US20170181741A1 - Endoscopic purse string surgical device - Google Patents

Abstract

An endoscopic surgical stapler for applying a suture to tissue including an elongated tubular member, a first jaw positioned at the distal end portion of the tubular member and having a longitudinal axis, and a second jaw disposed in substantially parallel relation to the first jaw at the distal end portion of the tubular member. The second jaw is movable in a direction substantially perpendicular to its longitudinal axis toward the first jaw, while maintaining the substantially parallel relation between the first and second jaws. A stapling assembly is disposed in each of the first and second jaws and configured to apply surgical staples to the tissue such that a suture, in combination with the surgical staples, forms a purse string with the tissue when the surgical stapler is activated.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This application is a continuation of U.S. patent application Ser. No. 14/338,862, filed Jul. 23, 2014, which is a continuation of U.S. patent application Ser. No. 13/166,039, filed Jun 22, 2011, now U.S. Pat. No. 8,827,136, which claims the benefit of, and priority to, U.S. Provisional Patent Application Ser. No. 61/372,610, filed Aug. 11, 2010. The entire contents of each of the above applications are hereby incorporated by reference.
BACKGROUND
• Technical Field
• The present disclosure relates to a surgical stapler, and more particularly, to an endoscopic surgical stapler for affixing a purse string suture to tissue.
• Background of Related Art
• A circular stapler is one device that can be used in surgical applications for the joining of body tissue. In the area of surgical anastomotic stapling, it can be used for joining pieces of tissue in a manner such that a continuous pathway, lumen, or surgical opening, is formed after the tissue is stapled together. This lumen is formed when a circular array of staples is used to join two pieces of tissue after which the tissue interior to the innermost circle of staples is cut out by a concentric circular retractable blade. Retraction of the circular stapler removes the cut tissue to form a lumen.
• In the art of surgery, it has been known to use purse string sutures and purse string appliers for circular staplers. The suture is typically placed using a needle, staples or other suitable means for attaching the suture to the tissue. After attachment, the ends of the suture remain loose for pulling to contract or close the tissue. Conventional needles and instruments are well known in the art for inserting or attaching purse string sutures to tissue. For example, purse string surgical instruments utilizing needles and toothed jaws are disclosed in U.S. Pat. Nos. 4,345,600; 4,915,107; and 5,188,636. U.S. Pat. Nos. 4,821,939; 5,158,567; and 5,490,856 disclose purse string applicators with stapling cartridges for attaching a suture to tissue and are incorporated herein by reference in their entirety.
• Surgical instruments for attaching a purse string can require a relatively high degree of dexterity. Typically, for example, at least one free unattached end portion of the suture is in a loose state, both during and after attachment to tissue. This requires the user of the surgical instrument to either hold or keep track of the unattached end portion. Furthermore, when attempting to pull the purse string to a desired tension, it can be difficult to maintain that tension while attempting other hand movements.
• It would therefore be advantageous to provide a purse string instrument having means to hold or retain at least the end portion or portions of the suture during certain surgical procedures.
• Additionally, with the advent of minimally invasive, e.g. endoscopic, surgical procedures, it would be advantageous to provide an endoscopic purse string device which could minimally invasively apply purse string sutures. The benefits of minimally invasive surgery, e.g. shorter recovery time, reduced patient trauma, shorter hospital stay, etc. are well known.
SUMMARY
• In one aspect of the present disclosure, a surgical stapler is provided which includes a tubular member having a distal end portion and a proximal end portion, a first jaw positioned at the distal end portion of the tubular member and having a longitudinal axis, and a second jaw disposed in substantially parallel relation to the first jaw at the distal end portion of the tubular member. The second jaw is movable in a direction substantially perpendicular to its longitudinal axis toward the first jaw, while maintaining the substantially parallel relation between the first and second jaws. The surgical stapler further includes a stapling assembly disposed in each of the first and second jaws and configured to form a purse string with the tissue when the surgical stapler is activated.
• In some embodiments, the surgical stapler includes a plunger longitudinally movable within the outer tube member and a cam arm positioned to move the second jaw substantially perpendicularly to the longitudinal axis in response to longitudinal movement of the plunger.
• The surgical stapler is preferably sized to allow insertion of the surgical stapler into a surgical port for use in a minimally invasive surgical procedure.
