Apparatus, system, and method for torque amplification in medical systems - Patents.com

Abstract

The medical device may include a shaft extending from a proximal end to a distal end, an actuator at a proximal portion of the medical device, an end effector located at a distal end of the shaft and including a first jaw and a second jaw, a motor, and a torque amplification system. The torque amplification system may include a drive shaft coupled to the motor, a spring coupled to the drive shaft and configured to expand or contract in a proximal or distal direction relative to the drive shaft, a hammer movably coupled to the drive shaft, and an anvil coupled to the end effector and abutting the hammer. The anvil may be configured to provide a rotational output to the end effector to move the first jaw and / or the second jaw.

Description

[Technical field]

[0001] The present disclosure generally relates to medical systems, devices, and related methods that may be used to treat a subject. Aspects of the present disclosure relate to medical systems, devices, and methods for medical procedures, such as actuating one or more medical devices during an endoscopic procedure, among other aspects. This application claims the benefit of priority to U.S. Provisional Patent Application No. 63 / 310,424, filed February 15, 2022, which is incorporated herein by reference in its entirety. [Background technology]

[0002] Advances in technology are providing users of medical systems, devices, and methods with the ability to perform increasingly complex procedures on subjects. For example, robotization of medical procedures can provide multiple benefits and potential new capabilities that lead to higher quality health care, efficient procedures, new interventions, faster surgeon training, and reduced readmissions for repeat procedures. Technologies enabling the trend toward robotization still require development. For example, luminal endoscopic surgical tools present several challenges for robotization, such as the small scale required for the technology and the unique requirements of tools operating on humans. In one example, to actuate any instrument or tool at the distal end of a catheter device, such as a grasper, the force must be applied in a controlled and commanded manner with sufficient force to activate the tool. Also, the need to manually re-actuate the device to apply the appropriate level of force to the patient can increase the duration of the procedure. Furthermore, manual actuation can increase the burden on the operator of the device. There is a need for improvements in micro-actuation technology for catheter devices and other luminal endoscopic surgical tools to cut, grasp, collect, and otherwise manipulate tissue, among other applications.

[0003] The systems, apparatus, and methods of the present disclosure may remedy some of the problems discussed above or address other aspects of the art. Summary of the Invention

[0004] Examples of the present disclosure relate, inter alia, to systems, devices, and methods for performing one or more medical procedures with medical systems and devices. Each embodiment disclosed herein may include one or more of the features described in association with any of the other disclosed embodiments.

[0005] In one embodiment, a medical device may include a shaft extending from a proximal end to a distal end, an actuator at a proximal portion of the medical device, an end effector located at the distal end of the shaft and including a first jaw and a second jaw, a motor, and a torque amplification system. The torque amplification system may include a drive shaft coupled to the motor, a spring coupled to the drive shaft and configured to expand or contract in a proximal or distal direction relative to the drive shaft, a hammer movably coupled to the drive shaft, and an anvil coupled to the end effector and abutting the hammer. The anvil may be configured to provide a rotational output to the end effector to move the first jaw and / or the second jaw.

[0006] In other aspects, the medical device may include one or more of the following features: The motor may be disposed within a distal portion of the shaft. The medical device may further include a handle coupled to a proximal end of the shaft. The actuator may be located on the handle. The end effector may be an endoscopic stapler, a grasper, a forceps, or a scissors. The hammer may include a first flange extending distally from a distal surface of the hammer. The anvil may include a second flange extending proximally from a proximal surface of the anvil. The first flange may be configured to engage the second flange to rotate the anvil about a central longitudinal axis of the anvil. The hammer may be cylindrical and may include an inner tubular portion. The inner tubular portion may include a channel extending obliquely relative to a central longitudinal axis of the hammer.

[0007] The drive shaft may include a ball bearing coupled to a distal end of the drive shaft. The ball bearing may be movably disposed within the channel. The spring may extend circumferentially about a radially outer surface of the drive shaft and may abut a proximal end of the inner tubular portion. The torque multiplication system may further include a central longitudinal lumen extending through the drive shaft, the hammer, the spring, and the anvil. Each of the hammer and the anvil may be cylindrical, and the hammer may have a diameter substantially the same as a diameter of the anvil. The drive shaft may include (i) a recess extending longitudinally through the drive shaft from a distal end of the drive shaft, and (ii) a pair of channels extending proximally from the distal end. The spring may be disposed in the recess. The hammer may include (i) a pair of protrusions extending proximally from a proximal face of the hammer and configured to be received by the pair of channels, respectively, and (ii) a pair of flanges extending distally from a distal end face of the hammer.

[0008] In other aspects, the medical device may include one or more of the following features: The anvil may be T-shaped. The drive shaft may include a first recess. The hammer may include a second recess and a pair of protrusions extending distally from a distal face of the hammer. The spring may be disposed within the first recess. A distal end of the spring may be fixedly coupled to a proximal opposing surface within the second recess. A distal portion of the drive shaft may be received within the second recess. The hammer may include a first channel within the second recess. The drive shaft may include a second channel on a radially outer surface relative to a central longitudinal axis of the drive shaft. The ball bearing may be located between the first channel and the second channel. The spring may be conical. A ratchet mechanism may be coupled to the drive shaft.

[0009] In another aspect, a medical device may include an end effector and a torque amplification system. The torque amplification system may include a drive shaft coupled to the motor, a spring coupled to the drive shaft and configured to expand or contract in a proximal or distal direction relative to the drive shaft, a hammer movably coupled to the drive shaft, an anvil coupled to the output shaft and abutting the hammer, the anvil configured to provide a rotational output to the output shaft, and a lumen extending along a central longitudinal axis of the torque amplification system, the lumen extending through the drive shaft, the spring, the hammer, and the anvil. The output shaft may be coupled to an end effector.

[0010] In other aspects, the medical device may include one or more of the following features: The hammer may be cylindrical and may include an inner tubular portion. The inner tubular portion may include a channel extending transversely relative to a central longitudinal axis of the hammer. The drive shaft may include a ball bearing coupled to a distal end of the drive shaft. The ball bearing may be movably disposed within the channel. The spring may extend circumferentially on a radially outer surface of the drive shaft and circumferentially abut a proximal end of the inner tubular portion.

