous puncture point (such as a cannula) and subsequently expand the anvil within a target site (such as a proximal bowel) for anastomosis procedures. Furthermore, the device allows the surgeon to collapse the anvil to facilitate its removal and reduce stress on the anastomosis line.

[0011] In various embodiments, the actuator includes a lever that extends at least partially through the first and second jaws. An engagement element may include a rotatable element at the distal end of the lever, or the engagement element may include a distal portion of the lever. The lever is configured to engage with an interface on the anvil such that rotation of the lever relative to the instrument axis (or rotation of the rotatable element relative to the lever) causes the anvil to move between a collapsed configuration and an expanded configuration.

[0012] In another embodiment, the actuator includes a rod that at least partially extends through the first and second jaws. The rod is movable in the longitudinal direction relative to the elongated axis of the instrument, such that the abutment seat moves between a collapsed configuration and an expanded configuration.

[0013] In various embodiments, the anvil includes a head and a proximal axis. The anvil head includes a tissue contact surface that defines a staple-forming recess for receiving the staple. The head is configured to pivot relative to the axis between a collapsed configuration and an expanded configuration, wherein in the collapsed configuration the head is oriented substantially parallel to the axis, and in the expanded configuration the head is oriented substantially perpendicular to the axis. Compared to the expanded configuration, the head has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of the axis) in the collapsed configuration. In an exemplary embodiment, the anvil has an external dimension or diameter of less than about 14 mm in the collapsed configuration so that the anvil can be advanced through a cannula or other percutaneous access point within the patient. The anvil may have an external dimension or diameter of at least about 20 mm or at least about 25 mm in the expanded configuration.

[0014] In various embodiments, the first and second jaws of the instrument are sized to contact and engage the outer surface of the proximal shaft of the anvil in the closed position. In the closed position, the jaws are substantially parallel to each other and in contact with the outer surface of the anvil shaft. This configuration provides a stronger grip on the anvil shaft and prevents the shaft from slipping out of the jaws or exhibiting a "watermelon seeding" effect.

[0015] In various embodiments, the instrument grippers and / or actuators are configured for coupling to a remote operation control system or robot control system controlled remotely by a user. In one such embodiment, the actuator includes a proximal portion configured for coupling to an actuator that controls the actuator. The actuator may be located within the proximal handle of the instrument or may be remotely positioned within a housing in the operating room. The control system includes input devices coupled to a controller that allow the user to control the actuator from a remote location.

[0016] On the other hand, a circular stapler system includes: a staple assembly comprising a plurality of staples and a cutting element; and an anvil movably coupled to the staple assembly. The anvil is configured to be deployed between a collapsed configuration and an expanded configuration. The system also includes a delivery device comprising an engagement mechanism for engaging the anvil and causing the anvil to move between the collapsed and expanded configurations.

[0017] In various embodiments, the anvil is pivotable between a collapsed configuration and an expanded configuration. In one such embodiment, the anvil includes a head and an axis. The head is pivotable relative to the axis from a collapsed configuration (where the head is oriented substantially parallel to the axis) to an expanded configuration (where the head is oriented substantially perpendicular to the axis).

[0018] In one such embodiment, the anvil head includes a central member and a first lateral member and a second lateral member. The central member is pivotally coupled to a shaft such that it can move between a collapsed configuration and an expanded configuration. Furthermore, the first and second lateral members are pivotally coupled to the central member and configured to fold inward toward the central member to further reduce the overall cross-sectional area or lateral dimension of the anvil.

[0019] In various embodiments, the engagement mechanism includes a rod extending at least partially between the first and second jaws. The rod includes a distal portion configured such that the central member of the abutment pivots between a collapsed configuration and an expanded configuration. The rod may also be configured such that the lateral member folds inward toward the central member. Alternatively, the instrument may include a second actuator for engaging and deploying the lateral member.

[0020] On the other hand, a robot control system includes: a circular stapler comprising a staple assembly, an anvil movably coupled to the staple assembly; and an instrument configured to move the anvil from a collapsed configuration to an expanded configuration. The system also includes a robot controller configured to control the instrument.

[0021] In various embodiments, the system further includes an input device coupled to the controller and movable by a user, such that movement of the input device generates an input signal. The controller is coupled to an actuator configured to control a driver on the instrument to move the anvil between a collapsed configuration and an expanded configuration based on the input signal.

[0022] In various embodiments, the system further includes one or more sensors coupled to the controller for detecting forces or torques applied to the instrument by the robot controller. In other embodiments, the system includes one or more sensors coupled to the controller for detecting forces or torques applied to the anvil by the instrument. The controller is configured to receive this force / torque information from the sensors and provide the user with input regarding the amount of force applied to the tissue during the expansion or manipulation of the anvil within the patient's body. This torque / force feedback can be used for deployment diagnostics to optimize the placement of the anvil at the target site and / or to provide additional safety for the patient. For example, the system may include a processor configured to, for example, warn the user and / or automatically overridden the actuators within the instrument to stop the expansion of the anvil when the force applied to the anvil exceeds a threshold amount.

[0023] On the other hand, a method for connecting two tissue structures includes: introducing an anvil in a collapsed configuration into a patient's body adjacent to a first tissue structure via a cannula, and moving the anvil from the collapsed configuration to an expanded configuration. The method further includes: positioning an anastomosis staple assembly in the patient's body adjacent to a second tissue structure, and advancing a plurality of staples into the first and second tissue structures to attach the first tissue structure to the second tissue structure.

[0024] In various embodiments, the method further includes clamping the shaft of the anvil to move the anvil to the first tissue structure. The shaft can be clamped by a pair of jaws on the instrument. The jaws are movable to a closed position, in which the jaws are sized to contact and engage the outer surface of the proximal shaft of the anvil. In the closed position, the jaws are substantially parallel to each other and contact the outer surface of the anvil shaft.

[0025] In various embodiments, the method includes rotating an actuator within the delivery device to move the anvil into an expanded configuration. In other embodiments, the actuator is advanced or retracted in the longitudinal direction to move the anvil into the expanded configuration.

[0026] The two tissue structures may include tubular structures, such as two separate segments of the intestine. The method further includes an anastomosis staple advancer to drive the staples through the two tissue structures against an abutment, thereby connecting the first tissue structure to the second tissue structure. The method may also include an advance blade to cut the tissue structures adjacent to a row of staples.

[0027] In various embodiments, the method further includes using an instrument actuator to collapse the anvil and withdraw the anvil from the first tissue structure to complete the anastomosis.

[0028] It should be understood that the foregoing general description and the following detailed description are exemplary and explanatory only, and are not intended to limit the scope of the description. Other features will be set forth in part in the following description, or may be learned by practicing this description. Attached Figure Description

[0029] The above and other aspects, features, and advantages of this surgical instrument will become more apparent when read in conjunction with the following detailed description, in conjunction with the accompanying drawings, in which: Figure 1 This is a perspective view of the distal end of a circular stapler; Figures 2A-2C An embodiment of the anvil of a circular stapler is shown; Figure 3 This is a perspective view of the distal portion of the conveying device used for the anvil seat; Figure 4 A delivery device with closed jaws is shown for advancing an anvil into a target area within a patient's body; Figure 5 The conveying device is shown after the anvil has been expanded at the target area; Figure 6 The shaft of the delivery device that operates the anvil of the circular stapler is shown; Figure 7 The jaws of the conveying device are shown gripping the anvil shaft; Figure 8 The operation of a circular stapler used for sealing and cutting tissue is illustrated schematically; Figure 9 Another embodiment of a collapsible anvil for a circular stapler is shown; Figures 10A-10C It shows Figure 9 The deployment of the anvil head of the anvil; Figure 11A and Figure 11B Another embodiment of an anvil for a circular stapler is shown; Figure 12A Another embodiment of the anvil of a circular stapler in an expanded configuration is shown; Figure 12B It shows the extended configuration Figure 12A The anvil; Figure 13A and Figure 13B Another embodiment of a collapsible anvil for a circular stapler is shown; Figures 14A-14C Show Figure 13A and Figure 13B The deployment of the anchor pins; Figure 15A and Figure 15B Another embodiment of a collapsible anvil for a circular stapler is shown; Figures 16A-16C Another embodiment of a collapsible anvil for a circular stapler is shown; Figure 17A and Figure 17B Another embodiment of a collapsible anvil for a circular stapler is shown; Figures 18A-18C Show Figure 17A and Figure 17B The deployment of the anchor pins; Figure 19A and Figure 19B It is a perspective view of a representative remotely operated surgical instrument; Figure 20 A top view of the operating room employing a robotic surgical system is shown; and Figure 21 A simplified side view of the robot arm assembly is shown. Detailed Implementation

[0030] Specific embodiments of this surgical instrument will be described below with reference to the accompanying drawings; however, it should be understood that the disclosed embodiments are merely exemplary and may be embodied in various forms. Therefore, the specific structural and functional details disclosed herein should not be construed as limiting, but should only serve as the basis for the claims and as a representative basis for teaching those skilled in the art to apply the device described herein in various appropriately detailed configurations. Well-known functions or constructions will not be described in detail to avoid obscuring this description with unnecessary detail. Identical numerals in two or more drawings represent identical or similar elements. Furthermore, whenever practicable, elements and related aspects described in detail with reference to one embodiment are also included in other embodiments where they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment but not with reference to a second embodiment, that element may still be claimed to be included in the second embodiment. Moreover, the illustrations herein are for illustrative purposes only and do not necessarily reflect the actual shape, size, or dimensions of the system or the components shown.

[0031] While the following description pertains to systems and apparatus for delivering and manipulating circular anastomotic instruments, it should be understood that certain features of the surgical instruments described herein are readily applicable to delivery instruments for any type of surgical clamping, cutting, ligating, dissecting, clipping, cauterizing, suturing, and / or sealing instruments, regardless of whether the surgical instrument applies anastomotic staples or other types of fasteners. Furthermore, the features of the circular anastomotic instruments described herein are readily applicable to surgical instruments actuated using any technique within the scope of those skilled in the art, such as manually activated surgical instruments, powered surgical instruments (e.g., electromechanical instruments), robotic surgical instruments, etc.

