US20120061446A1 - Method for Treating Tissue With an Articulated Surgical Instrument - Google Patents

Abstract

One example of a surgical method of treating tissue within the body of a patient may include providing a surgical instrument that includes a handle; a shaft extending from the handle, an end effector connected to the shaft, where the shaft includes a lumen defined therethrough and an articulated region; and at least one feeder belt extending through the lumen of the shaft into the end effector, where the feeder belt includes at least one staple frangibly united therewith; inserting the end effector into the body of a patient; orienting the end effector relative to tissue to be treated within the body of the patient and relative to a remainder of the shaft; actuating the end effector to staple tissue; and removing the end effector from the body of the patient.

Description

• This application is a divisional of U.S. patent application Ser. No. 12/400,760, filed on Mar. 9, 2009, which is herein incorporated by reference in its entirety.
FIELD OF THE INVENTION
• The invention generally relates to an articulated surgical instrument, and more specifically to an instrument that may be used to articulate a surgical stapler or endocutter.
BACKGROUND
• Minimally invasive surgery is performed through small incisions in the body, into which trocar ports may or may not be placed. One or more surgical instruments are inserted through each incision in order to perform the surgical procedure. In order to effectuate one of the objectives of minimally invasive surgery, which is the minimization of incisions to the body to reduce healing time and scarring, it is desirable to minimize the number of incisions made in the body. The number of incisions and their placement are determined by the particular surgical procedure to be performed and the configuration of the instruments used to carry out that procedure.
• One problem encountering during the performance of a minimally invasive surgical procedure is access to the tissue to be treated. Depending on the specific anatomy of the patient, it may be difficult to reach an area to be treated with a specific surgical instrument. As a result, one or more additional incisions may need to be made in the patient in order to access that tissue. Or, the surgeon may need to obtain a different surgical instrument, adding to the time and expense of the procedure. Additionally, where more incisions may be made or additional instruments may be utilized, it can be difficult and/or time-consuming for the surgeon to find the surgical site again.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 is a perspective view of a an exemplary surgical instrument.
• FIG. 2 is a detail perspective view of an exemplary articulated region on a shaft of the surgical instrument ofFIG. 1.
• FIG. 3 is a detail perspective view of a second exemplary articulated region on a shaft of the surgical instrument ofFIG. 1.
• FIG. 4 is a side cutaway view of a handle of the surgical instrument ofFIG. 1.
• FIG. 5 is a detail side cutaway view of the distal end of the handle of the surgical instrument ofFIG. 1.
• FIG. 6 is a top cross-section view of a handle of the surgical instrument ofFIG. 1.
• FIG. 7 is a detail cutaway view of a portion of the proximal end of the handle of the surgical instrument ofFIG. 1.
• FIG. 8 is a top cross-section view of the proximal end of the handle of the surgical instrument ofFIG. 1.
• FIG. 9 is a side cutaway view of the proximal end of the handle of the surgical instrument ofFIG. 1.
• FIG. 10 is a perspective view of an exemplary end effector of the surgical instrument ofFIG. 1.
• FIG. 11 is a perspective view of an exemplary feeder belt with two rows of staples frangibly connected thereto.
• The use of the same reference symbols in different figures indicates similar or identical items.
DETAILED DESCRIPTION
• U.S. patent application Ser. No. 11/851,379, filed Sep. 6, 2007; U.S. patent application Ser. No. 11/956,988, filed Dec. 14, 2007; and U.S. patent application Ser. No. 12/263,171, filed Oct. 31, 2008 (the “Endocutter Applications”) are hereby incorporated by reference herein in their entirety. Those documents, and any and all other documents incorporated by reference in this specification, are as much as a part of the specification as if the text were repeated in the application.
• Surgical Instrument
• Referring toFIG. 1, asurgical instrument1 includes ahandle2 attached to ashaft4, which in turn is attached to anend effector6. Thesurgical instrument1 may be an endocutter, a linear cutter, a stapler, or any other suitable surgical instrument. Theend effector6 may be one or more separate components that are connected to theshaft4, or may be fabricated integrally with the distal end of theshaft4. As discussed in greater detail below, theend effector6 may be fixed to theshaft4, or may be separable from theshaft4 such that afresh end effector6 may be attached to theshaft4 after one or more actuations of the surgical instrument. Theend effector6 and at least the distal end of theshaft4 may be sized to pass through an incision or through a standard trocar port that may be placed in the patient. Advantageously, theend effector6 may be sized to pass through a trocar port, having an opening between 5-10 millimeters in diameter. Alternately, thesurgical instrument1 may be used in the course of conventional open surgery, where a trocar port is not used. Theend effector6 may include astaple holder8 connected to ananvil10, and may be movable between an open configuration and a closed configuration. In the closed configuration, tissue may be clamped between thestaple holder8 and theanvil10. Alternately, theend effector6 may omit theanvil10. Alternately, theend effector6 need not include astaple holder8 oranvil10, and theend effector6 may instead be a different surgical instrument, such as but not limited to a bipolar cutter, a biopsy device, a grasper, or a stabilizer.
