US20140166723A1 - Dissection tip and introducer for surgical instrument - Google Patents

Abstract

The present disclosure describes a surgical fastener applying apparatus that includes an elongate body portion having proximal and distal ends, an end effector including a first movably coupled to a second jaw that is positioned at the distal end of the elongate body portion, and an introducer member. The introducer member has proximal and distal portions, and is configured and dimensioned for releasable connection with the end effector. The introducer member is at least partially formed from a flexible material, and is configured and dimensioned to separate target tissue from collateral tissue prior to positioning of the target tissue between the first and second jaws of the end effector.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• The present application is a continuation of U.S. patent application Ser. No. 13/727,685, filed Dec. 27, 2012, which is a continuation of U.S. patent application Ser. No. 13/371,799, filed on Feb. 13, 2012, now U.S. Pat. No. 8,403,196, which is a divisional of U.S. patent application Ser. No. 13/371,643, also filed on Feb. 13, 2012, now U.S. Pat. No. 8,403,195, which is a divisional of U.S. patent application Ser. No. 12/571,659, filed on Oct. 1, 2009, now U.S. Pat. No. 8,136,711, which is a continuation-in-part of U.S. patent application Ser. No. 11/851,495, filed on Sep. 7, 2007, now abandoned, which claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 60/843,254, filed on Sep. 8, 2006, now expired, the entire content of each of the above-identified applications being incorporated by reference herein.
BACKGROUND
• 1. Technical Field
• The present disclosure relates generally to an apparatus for the application of surgical fasteners to tissue. The present application also relates to flexible guide for use with a surgical fastener applying apparatus to facilitate the separation of tissue and access to internal anatomical structures.
• 2. Background of the Related Art
• In an effort to reduce trauma and recovery time, many surgical procedures are performed through small openings in the skin, such as an incision or a natural body orifice. Generally, such procedures are referred to as “endoscopic,” unless performed on the patient's abdomen, in which case the procedure is referred to as “laparoscopic.” Throughout the present disclosure, the term “minimally invasive” should be understood to encompass both endoscopic and laparoscopic procedures.
• During the course of minimally invasive surgical procedures, a surgical fastener applying apparatus is often employed to connect adjacent sections of tissue. Many varieties of such apparatus are known in the art, some of which are specifically adapted for use in particular surgical procedures including, but not limited to, end-to-end anastomosis, circular end-to-end anastomosis, open gastrointestinal anastomosis, endoscopic gastrointestinal anastomosis, and transverse anastomosis. Examples of suitable surgical fastener applying apparatus are disclosed in U.S. Pat. Nos. 5,915,616; 6,202,914; 5,865,361; and 5,964,394. Typically, these surgical fastener applying apparatus include a first member that is movable relative to a second member such that target tissue is positionable therebetween to facilitate grasping and/or clamping of the target tissue.
• Linear surgical fastener applying apparatus generally include two elongated jaw members, one of which includes a surgical fastener cartridge housing a plurality of surgical fasteners that are arranged in two or more linear rows, and the other of which includes an anvil component with a plurality of fastener forming pockets that are configured and dimensioned to receive and form the surgical fasteners upon ejection of the fasteners from the surgical fastener cartridge. Typically, the surgical fastener applying apparatus will also include a knife that is movable between the linear rows of surgical fasteners such that the tissue being joined and/or sealed is simultaneously, or nearly simultaneously, cut upon actuation of the surgical fastener applying apparatus. Given this capability, surgical fastener applying apparatus of the linear variety are commonly used during surgical procedures to simultaneously seal and cut target tissue, e.g., a patient's vasculature, organs, or the like.
• It is not uncommon that certain collateral tissues, e.g., vasculature or other connective tissues, adhere to, or are otherwise joined with, the target tissue. Accordingly, a surgical fastener applying instrument including structure capable of separating the target tissue from these adherent collateral tissues would be desirable to facilitate isolation of the target tissue before continuing with the surgical procedure.
SUMMARY
• In one aspect of the present disclosure, a surgical fastener applying apparatus is disclosed that includes an elongate body portion with proximal and distal ends, an end effector that is positioned at the distal end of the elongate body portion, and an introducer member.
• The end effector includes a first jaw that is movably coupled to a second jaw such that target tissue is positionable therebetween. The first jaw of the end effector includes an anvil component, and the second jaw of the end effector includes a surgical fastener cartridge that is configured and dimensioned to retain a plurality of surgical fasteners therein. The first jaw terminates in a tapered, rigid tip having engagement structure.
• The introducer member includes proximal and distal portions, and is configured and dimensioned for releasable connection with the end effector. The introducer member is at least partially formed from a flexible material, and is configured and dimensioned to separate the target tissue from collateral tissue to positioning of the target tissue between the first and second jaws of the end effector. The introducer has attachment structure at the proximal portion corresponding in configuration and dimensions to the engagement structure of the first jaw to facilitate releasable connection of the introducer member with the first jaw.
• In one embodiment of the surgical fastener applying apparatus, it is envisioned that the proximal portion of the introducer member may be formed from a first material, whereas the distal portion of the introducer member may be formed from a second, different material with a lower durometer.
• The proximal portion of the introducer member may be a separate part attached to the distal portion of the introducer. The proximal portion can be a conical member having ridges for frictionally engaging the distal portion.
• In certain embodiments, the first jaw includes an anvil component and the second jaw includes a surgical fastener cartridge. The cartridge is configured and dimensioned to retain a plurality of surgical fasteners therein. The second jaw member may be pivotably mounted with respect to the first jaw member. In certain embodiments, the engagement structure is formed on the tip of the anvil component.
• In order to facilitate connection of the introducer member to the end effector, it is envisioned that the proximal portion of the introducer member may include a hollow that is configured and dimensioned to at least partially receive one of the first jaw and the second jaw. To enhance the connection between the introducer member and the end effector, the engagement structure included on the end effector and the attachment structure included on the introducer member may be configured and dimensioned for connection in snap-fit arrangement. For example, the engagement structure provided on the end effector may include one or more recesses, and the attachment structure may include one or more detents that are configured and dimensioned for releasable positioning within the recess(es). When included, the recess(es) and the detent may be configured and dimensioned to provide the clinician with an audible, or tactile, indication upon successful connection of the introducer member to the end effector.
• In certain embodiments, the introducer member is longer than a length of the first jaw member.
• In another aspect of the present disclosure, a surgical fastener applying apparatus is disclosed that includes an elongate body portion with proximal and distal ends, an end effector that is positioned at the distal end of the elongate body portion, a connector member with proximal and distal ends that is configured and dimensioned for releasable engagement with the end effector, and an introducer member with proximal and distal portions that is configured and dimensioned for releasable engagement with the connector member. One of the first jaw and the second jaw terminates in a dissector tip and the connector member is engaged with the end effector at the dissector tip.
• The end effector includes a first jaw that is movably coupled to a second jaw such that target tissue is positionable therebetween. For example, the first jaw may include an anvil component, and the second jaw may include a surgical fastener cartridge that is configured and dimensioned to retain a plurality of surgical fasteners.
• The proximal end of the connector member may include first attachment structure, and the distal end of the connector member may include second attachment structure. To facilitate attachment of the connector member to the end effector, it is envisioned that at least one of the first and second jaws of the end effector may include first engagement structure, e.g., on the anvil component, that corresponds in configuration and dimensions to the first attachment structure included at the proximal end of the connector member. For example, the dissector tip includes the first engagement structure. Similarly, to facilitate attachment of the connector member to the introducer member, it is envisioned that the proximal end of the introducer member may include second engagement structure for engaging the second attachment structure. For example, it is contemplated that the first attachment structure and the first engagement structure may be configured and dimensioned for connection in snap-fit arrangement. Additionally, or alternatively, the first attachment structure and the first engagement structure may be configured and dimensioned to provide the clinician with an audible, or tactile, indication upon successful connection of the connector member and the end effector.
• In certain embodiments, the first jaw includes an anvil component and the second jaw includes a surgical fastener cartridge that retains a plurality of surgical fasteners. The dissector tip may form the terminal end of the first jaw. The first engagement structure may be formed on the anvil component.
• The introducer member is configured and dimensioned to separate target tissue from collateral tissue prior to positioning of the target tissue between the first and second jaws of the end effector. To facilitate connection of the introducer member and the connector member, it is envisioned that the proximal portion of the introducer member may include a hollow that is configured and dimensioned to at least partially receive the second attachment structure of the connector member. It is further envisioned that the proximal end of the introducer member may be at least partially formed from a flexible material such that receipt of the second attachment structure of the connector member causes outward expansion of the proximal end of the introducer member to create an interference fit between the introducer member and the connector member. In certain embodiments, the connector member defines ridges for frictionally engaging the proximal portion of the introducer member.
• In yet another aspect of the present disclosure, a flexible guide is disclosed for use with a surgical fastener applying apparatus that includes an end effector with first and second movable jaws, and the flexible guide is configured and dimensioned to separate target tissue from collateral tissue prior to positioning of the target tissue between the first and second jaws. The flexible guide is longer than each of the first and second jaws, and has a connector member configured and dimensioned for releasable, contemporaneous engagement with a dissector tip of the end effector and with an introducer member such that the connector member is positionable between the end effector and the introducer member. The connector member is formed from a biocompatible material that is relatively more rigid than the introducer member.
• In one embodiment, it is envisioned that the connector member may include a proximal end with first attachment structure and a distal end with second attachment structure. In this embodiment, the first attachment structure corresponds in configuration and dimensions to first engagement structure associated with at least one of the first and second jaws of the end effector, and the second attachment structure corresponds in configuration and dimensions to second engagement structure associated with the introducer member. The introducer member may be at least partially formed from a flexible material.
• These and other features of the presently disclosed surgical fastener applying apparatus, introducer member, and connector member will become more readily apparent to those skilled in the art through reference to the detailed description of various embodiments of the present disclosure that follows.
BRIEF DESCRIPTION OF THE DRAWINGS
• Various embodiments of the present disclosure are described herein below with references to the drawings, wherein:
