US20190076143A1 - Stapler anvil with compliant tip - Google Patents

Abstract

A surgical stapler is provided that includes a first jaw and a second jaw. The first jaw includes a proximal end portion and a distal end portion. The second jaw includes a proximal end portion and a distal end portion. The proximal end portion of the first jaw is pivotally mounted to the proximal end portion of the second jaw. A flexible guide is secured to the distal end portion of the first jaw.

Description

RELATED APPLICATIONS
• This patent application claims priority to and the benefit of the filing date of U.S. Provisional Patent Application 62/255,138, entitled “STAPLER ANVIL WITH COMPLIANT TIP” filed Nov. 13, 2015, which is incorporated by reference herein in its entirety.
BACKGROUND
• Minimally invasive surgical techniques are aimed at reducing the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. As a consequence, the average length of a hospital stay for standard surgery may be shortened significantly using minimally invasive surgical techniques. Also, patient recovery times, patient discomfort, surgical side effects, and time away from work may also be reduced with minimally invasive surgery.
• Minimally invasive teleoperated surgical systems have been developed to increase a surgeon's dexterity when working on an internal surgical site, as well as to allow a surgeon to operate on a patient from a remote location (outside the sterile field). In a teleoperated surgical system, the surgeon is often provided with an image of the surgical site at a control console. While viewing a three dimensional image of the surgical site on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master input or control devices of the control console. Each of the master input devices controls the motion of a servo-mechanically actuated/articulated surgical instrument. During the surgical procedure, the teleoperated surgical system can provide mechanical actuation and control of a variety of surgical instruments or tools having end effectors that perform various functions for the surgeon, for example, holding or driving a needle, grasping a blood vessel, dissecting tissue, stapling tissue, or the like, in response to manipulation of the master input devices.
SUMMARY
• In one aspect, a surgical stapler includes a first jaw that includes a proximal end portion and a distal end portion and a second jaw that includes a proximal end portion and a distal end portion. The proximal end portion of the first jaw is pivotally mounted to the proximal end portion of the second jaw. The flexible guide secured to the distal end portion of the first jaw.
BRIEF DESCRIPTION OF THE DRAWINGS
• Aspects of the present disclosure are best understood from the following detailed description when read with the accompanying figures. It is emphasized that, in accordance with the standard practice in the industry, various features are not drawn to scale. In fact, the dimensions of the various features may be arbitrarily increased or reduced for clarity of discussion. In addition, the present disclosure may repeat reference numerals and/or letters in the various examples. This repetition is for the purpose of simplicity and clarity and does not in itself dictate a relationship between the various embodiments and/or configurations discussed.
• FIG. 1 is an illustrative plan view illustration of a teleoperated surgical system in accordance with some embodiments.
• FIG. 2 is an illustrative perspective view of the Surgeon's Console in accordance with some embodiments.
• FIG. 3 is an illustrative perspective view of the Electronics Cart in accordance with some embodiments.
• FIG. 4 is an illustrative bock diagram diagrammatically representing functional relationships among components of a teleoperated surgery system in accordance with some embodiments.
• FIGS. 5A-5B are illustrative drawings showing a Patient Side Cart and a surgical tool62, respectively in accordance with some embodiments.
• FIG. 6 is an illustrative drawing showing an example surgical tool in accordance with some embodiments.
• FIG. 7A is an illustrative perspective drawing of a surgical tool assembly with a stapling device having first and second jaws and having a compliant guide tip secured to the first jaw in accordance with some embodiments.
• FIG. 7B is an illustrative side view of the distal portion of the surgical tool assembly with the stapling device jaws in a closed position in accordance with some embodiments.
• FIG. 8 is an illustrative exploded view of a detachable stationary second jaw in accordance with some embodiments.
• FIGS. 9A-9C are illustrative drawings showing positions of the driver shuttle within the cartridge body during different stages of staple deployment process in accordance with some embodiments.
• FIG. 10 is an illustrative perspective view of a flexible guide secured to the distal end of the first jaw, in accordance with some embodiments.
• FIGS. 11A-11B are illustrative drawings showing complementary attachment mechanisms formed in the far distal portion of the first jaw (FIG. 11A) and in the proximal base portion (FIG. 11B) of the flexible guide in accordance with some embodiments.
• FIGS. 12A-12B are illustrative simplified schematic drawings of a side elevation view (FIG. 12A) and a top elevation view (FIG. 12B) used to explain certain relative dimensions of a stapler device having a flexible tip in accordance with some embodiments.
• FIGS. 13A-13E are illustrative drawings of multiple alternative flexible guide tips having different contours that may be interchangeably secured to a far distal end portion of a first jaw in accordance with some embodiments.
• FIGS. 14A-14D are illustrative schematic diagrams showing use of a flexible guide tip to guide an anvil jaw of a stapler device among anatomical structures in accordance with some embodiments.