• The surgical stapler preferably includes a suture retaining member for mounting a suture onto an outer surface of the outer tube. The surgical stapler can have a plurality of guides having slots positioned on the outer tube for releasably retaining the suture adjacent the outer tube.
• In some embodiments, the surgical stapler includes a locking mechanism to prevent unintended firing of the surgical staples from the surgical stapler. The locking mechanism may be in some embodiments a removable tab or a pivotable catch. The removable tab acts as a stop to limit longitudinal movement of the plunger in relation to the outer tube. The pivotable catch is preferably sized and shaped to removably couple the catch within a lock recess to limit longitudinal movement of the plunger in relation to the outer tube.
• The surgical stapler can include a proximal spring to bias the plunger in a proximal position relative to the outer tube and a distal spring to bias the second jaw away from the first jaw. Both the proximal and distal springs can act to prevent unintentional expulsion of the surgical staples from the surgical stapler.
• In another aspect of the present disclosure, a surgical stapler is provided comprising an endoscopic surgical stapler for applying a suture to tissue comprising an elongated tubular member having a proximal end portion and a distal end portion, and first and second jaws positioned adjacent the distal end portion of the tubular member. At least the second jaw is movable toward the first jaw from a spaced apart position to an approximated position, and each of the jaws includes a plurality of staples and a portion of a suture. An approximation mechanism moves at least the first jaw with respect to the second jaw, and includes a linear slidable member positioned within the elongated tubular member.
• The first jaw can have a first length and the second jaw can have a second length, wherein the second length is greater than the first length. In other words, a portion of the second jaw may extend proximally beyond the first jaw. The biasing member may be disposed adjacent the portion of the second jaw that extends beyond the first jaw. The first jaw may be fixed, whereas the second jaw may be movable relative to the first jaw in a substantially parallel fashion.
DESCRIPTION OF THE DRAWINGS
• The accompanying drawings, which are incorporated in and form part of the specification, illustrate the present disclosure when viewed with reference to the description, wherein:
• FIG. 1 is a perspective view of a surgical stapler in accordance with the present disclosure shown with the jaws in the open (spaced) position;
• FIG. 2 is an enlarged perspective view of the distal end portion of the surgical stapler ofFIG. 1, depicting the jaws in an open (spaced) position;
• FIG. 3 is an enlarged perspective view of the proximal end portion of the surgical stapler ofFIG. 1 corresponding to the jaws in a closed position;
• FIG. 4 is an exploded perspective view of the surgical stapler ofFIG. 1 with a plunger and a proximal spring separated from an outer tube;
• FIG. 5 is an exploded perspective view of the distal end portion of the surgical stapler ofFIG. 1 with the movable mounting jaw and stationary mounting jaw separated from the outer tube;
• FIG. 6 is a perspective view of the surgical stapler ofFIG. 1 being inserted through a surgical port and into a sub-dermal body cavity, the jaws shown in the closed position;
• FIG. 7 is a cross-sectional view of the surgical stapler ofFIG. 1 taken along section line7-7;
• FIG. 8 is a cross-sectional view taken along line8-8 ofFIG. 6;
• FIG. 9 is a perspective view of the surgical stapler ofFIG. 1 located within and extending through the surgical port and into a sub-dermal body cavity, showing the jaws in the closed position;
• FIG. 10 is a perspective view of the surgical stapler ofFIG. 1 inserted through a surgical port to apply purse string sutures to sub-dermal tissue, showing the jaws in the open position;
• FIG. 11 is a perspective view of the surgical stapler ofFIG. 1 inserted through a surgical port and with a tissue section being inserted between the jaws of the surgical stapler;
• FIG. 12 is a perspective view of the surgical stapler ofFIG. 1 inserted through a surgical port and the tissue section located between the jaws of the surgical stapler;
• FIG. 13 is a perspective view of the surgical stapler ofFIG. 1 inserted through a surgical port, wherein the surgical stapler is applying the purse string suture to the tissue section;
• FIG. 14 is a cross-sectional view of the surgical stapler taken along section line14-14 ofFIG. 12;
• FIG. 15 is a cross-sectional view of the surgical stapler taken along section line15-15 ofFIG. 13;
• FIG. 16 is a perspective view of the surgical stapler ofFIG. 11 inserted through a surgical port with the purse string suture attached to the lumen and the suture separated from the surgical stapler; and
• FIG. 17 is a cross-sectional view illustrating formation of a staple of the surgical stapler ofFIG. 1.
• Other features of the present disclosure will become apparent from the following detailed description, taken in conjunction with the accompanying drawings, which illustrate, by way of example, the principles of the present disclosure.