[0032] The device or certain components of the device described herein may also be incorporated into various surgical instruments, such as co-appointed and co-pending U.S. patent application serial numbers 12 / 945,541, 16 / 205,128, 16 / 427,427, 16 / 678,405, 16 / 904,482, 17 / 081,088, and 17 / 084,981, and international patent numbers PCT / US2017 / 056075, PCT / US2017 / 050760, PCT / US2019 / 107646, PCT / US2019 / 019501, and PCT / US2019 / 019501. The disclosures of those applications described in PCT / US2020 / 062344, PCT / US2020 / 54568, PCT / US2019 / 064861, PCT / US2019 / 062768, PCT / 2020 / 025655, PCT / US2020 / 056979, PCT / 2019 / 066513, PCT / US2020 / 020672, PCT / US2019 / 066530, and PCT / US2020 / 033481 are incorporated herein by reference in their entirety for all purposes as if copied and pasted herein.

[0033] Figure 1The distal portion of a surgical circular anastomosis instrument 100 according to an illustrative embodiment is shown. The surgical instrument 100 includes an end effector 110, an elongated shaft 105, and in some embodiments, a wrist assembly (not shown) coupling the end effector 110 to the shaft 105. The end effector 110 generally includes a circular anastomosis assembly 120, an anvil 130, and a capture device (not shown) for advancing and retracting the anvil 130 relative to the anastomosis assembly 120, as discussed in more detail below. The anastomosis assembly 120 includes a housing having a generally cylindrical body with internal channels for receiving a cutting element assembly, an anastomosis advancer, and an anastomosis cartridge (not shown). The anastomosis assembly 120 may be removably coupled to the shaft 105 or may be permanently attached thereto. In some embodiments, the anastomosis assembly 120 is a disposable component of the instrument 100 and may be removably attached to the shaft 105. In other embodiments, the staple cartridge is a single-use component of the instrument and can be removably coupled to the staple assembly 120. In other embodiments, the entire instrument 100 is manufactured together and can be a single-use instrument or a reusable instrument.

[0034] The proximal portion of the elongated shaft 105 is operatively connected to an actuation mechanism (not shown), although those skilled in the art will understand upon reading this specification that components of the actuation mechanism may extend into and / or through the elongated shaft 105 and / or the wrist assembly. In various embodiments, the instrument 100 will include a proximal handle (not shown) for actuating the end effector 110, and in some embodiments, the proximal handle is used to control the orientation and movement of the end effector 110. In other embodiments, the instrument 100 is adapted for use with a robotic system. In these embodiments, the instrument 100 typically includes an actuation mechanism for controlling the orientation and movement of the end effector. The actuation mechanism will typically be controlled by a robotic manipulator assembly remotely controlled by a user. For example, in one configuration, the actuation mechanism will be manipulated by the robotic manipulator assembly to move the capture device 140 toward and away from the anastomosis assembly 120, and / or deploy anastomosis staples and cutting elements (such as knives), discussed in more detail below.

[0035] The actuation mechanism may include an input coupler (not shown) to replace or supplement the fixed and movable handle. In some embodiments, the surgical instrument 100 will also include a rear-end mechanism 510 coupled to the proximal portion of the elongated shaft 105 (see [link to relevant documentation]). Figure 10A Rear-end mechanisms typically provide mechanical coupling between the drive chords, rods, or cables of the instrument and the motorized axis of the mechanical interface of the drive system. Further details of known rear-end mechanisms and surgical systems are described, for example, in U.S. Patent Nos. 8,597,280, 7,048,745, and 10,016,244, each of which is incorporated herein by reference in its entirety.

[0036] The input coupler may interface with and be driven by a corresponding output coupler (not shown) of a remote surgical system, such as the system disclosed in U.S. Publication No. 2014 / 0183244A1, the entire disclosure of which is incorporated herein by reference. The input coupler is driven coupled to one or more input members (not shown) disposed within instrument shaft 105. The input members are driven coupled to end effector 110. Suitable input couplers are adaptable to mate with various types of motor assemblies (not shown), such as the stapler-specific motor assembly disclosed in U.S. Patent No. 8,912,746, or the general-purpose motor assembly disclosed in U.S. Patent No. 8,529,582, the disclosures of which are incorporated herein by reference in their entirety. Further details of known input couplers and surgical systems are described, for example, in U.S. Patent Nos. 8,597,280, 7,048,745, and 10,016,244. Each of these patents is incorporated herein by reference in its entirety for all purposes.

[0037] Although this document is described with reference to instruments configured for use with robotic surgical systems, it should be understood that the actuation and drive components described herein can be incorporated into manually actuated instruments, electromechanical instruments, or instruments actuated in any other manner. For example, an actuation mechanism may include a handle assembly for use by a user, the handle assembly including a fixed handle and a movable handle to serve as an actuator of surgical instrument 100.

[0038] Now for reference Figures 2A-2C A representative anvil 130 includes an anvil head 132 and an anvil shaft 134. The anvil shaft 134 is insertable into and removably and slidably secured within an internal channel of the staple assembly 120. A capture device (not shown) is configured to advance and retract through this internal channel, causing the anvil 130 to translate relative to the staple assembly 120 along a longitudinal axis, thereby causing the anvil 130 to approach or disengage relative to the staple assembly 120. Figure 1 As shown, the anvil head 132 includes a tissue contact surface 136, which defines a method for receiving the anastomosis staple 200 (see discussion below). Figure 9 The anastomotic pin forming recess (not shown).

[0039] The anvil head 132 includes a central portion 140 and a first lateral portion 142 and a second lateral portion 144. In one embodiment, the central portion 140 forms the central portion of the generally circular head 132, and the lateral portions 142 and 144 each include a semi-circular outer portion of the circular head 132. In an exemplary embodiment, the lateral portions 142 and 144 generally have the same size and shape, but it should be understood that one of the lateral portions may be larger than the other.

[0040] like Figure 2B As shown, the central component 140 is pivotally coupled to the shaft 134, so that it can be configured from a collapsed shape (where the central component 140 extends in a direction transverse to or substantially parallel to the shaft 134, see...) Figure 2B ) Move to the expanded configuration (where the central component 140 extends in a direction transverse to or substantially perpendicular to axis 134, see Figure 2C Furthermore, the first lateral member 142 and the second lateral member 144 are pivotally coupled to the central member 140, so that they can be in a collapsed configuration ( Figure 2B (where they fold together toward the central component 140 and extend substantially perpendicular to the central component 140) and the expanded configuration ( Figure 2C The lateral members 142 and 144 extend substantially parallel to the central member 140 to form abutments that are suitable for movement between the anastomoses that mate with the staple assembly 120.

[0041] The anvil 130 is configured such that it has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of shaft 134) in a collapsed configuration than in an expanded configuration. Herein, "lateral dimension" is defined as the radial distance from the longitudinal axis of the shaft to the radial surface or point of the anvil 130 furthest from the longitudinal axis. In some embodiments, the anvil 130 has a lateral dimension (or diameter in some embodiments) of less than about 14 mm in the collapsed configuration, allowing the anvil 130 to be advanced through the cannula or other percutaneous entry point for the patient. In the expanded configuration, the anvil 130 may have a lateral dimension (or diameter) of at least about 20 mm, at least about 25 mm, or about 21 to about 33 mm, but it should be understood that the size of the anvil 130 may vary depending on the surgical procedure and the size of the patient's percutaneous entry point.

[0042] The anastomosis head 132 is configured such that when the central portion 140 and the lateral portions 142, 144 are in an expanded configuration, they form a generally circular disc. This disc has sufficient rigidity to withstand clamping forces and / or forces driving the staples through tissue abutting against staple recesses on the proximal surface of the head 132. Furthermore, the staple recesses are aligned with the circumferential staples driven abutting against these recesses by the staple assembly 120.

[0043] The anvil 130 may also include one or more actuators (not shown) within the shaft 134, the actuators having a distal portion coupled to a pivot joint between the shaft 134 and the central component 140 and / or a pivot joint between the lateral components 142, 144 and the central component 140, such that these components pivot or rotate relative to each other. Alternatively, the actuators may be disposed within the circular stapler assembly 120 or within a separate anvil delivery device (not shown). The actuators may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0044] See now Figure 3 The anvil delivery device 200 includes an elongated shaft 202, the elongated shaft 202 being sized to advance through a suitable percutaneous puncture point, such as a cannula or trocar, into the patient's body. In some embodiments, the shaft 202 has an external dimension of less than about 14 mm, but it should be understood that the dimension of the shaft 202 can vary depending on the surgical procedure and the size of the patient's percutaneous entry point.

[0045] The instrument 200 also includes a first jaw 204 and a second jaw 206, which are movable relative to each other between an open position and a closed position. In some embodiments, the second jaw 206 is a movable jaw configured to move relative to the first jaw 204 from an open position to a closed position. In other embodiments, the first jaw 204 is a movable jaw configured to move relative to the second jaw 206 between an open position and a closed position. In an exemplary embodiment, both jaws 204 and 206 are movable relative to each other.

[0046] See now Figure 7 The jaws 204, 206 preferably pivot about a hinge, which may include a pivot pin 210 extending through a recess (not shown) in each jaw 204, 206. The instrument 200 includes an actuator (not shown) within a shaft 202 that causes the jaws 204, 206 to open and close about the pivot pin 210. The jaws 204, 206 can employ any suitable mechanism to achieve opening and closing, including but not limited to mechanisms described in any published literature incorporated herein by reference. The first jaw 204 and the second jaw 206 may also be able to hinge together relative to the shaft 202 about an axis substantially perpendicular to the longitudinal axis (e.g., a yaw axis or pitch axis). In these embodiments, the instrument 200 may also include a wrist assembly (not shown) to allow the jaws 204, 206 to hinge relative to the shaft 202.

