Self-adjusting staple height surgical stapler

Abstract

To provide a stapler that solves the problems of conventional staplers. [Solution] A surgical stapler is provided having a spring-loaded lift that automatically adjusts the staple cartridge and / or staple formation within a certain size range. The lift is automatically released when the staple firing mechanism begins its forward translation in the firing sequence. The automatic unidirectional adjustment also adjusts the staple cartridge while keeping it parallel to the anvil to provide consistent staple formation.

Description

Technical Field

[0005] ,

[0001] This application generally relates to surgical staplers, particularly surgical staplers having a self-adjusting staple height mechanism, system, and / or process.

[0002]

Description of Related Application

Background Art

[0003] Some surgical staplers have a mechanism that provides an adjustable jaw gap and a formed staple size. However, such staplers require user input, require tissue evaluation or measurement, provide no mechanism or process for making such evaluations or measurements, and moreover do not provide sufficient user feedback regarding the applied pressure. Such staplers also do not take into account the limitations associated with laparoscopic surgery, such as space and size constraints.

[0004] In the case of non-laparoscopic staplers, a dial or knob is provided at the rear of the instrument that allows the user to manually adjust the height of the closed staples in the range of 1.0 mm to 2.5 mm. The instrument also has an observation window that displays a predicted "gap setting value" to the user or displays the predicted staple height. Other staplers have a three-position toggle switch that allows the user to manually select a closed staple height of 1.5 mm, 1.8 mm, or 2.0 mm.

[0005] Thus, such staplers are fired at a fixed jaw gap height, compressing all tissue contained within the stapler's jaws to that specific height. In some cases, the user is required to select a specific staple reload with a particular height to be used, based on the user's skill, past staple firing experience, and perception of the tissue being fired at. Furthermore, the anatomical structure of human organs does not inherently have a constant or consistent wall thickness, and it varies from patient to patient. Healthy tissue also exhibits considerable variation in size and thickness compared to diseased or inflamed tissue. Therefore, deciding which size staple to reload for use is a difficult decision. Although a wide range of staple reloads are available with various jaw gap heights and staple sizes, staplers do not offer adaptability regarding tissue thickness.

[0006] For some staplers, the staple size is selected by the user before use based on the surgeon's perception of tissue thickness (where no measuring instrument is provided, used, or assumed) or through past experience with similar tissues. However, the thickness of specific organs within a patient's body can vary as much as the thickness of similar anatomical structures in other patients. Therefore, selecting the exact staple size for a given tissue is difficult, and it is often difficult to determine whether a given tissue falls within one of the four or five finite sizes specified or intended for a given staple. Instructions for use with such staplers suggest that precisely sized staples can be used for a specific range of tissue thicknesses. However, the user is not provided with a mechanism or process for accurately or efficiently measuring the tissue. Thus, the situation becomes even more complicated in that the numerous staple size options increase the number of permutations and combinations for determining the appropriate staple size, tissue thickness, and / or force.

[0007] Furthermore, since the stapler fires at a fixed height, it will always feed out staples with a forming height of, for example, 1.5 mm. This can be problematic if the user chooses to fire the stapler onto tissue located outside the intended range of the instrument, which is often limited to a 0.5 mm window. Consequently, the formed staples will not capture or form within the tissue, and thus will not provide the intended sealing or closure of the tissue by the formed staples. Therefore, the formed staples are too large for a given tissue. In addition, measuring the tissue thickness prior to firing the stapler is useless, and it can be difficult to obtain effective accuracy for such measurements.

[0008] Therefore, using an inaccurate staple size with an inaccurate staple height for a given tissue thickness can result in the staple not being properly formed and / or causing excessive compression or restricted blood flow, which may lead to other complications during staple formation. [Overview of the project]

[0009] A self-adjusting height-reloading stapler is provided that automatically adjusts to the size of the tissue placed within the jaws. Thus, the surgical stapler takes tissue thickness into account and automatically adjusts based on the actual tissue thickness, without relying on user estimation or assessment. In this way, the stapler provides sufficient tissue compression to provide a seal and hemostasis at the cutting line without clamping or compressing so strongly that it causes ischemia and / or tissue damage.

[0010] The stapler allows for jaw gap compensation even if the user selects a staple size or cartridge that is too large for the tissue to be stapled. Therefore, the stapler has the ability to accommodate any tissue between a maximum jaw gap height (e.g., 0.037 inches / 0.038 inches (0.944 mm / 0.965 mm)) and a minimum jaw gap height (e.g., 0.017 inches / 0.018 inches (0.432 mm / 0.475 mm)), rather than firing at a single predetermined finite height.

[0011] The stapler forms staples at a specific staple height for a given tissue based on its tissue thickness. The stapler adjusts and sets the appropriate staple height (the height of the staple after forming) using pressure-force feedback from the tissue being compressed within its jaws. The stapler jaws, in contact with the tissue, can detect and respond to the tissue thickness, adjusting the staple height accordingly to provide the ideal closing staple height for each firing of the instrument for each piece of tissue captured by the instrument.

[0012] In various embodiments, a stapler is provided having a unidirectional spring-pushed lift that automatically adjusts the staple cartridge and / or staple formation within a certain size range (e.g., jaw gap and / or closing staple height). The lift is automatically released when the staple firing mechanism begins its forward translation in the firing sequence. The automatic unidirectional adjustment also adjusts the staple cartridge while keeping it parallel to the anvil to provide consistent staple formation. In various embodiments, the surgical stapler has an automatically vertically adjusting staple cartridge.

[0013] In various embodiments, a surgical stapler has a first jaw including an anvil and a second jaw including a cartridge containing a plurality of staples, the first jaw being able to move closer to or away from the second jaw. The surgical stapler further has a cartridge lift provided between the second jaw and the cartridge, the lift being positioned to move the cartridge toward the first jaw while the lift is moving longitudinally.

[0014] In various embodiments, the surgical stapler has a first jaw including an anvil and a second jaw extending from a proximal end to a distal end, including a cartridge for housing a plurality of staples, the first jaw being able to move toward or away from the second jaw. The surgical stapler has a cartridge lift provided between the second jaw and the cartridge, which is biased longitudinally toward the proximal end away from the distal end of the second jaw.

[0015] In various embodiments, the surgical stapler has a first jaw including an anvil and a second jaw including a cartridge, the first jaw being able to move toward the second jaw. The surgical stapler further has an upper arm and a lower arm, and an operating beam that determines the distance between the upper arm and the lower arm, the distance being adjustable.

[0016] In various embodiments, the surgical stapler has an upper jaw including an anvil and a lower jaw including a cartridge. The lower jaw can move toward the upper jaw, and the distance between the upper and lower jaws is adjustable. The most proximal portion of the jaws has a gap of nearly zero between the upper and lower jaws.

[0017] These and other features of the present invention will become apparent from the description of embodiments, which will be made with reference to the relevant drawings.

[0018] The present invention can be understood by referring to the following description made in conjunction with the accompanying drawings, where the same reference numerals indicate the same parts throughout the drawings. [Brief explanation of the drawing]

[0019] [Figure 1A] A staple transsector (crosscutting device) receptacle for a surgical stapler as various embodiments of the present invention. [Figure 1B] This is a side view of an actuator for a surgical stapler according to an embodiment of the present invention. [Figure 2A] This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 2B] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 3A] This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 3B] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 4] This is an exploded assembly diagram of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 5] This is an exploded assembly diagram of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 6] This is an exploded assembly diagram of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 7A] This is an exploded assembly diagram of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 7B] This is an exploded assembly diagram of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 8A]A plan view of a staple pusher according to various embodiments of the present invention. [Figure 8B] A perspective view of a staple pusher according to various embodiments of the present invention. [Figure 8C] A perspective view of a staple pusher according to various embodiments of the present invention. [Figure 9A] A perspective view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 9B] A perspective view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 10A] A perspective view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 10B] A perspective view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 11A] A front view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 11B] A side cross - sectional view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 12A] A front view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 12B] A side cross - sectional view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 13A] A side cross - sectional view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 13B] A side cross - sectional view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 14A] A side cross - sectional view of a staple - transecting receptacle of a surgical stapler as various embodiments of the present invention. [Figure 14B] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 15A] This is a perspective view of several parts of a staple transsector receptacle for a surgical stapler as various embodiments of the present invention. [Figure 15B] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 16A] This is a perspective view of several parts of a staple transsector receptacle for a surgical stapler as various embodiments of the present invention. [Figure 16B] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 17A] This is a perspective view of the distal end of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 17B] This is a perspective view of the proximal end of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 17C] This is a perspective view of the distal end of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 17D] This is a perspective view of the proximal end of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 18] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 19] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 20] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 21] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 22] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 23] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 24] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 25] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 26] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 27] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 28] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 29] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 30] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 31] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 32] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 33] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 34] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 35] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 36] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 37] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 38] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 39] This is a perspective view of an actuator for a staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 40] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 41] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 42] This is a perspective view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 43] This is a side view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 44] This is a side view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 45A]This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 45B] This is a perspective view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 45C] This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 45D] This is a perspective view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 46] This is a perspective view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 47] This is a perspective view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 48] This is an exploded assembly diagram of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 49] This is a side view of an actuator for a surgical stapler as one of various embodiments of the present invention. [Figure 50A] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 50B] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 51A] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 51B] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 51C] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 52A]These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 52B] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 53A] This is a side view of a staple as one of various embodiments of the present invention. [Figure 53B] This is a side view of a staple as one of various embodiments of the present invention. [Figure 54] These are front cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 55A] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 55B] This is a side view of an actuator for a staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 56A] This is a side view of a staple as one of various embodiments of the present invention. [Figure 56B] This is a side view of a staple as one of various embodiments of the present invention. [Figure 56C] This is a side view of a staple as one of various embodiments of the present invention. [Figure 57A] This is a perspective view of several parts of a staple transsector receptacle for a surgical stapler as various embodiments of the present invention. [Figure 57B] This is a perspective view of several parts of a staple transsector receptacle for a surgical stapler as various embodiments of the present invention. [Figure 58A] This is a perspective view of several parts of a staple transsector receptacle for a surgical stapler as various embodiments of the present invention. [Figure 58B] This is a perspective view of several parts of a staple transsector receptacle for a surgical stapler as various embodiments of the present invention. [Figure 59A] These are front cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 59B] These are front cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 60] This is an exploded assembly diagram of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 61A] These are side cross-sectional views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 61B] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 62A] This is a perspective view from below of the staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 62B] This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 63A] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 63B] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 64A] This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 64B] This is a perspective view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 65A] This is a perspective view of a portion of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 65B]This is a perspective view of a portion of the staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 66A] This is a side view of a portion of the staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 66B] This is a side view of a portion of the staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 67A] This is a side view of a portion of the staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 67B] This is a side view of a portion of the staple transsector receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 68A] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 68B] This is a perspective view from below of the staple transceptor receptacle of a surgical stapler, as one of various embodiments of the present invention. [Figure 69A] This is a bottom-view perspective of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 69B] This is a bottom-view perspective of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 70A] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 70B] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 71] This is a side cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 72A]These are side views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 72B] These are side views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 73] These are side views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 74] These are side views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 75A] These are front views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 75B] These are side views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 75C] These are front views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 75D] These are side views of several parts of the staple transsector receptacle of a surgical stapler as various embodiments of the present invention. [Figure 76] This is a front cross-sectional view of a staple transsector receptacle of a surgical stapler as one of various embodiments of the present invention. [Figure 77A] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 77B] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 78A] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 78B]This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 79A] This is a plan view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 79B] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Figure 79C] This is a side view of a staple transsector receptacle for a surgical stapler as one of various embodiments of the present invention. [Modes for carrying out the invention]

[0020] According to various embodiments, a surgical stapler is provided. In various embodiments, this stapler has a unidirectional vertically adjustable staple cartridge. The stapler has a first jaw that holds the staple cartridge and a second jaw that holds the anvil. These jaws and shaft are dimensioned to fit into a cannula that has an inner diameter of at most 12 mm. The shaft is positioned between the jaws and the actuator. The actuator allows a user, such as a surgeon, to operate a handle, lever, switch or other operationally accessible actuator to open and close the jaws, thereby grasping tissue, articulating the jaws from end to end, and firing staples from the staple cartridge, keeping them in the grasped tissue and cutting the tissue between the jaws. The vertically adjustable staple cartridge is automatic and does not rely on user interaction, and after the jaws are closed, it exerts a uniform vertical compressive force toward the tissue and presses against the anvil. In one embodiment, the vertically adjustable mechanism is activated only after the jaws are closed, and firing is initiated without any function to prevent or stop firing. This prevents unwanted tissue compression or injury.