DETAILED DESCRIPTION
• Embodiments of the presently disclosed surgical stapler will now be described in detail with reference to the drawings wherein like numerals designate identical or corresponding elements in each of the several views. As is common in the art, the term “proximal” refers to that part or component closer to the user or operator, i.e., surgeon or physician, while the term “distal” refers to that part or component further away from the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.
• The example embodiments of the present disclosure are provided by virtue of a mechanical resecting, stapling, and/or suturing attachment which is coupleable to and remotely actuable by a mechanical device driver. In particular, the attachment includes a pair of jaws for clamping the selected section of tissue therebetween, the jaws expanding and closing in a substantially parallel disposition.
• The example embodiments of the present disclosure illustrate that in a natural state, the jaws would be in an open configuration. A catch stop would be pulled back to close the jaws in order to allow for insertion of the jaws through an access port such as a trocar. Once inside the patient, the jaws would be returned to an open configuration and would be slid over tissue, where the purse string staples of the stapling assemblies would be placed. Once the surgeon determines an appropriate position, an optional safety would be removed and the surgeon would move the movable jaw toward the fixed jaw. This action causes the staples to form pinching tissue around the outer diameter of the tissue, with a suture captured inside the formed staple. The surgical device would then be withdrawn, leaving the formed staples and the suture attached to the tissue.
• Prior to describing the present disclosure in further detail, it will first be helpful to define various terms that will be used throughout the following discussion. For example:
• The term “connect” or “connecting” may refer to adhere, affix, anchor, attach, band, bind, bolt, bond, brace, button, cohere, fasten, couple, embed, establish, fix, grip, hold, hook, implant, link, lock, lodge, screw, seal, rivet, tack on, tighten, or unite. The terms “connect” or “connecting” may refer to linking/fastening/attaching/locking any type of materials or elements or components or units in a removable or detachable or interchangeable manner. The terms “connect” and “lock” may be used interchangeably throughout the present disclosure.
• Reference will now be made in detail to embodiments of the present disclosure. While certain embodiments of the present disclosure will be described, it will be understood that it is not intended to limit the embodiments of the present disclosure to those described embodiments. To the contrary, reference to embodiments of the present disclosure is intended to cover alternatives, modifications, and equivalents as may be included within the spirit and scope of the embodiments of the present disclosure as defined by the appended claims.
• Referring now in specific detail to the drawings, with like reference numerals identifying similar or identical elements, the present disclosure is shown in cooperation with a surgical stapler for applying a suture to a tissue.
• With reference toFIG. 1, a perspective view of a surgical stapler in accordance with the present disclosure is presented.
• Thesurgical stapler100 includes astaple assembly104 positioned at a distal end and aplunger assembly106 positioned at a proximal end of thesurgical stapler100. Atubular member102 extends between the distal and proximal ends of thesurgical stapler100.
• In particular, the staplingassembly104 includes a jaw assembly. The jaw assembly includes afirst jaw122 and asecond jaw124. Thefirst jaw122 is preferably a stationary mounting jaw mounted to the distal end of thetubular member102. Thesecond jaw124 is preferably a movable mounting jaw. In an alternative embodiment, thefirst jaw122 may be of a different length compared to thesecond jaw124. For example, in one embodiment, thesecond jaw124 may be longer than thefirst jaw122 or vice versa.
• A staplingassembly126,128 is disposed along each of the mountingjaws122,124, the staplingassemblies126,128 being configured to apply at least one surgical staple to the tissue such that the distal end of thesuture130, in combination with the at least one surgical staple, forms a purse string with the tissue. This stapling/suturing process will be further described below with reference toFIGS. 6 and 9-13.
• The staplingassembly104 also includes a pair of suture guides132,134. Afirst guide132 is positioned at one end of thefirst jaw122 and asecond guide134 is positioned at one end of thesecond jaw124. The suture guides132,134 are configured to receive the distal end of thesuture130. Thesuture130 runs from the proximal end to the distal end of thesurgical stapler100, as will be described below.
• The staplingassembly104 also includes a biasingmember136. The biasingmember136 is for thesecond jaw124 to travel linearly in a direction substantially perpendicular to its longitudinal axis, while maintaining the substantially parallel correspondence between the first andsecond jaws122,124. In other words, the biasingmember136 allows for thesecond jaw124 to move substantially parallel to thefirst jaw122.