[0047] In an exemplary embodiment, the jaws 204 and 206 are configured to move in a closed position to a position substantially parallel to each other (e.g. Figure 7(As shown). The jaws 204, 206 are preferably sized such that each jaw contacts and grips the outer surface of the anvil shaft 134 when in the closed position. This configuration provides a stronger grip on the shaft 134 and prevents the shaft from slipping out of the jaws (i.e., the "watermelon seed effect," which is as typical of prior art instruments that do not close in a substantially parallel orientation).

[0048] In an exemplary embodiment, the jaws 204 include a jaw gripping portion 240 and a proximal support portion 242. The proximal support portion 242 extends downward toward the jaw gripping portion 244 of the jaws 206 and is coupled thereto by a pivot pin 210. The proximal support portion 242 is sized and shaped such that the pivot pin 210 is located closer to the jaw gripping portion 244 of the jaws 206 than the jaw gripping portion 242 of the jaws 204. Thus, the pin 210 and the gripping portion 242 are positioned on one side of the central longitudinal axis 250 of the shaft 202, while the jaw gripping portion 240 is located on the other side of the longitudinal axis 250. This provides an asymmetrical position for the hinge or pivot point between the jaws 204 and 206, allowing the jaws to be positioned in a closed position around the shaft 134 of the abutment 130 while remaining substantially parallel to the surface facing the shaft 134.

[0049] See again Figure 3 The delivery device 200 includes an actuator for moving the anvil head 132 between a collapsed configuration and an expanded configuration. In one embodiment, the actuator includes a rod 220 extending through a shaft 202. The rod 220 includes a distal portion 222 configured to extend at least partially through jaws 204, 206. In one embodiment, the rod 220 is sized and configured to extend through an internal lumen (not shown) within the anvil shaft 134 and is configured to be advanced distally through the shaft 134 to engage the anvil head 132 (see [link to product details]). Figure 4 and Figure 5 The rod 220 includes an engagement mechanism (not shown) on the distal portion 222, which engages with an engagement mechanism on the anvil head 134 to allow the anvil head 132 to move between a collapsed configuration and an expanded configuration.

[0050] In one embodiment, the lever 220 includes a rotatable element (not shown) configured to rotate relative to the lever 220. In another embodiment, the entire lever 220 is configured to rotate relative to axis 202. Rotation of the lever 220 or the rotatable element causes the central member 140 of the anvil head 132 to pivot between a collapsed configuration and an expanded configuration about a hinge on the anvil axis 134. Furthermore, rotation of the lever 220 causes the lateral members 142, 144 to pivot about a hinge between the lateral members 142, 144 and the central member 140. In an alternative embodiment, the device 200 includes a second actuator on the lever 220 or on other elements of the device 200, the second actuator causing the lateral members 142, 144 to pivot relative to the central member 140 (i.e., movement of the anvil head 132 toward the collapsed configuration can be achieved by one or more actuators in the device 200).

[0051] In another embodiment, the distal portion 222 of the lever 220 is configured to actuate the anvil head 232 via a push-pull mechanism. For example, longitudinal movement of the lever 220 relative to the instrument 200 causes the central member 240 to pivot about the anvil axis 134 and / or causes the lateral members 242, 244 to pivot about the central member 240.

[0052] The proximal portion of the device 200 is operatively connected to an actuation mechanism (not shown), but those skilled in the art will understand upon reading this specification that components of the actuation mechanism may extend into and / or through the device 200. In various embodiments, the device 200 will include a proximal handle (not shown) for actuating the jaws 204, 206 and the lever 220, and in some embodiments for controlling the orientation and movement of the distal portion of the device 200. In other embodiments, the device 100 is adapted for use with a robotic system. In these embodiments, the device 100 will generally include an actuation mechanism that controls the orientation and movement of the end effector, the opening and closing of the jaws 204, 206, and the actuation of the lever 220. The actuation mechanism will generally be controlled by a robot manipulator assembly remotely controlled by a user. For example, in one configuration, the actuation mechanism will be manipulated by the robot manipulator assembly to rotate the lever 220 or move the lever 220 in the longitudinal direction to expand and collapse the abutment 230.

[0053] The actuation mechanism may include an input coupler (not shown) to replace or supplement the fixed handle and the movable handle. In some embodiments, the surgical instrument 200 may also include a rear-end mechanism or a proximal housing 540 (see [link to relevant documentation]). Figure 10B The rear-end mechanism or proximal housing 540 is coupled to the proximal portion of the elongated shaft 202 (see below for details). The rear-end mechanism 540 can be coupled with... Figure 10A The rear-end mechanism 510 shown can be the same component, or it can be different components.

[0054] Now for reference Figure 8 The circular anastomotic instrument 100 and the anvil delivery instrument 200 form a system particularly suitable for connecting two tubular structures, such as arteries, veins, and / or intestinal tissue 302, within a patient's body. For example, in low colon surgery, surgeons typically use a conventional linear anastomosis device, which places two rows of anastomotic staples on each side of the lesion in the affected intestinal segment to be removed and anastomosed. The target area is cut while the adjacent ends are anastomosed. After removal of the affected area, the surgeon typically inserts the anvil 130 of the instrument 100 into the proximal end of the lumen, proximal to the anastomosis line. This is done by inserting the anvil head 132 into an opening that the surgeon has made in the proximal lumen. In some embodiments, the anvil 130 is placed transanally by placing the anvil head 132 distal to the instrument 200 and inserting the instrument 200 transrectally.

[0055] like Figure 4 As shown, the anvil 130 is delivered in a collapsed configuration to the proximal end of the lumen via the anvil delivery device 200. Specifically, the central member 140 is pivoted to an orientation substantially parallel to the axis 134, and the lateral members 142, 144 are folded inward to reduce the overall cross-sectional area of ​​the anvil 130 and allow the anvil 130 to be easily inserted through a cannula or other percutaneous access point.

[0056] like Figure 5 As shown, once the anvil 130 has been advanced to the target position within the proximal lumen, the lever 220 (manually via a handle on the instrument 200, or robotically as described below) is actuated to move the anvil 130 into an expanded configuration. The proximal end of the intestine is then ligated to the anvil axis 134 using sutures or other conventional ligation devices, and the proximal and distal ends of the intestine are secured within the gap between the anvil 130 and the anastomosis cartridge 180 by closing the gap.

[0057] like Figure 6 As shown, a surgeon can manipulate the anvil 130 to a target location proximal to the lumen of the intestine by using the jaws 204, 206 of the instrument 200 to grip the shaft 134 of the anvil 130. As previously described, the jaws 204, 206 are configured to close onto the anvil shaft 134 such that they are substantially parallel to each other. This increases the gripping force of the jaws and prevents the anvil shaft 134 from being released from the jaws 204, 206 (i.e., prevents the shaft from slipping out of the jaws or avoids the "watermelon seed effect" common in prior art instruments 300, such as...). Figure 8 (As shown).

[0058] See now Figure 8Once the anvil 130 is positioned within the first segment 304 of the separated intestinal tissue 302, the anastomosis staple assembly 120 is positioned within the second segment 306 of the intestinal tissue. The staple advancer within assembly 120 is advanced distally such that the staple 200 passes through the first and second segments 304 and deforms against the anvil 130, thereby connecting and sealing the tissue segments 304 and 306. The blade within staple assembly 120 is also advanced distally to cut the tissue segments 304 and 306 inside the staple 200, thus completing the anastomosis.

[0059] Once the anastomosis is complete, instrument 200 is coupled to anvil 130 to cause anvil 130 to collapse and be removed from the patient. As previously described, rod 220 is advanced through shaft 134 of anvil 130 and coupled to engagement mechanism within anvil 230. Rod 220 is then actuated (manually or robotically) to cause anvil collapse, causing central and lateral components 134, 140, 142 to pivot or fold inward. Anvil 230 can then be removed from the proximal bowel without disturbing the anastomosis line.

[0060] Now for reference Figure 9 and Figures 10A-10C Another embodiment of the anvil 1200 includes an anvil head 1202 and an anvil shaft 1204. The anvil shaft 1204 is insertable into an internal channel of the staple assembly 120 and is removably and slidably secured therein. A capture device (not shown) is configured to advance and retract through this internal channel to translate the anvil 1200 relative to the staple assembly 120 along a longitudinal axis, thereby bringing the anvil 1200 closer to or away from the staple assembly 120. The anvil head 1202 can be in a collapsed or substantially linear configuration (see...). Figure 9 and Figure 10C ) and expanded or disk-shaped configurations (see Figure 10A The head 1202 moves between the linear configuration and the longitudinal axis of the shaft 1204. The head 1202 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of the shaft 1204) in the linear configuration than in the circular configuration.

[0061] The anvil head 1202 includes one or more links movable between a linear configuration and a circular configuration. In one embodiment, the head 1202 includes a first link 1206, a second link 1208, and a third link 1210. Each link includes an outer surface 1217 and an inner surface 1218, the outer surface 1217 and the inner surface 1218 forming at least a partial sector of a circle (or a sector of a circle having a hollow central region). All links are designed to pivot toward each other such that the links form a circular disc 1240 (see...). Figure 10AEach link 1206, 1208, 2110 also includes a tissue contact surface defining a staple forming recess (not shown) for receiving the staple 1200.

[0062] In one exemplary embodiment, each link 1206, 1208, 1210 has substantially the same shape (i.e., fan-shaped) and thus forms one-third of the circular disc 1240 (see Figure 10A However, it should be recognized that each link can have a different shape. Furthermore, it should be recognized that the anvil head 1202 may include two links or four or more links. Additionally, it should be recognized that some links may be larger than others. For example, link 1206 may be semi-circular, forming one half of the disc 1240, while the remaining half is formed by two or more links. The staple forming recesses are circumferentially arranged on each link such that when the links form the disc 1240, the staple forming recesses align with the staple slots in the staple assembly 120.

