End effector, surgical stapling device, and method of using same

Abstract

Provides an end effector for the surgeon to use to staple the patient's anatomy. [Solution] The end effector includes a first jaw having a first end, a second end, a longitudinal axis, and an anvil having an anvil face; a second jaw having a first end, a second end, a longitudinal axis, and a cartridge configured to be operable to accommodate a plurality of staples and having a cartridge face; first coupling means for coupling the first end of the first jaw to the first end of the second jaw; and second coupling means for movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid link connected to the first jaw and the second jaw.

Description

[Technical field]

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application No. 62 / 545,324, filed August 14, 2017, U.S. Provisional Patent Application No. 62 / 579,703, filed October 31, 2017, U.S. Provisional Patent Application No. 62 / 662,517, filed April 25, 2018, U.S. Provisional Patent Application No. 62 / 676,493, filed May 25, 2018, and U.S. Provisional Patent Application No. 62 / 672,996, filed May 17, 2018, the contents of each of which are incorporated herein by reference in their entirety.

[0002] FIELD OF THE DISCLOSURE Embodiments of the present technology relate generally to surgical stapling technology and, more particularly, to end effectors and stapling devices and methods of using such devices in surgical procedures. [Prior art documents] [Patent documents]

[0003] [Patent Document 1] U.S. Patent Application Serial No. 15 / 129,385 Summary of the Invention [Means for solving the problem]

[0004] An embodiment includes an end effector for use by a surgeon to staple an anatomical structure of a patient, the end effector including a first jaw having a first end, a second end, a longitudinal axis, and an anvil having an anvil face; a second jaw having a first end, a second end, a longitudinal axis, and a cartridge operatively configured to receive a plurality of staples and having a cartridge face; first coupling means coupling the first end of the first jaw to the first end of the second jaw; and second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid link connected to the first jaw and the second jaw.

[0005] In certain embodiments, the first end of the first jaw is a distal end of the first jaw and the second end of the first jaw is a proximal end of the first jaw. In certain embodiments, the first coupling means includes a pin having a pin axis, the pin axis being transverse to a longitudinal axis of the first jaw and a longitudinal axis of the second jaw, the pin pivotally coupling the first end of the first jaw to the first end of the second jaw. In certain embodiments, the second coupling means includes a slot defined by the first jaw or the second jaw, the slot holding the rigid coupling such that the rigid coupling is slidable within the slot. In certain embodiments, the slot has a length between 3 millimeters and 8 millimeters. Certain embodiments include a plurality of staples at least partially held by a cartridge of the second jaw. In certain embodiments, the plurality of staples at least partially held by the cartridge are positioned between the first coupling means and the second coupling means. Certain embodiments include a blade having a cutting surface and at least one lateral arm. Certain embodiments include a channel defined by the first jaw or the second jaw for retaining at least one lateral arm of a blade, in which the blade is transitioned from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to resect an anatomical structure.

[0006] An example of a method for stapling an anatomical structure of a patient during a minimally invasive procedure includes the steps of providing an end effector, the end effector having a first jaw having a first end, a second end, a longitudinal axis, and an anvil having an anvil face; a second jaw having a first end, a second end, a longitudinal axis, and a cartridge holding a plurality of staples and having a cartridge face; first coupling means coupling the first end of the first jaw to the first end of the second jaw; second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid coupling connected to the first jaw and the second jaw; and a second coupling means coupled to the first jaw or the second jaw, the first jaw being coupled to the second jaw. The method includes providing an end effector including a first jaw and a knife slidable relative to the first jaw or the second jaw; inserting the end effector through a trocar to access the anatomical structure; positioning a cartridge face on a first side of the anatomical structure; positioning an anvil face on a second side of the anatomical structure; operating the end effector to move the rigid joint such that the first jaw is pushed toward the second jaw to clamp the end effector against the anatomical structure; operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure; and actuating the knife to cut the anatomical structure.

[0007] An embodiment includes a surgical instrument for stapling and resecting an anatomical structure of a patient, the surgical instrument including an end effector having a first jaw having a first end, a second end, a longitudinal axis, and an anvil having an anvil surface positionable on a first side of the anatomical structure, a second jaw having a first end, a second end, a longitudinal axis, and a cartridge operatively configured to receive a plurality of staples and having a cartridge surface positionable on a second side of the anatomical structure, and a first coupling for coupling the first end of the first jaw to the first end of the second jaw. an end effector comprising an elongate tube having a proximal end and a distal end, the distal end being coupled to the end effector; a handle having a proximal end and a distal end, the distal end of the handle being coupled to the proximal end of the elongate tube; and a drive assembly including a motor for actuating the end effector.

[0008] An embodiment includes a method of stapling an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure, the method including the steps of providing an end effector, the end effector being an anvil having a first end, a second end, an anvil face, a length, and a width, the length of the anvil being at least 10 times the width of the anvil; a cartridge having a first end, a second end, a cartridge face, a length, and a width, the length of the cartridge being at least 10 times the width of the anvil, the cartridge holding a plurality of staples, the first end of the anvil being coupled to the first end of the cartridge and the second end of the anvil being movably coupled to the second end of the cartridge; and a rigid coupling having a distal portion and a proximal portion, the rigid coupling being configured to couple the anvil to the first end of the cartridge. The method includes providing an end effector including an anvil second end and a rigid coupling movably coupling the anvil second end to the cartridge second end; inserting the end effector through a trocar to access the anatomical structure; positioning a cartridge face on a first side of the anatomical structure; positioning an anvil face on a second side of the anatomical structure; operating the end effector to move the rigid coupling such that the anvil is pushed toward the cartridge to clamp the end effector against the anatomical structure; operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure; and actuating a knife to cut the anatomical structure.

[0009] An embodiment includes a surgical instrument for stapling and resecting a patient's anatomical structure, the surgical instrument comprising an end effector, an anvil having a first end, a second end, an anvil face, a length, and a width, the length of the anvil being at least 10 times the width of the anvil, and a cartridge having a first end, a second end, a cartridge face, a length, and a width, the length of the cartridge being at least 10 times the width of the anvil, the cartridge being operatively configured to house a plurality of staples, the first end of the anvil being coupled to the first end of the cartridge, the second end of the anvil is movably coupled to the second end of the cartridge; a rigid coupling having a distal portion and a proximal portion, the rigid coupling movably coupling the second end of the anvil to the second end of the cartridge; an elongated tube having a proximal end and a distal end, the distal end being coupled to the end effector; a handle having a proximal end and a distal end, the distal end of the handle being coupled to the proximal end of the elongated tube; and a drive assembly including a motor for actuating the end effector.

[0010] An embodiment includes a method of stapling an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure, the method including the steps of providing an end effector, the end effector including an anvil having a first end, a second end, and an anvil face, a cartridge holding a plurality of staples and having a first end, a second end, and a cartridge face, the cartridge face including a channel extending from the first end of the cartridge to the second end of the cartridge, the first end of the cartridge being pivotally coupled to the first end of the anvil, a blade having a cutting surface and at least one elongated arm, the at least one elongated arm being slidably engaged with the channel, and a blade having a cutting surface and at least one elongated arm. The method includes providing an end effector including a rigid coupling movably coupled to a second end of the cartridge; inserting the end effector through a trocar to access the anatomical structure; positioning a cartridge face on a first side of the anatomical structure; positioning an anvil face on a second side of the anatomical structure; operating the end effector to move the rigid coupling such that the anvil is pushed toward the cartridge to clamp the end effector against the anatomical structure; operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure; and actuating a blade to cut the anatomical structure.

[0011] An embodiment includes a surgical instrument for stapling and resecting an anatomical structure of a patient, the surgical instrument including an end effector including an anvil having a first end, a second end, and an anvil face positionable on a first side of the anatomical structure, and a cartridge operatively configured to receive a plurality of staples, the cartridge face including a first end, a second end, and a cartridge face positionable on the second side of the anatomical structure, the cartridge face including a channel extending from the first end of the cartridge to the second end of the cartridge, the first end of the cartridge being pivotally coupled to the first end of the anvil. the anvil includes a cartridge, a blade having a cutting surface and at least one elongated arm, the at least one elongated arm being slidably engaged with the channel, the blade, a rigid link movably connecting the second end of the anvil to the second end of the cartridge, an end effector, an elongated tube having a proximal end and a distal end, the distal end being coupled to the end effector, a handle having a proximal end and a distal end, the distal end of the handle being coupled to the proximal end of the elongated tube, and a drive assembly including a motor for actuating the end effector.

[0012] An embodiment includes a method of stapling an anatomical structure of a patient during a minimally invasive procedure, the method including the steps of providing an end effector, the end effector including a first jaw having a first end, a second end, an anvil having an anvil face, and a first channel, a second jaw having a first end, a second end, a cartridge having a cartridge face, and a second channel, a first coupling means coupling the first end of the first jaw to the first end of the second jaw, and a second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection, a blade portion having a cutting edge, at least one upper lateral arm slidably positioned within the first channel, and a stapling member slidably positioned within the second channel. The method includes providing an end effector including an I-shaped blade including at least one lower lateral arm slidably positioned on the anatomical structure; inserting the end effector through a trocar to access the anatomical structure; positioning a cartridge face on a first side of the anatomical structure; positioning an anvil face on a second side of the anatomical structure; operating the end effector to move the rigid joint such that the anvil is pushed toward the cartridge to clamp the end effector against the anatomical structure; operating the end effector to push a plurality of staples from the cartridge to staple the anatomical structure; and actuating the I-shaped blade to cut the anatomical structure.

[0013] An embodiment includes a surgical instrument for stapling and resecting a patient's anatomical structure, the surgical instrument including an end effector having a first jaw having a first end, a second end, an anvil having an anvil face, and a first channel; a second jaw having a first end, a second end, a cartridge having a cartridge face, and a second channel; first coupling means coupling the first end of the first jaw to the first end of the second jaw; and second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection; and a cutting edge. the I-shaped blade including a blade portion having a first channel, at least one upper lateral arm slidably positioned within the first channel, and at least one lower lateral arm slidably positioned within the second channel; an elongated tube having a proximal end and a distal end, the distal end coupled to the end effector; a handle having a proximal end and a distal end, the distal end of the handle coupled to the proximal end of the elongated tube; and a drive assembly having a motor for actuating the end effector.

[0014] An embodiment includes an end effector for a surgeon to staple a patient's anatomical structure during a minimally invasive procedure, the end effector including: an anvil having a first end, a second end, and an anvil face; a cartridge having a first end, a second end, and a cartridge face and housing a plurality of staples, the first end of the anvil being coupled to the first end of the cartridge and the second end of the anvil being coupled to the second end of the cartridge; and a buttress including a first buttress member coupled to the anvil face such that the first buttress member covers a portion of the anvil face and a second buttress member coupled to the cartridge face such that the second buttress member covers a portion of the anvil face.

[0015] An embodiment includes an end effector for use by a surgeon to staple a patient's anatomical structure during a minimally invasive procedure, the end effector including: an anvil including a first end, a second end, and an anvil face positionable on a first side of the anatomical structure; a cartridge housing a plurality of staples and having a first end, a second end, and a cartridge face positionable on a second side of the anatomical structure, the first end of the cartridge being coupled to the first end of the anvil and the second end of the cartridge being coupled to the second end of the anvil; a blade having a cutting surface, the blade engageable with the anvil and the cartridge; and a buttress, which is a flat section of material coupled to the anvil face or cartridge face.

[0016] An embodiment includes an end effector including a first jaw having a first end, a second end, an anvil face, and a first channel; a second jaw having a first end, a second end, a cartridge face, and a second channel; first coupling means coupling the first end of the first jaw to the first end of the second jaw; second coupling means coupling the second end of the first jaw to the second end of the second jaw; an I-shaped blade including a blade portion having a cutting edge, at least one upper lateral arm slidably positioned within the first channel, and at least one lower lateral arm slidably positioned within the second channel; and a buttress, which is a flat section of material coupled to the anvil face or cartridge face.

[0017] An embodiment includes an end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, the end effector including a first jaw having an anvil having a first end, a second end, a longitudinal axis, and an anvil face positionable on the first side of the anatomical structure, a second jaw having a first end, a second end, a longitudinal axis, and a cartridge having a cartridge face that houses a plurality of staples and is positionable on the second side of the anatomical structure, first coupling means coupling the first end of the first jaw to the first end of the second jaw, second coupling means coupling the second end of the first jaw to the second end of the second jaw, and a buttress including a first buttress member positioned adjacent to the anvil face such that the first buttress member covers a portion of the anvil face, and a second buttress member positioned adjacent to the cartridge face such that the second buttress member covers a portion of the cartridge face.

[0018] An embodiment includes a method for a surgeon to staple an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure, the method including the steps of providing an end effector, the end effector having a first jaw having a first end, a second end, a longitudinal axis, and an anvil with an anvil surface positionable on the first side of the anatomical structure, a second jaw having a first end, a second end, a longitudinal axis, and a cartridge housing a plurality of staples and having a cartridge surface positionable on the second side of the anatomical structure, a first coupling means coupling the first end of the first jaw to the first end of the second jaw, and a second coupling means coupling the second end of the first jaw to the second end of the second jaw. providing a buttress, the buttress comprising a first buttress member and a second buttress member; attaching the first buttress member to an anvil face; attaching the second buttress member to a cartridge face; deploying a plurality of staples to perforate the first and second buttress members; attaching the first and second buttress members to an anatomical structure using the plurality of staples; and severing the first and second buttress members.

[0019] An embodiment includes a method for a surgeon to staple an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure, the method including the steps of providing an end effector, the end effector including an anvil having a first end, a second end, and an anvil face, and a cartridge having a first end, a second end, and a cartridge face and housing a plurality of staples, the first end of the anvil being coupled to the first end of the cartridge and the second end of the anvil being coupled to the second end of the cartridge; and providing a buttress. The method includes providing a buttress including a first buttress member and a second buttress member, attaching the first buttress member to an anvil face, attaching the second buttress member to a cartridge face, positioning an end effector adjacent to the anatomical structure, deploying a plurality of staples to perforate the first and second buttress members, coupling the first and second buttress members to the anatomical structure with the plurality of staples, and severing the first and second buttress members.

[0020] An embodiment includes an end effector for stapling an anatomical structure having a first side and a second side, the end effector including an anvil having a proximal end, a distal end, and an anvil face, an anvil blade channel defined by the anvil face, the anvil blade channel positioned to bisect the anvil face into a first half and a second half, a first pocket row including a plurality of first row staple pockets positioned on the first half of the anvil face, a second pocket row including a plurality of second row staple pockets positioned on the first half of the anvil face, a third row staple pockets positioned on the first half of the anvil face. the anvil includes a third pocket row including a plurality of staple row pockets positioned on the second half of the anvil face, a fourth pocket row including a plurality of fourth row staple pockets positioned on the second half of the anvil face, a fifth pocket row including a plurality of fifth row staple pockets positioned on the second half of the anvil face, and a sixth pocket row including a plurality of sixth row staple pockets positioned on the second half of the anvil face; a cartridge having a proximal end, a distal end, and a cartridge blade channel, the cartridge being configured to hold a plurality of staples; and a blade having a cutting edge, the blade being movable from a first position at the distal end of the cartridge to a second position at the proximal end of the cartridge.

[0021] An embodiment of the end effector can include a staple drive ramp operatively configured to drive the staples from the cartridge toward the anvil face, the staple drive ramp being movable from a distal end of the end effector to a proximal end of the end effector such that the end effector is operatively configured to deploy the staples from the cartridge when the blade is moved from the distal end to the proximal end. In certain embodiments, the proximal end of the anvil is coupled to the proximal end of the cartridge and the distal end of the anvil is coupled to the distal end of the cartridge. In certain embodiments, the plurality of first row staple pockets have a uniform first depth and the plurality of second row staple pockets have a uniform second depth, the uniform first depth being different from the uniform second depth. In certain embodiments, the uniform first depth is shallower than the uniform second depth. In certain embodiments, the first row of pockets is spaced a first distance from the second row of pockets and the second row of pockets is spaced a second distance from the third row of pockets, the second distance being greater than the first distance. In certain embodiments, the first row of pockets is offset from the second row of pockets. In certain embodiments, the plurality of first row staple pockets includes a first portion having a first pocket depth and a second portion having a second pocket depth. In certain embodiments, the first portion is a proximal portion and the second portion is a distal portion, and the first pocket depth is greater than the second pocket depth. In certain embodiments, each of the plurality of first row staple pockets has a different pocket depth. In certain embodiments, the first row staple pockets have a first depth corresponding to the fourth row staple pockets, the second row staple pockets have a second depth corresponding to the fifth row staple pockets, and the third row staple pockets have a third depth corresponding to the sixth row staple pockets. In certain embodiments, the first depth is less than the second depth and the second depth is less than the third depth.In certain embodiments, each of the plurality of first row staple pockets is sized to cooperate with the cartridge face to form B-shaped staples having a symmetrical configuration. In certain embodiments, at least a portion of the plurality of first row staple pockets are sized to form staples having an asymmetrical configuration. In certain embodiments, each of the plurality of first row staple pockets is sized to form staples having a three-dimensional geometric shape. In certain embodiments, each of the plurality of first row staple pockets includes a first cavity having a first depth and a second cavity having a second depth, the first depth being greater than the second depth.

[0022] Particular embodiments include an end effector for stapling an anatomical structure having a first side and a second side, the end effector including an anvil having a proximal end, a distal end, and an anvil face, an anvil blade channel defined by the anvil face, the anvil blade channel positioned to bisect the anvil face into a first half and a second half, a first pocket row including a plurality of first row staple pockets positioned on the first half of the anvil face, a first portion of the plurality of first row staple pockets having a first pocket depth and a second portion of the plurality of first row staple pockets having a second pocket depth different from the first pocket depth, a second pocket row including a plurality of second row staple pockets positioned on the first half of the anvil face, a first portion of the plurality of second row staple pockets having a first pocket depth and a second portion of the plurality of second row staple pockets having a second pocket depth different from the first pocket depth. the anvil includes a second pocket row including a plurality of third row staple pockets positioned on a second half of the anvil face, a first portion of the plurality of third row staple pockets having a first pocket depth and a second portion of the plurality of third row staple pockets having a second pocket depth; and a fourth pocket row including a plurality of fourth row staple pockets positioned on the second half of the anvil face, a first portion of the plurality of fourth row staple pockets having a first pocket depth and a second portion of the plurality of fourth row staple pockets having a second pocket depth; a cartridge having a proximal end, a distal end, and a cartridge face defining a cartridge blade channel, the cartridge being configured to hold a plurality of staples; and a blade having a cutting edge, the blade being movable from a first position at the distal end of the cartridge to a second position at the proximal end of the cartridge.

[0023] An embodiment includes an end effector for stapling an anatomical structure having a first side and a second side, the end effector including an anvil having a proximal end, a distal end, and an anvil face, an anvil blade channel defined by the anvil face, a knife channel bisecting the anvil face into a first half and a second half, a first inner pocket row including a plurality of first row staple pockets positioned on the first half of the anvil face, and a first inner pocket row including a plurality of first row staple pockets positioned on the first half of the anvil face. a first inner row of pockets, each of the plurality of second row staple pockets having a depth of 0.010 inch to 0.015 inch; a second central row of pockets including a plurality of second row staple pockets positioned on the first half of the anvil face, each of the plurality of second row staple pockets having a depth of 0.020 inch to 0.025 inch; a third outer pocket row including a plurality of third row staple pockets having a depth between 0.030 inches and 0.035 inches; a fourth inner pocket row including a plurality of fourth row staple pockets positioned on the second half of the anvil face, each of the plurality of fourth row staple pockets having a depth between 0.010 inches and 0.050 inches; a fifth center pocket row including a plurality of fifth row staple pockets positioned on the second half, each of the plurality of fifth row staple pockets having a depth between 0.010 inches and 0.050 inches, and a sixth outer pocket row including a plurality of sixth row staple pockets positioned on the second half of the anvil face, each of the plurality of sixth row staple pockets having a depth between 0.010 inches and 0.The anvil includes a sixth outer row of pockets having a depth of about 1.050 inches, a cartridge having a proximal end, a distal end, and a cartridge face defining a cartridge blade channel and configured to hold a plurality of staples, and a blade having a cutting edge and movable from a first position at the distal end of the cartridge to the proximal end of the cartridge.