• Thetubular member102 includes asuture retaining mechanism115. Theretaining mechanism115 is retained adjacent thetubular member102 through which afirst suture section110 and asecond suture section112 are run. Thetubular member102 is an elongated tube of deformable plastic, such as80 Duro polyvinyl chloride. Theretaining mechanism115 releasably retains the first andsecond suture sections110,112 longitudinally along a length of thetubular member102.
• Surgical stapler100 further includes a mounting structure for mounting theretaining mechanism115 to thetubular member102. For example, aholder114 and aclamp116 hold and clamp the first andsecond suture sections110,112 to thetubular member102.Holder114 is mounted adjacent thetubular member102 and has an opening through which the suture sections extend.Clamp116 is located adjacent the proximal end of thesurgical stapler100 and positioned adjacenttubular member102 through which first andsecond suture sections110,112 are disposed. The proximal location ofclamp116 allows a user to grasp and engage theclamp116 during use of thesurgical stapler100, so that theproximal end118 of thefirst suture section110 and theproximal end120 of thesecond suture section112 remain intact during operation. One skilled in the art may contemplate using various combinations and equivalent embodiments of holders and clamps to releasably retain first andsecond suture sections110,112 substantially adjacent thetubular member102. Theretaining mechanism115 can be positioned along other portions of thetubular member102. Additionally, use of more than oneretaining mechanism115 in a plurality of different configurations is contemplated.
• The proximal end of thesurgical stapler100 includes aplunger assembly106. Theplunger assembly106 includes ahandle140, aspring142, agrip144, and arecess146 located on a portion of thegrip144 in order to hold acatch lock302, as described below with reference toFIG. 3. Thedistal spring142 is positioned between thehandle140 and thegrip144. Upon release of thecatch lock302, thedistal spring142 moves thehandle140 away from thegrip144. The surgeon may then access and use thegrip144 to actuate theplunger assembly106.
• Theguides132,134 may be positioned on the distal ends of thefirst jaw122 and thesecond jaw124, respectively. However, guides132,134 may be positioned on the proximal ends of thefirst jaw122 and thesecond jaw124, respectively. Additionally, a plurality ofguides132,134 may be positioned across the length of the pair of staplingassemblies126,128, on the inner surface of the first andsecond jaws122,124.
• The suture guides132,134 provide for running theproximal end118 of thefirst suture section110 and theproximal end120 of thesecond suture section112 through theretaining mechanism115 located adjacent thetubular member102, to the pair of staplingassemblies126,128 where the distal end of thesuture130 is located. One skilled in the art may contemplate using various combinations and equivalent embodiments of guides to releasably retain the distal end of thesuture130 substantially adjacent the first andsecond stapling assemblies126,128 of the first andsecond jaws122,124.
• Moreover, during manufacture of thesurgical stapler100,suture130 may be placed intoguides132,134 and throughtubular member102, withsuture130 strung taut betweenguides132,134 to be disposed substantially adjacent first andsecond stapling assemblies126,128.
• The movable mounting jaw orsecond jaw124 includes acam arm202, thecam arm202 being positioned to move thejaw124 substantially perpendicular to the longitudinal axis in response to longitudinal movement of the plunger assembly106 (seeFIG. 1). Thecam arm202 includes acam slot204 for receiving acam pin206. Thecam pin206 allows for substantially parallel movement of thesecond jaw124 relative to the longitudinal axis of thefirst jaw122 and relative to the longitudinal movement of the plunger assembly106 (seeFIG. 1). Additionally, acam block210 having acam surface208 is positioned adjacent thecam arm202. Thecam block210 is positioned at the distal end of theplunger assembly106 and actuates thecam arm202 to move thesecond jaw124 toward thefirst jaw122. That is, the distal movement of theplunger assembly106 causes thecam surface208 to engagecam arm202 to cause the substantially parallel closure of the first andsecond jaws122,124 as can be appreciated by comparing FIGS.7 and8. The movement of thecam arm202 also moves thesecond jaw124 to apply a force against the tissue to effect firing of the staples as described below.