• FIG. 15 is an illustrative drawing showing a flexible tip used to guide an anvil jaw between anatomical structures in accordance with some embodiments.
DESCRIPTION OF EMBODIMENTS
• The following description is presented to enable any person skilled in the art to create and use a stapler anvil with compliant tip for use in surgery. Various modifications to the embodiments will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other embodiments and applications without departing from the spirit and scope of the inventive subject matter. Moreover, in the following description, numerous details are set forth for the purpose of explanation. However, one of ordinary skill in the art will realize that the inventive subject matter might be practiced without the use of these specific details. In other instances, well-known machine components, processes and data structures are shown in block diagram form in order not to obscure the disclosure with unnecessary detail. Identical reference numerals may be used to represent different views of the same item in different drawings. Flow diagrams in drawings referenced below are used to represent processes. A computer system may be configured to perform some of these processes. Modules within flow diagrams representing computer implemented processes represent the configuration of a computer system according to computer program code to perform the acts described with reference to these modules. Thus, the inventive subject matter is not intended to be limited to the embodiments shown, but is to be accorded the widest scope consistent with the principles and features disclosed herein.
• Referring now to the drawings, in which like reference numerals represent like parts throughout the several views,FIG. 1 is an illustrative plan view of a teleoperatedsurgical system10, typically used for performing a minimally invasive diagnostic or surgical procedure on a Patient12 who is lying down on an Operating table14. The system can include a Surgeon's Console16 for use by aSurgeon18 during the procedure. One ormore Assistants20 may also participate in the procedure. The teleoperatedsurgical system10 can further include a Patient Side Cart22 and anElectronics Cart24. The Patient Side Cart22 can manipulate at least one removably coupled tool assembly26 (hereinafter also referred to as a “tool”) through a minimally invasive incision in the body of the Patient12 while theSurgeon18 views the surgical site through the Console16. An image of the surgical site can be obtained by an imaging device28 (also called endoscope28 in contexts where endoscopes may be used), such as a stereoscopic endoscope, which can be manipulated by the Patient Side Cart22 to orient the endoscope28. TheElectronics Cart24 can be used to process the images of the surgical site for subsequent display to theSurgeon18 through the Surgeon's Console16. The number ofsurgical tools26 used at one time will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room among other factors.
• FIG. 2 is an illustrative perspective view of the Surgeon's Console16. The Surgeon's Console16 includes a left eye display32 and a right eye display34 for presenting theSurgeon18 with a coordinated stereo view of the surgical site that enables depth perception. The Console16 further includes one or more input control devices36, which in turn cause the Patient Side Cart22 (shown inFIG. 1) to manipulate one or more tools. The input control devices36 can provide the same degrees of freedom as their associated tools26 (shown inFIG. 1) to provide the Surgeon with telepresence, or the perception that the input control devices36 are integral with thetools26 so that the Surgeon has a strong sense of directly controlling thetools26. To this end, position, force, and tactile feedback sensors (not shown) may be employed to transmit position, force, and tactile sensations from thetools26 back to the Surgeon's hands through the input control devices36.
• FIG. 3 is an illustrative perspective view of theElectronics Cart24. TheElectronics Cart24 can be coupled with the endoscope28 and can include a processor to process captured images for subsequent display, such as to a Surgeon on the Surgeon's Console, or on another suitable display located locally and/or remotely. For example, where a stereoscopic endoscope is used, theElectronics Cart24 can process the captured images to present the Surgeon with coordinated stereo images of the surgical site. Such coordination can include alignment between the opposing images and can include adjusting the stereo working distance of the stereoscopic endoscope.
• FIG. 4 is an illustrative bock diagram diagrammatically representing functional relationships among components of a teleoperated surgery system50 (such assystem10 ofFIG. 1). As discussed above, a Surgeon's Console52 (such as Surgeon's Console16 inFIG. 1) can be used by a Surgeon to control a Patient Side Cart (Surgical Robot)54 (such as Patient Side Cart22 inFIG. 1) during a minimally invasive procedure. The Patient Side Cart54 can use an imaging device, such as a stereoscopic endoscope, to capture images of the procedure site and output the captured images to an Electronics Cart56 (such as theElectronics Cart24 inFIG. 1). As discussed above, the Electronics Cart56 can process the captured images in a variety of ways prior to any subsequent display. For example, the Electronics Cart56 can overlay the captured images with a virtual control interface prior to displaying the combined images to the Surgeon via the Surgeon's Console52. The Patient Side Cart54 can output the captured images for processing outside the Electronics Cart56. For example, the Patient Side Cart54 can output the captured images to a processor58, which can be used to process the captured images. The images can also be processed by a combination the Electronics Cart56 and the processor58, which can be coupled together to process the captured images jointly, sequentially, and/or combinations thereof. One or moreseparate displays60 can also be coupled with the processor58 and/or the Electronics Cart56 for local and/or remote display of images, such as images of the procedure site, or other related images.
