US20220304682A1 - Fastener cartridge with non-repeating fastener rows - Google Patents

Abstract

A surgical device having at least one rotary input screw in the end effector is provided. A rotary input screw can extend through a central longitudinal portion of the end effector. The end effector can include an improved closure system, firing systems, leveraging and alignment features between the staple cartridge and the surgical device, staple cartridges having multi-staple drivers, single-firing knifes and lockout/safety features for the same, and/or modified staple patterns, for example. Certain components can be 3D-printed components.

Description

BACKGROUND
• The present invention relates to surgical instruments and, in various arrangements, to surgical stapling and cutting instruments, end effectors, and staple cartridges for use therewith that are designed to staple and cut tissue.
BRIEF DESCRIPTION OF THE DRAWINGS
• Various features of the embodiments described herein, together with advantages thereof, may be understood in accordance with the following description taken in conjunction with the accompanying drawings as follows:
• FIG. 1 is a perspective view of a surgical stapling instrument comprising a handle, a shaft assembly, and an end effector, in accordance with at least one aspect of the present disclosure.
• FIG. 2 is a perspective view of the end effector and a portion of the shaft assembly of the surgical stapling instrument ofFIG. 1, wherein the end effector is illustrated in a straight, or non-articulated, configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 3 is a perspective view of the end effector and a portion of the shaft assembly of the surgical stapling instrument ofFIG. 1, wherein the end effector is illustrated in an articulated configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 4 is an exploded perspective view of the end effector and a portion of the shaft assembly of the surgical stapling instrument ofFIG. 1, in accordance with at least one aspect of the present disclosure.
• FIG. 5 is a cross-sectional elevation view of the end effector and a portion of the shaft assembly of the surgical stapling instrument ofFIG. 1, wherein the end effector is illustrated in an unfired, clamped configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 6 is a plan view of the end effector and a portion of the shaft assembly of the surgical stapling instrument ofFIG. 1, in accordance with at least one aspect of the present disclosure.
• FIG. 7 is a cross-sectional elevation view of the end effector and a portion of the shaft assembly ofFIG. 1 taken along section line6-6 inFIG. 6, wherein the end effector is illustrated in an open configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 8 is a cross-sectional elevation view of the end effector and a portion of the shaft assembly ofFIG. 1 taken along section line7-7 inFIG. 6, wherein the end effector is illustrated in a clamped configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 9 is a perspective view of a surgical stapling assembly comprising a shaft assembly and the end effector ofFIG. 1, wherein the end effector is attached to the shaft assembly by way of an articulation joint, in accordance with at least one aspect of the present disclosure.
• FIG. 10 is an exploded perspective view of the surgical stapling assembly ofFIG. 9, in accordance with at least one aspect of the present disclosure.
• FIG. 11 is a cross-sectional elevation view of the surgical stapling assembly ofFIG. 9, wherein the end effector is illustrated in an unfired, clamped configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 12 is a perspective view of a surgical stapling assembly comprising a shaft assembly and the end effector ofFIG. 1, wherein the end effector is attached to the shaft assembly by way of an articulation joint, in accordance with at least one aspect of the present disclosure.
• FIG. 13 is an exploded perspective view of the surgical stapling assembly ofFIG. 12, in accordance with at least one aspect of the present disclosure.
• FIG. 14 is a cross-sectional elevation view of the surgical stapling assembly ofFIG. 12, wherein the end effector is illustrated in an unfired, clamped configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 15 is a perspective view of a surgical stapling assembly comprising a shaft assembly and the end effector ofFIG. 1, wherein the end effector is attached to the shaft assembly by way of an articulation joint, in accordance with at least one aspect of the present disclosure.
• FIG. 16 is an exploded perspective view of the surgical stapling assembly ofFIG. 15, in accordance with at least one aspect of the present disclosure.
• FIG. 17 is a cross-sectional elevation view of the surgical stapling assembly ofFIG. 15, wherein the end effector is illustrated in an unfired, clamped configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 18 is a perspective view of a surgical end effector assembly comprising the end effector ofFIG. 1 and a flexible firing drive system, in accordance with at least one aspect of the present disclosure.
• FIG. 19 is an exploded perspective view of the surgical stapling assembly ofFIG. 18, in accordance with at least one aspect of the present disclosure.
• FIG. 20 is a cross-sectional elevation view of the surgical end effector assembly ofFIG. 18, wherein the surgical end effector assembly is illustrated in an unfired, clamped configuration, in accordance with at least one aspect of the present disclosure.
• FIG. 21 is a perspective view of robotic controller, in accordance with at least one aspect of the present disclosure.
• FIG. 22 is a perspective view of a robotic arm cart for a robotic surgical system, depicting manipulators on the robotic arm cart operably supporting surgical tools, in accordance with at least one aspect of the present disclosure.
• FIG. 23 is a side view of a manipulator of the surgical arm cart ofFIG. 22 and a surgical grasping tool, in accordance with at least one aspect of the present disclosure.
• FIG. 24 is a perspective view of a staple cartridge, according to various aspects of the present disclosure.
• FIG. 25 is a perspective view of a portion of the staple cartridge ofFIG. 24, depicting a triple driver in a fired configuration in the staple cartridge, according to various aspects of the present disclosure.
• FIG. 26 is a perspective view of the triple driver ofFIG. 25, according to various aspects of the present disclosure.
• FIG. 27 is a plan view of the triple driver ofFIG. 26, according to various aspects of the present disclosure.
• FIG. 28 is a bottom perspective view of the triple driver ofFIG. 26, according to various aspects of the present disclosure.
• FIG. 29 is an elevation cross-section view of a portion of an end effector, depicting a staple cartridge therein with portions of the staple cartridge hidden for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 30 is a detail view of the end effector ofFIG. 29, according to various aspects of the present disclosure.
• FIG. 31 is an elevation cross-section view of a portion of an end effector including a staple cartridge therein, according to various aspects of the present disclosure.
• FIG. 32 is a schematic of a triple driver, depicting a modified geometry with dashed lines and showing relative positioning of a rotary drive screw with phantom lines, according to various aspects of the present disclosure.
• FIG. 33 is a bottom perspective view of a cartridge body with portions hidden for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 34 is a detail view of a portion of the cartridge body ofFIG. 33, depicting a chamfer defined into the cartridge body around an inner staple cavity, according to various aspects of the present disclosure.
• FIG. 35 is an elevation cross-section view of an inner support column of a driver and a portion of the cartridge body ofFIG. 33, depicting the inner support column in an unfired configuration relative to an inner staple cavity, according to various aspects of the present disclosure.
• FIG. 36 is a perspective view of a portion of a support column of a driver, according to various aspects of the present disclosure.
• FIG. 37 is an elevational view of the portion of the support column ofFIG. 36, depicting a portion of a staple supported on the support column, according to various aspects of the present disclosure.
• FIG. 38 is an elevation view of a staple cartridge, according to various aspects of the present disclosure.
• FIG. 39 is an elevation cross-section view of the staple cartridge ofFIG. 38 taken along a plane shown inFIG. 38, according to various aspects of the present disclosure.
• FIG. 40 is a perspective cross-section view of a portion of the staple cartridge ofFIG. 38 taken along the plane shown inFIG. 38, depicting a driver in a fully fired position therein, according to various aspects of the present disclosure.
• FIG. 41 is a perspective view of the driver ofFIG. 40, according to various aspects of the present disclosure.
• FIG. 42 is a perspective view of a driver, according to various aspects of the present disclosure.
• FIG. 43 is a perspective cross-section view of a portion of an anvil, according to various aspects of the present disclosure.
• FIG. 44 is a schematic depicting a deformation process for a 4D printed matrix for a staple cartridge, according to various aspects of the present disclosure.
• FIG. 45 is a perspective view of a staple cartridge and a channel, depicting alignment and leveraging features for installing the staple cartridge into the channel, further depicting the staple cartridge in an aligned and partially installed configuration relative to the channel, according to various aspects of the present disclosure.
• FIG. 46 is an elevation view of a proximal portion of the staple cartridge and the channel ofFIG. 45 depicting the staple cartridge in the aligned and partially installed configuration, according to various aspects of the present disclosure.
• FIG. 47 is a perspective view of a distal portion of the staple cartridge and the channel ofFIG. 45, depicting the staple cartridge in the aligned and partially installed configuration, according to various aspects of the present disclosure.
• FIG. 48 is a perspective view of a distal portion of the staple cartridge and the channel ofFIG. 45, depicting the staple cartridge installed and fully seated in the channel, further depicting an anvil in a clamped configuration relative to the staple cartridge, according to various aspects of the present disclosure.
• FIG. 49 is a perspective view of the distal portion of the staple cartridge, the channel, and the anvil ofFIG. 48, depicting the staple cartridge installed and fully seated in the channel, and further depicting a latch on the underside of the staple cartridge in a latched position relative to the channel, according to various aspects of the present disclosure.
• FIG. 50 is a perspective view of a distal portion of a staple cartridge, a channel, and an anvil, depicting the staple cartridge installed in the channel and the anvil in a clamped configuration relative to the staple cartridge, further depicting a flexible latch on the underside of the staple cartridge in a latched position relative to the channel, according to various aspects of the present disclosure.
• FIG. 51 is a perspective view of a channel and a staple cartridge, depicting alignment and leveraging features for installing the staple cartridge into the channel, further depicting the staple cartridge in an aligned and partially installed configuration relative to the channel, according to various aspects of the present disclosure.
• FIG. 52 is a perspective view of a portion of a staple cartridge and a channel, depicting lateral latching arms of the staple cartridge engaged with lateral passages in sidewalls of the channel, according to various aspects of the present disclosure.
• FIG. 53 is a plan partial cross-section view of the portion of the staple cartridge and the channel ofFIG. 52, depicting the lateral latching arms of the staple cartridge engaged with lateral passages in sidewalls of the channel, according to various aspects of the present disclosure.
• FIG. 54 is a perspective view of a staple cartridge and a rotary drive screw, according to various aspects of the present disclosure.
• FIG. 55 is a perspective view of a distal portion of the staple cartridge and the rotary drive screw ofFIG. 54, depicting a cartridge body and drivers with the drivers in their unfired positions in the cartridge body, according to various aspects of the present disclosure.
• FIG. 56 is a perspective view of the distal portion of the staple cartridge and the rotary drive screw ofFIG. 55 with the drivers in their unfired positions and depicting hidden internal features with dashed lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 57 is another perspective view of a distal portion of the staple cartridge and the rotary drive screw ofFIG. 55 with the drivers in their unfired positions and depicting hidden internal features with dashed lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 58 is a perspective view of a distal portion of the staple cartridge ofFIG. 54 with the drivers moved to their fired positions in the cartridge body, according to various aspects of the present disclosure.
• FIG. 59 is a perspective view of the distal portion of the staple cartridge ofFIG. 58 with the drivers in their fired positions and depicting hidden internal features with dashed lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 60 is a perspective view of a proximal portion of a staple cartridge having a row of indentations, according to various aspects of the present disclosure.
• FIG. 61 is a perspective cross-section view of the staple cartridge ofFIG. 60, depicting an indentation in the cartridge body engaged with a lip on a sidewall of a driver, according to various aspects of the present disclosure.
• FIG. 62 is a perspective exploded view of a portion of a cartridge body and a driver having interference features for engaging the cartridge body, according to various aspects of the present disclosure.
• FIG. 63 is a perspective exploded view of a staple cartridge, according to various aspects of the present disclosure.
• FIG. 64 is perspective view of a portion of a cartridge frame and arm thereof in an unformed configuration, according to various aspects of the present disclosure.
• FIG. 65 is a perspective view of the portion of the cartridge frame and the arm ofFIG. 64, depicting the arm in a formed configuration, according to various aspects of the present disclosure.
• FIG. 66 is an elevation cross-section view of a cartridge body and a cartridge frame depicting a heat staked retention feature therebetween, according to various aspects of the present disclosure.
• FIG. 67 is an elevation cross-section view of a cartridge body and a cartridge frame during a heat staking process, according to various aspects of the present disclosure.
• FIG. 68 is a perspective view of a cartridge frame and an insert support for use during the heat staking process ofFIG. 67, according to various aspects of the present disclosure.
• FIG. 69 is a perspective view of a composite cartridge body including a metal pan and plastic composite material, depicting the hidden metal pan with dashed lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 70 is an elevation view of the composite cartridge body ofFIG. 69 depicting the hidden metal pan with dashed lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 71 is a perspective view of a portion of a surgical end effector including a staple cartridge positioned therein, according to various aspects of the present disclosure.
• FIG. 72 is an elevation cross-section view of the portion of the surgical end effector and staple cartridge ofFIG. 71, according to various aspects of the present disclosure.
• FIG. 73 is a perspective view of a tamper-evident tear-away lid, according to various aspects of the present disclosure.
• FIG. 74 is a perspective view of a body of a sled assembly, according to various aspects of the present disclosure.
• FIG. 75 is a perspective, exploded cross-section view of the sled assembly ofFIG. 74 including the body and a knife, according to various aspects of the present disclosure.
• FIG. 76 is a perspective cross-section view of the sled assembly ofFIG. 74, according to various aspects of the present disclosure.
• FIG. 77 is an elevation partial cross-section view of an end effector with portions removed for illustrative purposes, depicting a firing member, a cartridge body, and the sled assembly ofFIG. 74, according to various aspects of the present disclosure.
• FIG. 78 is a perspective view of a sled assembly aligned with rows of drivers, according to various aspects of the present disclosure.
• FIG. 79 is a perspective exploded view of the sled assembly ofFIG. 78, according to various aspects of the present disclosure.
• FIG. 80 is a perspective partial cross-section view of the sled assembly ofFIG. 78, according to various aspects of the present disclosure.
• FIG. 81 is a perspective view of the sled assembly ofFIG. 78 engaged with a firing system including a rotary drive screw and a firing member threadably coupled to the rotary drive screw, according to various aspects of the present disclosure.
• FIG. 82 is a perspective view of an end effector including a lockout in a locked configuration, according to various aspects of the present disclosure.
• FIG. 83 is a perspective view of a portion of the end effector ofFIG. 82 with parts removed for illustrative purposes, depicting the lockout in the locked configuration, according to various aspects of the present disclosure.
• FIG. 84 is an elevation cross-section view of a portion of the end effector ofFIG. 82, depicting the lockout in the locked configuration, according to various aspects of the present disclosure.
• FIG. 85 is a perspective view of a portion of the end effector ofFIG. 82 with parts removed for illustrative purposes, depicting a staple cartridge including the sled assembly ofFIG. 78 installed in the end effector, further depicting the lockout in the unlocked configuration, according to various aspects of the present disclosure.
• FIG. 86 is an elevation view of a portion of the staple cartridge and the sled assembly ofFIG. 85, depicting the sled assembly in an unfired position, according to various aspects of the present disclosure.
• FIG. 87 is a plan view of a portion of the underside of the staple cartridge and the sled assembly ofFIG. 85, depicting a portion of the firing assembly with phantom lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 88 is an elevation cross-section view of the staple cartridge ofFIG. 85, according to various aspects of the present disclosure.
• FIG. 89 is an elevation cross-section view of a staple cartridge, according to various aspects of the present disclosure.
• FIG. 90 is a perspective view of a firing member and a sled assembly, depicting the firing member in an unfired configuration, according to various aspects of the present disclosure.
• FIG. 91 is an exploded view of the sled assembly ofFIG. 90, according to various aspects of the present disclosure.
• FIG. 92 is a perspective view of the firing member and the sled assembly ofFIG. 90 relative to a cartridge body which is shown in phantom lines for illustrative purposes, depicting the firing assembly in a first advanced configuration in which the firing member is moved into driving engagement with the sled assembly, which is moved into driving engagement with drivers in the cartridge body, according to various aspects of the present disclosure.
• FIG. 93 is an elevation view of the firing member and the sled assembly ofFIG. 90 with certain hidden features shown with dashed lines for illustrative purposes, depicting the firing member in the first advanced configuration, according to various aspects of the present disclosure.
• FIG. 94 is an elevation cross-section view of the firing member and the sled assembly ofFIG. 90 taken along the plane indicated inFIG. 90, depicting the firing member in the first advanced configuration, according to various aspects of the present disclosure.
• FIG. 95 is an elevation cross-section view of the firing member and the sled assembly ofFIG. 90 taken along the plane indicated inFIG. 93, depicting the firing member in the first advanced configuration, according to various aspects of the present disclosure.
• FIG. 96A is an elevation view of the firing member and the sled assembly ofFIG. 90 with certain hidden features shown with dashed lines for illustrative purposes, depicting the firing member in a first retracted configuration, according to various aspects of the present disclosure.
• FIG. 96B is an elevation view of the firing member and the sled assembly ofFIG. 90 with certain hidden features shown with dashed lines for illustrative purposes, depicting the firing member in a second retracted configuration, according to various aspects of the present disclosure.
• FIG. 96C is an elevation view of the firing member and the sled assembly ofFIG. 90 with certain hidden features shown with dashed lines for illustrative purposes, depicting the firing member in a third retracted configuration, according to various aspects of the present disclosure.
• FIG. 96D is an elevation view of the firing member and the sled assembly ofFIG. 90 with certain hidden features shown with dashed lines for illustrative purposes, depicting the firing member in a fourth retracted configuration, according to various aspects of the present disclosure.
• FIG. 97 is an elevation view of the firing member and the sled assembly ofFIG. 90 relative to the cartridge body ofFIG. 92, depicting the firing member in the fourth retracted configuration ofFIG. 96D, wherein the cartridge body is shown in phantom lines for illustrative purposes, according to various aspects of the present disclosure.
• FIG. 98 is a plan view of the firing member and the sled assembly ofFIG. 90 and the cartridge body ofFIG. 92, depicting the firing assembly in the fourth retracted configuration ofFIG. 96D, according to various aspects of the present disclosure.
• FIG. 99 is a perspective view of a surgical end effector having a firing assembly including a rotary drive screw and a reusable firing member with an integral two-rail sled, according to various aspects of the present disclosure.
• FIG. 100A is an exploded perspective view of the reusable firing member ofFIG. 99 and a single-use knife and a firing indicator for use with the reusable firing member, according to various aspects of the present disclosure.
• FIG. 100B is a perspective view of the single-use knife and firing indicator ofFIG. 100A assembled to the reusable firing member ofFIG. 99, and further depicting triple drivers and staples thereon being deployed by the integral two-rail sled of the reusable firing member, according to various aspects of the present disclosure.
• FIG. 101 is an elevation view of the triple drivers, staples, and the reusable firing member ofFIG. 100B, according to various aspects of the present disclosure.
• FIG. 102 is a perspective view of one of the triple drivers ofFIG. 100B, according to various aspects of the present disclosure.
• FIG. 103 is a plan view of a portion of a cartridge body housing the triple drivers ofFIG. 100B, and further depicting the firing member ofFIG. 100A, according to various aspects of the present disclosure.
• FIG. 104 is perspective view of the underside of a portion of the cartridge body ofFIG. 103, according to various aspects of the present disclosure.
• FIG. 105 is an elevation cross-section view of an end effector including the cartridge body, the firing member, and the triple drivers ofFIG. 103, according to various aspects of the present disclosure.
• FIG. 106 is a perspective cross-section view of the cartridge body ofFIG. 103, according to various aspects of the present disclosure.
• FIG. 107 is a perspective view of a cartridge body, according to various aspects of the present disclosure.
• FIG. 108 is a perspective view of a portion of an end effector including the drive assembly ofFIG. 99, depicting a lockout arrangement including a lock nut mounted to the rotary drive screw, wherein the lockout nut is in a locked position, according to various aspects of the present disclosure.
• FIG. 109A is an elevation view of the end effector ofFIG. 108 with certain parts removed and other parts hidden and shown with phantom lines, depicting the lock nut in the locked position, according to various aspects of the present disclosure.
• FIG. 109B is an elevation cross-section view of the end effector ofFIG. 108 with certain parts removed and other parts hidden and shown with phantom lines, depicting the lock nut in an unlocked position, according to various aspects of the present disclosure.
• FIG. 110 is a perspective view of a portion of the cartridge body ofFIG. 103 and further depicting a lockout key in a proximal position in the cartridge body, according to various aspects of the present disclosure.
• FIG. 111 is a perspective view of a portion of the end effector ofFIG. 108 with the cartridge body ofFIG. 110 installed in the end effector and the lockout key in a proximal position in which the lockout key is positioned to overcome the lockout arrangement by moving the lock nut to the unlocked position ofFIG. 109B, according to various aspects of the present disclosure.
• FIG. 112 is a perspective view of a portion of the underside of the cartridge body ofFIG. 110, depicting the lockout key in the unfired position, according to various aspects of the present disclosure.
• FIG. 113 is a perspective partial cutaway view of a portion of the end effector ofFIG. 108 with the cartridge body ofFIG. 110 installed in the end effector and partially cutaway for illustrative purposes to expose the lockout key advanced to a distal position, according to various aspects of the present disclosure.
• FIG. 114 is a perspective view of the portion of the end effector and the cartridge body ofFIG. 113 with the lockout key in the distal position, according to various aspects of the present disclosure.
• FIG. 115 is a perspective partial cutaway view of a portion of the end effector ofFIG. 108 with the cartridge body ofFIG. 110 installed in the end effector and partially cutaway for illustrative purposes to expose the lock nut in the locked position, according to various aspects of the present disclosure.
• FIG. 116 is a perspective view of a portion of an end effector with certain portions removed and other portions transparent and shown with phantom lines for illustrative purposes, depicting a lockout arrangement in a locked configuration, according to various aspects of the present disclosure.
• FIG. 117 is a perspective view of a portion of the end effector ofFIG. 116 with certain portions removed and other portions transparent for illustrative purposes, depicting the lockout arrangement in the locked configuration, according to various aspects of the present disclosure.
• FIG. 118 is a plan view of a staple cartridge depicting patterns of staple cavities, according to various aspects of the present disclosure.
• FIG. 119 is a schematic depicting staple cavity patterns for a staple cartridge, according to various aspects of the present disclosure.
• FIG. 120 is a schematic depicting staple cavity patterns for a staple cartridge, according to various aspects of the present disclosure.
• FIG. 121 is a plan view of a staple cartridge depicting patterns of staple cavities, according to various aspects of the present disclosure.
• FIG. 122 is a plan view of staple cartridges schematically depicting a tissue stops, according to various aspects of the present disclosure.
• Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate various embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
DETAILED DESCRIPTION
• Applicant of the present application owns the following U.S. Patent Applications that were filed on even date herewith and which are each herein incorporated by reference in their respective entireties:
• U.S. Patent Application entitled METHOD OF USING A POWERED STAPLING DEVICE, Attorney Docket No. END9298USNP1/200859-1M;
• U.S. Patent Application entitled SURGICAL STAPLING ASSEMBLY COMPRISING NONPLANAR STAPLES AND PLANAR STAPLES, Attorney Docket No. END9298USNP2/200859-2;
• U.S. Patent Application entitled SURGICAL STAPLE CARTRIDGE COMPRISING LONGITUDINAL SUPPORT BEAM, Attorney Docket No. END9298USNP3/200859-3;
• U.S. Patent Application entitled ROTARY-DRIVEN SURGICAL STAPLING ASSEMBLY COMPRISING ECCENTRICALLY DRIVEN FIRING MEMBER, Attorney Docket No. END9298USNP4/200859-4;
• U.S. Patent Application entitled ROTARY-DRIVEN SURGICAL STAPLING ASSEMBLY COMPRISING A FLOATABLE COMPONENT, Attorney Docket No. END9298USNP5/200859-5;
• U.S. Patent Application entitled DRIVERS FOR FASTENER CARTRIDGE ASSEMBLIES HAVING ROTARY DRIVE SCREWS, Attorney Docket No. END9298USNP6/200859-6;
• U.S. Patent Application entitled MATING FEATURES BETWEEN DRIVERS AND UNDERSIDE OF A CARTRIDGE DECK, attorney Docket No. END9298USNP7/200859-7;
• U.S. Patent Application entitled LEVERAGING SURFACES FOR CARTRIDGE INSTALLATION, Attorney Docket No. END9298USNP8/200859-8;
• U.S. Patent Application entitled FIRING MEMBERS HAVING FLEXIBLE PORTIONS FOR ADAPTING TO A LOAD DURING A SURGICAL FIRING STROKE, Attorney Docket No. END9298USNP10/200859-10;
• U.S. Patent Application entitled STAPLING ASSEMBLY COMPONENTS HAVING METAL SUBSTRATES AND PLASTIC BODIES, Attorney Docket No. END9298USNP11/200859-11;
• U.S. Patent Application entitled MULTI-AXIS PIVOT JOINTS FOR SURGICAL INSTRUMENTS AND METHODS OF MANUFACTURING SAME, Attorney Docket No. END9298USNP12/200859-12;
• U.S. Patent Application entitled JOINT ARRANGEMENTS FOR MULTI-PLANAR ALIGNMENT AND SUPPORT OF OPERATIONAL DRIVE SHAFTS IN ARTICULATABLE SURGICAL INSTRUMENTS, Attorney Docket No. END9298USNP13/200859-13; and
• U.S. Patent Application entitled SURGICAL INSTRUMENT ARTICULATION JOINT ARRANGEMENTS COMPRISING MULTIPLE MOVING LINKAGE FEATURES, Attorney Docket No. END9298USNP14/200859-14.
• Applicant of the present application owns the following U.S. Patent Applications and U.S. Patents that were filed on Dec. 19, 2017 and which are each herein incorporated by reference in their respective entireties:
• U.S. Pat. No. 10,835,330, entitled METHOD FOR DETERMINING THE POSITION OF A ROTATABLE JAW OF A SURGICAL INSTRUMENT ATTACHMENT ASSEMBLY;
• U.S. Pat. No. 10,716,565, entitled SURGICAL INSTRUMENTS WITH DUAL ARTICULATION DRIVERS;
• U.S. patent application Ser. No. 15/847,325, entitled SURGICAL TOOLS CONFIGURED FOR INTERCHANGEABLE USE WITH DIFFERENT CONTROLLER INTERFACES, now U.S. Patent Application Publication No. 2019/0183491;
• U.S. Pat. No. 10,729,509, entitled SURGICAL INSTRUMENT COMPRISING CLOSURE AND FIRING LOCKING MECHANISM;
• U.S. patent application Ser. No. 15/847,315, entitled ROBOTIC ATTACHMENT COMPRISING EXTERIOR DRIVE ACTUATOR, now U.S. Patent Application Publication No. 2019/0183594; and
• U.S. Design Pat. No. D910,847, entitled SURGICAL INSTRUMENT ASSEMBLY.
• Applicant of the present application owns the following U.S. Patent Applications and U.S. Patents that were filed on Jun. 28, 2017 and which are each herein incorporated by reference in their respective entireties:
• U.S. patent application Ser. No. 15/635,693, entitled SURGICAL INSTRUMENT COMPRISING AN OFFSET ARTICULATION JOINT, now U.S. Patent Application Publication No. 2019/0000466;
• U.S. patent application Ser. No. 15/635,729, entitled SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO, now U.S. Patent Application Publication No. 2019/0000467;
• U.S. patent application Ser. No. 15/635,785, entitled SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM RATIO, now U.S. Patent Application Publication No. 2019/0000469;
• U.S. patent application Ser. No. 15/635,808, entitled SURGICAL INSTRUMENT COMPRISING FIRING MEMBER SUPPORTS, now U.S. Patent Application Publication No. 2019/0000471;
• U.S. patent application Ser. No. 15/635,837, entitled SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE TO A FRAME, now U.S. Patent Application Publication No. 2019/0000472;
• U.S. Pat. No. 10,779,824, entitled SURGICAL INSTRUMENT COMPRISING AN ARTICULATION SYSTEM LOCKABLE BY A CLOSURE SYSTEM;
• U.S. patent application Ser. No. 15/636,029, entitled SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A HOUSING ARRANGEMENT, now U.S. Patent Application Publication No. 2019/0000477;
• U.S. patent application Ser. No. 15/635,958, entitled SURGICAL INSTRUMENT COMPRISING SELECTIVELY ACTUATABLE ROTATABLE COUPLERS, now U.S. Patent Application Publication No. 2019/0000474;
• U.S. patent application Ser. No. 15/635,981, entitled SURGICAL STAPLING INSTRUMENTS COMPRISING SHORTENED STAPLE CARTRIDGE NOSES, now U.S. Patent Application Publication No. 2019/0000475;
• U.S. patent application Ser. No. 15/636,009, entitled SURGICAL INSTRUMENT COMPRISING A SHAFT INCLUDING A CLOSURE TUBE PROFILE, now U.S. Patent Application Publication No. 2019/0000476;
• U.S. Pat. No. 10,765,427, entitled METHOD FOR ARTICULATING A SURGICAL INSTRUMENT;
• U.S. patent application Ser. No. 15/635,530, entitled SURGICAL INSTRUMENTS WITH ARTICULATABLE END EFFECTOR WITH AXIALLY SHORTENED ARTICULATION JOINT CONFIGURATIONS, now U.S. Patent Application Publication No. 2019/0000457;
• U.S. Pat. No. 10,588,633, entitled SURGICAL INSTRUMENTS WITH OPEN AND CLOSABLE JAWS AND AXIALLY MOVABLE FIRING MEMBER THAT IS INITIALLY PARKED IN CLOSE PROXIMITY TO THE JAWS PRIOR TO FIRING;
• U.S. patent application Ser. No. 15/635,559, entitled SURGICAL INSTRUMENTS WITH JAWS CONSTRAINED TO PIVOT ABOUT AN AXIS UPON CONTACT WITH A CLOSURE MEMBER THAT IS PARKED IN CLOSE PROXIMITY TO THE PIVOT AXIS, now U.S. Patent Application Publication No. 2019/0000459;
• U.S. Pat. No. 10,786,253, entitled SURGICAL END EFFECTORS WITH IMPROVED JAW APERTURE ARRANGEMENTS;
• U.S. patent application Ser. No. 15/635,594, entitled SURGICAL CUTTING AND FASTENING DEVICES WITH PIVOTABLE ANVIL WITH A TISSUE LOCATING ARRANGEMENT IN CLOSE PROXIMITY TO AN ANVIL PIVOT AXIS, now U.S. Patent Application Publication No. 2019/0000461;
• U.S. patent application Ser. No. 15/635,612, entitled JAW RETAINER ARRANGEMENT FOR RETAINING A PIVOTABLE SURGICAL INSTRUMENT JAW IN PIVOTABLE RETAINING ENGAGEMENT WITH A SECOND SURGICAL INSTRUMENT JAW, now U.S. Patent Application Publication No. 2019/0000462;
• U.S. Pat. No. 10,758,232, entitled SURGICAL INSTRUMENT WITH POSITIVE JAW OPENING FEATURES;
• U.S. Pat. No. 10,639,037, entitled SURGICAL INSTRUMENT WITH AXIALLY MOVABLE CLOSURE MEMBER;
• U.S. Pat. No. 10,695,057, entitled SURGICAL INSTRUMENT LOCKOUT ARRANGEMENT;
• U.S. Design Pat. No. D851,762, entitled ANVIL;
• U.S. Design Pat. No. D854,151, entitled SURGICAL INSTRUMENT SHAFT; and
• U.S. Design Pat. No. D869,655, entitled SURGICAL FASTENER CARTRIDGE.