[0024] An embodiment includes an end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, the end effector including an anvil having a first end, a second end, an anvil face, a length, and a width, the anvil length being at least 10 times the anvil width; a cartridge having a first end, a second end, a cartridge face, a length, and a width, the cartridge length being at least 10 times the anvil width, the cartridge operatively configured to house a plurality of staples, the anvil first end being coupled to the cartridge first end and the anvil second end being movably coupled to the cartridge second end; and a rigid coupling having a distal portion and a proximal portion, the rigid coupling movably coupling the anvil second end to the cartridge second end.

[0025] An embodiment includes an end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, the end effector including: an anvil including a first end, a second end, and an anvil face positionable on the first side of the anatomical structure; a cartridge operatively configured to accommodate a plurality of staples, the cartridge including a first end, a second end, and a cartridge face positionable on the second side of the anatomical structure, the cartridge face including a channel extending from the first end of the cartridge to the second end of the cartridge, the first end of the cartridge being pivotally coupled to the first end of the anvil; a blade having a cutting surface and at least one elongated arm, the at least one elongated arm being slidably engaged with the channel; and a rigid connection movably coupling the second end of the anvil to the second end of the cartridge.

[0026] An embodiment includes an end effector including a first jaw having a first end, a second end, an anvil having an anvil face, and a first channel; a second jaw having a first end, a second end, a cartridge having a cartridge face, and a second channel; first coupling means coupling the first end of the first jaw to the first end of the second jaw; second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection; and an I-shaped blade including a blade portion having a cutting edge, at least one upper lateral arm slidably positioned within the first channel, and at least one lower lateral arm slidably positioned within the second channel.

[0027] An embodiment relates to an end effector for use by a surgeon to staple an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure. The end effector includes a first jaw having a first end, a second end, a longitudinal axis, and an anvil having an anvil face positionable on the first side of the anatomical structure. A second jaw has a first end, a second end, a longitudinal axis, and a cartridge operatively configured to receive a plurality of staples and having a cartridge face positionable on the second side of the anatomical structure. A first coupling means couples the first end of the first jaw to the first end of the second jaw, and a second coupling means movably couples the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection.

[0028] The first end of the first jaw may be a distal end of the first jaw and the second end of the first jaw may be a proximal end of the first jaw. The first coupling means may include a pin having a pin axis transverse to a longitudinal axis of the first jaw and a longitudinal axis of the second jaw, the pin pivotally coupling the first end of the first jaw to the first end of the second jaw.

[0029] The second coupling means may comprise a slot in the first jaw or the second jaw, the slot retaining the rigid coupling such that the rigid coupling may be slidable within the slot. The slot may have a length of 3 millimeters to 8 millimeters. A plurality of staples may be at least partially retained by the cartridge in the second jaw. The plurality of staples retained at least partially by the cartridge may be positioned between the first coupling means and the second coupling means. The end effector may further comprise a blade having a cutting surface and at least one lateral arm. There may also be a channel defined by the first jaw or the second jaw for retaining at least one lateral arm of the blade. The blade may transition from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to be able to resect an anatomical structure.

[0030] Another embodiment discloses an end effector for use by a surgeon to staple an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure. The end effector includes an anvil having a first end, a second end, an anvil face, a length, and a width, and the length of the anvil may be at least 10 times the width of the anvil. The end effector also includes a cartridge having a first end, a second end, a cartridge face, a length, and a width, and the length of the cartridge may be at least 10 times the width of the anvil. The cartridge may be operatively configured to house a plurality of staples, and the first end of the anvil may be coupled to the first end of the cartridge, and the second end of the anvil may be movably coupled to the second end of the cartridge.

[0031] A rigid connection having a distal portion and a proximal portion can movably couple the second end of the anvil to the second end of the cartridge. The end effector can further include a control unit operable to move the rigid connection in a first direction such that the anvil and the cartridge are spaced a first distance apart at the first position. The control unit can also be operable to move the rigid connection in a second direction such that the anvil and the cartridge are spaced a second distance apart at the second position, the first distance being greater than the second distance. For example, the first direction can be a distal direction and the second direction can be a proximal direction. A distal portion of the rigid connection can be connected to the end effector and a proximal portion of the rigid connection can be connected to the control unit.

[0032] In another embodiment, the end effector can further include a ramp, and the rigid connection can include a ramped surface, the ramped surface being operatively configured to transition the end effector from a closed position to an open position when the ramped surface of the rigid connection engages the ramp. The rigid connection can include a ramped surface, the ramped surface being operatively configured to transition the end effector from an open position to a closed position when the ramped surface of the rigid connection engages an elongated tube coupled with the end effector. The end effector can further include an elongated slot defined by an anvil or cartridge that slidably retains the rigid connection. The end effector can further include a blade having a cutting surface and at least one lateral arm, the lateral arm being slidably engageable with a channel defined by an anvil or cartridge. The blade can transition from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to resect an anatomical structure.

[0033] In another embodiment, an end effector for use by a surgeon to staple an anatomical structure of a patient has an anvil including a first end, a second end, and an anvil face positionable on a first side of the anatomical structure. A cartridge operatively configured to house a plurality of staples can be provided on the end effector, the cartridge having a first end, a second end, and a cartridge face positionable on the second side of the anatomical structure. The cartridge face can include a channel extending from the first end of the cartridge to the second end of the cartridge, the first end of the cartridge can be pivotally coupled to the first end of the anvil. A blade can have a cutting surface and at least one elongated arm, the elongated arm can be slidably engaged with the channel. A rigid connection can movably couple the second end of the anvil to the second end of the cartridge.

[0034] In one embodiment, at least one elongated arm of the blade pushes each of the plurality of staples out of the cartridge when the blade is advanced from a first position at the distal end of the cartridge to a second position at the proximal end of the cartridge. The blade may be I-shaped such that the blade compresses the anvil and the cartridge together during use. The first end of the cartridge may be the distal end and the second end of the cartridge may be the proximal end. The rigid connection may be an integrally formed unitary structure. The first end of the cartridge may be pivotally coupled to the first end of the anvil.

[0035] In another embodiment, an end effector is disclosed having a first jaw having a first end, a second end, an anvil having an anvil face, and a first channel, a second jaw having a first end, a second end, a cartridge having a cartridge face, and a second channel, first coupling means coupling the first end of the first jaw to the first end of the second jaw, second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection, and an I-shaped blade. The I-shaped blade has a blade portion having a cutting edge, at least one upper lateral arm slidably positionable within the first channel, and at least one lower lateral arm slidably positionable within the second channel. The cartridge can include a plurality of staples.

[0036] In a further embodiment, a surgical instrument for stapling and resecting an anatomical structure of a patient is disclosed, the surgical instrument including an end effector having a first jaw having an anvil having a first end, a second end, a longitudinal axis, and an anvil face positionable on a first side of the anatomical structure, a second jaw having a first end, a second end, a longitudinal axis, and a cartridge operatively configured to receive a plurality of staples and having a cartridge face positionable on a second side of the anatomical structure, first coupling means coupling the first end of the first jaw to the first end of the second jaw, and second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid link connected to the first jaw and the second jaw. The device can include a drive assembly having a motor to actuate the end effector.

[0037] The device may further include an elongated tube having a proximal end and a distal end, the distal end being capable of coupling with the end effector, and a handle having a proximal end and a distal end, the distal end of the handle being capable of coupling with the proximal end of the elongated tube. For example, the first end of the first jaw may be the distal end of the first jaw and the second end of the first jaw may be the proximal end of the first jaw. The first coupling means may include a pin having a pin axis, the pin axis being transverse to the longitudinal axis of the first jaw and the longitudinal axis of the second jaw, the pin pivotally coupling the first end of the first jaw to the first end of the second jaw. The second coupling means may include a slot defined by the first jaw or the second jaw, the slot retaining the rigid coupling such that the rigid coupling may be slidable within the slot. The slot may have a length of 3 mm to 8 mm. A plurality of staples may be at least partially held by a cartridge in the second jaw and positioned between the first and second coupling means. The blade may have a cutting surface and at least one lateral arm, and a channel may be defined by the first or second jaw for holding the lateral arm of the blade. The blade may transition from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to be able to resect an anatomical structure.

[0038] In another embodiment, a surgical instrument for stapling and resecting a patient's anatomical structure is described as having an end effector, the end effector being an anvil having a first end, a second end, an anvil face, a length, and a width, where the length of the anvil may be at least ten times the width of the anvil; a cartridge having a first end, a second end, a cartridge face, a length, and a width, where the length of the cartridge may be at least ten times the width of the anvil, the cartridge operatively configured to house a plurality of staples, where the first end of the anvil can be coupled to the first end of the cartridge and the second end of the anvil can be movably coupled to the second end of the cartridge; and a rigid coupler having a distal portion and a proximal portion, where the rigid coupler movably couples the second end of the anvil to the second end of the cartridge. The instrument can further include an elongated tube having a proximal end and a distal end, the distal end capable of coupling to the end effector, and a handle having a proximal end and a distal end, the distal end of the handle capable of coupling to the proximal end of the elongated tube. The instrument can include a drive assembly having a motor to actuate the end effector.

[0039] The instrument can further include a control unit connected to the end effector, the control unit can be operable to move the rigid connection in a first direction such that the anvil and cartridge are spaced a first distance apart at a first position, and the control unit can be operable to move the rigid connection in a second direction such that the anvil and cartridge are spaced a second distance apart at a second position, the first distance being greater than the second distance. The control unit can include a drive assembly having a motor to actuate the end effector.

[0040] For example, the first direction may be a distal direction and the second direction may be a proximal direction. A distal portion of the rigid connection may be connected to the end effector and a proximal portion of the rigid connection may be connected to the control unit. The surgical instrument may further include a ramp, and the rigid connection may include a ramped surface, the ramped surface operatively configured to transition the end effector from a closed position to an open position when the ramped surface of the rigid connection engages the ramp. The rigid connection may also include a ramped surface, the ramped surface operatively configured to transition the end effector from an open position to a closed position when the ramped surface of the rigid connection engages an elongated tube coupled with the end effector.

[0041] The surgical instrument can further include an elongated slot defined by an anvil or cartridge that slidably retains the rigid connection, and a blade having a cutting surface and at least one lateral arm, the at least one lateral arm slidably engageable with a channel defined by the anvil or cartridge. The blade can transition from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to resect an anatomical structure.

[0042] In yet another embodiment, a surgical instrument for stapling and resecting an anatomical structure of a patient is disclosed having an end effector including an anvil having a first end, a second end, and an anvil face positionable on a first side of the anatomical structure; a cartridge operatively configured to receive a plurality of staples, the cartridge having a first end, a second end, and a cartridge face positionable on the second side of the anatomical structure, the cartridge face including a channel extending from the first end of the cartridge to the second end of the cartridge, the first end of the cartridge pivotably coupleable to the first end of the anvil; a blade having a cutting surface and at least one elongated arm, the at least one elongated arm slidably engageable with the channel; and a rigid connection movably coupling the second end of the anvil to the second end of the cartridge. The instrument may include an elongated tube having a proximal end and a distal end, the distal end capable of coupling with the end effector, and a handle having a proximal end and a distal end, the distal end of the handle capable of coupling with the proximal end of the elongated tube. A plurality of staples may be at least partially contained by the cartridge. At least one elongated arm of the blade may be used to push each of the plurality of staples out of the cartridge as the blade advances from a first position at the distal end of the cartridge to a second position at the proximal end of the cartridge. The blade may be I-shaped such that the blade compresses against the anvil and the cartridge during use.

[0043] In another embodiment, a surgical instrument useful for stapling and resecting a patient's anatomical structures is disclosed having an end effector having a first jaw having a first end, a second end, an anvil having an anvil face, and a first channel; a second jaw having a first end, a second end, a cartridge having a cartridge face, and a second channel; first coupling means coupling the first end of the first jaw to the first end of the second jaw; second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection; and an I-shaped blade having a blade portion having a cutting edge, at least one upper lateral arm slidably positionable within the first channel, and at least one lower lateral arm slidably positionable within the second channel.

[0044] The surgical instrument can further include an elongated tube having a proximal end and a distal end, the distal end capable of coupling to the end effector, and a handle having a proximal end and a distal end, the distal end of the handle capable of coupling to the proximal end of the elongated tube. The at least one lower lateral arm can be configured to be operable to eject each of the plurality of staples from the cartridge when the I-shaped blade is actuated from a first position at the distal end of the end effector to a second position at the proximal end of the end effector.

[0045] In yet a further embodiment, a method of stapling a patient's anatomical structure during a minimally invasive procedure is disclosed comprising providing an end effector having a first jaw having a first end, a second end, a longitudinal axis, and an anvil having an anvil face; a second jaw having a first end, a second end, a longitudinal axis, and a cartridge housing a plurality of staples and having a cartridge face; first coupling means coupling the first end of the first jaw to the first end of the second jaw; second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid link connected to the first jaw and the second jaw; and a knife coupled to the first jaw or the second jaw and slidable relative to the first jaw or the second jaw. The method further includes inserting an end effector through the trocar to access the anatomical structure, positioning a cartridge face against a first side of the anatomical structure, positioning an anvil face against a second side of the anatomical structure, operating the end effector to move the rigid joint such that the first jaw can be pushed toward the second jaw to clamp the end effector against the anatomical structure, operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure, and actuating the knife to cut the anatomical structure.

[0046] The first end of the first jaw may be a distal end of the first jaw and the second end of the first jaw may be a proximal end of the first jaw. The first coupling means may include a pin having a pin axis, the pin axis being transverse to a longitudinal axis of the first jaw and a longitudinal axis of the second jaw, the pin pivotally coupling the first end of the first jaw to the first end of the second jaw. The second coupling means may comprise a slot defined by the first jaw or the second jaw, the slot retaining the rigid coupling such that the rigid coupling may be slidable within the slot.

[0047] The steps of operating the end effector to eject the staples from the cartridge and actuating the knife to cut the anatomical structure may occur simultaneously. Actuating the knife to cut the anatomical structure may include advancing the knife from a first distal position to a second proximal position. Operating the end effector to eject the staples from the cartridge to staple the anatomical structure may include ejecting the staples from the cartridge between the first coupling means and the second coupling means. Actuating the knife to cut the anatomical structure may include advancing at least a portion of the knife through a channel defined by the first jaw or the second jaw. The knife may transition from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to be able to resect the anatomical structure.

[0048] In another embodiment, a method of stapling a patient's anatomical structure during a minimally invasive procedure is described, the method including the steps of providing an end effector, the end effector being an anvil having a first end, a second end, an anvil face, a length, and a width, wherein the length of the anvil may be at least 10 times the width of the anvil; an anvil; and a cartridge having a first end, a second end, a cartridge face, a length, and a width, wherein the length of the cartridge may be at least 10 times the width of the anvil, the cartridge holding a plurality of staples, wherein the first end of the anvil is capable of coupling to the first end of the cartridge and the second end of the anvil is capable of movably coupling to the second end of the cartridge; and a rigid coupling having a distal portion and a proximal portion, wherein the rigid coupling is configured to couple the anvil to the first end of the cartridge. The method includes providing an end effector having an anvil second end and a rigid coupling movably coupling the anvil second end to the cartridge second end; inserting the end effector through a trocar to access the anatomical structure; positioning a cartridge face on a first side of the anatomical structure; positioning an anvil face on a second side of the anatomical structure; operating the end effector to move the rigid coupling such that the anvil can be pushed toward the cartridge to clamp the end effector against the anatomical structure; operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure; and actuating a knife to cut the anatomical structure.

[0049] The method may further utilize a control unit connected to the end effector, the control unit may be operable to move the rigid connection in a first direction such that the anvil and cartridge are spaced apart a first distance at a first position. The control unit may also be operable to move the rigid connection in a second direction such that the anvil and cartridge are spaced apart a second distance at a second position, the first distance being greater than the second distance. For example, the first direction may be a distal direction and the second direction may be a proximal direction. A distal portion of the rigid connection may be connected to the end effector and a proximal portion of the rigid connection may be connected to the control unit. The steps of operating the end effector to eject the plurality of staples from the cartridge and actuating the knife to cut the anatomical structure may occur simultaneously. The step of actuating the knife to cut the anatomical structure may include forming a sleeve according to a sleeve gastrectomy.

[0050] In yet another embodiment, a method of stapling an anatomical structure of a patient during a minimally invasive procedure is described, the method including providing an end effector having an anvil having a first end, a second end, and an anvil face; a cartridge holding a plurality of staples, the cartridge face including a first end, a second end, and a channel extending from the first end of the cartridge to the second end of the cartridge, the first end of the cartridge being pivotably coupleable to the first end of the anvil; a blade having a cutting surface and at least one elongated arm, the at least one elongated arm being slidably engageable with the channel; and a rigid connection movably coupling the second end of the anvil to the second end of the cartridge. The method further includes inserting an end effector through the trocar to access the anatomical structure, positioning a cartridge face on a first side of the anatomical structure, positioning an anvil face on a second side of the anatomical structure, operating the end effector to move the rigid linkage such that the anvil can be pushed toward the cartridge to clamp the end effector against the anatomical structure, operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure, and actuating the blade to cut the anatomical structure.

[0051] In yet a further embodiment of a method for stapling a patient's anatomical structure during a minimally invasive procedure, the method includes providing an end effector having a first jaw having a first end, a second end, an anvil having an anvil face, and a first channel; a second jaw having a first end, a second end, a cartridge having a cartridge face, and a second channel; first coupling means coupling the first end of the first jaw to the first end of the second jaw; second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid connection; and an I-shaped blade having a blade portion having a cutting edge, at least one upper lateral arm slidably positionable within the first channel, and at least one lower lateral arm slidably positionable within the second channel. The method further includes inserting an end effector through a trocar to access the anatomical structure, positioning a cartridge face on a first side of the anatomical structure, positioning an anvil face on a second side of the anatomical structure, operating the end effector to move the rigid connection such that the anvil can be pushed toward the cartridge to clamp the end effector against the anatomical structure, operating the end effector to eject a plurality of staples from the cartridge to staple the anatomical structure, and actuating the I-shaped blade to cut the anatomical structure. The anatomical structure may be a stomach, and actuating the I-shaped blade to cut the anatomical structure may include forming a sleeve in accordance with a sleeve gastrectomy.

[0052] The at least one lower lateral arm can be operatively configured to eject each of the plurality of staples from the cartridge when the I-shaped blade is actuated from a first position at the distal end of the end effector to a second position at the proximal end of the end effector. The at least one lower lateral arm can be operatively configured to eject each of the plurality of staples from the cartridge when the I-shaped blade is actuated from a first position at the distal end of the end effector to a second position at the proximal end of the end effector.

[0053] In one embodiment, an end effector is disclosed for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure. The anatomical structure has a first side and a second side. The end effector includes a first jaw having a first end, a second end, and an anvil having an anvil surface that can be positionable on the first side of the anatomical structure. A second jaw is also included having a first end, a second end, and a cartridge that houses a plurality of staples, the cartridge having a cartridge surface that can be positionable on the second side of the anatomical structure.

[0054] A first coupling means couples a first end of the first jaw to a first end of the second jaw and includes a second coupling means movably coupling a second end of the first jaw to a second end of the second jaw, the second coupling means including a rigid link movably coupled to the first and second jaws. The end effector can have a longitudinal axis and the first coupling means includes a pin rotatably coupling the first jaw to the second jaw, the rotation about the pin being transverse to the longitudinal axis. The pin rotatably coupling the first jaw to the second jaw can be slidably received within a slot in at least one of the first jaw or the second jaw.

[0055] At least one of the first jaw or the second jaw can slidably receive a rigid connection within the slot when the first jaw is moved toward the second jaw. The rigid connection can be coupled to the first jaw using a slot that allows the rigid connection to move in a first direction but limits movement of the rigid connection in a direction perpendicular to the first direction. In one embodiment, the rigid connection pushes the anvil apart in a vertical direction. The slot can have a length of about 3 to about 8 millimeters, and preferably has a length of about 6 to about 7 millimeters. The plurality of staples can be positioned between the first and second coupling means. The end effector can include a blade having an outer surface and an elongated arm, the elongated arm extending from the blade positionable at least near the second end of the cartridge to the first end of the cartridge, the arm slidably engaging the cartridge channel.