• FIGS. 5A-5B are illustrative drawings showing a Patient Side Cart22 and a surgical tool62, respectively in accordance with some embodiments. The surgical tool62 is an example of thesurgical tools26. The Patient Side Cart22 shown provides for the manipulation of threesurgical tools26 and an imaging device28, such as a stereoscopic endoscope used for the capture of images of the site of the procedure. Manipulation is provided by teleoperated mechanisms having a number of robotic joints. The imaging device28 and thesurgical tools26 can be positioned and manipulated through incisions in the patient so that a kinematic remote center is maintained at the incision to minimize the size of the incision. Images of the surgical site can include images of the distal ends of thesurgical tools26 when they are positioned within the field-of-view of the imaging device28.
• FIG. 6 is an illustrative drawing showing an examplesurgical tool70 that includes aproximal chassis72, aninstrument shaft74, and adistal end effector76 having ajaw78 that can be articulated to grip a patient tissue. The proximal chassis includes input couplers that are configured to interface with and be driven by corresponding output couplers of the Patient Side Cart22. The input couplers are drivingly coupled with drive shafts that are disposed within theinstrument shaft74. The drive shafts are drivingly coupled with theend effector76.
• FIG. 7A is an illustrative perspective drawing of a surgical tool assembly200 with a stapling device210 (also “stapler device210”) having a compliant guide (also called flexible guide)211 disposed at a distal end in accordance with some embodiments. The stapling device includes rigid first andsecond jaws214,216 shown in an open position. Thecompliant guide211 is secured to thefirst jaw214 of thestapling device210 to aid a surgeon in guiding thefirst jaw214 to an anatomical tissue structure that is to be stapled that is located behind other anatomical features that obscures the tissue structure from a surgeon's view. The tool assembly200 includes aproximal actuation assembly202, amain shaft206, a two degree of freedom (2-dof) wrist208, shown in partial cutaway, and thestapling device210. Thestapling device210 includes anend effector base212 coupled to a distal side of the 2-dof wrist208, a firstarticulable jaw214 and a stationarysecond jaw216. Thefirst jaw214, sometimes referred to as theanvil jaw214, has a distal end214-1 and a proximal end214-2. Thesecond jaw216 also has a distal end216-1 and a proximal end216-2. Theend effector base212 includes apivot pin217 secured between theend effector base212 and a proximal end of thefirst jaw214, about which a proximal end of thefirst jaw214 pivots to achieve opening and closing movement of thefirst jaw214 relative to thesecond jaw216. In an open position shown inFIG. 7A, thefirst jaw214 is rotated to a position in which distal ends214-1,216-1 of the first andsecond jaws214,216 are spaced apart so that the jaws can be more easily maneuvered within a surgical site to encompass anatomical tissue (not shown) between them without actually clamping the tissue in place between them.
• In many embodiments, theactuation assembly202 is operatively coupled with the wrist208 so as to selectively reorient thestapling device210 relative to themain shaft206 in two dimensions, referred to as pitch and yaw, and is operatively coupled with thestapling device210 so as to actuate rotation of thefirst jaw214 about thepivot pin217 to open and close thefirst jaw214 relative to theend effector base212 and thesecond jaw216. In accordance with some embodiments, control cables (not shown) extend through a bore in themain shaft206 to interconnect theactuation assembly202 with the wrist208. Theactuation assembly202 imparts forces to the control cables that result in pitch and yaw movement of the wrist208 and thestapler device210. Details of a suitable cable control mechanisms that can be used are disclosed in U.S. Pat. No. 8,852,174 (filed Nov. 12, 2010) issued to Burbank, which is expressly incorporated herein in its entirety by this reference. In accordance with some embodiments a rotationally-driven clamping mechanism (not shown) actuates theupper jaw214 relative to thelower jaw216 to securely clamp tissue between the upper and lower jaws. The clamping mechanism is rotationally driven by a drive shaft (not shown) disposed internal to themain shaft206. Details of a suitable drive shaft-driven clamping mechanism that can be used are disclosed in U.S. Pat. No. 8,876,857 issued to Burbank (filed Nov. 12, 2010), the full disclosure of which is hereby expressly incorporated herein by reference. In alternative embodiments, suitable cables (not shown) are used to impart forces to open or close thejaws214,216. Details of a suitable cable-driven clamping mechanism that can be used are disclosed U.S. Patent Application Ser. No. 62/255,123, filed on Nov. 13, 2015 and entitled “Stapler with composite cardan and screw drive,”, the full disclosure of which is hereby expressly incorporated herein by reference.