[0021] The vertical adjustment mechanism drives the staple cartridge only vertically toward the anvil, not side-to-side, or allows wobbling. Furthermore, in various embodiments, the staple cartridge can only move toward the tissue and anvil, not away from them. Therefore, once the vertical adjustment mechanism is activated, the staple cartridge can only move in one direction.

[0022] Referring to Figures 1 to 79, surgical staplers are provided according to various embodiments. In various illustrated embodiments, the surgical stapler has an actuator 2 detachably connected to a staple transsector receptacle (STR) 10. The STR has an upper movable jaw 11 and a lower stationary jaw 12 located at the distal end of an elongated shaft 14. The upper jaw 11 is configured to have an anvil 9, and the lower jaw is configured to have a staple cartridge 5. An actuator interface 15 is provided at the proximal end of the elongated shaft 14. The actuator interface connects the STR 10 to and from the actuator 2. The actuator 2 has a rotator 16 that, when turned by the user, rotates the elongated shaft 14 and thus the jaws 11, 12. The actuator 2 further has a trigger or movable handle 21 connected to a stationary handle or handle base or base 22. In one embodiment, the handle base has two halves that connect to each other to form a handle base 22. When the trigger 21 is operated by the user under specific conditions described in detail below, it results in the opening and closing of the jaws 11, 12, the firing of staples, the translation of the blades, and the vertical adjustment of the staple cartridge. In one embodiment, both the upper and lower jaws move relative to each other, and in another embodiment, the lower jaw moves while the upper jaw remains stationary.

[0023] The upper jaw 11 has an anvil 9 for shaping a plurality of staples 6 that are sequentially ejected from the staple cartridge 5. The upper jaw 11 is rotatably coupled to an upper outer cover 91, which is coupled to a lower outer cover 92. The upper jaw 11 has a jaw spring 93 that biases the upper jaw to an open or separated position. The lower outer cover 92 is coupled to a retainer 121. The retainer 121 is attached to the retainer and holds an inclined track 80 having a plurality of inclined projections 81. The retainer 121 also houses a movable cartridge platform or lift 82 having a plurality of inclined projections 83, the inclined projections 83 coupled in correspondence with the plurality of inclined surfaces 81 of the inclined track 80. The staple cartridge 5 rests on the cartridge lift 82. When the cartridge lift 82 is moved longitudinally and proximal (for example, as indicated by arrow H), the inclined projection 83 of the cartridge lift 82 slides on the inclined projection 81 of the ramp 80, thereby moving the cartridge 5 vertically (for example, as indicated by arrow V) or laterally (for example, perpendicular to) the longitudinal axis 1 of STR10.

[0024] The staple cartridge 5 has multiple staples 6 located in multiple staple pockets and a corresponding set of staple pushers 7. Through the interaction of a set of fins 171 on the slider 17 and the staple pushers, staples are launched or ejected from the staple cartridge 5. Staples in the cartridge 5 are thus launched by the longitudinal motion of the slider, which interacts with the staple pushers in the cartridge's staple pockets. The launched staples penetrate the tissue clamped between the jaws 11, 12 and strike an anvil pocket provided in the anvil 9, where they are formed. The slider 17 is operationally connected to an actuation beam 18. The actuation beam 18 has a blade 19, which is connected to an actuation slider 180. In one embodiment, the actuation slider 180 consists of a proximal actuation slider 181 coupled to a distal actuation slider 182. The distal actuation slider 182 is perpendicular to the proximal actuation slider 181, and both sliders extend parallel to the longitudinal axis 1 of STR10. In the illustrated embodiment, the intersection lines of the proximal actuation slider and the distal actuation slider form a cross shape when viewed in cross-section.

[0025] The operating beam 18 has an upper guide or roof 183 configured to move within a longitudinal slot or channel provided in the upper jaw 11 and a lower guide or floor 184 configured to move within a longitudinal slot or channel provided in the lower jaw 12. Similarly, the staple cartridge 5, cartridge lift 82 and retainer 121 have longitudinal channels through which the lower guide 184 is inserted. The upper and lower guides of the operating beam ensure parallel jaw alignment and compression of the closing jaws 11 and 12.

[0026] The actuating sliders 181 and 182 are surrounded by an actuating cover tube 185, which has an opening 186, and the STR reuse lockout 41 is biased by a leaf spring 42 through the opening 186 of the actuating cover tube 185. The actuating cover tube has slots or guides to ensure the alignment and translational motion of the actuating sliders 181 and 182.

[0027] An outer tube 94 surrounds an operating cover tube 185, which is coupled to an actuator interface 15 by a pair of opposite projections on opposite sides of the interface, thereby enabling a removable connection to an STR coupler 151. A coupler spring 152 is positioned between the rotor and the STR coupler to bias the rotor distally, so that the spring is compressed by the rotor's movement in the proximal direction, exposing the coupling portion to the coupler 151 and the actuator interface 15, enabling a removable connection to the coupler. An articulated beam 51 is provided, extending parallel to the operating cover tube 185 and the operating sliders 181, 182. The articulated beam 51 is coupled to the upper and lower outer covers 91, 92, and in one embodiment has a proximal end that fits into a slot in the operating cover tube 185 and floats and moves within it.

[0028] Actuator 2 is operably coupled to STR10, which is detachably coupled, and this actuator acts the jaws 11, 12 from an open / closed configuration to a unidirectional automatic self-adjusting stapler, or acts them from a forward configuration to a reverse configuration by driving or manipulating the actuation beam 18 forward or backward (distal or proximal). Figures 17 to 46 show, in particular, the actuator 2 with the internal mechanism mounted in various operating states according to various embodiments. For example, Figures 17A and 17B show the stapler with its jaws open or in an initial configuration, and Figures 17C and 17D show the stapler with its jaws closed but in a non-firing or non-firing configuration.

[0029] In the stapler's initial position, the actuating beam 18 is positioned at its most proximal travel position, and the jaws 11, 12 are in the open position. The actuating beam engages with the upper jaw 11 as it is translated distally along the longitudinal axis 1 of the elongated shaft 14. By translating the actuating beam distally from the initial position by a first specified longitudinal distance (e.g., 0.225 inches (5.715 mm)), the jaws can be actuated from the open position to the closed position. With the jaws in the closed position, the jaw spring biases the jaws to the open position and can be influenced to move the actuating beam proximal by moving the same first distance back to the open position. The trigger 21 of the actuator 2 is operatively coupled to the actuating beam so that when the trigger is squeezed, the jaws close, and when the trigger is pushed open or, in one embodiment, released, the jaws open. In one embodiment, the trigger 21 is connected to a forward distal pivot pawl 25 having a top or teeth that can engage with a groove or notch 71 provided on an actuation rod 62 which is actuarially connected to the actuation beam 18. The engagement of the forward distal pivot pawl with the groove 71 on the actuation rod helps to move the actuation rod distally when the trigger is rotated toward the handle base. This distal movement of the actuation rod moves the actuation beam 18 distally, thereby closing the jaws.

[0030] Similarly, in one embodiment, the trigger 21 is connected to a forward proximal pivot pawl 28 having a tip or teeth that can engage with a groove or notch 72 provided on an actuation rod 62 which is actuarially connected to the actuation beam 18. The engagement of the forward proximal pivot pawl with the groove 72 on the actuation rod helps to move the actuation rod in the proximal direction when the trigger is rotated away from or released from the handle base. This proximal movement of the actuation rod allows the jaws to open. The trigger 21 is spring-driven so that the trigger is biased back to the initial or open position when the trigger is rotated away from the handle base. The forward distal pivot pawl 25 and the forward proximal pivot pawl 28 are rotatably connected to the trigger 21 and, in one embodiment, form a "V" or a similar shape, with the distal pivot pawl 25 extending in the opposite direction to the proximal pivot pawl 28. The groove or notch 71, which is operatively engageable with the distal pivot claw 25, is located near the distal end of the operating rod and far from the groove 72, which is operatively engageable with the proximal pivot claw 28. The opening and closing operation can be repeated many times as desired by the user, thereby enabling, for example, grasping or cutting tissue in a given surgical procedure.

[0031] In various embodiments, the STR recognition cylinder 31 prevents the firing operation or movement if the STR 10 is not attached to the actuator 2. However, the movement or articulation of the trigger 21 of the actuator 2 is not prevented. Enabling the movement of the actuator can aid in the packaging and testing of the actuator. In addition, this allows for the attachment of other front-end actuating units that may require gripping and / or articulation, whether or not they have the function or use for firing staples, thereby increasing the versatility of the actuator 2. In various embodiments, the attachment of the STR causes the recognition cylinder 31 to move proximal, thereby compressing the STR recognition spring 32, which is coupled to the recognition spring. The spring 32 biases the recognition cylinder distal, and in one embodiment, this spring is coupled to and trapped between the outer surface of the actuating cylinder 55 and the inner surface of the recognition cylinder surrounding the spring 32. The recognition cylinder, spring, and articulation cylinder are coaxially aligned. The movement of the recognition cylinder moves the first connector arm 33, which is connected to the cylinder. In one embodiment, the connector arm 33 has a distal end attached to the proximal end of the recognition cylinder, and a notch provided on the distal end of the connector arm 33 engages with a peripheral flange provided around the proximal end of the recognition cylinder. The proximal end of the connector arm 33 has a flange that is slidably coupled to the arming hub 61 via a notch or slot provided on the arming hub. When the flange of the connector arm 33 is positioned within the slot of the arming hub 61, the rotational movement of the arming hub 61 is prevented. As will be described in detail below, the rotational movement of the arming hub 61 rotates the actuation rod 62, thereby allowing the interaction between the rod and the trigger to fire staples or open and close the jaws.