• Applicant of the present application owns the following U.S. Patent Applications and U.S. Patents that were filed on Jun. 27, 2017 and which are each herein incorporated by reference in their respective entireties:
• U.S. patent application Ser. No. 15/634,024, entitled SURGICAL ANVIL MANUFACTURING METHODS, now U.S. Patent Application Publication No. 2018/0368839;
• U.S. Pat. No. 10,772,629, entitled SURGICAL ANVIL ARRANGEMENTS;
• U.S. patent application Ser. No. 15/634,046, entitled SURGICAL ANVIL ARRANGEMENTS, now U.S. Patent Application Publication No. 2018/0368841;
• U.S. Pat. No. 10,856,869, entitled SURGICAL ANVIL ARRANGEMENTS;
• U.S. patent application Ser. No. 15/634,068, entitled SURGICAL FIRING MEMBER ARRANGEMENTS, now U.S. Patent Application Publication No. 2018/0368843;
• U.S. patent application Ser. No. 15/634,076, entitled STAPLE FORMING POCKET ARRANGEMENTS, now U.S. Patent Application Publication No. 2018/0368844;
• U.S. patent application Ser. No. 15/634,090, entitled STAPLE FORMING POCKET ARRANGEMENTS, now U.S. Patent Application Publication No. 2018/0368845;
• U.S. patent application Ser. No. 15/634,099, entitled SURGICAL END EFFECTORS AND ANVILS, now U.S. Patent Application Publication No. 2018/0368846; and
• U.S. Pat. No. 10,631,859, entitled ARTICULATION SYSTEMS FOR SURGICAL INSTRUMENTS.
• Applicant of the present application owns the following U.S. Patent Applications that were filed on Jun. 2, 2020 and which are each herein incorporated by reference in their respective entireties:
• U.S. Design patent application Ser. No. 29/736,648, entitled STAPLE CARTRIDGE;
• U.S. Design patent application Ser. No. 29/736,649, entitled STAPLE CARTRIDGE;
• U.S. Design patent application Ser. No. 29/736,651, entitled STAPLE CARTRIDGE;
• U.S. Design patent application Ser. No. 29/736,652, entitled STAPLE CARTRIDGE;
• U.S. Design patent application Ser. No. 29/736,653, entitled STAPLE CARTRIDGE;
• U.S. Design patent application Ser. No. 29/736,654, entitled STAPLE CARTRIDGE; and
• U.S. Design patent application Ser. No. 29/736,655, entitled STAPLE CARTRIDGE.
• Applicant of the present application owns the following U.S. Design Patent Applications and U.S. Patents that were filed on Nov. 14, 2016, and which are each herein incorporated by reference in their respective entireties:
• U.S. patent application Ser. No. 15/350,621, now U.S. Patent Application Publication No. 2018/0132849, entitled STAPLE FORMING POCKET CONFIGURATIONS FOR CIRCULAR STAPLER ANVIL;
• U.S. patent application Ser. No. 15/350,624, now U.S. Patent Application Publication No. 2018/0132854, entitled CIRCULAR SURGICAL STAPLER WITH ANGULARLY ASYMMETRIC DECK FEATURES;
• U.S. Design Pat. No. D833,608, titled STAPLING HEAD FEATURE FOR SURGICAL STAPLER; and
• U.S. Design Pat. No. D830,550, titled SURGICAL STAPLER.
• Numerous specific details are set forth to provide a thorough understanding of the overall structure, function, manufacture, and use of the embodiments as described in the specification and illustrated in the accompanying drawings. Well-known operations, components, and elements have not been described in detail so as not to obscure the embodiments described in the specification. The reader will understand that the embodiments described and illustrated herein are non-limiting examples, and thus it can be appreciated that the specific structural and functional details disclosed herein may be representative and illustrative. Variations and changes thereto may be made without departing from the scope of the claims.
• The terms “comprise” (and any form of comprise, such as “comprises” and “comprising”), “have” (and any form of have, such as “has” and “having”), “include” (and any form of include, such as “includes” and “including”) and “contain” (and any form of contain, such as “contains” and “containing”) are open-ended linking verbs. As a result, a surgical system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more elements possesses those one or more elements, but is not limited to possessing only those one or more elements. Likewise, an element of a system, device, or apparatus that “comprises,” “has,” “includes” or “contains” one or more features possesses those one or more features, but is not limited to possessing only those one or more features.
• The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical device. The term “proximal” refers to the portion closest to the clinician and the term “distal” refers to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical device are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute. In the following description, terms such as “first,” “second,” “top,” “bottom,” “up,” “down,” and the like are words of convenience and are not to be construed as limiting terms.
• References to items in the singular should be understood to include items in the plural, and vice versa, unless explicitly stated otherwise or clear from the text. Grammatical conjunctions are intended to express any and all disjunctive and conjunctive combinations of conjoined clauses, sentences, words, and the like, unless otherwise stated or clear from the context. Thus, the term “or” should generally be understood to mean “and/or”, etc.
• Recitation of ranges of values herein are not intended to be limiting, referring instead individually to any and all values falling within the range, unless otherwise indicated herein, and each separate value within such a range is incorporated into the disclosure as if it were individually recited herein. The words “about,” “approximately” or the like, when accompanying a numerical value, are to be construed as indicating a deviation as would be appreciated by one of ordinary skill in the art to operate satisfactorily for an intended purpose. Similarly, words of approximation such as “approximately” or “substantially” when used in reference to physical characteristics, should be construed to contemplate a range of deviations that would be appreciated by one of ordinary skill in the art to operate satisfactorily for a corresponding use, function, purpose or the like.
• The use of any and all examples, or exemplary language (“e.g.,” “such as,” or the like) provided herein, is intended merely to better illuminate the embodiments and does not pose a limitation on the scope of the embodiments. No language in the specification should be construed as indicating any unclaimed element as essential to the practice of the embodiments.
• Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the reader will readily appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, in connection with open surgical procedures. As the present Detailed Description proceeds, the reader will further appreciate that the various surgical devices disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, etc. The working portions or end effector portions of the surgical devices can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end effector and elongate shaft of a surgical device can be advanced.
• A surgical stapling system can comprise a shaft and an end effector extending from the shaft. The end effector comprises a first jaw and a second jaw. The first jaw comprises a staple cartridge. The staple cartridge is insertable into and removable from the first jaw; however, other embodiments are envisioned in which a staple cartridge is not removable from, or at least readily replaceable from, the first jaw. The second jaw comprises an anvil configured to deform staples ejected from the staple cartridge. The second jaw is pivotable relative to the first jaw about a closure axis; however, other embodiments are envisioned in which the first jaw is pivotable relative to the second jaw. The surgical stapling system further comprises an articulation joint configured to permit the end effector to be rotated, or articulated, relative to the shaft. The end effector is rotatable about an articulation axis extending through the articulation joint. Other embodiments are envisioned which do not include an articulation joint.
• The staple cartridge comprises a cartridge body. The cartridge body includes a proximal end, a distal end, and a deck extending between the proximal end and the distal end. In use, the staple cartridge is positioned on a first side of the tissue to be stapled and the anvil is positioned on a second side of the tissue to be stapled. The anvil is moved toward the staple cartridge to compress and clamp the tissue against the deck. Thereafter, staples removably stored in the cartridge body can be deployed into the tissue. The cartridge body includes staple cavities defined therein wherein staples are removably stored in the staple cavities. The staple cavities are arranged in six longitudinal rows. Three rows of staple cavities are positioned on a first side of a longitudinal slot and three rows of staple cavities are positioned on a second side of the longitudinal slot. Other arrangements of staple cavities and staples are contemplated.
• The staples are supported by staple drivers in the cartridge body. The drivers are movable between a first, or unfired, position and a second, or fired, position to eject the staples from the staple cavities. The drivers are retained in the cartridge body by a retainer which extends around the bottom of the cartridge body and includes resilient members configured to grip the cartridge body and hold the retainer to the cartridge body. The drivers are movable between their unfired positions and their fired positions by a sled. The sled is movable between a proximal position adjacent a proximal end of the cartridge body and a distal position adjacent a distal end of the cartridge body. The sled comprises a plurality of ramped surfaces configured to slide under the drivers and lift the drivers, and the staples supported thereon, toward the anvil.
• Further to the above, the sled is moved distally by a firing member. The firing member is configured to contact the sled and push the sled toward the distal end. The longitudinal slot defined in the cartridge body is configured to receive the firing member. The anvil also includes a slot configured to receive the firing member. The firing member further comprises a first cam which engages the first jaw and a second cam which engages the second jaw. As the firing member is advanced distally, the first cam and the second cam can control the distance, or tissue gap, between the deck of the staple cartridge and the anvil. The firing member also comprises a knife configured to incise the tissue captured intermediate the staple cartridge and the anvil. It is desirable for the knife to be positioned at least partially proximal to the ramped surfaces such that the staples are ejected into the tissue ahead of the knife transecting the tissue.
• FIGS. 1-8 depict asurgical stapling instrument10 configured to clamp, staple, and cut tissue of a patient. Thesurgical stapling instrument10 comprises ahandle20, ashaft assembly100 attached to thehandle20, and anend effector200. To cut and staple tissue of a patient, theend effector200 comprises acartridge jaw201 and ananvil jaw203. Theanvil jaw203 is pivotable relative to thecartridge jaw203 to clamp tissue between theanvil jaw203 and thecartridge jaw203. Once tissue is clamped between thejaws201,203, thesurgical stapling instrument10 may be actuated to advance a firing member through thejaws201,203 to staple and cut tissue with theend effector200 as discussed in greater detail below.
• Discussed in greater detail below, theend effector200 is articulatable by way of anarticulation region110 of theshaft assembly100. Such articulation provides a user of thesurgical stapling instrument10 with the ability to position and/or maneuver theend effector200 near the target tissue more accurately.
• Thehandle20 comprises ahousing21 configured to house various mechanical and electrical components and ahandle portion22 extending from thehousing21. Thehandle portion22 is configured to fit in the palm of a user and/or be gripped and/or held by a user using thesurgical stapling instrument10. Thehandle20 further comprises various actuators and/or triggers configured to be actuated by a user to operate one or more functions of thesurgical stapling instrument10. Thehandle20 comprises aclosure trigger24, a firingtrigger25, and at least onearticulation actuator26. When actuated by a user, theclosure trigger24 is configured to clamp tissue with theend effector200 by moving theanvil jaw203 toward thecartridge jaw201. When actuated by a user, the firingtrigger25 is configured to cut and staple tissue with theend effector200 by advancing a firing member to eject staples and cut tissue with a knife. When actuated by a user, thearticulation actuator26 is configured to articulate theend effector200 relative to theshaft assembly100 by way of thearticulation region110. The triggers and actuators of thesurgical stapling instrument10 can either trigger one or more motors within thehandle20 to actuate various function of thesurgical stapling instrument10 and/or manually drive various drive shafts and components to actuate various function of thesurgical stapling instrument10.
• Thehandle20 further comprises anozzle assembly30 configured to support theshaft assembly100 therein. Thenozzle assembly30 comprises anactuation wheel31 configured to be rotated by a user to rotate theshaft assembly100 andend effector200 about a longitudinal axis LA relative to thehandle20. Such a mechanism permits the user of thesurgical stapling instrument10 to rotate only theshaft assembly100 and/orend effector200 without having to rotate theentire handle20.
• Thehandle20 further comprises abattery23 configured to provide power to various electronic components, sensors, and/or motors of thesurgical stapling instrument10. Embodiments are envisioned where thesurgical stapling instrument10 is directly connected to a power source. Embodiments are also envisioned where thesurgical stapling instrument10 is entirely manual or, non-powered, for example. Embodiments are further envisioned where articulation of the end effector, clamping and unclamping of the jaws, firing of the end effector staple and cut tissue, and shaft and/or end effector rotation are all powered systems.
• In at least one instance, theshaft assembly100 and theend effector200 may be modular and removable from thehandle20. In at least one instance, theend effector200 may be modular in that theend effector200 can be removed from theshaft assembly100 and replaced with a different end effector. In at least one instance, theshaft assembly100 and/or theend effector200 is employable in a surgical robotic environment. Such an embodiment would provide powered inputs from a surgical robotic interface to actuate each function of theend effector200. Examples of such surgical robots and surgical tools are further described in U.S. Patent Application Publication No. 2020/0138534, titled ROBOTIC SURGICAL SYSTEM, which published on May 7, 2020, which is incorporated by reference herein in its entirety.
• In at least one instance, theshaft assembly100 and theend effector200 are configured to be used with a surgical robot. In such an instance, theshaft assembly100 and theend effector200 are configured to be coupled to a surgical robot comprising a plurality of output drives. The plurality of output drives of the surgical robot are configured to mate with the drive systems of theshaft assembly100 andend effector200. In such an instance, the surgical robot can actuate the various different functions of theend effector200 such as, for example, articulating the end effector about multiple different articulation joints, rotating theshaft assembly100 and/orend effector200 about its longitudinal axis, clamping theend effector200 to clamp tissue between the jaws of theend effector200, and/or firing theend effector200 to cut and/or staple tissue.
• Theshaft assembly100 is configured to house various drive system components and/or electronic components of thesurgical stapling instrument10 so that theend effector200 andshaft assembly100 may be inserted through a trocar for laparoscopic surgery. The various drive system components are configured to be actuated by the various triggers and actuators of thehandle20. Such components can include drive shafts for articulation, drive shafts for clamping and unclamping theend effector200, and/or drive shafts for firing theend effector200. Such drive shafts may be rotated by a drive system in thehandle20 or a surgical robotic interface in the instance where theshaft assembly100 is connected to the same. In various aspects, a stapling end effector can include two independently rotatable drive members—one for grasping tissue and one for firing staples, for example. The stapling end effector can further include an articulation joint, and the rotary motions can be transmitted through the articulation joint. In various aspects, the stapling end effector can include one or more 3D printed assemblies, which can be incorporated into an articulation, grasping, or firing systems.
• Such drive shafts may be actuated by a drive system in thehandle20 or a surgical robotic interface in the instance where theshaft assembly100 is connected to the same. Such drive shafts may comprise linear actuation, rotary actuation, or a combination thereof. A combination of rotary actuation and linear actuation may employ a series of rack gears and/or drive screws, for example.
• In at least one instance, theshaft assembly100 is also configured to house electrical leads for various sensors and/or motors, for example, positioned within theshaft assembly100 and/orend effector200, for example.
• Theshaft assembly100 comprises anouter shaft101 extending from thenozzle assembly30 to thearticulation region110 comprising dual articulation joints, discussed in greater detail below. Thearticulation region110 allows theend effector200 to be articulated relative to theouter shaft101 in two distinct planes about two separate axes AA1, AA2.
• Referring now primarily toFIG. 4, articulation of theend effector200 will now be described. Thearticulation region110 comprises two distinct articulation joints and twoarticulation actuators150,160. This allows theend effector200 to be articulated in two different planes about two different axes AA1, AA2 independently of each other. Thearticulation region110 comprises a proximaljoint shaft component120, an intermediatejoint shaft component130, and a distaljoint shaft component140. The proximaljoint shaft component120 is attached to a distal end of theshaft assembly100, the intermediatejoint shaft component130 is pivotally connected to the proximaljoint shaft component120 and the distaljoint shaft component140, and the distaljoint shaft component140 is fixedly attached to theend effector200 by way of aretention ring146. Discussed in greater detail below, this arrangement provides articulation of theend effector200 relative to theshaft assembly100 about axis AA1 and axis AA2 independently of each other.
• The proximaljoint shaft component120 comprises a proximal annular portion121 fixedly fitted within theouter shaft101. The proximaljoint shaft component120 also includes a hollow passage122 to allow various drive system components to pass therethrough, and further includes anarticulation tab123 comprising apin hole124 configured to receivearticulation pin125. Thearticulation pin125 pivotally connects the proximaljoint shaft component120 to aproximal articulation tab131 of the intermediatejoint shaft component130. To articulate theend effector200 about axis AA1, thearticulation actuator150 is actuated linearly either in a distal direction or a proximal direction. Such an actuator may comprise a bar or rod made of any suitable material such as metal and/or plastic, for example. Thearticulation actuator150 is pivotally mounted to anarticulation crosslink151. Thearticulation crosslink151 is pivotally mounted to the intermediatejoint shaft component130 off-axis relative to thearticulation pin125 so that when thearticulation actuator150 is actuated, a torque is applied to the intermediatejoint shaft component130 off-axis relative to thearticulation pin125 by thearticulation crosslink151 to cause the intermediatejoint shaft component130 and, thus, theend effector200, to pivot about axis AA1 relative to the proximaljoint shaft component120.
• The intermediatejoint shaft component130 is pivotally connected to the proximaljoint shaft component120 by way of thearticulation pin125 which defines axis AA1. Specifically, the intermediatejoint shaft component130 comprises aproximal articulation tab131 that is pivotally connected to the proximaljoint shaft component120 by way of thearticulation pin125. The intermediatejoint shaft component130 further comprises ahollow passage132 configured to allow various drive system components to pass therethrough and adistal articulation tab133. Thedistal articulation tab133 comprises a pin hole134 configured to receive anotherarticulation pin136, which defines axis AA2, and a distally-protrudingkey135.
• To articulate theend effector200 about axis AA2, thearticulation cable160 is actuated to apply an articulation torque to aproximal tab141 of the distaljoint shaft component140 by way of the key135. Thearticulation cable160 is fixed to the key135 such that, as thecable160 is rotated, the key135 is pivoted relative to the intermediatejoint shaft component130. The key135 is fitted within akey hole144 of the distaljoint shaft component140. Notably, the key135 is not fixed to the intermediatejoint shaft component130 and the key135 can be rotated relative to the intermediatejoint shaft component130. Thearticulation cable160 also contacts theproximal tab141 around thepin hole142. This provides an additional torque moment from thearticulation cable160 to the distaljoint shaft component140. Thearticulation pin136 is received within thepin hole142 to pivotally couple the intermediatejoint shaft component130 and the distaljoint shaft component140.
• In at least one instance, thearticulation cable160 is only able to be pulled in a proximal direction. In such an instance, only one side of thearticulation cable160 would be pulled proximally to articulate theend effector200 in the desired direction. In at least one instance, thearticulation cable160 is pushed and pulled antagonistically. In other words, thecable160 can comprise a rigid construction such that one side of thearticulation cable160 is pushed distally while the other side of thearticulation cable160 is pulled proximally. Such an arrangement can allow the articulation forces to be divided between the pushed half of thecable160 and the pulled half of thecable160. In at least one instance, the push-pull arrangement allows greater articulation forces to be transmitted to the corresponding articulation joint. Such forces may be necessary in an arrangement with two articulation joints. For example, if the proximal articulation joint is fully articulated, more force may be required of the articulation actuator meant to articulate the distal articulation joint owing to the stretching and/or lengthened distance that the articulation actuator for the distal articulation joint must travel.
• The distaljoint shaft component140 further comprises a cutout143 to allow various drive components to pass therethrough. Theretention ring146 secures achannel210 of thecartridge jaw201 to the distaljoint shaft component140 thereby fixing theend effector assembly200 to a distal end of thearticulation region110.
• As discussed above, theanvil jaw201 is movable relative to thecartridge jaw203 to clamp and unclamp tissue with theend effector200. Operation of this function of theend effector200 will now be described. Thecartridge jaw201 comprises thechannel210 and astaple cartridge220 configured to be received within acavity214 of thechannel210. Thechannel210 further comprises anannular groove211 configured to receive theretention ring146 and a pair of pivot holes213 configured to receive a jaw-coupling pin233. Thejaw coupling pin233 permits theanvil jaw203 to be pivoted relative to thecartridge jaw201.
• Theanvil jaw203 comprises ananvil body230 and a pair of pivot holes231. The pivot holes231 in the proximal portion of theanvil jaw203 are configured to receive the jaw-coupling pin233 thereby pivotally coupling theanvil jaw203 to thecartridge jaw201. To open and close theanvil jaw203 relative to thecartridge jaw201, aclosure drive250 is provided.
• Theclosure drive250 is actuated by aflexible drive segment175 comprised of universally-movable joints arranged or formed end-to-end. In various instances, theflexible drive segment175 can includes serial 3D-printed universal joints, which are printed all together as a single continuous system. Discussed in greater detail below, theflexible drive segment175 is driven by an input shaft traversing through theshaft assembly100. Theflexible drive segment175 transmits rotary actuation motions through the dual articulation joints. Theclosure drive250 comprises aclosure screw251 and aclosure wedge255 threadably coupled to theclosure screw251. Theclosure wedge255 is configured to positively cam theanvil jaw203 open and closed. Theclosure screw251 is supported by afirst support body258 and asecond support body259 secured within thechannel210.
• To move theanvil jaw203 between a clamped position (FIG. 8) and an unclamped position (FIG. 7), a closure drive shaft is actuated to actuate theflexible drive segment175. Theflexible drive segment175 is configured to rotate theclosure screw251, which displaces theclosure wedge255. For example, theclosure wedge255 is threadably coupled to theclosure screw251 and rotational travel of theclosure wedge255 with thestaple cartridge220 is restrained. Theclosure screw251 drives theclosure wedge255 proximally or distally depending on which direction theclosure screw251 is rotated.
• To clamp theend effector200 from an unclamped position (FIG. 7), theclosure wedge255 is moved proximally. As theclosure wedge255 is moved proximally, aproximal cam surface256 of theclosure wedge255 contacts a correspondingcam surface234 defined in aproximal end235 of theanvil body230. As thecam surface256 contacts thecam surface234, a force is applied to theproximal end235 of theanvil body230 causing theanvil body230 to rotate into the clamped position (FIG. 8) about thepin233.
• To open or unclamp theend effector200 from a clamped position (FIG. 8), theclosure wedge255 is moved distally by rotating theclosure screw251 in a direction opposite to the direction that causes theclosure wedge255 to move proximally. As theclosure wedge255 is moved distally, a pair ofnubs257 extending from a distal end of theclosure wedge255 contact thecam surface234 near a downwardly extendingtab237 of theanvil body230. As thenubs257 contact thecam surface234 near thetab237, a force is applied to theanvil body230 to rotate theanvil body230 into the open position (FIG. 7) about thepin233.
• In at least one instance, the profile of thecam surface234 corresponds to the profile of thecam surface256. For example, thecam surface234 and thecam surface256 may match such that a maximum cam force is applied to theanvil body230 to cause the desired rotation of theanvil body230. As can be seen inFIG. 8, for example, thecam surface234 defined by theproximal end235 of theanvil body230 comprises a ramped section similar to that of the upper ramped section of thecam surface256.
• As discussed above, thesurgical stapling instrument10 may be actuated to advance a firing member through thejaws201,203 to staple and cut tissue with theend effector200. The function of deployingstaples226 from thestaple cartridge220 and cutting tissue withknife283 will now be described. Thestaple cartridge220 comprises acartridge body221, a plurality ofstaple drivers225, and a plurality ofstaples226 removably stored within thecartridge body221. Thecartridge body221 comprises adeck surface222, a plurality ofstaple cavities223 arranged in longitudinal rows defined in thecartridge body221, and alongitudinal slot224 bifurcating thecartridge body221. Theknife283 is configured to be driven through thelongitudinal slot224 to cut tissue clamped between theanvil body230 and thedeck surface221.
• Thedeck surface221 comprises a laterally-contoured tissue-supporting surface. In various aspects, the contour of thedeck surface221 can form a peak along a central portion of thecartridge body221. Such a peak can overlay a longitudinally-extendingfiring screw261 that extends through the central portion of thecartridge body221, which is further described herein. The increased height along the peak can be associated with a smaller tissue gap along a firing path of theknife283 in various instances. In certain aspects of the present disclosure, driver heights, formed staple heights, staple pocket extension heights, and/or staple overdrive distances can also vary laterally along thedeck surface221. Laterally-variable staple formation (e.g. a combination of 2D staples and 3D staples) is also contemplated and further described herein.
• Thestaple drivers225 are configured to be lifted by asled280 as thesled280 is pushed distally through thestaple cartridge220 to eject thestaples226 supported by thestaple drivers225 in thestaple cavities223. Thesled280 comprisesramps281 to contact thestaple drivers225. Thesled280 also includes theknife283. Thesled280 is configured to be pushed by a firingmember270.
• To deploy thestaples226 and cut tissue with theknife283, theend effector200 comprises afiring drive260. The firingdrive260 is actuated by aflexible drive shaft176. Discussed in greater detail below, theflexible drive shaft176 is driven by an input shaft traversing through theshaft assembly100. Theflexible drive shaft176 transmits rotary actuation motions through the dual articulation joints. The firingdrive260 comprises a firingscrew261 configured to be rotated by theflexible drive shaft176. The firingscrew261 comprises journals supported within bearings in thesupport member259 and thechannel210. In various instances, the firingscrew261 can float relative to thechannel210, as further described herein. The firingscrew261 comprises aproximal end262 supported within thesupport member259 and thechannel210, adistal end263 supported within thechannel210, andthreads265 extending along a portion of the length of the firingscrew261.
• The firingmember270 is threadably coupled to thefiring screw261 such that as the firingscrew261 is rotated, the firingmember270 is advanced distally or retracted proximally along the firingscrew261. Specifically, the firingmember270 comprises abody portion271 comprising a hollow passage272 defined therein. The firingscrew261 is configured to be received within the hollow passage272 and is configured to be threadably coupled with a threadedcomponent273 of the firingmember270. Thus, as the firingscrew261 is rotated, the threadedcomponent273 applies a linear force to thebody portion271 to advance the firingmember270 distally or retract the firingmember270 proximally. As the firingmember270 is advanced distally, the firingmember270 pushes thesled280. Distal movement of thesled280 causes the ejection of thestaples223 by engaging the plurality ofstaple drivers225, as further described herein. Thedriver225 is a triple driver, which is configured to simultaneously firemultiple staples223. Thedriver225 can comprise lateral asymmetries, as further described herein, to maximum the width of the sled rails and accommodate thefiring screw261 down the center of thecartridge220 in various instances.
• At a point during firing of theend effector200, a user may retract the firingmember270 to allow unclamping of thejaws201,203. In at least one instance, the full retraction of the firingmember270 is required to open thejaws201,203 where upper and lower camming members are provided on thebody portion271 which can only be disengaged from thejaws201,203 once the firingmember270 is fully retracted.
• In various instances, the firingmember270 can be a hybrid construction of plastic and metal portions as further described herein. In various instances, the threadedcomponent273 can be a metal component, for example, which is incorporated into the firingmember body271 with insert molding or over molding.
• The firingmember270 can also be referred to an I-beam in certain instances. The firingmember270 can include a complex 3D-printed geometry comprising a lattice pattern of spaces therein. In various instances, 3D printing can allow the firing member or a portion thereof to act as a spring and allows a portion to more readily flex, which can improve the force distribution and/or tolerances during a firing stroke, for example.
• FIGS. 9-11 depict asurgical stapling assembly300 comprising ashaft assembly310 and theend effector200 ofFIGS. 1-8 attached to theshaft assembly310. Theshaft assembly310 may be similar in many respects to various other shaft assemblies discussed herein; however, theshaft assembly310 comprises a single articulation joint and an articulation bar configured to articulate theend effector200 about the single articulation joint. Thesurgical stapling assembly300 is configured to cut and staple tissue. Thesurgical stapling assembly300 may be attached to a surgical instrument handle and/or surgical robotic interface. The surgical instrument handle and/or surgical robotic interface can be configured to actuate various functions of thesurgical stapling assembly300. Theshaft assembly310 comprises an articulation joint320. Discussed in greater detail below, theend effector200 is configured to be articulated relative to anouter shaft311 of theshaft assembly310 about axis AA.
• Theshaft assembly310 comprises theouter shaft311, a first shaftjoint component330, and a second shaftjoint component350 pivotally coupled to the first shaftjoint component330 by way of anarticulation pin354. The first shaftjoint component330 comprises aproximal tube portion331 configured to fit within the inner diameter of theouter shaft311. Such a fit may comprise a press fit, for example. However, any suitable attachment means can be used. The first shaftjoint component330 also includes adistal portion332. Thedistal portion332 comprises anarticulation tab333 comprising apin hole334 defined therein and ahollow passage335 through which various drive components of thesurgical stapling assembly300 can pass. Such drive components can include articulation actuators, closure actuators, and/or firing actuators for example.
• The first shaftjoint component330 is pivotally connected to the second shaftjoint component350 by way of thearticulation pin354. Thearticulation pin354 is also received within a pin hole353 of a proximally-extending articulation tab351 of the second shaftjoint component350. The pin hole353 is axially aligned with thepin hole334. Thearticulation pin354 allows the second shaftjoint component350 to be articulated relative to the first shaftjoint component330 about the articulation axis AA. The second shaftjoint component350 further comprises a pin protrusion352 extending from the proximal-extending articulation tab351. Discussed in greater detail below, the pin protrusion352 is configured to be pivotally coupled to an articulation drive system. The second shaftjoint component350 further comprises adistal portion355 comprising anannular groove356 configured to receive aretention ring358. Thedistal portion355 also includes ahollow passage357 through which various drive components of thesurgical stapling assembly300 can pass. Theretention ring358 is configured to hold thefirst jaw201 to the second shaftjoint component350 by fitting within theannular groove211 of thecartridge channel210 and theannular groove356 of the second shaftjoint component350.
• To articulate theend effector200 about the articulation axis AA, anarticulation bar360 is provided. Thearticulation bar360 may be actuated by any suitable means such as, for example, by a robotic or motorized input and/or a manual handle trigger. Thearticulation bar360 may be actuated in a proximal direction and a distal direction, for example. Embodiments are envisioned where the articulation system comprises rotary driven actuation in addition to or, in lieu of, linear actuation. Thearticulation bar360 extends through theouter shaft311. Thearticulation bar360 comprises adistal end361 pivotally coupled to anarticulation link362. Thearticulation link362 is pivotally coupled to the pin protrusion352 extending from the proximally-extending articulation tab351 off center with respect to the articulation axis AA. Such off-center coupling of thearticulation link362 allows thearticulation bar360 to apply a force to the secondjoint shaft component350 to rotate the second shaftjoint component350 and, thus, theend effector200, relative to the firstjoint shaft component330. Thearticulation bar360 can be advanced distally to rotate theend effector200 in a first direction about the articulation axis AA and retracted proximally to rotate theend effector200 in a second direction opposite the first direction about the articulation axis AA.
• Theshaft assembly310 further comprises an articulationcomponent support structure340 positioned within the articulation joint320. Such a support structure can provide support to various drive components configured to pass through the articulation joint320 to theend effector200 as theend effector200 is articulated. Thesupport structure340 may also serve to isolate the drive components from tissue remnants during use.
• FIGS. 12-14 depict asurgical stapling assembly400 comprising ashaft assembly410 and theend effector200 ofFIGS. 1-8 attached to theshaft assembly410. Theshaft assembly410 may be similar in many respects to various other shaft assemblies discussed herein; however, theshaft assembly410 comprises a single articulation joint and an articulation cable configured to articulate theend effector200 about the single articulation joint. Thesurgical stapling assembly400 is configured to cut and staple tissue. Thesurgical stapling assembly400 may be attached to a surgical instrument handle and/or surgical robotic interface. The surgical instrument handle and/or surgical robotic interface can be configured to actuate various functions of thesurgical stapling assembly400. Theshaft assembly410 comprises an articulation joint420. Discussed in greater detail below, theend effector200 is configured to be articulated relative to anouter shaft411 of theshaft assembly310 about an axis AA.
• Theshaft assembly410 comprises theouter shaft411, a first shaftjoint component430, and a second shaftjoint component450 pivotally coupled to the first shaftjoint component430 by way of anarticulation pin454. The first shaftjoint component430 comprises aproximal tube portion431 configured to fit within the inner diameter of theouter shaft411. Such a fit may comprise a press fit, for example. However, any suitable attachment means can be used. The first shaftjoint component430 also includes adistal portion432, which comprises anarticulation tab433 comprising apin hole434 defined therein. Thedistal portion432 further defines ahollow passage435 through which various drive components of thesurgical stapling assembly400 can pass. Such drive components can include articulation actuators, closure actuators, and/or firing actuators, for example.