• FIG. 1 is a side, perspective view of a surgical fastener applying apparatus including an end effector at a distal end thereof that is configured and dimensioned for releasable connection to an introducer member in accordance with one embodiment of the present disclosure;
• FIG. 2 is a partial, perspective view of the end effector seen inFIG. 1 with parts separated illustrating an anvil component and a surgical fastener cartridge;
• FIG. 3 is a side, plan view of the anvil component illustrating an anvil plate and an anvil cover;
• FIG. 4 is a side, perspective view of a surgical fastener for use with the presently disclosed surgical fastener applying apparatus;
• FIG. 5 is a schematic, enlarged view of the area of detail indicated inFIG. 2 illustrating a tissue contacting surface of the anvil plate and a plurality of pockets formed therein;
• FIG. 6 is a partial, longitudinal, cross-sectional view taken along line6-6 inFIG. 5;
• FIG. 7 is a side, perspective view of the surgical fastener shown inFIG. 4 exhibiting a standard “B” shaped configuration subsequent to formation through engagement with the pockets formed in the tissue contacting surface of the anvil plate seen inFIGS. 5 and 6;
• FIG. 8 is a side, plan view illustrating an introducer member attached to an end effector;
• FIG. 9 is a side, plan view of the introducer member seen inFIG. 8 shown attached to the end effector, and positioned between target tissue and collateral tissue;
• FIG. 10 is a top view illustrating one embodiment of the presently disclosed introducer member prior to attachment to the end effector;
• FIG. 11 is a longitudinal, cross-sectional view of an embodiment of a presently disclosed introducer member;
• FIG. 12 is a side, plan view illustrating another introducer member before attachment to an end effector;
• FIG. 13 is a partial, rear, perspective view illustrating a proximal end of the presently disclosed introducer member according to an embodiment of the present disclosure;
• FIG. 14 is a partial, longitudinal, cross-sectional view of the proximal end of the introducer member shown inFIG. 13;
• FIG. 15 is a top, perspective view of one embodiment of a dissector portion or dissector tip included on the anvil component of the end effector;
• FIG. 16 is a partial, rear, perspective view illustrating a proximal end of the presently disclosed introducer member according to another embodiment of the present disclosure;
• FIG. 17 is a top, perspective view illustrating an alternative embodiment of the dissector portion for use with the introducer member shown inFIG. 16;
• FIG. 18 is a partial, bottom, perspective view illustrating the end effector of the surgical fastener applying apparatus, one embodiment of the presently disclosed introducer member, and a connector member that is positionable between the end effector and the introducer member;
• FIG. 19 is an enlarged view of the area of detail indicated inFIG. 18;
• FIG. 20 is a partial, top, plan view illustrating another embodiment of the presently disclosed introducer member shown separated from the end effector according to an embodiment of the present disclosure;
• FIG. 21 is a partial, top, plan view illustrating an alternative embodiment of the introducer member shown inFIG. 20;
• FIG. 22 is a partial, top, schematic view illustrating one embodiment of the dissector portion of the anvil component including a tip that is secured between the anvil plate and the anvil cover;
• FIG. 23 is a partial, side, schematic view of the dissector portion seen inFIG. 22;
• FIG. 24 is a partial, bottom, schematic view of the dissector portion seen inFIG. 22;
• FIG. 25 is a partial, top, schematic view illustrating an alternative embodiment of the tip of the dissector portion shown separated from the remainder of the anvil component;
• FIG. 26 is a partial, side, schematic view illustrating the tip seen inFIG. 25 following connection with the anvil component;
• FIG. 27 is a partial, bottom view illustrating the tip seen inFIG. 25 following connection with the anvil component;
• FIG. 28 is a longitudinal, cross-sectional view of another embodiment of the presently disclosed introducer member;
• FIG. 29 is a partial, side, plan view illustrating another embodiment of the dissector portion of the anvil component incorporating a roughened surface;
• FIG. 30 is a partial, side, plan view illustrating an alternative embodiment of the dissector portion shown inFIG. 29;
• FIG. 31 is a partial, top view of the anvil component including an alternative embodiment of the presently disclosed introducer member;
• FIG. 32 is a partial, side view of the anvil component shown inFIG. 32 illustrating the introducer member in a retracted position;
• FIG. 33 is a partial, side view of the anvil component shown inFIG. 32 illustrating the introducer member in an advanced position;
• FIGS. 34 and 35 are partial, top views of the anvil component including an another embodiment of the presently disclosed introducer member that is pivotably connected thereto;
• FIG. 36 is a partial, top view of the anvil component including an alternative embodiment of the presently disclosed introducer member;
• FIG. 37 is a partial, side, schematic view of the anvil component and the introducer member shown inFIG. 36;
• FIG. 38 is a partial, side, schematic view of an alternative embodiment of the anvil component and the introducer member shown inFIG. 36;
• FIG. 39 is a partial, top view of the anvil component including an alternative embodiment of the presently disclosed introducer member;
• FIG. 40 is a partial, side view of the anvil component and the introducer member shown inFIG. 39;
• FIG. 41 is a partial, side view of the anvil component including yet another embodiment of the presently disclosed introducer member;
• FIG. 42 is a cross-sectional view of the anvil component and the introducer member taken along line42-42 inFIG. 41;
• FIG. 43 is a partial, top, schematic view of the anvil component and the introducer member according to another embodiment of the present disclosure;
• FIG. 43A is a side view of another embodiment of the presently disclosed introducer member for use with the anvil component seen inFIG. 43;
• FIG. 44 is a partial, longitudinal, cross-sectional view of the presently disclosed anvil component and introducer member according to another embodiment of the present disclosure;
• FIG. 45 is an enlarged view of the area of detail indicated inFIG. 44;
• FIG. 46 is a side, schematic view of another embodiment of the presently disclosed introducer member;
• FIG. 47 is a partial, top, cross-sectional view illustrating another embodiment of the presently disclosed introducer member;
• FIG. 48 is a partial, top, cross-sectional view illustrating an alternative embodiment of the introducer member seen inFIG. 47;
• FIG. 49 illustrates an end-to-end anastomosis device for use with an alternative embodiment of the presently disclosed introducer member;
• FIG. 50 illustrates a surgical fastener applying instrument for use with one embodiment of the presently disclosed introducer member; and
• FIG. 51 illustrates a transverse anastomosis fastener applying instrument for use with another embodiment of the presently disclosed introducer member.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
• Various embodiments of the presently disclosed surgical fastener applying apparatus, introducer member, connector member, and methods of using the same will now be described in detail with reference to the drawings wherein like references numerals identify similar or identical elements. In the drawings, and in the following description, the term “proximal” should be understood as referring to the end the surgical fastener applying apparatus, introducer member, or connector member discussed below, or component thereof, that is closer to the clinician during proper use, while the term “distal” should be understood as referring to the end that is further from the clinician, as is traditional and conventional in the art. In addition, the term “surgical fastener” should be understood to include any substantially rigid structure formed of a biocompatible material that is suitable for the intended purpose of joining tissue together, including but not being limited to surgical staples, clips, and the like. Moreover, the term “tissue” should be understood as referring to any human or animal tissue, artery, vein, organ, or other such anatomical structure found within the body. Specifically, use of the term “target tissue” herein below identifies the tissue that is the target, or subject, of the surgical procedure, whereas use of the term “collateral tissue” refers to any tissue surrounding the target tissue that is not the subject of the surgical procedure.
• FIG. 1 illustrates a surgicalfastener applying apparatus10, of either the re-usable or disposable variety, that includes ahandle assembly12 with amovable handle14 and astationary handle16, anelongated shaft18 that extends distally from thehandle assembly12, anend effector20 that is positioned at adistal end22 of theelongated shaft18, and anintroducer member100 that is releasably connectable to theend effector20.
• In various embodiments, it is envisioned that thehandle assembly12 may include motor-driven, hydraulic, ratcheting, or other such mechanisms to facilitate actuation of the surgicalfastener applying apparatus10.
• In general, theend effector20 is adapted to clamp, fasten together, and sever adjacent tissue segments along a cut-line. During use, the surgicalfastener applying apparatus10 is approximated and fired similarly to, and in accordance with, other known surgical fastener applying apparatus. A discussion of the approximation and firing of surgicalfastener applying apparatus10, including the components and interaction of thehandle assembly12 and included drive assembly, is provided below. However, additional details regarding approximation and firing of surgicalfastener applying apparatus10 may also be obtained through reference to commonly assigned U.S. Pat. No. 5,865,361, currently assigned to Tyco Healthcare Group LP, the entire contents of which are hereby incorporated by reference in their entirety.
• Referring now toFIGS. 2-6 as well, theend effector20 includes afirst jaw24 that is pivotally coupled to asecond jaw26 to facilitate approximation thereof, and is adapted to clamp, fasten together, and sever adjacent tissue segments along a cut-line. Thefirst jaw24 of theend effector20 includes ananvil component28 comprising an anvil plate30 (FIGS. 2,3) and an anvil cover32 (FIG. 3), and thesecond jaw26 includes a surgical fastener cartridge34 (FIG. 2) that is loaded with a plurality of surgical fasteners36 (FIGS. 2,4). Pivoting the movable handle14 (FIG. 1) towards thestationary handle16 approximates thefirst jaw24 and thesecond jaw26. After thejaws24,26 are approximated, i.e., brought into close operative alignment, continued pivoting of themovable handle14 ejects the plurality of surgical fasteners36 (FIGS. 2,4) from the surgical fastener cartridge34 (FIG. 2) such that the plurality ofsurgical fasteners36 are driven into theanvil plate30, thus being formed into completed surgical fasteners, as described below. Further details regarding ejection of thesurgical fasteners36 are also provided below.
• It is envisioned that thesurgical fastener cartridge34 may be removable and replaceable with another loaded cartridge. In other embodiments, the present disclosure contemplates that theend effector20 may constitute a component of a removable and replaceable loading unit for the surgicalfastener applying apparatus10.
• With reference now toFIG. 4, eachsurgical fastener36 loaded into the surgical fastener cartridge34 (FIG. 2) includes twolegs38 that are connected by abackspan40 extending therebetween. Thelegs38 extend from the backspan40 to penetrating ends42 that are configured and dimensioned to facilitate passage of thelegs38 through tissue. The dimensions of thebackspan40 and thelegs38 can be varied such that thesurgical fastener36 may be used to fasten tissue with varying attributes, such as tissues of different thickness, or tissues including scar tissue.
• Thelegs38 and thebackspan40 may define a cross-section having any suitable geometric configuration including, but not limited to, rectangular, oval, square, triangular, trapezoidal, etc. Thelegs38 and thebackspan40 may exhibit the same geometrical configuration, as shown inFIG. 4, or alternatively, thelegs38 and thebackspan40 may exhibit different geometrical configurations. For example, thelegs38 may exhibit a rectangular cross-section, whereas thebackspan40 may exhibit an oval cross-section.
• The penetrating ends42 of thelegs38 may be tapered to facilitate the penetration of tissue, or alternatively, the penetrating ends42 may not include a taper. In various embodiments, it is envisioned that the penetrating ends42 may define either a conical surface, or flat surface.
• Prior to formation, thelegs38 of eachsurgical fastener36 may extend from the backspan40 such that they are substantially parallel. In the alternative, however, thelegs38 may converge or diverge from thebackspan40.
