Mechanism for improving staple height consistency in a curved surgical stapler - Patents.com

Abstract

The device includes a housing, an anvil, a backing member, and a concave surface. The housing has a plurality of staples and the anvil faces the housing, the anvil and the housing being configured to cooperate to clamp tissue. The anvil is configured to shape the staples ejected from the housing into the clamped tissue. The backing member is coupled to the anvil, and the concave surface defines a gap between the backing member and an adjacent element of the device. The anvil is configured to deflect toward the gap upon actuation of the device to at least one of clamp and staple tissue.

Description

[Background technology]

[0001] Some surgical staplers are operable to clamp one or more tissue layers of a patient, form staples through the tissue layers to substantially seal the tissue layers together near the formed staples, and sever the tissue layers to form a cut edge of the tissue that is operatively sealed. An exemplary stapling instrument may include a pair of cooperating elongated jaw members, each of which may be adapted to be inserted into a patient and positioned relative to the tissue to be stapled and / or incised. One of the jaw members may support a staple cartridge having at least two laterally spaced rows of staples therein, and the other jaw member may support an anvil having staple forming pockets aligned with the rows of staples in the staple cartridge. In general, the stapling instrument may further include a pusher bar and a knife blade slidable relative to the jaw members to sequentially or simultaneously eject staples from the staple cartridge via cam surfaces on the pusher bar and / or cam surfaces on a wedge sled that is pushed by the pusher bar. The cam surface may be configured to actuate one or more staple drivers carried by the cartridge and associated with the staples to drive the staples against the anvil and form laterally spaced rows of deformed staples in tissue grasped between the jaw members. Such rows may be arranged in linear and / or arcuate rows for sequentially or simultaneously stapling and cutting the patient's tissue in a predetermined pattern. A knife blade may track the cam surface to cut the tissue along a linear or arcuate line between the rows of staples formed in the tissue.

[0002] Merely exemplary surgical staplers include U.S. Patent No. 6,988,650, issued on January 24, 2006, entitled "Retaining Pin Lever Advancement Mechanism for a Curved Cutter Stapler"; U.S. Patent No. 7,134,587, issued on November 14, 2006, entitled "Knife Retraction Arm for a Curved Cutter Stapler"; U.S. Patent No. 7,147,139, issued on December 12, 2006, entitled "Closure Plate Lockout for a Curved Cutter Stapler"; U.S. Patent No. 7,147,140, ​​issued on December 12, 2006, entitled "Cartridge Retainer for a Curved Cutter Stapler"; U.S. Patent No. 7,147,141, issued on April 17, 2007, entitled "Slotted Pins Guiding Knife in a Curved Cutter Stapler"; No. 7,204,404 entitled "Cartridge with Locking Knife for a Curved Cutter Stapler" issued on April 24, 2007; and U.S. Patent No. 7,207,472 entitled "Cartridge with Locking Knife for a Curved Cutter Stapler" issued on April 24, 2007. . Change Merely exemplary surgical staplers are disclosed in U.S. Patent Application Publication No. 2005 / 0139636, published June 30, 2005, entitled "Replaceable Cartridge Module for a Surgical Stapling and Cutting Instrument," U.S. Patent Application Publication No. 2005 / 0143759, published June 30, 2005, entitled "Curved Cutter Stapler Shaped for Male Pelvis," and U.S. Patent Application Publication No. 2005 / 0145672, published July 7, 2005, entitled "Curved Cutter Stapler with Aligned Tissue Retention Feature." do.

[0003] U.S. Patent Application Publication No. 2020 / 038018(A1) discloses a surgical staple including a crown and a deformable member extending from the crown, the deformable member having a notch configured to bend the deformable member at the notch when the staple is deformed from a first shape to a second shape.

[0004] U.S. Patent Application Publication No. 2017 / 189022(A1) discloses a method for manipulating tissue of a patient, including a surgical instrument having a handle assembly, a shaft assembly, and an end effector.

[0005] A surgical stapler can be inserted into a patient to perform colorectal surgery. Such surgery can include using the stapler to operatively seal, cut, and remove the patient's colon, either in whole or in part. For example, a proctocolectomy can be performed during a lower anterior resection ("LAR") to treat and prevent the spread of colorectal cancer cells. Of course, surgical staplers can be used in a variety of other settings and procedures.

[0006] While many different types of surgical stapling instruments and related components have been made and used, it is believed that no one prior to the present inventors has made or used the invention as set forth in the appended claims. [Brief description of the drawings]

[0007] The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the embodiments given below, serve to explain the principles of the invention. [Figure 1A] 1 illustrates a perspective view of an exemplary surgical stapling instrument with a pin actuation mechanism in an open position and a staple cartridge unit of an end effector of the instrument in an open position; [Figure 1B] FIG. 1B illustrates a perspective view of the surgical stapling instrument of FIG. 1A with the pin actuating mechanism in a closed position and the staple cartridge unit in an open position; [Figure 1C] FIG. 1B illustrates a perspective view of the surgical stapling instrument of FIG. 1A with the pin actuation mechanism in a closed position and the staple cartridge unit in a closed position due to actuation of the closure mechanism; [Figure 1D]FIG. 1B illustrates a perspective view of the surgical stapling instrument of FIG. 1A with the pin actuation mechanism and staple cartridge unit in a closed position and the firing trigger in a fired position for stapling and severing tissue of a patient; [Diagram 2] FIG. 1B shows a distal perspective view of the staple cartridge unit of FIG. 1A. [Diagram 3] 3 shows a proximal perspective view of the staple cartridge unit of FIG. 2; [Figure 4] FIG. 3 is an exploded perspective view of the staple cartridge unit of FIG. 2; [Diagram 5] 3 illustrates a proximal perspective view of an exemplary cutting washer of the staple cartridge unit of FIG. [Figure 6] 6 shows an enlarged perspective view of the middle portion of the cut-off washer of FIG. 5; [Figure 7A] FIG. 7B shows a schematic cross-sectional view of a portion of the end effector of the surgical stapling instrument of FIG. 1A taken along line 7-7 of FIG. 1D, illustrating the concave proximal side of the cutting washer interacting with the anvil of the staple cartridge unit in an undeflected state. [Figure 7B] 7A shows another schematic cross-sectional view of the end effector portion of FIG. 7A taken along line 7-7 of FIG. 1D, illustrating the concave proximal side of the cutting washer tissue interacting with the anvil in a flexed state. [Figure 8] 13A shows a schematic cross-sectional view of a portion of another exemplary end effector having a support structure with a concave proximal side, showing the anvil and cutting washer of the end effector in an undeflected state relative to the support structure. [Figure 9] 13A shows a schematic cross-sectional view of a portion of yet another exemplary end effector having an anvil with a concave distal side, showing the anvil in an undeflected state relative to a cutting washer and a support structure. [Figure 10] 13A illustrates a schematic cross-sectional view of a portion of yet another exemplary end effector having a cutting washer with a concave distal side, showing the cutting washer and anvil in an undeflected state relative to a support structure.

[0008] The drawings are not intended to be limiting in any manner, and it is contemplated that various embodiments of the invention may be embodied in other various ways, including those not necessarily depicted in the drawings. The accompanying drawings, which are incorporated in and form a part of this specification, illustrate several aspects of the invention and, together with the description, serve to explain the principles of the invention. It will be understood, however, that the invention is not limited to the precise arrangements shown. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0009] The following description of a specific embodiment of the present invention should not be used to limit the scope of the present invention. Other embodiments, features, aspects, embodiments, and advantages of the present invention will become apparent to those skilled in the art from the following description, which is one of the best modes contemplated for carrying out the present invention by way of example. As will be understood, the present invention is capable of other different and obvious aspects, none of which departs from the present invention. Thus, the drawings and description should be regarded as illustrative in nature, and not restrictive.