[0011] In other aspects, the medical device may include one or more of the following features: The drive shaft may include (i) a recess extending longitudinally through the drive shaft from a distal end of the drive shaft, and (ii) a pair of channels extending proximally from the distal end. The spring may be disposed in the recess. The hammer may include (i) a pair of protrusions extending proximally from a proximal face of the hammer, each of which may be configured to be received by the pair of channels, and (ii) a pair of flanges extending distally from a distal end face of the hammer. The drive shaft may include the first recess. The hammer may include a second recess, a pair of protrusions extending distally from a distal face of the hammer, and a first channel within the second recess. The spring may be disposed within the first recess. A distal end of the spring may be fixedly coupled to a proximal opposing surface within the second recess. A distal portion of the drive shaft may be received within the second recess. The drive shaft may include a second channel on a radially outer surface relative to a central longitudinal axis of the drive shaft. A ball bearing may be movably disposed between the first channel and the second channel.

[0012] In another aspect, a medical device may include a shaft extending longitudinally from a proximal end portion to a distal end portion, a motor disposed within the distal end portion, an end effector at the distal end portion, and a torque multiplication system that may include a drive shaft coupled to the motor, a spring coupled to the drive shaft and configured to move relative to the drive shaft, a hammer movably coupled to the drive shaft, and an anvil coupled to the end effector and abutting the hammer, the anvil configured to provide a rotational output to the end effector.

[0013] Both the foregoing summary and the following description are exemplary and explanatory only and are not restrictive of the present disclosure, as claimed. The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate exemplary embodiments of the present disclosure and, together with the following description, serve to explain the principles of the disclosure. [Brief description of the drawings]

[0014] [Figure 1] FIG. 1 illustrates a perspective view of a medical device system according to an embodiment of the present disclosure. [Diagram 2] FIG. 2 illustrates a distal portion of the medical device system of FIG. 1 according to an embodiment of the present disclosure. [Diagram 3] FIG. 3 illustrates a side view of a torque amplification system according to an embodiment of the present disclosure. [Figure 4-5] 4 and 5 show side views of components of the torque amplification system of FIG. 3 according to an embodiment of the present disclosure. [Figure 6-8] 6, 7, and 8 show side views of the torque amplification system of FIG. 3 in various states during operation, according to an embodiment of the present disclosure. [Figure 9] FIG. 9 illustrates a side view of a partially exploded torque amplification system according to an embodiment of the present disclosure. [Figure 10] 10 is a cross-sectional side view of the torque amplification system of FIG. 9 in an assembled state, according to an embodiment of the present disclosure. [Figure 11] FIG. 11 illustrates a side view of the torque amplification system of FIG. 9 in an assembled state, according to an embodiment of the present disclosure. [Figure 12] FIG. 12 illustrates a perspective view of the torque multiplication system of FIG. 9 in an assembled state, according to an embodiment of the present disclosure. [Figure 13-14] 13 and 14 show perspective and side views of the torque amplification system of FIG. 9 according to an embodiment of the present disclosure. [Figure 15] FIG. 15 illustrates a perspective view of a torque amplification system according to an embodiment of the present disclosure. [Figure 16] FIG. 16 illustrates a cross-sectional side view of the torque amplification system of FIG. 15 according to an embodiment of the present disclosure. [Figure 17-19] 17, 18, and 19 show a portion of the torque multiplication system of FIG. 15 according to an embodiment of the present disclosure. [Figure 20] FIG. 20 illustrates a side view of the torque amplification system of FIG. 15 in a partially disassembled state, according to an embodiment of the present disclosure. [Figure 21]FIG. 21 illustrates a side view of another torque amplification system in a partially disassembled state, according to an embodiment of the present disclosure. [Figure 22] FIG. 22 illustrates a cross-sectional side view of the torque multiplication system of FIG. 21 according to an embodiment of the present disclosure. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0015] The terms "proximal" and "distal" as used herein are used to refer to the relative locations of components of the exemplary medical system and exemplary medical device. As used herein, "proximal" refers to a location relatively closer to the outside of the body or to the medical professional using the medical system or medical device. In contrast, "distal" refers to a location relatively farther from the medical professional using the medical system or medical device or to a location closer to the inside of the body. The proximal and distal directions are labeled with arrows marked "P" and "D", respectively, throughout the drawings. As used herein, the terms "comprises," "comprising," "having," "including," or other variations thereof are intended to cover a non-exclusive inclusion, such that a system, device, or method comprising a list of elements does not include only those elements, but may include other elements not expressly listed or inherent thereto. Unless otherwise stated, the term "exemplary" is used in the sense of "example" rather than "ideal." As used herein, the terms "about," "substantially," and "approximately" indicate a range of values ​​within + / - 10% of the stated value.

[0016] Embodiments of the present disclosure include devices, systems, and methods for manipulating, cutting, stapling, grasping, and / or otherwise treating tissue. In some examples, the devices, systems, and / or methods described herein may be utilized during an endoscopic medical procedure, such as an endoscopic mucosal resection (EMR) and / or an endoscopic submucosal dissection (ESD) procedure. In examples, the procedure may include luminal endoscopic placement of the medical device in proximity to a target area within the patient's body. Placement of the medical device may be via a catheter, scope (endoscope, bronchoscope, colonoscope, gastroscope, duodenoscope, etc.), tube, or sheath, and may be inserted into the GI tract via a natural orifice or an incision. The orifice may be, for example, the nose, mouth, or anus. Placement may be in any part of the GI tract, including the esophagus, stomach, duodenum, large intestine, or small intestine. Placement may also be in other organs accessible via the GI tract or otherwise via an incision. The patient's tissue may be manipulated via the medical device, such as grasping, stapling, and / or cutting tissue for subsequent removal from the patient's body. In other examples, the devices, systems, and methods may be incorporated into a needle device used to pierce tissue and implemented to apply a translational force to the needle to facilitate piercing the tissue. In some other examples, the devices, systems, and methods of the present application may be used to facilitate articulation of the distal end of a catheter device, for example, to facilitate movement of tissue via contact with the distal end of a catheter.

[0017] Reference will now be made in detail to the illustrative embodiments of the present disclosure described above and illustrated in the accompanying drawings, in which: Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.

[0018] FIG. 1 illustrates a perspective view of an exemplary medical device assembly 100 including an endoscope 101 and a medical device 110. Although the medical device assembly 100 is illustrated with an endoscope 101, any other similar insertion device, such as a bronchoscope, colonoscope, gastroscope, duodenoscope, etc., may be used with the medical device assembly 100. The endoscope 101 may include a handle 102, an actuator 104, and a body 107 extending from the handle 102 to a distal end 108. A working channel 106 may extend from a working channel port 103 located on the handle 102 to an opening at the distal end 108. The distal end 108 of the endoscope 101 may also include a camera 105. Movement of the distal end 108 and / or functionality of the camera 105 may be controlled via one or more actuators 104 on the handle 102. The medical device 110 may be configured to be inserted into the working channel 106 of the endoscope 101.