• FIG. 3 illustrates how thehandle140 andgrip144 of theplunger assembly106 are actuated. Apivotal catch lock302 is securely locked at therecess146 of thegrip144. Thecatch lock302 is attached to thehandle140 via acatch pin306. Thecatch lock302 is releasably secured to thegrip144 via acatch stop304 that frictionally locks into therecess146 of thegrip144. In operation, when the catch stop304 is released from therecess146 of thegrip144, i.e. pivoted out ofrecess146, thehandle140 may be manipulated by a user to actuate theplunger assembly106 to drive the cam block210 (seeFIG. 2) to engagecam arm202, in order to move thesecond jaw124 in substantially parallel movement toward thefirst jaw122. It is noted that when the catch stop304 is positioned within therecess146, thedistal spring142 is in a compressed position. Thus, thedistal spring142 urges thehandle140 and thegrip144 apart when the catch stop304 is released, thereby opening the first andsecond jaws122,124 in a substantially parallel manner assecond jaw124 returns to its normal position. Thecatch lock302 enables the holding of the first andsecond jaws122,124 in a closed position for insertion through, for example, asurgical port610 and surgical port tube620 (seeFIG. 6).
• The exploded perspective view illustrates how certain components of thesurgical instrument100 are connected to each other; however, one skilled in the art may contemplate connecting such components in a plurality of different configurations. Thehandle140 is operably connected to a proximal end of adrive shaft402. The distal end of thedrive shaft402 includes thecam block210 having cam surface208 (seeFIG. 2). Additionally, thecatch lock302 having acatch stop304 is connected to an upper portion of thehandle140 via the catch pin306 (seeFIG. 3). Thedrive shaft402 is slidably positioned within thetubular member102. Thedrive shaft402 travels throughspring142 in order to allow for a predetermined distance between thehandle140 and thegrip144. The remaining components have been fully described above with reference toFIGS. 1-3.
• Cam arm202 (seeFIG. 2) interconnects thesecond jaw124 to thefirst jaw122 via ajaw mount502. Thejaw mount502FIG. 5) creates a connecting relationship between thefirst jaw122, thesecond jaw124, and thetubular member102. Thefirst jaw122 is connected to thejaw mount502 via ajaw receiving slot512. Thesecond jaw124 is connected to thejaw mount502 viapin508 extending throughhole510.Biasing member136 is inserted into thespring slot506 ofjaw mount502. That is, ajaw mount pin508 is inserted through theperpendicular slots504 of thejaw mount502 and then through thepin hole510 in order to securedly, yet movably affix thecam arm202 of thesecond jaw124 to thejaw mount502. This connects the first andsecond jaws122,124. Thetubular member102 connects to thecam arm202 via thecam pin206 inserted through acam pin hole522 of thetubular member102 and engagingslot204 ofcam arm202.
• In an example embodiment, one or more tube suture guides520 may be positioned on various surfaces of thetubular member102 in order to provide for supplemental support of the first andsecond suture sections110,112. The guides have a recess dimensioned to frictionally engage the suture. In another example embodiment, the suture guides520 may be positioned across the entire length oftubular member102.
• The partial cut-away view ofFIG. 6 depicts thesurgical instrument100 before it is inserted into a body of a patient. The staplingassembly104 of thesurgical instrument100 is inserted through thesurgical port610 having asurgical port tube620. Thesurgical port610 is positionedadjacent tissue640 of a patient, and extends through thetissue640 of the patient to provide access to the body cavity of the patient. One ormore connectors630 may be connected to thesurgical port610. For certain applications, the surgical port can include one or more internal seals.
• The operation of thesurgical stapler100 will be described with reference toFIGS. 6 and 9-13. In the illustrated embodiment, in summary, in a natural state, the jaws would be in an open configuration. The jaws would then be closed to allow for insertion of the jaws through a surgical port, e.g. trocar. (Catch lock302 can be used to hold the jaws in the closed position) Once inside the patient, the jaws would be returned to an open configuration and would be slid over tissue, where the purse string staples of the stapling assemblies would be placed. Once the surgeon determines an appropriate position, plunger would be actuated to move the movable jaw toward the fixed jaw. On continued movement, the staples would be forced from the jaws, causing the staples to form pinching tissue around the outer diameter of the tissue, with a suture captured inside the formed staple. Afterward, the plunger would be released, allowing the jaws to move to the open position, thus leaving the formed staples and the suture attached to the tissue. The jaws would then be re-closed for removal through the port. A two stage operation is therefore contemplated with the first stage closing the jaws to clamp tissue and the second stage applying sufficient force to the tissue to retract elements within the jaws as described below to from the staples. Note a tactile indicator, or a stop, can be provided to demarcate the two stages. If a stop is provided, it would be released after initial jaw approximation to allow additional movement to fire the staples.
• It is also contemplated that alternatively the jaws can be in a closed position in a natural state and then after injection through a surgical port moved to an open position to be slid over tissue.