• FIG. 7B is an illustrative side view of the distal portion of the surgical tool assembly200 with thejaws214,216 in a closed position disposed parallel to each other spaced apart by an amount to accommodate anatomical tissue (not shown) that may be clamped between them in accordance with some embodiments. Thefirst jaw214 includes an anvil220 having a rigid metal anvil surface220-1 that faces thesecond jaw216. In operation, staples are deformed against the anvil surface220-1 to staple together tissue (not shown) disposed between the first andsecond jaws214,216. Thesecond jaw216 includes an elongatedstapler cartridge body218 seated within a rigid metal stapler cartridgebody support channel221 configured to support thecartridge body218. Thestapler cartridge body218 carries staples to be used to attach tissue during a surgical procedure. Thestapler cartridge body218 defines a centrallongitudinal knife slot238 that extends through thecartridge body218 and extends along substantially its entire length. Thestapler cartridge body218 also defines multiple laterally spaced rows ofstaple openings106 that each extends longitudinally along thecartridge body218. In some embodiments, three rows ofstaple openings106 extended along one side of theknife slot238, and three rows of staple openings extended along an opposite side of theknife slot238. Each staple retention slot240 (also “staple opening240”) is sized to receive a staple.
• FIG. 8 is an illustrative exploded view of a stationarysecond jaw216 in accordance with some embodiments. Thesecond jaw216 includes thecartridge body218 received within asupport channel structure221. Thecartridge body218 includes a proximal end218-1 and a distal end218-2. Thecartridge body218 includes cartridgeouter sidewalls234 and anupper surface236. Theupper surface236 faces the anvil220-1 of thefirst jaw214, which acts as an anvil, when the second jaw is mounted to theend effector base212. Theupper surface236 of thecartridge218 defines a central firstlongitudinal cartridge slot238 that extends through thecartridge218 when thecartridge body218 is disposed within thesupport channel structure221. Theupper surface236 also defines multiple rows of laterally spacedstaple retention slots240 that extend longitudinally along one side of thefirst cartridge slot238 and defines multiple rows of laterally spacedstaple retention slots240 that extend longitudinally along an opposite side of thefirst cartridge slot238. Eachstaple retention slot240 is sized to receive astaple242. Adrive shuttle144 includes a plurality of inclinedupstanding cam wedges246 and aknife248 upstanding between and proximal to thecam wedges246. Thecartridge body218 defines longitudinal slots (not shown) in its underside along which thecam wedges246 can slide with the knife upstanding from and sliding within thefirst cartridge slot238.
• FIGS. 9A-9C are illustrative drawings showing positions of thedrive shuttle144 within thecartridge body218 during different stages of staple deployment process in accordance with some embodiments. Thecartridge body218 defines an internalcentral cavity320 extending between its distal end218-1 and its proximal end218-2. Alead screw134 is mounted within thecavity320 in engagement with complementary threads (not shown) located at thedrive shuttle144 for rotation relative to thehousing cartridge body218 and extends between the distal end218-1 and its proximal end218-2 through the central cavity620.
• FIG. 9A shows thedrive shuttle144 located adjacent the proximal end218-2 of thecartridge body218 at the beginning of a stapling run.FIG. 9B shows thedrive shuttle144 disposed in a middle portion of thecartridge body218 during a stapling run.FIG. 9C shows thedrive shuttle144 located adjacent the distal end218-2 after stapling completion of a stapling run. In operation during a stapling run using thestapler device210, thedrive shuttle144 translates through the longitudinal pusher slots239-1,239-2, formed in an underside of thecartridge218 to advance thecam wedges246 into sequential contact withdrive shuttle144 within the longitudinally spacedretention slots240, to causedrive shuttle144 to translate vertically withinretention slots240, and to urgestaples242 fromretention slots240 into the staple deforming cavities (not shown) formed within the anvil220 of thefirst jaw214. As thedrive shuttle144 translates longitudinally, it pushes up fasteners staples, which are deformation against the anvil220. Meanwhile, theknife248 upstands through thefirst cartridge slot238 and cuts tissue between tissue regions stapled through action of thecam wedges246, fasteners staples and the anvil220. U.S. Pat. No. 8,991,678 (filed Oct. 26, 2012) issued to Wellman et al., which is incorporated herein in its entirety by this reference, discloses a surgical stapler cartridge and its operation.
• FIG. 10 is an illustrative perspective view of aflexible guide211 secured to the distal end214-1 of thefirst jaw214, in accordance with some embodiments. The distal end of the first jaw includes a fardistal portion266. The anvil surface220-1 includes multiple rows of staple deformation indents260 configured to have staples deflected against them during dispensing of thestaples242. The fardistal portion266 of thefirst jaw214 is disposed distal to the portion of thefirst jaw214 in which theindents260 are formed. Theindents260 are positioned to align withstaple openings240 formed in thecartridge body218, when thestaple device210jaws214,216 are disposed in a closed position parallel to one another. In accordance with some embodiments, the anvil surface220-1 includes acenterline region262 with three rows ofindents260 on each side of it. The three rows ofindents260 are aligned with three rows ofstaple openings240 formed on opposite sides of theknife slot238 when the jaws are closed. Thus, it will be appreciated that the distal end214-1 is wide enough to accommodate the multiple rows of deformation indents260. Theflexible guide211 includes a proximal base portion211-2 secured to the distal end214-1 of thefirst jaw214 and includes a distal tip portion211-1. Theflexible guide211 has a tapered shape that is wider at its proximal base211-2 and narrower at its distal tip211-1. Theflexible guide211 and the distal end214-1 of thefirst jaw214 have complementary outer surface contours that cooperate to provide a continuous smooth surface that includes the surface of the fardistal portion266 and the outer surface of theflexible guide211.