[0032] The arming hub 61 is also connected to a firing button 60, which allows the user to set the stapler to firing mode or reverse mode. Each time the firing button is activated, the rod rotates to the respective operating position for the corresponding operation. Thus, the connector arm 33, located within the slot of the arming hub 61, prevents the rotational movement of the arming arm, thereby also preventing the activation of the firing button, and thus preventing the switching of the stapler's operation. Since the STR is attached to the actuator, the entire operation of the handle assembly is restored or advanced. In one embodiment, a bifurcated operating rod, for example, a proximal operating rod 63 and a distal operating rod 64, allows rotational movement by the user via the rotator 16 without operating the stapler.

[0033] The distal end of the actuating rod 62 is detachably coupled to the actuating slider of the STR. In one embodiment, the distal end of the actuating rod has a slotted shape, which is configured to receive and twist a corresponding paired flange provided on the actuating slider to lock the actuating rod into a detachable paired connection to the actuating slider 180. Thus, the translational motion of the actuating rod also causes the actuating slider to translate.

[0034] Once the jaws 11 and 12 are completely closed by squeezing the trigger, the user can change the mode of the handle to a forward configuration in which the firing and self-adjusting mechanism is activated by pressing the actuator forward or the firing button 60.

[0035] As described above, in one embodiment, the STR must be attached in order to activate the firing button 60. In one embodiment, the firing button 60 also cannot be activated until the operating rod moves to a predetermined first distal distance. According to various embodiments, for example, as shown in Figures 27 to 29, once the trigger 21 is released with the STR attached and the jaws fully closed, the jaws cannot be opened again until the staples are fired.

[0036] Once in the first operating position, activation of the trigger drives the operating beam distally (i.e., in only one direction). In one embodiment, the initial throttling of the trigger also activates a self-adjusting height mechanism to resize the gap between the jaws. In one embodiment, the cartridge lift 82 of the lower jaw 12 is activated, thereby lifting the cartridge or moving only vertically to self-adjust to the tissue in the jaw. In one embodiment, at this point, the STR reuse lock 41 is also activated. This STR reuse lock 41 ensures that the STR is placed in firing mode only once to prevent the user from inadvertently attempting to fire a previously used STR. Once the STR is opened or closed or returned to its initial position, the STR reuse lock 41 prevents the STR from firing again. Further activation of the trigger drives the operating beam further forward, sequentially ejecting the staples and traversing the tissue gripped between the closed jaws.

[0037] In one embodiment, the slider 17 has two or more inclined fins 171, and the slider can move longitudinally to sequentially contact the staple pusher 7 to push the staples 6 in the staple cartridge 5. A longitudinally movable actuation beam 18 moves the slider distally and longitudinally. In one embodiment, the slider is not connected, and the slider does not have a key, hook or cavity for attachment to the actuation beam. Therefore, the slider can only move distally in the longitudinal direction, and the slider cannot retract, return to, or move toward its proximal or initial position by the movement of the actuation beam. However, the actuation beam 18 can return to or move toward its proximal or initial position. Therefore, in one embodiment, this allows the pusher 7 to fall back into the staple cartridge after being partially pushed or moved vertically by the longitudinal movement of the slider. This return motion into the cartridge reduces potential trauma to the tissue, potential adhesion of the staples to the tissue, and thus provides a smooth overall surface of the staple cartridge, allowing for the removal of tissue from between the jaws.

[0038] In addition, in embodiments in which the cutting blade 19 is incorporated into or mounted on the working beam 18, the working beam is allowed to return to or move toward its proximal or initial position and then return to that position simultaneously, or without constraint, thereby further cutting or cutting tissue if desired or necessary. The working beam has an upright edge, and the top and bottom vertical edges form or comprise an upper guide 183 and a lower guide 184. The upright edge moves within a longitudinal slot or channel that penetrates the staple cartridge and extends between the staples and the staple pusher. The cutting blade is incorporated into or mounted on the upright edge of the working beam to cut tissue between the jaws. Thus, the blade and upright edge of the working beam move through a longitudinal channel provided in the staple cartridge, anvil, or both in one embodiment. The top and bottom vertical edges rest along the outer surface of the jaws and ensure a fixed gap height, i.e., the distance between the top edge and the bottom edge, thereby exerting localized compressive force on the tissue. The top vertical edge or upper guide pushes the anvil and tissue vertically downward toward the staple cartridge and other jaws, pressing them against each other, while the bottom vertical edge or lower arm pushes the staple cartridge and tissue vertically upward toward the anvil and opposing jaws, pressing them against each other. The compressive force is localized where the edges are positioned on the outer surface of the jaws during the operation or firing stroke of the working beam.

[0039] When the firing button 60 is pressed, for example as shown in Figures 30 to 32, the arming hub 61 rotates when the button is translated in a direction perpendicular to the longitudinal axis 1. In one embodiment, the arming hub 61 rotates in one direction, for example counterclockwise, when the button is translated in a linear direction, and in the opposite direction, for example clockwise, when the button is translated in the opposite linear direction. The actuation rod 62 (and / or proximal actuation rod 63 as shown) connected to the arming hub 61 also rotates clockwise when the arming hub is rotating. Similarly, the actuation rod rotates counterclockwise when the arming hub is rotating in the same direction.

[0040] The arming hub 61 is circular in shape and has a central opening through which the actuation rod is inserted. The outer portion of the arming hub has a slot or groove that operatively connects to the connecting arm. A series of teeth are provided along another portion of the outer portion, which operatively connect to or mesh with a similar series of teeth on the firing button 60. The inner portion of the arming hub has a projection or knob-like projection that extends toward the central opening and connects to a longitudinal slot provided on the actuation rod.

[0041] With the fire or forward button pressed and the actuation rod rotated, the tips or teeth of the proximal pivot claw 28 and distal pivot claw 25 now actuarially engage with a series of teeth 73 longitudinally arranged along the actuation rod 62 (and / or the proximal actuation rod 63 as shown). When the trigger 21 is rotated, the proximal pivot claw 28 and distal pivot claw 25 translate along or distal to the actuation rod. Once the proximal pivot claw 28 engages with one of the teeth 73 located in or on the actuation rod, the actuation rod moves or translates distally as the trigger continues to rotate. By releasing the trigger or moving it away from the handle base 22, the proximal pivot claw 28 and distal pivot claw 25 return along or proximal to the actuation rod. However, the tips or teeth of the proximal pivot claw 28 and distal pivot claw 25 now actuarially engage with the more proximal portion of a series of teeth 73 longitudinally arranged along the actuation rod 62. The distal pivot claw 25, engaged with one of the teeth of the series of teeth 73, prevents the proximal movement of the actuation rod and actuation slider and prevents the jaws from opening. The proximal pivot claw, engaged with one of the teeth of the series of teeth 73, allows the actuation rod, actuation slider, and actuation beam to move further distally and enables the continued firing of staples and the cutting of tissue between the jaws. Thus, by performing multiple strokes or releases of the trigger, the proximal and distal pivot claws can be moved sufficiently to fully eject the staples and cut the tissue between the jaws. In one embodiment, only one stroke is used to eject the staples and cut the tissue between the jaws. The actuator is shown in the state at the end of its movement or after the staples have been fully ejected, for example, in Figures 33-35 and 45C-45D.

[0042] According to various embodiments, the trigger 21 is coupled to an intermediate action gear 23 and a trigger action gear 24. In the illustrated embodiment, the trigger action gear 24 has a central opening through which a pivot projection of a movable handle is inserted. The trigger action gear has a set of teeth that mesh with or are coupled to one of two sets of teeth of the intermediate action gear. By rotating the trigger 21, the trigger action gear rotates, and the intermediate action gear 23 rotates in response. In particular, by tightening the trigger 21, the trigger action gear 24 rotates in one direction, for example, counterclockwise, and thereby the intermediate action gear 23 rotates in the opposite direction, for example, clockwise. The other set of teeth of the intermediate action gear meshes with the teeth of the movable rack 27, thereby moving the rack proximally. In one embodiment, the movable rack is positioned parallel to the operating rod. Also, by moving the rack proximally, the reverse pawl 26 moves or translates proximally. In firing mode, during staple firing, the tip of the reverse claw slides within or against the outer surface or slot provided on the actuating rod 62 (and / or the proximal actuating rod 63 as shown in the figure). Thus, the rack can move distally and proximal based on the actuation or rotation of the trigger.

[0043] In one embodiment, when the tip of the reversing pawl 26 moves to its proximal or most proximal position, this tip engages with the wall in the slot of the actuating rod or with teeth along the actuating rod 62. The wall or teeth of the actuating rod 62 act as a hard stop or additional stop that prevents the actuating rod from moving further distally.

[0044] The rack 27 is positioned within a slot or channel provided in the handle base 22, and in one embodiment, when the rack 27 is moved to a proximal or most proximal position, it engages with the wall or proximal end of the slot, thereby preventing further proximal movement of the rack 27, thus resisting further rotation of the intermediate action gear 23, thereby resisting further rotation of the trigger action gear 24, thereby preventing further tightening or closing of the trigger 21. Similarly, in one embodiment, when the rack 27 is moved to a distal or most distal position, it engages with the wall or distal end of the slot, thereby preventing further distal movement of the rack 27, thus resisting further rotation of the intermediate action gear 23, thereby resisting further rotation of the trigger action gear 24, thereby preventing further opening of the trigger 21 or movement of the trigger away from the handle base.

[0045] Therefore, when the trigger is activated toward the handle base 22, the intermediate action gear 23 rotates in one direction, for example clockwise, thereby translating the rack 27 proximal, and when the trigger is activated toward the away from the handle base, the intermediate action gear rotates in the opposite direction, for example counterclockwise, thereby translating the rack distal. The reverse pawl 26, which is rotatably connected to the distal end of the movable rack 27, slides proximal or distal as the rack is translating proximal or moving distally.

[0046] According to various embodiments, the surgical stapler provides unidirectional automatic vertical adjustment of the staple cartridge 5. The cartridge 5 is moved vertically within the lower jaw 12, and in one embodiment, the cartridge can move perpendicular to the retainer 121 of the lower jaw 12. The cartridge within the lower jaw can move perpendicularly toward the anvil (for example, as indicated by arrow V) by the interaction of an inclined projection 83 provided on the bottom surface of the cartridge lift 82 and an inclined projection 81 on the ramp 80. The cartridge rests on the upper surface of the cartridge lift 82. The upper surface of the cartridge lift 82 is flat as a whole and / or has no inclined projections at all. In one embodiment, the cartridge lift has guides or protrusions provided along the sides of the cartridge lift to ensure proper seating or assembly of the cartridge on the upper surface of the cartridge lift. In one embodiment, the cartridge lift further has channels or slots through which such channels or slots receive the blades and / or upright edges of the working beam that can move longitudinally through them. In the illustrated embodiment, the cartridge is configured to move in only one direction, i.e., vertically (as indicated by arrow V). A cartridge lift is also positioned between the cartridge and the ramp. The ramp remains stationary and cannot move, while the cartridge can move in one direction, i.e., vertically and away from the ramp. When the cartridge lift is moved longitudinally and proximal (as indicated by arrow H), the inclined projection 83 of the cartridge lift slides along the inclined projection 81 of the ramp 80, which remains fixed within the lower jaw 12, thereby lifting the cartridge 5 vertically. Thus, the surgical stapler has a series of inclined projections that lift the cartridge vertically and allow adjustment of the molded staple height to multiple intermediate points between the upper and lower staple heights and gap limits and along the gradient of the inclined projections.