• With reference now toFIGS. 1-3 and6 in particular, the anvil component28 (FIG. 3) will be discussed. As mentioned above, theanvil component28 includes theanvil plate30 and theanvil cover32. Theanvil plate30 is an elongated member with a tissue contacting surface44 (FIG. 5) that includes a plurality ofpockets46 formed therein. Each of thepockets46 is positioned to receive and deform the legs38 (FIG. 4) of asurgical fastener36 to achieve a formed configuration. More particularly, eachpocket46 formed in theanvil component28 includes two forming surfaces48 (FIG. 5) that extend into theanvil component28, i.e., away from thetissue contacting surface44, to define a depth “D,” as best seen inFIG. 6. Upon engagement of thelegs38 with the formingsurfaces48, the formingsurfaces48 guide thelegs38 inwardly in the direction of arrows “A” (FIG. 5) to facilitate deformation of thesurgical fastener36 into a standard “B” shaped configuration (FIG. 7). In an alternative embodiment, it is envisioned that thepockets46 formed in thetissue contacting surface44 of theanvil plate30 may be configured and dimensioned to deform thesurgical fastener36 so as to achieve a single-loop configuration or other shape upon formation. It should be appreciated that additional configurations and dimensions for thepockets46 are also contemplated herein such that thesurgical fasteners36 may exhibit other configurations upon formation.
• Thepockets46 are arranged into rows disposed on opposite sides of a slot50 (FIGS. 2,5) extending through theanvil plate30. Theslot50 is configured to accommodate movement of a knife52 (FIG. 2), or other such cutting element, in order to facilitate severing of tissue along a cut-line. Although theslot50 is depicted as extending longitudinally through theanvil plate30, in alternative embodiments, it is envisioned that theslot50 may define a configuration that is angled, arcuate, or shaped otherwise. Theslot50 may extend along a centerline of theanvil plate30, as shown in the embodiment illustrated inFIGS. 2 and 5, or alternatively, theslot50 may be offset from the centerline of theanvil plate30.
• In the embodiment of theanvil plate30 seen inFIGS. 2 and 5, thepockets46 formed in thetissue contacting surface44 are arranged into a pair ofinner rows54A, a pair ofintermediate rows54B, and a pair ofouter rows54C (FIG. 4). The pair ofinner rows54A are spaced laterally outward of theslot50 and are closest thereto, the pair ofintermediate rows54B are spaced laterally outward from the pair ofinner rows54A, and the pair ofouter rows54C are spaced laterally outward from the pair ofintermediate rows54B and are furthest from theslot50. While theanvil plate30 is depicted as including three pairs of rows, i.e., the respective pairs of inner, intermediate, andouter rows54A,54B,54C, alternative embodiments of theanvil plate30 including fewer and greater numbers of rows ofpockets46 are not beyond the scope of the present disclosure.
• Referring now toFIG. 3, theanvil cover32 includes anouter surface56 and is fixed relative to theanvil plate30 such that there is no relative movement therebetween. For example, it is envisioned that theanvil cover32 may be secured to theanvil plate30 in a snap-fit arrangement, via one or more welds, or in any other manner suitable for the intended purpose of establishing a secured connection therewith.
• Second jaw26 includes asurgical fastener cartridge34 and achannel66. Thesurgical fastener cartridge34 will now be described with reference toFIG. 2. Thesurgical fastener cartridge34 includes acartridge body58 with a pair ofsidewalls60, abottom wall62, and atop wall64, and resides in thechannel66 of thesecond jaw26. In the illustrated embodiment, thecartridge body58 includes aslot68 extending therethrough that is configured to accommodate longitudinal movement of theknife52. As discussed above with respect to theanvil component28, while theslot68 is depicted as extending longitudinally through thesurgical fastener cartridge34, in alternative embodiments, theslot68 may define a configuration that is angled, arcuate, or shaped otherwise. The position of theslot68 corresponds to that of theslot50 extending through theanvil plate30 such that theslot68 aligns with theslot50. Theslot68 may extend along a centerline of thesurgical fastener cartridge34, as seen inFIG. 3, or alternatively, theslot68 may be spaced therefrom.
• Thetop wall64 of thecartridge body58 includes a substantially planar configuration that extends in substantially parallel relation to the tissue contacting surface44 (FIG. 5) of theanvil plate30, as well as a plurality ofretention slots68. Theretention slots68 are arranged into rows corresponding in position to the rows of pockets46 (FIG. 5) formed in thetissue contacting surface44 of theanvil plate30. Accordingly, in the particular embodiment of thesurgical fastener cartridge34 seen inFIG. 2, theretention slots68 are arranged into a pair ofinner rows72A, a pair ofintermediate rows72B, and a pair ofouter rows72C, each of which is disposed on opposite sides of theslot68. The pair ofinner rows72A are spaced laterally outward of theslot68 and are closest thereto, the pair ofintermediate rows72B are spaced laterally outward from the pair ofinner rows72A, and the pair ofouter rows72C are spaced laterally outward from the pair ofintermediate rows72B and are furthest from theslot68. While thesurgical fastener cartridge34 is depicted as including three pairs of rows, i.e., the respective inner, intermediate, andouter rows72A,72B,72C, alternative embodiments of thesurgical fastener cartridge34 including fewer and greater numbers of rows offastener retention slots68 are not beyond the scope of the present disclosure.
• Eachfastener retention slot68 is configured and dimensioned to receive a surgical fastener36 (FIGS. 2,4), as well as a correspondingly dimensioned pusher74 (FIG. 2) positioned therein. During use, thepushers74 are driven upwardly, i.e. towards thetop wall64 of thecartridge body58, by a sled76 (FIG. 3) into engagement with thesurgical fasteners36 to thereby eject thesurgical fasteners36 from theretention slots68, as discussed in further detail below. As thesurgical fasteners36 exit thefastener retention slots68, they are deployed in rows, e.g., inner, intermediate, and outer rows in the illustrated embodiment, on opposite sides of the cut-line created in the tissue.
• With reference now to FIGS.1 and8-10, one embodiment of the presently disclosed introducer member, which is identified by thereference character100, will be discussed. Theintroducer member100 includes respective proximal anddistal ends102,104, and is formed from a pliable, biocompatible material, including but not limited to polymeric materials, such as rubbers or plastics. In one particular embodiment, it is envisioned that theintroducer member100 may be entirely formed from a flexible material. Alternatively, however, it is envisioned that theintroducer member100 may include portions of increased rigidity formed from a higher durometer material to provide additional structure to theintroducer member100, and/or assist in the separation of tissue.
• The openproximal end102 of theintroducer member100 is configured and dimensioned to facilitate placement over adistal end20A of theend effector20. For example, as illustrated inFIGS. 8 and 9, theproximal end102 of theintroducer member100 may be configured and dimensioned for placement about theanvil component28, or alternatively, theproximal end102 may be configured and dimensioned for placement about thesurgical fastener cartridge34. To facilitate connection and disconnection of theintroducer member100 to theend effector20, it is envisioned that theproximal end102 of theintroducer100 may include radiused edges “E,” as shown inFIG. 10.
• In one embodiment, it is envisioned that theintroducer member100 may be operatively connected to the handle assembly12 (FIG. 1) of the surgicalfastener applying apparatus10 such that theintroducer member100 is steerable by the clinician. For example, theintroducer member100 may be operatively connected to thehandle assembly12 via one or more flexible members (not shown), such as cables, guidewires, or the like, that are attached at various points along the length of theintroducer member100 such that manipulation of the flexible member(s) will cause corresponding movement of theintroducer member100. For example, the flexible member(s) may be attached to theintroducer member100 such that proximal retraction of the flexible member(s) causes bending or flexing of theintroducer member100 at a predetermined location, thereby allowing the clinician to selectively reconfigure theintroducer member100, and effectively steer theintroducer member100 between the target tissue “T” (FIG. 10) and the collateral tissue “C.”
• Theintroducer member100 is configured, dimensioned, and adapted to guide theend effector20 into position between the target tissue “T” (FIG. 10) that is the subject of the surgical procedure, and any collateral tissue “C” surrounding the target tissue “T.” To this end, theintroducer member100 may include a partially or wholly curved configuration that defines an arc substantially in the range of approximately 5° to approximately 90°. In one embodiment, for example, as shown inFIGS. 8 and 9, theintroducer member100 curves from theanvil component28 towards thesurgical fastener cartridge34, and is longer than the jaws, so that the target tissue is approached at an angle and directed between the jaws of the surgical fastener applying apparatus. It should be appreciated, however, that theintroducer member100 may curve in any direction suitable for the intended purpose of guiding the instrument into position and/or facilitating separation of the target tissue “T” from any collateral tissue “C.”
• Additionally, theintroducer member100 includes an elongate profile that tapers towards thedistal end104, as seen in FIGS.1 and9-11. Including a tapered profile allows thedistal end104 of theintroducer member100 to define a reduced cross-sectional area when compared to more proximal portions thereof in order to facilitate advancement of theintroducer member100 through the patient's tissue. Additionally, the reduced cross-sectional area at thedistal end104 of theintroducer member100 facilitates access to internal spaces and tissues that would otherwise be inaccessible given the larger dimensions of the end effector20 (FIG. 1), and reduces the effect that distal advancement of the surgicalfastener applying apparatus10 has upon the patient's internal tissues. For example, in one embodiment, it is envisioned that thedistal end104 of theintroducer member100 may have a transverse dimension in the range of approximately 2 mm to approximately 6 mm, although dimensions that are both larger and smaller are not beyond the scope of the present disclosure.
• Theintroducer member100 may have any cross-sectional configuration suitable for the intended purpose of atraumatically separating the target tissue “T” (FIG. 10) from any collateral tissue “C” in order to facilitate access to a patient's internal tissues and organs with the surgical fastener applying apparatus10 (FIG. 1). For example, theintroducer member100 may have an oval cross-sectional configuration (seeFIG. 13), a substantially rounded cross-sectional configuration, or a polygonal cross-sectional configuration.
• Referring now toFIGS. 1-10, use and operation of the surgical fastener applying apparatus10 (FIG. 1) will be discussed in connection with theintroducer member100. As mentioned above and seen inFIG. 1, thehandle assembly12 includes amovable handle14. Themovable handle14 is operatively connected to an actuation shaft (not shown), which receives the proximal end of a control rod such that linear advancement of the actuation shaft causes corresponding linear advancement of the control rod. The control rod is further engagable with an axial drive assembly including an elongated drive beam78 (FIG. 2) having a distal end that is configured and dimensioned to support theknife52. Thesled76, as discussed above, drives thepushers74 upwardly, driving thefasteners36 against thepockets46 of theanvil component28. Theknife52 is positioned on thedrive beam78 to translate behind thesled76. Thedrive beam78 includes anupper flange79A that is configured and dimensioned to move along a top surface of theanvil plate30, and alower flange79B that is configured and dimensioned for movement along the outer side of thechannel66 while the drive beam moves through theslot50 of the anvil component and theslot68 of thechannel66.
• Initially, theintroducer member100 is connected to the end effector20 (FIG. 1,8,9), i.e., theintroducer member100 is positioned about theanvil component28 or thesurgical fastener cartridge34. Thereafter, the assembly of the surgical fastener applying apparatus10 (FIG. 1) and theintroducer member100 can be manipulated such that thedistal end104 of theintroducer member100 is positioned between the target tissue “T” (FIG. 10) and the collateral tissue “C.” During manipulation of theintroducer member100, the flexible material comprising theintroducer member100 allows theintroducer member100 to gently urge the collateral tissue “C” away from the target tissue “T,” thereby establishing and/or dilating a pathway along which theend effector20 can travel.
• To facilitate positioning of the target tissue “T” (FIG. 9) between theanvil component28 and thesurgical fastener cartridge34, thedistal end104 of theintroducer member100 can be withdrawn, or pulled proximally, e.g., via the aforementioned flexible member(s) (not shown), if included. Manipulating theintroducer member100 in this manner guides the target tissue “T” into position between theanvil component28 and thesurgical fastener cartridge34, while simultaneously protecting the collateral tissue “C” from undesirable contact with any components of the surgicalfastener applying apparatus10.