[0010] It will be further understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Thus, the teachings, expressions, embodiments, examples, etc. described below should not be considered in isolation from one another. Various suitable ways in which the teachings herein can be combined will be readily apparent to those skilled in the art in light of the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.

[0011] For clarity of this disclosure, the terms "proximal" and "distal" are defined herein relative to a human or robotic surgical instrument operator. The term "proximal" refers to a location of an element closer to a human or robotic surgical instrument operator and further away from a surgical end effector of the surgical instrument. The term "distal" refers to a location of an element closer to a surgical end effector of the surgical instrument and further away from a human or robotic surgical instrument operator. It will be further understood that for convenience and clarity, spatial terms such as "vertical," "horizontal," "lower," "upper," "forward," and "rearward" are used herein with reference to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and / or absolute.

[0012] As used herein, the terms "about," "approximately," and the like in connection with any numerical value or range of numerical values ​​are intended to encompass the exact value referenced, as well as a suitable dimensional tolerance that enables the referenced feature, or combination of features, to function for the intended purpose described herein.

[0013] I. Overview of an Exemplary Surgical Stapler 1A-1D illustrate an exemplary surgical stapler (10) including a handle assembly (12), a shaft assembly (14) extending distally from the handle assembly (12), and an end effector (16) at the distal end of the shaft assembly (14). It should be understood that the terms "proximal," "distal," "right," and "left" are used herein with reference to a clinician gripping the handle assembly (12) of the surgical stapler (10). Thus, the end effector (16) is distal relative to the handle assembly (12), which is relatively proximal. Unless otherwise noted herein, the surgical stapler (10) is 、2U.S. Patent Application Publication No. 2005 / 0143759, published June 30, 2005 and entitled "Curved Cutter Stapler Shaped for Male Pelvis" and / or is 2 The present invention can be constructed and operated in accordance with at least a portion of the teachings of U.S. Pat. No. 10,194,913, issued Feb. 5, 2019, and entitled "Surgical Instrument Comprising Systems for Assuring the Proper Sequential Operation of the Surgical Instrument."

[0014] The handle assembly (12) includes several actuation mechanisms for manipulating the end effector (16) during a surgical procedure. To this end, the exemplary handle assembly (12) includes a saddle slide (18), a closure trigger (20), and a firing trigger (22) that communicates with the end effector (16) via the shaft assembly (14). Figure 1A shows the slide (18) and closure trigger (20) in an open configuration such that the end effector (16) is configured to receive tissue laterally into a gap (25) between an anvil (26) of a replaceable cartridge unit (24) mounted within the end effector (16) and a cartridge housing (28) of the cartridge unit (24). As described in more detail below, distal translation of the slider (18) toward the end effector (16) slides a retaining pin (30) of the end effector (16) distally, as shown in FIG. 1B, to capture tissue between the anvil (26) and the cartridge housing (28). Sequential actuation of the closure trigger (20) and firing trigger (22), respectively, compresses the tissue between the anvil (26) and the cartridge housing (28) in a closed configuration, then forms a plurality of staples (not shown) in the tissue and severs the tissue with a curved knife (32) (see FIG. 4), as shown in FIG. 1C and FIG. 1D.

[0015] A. Surgical Stapler Handle Assembly and Shaft Assembly As shown in FIG. 1A, the handle assembly (12) of the surgical stapler (10) includes a handle housing (34) and a pair of handle frame plates (35, 36) having a proximal portion (not shown) housed within the handle housing (34) and an elongated distal portion extending distally along the shaft assembly (14). As briefly described above, the handle assembly (12) further includes a saddle slide (18), a closure trigger (20), and a firing trigger (22). The handle housing (34) defines a hand grip (38) that can be grasped by an operator with the palm of at least one hand. The handle housing (34) in this example is formed by a right shrouded handle portion (40) and a left shrouded handle portion (42). The closure trigger (20) is positioned proximally relative to the firing trigger (22). Each trigger (20, 22) is pivotally mounted to a frame plate (35, 36) and exposed through an underside of the handle housing (34) for actuation by an operator's finger. Figure 1A shows the closure and firing triggers (20, 22) in an unactuated position prior to closure of the end effector (16) and firing of the staples (not shown) and curved knife (32). Thus, the cartridge housing (28) is spaced proximally from the anvil (26) to receive tissue within the gap (25) between the cartridge housing (28) and the anvil (26).

[0016] The surgical stapler (10) is operable to capture tissue prior to actuation of the closure and firing triggers (20, 22) via a tissue retaining pin actuation mechanism (37). The tissue retaining pin actuation mechanism (37) includes a slider (18) on the handle assembly (12), a tissue retaining pin (30) on the end effector (16), and an elongated push rod (50) on the shaft assembly (14). The slider (18) is mounted on an upper surface of the handle housing (34) and is configured for linear translation between a proximal position and a distal position. The push rod (50) operably couples the slider (18) to the tissue retaining pin (30), such that longitudinal translation of the slider (18) drives longitudinal actuation of the tissue retaining pin (30) via the push rod (50) between a proximal open position (see FIG. 1A) and a distal closed position (see FIG. 1B).

[0017] The closure mechanism (52) of the surgical stapler (10) is configured to selectively actuate the cartridge housing (28) of the cartridge unit (24) between a proximal open position ( FIG. 1A ) and a distal closed position ( FIG. 1C ) to clamp tissue between the cartridge housing (28) and the anvil (26). The closure mechanism (52) includes a closure trigger (20) of the handle assembly (12) and an elongated closure member (54) coupled at its proximal end to the closure trigger (20). The closure member (54) has a generally U-shaped cross-section and extends distally from the handle assembly (12), through the shaft assembly (14), and into the end effector (16) such that a distal end of the closure member (54) is configured to receive the cartridge unit (24) within the end effector (16), as shown in FIG. The proximal end of the closure member (54) is operatively connected to the closure trigger (20) by a plurality of linkages (not shown) configured to translate pivotal motion of the closure trigger (20) into translation of the closure member (54). Thus, pivoting the closure trigger (20) toward the pistol grip (38) to a closed position (FIG. 1C) drives the closure member (54) distally, which in turn drives the cartridge housing (28) distally toward the anvil (26) to clamp tissue between the cartridge housing (28) and the anvil (26). Subsequently, pivoting the closure trigger (20) away from the pistol grip (38) to an open position (FIG. 1A) drives the closure member (54) proximally, which in turn drives the cartridge housing (28) proximally away from the anvil (26) to release the stapled tissue.

[0018] In some variations, the closure member (54) may be further configured to cooperate with the tissue retaining pin actuation mechanism (37) to automatically actuate the retaining pin (30) distally to its closed position when the operator pulls the closure trigger (20). Such automation may be useful if the operator does not manually actuate the retaining pin (30) distally via the slide (18) prior to pulling the closure trigger (20). The closure trigger (20) may be biased toward the open position by a resilient member (not shown) contained within the handle housing (34).