• The first shaftjoint component430 is pivotally connected to the second shaftjoint component450 by way of thearticulation pin454. Thearticulation pin454 is also received within apin hole453 of a proximally-extendingarticulation tab451 of the second shaftjoint component450. Thearticulation pin454 allows the second shaftjoint component450 to be articulated relative to the first shaftjoint component430 about the articulation axis AA. The second shaftjoint component450 further comprises adrive ring structure452. Thedrive ring structure452 extends from the proximally-extendingarticulation tab451 and further defines a portion of thepin hole453. Discussed in greater detail below, thedrive ring structure452 is configured to be engaged by an articulation drive system. The second shaftjoint component450 further comprises adistal portion455 comprising anannular groove456 configured to receive aretention ring458. Ahollow passage457 through thedistal portion455 is configured to receive various drive components of thesurgical stapling assembly400 therethrough. Theretention ring458 is configured to hold thefirst jaw201 to the second shaftjoint component450 by fitting within theannular groove211 of thecartridge channel210 and theannular groove456 of the second shaftjoint component450.
• To articulate theend effector200 about the articulation axis AA, anarticulation cable460 is provided. Thearticulation cable460 may be actuated by any suitable means such as, for example, by a robotic input and/or a manual trigger on a handle of a handheld surgical instrument. Thearticulation cable460 may comprise an antagonistic actuation profile. In other words, as a first side of thearticulation cable460 is pulled proximally a second side of thearticulation cable460 is allowed to advance distally like a pulley system. Similarly, as the second side is pulled proximally, the first side is allowed to advance distally. Thearticulation cable460 extends through theouter shaft411. Thearticulation cable460 is positioned around thedrive ring structure452 and frictionally retained thereon to permit rotation of the second shaftjoint component450 as thearticulation cable460 is actuated. As thearticulation cable460 is actuated, thearticulation cable460 is configured to apply a rotational torque to thedrive ring structure452 of the secondjoint shaft component450 and, thus, theend effector200. Such torque is configured to cause the secondjoint shaft component450 to rotate, or pivot, relative to the firstjoint shaft component430 thereby articulating theend effector200 relative to theouter shaft411. A first side of thearticulation cable460 can pulled to rotate theend effector200 in a first direction about the articulation axis AA and a second side of thearticulation cable460 can be pulled to rotate theend effector200 in a second direction opposite the first direction about the articulation axis AA.
• Theshaft assembly410 further comprises an articulationcomponent support structure440 positioned within the articulation joint420. Such asupport structure440 can provide support to various drive components configured to pass through the articulation joint420 to theend effector200 as theend effector200 is articulated. Thesupport structure440 may also serve to isolate the drive components from tissue remnants during use.
• Thesurgical stapling assembly400 further comprises a closuredrive shaft segment475 and a firingdrive shaft segment476 each configured to transmit rotary motion through the articulation joint420 to theend effector200. Thedrive shaft segments475,476 are configured to passively expand and contract longitudinally as theend effector200 is articulated. For example, articulation can cause expansion and contraction of thedrive shaft segments475,476 to account for the respective longitudinal stretching of or contracting of the length of the drive shafts owing to articulation of theend effector200 relative to theshaft assembly410. During expansion and contraction of thedrive shaft segments475,476, thedrive shaft segments475,476 maintain rotary driving engagement with corresponding input shafts extending through theouter shaft411 and output shafts in theend effector200. In at least one instance, the output shafts comprise theclosure screw251, which is configured to effect grasping, closing, or tissue manipulation with thejaws201,203, and the firingscrew261, which is configured to effect clamping of thejaws201,203 and firing of the firingmember270.
• FIGS. 15-17 depict asurgical stapling assembly500 comprising ashaft assembly510 and theend effector200 ofFIGS. 1-8 attached to theshaft assembly510. Theshaft assembly510 may be similar in many respects to various other shaft assemblies discussed herein; however, theshaft assembly510 comprises a single articulation joint and drive shaft segments configured to passively expand and contract. Thesurgical stapling assembly500 is configured to cut and staple tissue. Thesurgical stapling assembly500 may be attached to a surgical instrument handle and/or surgical robotic interface. The surgical instrument handle and/or surgical robotic interface can be configured to actuate various functions of thesurgical stapling assembly500. Theshaft assembly510 comprises an articulation joint520. Discussed in greater detail below, theend effector200 is configured to be articulated about an axis AA.
• Theshaft assembly510 comprises a first shaftjoint component530 and a second shaftjoint component540 pivotally coupled to the first shaftjoint component530 by way of anarticulation pin543. The first shaftjoint component530 is configured to be attached to a shaft of a surgical instrument assembly and/or a surgical robotic interface. The first shaftjoint component530 comprises aproximal portion531 and anarticulation tab533 comprising apin hole534 defined therein. In at least one instance, the first shaftjoint component530 comprises a hollow passage through which various drive components of thesurgical stapling assembly400 can pass. Such drive components can include articulation actuators, closure actuators, and/or firing actuators for example.
• The first shaftjoint component530 is pivotally connected to the second shaftjoint component540 by way of thearticulation pin543. Thearticulation pin543 is also received within apin hole542 of a proximally-extendingarticulation tab541 of the second shaftjoint component540. Thearticulation pin543 allows the second shaftjoint component540 to be articulated relative to the first shaftjoint component530 about the articulation axis AA. The second shaftjoint component540 further comprises adistal portion545 comprising anannular groove547 configured to receive aretention ring548 and ahollow passage546 through which various drive components of thesurgical stapling assembly500 can pass. Theretention ring548 is configured to hold thefirst jaw201 to the second shaftjoint component540 by fitting within theannular groove211 of thecartridge channel210 and theannular groove547 of the second shaftjoint component540.
• Any suitable articulation drive system can be used to articulate theend effector200 about axis AA. In at least one instance, theend effector200 is passively articulated. In such an instance, theend effector200 may be pressed against tissue, for example, to apply a force to theend effector200 and cause theend effector200 to articulate about an articulation axis. In at least one instance, theend effector200 further comprises a spring configured to apply a neutral biasing force to the second shaftjoint segment540, for example, to cause theend effector200 to be biased toward an unarticulated configuration.
• Thesurgical stapling assembly500 further comprises a closuredrive shaft segment575 and a firingdrive shaft segment576 each configured to transmit rotary motion through the articulation joint520 to theend effector200. Thedrive shaft segments575,576 are configured to passively expand and contract longitudinally as theend effector200 is articulated. Articulation causes thedrive shaft segments575,576 to expand and contract to account for the longitudinal stretching of or contracting of the length of the drive shafts owing to articulation of theend effector200. During expansion and contraction of thedrive shaft segments575,576, thedrive shaft segments575,576 maintain rotary driving engagement with corresponding input shafts and output shafts in theend effector200. In at least one instance, the output shafts comprise theclosure screw251 and the firingscrew261, which are further described herein.
• FIGS. 18-20 depict a surgical staplingend effector assembly600 comprising ashaft portion610 and anend effector600. Theend effector assembly600 is similar in many respects to various other end effector assemblies disclosed herein; however, theend effector assembly600 comprises a multi-component firing member driven by a flexible firing shaft. Theend effector assembly600 is configured to cut and staple tissue. Theend effector assembly600 may be attached to a surgical instrument handle and/or surgical robotic interface by way of aproximal tab611 of theshaft portion610. The surgical instrument handle and/or surgical robotic interface can be configured to actuate various functions of theend effector assembly600. Theend effector assembly600 comprises acartridge channel jaw620 and ananvil jaw660 pivotally mounted to thecartridge channel jaw620 to clamp tissue between thecartridge channel jaw620 and theanvil jaw660.
• Thecartridge channel jaw620 comprises achannel630 comprising a proximal end631, astaple cartridge640 configured to store a plurality of staples therein and configured to be received within thechannel630, and asupport brace650 fitted within thestaple cartridge640. Thestaple cartridge640 and thesupport brace650 are configured to be assembled together prior to installing thestaple cartridge640 into thechannel630. Discussed in greater detail below, thesupport brace650 is configured to further support a firing member assembly as the firing member assembly is advanced through theend effector assembly600.
• Theanvil jaw660 is configured to form staples ejected from thestaple cartridge640. Theanvil jaw660 comprises aproximal end661 comprising a pair of pin holes662 defined therein configured to receive acoupling pin663. Theanvil jaw660 is pivotable about thecoupling pin663 between an unclamped position and a fully clamped position. Thecoupling pin663 is also received within a pair of pin holes633 defined in the proximal end631 of thechannel630. Thecoupling pin663 serves to pivotally mount theanvil jaw660 to thechannel630. In at least one instance, thechannel630 is mounted to theshaft portion610 by way of a retention ring, or band, that fits around anannular groove632 of thechannel630 andannular groove615 of theshaft portion610. The retention ring, or band, is configured to hold thechannel630 to theshaft portion610.
• Theend effector assembly600 comprises aclosure drive670 configured to grasp tissue between theanvil jaw660 and thecartridge channel jaw620 by pivoting theanvil jaw660 relative to thechannel630. Theend effector assembly600 also includes afiring drive680 configured to clamp, staple, and cut tissue by deploying a plurality of staples from thestaple cartridge640. Theclosure drive670 comprises aclosure screw671 positioned within thechannel630 and aclosure wedge675 threadably coupled to theclosure screw671. As theclosure screw671 is rotated, theclosure wedge675 is advanced distally or retracted proximally to open or close theanvil jaw660, respectively. Theclosure drive670 may be actuated by any suitable means. For example, a rotary drive shaft may extend through theshaft portion610 from an actuation interface, for example, to rotate theclosure screw671. Other examples of suitable rotary drive shafts are further described herein.
• The firingdrive680 comprises aflexible drive shaft681 that is configured to be moved linearly through theend effector assembly600. Theflexible drive shaft681 may be actuated by a robotic input and/or a manually-actuated drive shaft of a handle assembly, for example. Theflexible drive shaft681 is configured to extend through ahollow passage614 of adistal end613 of theshaft portion610 and is flexible so that theend effector assembly600 may be articulated relative to a shaft from which theend effector600 extends. Theflexible drive shaft681 extends through aclearance slot676 defined in theclosure wedge675 and is fixedly attached to alower firing member682. Thelower firing member682 is configured to be reused with different staple cartridges.
• Thestaple cartridge640 comprises a disposableupper firing member683 configured to hookingly engage or, latch, onto thelower firing member682 such that the lower firing member582 can push or, drive, theupper firing member683 through thestaple cartridge640 andsupport brace650. In other words, the firing actuation involves a two-part firing member—a disposableupper firing member683 incorporated into thecartridge640 and a reusablelower firing member682 incorporated into thefiring drive680, which can be coupled together when thecartridge640 is seated in theelongate channel630. The two-part firing member is further described herein.
• Theupper firing member683 comprises an upper flange configured to engage and position theanvil jaw660, a knife edge configured to cut tissue, and a latch portion configured to hookingly engage thelower firing member682. Thestaple cartridge640 further comprises asled684 configured to engage staple drivers positioned within thestaple cartridge640 to eject staples from thestaple cartridge640. Because a knife and cutting edge are incorporated into the disposableupper firing member683 of thestaple cartridge640, a new and/or fresh cutting edge can be supplied with each staple cartridge loaded into theend effector assembly600.
• Thelower firing member682 and theupper firing member683 are configured to move through thesupport brace650 such that the vertical loads associated with the firing sequence are configured to be distributed through thesupport brace650, thestaple cartridge640, thechannel630, and theanvil jaw660. Thesupport brace650 may be comprised of a metal material, for example, to be inserted within thestaple cartridge640. Thesupport brace650 compriseskey rails655 configured to fit within corresponding key slots defined in a longitudinal slot of thestaple cartridge640. Thesupport brace650 further comprises alongitudinal slot653 configured to receive the knife of theupper firing member683, acylindrical passage657 configured to receive a portion of theupper firing member683, a portion of thelower firing member682, and theflexible drive shaft681. Thesupport brace650 further comprises verticalkey extensions656 configured to be received within corresponding key holes in the cartridge deck. Such extensions may be visible through the cartridge deck when thesupport brace650 is installed within thestaple cartridge640. In at least one instance, thesupport brace650 is configured to be inserted into thestaple cartridge640 from the bottom of thestaple cartridge640 facing thechannel630.
• Thesupport brace650 further comprises aproximal tab651 and adistal tab653, which are both configured to be engaged with thechannel630. Thetabs651,653 are configured to distribute at least some of the forces transmitted through theassembly600 by the firingdrive680 and corresponding components. Thedistal tab651 may serve to block the upper andlower firing members683,682 from being pushed through a distal end of thesupport brace650 by sharing and/or redistributing the load applied to thesupport brace650 by the firingdrive680 with thechannel630.
• When thestaple cartridge640 is replaced so that theend effector assembly600 can be reused, thestaple cartridge640 is removed from thechannel jaw630. Removing thestaple cartridge640 from thechannel jaw630 removes theupper firing member683, thesled684, thesupport brace650, and thestaple cartridge640. A fresh knife can be provided with a replacement staple cartridge.
• Various embodiments disclosed herein may be employed in connection with arobotic system700. An exemplary robotic system is depicted inFIGS. 21-23, for example.FIG. 21 depicts amaster controller701 that may be used in connection with a surgical robot, such as the roboticarm slave cart800 depicted inFIG. 22, for example.Master controller701 and roboticarm slave cart800, as well as their respective components and control systems are collectively referred to herein as arobotic system700. Examples of such systems and devices are disclosed in U.S. Pat. No. 7,524,320, entitled MECHANICAL ACTUATOR INTERFACE SYSTEM FOR ROBOTIC SURGICAL TOOLS, as well as U.S. Pat. No. 9,072,535, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, which are each hereby incorporated by reference herein in their respective entireties. As is known, themaster controller701 generally includes controllers (generally represented as703 inFIG. 21) which are grasped by the surgeon and manipulated in space while the surgeon views the procedure via astereo display702. Thecontrollers701 generally comprise manual input devices which preferably move with multiple degrees of freedom, and which often further have an actuatable handle, trigger, or actuator for actuating tools (for example, for closing grasping jaws, applying an electrical potential to an electrode, or the like).
• As can be seen inFIG. 22, in one form, therobotic arm cart800 may be configured to actuate one or more surgical tools, generally designated as900. Various robotic surgery systems and methods employing master controller and robotic arm cart arrangements are disclosed in U.S. Pat. No. 6,132,368, entitled MULTI-COMPONENT TELEPRESENCE SYSTEM AND METHOD, the entire disclosure of which is hereby incorporated by reference herein.
• In various forms, therobotic arm cart800 includes a base702 from which, in the illustrated embodiment,surgical tools900 may be supported. In various forms, the surgical tool(s)900 may be supported by a series of manually articulatable linkages, generally referred to as set-upjoints804, and arobotic manipulator806. In various embodiments, the linkage and joint arrangement may facilitate rotation of a surgical tool around a point in space, as more fully described in U.S. Pat. No. 5,817,084, entitled REMOTE CENTER POSITIONING DEVICE WITH FLEXIBLE DRIVE, the entire disclosure of which is hereby incorporated by reference herein. The parallelogram arrangement constrains rotation to pivoting about anaxis812a, sometimes called the pitch axis. The links supporting the parallelogram linkage are pivotally mounted to set-up joints804 (FIG. 22) so that the surgical tool further rotates about anaxis812b, sometimes called the yaw axis. The pitch andyaw axes812a,812bintersect at theremote center814, which is aligned along an elongate shaft of thesurgical tool900. Thesurgical tool900 may have further degrees of driven freedom as supported by themanipulator806, including sliding motion of thesurgical tool900 along the longitudinal axis “LT-LT”. As thesurgical tool900 slides along the tool axis LT-LT relative to manipulator806 (arrow812c), theremote center814 remains fixed relative to thebase816 of themanipulator806. Hence, the entire manipulator is generally moved to re-position theremote center814.Linkage808 ofmanipulator806 may be driven by a series ofmotors820. These motors actively movelinkage808 in response to commands from a processor of a control system. Themotors820 may also be employed to manipulate thesurgical tool900. Alternative joint structures and set up arrangements are also contemplated. Examples of other joint and set up arrangements, for example, are disclosed in U.S. Pat. No. 5,878,193, entitled AUTOMATED ENDOSCOPE SYSTEM FOR OPTIMAL POSITIONING, the entire disclosure of which is hereby incorporated by reference herein.
• While the data communication between a robotic component and the processor of the robotic surgical system is primarily described herein with reference to communication between the surgical tool and themaster controller701, it should be understood that similar communication may take place between circuitry of a manipulator, a set-up joint, an endoscope or other image capture device, or the like, and the processor of the robotic surgical system for component compatibility verification, component-type identification, component calibration (such as off-set or the like) communication, confirmation of coupling of the component to the robotic surgical system, or the like. In accordance with at least one aspect, various surgical instruments disclosed herein may be used in connection with other robotically-controlled or automated surgical systems and are not necessarily limited to use with the specific robotic system components shown inFIGS. 21-23 and described in the aforementioned references.
• It is common practice during various laparoscopic surgical procedures to insert a surgical end effector portion of a surgical instrument through a trocar that has been installed in the abdominal wall of a patient to access a surgical site located inside the patient's abdomen. In its simplest form, a trocar is a pen-shaped instrument with a sharp triangular point at one end that is typically used inside a hollow tube, known as a cannula or sleeve, to create an opening into the body through which surgical end effectors may be introduced. Such arrangement forms an access port into the body cavity through which surgical end effectors may be inserted. The inner diameter of the trocar's cannula necessarily limits the size of the end effector and drive-supporting shaft of the surgical instrument that may be inserted through the trocar.
• Regardless of the specific type of surgical procedure being performed, once the surgical end effector has been inserted into the patient through the trocar cannula, it is often necessary to move the surgical end effector relative to the shaft assembly that is positioned within the trocar cannula in order to properly position the surgical end effector relative to the tissue or organ to be treated. This movement or positioning of the surgical end effector relative to the portion of the shaft that remains within the trocar cannula is often referred to as “articulation” of the surgical end effector. A variety of articulation joints have been developed to attach a surgical end effector to an associated shaft in order to facilitate such articulation of the surgical end effector. As one might expect, in many surgical procedures, it is desirable to employ a surgical end effector that has as large a range of articulation as possible.
• Due to the size constraints imposed by the size of the trocar cannula, the articulation joint components must be sized so as to be freely insertable through the trocar cannula. These size constraints also limit the size and composition of various drive members and components that operably interface with the motors and/or other control systems that are supported in a housing that may be handheld or comprise a portion of a larger automated system. In many instances, these drive members must operably pass through the articulation joint to be operably coupled to or operably interface with the surgical end effector. For example, one such drive member is commonly employed to apply articulation control motions to the surgical end effector. During use, the articulation drive member may be unactuated to position the surgical end effector in an unarticulated position to facilitate insertion of the surgical end effector through the trocar and then be actuated to articulate the surgical end effector to a desired position once the surgical end effector has entered the patient.
• Thus, the aforementioned size constraints form many challenges to developing an articulation system that can effectuate a desired range of articulation, yet accommodate a variety of different drive systems that are necessary to operate various features of the surgical end effector. Further, once the surgical end effector has been positioned in a desired articulated position, the articulation system and articulation joint must be able to retain the surgical end effector in that locked position during the actuation of the end effector and completion of the surgical procedure. Such articulation joint arrangements must also be able to withstand external forces that are experienced by the end effector during use.
• Various surgical instruments employ a variety of different drive shaft arrangements that serve to transmit drive motions from a corresponding source of drive motions that is supported in a handle of the surgical instrument or other portion of an automated or robotically controlled system. These drive shaft arrangements must be able to accommodate significant articulated orientations of the end effector while effectively transmitting such drive motions across the articulation joint of the surgical instrument. In addition, due to the above-mentioned size constraints dictated by the sizes of trocars through which the instrument shafts must be inserted, these drive shaft components must occupy as little space as possible within the shaft. To accommodate such requirements, many drive shaft arrangements comprise several movable elements that are coupled together in series. The small sizes (e.g., 4 mm diameter) and numbers of components lead to difficult and lengthy assembly procedures that add to the cost and complexity of the device.
• As further described herein, a powered stapling device can include two independently rotatable drive members: a first rotary drive member configured to effect closing of the jaws of the end effector and a second rotary drive member configured to effect firing of a staple cartridge installed in the end effector. The first and second rotary drive members are flexible and configured to extend through at least one articulation joint. In such instances, the first and second rotary drive members can transmit rotary actuation motions through the articulation joint(s) when in a non-flexed configuration and when in a flexed configuration. Exemplary rotary drive members are further described herein.
• The powered stapling assembly further comprises a first jaw, a second jaw, a closure drive comprising the first rotary drive member extending through the articulation joint, and a firing drive comprising the second rotary drive member extending through the articulation joint. The second rotary drive member can be rotatable independent of the first rotary drive member. The closure drive can be activated by a closure trigger, for example, whereupon an actuation of the closure drive effects a rotation of the first rotary drive member, which transmits a rotary motion through the articulation joint to a closure screw. The closure drive further comprises a closure wedge threadably coupled to the closure screw, wherein the closure wedge is configured to engage the first jaw to move the first jaw from an open position to a closed position upon rotation of the first rotary drive member.
• The firing drive can be activated by a firing trigger, for example, which is separate from the closure trigger. The rotation of the second rotary drive member is separate from the rotation of the first rotary drive member, and a closure motion is separate and distinct from a firing motion. Activation of the firing drive effects a rotation of the second rotary drive member, which transmits a rotary motion through the articulation joint to a firing screw. The firing drive further comprises a firing member threadably coupled to the firing screw, wherein the firing member is configured to camming engage the first jaw and the second jaw and to move a cutting member and/or a staple-firing sled upon rotation of the second rotary drive member.
• In various instances, at least one component in the powered stapling device can be a 3D-printed component. 3D-printed components can be incorporated into an articulation system, a closure/grasping system, and/or a firing system, as further described herein. 3D printing technology can be utilized to improve component capabilities in certain instances. For example, 3D printing can allow the printed component to exhibit metamaterial properties, such that the 3D-printed components exhibits greater structural strength and stiffness while allowing precision in the forming of small detailed features and optimizing other properties of the component such as selective flexibility and/or lubrication, for example. Exemplary 3D-printed components for the powered stapling device are further described herein and include the flexible rotatable drive member(s), e.g. serial 3D-printed universal joints, the firing member or I-beam, and/or the staple cartridge and/or sub-components thereof. In one instance, the staple cartridge can be a composite plastic-metal 3D-printed component. 3D printing of various components and considerations therefor are further described herein.
• A method of stapling with such surgical stapling assemblies is also contemplated. The method can include obtaining the surgical stapling assembly and activating, by the closure trigger, the closure drive, wherein the closure wedge is configured to engage the first jaw to move the first jaw from an open position to a closed position upon a rotation of the first rotary drive member. The method can further includes activating, by the firing trigger, the firing drive, wherein the firing member is configured to camming engage the first jaw and the second jaw and to advance a cutting member and a staple-firing sled during a firing motion upon a rotation of the second rotary drive member. Various applications of 3D-printed components in such assemblies are further described herein.
• In various instances, a surgical end effector and or stapling assembly for a surgical device can include a rotary drive screw or rotary drive member, as further described herein. A rotary drive screw can extend through a channel and/or portion of a staple cartridge to a distal location in the end effector. The rotary drive screw can facilitate clamping and/or firing of the staple cartridge, as further described herein. The rotary drive screw can extend along a longitudinal axis and can be aligned with a centerline of the staple cartridge extending from a proximal end to a distal end thereof.
• A rotary drive screw through an end effector can take up a substantial portion of the limited real estate along the longitudinal center portion of the end effector and staple cartridge thereof. In various instances, the rotary drive screw may interfere with certain existing firing components, such as the drivers and/or the sled, for example. The small footprint of the staple cartridge and the significant firing forces applied to various components in an end effector and staple cartridge can pose various challenges to structural variations and/or the relocation of certain components.
• For example, the firing component(s) in a staple cartridge having a rotary drive screw therethrough need to be modified to avoid interference and provide a sufficient clearance around the rotary drive screw while withstanding the firing forces and balancing torques during the firing stroke in order to minimize damage to the components and/or misfiring of the staples. In various instances, the rows of staples can be condensed (i.e. a denser staple arrangement) and/or shifted laterally outboard away from the rotary drive screw to increase lateral space around the centerline of the staple cartridge. Relocation and/or increased density of the staple rows may require various adaptions to the firing components such as the drivers and/or the sled, for example.
• In various instances, the drivers and/or the sled can be modified to correspond to the relocated and/or condensed staple rows while minimizing jams and/or incidences of misfiring. Modifications to the staple drivers may include structural and geometric variations to the staple support columns and/or bridges therebetween, for example. In certain instances, an upper portion of the driver (e.g. the widths of the staple supporting columns) can be asymmetric relative to a centerline of the driver. Additionally or alternatively, a lower portion of the driver (e.g. the bridges and/or base of the staple supporting columns) can be asymmetric relative to a centerline of the driver.
• For example, in one aspect of the present disclosure, a staple cartridge can include a body extending along a longitudinal axis, rows of staples, and a triple driver configured to fire three staples simultaneously. The rows of staples can include an inner row on a first side of the longitudinal axis, wherein the inner row comprises an inner staple. The rows of staples can also include an intermediate row on the first side of the longitudinal axis, wherein the intermediate row comprises an intermediate staple. Furthermore, the rows of staples can include an outer row on the first side of the longitudinal axis, wherein the outer row comprises an outer staple. The intermediate row can be equilaterally spaced from the inner row and the outer row. The triple driver can include an inner support column defining a first width, wherein the inner support column is configured to support the inner staple. The triple driver can also include an intermediate support column defining a second width, wherein the intermediate support column is configured to support the intermediate staple. Further, the triple driver can include an outer support column defining a third width, wherein the outer support column is configured to support the outer staple. The first width can be less than the second width and less than the third width. In certain instances, the first width, the second width, and the third width can all be different.
• In various aspects of the present disclosure, varied widths of the staple support columns of a multi-staple driver can be configured to provide a wider space for the sled rails while optimizing real estate for a rotary drive screw along a central longitudinal portion of the staple cartridge. Various improvements to the staple cartridge, including to the drivers and the cartridge body, for example, and advantages thereof are further described herein.
• Referring now toFIGS. 24 and 25, astaple cartridge20100 includes abody20102 extending along a longitudinal axis A. Staples are removably positioned in thebody20102. The staples can be ejected from thebody20102 and fired into tissue, for example, during a firing stroke. The staples are arranged in longitudinal rows on either side of the longitudinal axis A. Thecartridge body20102 also includes adeck20104, which can be referred to as a tissue-supporting surface, for example. Thedeck20104 is a laterally-curved tissue-supporting surface and defines a curved surface or contour from a first lateral side of thebody20102 to a second lateral side of thebody20102. A peak in the laterally-curved tissue-supportingdeck20104 is defined at an intermediate portion of thebody20102. The peak can be positioned between the longitudinal rows of staples and overlie the longitudinal axis A, for example. In various instances, a rotary drive screw, like the firing screw261 (FIGS. 4 and 5), for example, extends through a portion of thestaple cartridge20100, as further described herein.
• The staples are positioned incavities20110 defined in thecartridge body20102. The staples are arranged in longitudinal rows on either side of the longitudinal axis A. For example, thecavities20110 are arranged in cavity rows20112. The cavity rows include aninner row20112a, anintermediate row20112b, and anouter row20112con each side of the longitudinal axis A. Theintermediate row20112bis equilaterally spaced between theinner row20112aand theouter row20112c. For example, theinner cavity row20112acan be laterally spaced inward from theintermediate cavity row20112bby a distance, and theouter cavity row20112ccan be laterally spaced outward from theintermediate cavity row20112bby the same distance. The rotary drive screw can be aligned with the longitudinal axis A, and can extend through thecartridge body20102 adjacent to theinner cavity rows20112a. The rotary drive screw can be between and parallel to theinner cavity rows20112a, for example.
• Theinner rows20112ahold inner staples, theintermediate rows20112bhold intermediate staples, and theouter rows20112chold outer staples. In various instances, the inner staples, the intermediate staples, and the outer staples can be identical. In other instances, the inner staples, the intermediate staples, and/or the outer staples can be each be different with respect to staple type (e.g. wire or stamped), material, and/or size (e.g. different heights), for example. The reader will appreciate that various staples, staple cavities, staple drivers, and staple cartridges are described herein. However, in certain instances, alternative fasteners can be utilized and such fasteners can be incorporated into fastener cavities, driven by fastener drivers, and/or fired from fastener cartridges which can be similar to the staple cavities, staple drivers and/or staple cartridges described herein in many aspects.
• Thestaple cartridge20100 may have a different arrangement of staples. For example, thestaple cartridge20100 may have less than three rows of staples on each side of the longitudinal axis A and, in one aspect, may only have two rows of staples on each side of the longitudinal axis A. In still other instances, thestaple cartridge20100 can include four or more rows of staples on one or more sides of the longitudinal axis A. In various instances, the rows of staples may be asymmetrical relative to the longitudinal axis A. For example, the first side of thestaple cartridge20100 can have a different number of rows of staples than the second side of thestaple cartridge20100.
• Eachstaple cavity20110 includes a proximal end, a distal end, and lateral guide surfaces intermediate the proximal end and the distal end. Thestaple cavities20110 are structured and dimensioned to guidedrivers20120 through thestaple cavities20110 toward thedeck20104. More specifically, the geometry of thestaple cavities20110 can complement the geometry of thedrivers20120. For example, the lateral guide surfaces in eachstaple cavity20110 are configured to guidesidewalls20134 of the driver20120 (e.g. sidewalls of the staple-supporting columns) as thedriver20120 moves through thestaple cavity20110. Additionally or alternatively, the proximal end and/or the distal end of eachstaple cavity20110 can include an upright groove configured to slidably receive an end and/or tongue thereof of thedriver20120. Alternative tongue and groove arrangements are also contemplated, which can be configured to guide thedrivers20120 through thestaple cavities20110 during firing of the staples from thestaple cartridge20100.
• Thedrivers20120 are configured to support and drive multiple staples from thecartridge body20102 during a firing stroke. Thedrivers20120 can movably support staples spanning two or more longitudinal rows of staple cavities20112. For example, thedrivers20120 can movably support an inner staple, an intermediate staple, and an outer staple on the same side of thestaple cartridge20100.
• Referring primarily now toFIGS. 26-28, thedriver20120 is shown. Multiple drivers like thedriver20120 are incorporated into thestaple cartridge20100, for example. Thedriver20120 is a triple driver, which is configured to drive three staples simultaneously. Thedriver20120 includes three support columns—aninner support column20122aconfigured to support an inner staple in an inner row of staples, anintermediate support column20122blaterally outboard of theinner support column20122aconfigured to support an intermediate staple in an intermediate row of staples, and anouter support column20122claterally outboard of theintermediate support column20122band configured to support an outer staple in an outer row of staples. Thesupport columns20122a,20122b,20122cof each drive20120 can be longitudinally staggered in various instances.
• Thedriver20120 also includes bridges20126 extending between adjacent support columns20122. For example, afirst bridge20126aextends between theinner support column20122aand theintermediate support column20122b, and asecond bridge20126bextends between theintermediate support column20122band theouter support column20122c. Thebridges20126a,20126beach include a rampedunderside20128 configured to be drivingly engaged by a sled during a firing stroke. Stated differently, eachdriver20120 is configured to be engaged and lifted by two parallel sled rails along the rampedundersides20128 of thedriver20120. For example, a sled can be configured to move along a firing path during a firing stroke. The sled can comprise a central portion aligned with the longitudinal axis A, a first rail on a first side of the longitudinal axis A that is configured to driving engage the rampedunderside20128 of thefirst bridge20126a, and a second rail on a second side of the longitudinal axis A that is configured to drivingly engage the rampedunderside20128 of thesecond bridge20126b. Sleds and firing motions thereof are further described herein.
• Each support column20122 includes aproximal end20130, adistal end20132, and a pair of opposingsidewalls20134 extending longitudinally between theproximal end20130 and thedistal end20132. Thesidewalls20134 are configured to slidably engage the lateral guide surfaces in therespective staple cavity20110 during a firing motion. Each support column20122 includes a staple-supportingcradle20124. A base of the staple can be held in the staple-supportingcradle20124.