• After confirming that that the target tissue “T” has been positioned as desired between theanvil component28 and thesurgical fastener cartridge34, and confirming that the collateral tissue “C” is not located in a position that will result in damage to the target tissue “T” or the collateral tissue “C” upon actuation of the surgical fastener applying apparatus10 (FIG. 1), theintroducer member100 can be removed from theend effector20. Thereafter, thejaws24,26 (FIG. 1) are approximated using thehandle assembly12 to clamp the target tissue “T” (FIG. 9) therebetween, and apply a compressive force thereto. Specifically, manipulation of themovable handle14 advances the actuation shaft to effectuate corresponding advancement of the control rod. In particular embodiments, the actuation shaft includes a toothed rack defined thereon, and themovable handle14 has a ratcheting pawl mounted thereto for incrementally engaging and advancing the actuation shaft. The pawl may be mounted on a pivot pin and a coiled torsion spring may be provided to bias the pawl into engagement with the toothed rack. The control rod is connected at its distal end to the axial drive assembly, which includes the aforementioned drive beam78 (FIG. 2), such that distal movement of control rod effects distal movement of thedrive beam78, which in turn, forces the anvil component28 (FIG. 2) towards thesurgical fastener cartridge34. Specifically, the control rod advances thedrive beam78 distally such that theupper flange79A traverses the top surface of theanvil plate30, and thelower flange79B traverses thechannel66 extending through thesurgical fastener cartridge34.
• With the tissue securely clamped between thejaws24,26 (FIGS. 1,2), the surgicalfastener applying apparatus10 is fired to eject the surgical fasteners36 (FIG. 2). The surgicalfastener applying apparatus10 is approximated and fired similarly to, and in accordance with other known surgical fastener applying apparatus, such as, for example, the surgical fastener applying apparatus disclosed in commonly assigned U.S. Pat. No. 5,865,361, which is currently assigned to Tyco Healthcare Group LP, the disclosure of which is hereby incorporated by reference herein in its entirety. Specifically, themovable handle14 is manipulated to cause advancement of the drive assembly, which causes the sled76 (FIG. 2) to traverse thecartridge body58 and engage thepushers74 to thereby eject the plurality ofsurgical fasteners36 from thesurgical fastener cartridge34. During distal advancement of thesled76, angled leading surfaces thereof sequentially contact cam surfaces included on thepushers74. The interaction between the leading surfaces of thesled76 and the cam surfaces of thepushers74 urges thepushers74 towards thetop wall64 of thecartridge body58 to eject thesurgical fasteners36 from theretention slots68 formed in thecartridge body58. Sequential firing of thesurgical fasteners36 continues until thesled76 is advanced to the distal end of thesurgical fastener cartridge34, at which time all of thesurgical fasteners36 housed within thesurgical fastener cartridge34 will have been ejected.
• During ejection, the plurality ofsurgical fasteners36 pass through theretention slots68 through the target tissue “T,” and into engagement with the pockets46 (FIGS. 2,5) defined in thetissue contacting surface44 of theanvil component28. Engagement of thesurgical fasteners36 with thepockets46 forms thesurgical fasteners36 to thereby connect adjacent portions of the target tissue “T” (FIG. 9).
• Referring now toFIGS. 11-48, alternative embodiments of the presently disclosed introducer member will be discussed. Each embodiment of the introducer member discussed herein below is similar to theaforedescribed introducer member100, and accordingly, will only be discussed with respect to any differences therefrom.
• With specific reference toFIGS. 11-14, an embodiment of the introducer member identified by thereference character200 will be discussed. Theintroducer member200 may be entirely or partially hollow or solid, and includes an openproximal end202, and a closeddistal end204. When configured as a solid member, interior surfaces of the openproximal end202 may be shaped to abut exterior surfaces of the anvil component28 (FIG. 3) to provide stability and support for theintroducer member200.
• To facilitate distal advancement and navigation of theintroducer member200 between the target tissue “T” (FIG. 9) and the collateral tissue “C,” it is envisioned that theintroducer member200 may include a dual taper. Specifically, theintroducer member200 may include a tapered profile that decreases in cross-sectional height and width from theproximal end202 to thedistal end204.
• The openproximal end202 of theintroducer member200 is configured, dimensioned, and adapted to facilitate slidable engagement and disengagement with the end effector20 (FIGS. 1,12). For example, the openproximal end202 of theintroducer member200 may be configured and dimensioned to frictionally engage thesurgical fastener cartridge34, as shown inFIG. 13, or alternatively, the openproximal end202 of theintroducer member200 may be configured and dimensioned to frictionally engage the anvil component28 (FIG. 3), e.g., in a manner similar to that discussed above with respect to the introducer member100 (FIGS. 1-11).
• To ensure proper operation of the end effector20 (FIGS. 1,12) without having to remove theintroducer member200 prior to actuation of surgical fastener applying apparatus10 (FIG. 1), it is envisioned that the portion of theintroducer member200 positioned between the anvil component28 (FIG. 12) and thesurgical fastener cartridge34 may have a thickness less than the designed gap between theanvil component28 and thesurgical fastener cartridge34, thus inhibiting interference with theanvil component28 upon actuation of the surgicalfastener applying apparatus10. Additionally, or alternatively, it is envisioned that theproximal end202 of theintroducer member200 may include a cutout (not shown) that is positionable between theanvil plate30 and thesurgical fastener cartridge34.
• To facilitate engagement with, and disengagement from, the end effector20 (FIGS. 1,12), it is envisioned that theintroducer member200 may incorporate an adhesive, or alternatively, that theintroducer member200 may include structure that is configured and dimensioned for engagement with corresponding structure formed on theend effector20. For example, theintroducer member200 may include structure, e.g., projections206 (FIG. 13), formed on opposing surfaces within theproximal end202 that is configured and dimensioned for engagement with corresponding structure on theend effector20, e.g., withnotches80 formed in thesidewalls60 of thecartridge body58. Typically, thenotches80 formed in thesidewalls60cartridge body58 are configured and dimensioned for engagement with corresponding structure (not shown) on the second jaw26 (FIG. 1) to assist in secured placement of thesurgical fastener cartridge34. In this embodiment, during use, theintroducer member200 is positioned about the distal end of thesurgical fastener cartridge34 until theprojections206 within theproximal end202 of theintroducer member200 engage thenotches80. To remove theintroducer member200, the clinician applies a force sufficient to deform theproximal end202 of theintroducer member200 such that theproximal end202 flexes outwardly, thereby disengaging theprojections206 from thenotches80. Subsequently, theintroducer member200 can be removed from thesurgical fastener cartridge34.
• It is envisioned that that theintroducer member200 may include one or more recessed portion(s), cutouts, or the like (not shown) to inhibit interference with movable structure of theend effector20, such as a flange81 (FIG. 12) formed on thesurgical fastener cartridge34. In the illustrated embodiment of thesurgical fastener cartridge34, theflange81 is configured and dimensioned for longitudinal, slidable movement towards the distal end of thesurgical fastener cartridge34 as theanvil component28 is progressively clamped to balance clamping forces generated within theend effector20.
• Although each embodiment of the presently disclosed introducer has been discussed hereinabove as being a removable component of the surgical fastener applying apparatus10 (FIG. 1), it is also envisioned that either of theintroducer members100,200 may be integrally formed with theend effector20, such that theintroducer members100,200 are not detachable from theend effector20.
• As discussed above with respect to the introducer member100 (FIGS. 1-10), it is envisioned that theintroducer member200 may be operatively connected to the handle assembly12 (FIG. 1) of the surgicalfastener applying apparatus10 via a linkage, e.g., cables, bands, or the like, to facilitate selective reconfiguration of theintroducer member200.
• In addition to being steerable, it is envisioned that theintroducer member200 may be biased towards a curved configuration (FIG. 12) relative to the component of the end effector20 (FIGS. 1,12) to which theintroducer member200 is attached, e.g., the anvil component28 (FIG. 12) or thesurgical fastener cartridge34, or alternatively, that theintroducer member200 may be biased towards a linear position (FIG. 12)
• Referring now toFIGS. 13-15, an embodiment of the presently disclosed introducer, which is identified by thereference character300, will be discussed. During certain procedures, certain vasculature or other adherent connective, joined or other tissue, adheres or is joined with the target tissue, i.e., the tissue to be stapled and severed. If such tissue must be separated before accessing the target tissue, separating the tissue and guiding the surgical fastening apparatus into place so that the target tissue is directed between the jaws, while the collateral tissue is avoided, it is advantageous to include a dissector portion ordissector tip85 on one of the jaws. In a certain preferred embodiment, thedissector tip85 is a rigid, tapered tip that is integral with or attached to the anvil component of the surgical fastening apparatus. Such adissector tip85 can be seen inFIG. 16. Thedissector tip85 is desirably curved or angled so as to approach thesurgical fastener cartridge34 so that when tissue is approached at an angle, the tissue is directed between the jaws.
• Theintroducer300 includes aproximal end302 defining a hollow304 that is configured and dimensioned to at least partially receive the dissector tip of the anvil component28 (FIGS. 2,3). As illustrated inFIGS. 13-15, for example, the hollow304 is configured and dimensioned to receive a portion of theanvil component28, and more specifically, anoptional dissector portion83 ortip85 of the anvil component28 (FIGS. 1,3,15). Theintroducer300 provides a flexible, longer guide for the surgical fastener apparatus and extends the access of the apparatus, while more gradually guiding the apparatus toward the target tissue. Theintroducer300 is flexible, in contrast to the rigid dissector tip, to give the user more options in how to approach the tissue. If the user prefers, theintroducer300 can be attached to the dissector tip, or removed so that the dissector tip can be used to approach, access and separate tissue while guiding the tissue into place between the jaws.
• To facilitate connection between theintroducer member300 and the end effector20 (FIG. 1), theproximal end302 of theintroducer member300 includes attachment structure306 (FIG. 13) that is configured and dimensioned for releasable connection with corresponding engagement structure82 (FIG. 15) included on the dissector portion of the end effector20 (FIG. 1), e.g., on thedissector portion83 ortip85 in the embodiment shown inFIG. 16. To establish, and maintain, connection with theend effector20, it is envisioned that theattachment structure306 included at theproximal end302 of theintroducer member300 may be formed from a material different than that comprising the remainder of theintroducer member300. In one specific embodiment, for example, it is envisioned that theattachment structure306 may be formed from a material having a higher durometer than that of the material comprising the remainder of theintroducer member300.
• With continued reference toFIGS. 13-15, in one embodiment of the present disclosure, the attachment structure306 (FIGS. 13,14) and the engagement structure82 (FIG. 15) are configured and dimensioned for engagement in a snap-fit manner. More specifically, theattachment structure306 includes one or more raisedprotrusions308 that extend inwardly into the hollow304, and theengagement structure82 includes one or more recess(es)84 that correspond in configuration and dimensions to the protrusion(s)308. It is contemplated that the particular configuration and dimensions of the protrusion(s)308 and the recess(es)84 may be such that the clinician is provided with an audible, or tactile, indication upon successful connection of theintroducer member100 with theend effector20.
• The protrusion(s)308 and the recess(es)84 may have any geometrical configuration suitable for the intended purpose of establishing a releasable connection between theintroducer member300 and the end effector20 (FIG. 1). For example, it is contemplated that the protrusion(s)308 may be configured as one or more raised ribs310 (FIG. 13), and that the recess(es)84 may be configured as one or more corresponding linear channels85 (FIG. 15). Alternatively, the protrusion(s)308 may be configured as one or more hemispherical protuberances312 (FIG. 16), and the recess(es)84 may be configured as one or more corresponding cavities92 (FIG. 17).