[0063] The first link 1206 includes a pin 1224 pivotally coupled to a universal joint or disc 1212 on the distal portion 1240 of the abutment shaft 1204. The second link 1208 is pivotally coupled to the first link 1206 and the third link 1210 via connecting pins 1214 and 1216, respectively. The distance or radius between the inner surface 1217 and the outer surface 1218 of each link 1206, 1208, 1210 can be smaller than the total radius of the circular disc when the links are formed together. Therefore, as... Figure 10A As shown, the link forms a central opening 1232 in the expanded configuration. This configuration reduces the overall size of the link, thereby facilitating the deployment process.

[0064] In one embodiment, the disc 1212 of the abutment shaft 1204 is a universal joint configured to transmit rotational power from the shaft 1204 or an actuator within the shaft 1204. The disc 1212 is rotatably coupled to the distal portion 1240 of the shaft 1204 at pin 1222. The disc 1212 can rotate relative to the shaft 1204 such that, for example, counterclockwise (or clockwise) rotation of the disc 1212 causes the link 1206 to rotate in a clockwise (or counterclockwise) direction. This rotation further causes the link 1208 to rotate in a clockwise direction, which in turn causes the link 1210 to rotate in the same direction until the side surfaces of each link contact each other, thereby forming a circular disc 1240 (see [link]). Figures 10A-10C ).

[0065] The disc 1212 is also configured to pivot between a first configuration (in which the disc 1212 is substantially parallel to the axis 1204) and a second configuration (in which the disc 1212 is transverse to the axis 1204, or preferably perpendicular to the axis 1204). The disc 1212 is coupled to the first link 1206 such that this rotation, in turn, causes the circular disc 1240 to rotate substantially perpendicular to the anvil axis 1204, and such that the tissue contact surface is positioned in a proximal direction to receive the staples from the staple assembly 120.

[0066] In use, the disc body 1212 and the attached connecting rods 1206, 1208, and 1210 first rotate about pin 1222 until they are substantially perpendicular to shaft 1204. Then, the connecting rods 1206, 1208, and 1210 rotate sequentially about their connecting pins 1224, 1214, and 1216 until they all contact the disc body 1212 to form an integral circular disc body 1240.

[0067] The anvil 1200 may also include one or more actuators (not shown) within the shaft 1204, the actuators having a distal portion coupled to the connector 1212 for rotation and / or pivoting of the connector 1212. Alternatively, the actuators may be disposed within the circular stapler assembly 120 or within a separate anvil delivery device (not shown). The actuators may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0068] Now for reference Figure 11A and Figure 11B Another embodiment of the anvil 1300 includes an anvil head 1304 and an anvil shaft 1302. As described in the previous embodiment, the anvil shaft 1302 is insertable into an internal channel of the staple assembly 120 and is removably and slidably secured therein. The anvil head 1304 includes one or more links 1306, 1308 movable between a linear configuration and a circular configuration. Each link includes an outer surface 1316 and an inner surface 1318 forming a circle. All links are designed to pivot toward each other such that the links form a circular disc (similar to...). Figure 14A The disc 1240 in the middle). Each link also includes a tissue contact surface that defines a staple forming recess (not shown) for receiving staples 200.

[0069] In one exemplary embodiment, the anvil head 1302 includes four links that are substantially the same shape (i.e., partially circular) and thus form a quarter of a circular disc; however, it should be appreciated that each link may have a different shape. Furthermore, it should be appreciated that the anvil head 1302 may include two links, three links, or five or more links. For example, Figure 11B An embodiment with two links 1306, 1308 is shown, each link comprising a semicircle. Additionally, it should be recognized that some links may be larger than others. For example, link 1306 may be semicircular, thus forming one half of the disc, while the remaining half is formed by two or more links.

[0070] Links 1306 and 1308 are pivotally coupled to each other at joints 1340 and 1342 on their side surfaces. Proximal link 1306 is also pivotally coupled to rod or bar 1320 at joint 1330. Rod 1320 is further pivotally coupled to the head 1322 of the distal portion 1326 of shaft 1302 via joint 1332. The distal portion 1326 is further pivotally coupled to the remainder of shaft 1302 via a hinge or pin 1324 extending through a channel (not shown) within shaft 1302, allowing the distal portion 1326 to be oriented substantially parallel to shaft 1304 (see [link to shaft 1304]). Figure 11A ) and basic vertical orientation (see Figure 11B It pivots between ).

[0071] In use, the distal portion 1326 rotates about pin 1332 to a substantially perpendicular orientation relative to axis 1302 (see...). Figure 11B Then, the links 1306, 1308 rotate about the head 1322 until they form a circular disc that presents the tissue contact surface in a proximal direction to receive the staples from the staple assembly 120.

[0072] The anvil 1300 may also include one or more actuators (not shown) within the shaft 1304, the actuators having a distal portion coupled to the head 1322 for rotation and / or pivoting of the head 1322. Alternatively, the actuators may be disposed within the circular stapler assembly 120 or within a separate anvil delivery device (not shown). The actuators may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0073] Now for reference Figure 12A and Figure 12B Another embodiment of the anvil 1350 includes an anvil head 1352 and an anvil shaft 1354. Similar to the previous embodiment, the anvil shaft 1354 is insertable into an internal channel of the staple assembly 120 and is removably and slidably secured therein. The anvil head 1352 can be in a collapsed or stacked configuration (…). Figure 12A ) and expansion or disk-shaped configuration ( Figure 12B The head 1352 moves between the stacked configuration and the circular configuration. The head 1352 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of axis 1354) than the head 1352 has in the stacked configuration.

[0074] In this embodiment, the anvil head 1352 includes one or more links movable between a "stacked" configuration and a "non-stacked" configuration. In one embodiment, the head 1352 includes a first link 1356, a second link 1358, a third link 1360, and a fourth link 1362. Each link includes an outer and inner surface forming a sector. All links are designed to move from a stacked configuration (…). Figure 12A ) Move to a non-stacked configuration, so that the link forms a circular disk (see Figure 12B In a stacked configuration, the linkage is substantially aligned with the longitudinal axis of shaft 1354. Anchor 1350 may also include one or more actuators (not shown) within shaft 1354, each having a distal portion coupled to a joint or linkage at the distal end of shaft 1354 for rotation and / or pivoting of linkages 1356, 1358, 1360, 1362. Alternatively, the actuators may be located within the circular stapler assembly 120 or within a separate anchor delivery device (not shown). The actuators may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0075] like Figure 12B As shown, in the stacked configuration, each link includes a proximal surface 1382 and a distal surface 1380. The proximal surface 1382 includes a staple recess (not shown) for receiving staples from the staple assembly 120. In this configuration, the proximal surface 1382 of link 1356 faces and can contact the abutment shaft 1354. The proximal surface 1382 of link 1358 faces and can contact the distal surface 1380 of link 1360 (and so on, for each link in the stack).

[0076] The distance or radius between the inner and outer surfaces of each link 1356, 1358, 1360, 1362 can be smaller than the total radius of the circular disk when the links are formed together. Therefore, as Figure 12B As shown, the link forms a central opening 1370 in the expanded configuration. This configuration reduces the overall size of the link, thereby facilitating the deployment process.

[0077] In one exemplary embodiment, links 1356, 1358, 1360, and 1362 have substantially the same shape (i.e., fan-shaped) and thus form one-quarter of the circular disc; however, it should be appreciated that each link may have a different shape. Furthermore, it should be appreciated that the anvil head 1352 may include two or three links, or five or more links. Additionally, it should be appreciated that some links may be larger than others. For example, link 356 may be semi-circular, thus forming one half of the disc, while the remaining half is formed by two or more links.

[0078] Now for reference Figure 13A , Figure 13B and Figures 14A-14C Another embodiment of the anvil 1400 includes an anvil head 1402 and an anvil shaft 1404. Similar to the previous embodiment, the anvil shaft 1404 is insertable into an internal channel of the staple assembly 120 and is removably and slidably secured therein. The anvil head 1402 can be in a collapsed or folded configuration (see...). Figure 14A ) and expansion or dome-shaped configurations (see Figure 14C The head 1402 moves between the collapsed configuration and the expanded configuration. The head 1402 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of the shaft 1404) than the head 1402 has in the collapsed configuration.

[0079] like Figures 14A-14C As shown, the anvil head 1402 includes a plurality of blades or lobes 1406 coupled to each other, such that the lobes 1406 overlap each other in a folded configuration. Upon expansion, the lobes 1406 are configured to form a generally dome-shaped or umbrella-shaped shape, having a convex outer surface 1440 with a apex 1442 and a concave inner surface 1436 (see...). Figure 13A and Figure 13B Vertex 1442 may be coupled to the distal portion of shaft 1404. Alternatively, lobes 1406 may be configured to further expand, such that the anvil head 1402 has a generally flat or circular disk shape in the expanded configuration (similar to the previous embodiment). Head 1402 may include at least two lobes 1406, or three or more lobes 1406.

[0080] One or more (or all) of the flaps 1406 include a tissue contact surface 1436, which includes a staple forming recess (not shown) for receiving staples from the staple assembly 120. The flaps 1406 are configured such that, in an expanded configuration, the staple recess is aligned with the staples in the staple assembly 120. In some embodiments, each flap 1406 includes one or more staple forming recesses. In other embodiments, the staple forming recesses may be alternately arranged between the flaps 1406, such that, for example, one flap may include one staple forming recess while its adjacent flap does not.

[0081] In this embodiment, the flaps 1406 are designed to overlap each other in both an expanded and collapsed or folded configuration. Thus, in the expanded configuration, the flaps 1406 overlap to provide mutual support and rigidity to the anvil head 1402, enabling it to resist the forces of the anastomosis operation. The anvil 1400 may also include an actuator (not shown) within a shaft 1404, having a distal portion coupled to the head 1402 for expanding and collapsing the flaps 1406. For example, the anvil head 1402 may include one or more rigid elements coupled to the flaps 1406, these rigid elements being designed to telescopate or move radially outward to push the flaps outward and expand the head 1402. Alternatively, the actuator may be disposed within the circular anastomosis assembly 120 or within a separate anvil delivery device (not shown). The actuator may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0082] Now for reference Figure 15A and Figure 15B Another embodiment of the anvil 1500 includes an anvil head 1502 and an anvil shaft 1504. As in the previous embodiment, the anvil shaft 1504 is insertable into the internal channel of the staple assembly 120 and is removably and slidably secured therein. The anvil head 1502 may be in a collapsed or folded configuration (see...). Figure 15B ) and expansion or dome-shaped configurations (see Figure 15A The head 1502 moves between the folded configuration and the dome configuration. The head 1502 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of axis 1504) than the dome configuration.