[0019] The firing mechanism (80) of the surgical stapler (10) is configured to actuate the end effector (16) in response to manipulation of a firing trigger (22) of the handle assembly (12) to staple and sever tissue clamped between the anvil (26) and the cartridge housing (28). In that regard, the firing mechanism (80) includes the firing trigger (22), a cartridge unit (24), and an elongated firing bar (not shown) extending longitudinally through the shaft assembly (14) and operably coupling the firing trigger (22) with the cartridge unit (24). The firing trigger (22) is positioned distal to the closure trigger (20) such that the firing trigger (22) can only be closed when the closure trigger (20) is first pivoted closed. Pivoting the firing trigger (22) from an open position (FIG. 1C) toward a closed (or "fired") position (FIG. 1D) drives the firing bar distally, which in turn drives the internal components of the cartridge housing (28) distally, thereby stapling and severing tissue clamped by the end effector (16), as described in more detail below.

[0020] One or both of the closure trigger (20) and the firing trigger (22) may be configured to be releasably locked into one or more pivotal positions, such as a fully closed position and / or one or more intermediate positions between fully open (i.e., unactuated) and fully closed (i.e., fully actuated). Thus, advantageously, an operator can release one or more hands from the triggers (20, 22) and hand grip (38) to perform another task during a surgical procedure, while the triggers (20, 22) maintain their positions. The operator can then release the triggers (20, 22) from their locked state by depressing a release button (23) located at the proximal end of the handle assembly (12).

[0021] Although not shown, shaft assembly (14) of surgical stapler (10) may include various additional components, such as an articulation joint, or may include rearrangements of various components such that shaft assembly (14) is modular with respect to handle assembly (12).

[0022] B. Surgical Stapler End Effector As best seen in FIGS. 1A-4, the end effector (16) of this embodiment includes a C-shaped support structure (128) and a replaceable cartridge unit (24) removably received by the C-shaped support structure (128). The support structure (128) includes a proximal base portion (131), an intermediate arm (133) extending distally from the proximal base portion (131), and a distal arm (135) projecting laterally (e.g., upwardly) from a distal end of the intermediate arm (133). The proximal base portion (131) is secured to the distal end of the handle frame plate (35, 36) at the distal end of the shaft assembly (14) by a shoulder rivet (129) and a pair of posts (130). The distal arm (135) includes a fixed end (165) secured to the intermediate arm (133) and a free end (167). The proximal base portion (131) is configured to releasably receive and support the cartridge housing (28), and the distal arm (135) is configured to releasably receive and support the anvil (26) and washer (168).

[0023] The term "C-shaped" is used herein in reference to the curvature of the support structure (128) and cartridge unit (24) having a first concave side and a second convex side, each of which is opposite one another. In other words, each element of the support structure (128) and cartridge unit (24) extends along a respective arcuate path perpendicular to and in a respective plane intersected by the longitudinal shaft axis (LAS). Such a configuration enhances functionality and accessibility to tissue within a patient. By way of example only, the C-shaped configuration of the support structure (128) and cartridge unit (24) may allow the end effector (16) to easily access the lower colon within the pelvic recess of a patient, for example, to perform a low anterior resection ("LAR") in a proctocolectomy. Thus, as used herein, the term "C-shaped" should be construed to include various concave shapes that similarly enhance functionality of surgical stapling and severing instruments. In other variations, the cartridge unit 24 and the support structure 128 may be shaped into a variety of other curved and non-curved shapes. For example, the cartridge unit 24 and the support structure 128 may be shaped into a variety of other curved and non-curved shapes, for example. 、2 A U.S. patent application filed on April 26, 2019 entitled "Tissue Cutting Washer for Right Angle Surgical Stapler" public No. 2020 / 0337698(A1) As described in US Pat. No. 5,993,523, the present invention may be formed into a shape having a rectilinear configuration.

[0024] The replaceable cartridge unit (24) includes an anvil (26) and a cartridge housing (28) movably coupled to one another by a guide pin (166) and an anvil arm (196), as described in more detail below. The distal end of the cartridge housing (28) defines a distally facing staple deck (134) configured to contact tissue. The staple deck (134) includes a plurality of staple openings (136) formed in a staggered configuration in a pair of rows on either side of an arcuate knife slot (152). Various other numbers of rows of staple openings (136) may be provided in other variations. The cartridge housing (28) houses a plurality of staples (not shown) configured to be driven distally through the staple openings (136) and relative to the anvil (26), thereby forming staples in patient tissue. Although not shown, the cartridge unit (134) may further include a retainer configured to be removably coupled to the staple deck (134) to cover the staple openings (136) and the knife slots (152) prior to use of the cartridge unit (24), such as during storage of the cartridge unit (24), and optionally also after use of the cartridge unit (24).

[0025] As shown in FIG. 4, the cartridge housing (28) further houses the retaining pin (30), a staple driver assembly (140), and a knife holder (142). The staple driver assembly (140) is positioned immediately proximal to the staples (not shown) housed within the cartridge housing (28) and distal to the knife holder (142). The staple driver assembly (140) in this embodiment is formed as a unitary structure defining a plurality of staple drivers (141). Thus, the term "assembly," when used in connection with the staple driver assembly (140), is not intended to be limited to an assembly of individual elements, but may also include elements formed integrally with a unitary structure. The driver assembly (140) is configured to translate distally within the cartridge housing (28) such that the staple drivers (141) drive staples distally from their respective staple openings (136) toward the anvil (26) to form staples in tissue clamped between the anvil (26) and the cartridge housing (28).

[0026] A knife holder (142) is movably disposed within the cartridge housing (28) immediately proximal to the staple driver assembly (140). The knife holder (142) supports a curved knife (32) along its distal side, and the knife holder (142) is configured to translate within the cartridge housing (28) such that the curved knife (32) extends distally through an arcuate slot (150) in the driver assembly (140) and an arcuate slot (152) in the staple deck (134). For example, 、2As disclosed in U.S. Patent No. 10,045,780, issued Aug. 14, 2018 and entitled “Method of Applying Staples in Lower Anterior Bowel Resection,” the proximal side of knife holder (142) includes a slot (144) and a ledge (146) configured to mate with a knife retractor hook (not shown) for retracting curved knife (32) after firing of cartridge unit (24).

[0027] As shown in FIGURE 2, the cartridge housing (28) includes two longitudinally extending, generally circular holes (162, 164) at the upper and lower ends of each of the arcuate knife slots (152) on the staple deck (134). The holes (162, 164) in this embodiment are positioned such that the staple openings (136) and the staples ejected from the staple openings (136) extend beyond the holes (162, 164) at the upper and lower ends of the staple deck (134). The lower hole (162) is shaped and dimensioned to slidably receive a guide pin (166) that extends longitudinally between the cartridge housing (28) and the anvil (26). The upper bore (164) is shaped and dimensioned to slidably receive the retaining pin (30) therethrough, thereby enabling the retaining pin (30) to be actuated longitudinally relative to the cartridge housing (28) and the anvil (26) between a proximal retracted position (FIG. 1A) and a distal extended position (FIG. 1B).

[0028] As shown in FIGURE 3, a side of cartridge housing (28) includes a longitudinally extending detent slot (155) defined between a pair of opposing resilient members. A first side of detent slot (155) includes a first proximal detent projection (156) and an opposing second side of detent slot (155) includes a second proximal detent projection (159) and a distal detent projection (160). Detent slot (155) is configured to slidably receive detent post (154) of knife holder (142) and detent post (158) of staple driver assembly (140). As staple driver assembly (140) and knife holder (142) translate distally within cartridge housing (28), detent post (154) resiliently engages detent protrusion (156) and detent post (158) resiliently engages detent protrusions (159, 160).