[0047] The cartridge lift 82 is also biased in the proximal longitudinal direction in one embodiment. Such biasing occurs, in one embodiment, only when the height adjustment mechanism is activated or the firing operation is initiated, for example, when the actuation slider has moved beyond a first specified distance. In a particular embodiment, the cartridge lift 82 is biased or tensioned by a cartridge lift spring 87 that pulls the cartridge lift in a proximal direction along or aligned with the longitudinal axis. The biased lift applies an effective vertical force to the cartridge 5, thereby pressing the cartridge 5 against the tissue held between the jaws 11, 12.

[0048] In another embodiment, initially, the spring 87 or tension mechanism is locked or inoperable, and thus does not provide any tension or force to pull the cartridge lift in the proximal direction. Therefore, when inoperable, the cartridge 5 and associated cartridge lift 82 remain in their initial or lowest vertical position.

[0049] The cartridge lift 82 is biased or pulled in the proximal direction by spring 87 when the cartridge lift is unlocked or the spring is released (for example, as indicated by arrow H). Once unlocked, the cartridge lift is pulled or pulled proximal, and thus resists or cannot move freely distally back to its original or initial position. Similarly, the cartridge 5 is lifted vertically from its initial or lowest position. The amount or distance the cartridge moves vertically is based on the force applied by the spring, the amount of tissue between the jaws, and the clamping or compressive force exerted on the tissue by the jaws in the closed position. According to various embodiments, the cartridge exerts a uniform, unidirectional, consistent vertical force when biased by the force applied by the spring. The cartridge lift and / or lift bias or spring (e.g., spring 87) are, in various embodiments, restrained by a lift lock, which, in various embodiments, is not accessible to the user. Once the lift lock is displaced, the cartridge lift is pulled or subjected to tension, and thus resists returning to its original or initial position, or is unable to return to that position.

[0050] In the illustrated embodiment, the cartridge lift 82 is connected to the cartridge lift beam 84, and the cartridge lift beam 84 is connected to the cartridge lift cylinder 85. In one embodiment, the proximal end of the cartridge lift has an opening for receiving a pin and a slot for receiving a flange connected to or extending from the distal end of the cartridge lift beam 84. The proximal end of the lift beam is connected to the distal end of the lift cylinder 85, for example, by welding or riveting. The lift cylinder has a central opening and is provided around or surrounds the operating cover tube 185. The lift cylinder is thus coaxial with the operating cover tube 185, the operating slider 180, the operating rod 82 and the lift beam 84, and is also parallel to the operating slider 180 and the operating rod 62. The lift cylinder is biased in the proximal direction by the cartridge lift spring 87 (for example, as indicated by arrow H). The cartridge lift spring also surrounds the operating cover tube 185, which is aligned and positioned between the upper and lower outer covers 91, 92 and the lift cylinder 85. In the illustrated embodiment, the cartridge lift spacer 86 is positioned between the spring and the lift cylinder (e.g., behind the spring) or, in one embodiment, between the upper and lower outer covers and the spring (e.g., in front of the spring) to accommodate tolerances in the assembly or dimensionality of the spring, and thus accommodate the strength of the spring, thereby ensuring that an appropriate compressive force is applied to a given structure positioned between the jaws. The lift cylinder 85 can fire staples or remains stationary or is prevented from moving proximally until or immediately before the stapler is in the firing configuration or position. In various embodiments, the lift cylinder 85 is stopped by a lift lock, which in various embodiments is not accessible to the user. In various embodiments, the lift lock is a reload or STR reuse lockout. In various embodiments, the STR reuse lockout 41 is aligned with the lift cylinder 85 and thus biased to be in contact with the lift cylinder, thereby preventing the lift cylinder from moving proximal to the longitudinal side.If the STR reuse lockout becomes misaligned or is moved away from the lift cylinder, the lift spring 87 biases the lift cylinder proximal. In various embodiments, the lift lock or STR reuse lockout is in contact with or coupled to the actuating slider, and thus becomes misaligned once the actuating slider initiates a firing operation or just before it is able to fire staples or is ready to fire at any time.

[0051] In one embodiment, the lift cylinder also slides along the STR reuse lockout, thereby preventing the STR reuse lockout and the lift cylinder from moving in parallel. Therefore, once the lift cylinder is actuated, it cannot be relocked or returned to its initial or proximal position. Similarly, the cartridge lift, which is connected to the lift cylinder by the lift beam, cannot return to its initial or proximal position. The cartridge lift also moves longitudinally and proximal (as indicated by arrow H, for example) under the influence of the spring and the movement of the cylinder. The interaction between the inclined projection of the cartridge lift and the inclined projection of the ramp when the cartridge lift is moving proximal causes the cartridge lift to move the staple cartridge 5 uniformly vertically (as indicated by arrow V, for example). According to various embodiments, slots or channels that interact in correspondence with projections or stoppers provided on the cartridge, retainer, or both ensure or assist in the uniform and single vertical movement of the cartridge. The interaction between the inclined projection and the biasing force of the lift cylinder also acts as an integrated height lockout for the staple cartridge, thereby allowing the stapler to fire at the adjusted staple height position, in which case it is not possible for it to be returned to the open or pointed position.

[0052] The adjustment of the cartridge height occurs while the jaws are closed over a piece of tissue, and this adjustment is performed automatically by the stapler. The surgeon / user does not select the staple height or staple size. Therefore, the staple height is automatically set by the stapler based on the thickness of the tissue and the resistance it provides. Adjusting the cartridge height also causes the cartridge to move relative to the anvil while its apex and basal surfaces are parallel to each other. During adjustment, the apex and basal surfaces remain parallel to each other, and these surfaces remain parallel to each other even after the movement is complete.

[0053] As shown in Figure 50A, the distal end of the STR reuse lockout 41 initially rests on the outer top surface of the actuating slider 180 or, in one embodiment, the proximal actuating slider 181. In one embodiment, the proximal end of the STR reuse lockout is connected to the actuating cover tube 185. A leaf spring rests on the top of the STR reuse lockout and is connected to the cover tube. The leaf spring biases or rotates the distal end of the STR reuse lockout so that it rests against or presses against the actuating slider. Next, also referring to Figure 51B, when the jaws are being opened and closed, the distal end of the STR reuse lockout remains on the outer top surface of the actuating slider and, as the slider moves and the jaws are opened and closed, it floats and moves longitudinally proximal and distal.

[0054] Once staple firing is initiated or activated, the actuation slider moves distally forward, thereby allowing the distal end of the STR reuse lockout 41 to fall into a slot or opening 187 provided in the actuation slider. Thus, the distal end of the STR reuse lockout rests on or on the outer surface of the slot in the actuation slider, as shown in Figures 51A–51C, when the actuation slider moves longitudinally distally to eject the staple from the staple cartridge.

[0055] The top or outer surface of the distal end of the STR reuse lockout falls below the bottom surface of the outer cover tube, lift cylinder, or both. Similarly, the bottom or underside of the distal end of the STR reuse lockout rests on the slot or top of the distal underside of the actuating slider. Thus, the distal end of the STR reuse lockout is positioned or captured between the outer cover tube or lift cylinder and the actuating slider. In addition, unlike the actuating slider, the STR reuse lockout does not move longitudinally, but rotates or moves perpendicular to or laterally to the longitudinal direction of the actuating slider.

[0056] When the actuari slider is returned, the distal end of the STR reuse lockout is trapped or engaged within the distal slot provided in the actuari slider, as shown in Figures 52A and 52B. Thus, the STR reuse lockout prevents further movement of the actuari slider in both the longitudinal proximal and distal directions. Consequently, the STR can no longer fire or eject any staples, nor can it move the knife blade or reset the cartridge lift. According to various embodiments, the fact that the staple cartridge is now in a raised state can serve as an indicator that the STR and / or cartridge can no longer fire, that there are no staples, that the stapling or cutting operation is complete, or any combination thereof.

[0057] According to various embodiments, the staple cartridge 5 has one or more stoppers or protrusions 551, 552 that are positioned and shaped to fit into and slide within slots or openings 1211, 1212 provided in the lower jaw 12. The protrusions 551, 552 are provided on the side wall of the staple cartridge, and the slots 1211, 1212 are provided on the side wall of the cartridge holder, retainer 121, or the lower jaw 12 of the stapler. The fitting of the protrusions and slots allows the staple cartridge to move vertically, but also restricts the staple cartridge to move only vertically and not from side to side or longitudinally distally or proximal. In various embodiments, the protrusions or stoppers, for example, protrusion 551, restrict the movement of the staple cartridge in directions other than vertical and prevent the staple cartridge from being removed from the lower jaw of the stapler. In various embodiments, the staple cartridge can move vertically but is permanently attached to the jaws, thereby limiting the reuse or ejection or removal of the staple cartridge and ensuring consistent stapler operation. In various embodiments, the staple cartridge may be provided with just one projection or a set of projections, for example, projection 551, projection 552, or a combination thereof.

[0058] In various embodiments, the staple cartridge is a single, integrated structure that helps to compress the tissue by applying a uniform force. Individual staple pushers are provided within the staple cartridge in individual pockets, and individual staples are housed in each pocket. The action of the staple pushers causes the associated staples to protrude from the staple pockets and enter the clamped tissue and the anvil that forms or closes the staples.

[0059] In one embodiment, the fins of the slider 17 are offset longitudinally, so that one side of the blade, for example the right fin, is positioned distal to the blade compared to the opposite side, for example the left fin. Thus, the left fin is positioned proximal to the right fin. The fin offset distributes the force during staple ejection, thus reducing potentially excessive pressure on the tissue and decreasing the amount of force required to sequentially eject the staples from the staple pocket via the staple pusher.

[0060] The stapler has an articulated lever or switch 50 that moves the jaws 11, 12 along an elongated shaft from a zero or initial position to a tilted or 45° position relative to the longitudinal axis, and then back to the zero or initial position. When the surgeon operates the lever, it engages with the articulated anterior arm 52 and the articulated posterior arm 54, which move these arms from a separated or misaligned position to a aligned and linear position. One end of the posterior arm is connected to the lever, and the other end of the posterior arm is connected to the housing base. One end of the anterior arm is connected to the posterior arm along its middle section, and the other end of the anterior arm is connected to the articulated extension arm 53.