• Theshaft4 advantageously has a tubular shape with a lumen defined therein. Optionally, theshaft4 may include a cutaway, trough or other feature (not shown) to allow a guidewire (if any) or other positioning aid that may be used in the surgical procedure to remain in place during actuation of thesurgical instrument1. Theshaft4 may be flexible or rigid, in whole or in part. Theshaft4 may be articulated in at least one location, if desired. Referring toFIG. 2, as one example, theshaft4 may be generally rigid, with the exception of a flexible articulatedregion12 that connects two generally-rigid segments of theshaft4. A plurality ofslots14 may be located in theshaft4 in the articulatedregion12. Theslots14 may extend completely through the wall of theshaft4 from the outer surface of the shaft to the lumen in theshaft4. Theslots14 may be arranged in any suitable manner. As one example, eachslot14 may extend along greater than 180 degrees of circumference of theshaft4, between twovertices15. Proceeding proximally along theshaft4, at least twoslots14 may be generally arranged in an alternating manner. That is, oneslot14 may open generally in one direction away from the longitudinal centerline of theshaft4, and theslot14 proximal to that may open generally in the opposite direction away from the longitudinal centerline of theshaft4. To accomplish this, thevertices15 of a slot opening (for example) laterally to the left may be located laterally to the right of the vertices of a longitudinally adjacent slot opening laterally to the right. As a result, where at least twoslots14 extend along greater than 180 degrees of circumference of theshaft4, no line on the surface of theshaft4 that is parallel to the longitudinal centerline of theshaft4 can extend completely through the articulatingregion12 without encountering aslot14. Put another way, every line on the surface of theshaft4 that is parallel to the longitudinal centerline of theshaft4 crosses at leastslot14. Theslots14 may be oriented and arranged relative to one another to provide for lateral articulation of theshaft4. That is, theslots14 may be oriented and arranged such that the portion of theshaft4 distal to the articulatingregion12 is rotatable in a single plane, laterally left and right. Alternately, theslots14 may be oriented and arranged such that the portion of theshaft4 distal to the articulatingregion12 is rotatable in a single plane in a direction other than laterally left and right. Alternately, theslots14 may be oriented and arranged such that the portion of theshaft4 distal to the articulatingregion12 is rotatable in more than a single plane.
• At least oneslot14 may be angled. That is, extending outward from avertex15 of theslot14, the walls of the slot may be angled relative to one another rather than parallel. Such an angle facilitates bending of the articulatedregion12. Advantageously, at least oneslot14 has an angle of substantially two degrees between its walls. However, the angle may be different, or the walls may instead be substantially parallel to one another. The width and angle of eachslot14 may be selected to affect the total amount of travel of the articulating section. Advantageously, the articulatingsection12 is bendable such that the portion of theshaft4 distal to the articulatingsection12 is movable through substantially ninety degrees relative to the portion of theshaft4 proximal to the articulating section, where 45 degrees of such movement is on either side of the longitudinal centerline of theshaft4. Alternately, the articulatingsection12 may be configured to allow a different amount of movement, either greater than or less than ninety degrees. Alternately, the articulatingsection12 may be configured to allow movement in more than one plane, in either the same or different amounts in either plane. Alternately, the articulatingsection12 may be configured to allow asymmetrical articulation, wherein the distal end of theshaft4 distal to the articulating section may be movable through a first angle on one side of the longitudinal centerline of theshaft4 that is greater than a second angle on the other side of the longitudinal centerline of theshaft4.
• Referring toFIG. 3, another example of an articulatingregion12 is shown. Theslots14 may be configured similarly to those described above with regard toFIG. 2. However, at least one of theslots14 may extend along less than 180 degrees of circumference of theshaft4. If all of theslots14 do so, then theslots14 may be arranged such that a line on the surface of theshaft4 that is parallel to the longitudinal centerline of theshaft4 can extend completely through the articulatingregion12 without encountering aslot14. One ormore slots14 may be connected to alongitudinal aperture17 at avertex15 thereof, such that theslot14 may have a T-shaped appearance if viewed from above. The presence of thelongitudinal aperture17, and its length, provide for greater flexibility of the articulatedregion12. The longer thelongitudinal apertures17, the more flexible the articulatedregion12.