[0029] As shown in FIGURE 4, the proximal end of the retaining pin (30) includes a first coupling feature (172) (e.g., a protrusion) configured to mate with a corresponding coupling feature (not shown) (e.g., a groove) of the coupler (170), thereby securing the retaining pin (30) to the coupler (170). The coupler (170) and the retaining pin (30) are slidably disposed within an upper arm (176) of the cartridge housing (28) and are proximally captured within the upper arm (176) by an end cap (178) secured to the upper arm (176) adjacent the coupler (170). The distal end of the push rod (50) of the tissue retaining pin actuation mechanism (37) described above is operably coupled to the coupler (170). Thus, longitudinal actuation of the push rod (50) through the slide (18) of the handle assembly (12) drives the coupler (170), and thus the retaining pin (30), longitudinally relative to the cartridge housing (28) to capture the tissue to be stapled by the end effector (16).

[0030] The anvil (26) of this example includes a plate portion (138) secured to a proximal side of an anvil plate backing member in the form of a plastic cut-off washer (168). The anvil plate portion (138) includes an elongated arcuate slot (192) configured to receive a cut-off mechanism of the cut-off washer (168) in the form of an arcuate projection (169) that is threaded through the anvil plate portion (138) relative to the cut-off washer (168). As best shown in FIG. 3, the anvil plate portion (138) further includes a plurality of pockets arranged in rows along either side of the arcuate slot (192). These pockets are configured to receive and form the legs (not shown) of staples driven distally from the staple openings (136) in the staple deck (134). Accordingly, the anvil (26) is spaced distally from the staple deck (134) and aligned with the staple deck (134) such that each pocket of the anvil plate portion (138) is aligned with a corresponding staple opening (136).

[0031] The anvil plate portion (138) further includes a first circular opening (194) disposed at an upper end of the arcuate slot (192) and a second circular opening (see FIG. 4) disposed at a lower end of the arcuate slot (192). The first opening (194) is configured to slidably receive a pointed distal tip of the tissue retaining pin (30) when the tissue retaining pin (30) is actuated distally to capture tissue positioned between the anvil (26) and the cartridge housing (28). The second opening on the underside of the anvil plate portion (138) receives the distal end (190) of the guide pin (166) therethrough. The distal end (190) of the guide pin (166) extends through and is fixedly coupled to the lower end of the cut-off washer (168), thereby longitudinally fixing the guide pin (166) to the anvil (26).

[0032] The proximal end (188) of the guide pin (166) is slidably received through a lower aperture (162) formed in the staple deck (134) of the cartridge housing (28), as described above. An anvil arm (196) projecting proximally from the lower end of the anvil plate portion (138) is movably received through the open lower end of the cartridge housing (28), thereby capturing the proximal end (188) of the guide pin (166) within the cartridge housing (28) while also allowing the cartridge housing (28) to be actuated toward the anvil (26). Thus, the cartridge housing (28) is configured to slide longitudinally along the guide pin (166) (and tissue retaining pin (30)) relative to the anvil (26) in response to actuation of the closure trigger (20) as described above. 4, the interior of guide pin (166) includes a longitudinal slot (180) configured to slidably receive a corresponding lower end (184) of curved knife (32) when cartridge housing (28) is actuated longitudinally relative to anvil (26). The interior of tissue retaining pin (30) may include a similar longitudinal slot (not shown) configured to slidably receive a corresponding upper end (186) of curved knife (32) when cartridge housing (28) is actuated longitudinally relative to anvil (26).

[0033] C. Exemplary Operation of a Surgical Stapler Having described various structural features of the surgical stapler (10) above, including the cartridge unit (24), an exemplary operation of the surgical stapler (10) during a surgical procedure will now be described. The surgical stapler (10) is first appropriately manipulated within a patient's body cavity to position patient tissue within the gap (25) (see FIG. 1A) between the anvil (26) and the cartridge housing (28). As shown in FIG. 1B, the slide (18) is then actuated distally to distally drive the push rod (50), thereby driving the tissue retaining pin (30) distally from the cartridge housing (28) toward the anvil (26). The sharpened distal tip of the tissue retaining pin (30) firmly engages (e.g., pierces) the tissue, thereby capturing it within the gap (25).

[0034] As shown in FIG. 1C, the closure trigger (20) is then pulled toward the pistol grip (38) to drive the closure member (54) distally, thereby driving the cartridge housing (28) distally along the tissue retaining pins (30) and guide pins (166) toward the anvil (26) to clamp tissue between the cartridge deck (134) and the anvil (26). The cartridge housing (28) may be maintained in this closed position relative to the anvil (26) by an internal locking mechanism (not shown) in the handle assembly (12) that holds the closure trigger (20) in the pulled position, as described above. As shown in FIG. 1D, while the cartridge unit (24) remains in this closed position, the firing trigger (22) is then pulled toward the closure trigger (20) and pistol grip (38) to drive the elongated firing bar (not shown) distally, thereby driving the staple driver assembly (140) and knife holder (142) distally within the cartridge housing (28). The stapler driver (141) of the driver assembly (140) drives the staples (not shown) distally through the captured tissue and into contact with the anvil plate portion (138) of the anvil (26) to form the staples in the tissue, thereby fluidly sealing the tissue. As the staples are formed, the curved knife (32) is driven distally by the knife holder (142) through the arcuate slots (150, 152), through the clamped tissue, and into contact with the arcuate projections (169) (see FIG. 5) of the cutting washer (168), thereby cutting the tissue along an arcuate path (AP) that extends between the innermost two rows of formed staples. After completely cutting the clamped tissue, the curved knife (32) can penetrate distally into the arcuate projections (169) of the cutting washer (168). Optionally, in response to such penetration, the body of the cutting washer (168) may break off along with the distal cutting edge of the curved knife (32), thereby providing an audible indication to the surgeon (e.g., via a "snap" sound) that the firing stroke is complete and the clamped tissue is fully stapled and severed.

[0035] Similar to closure trigger (20), firing trigger (22) may be held in its pulled position by an internal locking mechanism (not shown) in handle assembly (12). It will be appreciated that surgical stapler (10) may, in some variations, be configured such that tissue clamped within gap (25) by end effector (16) is simultaneously stapled and cut, or, in other variations, such that tissue is fully stapled and then subsequently cut in successive steps.

[0036] Once the surgical stapler (10) has been fully fired into the patient's tissue as described above, the operator can depress the release button (23) on the handle assembly (12) to release the firing trigger (22) and the closure trigger (20) from their pulled positions. In this manner, the curved knife (32) may be retracted proximally into the cartridge housing (28), which can then be retracted proximally along the pins (20, 166) to release the freshly stapled and severed tissue from between the anvil (26) and the cartridge deck (134). The fired cartridge unit (24) can then be removed from the support structure (128) of the end effector (16) and discarded, and replaced for further procedures if necessary.

[0037] Surgical stapler (10) may further be constructed and function in accordance with any of the teachings of the references cited herein.

[0038] II. Exemplary End Effector with Concave Surface to Allow Deflection for Increased Staple Height Consistency As described above, the support structure 128 defines the end effector 16 by supporting and providing rigidity to the cartridge unit 24. However, in some cases, the free end 167 of the distal arm 135 of the support structure may be pivotally deflected distally about the attachment end 165 in a cantilever-like manner in response to distal tissue compression and firing forces applied by the cartridge housing 28 and knife 32. In this case, since the attachment end 165 does not deflect distally, each staple may be formed to an appropriate height (i.e., distally) at the attachment end 165. However, since the free end 167 deflects distally relative to the fixed end 165, the staples may be formed to an increasing staple height in a direction toward the free end 167. Thus, the resulting height of the formed staples along the arcuate length of the staple deck (134) and anvil plate portion (138) may be relatively non-uniform, especially if the tissue thickness varies along that arcuate length, and a formed staple having a greater height in the region of the free end (167) may not be able to provide effective hemostasis in the corresponding region of the tissue.