[0056] In one particular embodiment, a surgical instrument is used to staple an anatomical structure of a patient having a first side and a second side. The surgical instrument can include an elongated end effector having a length and a width, the length being at least 10 times the width, the length defining a longitudinal axis, the longitudinal axis defining an axial direction perpendicular to the longitudinal axis. An anvil of the instrument can include a first end, a second end, and an anvil face. The instrument can also have a cartridge housing a plurality of staples, the cartridge face including a first end, a second end, and a cartridge face, the second end of the anvil can be movably coupled to the second end of the cartridge, and at least one of the anvil and the cartridge can include an elongated slot having an extension direction along the longitudinal axis. A rigid connection can be movably coupled to the first end of the anvil to the first end of the cartridge, the rigid connection can be retained within the elongated slot such that the rigid connection is slidable along the elongated slot, but movement of the rigid connection within the elongated slot in an axial direction is restricted. The surgical instrument may further include a control unit longitudinally connected to the end effector by a tube, the control unit operable to move the rigid connection to axially space the anvil and the cartridge.

[0057] The elongated slot can permit longitudinal movement of the rigid connection relative to the tube. The handle can be operable to push the rigid connection out of the tube and pull the rigid connection into the tube. The rigid connection can include a distal portion connected to the end effector and a proximal portion connected to the handle, the end effector including a ramp adjacent the distal portion of the rigid connection, the ramp positioned to axially push the rigid connection as the rigid connection moves distally.

[0058] The rigid connection can include a ramped surface that slides along the ramp as the rigid connection moves distally. The rigid connection can include a distal portion connected to the end effector and a proximal portion connected to the handle, the rigid connection including a ramped surface between the distal and proximal portions that engages the tube when the rigid connection is pulled proximally by the handle, the engagement of the tube moving the anvil face and the cartridge face relative to one another.

[0059] The elongated slot can be offset from the longitudinal axis. Additionally, the elongated slot can have an extension axis that intersects the longitudinal axis. The end effector can include a blade having a cutting surface and an elongated arm, the elongated arm extending from the blade positionable at least near the second end of the cartridge to the first end of the cartridge, the arm slidably engaging the cartridge channel.

[0060] In another embodiment, an end effector for use by a surgeon to staple a patient's anatomical structure during a minimally invasive procedure includes an anvil having a first end, a second end, and an anvil face that can be positionable on a first side of the anatomical structure. The end effector further includes a cartridge housing a plurality of staples, the cartridge face having a first end, a second end, and a cartridge face that can be positionable on the second side of the anatomical structure. The cartridge face can include a channel extending from the second end to the first end, and a blade having a cutting surface and an elongated arm extending from the blade positionable at least near the second end of the cartridge to the first end of the cartridge engages the cartridge channel. A rigid connection can movably couple the first end of the anvil to the first end of the cartridge, and the second end of the anvil can movably couple to the second end of the cartridge. Each of the anvil and cartridge can be insertable through a trocar, the end effector can be remotely operable from outside the patient, and at least a portion of one of the anvil and cartridge is movable toward the other to clamp the end effector to an anatomical structure.

[0061] The elongated arms of the blade can fill the cartridge channel proximally from the blade when the blade is moved from the second end to the first end, thereby forming staples in the anatomical structure as the blade cuts the anatomical structure. The blade can include an I-shaped portion having a top and a bottom connected by an intermediate blade portion, the intermediate blade portion having a sharp cutting edge. The anvil includes a first opening near the first end and a second opening near the second end, each of the first opening and the second opening operable to removably receive a top of the I-shaped portion when the anvil is approached or disengaged from the cartridge. The elongated arms of the blade can fill the cartridge channel proximally from the blade when the blade is moved from the second end to the first end, thereby forming staples in the anatomical structure as the blade cuts the anatomical structure.

[0062] The surgical instrument may further include a control unit longitudinally connected to the end effector by a tube, the control unit operable to move the rigid linkage to axially separate the anvil and the cartridge. The rigid linkage may include a distal portion connected to the end effector and a proximal portion connected to the handle, and the end effector may include a ramp adjacent the distal portion of the rigid linkage, the ramp positioned to axially urge the linkage as the linkage moves distally. The rigid linkage may include a ramp surface that slides along the ramp as the rigid linkage moves distally.

[0063] In a further embodiment, the stapler includes a first jaw having an anvil having a first end, a second end, and an anvil face, and a second jaw having a cartridge housing a plurality of staples and having a cartridge face and a cartridge channel along a length of the cartridge. There is a first coupling means coupling the first jaw to the second jaw, and a second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid link movably coupled to the first jaw and the second jaw. The stapler can include a blade having an I-shaped portion having a top and a bottom connected by an intermediate blade portion, the intermediate blade portion having a sharp cutting edge, and the anvil has a first opening near the first end and a second opening near the second end, each of the first opening and the second opening operable to removably receive the top of the I-shaped portion when the anvil is approached or disengaged from the cartridge.

[0064] The stapler can include a rigid connection that is retained within the elongated slot such that the rigid connection is slidable along the elongated slot in a first direction but movement of the rigid connection within the elongated slot is restricted in a second direction. The elongated slot can be offset from a longitudinal axis of the stapler.

[0065] In yet a further embodiment, a method of stapling an anatomical structure of a patient during a minimally invasive procedure, the method includes the steps of providing a stapler having an end effector, the end effector having a first jaw having a first end, a second end, and an anvil having an anvil surface, a second jaw having a first end, a second end, and a cartridge holding a plurality of staples and having a cartridge surface, first coupling means coupling the first jaw to the second jaw, and second coupling means movably coupling the second end of the first jaw to the second end of the second jaw, the second coupling means including a rigid link movably coupled to the first jaw and the second jaw. The method may include providing a stapler, inserting an end effector through a trocar to access the anatomical structure, positioning a cartridge face on a first side of the anatomical structure, positioning an anvil face on a second side of the anatomical structure, remotely operating the stapler from outside the patient to move a coupling such that at least a portion of one of the anvil and cartridge is moved toward the other to clamp the end effector to the anatomical structure, and firing the stapler to simultaneously staple and cut the anatomical structure.

[0066] The end effector can have a longitudinal axis and the first coupling means includes a pin rotatably coupling the first jaw to the second jaw, the rotation about the pin being transverse to the longitudinal axis. The method can further include slidably receiving the coupling within a slot in at least one of the anvil or the cartridge when the end effector is clamped to the anatomical structure, the coupling being rigid. The rigid coupling can be coupled to the anvil using a slot such that the slot allows the rigid coupling to move within the slot in a first direction but limits movement of the rigid coupling within the slot in a direction substantially perpendicular to the first direction. The rigid coupling can be coupled to the cartridge using a slot such that the slot allows the rigid coupling to move within the slot in a first direction but limits movement of the rigid coupling within the slot in a direction substantially perpendicular to the first direction.

[0067] The rigid link may be movable within the slot in a first direction through a length of about 3 to about 8 millimeters, and preferably the rigid link may be movable within the slot in a first direction through a length of about 7 millimeters. In one embodiment, the first coupling means is distal to the second coupling means, and the method further includes compressing the anatomical structure between the first coupling means and the second coupling means.

[0068] In a further embodiment, a method of stapling an anatomical structure of a patient using a surgical instrument, the anatomical structure having a first side and a second side, is disclosed, the method including the steps of providing an elongated end effector having a length and a width, the length being at least ten times the width, the length defining a longitudinal direction, the longitudinal direction defining an axial direction substantially perpendicular to the longitudinal direction; providing an anvil on the end effector, the anvil having a first end, a second end, and an anvil face; and providing a cartridge on the end effector, the anvil housing a plurality of staples, the cartridge including a first end, a second end, and a cartridge face. The surgical instrument includes the steps of providing a cartridge, wherein a second end of the anvil is movably coupled to a second end of the cartridge, at least one of the anvil and the cartridge including an elongated slot having an extension direction substantially along a longitudinal direction; actuating a rigid connection that movably couples a first end of the anvil to a first end of the cartridge; and holding the rigid connection within the elongated slot when the surgical instrument is actuated such that the rigid connection slides within the elongated slot along the longitudinal direction but movement of the rigid connection within the elongated slot in an axial direction is substantially restricted.

[0069] The method may further include using a handle connected to the end effector by a tube along a longitudinal direction, the method further including manipulating the handle to move the rigid connection and axially separate the anvil and the cartridge. The handle may be operable to push the rigid connection out of the tube and pull the rigid connection into the tube. The rigid connection may include a distal portion connected to the end effector and a proximal portion connected to the handle, the end effector including a ramp adjacent the distal portion of the rigid connection, the method further including pushing the rigid connection onto the ramp that pushes the rigid connection axially when the rigid connection is pushed. The rigid connection may include a ramped surface, the method further including sliding the ramped surface along the ramp as the rigid connection moves. The rigid connection may alternatively include a distal portion connected to the end effector and a proximal portion connected to the handle, the rigid connection including an inclined surface between the distal and proximal portions, the method further including the step of engaging a tube to compress the rigid connection along the inclined surface when the rigid connection is pulled proximally by the handle, the engagement of the tube moving the anvil face and the cartridge face relative to one another.

[0070] In another embodiment, a method of stapling an anatomical structure of a patient during a minimally invasive procedure, the method includes the steps of providing an anvil including a first end, a second end, and a face, positioning the anvil face on the first side of the anatomical structure, providing a cartridge housing a plurality of staples and including a face including a first end, a second end, and a channel extending from the second end to the first end, the second end of the anvil being movably coupled to the second end of the cartridge, positioning the cartridge face on the second side of the anatomical structure, and providing a blade having a cutting surface and an elongated arm, the elongated arm extending from at least the second end of the cartridge. The method includes providing a blade extending from a blade positionable near a first end of the cartridge, the arm being slidably engaged with the cartridge channel; providing a rigid connection movably connecting the first end of the anvil to the first end of the cartridge; moving the rigid connection such that at least a portion of one of the anvil and the cartridge is moved toward the other to clamp the anatomical structure between the anvil face and the cartridge face; and pulling the blade through the anatomical structure while simultaneously cutting and stapling the anatomical structure.

[0071] The elongated arm of the blade can substantially fill the cartridge channel proximally from the blade as the blade is moved from the second end to the first end. The blade can include a substantially I-shaped portion having a top and a bottom connected by an intermediate blade portion, the intermediate blade portion having a sharp cutting edge, and the anvil has a first opening near the first end and a second opening near the second end. The method can further include receiving the top of the substantially I-shaped portion into the first opening before drawing the blade through the anatomy, and removing the top of the substantially I-shaped portion from the second opening after the blade has been drawn through the anatomy. The rigid connection can include a distal portion connected to the anvil and a proximal portion connected to the handle, and the cartridge includes a ramp adjacent the distal portion of the rigid connection, and the method can further include sliding the rigid connection relative to the ramp to axially push the rigid connection as the rigid connection slides. The rigid connection can include a ramp surface that contacts the ramp as the rigid connection slides. One or more of the methods disclosed herein may be useful in sleeve gastrectomy, vertical sleeve gastrectomy, or procedures involving resection of the stomach.

[0072] In another embodiment, an end effector is disclosed for use by a surgeon to staple an anatomical structure having a first side and a second side of a patient during a minimally invasive procedure, the end effector including an anvil including a first end, a second end, and an anvil face positionable on the first side of the anatomical structure and having a plurality of anvil side cord supports, a cartridge including a first end, a second end, and a cartridge face positionable on the second side of the anatomical structure and having a plurality of cartridge side cord supports, a coupling movably coupling the first end of the anvil to the first end of the cartridge, and the second end of the anvil movably coupled to the second end of the cartridge, each of the anvil and cartridge being insertable through a trocar, and the end effector can be remotely operable from outside the patient to move at least a portion of one of the anvil and the cartridge toward the other to clamp the end effector against the anatomical structure. The anvil cord supports can have openings facing away from the cartridge, and the cartridge cord supports can have openings facing away from the anvil. The anvil cord supports and the cartridge cord supports can have open tubular structures having a substantially C-shaped cross-sectional shape. In one particular embodiment, the anvil cord supports and the cartridge cord supports have open tubular structures having a substantially C-shaped cross-sectional shape, with an opening of C facing away from the cartridge on the anvil cord supports and an opening of C facing away from the anvil on the cartridge cord supports.

[0073] The anvil cord supports and the cartridge cord supports can have hollow tubular structures, and the end effector can include a buttress material having a plurality of openings, the cords being slidably positioned within the plurality of openings in the buttress material. The cords can be slidably positioned within at least one of the anvil cord supports and the cartridge cord supports within a number of the plurality of openings in the buttress material. The cartridge cord supports can be attached to a cartridge frame.

[0074] At least one of the anvil and the cartridge can include an elongated slot, and the end effector has a rigid connection movably connecting a first end of the anvil to a first end of the cartridge, the rigid connection being retained within the elongated slot such that the rigid connection is slidable along the elongated slot in a first direction but movement of the rigid connection within the elongated slot in a second direction is limited.

[0075] In one embodiment, a surgical instrument for stapling an anatomical structure of a patient having a first side and a second side is disclosed. The surgical instrument includes an elongated end effector having a length and a width, the length being at least ten times the width, the length defining a longitudinal direction, the longitudinal direction defining an axial direction substantially perpendicular to the longitudinal direction. The surgical instrument has an anvil including a first end, a second end, a plurality of anvil cord supports disposed about the first end to about the second end, and an anvil face positionable on the first side of the anatomical structure. The surgical instrument further includes a cartridge housing a plurality of staples and including a first end, a second end, a plurality of cartridge cord supports disposed about the first end to about the second end, and a cartridge face positionable on the second side of the anatomical structure, the second end of the anvil being movably coupled to the second end of the cartridge. At least one of the anvil and the cartridge includes an elongated slot having an extension direction substantially along the longitudinal direction and a rigid connection movably connecting a first end of the anvil to a first end of the cartridge, the rigid connection being retained within the elongated slot such that the rigid connection is slidable along the elongated slot but movement of the rigid connection within the elongated slot in the axial direction is substantially limited.

[0076] In one particular embodiment, the anvil cord supports have openings that face substantially outwardly from the cartridge, and the cartridge cord supports have openings that face substantially outwardly from the anvil. The anvil cord supports and the cartridge cord supports can have open tubular structures having a substantially C-shaped cross-sectional shape, and the opening of the C can face outwardly from the cartridge on the anvil cord supports, and the opening of the C can face outwardly from the anvil on the cartridge cord supports.

[0077] The anvil cord supports and the cartridge cord supports can have hollow tubular structures, and the end effector can include a buttress material having a plurality of openings, the cords being slidably positioned within the plurality of openings. The cords can be slidably positioned within at least one of the anvil cord supports and the cartridge cord supports within a number of the plurality of openings in the buttress material. The cartridge cord supports can be attached to a cartridge frame. The buttress material can include an adhesive that removably adheres the buttress material to one of the anvil face and the cartridge face.

[0078] In yet a further embodiment, a method of applying buttress material with an end effector includes the steps of providing an end effector having an anvil having a first end, a second end, and an anvil face, a cartridge housing a plurality of staples and having a first end, a second end, and a cartridge face, and a rigid connection movably connecting the first end of the anvil to the first end of the cartridge, where the second end of the anvil is movably connected to the second end of the cartridge; providing the buttress material; and rotating the anvil face outwardly from the cartridge face. The method includes moving the rigid connection to open the anvil face toward the cartridge face, attaching the buttress material to at least one of the anvil face and the cartridge face, moving the rigid connection to close the anvil face toward the cartridge after the buttress material is attached, driving a plurality of staples from the cartridge through the buttress material toward the anvil to form staples, moving the rigid connection to open the anvil face outwardly from the cartridge face after the staples are driven, and removing the buttress material from the end effector. The buttress material can be formed from a bioabsorbable material. The buttress material can be attached to at least one of the anvil face and the cartridge face using an adhesive. The anvil can include a plurality of anvil-side cord supports disposed about the first end to about the second end, the cartridge includes a plurality of cartridge-side cord supports disposed about the first end to about the second end, the buttress material includes a plurality of openings, and the cords are slidably positioned within the plurality of openings.The method may further include one or more of the steps of sliding the cord from the buttress material onto the multiple cord supports when attaching the buttress material to at least one of the anvil face and the cartridge face; sliding the cord from the buttress material and outwardly from the multiple cord supports when removing the buttress material from the end effector; tensioning the cord to align the buttress material with the end effector; and pulling the cord to disengage the buttress material from the end effector by sliding the cord outwardly from the multiple cord supports and outwardly from the multiple openings in the buttress material.

[0079] In another embodiment, a device is disclosed that includes a first jaw having an anvil including a first end, a second end, and an anvil face and having a plurality of anvil-side cord supports, a second jaw having a cartridge housing a plurality of staples and including a first end, a second end, and a cartridge face and having a plurality of cartridge-side cord supports, a first coupling means coupling a first end of the first jaw to a first end of the second jaw, and a second coupling means movably coupling a second end of the first jaw to a second end of the second jaw, the second coupling means including a rigid link movably coupled to the first and second jaws, an outer tube is extendable from the first and second jaws to an actuator, the actuator moves the outer tube from a first position to a second position, a first portion of the tube enables the rigid link to maintain the jaws in an open position, and the second position of the tube moves the rigid link to move the first jaw toward the second jaw. The second jaw may have a longitudinal axis and the first coupling means may include a pin rotatably coupling the first jaw to the second jaw, with rotation about the pin being transverse to the longitudinal axis. The pin rotatably coupling the first jaw to the second jaw may be slidably received within a slot in at least one of the first jaw or the second jaw. In one embodiment, at least one of the first jaw or the second jaw slidably receives a rigid connection within the slot when the first jaw is moved towards the second jaw. The rigid connection may be coupled to the first jaw using a slot that allows the rigid connection to move in a first direction but limits movement of the rigid connection in a direction perpendicular to the first direction.

[0080] In another embodiment, an end effector useful for stapling an anatomical structure having a first side and a second side is disclosed. The end effector includes an anvil including a first end, a second end, and an anvil face including a plurality of rows of staple forming pockets, the first row of the plurality of rows of staple forming pockets having a first pocket depth and the second row of the plurality of rows of staple forming pockets having a second pocket depth, the first pocket depth being different from the second pocket depth; a cartridge that houses a plurality of staples and includes a first end, a second end, and a cartridge face that is positionable on the second side of the anatomical structure; and a staple drive ramp and tissue cutting assembly having a staple drive ramp that moves from the first end of the cartridge to the second end of the cartridge and drives staples from the cartridge toward the anvil to form staples, the staple drive ramp and tissue cutting assembly further including a blade that cuts the anatomical structure after the staples are formed, and at least a portion of one of the anvil and the cartridge is movable toward the other to clamp the end effector against the anatomical structure.

[0081] The cartridge face can include a channel extending from about the second end to about the first end and defining a path for the cutting blade, a pocket depth of a first row of the plurality of rows of staple forming pockets having a first pocket depth that is shallower than a pocket depth of a second row of the plurality of rows, the first row of the plurality of rows of staple forming pockets being closer to the slot than the second row of the plurality of rows of staple forming pockets. The anvil can have an anvil length extending from about the first end of the anvil to about the second end of the anvil, the plurality of rows of the plurality of staple forming pockets extending along the anvil length, and in at least one row of the plurality of rows of the plurality of staple forming pockets a first pocket depth at a first location along the length is different from a second pocket depth at a second location along the length. The anvil can include at least three rows of the plurality of staple forming pockets, each of the at least three rows having a plurality of pocket depths that are different from the other two rows of the at least three rows. For example, the row of staple forming pockets closest to the channel may be shallower than the row of staple forming pockets furthest from the channel, hi one embodiment, the row of staple forming pockets is substantially circular.