[0083] The anvil head 1502 includes a plurality of blades or lobes 1506 coupled to each other, such that the lobes 1506 overlap each other in a folded configuration. Upon expansion, the lobes 1506 are configured to form a generally dome-shaped or umbrella-shaped form having a convex outer surface 1508 and a concave inner surface (not shown). Alternatively, the lobes 1506 can be configured to expand further, such that the anvil head 1502 has a generally flat or circular disc shape in an expanded configuration. The head 1502 may include at least two lobes 1506, or three or more lobes 1506.

[0084] One or more (or all) of the flaps 1506 have tissue contact surfaces including one or more staple forming recesses (not shown) for receiving staples from the staple assembly 120. The flaps 1506 are configured such that, in an expanded configuration, the staple recesses are aligned with the staples in the staple assembly 120. In some embodiments, each flap 1506 includes one or more staple forming recesses. In other embodiments, the staple forming recesses may be alternately arranged between the flaps 1506, such that, for example, one flap may contain one staple forming recess while its adjacent flap does not contain a staple forming recess.

[0085] The anvil head 1502 also includes one or more generally rigid elements or rods 1510 that extend substantially from the proximal surface edge 1512 to the central portion or apex 1514 of the head 1502. The rods 1510 are configured to expand outwards together with the flaps 1506 and provide stability and rigidity to the head 1502 in an expanded configuration. One or more ridges or other surface features may be included on the rods 1510 to provide additional stability to the head 1502 when it expands. The rods 1510 are configured to pivot at the apex 1514 and the proximal surface 1512 to allow the anvil head 1502 to transition between an expanded and collapsed configuration.

[0086] In some embodiments, the anvil head 1502 may further include one or more cables extending around the head 1502 to allow the head to transition between a collapsed configuration and an expanded configuration. In one such embodiment, the head 1502 includes a lower cable 1530 and an upper cable 1532. The lower cable 1530 is disposed in the proximal region of the lobes 1506 near the proximal surface 1512, and the upper cable 1532 is disposed in the distal region of the head 1502 near the apex 1514. Cables 1530, 1532 are coupled to one or more actuators (not shown) that extend through the shaft 1504 of the anvil 1500 and are configured to tension cables 1530, 1532 to expand the anvil head 1502 into an umbrella or dome shape. The actuators (not shown) may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0087] Now for reference Figures 16A-16C Another embodiment of the anvil 1600 includes an anvil head 1602 and an anvil shaft 1604. Similar to the previous embodiment, the anvil shaft 1604 is insertable into an internal channel of the staple assembly 120 and can be removably and slidably secured therein. The anvil head 1602 can be in a collapsed or folded configuration (see...). Figure 16A ) and expansion or dome-shaped configurations (see Figure 16B and Figure 16C The head 1602 moves between the collapsed configuration and the expanded configuration. The head 1602 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of the shaft 1604) than the head 1602 has in the collapsed configuration.

[0088] like Figure 16A As shown, the anvil head 1602 includes a plurality of blades or lobes 1606 coupled to each other, such that the lobes 1606 overlap each other in a collapsed configuration. Upon expansion, the lobes 1606 are configured to form a generally dome-shaped or umbrella-shaped shape, having a convex outer surface 1608 and a concave inner surface 1612. Alternatively, the lobes 1606 can be configured to expand further, such that the anvil head 1602 has a generally flat or circular disc shape in an expanded configuration. The head 1602 may include at least two lobes 1606, or three or more lobes 1606.

[0089] One or more (or all) of the flaps 1606 include a tissue contact surface 1636 that defines a staple forming recess (not shown) for receiving staples 200. The flaps 1606 are configured such that, in an expanded configuration, the staple recess is aligned with the staple in the staple assembly 120 (i.e., the staple leg or tip is aligned with the staple groove or recess, thereby properly forming the staple). In some embodiments, each flap 1606 includes one or more staple forming recesses. In other embodiments, the staple forming recesses may be alternately arranged between the flaps 1606, such that, for example, one flap may contain one staple forming recess while its adjacent flap does not contain a staple forming recess.

[0090] Similar to the previous embodiments, the anvil 1600 may also include one or more actuators (not shown) within the shaft 1604, each having a distal portion coupled to the head 1602 for expanding and collapsing the flap 1606. For example, the anvil head 1602 may include one or more rigid elements coupled to the flap 1606, these rigid elements being designed to telescopate or move radially outward to push the flap outward and expand the head 1602. Alternatively, the actuators may be disposed within the circular stapler assembly 120 or within a separate anvil delivery device (not shown). The actuators may have a proximal end coupled to a suitable actuation mechanism (discussed in more detail below).

[0091] In this embodiment, the anastomosis seat 1600 also includes an expandable element 1610 (e.g., a balloon or the like) configured to expand / inflate and apply pressure to the outer surface 1608 of the head 1602. This ensures that the anastomosis receptacle plane can resist forces from tissue clamping as well as subsequent forces from firing and cutting. The balloon 1610 can be inflated in any suitable manner, such as fluid inflation (e.g., air or other gases, or liquids), chemical inflation (e.g., mixing certain materials together to form an inflatable gas within the balloon), etc. In one embodiment, the balloon 1610 includes a proximal end configured to be coupled to a suitable fluid source, such as carbon dioxide, saline, or the like. The fluid source can be any suitable source, such as a pressurized carbon dioxide canister, a syringe filled with gas or fluid (e.g., saline), or a blow-in source.

[0092] Now for reference Figure 17A , Figure 17B and Figures 18A-18C Another embodiment of the anvil 1700 includes an anvil head 1702 and an anvil shaft 1704. The anvil shaft 1704 is insertable into an internal channel of the staple assembly 120 and is removably and slidably secured therein. The anvil head 1702 can be in a collapsed configuration (see...) Figure 18A ) and extended configuration (see Figure 18C The head 1702 moves between the collapsed configuration and the expanded configuration. The head 1702 has a smaller cross-sectional area or lateral dimension (relative to the longitudinal axis of axis 1704) than the head 1702 has in the collapsed configuration.

[0093] In this embodiment, the anvil head 1702 includes an expandable element 1710, such as a balloon or the like. The balloon 1710 can be inflated in any suitable manner, such as fluid inflation (e.g., air or other gases, or liquids), chemical inflation (e.g., mixing certain materials together to form an inflatable gas within the balloon), etc. In one embodiment, the balloon 1710 includes a proximal end configured to be coupled to a suitable fluid source, such as carbon dioxide, saline, or the like. The fluid source can be any suitable source, such as a pressurized carbon dioxide canister, a syringe filled with gas or fluid (e.g., saline), or a blow-in source.

[0094] The anvil 1700 also includes an annular membrane 1720, the inner surface 1722 of which has a larger diameter than the shaft 1704. The membrane 1720 includes a tissue contact surface 7136 that defines a staple forming recess (not shown) for receiving the staple 200. The membrane 1720 preferably comprises any suitable material, such as a metal or rigid polymer, having sufficient rigidity to be configured to resist the forces exerted by tissue clamping and subsequent impact and cutting forces from the stapler assembly.

[0095] In one embodiment, membrane 1720 is coupled to the proximal surface of balloon 1710 (see...). Figures 18A-18C The membrane 1720 can be configured to expand radially outward as the balloon 1710 is inflated, such that, in the expanded configuration, the staple recess is configured to align with the staple in the staple assembly 120 (i.e., such that the staple leg or tip aligns with the staple groove or recess, thereby properly shaping the staple). In another embodiment, the membrane 1720 is configured to advance distally along the anvil axis 1704 after the balloon 1710 has expanded. In this embodiment, the membrane 1720 can be configured to expand by a separate actuator after the membrane 1720 has been advanced to contact the balloon 1710. The balloon 1710 is configured to apply pressure to the distal surface of the membrane 1720 to ensure that the membrane 1720 resists forces applied during the anastomosis operation.

[0096] The proximal portion of the aforementioned anvil is operatively connected to one or more actuators or actuation mechanisms (not shown), although those skilled in the art will understand upon reading this specification that components of the actuators may extend into and / or through the anvil shaft and / or anastomosis device 100. In various embodiments, the anvil and / or device 100 will include a proximal handle (not shown) for actuating actuators that move the anvil between a collapsed and expanded configuration, and in some embodiments, for controlling the orientation and movement of the anvil. Alternatively, the system may include an anvil delivery device comprising one or more actuators for expanding and collapsing the anvil.

[0097] The surgical instruments and delivery devices described herein can be coupled to a proximal control system that monitors and controls the linkages or discs in the wrist assembly to articulate the end effector 110 relative to the shaft 105 and to cause the drive member to translate distally and proximally to deploy the anastomosis staples and cutting elements. Furthermore, the control system can monitor and control one or more actuators that move the anastomosis seat between open and closed positions and / or control the operation of the anastomosis seat delivery device 200. This control system can be a manual control system with a user interface allowing the user to control each function of the instrument, or it can be an automated control system that monitors and controls these functions. In some embodiments, the control system is a combination of manual and automated control, allowing the user to adjust or control certain functions while automatically limiting those functions to specific ranges or parameters.

[0098] In some embodiments, the instrument may include sensors (not shown) for detecting the position of drive members and actuators within the instrument. The sensors may include any suitable sensors for detecting position, force, and / or torque. In one embodiment, the sensor includes an optical fiber bending sensor, such as a fiber Bragg grating (FBG), for providing strain measurements in the staple assembly, anvil, and / or other components of the surgical instrument. Various systems and methods for monitoring the three-dimensional shape and relative position of optical fibers are described in U.S. Patent Application Publication No. 2006 / 0013523 (filed July 13, 2005) and U.S. Patent No. 6,389,187 (filed June 17, 1998), the entire disclosure of which is incorporated herein by reference for all purposes.