[0019] The medical device 110 may include a handle 112, a shaft 115 extending from the handle 112 to a distal portion 116 of the medical device 110, and a grip 118 at a distal end 117 of the device. The handle 112 may include actuators 124, 126. The shaft 115 may extend through a connector 121 at the working channel port 103. The connector 121 may be directly coupled to the working channel port 103 of the endoscope 101. In other embodiments, the medical device 110 may not include the connector 121. The shaft 115 may extend from the handle 112 through the connector 121 into the working channel 106 of the endoscope 101 and may be movable within the working channel 106. The shaft 115 may extend longitudinally a length greater than the longitudinal length of the endoscope 101 such that when the shaft 115 is delivered into the working channel 106, a portion of the shaft 115 extends distally from a distal opening of the working channel 106 (as shown in FIG. 1 ). The distal portion 116 of the medical device 110 may include a first articulation shaft 120, a second articulation shaft 122, and a grip 118 at a distal end 117 of the medical device 110. In other embodiments, the medical device 110 may not include both the first articulation shaft 120 and the second articulation shaft 122. For example, the medical device 110 may include only a single articulation shaft 120 or articulation shaft 1122, or may not include articulation shafts 120, 122, and the shaft 115 may extend to the grip 118. The articulation axes 120 , 122 may be movable via one or more actuators 124 , 126 in the handle 112 .

[0020] The gripper 118 may open and close via actuation of one or more actuators 124, 126 of the handle 112. The medical device 110 may include a motor 310 (shown in FIG. 3) disposed within the medical device 110. The gripper 118 may move between an open position and a closed position via actuation of the motor 310. For example, as described in more detail below, the motor 310 may be coupled to a gear assembly configured to move the gripper 118 from a closed position to an open position, and from an open position to a closed position. For example, the gear assembly may convert a rotational output of the motor 310 into a translational output to move one or both of the two jaws or portions of the gripper 118 to transition from an open position to a closed position, and from a closed position to an open position. In some examples, the motor 310 may be a micromotor located within the main shaft 115 or one or more articulation shafts 120, 122. One or more of the actuators 124, 126 may be electrically coupled to the motor 310 via one or more electrical wires or wirelessly. The one or more actuators 124, 126 may control the output of the motor 310 to open or close the gripper 118.

[0021] 2 illustrates a distal end 108 of an endoscope 101 with a camera 105 and two different medical devices 201, 252 disposed within two different working channels 106, 205 of the endoscope 101. In one embodiment, the medical device 201 can be a medical stapler device 201 and the medical device 252 can be a gripper 252. Each of the medical stapler device 201 and the gripper 252 can be disposed within the working channel 205 and the working channel 106, respectively. The gripper 252 includes a longitudinal axis 253 and an end effector 254 including jaws 256, 257. Similar to that described above with respect to medical device 110, a motor (e.g., motor 310) may be disposed within shaft 253 and may actuate end effector 254 to move jaws 256, 257 toward or away from each other, thereby transitioning jaws 256, 257 between open and closed configurations.

[0022] The medical stapler device 201 includes a longitudinal axis 231, a stapler body 222, and an anvil 220. The stapler body 222 can include a plurality of staples with a cartridge (not shown). Each of the plurality of staples can be configured to be deployed from the stapler body 222. A motor (e.g., motor 310) can be disposed within the stapler body 222, the anvil 220, and / or the axis 231. The motor can be configured to actuate the medical stapler device 201 to move the stapler body 222 and the anvil 220 toward or away from one another, thereby transitioning the stapler body 222 and the anvil 220 between an open configuration and a closed configuration. In some examples, the motor (e.g., motor 310) can be used to deploy staples or other fasteners from the stapler body 222. 2, the devices, systems, and methods of the present disclosure may be incorporated into any other medical device for insertion into or otherwise acting on a patient's body. For example, the devices, systems, and methods described in this application may be incorporated into an endoscopic snare device, a cutting device (e.g., endoscopic scissors or other device for moving one or more cutting elements), an endoscopic burr, a cleaning brush, a ligation device, a biopsy forceps, a suturing system, or any other device or system known in the art.

[0023] The torque amplification system described in this application generally relates to a system for increasing the amount of torque applied to a rotational output of a motor in a medical device, such as a micromotor in a medical device. One example of a torque amplification system is an impact driver system that may include a spring driven mechanism that applies rotational strikes to a rotational output shaft. Each of the rotational strikes has a greater torque than an input torque provided to the impact driver system, such as an input of rotational force provided by a motor. Further details of the torque amplification system and how the system operates are provided below.

[0024] FIG. 3 illustrates a torque amplification system 300 configured for use in a medical device, such as an endoscopic medical device for insertion into a patient's body. The system 300 includes a drive shaft 302, a hammer 304, an anvil 306, a spring 308, and a central lumen 372. The central lumen 372 may extend through the entire length of the torque amplification system 300. A central longitudinal axis 399 may extend longitudinally through a center of the system 300. The drive shaft 302 may be located at a proximal end of the system 300. The drive shaft 302 may be cylindrical and may be coupled to a motor 310. A proximal portion 312 of the drive shaft 302 may project radially outward from the axis 399 relative to a distal portion 313 of the drive shaft 302. The proximal portion 312 may form a ledge 315. The ledge 315 may be configured to be coupled to the spring 308 and / or may support a proximal end of the spring 208. The central lumen 317 may extend through the drive shaft 302 in a proximal to distal direction. A distal end 339 (shown in FIG. 5 ) of the drive shaft 302 may be located within the central lumen 319 of the hammer 304. As shown in FIG. 5 , the distal end 339 of the drive shaft 302 may include ball bearings 335, 336 disposed within recesses 337, 338 of the drive shaft 302. Each ball bearing 335, 336 may extend radially outward from a radially outermost surface 366 of the drive shaft 302 relative to the axis 399. FIG. 5 illustrates the distal end 339 of the drive shaft 302 with ball bearings 335, 336 disposed within recesses 337, 338. In some embodiments, the drive shaft 302 may be part of the motor 310. In other embodiments, the drive shaft 302 may be separate from the motor 310 and may be directly or indirectly coupled to the motor 310. In these examples, the motor 310 may drive the motion of the drive shaft 302 (ie, rotational motion about axis 399).