[0082] The staples in a first row of the plurality of staple rows can be made from a first material and the staples in a second row of the plurality of staple rows can be made from a second material, the first material being different from the second material. The anvil has an anvil length extending from about a first end of the anvil to about a second end of the anvil, and in at least one row of the plurality of rows of staple forming pockets, a first pocket depth at a first location along the length is different from a second pocket depth at a second location along the length. The pocket depth can vary continuously along the anvil length. In one embodiment, in at least one row of the plurality of staple forming pocket rows, the pocket depth has a first depth for a first portion of the row length and a second depth for a second portion of the row length. In another embodiment, in at least one of the plurality of rows of staple forming pockets, the pocket depth has a first depth for a first portion of the row length, a second depth greater than the first depth for a second portion of the row length adjacent the first portion of the row length, and a third depth less than the second depth for a third portion of the row length adjacent the second portion of the row length. The rows of staple forming pockets may be substantially circular, such as for use in a circular stapler useful for bowel resection, linear for a linear cutter, or another desired shape. In at least one of the plurality of rows of staple forming pockets in one embodiment, the pocket depth variation along the length of a first row of the plurality of rows varies in pocket depth at a different scale or rate than a second row of the plurality of rows.

[0083] In another embodiment, an end effector for stapling an anatomical structure having a first side and a second side is disclosed, the end effector includes an anvil having a first end, a second end, and an anvil face positionable on the first side of the anatomical structure and including a plurality of rows of staple forming pockets, the first row of the plurality of rows of staple forming pockets having a first pocket depth and the second row of the plurality of rows of staple forming pockets having a second pocket depth, the first pocket depth being different than the second pocket depth, a cartridge housing a plurality of staples and including a cartridge face positionable on the second side of the anatomical structure, and a cartridge movable from the first end of the cartridge to the second end of the cartridge to staple the staples. and a staple driving ramp and tissue cutting assembly for driving the staples from the cartridge towards the anvil to form a staple, the staple driving ramp and tissue cutting assembly further comprising a blade for cutting the anatomical structure after the staples are formed, wherein at least a portion of one of the anvil and the cartridge is movable towards the other to clamp the end effector against the anatomical structure, and wherein a first row of the plurality of staple forming pocket rows has a first pocket shape and a second row of the plurality of staple forming pocket rows has a second pocket shape, the first pocket shape being different from the second pocket shape. In one example, the first row of the plurality of staple forming pocket rows can generate bowtie shaped staples and after formation, the second row of the plurality of staple forming pocket rows can generate rectangular staples. In another example, the first row of the plurality of staple rows can be manufactured from a first material and the plurality of staples in the second row of the plurality of staple rows can be manufactured from a second material, the first material being different from the second material. For example, the first material may comprise greater than 95% by weight titanium and the second material may be an alloy of less than 95% by weight titanium alloyed with aluminum.In another example, the first material may include greater than 96% titanium by weight and the second material may be an alloy of less than 96% titanium alloyed with aluminum and vanadium. In another example, the staples at a first location along the length may be made from a material that is greater than 95% titanium by weight and the staples at a second location along the length may be made from an alloy of less than 95% titanium alloyed with aluminum. In another embodiment, the rows of staples closer to the channel have staples that have less springback than the rows of staples further from the channel.

[0084] In another exemplary embodiment, an anvil includes a first end, a second end, and an anvil face positionable on a first side of an anatomical structure. A cartridge houses a plurality of staples and includes a first end, a second end, a cartridge length extending from about the first end of the cartridge to about the second end of the cartridge, and a cartridge face positionable on the second side of the anatomical structure. The cartridge can include a plurality of rows of staples, and a plurality of staples in a first portion of the first row of the plurality of staple rows can be made from a first material and a plurality of staples in a second portion of the first row of the plurality of staple rows can be made from a second material, the first material being different from the second material. A staple drive ramp and tissue cutting assembly can have a staple drive ramp moving from the first end of the cartridge to the second end of the cartridge to drive the staples from the cartridge toward the anvil to form the staples. The staple driving ramp and tissue cutting assembly can further include a blade that cuts the anatomical structure after the staples are formed, and at least a portion of one of the anvil and cartridge is movable toward the other to clamp the end effector to the anatomical structure. For example, the first material can include greater than 96% titanium by weight and the second material can be an alloy of less than 96% titanium alloyed with aluminum and vanadium.

[0085] In another embodiment, an end effector is disclosed that is useful for stapling an anatomical structure having a first side and a second side during a surgical procedure. The end effector includes an anvil having a first end, a second end, and an anvil face that can be positionable on the first side of the anatomical structure and includes a plurality of rows of staple forming pockets, the first row of the plurality of rows of staple forming pockets having a first pocket shape and the second row of the plurality of rows of staple forming pockets having a second pocket shape, the first pocket shape being different from the second pocket shape. Also disclosed is a cartridge that houses a plurality of staples and includes a first end, a second end, and a cartridge face that can be positionable on the second side of the anatomical structure. A staple driving ramp and tissue cutting assembly is disclosed having a staple driving ramp that moves from a first end of the cartridge to a second end of the cartridge and drives staples from the cartridge toward the anvil to form the staples, the staple driving ramp and tissue cutting assembly further including a blade that cuts the anatomical structure after the staples are formed, and at least a portion of one of the anvil and the cartridge is movable toward the other to clamp the end effector against the anatomical structure. For example, after formation, a first row of the plurality of rows of staple forming pockets can generate bowtie-shaped staples and after formation, a second row of the plurality of rows of staple forming pockets can generate rectangular staples. In at least one row of the plurality of rows of staple forming pockets, a first pocket shape at a first location along the length is different from a second pocket shape at a second location along the length. In another example, after formation, a first row of the plurality of rows of staple forming pockets can produce bowtie shaped staples and after formation, a second row of the plurality of rows of staple forming pockets can produce rectangular shaped staples.Also, a plurality of staples in a first portion of a first row of the plurality of staple rows can be made from a first material and a plurality of staples in a second portion of the first row of the plurality of staple rows can be made from a second material, where the first material is different from the second material.

[0086] The present disclosure will be more readily understood from the detailed description of several sample embodiments taken in conjunction with the accompanying drawings. [Brief description of the drawings]

[0087] [Figure 1] FIG. 1 illustrates the anatomy of the stomach. [Figure 2A] FIG. 1 is a perspective view of a stapling device having an end effector, an elongate tube, and a handle portion in an open position according to one embodiment. [Figure 2B] FIG. 2B is a perspective view of the stapling device of FIG. 2A in a closed position in accordance with one embodiment. [Figure 3A] FIG. 2C is a partial exploded perspective view of the stapling device shown in FIGS. 2A and 2B. [Figure 3B] FIG. 2C is an exploded perspective view of the stapling device shown in FIGS. 2A and 2B. [Figure 4] FIG. 2C is an axial cross-sectional view along section AA of the end effector shown in FIG. 2B, illustrating the relationship between the blade, anvil assembly, and cartridge assembly of the end effector. [Figure 5A] A side cross-sectional view along section BB of the handle portion of the stapling device shown in Figure 2B in a first position. [Figure 5B] A side cross-sectional view along section BB of the handle portion of the stapling device shown in Figure 2B in a second position. [Figure 5C] A side cross-sectional view of the handle portion of the stapling device shown in Figure 2B in a third position, taken along section BB. [Figure 5D]A side cross-sectional view along section BB of the handle portion of the stapling device shown in Figure 2B in a fourth position. [Figure 5E] A side cross-sectional view along section BB of the handle portion of the stapling device shown in Figure 2B in a fifth position. [Figure 6] FIG. 1 is a partial perspective view of a blade assembly and drive mechanism of a surgical device according to one embodiment. [Figure 7] 7 is a cross-sectional view of the elongated support tube shown in FIG. 2B along section CC, illustrating the relationship between the blade assembly and drive mechanism shown in FIG. 6, according to one embodiment. [Figure 8] 7 is a partial side cross-sectional view of the handle portion shown in FIG. 2B illustrating the relationship between the blade assembly and drive mechanism shown in FIG. 6 according to one embodiment. [Figure 9] FIG. 2B is a side view of the proximal end of the end effector shown in FIG. [Figure 10] FIG. 2 is a partial bottom plan view of an anvil assembly, according to one embodiment. [Figure 11] FIG. 2 is a perspective view of a stapling device having an end effector, an elongated tube, a handle portion, and a motor in an open position according to an alternative embodiment. [Figure 12] FIG. 12 is a partially exploded perspective view of the end effector, elongated tube, and handle portion of the stapling device shown in FIG. [Figure 13] FIG. 12 is a partial exploded perspective view of the motor of the stapling device shown in FIG. 11; [Figure 14A] FIG. 12 is a side view of the stapling device of FIG. 11 in an open position. [Figure 14B] FIG. 12 is a side view of the stapling device of FIG. 11 in a closed position. [Figure 15] FIG. 14B is a side cross-sectional view of the handle portion and motor shown in FIG. 14A along section DD. [Figure 16] FIG. 14B is a side view of the end effector shown in FIG. [Figure 17]FIG. 14C is a side cross-sectional view of the handle portion and motor shown in FIG. 14B along section EE. [Figure 18] FIG. 14C is a side view of the end effector shown in FIG. [Figure 19] FIG. 2 is a cross-sectional side view of a blade assembly and a drive assembly of a stapling device according to one embodiment. [Figure 20] FIG. 2 is a cross-sectional side view of a blade assembly and a drive assembly of a stapling device according to an alternative embodiment. [Figure 21] FIG. 2 is a cross-sectional side view of a blade assembly and a drive assembly of a stapling device according to an alternative embodiment. [Figure 22] FIG. 2 is a partial perspective view of an anvil assembly having an anvil face according to one embodiment. [Figure 23] FIG. 1 is a perspective view of a motor controller according to one embodiment. [Figure 24] FIG. 24 is an exploded perspective view of the motor controller shown in FIG. 23. [Diagram 25] FIG. 1 is a partial cross-sectional perspective view of an end effector of a stapling device showing a blade assembly in relationship to a cartridge assembly having a plurality of drivers and staples. [Figure 26A] FIG. 1 is a side cross-sectional view of an end effector of a stapling device including an anvil assembly and a cartridge assembly having a plurality of staple drivers having variable heights combined with a plurality of staples having variable heights, according to one embodiment. [Figure 26B] FIG. 11 is a side cross-sectional view of an end effector of a stapling device including an anvil assembly and a cartridge assembly having a plurality of staple drivers having variable heights combined with a plurality of staples having variable heights in accordance with an alternative embodiment. [Figure 26C]FIG. 1 is a cross-sectional view of an end effector of a stapling device including an anvil assembly and a cartridge assembly having a plurality of staple drivers having a first height associated with a plurality of staples having a first height, and a plurality of drivers having a second height associated with a plurality of staples having a second height, according to one embodiment. [Figure 26D] FIG. 1 is a cross-sectional view of an end effector of a stapling device including an anvil assembly and a cartridge assembly having a plurality of staple drivers having a uniform height combined with a plurality of staples having variable heights, according to one embodiment. [Figure 26E] A cross-sectional view of an end effector of a stapling device including an anvil assembly having an angled anvil plate and a cartridge assembly, the stapling device having a plurality of staple drivers having uniform heights and a plurality of staples having uniform heights. [Figure 27] 1 is a flow diagram illustrating a method of operating a stapling device according to one embodiment. [Figure 28] 4 is a partial flow diagram illustrating a method of operating a stapling device, according to one embodiment. [Figure 29] 30 is a partial flow diagram illustrating a method of operating the stapling device, following the method of FIG. 28. [Diagram 30] 30 is a partial flow diagram illustrating a method of operating the stapling device, following the method of FIG. 29. [Diagram 31] FIG. 1 is a perspective view of a stapling device having an end effector, an elongated tube, a handle portion, and a motor in an open position according to one embodiment. [Diagram 32] FIG. 32 is a partially exploded perspective view of the stapling device of FIG. 31 shown with a buttress; [Figure 33A] FIG. 32 is a side view of the stapling device of FIG. 31 in an open position. [Figure 33B]A side view of the stapling device of Figure 31 in a closed position. [Figure 34A] FIG. 33 is a top view of the buttress shown in FIG. [Figure 34B] FIG. 33 is a partial perspective view of the buttress shown in FIG. 32. [Figure 35A] FIG. 32 is a bottom plan view of the anvil assembly of the end effector shown in Figure 31. [Figure 35B] FIG. 33 is a bottom plan view of the anvil assembly shown in FIG. 31 with the buttress of FIG. 32 attached thereto, according to one embodiment. [Diagram 36] FIG. 33 is a perspective view of the stapling device of FIG. 31 shown with the buttress of FIG. 32 attached thereto, according to one embodiment. [Figure 37] FIG. 1 is a partially exploded perspective view of a stapling device having an end effector, an elongate tube, a handle portion, and an adhesive buttress in an open position according to one embodiment. [Figure 38A] FIG. 38 is a cross-sectional view taken along section FF of the adhesive buttress shown in FIG. 37. [Figure 38B] FIG. 38 is a perspective view of the adhesive buttress shown in FIG. 37 with the removable portion removed. [Figure 38C] FIG. 38C is a front view of the adhesive buttress shown in FIG. [Figure 38D] FIG. 38 is a side view of the end effector of FIG. 37, showing an adhesive buttress attached to the end effector, according to one embodiment. [Figure 38E] FIG. 1 is a front view of the stomach shown resected with staple lines joined with buttress material forming a sleeve gastrectomy. [Figure 39A] FIG. 2 is a bottom view of an anvil assembly of an end effector of a stapling device, according to one embodiment. [Figure 39B] A cross-sectional view along section GG of the anvil assembly shown in Figure 39A according to one embodiment. [Figure 39C]A cross-sectional view along section HH of the anvil assembly shown in Figure 39A according to one embodiment. [Diagram 40] FIG. 13 is a side cross-sectional view of an end effector having an anvil plate with variable pocket depth, according to one embodiment. [Diagram 41] FIG. 1 is an axial cross-sectional view of an anvil assembly having an anvil plate shown with a plurality of staples, according to one embodiment. [Figure 42A] FIG. 41 is a side view of the staples formed by the anvil plate of FIG. 40; [Figure 42B] FIG. 41 is a side view of a staple formed by the anvil of FIG. 40; [Figure 42C] FIG. 41 is a side view of a staple formed by the anvil of FIG. 40; [Figure 43A] FIG. 2 is a partial bottom plan view of an anvil assembly having multiple anvil pockets according to one embodiment. [Figure 43B] FIG. 43B is a more detailed view of the cross section of the anvil assembly shown in FIG. [Figure 43C] FIG. 13 is a partial bottom plan view of an anvil of an end effector having multiple anvil pockets according to an alternative embodiment. [Diagram 44] FIG. 13 is a side view of a staple formed by an anvil assembly according to one embodiment. [Diagram 45] FIG. 11 is a top view of a staple formed by an anvil assembly according to an alternative embodiment; [Figure 46] FIG. 13 is a perspective view of a staple formed by an anvil assembly according to an alternative embodiment; [Figure 47] FIG. 1 is a perspective view of a stapler according to one embodiment having a circular anvil. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0088] Various non-limiting examples of the present disclosure are now described to provide a general understanding of the principles of structure, function, and use of the devices, systems, methods, and processes disclosed herein. One or more examples of these non-limiting examples are illustrated in the accompanying drawings. Those skilled in the art will appreciate that the systems and methods specifically described herein and illustrated in the accompanying drawings are non-limiting examples. Features illustrated or described in connection with one non-limiting example may be combined with features of other non-limiting examples. Such modifications and variations are intended to be included within the scope of the present disclosure. When reference is made throughout this specification to "various examples," "several examples," "one example," "several example examples," "one example example," or "one example," this means that a particular feature, structure, or characteristic described in connection with any example is included in at least one example. Thus, the appearance of the phrases "in various embodiments," "in some embodiments," "in one embodiment," or "in some example embodiments," "in one example embodiment," or "in an embodiment" in places throughout this specification are not necessarily all referring to the same embodiment. Furthermore, particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Example embodiments of surgical stapler apparatus, systems, and methods are described herein. In one example embodiment, an end effector and / or endocutter-stapling device (collectively referred to herein as the "device") for forming a resection line during resection of an organ, tissue, or other anatomical structure is disclosed. In some embodiments, the device can be used during a minimally invasive surgical procedure. This application is related to U.S. Patent Application Serial No. 15 / 129,385, which is incorporated herein by reference in its entirety.

[0089] A surgical stapler according to embodiments described herein can include a handle, an actuator, and an end effector including a clamping mechanism. The clamping mechanism can include a cartridge and an anvil. During surgery, a surgeon can clamp two members (e.g., an anvil and a cartridge) against an organ and compress the organ between them. Once the organ is compressed, the surgeon can use the stapler to drive or fire the staples through the organ. In one embodiment, multiple B-shaped staples can be formed with desired compression and alignment of the clamping mechanism. In some embodiments, the stapling device can be fired multiple times using multiple cartridges, or in alternative embodiments, a single cartridge can be used with a single firing to completely resect an organ. It can be advantageous to reduce the number of firings and cartridges required as procedure costs can increase with the use of cartridges and longer procedures that can be associated with multiple stapler firings. It can also be advantageous to allow for staples and / or resection of an organ with a single cartridge to reduce the time a patient spends in surgery, which can improve clinical outcomes. For example, resecting a portion of the stomach according to a sleeve gastrectomy procedure using a single cartridge and stapler firing can improve patient outcomes and reduce complications that may be associated with such procedures.

[0090] Staple line integrity may depend in part on proper formation of B-shaped staples, when such staples are desired. By providing a stapling device with a single cartridge and single firing, the quality of staple formation may be improved over devices or systems that use multiple cartridges to complete the same procedure. For example, when an end effector is used multiple times to staple and resect tissue, previously deployed staples may come into contact with new staples and / or cutting knives in subsequent applications. Allowing for a single cartridge and staple firing may help ensure that staple lines and staple shapes are consistent.

[0091] Single cartridge and single firing staple devices can also provide compression benefits compared to devices and systems requiring the use of multiple cartridges. It can be advantageous to provide a single firing staple device that allows for the desired compression along the length of the tissue being resected while also allowing for a single staple line with properly formed staples. B-shaped staples are the standard for addressing gastrointestinal, vascular, pulmonary, and hepatic applications of surgical tissue fastening devices. Staple delivery and formation can be improved by the clamping mechanism aligning itself (e.g., anvil aligning with cartridge) on each side of the organ in each of the X, Y, and Z axes. It will be appreciated that any suitable structure or mechanism can be incorporated into the staple devices described herein to allow for such alignment.

[0092] The embodiments of the stapling devices described herein can include multiple rows of staples such that the chance of leakage of luminal contents between each of the staples and between the rows of staples is reduced. For example, a stapling device may have 2-6 rows of staples, and the rows of staples may be bisected by a knife or blade configured to pass between the rows to excise the stapled tissue. In one embodiment, the rows of staples may be spaced and / or staggered to reduce the chance of leakage.

[0093] An embodiment of a stapling device can include an anvil and a cartridge, where the cartridge can include recesses that hold a plurality of staples. The staples can be held above one or more staple drivers that can drive each of the plurality of staples upward through tissue and onto the face of the anvil during surgery. The anvil, which can include pockets having any suitable size, number, and dimensions, can cooperate with the cartridge driver to form, for example, a B-shape in the tissue. The pockets of the anvil can be sized to provide a desired closed staple height, which can be determined by the gap between the anvil and the cartridge, the depth of the pockets, and the height of the staples and / or staple drivers and driver mechanisms, in one embodiment.

[0094] During stapling, it may be advantageous to provide a support or buttress material through which the staples can be deployed. The buttress or support material may distribute the pressure of the multiple staple rows to improve staple build-up in tissue or help maintain staple line integrity. For example, a biodegradable material may be provided on the surface of the anvil and / or cartridge through which the staples can be deployed during use. This buttress material that holds the staples may then be cut by a blade or knife and, in one embodiment, may be left in the patient. According to the embodiments described herein, any suitable support or buttress material may be used, such as those comprised of polymers (both permanent and bioabsorbable) and biological membranes. These materials may be reversibly bonded to the anvil, cartridge, or both.

[0095] The method of attaching the buttress or support material to the anvil or cartridge can include an adhesive, such as a hydrogel polymer, and the buttress can be pulled from the end effector after the end effector is secured to the tissue by the staples. The end effector can also include a mechanical structure or element, such as a protrusion, for retaining the buttress. In one embodiment, the anvil and / or cartridge can include a plurality of spaced apart protrusions, the buttress material can define a plurality of apertures, and a cord or suture can be used to sew and secure the buttress material to the protrusions of the anvil and / or cartridge.