[0061] The other end of the articular movement extension arm 53 is connected to an articular arm hub 57, which surrounds and is connected to the articular movement cylinder 55. The articular movement cylinder has a plug-in coupling configured to be releasably coupled to the articular movement beam 51, and the distal end of the articular movement beam 51 is connected to a pivot post near the jaw pivot post that rotatably connects the jaws 11 and 12. The pivot post is positioned perpendicular to the jaw pivot post and offset from the center or longitudinal midline of the elongated shaft. By arranging the articular movement front arm and articular movement rear arm in a line with each other, the articular movement extension arm 53 is pulled or slid proximally, thereby sliding the articular movement hub and cylinder proximally and pulling the articular movement beam proximally. The proximal movement of the beam pulls the pivot post, thereby pulling the upper and outer covers 91 and 92, which are connected to the jaws 11 and 12 and also to the pivot post, proximally. Since the pivot post is positioned offset from the center of the shaft, the jaw cover moves toward the pivot post to position the jaws in an inclined position. When the lever is fully depressed, the front and rear arms are aligned and set in place, thereby holding the jaws in an inclined position. When the lever is released or returned to its original or initial position, the front and rear arms separate or become misaligned, thereby pulling the articulation beam proximal and releasing it, thus causing the articulation beam to move distally. By moving the articulation beam distally, the upper and lower outer covers and thus the jaws 11, 12 rotate back to their initial or zero position, thereby aligning the jaws with the longitudinal axis 1 of the stapler.

[0062] In one embodiment, the articular movement cylinder has a bias component, such as an articular movement cylinder spring 56, that surrounds the articular movement cylinder and is positioned between the outer surface of the articular movement cylinder and the inner surface of the articular movement hub. This spring biases the articular movement cylinder distally, and the articular movement cylinder also biases the articular movement beam distally, thereby biasing the jaws to the initial or zero position.

[0063] According to various embodiments, the reverse button (or the firing button) can be pressed at any point while the operating rod 62 is translating distally. Pressing the reverse button reverses the operation of the stapler, thereby allowing longitudinal movement of the operating rod backward or proximal.

[0064] For example, as shown in Figures 36-38 and Figures 46 and 47, when the reverse button is pressed (the fire button 60 is pressed again), the arming hub 61 rotates back to its initial position or in the opposite direction, for example, clockwise, while the button is moving in a linear direction. The actuation rod 62 (and / or the proximal actuation rod 63 as shown) connected to the arming hub also rotates back to its initial position or in the opposite direction, for example, clockwise.

[0065] With the firing or reverse button pressed and the operating rod rotating, the reverse claw 26, which is connected to the movable slider or rack 27, engages with or can engage with a series of teeth 74 that are longitudinally arranged along or within the operating rod 62. When the operating rod 62 is distal or in its most distal position, the teeth 74 become accessible or exposed to the reverse claw 26.

[0066] When the trigger 21 is activated or squeezed toward the handle base 22, the trigger action gear 24 rotates, thereby rotating the intermediate action gear 23, which in turn translates the rack 27 proximally. The reverse pawl 26 connected to the rack 27 also moves proximally and longitudinally. The reverse pawl 26, which engages with one of the teeth 74 on the operating rod 62, also moves the operating rod 62 proximally and longitudinally.

[0067] By releasing the trigger or moving the trigger away from the handle base 22, the reverse pawl 26 and rack return distally through the interaction and cooperation between the trigger and the intermediate action gear. However, the tip or teeth of the reverse pawl 26 operatively engage with the more distal portion of a series of teeth 74 longitudinally arranged along the actuarial rod 62. In addition, the engagement of the reverse pawl with the teeth 74 prevents or hinders the distal movement of the actuarial rod 62. Thus, by performing multiple strokes or throttling and release of the trigger, the actuarial rod 62 can be returned completely or nearly returned to its initial or most proximal position, thereby fully opening the jaws. Such strokes, in one embodiment, open the jaws in small increments, thus allowing the stapler to detach from the stapled tissue. In one embodiment, a single stroke is used to fully open the jaws. In various embodiments, the operation (e.g., closing / opening the jaws and / or firing staples) or the articulation of the stapler is assisted by one or more motors.

[0068] The anterior proximal and distal claws 28, 25 slide distally and proximal on the outer surface of the actuator rod 62 when the trigger is squeezed and released and when the rack moves proximal or distal. Thus, performing multiple strokes of the trigger or squeezing and releasing can fully or nearly return the actuator rod 62 to its initial or most proximal position, and can return or position or nearly return the anterior proximal and distal claws 28, 25 to their initial positions relative to the actuator rod 62 (for example, the anterior proximal claw 28 engages with the notch 72, and the anterior distal claw 25 engages with the notch 71). The actuator is shown in its end state of reverse movement, for example, in Figures 39 to 44. In one embodiment, when the trigger is finally squeezed while in reverse mode, STR is locked out and actuator 2 is reset to its initial or open / closed mode, for example, as shown in Figures 42 to 44.

[0069] According to various embodiments, the jaws 11, 12 and the elongated shaft, when closed, have an outer diameter less than or equal to the inner diameter of the trocar cannula. Typical surgical procedures may include single-site surgical access instruments or multiple trocar cannulas positioned on and through the patient's body. In one particular embodiment, the inner diameter of the trocar cannula matches 12 mm, and the jaw composition or components include upper and lower jaws, a pusher, staples, a cartridge, and jaw gap height. The cartridge is a nest for the pusher and staples, and in one embodiment, the cartridge is fixed within the lower jaw. The pusher is located below the staples, and when the pusher is subjected to action by the slider, it completely pushes the staples out of the cartridge pocket within the cartridge. Once the staples are pushed out of the cartridge, they are forced to pass through the tissue and deform by entering and contacting the corresponding anvil pockets within the anvil of the upper jaw. The working beam is a high-stress component because it compresses the tissue between itself and the hinged upper jaws, closing the hinged upper jaws, deploying the pusher to fire the staples, and then cutting the tissue at the center of the jaws.

[0070] According to various embodiments, with respect to a 3.5 mm stapler STR, the staple has a height of approximately 0.140 inches (3.556 mm), and the pusher is approximately 2 / 3 of the staple height to push the staple out of the cartridge and fully unfold it. With respect to such a staple, the jaw gap height between the upper jaw and the lower jaw is approximately 0.036 inches (0.914 mm). Figures 53A and 53B show a 3.5 mm staple 6 formed according to various embodiments and a 3.5 mm staple 6 in an unformed state. In the unformed state, the staple 6 has a height of approximately 3.5 mm and a width of approximately 3.0 mm, and in the formed state, the staple has a height of approximately 1.5 mm. The formed height may vary based on the tissue thickness and other conditions affecting staple formation. Figures 56A to 56C show an exemplary unformed staple 6, an exemplary staple 6 formed at the minimum height, and an exemplary staple 6 formed at the maximum height.

[0071] In the illustrated embodiment, the lower jaw has a thickness of 0.030 inches (0.762 mm) to ensure that the jaw remains rigid when clamped to tissue. The lower jaw has increased vertical strength because its sidewalls bend and wrap around the side of the cartridge and upward. The upper jaw is, generally speaking, a flat piece of metal that is susceptible to bending when clamped to tissue, and thus is thicker.

[0072] Overall, while it is possible to slightly alter the dimensions of all components within the cross-section of the distal portion of the STR, this is usually only a slight alteration. Thus, providing additional functionality to the distal portion of the STR while working under these spatial constraints and maintaining functionality / reliability is a considerable challenge.

[0073] Figure 54 illustrates the requirements or limits on the limited space, and within such requirements or limits, the laparoscopic surgical stapler must conform to these dimensions. Otherwise, the increased incision size will result in longer recovery times and undesirable patient trauma. In certain embodiments, the outer diameter 541 of the stapler is approximately 0.5 mm. Thus, the upper jaws 11, including the anvil 9 and the upper guide 183 of the beam 18, occupy approximately one-third of this space. The gap between the jaws 11, 12 is maintained to allow for the gripping of tissue and to form together with the staple pusher 7, which is partially protruding from the cartridge to eject the staples 6. This gap is preferably approximately 0.036 inches (0.914 mm) according to various embodiments. The lower jaws 12, including the lower guide 184 of the beam 18 and the cartridge 5, occupy the remaining space. The height or space occupied by the cartridge 5 is further limited by the height of the staples 6 and the pusher 7 used to eject the staples. The dimensions of the lower jaw 12 and the lower guide 184 of the beam 18 are also limited due to space constraints and the desired strength and durability to ensure proper staple firing. Similarly, the dimensions of the upper jaw 11 and the upper guide 183 of the beam 18 are also limited due to space constraints and the depth and shape of the anvil pocket 99 of the anvil 9, as well as the strength and durability required to ensure proper staple forming.

[0074] Figures 55A and 55B show the jaws of a stapler as various embodiments providing a maximum jaw clearance height 554 (e.g., 0.038 inches (0.965 mm)) and a minimum jaw clearance height 553 (e.g., 0.018 inches (0.457 mm)). At the maximum jaw clearance height or initial condition, the cartridge is at its lowest height position, and the protrusions 551, 552 of the cartridge 5 are firmly fitted into the slots 1211, 1212 of the lower jaws 12 at the lowest position of the cartridge. At the minimum jaw clearance height or unrestrained condition, the cartridge 5 is at its highest height position, and the protrusions of the cartridge are within the slots 1211, 1212 of the lower jaws 12 at these highest positions. According to various embodiments, the interaction between the protrusion, e.g., protrusion 551, and the slot, e.g., slot 1211, further restricts or adjusts the range between the maximum jaw clearance height and the minimum jaw clearance height.

[0075] Generally speaking, laparoscopic linear surgical staplers have a series of oppositely positioned inclined projections at a small angle to uniformly lift the staple cartridge and lock it in place. One pair of inclined projections remains stationary, while a second pair is moved longitudinally relative to the stationary pair of inclined projections, thereby driving the surfaces of the inclined projections to slide against each other. The series of inclined projections are arranged along the length of the cartridge, and the interaction of the inclined projections causes the cartridge to lift uniformly. The cartridge houses the staples, pusher, and slider.

[0076] In its initial or default position, for example, as transported, the cartridge is at its lowest height, and thus the gap distance between the jaws is greatest. In this initial configuration, the stapler jaws can open and close freely to grip the tissue between them in a gentle manner. Thus, the jaws can also be gently positioned on the tissue, and the tissue is positioned at the desired firing position or location. Once the user has found the desired firing position, the cartridge lift is activated or operated. In one embodiment, the cartridge lift is operated automatically during the initial firing stroke to fire or eject the staples from the cartridge. By operating the cartridge lift, it is moved longitudinally, and a vertical lifting force is applied to the cartridge by the interaction of the inclined projections on the cartridge lift with the ramp or retainer and the biased lift, thereby moving the cartridge vertically toward the anvil and applying a predetermined pressure to the tissue between the jaws.

[0077] The clamping force between the jaws, cartridge, and inclined projections is directed perpendicular to the longitudinal axis of the stapler. This force also pushes the two pairs of inclined projections against each other. Due to the small angle between the surfaces of the inclined projections relative to each other and the large degree of inclination perpendicular to the force, the clamping force, reaction force, or pressure cannot drive the inclined projections and thus the lift back to their initial position longitudinally. According to various embodiments, even if a large additional force is encountered during staple firing / forming, also in the same perpendicular direction, or if the pressure is unexpectedly high, the inclined projections and other components will deform without returning to their longitudinal position. The cartridge lift thus allows the cartridge to be raised to an infinite number of intermediate heights between the lowest and highest points, rather than to set small increments, while simultaneously locking the cartridge or preventing it from returning downwards. This, too, can be done automatically, for example without user interaction, to set or determine a specific height and adjust or set the staples to that determined height.