• Thehandle2 may be attached to the proximal end of theshaft4, or any other suitable portion of theshaft4. Theshaft4 may be fabricated integrally with thehandle2. Alternately, theshaft4 and thehandle2 may be two separate items that are connected together in any suitable manner. Thehandle2 may include any mechanism, mechanisms, structure or structures that are suitably configured to actuate theend effector6. Thehandle2 may also include a source of stored energy for actuating theend effector6. The source of stored energy may be mechanical (such as a spring), electrical (such as a battery), pneumatic (such as a cylinder of pressurized gas) or any other suitable source of stored energy. The source of stored energy, its regulation, and its use in actuating theend effector6 may be as described in the U.S. patent application Ser. No. 11/054,265, filed on Feb. 9, 2005, which is herein incorporated by reference in its entirety. Thehandle2 may instead, or also, include a connector or connectors suitable for receiving stored energy from an external source, such as a hose connected to a hospital utility source of pressurized gas or of vacuum, or an electrical cord connectable to a power source.
• Referring also toFIGS. 4 and 8, acable64 extends through the lumen of theshaft4 proximally into thehousing20 of thehandle2. Thecable64 wraps around anrotary articulator62 and then extends distally back out of thehousing20 into the lumen of theshaft4. Therotary articulator62 may be spherical, partially spherical, spheroidal, cylindrical, or may have any other suitable shape. Thecable64 may be fixed to therotary articulator62, such as by acylinder66, tab, or other wider structure that is fixed to thecable64. Thecylinder66 is held by a corresponding detent in therotary articulator62, such as in its proximal end. Thecylinder66 may be fixed to therotary articulator62, such as by welding, adhesive, crimping, pressure fitting, or any other or additional structure, mechanism or method. Alternately, thecable64 may be fixed directly to therotary articulator62, such as by welding, adhesive, crimping, pressure fitting, or any other or additional structure, mechanism or method. Thecable64 may be wrapped around therotary articulator62 once, or more than once. Advantageously, thecable64 is wrapped around the proximal end of therotary articulator62 such that thecable64 is routed proximally from theshaft4 along one side of therotary articulator62, around the proximal end of therotary articulator62, then distally along the other side of therotary articulator62 to theshaft4. Referring also toFIG. 6, thecable64 is routed through thehandle2 such that it is capable of moving substantially freely. Theclamp controller32 may include two ormore ramps112 or apertures that receive thecable64 and allow thecable64 to smoothly enter the lumen of theshaft4. Theclamp controller32 may also include atunnel114 or opening extending longitudinally therethrough to allow theactuation cable110 to extend therethrough into the lumen of theshaft4.
• Referring also toFIG. 10, the proximal end of theend effector6 may include abulkhead90 in which one ormore apertures94 are defined. Advantageously, both ends of thecable64 extend throughseparate apertures94, where thoseapertures94 are laterally spaced apart from one another. Advantageously, those twoapertures94 through which thecable64 extends and the longitudinal centerline of theshaft4 are aligned along a straight line. Distal to thebulkhead90, the ends of thecable64 may be knotted, fixed to structures wider than the diameter of theaperture94, or otherwise secured distal to thebulkhead90. Thecable64 may be under tension when the ends of thecable64 are secured relative to thebulkhead90. Alternately, one or more of theapertures94 may be omitted, and at least one end of thecable64 is fixed directly to the bulkhead, such as by welding, adhesive, crimping, pressure fitting, or any other or additional structure, mechanism or method. Alternately, thebulkhead90 may be fixed to theshaft4, rather than theend effector6. Alternately, thebulkhead90 may be any rigid structure substantially fixed relative to the distal end of theshaft4.
• Therotary articulator62 may be held in acradle72 within the housing of thehandle2. Thecradle72 holds therotary articulator62 in a substantially fixed longitudinal position within thehandle2. The proximal end of thecradle72 may be shaped substantially the same as the proximal surface of therotary articulator62, such that therotary articulator62 can rotate smoothly in thecradle72. One ormore pins100, lips or tabs may extend inward from the distal end of thecradle72 to retain therotary articulator62 within thecradle72 while still allowing therotary articulator62 to rotate. Alternately, thecradle72 is not used, and thehousing20 or other component of thehandle2 holds therotary articulator62 in a substantially fixed longitudinal position within thehandle2. Referring also toFIG. 9, at least oneaxle68 may extend from thecradle72 into acorresponding slot70 defined in therotary articulator62. The axle oraxles68 define an axis about which therotary articulator62 is rotatable. Alternately, theaxles68 are not utilized, and therotary articulator62 is otherwise constrained to rotate about one or more axes.