[0096] An embodiment of a stapling device described herein using a laparoscopic approach can include inserting a stapler end effector through a trocar to perform a surgical procedure. By way of example, a minimally invasive surgical procedure can include a laparoscopic vertical sleeve gastrectomy. Because the spatial environment for such procedures is limited, a surgical stapling device according to an embodiment described herein can have a relatively low profile. Minimally invasive devices in the prior art are generally long (e.g., 35 mm to 60 mm) and thin (e.g., 5 mm to 15 mm diameter) devices. This long and thin configuration can be necessary to fit through a trocar into a body cavity. The limited size can present a mechanical challenge, since B-shaped staple formation typically requires pressures of about 100 psi. Under these pressures, a small, less rigid stapler can deform, thus preventing proper B-shaped staple formation.

[0097] Prior art devices used in minimally invasive surgical procedures often have a fixed hinge at the proximal end. This hinge allows the anvil and cartridge to separate into a V-shaped configuration. Once separated, the surgeon can place the open anvil and cartridge around an organ and then collapse the V to the organ. However, as the length of the anvil and cartridge increases, it can become more difficult to maintain alignment between the anvil and cartridge over the length of the tissue. At the very distal end of such devices, the force required to compress the tissue can exacerbate poor alignment with such designs. This deflection limits the length of current V-shaped staplers for minimally invasive procedures. As a result of this limitation, the anvil and cartridge are correspondingly limited in length. This limited length requires multiple reloading and firing of staples to complete procedures such as sleeve gastrectomy for larger organs such as the stomach. Each reload may require the surgeon to withdraw the stapler from the trocar, reload the cartridge, reinsert, and then reposition the stapler relative to the organ. Such systems may require more surgical time, may be more costly, may increase the likelihood of an adverse patient event, and may result in poor staple line integrity.

[0098] The examples discussed herein are merely examples and are provided to aid in the description of the apparatus, devices, systems, and methods described herein. None of the features or components shown in the drawings or discussed below should be construed as essential to any particular embodiment of any of these apparatus, devices, systems, or methods, unless specifically designated as essential. For ease of reading and clarity, certain components, modules, or methods may be described only in connection with certain drawings. Any combination or subcombination of components is not specifically described, and should not be understood as indicating that any combination or subcombination is not possible. Also, for any method described, whether or not the method is described with a flow diagram, unless otherwise specified or required by context, any explicit or implicit ordering of steps performed in the execution of the method does not imply that the steps must be performed in the order presented, but may instead be performed in a different order or in parallel.

[0099] The illustrative embodiments described herein may be used, for example, in sleeve gastrectomy procedures or gastric resections. However, it will be appreciated that the devices may be used in other procedures involving other anatomical structures. For example, the devices may be used in parenchymal resections, lung volume reductions, or other procedures involving the lungs. Additionally, the embodiments described herein may be useful in lobectomy, non-anatomical parenchymal resections, or other procedures involving the liver, or partial nephrectomy, total nephrectomy, or other procedures involving the kidney.

[0100] Referring now to FIG. 1, the anatomy of the stomach 10 and an example resection line 12 for a vertical sleeve gastrectomy are shown. The stomach 10 generally includes a lower end 14, an upper end 16, an anterior side 18, and a posterior side 20. The gastroesophageal junction 22 opens into the stomach 10 and is a common landmark in bariatric surgery. The section of the stomach 10 defined by the fundus 24 and the greater curvature 26 is generally the portion of the stomach 10 that is removed during a vertical sleeve gastrectomy. The remaining pouch or sleeve is generally defined by the lesser curvature 28 and the resection line 12, indicating that the stomach volume is significantly reduced. The desired location of the resection line 12 may be about 0.5 cm to about 2 cm lateral from the gastroesophageal junction 22 and about 2 cm to about 10 cm lateral from the pylorus 30. According to the embodiments described herein, an endocutter-stapling device may be utilized to create a high quality, consistent resection line during a vertical sleeve gastrectomy. Embodiments of the device may be advantageous because they may be easily positionable laparoscopically, may be able to accommodate tissue of different thicknesses along the length of the resection line, may be able to apply uniform compressive pressure to the tissue along the resection line, and may allow for low staple firing forces.

[0101] Fig. 2A shows a perspective view of stapling device 100 including end effector 121, support tube 140 and handle portion 123 shown in an open position. Fig. 2B shows a perspective view of stapling device 100 shown in a closed position.

[0102] 3A and 3B show exploded perspective views of a stapling device 100 shown in accordance with at least one embodiment. An end effector 121 of the stapling device 100 can include an anvil assembly 101 and a cartridge assembly 103. The anvil assembly 101 can include an anvil frame 102 and an anvil plate 112. The anvil plate 112 can be welded to the anvil frame 102 or otherwise attached to the anvil frame 102 or the end effector 121 by gluing, brazing, sintering, machining, 3D printing, and the like. The anvil assembly 101 can include a longitudinal axis along which the anvil frame 102 and the anvil plate 112 are oriented. The anvil plate 112 can define an anvil plate channel 137 aligned with the longitudinal axis, which can be sized to receive a blade 107 associated with the blade assembly 108. As shown in FIG. 4, the anvil frame 102 and the anvil plate 112 can cooperate to define an anvil blade channel 139 that can be sized to receive the upper portion 228 of the blade 107. During surgery, the anvil blade channel 139 can guide the blade 107 as it moves, for example, from a distal first position to a proximal second position within the anvil blade channel 137. In alternative embodiments, the blade 107 can transition from a proximal first position to a distal second position. In certain embodiments, the distal end of the end effector 121 is coupled rather than open, allowing the blade 107 to be initially positioned at the distal end of the end effector prior to use or cutting. Such a position can be advantageous because the blade 107 associated with the blade assembly 108 can be pulled rather than pushed to prevent buckling. It may be beneficial to provide the blade assembly 108 with an elongated beam 226 (FIG. 6) because when the beam 226 is in the anvil and cartridge channel, it can prevent the cartridge from deflecting into the cavity of the channel.Such deflection into the channel can cause malformed staples. The I-beam portion of the blade can compensate for deflection of the anvil and cartridge structural members that may occur during loading to allow proper gap for staple formation to be achieved.

[0103] 3A and 3B, the anvil plate 112 may be, for example, 20 cm to 26 cm long, 10 cm to 30 cm long, 5 cm to 32 cm long, 21 cm to 24 cm long, or any other suitable length. In one embodiment, the length of the anvil plate 112 is sized to span the length of an organ such as a stomach for use in a sleeve gastrectomy procedure. For example, the anvil plate 112 may be 23 cm long so that it can be used in combination with the cartridge assembly 103 to provide staple lines in a single fire, single cartridge sleeve gastrectomy procedure.

[0104] The cartridge assembly 103 can include a cartridge frame 116 that can hold the cartridge plate 114 and the cartridge 110. The cartridge plate 114 can be welded to the cartridge frame 116 or otherwise attached to the cartridge frame 116 or the end effector 121 by gluing, brazing, sintering, machining, 3D printing, etc. The cartridge assembly 103 can include a longitudinal axis along which the cartridge frame 116 and the cartridge plate 114 can be oriented. The cartridge plate 114 can define a cartridge channel 143 aligned with the longitudinal axis that can be sized to receive a blade 107 associated with the blade assembly 108. As shown in FIG. 4, the cartridge frame 116 and the cartridge plate 114 can cooperate to define a cartridge blade channel 141 that can be sized to receive a bottom 230 of the blade 107. During surgery, the cartridge blade channel 141 can guide the blade 107 as it moves, for example, from a distal first position to a proximal second position within the cartridge channel 143. In alternative embodiments, the blade 107 can transition from a proximal first position to a distal second position. In alternative embodiments, the cartridge blade channel 141 or an associated channel can be curvilinear or have any other suitable configuration.

[0105] 3A and 3B, the cartridge 110 can be attached to the cartridge frame 116 by a first cartridge pin 136 at a first end and a second cartridge pin 118 at a second end, or alternatively, the cartridge 110 can be attached to the cartridge frame 116 via a snap fit, adhesive, or other attachment method. The cartridge 110 can be, for example, 20 cm to 26 cm long, 10 cm to 30 cm long, 5 cm to 32 cm long, 21 cm to 24 cm long, or any other suitable length. In one embodiment, the length of the cartridge 110 is sized to span the length of an organ, such as a stomach, for use in a sleeve gastrectomy procedure. For example, the cartridge 110 can be 23 cm long so that it can be used in combination with the anvil assembly 101 to provide a staple line in a single-fire, single-cartridge sleeve gastrectomy procedure.

[0106] The end effector 121 can include a master link 106 that can be used to transition the end effector 121 from a closed position (see, e.g., FIG. 2B) to an open position (FIG. 2A) and back to the closed position. The master link 106 can be attached to a first end of the anvil frame 102, which can be a proximal end of the anvil frame 102, by a first master link pin 104 such that the first master link pin 104 pivotally and slidably engages a master link slot 105 defined by the anvil frame 102. The master link slot 105 can be a channel parallel to the longitudinal axis of the anvil frame 102, or the master link slot 105 can be angled up or down or otherwise offset relative to the longitudinal axis of the anvil frame. In certain embodiments, the master interface slot 105 may be angled or offset to achieve a larger (angled away from the gap) or smaller (angled towards the gap) gap between the anvil assembly 101 and the cartridge assembly 103. In certain embodiments where the master interface slot 105 is angled or offset, the master interface 106 can be configured to stop at any point along the master interface slot 105 to change the gap and therefore the angle of the anvil assembly 101 relative to the cartridge assembly 103. Angling the master interface slot 105 can also improve the closure efficiency of the end effector 121.

[0107] A second master interface pin 138 can be used to pivotally couple master interface 106 to platform 142, as described further herein below. In the embodiment shown in Figures 3A and 3B, cartridge frame 116 can be insertable at its proximal end into support tube 140 such that end effector 121 of stapling device 100 is aligned with and connected to handle portion 123 of stapling device 100.

[0108] The support tube 140 can be an elongate member having a proximal end and a distal end that can be configured to extend through a trocar (not shown) so that the end effector 121 of the stapling device 100 can access an organ of a patient. The support tube 140 can be of any suitable length, such as, for example, 50 mm to 350 mm, 100 mm to 350 mm, 100 mm to 200 mm, 150 mm to 300 mm, or 100 mm. The support tube 140 can have an outer diameter of, for example, 5 mm to 22 mm and a wall thickness of 0.25 mm to 1.5 mm.

[0109] The support tube 140 can be formed as a single piece by a monolithic construction, or in alternative embodiments, the support tube 140 can include multiple sections. The support tube 140 can have a uniform diameter of any size, for example, to access a body cavity following a laparoscopic procedure. The proximal end of the support tube 140 can be coupled to the handle portion 123 of the stapling device 100. The support tube 140 can have a handle ring 144 that slidably engages an outer surface of the support tube 140 and supports alignment and connection of the support tube 140 to the handle portion 123. A tube mount 174 can be secured to the support tube 140 for attachment to the handle portion 123.

[0110] The handle portion 123 of the stapling device 100 can be used to facilitate insertion of the end effector 121 into a body cavity of a patient. The handle portion 123 can include mechanical or powered components to facilitate actuation of the end effector 121. In one embodiment, the handle portion 123 can include a right handle half 120 and a left handle half 122 that can be joined together in a clam-like fashion. The right handle half 120 and the left handle half 122 can be joined by, for example, handle nuts 168, 170 and handle screws 160, 162, 164, or may be ultrasonically welded, press-fit, glued, screwed with self-tapping screws into holes molded in the right handle half 120, or otherwise assembled.

[0111] The handle portion 123 may include a trigger 146 that may be used to actuate and activate the stapling device 100. The trigger 146 may include a first attachment mechanism 148 and a second attachment mechanism 150 that may be used to attach the trigger 146 so that it is pivotable or movable relative to the right and left handle halves 120, 122. A trigger stop 158 may be positioned within the handle portion 123 adjacent the trigger 146 and may include recentering springs 152, 154 and a reset spring 156 that may be used to center and reset the trigger stop 158 in conjunction with use of the trigger 146. One embodiment of the operation of the handle portion 123 and the trigger 146 is shown in more detail in Figures 5A-5B.

[0112] The tube mounts 174 of the support tube 140 can engage features within the right and left handle halves 120, 122 to couple the support tube 140 to the handle portion 123. The platform 142 can be coupled through the support tube 140 to a tooth rack 176 or other engagement mechanism that can engage the pawl arm 128. The pawl arm 128 can be biased towards the rack 176 using a pawl spring 130. The pawl arm 128 can be at least partially retained within the handle portion 123 and can include left and right release levers 126, 124 that can be used interchangeably with either hand to overcome the bias of the pawl spring 130 and lift the pawl 208 of the pawl arm 128 from the rack 176.

[0113] In one embodiment, an electric motor 192 including an armature 193 may be insertable into a motor mount 194 and attached via screws 190 for use as a driver or actuator. In certain embodiments, the electric motor 192 may be selectively removable from the motor mount 194 for reuse by an operator, and the end effector 121 and / or support tube 140 may be single-use and disposable.

[0114] The electric motor 192 and switch 196 may be retained within the motor mount 194 using a cap 197 and an outer cap 198. The armature 193 may be coupled to the rotating member 180 using a gear 186 and a hub 188. A thrust washer 184 may be used to allow abutment of the trigger return spring 181. A switch 134 associated with a switch pad 132 may be used in cooperation with the switch 196 to engage the electric motor 192 and actuate the rotating member 180. The motor mount 194 may be mountable into the handle portion 123 using a left mounting arm 195 and a right mounting arm 199 and may be secured in place via pins formed in the left handle half 122 and left release lever 126 using screws such as the handle screw 164 or other retention structure or method.

[0115] FIG 5A is a side cross-sectional view of handle portion 123 of stapling device 100 shown in a first open position (see, e.g., FIG 2A). FIG 5B is a side cross-sectional view of handle portion 123 being transitioned to a second closed position (see, e.g., FIG 2B). Second attachment mechanism 150 of trigger 146 can include an elongated slot such that trigger pin 204 can move within second attachment mechanism 150 in a non-load-holding orientation while trigger 146 applies a load to platform 142 when trigger 146 is pulled proximally. When trigger 146 is pushed proximally, second attachment mechanism 150 can correspondingly apply a force to trigger pin 204 that pushes platform 142 proximally. The rack 176 can be rigidly attached to the proximal end of the platform 142 such that when the trigger 146 is pushed proximally, the teeth 206 of the rack 176 engage a pawl 208 on the pawl arm 128 to prevent distal movement of the rack 176 and platform 142. The rack 176 and platform 142 can be prevented from moving distally until, for example, the left release lever 126 ( FIG. 3 ) or the right release lever 124 ( FIG. 3 ) is pressed to release the pawl 208 from the teeth 206 of the rack 176. The teeth 206 on the rack 176 can allow the end effector 121 to close incrementally as the trigger 146 is pulled, thereby allowing the end effector 121 to be precisely positioned relative to the tissue. The clinician can push the trigger 146 proximally until the desired compression or position relative to the tissue is achieved. If the clinician needs to reposition the stapling device 100, the right release lever 124 or the left release lever 126 can be actuated to open the stapling device 100 and release the tissue.

[0116] Handle portion 123 can include a trigger stop 158 having a trigger stop tip 210. As shown in FIG. 5B, trigger 146 can be pushed proximally until trigger edge 212 of trigger 146 touches trigger stop tip 210, thereby preventing trigger 146 from moving further proximally. In one embodiment, when trigger 146 engages the trigger stop, stapling device 100 is in a fully closed position (see, e.g., FIG. 2B). In the fully closed position, the endocutter can be used to deploy staples and / or transcribe tissue.

[0117] 5C, once the stapling device 100 is in the closed position, the stapling device 100 can transition to a third, pre-fired position. In one embodiment, the stapling device 100 can be fired only after the trigger stop 158 has been moved laterally relative to the trigger 146 such that the trigger stop tip 210 is aligned with the trigger release recess 202. Once the trigger stop 158 is aligned with the trigger release recess 202, the trigger 146 can be pushed further proximally such that the trigger stop tip 210 enters the trigger release recess 202. The trigger stop 158 can be pushed laterally by the clinician, for example, by squeezing the recentering spring 152 or the recentering spring 154 to allow the trigger stop tip 210 to move laterally relative to the trigger edge 212 until the trigger stop tip 210 engages the trigger release recess 202.

[0118] 5D, when trigger stop tip 210 is aligned with trigger release recess 202, trigger 146 can be pushed more proximally to a fourth, fired position to actuate switch 172, which engages electric motor 192 to drive blade assembly 108. As blade assembly 108 is driven, stapling device 100 can correspondingly apply a staple line while simultaneously cutting tissue. A nut 109 (FIGS. 6 and 7) can be coupled to blade assembly 108 and can transfer force from rotating member 180 to blade assembly 108 when rotating member 180 is actuated by electric motor 192.

[0119] 5E, when trigger 146 is released, reset spring 156 can push trigger stop 158 distally, disengaging switch 172 and turning off electric motor 192. Recentering spring 152 and recentering spring 154 can then recenter trigger stop 158 and reset stapling device 100, such that electric motor 192 cannot be inadvertently re-engaged.

[0120] 6, a perspective view of the blade assembly 108 is shown showing that the nut 109 can be attached to the blade assembly 108 via pin 145, spot welding, or can be integrally formed with the blade assembly 108 as a unitary structure. The blade 107 can be secured to the distal end of the blade assembly 108 and can be pushed, for example, from a distal position to a proximal position to cut tissue during staple formation. FIG. 7 is a cross-sectional view of one example of the relationship between the support tube 140, the platform 142, the nut 109, and the rotating member 180. It will be appreciated that any suitable coupling that facilitates the transfer of force from the rotating member 180 to the blade assembly 108 is contemplated.

[0121] In embodiments, the blade 107 can be pushed proximally to cut tissue while simultaneously deploying staples from the cartridge 110. Prior to delivering the staples and cutting the tissue, the blade 107 can be advantageously positioned at the distal end of the end effector 121, supported by an elongated beam 226. The elongated beam 226 can provide additional support to the cartridge frame 116 during positioning and transition of the end effector 121 from an open position to a closed position.

[0122] 3A, 3B, and 4, the blade 107 can include a top portion 228 that can be sized to slidably move within the anvil blade channel 139, and the blade 107 can include a bottom portion 230 that can be sized to slidably move within the cartridge blade channel 141. In one embodiment, as the blade 107 is pushed proximally to cut tissue, the top portion 228 and bottom portion 230 of the blade 107 can compress against the end effector 121 to provide beneficial compression against the tissue.

[0123] It will be appreciated that the manually operated embodiment of stapling device 100 is described by way of example only. For example, the handle of stapling device 100 can be a control unit from a surgical robot, and stapling device 100 can be remotely actuated using the surgical robot or other electromechanical system, such as by electric motors, cables and pulleys, pneumatic or hydraulic mechanisms, and the like.

[0124] 8 is a side cross-sectional view of selected components of the handle portion 123 of the stapling device 100, in accordance with at least one embodiment. The rotating member 180 can include a threaded or threaded groove 214 that can be used to actuate the stapling device 100. When the rotating member 180 is actuated, corresponding threads on the nut 109 can push the nut 109 in a proximal or distal direction. The nut 109, which is coupled to an elongated beam 226 of the blade assembly 108, can advance the blade 107 in a proximal or distal direction.

[0125] FIG. 9 is a side view of one end of the end effector 121 according to at least one embodiment. In the illustrated version, the cartridge frame 116 is shown extending into the support tube 140, which can provide advantageous rigidity and support for the end effector 121. The cartridge frame 116 can include a ramp 216, which can be unitarily formed with the cartridge assembly 103 as a unitary structure or can be a separate component that can be secured to the cartridge frame 116. The ramp 216 can be positioned to interfere with a ramp face 220 of the master interface 106. When the platform 142 is advanced distally, the ramp face 220 can engage the ramp 216 and push the master interface 106 upward to open the end effector 121. The ramp 216 can have any suitable shape and configuration that can cause the master interface 106 to open or otherwise space the cartridge assembly 103 and the anvil assembly 101 apart. In an alternative embodiment (not shown), the ramp may be replaced by a spring to bias the master link into the open or up position.