[0025] The spring 308 may be helical and may include a central lumen that receives the distal portion 313 of the drive shaft 302 and may extend circumferentially around the drive shaft 302. The spring 308 may be coupled to or otherwise abut a shelf 315 at a proximal end of the spring 308 and may extend longitudinally along the radially outer side of at least a portion of the drive shaft 302. In some embodiments, the spring 308 may be coupled to or otherwise abut a proximal end of the tube 314. In other embodiments, the spring 308 may not be coupled to a proximal end of the tube 314. The spring 308 may be compressible such that the spring 308 may move proximally and distally relative to the drive shaft 302. For example, distal movement of the tube 314 relative to the drive shaft 302 may compress the spring 308, and proximal movement of the tube 314 relative to the drive shaft 302 may expand the spring 308. Axis 399 may extend longitudinally through the center of spring 308. Spring 308 may be any suitable material, such as Nitinol or any other suitable shape memory material.

[0026] The hammer 304 is shown transparent in FIG. 3 to show the tube 314 within the hammer 304. The tube 314 may be an inner tubular portion of the hammer 304. The hammer 304 may be cylindrical and may have a uniform diameter along the entire length of the hammer 304. The hammer 304 may include a central longitudinal lumen 319 extending through the entire length of the hammer 304. The lumen 319 may be configured to receive the tube 314 (shown in FIG. 4), the drive shaft 302, and the spring 308. The drive shaft 302 and the spring 308 may move freely in the proximal and distal directions through the lumen 319 (i.e., without contacting any internal protrusions or obstructions within the lumen 319). The hammer 304 may include a flange 318 that protrudes distally from a distal face 341 of the hammer 304. The flange 318 may be rectangular in shape and may have a distal-most edge that is substantially parallel to the distal face 341. The hammer 304 may be made from metal, plastic, or any other suitable material.

[0027] The anvil 306 may be cylindrical and may have a central longitudinal lumen 349 extending longitudinally therethrough. The anvil 306 may have approximately the same diameter as the hammer 304 or may have a different diameter than the hammer 304. The diameter of the anvil 306 may remain constant throughout the longitudinal length of the anvil 306. The anvil 306 and hammer 304 overlap radially such that distal movement of the anvil 306 causes the anvil to contact the hammer 304. The anvil 306 may have a flange 320 extending proximally from a proximal face 322 of the anvil 306. The flange 320 may be rectangular in shape and may have a proximal-most edge 320a substantially parallel to the proximal face 322. The flange 320 may have a radially outermost surface 362 having the same radius of curvature relative to the axis 399 as a radially outermost surface 361 of the anvil 306. In some embodiments, the radially outermost surface 361 can have a constant diameter across the longitudinal length of the surface 361 from the proximal surface 322 to the distal end surface 359 .

[0028] During operation, the flange 318 of the hammer 304 can abut the proximal face 322 and / or the flange 320 of the anvil 306. In some embodiments, the flange 318 of the hammer 304 can slide across the proximal face 322 and the flange 320 of the anvil 306. The lumen 349 of the anvil 306 can be longitudinally aligned with the lumen 319 of the hammer 304, and the lumen 349 can have substantially the same diameter as the lumen 319. The anvil 306 can be fixedly coupled to an output shaft (not shown) that is connected to an end effector, such as the gripper 118, the end effector 254, or the stapler device 201. For example, the output shaft can control the opening and closing of the end effector 254 or the opening and closing of the anvil / stapler jaws 220 relative to the stapler body 222.

[0029] FIG. 4 illustrates a portion of the torque amplification system 300, including the drive shaft 302, the spring 308, the tube 314, and the flange 320 of the anvil 306. The tube 314 may be fixedly coupled to the hammer 304 within the lumen 319 such that as the tube 314 rotates about the axis 399 ( FIG. 3 ), the hammer 304 also rotates. In some embodiments, the tube 314 may be welded to the hammer 304. The tube 314 may include a longitudinal lumen 357. The lumen 357 may be configured to receive the drive shaft 302. In some embodiments, the lumen 357 may have a diameter substantially the same as a diameter of the drive shaft 302. The tube 314 may include helical cut channels 330, 331 extending longitudinally from a proximal portion to a distal portion of the tube 314. Each of the helical cut channels 330, 331 may extend obliquely relative to the axis 399. Each channel 330, 331 may be configured to receive a ball bearing 335, 336 such that each ball bearing 335, 336 may move within one of the channels 330, 331. The channels 330, 331 may be curved and may have closed proximal and distal ends. Each channel 330, 331 terminates proximally to the distal-most end of the tube 314 and distally to the proximal-most end of the tube 314.

[0030] The radially outermost surface of tube 314 can be spaced the same distance from axis 399 as the radially outermost surface of proximal portion 312 of drive shaft 302. In some embodiments, spring 308 can be fixedly coupled to proximal surface 358 of tube 314. In other embodiments, spring 308 can abut proximal surface 358 and not be fixedly coupled to proximal surface 358. Tube 314 can be configured to compress spring 308 as tube 314 moves proximally on drive shaft 302. In some embodiments, tube 314 can be coupled to hammer 304 such that a distal most end 353 of tube 314 is located proximally of distal surface 341 of hammer 304 ( FIG. 3 ). Because the lumens 317, 319, 349 are all longitudinally aligned, the torque amplification system 300 includes a central longitudinal lumen 372 (FIG. 3) that extends the entire length of the torque amplification system, which may allow one or more tools or other devices to pass through the central longitudinal lumen 372 during operation of the torque amplification system 300.

[0031] In operation, the torque amplification system 300 can deliver a pulse rotation of the hammer 304, where energy provided by the motor 310 through the drive shaft 302 is stored in the spring 308 and then released by rotating the hammer 304 to deliver a high torque impact to the anvil 306 (and output shaft). Thus, the motor 310 can provide a small amount of torque and the output to the anvil 306 can be a large amount of torque. The operation of the torque amplification system 300 is described in further detail below with respect to FIGS. 6-10. In describing the operation of the torque amplification system 300, direction 601 is a counterclockwise rotational direction about the central longitudinal axis 399 facing the distal end face 359 of the anvil 306, and direction 602 is a clockwise rotational direction about the central longitudinal axis 399 facing the distal end face 359 of the anvil 306.