• Referring also toFIG. 9, anarticulation control60 may be connected to therotary articulator62, and extend through anopening74 in thehousing20 as well as anopening88 in the proximal end of thecradle72. Thearticulation control60 may be fixed to therotary articulator62, and may be connected to it in any suitable manner, such as by fasteners, adhesive, welding, or any other suitable structure, mechanism or method. Thearticulation control60 is configured such that motion of thearticulation control60 from side to side causes rotation of therotary articulator62 about an axis, such as defined by one or more of theaxles68. Atube81 may extend from thearticulation control60 toward the rotary articulator, and apin80 may be positioned partially in the lumen of and extending proximally from thattube81. Thepin80 may be slidable within the lumen of thetube81. Aclip82 is fixed to thepin80, and extends distally into thetube81. Theclip82 may includes twolegs84 biased outward relative to the longitudinal centerline of thetube81. Thelegs84 may be generally symmetrical and generally thin and planar, or may be otherwise configured. Thelegs84 may be spaced apart from one another.
• Theopening88 in the proximal end of thecradle72 may have a plurality ofteeth86 defined along its upper and/or lower edges. Theclip82 is configured to slide betweenadjacent teeth86 when thepin80 moves distally. Thepin80 may be biased distally, or may be configured to remain placed where the user sets it. When thepin80 is moved proximally, thelegs84 are positioned proximal to the proximal edges of theteeth86, such that thearticulation control60 may be rotated left or right in order to rotate therotary articulator62. Theclip82 optionally may be shaped such that when thepin80 is moved proximally, the outer edges of thelegs84 encounter the distal end of thetube81 and are colleted down by that contact. Such motion may facilitate free motion of therotary articulator62. When thepin80 is moved distally, it enters a space between twoteeth86, thereby preventing rotation of therotary articulator62 and fixing therotary articulator62 in place. Theteeth86 may be angled such that if aleg84 encounter a space betweenteeth86 while moving distally, theleg84 is directed to the left or right into the space betweenadjacent teeth86. The spacing between theteeth86 defines the number of discrete positions at which therotary articulator62 can be selectively fixed. Alternately, theteeth86 may be omitted, and any other suitable mechanism may be used to selectively fix therotary articulator62, either in one of a number of discrete positions, or along an infinitely variable continuum.
• As therotary articulator62 is rotated about the axle oraxles68, thecable64 transmits that rotation to theend effector6, as described in greater detail below. Therotary articulator62 may provide for articulation about one axis. Optionally, arototube50 may provide for rotation about a second axis. Alternately, therotary articulator62 is not used, and therototube50 provides rotation about its axis. Where therototube50 is utilized, thecradle72 may be fixed to the proximal end of therototube50. Thecradle72 may include one or morelateral protrusions102 that is held between tworidges104 defined in the inner surface of thehousing20 of thehandle2. Theridges104 may be generally parallel to one another, and each in a plane generally perpendicular to the longitudinal centerline of therototube50. In this way, thecradle72 is able to rotate about the longitudinal axis of therototube50, along with a remainder of therototube50, while remaining at substantially the same longitudinal position relative to thehandle2. Referring also toFIG. 6, the distal end of the rototube necks down to connect to the proximal end of theshaft4. Theshaft4 is configured to be held by thehandle2 in such a manner that theshaft4 is rotatable relative to the handle. Theaperture106 at the distal end of thehandle2 supports theshaft4, but is not fixed to theshaft4, such that theshaft4 is rotatable within theaperture106. By rotating therototube50 about its longitudinal axis, another axis of rotation is provided for theend effector6 in addition to the axis of rotation provided by therotary articulator62. Therototube50 may be actuated to rotate about its longitudinal axis in any suitable manner. As one example, after therotary articulator62 is locked in place as described above, thearticulation control60 may be rotated about its axis, thereby rotating therototube50 about its longitudinal axis as well. As another example, thearticulation control60 may be actuated to rotate therototube50 prior to locking therotary articulator62 in place. As another example, thearticulation control60 may be free to both rotate therototube50 and therotary articulator62 at the same time.
• Referring toFIGS. 4-5, thehandle2 may include a clampingtrigger22 for actuating theend effector6 to move to a clamped position or state, and anactuating trigger40 for actuating theend effector6 to deploy staples and/or otherwise actuate theend effector6. Where theend effector6 is not configured to clamp tissue, the clampingtrigger22 may be omitted. The clampingtrigger22 may be configured in any suitable manner that allows it to actuate theend effector6 to a clamped position or state. As one example, an aperture may be defined through thehousing20 such that the distal end of the clampingtrigger22 enters thehousing20. A clampingaxle30 may be defined in thehousing20 and extend inward from the inner surface of thehousing20, and the clampingtrigger22 may be configured to rotate about that clampingaxle30. The clampingtrigger22 may have apivot26 defined therein, where thatpivot26 is oriented substantially perpendicular to the longitudinal centerline of the proximal end of theshaft4. Alinkage24 is rotatably connected to thepivot26 at or near one end, and the other end of thelinkage24 is positioned in anotch34 in aclamp controller32. Theclamp controller32 may be generally cylindrical, and thenotch34 defined therein may extend around part or all of the circumference of theclamp controller32. Thenotch34 may be oriented substantially perpendicular to the longitudinal centerline of the proximal end of theshaft4. As the free end of the clampingtrigger22 is depressed, and the clampingtrigger22 rotates about the clampingaxle30, theproximal end28 of thelinkage24 moves proximally, urging theclamp controller32 proximally to actuate theend effector6 to clamp, as described in greater detail below.