[0126] As the platform 142 is advanced, the first master link pin 104 may engage a distal end of the master link slot 105 to push the anvil assembly 101 upward or outward from the cartridge assembly 103. The master link slot 105 may be an elongated channel that may be sized to allow the platform 142 and the master link 106 to move proximally and distally along a longitudinal axis to allow the master link 106 to apply an opening and closing force to the anvil frame 102. The master link slot 105 may be sized such that after the end effector 121 is fully closed and the master link 106 is horizontal within the support tube 140, the master link slot 105 may allow the trigger 146 to be advanced further proximally to engage the trigger edge 212 with the switch 172.

[0127] 9, the master interface 106 can include a second surface 221 that can contact a tube edge 223 of the support tube 140 when the trigger 146 is actuated. When the platform 142 is pushed proximally to close the end effector 121, the tube edge 223 can push against the second surface 221 to move the anvil frame 102 toward the cartridge assembly 103. The ramp surface 220 can facilitate manipulating the stapling device 100 and the second surface 221 can facilitate closing the stapling device 100 to improve operation of the stapling device 100 during use. In one embodiment, coupling a first end of the master interface 106 to the platform 142 and coupling a second end of the master interface 106 to the anvil frame 102 can facilitate actuating the end effector 121 without the need to actuate the support tube 140.

[0128] As shown in FIG. 9, the master link 106 can be pivotally attached at a first end by a first master link pin 104 and at a second end by a second master link pin 138. The master link 106 can have a linear configuration, or as shown in FIG. 9, the master link can have a first linear portion that originates around the second master link pin 138 and a second linear portion that is connected to the anvil frame 102 via the first master link pin 104. The first linear portion and the second linear portion can be offset by, for example, 1.5 to 10.0 millimeters, and can be offset by 2.5 millimeters. The included angle between the linear portion and the ramp surface 220 and the second surface 221 can be, for example, 20 degrees to 50 degrees, or 37 degrees. The distance between the first master link pin 104 and the second master link pin 138 can be 10 mm to 50 mm, 15 mm to 20 mm, or 18 mm. The length of the second surface 221 from the top of the first linear portion to the top of the second linear portion may be 15 mm to 22 mm, 10 mm to 30 mm, or 18 mm. The master interface slot 105 may have a length of 4 mm to 9 mm, 3 mm to 8 mm, or 6 mm to allow for the desired movement of the first master interface pin 104 within the master interface slot 105. The height and width of the master interface 106 may be, for example, 3 mm to 13 mm, or 6 mm to provide strength and rigidity while still fitting within the profile of the end effector 121. The material of the master interface 106, in combination with the size of the master interface 106, may be selected to ensure that the master interface 106 can withstand a closing load of, for example, 10 lbs to 100 lbs. In one embodiment, the width of the master junction 106 is 8 mm, the height of the master junction 106 is 4.6 mm, and the material of construction of the master junction 106 is stainless steel.

[0129] 10 is a bottom plan view of anvil assembly 101, according to one embodiment. Blade 107 is shown positioned at one end of anvil frame 102 in first opening 234. When anvil assembly 101 is closed against cartridge assembly 103, cutting portion 107 can enter anvil plate channel 137 to cut tissue between the staples. After reaching the end of its cutting sequence, blade 107 can enter second opening 236, which can allow end effector 121 to be opened. Blade 107 can be guided through anvil plate channel 137 to keep blade 107 centered.

[0130] 11 is a perspective view of a stapling device 300 according to one embodiment. The stapling device 300 can include an end cutter 308 and a motor assembly 315. The stapling device 300 includes an end effector 321 including an anvil assembly 301 and a cartridge assembly 303, a support tube 340, and a handle portion 323. The anvil assembly 301 can function as a first jaw of the end effector 321, and the cartridge assembly can function as a second jaw of the end effector 321. The end effector 321 can be connected to the handle portion 123 via the support tube 340. The handle portion 323 can include a handle 311 and a trigger 304 for actuating the stapling device 300.

[0131] The handle portion 323 can include a mode button 324 for switching between multiple operating modes. For example, in a first mode, the trigger 304 can be pressed upward to open the jaws (e.g., anvil and cartridge) or pressed downward to close the jaws. When the jaws are in a closed position, the mode button 324 can be depressed to transition the stapling device 300 to a firing mode. When in the firing mode, depressing the trigger 304 can fire the stapling device 300 to simultaneously cut tissue while forming a staple line including one or more staple rows. In one embodiment, depressing the trigger 304 in the firing mode can deploy a staple line including six staple rows, and a knife (not shown) can simultaneously cut tissue between the third and fourth staple rows.

[0132] 12 illustrates an exploded perspective view of an endocutter 308 according to at least one embodiment. The anvil assembly 301 can include an anvil frame 302 and an anvil plate 312. The anvil plate 312 can be welded to the anvil frame 302 or can be otherwise attached, such as by gluing, brazing, sintering, machining, 3D printing, etc. A cartridge 310 containing a plurality of staples can be attached to the cartridge frame 316 by a first cartridge pin 341 at a first end and a second cartridge pin 318 at a second end, or alternatively, the cartridge 310 can be attached to the cartridge frame 316 via a snap fit, adhesive, or other attachment method.

[0133] 12, the cartridge frame 316 can be inserted at its proximal end into a support tube 340 to align and connect the end effector 321 of the endocutter 308 to the handle portion 323. The blade assembly 322 can include a knife or blade 307 that can be coupled to a rotating member 380 via a bushing.

[0134] The handle portion 323 may include a right handle half 320 and a left handle half 322 that may be held together in a clamshell-like fashion. The right handle half 320 and the left handle half 322 may be joined by, for example, ultrasonic welding, adhesives, screws, gripper or press-fit pins that fit into holes molded into the handles, or other assembly methods. Left handle shells 350 and right handle shells 352 may be used to cover the left handle half 322 and the right handle half 320, providing a neat aesthetic to the exterior of the handle portion 323.

[0135] A drive screw 354 may be used to drive the control arm 351 via a control arm nut 353. The drive screw 354 may be connected to a second drive gear coupling 345 that may engage with the motor assembly 315. The rotating member 380 may be coupled to the motor assembly 315 via a firing drive gear 366 and a second firing drive gear 369, which may engage with a first drive gear coupling 356 that may be coupled with the motor assembly 315. In one embodiment, the second firing drive gear 369 and the first drive gear coupling 356 may be a single component or mechanism.

[0136] FIG. 13 is a perspective view of the motor assembly 315 according to one embodiment. A first electric motor 335 and a second electric motor 337 can be provided within the motor housing 313. In one embodiment, the first motor gear 363 can be coupled to the first drive gear coupling means 356 (FIG. 12) and the second motor gear 365 can be coupled to the second drive gear coupling means 345 (FIG. 12). The motor housing 313 can include a left motor housing half 327 and a right motor housing half 316. The motor housing 313 can include a snap 317 for coupling the motor assembly 315 to the handle portion 323. A strain relief 319 can be provided on the support wire to the motor assembly 315. A connector 325 can allow electrical coupling of the trigger 304 (FIG. 12) and other electrical components between the motor assembly 315 and the stapling device 300.

[0137] 14A is a side view of a stapling device 300 according to one embodiment showing an end effector 321 in an open position. The end effector 321 can include a first jaw comprising an anvil assembly 301 and a second jaw comprising a cartridge assembly 303. The end effector 321 can include a master link 306 operably coupled to a motor assembly 315.

[0138] 14B is a side view of stapling device 300 showing end effector 321 in a closed position. In its closed position, end effector 321 can be ready for firing, which can include deploying staples and / or cutting tissue. In one embodiment, end effector 321 can include a blade 307 (FIG. 12) for cutting tissue while deploying staples.

[0139] FIG. 15 shows a side cross-sectional view of the handle portion 323 of the stapling device 300 in an open position (e.g., the position shown in FIG. 14A). A second drive gear coupling means 345 for opening and closing the end effector 321 can be coupled to a second motor gear 365 (FIG. 13) associated with the second electric motor 337. The second drive gear coupling means 345 can rotate the drive screw 354 to open and close the end effector 321 and transition the end effector 321 from the open position to the closed position and vice versa. In FIG. 15, the control arm nut 353 is shown in its distal-most position on the drive screw 354 such that the master coupling 306 is fully extended and the end effector 321 is in the open position. When the end effector 321 is in the fully open position, a control arm distal limit switch 368 can be contacted by the control arm nut 353 in the position shown to prevent power to the second electric motor 337. The first drive gear coupling means 356 can be coupled to the second motor gear 365 to deploy staples from the stapling device 300 while simultaneously cutting tissue.

[0140] 16 illustrates a side view of the end effector 321 of the stapling device 300 shown in an open position. The master link 306 can be attached to a first end of the anvil frame 302 by a first master link pin 320 such that the first master link pin 320 can pivotally and slidably engage a master link slot 305. The master link slot 305 can be a channel parallel to the longitudinal axis of the anvil assembly 301, or the master link slot 305 can be angled up or down relative to the longitudinal axis. A second master link pin 338 can be used to pivotally couple the master link 306 to a control arm 351.

[0141] 17 illustrates a side cross-sectional view of the handle portion 323 of the stapling device 300 shown in a closed position. The control arm nut 353 is shown in its proximal-most position on the drive screw 354 such that the anvil assembly 301 is closed relative to the cartridge assembly 303. In one embodiment, when the end effector 321 is closed, the control arm nut 353 can advance proximally until it contacts a proximal limit switch 355. Upon contacting the proximal limit switch 355, the control arm nut 353 can prevent power to the second electric motor 337. The stapling device 300 can be configured to be unable to transition to a firing mode until the control arm nut 353 engages the proximal limit switch 355 to ensure that the stapling device 300 is in a closed position prior to firing.

[0142] 18 illustrates a side view of the end effector 321 of the stapling device 300 shown in the closed position. The master coupling 306 is shown as being partially inserted into the support tube 340 such that the anvil assembly 301 and cartridge assembly 303 are in the closed position ready to fire.

[0143] 19 is a side view of a drive assembly 460 for simultaneously stapling and cutting tissue. The drive assembly 460 can include a blade assembly 408 including a blade 407 coupled to a beam 426. The beam 426 can include a nut 409 that can be threadably engaged with a rotating member 480. The rotating member 480 can be operatively coupled to a first electric motor 412 such that rotation of the rotating member 480 urges the nut 409 proximally. In operation, actuation of the first electric motor 412 can urge the nut 409 proximally, resulting in a corresponding proximal movement of the beam 426 and the blade assembly 408. As the blade assembly 408 is urged proximally, a cutting edge 432 of the blade 407 can transecte tissue. The blade 407 can include an upper portion 428 and a lower portion 430 that can compress an anvil and cartridge of an end effector as it is urged proximally.

[0144] 19 , when the blade assembly 408 is pulled to its proximal-most position, the nut 409 may engage a fired limit switch 468. When the nut 409 engages the fired limit switch 468, power to the first electric motor 412 may be prevented. It is contemplated that the nut 409 may be attached to the blade assembly 408 or the beam 426 in any suitable manner, such as via pins, spot welding, or other attachment methods. Alternatively, the nut 409 may be integrally formed with the blade assembly 408 or the beam 426 as a unitary structure.

[0145] 20 is a side view of a drive assembly 560 for opening and closing the anvil assembly 501, according to one embodiment. The anvil assembly 501 can be movably coupled to a master coupling 506, which can be pivotally coupled to a distal end of the platform 542.

[0146] In the illustrated embodiment, the master link 506 includes a first master link pin 504 that can engage a master link slot 505 positioned at a proximal end of the anvil assembly 501. The first master link pin 504 can translate within the master link slot 505 to facilitate opening and closing the anvil assembly 501. The proximal end of the platform 542 can include a drive nut 567 that can be threadably engaged with the drive screw 554. The drive nut 567 and the drive screw 554 can be coupled such that rotation of the drive screw 554 in a first direction pushes the drive nut 567 proximally and rotation of the drive screw 554 in a second direction pushes the drive nut 567 distally. The proximal end of the drive screw 554 can be coupled to a second motor gear 565 that is rotatably coupled to the second electric motor 514. In operation, the second electric motor 514 can rotate the drive screw 554 clockwise or counterclockwise to open and close the anvil assembly 501, respectively.

[0147] 20 , the drive assembly 560 may include a distal limit switch 557 and a proximal limit switch 555. When the anvil assembly 501 is in a fully open position, the drive nut 567 may be in its distal most position, thereby contacting the distal limit switch 557 and preventing power to the second electric motor 514. When the anvil assembly 501 is in a fully closed position, the drive nut 567 may be in its proximal most position, thereby contacting the proximal limit switch 555 and preventing power to the second electric motor 514.

[0148] 21 is a side view of a drive assembly 660 for opening and closing the anvil assembly 601 according to an alternative embodiment. The anvil assembly 601 can be movably coupled to a master coupling 606, which can be pivotally coupled to a distal end of the platform 642.

[0149] In the illustrated embodiment, the anvil assembly 601 can include a distal slot 669 that can engage a pin (not shown) positioned at a distal end of the anvil assembly 601 to allow the pin to move within the distal slot 669 to facilitate opening and closing of the drive assembly 660. The proximal end of the anvil assembly 601 can include a locking pin 604 that can pivotally couple the anvil assembly 601 and the master coupling 606. The proximal end of the platform 642 can include a drive nut 667 that can be threadably engaged with the drive screw 654. The drive nut 667 and the drive screw 654 can be coupled such that rotation of the drive screw 654 in a first direction urges the drive nut 667 proximally and rotation of the drive screw 654 in a second direction urges the drive nut 667 distally. A proximal end of the drive screw 654 may be coupled to a second motor gear 665 that is rotatably coupled to the first electric motor 614. In operation, the first electric motor 614 may rotate the drive screw 654 clockwise or counterclockwise to open and close the anvil assembly 601, respectively.

[0150] 21 , the drive assembly 660 may include a distal limit switch 657 and a proximal limit switch 655. When the anvil assembly 601 is in a fully open position, the drive nut 667 may be in its distal-most position, thereby contacting the distal limit switch 657 and preventing power to the first electric motor 614. When the anvil assembly 601 is in a fully closed position, the drive nut 667 may be in its proximal-most position, thereby contacting the proximal limit switch 655 and preventing power to the first electric motor 614.

[0151] During closure of the end effector, the anvil can rotate or deflect slightly relative to the longitudinal axis from tissue loads, so that the anvil can interfere with the cartridge as it closes on the tissue. FIG. 22 is a perspective view of a distal portion of anvil frame 701, according to one embodiment. Anvil frame 701 can include a bevel feature, such as anvil face 771, that can help guide the anvil frame into channel 702 in cartridge assembly 703 to ensure alignment during closure. The tissue between the jaws can be thicker on one side of the end effector than the other, and anvil face 771 can aid in alignment when uneven tissue causes slight misalignment prior to closing the jaws of the end effector. The bevel or bevels can act as a retraction feature that can function to align the end effector and help ensure that staples are properly deployed in various tissue thicknesses.

[0152] 23 is a perspective view of a motor controller 870 according to one embodiment. The motor controller 870 can include a controller housing 872 having an on / off switch 874, a display 875, and a device cable connector 876. The on / off switch 874 can provide power from a wall outlet, such as 110 volt or 220 volt AC power from a wall outlet, or can provide battery power to the motor controller 870. The device cable connector 876 can connect a number of wires from a motor assembly of the stapling device to the motor controller 870. For example, the device cable connector 876 can provide positive and negative voltage wires to a first electric motor (e.g., the first electric motor 335 shown in FIG. 13), positive and negative voltage wires to a second electric motor 337 (e.g., the second electric motor 337 shown in FIG. 13), wires to a trigger (e.g., the trigger 304 shown in FIG. 12), positive and negative sense wires to each of the fire complete limit switch 368 (FIG. 15), the proximal limit switch 555 (FIG. 20), and the distal limit switch 557 (FIG. 20), as well as any other wires useful for the endocutter.

[0153] FIG. 24 is an exploded perspective view of a motor controller 870 according to one embodiment. A lid 873, which may be part of the controller housing 872, may house the components inside the controller housing 872. In the embodiment shown in FIG. 24, power from a wall outlet may be drawn to the controller housing 872 via an electrical supply 878. A fan 880 may also be included to cool the interior of the controller housing 872. A pair of speakers 882 may be provided to inform the user of the condition of the stapling device, such as, for example, jaws open, jaws closed, firing complete, ready to fire, or other useful information. A display 875 may be used to provide visual indications, data, error conditions, instrument identification information, or other useful data.

[0154] A motor controller board 828 can provide power to the first electric motor 335 (FIG. 13) or the second electric motor 337 (FIG. 13) as appropriate. The motor controller board 828 can be instructed by a processor board 830 to turn the first electric motor 335 or the second electric motor 337 on and off. The processor board 830 can include a processor useful for controlling a stapling device, such as an ARM processor or other processor. For example, the processor board 830 can include software that reads the conditions of the limit switches 555, 557, 368 (FIGS. 15 and 20) and the trigger 304 (FIG. 12) and can control the motor controller board 828 to, for example, open and close the jaws, fire the system, or perform other useful functions.

[0155] In one illustrative embodiment, an ARM processor can be used to communicate with an endocutter (e.g., stapling device 100 shown in FIGS. 2A and 2B). For example, stapling device 100 can include an EEPROM or other memory holding device that can encode a serial number during manufacturing. The memory can be used to provide information to a motor controller. For example, the processor can be capable of measuring and recording the amperage of the opening and closing motor during operation on a manufacturing line, the amperage of the firing motor during operation on a manufacturing line, the amperage of the opening and closing motor during clinical use, the amperage of the firing motor during clinical use, or other data useful to the manufacturer or operator. This data can also be relayed and stored to motor controller 870. Such information can also be displayed to a user during firing in motor controller 870 by connecting motor controller 870 to a screen or display that can be incorporated into stapling device 100, or the data can be transmitted to a monitor used by a laparoscopic camera in a minimally invasive procedure.

[0156] FIG. 25 illustrates a side cross-sectional view of a portion of the end effector 321 of the stapling device 300 shown in FIG. 11. A plurality of stapling devices 332 can be positioned within the cartridge 310 beneath a plurality of staples 334 in a plurality of staple pockets 336. The anvil frame 302 can include an anvil channel 344 that can receive an upper portion 328 of the blade 307. A staple driving ramp 343 can slide or otherwise move past a plurality of driving ramp slots 342. When the stapling device 300 is fired, the staple driving ramp 343 can engage the stapling device 332 to drive the staples 334 into the anvil assembly 301. Behind each staple formed, the cutting edge 339 of the blade 307 can transect tissue held between the anvil assembly 301 and the cartridge assembly 303. The height of staple drivers 332 can range, for example, from 1.5 mm to 4.5 mm, and the length of staples 334 can range, for example, from 3.0 mm to 5.0 mm. In certain embodiments, taller drivers and shorter staples can be used for thinner tissue, and shorter drivers can be used with longer staples for thicker tissue.

[0157] 26A is a side cross-sectional view of end effector 321 of stapling device 300, according to one embodiment. In the embodiment shown, anvil plate 312 is flat and cartridge 310 includes three staple driver 332 heights in sections 390, 391, and 392 that are sized to drive staples 334 of equal length. By providing section 390 (e.g., a 2.2 mm driver height for forming 1.2 mm formed staples), section 391 (e.g., a 2.7 mm driver height for forming 1.7 mm formed staples), and section 392 (e.g., a 3.2 mm driver height for forming 2.2 mm formed staples), various tissue thicknesses can be accommodated within stapling device 300 during use. Higher driver heights can form staples through thinner tissue thicknesses and shorter driver heights can provide staples suitable for thicker tissue. The clamping surface of the cartridge 310 can be angled, such as 0.1 degrees to 0.35 degrees, or 0.25 degrees, relative to the anvil to provide uniform compression against the stomach where tissue thickness is non-uniform.

[0158] 26B is a side cross-sectional view of the end effector 321 assembly of the stapling device 300 in accordance with an alternative embodiment. In the variation shown, the anvil plate 312 is flat and the cartridge 310 can include three staple driver 332 heights in sections 390, 391, and 392 that can drive staples 334 of three or more different lengths.