• The staple-supportingcradles20124 are each aligned with one of an inner axis A1, an intermediate axis A2, or an outer axis A3, which correspond to the axes defining the longitudinal rows of staples andstaple cavities20110 on one side of thestaple cartridge20100. A first lateral distance D1 is defined between the inner axis A1 and the intermediate axis A2, and a second lateral distance D2 is defined between the outer axis A3 and the intermediate axis A2. The axes are equilaterally spaced; the first lateral distance D1 and the second lateral distance D2 are the same. Though the lateral distances D1, D2 between the axes and adjacent rows ofstaple cavities20110 are the same, thedriver20120 is asymmetrical relative to a centerline of thedriver20120. For example, the centerline of thedriver20120 corresponds to the intermediate axis A2 and the inner and outer staples are positioned equidistant from intermediate axis A2; however, thedriver20120 is not symmetrical about the intermediate axis A2.
• Referring primarily toFIG. 27, theinner support column20122adefines a first width Wa between itssidewalls20134, theintermediate support column20122bdefines a second width Wb between itssidewalls20134, and theouter support column20122cdefines a third width Wc between itssidewalls20134. The first width Wa is different than the second width Wb and the third width Wc. For example, the first width Wa can be reduced or narrowed to less than the second width Wb and less than the third width Wc to accommodate the rotary drive screw through a center portion of thestaple cartridge20100. In certain instances, one or more narrower support columns20122 can effectively narrow and reduce the footprint of thedriver20120 while maximizing the width the bridge20126 and, thus, maximizing the width of the sled rails, which engage the rampedundersides20128 of the bridges20126 and deliver the firing force to thedriver20120, for example. In various instances, increasing the width of the bridge20126 and the sled rails may improve the stiffness of the sled rails and minimize deformations and/or damage to the sled during a firing stroke.
• The widths Wa, Wb, and Wc are all different. For example, the width Wb of theintermediate support column20122bis greater than the width Wa of theinner support column20122aand the width Wc of theouter support column20122c. The width Wc is less than the width Wb of theintermediate support column20122band greater than the width Wa of theinner support column20122a. The differing widths Wa, Wb, and Wc are configured to optimize the width of thedriver20120 to accommodate a rotary drive screw along the longitudinal axis A, while effectively transferring the firing force and minimizing torque and mis-firings, for example.
• As provided herein, in certain instances, the width of the staple support columns on the drivers can be varied to accommodate a rotary drive screw positioned in the staple cartridge. Additionally or alternatively, in certain aspects of the present disclosure, the lower portions of a driver can also vary laterally and the lower portion (e.g. the lower portion of the support columns and/or the bridges) may be asymmetric relative to a centerline through the intermediate support column. For example, a lower portion of the drivers can be improved to increase the available real estate in a longitudinal center portion of the staple cartridge. An asymmetric geometry for the lower portion of the drivers can be selected to improve the strength and stiffness of the triple driver while minimizing the height of the driver. In various instances, though the support column thickness and/or bridge geometry can vary laterally, the support columns can be equally spaced from a centroid of the substantially triangular triple driver. For example, the intermediate support column can be longitudinally aligned with the centroid, and the inner and outer support columns can be longitudinally offset from the centroid. In various instances, the ramped surfaces can be equilaterally spaced from the centroid of the triple driver.
• Referring toFIGS. 29 and 30, anend effector20240 including astaple cartridge20200 and atriple driver20220 is shown. Thestaple cartridge20200 is similar in many aspects to the staple cartridge20100 (FIG. 24), and thetriple driver20220 is similar in many aspects to the triple driver20120 (FIG. 26). For example, thestaple cartridge20200 includes acartridge body20202 including three rows of staple cavities on each side of therotary drive screw20242, and thetriple driver20220 include three parallel staple-supportingcradles20224 configured to support staples, wherein thetriple driver20220 is configured to fire staples from an inner row, an intermediate row, and an outer row.
• Theend effector20240 includes arotary drive screw20242 and a firingmember20244, which are similar to the firing screw261 (FIGS. 4 and 5) and the firing member270 (FIGS. 4 and 5), respectively. The firingmember20244 is configured to move through thestaple cartridge20200 during a firing stroke to advance the sled and lift thedriver20220.
• Thedriver20220 includes aninner support column20222a, anintermediate support column20222b, and anouter support column20222c. The columns20222 comprise different widths, as further described herein. In various aspects of the present disclosure, one or more of the columns20222 can also include a different height than the other columns. In various instances, the different heights are configured to form staples to varying heights, which can correspond to the contour of a laterally-curved tissue-support surface or deck of the cartridge body, for example.
• The lower portion of thedriver20220 includes a chamferedinner edge20236. The chamferedinner edge20236 is a cutaway or scalloped edge dimensioned to accommodate thedrive screw20242 and a lower portion of the firingmember20244. For example, thedrive screw20242 extends along the longitudinal axis A and is positioned between thedrivers20220 on opposite sides of the longitudinal axis A. In such instances, thedrive screw20242 can extend through thestaple cartridge20200 while minimizing the dimensions ofstaple cartridge20200 andend effector20240. The chamferedinner edge20236 comprises a cutaway into a base portion of theinner support column20222a, which provides a clearance for the firing components positioned along the longitudinal center portion of theend effector20240. Moreover, the chamferedinner edge20236 is configured to provide a space closer to a vertical centerline of the of the end effector, i.e. equidistance between the upper cam and the lower cam, which can improve and/or help to balance the forces during the firing stroke.
• Additionally or alternatively, the bridges of a driver can vary laterally and/or be asymmetric relative to a centerline through the intermediate support column of the driver. Referring now toFIG. 31, anend effector20340 including astaple cartridge20300 and atriple driver20320 is shown. Thestaple cartridge20300 is similar in many aspects to the staple cartridge20100 (seeFIG. 24), and thetriple driver20320 is similar in many aspects to the triple driver20120 (seeFIG. 26). For example, thestaple cartridge20300 includes acartridge body20302 anddeck20304; three rows of staple cavities are positioned on each side of the rotary drive screw, and thetriple driver20320 includes three parallel staple-supportingcradles20324 configured to support staples, wherein thetriple driver20320 is configured to fire staples from an inner row, an intermediate row, and an outer row. Thedriver20320 is depicted in a fired configuration inFIG. 31, in which an upper portion of staple support columns extend through the deck20304 (i.e. staple overdrive).
• Theend effector20340 can include a rotary drive screw and a firing member, as further described herein, the firing member moves through thestaple cartridge20300 during a firing stroke to advance asled20350 havingrails20352 to lift thedriver20320. Thedriver20320 includes aninner support column20322a, anintermediate support column20322b, and anouter support column20322c. The columns20322 comprise different widths, as further described herein. In various aspects of the present disclosure, one or more of the columns20322 can also include a different height than the other columns, as further described herein.
• The lower portion of thedriver20320 includes a chamferedinner edge20336, which is similar in many aspects to the chamfered edge20236 (FIG. 29). The lower portion of thedriver20320 also includes the bridges20326 between adjacent staple support columns20322. Afirst bridge20326aconnects theinner support column20322ato theintermediate support column20322b, and asecond bridge20326bconnects theintermediate support column20322bto theouter support column20322c. The geometry of thefirst bridge20326ais different than the geometry of thesecond bridge20326b. Stated differently, thebridges20326aare asymmetric relative to a vertical plane P (FIG. 31) through thedriver20320 and aligned with an axis of an intermediate staple base/crown supported thereon.
• Thefirst bridge20326ais taller than thesecond bridge20326b. In various instances, as further described herein, a central longitudinal portion of thestaple cartridge20300 can be taller and define a greater height at a peak of the laterally-curved tissue support surface than along the sides of thestaple cartridge20300. As a result, thestaple cartridge20300 can accommodate additional material and/or increased height/volume of thedriver20320 between theinner support column20322aand theintermediate support column20322bthan between theouter support column20322cand theintermediate support column20322b. The increased height of thefirst bridge20326afrom the base surface compared to thesecond bridge20326bcan compensate for rigidity losses resulting from the chamferedinner edge20336, for example. Additionally or alternatively, the greater height of thefirst bridge20326acompared to thesecond bridge20326bcan improve the stiffness and strength of thetriple driver20320, while minimizing the dimensions and maintaining a compact form factor for thestaple cartridge20300 and theend effector20340.
• In certain instances, an upper portion of thefirst bridge20326acan be configured to guide thedriver20320 through the staple cavities during an initial portion of the firing motion through the staple cavities. For example, when theinner support column20322ais in an unfired position, theinner support column20322amay be at least partially unsupported or unguided by lateral guide surfaces because of cutouts in a central portion of thecartridge body assembly20300 to accommodate the rotary drive screw. In the absence of certain lateral support surfaces around theinner support column20322a, thedriver20320 may be prone to torque and/or misfiring. However, the increased height of thefirst bridge20326acan be configured to engage an upright support surface in the cartridge body during an initial portion of the firing motion to improve the guidance and support of thedriver20320.
• Referring now toFIG. 32, an alternative driver geometry for adriver20420 is shown. Thedriver20420 is a triple driver and is similar in many aspects to the triple driver20120 (FIG. 26). For example, thetriple driver20420 includes three parallel staple-supportingcradles20424 configured to support staples, and thetriple driver20420 is configured to fire staples from an inner row, an intermediate row, and an outer row. Thedriver20420 can be incorporated in various staple cartridges disclosed herein. For example, thedriver20420 can be utilized with a staple cartridge adapted to receive a rotary drive screw extending along a longitudinal axis and with a variable height deck.
• Thedriver20420 includes aninner support column20422a, anintermediate support column20422b, and anouter support column20422c. The columns20422 comprise different widths, as further described herein. In various aspects of the present disclosure, one or more of the support columns20422 can also include a different height than the other support columns, as further described herein.
• The lower portion of thedriver20420 includes a chamferedinner edge20436, which is similar in many aspects to the chamfered edge20236 (FIG. 29). The lower portion of thedriver20420 also includes bridges between adjacent staple support columns20422. Afirst bridge20426aconnects theinner support column20422ato theintermediate support column20422b, and a second bridge20426bconnects theintermediate support column20422bto theouter support column20422c. Variations to the geometry of a lower portion of thedriver20420 are indicated with dashed lines in the schematic illustration ofFIG. 32. For example, to provide adequate space and clearance along a central longitudinal portion of the staple cartridge for arotary drive screw20442, which is similar to the firing screw261 (FIGS. 4 and 5) in many aspects, thedriver20420 includes the chamferedinner edge20436 and the upper gusset20438 between thefirst bridge20426aand theinner support column20422a. In such instances, thedriver20420 can provide a space and clearance for therotary drive screw20442 while maintaining sufficient structural integrity and stiffness to appropriately transfer the firing loads.
• In various instances, a tallest height of the variable height deck and the staple cartridge can be adjacent to therotary drive screw20442. In such instances, a tighter tissue gap can be defined along the firing bar and cutting edge. The portion of the variable height deck overlaying theinner support column20422aand/orfirst bridge20426acan define the greatest height and, thus, in certain aspects, can fit the heightenedfirst bridge20426aand/or the gusset20438 intermediate thefirst bridge20426aand theinner support column20422a.
• In certain instances, one or more gusset plates can extend between an upper edge of thefirst bridge20426aand theinner support column20424. In certain instances, the gusset20438 can comprise a longitudinal gusset rib along at least a portion of the length of theinner support column20422aand thefirst bridge20426a. Thedriver20420 is asymmetric relative to a vertical plane P (FIG. 32) through theintermediate support column20422band aligned with the longitudinal axis of a staple base supported therein. For example, thefirst bridge20426acan define a different geometry and different cross-sectional profile than the second bridge20426bowing to the gusset20438 and/or to the chamferedinner edge20436.
• In certain instances, to accommodate a rotary drive screw along a central portion of the staple cartridge, a portion of the cartridge body can be cutaway. The cartridge body can include additional guides and support features configured to guide the driver through the staple cavity and toward the deck of the cartridge body. The guides can be configured to engage and support the driver even when a portion the driver is not fully seated within the staple cavity.
• Referring toFIGS. 33 and 34, acartridge body20502 is shown. In various instances, thecartridge body20502 can be similar in many aspects to the cartridge body20102 (FIG. 24) and can be incorporated into thestaple cartridge20100 and use the drivers20120 (FIG. 26). Staples can be positioned incavities20510a,20510b,20510cdefined in thecartridge body20502. The staples are arranged in longitudinal rows on either side of a longitudinal axis A along a centerline of thecartridge body20502. For example, thecavities20510a,20510b,20510care arranged in cavity rows. The cavity rows include aninner row20512a, anintermediate row20512b, and anouter row20512con each side of the longitudinal axis. A rotary drive screw (e.g. firing screw261 inFIGS. 4 and 5) can be aligned with the longitudinal axis A, and can extend through thecartridge body20502 adjacent to theinner cavity rows20512a. The rotary drive screw can be between and parallel to theinner cavity rows20512a, for example.
• Referring primarily toFIG. 34, thecartridge body20502 includes guide surfaces20514 extending around theinner cavities20510ain theinner row20512a. In various instances, the guide surfaces20514 are configured to guide the driver (e.g. theinner support column20122aof the triple driver20120) into and through theinner cavity20510aeven when theinner support column20122ais not fully seated in theinner cavity20510abefore firing. In various instances, the guide surfaces20514 are circumferential chamfers on the underside cartridge surface extending around theinner cavities20510a. Such circumferential chamfers are configured to prevent inadvertent snags and hang-ups as the inner support column of the driver is advanced into theinner cavity20510a. In other instances, the guide surfaces20514 can comprise a fillet, for example. The guide surfaces20514 can extend around the entire perimeter of theinner cavities20510a. In other instances, the guide surfaces20514 can be positioned around a portion of the perimeter, e.g. a first lateral side, a proximal end, and/or a distal end.
• Referring also toFIG. 35, a portion of theinner cavity20510aand thedriver20120 is shown. The lower edge of theinner cavity20510aincludes the guide surfaces20514 extending around theinner cavity20510a. The top edge of theinner support column20122aalso includes aguide surface20125, which is configured to guide theinner support column20122ainto alignment with theinner cavity20510aeven when theinner support column20122ais not fully seated in theinner cavity20510aprior to the firing stroke and initial lift of thedriver20120 by a sled. In such instances, the guide surfaces20514,20125 on the lower edge of theinner cavity20510aand the top edge of theinner support column20122a, respectively, are configured to interact to ensure theinner support column20122amoves smoothly into theinner cavity20510aduring a firing stroke. As further described herein, theinner support column20122amay not be fully seated in theinner cavity20510aprior to the firing stroke owing to the space required by the rotary drive screw along a central longitudinal portion of thecartridge body20502.
• Referring now toFIGS. 36 and 37, a portion of adriver20620 is shown. In various aspects of the present disclosure, thedriver20620 can be a triple driver and similar in many aspects to the driver20120 (FIG. 26). Thedriver20620 can be incorporated into the staple cartridge20100 (FIG. 24) in various aspects of the present disclosure. Thedriver20620 includes asupport column20622 configured to support a staple20680 (FIG. 37). Thesupport column20622 includes aproximal end20630, adistal end20632, and a pair of opposingsidewalls20634 extending longitudinally between theproximal end20630 and thedistal end20632. Thesidewalls20634 are configured to slidably engage the lateral guide surfaces in the respective staple cavity. Thesupport column20622 also includes a staple-supportingcradle20624, and a base of thestaple20860 can be held in the staple-supportingcradle20624.
• Thedriver20630 further includes proximal and distal upright features20636,20638 or extensions, which extend away from the base of thedriver20630 and away from the staple-supportingcradle20624. The proximalupright feature20636 is a proximal-most feature of thesupport column20622 and extends from theproximal end20630 of thesupport column20622. The distalupright feature20638 is a distal-most feature of thesupport column20622 and extends from thedistal end20636 of thesupport column20622. In the driver's unfired position, the proximal and distal upright features20636,20638 can be below the deck of the staple cartridge and extend toward the deck. The proximal and distal upright features20636,20638 can be configured to support thestaple20680 and guide the staple legs during formation, for example.
• The proximal and distal upright features20636,20638 are the tallest portions of thesupport column20622. In certain instances, when the driver is moved to the fired position, the proximal and distal upright features20636,20638 can extend above the deck and facilitate gripping and/or holding of tissue adjacent to thestaples20860. For example, the proximal and distal upright features20636,20638 can grip tissue at the proximal end and the distal end of the staple cavity. Moreover, the proximal and distal upright features20636,20638 can act as guide surfaces for thedriver20630 and can guide thesupport column20632 into the fastener cavity in certain instances. For example, when thesupport column20622 is not fully seated in the staple cavity prior to firing, as further described herein, the proximal and distal upright features20636,20638 are configured to guide thesupport column20622 into alignment with the staple cavity during the firing motion.
• In certain instances, the proximal and distal upright features20636,20638 may be incorporated into an inner support column (i.e. the support column adjacent to a firing path and/or rotary drive screw). In such instances, the proximal and distal upright features20636,20638 can engage the staple cavity during the firing stroke and are configured to guide the inner support column even if the inner support column is not fully seated in the staple cavity prior to firing, as further described herein. In other instances, the intermediate support column and/or the outer support column can also include at least one of a proximalupright feature20636 and/or a distalupright feature20638.
• In certain aspects of the present disclosure, the proximal and distal upright features20636,20638 are configured to be received into recesses along an underside of the tissue-supporting deck when thedriver20620 is in the fully advanced position. As further described herein, the underside of the tissue-supporting deck can include an array of recesses that fit within the pocket extenders on the anvil-facing side of the deck. Pocket extenders can surround or at least partially surround the openings in the tissue-supporting deck to grip tissue and/or guide the staple legs during the firing stroke. The nesting of features on the driver with underside recesses in the tissue-supporting deck is further described herein. Nesting of the proximal and distal upright features in the pocket extenders or ridges of the cartridge deck can maintain the desired tissue gap and deck thickness in various instances.
• In certain instances, a replaceable staple cartridge can be used with each firing stroke and then replaced with another replaceable staple cartridge for a subsequent firing stroke. The replaceable staple cartridge can include a cartridge body, drivers, staples, and a sled, as further described herein. Reusable, multi-fire cutting edges can be incorporated into the end effector and advanced relative to the replaceable staple cartridge in certain instances. For example, an end effector can include a firing member, such as an I-beam or an E-beam, for example, having a distal-facing upright cutting edge along a leading edge thereof. Exemplary firing members having a reusable cutting edge for use during multiple firing strokes are further described herein. In certain instances, reusable knives and the cutting edge(s) thereof can be a hardened part, which may be expensive to manufacture. In certain instances, the placement of a reusable knife in a surgical device may limit the number of times the surgical device can be reused. Moreover, to resist dulling of the knife with multiple firings, a reusable knife may not be as sharp as a single-use knife in certain instances.
• In other instances, a firing member, end effector, and/or surgical device may not include a multi-fire tissue-transecting knife. Instead of being incorporated into the surgical device itself, for example, a knife can be incorporated into a replaceable staple cartridge, for example. In such instances, a fresh cutting edge can be used with each firing stroke.
• Various replaceable staple cartridge assemblies having a tissue-transecting knife are described herein. In one instance, the firing member can include an integral sled component and the knife can be releasably attached or mounted to the firing member upon insertion of the staple cartridge into the surgical device or end effector thereof having the firing member.
• Referring now toFIG. 99, anend effector20840 having a firingmember20841 with anintegral sled20860 and attachment features (e.g. a recess20846) for connecting to a single-use knife20830 is shown. Theend effector20840 is similar in many aspects to the end effector200 (seeFIGS. 4 and 5) and is configured to cut and staple the tissue of a patient. For example, theend effector20840 includes acartridge jaw20850 having opposingsidewalls20852, and theend effector20840 also includes ananvil jaw20854. Thecartridge jaw20850 is configured to receive a staple cartridge, such as areplaceable staple cartridge20800 shown inFIG. 103, for example. Theend effector20840 also includes afiring drive system20839 that includes a rotary drive screw20842 (FIG. 105) and the firingmember20841, which are similar to the firing screw261 (FIGS. 4 and 5) and the firing member270 (FIGS. 4 and 5), respectively. The firingmember20841 is driven through theend effector20840 upon a rotation of therotary drive screw20842 during a firing stroke to fire staples from thestaple cartridge20800. Therotary drive screw20842 extends along a longitudinal axis A through thefastener cartridge20800.
• Referring primarily toFIG. 100A, the firingmember20841 includes anupright body portion20843,upper cam members20844 extending laterally from both sides of theupright body portion20843, andlower cam members20845 extending laterally from both sides of theupright body portion20843. When theend effector20840 is in a clamped configuration (FIG. 105), theupper cam members20844 are configured to cammingly engage ananvil jaw20854 of theend effector20840 during a firing stroke, and thelower cam members20845 are configured to cammingly engage thecartridge jaw20850 of theend effector20840 during the firing stroke. The upper andlower cam members20844,20845 are configured to clamp the jaws of theend effector20840 and define a tissue gap during a firing stroke, as further described herein with respect to various firing members (e.g. I-beams and E-beams). A threadedopening20847 through theupright body portion20843 is configured to receive therotary drive screw20842 therethrough. In other instances, a threaded nut can be threadably coupled to therotary drive screw20842 and mounted to the firingmember20841. Various threaded nuts and alternative firing members are further described herein.
• Referring still toFIG. 100A, the firingmember20841 further includes anintegrated sled20860. Thesled20860 has tworails20866. One of therails20866 is configured to engage a row of staple drivers on each side of thesurgical end effector20800. Stated differently, thesled20860 includes asingle rail20866 for each side of thesurgical end effector20800, i.e. for each side of the staple cartridge20800 (FIG. 103). A single rail on each side can save lateral space in thesurgical end effector20840, which can provide additional space to accommodate therotary drive screw20842 along the central portion of thesurgical end effector20840. In such instances, thesled20860 can be a reusable component that is provided with the firingmember20841 and the surgical device, for example.
• Referring primarily toFIG. 103, the firingmember20841 is driven through thestaple cartridge20800, which includes acartridge body20802 anddrivers20820,20821 movably positioned therein. Thedrivers20820 are triple drivers, and thedrivers20821 are double drivers. In various instances, the proximal-most drivers in thestaple cartridge20800 are thedouble drivers20821 and, in other instances, one or more of the proximal-most drivers can be single drivers. Thedouble drivers20821 include a lateral flange that includes a ramped surface for driving engagement by thesled rail20866 that is also aligned with ramped recesses20818 (FIG. 102) on thetriple drivers20820. Stated differently, the double drives20821 and thetriple drivers20820 are both driven by asingle sled rail20866 on each side of thefastener cartridge20800.
• Parallel longitudinal slots20803 (FIG. 103) through thecartridge body20802 are dimensioned to receive therails20866 during the firing stroke. Stated differently, as theupright body portion20843 of the firingmember20841 moves through a centrallongitudinal slot20808 in thecartridge body20802, therails20866 move alongparallel slots20803 along an underside of thecartridge body20802. The parallellongitudinal slots20803 are also parallel to thelongitudinal slot20808 through which theupright body portion20843 of the firingmember20841 protrudes.
• In other instances, the integral sled of a firingmember20841 can more than one rail on each side. For example, integrated sleds having four rails and six rails are also contemplated.
• The firingmember20841 is adapted to releasably connect to theknife20830. Theknife20830 includes opposingspring arms20832, which extend proximally toward theupright body portion20843 of the firingmember20841 and resiliently engage theupright body portion20843. Thespring arms20832 snap around theupright body portion20843 and extend into acavity20846 defined into theupright body portion20843. Theknife20830 also includes alongitudinal body20834, which is configured to rest and/or nest on a complementary surface on the firingmember20841 over the threadedopening20847 for therotary drive screw20842, for example. Theknife20830 further includes anupright cutting edge20836, which is configured to extend above a tissue-supporting deck20804 (FIG. 105) to transect tissue during a firing stroke.
• In various instances, thefastener cartridge20800 and thecartridge jaw20850 can include alignment and/or leveraging features for facilitating installation of thefastener cartridge20800 into thecartridge jaw20850. Various alignment and leveraging features are further described herein. These features can also align theknife20830 with the firingmember20841 and, more specifically, align thespring arms20832 with thecavity20846, to ensure theknife20830 is connected to the firingmember20841 upon insertion of thestaple cartridge20800 into thecartridge jaw20850.
• In theunfired staple cartridge20800, theknife20830 is aligned with theindicator sled20828, which is configured to be pushed distally by theknife20830 during the firing stroke. As further described herein, theindicator sled20828 provides a visible indication to a clinician and/or user when a firing stroke has been completed by moving into a window20806 (FIG. 114) in the nose of thecartridge body20802, as further described herein. Moreover, theindicator sled20808 is configured to selectively overcome a missing and/or spent cartridge lockout in certain instances, as further described herein.
• Theindicator sled20828 and theknife20830 are components of thestaple cartridge20800. When thestaple cartridge20800 is installed in thesurgical end effector20840, theknife20830 is brought into alignment with the firingmember20841 such that thespring arms20832 resiliently engage theopening20846. The insertion angle of thestaple cartridge20800 is configured to ensure the proper alignment of thespring arms20832 and theopening20846. In such instances, a fresh knife can be provided with eachstaple cartridge20800 and for each firing stroke.
• Referring primarily toFIGS. 100B and 101, theintegral sled20862 is configured to drivingly engage thetriple drivers20820 during a firing stroke. The firingmember20841 and thesled20862 move along a longitudinal path in thestaple cartridge20800 during a firing stroke to lift thedrivers20820 along transverse axes.
• Thetriple drivers20820 are lifted by asingle sled rail20862 on each side of thestaple cartridge20800. Eachtriple driver20820 includes a recessed ramp20818 (FIG. 102), which is positioned and dimensioned to receive thesled rail20862. Stated differently, thesled20860 has asingle rail20862 on each side of the central portion, and thesingle rail20872 is configured to lift and drive thetriple drivers20820. In effect, asingle rail20862 is configured to fire all the staples on one side of thestaple cartridge20800 and is configured to fire staples across three rows (e.g. inner row, intermediate row, outer row) via thetriple drivers20820. Referring primarily toFIG. 102, thetriple driver20820 includes the recessed ramp20818 (FIG. 102), which is dimensioned to receive thesled rail20862. The recessedramp20818 extends along a central portion of the triple driver20820 (e.g. underlying an intermediate/middle support column), as further described herein.
• Thetriple driver20820 can be similar to the triple driver20120 (FIG. 26) in many aspects. For example, thetriple driver20820 is configured to support three staples20890 (FIGS. 100B and 101), and to lift the threestaples20890 simultaneously. Thetriple driver20820 also includes three support columns—aninner support column20822aconfigured to support aninner staple20890 in an inner row of staples, anintermediate support column20822blaterally outboard of theinner support column20822aconfigured to support anintermediate staple20890 in an intermediate row of staples, and anouter support column20822blaterally outboard of theintermediate support column20822band configured to support anouter staple20890 in an outer row of staples.
• Thetriple driver20820 also includes bridges20826 extending between adjacent support columns20822. For example, afirst bridge20826aextends between theinner support column20822aand theintermediate support column20822b, and asecond bridge20826bextends between theintermediate support column20822band theouter support column20822c. The recessedramp20818, which is aligned with thedrive rail20866, is positioned between thefirst bridge20826aand thesecond bridge20826band proximal to theintermediate support column20822b.
• More specifically, the recessedramp20818 is longitudinally aligned with theintermediate support column20822b. Consequently, theintermediate support columns20822bof the drivers28020 are positioned in the parallellongitudinal slots20803 through thecartridge body20802 and are unsupported, or at least unsupported along a lower portion thereof, by thecartridge body20802 when in the unfired positions in thecartridge body20802. In such instances, thestaple20890 in the intermediate row of staples on each side of the cartridge body is supported by theintermediate support column20822band guided largely by a tissue-supportingdeck20804 of thecartridge body20802. In certain instances, pocket extenders and/or ridges along the tissue-supportingdeck20804 can further guide thestaples20890 during the firing stroke.
• Thetriple driver20820 can be symmetrical about a longitudinal axis along the recessedramp20818. In various instances, thetriple driver20820 can includewings20824, which extend laterally outward on both sides of theintermediate support column20822b. Thewings20824 are configured to prevent driver roll and to strengthen theintermediate support column20822b, in certain instances. For example, thewings20824 can help balance theintermediate support column20822bduring the firing stroke when theintermediate support column20822bis unsupported, or largely unsupported, by thecartridge body20802.
• Referring primarily toFIG. 103, thewings20824 extend intocomplementary grooves20805 in thecartridge body20802. During a firing stroke, thewings20824 move in thegrooves20805 upward toward the tissue-supportingdeck20804. Referring primarily toFIG. 104, thegrooves20805 are positioned on either side of the intermediate staple cavities and extend from the underside of thecartridge body20802 to the tissue-supportingdeck20804. In certain instances, the tissue-supportingdeck20804 can catch, block, and/or stop further upward motion of thewings20824 to retain thedrivers20820 in thecartridge body20800 upon completion of the firing stroke.
• Referring still toFIG. 103, a distal portion of theintermediate support column20822bis further configured to nest in a portion of the adjacenttriple driver20820. More specifically, thetriple driver20820 include a proximal groove20817 (FIG. 102), which is dimensioned to receive a distal tip of the adjacent (e.g. directly behind/proximal)triple driver20820. The nesting arrangement oftriple drivers20820 arranged end-to-end with nesting features therebetween is configured to further facilitate alignment and cooperative support of thetriple drivers20820 in thecartridge body20802.
• In short, thestaple cartridge20800 can includetriple drivers20820 which are configured to be lifted by asingle sled rail20866 that pushes on a center portion and rampedrecess20818 of thetriple driver20820 during a firing stroke. Thetriple drivers20820 can further includeswings20824 on both sides, which prevent roll of thetriple driver20820 during the firing stroke. Thewings20824 can move in corresponding slots in thecartridge body20802. In certain instances, thesled20860 can be integrally-formed with the firing member20841 (e.g. an I-beam or E-beam). In such instances, thesled20860 can be a reusable component along with the firingmember20842; however, afresh knife20830 can be provided with eachstaple cartridge20800. In other instances, the sled can be a discrete component in the staple cartridge and, in certain instances, the firingmember20841 can include an integral cutting edge.
• In various instances, triple drivers and a firing member with an integral two-rail sled, as described herein, can allow the triple driver to be narrower and, thus, allow more space in the cartridge body for a rotary drive screw. For example, the rotary drive screw can be positioned farther upward in the end effector closer to the upper cam of the firing member, rather than along the lowest portion of the end effector. Narrower drivers can provide a tighter staple line, for example, which may also improve homeostasis in certain instances. Additionally, the inner rows of staples can be moved laterally outward to accommodate the rotary drive screw, which may reduce the likelihood and/or incidences of staple tear out. Moreover, the cartridge body can provide a robust design without narrower support columns, towers, and/or thin sidewalls between the staple cavities and/or the longitudinal slot for the firing member. The sled rails can also be wider in certain instances and, thus, may be less prone to bending under substantial firing loads. In certain instances, the staple overdrive can be minimized when bending and flexing of the sled rails is limited.
• Referring primarily toFIG. 106, thestaple cartridge20800 includes robust support walls for withstanding a clamping load, and the tissue-supportingdeck20804 defines a thickness t1 along an inner edge of the intermediate staple cavity and a thickness t2 along an outer edge of the intermediate staple cavity. Conversely, referring now to astaple cartridge20900 having acartridge body20902 and a tissue-supportingdeck20904, the support walls of thecartridge body20902 can be narrower than the walls in thecartridge body20802. Moreover, the tissue-supportingdeck20904 has a thickness t3, which is less than the thickness t1 and thickness t2 of the tissue-supportingdeck20804. Thecartridge body20902 is adapted to receive a four-rail sled, for example.