• Theactuating trigger40 may be configured in any suitable manner that allows it to actuate theend effector6 to deploy staples and/or otherwise actuate theend effector6. Atrigger axle42 may be defined in thehousing20 and extend inward from the inner surface of thehousing20, and theactuating trigger40 may be configured to rotate about thattrigger axle42. Thetrigger40 is advantageously oriented to be compressed by hand by the user. The upper surface of thetrigger40 may include one ormore teeth44 defined therein. Alternately, theteeth44 may be defined in a different part of thetrigger40. Correspondingly, one ormore teeth48 may be defined in the lower surface of anactuation controller46, and configured to engage theteeth44 of thetrigger40. As thetrigger40 is depressed, thetrigger40 rotates about thetrigger axle42, such that the upper surface of thetrigger40 moves proximally. As that upper surface moves proximally, theteeth44 of thetrigger40 engage theteeth48 of theactuation controller46 and urge the actuation controller proximally to actuate theend effector6, as described in greater detail below. Therototube50 may include at least onecutout52 defined therein to allow therototube50 to rotate about its longitudinal axis without colliding with the upper end of thetrigger40.
• A portion of at least onefeeder belt120 may extend from theshaft4 into, or be positioned within, theend effector6. Where at least one feeder belt extends from theshaft4 through thebulkhead90 into theend effector6, each feeder belt may extend through the feederbelt access apertures96 in thebulkhead90. Thefeeder belt120 and its associated hardware may be as set forth in the Endocutter Applications and inFIG. 11. In the interest of brevity, thefeeder belt120 will not be described in detail herein. Eachfeeder belt120 may be a long, narrow, thin strip of material from which one ormore staples122 extend. At least onestaple122 may be frangibly connected to thefeeder belt120 at one end, with the other end of the staple being free. Onerow124 ofstaples122 may be located along each side of thefeeder belt120. Eachfeeder belt120 may be movable relative to theend effector6, as set forth in the Endocutter Applications, such that theend effector6 can be actuated multiple times without the need to exchange cartridges or remove theend effector6 from the patient between actuations. Theend effector6 may be configured generally as set forth in the Endocutter Applications, as one example, or may be configured differently.
• Theend effector6 optionally may include at least oneengagement feature92 defined therein, or thereon. Theengagement feature92 connects to a corresponding feature on theshaft4, such that theend effector6 can be removed from theshaft4, and anew end effector6 connected to theshaft4. That is, theend effector6 optionally may be interchangeable on theshaft4. In this way, theend effector6 can be removed for sterilization of a remainder of thesurgical instrument1, and/or theend effector6 can be reloaded during a surgical procedure with afresh end effector6 of the same type, or adifferent end effector6 of a different type. If so, the feeder belt optionally may not extend through thebulkhead90, such that theapertures96 need not be provided in thebulkhead90.
• Operation
• Theend effector6 of thesurgical instrument1 is introduced into the body of the patient, whether through a trocar port, a small incision for minimally invasive surgery, or a larger incision for conventional open surgery. At least part of theshaft4 may follow theend effector6 into the patient. Theend effector6 is positioned by the user at a surgical site. As one example, where theend effector6 is an endocutter such as described in the Endocutter Applications, a surgical site is located on a blood vessel which is to be transected. For clarity, this document describes the exemplary operation of thesurgical instrument1 for transection of a blood vessel. However, the use of thesurgical instrument1 is not limited to blood vessel transection; thesurgical instrument1 may be used to perform any other suitable procedure at any other surgical site in the body. For example, thesurgical instrument1 may be used to transect a bile duct, to remove a diseased appendix, to transect gastrointestinal tissue, and/or to transect soft tissue or organs. Alternately, theend effector6 may be used to treat a surface of the body, such that theend effector6 is not inserted into the patient.
• Theend effector6 may be inserted into the body of a patient through an opening, incision, trocar port or other aperture, in the open or closed position. Theend effector6 is then advanced to a site where tissue to be treated is located. An endoscope, inserted through the same or a different opening, incision, trocar port, or aperture may be used to guide theend effector6 into position, where theend effector6 is utilized for a minimally-invasive surgical procedure. Alternately, a camera (not shown) is attached to theend effector6 and/orshaft4 of thesurgical instrument1; a light source and any other necessary auxiliary hardware may be attached to theend effector6 and/orshaft4 as well. If so, the surgeon may visualize the surgical site solely utilizing thesurgical instrument1, thereby reducing the number of openings that are made in the patient and rendering the surgical procedure more minimally invasive.