• FIGS. 11A-11B are illustrative drawings showing complementary attachment mechanisms formed in the fardistal portion266 of the first jaw214 (FIG. 11A) and in the proximal base portion211-2 (FIG. 11B) of theflexible guide211 in accordance with some embodiments. Referring toFIG. 11A, the fardistal portion266 of thefirst jaw214 includes a substantially rectangulardistal end face268 that defines anend face opening270 surrounded by a retainer surface272 (in this case, also a “proximal end face272”). Referring toFIG. 11B, the proximal base portion211-2 of theflexible guide211 includes a substantially rectangularproximal end face272. Abeam274 upstands proximally from theproximal end face272. Thebeam274 includes an outward projectingflange276. Theend face opening270 is sized to permit passage of theflange276 through it. More particularly, thebeam274 and itsflange276 are formed of a flexible material that is sufficiently deformable for theflange276 to be pushed through theend face opening270. Moreover, theretainer surface272 and theflange276 have complementary surfaces that interact to secure theguide211 in place once theflange276 is received within theend face opening270. Thus, to secure theguide211 to thefirst jaw214, a user may apply a force to push theflange276 to deform it sufficiently to squeeze through theend face opening270 so that theflange276 engages theretainer surface272. Conversely, a user may apply a force to pull theflange276 out of engagement with theretainer surface272 so that theupstanding beam274 and theflange276 can be removed through theend face opening270.
• Theflexible guide211 is used by a surgeon working manually or using a teleoperated minimally invasive surgical system to guide thefirst jaw214, also referred to as the anvil jaw, of astapler device210 into a position in which the first and second jaws214-216 can be closed to clamp anatomical tissue between them for stapling. Theflexible guide211 has a tapered contour that smoothly changes over its length between a small-dimension distal tip portion211-1 and a greater dimension proximal base portion211-2 that matches the dimension of the fardistal portion266 of thefirst jaw214. The taper contour of theflexible guide211 aids a surgeon in using the flexible guide to locate an unseen passage between anatomical structures that thefirst jaw214, which is secured to theflexible guide211, can follow.
• In accordance with some embodiments, theflexible tip211 is formed from a material that is sufficiently compliant so that theflexible guide211 flexes in response to abutting against delicate anatomical tissue likely to be encountered in the course of its passage unseen by a surgeon behind other anatomical structures. In accordance with some embodiments, the material is sufficiently compliant that it is likely to comply with and conform to the contour of such anatomical structures so as to avoid deforming their shape and possibly causing damage. likely to be encountered while the tip is out of view of a surgeon guiding the tip due to passage of theguide211 behind other anatomical structures.
• More specifically, in accordance with some embodiments, theflexible guide211 is formed from a medically inert material, i.e. a material that does not interact chemically with tissue structures of a surgical site, having a durometer hardness measure that preferably is in a range 30-60 Shore A, and that is even more preferably in a range 40-50 Shore A. Suitable materials include Silicon, TPE, TPU, Ktryton, and Viton.
• FIGS. 12A-12B are illustrative simplified schematic drawings of a side elevation view (FIG. 12A) and a top elevation view (FIG. 12B) used to explain certain relative dimensions of astapler device210 having aflexible tip211 in accordance with some embodiments. Referring toFIG. 12A, thepivot217 rotatably secures thefirst jaw214 to thebase212. Thesecond jaw216 is fixedly secured to thebase212. Thejaws214,216 are shown in an open position. Referring toFIGS. 12A-6B, thefirst jaw214 and theflexible guide211 share a longitudinalcentral axis280.
• A flexible tip length (T_L) refers to a length along thecentral axis280 between a length between the proximal base portion211-2 and the distal tip portion211-1 of theflexible tip211. A flexible tip height (T_H) refers to a transverse length, perpendicular to thecentral axis280, between anupper portion650 of the proximal base portion211-2 and the distal tip portion211-1 of theflexible guide211. Theupper portion650 of the proximal base portion211-2 is disposed adjacent a back side surface220-2 of thefirst jaw214 that faces away from the anvil surface220-1 when theflexible guide211 is secured to thefirst jaw214. A flexible tip curvature (T_C) is defined as the ratio of tip height to tip length (T_H/T_L). In accordance with some embodiments, thefirst jaw214 has a generally rectangular shape in which a first jaw length dimension extends parallel to thelongitudinal axis280 and a first jaw width dimension extends perpendicular to thelongitudinal axis280. Thus, a first jaw width dimension (A1_W) refers to a transverse distance, perpendicular to thecentral axis280, in a plane of the anvil surface220-1. Moreover, a first jaw height (A1_H) refers to a distance between the anvil surface220-1 and the back side surface220-2 of thefirst jaw214. Thus, the first jaw height dimension extends perpendicular to the length and width dimensions and perpendicular to thecentral axis280.