• In use, and with initial reference toFIG. 9, in a first position, a portion of thesurgical instrument100 is inserted through thesurgical port610 and thesurgical port tube620 so as to expose the staplingassembly104 within the body of the patient. In the first position ofFIG. 9, theplunger assembly106 remains in a locked configuration due to the locking engagement of the catch stop304 ofcatch lock302 inrecess146 of the grip144 (see alsoFIG. 3).
• Next, as shown inFIG. 10, in a second position, the catch stop304 of thecatch lock302 is manually released by the surgeon from therecess146 of thegrip144 in order to actuate theplunger assembly106 via the distal spring142 (seeFIG. 3). That is, when the catch stop304 is released, thehandle140 ofplunger assembly106 is moved proximally in a longitudinal direction due to the bias ofspring142. This withdraws the cam block210 from cam arm202 (seeFIG. 2) so that thesecond jaw124 moves away from thefirst jaw122 in a substantially parallel fashion (see also the open jaw position ofFIG. 7). Thus, an opening is created between the first andsecond jaws122,124 in order to grasp tissue, for example, intestinal tissue1110 (seeFIGS. 11-13 described below).
• The first andsecond jaws122,124 are moved to approach a target as shown inFIG. 11, such as, for example,intestinal tissue1110. Once the surgeon locates thetarget tissue1110, the surgeon may maneuver the first andsecond jaws122,124 to grasp thetarget tissue1110.
• The first andsecond jaws122,124 then grasp a portion of theintestinal tissue1110 as shown inFIG. 12 (andFIG. 14). Theintestinal tissue1110 is positioned between the first andsecond jaws122,124 so that the first andsecond stapling assemblies126,128 contact a portion or portions of thetissue1110. Thecam arm202 is partially moved downwardly so as to partially compress the biasingmember136. This is shown by the movement of thecam slot204 relative to the fixedcam pin206. Thecam slot204 may move within a predetermined region defined by the location of thecam pin206.
• The surgeon subsequently manipulates thehandle140, e.g. moves thehandle140 longitudinally distally to overcome the bias ofspring142 in order to actuate theplunger assembly106 to move thecam block210 to the cam arm202 (seeFIG. 2), which in turn moves thesecond jaw124 closer to thefirst jaw122 in a substantially parallel fashion. That is, as thecam block210 moves distally, thecam surface208 rides across the top surface of thecam arm202 to force/actuate thesecond jaw124 to move in substantially parallel movement relative to thefirst jaw122. This overrides thedistal spring136 which normally maintains thejaws122,124 open relative to each other. By moving thesecond jaw124 closer to thefirst jaw122 in a substantially parallel fashion, theintestinal tissue1110 is firmly grasped between thefirst jaw122 and the second jaw124 (see alsoFIG. 15). The firm grasp allows the first andsecond stapling assemblies126,128 to firmly contact thetissue1110 in order to fire staples through thetissue1110 and/or to suture thetissue1110 in order to form a purse string suture. Note that thecam arm202 is fully moved downwardly so as to fully compress the biasingmember136. (One skilled in the art may contemplate using a plurality of different biasing members to interact with the cam arm202) This is shown by the movement of thecam slot204 relative to the fixedcam pin206. Thecam slot204 may move within a predetermined region defined by the location of thecam pin206. Therefore, in accordance withFIGS. 14 and 15, thesecond jaw124 is movable relative to thefirst jaw122, in a substantially parallel manner, via acam arm202 riding in acam slot204. Moreover, inFIG. 14, the distal end of thesuture130 is somewhat taut, whereas inFIG. 15, the distal end of thesuture130 is loose.
• The staples are formed as shown inFIGS. 17.Staple cartridge316 has ahousing319 having a pair of opposedwalls328, each defining aninternal opening320. In addition, eachwall328 is provided on the outside with a stiffener plate and has afirst slot329 extending longitudinally of theopening320 in order to slidingly receive one side of astaple321, that is, a rounded transition portion327. In addition asecond slot330 of greater width than theslot329 extends coaxially of theslot329 in order to slidably receive one side of a former322. Former322 is moved byrib318.
• The width of astaple321 is greater than the width of apusher322. Further, the lower surface of each former322 is provided with a surface complementary to the undulatingbase323 of a staple321 so as to have a projection (not shown) seated in therecess324 of thestaple321. This arrangement serves to center thestaple321 within theopening320 while also ensuring uniform motion of a staple321 out of theopening320.
• Thelegs325 ofstaple321 are deformed at the mouth of eachopening320 by a pair of inwardly directedlips331. As indicated, eachlip331 is disposed at one end of thestaple receiving slot329 in awall328. Further, thelips331 are spaced apart to define an outlet of less width than theopening320 and less width than astaple321.
• Thus, as jaws apply pressure to tissue, the lips231 are pusher rearwardly while former322 remains stationary applying lateral forces against thelegs325 by thelips331 so that thelegs325 begin to deform and move towards each other while penetrating into the layer of tissue312.