[0078] According to various embodiments, the inclined projections and ramps of the cartridge lift have the same dimensions and shape. In various embodiments, the inclined projections have different dimensions or shapes from each other, and the gradient of the inclined projections determines or takes into account the compressive force applied to the tissue gripped between the jaws 11, 12. According to various embodiments, the ramps 80 are realized or incorporated in the retainer or lower jaw 12, for example, as shown in Figures 69 and 70. Also as shown, the inclined projection 81 is an inclined projection with a gradually increasing gradient extending proximally, and the inclined projection 83 provided on the cartridge lift 82 is configured as a gradually decreasing inclined projection that inclines or extends proximally to connect or interact with each other to move the cartridge vertically when the cartridge lift is moved proximally.

[0079] The movable inclined projections are connected to a preloaded spring designed to apply a desired longitudinal force once released or activated. The spring is also designed to apply a load to the inclined projections, thereby moving the cartridge vertically to achieve a desired predetermined and optimal pressure applied to the tissue, thereby producing the desired staple formation with minimal overpressure or trauma to the tissue and surrounding tissue.

[0080] By positioning biasing members or springs within the shaft or distal to the jaws, larger biasing members (e.g., springs without space constraints imposed by one or more jaws of a stapler) can be considered, providing easier manufacturing, reducing space constraints at the jaws, and allowing a single force to be spread and applied uniformly across the jaws. Such biasing members within the jaws are often impractical or ineffective because they cannot effectively apply a uniform force to the cartridge to press the tissue against the anvil. Proper tissue compression and proper jaw clearance height ensure proper stapling. Proper stapling eliminates leaks and reduces trauma to the tissue.

[0081] According to various embodiments, a surgical stapler applies compressive force at three different intervals. The first compression is preferably applied when the jaws are closed over the tissue. The second compression occurs when the vertical adjustment drive is activated, and the third compression occurs when the firing mechanism applies pressure to both jaws. By widening or ordering the compression intervals, the tissue is further compressed and its resistance to compression is reduced, thereby providing optimal stapling while reducing tissue trauma.

[0082] The movable wedge is preferably biased by a cable or motor driven by a pressure sensor. The stapler is a single-use disposable instrument, and therefore, once the lift mechanism is started, it cannot be reset, and thus the lift mechanism cannot be reused with the associated cartridge. According to various embodiments, the lift mechanism is preferably provided with an inclined projection or wedge provided on the bottom of the cartridge along the side of the cartridge, an inclined projection as a lower jaw or a separate insert assembled or incorporated into the cartridge, and / or an inclined slot or channel provided in place of or in addition to the wedge. According to various embodiments, the cartridge lift is preferably biased distally rather than proximal to lift the cartridge, and thus the direction or gradient of the inclined projection is also reversed. According to various embodiments, separate lockout or lift limiting means are provided, such as a toothed or ratchet-like mechanism provided on the cartridge lift, or other means that provide only unidirectional proximal or distal longitudinal and small-step movements of the cartridge, lift cylinder, lift beam, or cartridge lift or staple cartridge.

[0083] In various embodiments, the retainer is capable of moving longitudinally and proximal and has multiple inclined projections that interact with a cartridge lift that lifts the cartridge vertically. In various embodiments, the cartridge lift does not have inclined projections with smooth, flat top and bottom surfaces, but is fitted with inclined projections or protruding forms and interacting means as described throughout this specification. In various embodiments, for example, as shown in Figures 60 to 65, the cartridge lift 8211 has multiple inclined projections 8212 such that the cartridge 5 is lifted vertically by moving the cartridge lift distally (arrow D), for example, away from the actuator. The inclined projections of the cartridge lift are lower or inclined downward on the proximal side, and the inclined projections of the retainer are inclined upward on the distal side. As shown, the retainer is incorporated or replaced by a lower jaw 12, in which case the lower jaw 12 has a corresponding inclined projection 1221. The staple cartridge 5 rests on the cartridge lift, and as the cartridge lift is moved distally, the inclined projection of the cartridge lift slides on the inclined projection of the lower jaw, thereby moving the cartridge vertically. In addition, articulation is provided such that the jaw can rotate or tilt away from the longitudinal axis or de-align with the longitudinal axis without opening or closing the jaw. In various embodiments, the cartridge lift is biased distally. According to various embodiments, a spring 871 biases the cartridge lift distally. The proximal end of the cartridge lift has a vertically extending or extended base 8213. The extension base is positioned between the spring 871 and the actuating beam 18. The spring applies force to the extension base distally. However, the position of the actuating beam restricts or limits the distal movement of the extension base of the cartridge lift and thus the release of the spring 871.

[0084] In firing mode, the actuarial beam is moved distally, thus enabling the movement of the extension base and the release of the spring, thereby applying spring force to the cartridge lift. Consequently, the spring moves the cartridge lift distally, causing the cartridge to lift upward or move only vertically, and self-adjusts to the tissue within the jaws.

[0085] In various embodiments, as shown, for example, in Figures 68A and 68B, the cartridge lift 824 has an aperture 825 through which a plurality of inclined projections 503 provided on the cartridge platform 501 are inserted. By moving the cartridge lift proximal, the cartridge platform or frame is lifted vertically. In particular, when the cartridge lift is moved proximal, the most distal end or wall of the aperture interacts with the inclined projections of the cartridge platform that are inclined downward proximal. As a result, the cartridge platform is moved longitudinally, and vertically, for example, when the cartridge lift is moved proximal. In various embodiments, the cartridge rests on the cartridge platform, and therefore the cartridge and cartridge platform move only vertically or laterally with respect to the longitudinal movement of the cartridge lift. In various embodiments, the cartridge and cartridge platform are integrated to form a single structure.

[0086] In various embodiments, as shown in Figure 71, for example, the cartridge platform 505 has a plurality of protrusions 507 (e.g., knob-like projections), and the cartridge lift 826 has a plurality of inclined projections 828. Therefore, when the cartridge lift 826 is moved proximal, the inclined projections of the cartridge lift interact with the knob-like projections of the cartridge platform to lift the cartridge 5 vertically.

[0087] In various embodiments, the cartridge lift is connected to a flexible pull cable, e.g., cable 714. The flexible pull cable has a retaining / releasing block 715 coupled to a tension spring 716. The flexibility of the pull cable assists the deflection or articulation of the jaws relative to the elongated shaft (e.g., at the points of deflection or joints conceptually indicated by the curved line 701). The tension spring biases the cartridge lift proximal. The retaining / releasing block restricts or limits the movement of the pull cable and, likewise, the cartridge lift. Once actuated, the retaining / releasing block is released, thereby allowing the pull cable and cartridge lift to be pulled proximal. When the cartridge lift is moved proximal, the cartridge moves perpendicularly toward the upper jaw 11. In various embodiments, the cartridge rests on a cartridge platform, and therefore the cartridge and cartridge platform move only vertically or laterally relative to the longitudinal movement of the cartridge lift. In various embodiments, the cartridge and cartridge platform are integrated to form a single-piece structure.

[0088] In various embodiments, for example as shown in Figures 66 and 67, an actuation lock or link 661 is rotatably connected to the actuation rod or slider, in which case, in one position, the actuation link restrains the actuation rod or slider, preventing staple firing and tissue cutting between the jaws. The actuation rod or slider operates as described above in various embodiments. Initially, the actuation link 661 engages with an actuation pin 663 connected to the actuation rod. The actuation slider is connected to a trigger, and when the trigger is operated, the actuation slider also moves, but in the opposite direction. Thus, when the trigger is squeezed proximal, the actuation slider moves distally, eventually closing the jaws and ejecting staples, for example as shown in Figures 66A and 66B. By returning the actuation slider to the metal side, the jaws open. As shown in Figure 66B, when the actuation slider is returned, the actuation link rotates or rotates upward, disengaging or detaching the link from the actuation pin 663. This disconnection makes it impossible to connect the actuation slider to the distal actuation part of the stapler, preventing, for example, staple firing or jaw movement. As shown in Figures 67A and 67B, the actuation pin 663 can move freely proximal and distal, but is no longer connected to the actuation link. Thus, even if the actuation pin moves, the distal actuation part of the stapler does not move, and thus even if the trigger moves, the distal actuation part of the stapler does not move. In various embodiments, only the ability to fire staples is disconnected by the interaction between the actuation link and the actuation pin, but the opening and closing of the jaws is still permitted. Therefore, the jaws can be opened and closed by moving the trigger while any movement or component that fires staples is not working.

[0089] In various embodiments, as shown in Figures 57-59, for example, an inclined projection or slot 821 is additionally provided along the side of the cartridge lift 820, and a corresponding projection or stopper 501 extends from the cartridge retainer or cartridge 5, rather than along the bottom and top surfaces of the lift and jaws, respectively. In various embodiments, the cartridge lift 820 is similarly biased, for example, in the proximal direction (arrow H), and once actuated, the interaction between the projection of the cartridge and the slot of the lift 820 lifts the cartridge vertically (arrow V). In various embodiments, the projection is provided on the lift and the slot is provided on the cartridge, or in various embodiments, various combinations of projections and slots are provided, some on the cartridge and some on the cartridge lift, for example, the cartridge has a proximal projection and a distal slot, and the cartridge lift has a corresponding proximal slot and a distal projection. The protrusion may be desirable to extend from the cartridge to maximize the space within the cartridge for the staples and to maximize the staple protrusion. Some parts of the lower jaw 12 and cartridge 5 have been omitted from the illustrated embodiments to facilitate the description of the embodiments. In addition, although shown separately, the cartridge lift is connected proximal to a shaft or actuator in various embodiments, thereby forming a single, integrated structure to further ensure uniform motion of the lift.

[0090] According to various embodiments, the actuating beam provides functional, parallel jaws during closing and compression, and generates a large force for staple firing / forming. Thus, the actuating beam closes the jaws and maintains a consistent, parallel closing along the length of the jaws, and in various embodiments, the actuating beam is configured to withstand a considerably large firing / closing force at a given height (the height to which the actuating beam is manufactured). Thus, the actuating beam structural members are made of, for example, high-grade stainless steel, and are thus strong and rigid. By manufacturing or providing an adjustable actuating beam, the inherent strength and rigidity of the actuating beam can be sacrificed or reduced.

[0091] In various embodiments, an adjustable working beam can provide an adjustable jaw gap and / or a smaller or reduced overall outer diameter or body diameter. In various embodiments, such an adjustable working beam can result in width constraints, complex structures, such as the working beam or jaw mechanism, and / or a reduction in working beam intensity.