[0039] In addition to, or in lieu of, such distal cantilever-like deflection of the free end (167) of the distal arm (135), the portion of the distal arm (135) inboard of the free end (167) (i.e., toward the mounting end (165)) may deflect proximally in response to closure and / or firing of the end effector (16). In some cases, such proximal deflection may be the result of a three-point bending effect caused by interaction between the tissue gap setting protrusions located on the inner and / or outer ends of the washer (168) and / or anvil plate portion (138) and the inner and / or outer ends of the staple deck (134). Such proximal deflection of the portion of the distal arm (135) may undesirably result in non-uniformity in the formed staple height.

[0040] It may therefore be desirable to provide the end effector (16) with one or more formed portions that mitigate or otherwise compensate for such deflection of the distal arms (135) of the support structure, thereby facilitating the formation of staples having a uniform staple height along the arcuate length of the end effector (16). As described in more detail below, the end effector (16) may include a recess defined by a concave surface of the end effector (16). This recess allows a portion of the anvil (26) and / or cutting washer (168) to deflect distally relative to adjacent elements of the end effector (16) when the stapler (10) is fired. Such a configuration may mitigate and compensate for the deflection of the distal arms (135), thereby minimizing the variation in staple height over the arcuate length of the staple deck (134) and anvil plate portion (138), thus improving hemostasis with the formed staples.

[0041] A. Cutting washer with concave proximal side FIG. 5 illustrates an exemplary configuration in which the cutting washer (168) includes a concave proximal surface (210) that allows the anvil plate portion (138) to flex distally relative to the cutting washer (168) upon firing of the end effector (16), thereby creating a more uniform staple height. As shown in FIGS. 2-4, the cutting washer (168) is positioned distally relative to the anvil plate portion (138) and proximally relative to the support structure (128). The cutting washer (168) includes a body (214) extending transversely relative to the shaft longitudinal axis (LAS) (see FIGS. 1A-1D) from a first end (216) to a second end (218) and a tang (220) extending proximally from the first end (216). The body (214) may be, for example, C-shaped, J-shaped, or straight. In this embodiment, the body (214) extends along an arcuate path (AP) in a plane that intersects the shaft longitudinal axis (LAS) perpendicularly and is C-shaped. The curved body (214) includes a distal side (222) that faces the distal arm (135) of the support structure (128) and a proximal side (224) that faces and supports the anvil plate portion (138).

[0042] The proximal side (224) of the cut-off washer body (214) includes a first end portion (226), a second end portion (228), and an intermediate portion (230). The first end portion (226) extends from the first end (216) toward the intermediate portion (230), which further extends toward the second end portion (228). The second end portion (228) extends to the second end (218). The distal side (224) also includes a recess (202) defined by the concave surface (210), the rim (234), and the arcuate projection (169). The concave surface (210) extends from the first end (216) to the second end (218) along the curved longitudinal axis of the washer body (214). The concave surface (210) faces the arcuate pathway (AP) in the proximal direction and extends along the arcuate pathway (AP).

[0043] A rim plane (P1) is defined at the proximal-most side of the rim (234). The rim (234) is disposed along the outer edge of the concave surface (210) and extends both proximally and distally from the concave surface (210). The distal extension of the rim (234) is configured to secure the cutting washer (168) to the proximal side of the support structure (128). In this embodiment, the rim (234) extends distally on three sides of the support structure (128) and includes a pair of clips (240) on the distal side (222) of the concave surface (210) configured to assist in retention of the cutting washer (168) by the support structure (128). In addition to extending distally, the rim (234) extends proximally around the outer edge of the concave surface (210) to a rim plane (P1) along a first elongated edge (238), an edge end (239), and a second elongated edge (240). The edge end (239) of the rim (234) curves in an arcuate path from the first elongated edge (238) to the second elongated edge (240). The edge end (239) also includes an end retainer (241) configured to retain a corresponding end of the anvil plate portion (138).

[0044] The arcuate projection (169) extends proximally from the concave surface (210) toward the rim plane (P1). The arcuate projection (169) extends along an arcuate path (AP) generally from a first Long and thin Edge (238) and second Long and thin The arcuate projection (169) extends transversely between the concave surface (210) and the recess (202) and extends transversely between the concave surface (210) and the edge (240). In this embodiment, the arcuate projection (169) generally separates the concave surface (210) and the recess (202) to form first and second longitudinal portions of the recess (202) that are disposed between the arcuate projection (169) and a corresponding one of the first and second elongated edges (238, 240). As discussed above, the arcuate projection (169) is configured to be received in the arcuate knife slot (152) of the anvil plate portion (138).

[0045] First and second ends (226, 228) of cut-off washer body (214) extend longitudinally through concave surface (210) and include first and second washer holes (242, 244), respectively, configured to align with holes (162, 164), respectively, of cartridge housing (28). First and second washer holes (242, 244) are configured to align anvil plate portion (138) and cut-off washer (168) when guide pin (166) and retaining pin (30) are received through first and second washer holes (242, 244), respectively.

[0046] A tang (220) of the cut-off washer (168) is fitted to the first end (216) and extends proximally to follow the contour of the anvil arm (196) as it extends proximally. The tang (220) includes a tang bore (not shown) extending transversely therethrough and a tang projection (246) extending transversely in a direction opposite to that in which the body (214) extends. The tang bore aligns with an anvil arm bore (not shown) on the anvil arm (196) to receive a pin (not shown) therethrough to secure the anvil arm (196) relative to the tang (220). This fixation of the tang (220) relative to the anvil arm (196) longitudinally secures the anvil plate portion (138) relative to the cut-off washer (168). The tang projection (246) extends transversely to the longitudinal axis of the shaft and is configured to be received within the support structure (128) to longitudinally position the cut-off washer (168) relative to the support structure (128).

[0047] As best seen in Figures 5-6, the concave surface (210) of the cutting washer (168) is shaped such that the mid-portion depth (D1) of the recess (202) at the mid-portion (230) of the cutting washer body (214) is greater than the first and second end depths (D2, D3) of the recess (202) at the first and second ends (226, 228). The depth of the recess (202) is defined in the proximal-distal direction by the distance from the rim plane (P1) to the concave surface (210). As discussed above, the rim plane (P1) is defined by the proximal-most portion of the rim (234) and the proximal-most portion of the elongated projection (169) when the end effector is in an undeflected state (see Figure 1A). The first and second end portions (226, 228) of the cut-off washer body (214) are sized so that the recess (202) receives the anvil plate portion (138) with the proximal side of the anvil plate portion (138) generally lying in the rim plane (P1). 0.127mm ~about 0.381mm The distal end of the catheter can be formed to have a maximum distal depth of 0.01 mm.

[0048] In this embodiment, the concave surface (210) of the cutting washer (168) slopes distally away from the rim plane (P1) as the first end portion (226) extends toward the intermediate portion (230). In some variations, the curvature of the concave surface (210) can be defined by a single radius that extends from around the first end portion (226) through the intermediate portion (230) to the second end portion (228). In other variations, the curvature of the concave surface (210) may be defined by multiple radii. At the intermediate portion (230), the concave surface (210) continues to slope away in the distal direction as the concave surface (210) extends toward the midpoint (250) of the intermediate portion (230). Upon reaching the midpoint (250) of the intermediate portion (230), the concave surface (210) slopes proximally as it extends toward the second end portion (228). Upon reaching the second end (228), the concave surface (210) continues to slope proximally until a depth is achieved between the rim (234) and the concave surface (210) that is approximately equal to the thickness of the anvil plate portion (138).