• The surgeon advances theend effector6 into proximity to the surgical site. Theend effector6 fortuitously may be properly oriented relative to the surgical site at this time. If so, theend effector6 need not be articulated. If theend effector6 is not properly oriented relative to the surgical site, then theend effector6 may be articulated. The surgeon first may move thearticulation control60, such as with his or her thumb. Thepin80 is moved proximally, if it is not already in that position whether due to its affirmative motion proximally by the surgeon, or due to a force biasing thepin80 proximally. As a result, thearticulation control60, and consequently therotary articulator62, is free to rotate left and right about the axle oraxles68. Thecable64 is under tension, and is fixed to therotary articulator62 as described above. As the surgeon rotates thearticulation control60 to the left, for example, thecable64 exerts a force in the proximal direction on the right side of thebulkhead90 of theend effector6, at a point lateral to and spaced apart from the longitudinal centerline of theend effector6, such as at anaperture94 on the right side of thebulkhead90. As a result, this force exerts a torque about the yaw axis, causing theshaft4 to bend to the right due to bending in the articulatedregion12. As the only flexible region between thebulkhead90 of theend effector6 and thehandle2, bending is focused in and substantially restricted to the articulatedregion12. Because the articulatedregion12 is flexible, and because springs or other force transmission members are advantageously not used in articulating theshaft4 and/or returning theshaft4 to a neutral position, the surgeon need not overcome a substantial force in order to articulate theend effector6, and can move thearticulation control60 one-handed. The surgeon moves thearticulation control60 left or right until the desired orientation is reached, and then moves thepin80 distally. The surgeon may release thepin80, if it is biased distally, or may affirmatively move thepin80 distally. As thepin80 moves distally, thelegs84 of theclip82 move distally, and may move apart from one another as well. Eachleg84 enters a space betweenadjacent teeth86 defined in theopening88, or between atooth86 and a wall defining the leftmost or rightmost edge of theopening88. As thelegs84 enter those spaces, the orientation of theend effector6 may change slightly; the spaces betweenteeth86 define discrete positions, and theteeth86 are tapered to a point extending in the proximal direction to assist thelegs84 in sliding therebetween and slightly reorienting theend effector6 as a result. Therotary articulator62 is thus locked in place. If the surgeon is unhappy with the resulting orientation, or changes his or her mind, thepin80 may be retracted proximally, and thearticulation control60 may be moved again. Therotary articulator60 is then locked in place in the desired position, as set forth above.
• Next, if necessary, the surgeon may rotate therototube50 to orient theend effector6 more precisely. To do so, the surgeon may rotate thearticulation control60 about its longitudinal axis. With therotary articulator62 locked in place relative to thecradle72, and with thecradle72 being fixed to therototube50, the rotation of thearticulation control60 about its longitudinal axis causes rotation of therototube50. Alternately, therototube50 may be actuated by a separate control. As therototube50 rotates, the shaft4 (the proximal end of which is at least rotationally fixed to the distal end of the rototube50) rotates as well, about the longitudinal axis of the part of theshaft4 located proximal to the articulatedsection12 of theshaft4. Thearticulation control60 may then be locked into position in any suitable manner, to prevent further movement of theend effector6. Alternately, thearticulation control60 need not be locked further; for example, clamping of theend effector6 onto tissue at or in proximity to the surgical site may provide sufficient restriction of further motion of theend effector6.
• In this way, theend effector6 is articulable in two degrees of freedom, about the roll and yaw axes. Although articulation of theend effector6 has been described in a particular order, the surgeon could reverse the order, such that therototube50 is rotated first, then the articulation left or right about the yaw axis is performed. To do so, the surgeon may simply lock therotary articulator62 in a random position, rotate therototube50, then unlock therototube50 and articulate theend effector6 to cause bending of theshaft4 in the articulatedregion12. Alternately, the surgeon may articulate theend effector6 about both axes at the same time, if desired, then lock therotary articulator62 in place.