[0092] In various embodiments, the actuating beam causes the top jaw to close relative to the bottom jaw when the actuating beam is advanced. The actuating beam closes the jaws together at a fixed height or jaw gap. If the actuating beam is height adjustable, the user can adjust the jaw gap appropriately for the desired tissue in order to continue using the jaw gap. According to various embodiments, an adjustable actuating beam 1800 is shown, for example, in Figures 72 to 74, in which the actuating beam is split or forked at its distal end, providing an upper arm 188 and a lower arm 189, with the space and / or intermediate portion between these two being omitted. For example, in Figures 72A and 72B, the working beam 1800 has an adjustable or stretchable material or web 1802 located between the upper and lower guides of the working beam, in one embodiment being stretchable or inherently biased to bias these guides toward each other or constrict them toward each other, thereby reducing the staple height or jaw gap and / or applying compressive force to the tissue between the jaws. According to various embodiments, in Figure 73, a ratchet 1803, for example, teeth or a rack, extends from either one or both of the upper and lower arms of the working beam 185. In various embodiments, a vertical extension tab extends from the upper arm of the working beam, and this extension tab has a plurality of projections, and a vertical extension tab extends from the lower arm of the working beam, and this extension tab has a plurality of projections arranged to interact with the plurality of projections of the vertical extension tab on the upper arm of the working beam. The interaction of such ratchets or protrusions holds or biases the arms toward each other, and by utilizing such interaction of ratchets or protrusions, the overall height of the beam or the distance between the arms can be adjusted in small increments. In Figure 74, according to various embodiments, a cover tube or another operating tube or cover 1805 is provided to push or bias the upper and lower arms of the operating beam toward each other when the beam is pushed into the tube or the tube is fitted onto the arms of the beam.These upper and lower guides may also include material or a ratchet provided between them to further assist in providing uniform and consistent closing or pressure when the guides are joined. In addition, such force or biasing material or mechanism may be unidirectional in various embodiments, for example, by moving to close the guides together, and thus unable to open or release, and / or unidirectional, for example, by moving toward each other or toward the upper or lower guide, thereby maintaining the parallel relationship between the guides and the parallel relationship between the guides and their longitudinal axes. A separate release or detachment component is used to separate the arms sufficiently from each other to release the stapled tissue.

[0093] However, such an adjustable actuation beam may still need to provide sufficient strength to close the jaws, especially if the tissue between the jaws is thick. The adjustable actuation beam is better if it is very thin to leave space for multiple rows of staples within the cartridge. The jaws may also need to remain parallel to the cartridge during firing. Therefore, a mechanism may be needed that allows one or both of the jaws to reposition the gap to match the adjustable actuation beam. The actuation beam may also need to be acted upon by a separate biasing component or mechanism to adjust its height. The additional biasing component or mechanism may also need to articulate. The pivot joint between the top and bottom jaws may also need to be adjusted accordingly to match the actuation beam and maintain the jaws parallel to each other.

[0094] The inclined projection configurations described above, according to various embodiments, have fewer parts compared to the configurations of adjustable actuation beams. The inclined projection has, for example, a single-location jaw pivot pin with a thin and simple or straight actuation beam.

[0095] In various embodiments, as shown, for example, in Figures 77 to 79, the stapler provides adjustable top jaws or adjustable anvil surfaces that provide jaws parallel to each other at various staple height positions. However, given limited space, the top jaws are usually not thick enough or do not provide sufficient space for the lift mechanism, particularly for the size of the bottom jaws and associated staples.

[0096] As shown in Figures 75A and 75B, a gap 751 is present at the most distal portions of the typical jaws 111, 112, and in various embodiments, this gap is closed or reduced to nearly zero, thereby making good use of the typical lost space to capture and compress the tissue. As shown in Figures 75C and 75D, the inclined bottom jaw 754 regenerates some of the lost space. The gap 751 at the most distal portions of the jaws is reduced to nearly zero, while the tissue gap at the proximal portions of the jaws remains unchanged. During staple firing, the top jaw 111 is opened or moved away from the bottom jaw 112, thereby positioning the top jaw parallel to the bottom jaw to ensure uniform compression and stapling of the tissue.

[0097] In Figures 77A and 77B, when the sliding top jaw 115 is closed, it is positioned proximal to the offset or fixed bottom jaw 125. In this position, a small or zero gap 751 exists between the jaws, thereby defining or forming a small outer diameter to facilitate the insertion or removal of small-diameter surgical access ports, such as a 5 mm cannula. When the sliding top jaw is fully open, it defines a large gap 751 between the jaws, thereby increasing the jaw's ability to capture a large portion of the tissue between them. However, the sliding pivot 775 of the sliding top jaw ensures that the jaws remain parallel to each other, thereby ensuring uniform compression and stapling of the tissue. According to various embodiments, the jaws are moved from open and closed positions by moving the working beam distally, or a separate rod, cable, or tube is used to move the jaws from open and closed positions, or vice versa.

[0098] As shown in Figures 78A to 79C, when the toggle top jaws 116 and 117 are closed, they create a specific gap between them. This specific gap should be small enough to facilitate the placement of instruments through small-diameter surgical access ports and their removal from such small-diameter surgical access ports. When the toggle top jaws are fully open, they create a larger gap between them, increasing the jaws' ability to capture a large portion of tissue between them. However, the toggle top jaws remain parallel to each other, thereby ensuring uniform compression and stapling of the tissue. According to various embodiments, moving the working beam 18 distally allows the jaws to move from the open and closed positions. The proximal portion of the beam interacts with the toggle top jaws to prevent further rotation or rotation of the jaws, thereby ensuring the jaws remain parallel to each other, thereby ensuring uniform compression and stapling of the tissue. In various embodiments, the slot 1174 of the toggle top jaw interacts with the actuation beam to rotate or pivot the jaw. In various embodiments, the foot or proximal end 1173 of the toggle top jaw interacts with the stapler shaft to prevent further rotation or pivoting of the jaw. In various embodiments, the toggle top jaw has top jaw toggles 1161, 1171 and toggle links 1162, 1172 and / or bottom jaws or bottom jaw supports rotatably connected to the shaft. The toggle links are also rotatably connected to the top jaw toggles. The top jaw toggle remains parallel to the bottom jaw 125 and has an anvil. In various embodiments, the top jaw toggle is made of or consists of a material stronger or more rigid than the toggle links to withstand stapling forces and facilitate stapling.

[0099] An adjustable top jaw with an actuation beam 18 is substantially the same as that of the embodiment described above. The actuation beam height remains constant during use, but any difference in staple height is accommodated by a small shoe or spacer present in the top jaw or lower jaw assembly. For example, if a small jaw gap is desired, a spacer is added; on the other hand, if a large jaw gap is desired, no spacer is used. The decision of whether or not to add a spacer is to be left to the user. The engagement of the desired spacer is to be actuated by an actuation beam or similar mechanism used in the firing or pre-firing process. Such a mechanism may also need to have articulation. The top or bottom jaw may need to be thin to provide space for a spacer, which can reduce the jaw strength. The strength of the spacer is also to be increased to accommodate the reduced jaw strength and to withstand the compressive forces during the staple forming process. Space should also be provided to accommodate the storage of the spacer when not in use.

[0100] Compared to the various other embodiments described above, the top jaw has a similarly thick cross-section. A rigid top jaw that minimizes bending is often desirable for proper stapling. Therefore, a single, integrated jaw is often preferable. Spacers result in a finite number of gap height changes, and such spacers are not automatically adjustable.

[0101] According to various embodiments, adjustable top jaws can provide adjustable and comparable jaw clearance and a smaller overall body diameter. However, adjustable top jaws can also increase the space between staple lines, increase complexity to the working beam or other components, and / or decrease the top jaw strength.

[0102] According to various embodiments, the cartridge is adjusted using a spring or other similar biasing mechanism. However, in such embodiments, it can be difficult to lock the cartridge in place once the optimal spacing is reached. For example, a spring located beneath the cartridge allows the cartridge to move or adjust due to tissue thickness. However, the cartridge also moves due to the large forces encountered during staple firing and shaping. Therefore, although the cartridge moves freely according to tissue thickness, it may not be possible to firmly lock it in place once the optimal height is found and all parts are contained within the limited space of the linear laparoscopic cutting cartridge.

[0103] Referring to Figure 76, according to various embodiments, the cartridge 5 is in a floating state or not directly coupled to the stapler jaws. By contact between the cartridge and tissue, the cartridge resizes to fit the optimal tissue gap. The cartridge has teeth 5002 that interlock with corresponding teeth 1202 provided on the jaws to lock the cartridge in place at the optimal tissue gap. In one embodiment, the bottom jaw clamps the cartridge to interlock the cartridge teeth with the bottom jaw. In another embodiment, the movement of the working beam causes the cartridge to slide laterally, interlocking the cartridge teeth with the bottom jaw. Teeth are provided on both sides of the cartridge, and corresponding interlocking teeth are provided on both sides of the bottom jaw.

[0104] According to various embodiments, adjustable top / bottom jaws are provided without the use of an actuation beam. Other mechanisms for opening and closing the jaws provide jaws parallel to each other during closing and stapling, and react to or take into account the compressive forces encountered during closing and stapling. Thus, such mechanisms may be thick and rigid, thereby reducing joint mobility or decreasing space utilization to address the space constraints in laparoscopic procedures.

[0105] The top jaw must be significantly thicker than a normal jaw because it does not have an operating beam. The cartridge must house the cutting blade and protect it after the instrument is fired and the jaws are opened.

[0106] According to various embodiments, one or more inclined projections are arranged along the side of a cartridge or cartridge lift that interact with inclined projections provided on the side of a ramp, retainer, or lower jaw. An actuation beam is provided, along with a cutting beam for closing the jaws, firing staples, releasing the jaw gap spring, and cutting tissue. The jaw gap is set by the side inclined projections, and in one embodiment, the cartridge is held in place by a frame under the action of the cartridge lift. When the cartridge lift is actuated, the frame and cartridge close the gap based on a biasing member, such as a spring and its spring constant, which is defined or predetermined as optimal for tissue compression. The jaw gap is changed automatically.

[0107] In such embodiments, the compressive force is transmitted to the side of the cartridge or cartridge lift, rather than being distributed onto a flat bottom surface as provided in the various other embodiments described above. Such side distribution may reduce the ability to cope with such forces for proper stapling, or may require a thicker or more rigid wedge or side of such component to account for the forces encountered. According to various embodiments, side inclined projections provide an adjustable and equivalent jaw clearance and an overall smaller body diameter. However, side inclined projections may be limited in width. In various embodiments, the stapler has a switch or button accessible by a separate user to initiate, unlock, or operate the biasing of the cartridge lift or lift lock. In various embodiments, the separate switch is preferably accessible only once the staple firing is activated or unlocked. The biasing of the cartridge is preferably carried out by one or more springs, elastic bands, cables, magnets, hydraulic technology, or other similar biasing systems in various embodiments. The cartridge lift, biasing system, or both are preferably assisted by a motor and / or sensor in various embodiments. In various embodiments, the lift lock cannot be re-locked, or the biasing system cannot be reset or returned to its initial position.