• Referring now to FIGS.1 and13-15, a method of fastening tissue with the surgical fastener applying apparatus10 (FIG. 1) will be discussed in connection with theintroducer member300. Prior to inserting the surgical fastener applying apparatus10 (FIG. 1) into the patient, the introducer member300 (FIGS. 14,15) is connected to the end effector20 (FIG. 1), e.g., to the dissector portion83 (FIGS. 1,3,16) of the anvil component28 (FIG. 3). Upon connection, the attachment structure306 (FIGS. 14,15) included at theproximal end302 of theintroducer member300 mates with the corresponding engagement structure82 (FIG. 16) included on the dissector portion83 (FIG. 16), or other component of theend effector20.
• Following assembly, the surgical fastener applying apparatus10 (FIG. 1) is inserted into, and advanced distally through, the patient's tissue. During distal advancement, theintroducer member300 atraumatically separates the patient's internal tissues and organs to provide the clinician with access to the target tissue “T” (FIG. 9). When the target tissue “T” is reached, the clinician may elect to remove theintroducer member300, e.g., through an incision, or alternatively, theintroducer member300 may be left in place. When left in place, the flexible material comprising theintroducer member300 allows theintroducer member300 to bend and flex during manipulation to accommodate movement of theintroducer member300 without damaging the patient's internal tissues. The clinician then orients the surgical fastener applying apparatus10 (FIG. 1) such that the target tissue “T” (FIG. 9) is disposed between theopen jaws24,26 (FIG. 1) of theend effector20. After the target tissue “T” is positioned as desired, thejaws24,26 are approximated using thehandle assembly12 to clamp the target tissue “T” therebetween, and the surgicalfastener applying apparatus10 is fired to thereby eject the surgical fasteners36 (FIG. 2) from thesurgical fastener cartridge34, as discussed above. After passing through the target tissue “T,” thesurgical fasteners36 are formed through engagement with theanvil plate30 to achieve a formed configuration, and thereby attach adjacent portions of the target tissue “T.” During ejection of thesurgical fasteners36 from thesurgical fastener cartridge34, the target tissue “T” is simultaneously, or nearly simultaneously, severed by the aforementioned knife52 (FIG. 2) which moves in concert with thedrive beam78 in a position behind, i.e., proximally of, thesled76.
• Referring now toFIGS. 18 and 19, in an alternative embodiment of the present disclosure, aconnector member400 is provided to connect the surgical fastener applying apparatus10 (FIG. 1), e.g., theanvil component28, with theintroducer member300 discussed in connection withFIGS. 14 and 15.
• Theconnector member400 is formed from a biocompatible material suitable for contact with a patient's internal tissue during a surgical procedure, e.g., polymeric materials or stainless steel, and includes respective proximal anddistal ends402,404. Theconnector member400 is configured and dimensioned for releasable engagement with theanvil component28, or other such component of theend effector20, as well as theintroducer member300, to facilitate operative attachment of theintroducer member300 to theend effector20. Specifically, theproximal end402 of theconnector member400 is engagable with theend effector20, (FIG. 1), e.g., thedissector portion83 of theanvil component28, as shown inFIGS. 18 and 19, such that theconnector member400 extends distally from theanvil component28, and thedistal end404 of theconnector member400 is engagable with theproximal end302 of theintroducer member300, such that theintroducer member300 extends distally from theconnector member400.
• As seen inFIG. 19, in one embodiment of theconnector member400, theproximal end402 thereof includes aninternal space406 that is configured and dimensioned to at least partially receive thedissector portion83 of theanvil component28. To facilitate connection between theconnector member400 and theanvil component28, theproximal end402 of theconnector member400 includesproximal attachment structure408 that is configured and dimensioned for releasable connection with theaforedescribed engagement structure82 included on thedissector portion83, which corresponds in configuration and dimensions thereto. Although illustrated as part of thedissector portion83 inFIGS. 18 and 19, as discussed above, it should be appreciated that theengagement structure82 may be associated with any other portion of the anvil component28 (or the surgical fastener cartridge34 (FIG. 2), in alternative embodiments of the present disclosure).
• In the embodiment of theconnector member400 shown inFIGS. 18 and 19, theproximal attachment structure408 is illustrated as including one or more raisedprotrusions410 extending inwardly into theinternal space406 that is/are configured and dimensioned for engagement with the recess(es)84 formed on thedissector portion83 of theanvil component28. In alternative embodiments of the present disclosure, however, theproximal attachment structure408 and theengagement structure82 may assume any configuration or dimensions suitable for the intended purpose of creating a releasable connection between theconnector member400 and the end effector20 (FIG. 1). As discussed above with respect to the introducer member100 (FIGS. 1-11), it is contemplated that the particular configuration and dimensions of theattachment structure408 and theengagement structure32 may be such that the clinician is provided with an audible, or tactile, indication upon successful connection of theconnector member400 to theend effector20.
• To facilitate engagement between theconnector member400 and theintroducer member100, thedistal end404 of theconnector member400 includesdistal attachment structure412 that is configured and dimensioned for partial or complete reception by the hollow304 (FIG. 19) included at theproximal end302 of theintroducer member300.
• In one embodiment, it is envisioned that thedistal attachment structure412 may include one or more protrusions (not shown), e.g., having an annular configuration, that are configured and dimensioned for engagement with one or more recesses (not shown) formed in the hollow304 at theproximal end302 of theintroducer member300 such that thedistal attachment structure412 is engagable with theproximal end302 of theintroducer member300 in a snap-fit, or friction-fit, arrangement. As mentioned in connection with theattachment structure408 formed at theproximal end402 of the connector member and theengagement structure82 formed on the end effector20 (FIG. 1), thedistal attachment structure412 and the hollow304 may be configured and dimensioned so as to provide the clinician with an audible, or tactile, indication upon successful connection of theconnector member400 to theintroducer member300.
• Alternatively, however, as seen inFIGS. 18 and 19, thedistal attachment structure412 may include a series of taperedportions414 that progressively decrease in size to defineridges416 at the location where adjacent taperedportions414 intersect. In this embodiment, as thedistal attachment structure412 is received by the hollow304, the flexible material comprising theintroducer member300 allows the taperedportions414 to expand theproximal end302 of theintroducer member300 outwardly such that an interference fit is created between theproximal end302 of the introducer member and thedistal attachment structure412 of theconnector member400. After expansion, theridges416 engage the inner surface of the hollow304 in a manner which maintains the position of theintroducer300 relative to theconnector member400 until disconnection is desired.
• Referring now toFIGS. 1,18, and19, a method of fastening tissue with the surgical fastener applying apparatus10 (FIG. 1) will be discussed in connection with theintroducer member300 and theconnector member400. Prior to inserting the surgical fastener applying apparatus10 (FIG. 1) into the patient's tissue, theproximal end402 of theconnector member400 is attached to theend effector20, e.g., thedissector portion83 of theanvil component28, and theintroducer member300 is connected to thedistal end404 of theconnector member400. Upon connection, theproximal attachment structure408 of theconnector member400 mates with thecorresponding engagement structure82 included on thedissector portion83, and thedistal attachment structure412 of theconnector member400 is inserted into the hollow304 defined in theproximal end302 of theintroducer member300 such that theridges416 engage an inner surface thereof to maintain the relative positions of theintroducer member300 and theconnector member400.
• After assembly, the surgical fastener applying apparatus10 (FIG. 1) is inserted into, and advanced distally through, the patient's tissue, during which time theintroducer member300 atraumatically separates the target tissue “T” (FIG. 9) from any collateral tissue “C” to provide access to the target tissue “T” with the surgicalfastener applying apparatus10.
• When the target tissue “T” is reached, the clinician may elect to remove theintroducer member300 and theconnector member400, or leave them in place, as mentioned previously. The clinician can then proceed with the grasping, fastening, and cutting of the target tissue “T” in accordance with the discussion above.
• Referring now toFIG. 20, another embodiment of the presently disclosed introducer member, which is identified by thereference character500, will be discussed. Theintroducer500 includes aproximal end502 and adistal end504. Theproximal end502 of theintroducer member500 is formed from an at least partially resilient material, and includes a Y-shaped configuration with respective first andsecond branches506,508. Thebranches506,508 are configured and dimensioned to facilitate releasable engagement with theend effector20 of the surgical fastener applying apparatus10 (FIG. 1), e.g., with either the anvil component28 (FIGS. 2,3) or the surgical fastener cartridge34 (FIG. 2). Specifically, thebranches506,508 of theintroducer member500 includeattachment structure510 that is configured and dimensioned for releasable connection with theengagement structure82 included on theend effector20. While theengagement structure82 is shown as formed on theanvil component28 of theend effector20 in the illustrated embodiment, it should be appreciated that theattachment structure510 may alternatively be configured and dimensioned for engagement with structure formed on the surgical fastener cartridge34 (FIG. 2). Additionally, although thebranches506,508 of theintroducer member500 are illustrated as being configured and dimensioned to facilitate connection withengagement structure82 that is positioned onside portions87 of theend effector20, in alternative embodiments, it is envisioned that theengagement structure82 may be included on upper and lower portions of theend effector20, and that thebranches506,508 of theintroducer member500 may be configured and dimensioned accordingly.
• In the embodiment of theintroducer500 illustrated inFIG. 20, theattachment structure510 included on thebranches506,508 includes a pair ofprotrusions512 that are configured asarcuate detents514, and theengagement structure82 included on theanvil component28 is configured as recess(es)84 of corresponding configuration and dimensions. It should be appreciated, however, that in alternative embodiments of the present disclosure, theattachment structure510 and theengagement structure82 may assume other geometrical configurations without departing from the scope of the present disclosure.
• Thedistal end504 of theintroducer member500 includes an elongate profile that is configured and dimensioned to facilitate atraumatic distal advancement of theintroducer member500 through the patient's tissue. Thedistal end504 includes a flexible, resilient material that allows thedistal end504 to bend and flex when necessary so as to permit the clinician to navigate theintroducer member500 around the target tissue “T” (FIG. 9) and the collateral tissue “C” without causing unnecessary trauma.
• Upon application of theintroducer member500 to theanvil component28, theattachment structure510 rides along an outer surface of theend effector20, which causes thebranches506,508 to splay slightly outward in the direction indicated byarrows1. However, upon positioning of theattachment structure510 within theengagement structure82, the resilient material comprising theproximal end502 allows thebranches506,508 to return to their normal configuration, whereby thebranches506,508 are caused to engage theend effector20 in press- fit arrangement. To disconnect theintroducer500 from theend effector20, the clinician applies a predetermined force to theintroducer member500 to separate theattachment structure510 from theengagement structure82. For example, the clinician can pull theintroducer member500 distally, or rotate theintroducer member500 relative to theend effector20, to force thedetents514 from the recess(es)84. more
• In an alternative embodiment of theintroducer member500, which is shown inFIG. 21, it is envisioned that thebranches506,508 of theintroducer member500 may further includepivot members516, in addition to theattachment structure510, to facilitate separation of theintroducer500 from theend effector20. In this embodiment, when disengagement of theintroducer500 from theend effector20 is desired, a force is applied to thebranches506,508 about thepivot members516 that is directly inwardly, i.e., in the direction identified byarrows2. This application of force to thebranches506,508 about thepivot members516 causes thebranches506,508 to bend about thepivot members516 such that more proximal portions of thebranches506,508 splay outwardly, i.e., in the direction indicated byarrows1, thereby releasing theattachment structure510 from theengagement structure82, and allowing for removal of theintroducer member500.