[0049] In this variation, the concave surface (210) is shaped such that the first and second ends (226, 228) are generally planar and lie along a reference plane (not shown) defined by the distal side of the anvil plate portion (138). Additionally, the surface (210) may be shaped such that the concave intermediate portion (230) comprises approximately 75% of the arcuate length of the surface (210) and the first and second planar end portions (226, 228) collectively comprise the remaining 25% of the arcuate length of the surface (210). Additionally, relative to a center point along the arcuate length of the surface (210), the concave intermediate portion (230) may extend along an arc of approximately 27 degrees in each of a first direction toward the first end (216) of the washer body (214) and a second direction toward the second end (218) of the washer body (214).

[0050] The first and second end portions (226, 228) are configured to engage the anvil plate portion (138) in an undeflected state along the reference surface prior to firing of the stapler (10). The reference surface thus serves as a deflection baseline for deflection of the anvil plate portion (138). The intermediate portion (230) of the concave surface (210) is a fixed distal distance from the first and second end portions (226, 228) and smoothly transitions to the first and second end portions (226, 228) with a fixed curvature. The concave surface (210) is shaped such that the deepest, most distal point of the intermediate portion (230) that defines the recess (202) is centered along the arcuate length of the arcuate projection (169). In this variation, the first and second end portions (226, 228) engage the anvil plate portion (138) uniformly along their lengths as the first and second end portions (226, 228) gradually transition from the anvil plate portion (138) in its undeflected pre-fired state to an intermediate portion (230) having a smooth contour. In some variations, the contour of the intermediate portion (230) of the concave surface (210) may be stepped in a direction distally away from the first and second end portions (226, 228).

[0051] In the undeflected state of the anvil plate portion (138) (see FIG. 7A), a distal side of a first end of the anvil plate portion (138) lies against a proximal side of a first end (216) of the cutting washer (168) and a distal side of a second end of the anvil plate portion (138) lies against a proximal side of a second end (218) of the cutting washer (168). The distal side of the anvil plate portion (138) and the concave surface (210) define a gap (252) (see FIG. 7A) that is flanked by the rim (234) and the arcuate projection (169) within the recess (202).

[0052] 7A shows the anvil plate portion (138) in a schematic undeflected state when the end effector (16) is in the open position (see FIG. 1A). The proximal side of the laterally projecting distal arm (135) of the support structure (128) is shown abutting the distal side (222) of the cutting washer (168). As mentioned above, the concave surface (210) is located on the proximal side (224) of the cutting washer (168) and faces the distal side of the anvil plate portion (138) such that the first and second ends (216, 218) or the first and second end portions (226, 228) of the cutting washer body (214) can directly contact and support the first and second ends of the anvil plate portion (138). A distally rounded gap (252) is located between the concave surface (210) and the distal side of the anvil plate portion (138). Thus, in such undeflected state of the anvil plate portion (138), at least a middle portion of the anvil plate portion (138) is spaced proximally from the middle portion (230) of the cut-off washer body (214).

[0053] As shown diagrammatically in Figure 7B, the anvil plate portion (138) has transitioned to a distally deflected state relative to the cutting washer (168). Such deflection of the anvil plate portion (138) may occur in response to actuation of the end effector (16) to a closed position (see Figure 1C) to clamp tissue, and / or upon actuation of the end effector (16) to a fired state (see Figure 1D) in which staples (not shown) and knife (32) have been driven distally through the clamped tissue. Distal staple forming and / or tissue compressive forces acting on the anvil plate portion (138) cause an intermediate portion of the anvil plate portion (138) to deflect distally into the gap (252) (see FIG. 7A ) defined by the recess (202) in the cutting washer (168), such that the distal side of the anvil plate portion (138) faces, generally conforms to, and may contact, the concave surface (210) of the cutting washer (168) from the first end (216) to the second end (218).

[0054] Such permitted distal deflection of the anvil plate portion (138) into the gap (252) provides an optimized staple forming surface that provides more uniform staple height along the length of the anvil plate portion (138) as the stapler (10) is fired. More specifically, the distal deflection of the medial portion of the anvil plate portion (138) into the gap (252) can mitigate and / or compensate for the cantilever-like distal displacement of the free end (167) of the support structure distal arm (135) relative to the fixed end (165) (see FIGS. 1A-1D ), as well as the proximal deflection of the inner portion of the distal arm (135) as the end effector (16) is closed and fired, by providing a relatively uniform distal spacing between the staple deck (134) and the anvil plate portion (138) along their arcuate lengths while the end effector (16) is closed against tissue. This uniform distal spacing (also referred to as the "tissue gap distance") along the length of the staple deck (134) and anvil plate portion (138) allows the staples fired by the cartridge housing (28) to be formed by the anvil plate portion (138) at a relatively uniform height along the length of the staple deck (134) and anvil plate portion (138). The resulting uniformity in formed staple height provides consistent and effective hemostasis along the stapled portion of tissue. Optionally, to further mitigate the above-mentioned undesirable effects caused by cantilever-like distal deflection of the distal arm (135) upon closure and / or firing of the end effector (16), all or a portion of the surface (210) of the washer (168) may be tapered along its arcuate length.

[0055] B. Support structure with concave proximal side In some cases, it may be desirable to replace or supplement the concave proximal surface (210) of the cutting washer (168) with a concave surface formed on another portion of the end effector (16) to promote uniform staple height. Figure 8 illustrates a portion of another example end effector (316) that includes a concave surface (310) that provides such a functional benefit. The end effector (316) is constructed and functions similarly to the end effector (16) previously described, except as described below.

[0056] In this example, the concave surface (310) on the proximal side of the laterally projecting distal arm (335) can be shaped similarly to the concave surface (210) described above. The end effector (316) is shown in an open position (see FIG. 1A). The concave surface (310) of the laterally projecting distal arm (335) is configured to engage a distal side of the cutting washer (368) at its first and second ends (314, 318), defining a distally rounded gap (352) between the concave surface (310) and the distal side of the cutting washer (368). The distal side of the cutting washer (368) defines a reference surface that serves as an engagement surface where the first and second ends (314, 318) of the cutting washer (368) engage the laterally projecting distal arm (335) in an undeflected state. The proximal side of the cutting washer (368) fits flush with the anvil plate portion (138).

[0057] As detailed above, when the end effector (316) is transitioned to a closed position to clamp tissue (see FIG. 1D ) and subsequently fired to staple and cut the clamped tissue, staple forming and / or tissue compressive forces cause at least an intermediate portion of the anvil plate portion (138) and an intermediate portion of the cutting washer (368) to flex distally to fill the gap (352). During such flexing, a distal side of the cutting washer (368) is configured to mate with the concave surface (310) and a distal side of the anvil plate portion (138) is configured to remain mated with a proximal side of the cutting washer (368), such that both the anvil plate portion (138) and the washer (368) are configured to flex distally into the gap (352). This flexing of the cutting washer (368) and anvil plate portion (138) into the gap (352) may provide a uniform tissue gap distance between the staple deck (134) and the anvil plate portion (138) along their lengths, compensating for and minimizing distal displacement of the free end (367) of the support structure distal arm (335) relative to its fixed end (365). Such a uniform tissue gap distance promotes a uniform and proper staple height along the end effector (316) and provides effective hemostasis of the stapled tissue.

[0058] C. Anvil plate with a concave distal side 9 illustrates a portion of yet another example end effector (416) that includes a concave surface (410) that provides similar functional benefits as the concave surfaces (210, 310) described above. End effector (416) has a similar structure and function to end effector (16) described above, except as described below.