[0108] In addition, while this application discloses certain embodiments and examples, as will be understood by those skilled in the art, the present invention extends beyond the specifically disclosed embodiments to other modified embodiments and / or uses of the invention, obvious modifications and their equivalents. Furthermore, various features of these inventions can be used alone or in combination with other features of the invention other than those explicitly described above. Therefore, it should be understood that while certain combinations of embodiments and features or aspects of various embodiments may not be explicitly described, such combinations are assumed to fall within the scope of the invention. Thus, the scope of the invention disclosed herein is not intended to be limited by the specifically disclosed embodiments described above. 1. A surgical stapler, Having the first Joe, including Anvil, It has a second jaw containing a cartridge holding multiple staples, and the first jaw can move closer to or away from the second jaw. A stapler having a cartridge lift provided between the second jaw and the cartridge, wherein the lift is arranged to move the cartridge toward the first jaw while the lift is moving longitudinally. 2. The stapler described in paragraph 1, wherein the lift moves only in the proximal direction. 3. The stapler according to paragraph 1 or 2, wherein the cartridge moves only in the direction toward the first jaw. 4. The cartridge is a stapler according to any one of paragraphs 1 to 3, which moves prior to firing the staples. 5. A stapler according to any one of paragraphs 1 to 4, further comprising a spring connected to the cartridge lift. 6. The spring is restrained by a stapler as described in any of paragraphs 1 through 5. 7. A stapler according to any one of paragraphs 1 to 6, further comprising an elongated shaft connected to the first and second jaws, wherein the first and second jaws are rotatably connected to each other, and an actuator is detachably connected to the elongated shaft, the actuator being configured to open and close the jaws, fire the staples, translate the blades and release the spring. 8. The stapler according to any one of paragraphs 1 to 7, wherein the cartridge lift has an inclined projection with a lower surface facing the retainer, the retainer has an inclined projection with an upper surface facing the cartridge lift, and the upper surface of the inclined projection of the retainer is shaped and positioned to complement the lower surface of the inclined projection of the cartridge lift. 9. A stapler according to any one of paragraphs 1 to 8, further comprising a lift lock for restraining the movement of the cartridge lift. 10. The stapler according to any one of paragraphs 1 to 9, wherein the retainer and the anvil remain stationary when the cartridge is moving vertically. 11. The stapler according to any one of paragraphs 1 to 10, wherein the cartridge lift is biased by the cartridge lift spring pulling the cartridge lift in a proximal direction. 12. The stapler according to any one of paragraphs 1 to 11, wherein the spring is initially locked and the cartridge lift remains in its lowest vertical position. 13. The spring is released once the firing operation begins, as described in any of paragraphs 1 through 12 of the stapler. 14. A stapler as described in any of paragraphs 1 through 13, which is unable to relock the spring. 15. The stapler according to any one of paragraphs 1 to 14, wherein the cartridge lift exerts an active vertical force on the cartridge. 16. A surgical stapler, Having the first Joe, including Anvil, It includes a cartridge with multiple staples and has a second jaw extending from the proximal end to the distal end, the first jaw being able to move closer to or away from the second jaw, A stapler having a cartridge lift provided between the second jaw and the cartridge, which is biased in the longitudinal direction toward the proximal side away from the distal end of the second jaw. 17. The stapler according to paragraph 16, wherein the cartridge can only move in a single direction laterally to the single direction in which the cartridge lift moves. 18. The stapler according to claim 16 or 17, wherein the anvil is immovable. 19. The anvil is a stationary stapler as described in any of paragraphs 16 to 18. 20. The stapler according to any one of paragraphs 16 to 19, wherein the movable lift is biased by a lift spring. 21. A stapler according to any one of paragraphs 16 to 20, further comprising a lift lock for preventing the lift spring from moving, wherein the lift lock is released once the firing operation has begun to release the lift spring. 22. A stapler according to any one of paragraphs 16 to 21, which is unable to relock the lift lock. 23. The lift lock is not accessible to the user, as described in any of paragraphs 16 to 22 of the stapler. 24. A surgical stapler, Having the first Joe, including Anvil, It has a second jaw containing a cartridge, and the first jaw can move toward the second jaw. A stapler having an upper arm and a lower arm, and an operating beam that determines the distance between the upper arm and the lower arm, wherein the distance is adjustable. 25. The stapler according to paragraph 24, further comprising a web provided between the upper arm and the lower arm of the working beam, which limits the adjustable distance between the upper arm and the lower arm. 26. The stapler according to paragraph 24 or 25, further comprising a vertical extension tab extending from the upper arm of the working beam and including a plurality of protrusions, and a vertical extension tab extending from the lower arm of the working beam, wherein the vertical extension tab has a plurality of protrusions arranged to interact with the plurality of protrusions of the vertical extension tab of the upper arm. 27. A stapler according to any one of paragraphs 24 to 26, further comprising an upper tab extending laterally from the upper arm of the working beam and a lower tab extending laterally from the lower arm of the working beam, wherein the upper tab is positioned to interact with the lower tab to limit the adjustable distance between the upper arm and the lower arm of the working beam. 28. A surgical stapler, It has an upper jaw including an anvil, A stapler having a lower jaw including a cartridge, the lower jaw being able to move toward the upper jaw, the distance between the upper jaw and the lower jaw being adjustable, and the most proximal portion of the jaw having a gap of nearly zero between the upper jaw and the lower jaw. 29. The stapler according to paragraph 28, wherein the first jaw has a toggle jaw link between the proximal portion of the jaw and the distal portion of the jaw. 30. The stapler according to paragraph 28 or 29, wherein the lower jaw is inclined toward the upper jaw, and the lower jaw has an inclined surface with a gradient that gradually increases from the proximal end to the distal end of the lower jaw. 31. The stapler according to any one of claims 28 to 30, wherein the cartridge is in a floating state such that its longitudinal movement is constrained with respect to the lower jaw, but its vertical movement is not constrained with respect to the lower jaw. 32. The stapler according to any one of paragraphs 28 to 31, wherein the upper jaw is connected to a sliding pivot.

Claims

1. It is a surgical stapler, Having the first Joe, including Anvil, It has a second jaw containing a cartridge holding multiple staples, and the first jaw can move closer to or away from the second jaw. A stapler having a cartridge lift provided between the second jaw and the cartridge, wherein the lift is arranged to move the cartridge toward the first jaw while the lift is moving longitudinally.

2. The stapler according to claim 1, wherein the lift moves only in the proximal direction.

3. The stapler according to claim 1 or 2, wherein the cartridge moves only in the direction toward the first jaw.

4. The stapler according to any one of claims 1 to 3, wherein the cartridge moves prior to firing the staples.

5. The stapler according to any one of claims 1 to 4, further comprising a spring connected to the cartridge lift.

6. The aforementioned spring is constrained, as described in any one of claims 1 to 5.

7. A stapler according to any one of claims 1 to 6, further comprising an elongated shaft connected to the first and second jaws, wherein the first and second jaws are rotatably connected to each other, and an actuator is detachably connected to the elongated shaft, the actuator being configured to open and close the jaws, fire the staples, translate the blades and release the spring.

8. The stapler according to any one of claims 1 to 7, wherein the cartridge lift has an inclined projection with a lower surface facing the retainer, the retainer has an inclined projection with an upper surface facing the cartridge lift, and the upper surface of the inclined projection of the retainer is shaped and positioned to complement the lower surface of the inclined projection of the cartridge lift.

9. The stapler according to any one of claims 1 to 8, further comprising a lift lock for restraining the movement of the cartridge lift.

10. The stapler according to any one of claims 1 to 9, wherein the retainer and the anvil remain stationary when the cartridge is moving vertically.

11. The stapler according to any one of claims 1 to 10, wherein the cartridge lift is biased by the cartridge lift spring pulling the cartridge lift in a proximal direction.

12. The stapler according to any one of claims 1 to 11, wherein the spring is initially locked and the cartridge lift remains in its lowest vertical position.

13. The stapler according to any one of claims 1 to 12, wherein the spring is unlocked once the firing operation has started.

14. The stapler according to any one of claims 1 to 13, wherein the spring cannot be re-locked.

15. The stapler according to any one of claims 1 to 14, wherein the cartridge lift exerts an active vertical force on the cartridge.

16. It is a surgical stapler, Having the first Joe, including Anvil, It includes a cartridge with multiple staples and has a second jaw extending from the proximal end to the distal end, the first jaw being able to move closer to or away from the second jaw, A stapler having a cartridge lift provided between the second jaw and the cartridge, which is biased in the longitudinal direction toward the proximal side away from the distal end of the second jaw.

17. The stapler according to claim 16, wherein the cartridge can only move in a single direction laterally to the single direction in which the cartridge lift moves.

18. The stapler according to claim 16 or 17, wherein the anvil is immovable.

19. The stapler according to any one of claims 16 to 18, wherein the anvil is stationary.

20. The stapler according to any one of claims 16 to 19, wherein the movable lift is biased by a lift spring.

21. The stapler according to any one of claims 16 to 20, further comprising a lift lock that prevents the lift spring from moving, wherein the lift lock is released once the firing operation has started to release the lift spring.

22. The stapler according to any one of claims 16 to 21, wherein the lift lock cannot be relocked.

23. The stapler according to any one of claims 16 to 22, wherein the lift lock is not accessible to the user.

24. It is a surgical stapler, Having the first Joe, including Anvil, It has a second jaw containing a cartridge, and the first jaw can move toward the second jaw. A stapler having an upper arm and a lower arm, and an operating beam that determines the distance between the upper arm and the lower arm, wherein the distance is adjustable.

25. The stapler according to claim 24, further comprising a web provided between the upper arm and the lower arm of the operating beam, which limits the adjustable distance between the upper arm and the lower arm.

26. The stapler according to claim 24 or 25, further comprising a vertical extension tab extending from the upper arm of the working beam and including a plurality of protrusions, and a vertical extension tab extending from the lower arm of the working beam, wherein the vertical extension tab has a plurality of protrusions arranged so as to interact with the plurality of protrusions of the vertical extension tab of the upper arm.

27. A stapler according to any one of claims 24 to 26, further comprising an upper tab extending laterally from the upper arm of the working beam and a lower tab extending laterally from the lower arm of the working beam, wherein the upper tab is positioned to interact with the lower tab to limit the adjustable distance between the upper arm and the lower arm of the working beam.

28. It is a surgical stapler, It has an upper jaw including an anvil, A stapler having a lower jaw including a cartridge, the lower jaw being able to move toward the upper jaw, the distance between the upper jaw and the lower jaw being adjustable, and the most proximal portion of the jaw having a gap of nearly zero between the upper jaw and the lower jaw.

29. The stapler according to claim 28, wherein the first jaw has a toggle jaw link between the proximal portion of the jaw and the distal portion of the jaw.

30. The stapler according to claim 28 or 29, wherein the lower jaw is inclined toward the upper jaw, and the lower jaw has an inclined surface with a gradient that gradually increases from the proximal end to the distal end of the lower jaw.

31. The stapler according to any one of claims 28 to 30, wherein the cartridge is in a floating state such that its longitudinal movement is constrained with respect to the lower jaw, but its vertical movement is not constrained with respect to the lower jaw.

32. The stapler according to any one of claims 28 to 31, wherein the upper jaw is connected to a sliding pivot.

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