[0032] FIG. 6 illustrates the beginning of an operating cycle of the torque amplification system 300. In FIG. 6, the first end 611 of the flange 318 of the hammer 304 abuts the first end 610 of the flange 320 of the anvil 306, and the hammer 304 is prevented from rotating by an applied load at an output shaft (not shown) coupled to the anvil 306. In this example, the drive shaft 302 is rotating in a rotational direction 602. The drive shaft 302 continues to rotate in the direction 602 while the anvil 306 remains stationary due to the applied load. As the drive shaft 302 continues to rotate and the anvil 306 remains stationary, the hammer 304 moves proximally and the spring 308 compresses as the ball bearings 335, 336 (FIG. 5) move distally through the channels 330, 331, respectively. As the hammer 304 moves proximally, the first end 611 retracts proximally and slides across the first end 610. Additionally, as hammer 304 moves proximally, energy is stored in compressed spring 308 .

[0033] FIG. 7 shows the hammer 304 in a position where the flange 318 has reached the proximal end of the flange 320, with the spring 308 in a position compressed by the proximal movement of the hammer 304. When the first end 611 of the flange 318 disengages from the first end 610 of the flange 320, the hammer 304 rotates in the direction 602 about the axis 399, causing the flange 318 to move across the proximal end of the flange 320. When the flange 318 is released from the flange 320, the hammer 304 increases its rotational speed due to the release of the energy stored in the spring 308, and the hammer 304 is pushed distally by the spring 308 as the spring 308 expands distally. Also, at this point when the flange 318 is released from the flange 320, the ball bearings 335, 336 move within the channels 330, 331 at a speed greater than the rotational speed of the drive shaft 302. At this point, flange 318 moves distally against proximal face 322 of anvil 306 and hammer 304 rotates about axis 399 in direction 602 causing flange 318 to apply a rotational force to flange 320 via both the force applied by drive shaft 302 and the force applied by spring 308. Because both the force from drive shaft 302 and the force from spring 308 are applied to hammer 304, the amount of force that hammer 304 applies to anvil 306 is increased compared to if drive shaft 302 were only applying a force to anvil 306.

[0034] 8 shows the torque amplification system 300 after an operating cycle of the torque amplification system 300 is completed and the process begins again. In FIG. 8, the flange 318 abuts the flange 320 and the spring 308 is in an expanded state. The torque amplification system 300 can provide a rotational output that is greater than the rotational output provided by the motor 310 alone.

[0035] FIG. 9 shows a partially exploded side view of another embodiment of a torque amplification system 1100. The orientation of the proximal P and distal D is inverted relative to the previous figure (i.e., proximal is on the right and distal is on the left compared to the previous figure where the left is proximal and the right is distal). As shown in FIG. 9, the torque amplification system 1100 may include a drive shaft 1102, a gear assembly 1105, such as a gear assembly, a spring 1108, a hammer 1104, a central lumen 1198, and a central longitudinal axis 1199. In FIG. 11, an anvil 1106 of the torque amplification system 1100 is shown. The spring 1108 may be disposed within a recess 1138 extending longitudinally through the drive shaft 1102 from a distal-most end face 1122 of the drive shaft 1102. The recess 1138 may be substantially cylindrical and may terminate at a proximal end 1142 (shown in FIG. 10). In some embodiments, the drive shaft 1102 can be fixedly coupled to a gear assembly 1105 at a proximal end of the drive shaft 1102. For example, the gear assembly 1105 can be integrally formed with the drive shaft 1102. The drive shaft 1102 includes two channels 1145, 1146 extending proximally from a distal-most end face 1122 of the drive shaft 1102. Each channel 1145, 1146 can extend at an angle relative to the central longitudinal axis 1199. The channel 1145 can be disposed on an opposite side of the central longitudinal axis 1199 from the channel 1146. A central lumen 1195 can extend through the drive shaft 1102.

[0036] The hammer 1104 may include a central lumen 1137 extending longitudinally through the hammer 1104, a cylindrical body 1113, two protrusions 1118, 1119 extending proximally, and two flanges 1125, 1126 extending distally from a distal face 1129 of the cylindrical body 1113. Each of the protrusions 1118, 1119 may protrude proximally from a proximal face 1141 of the cylindrical body 1113. Each of the protrusions 1118, 1119 may be angled relative to the longitudinal axis 1199, for example, at an angle the same as or similar to the angle of the channels 1145, 1146, respectively, relative to the longitudinal axis 1199. The protrusion 1118 may be located on the opposite side of the axis 1199 from the protrusion 1119. The protrusion 1118 may be angled to intersect with the protrusion 1119. Each protrusion 1118, 1119 can include a proximally facing front surface 1188, 1189, respectively. The proximally facing front surfaces 1188, 1189 can each be substantially perpendicular to the central longitudinal axis 1199. Each protrusion 1118, 1119 can be configured to be received by a respective channel 1145, 1146. Each flange 1125, 1126 can be offset from each protrusion 1118, 1119 by approximately 90 degrees. The radially outermost surface 1186 of the hammer 1104 can be spaced from the shaft 1199 the same distance as the radially outermost surface 1185 of the drive shaft 1102 such that the drive shaft 1102 and the hammer 1104 have a uniform diameter.

[0037] 10 shows a side cross-sectional view of a torque amplification system 1100 including a drive shaft 1102, a gear assembly 1105, a hammer 1104, and a spring 1108. As shown in FIG. 10, the spring 1108 may be coupled to or abut the drive shaft 1102 at a proximal end 1142 of the recess 1138 and may be coupled to or abut the hammer 1104 at a proximal face 1141 of the hammer 1104. The spring 1108 may expand and contract within the recess 1138 and may move proximally or distally through the recess 1138 along a longitudinal axis 1199.

[0038] FIG. 11 illustrates a side view of the torque amplification system 1100 including the drive shaft 1102, the gear assembly 1105, the hammer 1104, the spring 1108, the anvil 1106, and the output shaft 1160. The output shaft 1160 may have a radially outer surface 1164. As shown in FIG. 11, the hammer 1104 abuts the drive shaft 1102 when the torque amplification system 1100 is in a fully assembled state, with the protrusions 1118, 1119 partially located within the channels 1145, 1146, respectively. FIG. 11 illustrates the torque amplification system 1100 when the spring 1108 is in a balanced state and is not storing energy. The spring 1108 is housed within and / or between the drive shaft 1102 and the hammer 1104, and the protrusions 1118, 1119 may move in and out of the channels 1145, 1146 during operation of the torque amplification system 1100. The anvil 1106 may be coupled to an output shaft 1160. The output shaft 1160 may extend longitudinally distally from the anvil 1106 along an axis 1199. The drive shaft 1102, hammer 1104, and anvil 1106 may all have a uniform diameter 1187 about the axis 1199. This may facilitate disposing the torque amplification system 1100 in a smaller space, such as in an endoscopic catheter.