• Referring again toFIG. 20, it is envisioned that theproximal end502 of theintroducer member500, including theattachment structure510, may be formed from a first material, whereas thedistal end504 of theintroducer member500 may be formed from a second, different material. For example, the first material may have a higher durometer than the second material. Incorporating a material with a higher durometer at theproximal end502 of theintroducer500, as opposed to a more compliant material, facilitates a more secure connection between theattachment structure510 and theengagement structure82. The material comprising thedistal end504 of theintroducer500, while more flexible than the material comprising theproximal end502, is sufficiently rigid to facilitate separation of the target tissue “T” (FIG. 9) from the collateral tissue “C” in the manner discussed above.
• In one embodiment of the disclosure, it is envisioned that thedistal end504 of theintroducer member500 may incorporate a material having a highly visible color, such as red, green, yellow, etc., in order to increase visibility of theintroducer member500 within an internal workspace.
• Referring now toFIGS. 22-24, in one embodiment of the present disclosure, it is envisioned that thedissector portion83 of theanvil component28 may comprise atip600 that is secured between the anvil plate30 (FIGS. 23,24) and the anvil cover32 (FIG. 22). As seen inFIG. 23, thetip600 includes an arcuatedistal portion602 that is configured and dimensioned to facilitate separation of the target tissue “T” (FIG. 9) from any collateral tissue “C.” Thetip600 may be formed from any suitable biocompatible material, including but not limited to polymeric materials, through any suitable process, such as molding.
• Thetip600 is secured to theanvil plate30 via apost604, rivet, or the like, that extends through corresponding openings (not shown) formed in thetip600 and theanvil plate30. Following placement of thepost604 through thetip600 and theanvil plate30, the anvil cover32 (FIG. 22) is secured to theanvil plate30 in the aforedescribed manner, e.g., via one or more welds.
• Referring now toFIGS. 25-27, an alternative embodiment of the tip, which is identified by thereference character600′, will be discussed. Thetip600′ is substantially similar to thetip600 discussed with respect toFIGS. 22-24, and accordingly, will only be described with respect to any differences therefrom.
• Thetip600′is inserted into theanvil component28 through an opening92 (FIG. 25) formed in adistal end28A thereof. As discussed above with respect to the tip600 (FIGS. 22-24), when properly positioned relative to theanvil component28, thetip600′ is oriented between the anvil plate30 (FIGS. 26,27) and the anvil cover32 (FIG. 25). In lieu of the post604 (FIG. 24) discussed above, or in addition thereto, thetip600′ includes atab606 that is configured and dimensioned for positioning within theslot50 formed in theanvil plate30 to inhibit inadvertent disconnection of thetip600′ from theanvil component28. Specifically, thetab606 is configured and dimensioned for engagement with a distal wall93 (FIGS. 25,26) defined by theslot50. Engagement of thetab606 and thedistal wall93 of theslot50 prevents distal movement of thetip600′ relative to theanvil component28 beyond a predetermined location.
• To further facilitate separation of the target tissue “T” (FIG. 9) from any collateral tissue “C,” it is envisioned that the tip600 (FIGS. 22-24),600′ (FIGS. 25-27) may be used in conjunction with any embodiment of the presently disclosed introducer member described herein, such as, for example, the introducer member identified by thereference character700 inFIG. 28.
• Theintroducer member700 includes aproximal end702 defining a hollow704 that is configured and dimensioned to facilitate attachment with thedistal end28A of the anvil component28 (seeFIG. 25). It should be appreciated, however, that the hollow704 may be configured and dimensioned for engagement with the surgical fastener cartridge34 (FIG. 2) in alternative embodiments of theintroducer member700. To facilitate attachment of theintroducer member700 to theanvil component28, theintroducer member700 includesattachment structure706 that is positioned on aninternal wall708 of theproximal end702. Theattachment structure706 extends into the hollow704, and includes a plurality ofprotrusions710. Although theprotrusions710 are illustrated as including a configuration defining a plurality ofteeth712, it should be appreciated that alternative configurations for theprotrusions710 are not beyond the scope of the present disclosure, e.g., protrusions with an arcuate configuration.
• To further enhance the connection between theintroducer member700 and theanvil component28, it is contemplated that theanvil component28, e.g., thedissector portion83, may include a roughened surface88. While the roughened surface88 has been illustrated as formed on theanvil component28 in the illustrated embodiment, the roughened surface88 alternatively be formed on the surgical fastener cartridge34 (FIG. 2) in order to enhance the connection between theintroducer member700 and thesurgical fastener cartridge34, when desired. The roughened surface88 may include any structure suitable for the intended purpose of facilitating attachment with the proximal end702 (FIG. 28) of theintroducer member700. For example, the roughened surface88 may include asurface coating89, as shown inFIG. 29, or alternatively, the roughened surface88 may include a glass-bit surface finish90, as shown inFIG. 30.
• To facilitate insertion of theanvil component28 into the hollow704 defined in theproximal end702 of theintroducer member700, it is envisioned that theanvil component28 may include apolished tip91, as also shown inFIG. 30. Thepolished tip91 serves to reduce friction between theanvil component28 and theproximal end702 of theintroducer member700 in order to allow for sufficient advancement of theanvil component28 into the hollow704 to facilitate engagement of theattachment structure706 with the roughened surface88.
• With reference now toFIGS. 31-33, an embodiment of the presently disclosed introducer member is illustrated, which is identified by thereference character800. Theintroducer member800 includes aproximal end802 and adistal end804, and is configured and dimensioned for longitudinal movement relative to the end effector20 (FIG. 1), e.g., theanvil component28. More specifically, theintroducer member800 is configured and dimensioned for slidable movement through aslot94 formed in theanvil cover32 such that theintroducer member800 is selectively repositionable between a retracted position (FIGS. 31,32) and an advanced position (FIG. 33). In the retracted position, thedistal end804 of theintroducer member800 is positioned proximally of adistal-most tip95 of theanvil component28, and in the advanced position, thedistal end804 of theintroducer member800 is positioned distally of thedistal-most tip95 of theanvil component28 to facilitate separation of the target tissue “T” (FIG. 9) from any collateral tissue “C.”
• To facilitate movement between the retracted and advanced positions, it is envisioned that theintroducer member800 may include amanual member806 that is configured and dimensioned for engagement by the clinician. In one embodiment of theintroducer member800, themanual member806 extends upwardly from theintroducer member800, and may be positioned at theproximal end802 of theintroducer member800, as shown inFIGS. 31-33, or in any other suitable location. Alternatively, themanual member806 may constitute a roughened surface (not shown) which does not extend upwardly from theintroducer member800, but rather, extends along the plane of the anvil cover32 (FIG. 3).
• In order to increase the clinician's ability to manipulate theintroducer member800, it is envisioned that theintroducer member800 may be connected to the end effector20 (FIG. 1) so as to allow for lateral movement thereof, e.g., side-to-side, as well as longitudinal movement. For example, as shown inFIGS. 34 and 35, theintroducer member800 may be connected to theanvil component28 via apivot member808 such that theintroducer member800 is movable in the directions indicated byarrows1 and2. Allowing for both longitudinal and lateral movement provides the clinician with increased access to internal spaces, which allows the clinician to more accurate place theintroducer member800 during navigation around the patient's internal tissues.
• FIGS. 36-38 illustrate another embodiment of the introducer member, which is identified by thereference character900. Theintroducer member900 includes a pair offlexible wings902 withfeet904 that are configured and dimensioned to securely engage theanvil component28, e.g., theanvil cover32. For example, it is envisioned that thefeet904 may be configured and dimensioned to engage theanvil component28 in snap-fit relation. Theintroducer member900 further includes a rail906 (FIGS. 37,38) that is configured and dimensioned for positioning within theslot50 formed in theanvil plate30. Therail906 includes awall908 that is configured and dimensioned for engagement with thedistal wall93 defined by theslot50 to inhibit distal movement of theintroducer member900 relative to theanvil component28 beyond a predetermined location in order to reduce the likelihood of inadvertent disconnection therefrom. After theanvil component28 is in the desired position adjacent the target tissue “T” (FIG. 9), prior to firing of the surgical fastener applying apparatus10 (FIG. 1), theintroducer member900 can be removed from theanvil component28 by disengaging thefeet904 from theanvil cover32. For example, thewings902 can be deformed laterally outward, e.g., by rotating theintroducer member900 relative to theanvil component28.
• FIGS. 39 and 40 illustrate another embodiment of the presently disclosed introducer that is identified by thereference character1000. Theintroducer member1000 is mounted to theanvil component28 by apivot member1002 that extends through theintroducer1000 and one ormore pivot plates1004 that are secured to an outer surface of theend effector20. Thepivot member1002 may be any member suitable for the intended purpose of facilitating lateral pivotal movement of theintroducer member1000, i.e., side-to-side in the direction indicated by arrows1 (FIG. 39), including but not limited to screws, rivets, or the like.
• It is envisioned that theintroducer member1000 may be utilized in connection withend effectors20 of various configurations. For example, it is envisioned that theintroducer member1000 may be employed in connection with ananvil component28 having a substantially linear configuration (seeFIG. 41), or alternatively, with ananvil component28 that includes theaforementioned dissector portion83, as shown inFIG. 40.
• Another embodiment of the introducer member, which is identified by thereference character1100, is illustrated inFIGS. 41 and 42. Theintroducer member1100 includes a proximal end1102 with acollar1104 that is configured and dimensioned for positioning about theanvil cover32, and adistal portion1106 that is configured and dimensioned to facilitate separation of the target tissue “T” (FIG. 9) from any collateral tissue “C.” Thecollar1104 is configured and dimensioned to engage theanvil component28 such that relative longitudinal movement therebetween is substantially inhibited. For example, it is envisioned that thecollar1104 may comprise an at least partially resilient material allowing thecollar1104 to be deformed outwardly upon association with theanvil component28 in order to facilitate a snap-fit connection with theanvil cover32.
• To further enhance stability of the connection between theintroducer1100 and theanvil component28, it is envisioned that thedistal portion1106 of theintroducer member1100 may include one ormore tabs1108, snaps, protrusions, or the like that are configured and dimensioned for engagement with corresponding structure in theanvil cover32, as shown inFIG. 41.
• With reference now toFIG. 43, another embodiment of the introducer member, which is identified by thereference character1200, will be discussed. Theintroducer member1200 includes aproximal end1202 incorporating attachment structure11204, adistal end1206 including anatraumatic tip portion1208, and anelongate body portion1210. As illustrated inFIG. 43, theelongate body portion1210 of theintroducer member1200 may include a tapered configuration to facilitate separation of the target tissue “T” (FIG. 9) from any collateral tissue