[0099] The control system may include one or more processors (e.g., microprocessors, microchips, or application-specific integrated circuits), one or more memory devices (e.g., random access memory and / or read-only memory), and I / O interfaces and / or communication interfaces. The processor may include one or more computer-readable storage devices storing program instructions that allow the processor to compare detected torque or force with a specified range. I / O devices may include one or more devices (e.g., user interfaces) that enable a user to interact with the system. I / O devices may include, for example, a touchscreen display, a keypad, one or more selectors, or one or more indicators.

[0100] Although described as a processor, it should be understood that in practice, controllers can be implemented by any combination of hardware, software, and firmware. Furthermore, their functions, as described herein, can be performed by a single unit or distributed among different components, each of which can in turn be implemented by any combination of hardware, software, and firmware.

[0101] refer to Figure 19A and Figure 19B Exemplary embodiments of remotely operated surgical instruments 500, 500A that can support a circular stapler instrument 100 and an anvil delivery instrument 200 will now be described. Figure 19A As shown, the device 500 typically includes a proximal housing 510 located at its proximal end and coupled to a shaft 520 of the device, and a circular anastomosis assembly 530 at the distal end of the shaft 520. Figure 19B The device 500A is shown, which includes a proximal housing 540 of a shaft 550 coupled to a delivery device 200.

[0102] Both proximal housings 510 and 540 may include instrument memory or storage devices (not shown). When an instrument is loaded onto a manipulator arm (not shown) of the robot control system, the memory can perform multiple functions. For example, the memory can provide signals to verify the compatibility of the instrument with that particular surgical system. Furthermore, the memory can identify the type of instrument and end effector (whether it is a delivery instrument, a circular stapler, or the like) to the surgical system so that the system can reconfigure its programming to fully utilize the instrument's capabilities. As discussed further below, the memory may contain detailed information about the instrument architecture and include specific values ​​that should be used in the control algorithm, such as tool compliance and gain values.

[0103] The proximal housings 510 and 540 may further include a force / torque drive transmission mechanism (not shown) for receiving output from a motor of the manipulator arm. The force / torque drive transmission mechanism transmits the output from the motor to the end effector 530 of the instrument via instrument shafts 520 and 550 mounted to the transmission mechanism. Exemplary surgical robotic instruments, instrument / manipulator arm interface structures, and data transmission between the instrument and servo mechanisms are more fully described in U.S. Patent No. 6,331,181, the entire disclosure of which is incorporated herein by reference.

[0104] In some embodiments, surgical instruments 500, 500A can provide force / torque feedback to the user, which can be used as deployment diagnostics to optimize the placement of the anvil 130 or anastomosis assembly 120 at a target location. In one such embodiment, multiple force / torque sensors are disposed on the anvil 130, the anastomosis assembly 120, and / or the anvil delivery instrument 200. The force / torque sensors are coupled to a controller located within housing 510 or 540, or remotely in a robotically operated surgical system, as referenced below. Figure 20 and Figure 21 As stated above.

[0105] In one embodiment, the device 500A includes one or more force / torque sensors located on a rod 220 of the anvil delivery device 200. The sensors are configured to detect forces or torques applied to the anvil 130 by the rod 220 during deployment of the anvil into an expansion configuration. Alternatively, the sensors may also detect forces or torques applied to the rod 220 by a proximal actuator. A controller is configured to receive this force / torque information from the sensors and provide the user with input regarding the amount of force applied to the tissue during the expansion of the anvil 130. In some embodiments, the controller may include a processor configured to, for example, alert the user and / or automatically override the actuators within the device 200 to stop the expansion of the anvil 130 when the force applied to the anvil exceeds a threshold amount.

[0106] In another such embodiment, the device 500A includes one or more force / torque sensors located on the jaws 204, 206 of the anvil delivery device 200 and / or on the anvil 130 itself. The sensors are configured to detect the force or torque applied to the anvil 130 as the device 200 manipulates the anvil 130 to a target location within the patient's body. The controller is configured to receive this force / torque information from the sensors and provide the user with input regarding the amount of force applied to the tissue during manipulation and / or advancement of the anvil 130 to the target location. In some embodiments, the controller may include a processor configured to, for example, alert the user and / or automatically control the anvil 130 to stop or alter its movement when the force applied to the anvil exceeds a threshold amount.

[0107] Alternatively, the processor within the controller can be configured to control the rate of expansion or collapse of the anvil 130 under user operation. For example, the instrument 500A may include one or more sensors that provide information on the speed, rotational movement, or longitudinal movement of the lever 220. These sensors transmit this information to the controller, and the controller can be configured to ensure that the anvil 130 expands or collapses at a specified rate and / or below a threshold rate. Alternatively, the controller may control the entire movement of the lever 220 such that, for example, the user only needs to engage an on / off user interface (such as a button). Once the interface is engaged by the user, the controller takes over the operation of the lever 220 and ensures that the anvil expands or collapses at the specified rate.

[0108] As described above, this surgical instrument can be used in robotic remote-operated surgical systems. Figure 20 An example is shown as a top view of an operating room employing a robotic surgical system. The robotic surgical system here is robotic surgical system 600, which includes a console (“C”) used by a surgeon (“S”) to perform minimally invasive diagnostic or surgical procedures, typically with the assistance of one or more assistants (“A”), to operate on a patient (“P”) lying on an operating table (“O”).

[0109] Servo mechanisms used in remote surgery typically accept input from two master controllers (one for each of the surgeon's hands) and may include two or more robotic arms. Surgical instruments are mounted on each robotic arm. Operational communication between the master controllers and the associated robotic arms and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor that relays input commands from the future autonomous controllers to the associated robotic arms and instrument assemblies and, in cases of force feedback, sends feedback back. An example of a robotic surgical system is the DA VINCI™ system, commercially available from Intuitive Surgical, Inc. (located in Sunnyvale, California).

[0110] During robotic surgery, various structural arrangements have been used to support surgical instruments at the surgical site. Driven links, or “slave” links, are commonly referred to as robotic surgical manipulators, and exemplary link arrangements for robotic surgical manipulators used during minimally invasive robotic surgery are described in U.S. Patents 7,594,912, 6,758,843, 6,246,200, and 5,800,423, the entire disclosure of which is incorporated herein by reference for all purposes. These links typically manipulate an instrument holder to which an instrument with an axis is mounted. Such manipulator structures can include parallelogram-shaped link portions that generate a movement of the instrument holder limited to rotation about a pitch axis that intersects a remote control center along the length of the instrument axis. Such manipulator structures can also include yaw joints that generate a movement of the instrument holder limited to rotation about a yaw axis that is perpendicular to the pitch axis and also intersects the remote control center. By aligning the remote manipulation center with the incision point at the internal surgical site (e.g., a cannula or trocar located in the abdominal wall during laparoscopic surgery), the end effector of the surgical instrument can be safely positioned by moving the proximal end of the axis using the manipulator linkage without exerting potentially harmful forces on the abdominal wall. Alternative manipulator configurations are described, for example, in U.S. Patents 6,702,805, 6,676,669, 5,855,583, 5,808,665, 5,445,166, and 5,184,601, the full disclosures of which are incorporated herein by reference in their entirety for all purposes.

[0111] In surgical procedures, remote surgical systems can provide mechanical actuation and control of various surgical instruments or tools with end effectors. These end effectors respond to manipulation by a master input device, performing various functions for the surgeon, such as holding or driving needles, clamping blood vessels, dissecting tissue, etc. Manipulation and control of these end effectors is a particularly beneficial aspect of robotic surgical systems. Therefore, it is desirable to provide surgical tools that include mechanisms that provide two or three rotational degrees of freedom for the end effectors to mimic the natural movements of the surgeon's wrist. Such mechanisms should have appropriate dimensions suitable for minimally invasive surgery and be relatively simple in design to reduce potential points of failure. Furthermore, such mechanisms should provide a suitable range of motion to allow the end effectors to be manipulated in multiple positions.

[0112] The console includes a monitor 604 for displaying images of the surgical site to the surgeon, left and right operable control devices 608 and 609, a foot pedal 605, and a processor 602. Control devices 608 and 609 may include any one or more of various input devices, such as joysticks, gloves, trigger guns, handheld controllers, etc. The processor 602 may be a dedicated computer, which may be integrated into the console or positioned alongside it.

[0113] The surgeon performs minimally invasive surgery by manipulating control devices 608 and 609 (also referred to herein as “master manipulators”), such that processor 602 causes their respective associated robotic arm assemblies 628 and 629 (also referred to herein as “slave manipulators”) to manipulate their respective removably coupled surgical instruments 638 and 639 (also referred to herein as “tools”), while the surgeon views the surgical site in three dimensions on console monitor 604, captured by stereoscopic endoscope 640.

[0114] Each tool 638 and 639, as well as endoscope 640, can be inserted into the patient via a cannula or other tool guide (not shown) to extend downwards to the surgical site through a corresponding minimally invasive incision (such as incision 666). Each robotic arm typically consists of links (such as link 662) coupled together and manipulated via a motor-controlled or active connector (such as connector 663).

[0115] The number of surgical instruments used at one time, and therefore the number of robotic arms used in system 600, will typically depend on factors such as diagnostic and surgical procedures and space constraints within the operating room. If it is necessary to change one or more of the instruments in use during the procedure, the assistant can remove the unused instrument from their robotic arm and replace it with another instrument 331 from a tray (“T”) in the operating room.

[0116] Monitor 604 can be positioned close to the surgeon's hand, so that the projected image it displays is oriented so that the surgeon feels he or she is actually looking directly down at the surgical site. For this purpose, the images from tools 638 and 639 may appear to be positioned substantially where the surgeon's hand is.

[0117] The processor 602 performs various functions within the system 600. One of its functions is to convert and transmit the mechanical movements of control devices 608 and 609 to their respective robotic arms 628 and 629 via control signals on the bus 610, enabling the surgeon to effectively manipulate their respective tools 638 and 639. Another important function is to implement the various control system processes described herein.