[0039] 12 shows a perspective view of the torque amplification system 1100 showing the anvil 1106 abutting the distal end surface 1129 of the hammer 1104. The anvil 1106 may be T-shaped and may include a central portion 1163, a first side portion 1161, a second side portion 1162, and a central lumen 1590. The central portion 1163 may be generally cylindrical and the central lumen 1590 may extend through the center of the central portion 1163. The first side portion 1161 may extend radially outward from the central portion 1163 relative to the axis 1199. The second side portion 1162 may extend radially outward from the central portion 1163 relative to the axis 1199 on an opposite side of the central portion 1163 from the first side portion 1861. The output shaft 1160 may be fixedly coupled to the anvil 1106, for example, via the central lumen. The output shaft 1160 can include a central lumen 1590 extending longitudinally through at least a portion of the output shaft 1160. As shown in FIG. 12, the central lumen 1590 can include one or more flat inner surfaces, for example, six flat surfaces forming a substantially hexagonal shaped lumen. Each flange 1125, 1126 can be configured to engage the anvil 1106 such that when the flanges 1125, 1126 abut the anvil 1106, the flanges 1125, 1126 can impart a rotational force to the anvil 1106 to rotate the output shaft 1160.

[0040] In operation, the torque amplification system 1100 can deliver a pulse rotation of the hammer 1104, where energy provided by the motor through the drive shaft 1102 is stored in the spring 1108 and then released by rotating the hammer 1104 to deliver a high torque impact to the anvil 1106 and output shaft 1160, similar to that described above with respect to the torque amplification system 300. In describing the operation of the torque amplification system 1100, direction 1301 is a counterclockwise rotational direction about the central longitudinal axis 1199 facing the distal end face 1129 of the hammer 1104, and direction 1302 is a clockwise rotational direction about the central longitudinal axis 1199 facing the distal end face 1129 of the hammer 1104.

[0041] An operating cycle of the torque multiplication system 1100 may begin when each of the first ends 1201, 1202 of the flanges 1125, 1126 abuts the first end 1114 of the first side 1161 and the second end 1115 of the second side 1162 of the anvil 1106, respectively. This position is shown in FIG. 13. The hammer 1104 is prevented from rotating by an applied load on the output shaft 1160 coupled to the anvil 1106. In this example, the drive shaft 1102 is rotating in a rotational direction 1302. The drive shaft 1102 continues to rotate in the direction 1302 while the anvil 1106 remains stationary due to the applied load. As the drive shaft 1102 continues to rotate and the anvil 1106 remains stationary, the hammer 1104 moves proximally, compressing the spring 1108 as the projections 1118, 1119 move proximally within the channels 1146, 1146, respectively. As the hammer 1104 moves proximally, energy is stored in the spring 1108 as it compresses.

[0042] 14 shows the hammer 1104 in a position where the flanges 1125, 1126 reach the proximal end 1410 of the anvil 1106, and the spring 1108 is in a compressed position due to the proximal movement of the hammer 1104. When the first end 1201 of the flange 1126 disengages from the second end 1115 of the anvil 1106 and the second end 1202 of the flange 1125 disengages from the first end 1114 of the anvil 1106, the hammer 1104 rotates in the direction 1301 about axis 399. The flange 1125 then moves across the proximal end of the side portion 1162 and the flange 1126 moves across the proximal end of the side portion 1161. As the flanges 1125, 1126 are released from the anvil 1106, the hammer 1104 increases its rotational speed due to the release of energy stored in the spring 1108, and as the spring 1108 expands distally, the hammer 1104 is pushed distally by the spring 1108. Also, at this point when the flanges 1125, 1126 are released from the anvil 1106, the projections 1118, 1119 move within the channels 1145, 1146 at a speed greater than the rotational speed of the drive shaft 1102. At this point, the flanges 1125, 1126 move distally such that the distal face 1129 of the hammer abuts the anvil 1106, and the hammer 1104 rotates about axis 1199 in direction 1301 such that the flanges 1125, 1126 apply a rotational force to the anvil 1106 via both the force applied by the drive shaft 1102 and the force applied by the spring 1108. Because both the force from the drive shaft 1102 and the force from the spring 1108 are applied to the hammer 1104, the amount of force that the hammer 1104 applies to the anvil 1106 is increased compared to if only the drive shaft 1102 were applying a force to the anvil 1106. By utilizing the protrusions 1118, 1119 of the hammer 1104 and the channels 1145, 1146 of the drive shaft, the overall size (e.g., overall diameter) of the torque amplification system 1100 can be reduced, thereby facilitating placement of the torque amplification system 1100 within a medical device, such as an endoscopic medical device.

[0043] 15 illustrates a perspective view of another embodiment of a torque amplification system 1800. As shown in FIG. 15, the torque amplification system 1800 can include a drive shaft 1802, a gear assembly 1805, such as a planetary gear assembly, a hammer 1804, a central lumen 1837, and a central longitudinal axis 1899. The hammer 1804 can be cylindrical and can include two protrusions 1825, 1826 extending distally outward from a distal end face 1889 of the hammer 1804. In some examples, each protrusion 1825, 1826 can include a first surface 1866, 1867 and a second surface 1868, 1869, respectively. Each first surface 1866, 1867 can be configured to engage with the anvil 1806. The first surfaces 1866, 1867 can be substantially perpendicular to the distal end face 1889. The second faces 1868, 1869 of the protrusions 1825, 1826 may be angled relative to the distal end face 1889. Each protrusion 1825, 1826 may be located at an outer periphery region of the distal end face 1889. The protrusion 1825 may be located on an opposite side of the axis 1899 from the protrusion 1826. The first face 1866 may face in a direction opposite to the direction in which the first face 1867 faces. As shown in FIG. 16, the hammer 1804 may include a central recess 1851 configured to receive the drive shaft 1802. The hammer 1804 is described in further detail below with respect to FIGS. 17 and 18.