• Effecting a firing stroke when a staple cartridge is missing from the surgical end effector can result in a knife transecting the clamped tissue without any means for sealing the transection. For example, without staples, such as staples, for example, a stapling device cannot staple and seal the cut tissue. Similarly, if an empty or spent staple cartridge is loaded in the end effector, i.e. a staple cartridge without staples or without a full set of staples, the tissue also would not be fully sealed along the transection. A missing cartridge lockout can prevent a firing stroke when a staple cartridge is missing from the end effector and a spent cartridge lockout can prevent a firing stroke when a spent staple cartridge is loaded in the end effector. In certain instances, a lockout can prevent a firing stroke when the staple cartridge is missing and spent. In instances in which a rotary firing screw extends through the end effector, the lockout can be configured to limit and/or prevent rotation of the rotary firing screw and, thus, to prevent the firing stroke.
• In one aspect, a lock nut can be positioned on the rotary drive screw and a lockout key can be incorporated into a movable feature in the staple cartridge. In the locked configuration, the lock nut rotates out of firing alignment and into a lockout notch in the end effector. Upon installing an unfired staple cartridge in the end effector, the lockout key engages the lock nut to rotate it into firing alignment and out of the lockout notch. The lock nut moves distally along the rotary drive screw during the firing stroke and the lockout key is also pushed distally during the firing stroke. The lockout key can remain in a distal position upon completion of the firing stroke and/or retraction of the firing member; however, the lock nut can return to a proximal position in the end effector. Because the staple cartridge has been fired (e.g. spent), the lock nut again rotates out of firing alignment and into the lockout notch to prevent a subsequent firing stroke until a replacement unfired staple cartridge is installed in the end effector. In other instances, a lock on the rotary drive screw may not be threadably engaged with the rotary drive screw and a spring can bias the lock into a lockout notch to selectively prevent a firing stroke.
• Such a lockout arrangement can be configured to prevent a firing stroke when a staple cartridge is missing and/or when the staple cartridge in the end effector has been spent/fired. Moreover, these arrangements can take up a minimal amount of space in the end effector. Moreover, the components can be simple and robust. In the instances of a lock nut threadably coupled to the rotary drive screw, only a single additional component in the end effector is needed for the lockout configuration. In various instances, the lockout key can provide a visual indication to a clinician that the staple cartridge has already been fired.
• Referring now toFIGS. 108-115, alockout arrangement21868 and various components thereof are shown. Thelockout arrangement21868 is incorporated into asurgical end effector21840, which is similar to the surgical end effector20840 (seeFIG. 99) in many aspects. Moreover, theend effector21840 is adapted to receive the staple cartridge20800 (seeFIG. 103). Theend effector21840 includes acartridge jaw21850, which is similar to the cartridge jaw20850 (seeFIG. 99); however, thecartridge jaw21850 further includes alockout notch21854 defined in abottom side21856.
• More specifically, thecartridge jaw21850 includes abottom side21856 andsidewalls21852 forming a channel that is dimensioned and structured to receive thestaple cartridge20800 therein. Thelockout notch21854 comprises a lateral recess or opening in a proximal portion of thebottom side21856. Thelockout notch21854 is aligned with alockout nut21874 threadably coupled to therotary drive screw20842 when therotary drive screw20842 andlockout nut21874 thereon are in an unfired or proximal position.
• Thelock nut21870 includes a central threaded aperture through a body portion, opposingflanges21874, and alug21872. Theflanges21874 and thelug21872 extend radially outward from the body portion. In an unlocked position (FIGS. 109B and 111), theflanges21874 extend laterally outward to an inside surface of thebottom side21856 of thecartridge channel21850 and are positioned to ride along and/or adjacent to the inside surface. Moreover, in an unlocked positioned, thelug21872 is aligned with theupright body portion20843 of the firingmember20841. In the locked position (seeFIGS. 108, 109A, 115), theflanges21874 are rotated out of alignment with the inside surface of thebottom side21856 such that one of theflanges21874 rotates into thelockout notch21854. Moreover, in the locked position, thelug21872 is rotated out of firing alignment with theupright body portion20843 of the firingmember20841.
• Thelock nut21870 is threadably coupled to therotary drive screw20842. A rotation of therotary drive screw20842 can rotate thelock nut21870 therewith unless the rotation of thelock nut21870 is prevented or blocked. Initially, when theend effector21840 is without a staple cartridge therein (FIGS. 108 and 109A), the rotation of therotary drive screw20842 is configured to rotate thelock nut21870 such that one of theflanges21874 is rotated into thelockout notch21854 aligned therewith. When anunspent staple cartridge20800 is installed in thesurgical end effector21840, thelockout nut21854 is rotated to the unlocked position. The unlocked position of thelockout nut21854 is shown inFIG. 109B; however, the staple cartridge is hidden for illustrative purposes.
• Referring primarily toFIGS. 111 and 112, thelockout key20828 includes afoot20827, which extends into a space in thecartridge body20802 above therotary drive screw20842. When anunfired staple cartridge20800 is installed in theend effector21840, thefoot20827 of thelockout key20828 rotates thelockout nut21870 into the unlocked position. More specifically, thefoot20827 includes beveled surfaces configured to engage and abut thelug21872 to bias and rotate thelug21872 into alignment with theupright body portion20843. Referring primarily toFIG. 112, thecartridge body20802 includes adetent20809, which extends toward thelongitudinal slot20808 in thecartridge body20802. Thedetent20809 is configured to hold thelockout key20828 in place upon insertion of thestaple cartridge20800 into theend effector21840.
• Thelockout key20828 also defines acontoured profile20829 that corresponds to acontoured profile track20807 in thecartridge body20802. Thecontoured profile track20807 is configured to resist rotation of thelockout key20828 as thelockout key20828 is pushed distally. In various instances, thefoot20827 forms a nook into which thelug21872 is received. Thefoot20827 rotates thelug20872 into the unlocked position. Subsequently, during a firing stroke, thelug21872 can remain engaged with the nook in thelockout key20828 and can push thelockout key20828 distally through the contouredprofile track20807. The firing force can be sufficient to overcome thedetent20809 holding thefoot20827 in a proximal position thecartridge body20802.
• Additionally or alternatively, theknife20830 can push thelockout key20828 distally through thecartridge body20802. Theknife20830 also comprises a contoured profile, which is configured to travel through the contouredprofile track20807 without rotating out of firing alignment during the firing stroke.
• Referring now toFIGS. 113 and 114, upon completion of the firing stroke, thelockout key20828 can be pushed to a distal position in thecartridge body20802. In the distal position, thelockout key20828 is visible through thewindow20806 in thecartridge body20802. For example, the distal nose of thecartridge body20802 can include thewindow20806 and thelockout key20828 can be parked near thewindow20806 such that thelockout key20828 is visible. Thefoot20827 of thelockout key20828 prevents thelockout key20828 from falling out of thecartridge body20802 through thewindow20808.
• Reversing rotary motion of therotary drive screw20842 is configured to retract the firingmember20841. As further described herein, theknife20830 can be retracted along with the firingmember20841 in various instances. However, the lockout key21828 can be released from theknife20830 and can remain at the distal position in thecartridge body20802. Referring primarily toFIG. 115, when the firingmember20841 is retracted back to a proximal position in thecartridge body20802, thelockout nut21870 is also retracted proximally along therotary drive screw20842. Owing to the rotary direction of therotary drive screw20840 during a retraction motion, thelockout nut21870 is not rotated into thelockout notch21854. Stated differently, thelockout nut21870 can remain in the unlocked position and move proximally past thelockout notch21854 during the retraction motion. However, if another firing motion is initiated and the rotary direction of therotary drive screw20842 is reversed, upon moving distally in theend effector21840, thelockout nut21870 will again rotate out of alignment with the firingmember20841 and aflange21874 of thelockout nut21870 can be rotated into thelockout notch21854.
• In the locked position, thelockout nut21870 cannot rotate relative to therotary drive screw20842 and cannot translate longitudinally through theend effector21840. As a result, rotary motion of therotary drive screw20842 is resisted and the firing stroke is prevented until thelockout nut21870 assumes the unlocked position.
• Thelockout arrangement21868 described herein with respect toFIGS. 108-115 includes a threadedlockout nut21870, which is coupled to therotary drive screw20842. Displacement of the threadedlockout nut21870 is a function of the rotation of therotary drive screw20840. In other instances, a lockout arrangement can includes a non-threaded lock positioned around therotary drive screw20842. Referring now toFIGS. 116 and 117, alockout arrangement22868 and various components thereof are shown. Thelockout arrangement22868 is incorporated into asurgical end effector22840, which is similar to the surgical end effector20840 (seeFIG. 99) in many aspects. Theend effector22840 is adapted to receive the staple cartridge20800 (seeFIG. 103). Theend effector22840 includes acartridge jaw22850, which is similar to the cartridge jaw20850 (seeFIG. 99); however, thecartridge jaw22850 further includes alockout notch22854 defined in abottom side21856. Moreover, theend effector22840 includes a firingmember22841, which is similar to the firingmember20841 in many aspects; however, theintegral sled20860 of the firingmember22841 includes sled rails22868 havingholes22868 therein, as further described here.
• Thelockout arrangement22868 includes alock22870, which is similar in many aspects to thelockout nut21870; however, thelock22870 is not threadably coupled to therotary drive screw20842. Thelock22870 includes central non-threaded aperture through a body portion, opposingflanges22874, and alug22872. Theflanges22874 and thelug22872 extend radially outward from the body portion.
• In an unlocked position, theflanges22874 extend laterally outward to an inside surface of thebottom side22856 of thecartridge channel22850 and are positioned to ride along and/or adjacent to the inside surface. Theflanges22874 are received in theholes22868 in thesled22860. For example, theholes22868 are through-holes in the sled rails20866 that are dimensioned and positioned to receive the opposingflanges22874 when thelock22870 is in the unlocked position. As a result, the firingmember22841 andsled rails22868 thereof are configured to pull thelock22870 along therotary drive screw20842 during the firing stroke. Moreover, in the unlocked positioned, thelug22872 is aligned with the upright body portion of the firingmember22841.
• In the locked position (FIGS. 116 and 117), theflanges22874 are rotated out of alignment with the inside surface of thebottom side22856 such that one of theflanges22874 rotates into thelockout notch22854. Moreover, in the locked position, thelug22872 is rotated out of firing alignment with the upright body portion of the firingmember22841.
• Thelockout arrangement22868 also includes aspring22870, which is configured to bias thelock22870 into thelockout notch22854. Thelockout arrangement22868 can function like thelockout arrangement21868; however, thespring22870 can bias thelock22870 into thelockout notch22854 such that thelockout arrangement22868 is always locked unless anunfired staple cartridge20800 is loaded into theend effector22840 and the lockout key21828 thereof temporarily overcomes thelockout arrangement22868 until the completion of the firing stroke. As described above with respect to thelockout arrangement21868, the lockout key21828 is configured to move through thewindow20806 in thecartridge body20802 at the completion of the firing stroke to communicate the completion of a firing stroke and that the staple cartridge has been fired/spent.
• The formed staple height is a function of the space between the staple-supporting surface and the staple-forming surface. More specifically, a vertical space between (A) a staple-supporting cradle on a driver in a fired position and (B) a staple-forming pocket surface in an anvil in the clamped position controls the formed height of the staples. Different formed staple heights are selected for different surgical procedures and/or different tissue types, for example. When a staple cartridge includes a rotary firing screw therethrough, the arrangement of staples and corresponding staple cavities and drivers can be altered to accommodate the rotary firing screw. For example, the drivers can include at least one asymmetry, as further described herein. Additionally or alternatively, the drivers can be narrower and, thus, need additional support and/or strength. Moreover, in various instances, it is desirable to optimize a tissue gap while maintaining a desired formed staple height. For example, the tissue gap between the tissue-supporting deck surface and the anvil can be maximized when the end effector is in a closed configuration while the desired formed staple height is maintained.
• In various instances, an underside of the tissue-supporting deck can include a contoured and/or rutted surface, which is configured to receive one or more portions of the drivers when the drivers are in their fully fired and/or overdriven positions. The interlocking and/or nesting between the underside of the tissue-supporting deck and the tissue-facing side of the drivers can maximize the tissue gap while still maintaining a desired formed staple height. Moreover, the interlocking features can improve the strength of the drivers in various instances.
• In one example, a staple cartridge can include a body comprising a tissue-supporting deck, wherein staple cavities are defined through the tissue-supporting deck in the body, and wherein the tissue-supporting deck includes a tissue-facing side comprising a bumpy or ridged surface. The tissue-support deck further includes an underside opposite the tissue-facing side, wherein the underside comprises a rutted surface. Staples can be removably positioned in the staple cavities. Drivers can movably support the staples and be configured to move through a portion of the staple cavities to fired positions to eject the staples from the staple cavities. Each driver can include a base housed in the staple cartridge and comprising surface contours configured to mate with the rutted surface on the underside of the tissue-supporting deck when moved to the fired position.
• Referring now toFIGS. 38-40, astaple cartridge22100 is shown. Thestaple cartridge22100 is similar in many aspects to the staple cartridge20100 (FIG. 24). For example, thestaple cartridge22100 includes abody22102 extending along a longitudinal axis A. Staples are removably positioned in thebody22102. The staples can be ejected from thebody22102 and fired into tissue, for example, during a firing stroke. The staples are arranged in longitudinal rows on either side of the longitudinal axis A, which is aligned with a rotary drive shaft22242 (FIG. 39) extending therethrough. Thecartridge body22102 also includes adeck22104, which can be referred to as a tissue-supporting deck, for example. Thedeck22104 is a laterally-curved tissue supporting deck and defines a curved tissue-facing surface from a firstlateral side22101 of thebody22102 to a secondlateral side22103 of thebody22102. Apeak22105 in the laterally-curvedtissue supporting deck22104 is defined at an intermediate portion of thebody22102. Thepeak22105 can be positioned between the longitudinal rows of staples and overlie the longitudinal axis A, for example. In various instances, the rotary firing screw22242 (FIG. 39) extends through a portion of thestaple cartridge22100.
• Thecartridge body22102 also includes an array of pocket extenders orridges22114 extending from thetissue supporting deck22104. Theridges22114 extend around a perimeter or opening formed in thetissue supporting deck22104 for a staple cavity. Theridges22114 can be configured to grip and engage tissue positioned between thestaple cartridge22100 and an opposing anvil. In various instances, theridges22114 can limit and/or constrain tissue flow, for example. Additionally or alternatively, theridges22114 can be configured to guide the legs of the staples as they enter tissue and are directed into engagement with respective forming pockets on the staple-forming surface of the anvil. Theridges22114 can extend around the proximal and distal ends of the staple cavities, for example. Proximally- and distally-positioned projections or pocket extensions can prevent outwardly-biased staple legs (of V-shaped staples, for example) from flaring outwardly and missing the target location in the forming pocket aligned therewith.
• In certain aspects,adjacent ridges22114 can be connected. For example, theridges22114 can be interconnected with respect to longitudinally-offset staple cavities and/or laterally-offset staple cavities.
• In various instances, an array of laterally-offsetridges22114 can define different heights. In various instances, theridges22114 can define different heights laterally along the width of thecartridge body22102. Different heights can correspond to the lateral curve of thetissue supporting deck22104 and/or different lengths for guiding the staples beyond the tissue-supportingdeck22104 and/or different tissue gaps when the end effector is clamped, for example. With respect to thecartridge body22102, theridges22114 span three laterally-spaced rows ofstaple cavities22112a,22112b,22112cand theridges22114 aligned withouter row22112care taller than theinner rows22112a,22112band, thus, would guide the staple legs over a greater distance. However, the tissue gap is also larger over theouter rows22112cthan theinner rows22112a,22112bowing to the lateral curve of the tissue-supportingdeck22104 and the non-stepped/non-contoured tissue-clamping surface of the anvil.
• The staples are positioned in cavities defined in thecartridge body22102, similar to the cavities20110 (FIG. 24). For example, the staples are arranged inlongitudinal rows22112 on either side of the longitudinal axis A. Thecavity rows22112 include aninner row22112a, anintermediate row22112b, and anouter row22112con each side of the longitudinal axis A. Theintermediate row22112bcan be equilaterally-spaced between theinner row22112aand theouter row22112c. Therotary drive screw22242 can be aligned with the longitudinal axis A, and can extend through thecartridge body22102 adjacent to theinner cavity rows22112a. Therotary drive screw22242 can be between and parallel to theinner cavity rows22112a, for example.
• Theinner rows22112ahold inner staples, theintermediate rows22112bhold intermediate staples, and theouter rows22112chold outer staples. In various instances, the inner staples, the intermediate staples, and the outer staples can be identical. In other instances, the inner staples, the intermediate staples, and/or the outer staples can each be different with respect to staple type (e.g. wire or stamped), material, and/or size (e.g. different heights), for example.
• In other instances, thestaple cartridge22100 may have a different arrangement of staples. For example, thestaple cartridge22100 may have less than three rows of staples on each side of the longitudinal axis A. In one aspect of the present disclosure, thestaple cartridge22100 may only have two rows of staples on each side of the longitudinal axis A. In still other instances, thestaple cartridge22100 can include four or more rows of staples on one or more sides of the longitudinal axis A. In various instances, the rows of staples may be asymmetrical relative to the longitudinal axis A. For example, the first side of thestaple cartridge22100 can have a different number of rows of staples than the second side of thestaple cartridge22100.
• The staple cavities in thecartridge body22102 can each include a proximal end, a distal end, and lateral guide surfaces intermediate the proximal end and the distal end. The staple cavities are structured and dimensioned to guidedrivers22120 through the staple cavities toward thedeck22104. Referring primarily toFIG. 41, adriver22120 is shown. Moreover, onedriver22120 is shown in thestaple cartridge22100 inFIGS. 41 and 42. Though onedriver22120 is depicted in these figures, the reader will appreciate that additional drivers like thedriver22120 would be incorporated into thestaple cartridge22100 to fire staples from additional staple cavities during a firing stroke.
• The geometry of the staple cavities can complement the geometry of thedrivers22120. For example, lateral guide surfaces in each staple cavity are configured to guidesidewalls22134 of thedriver22120 as thedriver22120 moves through the staple cavity. Additionally or alternatively, the proximal end and/or the distal end of each staple cavity can include an upright groove configured to slidably receive an end and/or tongue thereof of thedriver22120. Alternative tongue and groove arrangements are also contemplated, which can be configured to guide thedrivers22120 through the staple cavities during firing of the staples from thestaple cartridge22100.
• Thedrivers22120 are configured to support and drive multiple staples from thecartridge body22102 during a firing stroke. Thedrivers22120 can movably support staples spanning two or morelongitudinal rows22112. For example, thedrivers22120 can movably support an inner staple, an intermediate staple, and an outer staple on the same side of thestaple cartridge22100.
• Thedriver22120 is a triple driver, which is configured to drive three staples simultaneously. Thedriver22120 includes three support columns—aninner support column22122aconfigured to support an inner staple in an inner row of staples, anintermediate support column22122blaterally outboard of theinner support column22122aconfigured to support an intermediate staple in an intermediate row of staples, and anouter support column22122claterally outboard of theintermediate support column22122band configured to support an outer staple in an outer row of staples.
• Thedriver22120 also includes bridges22126 extending between adjacent support columns22122. For example, afirst bridge22126aextends between theinner support column22122aand theintermediate support column22122b, and asecond bridge22126bextends between theintermediate support column22122band theouter support column22122c. Thebridges22126a,22126beach include a rampedunderside22128 configured to be drivingly engaged by a sled during a firing stroke. For example, a sled22150 (FIG. 39) can be configured to move along a firing path during a firing stroke. Thesled22150 can comprise a central portion aligned with the longitudinal axis A, a first rail configured to drivingly engage the rampedunderside22128 of thefirst bridge22126a, and a second rail configured to drivingly engage the rampedunderside22128 of thesecond bridge22126b. Sleds and firing motions thereof are further described herein.
• Referring primarily toFIGS. 38 and 39, the tissue-supportingdeck22104 includes a tissue-facingside22115 having the array ofridges22114, which form a bumpy tissue-gripping surface. The tissue-supportingsurface22104 also includes anunderside22116 opposite the tissue-facingside22115. Theunderside22116 comprises a rutted surface having an array ofruts22118 therein. Theruts22118 can define a pattern of recesses and/or divots in theunderside22116. The tissue-supportingdeck22104 defines a deck height between the bumpy tissue-facingside22115 and therutted underside22116. The deck height varies; however, a certain minimum height around the openings in thedeck22104 provides a minimum amount of guide length for the staples during the firing stroke. For example, if the deck were too thin around the staple cavities, the staples may not be adequately supported during deployment into the tissue and toward the forming pockets.
• Thedrivers22120 are configured to mate or nest with therutted underside22116 when thedrivers22120 are move to the fired positions. Referring again primarily toFIG. 41, thebridges22126a,22126bof thedriver22120 includes aprojection22130. Theprojections22130 are surface contours and projections on an upper tissue-facing surface of thebridges22126a,22126bopposite the rampedunderside22128 of thebridges22126a,22126b. Theprojections22130 are configured to be received in theruts22118 on theunderside22116 of the tissue-supportingdeck22104 when thedrivers22120 are moved to their fired positions. In the fired position, referring primarily toFIG. 40, thedriver22120 is overdriven relative to thedeck22104 such that a portion of thedriver22120 extends beyond the tissue-facingside22115 and out of thecartridge body22102.
• The top surface of thebridges22126aand22126bare symmetric relative to a longitudinal centerline of therespective bridge22126a,22126b. The centerline of eachbridge22126a,22126bcan be equidistant between the longitudinal axes defined by staple-supportingcradles22124 of adjacent support columns22122. Theprojections22130 are symmetric relative to the longitudinal centerline of therespective bridge22126a,22126b.
• In other instances, the drivers, the bridges thereof, and/or the top surfaces thereof, can be laterally asymmetric, as further described herein. Referring to adriver22220 inFIG. 42, the driver22200 is similar in many aspects to the driver22120 (FIG. 41); however, the driver22200 defines a lateral asymmetry with respect to the interconnectingbridges22226a,22226band respectivetop surface22230 thereon. Thedriver22220 includes threesupport columns22222a,22222b,22222ceach having a staple-supportingcradle22224. Thebridges22226a,22226bconnect laterallyadjacent support columns22222a,22222b,22222c. Thebridges22226a,22226bincludes a rampedunderside22228, which is driven by a sled during a firing stroke, as further described herein. Thetop surface22230 of thebridges22226a,22226bincludes a diagonal surface and is asymmetric relative to a centerline through thebridge22226a,22226band aligned with a firing path of a sled rail during a firing stroke. The centerline of eachbridge22226a,22226bis equidistant between the axes aligned with adjacent staple-supportingcradles22224 and staple bases/crowns therein.
• Thetop surface22230 of eachbridge22226a,22226bincludes a laterally-sloped top surface, which is configured to complement a portion of the contoured underside of a tissue-supporting deck, such as the rutted underside22116 (FIGS. 39 and 40). Such bridge configurations may provide improved column-to-column support, which can allow theoverall bridges22226a,22226bto be thinner while sufficiently supporting the staples across multiple rows.
• Ananvil22370 for a surgical end effector is shown inFIG. 43. Theanvil22370 includes atissue compression surface22374 and pairs of staple-formingpockets22372 formed into thetissue compression surface22374. Each pair of staple-formingpockets22372 includes aproximal pocket22372aand adistal pocket22372b. The pockets can be aligned with the legs of a staple, e.g. the wire legs of a staple. During the firing stroke, the tips of the staple legs can be received within the staple-formingpockets22372 and formed into B-form staples, for example. In certain aspects of the present disclosure, the length of the staple-formingpockets22372 can be configured to match the wire diameter of the staple aligned therewith. For example, theproximal pocket22372aand thedistal pocket22372bin a first pair of staple-formingpockets22372 in theanvil22370 can have a first pocket length while theproximal pocket22372aand thedistal pocket22372bin a second pair of staple-formingpockets22372 in theanvil22370 can have a different pocket length. The first pocket length can correspond to a different staple wire diameter than the second pocket length. In various aspects, larger wire diameter staples can correspond to short pocket lengths.
• The space d between aproximal pocket22372aand adistal pocket22372bin a pair of staple-formingpockets22372 can be minimized in certain instances to maximize the longitudinal forming length of the staples. Generally, staples are over-bent during the forming process to compensate for staple spring-back. However, over-bending of staples can be reduced when the forming pockets are shorter and, thus, steeper in certain instances. Shorter and steeper staple pockets, which define a larger space or gap d between theproximal pocket22372aand thedistal pocket22372bin a pair of staple-formingpockets22372, can reduce spring-back. Shorter and steeper staple pockets can curve the staple legs more and deform the staples more plastically to reduce spring-back, for example. Moreover, shorter and steeper staple pockets can improve sequential staple leg bends in certain instances. Referring to the space d inFIG. 43, theproximal pocket22372aand thedistal pocket22372bin a pair of staple-formingpockets22372 can be shortened and the overall pair can maintain the same length L such that a larger space d is defined between theproximal pocket22372aand thedistal pocket22372b.
• For example, in an end effector, the staples and/or the drivers can vary from row-to-row. In certain instances, the staples can be shorter, comprise a different wire diameter, be lifted by a driver having a different height and/or a different amount of overdrive. In certain instances, shorter staple forming pockets, as described above, can be utilized with the one row of staples and not an adjacent row of staples in the same anvil. For example, shorter staples can utilize the shortened pockets to improve sequential staple leg bends, e.g. two sequential bends on each staple leg to assume a B-shape. In still other instances, staples along an inside row of staples, i.e. adjacent to a longitudinal knife path, can utilize the shortened pockets to bend the staples more plastically and reduce spring-back to form a tighter row. In these instances, the distance d inFIG. 43 can be different from row-to-row.
• A staple cartridge, such as the staple cartridge20100 (FIG. 24) and the staple cartridge22100 (FIG. 39), for example, include components having minimum size limitations to ensure suitable strength, stiffness, support, and/or manufacturing requirements are met. These minimum size limitations can make it difficult to optimize and/or increase the tissue gap in view of the other constraints on the surgical end effector. As an example, the minimum height of a tissue-supporting deck is 0.01 inches in certain instances due to molding constraints. As another example, the minimum height of the bridge between support columns on a driver is 0.022 inches in certain instances due to driver strength constraints. As another example, the minimum height of the driver (e.g. support column thereof) is 0.066 inches in certain instances due to driver roll constraints. As another example, the minimum height of the staple legs is 0.166 inches in certain instances, 0.160 inches in other instances, 0.150 inches in other instances, 0.102 inches other instances, and 0.085 inches in other instances based on the type of staple cartridge and targeted tissue. As another example, the minimum thickness of the anvil is 0.134 inches and, in certain instances, 0.154 inches due to anvil stiffness and strength constraints. In view of such minimum size constraints, it can be advantageous in certain instances to reduce the minimum size limitations and/or double count certain size limitations or portions thereof in a stack-up of components.
• For example, portion of the drivers can nest in recesses in the underside of the tissue-supporting deck in certain instances to reduce certain minimize size limitations. In various instances, to ensure the tissue-supporting deck maintains an appropriate height, the recesses can be aligned with localized regions along the tissue-supporting deck with an increased height, such as below pocket extenders/tissue-gripping ridges, for example. In other instances, one or more additional recesses in the underside of the tissue-supporting deck can be configured to receive a portion of the driver and/or bridge thereof. Exemplary staggering of interlocking features between the inner surfaces of the staple cartridge and the drivers is shown inFIG. 39, for example. Other driver features could similarly be received within corresponding recesses on the underside of the tissue-supporting deck.
• To reduce vertical stack-up dimensions of multiple components, the tissue-supporting deck of a staple cartridge, such as the staple cartridge20100 (FIG. 24) and the staple cartridge22100 (FIG. 39), for example, can have predefined clearance holes therethrough, which can be separate and distinct from the staple cavities. The predefined holes along the length and/or width of the staple cartridge can receive features of the drivers (e.g. portions of the bridge) in the driver's fully fired, and in various instances overdriven, positions. Additionally or alternatively, the tissue-supporting deck can include frangible or “break locations”, which are configured to be physically broken by the drivers upon moving to their fully fired positions.
• Additionally, the staple cartridges such as the staple cartridge20100 (FIG. 24) and the staple cartridge22100 (FIG. 39), for example, can further include selectively compressible and expandable features to reduce vertical stack-up dimensions. The drivers and/or cartridge body can include such features.
• For example, vertically-expandable drivers can be configured to reduce resting or unfired heights of the drivers within the staple cartridge. The drivers can be telescoping and can define a height that is approximately 50% of its final height when in the unfired position. In such instances, the staples can sit lower in the cartridge body prior to firing. In certain instances, a first part of the sled rail can activate the driver by overcoming a significant snap feature with the body of the driver and expanding it to its final height. Then, a second part of the sled rail can complete the firing of the driver to eject the staple(s) supported thereon out of the cartridge body. The first of the sled rail can be narrower than the second part of the sled rail.
• Additionally or alternatively, the tissue-supporting deck can comprise a variable-height, injection molded deck, which can compress when a predefined tissue load is applied to increase the tissue gap. As the sled fires the drivers and staples, the sled and/or the drivers can locally push the deck back into the tissue to an increased height momentarily in order to temporarily decrease the tissue gap. The tissue-support deck can then relax or otherwise return to the compressed state corresponding to an increased tissue gap after the sled has passed.
• For example, the cartridge body or tissue-supporting deck thereof can include selectively positioned wall segments, which can be thin and configured to buckle under the predefined tissue load while still maintaining appropriate alignment between the staples and the staple-forming pockets in the anvil. In certain instances, an electrically-actuated material (e.g. electroactive polymers) can be incorporated in the tissue-supporting deck. Components or features formed with such a material can become soft and/or more readily compressible when a current is applied thereto and rigid and/or less readily compressible when no current is applied. In certain instances, portions of the drivers can be received in the tissue-supporting deck when the material is energized and, thus, deformable to accommodate the additional structures therein.
• In certain instances, 4D printed materials can facilitate selective collapse of the tissue-supporting deck of the staple cartridge, such as the staple cartridge20100 (FIG. 24) and the staple cartridge22100 (FIG. 39), for example. For example, the cartridge body can include a 4D printed material that is printed on a top portion or upper half thereof. The 4D printed material can be heat sensitive. In certain instances, the material can have a glass transition point between room temperature and the temperature of the human body. For example, the material can become soft and deflectable, thus, increasing the tissue gap, when the cartridge is clamped onto tissue. In such instances, the increased heat from the patient can increase the heat of the 4D printed material to effect the shape change. When the cartridge body subsequently cools (e.g. is removed from thermal transfer contact with tissue), the 4D printed material can return to its original shape and/or height. In the original and recovered state, the tissue-supporting deck can be taller than in the heated and collapsed state, for example. The increased height in the original and recovered state can ensure the staples stored in the staple cartridge remain protected and are not protruding from the cartridge body prior to being fired, for example.
• Referring now toFIG. 44, a deformation andrecovery process22400 for a 4D printed matrix on a cartridge body is depicted. During ashape programming stage22490, the 4D printedmatrix22402 is heated, deformed from an original configuration to adeformed configuration22402′, and then cooled. During ashape recovery state22492, the 4D printedmatrix22402′ is heated and returns to itsoriginal configuration22402, and then cooled. Shape programming and recovery of 4D printed materials is further described in the article “4D Printing Reconfigurable, Deployable and Mechanically Tunable Metamaterials” from Materials Horizon, Issue 6, 2019 by Chen Yang et al.