[0118] Robotic surgical systems and methods are further described in U.S. Patent No. 5,797,900 (filed May 16, 1997, granted August 25, 1998), U.S. Patent No. 6,132,368 (filed November 21, 1997, granted October 17, 2000), U.S. Patent No. 6,331,181 (filed October 15, 1999, granted December 18, 2001), and U.S. Patent No. 6,441,577 (filed April 2001). U.S. Patent Nos. 6,902,560 (filed January 3, 2004, granted August 27, 2002), 6,936,042 (filed April 16, 2002, granted August 30, 2005), and 6,994,703 (filed December 4, 2002, granted February 7, 2006) are all incorporated herein by reference in their entirety for all purposes. The most suitable currently available robotic surgical system is the da Vinci S surgical system from Intuitive Surgical, Inc.

[0119] Figure 21 As an example, a simplified (not necessarily scaled or complete) schematic side view of a robotic arm assembly 700 (representing robotic arm assemblies 628 and 629) is shown, holding surgical instruments 750 (representing tools 638 and 639) for performing surgical procedures. The surgical instruments 750 are removably held in a tool holder 740. The arm assembly 700 is mechanically supported by a base 701, which may be part of a patient-side movable trolley or fixed to an operating table or ceiling. It includes links 702 and 703, which are coupled together and to the base 701 via mounting joints 704 and 705.

[0120] In this example, mounting joints 704 and 705 are passive joints that allow manual positioning of arm 700 when their brakes are released. For example, mounting joint 704 allows link 702 to be manually rotated about axis 706, and mounting joint 705 allows link 703 to be manually rotated about axis 707.

[0121] Although only two links and two mounting joints are shown in this example, more or fewer links and mounting joints may be used appropriately in this and other robot arm assemblies described in this disclosure. For example, while mounting joints 704 and 705 are used for the horizontal positioning of arm 700, additional mounting joints may be included for limited vertical and angular positioning of arm 700. However, for the primary vertical positioning of arm 700, arm 700 may also slide along the vertical axis of base 701 and be locked in place.

[0122] The robotic arm assembly 700 also includes three motor-driven active connectors. A yaw connector 710 allows arm segment 730 to rotate about axis 761, and a pitch connector 720 allows arm segment 730 to rotate about an axis perpendicular to axis 761 and orthogonal to the plane of the drawing. Arm segments 730 are configured such that segments 731 and 732 remain parallel to each other as the pitch connector 720 is rotated by its motor. Therefore, the instrument 770 can be controllably moved by driving the yaw and pitch motors, thereby pivoting about a pivot point 762, which is typically positioned at the patient's incision point via manually positioned mounting connectors 704 and 705. Furthermore, an insertion gear 745 can be coupled to a linear drive mechanism (not shown) to extend or retract the instrument 750 along its axis 763.

[0123] Although each of the yaw joint, pitch joint, and insertion joint, or gears 710, 720, and 745, is controlled by an independent joint or gear controller, these three controllers can be controlled by a common master / slave control system, so that the robotic arm assembly 700 (also referred to herein as the “slave manipulator”) can be controlled by a user (e.g., a surgeon) manipulating its associated master manipulator.

[0124] While several embodiments are illustrated in the accompanying drawings, this specification is not intended to be limited thereto, as it is intended to be as broad as possible within the scope permitted by the prior art, and the specification should be interpreted in the same manner. Therefore, the foregoing description should not be construed as restrictive, but rather as examples of the currently disclosed embodiments. Consequently, the scope of the embodiments should be determined by the appended claims and their legal equivalents, and not by the examples given.

[0125] Furthermore, the terminology used in this specification is not intended to limit the devices described herein. Unless otherwise stated herein or the context clearly contradicts it, the term "force" should be interpreted to encompass both force and torque. The terms "tool" and "instrument" are used interchangeably herein to refer to surgical instruments. In this specification and the appended claims, the singular forms "a," "an," and "the," as well as the singular use of any word, include plural references unless explicitly and unambiguously limited to a single referent. The terms "comprising," "having," "including," and "containing" should be interpreted as open-ended terms (i.e., meaning "including but not limited to,") unless otherwise stated. The terms "connected" and "coupled" should be interpreted as partially or wholly contained within, attached to, or linked together, even in the presence of intermediate elements.

[0126] Spatial relative terms—such as “proximal” and “distal”—are used to describe the relationship of one element or feature to another, as illustrated in the figure. These spatial relative terms are intended to encompass different positions (i.e., locations) and orientations (i.e., rotational orientations) of a device in use or operation, as shown in the figure. For example, the terms “proximal” and “distal” are relative terms, where the term “distal” refers to the portion of an object that is furthest from the instrument operator and closest to the surgical site, such as an opening in a tool sheath or an end effector of an instrument. The term “proximal” indicates proximity relative to the surgical instrument operator, referring to the portion of an object that is closest to the operator and furthest from the surgical site. In this application, an end effector refers to a tool mounted at the distal end of an instrument, including but not limited to forceps or grippers, needle drivers, scalpels, scissors, spatulas, blades, and other tools that may or may not use energy to cauterize tissue (i.e., monopolar or bipolar tools).

[0127] Those skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments. Features shown or described in connection with one exemplary embodiment may be combined with features of other embodiments. Various alternatives and modifications can be devised by those skilled in the art without departing from this disclosure. Therefore, this description is intended to cover all such alternatives, modifications, and variations. Similarly, those skilled in the art will appreciate further features and advantages of this disclosure based on the above embodiments. Therefore, this description should not be limited to what has been specifically shown and described unless specified by the appended claims.

[0128] For example, a first embodiment is a delivery device for a circular stapler with an anvil, the device comprising: an elongated shaft having a first jaw and a second jaw, the first jaw and the second jaw being movable between an open position and a closed position; and a driver extending through the shaft, the driver including an engagement mechanism for engaging the anvil and moving the anvil between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension.

[0129] The second embodiment is the first embodiment, wherein the actuator includes a rod that extends at least partially through the first and second jaws.

[0130] The third embodiment is any combination of the above embodiments, wherein the engagement mechanism includes a rotatable element at the distal end of the rod.

[0131] The fourth embodiment is any combination of the above embodiments, wherein the actuator rod is rotatable relative to the elongated axis of the instrument.

[0132] The fifth embodiment is any combination of the above embodiments, wherein the actuator rod is movable in the longitudinal direction relative to the elongated axis of the instrument.

[0133] The sixth embodiment is any combination of the above embodiments, wherein rotation of the rod causes the anvil to move from the collapsed configuration to the expanded configuration.

[0134] The seventh embodiment is any combination of the above embodiments, wherein the longitudinal movement of the rod causes the anvil to move from the collapsed configuration to the expanded configuration.

[0135] The eighth embodiment is any combination of the above embodiments, wherein the anvil includes a head and a proximal shaft, wherein the first jaw and the second jaw are sized to contact and engage the outer surface of the proximal shaft in the closed position.

[0136] The ninth embodiment is any combination of the above embodiments, wherein the first jaw and the second jaw are substantially parallel when in the closed position.

[0137] The tenth embodiment is any combination of the above embodiments, wherein the first jaw and the second jaw include a first jaw clamping portion and a second jaw clamping portion, and the first jaw clamping portion and the second jaw clamping portion are pivotally coupled to each other about a hinge.

[0138] The eleventh embodiment is any combination of the above embodiments, wherein the shaft includes a central longitudinal axis, wherein the first jaw gripping portion is disposed on a first side of the central longitudinal axis, and the second jaw gripping portion and the hinge are disposed on a second side of the central longitudinal axis, the second side being opposite to the first side.

[0139] The twelfth embodiment is any combination of the above embodiments, wherein the driver is configured to couple to a robot control system.

[0140] The thirteenth embodiment is a circular stapler system, comprising: a staple assembly including a plurality of staples and a cutting element; an anvil movably coupled to the staple assembly and configured to be deployed between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension; and a delivery device including an engagement mechanism for engaging the anvil and moving the anvil from the collapsed configuration to the expanded configuration.

[0141] The fourteenth embodiment is any combination of the thirteenth embodiment and the above embodiments.

[0142] The fifteenth embodiment is any combination of the above embodiments, wherein the anchor seat is pivotable between a collapsed configuration and an expanded configuration.

[0143] The sixteenth embodiment is any combination of the above embodiments, wherein the anvil includes a head and a shaft, wherein the head is pivotable relative to the shaft from a collapsed configuration to an expanded configuration, wherein in the collapsed configuration the head is oriented substantially parallel to the shaft, and in the expanded configuration the head is oriented substantially perpendicular to the shaft.

[0144] The seventeenth embodiment is any combination of the above embodiments, wherein the engagement mechanism includes a driver that extends at least partially between the first jaw and the second jaw.

[0145] The eighteenth embodiment is any combination of the above embodiments, wherein the engagement mechanism includes a rotatable element at the distal end of the driver.

[0146] The nineteenth embodiment is any combination of the above embodiments, wherein the actuator is rotatable relative to the elongated axis of the instrument.

[0147] The twentieth embodiment is any combination of the above embodiments, wherein the actuator is movable in the longitudinal direction relative to the elongated axis of the instrument.

[0148] The twenty-first embodiment is any combination of the above embodiments, wherein the rotation of the actuator causes the abutment to pivot from a collapsed configuration to an expanded configuration.

[0149] The twenty-second embodiment is any combination of the above embodiments, wherein the longitudinal movement of the actuator causes the abutment to pivot from a collapsed configuration to an expanded configuration.

[0150] The twenty-third embodiment is any combination of the above embodiments, wherein the driver is configured to couple to a robot control system.

[0151] The twenty-fourth embodiment is any combination of the above embodiments, wherein the anvil has a lateral dimension of less than about 14 mm in the collapsed configuration.

[0152] The twenty-fifth embodiment is any combination of the above embodiments, wherein the anvil has a lateral dimension of at least about 20 mm in the expanded configuration.