[0059] In this example, the concave surface (410) is on a distal side of the anvil plate portion (438). The end effector (416) is shown in an open position (see FIG. 1A) and extends from a first end (314) to a second end (318). The distal side of the anvil plate portion (438) includes a concave surface (410) that may be shaped similarly to the concave surface (210) described above. The concave surface (410) engages a proximal side of a cutting washer (368) at the first and second ends (314, 318). The proximal side of the cutting washer (368) defines a reference surface that serves as an engagement surface where the first and second ends (314, 318) of the cutting washer (368) engage the anvil plate portion (438) in an undeflected state. The cutting washer (368) fits flush with the laterally projecting distal arm (135) of the support structure (128). The concave surface (410) and the cutting washer (368) define a proximally rounded gap (452) between the first end (314) and the second end (318).

[0060] As detailed above, when the end effector (416) is transitioned to a closed position to clamp tissue (see FIG. 1D ) and subsequently fired to staple and cut the clamped tissue, staple forming and / or tissue compressive forces cause an intermediate portion of the anvil plate portion (438) to flex distally to fill the gap (452). The concave surface (410) of the anvil plate portion (438) is configured to flex distally to mate with a proximal side of the cutting washer (368) with the distal side of the cutting washer (368) mating with a proximal side of the laterally projecting distal arm (135). This flexing of the anvil plate portion (438) into the gap (452) can provide a uniform tissue gap distance between the staple deck (134) and the anvil plate portion (438) along their lengths, compensating for and minimizing distal displacement of the free end (167) of the support structure distal arm (135) relative to its fixed end (165). Such uniform tissue gap distance promotes a uniform and proper staple height along the end effector (416) and provides effective hemostasis of the stapled tissue.

[0061] D. Cutting washer with a concave distal side 10 illustrates yet another example of an end effector 516 that includes a concave surface 510 that provides similar functional benefits as the concave surfaces 210, 310, 410 described above. The end effector 516 has a similar structure and function to the end effector 16 described above, except as described below.

[0062] In this example, the concave surface (510) is on a distal side of the cutting washer (568). The end effector (516) is shown in an open position (see FIG. 1A) and extends from a first end (514) to a second end (518). The distal side of the cutting washer (568) includes a concave surface (510) that may be shaped similarly to the concave surface (210) described above. The proximal side of the laterally projecting distal arm (135) defines a reference surface that serves as an engagement surface where the first and second ends (514, 518) of the cutting washer (568) engage the laterally projecting distal arm (135) in an undeflected state. The proximal side of the cutting washer (568) fits flush with the distal side of the anvil plate portion (138). The concave surface (510) and the laterally projecting distal arm (135) define a proximally rounded gap (552) between the first end (514) and the second end (518). The proximal side of the cutting washer (568) fits flush with the anvil plate portion (138).

[0063] As detailed above, when the end effector (516) is transitioned to a closed position to clamp tissue (see FIG. 1D ) and subsequently fired to staple and cut the clamped tissue, staple forming and / or tissue compressive forces cause an intermediate portion of the cutting washer (168) to deflect distally into the gap (552). In particular, the concave surface (510) of the cutting washer (568) deflects distally to engage with the proximal side of the laterally projecting distal arm (335), while the proximal side of the cutting washer (568) remains engaged with the distal side of the anvil plate portion (138). Thus, in this variation, the anvil plate portion (138) and the intermediate portion of the cutting washer (568) are configured to both deflect distally into the gap (552) when the end effector (516) is fired. This flexing of the anvil plate portion (138) and washer (568) into the gap (552) provides a uniform tissue gap distance between the staple deck (134) and the anvil plate portion (138) along their lengths, compensating for and minimizing distal displacement of the free end (167) of the support structure distal arm (135) relative to its fixed end (165). Such uniform tissue gap distance promotes a uniform and proper staple height along the end effector (516) and provides effective hemostasis of the stapled tissue.

[0064] IV.Other It should be understood that any one or more of the teachings, expressions, embodiments, examples, etc. described herein can be combined with any one or more of the other teachings, expressions, embodiments, examples, etc. described herein. Thus, the above teachings, expressions, embodiments, examples, etc. should not be considered in isolation with respect to each other. Various suitable ways in which the teachings herein can be combined will be readily apparent to those skilled in the art in light of the teachings herein. Such modifications and variations are intended to be included within the scope of the claims.

[0065] Variations of the above devices may be applied to robotic-assisted medical procedures and surgeries as well as traditional medical procedures and surgeries performed by medical professionals. By way of example only, the various teachings herein may be readily incorporated into robotic surgical systems such as the DAVINCI™ system by Intuitive Surgical, Inc. (Sunnyvale, California). Similarly, one of ordinary skill in the art will recognize that the various teachings herein may be readily combined with the various teachings of any of the following: U.S. Patent No. 8,479,969, issued July 9, 2013, entitled "Drive Interface for Operably Coupling a Manipulatable Surgical Tool to a Robot"; U.S. Patent Application Publication No. 8,800,838, issued August 12, 2014, entitled "Robotically-Controlled Cable-Based Surgical End Effectors"; and U.S. Patent Application Publication No. 8,800,838, issued August 12, 2014, entitled "Robotically-Controlled Cable-Based Surgical End Effectors." issue, and / or U.S. Patent No. 8,573,465, issued November 5, 2013, entitled “Robotically-Controlled Surgical End Effector System with Rotary Actuated Closure Systems.” issue.

[0066] The device variations described above can be designed to be disposed of after a single use, or they can be designed to be used multiple times. The variations, in either or both cases, can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular parts, and subsequent reassembly. In particular, some device variations can be disassembled and any number of particular parts or pieces of the device can be selectively replaced or removed in any combination. Upon cleaning and / or replacement of particular parts, some device variations can be reassembled for subsequent use either at a reconditioning facility or by an operator immediately prior to a procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.

[0067] By way of example only, the variations described herein may be sterilized before and / or after treatment. In one sterilization technique, the device is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and device may then be placed in a radiation field that can penetrate the container, such as gamma radiation, x-rays, or high-energy electron beams. The radiation may kill bacteria on the device and in the container. The sterilized device may then be stored in the sterile container for later use. The device may also be sterilized using any other technique known in the art, including but not limited to beta or gamma radiation, ethylene oxide, or steam.

[0068] [Embodiment] (1) An apparatus comprising: (a) a housing containing a plurality of staples; (b) an anvil opposed to the housing, the anvil and the housing configured to cooperate to clamp tissue, the anvil configured to form staples ejected from the housing into the clamped tissue; (c) a backing member coupled to the anvil; and (d) a concave surface defining a gap between the backing member and an adjacent element of the device; The device, wherein the anvil is configured to deflect in a direction toward the gap upon actuation of the device to at least one of clamping or stapling tissue. (2) The apparatus of embodiment 1, wherein each of the housing, the anvil, and the backing member extends along an arcuate path. (3) The device of claim 1, wherein the concave surface is defined by the backing member. (4) The device of embodiment 1, wherein the anvil is disposed distally of the housing and the backing member is disposed distally of the anvil. (5) The apparatus of claim 4, wherein the backing member includes a first end, a second end, and an intermediate portion therebetween, the concave surface being defined by the backing member such that the backing member includes a concave recess having a maximum depth at the intermediate portion of the backing member.