• In certain instances, 4D printed matrixes can be used in combination with foldable or collapsible drivers, for example, which are further described herein. The 4D printed matrixes on the staple cartridge, for example, can be configured to selectively fold an interfering driver feature to consolidate and/or condense the footprint and stack-up within the staple cartridge at certain temperatures. The interfering features can then unfold when withdrawn from the interference condition, such as when the cartridge body resumes the original, undeformed state. In various aspects, the driver can be fully expanded when actively lifting and firing the staples. In certain instances, the driver can encounter an interfering surface near the fully fired position thereof, and an upper portion of the driver can be configured to fold into itself. The 4D matrix can form the interference surface in certain instances.
• A user may want to install a staple cartridge into a channel of an end effector or disposable loading unit quickly and easily during a surgical procedure. A robust connection can also be desired. Certain robust connections can require a clinician to overcome significant resistance and/or frictional forces between interfering components. Additionally or alternatively, a robust connection may have minimal clearances and require precise alignment of the components by the clinician. Though a robust connection between the staple cartridge and the channel may be desired, it may be helpful to make the installation of the staple cartridge quicker, easier, and/or to require less force and/or effort on the part of the clinician.
• In certain instances, a stapling assembly can include leveraging features which can facilitate installation of a staple cartridge into a channel. For example, the channel and the staple cartridge can include complementary geometric alignment features. Upon placing the alignment feature of the staple cartridge against the alignment feature of the channel, the alignment feature of the channel can provide a fulcrum or abutment surface about which the staple cartridge is leveraged to properly align the staple cartridge with the channel. When the staple cartridge is properly aligned owing to the abutting relationship between the alignment features, additional alignment features (e.g. a distal lug and notch) can facilitate further connection between the staple cartridge and the channel.
• In certain instances, a spring can bias the staple cartridge distally along a longitudinal axis perpendicular to an insertion axis to fully and securely seat the staple cartridge in the channel. Additionally or alternatively, a distal firing force during a firing stroke can further shift the staple cartridge distally to interconnect ramped surfaces on the alignment features (e.g. distal edges of the distal lug and notch). Alternative spring-loaded and/or resilient features are contemplated to further secure the staple cartridge to the channel upon appropriate placement of the staple cartridge relative to the channel. In certain instances, a user-activated release can be configured to release one or more resilient attachment features between the staple cartridge and the channel. In other instances, the firing stroke can result in the release and/or breakage of one or more resilient attachment features.
• In one example, a stapling assembly can include a staple cartridge including a cartridge body defining a longitudinal axis, wherein the cartridge body comprises a proximal cartridge alignment feature and a distal cartridge alignment feature. The stapling assembly can further include a channel dimensioned to receive the staple cartridge, wherein the channel comprises a sidewall comprising a proximal channel alignment feature and a distal channel alignment feature positioned to receive the distal cartridge alignment feature upon positioning the proximal cartridge alignment feature in abutting engagement with the proximal channel alignment feature and moving the staple cartridge along an insertion axis to a first position in the channel. The insertion axis can be perpendicular to the longitudinal axis. A spring can be configured to bias the staple cartridge distally within the channel along the longitudinal axis from the first position to a fully seated position. The proximal alignment features can include contoured abutment surfaces. The distal alignment features can includes a notch and a lug having complementary wedge-shaped distal ends.
• In various instances, the improved cartridge retention and release features can increase engagement retention forces while allowing the user to release the staple cartridge from the channel with a substantially lower force. For example, a user can slide the staple cartridge proximally by overcoming a minimal spring force to quickly and easily remove the staple cartridge from the channel. In certain instances, the force required to remove a spent or fired staple cartridge can be less than the force required to remove a new, unfired staple cartridge. For example, a firing stroke, or even a partial firing stroke, can be configured to disengage and/or release certain resilient attachment features connecting the staple cartridge to the channel.
• Referring now toFIG. 45, a staplingassembly24000 is shown. The staplingassembly24000 includes achannel24050 and astaple cartridge24100 removably positioned in thechannel24050. Thestaple cartridge24100 is a disposable, single-use component, which is configured to be removed from thechannel24050 after a firing stroke and surgical procedure therewith. Thechannel24050 can be reusable and configured to receive replacement staple cartridge assemblies therein. In other instances, thestaple cartridge24100 can be removed from thechannel24050, loaded with additional staples, and reinstalled in thechannel24050. Thechannel24050 can be a component of a disposable loading unit and/or a modular stapling assembly including an anvil and/or a shaft portion in certain instances.
• Thestaple cartridge24100 can be similar in certain aspects to the staple cartridge20100 (FIG. 24). For example, thestaple cartridge24100 includes acartridge body24102 having a tissue-supportingdeck24104,staples24160 removably positioned in thecartridge body24102, anddrivers24120 movably supporting thestaples24160. Thestaples24160 comprise a base from end-to-end and the base of the staples24106 are obliquely-oriented relative to a longitudinal axis A along the length of thestaple cartridge24100. Thestaples24160 can be configured to form a compliant staple line which allows a degree of twisting and/or stretching while minimizing damage to the tissue. In certain instances, thecartridge body24102 can include staples in a plurality of longitudinal rows having longitudinally-aligned staples in longitudinal rows parallel to the longitudinal axis A, as further described herein.
• Thecartridge body24102 includes at least onealignment nub24162 having aproximal alignment surface24164. In various instances, analignment nub24162 can protrude laterally from each side of thecartridge body24102. Theproximal alignment surface24164 defines a curved proximal edge of thealignment nub24162. In various instances, thealignment nubs24162 on either side of thecartridge body24102 can be symmetrical about the longitudinal axis A.
• Thecartridge body24102 further includes analignment lug24166 having aproximal end24168 and adistal end24170. Onealignment lug24166 is positioned on each side of thecartridge body24102. Theproximal end24168 defines an upright or vertical surface relative to the tissue-supportingdeck24104. Thedistal end24170 of thealignment lug24166 defines a wedge shape having a ramped distal surface. The ramped distal surface can form a narrower dimension along thedeck24104 and a wider dimension at the opposite end of thealignment lug24166. In various instances, analignment lug24166 can be positioned on each side of thecartridge body24102, and the alignment lugs24166 can be symmetrical about the longitudinal axis A. The alignment lugs24166 are closer to the distal end of thecartridge body24102 than thealignment nubs24162.
• Thechannel24050 includeslateral sidewalls24052 forming a U-shaped channel. Thestaple cartridge24100 can be releasably secured in the U-shaped channel between thesidewalls24052. Thesidewalls24052 and/or other portions of thechannel24050 can include resilient snap-fit features for engaging thestaple cartridge24100. Eachsidewall24052 includes analignment feature24054 including aproximal alignment contour24056. Theproximal alignment contour24056 comprises an edge, which is configured to catch theproximal alignment surface24164 of thealignment nub24162. Theproximal alignment contour24056 resists longitudinal displacement of thealignment nub24162 in the proximal direction beyond theproximal alignment contour24056. As further described herein, thealignment feature24054 can act as a fulcrum or support about which thestaple cartridge24100 is leveraged during insertion and installation of thestaple cartridge24100 into thechannel24050.
• Thechannel24050 further includes analignment notch24058 having aproximal end24060 and adistal end24062. Analignment notch24058 is positioned on each side of thechannel24050. Theproximal end24060 defines an upright or vertical surface in thesidewall24052 and thedistal end24062 defines another upright surface in thesidewall24052, which is not parallel with the vertical surface at theproximal end24060. The upright surface defining thedistal end24062 of thealignment notch24058 can define a sloped or ramped distal surface, which can form a wedge shape having a narrower dimension along an upper edge of thesidewall24052 and a wider dimension at the opposite end of thenotch24058. In various instances, thealignment notches24058 can be symmetrically positioned about the longitudinal axis A. Thealignment notches24058 are closer to the distal end of thecartridge body24102 than thealignment nubs24162. As further described herein, eachalignment notch24058 is positioned and dimensioned to receive one of the alignment lugs24166 therein.
• The alignment features between thechannel24050 and thestaple cartridge24100 are configured to interact to facilitate a quick and easy installation of thestaple cartridge24100 into thechannel24050. For example, to quickly align the alignment lugs24166 with thealignment notches24058, a clinician can draw thealignment nubs24162 proximally into abutting engagement with the corresponding alignment features24054 on thechannel24050. Theproximal alignment contour24056 on theproximal alignment feature24054 acts as a longitudinal stop, which prevents further proximal displacement of thestaple cartridge24100 relative to thechannel24050. The contouredproximal edge24164 of thealignment nubs24162 can match or complement the contoured profile of theproximal alignment contour24056. Upon mating of the complementary profiles, the alignment lugs24166 are also each aligned with theircorresponding alignment notch24058.
• Aspring24172 is positioned between an upright surface of thealignment lug24166 and an upright surface of thealignment notch24060. More specifically, thespring24172 is positioned between theproximal end24168 of thealignment lug24166 and theproximal end24060 of thealignment notch24060. Thespring24172 is configured to bias the rampeddistal end24170 of thealignment lug24166 distally into mating contact with the rampeddistal end24062 of thechannel24050 upon insertion of thestaple cartridge24100 into thechannel24050. Thespring24172 can be compressed between the uprightproximal end24060 of thealignment notch24060 and the uprightproximal end24168 of thelug24166 when thealignment nubs24162 are in abutting engagement with theproximal alignment contours24056 and thestaple cartridge24100 and alignment lugs24166 thereof are moved in aninstallation direction24101 parallel to an installation axis I into thechannel24050. The installation axis I is perpendicular to the longitudinal axis A.
• In use, thecartridge body24102 and thenubs24162 thereof can be leveraged against theproximal alignment contour24056 of thechannel24050 as thestaple cartridge24100 is moved along the installation axis I into the channel. The proximal leverage location of thealignment contour24056 can improve the mechanical advantage of installing thestaple cartridge24100 anddistal lugs24166 thereof into thechannel24050. Thenubs24164 can slide downward into thechannel24050 as thestaple cartridge24100 moves in theinstallation direction24101 into a first position, or an inserted position. After thestaple cartridge24100 has been moved to a first position, in which thestaple cartridge24100 is inserted, but not fully seated in thechannel24050, thespring24172 is configured to shift thestaple cartridge24100 distally in a direction parallel to the longitudinal axis L into a second position, in which thestaple cartridge24100 is fully seated in thechannel24050.
• Referring primarily toFIG. 47, thespring24172 is a flat spring. Thespring24172 is a cantilevered spring having a first end mounted to thealignment lug24166, a second end opposite the first end, and a curved portion intermediate the first end and the second end. The curved portion can define an S-shaped curve, which is compressible with minimal force and/or effort by the clinician upon alignment of theproximal alignment contours24056,24164 and leveraging of thestaple cartridge24100 proximally against thealignment feature24054. Upon release of the leveraging force and compressive force to thespring24172, thespring24172 is configured to rebound and bias thestaple cartridge24100 distally relative to thechannel24050 into a fully seated position (FIG. 48).
• In the fully seated position (FIG. 48), the distal ramped ends24062,24170 of thealignment lug24166 and thealignment notch24058, respectively, are in mating engagement. The undercut geometry of the distal ends24062,24170 is configured to secure thestaple cartridge24100 in thechannel24050 until thespring24172 is compressed by a user-applied force to draw thestaple cartridge24100 proximally along the longitudinal axis A and then upward in adirection24103 parallel to the installation axis I and opposite to theinstallation direction24101 to remove thestaple cartridge24100 from thechannel24050.
• In certain instances, a firing element is configured to apply a distal force to thestaple cartridge24100 during a firing stroke to further secure thestaple cartridge24100 in thechannel24050. For example, the rampeddistal ends24062,24170 can form an interlock between thestaple cartridge24100 and thechannel24050 when thestaple cartridge24100 is pushed distally. In certain instances, the distal firing force and undercut geometry of the rampeddistal ends24062,24170 can secure thestaple cartridge24100 to thechannel24050 even without the distal biasing force of thespring24172. For example, the staplingassembly24000 may not include a spring configured to bias thestaple cartridge24100 relative to thechannel24050 in the direction of the firing stroke. The reader will appreciate that in stapling assemblies utilizing a distal-to-proximal firing stroke, for example, the undercut interlock between thestaple cartridge24100 and thechannel24050 can be at aproximal end24168,24060 of thealignment lug24166 andalignment notch24058, respectively.
• Referring primarily toFIGS. 47-48, the staplingassembly24000 is shown with ananvil24090 in the clamped configuration relative to thechannel24050 and thestaple cartridge24100 fully seated therein. Thecartridge body24102 includes adistal nose24103 with alock24180. Thelock24180 includes alatching arm24182 on an underside of thecartridge body24102. The latchingarm24182 is configured to overlap a portion of thechannel24050 when thestaple cartridge24100 is fully seated in thechannel24050. For example, thechannel24050 includes a ledge orshelf24082 on the underside thereof facing the latchingarm24182. Thelock24180 is movable between a first position (FIG. 49), in which thelatching arm24182 secures thedistal nose24103 of thecartridge body24102 to the distal end of thechannel24050 by overhanging theshelf24082, and a second position, in which thelatching arm24182 releases theshelf24082 facilitating release of thestaple cartridge24100 from thechannel24050.
• Thelock24180 also includes an anvil-facingrelease button24184 opposite the latchingarm24182. The anvil-facingrelease button24184 can be flush, or substantially flush, with the top surface of thedistal nose24103. The anvil-facing release button24148 can be depressed by a clinician to drive thelock24180 downward and/or distally to release thelatch24182 from engagement with theshelf24082. In certain instances, thelock24180 can be comprised of a resilient and/or deformable material, which can flex upon receiving a user input on the anvil-facingrelease button24184 to move the latchingarm24182 to the second position. In other instances, thelock24180 can pivot relative to thecartridge body24102 to move the latching arm24812 to the second position.
• In other instances, the distal nose of a cartridge body can be deflectable to releasably engage retention features along the distal edge of the elongate channel. For example, referring now toFIG. 50, a staplingassembly24200 is shown with theanvil24190 in the clamped configuration relative to thechannel24050 and astaple cartridge24300 fully seated therein. Thestaple cartridge24300 is identical to thestaple cartridge24100; however, thedistal nose24301 is comprised of a flexible material, or a flexible portion forming alock24380 having a latching arm, which is configured to flex in and out of engagement with theshelf24082 on the underside of thechannel24050. In certain instances, the entiredistal nose24301 can be flexible to facilitate flexure of thelatching arm24382 out of engagement with theledge24082. In other instances, only thelock24380 and/or latchingarm24382 thereof is flexible enough to disengage theledge24082.
• In various instances, thecartridge body24302 can be a composite cartridge body comprised of different materials in different regions such that the flexibility of the unitary composite cartridge body can vary from region to region. For example, thecartridge body24302 can be 3D-printed and include flexible and/or resilient materials for thelock24380 and/or latchingarm24382 and less flexible and/or less resilient materials for adjacent regions in the cartridge body. Additionally or alternatively, in certain instances, adjacent portions can be printed with materials having the same or similar relatively low durometers as thelock24380 and/or latchingarm24382; however, embedded metallic within the cartridge body, such as a metal frame and/or longitudinal support, for example, can increase the overall strength and stiffness of the cartridge body.
• Additional alignment and retention features between the staple cartridge and the channel are contemplated, which can improve retention and release of the staple cartridge relative to the channel. Various features can improve the ease of aligning the components and the force required to remove the staple cartridge from the channel while maintaining sufficient retention forces between the staple cartridge and the channel. These additional alignment and retention features can be combined with the proximal alignment features between the staple cartridge and the channel further described herein.
• A staplingassembly25000 is shown inFIG. 51. The staplingassembly25000 is similar in many aspects to the staplingassembly24000 and includes astaple cartridge25100 and achannel25050; however, the stapling assembly includes alternative proximal alignment and retention features between thestaple cartridge25100 and thechannel25050. Additionally, thestaple cartridge25100 includes longitudinal rows of staple cavities in acartridge body25102 thereof and longitudinally-aligned staples positioned in the staple cavities. The staple cavities are oriented parallel to a longitudinal axis A extending along a longitudinal slot and centerline of thecartridge body25102.
• Thecartridge body25102 includes analignment lug25166, which comprises aproximal end25168 and adistal end25170. Analignment lug25166 can be positioned on each side of thecartridge body25102. Theproximal end25168 can define an upright or vertical surface, and thedistal end24170 can also comprise an upright or vertical surface. The upright surfaces defining the proximal anddistal ends25168,25170, respectively, can be parallel or substantially parallel. In various instances, analignment lug25166 can be positioned on each side of thecartridge body25102 and the alignment lugs25166 can be symmetrical about a centerline through thecartridge body25102.
• Thestaple cartridge25100 also includes alateral pin25180 protruding outwardly from thecartridge body25102. Another symmetrically-positionedlateral pin25180 can protrude laterally outward on the other side of thecartridge body25102.
• Thechannel25050 includeslateral sidewalls25052 forming a U-shaped channel. Thestaple cartridge25100 can be releasably secured in the U-shaped channel between thesidewalls25052. Thechannel25050 further includes analignment notch25058, which comprises aproximal end25060 and adistal end25062. Analignment notch25058 can be positioned on each side of thechannel24050 to receive acorresponding alignment lug25166. Theproximal end24060 defines an upright or vertical surface in thesidewall24052 and thedistal end24062 defines another upright surface in thesidewall24052. The upright surfaces can be parallel or substantially parallel.
• In other instances, the distal ends25062,25170 of thealignment notch25058,25166, respectively, can be undercut, as further described herein, to further secure thestaple cartridge25100 to thechannel25050 when thestaple cartridge25100 is fully seated in thechannel25050.
• Thechannel25050 further includes aslot25084 defining an internal track for thelateral pin25180. Theslot25080 includes a V-shaped or taperedentry portion25082 extending parallel to an insertion direction of thestaple cartridge25100 and aterminal portion25084 extending parallel to a longitudinal axis of the cartridge body. The V-shapedentry portion25082 provides awider entry region25083 for thelateral pin25180 into theslot25084, which ensures the clinician does not need to align thestaple cartridge25100 to thechannel25050 with exacting accuracy. Moreover, thewider entry region25083 to theslot25084 can define a larger range of longitudinal positions for thestaple cartridge25100 relative to thechannel25050 than the allowable range of longitudinal positions to align thealignment lug25166 with anentry region25063 of thealignment notch25058.
• The alignment features between thechannel25050 and thestaple cartridge25100 are configured to interact to facilitate a quick and easy installation of thestaple cartridge25100 into thechannel25050. For example, to quickly align the alignment lugs25166 with thealignment notches25058, a clinician can position thestaple cartridge25100 anywhere in the larger range of longitudinal positions for positioning thelateral pin25180 in theentry portion25083 of theslot25080. As the lateral pin(s)25180 move along the narrowing track of the V-shapedportion25082 of theslot25080, the lug(s)25166 can be funneled into alignment with thealignment notches25058.
• In various instances, thestaple cartridge25100 can drop into thechannel25050 with minimal interference or frictional resistance. For example, thestaple cartridge25100 may not be secured to thechannel25050 with robust friction-fit features between thestaple cartridge25100 and thechannel25050. Instead of such friction-fit features or in addition thereto, the geometry of theslot25080 can secure thestaple cartridge25100 in thechannel25050. For example, frictional forces exerted on thestaple cartridge25100 during a proximal-to-distal firing stroke can move thelateral pin25180 distally along theterminal portion25084 of theslot25080 and shift thestaple cartridge25100 distally in thechannel25050. In such instances, the firing forces can move the lug(s)25166 into their distal-most positions flush with the distal ends25062 of thealignment notches25058.
• In various instances, to remove a spentstaple cartridge25100 from thechannel25050, a clinician can draw thestaple cartridge25100 proximally to remove thelateral pin25180 from theterminal portion25084 of theslot25080. When thestaple cartridge25100 is shifted proximally by a clinician, which requires minimal force and exertion, the clinician can quickly and easily lift thestaple cartridge25100 out of thechannel25050.
• An alternative latching mechanism between astaple cartridge26100 and achannel26050 for astapling assembly26000 is shown inFIGS. 52 and 53. Thestaple cartridge26100 is similar in many aspects to the various staple cartridges described herein and can include acartridge body26102 having staples and staple-supporting drivers movably positioned within thecartridge body26102. Thechannel26050 includes opposingsidewalls26052 forming a U-shaped channel profile, which are configured to receive thestaple cartridge26100 therebetween or at least mostly therebetween. For example, thestaple cartridge26100 includeslateral latching arms26180 that are configured to releasably engagelateral recesses26080 along an outside surface of thesidewalls26052.
• The latchingarms26180 extend along lateral sides of thestaple cartridge26000 and can be integrally formed with (e.g. molded with) thecartridge body26102. For example, thecartridge body26102 and the latchingarms26180 can be a unitary, single-piece component. In various instances, the latchingarms26180 can be deflectable. The latchingarms26180 includes a user-actuation button26182 and acatch26184. Thecatch26184 is longitudinally offset from the user-actuation button26182. A lever arm extends between the user-actuation button26182 and thecatch26184 such that an actuation of thebutton26182 is configured to deflect thecatch26184. For example, an inwardly-exerted actuation to thebutton26182, is configured to deflect thecatch26184 outward out of engagement with thelateral recess26080. In certain instances, deflection of thecatch26184 upon a clinician's actuation to thebutton26182 is configured to remove thecatch26184 from therecess26080. In other instances, thecatch26184 can move to a less engaged and, thus, more easily overcome position relative to therecess26080. A clinician can apply a pinching motion to thebuttons26182 to simultaneously actuate bothbuttons26182 and deflect bothcatches26184 out of engagement with therecesses26080.
• In various instances, to install thestaple cartridge26100 in thechannel26050, thestaple cartridge26100 can be moved vertically in an insertion direction until a portion of thecartridge body26102 rests in thechannel26050. In this position, the latchingarms26180 can be aligned with longitudinal guides along the outer surface of thesidewalls26052. As thecartridge body26102 is slid proximally toward a fully seated position in thechannel26050, the latchingarms26180 move along the longitudinal guides and thecatches26184 snap into therecesses26080 to secure thestaple cartridge26100 in the fully seated position. When thestaple cartridge26100 is fully seated in thechannel26050 and thecatches26184 are engaged or locked in therecesses26080, the width of the stapling assembly can still be within the traditional sized trocar (e.g. a 12-mm profile). To release thestaple cartridge26100 from thechannel26050, a clinician pinches thebuttons26182 to bias thecatches26184 outward from therecesses26080 such that the clinician can remove thestaple cartridge26100 by drawing it distally along the longitudinal axis A and/or vertically away from thechannel26050.
• In certain instances, thecartridge body26102 is plastic and the latchingarms26180 are also plastic. For example, thecartridge body26102 and the latchingarms26180 can be a molded composite plastic component.
• In other instances, the cartridge body can be a composite assembly of plastic and metal. For example, the latching arms can be metallic springs, which are formed with the cartridge body. The latching arms can be insert molded metallic arms. Metal latching arms can provide a greater spring constant and a snappier latching feature than plastic arms in certain instances.
• In certain instances, a stapling assembly can include a frangible cartridge retention feature, which is configured to secure a staple cartridge in the channel until the frangible cartridge retention feature is intentionally broken by a user. For example, a clinician can intentionally break the cartridge retention feature and/or the feature can be broken during the firing stroke, such as at or near the completion of the firing stroke. Breaking of the frangible cartridge retention feature, can reduce the retention force between the staple cartridge and the channel such that a clinician can remove the staple cartridge with a lower amount of force. In various instances, when the frangible feature is broken, it can remain connected to the staple cartridge body. For example, referring again to thelock24380 inFIG. 50, the lock can include a frangible portion, which is configured to crack, but not fall off, when the user applies an intentional action to the staple cartridge to remove it from the channel.
• In certain instances, a staple cartridge can include a detent that is engaged with the channel and is released from the channel upon completion of the firing stroke. Referring now toFIGS. 54-59, astaple cartridge26200 is shown, which is similar in many aspects to the staple cartridge20100 (FIG. 24). For example, thestaple cartridge26200 includes acartridge body26202 including a tissue-supportingdeck26204 having staple cavities defined therein; the staple cavities are arranged in threelongitudinal rows26212a,26212b,26212con each side of arotary drive screw26242, which is similar to the firing screw261 (seeFIGS. 4 and 5) in many aspects. Staples in thestaple cartridge26200 are supported bydrivers26220, which are similar in many aspects to the triple driver20120 (FIG. 26). For example, thedriver26220 include three parallel staple-supporting cradles configured to support staples such that thedriver26220 is configured to fire staples from theinner row26212a, theintermediate row26212b, and theouter row26212csimultaneously.
• Thestaple cartridge26200 includes adetent26280 that releasably engages the channel. Thedetent26280 is movable between a locked configuration (FIGS. 54-57) and an unlocked configuration (FIGS. 58 and 59). In certain instances, an interior-facing side of a channel sidewall, which is positioned adjacent to thecartridge body26202, can include a recess dimensioned and structured to receive thedetent26280 in the locked configuration. For example, the channel20852 (FIG. 99) includesdistal recesses20853. The recess is configured to hold thedetent26280 and, thus, thestaple cartridge26200 relative to the channel until thedetent26280 is moved to the unlocked configuration. In other instances, the outward bias of thedetent26280 against the channel sidewall is configured to frictionally engage the channel without placement of thedetent26280 in a recess. Opposingdetents26280 on opposite sides of thestaple cartridge26000 are configured to frictionally-engage the channel to hold thestaple cartridge26000 therein.
• Thedetent26280 is housed in the distal-moststaple cavity26210 in theouter row26212c. A through-hole26205 is defined in anouter wall26203 of thecartridge body26202 into thedistal staple cavity26210 in theouter row26212c. Thedetent26280 is aligned with the through-hole26205 and protrudes from thecartridge body26202 at the through-hole26205 when thedetent26280 is in the locked configuration (FIGS. 54-57). Abar26282 extends from thedetent26280 and is operably engaged with thedriver26220 in the distal-moststaple cavity26210.
• When thedistal-most driver26220 is in the unfired position (FIGS. 54-57), thedistal-most driver26200 can bias thedetent26280 into the locked position. Referring now toFIGS. 58 and 59, at the completion of the firing stroke when thedistal-most driver26200 is lifted by the sled through the staple cavity and toward the tissue-supportingdeck26204, thedistal-most driver26220 can move away from thedetent26280 and engage thebar26282. As thedistal-most driver26220 moves along thebar26282, thedriver26220 is configured to bias the bar laterally outward, which pivots thedetent26280 inward into and/or through the through-hole26205 and out of engagement with the channel. In such instances, thedistal-most driver26220 releases the snap feature, i.e. thedetent26280, when the firing stroke is completed.
• In certain instances, multiple driver-releasable detents can be positioned along the length of thecartridge body26202. In certain instances, longitudinally-staggered and/or longitudinally-symmetrically detents can be positioned along both sides of thecartridge body26202. In addition to the drive-releasable detent26280, the sled can be configured to release snap-fit or detent features in certain aspects of the present disclosure. Moreover, in certain instances, the driver(s) can be configured to snap or break thedetent26280 and/or thebar26282 thereof during the firing stroke to release the attachment features.
• In various instances, the staple cartridge assemblies herein can include driver retention features configured to prevent the release of the drivers from the cartridge bodies. For example, certain staple cartridges include a metal pan, which is heat-staked or thermoformed to the cartridge body after the drivers are installed in the fastener cavities. The metal pan(s) can wrap around an underside of the cartridge body and hold the drivers therein. In certain instances, the drivers can be retained without a separate metal pan to create additional space in the small form factor of the cartridge assembly. For example, as further described herein, heat stakes between the cartridge body and the drivers can retain the drivers. Additionally or alternatively, the cartridge body can be over-molded with a metal pans. For example, driver retention features can include thermoformed interference features between the drivers and the cartridge body and/or insert molded components within the cartridge body.
• Astaple cartridge26300 is shown inFIGS. 60 and 61. Thestaple cartridge26300 is similar in many aspects to the staple cartridge20100 (FIG. 24). For example, thestaple cartridge26300 includes acartridge body26302 including a tissue-supportingdeck26304 having staple cavities defined therein; the staple cavities are arranged in threelongitudinal rows26312a,26312b,26312con each side of thecartridge body26302. Staples in thestaple cartridge26300 are supported by drivers26320 (FIG. 61), which are similar in many aspects to the triple driver20120 (FIG. 26). For example, thedriver26320 includes three parallel staple-supporting cradles configured to support staples such that thedriver26320 is configured to fire staples from theinner row26312a, theintermediate row26312b, and theouter row26312c.
• Thecartridge body26302 includes a row ofindentations26330, or dimples, along a lower portion of thecartridge body26302. The row ofindentations26330 can be positioned to engage and retain thedrivers26320 when thedrivers26320 are in their unfired positions. InFIG. 60, eachindentation26330 is configured to engage adriver26320. For example, eachdriver26320 can be held is position by anindentation26330 adjacent to the outer surface of the adjacent staple-supporting column thereof. Theindentations26330 in thecartridge body26302 can prevent the drivers from falling out of thecartridge body26302 when thedrivers26320 are in their unfired and down-most positions.
• Theindentations26330 in thecartridge body26302 are configured to engage arecess26321 in the outer surface of thedriver26320. Therecess26321 can include an upper lip or boundary, which prevents vertical displacement of thedriver26320 relative to thecartridge body26302. In various instances, theindentations26330 and the correspondingrecesses26320 can be thermoformed, melted, or otherwise coupled with a heat staking process. Heat staking is further described herein.
• Because thedrivers26320 are triple drivers, a heat stake connection between the outer wall of thedriver26320 and thecartridge body26302 can hold theentire driver26320, including the intermediate support column and the inner support column, in position in thecartridge body26302. The interference connection between theindentations26330 and therecesses26321 can be overcome by the sled during a firing stroke to sequentially release and lift thedrivers26320 as the sled moves along the row ofindentations26330. In certain instances, a series of heat-stakes along an inside surface in thecartridge body26302 can engage eachdriver26320 during a firing motion. In such instances, thedriver26320 can catch multiple vertical catches or dimples during the firing motion.
• In certain instances, the drivers and the cartridge body can include interference features molded into the drivers and/or the cartridge body. Referring toFIG. 62, astaple cartridge26400 is similar in many aspects to the staple cartridge20100 (FIG. 24). For example, thestaple cartridge26400 includes acartridge body26402 including a tissue-supportingdeck26404 havingstaple cavities26410 defined therein; thestaple cavities26410 are arranged in three longitudinal rows on each side of thecartridge body26402. Staples in thestaple cartridge26400 are supported by drivers26420 (FIG. 62), which are similar in many aspects to the triple driver20120 (FIG. 26); however, thedriver26420 is a double driver. The retention features described herein with respect to thedriver26420 can be incorporated into a single driver and/or a triple driver in other instances.
• Thedrivers26420 include an integrally-formedwedge26421, which is narrower along atop edge26423 of thewedge26421 and thicker along abottom edge26425 of thewedge26421. Thewedge26421 is positioned on a sidewall of a staple support column and is configured to abut a sidewall of thestaple cavity26410. For example, thestaple cavity26410 includes avertical groove26405, which is aligned with thewedge26421. Thewedge26421 is configured to move along thevertical groove26405 as thedriver26420 is lifted upward by a sled during a firing stroke. To accommodate thewedge26421, the cartridge walls are configured to flex outward when thedriver26420 is inserted into thecartridge body26402. In use, the firing force by the sled is sufficient to overcome the interference fit and lift thedriver26420. Stated differently, in the depicted embodiment, thewedge26421 is configured to travel through thevertical groove26405; however, the depth of thegroove26405 is not sufficient to allow free and clear passage of thewedge26421 therethrough. The narrowtop edge26423 can fit in the groove without interference; however, between the narrowtop edge26423 and thethicker bottom edge26425, thewedge26421 can interfere with thecartridge body26402 despite thevertical groove26405. The interference connection between thewedge26421 and thevertical groove26405 is configured to hold thedriver26420 in position within thestaple cavity26410 during the firing motion and resist downward motion; the interference can be overcome by the sled during a firing stroke to sequentially release and lift thedrivers26420 as thewedge26421 traverses thecartridge body26402 along the row ofindentations26330. Thecartridge body26402 can continue to flex as thedriver26420 andwedge26421 thereof move through thecavity26410.