[0153] The twenty-sixth embodiment is a robot control system, comprising: a circular stapler including a staple assembly and an anvil movably coupled to the staple assembly; an instrument configured to move the anvil from a collapsed configuration having a first diameter to an expanded configuration having a second diameter, wherein the first diameter is smaller than the second diameter; and a robot controller configured to control the instrument.

[0154] The twenty-seventh embodiment is any combination of the twenty-sixth embodiment and the above embodiments.

[0155] The twenty-eighth embodiment is any combination of the above embodiments, and further includes an input device coupled to the controller and movable by a user, such that the movement of the input device generates an input signal, wherein the controller is configured to move the abutment from a collapsed configuration to an expanded configuration based on the input signal.

[0156] The twenty-ninth embodiment is any combination of the above embodiments, and further includes a sensor coupled to the controller for detecting the force or torque applied to the instrument by the robot controller.

[0157] The thirtieth embodiment is any combination of the above embodiments, and further includes a sensor coupled to the controller for detecting the force or torque applied by the instrument to the abutment.

[0158] The thirty-first embodiment is any combination of the above embodiments, wherein the instrument includes a first jaw and a second jaw movable between an open position and a closed position, and an actuator extending at least partially through the first jaw and the second jaw.

[0159] The thirty-second embodiment is any combination of the above embodiments, wherein the controller is configured to rotate the driver to move the abutment from a collapsed configuration to an expanded configuration.

[0160] The thirty-third embodiment is any combination of the above embodiments, wherein the controller is configured to move the actuator longitudinally relative to the instrument axis to move the abutment from a collapsed configuration to an expanded configuration.

[0161] The thirty-fourth embodiment is a method for connecting two tubular tissue structures, the method comprising: introducing an anvil in a collapsed configuration into a patient's body adjacent to a first tissue structure through a cannula; moving the anvil from a collapsed configuration to an expanded configuration; positioning an anastomosis assembly in a patient's body adjacent to a second tissue structure; and advancing a plurality of anastomosis staples into the first and second tissue structures to attach the first tissue structure to the second tissue structure.

[0162] The thirty-fifth embodiment is any combination of the thirty-fourth embodiment and the above embodiments.

[0163] The thirty-sixth embodiment is any combination of the above embodiments, and further includes moving the anvil from an expanded configuration to a collapsed configuration to remove the anvil from the patient.

[0164] The thirty-seventh embodiment is any combination of the above embodiments, and further includes a shaft that clamps the anvil to move the anvil to the first tissue structure.

[0165] The thirty-eighth embodiment is any combination of the above embodiments, and further includes a driver within the rotary conveyor to move the anvil to an expanded configuration.

[0166] The thirty-ninth embodiment is any combination of the above embodiments, and further includes moving the driver within the delivery device in the longitudinal direction to move the anvil to an expanded configuration.

[0167] The fortieth embodiment is any combination of the above embodiments, wherein the first tissue structure and the second tissue structure include a first segment and a segment of the intestine.

Claims

1. A delivery device for a circular stapler having an anvil, the device comprising: An elongated shaft having a first jaw and a second jaw, the first jaw and the second jaw being movable between an open position and a closed position; as well as An extendable drive through the shaft, the drive including an engagement mechanism for engaging the anvil and moving the anvil between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension.

2. The delivery device of claim 1, wherein the drive includes a rod that extends at least partially through the first jaw and the second jaw.

3. The conveying device according to claim 2, wherein the engagement mechanism includes a rotatable element at the distal end of the rod.

4. The delivery device according to any one of claims 2 to 3, wherein the rod of the driver is rotatable relative to the elongated axis of the device.

5. The delivery device according to any one of claims 2 to 4, wherein the rod of the driver is movable in the longitudinal direction relative to the elongated axis of the device.

6. The conveying device of claim 4, wherein rotation of the rod causes the anvil to move from the collapsed configuration to the expanded configuration.

7. The conveying device of claim 5, wherein longitudinal movement of the rod causes the anvil to move from the collapsed configuration to the expanded configuration.

8. The delivery device according to any one of claims 1 to 7, wherein the anvil comprises a head and a proximal shaft, and the first jaw and the second jaw are sized to contact and engage the outer surface of the proximal shaft when in the closed position.

9. The conveying device according to claim 8, wherein the first jaw and the second jaw are substantially parallel in the closed position.

10. The conveying device according to any one of claims 1 to 9, wherein the first jaw and the second jaw include a first jaw clamping portion and a second jaw clamping portion pivotally coupled to each other about a hinge.

11. The conveying device of claim 10, wherein the shaft includes a central longitudinal axis, wherein the first jaw gripping portion is disposed on a first side of the central longitudinal axis, and the second jaw gripping portion and the hinge are disposed on a second side of the central longitudinal axis, the second side being opposite to the first side.

12. The conveying device according to any one of claims 1 to 11, wherein the driver is configured to couple to a robot control system.

13. A circular stapler system, comprising: The staple assembly includes multiple staples and a cutting element; An anvil, movably coupled to the anastomosis assembly, and configured for deployment between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension; and A delivery device includes an engagement mechanism for engaging the anvil and moving the anvil from the collapsed configuration to the expanded configuration.

14. The system of claim 13, wherein the anchor seat is pivotable between the collapsed configuration and the expanded configuration.

15. The system according to any one of claims 13 to 14, wherein the anvil comprises a head and an axis, the head being pivotable relative to the axis from the collapsed configuration to the expanded configuration, the head being oriented substantially parallel to the axis in the collapsed configuration and substantially perpendicular to the axis in the expanded configuration.

16. The system of claim 15, wherein the engagement mechanism includes a driver that extends at least partially between the first jaw and the second jaw.

17. The system of claim 16, wherein the engagement mechanism includes a rotatable element at the distal end of the driver.

18. The system according to any one of claims 16 to 17, wherein the actuator is rotatable relative to the elongated axis of the instrument.

19. The system according to any one of claims 16 to 18, wherein the actuator is movable in a longitudinal direction relative to the elongated axis of the instrument.

20. The system of claim 18, wherein rotation of the actuator causes the anvil to pivot from the collapsed configuration to the expanded configuration.

21. The system of claim 19, wherein longitudinal movement of the actuator causes the abutment to pivot from the collapsed configuration to the expanded configuration.

22. The system according to any one of claims 13 to 21, wherein the driver is configured to couple to a robot control system.

23. The system according to any one of claims 13 to 22, wherein the anvil has a lateral dimension of less than about 14 mm in the collapsed configuration.

24. The system according to any one of claims 13 to 23, wherein the anvil has a lateral dimension of at least about 20 mm in the expanded configuration.

25. The system of any one of claims 13 to 24, wherein the head of the anvil includes a first component and a second component, the first component and the second component being movable relative to each other and configured for deployment between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension; 26. The system of claim 24, wherein the first and second components of the head of the anvil are pivotable relative to the axis between the collapsed configuration and the expanded configuration, wherein in the collapsed configuration the head of the anvil is oriented substantially parallel to the axis, and in the expanded configuration the head of the anvil is oriented substantially perpendicular to the axis.

27. The system of claim 25, wherein the head of the anvil includes a central component pivotally coupled to the shaft, wherein the first component and the second component are pivotally coupled to the central component.

28. The system of any one of claims 13 to 24, wherein the head includes a plurality of flaps, each flap including a tissue contact surface defining a staple forming recess, wherein the flaps are configured for deployment between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension.

29. The system of any one of claims 13 to 24, wherein the anvil includes an expandable element coupled to an annular tissue contact surface and configured for deployment between a collapsed configuration having a first lateral dimension and an expanded configuration having a second lateral dimension, wherein the first lateral dimension is smaller than the second lateral dimension.

30. A robot control system, comprising: A circular stapler includes a staple assembly and an anvil movably coupled to the staple assembly; An instrument configured to move the anvil from a collapsed configuration having a first diameter to an expanded configuration having a second diameter, wherein the first diameter is smaller than the second diameter; and A robot controller configured to control the device.

31. The control system of claim 29, further comprising an input device coupled to the controller and movable by a user, such that movement of the input device generates an input signal, wherein the controller is configured to move the abutment from the collapsed configuration to the expanded configuration based on the input signal.

32. The control system according to any one of claims 29 to 30, further comprising a sensor coupled to the controller to detect a force or torque applied to the instrument by the robot controller.

33. The control system according to any one of claims 29 to 31, further comprising a sensor coupled to the controller to detect the force or torque applied by the instrument to the abutment.

34. The control system according to any one of claims 29 to 32, wherein the instrument includes a first jaw and a second jaw movable between an open position and a closed position, and an actuator extending at least partially through the first jaw and the second jaw.

35. The control system of claim 33, wherein the controller is configured to rotate the driver to move the anvil from the collapsed configuration to the expanded configuration.

36. The control system of claim 33, wherein the controller is configured to move the actuator longitudinally relative to the axis of the instrument to move the anvil from the collapsed configuration to the expanded configuration.

37. A method for connecting two tubular tissue structures, comprising: The collapsible anvil is introduced into the patient's body through a cannula into the adjacent first tissue structure; The anvil is moved from the collapsed configuration to the expanded configuration; Position the staple assembly within the patient's body adjacent to a second tissue structure; as well as Multiple staples are advanced into the first tissue structure and the second tissue structure to attach the first tissue structure to the second tissue structure.

38. The method of claim 36, further comprising moving the anvil from the expanded configuration to the collapsed configuration to remove the anvil from the patient.

39. The method according to any one of claims 36 to 37, further comprising a shaft clamping the anvil to move the anvil to the first tissue structure.

40. The method of any one of claims 36 to 38, further comprising a drive within a rotating delivery device to move the anvil into the expanded configuration.

41. The method according to any one of claims 36 to 39, further comprising moving a driver within the delivery apparatus in a longitudinal direction to move the anvil into the expanded configuration.

42. The method according to any one of claims 36 to 40, wherein the first tissue structure and the second tissue structure comprise a first segment and a segment of the intestine.

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