• Theend effector6 is now ready for actuation. Theend effector6 is in the open position as it is moved into position at the surgical site. Theend effector6 may be located in the desired position relative to the surgical site at the end of the articulation process. Alternately, theshaft4 may be advanced or moved after articulation to place the properly-orientedend effector6 at the surgical site. Where theend effector6 is used to perform transection of a blood vessel, theend effector6 is in the open configuration, and placed over the blood vessel to be transected until the blood vessel is located between thestaple holder8 and theanvil10 of theend effector6. Theend effector6 is then moved to the closed position. To do so, the clampingtrigger22 may be actuated. As the clampingtrigger22 is moved toward thehousing20 of thehandle2, thepivot26 of thetrigger22 moves toward thehousing20 as well, causing thelinkage24 to rotate about thepivot26 and move toward the housing, and causing the proximal end of thelinkage24 to move proximally. As set forth above, the proximal end of thelinkage24 resides at least partially within thenotch34 in theclamp controller32, and the proximal motion of the proximal end of thelinkage24 urges theclamp controller32 proximally. Theclamp controller32 may be connected to aclamp cable36, such that proximal motion of theclamp controller32 pulls theclamp cable36 proximally. Theclamp cable36 may extend into theend effector6 through anaperture94 in thebulkhead90 of theend effector6. Proximal motion of theclamp cable36, and/or tensioning of theclamp cable36, may move theend effector6 from the open position to the closed position, such as set forth in the Endocutter Applications.
• Theend effector6 then may be actuated. The surgeon may squeeze theactuating trigger40, which rotates about thetrigger axle42. As thetrigger40 rotates, theteeth44 of thetrigger40 engages theteeth48 of theactuation controller46. Thus, as the upper surface of thetrigger40 moves proximally, theteeth44 urge theteeth48, and thereby theactuation control46, proximally. Theactuation controller46 may be connected to anactuation cable110, such that proximal motion of theactuation controller46 pulls theactuation cable110 proximally. Theactuation cable110 may extend into theend effector6 through anaperture94 in thebulkhead90 of theend effector6. Proximal motion of theactuation cable110, and/or tensioning of theclamp cable36, may actuate theend effector6 such as set forth in the Endocutter Applications. For example, thestaple holder8 may deploy staples into the blood vessel and against theanvil10, along two or more lines, and a knife may cut the blood vessel between two such lines.
• As theactuation controller46 moves proximally, theslider54 connected to theactuation controller46 moves proximally as well. Theslider54 extends out of thehousing20, such as through aslot61 in the upper surface of thehousing20, and provides a visual indication that theend effector6 has been actuated. The actuation of theend effector6 is thus complete. The clampingtrigger22 may be moved away from thehousing20, thereby releasing tension on theclamp cable36, allowing theend effector6 to move back to the open position. Advantageously, theend effector6 is biased to the open position, such as by a spring. If the surgical procedure is complete, theend effector6 may be withdrawn from the patient.
• If the surgeon desires to use theend effector6 at a different location within the patient, and thesurgical instrument1 includes one or more feeder belts, as described in the Endocutter Applications, the feeder belt or belts may be advanced, placing a fresh set of staples in position for deployment within the staple holder. Such advancement may be accomplished as set forth in the Endocutter Applications. Optionally, theslider54 may be used to reset thesurgical instrument1 and advance the feeder belt or belts. For example, the slider may engage the driver and move the driver distally, thereby causing the ratchet pawl fixed to the driver to engage a corresponding face of the top plate of the feeder belt and advance the top plate distally, as set forth in the Endocutter Applications. In this way, theslider54 also acts to indicate that thesurgical instrument1 has been reset and is ready to be fired again. Theend effector6 need not be withdrawn from the body of the patient during advancement of the feeder belts. The feeder belts may extend through the lumen of theshaft4 into thehousing20 of thehandle2. If so, the feeder belts may enter theend effector6 through the feederbelt access apertures96 in thebulkhead90 of theend effector6. The surgeon may release theend effector6 from its selected, articulated position, such as by moving thepin80 proximally out of engagement with theteeth86. The surgeon may then articulate theend effector6 differently for use at a different surgical site, as set forth above.
• While the invention has been described in detail, it will be apparent to one skilled in the art that various changes and modifications can be made and equivalents employed, without departing from the present invention. It is to be understood that the invention is not limited to the details of construction, the arrangements of components, and/or the method set forth in the above description or illustrated in the drawings. Statements in the abstract of this document, and any summary statements in this document, are merely exemplary; they are not, and cannot be interpreted as, limiting the scope of the claims. Further, the figures are merely exemplary and not limiting. Topical headings and subheadings are for the convenience of the reader only. They should not and cannot be construed to have any substantive significance, meaning or interpretation, and should not and cannot be deemed to indicate that all of the information relating to any particular topic is to be found under or limited to any particular heading or subheading. Therefore, the invention is not to be restricted or limited except in accordance with the following claims and their legal equivalents.