• Referring now toFIG. 63, astaple cartridge26500 is shown. Thestaple cartridge26500 includes acartridge body26502 having staple cavities defined therein; the staple cavities are arranged in three longitudinal rows on each side of thecartridge body26502.Staples26580 in thestaple cartridge26500 are supported bydrivers26520, which are similar in many aspects to the triple driver20120 (FIG. 26). Thestaple cartridge26500 is similar in many aspects to the staple cartridge20100 (FIG. 24); however, thestaple cartridge26500 also includes an insert moldedmetal frame26503 within thecartridge body26502. The insert moldedmetal frame26503 is a two-part assembly including afirst pan26503aand asecond pan26503b, which extends along the sides of thecartridge body26502. Thepans26503a,26503bcan be insert molded with thecartridge body26502, snap-fit to thecartridge body26502 with a friction fit betweenbosses26505 along the length of thecartridge body26502 andopenings26507 in thepans26503a,26503b, and/or can be heat staked to thecartridge body26502 by deformingbosses26505 along the length of thecartridge body26502 within theopenings26507 in thepans26503a,26503b.
• In one aspect, flat, non-bent pans can be insert molded with the cartridge body26502 (e.g. thepans26503a,26503bcan initially define a linear profile instead of an L-shaped profile). Thecartridge body26502 can be formed with an over-molded metal sheet along the lateral side(s) thereof, for example. Then, the exposed length of the over-molded metal sheets can be bent around a portion of the underside of thecartridge body26502 to at least partially overlap some of the staple cavities to retain thedrivers26520 in thecartridge body26502 from the underside thereof. In certain instances, the drivers can be triple drivers spanning outer staple cavities, intermediate staple cavities, and inner staple cavities. The bent portion of the metal sheet can overlap, or substantially overlap, the lower portion of the outer staple cavities to maintain the drivers in the cartridge body.
• Alternatively, an L-shaped pan like thepans26503a,26503bcan be snap-fit to the lateral sides of thecartridge body26502 to retain the drivers in thecartridge body26502 from the underside thereof without insert molding thepans26503a,26503bto thecartridge body26502.
• In one aspect, thepans26503a,26503bcan be insert molded with thecartridge body26502 and can include exposed bendable metallic flanges or arms, that are bent around thecartridge body26502 after thedrivers26520 have been installed in the staple cavities. For example, referring now toFIGS. 64 and 65, a portion of a metal frame or pan26603 for a cartridge body, such as the cartridge body26502 (FIG. 63) or the cartridge body20102 (FIG. 24) is shown. Thepan26603 can be insert molded with the cartridge body. For example, thepan26603 includes aframe portion26605 over which the cartridge body has been molded. Thepan26603 also includes anarm26609. Thearm26609 can be deformed from an initial configuration (FIG. 64) to abent arm26609′ configuration (FIG. 65) with a deformation force in the direction F (FIG. 65), to wrap thearm26609 around a lower portion of the staple cavities and retain the drivers therein.
• In various aspects of the present disclosure, the various techniques for forming a piece of metal over the outer staple cavities to retain the drivers therein can be applied to the inner staple cavities in certain instances. For example, in various aspects of the present disclosure, the staple cartridge can include a support brace, such as thesupport brace650 fitted within the staple cartridge640 (seeFIGS. 19 and 20). As further described herein, thestaple cartridge640 and thesupport brace650 can be assembled together prior to installing thestaple cartridge640 into thechannel630. In certain instances, such asupport brace650 or other insert molded longitudinal frame member within the cartridge body can include a metal sheet, pan, or arm, which can be bent around an underside of the cartridge body to retain the drivers in the inner rows of staple cavities.
• As described herein, driver retention and/or interlocking features with the cartridge body can be heat staked to retain the drivers in the cartridge body. In at least one aspect of the present disclosure, each driver can include a corresponding heat stake feature with the cartridge body. It can be important to ensure the heat stake depth is sufficient to keep the drivers from disengaging but does not cause interference with the drivers in their unfired or down positions. The heat stake and orbital forming techniques can be controlled to ensure sufficient engagement.
• Referring now toFIG. 67, portions of astaple cartridge26700 are shown, including acartridge body26702 having adriver26720 therein. Thestaple cartridge26700 is similar in many aspects to the staple cartridge20100 (FIG. 24) but also includes alongitudinal support frame26703 and heat staked retention features26705 between thecartridge body26702 and thelongitudinal support frame26703. In various instances, the heat staking can be done against a solid sheet of metal to secure thecartridge body26702 to thelongitudinal support frame26703. Then, thedrivers26720 can be installed in the staple cavities. For example, thedriver26720 and a staple can be installed in astaple cavity26710. After thedrivers26720 have been installed, thelongitudinal support frame26703 can be bent over the underside of thecartridge body26702 to retain thedrivers26720 therein. For example, aportion26709 of thelongitudinal support frame26703 can overlay openings in the underside of thestaple cartridge body26702 associated with the outer staple-supporting column on thedriver26720 and outerstaple cavity26710.
• An insert support can be utilized in certain heat staking operations, which can reduce the amount of pressure and improve consistency. For example, a removable insert support or backer can be positioned behind each heat stake. Moreover, the insert supports can push the drivers into an upward position while staking to protect the drivers from deformation or other effects of the heat staking operation.
• Referring toFIG. 67, a heat staking operation for astaple cartridge26800 is shown in which acartridge body26802 is being secured to alongitudinal support frame26803 with aheat stake26805. Thestaple cartridge26800 is similar in many aspects to the staple cartridge20100 (FIG. 24) but also includes thelongitudinal support frame26803 and theheat stake26805. Thelongitudinal support frame26803 includes anupright sheet26808 and anorthogonal flange26809 extending therefrom to form an L-shaped profile. Theupright sheet26808 includesopenings26807 therethrough, which are aligned with the heat stakes26805. Theorthogonal flange26809 also includesopenings26806 therethrough, which are configured to receivefingers26892 of aninsert support26890 therein.
• During a heat staking operation, the L-shapedsupport frame26803 is positioned alongside a length of thecartridge body26802 and theinsert support26890 is positioned relative to thesupport frame26803 and thecartridge body26802 such that thefingers26892 extend through theopenings26806 in theorthogonal flange26809 and intostaple cavities26810. Thefingers26892 are configured to pushdrivers26820 upwards toward a tissue-supportingdeck26804 of thecartridge body26802. After the heat stakes26805 have been formed between thecartridge body26802 and the L-shapedsupport frame26803, theinsert support26890 can be removed from thestaple cartridge26800 allowing thedrivers26820 to move downward and assume their unfired positions in thestaple cavities26810. Theorthogonal flange26809 is configured to overlay a portion of the underside of thecartridge body26802 and may overlap multiple staple-supporting columns (e.g. an outer column and an intermediate column) and/or a bridge between two adjacent staple-supporting columns to hold thedrivers26820, which span multiple rows ofstaple cavities26810, in thecartridge body26802.
• As further described herein, certain end effector components may be constructed using 3D printing technology to improve component capabilities. In certain instances, 3D printing can allow the printed component to exhibit metamaterial properties, for example. A metamaterial is a synthetic composite material with a structure such that it exhibits properties not usually found in natural materials. 3D printing is one technique used to create a metamaterial by forming components with two or more materials and/or structures therein. In other instances, insert molding and over-molding can generate composite components that may have metamaterial properties in certain instances.
• Composite end effector components may exhibit greater structural strength and stiffness while allowing precision in the forming of small detailed features and can provide improved frictional properties in certain instances. For example, a metal-plastic composite cartridge body can exhibit certain metamaterial properties in that it may be stronger and stiffer than a similar injection-molded, entirely plastic, or composite, cartridge body, for example, while still allowing precision with respect to small detailed features. In certain instances, a metal-plastic composite cartridge body can demonstrate improved frictional properties with respect to the drivers movably positioned within each staple cavity. Certain composite metal-plastic components can be formed with insert molding or over-molding. In other instances, 3D printing can allow for the creation of complex geometries and/or material combinations that may otherwise be too costly and time consuming to manufacture with conventional molding techniques or, in certain instances, may even be impossible to manufacture absent 3D printing technology.
• Referring toFIG. 69, for example, a composite metal-plastic cartridge body30002 is shown. The composite metal-plastic cartridge body30002 can provide metamaterial properties in certain instances. Additionally or alternatively, the composite metal-plastic body can allow improved integration of electronic components, such as electronic sensors and flexible circuits.
• In one aspect, thecartridge body30002 is formed with a stampedmetal frame30001 or two or more pans that are stamped and otherwise formed into a skeleton shape for thecartridge body30002. Aplastic material30003 is then molded over themetal frame30001. In such instances, themetal frame30001 can be insert molded to theplastic material30003. The metal-plasticcomposite cartridge body30002 can exhibit increased strength and collapse stiffness in comparison to entirely plastic cartridge bodies, i.e. injection molded cartridge body without a metal frame therein.Plastic material30003 over a metal or composite frame can provide a structural functioning frame with intricate driver guidance features molded into theplastic material30003.
• Themetal frame30001 can comprise a thin metallic framework and the plastic material can be injection molded with structural members, in certain instances. In one aspect, the metal frame can constitute an integrated pan or pans, as further described herein, which can save space in the cartridge body and/or increase the tissue gap. Additionally, metal can be utilized for certain components related to lockouts, cartridge identification, and resetting. The metal can be less prone to breaking or cracking in certain instances and can withstand significant forces, which may be helpful for lockout components and/or mechanical keys (e.g. an extending tab or post) to prevent insertion of the staple cartridge into an incompatible channel and/or device Certain metallic components can be resilient during a firing stroke reset, i.e. when retracting the sled during manufacturing to test cartridge and ensure all components have been installed. Moreover, a composite metal-plastic cartridge body can facilitate smart cartridge technology, integrated wiring, and/or flexible circuits.
• In certain instances, themetal frame30001 could have flanges that interconnect or span multiple walls and/or columns in the cartridge body. For example, certain walls in the cartridge body can be thinner than other walls and the flanges can connect a thinner wall with a thicker wall to better distribute a torque load, rather than twisting the support. In certain instances, the main standing support walls in the cartridge body can be connected to an adjacent thicker support walls by the metal frame. For example, a thinner interior cartridge wall can be coupled to a thicker exterior cartridge wall to improve force distributions during clamping and/or firing.
• In other instances, a composite plastic-metal cartridge body can be 3D-printed. The orientation of the 3D build forming the composite plastic-metal cartridge body can be optimized to ensure smooth driver motions during the firing stroke. For example, referring again toFIG. 69, thecartridge body30002 includesstaple cavities30010 arranged in a plurality oflongitudinal rows30012. Thestaple cavities30010 are defined though a tissue-supportingdeck30004 and into thecartridge body30002. Drivers, such as the drivers20120 (FIG. 26), further described herein, can support staples in thecartridge body30002.
• The composite plastic-metal cartridge body30002 can be printed layer-upon-layer along the longitudinal axis A of thecartridge body30002. Stated differently, the orientation of the 3D build can be orthogonal to the longitudinal axis A and/or orthogonal to the tissue-supportingdeck30004. When the directional 3D printing of thecartridge body30002 is perpendicular to the longitudinal axis A (e.g. proximal-to-distal), the build layers can be aligned with the direction of driver motion during the firing stroke. Referring again toFIG. 69, eachstaple cavity30010 extends along an axis D, which is perpendicular to the longitudinal axis A. As a sled moves through thecartridge body30002 along the longitudinal axis A, each drivers is lifted upwards along its respective D axis toward the tissue-supportingdeck30004. The build direction is parallel to the staple cavities' D axes along which the drivers move during a firing stroke. Aligning the 3D build layers with the direction of driver motion can prevent driver binding and hang-ups as the drivers are lifted by the sled during the firing stroke, in certain instances.
• The 3D build for a composite plastic-metal cartridge body is proximal-to-distal in certain instances. In other instances, the 3D build can be distal-to-proximal, for example. Support structures for certain 3D builds can be minimized when building the narrower body portion on top of a wider distal nose of the cartridge body, in certain instances.
• In various instances, a 3D-printed composite cartridge body can include different infill percentages and/or different materials to obtain metamaterial properties related to improving the strength of the cartridge body while minimizing frictional forces during the firing stroke. Moreover, the support walls of such a cartridge body can define open spaces, voids, and/or cells therebetween. In various instances, the spaces between the support walls, such as the thin walls between the staple cavities, for example, can be configured to allow for improved bending resistance during a clamping load. For example, the spaces between the support walls of the cartridge body can include 3D-printed internal fillets, chamfers, and/or struts, which are configured to improve the open cell strength of the support walls.
• Certain cartridge bodies described herein may include a smaller cross-sectional geometry, less material, and/or thinner support walls owing to the footprint of a central firing screw (e.g. the firingscrew261 inFIGS. 4 and 5) therethrough, which takes up real estate in the compact form factor of the cartridge body. High loads on the cartridge body during the firing stroke can exert deformation forces on the cartridge body, which may result in deformation of the cartridge body or portions thereof. For example, the thin walls separating the staple cavities can tend to bend or buckle in certain instances, which can direct the drivers and staples supported thereon out of alignment with the forming pockets in the anvil. In any event, connecting the lateral sides of the cartridge body with a bridge can strengthen the cartridge body and help to maintain alignment between the staples in the staple cavities and their associated forming pockets in the anvil even when subject to high loads.
• Referring now toFIGS. 71 and 72, portions of asurgical end effector30140 are shown. Thesurgical end effector30140 is similar in many aspects to the surgical end effector20240 (FIG. 29). For example, theend effector30140 includes astaple cartridge30100, which is similar in many aspects to the staple cartridge20100 (FIG. 24) and includes acartridge body30102 and three rows of staple cavities on each side of a rotary drive screw30142 (FIG. 72), which is similar in many aspects to the drive screw261 (seeFIGS. 4 and 5) and the rotary drive screw20242 (FIG. 29), for example. Thestaple cartridge30100 is installed in achannel30150. A firingmember30144 having anupright cutting edge30146 is configured to move along therotary drive screw30142 through thestaple cartridge30100 during a firing stroke to advance the sled and lift the drivers and staples thereon into forming contact with forming pockets in the anvil.
• Thecartridge body30102 is similar in many aspects to the cartridge body20102 (FIG. 24), for example; however, thecartridge body30102 further includes abridge30106 extending between twolateral sides30102a,30102bof thecartridge body30102. Thebridge30106 covers a longitudinal knife-receivingslot30108 defined in thecartridge body30102, along which a portion of the firingmember30144 moves during a firing stroke. Thebridge30106 forms a contiguous tissue-supportingdeck30104 between the twolateral sides30102a,30102bof thecartridge body30102. In various instances, thebridge30106 can improve the strength of thecartridge body30102, for example, and may help to maintain alignment of the staples with the forming pockets on the anvil especially when firing under high loads, for example. In such instances, thebridge30106 can mitigate lateral staple misalignment resulting from high clamping loads, for example.
• Thebridge30106 is a frangible portion, which is configured to be cut or transected by theupright cutting edge30146 of the firingmember30144 during a firing stroke. In various instances, the geometry of thebridge30106 is configured to mitigate the risk of splintering. For example, the geometry can allow fora predictable geometry and orientation of destruction of thebridge30106. In instances in which thecartridge body30102 is 3D-printed, for example, thecartridge body30102 can include a different material, different infill percentage, and/or different infill geometry along thebridge30106 or portions of thebridge30106 compared to adjacent portions of thecartridge body30102, which can further facilitate transection of thebridge30106 during the firing stroke without damaging the firingmember30144 and/or splintering thecartridge body30102 from the firing load.
• In certain instances, as further described herein, thestaple cartridge30100 can include a single-use knife, for example, which can transect thebridge30106 during the firing stroke. Where a single-use knife is utilized, the knife does not risk becoming dull for a subsequent firing stroke upon transecting the frangible portion of thebridge30106. Thebridge30106 can comprise a plastic molded and/or 3D-printed component, for example, which can be easily transected by theupright cutting edge30146 without significant resistance thereof. In other instances, a reusable knife can be used to cut thebridge30106.
• In certain instances, thebridge30106 can include rows of perforations and/or break/tear lines along which thebridge30106 is configured to separate from thecartridge body30202. Referring toFIG. 73, for example, a tamper-evident lid30200 includes afrangible portion30206 having atear tab30202 and defined bybreak lines30204 between the frangible portion and the rest of thelid30200. Thefrangible portion30206 can be removed or separated from the tamper-evident lid30200 along the break lines30204. Similarly, thebridge30106 can be removed from thecartridge body30102 along break lines, which facilitate separation of thebridge30106 from thecartridge body30102. In certain instances, thebridge30106 can be interrupted with pockets along the sidewall of the knife-receivingslot30108. Deflected and/or separated portions of thebridge30106 can be configured to move into the pockets during the firing stroke, rather than being pushed out of thecartridge body30102 and into tissue clamped therebetween.
• In certain instances, as further described herein, a replaceable staple cartridge can include a single-use knife, which may provide a fresh cutting edge for each firing stroke. However, to cut tissue clamped between the jaws of an end effector, the knife should extend beyond the tissue-supporting deck of a staple cartridge, in various instances. Such a protruding knife and cutting edge risks unintentional and/or inadvertent contacts outside of the firing stroke, which may damage tissue and/or dull the cutting edge. For example, the cutting edge may inadvertently contact and/or cut the tissue of a patient and/or clinician before the firing stroke, such as when the staple cartridge is being loaded into the end effector. In other instances, upon completion of the firing stroke, the cutting edge may remain in a distal protruding position and may inadvertently contact and/or cutting the tissue of a patient and/or clinician when the end effector unclamps the tissue and is being withdrawn from the surgical site. Additional unintentional tissue contact scenarios are contemplated.
• In various instances, a tissue-transecting knife can be mounted to a sled in the staple cartridge. As the sled moves through the firing stroke, the knife can also move through the cartridge body. Moreover, the sled can interact with the firing member (e.g. the I-beam or E-beam) in the end effector. For example, the sled and knife thereon can be releasably coupled to the firing member, such that the sled and knife are advanced distally during a firing stroke. In certain instances, the sled and the knife can be retracted proximally along with the firing member upon completion or termination of the firing stroke. In such instances, the knife can be reset and/or returned to a proximal position in the cartridge body before the firing member permits the opening of the jaws. In such instances, the protruding knife and cutting edge thereof can returned to a predictable and/or at least partially-shielded position at the proximal end of the cartridge body. In other instances, a sled can include multiple separable components (e.g. a two-part sled), and a portion of the sled can be retracted proximally, while another portion of the sled remains in a distal position. In certain aspects, the retractable portion of the sled can include the knife. In still other instances, the non-retractable portion of the sled can include the knife, which can be directed downward into the cartridge body as the retractable portion of the sled moves past it. In certain instances, a portion of the sled can interact with a lockout feature to prevent a firing stroke when the cartridge is missing and/or spent.
• In one aspect of the present disclosure, a firing member can include a distally-extending hook and the sled can include a proximal cavity dimensioned to receive the distally-extending hook. Moreover, the knife can be pivotably coupled to the sled and positioned to selectively engage and retain the distally-extending hook in the sled. For example, the distally-extending hook can hook around a portion of the knife. In various instances, interconnection of the distally-extending hook and the knife is configured to hold the knife in a protruding position relative to the cartridge body.
• In such instances, the knife can be moved to the protruding position, in which the cutting edge is positioned to transect tissue clamped between the jaws, when the firing member is advanced into engagement with the sled. Prior to the firing stroke, the knife can be pivoted into a shielded position, in which at least a portion of the cutting edge is shielded by the sled and/or cartridge body. Moreover, upon completion of the firing stroke, the firing member can return with the sled to a proximal position in the cartridge body and return to its shielded position. In various instances, the foregoing arrangement may avoid certain inadvertent tissue contacts outside of the firing stroke.
• Referring now toFIGS. 74-77, asled assembly30320 for an end effector30340 (FIG. 77) is shown. Theend effector30340 is similar in many aspects to the end effector200 (seeFIGS. 4 and 5) and is configured to cut and staple the tissue of a patient. Theend effector30340 can include a cartridge jaw and an anvil jaw, for example, and the cartridge jaw can be configured to receive astaple cartridge30300 having a tissue-supportingdeck30304, which is similar in many aspects to the staple cartridge220 (seeFIGS. 4 and 5), for example. Theend effector30340 also includes a rotary drive screw and a firingmember30342, which are similar to the firing screw261 (seeFIGS. 4 and 5) and the firing member270 (seeFIGS. 4 and 5), respectively. The cartridge jaw is configured to receive thestaple cartridge30300, including staples that can be ejected when the firingmember30342 is advanced within thestaple cartridge30300. For example, the firingmember30342 is driven through theend effector30340 upon a rotation of the firing screw during a firing stroke to advance thesled assembly30320.
• The firingmember30342 includes abody portion30343,upper cam members30344 extending laterally from both sides of thebody portion30343, andlower cam members30345 extending laterally from both sides of thebody portion30343. Theupper cam members30344 are configured to cammingly engage an upper jaw, or anvil, of theend effector30340 during a firing stroke, and thelower cam members30345 are configured to cammingly engage a lower jaw, or elongate channel of theend effector30340 during the firing stroke.
• Further to the above, a longitudinal opening extends through thebody portion30343. The longitudinal opening is configured to receive the rotary drive screw described above. Thebody portion30343 further includes acutout region30349 configured to receive a firing drive nut30350. The firing drive nut30350 is configured to threadably engage the rotary drive screw to convert rotary motion of the rotary drive screw into translation of the firingmember30342. The firing drive nut30350 also includes laterally-extending members30351 that extend from both sides of the firing drive nut30350. The laterally-extending members30351 are aligned with thelower cam members30345. As such, thecam members30345,30351 cooperate to cammingly engage the lower jaw of theend effector30340 during the firing stroke.
• Thebody portion30343 of the firingmember30342 also includes adistal nose portion30346, that extends distally and forms a distal sled-abutment surface30352. A distal extension30347 extends from the distal sled-abutment surface30352 in a substantially distal direction and is configured to selectively interlock with thesled assembly30320. More specifically, the distal extension30347 includes a transverse portion or catch30348 extending in a direction transverse to the distal direction. The distal extension30347 and the catch30347 form a hooked geometry, which selectively engages a portion of thesled assembly30320, as further described herein.
• Thesled assembly30320 includes asled body30321 and aknife30338 havingrails30322 positioned to engage drivers, such as the drivers20120 (FIG. 26), for example. Therails30322 are configured to lift the drivers toward the tissue-supportingdeck30304 of thestaple cartridge30300. Acentral portion30333 of thesled body30321 moves along a central longitudinal path in thestaple cartridge30300 during a firing stroke. In various aspects, thecentral portion30333 includes anupright hub30334 havingsidewalls30335, which are dimensioned and structured to move along a longitudinal slot in thestaple cartridge30300. Thecentral portion30333 also includes an arcedunderside profile30334 dimensioned and positioned to accommodate the rotary drive screw without interference.
• Theupright hub30334 includes a recess orspace30328 between thesidewalls30335 and a shaft orpin30336 extending between thesidewalls30335. Astop30337 also extends between thesidewalls30334, and is further described herein. Theknife30338 of thesled assembly30320 is pivotably mounted to thepin30336 at ahub30339. In various aspects, thehub30339 can define a hub diameter that permits rotation of theknife30338 about thepin30336. Moreover, theknife30338 includes a mountingslot30329 having a narrower width than the hub diameter and into which thepin30336 passes to secure thehub30339 to thepin30336. In various instances, theknife30338 can be snap-fit or press-fit onto thepin30336, for example. Referring to an exploded view of thesled assembly30320 inFIG. 75, theknife30338 can be moved along the assembly axis A to rotatably mount theknife30338 to thesled body30321.
• In various instances, theknife30338 can pivot into a downward or recessed position relative to thesled body30321. For example, theknife30338 and cutting edge thereof can face generally downward, for example, and/or be shielded by thesidewalls30335 when theknife30338 is in the recessed position. In certain instances, a biasing element is configured to bias theknife30338 toward the recessed position.
• Referring primarily now toFIG. 77, during a firing stroke, the firingmember30340 is advanced distally into thestaple cartridge30300, which drives the distal extension30347 and catch30348 into thespace30328 between thesidewalls30335 of theupright hub30334. Upon insertion into thespace30348, thecatch30348 can hook around anend portion30328 of theknife30338. Theend portion30328 of theknife30338 defines aplanar abutment surface30327 andbulbous end30327 about with thecatch30348 extends to securely hold thecatch30348 against theplanar abutment surface30327. In such instances, thecatch30348 is held in thespace30328 at a location distal to theend portion30328 of theknife30338. Moreover, theknife30338 is rotated into a protruding position, in which the cutting edge protrudes out of the cartridge body30302 and into a tissue gap defined between the tissue-supportingsurface30304 and the anvil. In various instances, the distal extension30347 and/or theend portion30328 are configured to flex under a defined load during a distal firing motion to resiliently couple the distal extension30347 in thespace30328 of thesled assembly30320.
• Thereafter, the firingmember30340 can advance thesled assembly30320 distally. As thesled assembly30320 moves distally, theknife30338 is pushed in a clockwise direction from the orientation shown inFIG. 77. Resistance to the firing motion (e.g. tissue) can be configured to rotate theknife30338 in the clockwise direction. Theknife30338 can be rotated in a clockwise direction from the orientation inFIG. 77 into abutting engagement with thestop30337, which is configured to prevent further clockwise rotation of the knife30038. In such instances, theknife30338 is maintained in an upright or protruding position relative to the tissue-supportingdeck30304 during a distal motion of the firing stroke. For example, theabutment surface30327 can be flush, or substantially flush, against an inside surface of thecatch30348.
• A proximal retraction motion of the firingmember30320 is shown inFIG. 77 in which the firingmember30320 is withdrawn in the proximal direction P. Retraction of the firingmember30320 in the proximal direction B is configured to draw the distal extension30347 and thecatch30348 proximally, which exerts a force on theend portion30328 also in the proximal direction. In turn, this force on theend portion30328 is configured to rotate theknife30338 in the counterclockwise direction while retracting thesled assembly30320 along with the firingmember30320. In various instances, a slight clockwise rotation of theknife30338 is configured to pivot a cutting edge of theknife30338 downward into an orientation less likely to contact and/or cut tissue, for example.
• In various instances, the interconnection between the firingmember30340 and thesled assembly30320 is configured to ensure that thesled assembly30320 and theknife30338 thereof are reset in a proximal position in thestaple cartridge30300 before the jaws are released from engagement by thecam members30344,30345,30351 of the firingmember30340 and permitted to open. When firingmember30340 is further retracted and withdrawn from thestaple cartridge30300, the distal extension30347,catch30348, and/or theend portion30328 can be configured to deflect to release the distal extension30347 from thesled body30321 and pivot theknife30338 further counterclockwise from the orientation inFIG. 77 to a shielded orientation.
• In certain aspects of the present disclosure, a sled can be stamped from a sheet of metal. In certain instances, the sled can be a two-part sled formed from two stamped sheets. The stamped sleds can having substantially W-shaped profiles in certain instances. The knife can be integral with one of the stamped sheets, for example. In certain instances, the two-part sled can include a first stamped component, which is retractable with the firing member, and a second stamped component, which is not retracted with the firing member. In a proximal, unfired position, the second stamped component is configured to interact with and overcome a missing and spent cartridge lockout. In a distal, fired position from which the second stamped component is not retracted by the firing member, the missing and spent cartridge lockout is configured to engage the firing member and prevent a firing stroke.
• The two-part sled and lockout arrangement can prevent a firing stroke when the staple cartridge is missing from the end effector and/or when a spent or empty staple cartridge is installed in the end effector. Moreover, the sled being formed from two stamped metal sheets can provide a lower cost sled, in certain instances, with an integrated knife and cutting edge(s), coupling feature(s) for the firing member, and lockout engagement feature(s). Such a stamped metal sled can prevent bending or mushrooming of the sled rails under high staple-forming loads and may prevent breaking or cracking of the sled in certain instances. Moreover, the stamped metal sled can define thin rails allowing for more plastic (or other material(s)) in the cartridge body, which can improve the strength of the cartridge body including the strength of the support walls between the staple cavities. In certain instances, the thin profile of a stamped metal sled can allow the drivers to be positioned closer together and can better accommodate a rotary drive screw in certain instances.
• Referring now toFIGS. 74-89, asled assembly30420 for an end effector30440 (seeFIG. 82) is shown. Theend effector30440 is similar in many aspects to the end effector200 (seeFIGS. 4 and 5) and is configured to cut and staple the tissue of a patient. Theend effector30440 includes acartridge jaw30450 and ananvil jaw30454, for example, and thecartridge jaw30450 is configured to receive astaple cartridge30400 having acartridge body30402 and a tissue-supportingdeck30404, which is similar in many aspects to the staple cartridge220 (seeFIGS. 4 and 5), for example. Theend effector30440 also includes afiring drive system30339 that includes arotary drive screw30442 and a firingmember30441, which are similar to the firing screw261 (seeFIGS. 4 and 5) and the firing member270 (seeFIGS. 4 and 5), respectively. Thecartridge jaw30450 defines a channel having opposingsidewalls30452, which are configured to receive thestaple cartridge30400, including staples that can be ejected when the firingmember30441 is advanced through thestaple cartridge30400. For example, the firing member30341 is driven through theend effector30340 upon a rotation of therotary drive screw30442 during a firing stroke to advance thesled assembly30420.
• Referring primarily toFIG. 81, the firingmember30441 includes abody portion30443,upper cam members30444 extending laterally from both sides of thebody portion30443, andlower cam members30445 extending laterally from both sides of thebody portion30443. Theupper cam members30444 are configured to cammingly engage theanvil jaw30454 of theend effector30440 during a firing stroke, and thelower cam members30445 are configured to cammingly engage thecartridge jaw30450 of theend effector30400 during the firing stroke.
• Further to the above, a longitudinal opening extends through thebody portion30343. The longitudinal opening is configured to receive therotary drive screw30442 described above. In certain instances, therotary drive screw30442 can be threadably coupled to thebody portion30343 and, in other instances, can be threadably coupled to a firing drive nut housed therein, as further described herein.
• Referring primarily toFIGS. 78-81, thesled assembly30420 includes two discrete sleds—aproximal sled30422 and adistal sled30424. Eachsled30422,30424 is a separate and discrete stamped component. For example, eachsled30422,30424 can be formed with a separate stamping. Thesleds30422,30424 are formed from a stamped sheet of material, such as a metal sheet. In at least one aspect, thesleds30422,30424 are formed from steel sheets; however, other materials are also contemplated. Theproximal sled30422 and thedistal sled30422 cooperate to engagedrivers30416 housed in thecartridge body30402. Thedrivers30416 can be triple drivers in various instances, and can be similar in many aspects to the drivers20120 (FIG. 26), for example.
• Theproximal sled30422 and thedistal sled30424 can be connected with a push-connection. Stated differently, while theproximal sled30422 is applying a pushing force to thedistal sled30424, thesleds30422,30424 can remain connected. Absent the pushing force, thesleds30422,30424 are separable components which can be selectively moved and relocated in certain instances.