[0159] FIG. 26C is a side cross-sectional view of the end effector 321 of the stapling device 300 according to an alternative embodiment. In the variation shown, the anvil plate 312 can be angled and the cartridge 310 can include the same staple driver 332 height. In one embodiment, the cartridge 310 can include two different staple 334 lengths, with the longer legged staples (e.g., 4.4 mm) at a proximal portion of the cartridge 310 and the shorter legged staples (e.g., 3.8 mm) at a distal portion of the cartridge 310. In another embodiment, staples of equal length can be used along the entire length of the cartridge 310. In other embodiments, different staple lengths can be used in different rows or at different locations along the length of the stapling device 300 within a row to accommodate tissue thickness. Variation from row to row can accommodate variations in tissue thickness from patient to patient. Varying the staple height within a row can accommodate variations in tissue thickness that may occur from one end of the stomach to the other. Providing an angled anvil plate 312 can be advantageous when stapling tissue of differing thicknesses to allow for uniform tissue compression from the distal-most to the proximal-most portion of the cartridge 310 when the stapling device 300 is fired.

[0160] 26D is a side cross-sectional view of the end effector 321 of the stapling device 300 in accordance with an alternative embodiment. In the illustrated embodiment, the anvil plate 312 is angled and the cartridge 310 includes a single staple driver 332 height for driving staples 334 of various lengths. Any suitable number of different staple heights can be combined with the angled anvil plate 312 to provide the desired tissue compression and high staple line integrity. For example, as shown in FIG. 26D, the cartridge can include three different staple heights positioned along a tri-section of the cartridge 310.

[0161] 26E is a side cross-sectional view of the end effector 321 of the stapling device 300 in accordance with an alternative embodiment. In the variation shown, the anvil plate 312 is angled and the cartridge 310 can contain staples having a uniform length. Any suitable combination of anvil plate angle, driver height, and staple height is contemplated.

[0162] FIG. 27 illustrates a method 250 of operating an end effector portion of an endocutter (e.g., stapling device 300) according to one embodiment. The method 251 can enable safe and effective actuation and use of the stapling device. The steps illustrated in FIG. 27 may be implemented in software on the processor board 830 (FIG. 24), in firmware, using a programmable gate array, or by other suitable methods for implementing logic control. The method 251 includes an On / Off Mode 205, a Closure System Mode 207, a Firing System Mode 209, a System Idle Mode 211, and a Manufacturing Knife Reset Mode 213.

[0163] The on / off mode 205 can include the delivery or removal of power to the stapling device 100. The closure system mode 207 can enable the opening and closing of the end effector, jaws, or anvil and / or the anvil and cartridge of the stapling device to enable placement and adjustment of the endocutter relative to the tissue. The system firing mode 209 can include safety and detection steps to enable full and effective firing of the staples. The system idle mode 211 can communicate features and options to the user and await user instructions. For example, the system idle mode 211 can include using a programmable memory, such as an EEPROM, provided in the connector or handle to communicate information about the instrument to the controller. The knife manufacturing reset mode 213 can be useful during testing and manufacturing of the endocutter to verify functionality and properly position components for use during manufacturing.

[0164] The system firing mode 209 can include feedback to the operator regarding exceeding limits, such as compression limits, motor drive limits, tissue thickness limits, or other limits useful to the operator. For example, the motor current can be monitored by the controller, and when a predetermined motor current level is reached, the controller can provide feedback to the operator that the motor is reaching its load limit, so that the operator can decide to modify the procedure or take some other action.

[0165] In one embodiment, an endocutter or stapler device system according to embodiments described herein can have a unique serial number or other identifier to allow an operator to record the particular serial number of the instrument used in the patient's records. When the instrument is connected to a controller, such as the motor controller 870, the controller can communicate with the memory and provide the serial number on the display of the controller. The memory can also be used to record information regarding the use of the instrument. For example, an event log can be recorded in the memory from the controller that records the motor load, the number of times the instrument was opened or closed, the number of times the instrument was fired, error codes, or other useful information that can be placed in the memory for later review.

[0166] FIG. 28 is a flow diagram illustrating a method 251 according to one embodiment. The method 251 can include a System Ready State 252 followed by a Closure Switch Active / All Other Switches Inactive Decision 253. The switches can include, for example, the mode button 324, a proximal limit switch 555, a distal limit switch 557, or other useful switches. If the closure switch is active and any other switches are also active, the system can enter an Error State 254. If no switches other than the closure open switch are active, the system can enter a Closure System Mode 255. From the Closure System Mode 255, the method 251 can perform a Trigger Read 256 to determine if the trigger is in a trigger up state or a trigger down state. If the trigger read 256 returns a trigger up condition, a Closure-Open Switch Activated Decision 257 can be made. If the Closure-Open Switch Activated Decision 257 is negative, a Motor Opens Device Condition 259 can be made and another Trigger Read 256 can be made. If the Closure-Open Switch Activated Decision 257 is positive, a Device Open Condition 258 can be made.

[0167] If a trigger down condition is detected during the trigger read 256, a Closure Closed Switch Activated Decision 261 may be made. If the Closure Closed Switch Activated Decision 261 is negative, a Motor Closes Device 260 condition may be made, followed by another trigger read 256. If the Closure Closed Switch Activated Decision 261 is positive, a Device Closed Condition 262 may be made. For example, many conditions, such as the Device Closed condition 262, may provide feedback to the operator regarding the device, such as by flashing an LED light, providing an audible sound, or other feedback type. For example, audio files may be created and provided at various times during the method 251 to provide the user with information regarding system status, conditions, errors, or functionality of the stapling device 100. The method 251 of FIG. 25 may continue to FIG. 29 at link 263.

[0168] FIG. 29 is a flow diagram illustrating a method 251 that begins at a link 263 that links the portion of the method 251 from FIG. 28 to the portion of the method 251 shown in FIG. 29. When the method 251 is in a device closed condition 262, the method 251 can utilize a safety switch 264 to ensure that the operator intends to fire the endocutter before the system firing mode 265 is enabled. A suitable safety switch 264 can be, for example, the mode button 324 shown in FIG. 11. When the system firing mode 265 is enabled, a Firing Started Decision 266 can be made. If the Firing Started Decision 266 is negative, both the Safety Switch 268 active condition and the Trigger Up 267 condition are satisfied before the Closure System Mode 271 can be entered. If the Firing Started Decision 266 is positive, a Trigger Down condition 269 can precede a Firing Limit Switch Activated Decision 283. If the Begin Firing Decision 266 is affirmative, a Trigger Down Double-Click 270 can precede an Activate Firing Motor Condition 272. During the Activate Firing Motor Condition 272, the endocutter can fire or reset tissue until a Fire Limit Switch Activation Decision 283 determines that the fire limit switch is active.

[0169] If the fire limit switch activation decision 283 is affirmative, a Firing Motor Stops Condition 274 may be entered and the method 251 may enter a Firing Completion Mode 279 and then a System Idle Mode 280. If the fire limit switch activation decision 283 is negative, a Firing Motor Continues Condition 273 may occur until a fire limit switch, such as, for example, a proximal limit switch 555, is activated. The System Idle Mode 280 is further described below with reference to FIG.

[0170] FIG. 30 is a flow diagram illustrating the method 251 beginning in a system idle mode 280. The system may be idle until a trigger up condition 281 or a trigger down condition 282 occurs. The trigger up condition 281 may prompt a closure-opening switch activated decision 284. If the closure-opening switch activated decision 284 is positive, the closure motor may be stopped and a device open condition 289 may occur. If the closure-opening switch activated decision 284 is negative, the motor may continue to open the end cutter until the trigger is released or the closure opening switch is activated. The trigger down condition 282 may prompt a closure-closed switch activated decision 286. If the closure-closed switch activated decision 286 is positive, the closure motor may be stopped and a device closed condition 290 may occur. If the closure close switch activation decision 286 is negative, the motor can continue to close the endocutter until the trigger is released or the closure close switch is activated.

[0171] FIG. 31 is a perspective view of a stapling device 900 according to one embodiment. The stapling device 900 can include an endocutter 908 and a motor assembly 915. The endocutter 908 can include an anvil assembly 901 and a cartridge assembly 903 for clamping, stapling, and / or cutting tissue, or an end effector 921 including a first jaw and a second jaw, respectively. The end effector 921 can be connected to a handle portion 923 via a support tube 940. The handle portion 923 can include a handle 905 including a trigger 904 for actuating the stapling device 900. The handle portion 923 can include a mode button 924 for switching between multiple operating modes. For example, in a first mode, the trigger 904 can be pressed upward to open the jaws or pressed downward to close the jaws. After the jaws are closed, the mode button 924 can be pressed down, changing the functionality of the trigger 904 from an open / close mode to a firing mode. When in the firing mode, the stapling device 900 can be fired by depressing the trigger 904 to simultaneously form staple lines while cutting tissue between the staple lines.

[0172] As shown in FIG. 31 , the stapling device 900 can include, in part, a buttress assembly including a plurality of cord supports 988 positioned on the cartridge assembly 903 and the anvil assembly 901 to allow attachment of buttress material 991 ( FIG. 32 ) to the stapling device 900. The cord supports 988 can be useful for attaching the buttress material 991 before or during surgery. The buttress material 991 can be used to add support and boost to the staple line and provide an improved seal against the tissue being cut as the staples are formed. The buttress material 991 can be formed from absorbable or non-absorbable materials for either temporary or permanent application. The cord supports 988 can be used to hold the buttress material 991 on the stapling device 900 until after the staple line is formed, at which point the cords 387 ( FIG. 32 ) can be released to allow the buttress material 991 to separate from the cord supports 988 and the stapling device 900. A cord support 988 can be incorporated into the anvil assembly 901 or the cartridge assembly 903 so that the buttress material 991 can be attached to the stapling device 900 before or during the procedure, for example, by passing a suture material or cord 987 through a loop 999 in the buttress material 991 and over or around the cord support 988.

[0173] 32 shows an exploded perspective view of a stapling device 900 according to one embodiment. The anvil assembly 901 can include an anvil frame 902 and an anvil plate 912. The cartridge assembly 903 can include a cartridge frame 916 and a cartridge 910. The cartridge 910 can be attached to the cartridge frame 916 by a first cartridge pin 936 at a first end and a second cartridge pin 918 at a second end, or alternatively, the cartridge 910 can be attached to the cartridge frame 916 via a snap fit, adhesive, or other attachment method.

[0174] 32, the cartridge frame 916 can be insertable at its proximal end into a support tube 940 to align and connect an end effector 921 of the stapling device 900 to a handle portion 923 of the stapling device 900. The blade assembly 922 can include a blade 907 coupled to a rotating member 980 via a nut 909.

[0175] The handle portion 923 can include a right handle half 920 and a left handle half 922 that can be held together in a clamshell-like fashion. The right handle half 920 and the left handle half 922 can be joined by, for example, ultrasonic welding, gluing, screwing with self-tapping screws, gripper pins or press-fit pins into holes molded in the handles, or other assembly methods. The left handle shell 950 and the right handle shell 952 can be used to cover the left handle half 922 and the right handle half 920 to provide a neat aesthetic to the exterior of the handle portion 923.

[0176] A drive screw 954 may be used to drive the control arm 951 via a control arm nut 953. The drive screw 954 may be connected to a drive gear coupling 955 that may engage with a motor assembly 915 (FIG. 31). The rotating member 980 is shown as coupled to the drive gear coupling 956 via a first firing drive gear 966 and a second firing drive gear 969. The drive gear coupling 956 may be coupled to the motor assembly 915.

[0177] The cord support 988 may be attached to the cartridge 910 as shown in FIG. 32 or may be attached to the cartridge frame 916 as shown in FIG. 31. The cord support 388 may include lateral projections, hoops, tabs, hooks, loops, or other structures suitable for retaining the buttress material 991. The buttress material 991 may have a cord 987 incorporated therein to provide support and retain the buttress material 991 to the cartridge 910. For example, the cord support may be a tubular shape having a "C" shaped cross section (not shown) such that the cord support is not completely closed. The open "C" shape may allow the buttress material to be attached to the end effector by pulling the cord across the tubular shape so that the cord enters the opening of the "C" to hold the buttress material in place. The cord support 988 may be provided on the anvil frame 902 or the anvil plate 112. The cord 987 may be, for example, a suture material, a wire cable, a wire strand, individual wires, a rope, a monofilament, a thread or other suitable material.

[0178] 33A is a side view of a stapling device 900 in accordance with one embodiment having an open end effector 921. The end effector 921 may include an anvil assembly 901, a cartridge assembly 903, and a master interlock 906. The end effector 921 is shown prior to the installation of the buttress material 991. It will be appreciated that the buttress material 991 may be provided already attached to the end effector 921 from a supplier or the buttress material 991 may be placed on the end effector 921 in an open position during a surgical procedure. For example, the buttress material 991 may be provided in a sterile package and opened in a sterile field during a surgical procedure. The clinician can then apply buttress material 991 to the anvil or cartridge with the stapling device 900 in the fully open position and thread the cord 987 over the cord support or loop it through the cord support 988 to hold the buttress material 991 in place. As shown in FIGURE 33A, once the buttress material 991 is attached to the end effector 921, the stapling device 900 can be closed so that the end effector 921 can be fitted through the trocar to the surgical site.

[0179] 34A and 34B show buttress material 991 illustrated with a cord 987 engaged with a number of loops 999. Openings 984 defined by the buttress material 991 may be spaced between the loops 999 and may be sized and positioned to correspond with cord supports 988 on the end effector 921. It will be appreciated that the buttress material 991 may have any suitable size and shape to engage and selectively retain the cord 987 or any other suitable buttress material retention mechanism or structure. The cord 987 may be a single suture that is threaded through the loops 999, or it is contemplated that multiple cords or sutures may be used to secure the buttress material.

[0180] FIG 35A illustrates anvil assembly 901 shown with a plurality of cord supports 988 prior to attachment of buttress material 991. FIG 35B illustrates anvil assembly 901 with buttress material 991 attached to cord supports 988 by cords 987 according to one embodiment. FIG 36 illustrates a perspective view of stapling device 900 with buttress material 991 attached to anvil assembly 901 and cartridge assembly 903 by cords 987.

[0181] As shown in FIG. 37, the stapling device 1000 can include a buttress 1088 having an adhesive that can be positioned on the cartridge assembly 1003 and the anvil assembly 1001. The buttress 1088 can include a buttress material 1091 and one or more adhesive portions 1090 that can be used to bond the buttress material 1091 to the anvil assembly 1001 or the cartridge assembly 1003. The buttress 1088 can be used to add support and strength to the staple line and provide an improved seal against the tissue that is transected as the staples are formed. The buttress material 1091 can be formed from absorbent or non-absorbent materials for either temporary or permanent application. The adhesive portions 1090 can be used to hold the buttress material 1091 on the stapling device 1000 until after the staple line has been formed, at which point the staple line can hold all or a portion of the buttress material 1091 on the tissue.

[0182] In one embodiment, as shown in Figures 38A-38E, the buttress material 1091 can be bifurcated to include anvil buttress portion 1070 and cartridge buttress portion 1072. As shown in Figure 38A, the buttress 1088 can include a pair of removable portions 1076 that can couple the anvil buttress portion 1070 to the cartridge buttress portion 1072 prior to use. The removable portions 1076 can be adhered to the buttress 1088 or can be attached by weakened portions or the like.

[0183] In one embodiment, the removable portions 1076 are flexible such that pushing laterally inward on each of the removable portions 1076 allows the adhesive portions 1090 to pivot radially inward to contact the sides of the end effector 1021 (see, e.g., FIGS. 38B-38C). In one method of use, the buttress 1088 can be positioned within the end effector 1021, the backing 1074 can be removed to expose the adhesive portions 1090, the removable portions 1076 can be pushed inward such that the adhesive portions 1090 are adhesively coupled with the end effector 1021, and then the removable portions 1076 can be removed such that the anvil buttress portion 1070 is separated from the cartridge buttress portion 1072.

[0184] In an alternative embodiment, after the buttress 1088 is placed within the end effector in the closed position, the removable portion 1076 can be removed to allow the adhesive portions 1090 to flex so that each adhesive portion 1090 can engage a side of the end effector 1021 for attachment.

[0185] With reference to FIGS. 38A-38C, the buttress material 1091 can include four adhesive portions 1090 that can be located on the sides of the buttress material 1091. With reference to FIG. 38D, the anvil buttress portion 1070 and the cartridge buttress portion 1072 can each be sized to cover all or a portion of the anvil face 1012 and the cartridge face 1014 of the end effector 1021, respectively. The adhesive portions 1090 can each be sized to be folded to adhere to the sides of the anvil assembly 1001 or the cartridge assembly 1003, as shown in FIG. 38D. Prior to use, each of the adhesive portions 1090 can include a backing material 1074. To facilitate removal, the backing material 1074 can be coupled with one or more disposable threads 1093 (FIG. 38B) that can be pulled to remove the backing material 1074 from the adhesive portions 1090. As shown in FIG. 38E, once the stomach is resected, a portion of the staple line can cooperate with the buttress material to form a sleeve gastrectomy.

[0186] Varying pocket depths can improve the ability to achieve a minimum acceptable level of compression without overcompressing the tissue. Varying pocket depths can also reduce the risks associated with malformation of the staples that can occur when there is a mismatch between tissue thickness and staple height.

[0187] FIG. 39A is a bottom view of an anvil assembly 1101 according to one embodiment. In FIG. 39A, an anvil plate 1112 is shown having six anvil pocket rows including a first row of pockets 1115, a second row of pockets 1117, a third row of pockets 1119, a fourth row of pockets 1159, a fifth row of pockets 1161, and a sixth row of pockets 1163. The staple pockets 1134 in the anvil plate 1112 can be shaped to receive and shape the tips of the staples as they are driven into the anvil plate 1112. As the staples engage the anvil plate 1112, the tips of each staple can be guided until each has a substantially B-shaped configuration (see, e.g., FIGS. 42A-42C). The staple pockets 1134 may be machined into the anvil plate 1112, eroded into the anvil plate 1112 using an EDM process, created using precision electrochemical machining (PEM), formed using a sintering process, molded using a metal injection molding process, or otherwise manufactured.

[0188] The anvil plate 1112 may be divided into a left anvil half 1111 and a right anvil half 1113 that are separated by a knife channel 1138. It will be appreciated that any suitable number of rows of pockets having any suitable size, shape, and orientation are contemplated. In the illustrated example of FIG. 39A, the first row of pockets 1115 and the second row of pockets 1117 are spaced closer together than the third row of pockets 1119. Similarly, the fourth row of pockets 1159 and the fifth row of pockets 1161 are spaced closer together than the sixth row of pockets 1163. It will be appreciated that any spacing may be used between the rows, and that the spacing on the left anvil half 1111 may be different than the spacing on the right anvil half 1113. In the illustrated example, the rows of pockets are shown with a staggered relationship, which may be beneficial in maintaining staple line integrity. It will be understood that any desired offset or spacing may be used with any suitable number of staple rows. In the illustrated embodiment, each of the staple rows is parallel to the longitudinal axis of the anvil assembly 1101 and extends from the proximal end to the distal end of the anvil assembly 1101, although one or more rows may be offset and may have any suitable length.

[0189] The spacing between the staple rows may be, for example, 0.030 inches to 0.060 inches, or 0.044 inches. The staple rows may be offset relative to one another so that they overlap, such that the center of a staple in one row is between two staples in an adjacent row. In some procedures, such as a sleeve gastrectomy, where tissue is removed along one side of a cut and a gastric sleeve is formed on the other side of the cut, it may be useful to have the staple rows asymmetrically offset (not shown) on the left anvil half 1111 and the right anvil half 1113. The integrity of the portion of the staple line along the newly formed sleeve may be more important and therefore may include additional staple rows, different orientations of the staples, or may be configured in other manners. In one embodiment (not shown), one half of the anvil has three staple rows and the other half includes two staple rows.

[0190] FIG. 39B is a cross-sectional view of the anvil assembly 1101 shown in FIG. 39A along section GG. As shown, each of the pocket rows can include variable pocket depths that can result in different staple formations in addition to having variable sizing and positioning relative to the other pocket rows. For example, a first pocket 1125 from the fourth pocket row 1159 can have a first depth 1165. A second pocket 1127 from the fifth pocket row 1161 can have a second pocket depth 1166. A third pocket 1129 from the sixth pocket row 1163 can have a third pocket depth 167. In the illustrated embodiment, the depth of the first pocket 1125 is less than the depth of the second pocket 1127, which is less than the depth of the third pocket 1129. Varying pocket depths by row can be advantageous because it can allow tissue further from the knife channel 1138 to expand more than tissue closer to the knife channel 1138 when the procedure is completed. However, it should be understood that any pocket depth and relationship between pocket rows is contemplated.