• FIGS. 13A-13E are illustrative drawings of multiple alternative flexible guide tips having different contours that may be interchangeably secured to a fardistal end portion266 of thefirst jaw214 in accordance with some embodiments. The flexible guide tips602-606 ofFIGS. 13A-13C have different lengths and similar gentle curvatures. Theflexible guide tip608 ofFIGS. 13D-13E illustrates flexure of theflexible tip608 upon contact with tissue structure. Each of the example curvatures extends in a direction toward thesecond jaw216 and within the diameter of the device from thesecond jaw216 and toward from the anvil surface220-1. Each of the alternative flexible tips602-608 includes abeam274 andflange276 for use for selective engagement with the distal portion214-1 of thefirst jaw214. Different length guide tips608-608 are suitable for different surgical settings. The wider the tissue structure behind which thefirst jaw214 must pass, the longer the flexible tip that may be employed. In particular, for example, a surgeon may look for the tip to emerge from behind the tissue structure as an indication that a passage exists behind the structure through which thefirst jaw214 can safely pass. The wider the tissue structure, the longer the tip that may be used.
• Referring toFIGS. 13A-13C, respective first, second and thirdflexible tips602,604,606 each has a progressively longer flexible tip length (T_L) and each has a progressively shallower flexible tip curvature (T_C). However, each has the substantially the same flexible tip height (T_H). In accordance with some embodiments, the flexible tip height (T_H) is selected to be at least as great as the first jaw height (A1_H) so that each of the first, second and third flexible tips602-606 is suitable for use to explore for voids between anatomical structures (not shown) that are sufficiently wide to accommodate passage of the first jaw height (A1_H) dimension. The different length first, second and third flexible tips602-606 are suitable for different exploring different length passages between anatomical structures (not shown). Moreover, the greater a flexible tip's length dimension (T_L) for a given flexible tip height (T_H), the more pliant its distal tip portion211-1 it will be narrower at its distal tip portion211-1, and therefore, will include less mass and will more easily comply with tissue structures (not shown) that may be encountered during traversal of an anatomical tissue region.
• FIGS. 14A-14D are illustrative schematic diagrams showing use of a flexible guide tip to guide an anvil jaw of a stapler device among anatomical structures in accordance with some embodiments.FIG. 14A shows thestapler jaws214,216 in an open position, with theflexible guide211 extending behind alarge tissue structure302, such as lung tissue for example, so as to be out of view from a perspective of a surgeon (not shown). A region that is to be stapled, referred to as astaple target region304, indicated with dashed lines. First second and third individualanatomical structures306,308,310 are disposed nearby thestaple target region304. For example, the firstindividual structure306 may be a pulmonary artery; the secondindividual structure308 may be a pulmonary vein; and the thirdindividual structure310 may be a main artery. In this example, thestaple target region304 crosses over the first individualanatomical structure306. Referring toFIG. 14B, it is assumed that the surgeon has caused thefirst arm214 and theflexible guide211 to follow a path behind thelarge tissue structure302 in which theguide211 abuts the second individualanatomical structure308. However, theflexible guide211 is sufficiently flexible that its shape bends in compliance with the shape of the second individualanatomical structure308 that it has bumped into. Although the secondanatomical structure308 is shown to have been slightly deformed due to the contact, it is not deformed sufficiently to cause damage to it. Assume that the surgeon recognizes that theguide211 must have contacted an unseen anatomical structure, since theguide211 has not emerged from behind thelarge tissue structure302, even though it should have based upon how much of the tip's length is hidden behind it. Referring toFIG. 14C, the surgeon it is assumed that the surgeon now has inserted theanvil jaw214 and theguide211 behind the large tissue structure, but this time on a different path that threads between the hidden anatomical tissue structures306-310. The tip is shown poking out from a side of thelarge tissue structure302 that is opposite the side that it went in. The surgeon determines that thefirst jaw214 is properly aligned with thestaple target region304. Referring toFIG. 14D, thejaws214,216 are rotated to a closed position clamping thestaple target region304 between them, and the staples are dispensed.
• FIG. 15 is an illustrative drawing showing aflexible guide211 used to guide ananvil jaw214 between anatomical structures in accordance with some embodiments. Assume that alarge tissue structure402 hides theflexible guide211 and the distal portion of theanvil jaw214 from a surgeon's field view. Assume that the large tissue structure includes ling tissue and that hidden behind it are apulmonary artery406, apulmonary vein408 and amain artery410, Further assume that astaple target region404 indicated by dashed lines is disposed on thepulmonary artery406. It can be seen that theguide211 has passed behind thepulmonary artery406 and in front of thepulmonary vein408. Theguide211 is used by a surgeon to guide the anvil jaw, which follows behind it into position to dispense staples at thestaple target region404.
• The foregoing description and drawings of embodiments in accordance with the present invention are merely illustrative of the principles of the invention. Therefore, it will be understood that various modifications can be made to the embodiments by those skilled in the art without departing from the spirit and scope of the invention, which is defined in the appended claims.