Claims (20)

What is claimed is:

1. A surgical method of treating tissue within the body of a patient, comprising:

providing a surgical instrument including a handle; a shaft extending from said handle, an end effector connected to said shaft, wherein said shaft includes a lumen defined therethrough and an articulated region; and at least one feeder belt extending through said lumen of said shaft into said end effector, said feeder belt including at least one staple frangibly united therewith;

inserting said end effector into the body of a patient;

orienting said end effector relative to tissue to be treated within the body of the patient and relative to a remainder of said shaft;

actuating said end effector to staple tissue; and

removing said end effector from the body of the patient.

2. The surgical method ofclaim 1, wherein said orienting is performed about at least a first axis by bending said articulated region of said shaft, and is performed about a second axis different from said first axis by rotating the proximal end of said shaft.

3. The surgical method ofclaim 1, wherein said surgical instrument further comprises at least one actuation cable extending from said handle to said end effector through said lumen of said shaft, wherein said actuating is performed by pulling said actuation cable proximally.

4. The surgical method ofclaim 1, wherein said surgical instrument further comprises at least one clamp cable extending from said handle to said end effector through said lumen of said shaft; further comprising clamping said end effector by pulling said clamp cable proximally.

5. The surgical method ofclaim 1, further comprising repeating said orienting and said actuating before said removing.

6. The surgical method ofclaim 5, incorporating by reference all of the elements of that claim; wherein said repeating includes advancing at least part of at least one feeder belt from said lumen of said shaft into said end effector.

7. The surgical method ofclaim 6, further comprising a slider movable relative to said handle; and further comprising sliding said slider to cause said advancing.

8. The surgical method ofclaim 1, further comprising an articulation control associated with said handle, wherein said orienting is performed at least in part by exerting a force on one side of said articulation control lateral to the longitudinal centerline of said articulation control.

9. The surgical method ofclaim 1, wherein a plurality of said staples are arranged in at least one substantially longitudinal row on said feeder belt, and wherein said actuation serially deploys a plurality of said staples in at least one said row.

10. A surgical method of treating tissue within the body of a patient, comprising:

providing a surgical instrument including a handle; a shaft extending from said handle, an end effector connected to said shaft, wherein said shaft includes a lumen defined therethrough and an articulated region; and an articulation control connected to said handle, said articulation control movable from side to side;

inserting said end effector into the body of a patient;

orienting said end effector relative to tissue to be treated within the body of the patient and relative to a remainder of said shaft, wherein said orienting is performed at least in part by exerting a force on one side of said articulation control;

actuating said end effector to staple tissue; and

removing said end effector from the body of the patient.

11. The surgical method ofclaim 10, wherein said exerting a force on one side of said articulation control is performed with one hand.

12. The surgical method ofclaim 10, further comprising providing at least one feeder belt extending through said lumen of said shaft into said end effector, said feeder belt including at least one staple frangibly united therewith.

13. The surgical method ofclaim 10, wherein said articulated region is spaced apart from said handle, and wherein said articulation control is movable by rotation about an axis different from the longitudinal axis of the portion of said shaft between said handle and said articulated region.

14. The surgical method ofclaim 13, wherein said articulation control is additionally rotatable substantially about the longitudinal axis of the portion of said shaft between said handle and said articulated region.

15. The surgical method ofclaim 13, further comprising locking said articulation control in place after said orienting such that the orientation of said end effector relative to the portion of said shaft between said handle and said articulated region is also locked into place.

16. The surgical method ofclaim 10, wherein said orienting is performed with one hand.

17. The surgical method ofclaim 10, further comprising clamping said end effector to tissue before said actuating, and unclamping said end effector from tissue after said actuating.

18. The surgical method ofclaim 17, wherein said end effector is biased to a neutral position; further comprising allowing said end effector to return to said neutral position after said unclamping.

19. The surgical method ofclaim 10, wherein said inserting is through an opening in the body of the patient between 5 millimeters and 10 millimeters in diameter.

20. The surgical method ofclaim 10, further comprising repeating said orienting and said actuating before said removing.

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