• As the staple is formed, the biasing force on the former322 is sufficient to push thedeformed staple321 through the outlet of the mouth of theopening320 past thelips331 while deforming thelips331 sufficiently to permit passage. The amount of deformation of thelips331 is sufficient to permit passage of thedeformed staple321 while at the same time being insufficient to overly compress the layer of tissue312.
• Once the stapler has been fired, the purse string is pulled from the retainers and the stapler removed from the body.
• In summary, with reference toFIGS. 6 and 9-13 theplunger assembly106 operably cooperates with thecam arm202, where thecam arm202 slidably moves within a predetermined space defined by acam slot204. Thecam slot204 moves and the biasingmember136 compresses substantially perpendicular to a longitudinal axis of the stapler. Furthermore, theperpendicular slot504 of thejaw mount502 may be moved in relation to the movement of thecam arm202. Theperpendicular slot504 is configured to move within a region defined by a fixedjaw mount pin508.
• InFIG. 16, the staplingassembly104 has completed its task by stapling/suturing thetarget tissue1110. The staples can be applied in the manner described in U.S. Pat. No. 4,821,939 previously incorporated by reference. The distal end of thesuture130 is suspended from thetarget tissue1110. Thesuture130 may be released from thesurgical stapler100 by theclamp116. Theclamp116 may be released from theholder114 in order to allow the surgeon to cut thesuture130.
• In an alternative embodiment, one skilled in the art may contemplate making the first jaw movable and the second jaw fixed, by connecting the cam arm to the first jaw, instead of the second jaw. It is also contemplated that both jaws may each include a cam arm in order to make both jaws movable. In each of these scenarios, the jaws will move in a substantially parallel fashion relative to each other. It is also contemplated that one or both of the jaws can move in a pivoting movement.
• In an alternative embodiment, a safety mechanism (not shown) may be provided at the proximal end ofhandle140 for preventing undesired clamping of thehandle140. Safety mechanism may be in the form of a lever pivotally mounted about a pivot such as a pin. The safety mechanism may be sized to permit pivoting by a thumb or a free finger of the user.
• In an alternative embodiment, thetubular member102 may be a flexible shaft. The flexible shaft may include a tubular sheath formed of an elastomeric material. Various lengths of this shaft may be provided in conjunction with the present disclosure. Moreover, theflexible shaft102 and theplunger assembly106 may be separable. If separable, the interface between the proximal end of theshaft102 and the distal end of thehandle140 should include a coupling means for any drive components. In alternate embodiments, theflexible drive shaft102 can be capable of translating a torque from one or more motors in thehandle140 to the distal end of theshaft102, while still being flexible enough to be bent, angled, curved, etc. as the surgeon deems necessary to “snake” through the bowel of a patient. One skilled in the art may contemplate a handle that includes no motors, or any other type of electro-mechanical driving means.
• In an alternative embodiment, thehandle140 may include a remote status indicator (not shown). The remote status indicator may comprise an LCD (or similar read output device) by which the user may gain knowledge of the position of components (for example whether a clamping element is in the proper position prior to the driving of the staples).
• In an alternative embodiment, the first andsecond stapling assemblies126,128 may each include a plurality of sensors (not shown). Thefirst stapling assembly126 may include a first sensor electrode that electrically communicates via communication wires with a first contact pad, and thesecond stapling assembly128 may include a second sensor that electrically communicates via communication wires with a second contact pad. The contact nodes may electrically communicate with communication wires to form a sensor circuit, such that when thefirst jaw122 and thesecond jaw124 are clamped together, the sensor electrodes are in contact, the sensor circuit is closed, and the surgeon is alerted via other circuit components (not shown) to the clamped position of thejaws122,124.
• Suture material may be classified as either absorbable or non-absorbable. Absorbable suture may be placed below the skin surface where in time, the body decomposes, dissolves, and absorbs the suture material. There are numerous non-absorbable suture materials also used during surgical procedures. The non-absorbable materials may be employed and manually removed after the intended purpose has been completed such as a surgical site that is considered healed.
• While the present disclosure has been particularly shown and described with reference to the preferred embodiments, it will be understood by those skilled in the art that various modifications inform and detail may be made therein without departing from the scope and spirit of the present disclosure. Accordingly, modifications such as those suggested above, but not limited thereto, are considered the scope of the present disclosure.