[0191] 39C is a cross-sectional view of the anvil assembly 1101 shown in FIG. 35 at section HH, according to one embodiment. As shown, the depth of the pockets associated with each row can also vary along the length of the anvil assembly 1101. As shown, the fourth pocket 1131 from the fourth pocket row 1159 has a fourth pocket depth 1177, the fifth pocket 1133 from the fifth pocket row 1161 has a fifth pocket depth 1178, and the sixth pocket 1135 from the sixth pocket row 1163 has a sixth pocket depth 1179. In the illustrated embodiment, the depth of the fourth pocket 1131 is less than the depth of the fifth pocket 1133, which is less than the depth of the sixth pocket 1135. Also, as shown, the fourth pocket 1131 is shallower than the first pocket 1125, the fifth pocket 1133 is shallower than the second pocket 1127, and the sixth pocket 1135 is shallower than the third pocket 1129. A single staple row can include any desired pocket depth to form staples of any suitable shape or size. The pocket size can vary from a larger size at the proximal end of the anvil assembly 1101 to a smaller size at the distal end of the anvil assembly 1101, or vice versa. It will be appreciated that different sizes of staples can be used according to the various pocket depths and pocket rows to create the desired tissue effect.

[0192] It may be advantageous to provide a stapling device having an anvil assembly 1101 that can accommodate a broad sample of the human population. In one illustrative embodiment, the depth of the second row of pockets 1117 and the fifth row of pockets 1161 can have a depth that corresponds to a derived median stomach thickness of the human population. The first row of pockets 1115 and the fourth row of pockets 1159 can have a shallower depth that can correspond to a 25th percentile of stomach thickness of the human population. The third row of pockets 1119 and the sixth row of pockets 1163 can have a depth that can correspond to a 75th percentile of stomach thickness of the human population. In this manner, by varying the pocket depth to provide a range of staple heights within a row, cartridge selection issues can be eliminated, resulting in a universally applicable cartridge. By varying the pocket depth along the length or width of the staple line, variations within the human population can be accommodated. It will be appreciated that such an embodiment can be combined with any suitable cartridge having staples of any suitable size and shape and staple drivers of any suitable shape and size.

[0193] FIG. 40 illustrates a side cross-sectional view of the end effector 1121, shown in an open position. In FIG. 40, a row 1180 of staple pockets 1134 is shown in a cross-sectional view extending from a proximal-most staple pocket 1182 to a distal-most staple pocket 1183. The depth of the staple pockets 1134 may vary continuously in depth from the proximal-most staple pocket 1182, i.e., the deepest pocket, to the distal-most staple pocket 1183, i.e., the shallowest pocket. As previously disclosed, the depth may vary continuously along the length of the staple row, or may vary discretely at one or more points along the length of the anvil assembly 1101. It is contemplated that the depth of the staple pockets 1134 may vary only along the length of the anvil assembly 1101, only axially across the width of the anvil assembly 1101, or along both the length and width of the anvil assembly 1101. It is further contemplated that the pocket depth variation along a row closer to the knife channel 1138 may vary at a different scale or rate than another row positioned farther from the knife channel 1138.

[0194] FIG. 41 is an axial cross-sectional view of an anvil assembly 1201 having an anvil plate 1212, according to one embodiment. The anvil plate 1212 can include a plurality of anvil pockets 1234 having any suitable shape. For example, the anvil plate 1212 can define a frusto-conical cavity in each of the anvil pockets 1234, as shown, or the anvil pockets can have any shape, such as curved, bowl-shaped, etc. FIGS. 42A-C show examples of formed staples 1332 that can be formed by an anvil plate 1312 having pockets 1334 with different depths.

[0195] 43A-46, the stapling device can be configured to provide asymmetric staples to achieve a desired tissue effect. With reference to FIGS. 43A and 43B, the anvil plate 1412 can include a first pocket 1466 having a first shape and a second pocket 1488 having a second shape. As shown in FIG. 43C, the first pocket can include a first cavity 1423 for receiving a first tip 1426 (see, e.g., FIG. 44) of the staple 1332 and a second cavity 1424 for receiving a second tip 1427 of the staple, where the first cavity 1423 has a different geometry than the second cavity 1424. The first cavity 1423 can have a first depth 1478 and the second cavity 1424 can have a second depth 1481, where the first depth 1478 can be shallower than the second depth 1481. As shown in Fig. 44, the formed staples 1432 can be asymmetrical, which may be advantageous to provide uniform compression or to maintain staple line integrity. Pockets having any suitable cavity with any suitable geometry, angle, or sizing are contemplated.

[0196] 45 and 46, by varying the geometry of the pocket, staples can be created that are two-dimensional along a single plane, or three-dimensional, where the formed staple legs lie in different planes. For example, along the length of the anvil, the pocket shape can create varying amounts of offset of the staple legs, creating a three-dimensional staple with varying offset along the axial direction. In another example, the pocket shape can create varying amounts of offset of one row versus another row of a multi-row endocutter. Three-dimensional staples provided along the edges of the tissue being cut can allow for better hemostasis due to a larger compression zone.

[0197] FIG 45 is a top view of a formed staple 1532 produced by an endocutter according to one embodiment. The formed staple 1532 is shown as a three-dimensional formed staple having a first formed staple leg 1537 offset at an angle 1531 from a staple base 1541, while a second formed staple leg 1539 is offset at an angle 1533 from the staple base 1541 in the other direction. These opposing angular offsets can create a three-dimensional staple with tissue compression characteristics that can be beneficial. FIG 46 is a perspective view of a formed staple 1632 produced by an endocutter according to one embodiment having a three-dimensional shape.

[0198] 47 is a perspective view of a surgical stapling instrument 1725 according to one embodiment having a circular anvil assembly 1760. The surgical stapling instrument 1725 is shown as another type of stapling instrument that may advantageously utilize the embodiments described herein. Other instruments that may advantageously utilize the embodiments described herein include linear staplers, linear cutters, endocutters or other surgical stapling and cutting instruments.

[0199] The anvil assembly 1760 can include a first circular anvil pocket row and a second circular anvil pocket row. In a circular stapler, there are typically concentric staple lines. It can be advantageous to provide an innermost circular row with a staple pocket depth that is shallower or deeper than the pocket depth for the outer circular staple rows. It can also be useful to provide various pocket depths within a row as a function of position within the row. When there are more than one staple row in a circular configuration, it can be further useful to provide staples made from different materials in the inner row versus the outer rows.

[0200] The surgical stapling instrument 1725 can include a handle 1730 for grasping by a surgeon, a shaft 1735 extending distally from the handle 1730, and a distal staple end effector 1737 for end-to-end anastomosis of cylindrical tissue. A firing trigger 1732 can be pivotally connected to the handle 1730. The firing trigger 1732 is shown in an open position extending from the handle 1730 and can be movable to a closed position adjacent the handle 1730. The shaft 1735 can be slightly curved to anatomically position the staple end effector 1737 into difficult to reach lower anatomical locations. The staple end effector 1737 can have a fixed staple head assembly 1740 and an anvil assembly 1760 can be movably connected to the anvil closure knob 1731. Rotation of the anvil closure knob 1731 allows movement of the anvil assembly 1760 from a spaced position to a position adjacent to the staple head assembly.

[0201] The anvil assembly 1760 is separably connectable to the staple head assembly 1740 and can be easily removed from the surgical stapling instrument 1725 in the fully open position. The firing trigger 1732 can be movable from an open position to a closed position for stapling together and severing two sections of the colon or intestine within the staple end effector 1737. A safety latch 1733 is shown in a locked position for locking the firing trigger 1732 in the open position to prevent accidental firing.

[0202] Although illustrated with reference to an endocutter in the above figures, it is contemplated that the concepts presented herein may also be useful in other staplers, including, but not limited to, linear cutters, linear staplers, circular staplers, endocutters, or other instruments incorporating staples.

[0203] It is further contemplated to have different pocket shapes laterally in different rows, longitudinally in different segments, or both laterally and longitudinally. For example, by varying pocket shape and pocket depth to provide bow tie or rectangular shaped legs after forming the staples in the pockets, stronger staples that resist deformation can be provided at the side end locations. Both pocket depth and pocket shape can be varied as described herein, either individually or in combination.

[0204] The pocket depth may range, for example, from about 0.010 inches to 0.050 inches. In one embodiment, the inner row near the cut line may have a pocket depth of about 0.012 inches, the middle row may have a pocket depth of about 0.022 inches, and the outer row may have a pocket depth of about 0.032 inches. In another embodiment where the pocket depth varies along the length of the staple line, the pocket depth may vary, for example, from 0.012 inches at the shallowest pocket depth to 0.052 inches at the deepest pocket depth. Useful pocket depths may range, for example, from about 0.010 inches to 0.060 inches.

[0205] Any suitable staples having any suitable material may be used. The material composition of the staples may vary as a function of location, as described herein. By using an alloy with a higher concentration of vanadium and aluminum, each staple may be made more resistant to deformation and may increase spring back, and this material may be used in the outermost row to provide the tallest staples with the greatest mechanical strength, for example, to allow for improved blood flow to the tissue. For example, using pure titanium in the innermost row may allow for a minimal amount of spring back, which may be better for hemostasis.

[0206] In one embodiment, an alloy of titanium having 6% vanadium and 4% aluminum can be used for the outer rows of staples, an alloy of titanium having 4% vanadium and 2.5% aluminum can be used for the middle row of staples, and pure titanium can be used for the inner row of staples to vary the springback of each row and improve staple line results. As described herein, varying one or more of the staple anvil pocket depth, pocket staples, or staple composition as a function of lateral or longitudinal position can allow for improved results when using a surgical stapler.

[0207] In one embodiment, a rectangular, deeper pocket shape can be provided at the side locations (furthest from the cutting edge) using a stronger material to create a hyperplastic staple with a tight bend radius. An offset pocket shape with a shallower pocket using weaker staple material can be used adjacent the cutting edge to improve hemostasis. In a six row stapler, the middle row can use a combination of the side and cutting edge rows to blend such properties.

[0208] In the various embodiments disclosed herein, a single component may be replaced with multiple components and multiple components may be replaced with a single component to perform a given function or functions. Such substitutions are within the intended scope of the embodiments, except where such substitutions would be inoperative. For example, staple leg heights, staple manufacturing materials, anvil pocket depths, anvil pocket shapes, and anvil pocket asymmetries may all be altered in any combination.

[0209] The above description of the embodiments and examples has been presented for purposes of illustration and description. It is not intended to be exhaustive or to be limited to the forms described. Many variations are possible in light of the above teachings. Some of these variations have been discussed, and others will be appreciated by those skilled in the art. The embodiments were chosen and described in order to best illustrate the principles of the various embodiments as suited to the particular applications contemplated. The scope is of course not limited to the examples described herein, but may be utilized by those skilled in the art in any number of applications and equivalent devices. Rather, it is intended herein that the scope of the invention be defined by the appended claims.

Claims

1. 1. An end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, the anatomical structure having a first side and a second side, the end effector comprising: (a) an anvil having a first end, a second end, a longitudinal axis, and an anvil face, the anvil face positionable on the first side of the anatomical structure, the first end of the anvil being a distal end of the anvil and the second end of the anvil being a proximal end of the anvil; (b) a cartridge having a first end, a second end, a longitudinal axis, and a cartridge face, the cartridge housing a plurality of staples, the cartridge face positionable on the second side of the anatomical structure; (c) first coupling means for coupling the first end of the anvil to the first end of the cartridge pivotably about a direction perpendicular to the longitudinal axis of the anvil and the longitudinal axis of the cartridge such that the second end of the anvil is spaced from the second end of the cartridge and the second end of the anvil is coupled to the second end of the cartridge; and (d) a second coupling means including a rigid connection having a first end coupled to the second end of the anvil and a second end coupled to the second end of the cartridge; (e) a code; and (f) a buttress, (i) a first buttress member coupled to the anvil face such that the first buttress member covers a portion of the anvil face; and (ii) a second buttress member coupled to the cartridge face such that the second buttress member covers a portion of the cartridge face; at least one of the first buttress member or the second buttress member includes a plurality of loops, each of the plurality of loops defining a channel sized to receive the cord; Equipped with at least one of the anvil or the cartridge includes a plurality of cord supports, the cords being threaded through the plurality of loops distally along a first side and a second side of the end effector, attaching the first buttress member or the second buttress member to the plurality of cord supports, and wherein the cords do not extend between the cartridge face and the anvil face when the end effector is in a closed position where the second end of the anvil is coupled to the second end of the cartridge.

2. The end effector of claim 1 , wherein the first buttress member includes an adhesive for attachment to the anvil face and the second buttress member includes an adhesive for attachment to the cartridge face.

3. The end effector of claim 1 , wherein each of the plurality of staples is configured to be operable to pierce the first and second buttress members.

4. The end effector of claim 1 , wherein the first and second buttress members are formed from a bioabsorbable material.

5. The end effector of claim 1 , wherein the anvil comprises the plurality of cord supports spaced along a length of the anvil.

6. The end effector of claim 5 , wherein the first buttress member includes a first portion of the plurality of loops and the second buttress member includes a second portion of the plurality of loops.

7. 7. The end effector of claim 6, wherein the cord is threaded through the first portion of the plurality of loops of the first buttress member and the second portion of the plurality of loops of the second buttress member to retain the first buttress member adjacent the anvil face and the second buttress member adjacent the cartridge face.

8. The end effector of claim 7 , wherein the first buttress member and the second buttress member have a planar configuration.

9. 2. The end effector of claim 1, further comprising a blade having a cutting surface that is transitioned from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to sever the first and second buttress members.

10. 1. An end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, comprising: (a) an anvil having a first end, a second end, and an anvil face, the first end of the anvil being a distal end of the anvil and the second end of the anvil being a proximal end of the anvil; (b) a cartridge having a first end, a second end, and a cartridge face, the cartridge housing a plurality of staples; (c) first coupling means for coupling the first end of the anvil to the first end of the cartridge pivotably about a direction perpendicular to the longitudinal axis of the anvil and the longitudinal axis of the cartridge such that the second end of the anvil is spaced from the second end of the cartridge and the second end of the anvil is coupled to the second end of the cartridge; and (d) a second coupling means including a rigid connection having a first end coupled to the second end of the anvil and a second end coupled to the second end of the cartridge; (e) a code; and (f) a buttress, (i) a first buttress member coupled to the anvil face such that the first buttress member covers a portion of the anvil face; and (ii) a second buttress member coupled to the cartridge face such that the second buttress member covers a portion of the cartridge face; at least one of the first buttress member or the second buttress member includes a plurality of loops, each of the plurality of loops defining a channel sized to receive the cord; Equipped with at least one of the anvil or the cartridge includes a plurality of cord supports, the cords being threaded through the plurality of loops distally along a first side and a second side of the end effector, attaching the first buttress member or the second buttress member to the plurality of cord supports, and wherein the cords do not extend between the cartridge face and the anvil face when the end effector is in a closed position where the second end of the anvil is coupled to the second end of the cartridge.

11. The end effector of claim 10 , further comprising a blade having a cutting surface configured to cut through the first and second buttress members.

12. 12. The end effector of claim 11, wherein the blade is transitioned from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to sever the first and second buttress members.

13. The end effector of claim 10 , wherein the first buttress member includes an adhesive for attachment to the anvil face and the second buttress member includes an adhesive for attachment to the cartridge face.

14. The end effector of claim 10, wherein each of the plurality of staples is configured to be operable to pierce the first and second buttress members.

15. The end effector of claim 10 , wherein the first and second buttress members are formed from a bioabsorbable material.

16. The end effector of claim 10 , wherein the anvil comprises the plurality of cord supports spaced along a length of the anvil.

17. The end effector of claim 16, wherein the first buttress member includes a first portion of the plurality of loops and the second buttress member includes a second portion of the plurality of loops.

18. 18. The end effector of claim 17, wherein the cord is threaded through the first portion of the plurality of loops of the first buttress member and the second portion of the plurality of loops of the second buttress member to retain the first buttress member adjacent the anvil face or the second buttress member adjacent the cartridge face.

19. 1. An end effector for use by a surgeon to staple an anatomical structure of a patient during a minimally invasive procedure, comprising: (a) an anvil including a first end, a second end, and an anvil face positionable on a first side of the anatomical structure, the first end of the anvil being a distal end of the anvil and the second end of the anvil being a proximal end of the anvil; (b) a cartridge containing a plurality of staples, the cartridge having a first end, a second end, and a cartridge face positionable on a second side of the anatomical structure; (c) first coupling means for coupling the first end of the cartridge to the first end of the anvil pivotably about a direction perpendicular to the longitudinal axis of the anvil and the longitudinal axis of the cartridge such that the second end of the cartridge is spaced from the second end of the anvil and the second end of the cartridge is coupled to the second end of the anvil; and (d) a second coupling means including a rigid connection having a first end coupled to the second end of the cartridge and a second end coupled to the second end of the anvil; (e) a blade having a cutting surface, the blade engageable with the anvil and the cartridge; (f) a code; and (g) a buttress, a flat section of material coupled to the anvil face or the cartridge face, the buttress including a plurality of loops, each of the plurality of loops defining a channel sized to receive the cord; and Equipped with At least one of the anvil or the cartridge includes a plurality of cord supports, the cords being threaded through the plurality of loops distally along a first side and a second side of the end effector, attaching the buttress to the plurality of cord supports, and wherein when the end effector is in a closed position in which the second end of the anvil is coupled to the second end of the cartridge, the cords do not extend between the cartridge face and the anvil face.

20. 20. The end effector of claim 19, wherein the blade is transitioned from a first position at a distal end of the end effector to a second position at a proximal end of the end effector to cut the buttress.

21. The end effector of claim 19 , wherein the buttress includes an adhesive for attachment to the anvil face or the cartridge face.

22. The end effector of claim 19, wherein each of the plurality of staples is configured to be operable to pierce the buttress.

23. The end effector of claim 19 , wherein the buttress is formed from a bioabsorbable material.

24. The end effector of claim 19, wherein the anvil comprises the plurality of cord supports spaced along a length of the anvil.

25. 20. The end effector of claim 19, wherein the cord is threaded through the plurality of loops of the buttress to hold the buttress adjacent the anvil face or the cartridge face.

26. An end effector, (a) an anvil having a first end, a second end, an anvil face, and a first channel, the first end of the anvil being a distal end of the anvil and the second end of the anvil being a proximal end of the anvil; (b) a cartridge having a first end, a second end, a cartridge face, and a second channel; (c) first coupling means for coupling the first end of the anvil to the first end of the cartridge pivotably about a direction perpendicular to a longitudinal axis of the anvil and a longitudinal axis of the cartridge such that the second end of the anvil is spaced from the second end of the cartridge and the second end of the anvil is coupled to the second end of the cartridge; and (d) a second coupling means including a rigid connection having a first end coupled to the second end of the anvil and a second end coupled to the second end of the cartridge; (e) an I-blade, (i) a blade portion having a cutting edge; (ii) at least one upper portion slidably positioned in the first channel; and (iii) at least one lower portion slidably positioned in the second channel; an I-shaped blade comprising: (f) a code; and (g) a buttress, a flat section of material coupled to the anvil face or the cartridge face, the buttress including a plurality of loops, each of the plurality of loops defining a channel sized to receive the cord; and Equipped with At least one of the anvil or the cartridge includes a plurality of cord supports, the cords being threaded through the plurality of loops distally along a first side and a second side of the end effector, attaching the buttress to the plurality of cord supports, and wherein when the end effector is in a closed position in which the second end of the anvil is coupled to the second end of the cartridge, the cords do not extend between the cartridge face and the anvil face.

27. 2. The end effector of claim 1, wherein each of the plurality of loops has a central axis parallel to a longitudinal axis of the first or second buttress member, the plurality of loops and the plurality of cord supports being positioned in alternating fashion along the cord when the cord is threaded through the plurality of loops.

28. The end effector of claim 1 , wherein the cord does not extend beyond the cartridge face or the anvil face.

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