[0044] FIG. 16 shows a side cross-sectional view of the torque amplification system 1800 including the anvil 1806 and the spring 1808. The spring 1808 may be disposed within a recess 1838 that extends longitudinally through the drive shaft 1802 from the distal-most end face 1822. The recess 1838 may be cylindrical and may terminate at a proximal end 1842. In some embodiments, the spring 1808 may be fixedly coupled to or abut the proximal end 1842 of the drive shaft 1802. Also, the spring 1808 may be fixedly coupled to or abut the distal end portions 1876, 1878 of the hammer 1804. The spring 1808 may be movable both proximally and distally within the recess 1838. For example, the spring 1808 may be movable between a neutral state and a contracted or compressed state in which the spring 1808 may store mechanical energy. The spring 1808 can be longitudinally aligned with an axis 1899. The lumen 1837 can extend longitudinally through a central portion of the spring 1808.

[0045] The drive shaft 1802 may be fixedly coupled to the gear assembly 1805 at a proximal end of the drive shaft 1802. A central lumen 1895 may extend longitudinally through the drive shaft 1802. The lumen 1895 may open into the recess 1838. The drive shaft 1802 may be cylindrical and may be configured to be received by and / or move within the recess 1851 of the hammer 1804. The drive shaft 1802 may be rotatable about an axis 1899 within the recess 1851 of the hammer 1804. The anvil 1806 may be T-shaped and may be coupled to the output shaft 1860. The anvil 1806 may include a first side portion 1861, a second side portion 1862, and a lumen 1879 extending longitudinally through the anvil 1806 at a center portion of the anvil 1806.

[0046] 17 and 18 show perspective views of the hammer 1804 including the protrusions 1825, 1826, the recess 1851, the central lumen 1837, the distal end face 1889, and the proximal-most surface 1852. As shown in FIG. 18, the recess 1851 may be formed in part by a curved radially inner surface 1870. The radially inner surface 1870 may include a channel 1871 configured to receive a ball bearing 2485 (FIG. 20). The channel 1871 may be V-shaped and recessed from the radially inner surface 1870. The channel 1871 may allow for movement of the ball bearing 2485 as the hammer 1804 moves relative to the drive shaft 1802.

[0047] 19 shows a perspective view of the drive shaft 1802 including the gear assembly 1805 and the distal surface 1822. As shown in FIG. 19, the drive shaft 1802 can include a V-shaped channel 1883 on a radially outer surface 1884 of the drive shaft 1802. The channel 1883 can be configured to receive a ball bearing 2485. The channel 1883 can also be configured to align with the channel 1871 when the drive shaft 1802 is positioned within the hammer 1804.

[0048] FIG. 20 shows a side view of the torque amplification system 1800 in a partially disassembled state. In FIG. 20, the ball bearing 2485 is disposed within the channel 1883 and the spring 1808 is disposed within the hammer 1804. The ball bearing 2485 in combination with both the channel 1883 and the channel 1871 can facilitate compression of the spring 1808 when a load is applied to the anvil 1806. When the torque amplification system 1800 is in a fully assembled state, the drive shaft 1802 is located within the recess 1851 of the hammer 1804 and the ball bearing 2485 is received by both the channel 1883 and the channel 1871. The ball bearing 2485 can move within both the channel 1883 and the channel 1871 when the torque amplification system 1800 is in a fully assembled state. For example, movement of the ball bearings 2485 within both the channel 1883 and the channel 1871 during operation of the torque amplification system 1800 can cause the hammer 1804 to translate proximally relative to the drive shaft 1802 , allowing compression of the spring 1808 .

[0049] An operating cycle of the torque multiplication system 1800 may begin when each of the first faces 1866, 1867 abuts the anvil 1806. The hammer 1804 is prevented from rotating by an applied load at the output shaft 1860 coupled to the anvil 1806. In this example, the drive shaft 1802 rotates in a direction of rotation 1602, i.e., clockwise about axis 1899, when the observer is positioned to the right of the page and faces the distal end face 1889 of the hammer 1804. The direction of rotation 1601 is opposite to the direction 1602. The drive shaft 1802 continues to rotate in the direction 1602 while the anvil 1806 remains stopped due to the applied load. As the drive shaft 1802 continues to rotate and the anvil 1806 remains stationary, the hammer 1804 moves proximally relative to the drive shaft 1802, compressing the spring 1808 as each of the projections 1825, 1826 moves proximally away from the anvil 1806. Energy is stored in the spring 1808 as the hammer 1804 moves proximally.

[0050] When the projections 1825, 1826 reach the proximal end 1877 of the anvil 1806, the spring 1808 becomes compressed by the proximal movement of the hammer 1804, and the projections 1825, 1826 move across the proximal end 1877 of the anvil 1806 causing the hammer 1804 to rotate about the axis 1899 in the direction 1602. When the hammer 1804 is released from the anvil 1806, the hammer 1804 increases its rotational speed due to the release of the energy stored in the spring 1808, and the hammer 1804 is moved distally by the spring 1808 as the spring 1808 expands distally. Also, at this point when the hammer 1804 is released from the anvil 1806, the ball bearings 2485 move within the channels 1871, 1883 at a speed greater than the rotational speed of the drive shaft 1802. At this point, the projections 1825, 1826 move distally such that a distal end face 1889 of the hammer 1804 abuts the anvil 1806, and the hammer 1804 rotates about axis 1899 in direction 1602 such that the projections 1825, 1826 apply a rotational force to the anvil 1806 via both the force applied by the drive shaft 1802 and the force applied by the spring 1808. Because both the force from the drive shaft 1802 and the force from the spring 1808 are applied to the hammer 1804, the amount of force that the hammer 1804 applies to the anvil 1806 is increased compared to if the drive shaft 1802 were only applying a force to the anvil 1806. The torque multiplication system 1800 can provide a rotational output to actuate a medical device, such as a grasper or stapler device. Locating the spring 1808 within the drive shaft 1802 can facilitate constructing the torque amplification system 1800 on a scale small enough to be included within an endoscopic medical device, such as an endoscopic grasper or stapler.