Claims (20)

1-10. (canceled)

11. A method of forming a purse string suture in tissue, the method comprising:

positioning tissue between first and second jaw members of an end effector of a surgical instrument with the first and second jaws in a parallel relationship with one another, the end effector including a suture extending between the first and second jaw members distal of the tissue positioned between the first and second jaw members;

clamping the tissue between the first and second jaw members while maintaining the parallel relationship between the first and second jaw members; and

firing the end effector to eject staples from the first jaw member and the second jaw member such that the suture and the staples form a purse string with the tissue.

12. The method according toclaim 11, wherein clamping the tissue between the first and second jaw members includes activating a cam arm associated with the second jaw member.

13. The method according toclaim 12, wherein activating the cam arm includes translating a plunger to activate the cam arm.

14. The method according toclaim 11, wherein clamping the tissue between the first and second jaw members includes moving the second jaw member towards the first jaw member with the first jaw member fixed.

15. The method according toclaim 11, further comprising releasing the suture from the surgical instrument after firing the end effector.

16. The method according toclaim 15, wherein releasing the suture from the surgical instrument includes engaging a clamp positioned proximal of the end effector to release the suture.

17. The method according toclaim 16, wherein releasing the suture from the surgical instrument includes removing the suture from a guide of the surgical instrument, the guide disposed on an outer surface of the surgical instrument between the end effector and the clamp.

18. A method of forming a purse string suture in tissue, the method comprising:

positioning tissue between first and second jaw members of an end effector of a surgical instrument with the first and second jaws in a parallel relationship with one another, the end effector supported by a distal portion of an elongate tubular member and including a suture;

advancing a slider through the elongated tubular member to clamp the tissue between the first and second jaw members while maintaining the parallel relationship between the first and second jaw members; and

continuing to advance the slider to fire the end effector to eject staples from the first jaw member and the second jaw member such that the suture and the staples form a purse string with the tissue.

19. The method according toclaim 18, wherein positioning the tissue between the first and second jaw members includes positioning a portion of the suture extending between the first and second jaw members distal of the tissue positioned between the first and second jaw members.

20. The method according toclaim 18, wherein advancing the slider translates a plunger within the elongate tubular member.

21. The method according toclaim 19, wherein advancing translating the plunger activates a cam arm to move the second jaw member towards the first jaw member.

22. The method according toclaim 18, further comprising releasing the suture from the surgical instrument after firing the end effector.

23. The method according toclaim 22, wherein releasing the suture from the surgical instrument includes engaging a clamp positioned proximal of the end effector to release the suture.

24. The method according toclaim 23, wherein releasing the suture from the surgical instrument includes removing the suture from a guide of the surgical instrument, the guide disposed on an outer surface of the surgical instrument between the end effector and the clamp.

25. A method of forming a purse string suture in tissue, the method comprising:

positioning tissue between first and second jaw members of an end effector of a surgical instrument, the end effector supported by a distal portion of an elongate tubular member and including a suture;

advancing a slider through the elongated tubular member to clamp the tissue between the first and second jaw members;

continuing to advance the slider to fire the end effector to eject staples from the first jaw member and the second jaw member such that the suture and the staples form a purse string with the tissue; and

releasing the suture from an outer surface of the elongate tubular member after forming the purse string.

26. The method according toclaim 25, wherein positioning tissue between the first and second jaw members includes the and second jaws in a parallel relationship with one another.

27. The method according toclaim 25, wherein advancing the slider includes maintaining a parallel relationship between the first and second jaw members.

28. The method according toclaim 25, wherein releasing the suture from the outer surface includes removing the suture from guides disposed along the outer surface of the elongate tubular member.

29. The method according toclaim 25, wherein releasing the suture from the outer surface includes engaging a clamp disposed on the outer surface of the elongate tubular member proximal of the end effector.

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