Claims (23)

1. A surgical stapler comprising:

a first jaw that includes a proximal end portion and a distal end portion;

a second jaw that includes a proximal end portion and a distal end portion, wherein the proximal end portion of the first jaw is pivotally mounted to the proximal end portion of the second jaw; and

a flexible guide secured to the distal end portion of the first jaw.

2. The surgical stapler ofclaim 1, wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw; and

a tip portion distally spaced apart from the distal end portion of the first jaw.

3. The surgical stapler ofclaim 1, wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw; and

a tip portion distally spaced apart from the distal end portion of the first jaw, wherein the flexible guide has a tapered contour between the base portion and the tip portion.

4. The surgical stapler ofclaim 1, wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw

a tip portion distally spaced apart from the distal end portion of the first jaw, wherein the tip portion is more flexible than the base portion.

5. The surgical stapler ofclaim 1, wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw;

a tip portion distally spaced apart from the distal end portion of the first jaw, wherein a cross section of the tip portion is narrower than a cross section of the base portion, wherein a section of the tip portion comprises less mass than a section of the base portion.

6. The surgical stapler ofclaim 1,

wherein the first jaw includes an anvil surface; and

wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw, and

a tip portion distally spaced apart from the distal end portion of the first jaw, wherein the flexible guide has a contour between the base portion and the tip portion that curves toward the anvil surface.

7. The surgical stapler ofclaim 1,

wherein the first jaw includes an anvil surface and has a longitudinal central axis; and

wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw, and

a tip portion distally spaced apart from the distal end portion of the first jaw in alignment with the central axis, wherein the flexible guide has a contour between the base portion and the tip portion that curves toward the anvil surface.

8. The surgical stapler ofclaim 1,

wherein the first jaw includes an anvil surface and has a longitudinal central axis and a first jaw height; and

wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw, and

a tip portion distally spaced apart from the distal end portion of the first jaw in alignment with the central axis, wherein the flexible guide has a contour between the base portion and the tip portion that curves toward the anvil surface such that the tip portion is spaced apart from the first jaw by a first distance in a direction perpendicular to the central axis and the base portion is spaced apart from the first jaw by a second distance in the direction perpendicular to the central axis, and wherein the first distance is greater than the second distance by an amount equal to or greater than the first jaw height.