[0069] (6) The device of embodiment 5, wherein the concave surface is defined on a proximal side of the backing member, the gap is defined between the proximal side of the backing member and a distal side of the anvil, and the anvil is configured to deflect into the gap upon actuation of the device to at least one of clamping tissue or stapling tissue. (7) The apparatus of claim 1, further comprising a support structure configured to support the backing member, the concave surface being defined by one of the anvil, the backing member, or the support structure. (8) The device of embodiment 7, wherein the support structure includes a proximal portion and a distal portion, the proximal portion configured to support the housing, and the distal portion configured to support the anvil and the backing member. (9) The device of embodiment 7, wherein the housing is actuable distally relative to the support structure to clamp tissue against the anvil. (10) The device of embodiment 1, further comprising a knife movable relative to the housing and the anvil, the knife configured to cut the clamped tissue.

[0070] (11) The device of claim 10, wherein the backing member includes a cutting mechanism configured to cooperate with the knife to cut the clamped tissue. (12) The apparatus of claim 11, wherein the anvil includes an elongated slot, and the cutting mechanism includes a projection that projects through the elongated slot in a direction toward the housing. (13) A surgical instrument, (a) a main body; (b) a shaft extending distally from the body; and (c) an end effector at a distal end of the shaft, the end effector comprising the device described in embodiment 1. (14) The surgical instrument of claim 13, wherein the end effector includes a support structure supporting the backing member, and the concave surface is defined by one of the anvil, the backing member, or the support structure. (15) The surgical instrument of claim 13, wherein the housing, the anvil, and the backing member together define a unit removably coupled to the support structure.

[0071] (16) An apparatus comprising: (a) a main body; (b) a shaft extending distally from the body; and (c) an end effector at a distal end of the shaft, (i) a housing containing a plurality of staples; (ii) an anvil opposing the housing, the anvil and the housing configured to cooperate to clamp tissue, the anvil configured to form staples ejected from the housing into the clamped tissue; (iii) a backing member coupled to the anvil, the backing member including a concave surface that defines a gap between the backing member and an adjacent element of the end effector; The device, wherein the anvil is configured to deflect in a direction toward the concave surface upon actuation of the device to at least one of clamping or stapling tissue. (17) The device of claim 16, wherein the anvil is disposed distally of the housing, the backing member is disposed distally of the anvil, and the concave surface is defined by one of a proximal side or a distal side of the backing member. (18) The device of embodiment 16, wherein the shaft extends longitudinally along a shaft axis, and the housing and the anvil are configured to cooperate to clamp tissue in a plane perpendicular to the shaft axis. (19) An apparatus comprising: (a) a main body; (b) a shaft extending distally from the body along a shaft axis; (c) an end effector at a distal end of the shaft, (i) a housing containing a plurality of staples; (ii) an anvil disposed distally of the housing, the anvil and the housing configured to cooperate to clamp tissue in a plane intersecting the shaft axis, the anvil configured to form staples ejected from the housing into the clamped tissue; (iii) a backing member coupled to a distal side of the anvil, a proximal side of the backing member including a concave surface that defines a gap between the backing member and the distal side of the anvil; The device, wherein the anvil is configured to deflect distally into the gap upon actuation of the device to at least one of clamping or stapling tissue. (20) The apparatus of embodiment 19, wherein the housing, the anvil, and the backing member each extend along an arcuate path in corresponding planes intersected by the shaft axis.

Claims

1. 1. An apparatus comprising: (a) a housing (28) containing a plurality of staples; (b) an anvil (26) opposed to the housing, the anvil and the housing configured to cooperate to clamp tissue, the anvil configured to form staples ejected from the housing into the clamped tissue; (c) a backing member (168) coupled to the anvil; and (d) a concave surface (210, 310, 410, 510) defining a gap (252, 352, 452, 552) between the backing member and an adjacent element of the device; The device, wherein the anvil is configured to deflect in a direction toward the gap upon actuation of the device to at least one of clamping or stapling tissue.

2. The apparatus of claim 1, wherein each of the housing (28), the anvil (26), and the backing member (168) extends along an arcuate path.

3. The apparatus of claim 1 or 2, wherein the concave surface (210, 510) is defined by the backing member (168).

4. The apparatus of any one of claims 1 to 3, wherein the anvil (26) is disposed distally of the housing (28) and the backing member (168) is disposed distally of the anvil (26).

5. the concave surface (210, 510) is defined by the backing member (168) such that the backing member (168) includes a first end (226), a second end (228) and an intermediate portion (230) therebetween, the backing member (168) including a concave recess having a maximum depth at the intermediate portion (230) of the backing member (168), and optionally 5. The device of claim 4, wherein the concave surface (210) is defined on a proximal side of the backing member (168), the gap (252) is defined between the proximal side of the backing member (168) and a distal side of the anvil (26), and the anvil (26) is configured to deflect into the gap (252) upon actuation of the device to at least one of clamping or stapling tissue.

6. and a support structure (128) configured to support the backing member (168), wherein the concave surface (210, 310, 410, 510) is defined by one of the anvil (26), the backing member (168), or the support structure (128), and optionally The apparatus of any one of claims 1 to 5, wherein the support structure (128) includes a proximal portion (131) and a distal portion (135), the proximal portion (131) configured to support the housing (28) and the distal portion (135) configured to support the anvil (26) and the backing member (168).

7. The apparatus of claim 6, wherein the housing (28) is distally actuable relative to the support structure (128) to clamp tissue against the anvil (26).

8. The device of claim 1, further comprising a knife (32) movable relative to the housing (28) and the anvil (26), the knife (32) configured to cut the clamped tissue.

9. the backing member (168) includes a cutting mechanism (169) configured to cooperate with the knife (32) to cut the clamped tissue, and optionally 9. The apparatus of claim 8, wherein the anvil (26) includes an elongated slot (152), and the cutting mechanism (169) includes a projection that projects through the elongated slot (152) in a direction toward the housing (28).

10. 1. A surgical instrument comprising: (a) a main body (12); (b) a shaft (14) extending distally from said body (12); (c) an end effector (16) at a distal end of the shaft, the end effector (16) comprising the device of claim 1.

11. the end effector (16) includes a support structure (128) supporting the backing member (168), and the concave surface (210, 310, 410, 510) is defined by one of the anvil (26), the backing member (168), or the support structure (128); and / or The surgical instrument of claim 10, wherein the housing (28), the anvil (26), and the backing member (168) together define a unit removably coupled with the support structure.

12. The surgical instrument of claim 10, wherein the backing member (168) includes the concave surface (210, 510), and the anvil (26) is configured to deflect in a direction toward the concave surface (210, 510) in response to actuation of the apparatus to at least one of clamping tissue or stapling tissue.

13. 13. The surgical instrument of claim 12, wherein the anvil (26) is disposed distally of the housing (28), the backing member (168) is disposed distally of the anvil (26), and the concave surface (210, 510) is defined by one of a proximal side or a distal side of the backing member (168).

14. 14. The surgical instrument of claim 12 or 13, wherein the shaft (14) extends longitudinally along a shaft axis, and the housing (28) and the anvil (26) are configured to cooperate to clamp tissue in a plane perpendicular to the shaft axis.

15. The shaft (14) extends distally from the body (12) along a shaft axis, the anvil (26) is disposed distally of the housing (28), the anvil (26) and the housing (28) are configured to cooperate to clamp tissue in a plane intersecting the shaft axis, the backing member (168) is coupled to a distal side of the anvil (26), a proximal side of the backing member (168) includes the concave surface (210) defining a gap (252) between the backing member (168) and the distal side of the anvil (26), the anvil (26) is configured to deflect distally into the gap (252) upon actuation of the device to at least one of clamping and stapling tissue, and optionally The surgical instrument of claim 10, wherein each of the housing (28), the anvil (26), and the backing member (168) extend along an arcuate path in corresponding planes intersected by the shaft axis.

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