[0051] 21 shows a side view of another torque amplification system 2400 in a partially disassembled state. The torque amplification system 2400 may include a drive shaft 2402, a hammer 2404 including a recess 2451 and protrusions 2425, 2426, an anvil 2406, a spring 2408, an output shaft 2461, a central longitudinal lumen 2460, a ball bearing 2435, a gear assembly 2405 (e.g., a planetary gear assembly), and a central longitudinal axis 2499. The torque amplification system 2400 may include any of the features described above with respect to the torque amplification system 1800 and may operate in a manner similar to that described above with respect to the torque amplification system 1800. The spring 2408 may have a conical shape including a proximal end 2475 and a distal end 2476. The proximal end 2475 may have a diameter about the axis 2499 that is greater than the diameter of the distal end 2476 about the axis 2499. As seen in the side cross-sectional view of the torque amplification system 2400 in FIG. 22, the proximal end 2475 may be fixedly coupled to the inside of the drive shaft 2402, for example at the proximal end 2442 of the recess 2451. The distal end 2476 may be fixedly coupled to the inside of the hammer 2404 at the proximal portion 2443 of the hammer 2404 within the recess 2452. Or, in some embodiments, the distal end 2476 may abut the recess 2452. The conical shape of the spring 2408 may allow the spring 2408 to be compressed longitudinally and twisted about the axis 2499 during operation of the torque amplification system 2400.

[0052] Any of the torque amplification systems 300, 1100, 1800, 2400 may include a ratchet mechanism, such as by incorporating a ratchet mechanism in the motor 310 or drive shaft 302, 1102, 1802, 2402. The ratchet mechanism may prevent reverse rotation during operation of the torque amplification system 300, 1100, 1800, 2400 and may facilitate maintaining a closed or closed position during operation of the grasper, forceps, and / or endoscopic stapler device.

[0053] One or more embodiments of any of the medical devices, systems, and methods described herein may be used to cut, dissect, treat, staple, grasp, or resect tissue in any part of the human body. For example, any of the medical devices described herein may be used in medical procedures such as endoscopic submucosal dissection (ESD), cancer treatment, and / or other procedures in which removal, dissection, fulguration, stapling, fastening, grasping, moving, and / or ablation of tissue of that type is required.

[0054] Various aspects described herein can help reduce treatment times, increase tissue treatment effectiveness, reduce risks to the subject, and the like. Although the exemplary embodiments described above are disclosed in the context of a medical device for manipulating and ablating human tissue through a working channel of the medical device, through a natural orifice, or by incision, those skilled in the art will appreciate that the principles described above can be applied to any medical device or medical method and can be implemented in different ways without departing from the scope of the present disclosure as defined by the claims. In particular, structural details, including manufacturing techniques and materials, are within the understanding of those skilled in the art and will not be described in detail herein. These and other modifications and variations are well within the scope of the present disclosure and can be envisioned and implemented by those skilled in the art.

[0055] Furthermore, while certain exemplary embodiments have been illustrated and described herein in their entirety, it will be understood that any further configurations designed to accomplish the same or similar purpose may be substituted for the specific embodiments described and illustrated herein. The present disclosure is intended to encompass any and all further adaptations or modifications of the various embodiments. Combinations of the above embodiments, as well as other embodiments not specifically described herein, may become apparent to those skilled in the art upon review of the description.

[0056] Although the principles of the present disclosure have been described herein with reference to exemplary embodiments for specific applications, it can be understood that the present disclosure is not limited thereto. Those skilled in the art and who utilize the teachings provided herein can recognize that additional modifications, applications, embodiments, and equivalent replacements are all included within the scope of the embodiments described herein. Thus, the present disclosure should not be considered as limited by the above description.

[0057] Other exemplary embodiments of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the exemplary embodiments disclosed herein. It is intended that the specification and examples are exemplary only, and departures in form and detail may be made without departing from the scope and spirit of the disclosure as defined by the claims.

Claims

1. A medical device comprising: a main shaft extending from a proximal end to a distal end; an actuator at a proximal portion of the medical device; an end effector located at a distal end of the spindle and including a first jaw and a second jaw; A motor; a torque amplification system, wherein the torque amplification system comprises: a drive shaft coupled to the motor; a spring coupled to the drive shaft and configured to expand or contract in a proximal or distal direction relative to the drive shaft; a hammer movably coupled to the drive shaft; an anvil coupled to the end effector and abutting the hammer, the anvil configured to provide a rotational output to the end effector to move the first jaw and / or the second jaw.

2. The medical device of claim 1 , wherein the motor is located within a distal portion of the main shaft.

3. The medical device of claim 1 , further comprising a handle coupled to the proximal end of the shaft, the actuator being located on the handle.

4. The medical device of claim 1 , wherein the end effector is an endoscopic stapler, a grasper, forceps, or scissors.

5. the hammer including a first flange extending distally from a distal face of the hammer; the anvil including a second flange extending proximally from a proximal face of the anvil; The medical device of any one of claims 1 to 4, wherein the first flange is configured to engage the second flange to rotate the anvil about a central longitudinal axis of the anvil.

6. the hammer is cylindrical and includes an inner tubular portion; the inner tubular portion includes a channel extending obliquely relative to a central longitudinal axis of the hammer; the drive shaft including a ball bearing coupled to a distal end of the drive shaft; The medical device of claim 5 , wherein the ball bearing is movably disposed within the channel.

7. The medical device of claim 6 , wherein the spring extends circumferentially around a radially outer surface of the drive shaft and abuts a proximal end of the inner tubular portion.

8. The medical device of claim 6 , wherein the torque amplification system further comprises a central longitudinal lumen extending through the drive shaft, the hammer, the spring, and the anvil.

9. The medical device of any one of claims 1 to 4, wherein the hammer and the anvil are each cylindrical, the hammer having a diameter substantially the same as a diameter of the anvil.

10. the drive shaft including: (i) a recess extending longitudinally through the drive shaft from a distal end thereof; and (ii) a pair of channels extending proximally from the distal end thereof; The spring is disposed in the recess; 5. The medical device of claim 1, wherein the hammer includes: (i) a pair of protrusions extending proximally from a proximal face of the hammer and configured to be received by the pair of channels, respectively; and (ii) a pair of flanges extending distally from a distal end face of the hammer.

11. The medical device of claim 10 , wherein the anvil is T-shaped.

12. the drive shaft includes a first recess; the hammer including a second recess and a pair of protrusions extending distally from a distal face of the hammer; the spring is disposed within the first recess, a distal end of the spring fixedly coupled to a proximally opposed surface within the second recess; The medical device of claim 1 , wherein a distal portion of the drive shaft is received within the second recess.

13. the hammer includes a first channel within the second recess; the drive shaft includes a second channel on a radially outer surface relative to a central longitudinal axis of the drive shaft; The medical device of claim 12 , wherein a ball bearing is disposed between the first channel and the second channel.

14. The medical device of claim 13 , wherein the spring is conical.

15. The medical device according to any one of claims 1 to 4, further comprising a ratchet mechanism coupled to the drive shaft.

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