• Theproximal end1202 of theintroducer member1200 is configured and dimensioned for insertion into theopening92 formed at thedistal end28A of theanvil component28 such that theintroducer member1200 is positionable between the anvil cover32 (FIG. 3) and theanvil plate30. To facilitate attachment of theintroducer member1200 to theanvil component28, it is envisioned that theproximal end1202 of theintroducer member1200 and thedistal end28A of theanvil component28 may include corresponding structure that is configured and dimensioned for mating engagement. For example, in the embodiment shown inFIG. 43, it is envisioned that theattachment structure1204 included at theproximal end1202 of theintroducer member1200 may be configured and dimensioned for connection withcorresponding engagement structure96 formed within theopening92 at thedistal end28A of theanvil component28 in a press-fit arrangement. In the illustrated embodiment, theattachment structure1204 is depicted as including a plurality ofprotrusions1212, and theengagement structure96 is depicted as includingrecesses97 of corresponding configuration and dimensions. It should be appreciated, however, that alternative configurations for theattachment structure1204 and theengagement structure96 are not beyond the scope of the present disclosure.
• Although theintroducer member1200 is illustrated as including a configuration similar to that of the dissector portion83 (FIGS. 1,3,15), in alternative embodiments of the present disclosure, it is envisioned that theintroducer member1200 may assume other configurations. For example, as seen inFIG. 43A, theintroducer member1200 may include a more elongate configuration similar to that of theintroducer member100 discussed above with respect toFIGS. 1-10.
• Referring now toFIG. 44, in one embodiment, theattachment structure1204 included at theproximal end1202 of theintroducer member1200 may include astem1214 with ahead portion1216 attached thereto that is configured and dimensioned for positioning within the opening92 (FIG. 43) formed at thedistal end28A of theanvil component28. To facilitate retention of theattachment structure1204 within theopening92, theengagement structure96 included at thedistal end28A of theanvil component28 may include a pair ofshoulders98 defining a gap “G” (FIG. 45) therebetween. The transverse dimension of the gap “G” is larger than the transverse dimension of thestem1214, but smaller than the transverse dimension of thehead portion1216, in order to prevent inadvertent disconnection of theintroducer member1200 from theanvil component28.
• To facilitate advancement of, and control over, theintroducer member1200 during manipulation within an internal workspace, it is envisioned that thedistal end28A of theanvil component28 may be formed from a first material, e.g., a rigid material, such as solid or sheet metal, and that theintroducer member1200 may be formed from a second, more flexible material, such as plastic or rubber. To further enhance stability of the connection between theintroducer member1200 and theanvil component28, it is envisioned that theattachment structure1204 included at theproximal end1202 of theintroducer member1200 may be heat-staked to thedistal end28A of theanvil component28.
• FIG. 46 illustrates another embodiment of the presently disclosed introducer member, which is identified by thereference character1300, that includes aproximal portion1302 and adistal portion1304. Theproximal portion1302 of theintroducer member1300 includes anouter layer1306 and aninner layer1308 which collectively define acavity1310 therebetween, as well as a hollow1312 that is configured and dimensioned to receive the end effector20 (FIG. 1), e.g., the anvil component28 (FIG. 2,3) or the surgical fastener cartridge34 (FIG. 2). Theintroducer member1300 further includes apassage1314 extending longitudinally therethrough that is in fluid communication with thecavity1310 and aport1316 included on thedistal portion1304 of theintroducer member1300. Thepassage1314 allows for the communication of a fluid, such as air or saline, through theport1316 and into thecavity1310 to thereby fill and inflate thecavity1310. It is envisioned that theport1316 may include a seal (not shown), valve, or the like to inhibit the escape of fluid from thecavity1310 and/or theport1316 until such time that deflation of thecavity1310 is desired.
• Prior to inflation of thecavity1310, the hollow1312 at theproximal end1302 of theintroducer member1300 defines a transverse dimension that is smaller than the transverse dimension defined by the component of theend effector20 to which theintroducer member1300 is to be attached, e.g., a transverse dimension that is smaller than that of theanvil component28 or thesurgical fastener cartridge34. However, upon inflation of thecavity1310, as thecavity1310 fills with fluid, the transverse dimension of the hollow1312 is increased such that theend effector20, or component thereof, is positionable within the hollow1312. Following connection of theproximal end1302 of theintroducer member1300 to theend effector20, the clinician can optionally deflate thecavity1310 by draining the inflation fluid. It is also contemplated herein that the fluid within thecavity1310 may exert pressure upon theouter layer1306 and theinner layer1308, and that this pressure may be transmitted to an outer surface of the end effector20 (FIG. 1), thus assisting in retention of theproximal portion1302 of theintroducer member1300 about theend effector20.
• In order to accommodate expansion and contraction of thecavity1310, it is envisioned that either or both of theouter layer1306 and theinner layer1308 comprising theproximal portion1302 of theintroducer member1300 may be formed from a resilient material, e.g., materials with a relatively low durometer, such as shrink tubing.
• FIG. 47 illustrates another embodiment of the presently disclosed introducer member, which is identified by thereference character1400. Theintroducer member1400 includes aproximal portion1402 including a selectivelydeformable section1404, and adistal portion1406 that is positionable about thedeformable section1404.
• Thedeformable section1404 includes aresilient member1408 that is formed from a deformable, e.g., malleable, material that can be manually reconfigured by the clinician in order to assume a desired geometrical configuration. For example, it is envisioned that theresilient member1408 may include aflexible shaft1410 that is connected, either directly or operatively, to theend effector20, as shown inFIG. 47. In the illustrated embodiment theflexible shaft1410 is connected to theend effector20 viaattachment structure1412 formed, either integrally or releasably, with theend effector20, e.g., between the anvil plate30 (FIG. 3) and theanvil cover32.
• Thedistal portion1406 of theintroducer member1400 is formed from a material that is at least partially resilient in order to facilitate atraumatic advancement of theintroducer member1400 during a surgical procedure, such thatintroducer member1400 can be effectively navigated about the target tissue “T” (FIG. 9) and any collateral tissue “C” without causing unnecessary trauma. Thedistal portion1406 includes aninternal cavity1414 that is configured and dimensioned to receive thedeformable section1404. Thedistal portion1406 may be attached to theproximal portion1402 in any suitable manner, such as, for example, through the incorporation of a resilient material. Incorporating a resilient material allows thedistal portion1406 to be forced over thedeformable section1404 and/or theattachment structure1412 such that theproximal portion1402 and thedistal portion1406 engage one another in a force-fit arrangement. Alternatively, it is envisioned that theproximal portion1402 and thedistal portion1406 may include corresponding structure that is configured and dimensioned for releasable, mating engagement, such as that described in connection with several of the embodiments of the introducer member discussed herein above.
• Although theintroducer member1400 is illustrated as including an elongate configuration similar to that of theintroducer member100 discussed above with respect toFIGS. 1-10, in alternative embodiments of the present disclosure, it is envisioned that theintroducer member1400 may assume other configurations. For example, as seen inFIG. 49, theintroducer member1200 may include a configuration similar to that of the dissector portion83 (FIGS. 1,3,15).
• While each embodiment of the presently disclosed introducer member has been discussed and illustrated in connection with the end effector20 (FIG. 1), which is adapted for use in laparoscopic procedures for performing surgical anastomotic fastening of tissue, the introducer member may be adapted for use with any surgical instrument suitable for the intended purpose of applying the plurality of surgical fasteners36 (FIG. 2) to a section of tissue, and thereafter severing the tissue along a cut-line.
• The presently disclosed introducer member may alternatively be adapted for use with a surgical stapling apparatus3000 (FIG. 49), such as that disclosed in commonly assigned U.S. Pat. No. 7,334,717, currently assigned to Tyco Healthcare Group LP, the contents of which are hereby incorporated by reference herein in its entirety. Thesurgical stapling apparatus3000 includes a cartridge receiving half-section3002, which accommodates a plurality of surgical fasteners, and an anvil half-section3004. The half-sections3002,3004 are pivotally connected viahandles3006,3008 for approximation during use.
• Following approximation of the half-sections3002,3004, the surgicalfastener applying apparatus3000 is fired by driving afiring slide3010 distally through the advancement of afiring lever3012. Distal movement of thefiring slide3010 causes a plurality of cam bars to engage camming surfaces that interact with a plurality of pushers to expel the plurality of surgical fasteners from the cartridge receiving half-section3002. The surgical fasteners are positioned on either side of a track which guides a knife during longitudinal movement to thereby sever tissue along a cut-line.
• It is also envisioned that the presently disclosed introducer member may be adapted for use with a transverse anastomosis fastening instrument4000 (FIG. 50), such as that disclosed in commonly owned U.S. Pat. No. 5,964,394, currently assigned to United States Surgical Corporation, the contents of which are hereby incorporated by reference herein in its entirety. The surgicalfastener applying apparatus4000 includes anapproximation lever4001, amovable handle4002, anelongated portion4004 that extends distally from thehandle4002, and anarm4006 that extends from adistal end4008 of theelongated portion4004. The surgicalfastener applying apparatus4000 further includes aend effector4010 that includes ananvil4012 that is orthogonally affixed to thearm4006, and a surgicalfastener cartridge receiver4014 that is operatively coupled to thedistal end4008 of theelongated portion4004 for retention of thesurgical fastener cartridge200.
• Prior to firing of the surgicalfastener applying apparatus4000, theapproximation lever4001 is actuated to distally advance a drive member that is operatively connected to thesurgical fastener cartridge200 to move thesurgical fastener cartridge200 towards theanvil4012, which remains stationary, and capture tissue therebetween. Thereafter, thehandle4002 is moved to advance a pusher bar distally through theelongated portion4004 to cause corresponding movement of a head portion included at the distal end of the pusher bar. The head portion includes a plurality of fingers extending distally therefrom that are configured and dimensioned to engage the cartridge assembly to thereby discharge the plurality of surgical fasteners retained therein. Upon discharge, the surgical fasteners are driven through the tissue and into theanvil4012 for formation.
• Additionally, it is envisioned that the presently disclosed introducer member may be adapted for use with any of the other surgical fastener applying apparatus discussed in commonly owned U.S. Pat. Nos. 6,045,560; 5,964,394; 5,894,979; 5,878,937; 5,915,616; 5,836,503; 5,865,361; 5,862,972; 5,817,109; 5,797,538; and 5,782,396, the disclosures of which are hereby incorporated by reference herein in their entirety.
• In certain embodiments of the present disclosure, it is envisioned that the disclosed surgical fastener applying apparatus may include a plurality of cam bars for interacting with the pushers to deploy the surgical fasteners. For example, the apparatus disclosed in commonly owned U.S. Pat. No. 5,318,221, the disclosure of which is hereby incorporated by reference herein in its entirety, includes a cam bar adapter that holds a plurality of cam bars and a knife, as well as a channel that is advanced through operation of the handle of the apparatus, which drives the cam bars and knife forward. To clamp the anvil and the surgical fastener cartridge together, the apparatus further includes a clamp tube that is movable to surround the proximal end of the anvil.
• As another example, the apparatus disclosed in U.S. Pat. No. 5,782,396, the disclosure of which is hereby incorporated by reference herein in its entirety, includes an actuation sled and an elongated drive beam that is advanced distally through operation of the handle of the apparatus, driving the actuation sled forward. In this apparatus, the distal end of the drive beam engages the anvil and the channel that supports the surgical fastener cartridge as the drive beam travels distally to deploy the staples and clamp the anvil and surgical fastener cartridge together.
• Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, it is envisioned that the elements and features illustrated or described in connection with one exemplary embodiment may be combined with the elements and features of another without departing from the scope of the present disclosure, and that such modifications and variations are also intended to be included within the scope of the present disclosure. Accordingly, the invention is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.