9. The surgical stapler ofclaim 1,

wherein the first jaw includes an anvil surface and has a longitudinal central axis and a first jaw width; and

wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw; and

a tip portion distally spaced apart from the distal end portion of the first jaw in alignment with the central axis, wherein the flexible guide has a contour between the base portion and the tip portion that curves toward the anvil surface such that the tip portion is spaced apart from the first jaw by a first distance in a direction perpendicular to the longitudinal central axis and the base portion is spaced apart from the first jaw by a second distance in the direction perpendicular to the central axis, and wherein the first distance is greater than the second distance by an amount equal to or greater than the first jaw width.

10. The surgical stapler ofclaim 1,

wherein the first and second jaws are rigid; and

wherein the flexible guide includes a compliant material.

11. The surgical stapler ofclaim 1,

wherein the flexible guide includes a compliant material having a durometer measure within a range 30-60 Shore A.

12. The surgical stapler ofclaim 1,

wherein the flexible guide includes a compliant material having a durometer measure within a range 40-50 Shore A.

13. The surgical stapler ofclaim 1,

wherein the flexible guide includes a medically inert material.

14. The surgical stapler ofclaim 1, wherein the first jaw includes an anvil surface; the surgical stapler further including;

a stapler cartridge secured to the second jaw.

15. The surgical stapler ofclaim 14, wherein the flexible guide includes:

a base portion secured to the distal end portion of the first jaw; and

a tip portion distally spaced apart from the distal end portion of the first jaw, wherein the flexible guide has a contour between the base portion and the tip portion that curves toward the anvil surface.

16. The surgical stapler ofclaim 15,

wherein the first jaw has a longitudinal central axis and a first jaw height;

wherein the tip portion is spaced apart from the first jaw by a first distance in a direction perpendicular to the longitudinal central axis and the end portion is spaced apart from the first jaw by a second distance in the direction perpendicular to the longitudinal central axis; and

wherein the first distance is greater than the second distance by an amount equal to or greater than the first jaw height.

17. The surgical stapler ofclaim 15,

wherein the first jaw has a longitudinal central axis and a first jaw width;

wherein the tip portion is spaced apart from the first jaw by a first distance in a direction perpendicular to the longitudinal central axis and the end portion is spaced apart from the first jaw by a second distance in the direction perpendicular to the longitudinal central axis; and

wherein the first distance is greater than the second distance by an amount equal to or greater than the first jaw width.

18. The surgical stapler ofclaim 1, wherein the first jaw includes an anvil surface, the surgical stapler further including;

a stapler cartridge secured to the second jaw, wherein the flexible guide includes a compliant material having a durometer measure within a range 30-60 Shore A.

19. A surgical stapler comprising:

a first jaw that includes a proximal end portion, a distal end portion, and an anvil surface;

a second jaw that includes a proximal end portion and a distal end portion, wherein the proximal end portion of the first jaw is pivotally mounted to the proximal end portion of the second jaw; and

a flexible guide secured to the distal end portion of the first jaw, wherein the flexible guide has a base portion and a tip portion, wherein the tip portion is more flexible than the base portion, and wherein the flexible guide is tapered and has a contour that curves the tip portion towards the anvil surface

20. The surgical stapler ofclaim 19,

wherein the first jaw includes an anvil surface and has a jaw height and a jaw width;

wherein the tip portion is spaced apart from the first jaw by a first distance in a direction perpendicular to a central axis of the first jaw and the base portion is spaced apart from the first jaw by a second distance in the direction perpendicular to the central axis; and

wherein the first distance is greater than the second distance by an amount no less than a jaw dimension selected from the group consisting of: the jaw height and the jaw width.

21. The surgical stapler ofclaim 19, wherein the flexible guide includes a medically inert, compliant material having a durometer measure within a range 30-60 Shore A.

22. A method of assembling a surgical stapler comprising a first jaw and a second jaw, wherein a proximal end portion of the first jaw is pivotally mounted to a proximal end portion of the second jaw, the method comprising:

securing a flexible guide to the first jaw; and

securing a stapler cartridge to the second jaw.

23. The method ofclaim 22,

wherein the first jaw includes an anvil surface that is rigid relative to the flexible guide; and

wherein the flexible guide includes a base portion and a tip portion, wherein the tip portion is more flexible than the base portion, wherein the flexible guide has a contour that is tapered and curves the tip portion toward the anvil surface, and wherein the flexible guide includes a medically inert, compliant material.

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