Claims (13)

1-7. (canceled)

8. A method of dissecting tissue, comprising: providing a surgical fastener applying apparatus having an end effector; attaching to the end effector a flexible introducer member having an elongate profile, a proximal end of the introducer member including branches configured to receive a portion of the end effector; and atraumatically advancing the introducer member through tissue.

9. The method ofclaim 8, wherein the introducer member has first and second branches and including advancing the first and second branches toward the end effector.

10. The method ofclaim 8, wherein the end effector has a surgical stapling anvil and including attaching the introducer member to the anvil.

11. The method ofclaim 8, including using attachment structure to facilitate releasable connection of the introducer member to the end effector.

12. The method ofclaim 11, wherein a first branch of the introducer member includes a first attachment structure, and a second branch of the introducer member includes a second attachment structure.

13. The method ofclaim 12, wherein the first attachment structure has a first protrusion and the second attachment structure has a second protrusion.

14. The method ofclaim 13, including connecting at least one of the first protrusion and the second protrusion in a first recess of the end effector.

15. The method ofclaim 8, wherein the end effector includes a first jaw movably coupled with respect to a second jaw such that target tissue is positionable therebetween.

16. The method ofclaim 15, wherein one of the first jaw and the second jaws terminate in a dissector tip

17. The method ofclaim 16, including connecting the proximal end of the introducer member to the dissector tip.

18. The method ofclaim 8, further comprising separating a target tissue.

19. The method ofclaim 18, further comprising stapling the target tissue.

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