• Eachsled30422,30424 includes a pair of stamped wedges, which form the rails. Theproximal sled30422 includesouter rails30423 for thesled assembly30420, and thedistal sled30424 includesinner rails30425 for thesled assembly30420. Anouter rail30423 and aninner rail30425 can be configured to move along each side of the staple cartridge during a firing stroke and can be aligned with a row ofdrivers30416. Between therails30423,30425, the proximal anddistal sleds30422,30424 includes acentral upright portion30426,30428, respectively, defining alower arced profile30426a,30428a to accommodate the rotary drive screw30442 (FIG. 81) therethrough. The centralupright portions30426,30428 also include a key30426b,30428b, respectively, which are configured to align and guide thesleds30422,30424 through thecartridge body30402. Thekeys30426b,30428 are arcuate loops although other geometries are also contemplated. Orthogonal flanges connect the centralupright portions30426,30428 to theirrespective rails30423,30425, for example. The orthogonal flanges have the same thickness as the associatedrails30423,30425 owing to their stamped formation.
• Thesled assembly30420 is shown in a staple cartridge inFIG. 88. The thickness of the metal sheet can correlate to the thickness of therails30423,30425. In such instances, theinner rails30423 necessarily have the same thickness, and theouter rails30423 necessarily have the same thickness. In at least one aspect, theinner rails30423 and theouter rails30423 can have the same thickness though stamped separately. In any event, being formed from thin metal sheets, thesled assembly30420 can have a reduced thickness while still withstanding high loads without bending and/or breaking. For example, therails30423,30425 can be narrower than the cartridge walls between staple cavities in adjacent longitudinal rows. Comparatively, referring to astaple cartridge30500 inFIG. 89 having the same overall width and staple line geometry, inner andouter rails30523,30525 of a sled30530 (e.g. a molded plastic sled) in a cartridge body30502 can be wider than therails30423,30425. In such instances, the cartridge body30502 may have less space and, thus, less material and associated strength to support the inner row of drivers, for example.
• Theproximal sled30422 and thedistal sled30424 can be aligned and assembled along an assembly axis A (FIG. 79). When assembled, the centralupright portions30426,30428 can be longitudinally staggered and a proximal portion of theinner rails30425 can rest on the orthogonal flanges of the proximal sled30422 (seeFIG. 80). Moreover, the orthogonal flanges of bothsleds30422,30424 are configured to slide or otherwise move along a lower support surface, such as an inner surface of the cartridge jaw30450 (seeFIG. 82).
• Referring still toFIGS. 78-81, theproximal sled30422 also includes anintegral knife30430 having a distal-facingcutting edge30432. Theknife30430 can be cut into the sheet of material, for example, when theproximal sled30422 is stamped. Theproximal sled30422 also includes a proximal tail orextension30434, which is configured to releasably couple with the firing member30441 (FIG. 81), when thestaple cartridge30400 and thedriver assembly30420 thereof are installed in the cartridge jaw30450 (FIG. 82). Theproximal extension30434 is T-shaped and includes a lateral bias, which is configured to facilitate coupling with a T-shaped recess30448 (FIG. 81) in the firingmember30441. For example, referring toFIG. 87, theproximal extension30434 can initially reside in a notch in thecartridge body30402, which can hold theproximal sled30422 in position relative to thecartridge body30402. Then, when the firingmember30442 moves distally, theproximal extension30434 bends into the T-shapedrecess30448 to lock theproximal sled30422 to the firingmember30442. Alternative complementary profiles are also contemplated for coupling theproximal extension30434 and the firingmember30441.
• In various instances, when thestaple cartridge30400 is installed in thecartridge jaw30450, the firingmember30441 can be aligned with thedriver assembly30420, and can be configured to move into driving engagement with thedriver assembly30420, as shown inFIG. 81, when the firingmember30441 moves an initial distance distally during a firing stroke. Referring toFIG. 87, deflection of theproximal extension30434 into therecess30448 is permitted when the firingmember30441 starts to move proximally, for example.
• Theproximal extension30434 can be biased into holding engagement with therecess30448 in thebody30443 of the firingmember30441 and can remain in engagement with therecess30448 during proximal and distal displacement(s) of the firingmember30441 until the firingmember30441 is finally withdrawn proximally out of thestaple cartridge30400, or nearly out of thestaple cartridge30400, at the completion of the firing stroke. When the firingmember30441 is releasably attached to theproximal sled30422, theupright body portion30443 of the firingmember30441 is aligned with theknife30430. As shown inFIG. 81, thebody portion30443 can support theknife30430 as theknife30430 is advanced through tissue. In various instances, the additional support from the body portion is configured to prevent deflection of theknife30430 away from the firing path and longitudinal axis of theend effector30440.
• Thedistal sled30424 is pushed distally by theproximal sled30422 during the firing stroke. Thedistal sled30424 further includes a foot30429 (FIG. 86), which extends downward from the rails30245 and/or orthogonal flange. Thefoot30429 can be configured to move through a slot in thecartridge jaw30450 during the firing stroke as the firingmember30441 pushes theproximal sled30422, which pushes thedistal sled30424 distally during the firing stroke. In various instances, thefoot30429 is configured to engage a lockout in theend effector30440 when thedistal sled30424 is parked in a proximal, unfired position. Thedistal sled30424 and lockout features thereof are further described herein.
• Referring primarily toFIGS. 82-84, theend effector30440 includes alockout arm30460, which is selectively engaged by thedistal sled30424. Thelockout arm30460 is movable between a locked position (FIGS. 82-84), in which a firing stroke is prevented, and an unlocked position (FIG. 85), in which a firing stroke is permitted. Thelockout arm30460 is flexibly positioned in alongitudinal recess30453 in the channel portion of thecartridge jaw30450 and is configured to pivot about a central pivot portion40646 in certain instances.
• Thelockout arm30460 includes aproximal end30466 that is biased into alockout notch30449 in the firing member30341. For example, aspring30470 positioned in thecartridge jaw30450 is configured to push theproximal end30466 into thelockout notch30449 of the firing member30341 when the firing member30341 is in a proximal, pre-firing stroke position. When theproximal end30466 of thelockout arm30460 is received in thelockout notch30449, thelockout arm30460 is configured to resist translation of the firingmember30441 and, thus, prevent the firing stroke
• Thesled assembly30420 is configured to overcome thelockout arm30460 by removing theproximal end30466 thereof from thelockout notch30449. More specifically, when thedistal sled30424 is positioned in a proximal, unfired position in thestaple cartridge30400, thefoot30429 of thedistal sled30424 is positioned to engage adistal end30462 of the lockout arm30460 (seeFIG. 85). Thepivot portion30464 of thelockout arm30400, which is between theproximal end30466 and thedistal end30462, is held in anarcuate support30451 in thecartridge jaw30450. Thepivot portion30464, and thus the entire lockout arm20468, is configured to pivot about thearcuate support30451 in certain instances.
• For example, thelockout arm30460 pivots from the locked position to the unlocked position when thestaple cartridge30400 is installed in theend effector30440 and thedistal sled30424 is in the proximal unfired position, which indicates that the staple cartridge is not spent or empty. Thelockout arm30460 pivots from the unlocked position to the locked position when the firingmember30441 pushes theproximal sled30422 distally, which pushes thedistal sled30422 distally. When thefoot30429 on the bottom of thedistal sled30422 moves out of engagement with thedistal end30462 of thelockout arm30460, thelockout arm30460 pivots due to the biasing force of thespring30470. When the firing member later returns to a proximal position after a firing stroke and attempts to move thelockout notch30449 past thelockout arm30460, thespring30470 pushes theproximal end30466 of thelockout arm30460 into thelockout notch30449 to prevent the firing stroke. Thefoot30429 moves along thelongitudinal recess30453 in thechannel30450 during the firing stroke.
• As described herein, the two-part sled assembly30420 is configured to selectively overcome thelockout arm30460 to permit a firing stroke. Moreover, thesled assembly30420 includes anintegral knife30430, which is a single-use knife30420 have a suitablysharp cutting edge30432 for transecting tissue clamped by theend effector30440. The single-use knife30420 is retracted proximally upon completion of the firing stroke and along with the firingmember30441. Moreover, because thefiring beam30441 includes opposingcams30445,30446, the firingmember30441 can ensure that thejaws30450,30542 remain closed until theknife30420 is returned to a proximal position in thestaple cartridge30400.
• As described herein, certain surgical devices can include a reusable knife, which is incorporated into the surgical device, such as a distal-facing knife edge on a firing member, for example. Upon completion of a firing stroke, the reusable knife can be retracted out of the staple cartridge and subsequently re-fired with another staple cartridge. In such applications, the surgical device, including the reusable knife thereof, can be cleaned and sterilized between surgical procedures.
• In other instances, a single-use knife can be utilized with a surgical device. For example, a staple cartridge can include a single-use knife which is only used with that particular staple cartridge. When the staple cartridge is removed from the surgical device, the single-use knife is removed, as well. When a replacement staple cartridge is installed in the surgical device, a new single-use knife is provided therewith. In certain instances, the single-use knife can remain in the staple cartridge for the duration of the firing stroke and even after the firing stroke when the staple cartridge is removed from the surgical device. In certain instances, the cutting edge of the single-use knife can be at least partially shielded by a feature of the staple cartridge after the firing stroke and/or when the staple cartridge is removed from the surgical device. In certain instances, the knife or a portion thereof can be folded or otherwise deformed and/or pushed from a protruding orientation downward into the staple cartridge.
• For example, a staple cartridge can include a two-part sled assembly including a proximal sled and a distal sled. The proximal sled can connect to a firing member upon insertion of the two-part sled assembly into a surgical device. The distal sled can include an upright cutting edge. During a firing stroke, the firing member is configured to push the proximal sled distally, which, in turn, pushes the distal sled distally to transect tissue. Upon completion of the firing stroke, the proximal sled can be retracted proximally by the firing member and can separate from the distal sled. As the proximal sled is retracted proximally, a central ledge of the proximal sled is configured to move over the upright cutting edge to fold the cutting edge downward into the cartridge body. In various instances, the proximal sled can also include support features for supporting the upright cutting edge during the firing stroke.
• In certain instances, the two-part sled assembly can be manufactured from stamped metal sheets, which can be a low cost alternative to other manufacturing techniques. A stamped metal sled assembly can have thinner rails yet be stronger than a plastic sled for the same size staple cartridge, in certain instances. Moreover, a stamped metal sled assembly can form staples with less spring back and/or allow the staples to be positioned closer together in a staple line, in certain instances. In certain instance, the knife can be configured to dive and/or be deformed into the cartridge body anywhere along the length of the firing stroke and only the proximal stamped sled component can return with the firing member. The folding and/or deformation of the knife during the proximal retraction of the firing member and proximal stamped sled component can ensure the knife is not reused during a subsequent surgical operation. The proximal stamped sled component and the firing member can be positioned to support the distal stamped sled component and the knife thereof during the distal firing stroke in certain instances.
• Referring now toFIGS. 90-98, a two-part sled assembly30620 is shown. Thesled assembly30620 includes two discrete sleds—aproximal sled30622 and adistal sled30624. Eachsled30622,30624 is a separate and discrete stamped component. For example, eachsled30622,30624 can be formed with a separate stamping. Thesleds30622,30624 are formed from a stamped sheet of material, such as a metal sheet. In at least one aspect, thesleds30622,30624 are formed from steel sheets; however, other materials are also contemplated. Theproximal sled30622 and thedistal sled30622 cooperate to engage drivers30616 (FIG. 92) housed in acartridge body30602. Thedrivers30616 can be triple drivers in various instances, and can be similar in many aspects to the drivers20120 (FIG. 26), for example.
• Theproximal sled30622 and thedistal sled30624 can be connected with a push-connection. Stated differently, while theproximal sled30622 is applying a pushing force to thedistal sled30624, thesleds30622,30624 can remain connected. Absent the pushing force, thesleds30622,30624 are separable components that can be selectively moved and relocated in certain instances.
• Eachsled30622,30624 includes a pair of stamped wedges, which form the rails. Theproximal sled30622 includesouter rails30623 for thesled assembly30620, and thedistal sled30624 includesinner rails30625 for thesled assembly30620. Anouter rail30623 and aninner rail30625 can be configured to move along each side of the staple cartridge during a firing stroke and can be aligned with a row ofdrivers30616. Theproximal sled30622 includes acentral upright portion30626 andorthogonal flanges30621 connecting thecentral upright portion30426 to eachouter rail30623. Theorthogonal flanges30621 are configured to ride along a lower support surface during a firing stroke (e.g. along an inside surface of a cartridge jaw) and have the same thickness as theouter rails30423 owing to the stamped formation of theproximal sled30622. The central upright portion20426 is dimensioned to fit around a portion of thedistal sled20624 and defines aledge30627.
• Thedistal sled30624 includes acentral upright portion30628 andorthogonal flanges30619 connecting thecentral upright portion30626 to eachinner rail30625. Theorthogonal flanges30619 are configured to ride along a lower support surface during a firing stroke (e.g. along an inside surface of a cartridge jaw) and have the same thickness as theinner rails30625 owing to the stamped formation of thedistal sled30624. Thecentral upright portion30628 defines a lower arced profile30626adimensioned to accommodate a rotary drive screw30642 (FIG. 92) therethrough. Therotary drive screw30642 is similar to the firing screw261 (seeFIGS. 4 and 5) in many aspects. Thecentral upright portion30628 further includes an extendingknife30629 having a distally-facingcutting edge30630. Thecentral upright portion30626 of theproximal sled30622 is configured to fit around thecentral upright portion30628 of thedistal sled30622 except the extendingknife30629 which extends beyond theledge30627 and upper edge of thecentral upright portion30626. Thedistal sled30624 also includes ananti-retraction arm30632, which can be biased laterally into engagement with thecartridge body30602 to prevent proximal retraction of thedistal sled30624 after the firing stroke. In certain instances, ananti-retraction arm30632 can be positioned on each lateral side of thedistal sled30624.
• Referring primarily toFIG. 92, thesled assembly30620 is a component of astaple cartridge30600, which also includes thecartridge body30602,drivers30616, and staples removably positioned in thecartridge body30602. In various instances, thestaple cartridge30600, including thesled assembly30620 thereof, can be releasably installed in a surgical device or an end effector thereof having a cartridge jaw, an anvil jaw, and a firing member, as further described herein. Upon completion of the stapling motion, thestaple cartridge30600, including thesled30620 thereof, can be removed from the end effector. When installing thestaple cartridge30600 in the surgical end effector, thesled assembly30620 can be aligned with the firing member in the surgical end effector and thedistal sled30622 can be releasably coupled to the firing member when thestaple cartridge30600 is installed in the surgical end effector.
• Referring now toFIG. 90, a firingmember30641 for use with thesled assembly30620 is shown. When assembled together, the firingmember30641 and thesled assembly30620 form afiring assembly30639, which is configured to be advanced along therotary drive screw30642 during a firing stroke. The firingmember30641 includes anupright body portion30643,upper cam members30644 extending laterally from both sides of thebody portion30643, andlower cam members30645 extending laterally from both sides of thebody portion30643. Theupper cam members30644 are configured to cammingly engage an upper jaw, or anvil, of the end effector during a firing stroke, and thelower cam members30645 are configured to cammingly engage a lower jaw, or elongate channel of the end effector during the firing stroke. Thecam members30644,30645 are configured to clamp the jaws of the end effector30640 and define a tissue gap during a firing stroke, as further described herein with respect to various firing member (e.g. I-beams and E-beams).
• As shown inFIG. 90, when thestaple cartridge30600 including thesled assembly30620 is installed in a surgical end effector, thesled assembly30620 is brought into releasable engagement with the firingmember30641. More specifically, theproximal sled30622 includesproximal fingers30638, which extend laterally inward intolongitudinal tracks30637 along each inside edge of theorthogonal portions30621. Moreover, the firingmember30641 includesridges30648 positioned withinrespective slots30646 into thebody portion30645. Owing to the angle of insertion of thestaple cartridge30600 relative to the firingmember30641, theproximal fingers30641 are lifted over theridges30648 and positioned in theslots30646 in the firingmembers30641 to releasably retain theproximal sled30622 to the firingmember30641. Referring primarily toFIG. 95, the engagement features between theproximal sled30622 and the firingmember30641 are symmetrical about a longitudinal axis A through thestaple cartridge30600 and aligned with the firing drive screw30641 (FIG. 92). In other instances, the engagement features may only be positioned on one side of the firingassembly30639.
• When thestaple cartridge30600 is properly seated in the surgical end effector and theproximal sled30622 is releasably held to the firingmember30641, a firing stroke can be initiated. At the outset of the firing stroke, the firingmember30641 is advanced distally and the firingassembly30639 assumes the first advanced configuration ofFIGS. 92-95. In this initial portion of the firing stroke, the firingmember30641 moves distally relative to theproximal sled30622. For example, theproximal fingers30638 move through theslots30646 in the firingmember30641 as theridges30648 move along the tracks60637. The firingmember30641 is advanced distally until theridges30648 on the firingmember30641 abut the ends of thetracks30637, as shown inFIG. 95. Stated differently, theproximal sled30622 includeshard stops30636 in theorthogonal portions30621 at the distal ends of the tracks30637(FIG. 95). Theridges30648 cannot move distally past the hard stops30636. In short, the firingmember30641 moves relative to theproximal sled30622 until theridges30648 abut thehard stops30636 at which point the firingassembly30639 is in the first advanced configuration.
• In the first advanced configuration, the firingmember30641 is positioned to push theproximal sled30622 and theproximal sled30622 is positioned to push thedistal sled30624. In effect, the firing member30341 is in pushing engagement with thesled assembly30620 and can push thecollective sled assembly30620 distally to fire the staples and cut tissue. In the first advanced configuration, theupright body portion30643 of the firingmember30641 is pushed distally into abutting engagement with theknife30629. In this configuration, the firingmember30641 is configured to support theknife30629 during the firing stroke.
• Upon completion of the firing stroke or a portion thereof, the firingmember30641 can be retracted proximally. Proximal retraction of the firingmember30641 is configured to unclamp the jaws in various instances, as further described herein. The proximal retraction motion is shown inFIGS. 96A-96D. In a first retracted configuration (FIG. 96A), the firingmember30641 has been retracted proximally and moved relative to the sled assembly60620 including relative to the proximal sled60622. For example, the firingmember30641 is permitted to move proximally relative to the proximal sled60622 until theridges30648 abut the proximal ends of thetracks30637. The proximal ends of thetracks30637 are defined by theproximal fingers30638 extending laterally inward into theslot30645 in the firingmember30641. In the first retracted configuration, theridges30648 abut the distal ends of theproximal fingers30638.
• From the first retracted configuration, the firingmember30641 is configured to retract theproximal sled30622 along with the firingmember30641. Theanti-retraction arms30632 on thedistal sled30624 are configured to hold thedistal sled30624 in place in thecartridge body30602 as theproximal sled30622 is retracted. In the second retracted configuration (FIG. 96B), theledge30627 on thecentral upright portion30626 of theproximal sled30622 is pulled over the upward-protrudingknife30629 to deform or fold theknife30629 downward under theledge30627. Thecentral upright portion30628 of thedistal sled30624, which supports theknife30629, comprises a slender beam having at least one corner or bend, which can be deflected by theledge30627 moving over theknife30629. The bends can include a hollowed inside corner to facilitate bending when the downward force of theledge30627 is applied thereto. Thecentral upright portion30628 and theknife30629 thereof continue to be pushed downward when the firing assembly moves from the second retracted configuration to the third retracted configuration (FIG. 96C). From the third retracted configuration to the fourth retracted configuration (FIG. 96C), the firingmember30641 continues to draw theproximal sled30622 away from thedistal sled30624 andknife30639 thereof, which has been folded and/or deformed by theledge30627 during the proximal retraction motion of theproximal sled30622.
• Referring primarily toFIGS. 97 and 98, thedistal sled30624 is retained in a distal portion of thecartridge body30602 and theproximal sled30622 and the firingmember30641 are retracted proximally. In various instances, after thecams30644,30645 of the firingmember30641 are retracted out of engagement with the camming surfaces in the anvil jaw and the cartridge jaw, the jaws can be opened and the spent/firedstaple cartridge30600 can be removed from the end effector. For example, owing to the removal angle of thestaple cartridge30600, theproximal fingers30638 can be lifted over theridges30648 to disengage theproximal sled30622 from the firingmember30641. In such instances, thestaple cartridge30600 including the bent/deformed knife30629 shielded within thecartridge body30602 can be removed and replaced with a new staple cartridge.
• Certain staple cartridges described herein can include a central longitudinal support frame and/or a rotary drive screw extending along a substantial length of the staple cartridge. In various instances, the structures along the center of the staple cartridge can occupy a significant portion of the staple cartridge footprint and, notably, take up a significant width, which can impact the arrangement of staple cavities, staple drivers, and staples therein. Certain modifications to a staple line can impact hemostasis. Adjustments to the staple line configuration such as number of staples and spacing therebetween within a longitudinal row, lateral spacing between longitudinal rows, and variations in number of staples, spacing therebetween, and placement of proximal-most staples (i.e. offset) can be adjusted from row-to-row. Various staple line configurations are described herein, which are configured to optimize hemostasis and balance firing forces within the small footprint of the various staple cartridge assemblies described herein.
• The sled is subjected to significant forces during a firing stroke. For example, as the sled engages the drivers and lifts the drivers and staples thereon through the tissue and into forming contact with the anvil, significant transverse loads can be applied to the sled rails. To smooth the force-to-fire during a firing stroke, the staple patterns on opposing sides of the cartridge can be longitudinally offset.
• Referring now toFIG. 118, astaple cartridge25000 has acartridge body25002 andstaple cavities25010 defined in thecartridge body25002. Thestaple cavities25010 are dimensioned and structured to hold drivers and staples therein, as further described herein. Alongitudinal slot25006 divides thecartridge body25002 into afirst side25002aand asecond side25002b. Thestaple cavities25010 are arranged in two patterns: afirst pattern25014 on thefirst side25002aof thelongitudinal slot25006, and asecond pattern25016 on thesecond side25002bof thelongitudinal slot25006. Eachpattern25014,25016 includes aninner row25012a, anintermediate row25012b, and anouter row25012c. However, thefirst pattern25014 is different than thesecond pattern25016.
• More specifically, thefirst pattern25014 is longitudinally offset from thesecond pattern25016 by a distance, or longitudinal offset, O. Consequently, thefirst pattern25014 and thesecond pattern25016 are not symmetric relative to the longitudinal axis A. Thefirst pattern25014 includes proximal-most staples cavities, and thesecond pattern25016 includes proximal-most staple cavities. The longitudinal offset O between the proximal ends of the proximal-most staple cavities on either side of the longitudinal axis L is the longitudinal offset O.
• As further described herein, triple drivers include three staple-supporting columns connected by bridges. The triple drivers define a longitudinal length from the proximal end of the proximal-most support column to the distal end of the distal-most support column. The longitudinal length is length along the longitudinal axis A, e.g. the proximal-to-distal length of a driver configured to fire staples from a first cavity25010a, asecond cavity25010b, and athird cavity25010c. The proximal-to-distal length of a triple driver can be 0.1936 inches in certain instances. Other lengths are also contemplated.
• The longitudinal offset is configured to smooth the force-to-fire of the sled during the firing stroke in various instances. In various instances the longitudinal offset O is approximately 25% of the longitudinal length of the triple drivers housed in the staple cavity. In other instances, the longitudinal offset O can be less than 25% or more than 25% of the longitudinal length of the triple driver. For example, a longitudinal offset O of 5% to 35% of the longitudinal length of the triple driver is contemplated. Referring toFIG. 119, a longitudinal offset of 29.5% between afirst pattern25114 and asecond pattern25116, which corresponds to approximately 0.0573 inches for a 0.1936 inch proximal-to-distal length triple driver, is utilized. In other instances, referring toFIG. 120, a longitudinal offset of 9.2% between a first pattern25215 and asecond pattern25216, which corresponds to approximately 0.0178 inches for a 0.1936 inch proximal-to-distal length triple driver, is utilized.FIGS. 94-96 only depict a portion of eachpattern25014,25016,25114,25115,25214,25216, and the same pattern continues until the distal end of the staple cavities in certain instances.
• In certain instances, the triple drivers can be triangular, and the drivers on one side of the cartridge body are not aligned with the drivers on the opposite side of the cartridge body. An asymmetric arrangement of triple drivers in a cartridge body can allow the sled to be asymmetric about a longitudinal centerline. In such instances, one side of the cartridge body can have additional space at the proximal end where that side of the driver is longitudinally offset in a distal direction. The additional space can accommodate lockout components and/or rotary driver supports. Exemplary lockouts and rotary driver supports are further described herein. In certain instances, lockout components and rotary drive supports can be at least partially side-by-side in the proximal end of the cartridge body.
• In other instances, the sled rails can be longitudinally offset to balance the force-to-fire. For example, the sled rail(s) on a first side of the sled can be longitudinally offset from the sled rail(s) on the opposite side of the sled by 25% of the longitudinal length of the triple drivers housed in thecartridge body25002.
• Referring again toFIG. 94, in certain instances, thelongitudinal rows25012a,25012b,25012con eachside25002a,25002bcan be laterally spaced differently. For example, theinner row25012aand theintermediate row25012bon thesecond cartridge side25002bare closer together than theinner row25012aand theintermediate row25012bon thefirst cartridge side25002a. The distance betweenaxis25024 andaxis25025 is less than the distance betweenaxis25022 andaxis25023, for example. Moreover, theouter row25012cand theintermediate row25012bon thesecond cartridge side25002bare farther apart than theouter row25012cand theintermediate row25012bon thefirst cartridge side25002a. The distance betweenaxis25026 andaxis25025 is greater than the distance betweenaxis25021 andaxis25022, for example. Moreover, on both sides of thecartridge body25002, the lateral spacing between theinner row25012aand theintermediate row25012bis different than the lateral spacing between theintermediate row25012cand theouter row25012c.
• In other instances, none of the rows of staple patterns on one side of a cartridge body, e.g. one side of the longitudinal knife slot, can be a repeated pattern. A non-repeating and unique pattern in each row can permit customizations row-to-row to ensure a maximum number of staple cavities fit in the cartridge body, especially in a proximal region near the tissue stops. Moreover, in certain instances, the staple pattern can utilize the same drivers, e.g. the same triple driver, along the entire length of the staple line. In such instances, only a single type of driver is utilized in the staple cartridge, which can improve manufacturing processes. In certain instances, proximal-most and/or distal-most fastener cavities in the inner row and the outer row can be offset, for example.
• Referring now toFIG. 121, astaple cartridge25300 has a cartridge body25302 andstaple cavities25310 defined in the cartridge body25302. Thestaple cavities25310 are dimensioned and structured to hold drivers and staples therein, as further described herein. A longitudinal slot25306 divides the cartridge body25302 into a first side25302aand a second side25302b. Thestaple cavities25010 are arranged in two patterns: a first pattern25314 on thefirst side25002aof thelongitudinal slot25006, and a second pattern25316 on the second side25302bof the longitudinal slot25306. Each pattern25315 includes aninner row25012a, anintermediate row25012b, and anouter row25012c. Thefirst pattern25014 is the same as the second pattern (e.g. a symmetrical, mirror image about the longitudinal axis L).FIG. 97 only depicts a portion of each pattern25314,25316, and the same pattern continues until the distal end of the staple cavities in certain instances.
• In the first and second patterns25314,25316, the proximal-most staple cavity24310ais longitudinally offset from the second proximal-most staple cavity25310bby a first distance, or longitudinal offset, O1. Additionally, in the first and second patterns25314,25316, the second proximal-most staple cavity24310bis longitudinally offset from the third proximal-most staple cavity25310cby a second distance, or longitudinal offset, O2. The first longitudinal offset O1 is less than 50% of the staple crown lengths L1, L2, and L3, of staples in theinner row25012a,intermediate row25012b, and theouter row25012c, respectively. The second longitudinal offset O2 is selected based on the longitudinal offset O1 to stagger the staples fired from theintermediate row25012crelative to the staples fired from theinner rows25012aand theouter rows25012c. Stated differently, the second longitudinal offset O2 is selected to provide at least a small degree of longitudinal overlap row-to-row. The second longitudinal offset O2 is greater than the first longitudinal offset O1.
• Referring still to the patterns25314,25316, therows25312a,25312b,25312con eachside25002a,25002bare different from the other rows on that side. More specifically, the number of cavities and spacing between the cavities in the same; however, the starting location of therows25312a,25312b,25312cdiffers.
• Moreover, eachrow25312a,25312b,25312cextends along an axis that is parallel to the longitudinal axis L. The lateral spacing of therows25312a,25312b,25312c, i.e. the spacing of the axes along which the rows extend, can be different. For example, on both sides25302a,25302b, the lateral spacing between theinner row25312aand theintermediate row25312bis less than the lateral spacing between theintermediate row25312band theouter row25312c.
• In certain instances, rows on thesame side25002a,25002bcan be configured to receive different staples and/or can be aligned with forming pockets configured to form the staples to different sizes and/or geometries. For example, on thesame side25002a,25002bbut in different rows, certain staples can be larger than the staples in other rows and/or can be configured to be formed to a taller formed height than the staples in other rows. Additionally or alternatively, staples from thesame side25002a,25002bcan be formed into a 2D, planar configuration while staples on thatsame side25002a,25002bare configured to be formed into a 3D, non-planar staple.
• As further described herein, triple drivers include three staple-supporting columns connected by bridges. In various instances, the staple patterns25314 and25316 can be fired exclusively with triple drivers. Stated differently, a single type of driver can fire all of the staples from the patterns25314,25316.
• Other staple patterns having non-identical rows are also contemplated. For example, in certain instances, the inner row and the outer row can be symmetrical about the intermediate row until the proximal-most cavity and/or cavities which are positioned closer together to accommodate the tissue stops. In such instances, the inner row and the outer row would have some longitudinally aligned staples row-to-row and other non-longitudinally aligned staples row-to-row. In other instances, one of the rows could have fewer staples than the other rows. For example, the outer row could have few staples, which are spaced longitudinally farther apart.
• Referring now toFIG. 122, twostaple cartridges25400 and25500 are shown side-by-side for comparative purposes. Thestaple cartridges25400,25500 includescartridge bodies25402,25502, respectively, and three rows of staple cavities25410,25510, respectively, on each side of a longitudinal A. Thestaple cartridges25400,25500 are similar in many aspects to the various staple cartridges described herein.
• Eachstaple cartridge25400,25500 also includes adatum25408,25508, respectively, corresponding to the distal end of a tissue stop. When the clinician initially locates the target tissue between the anvil and the staple cartridge, it is important that the target tissue be located so that the knife does not cut into the target tissue unless it is first stapled. Tissue stops can be provided on the proximal end of the anvil body to prevent the target tissue from moving proximally past the proximal most staple pockets in the staple cartridge.
• In certain instance, a cartridge body can include at least one totaled or combined staple length on each side of the longitudinal axis A proximal to the tissue stop. A combined staple length is sum of the length of one or more staples or portions thereof positioned proximal to the tissue stop. The sum of those individual lengths is equivalent to the combined staple length. For example, referring to thestaple cartridge25400, one full staple and two half staples are proximal to the tissue stop for a combined staple length of two staples. However, because at least one combined staple length is desired proximal to thetissue stop datum25408, there is little room to shift thetissue stop datum25408 proximally.
• Conversely, referring to thestaple cartridge25500, the tissue stop is in a relatively more proximal position relative to the proximal end of thestaple cartridge25500 and the proximal-most fastener cavities. Moreover, the combined staple length on each side of the cartridge body still meets the goal of at least one combined staple length proximal to thetissue stop datum25508. Having two staple cavities longitudinally aligned, or closely aligned, at the proximal end of a pattern of staple cavities can allow the tissue stop to move proximally while still maintaining a suitable combined staple length proximal to the tissue stop.
• Various aspects of the subject matter described herein are set out in the following examples.
• Example 1—A fastener cartridge, comprising: a body extending along a longitudinal axis; fasteners removably positioned in the body; and drivers movably supporting the fasteners, wherein the drivers comprise a first driver comprising: a first support column defining a first width, wherein the first support column comprises a first fastener-supporting cradle; a second support column laterally outboard from the first support column and defining a second width, wherein the second width is different than the first width, and wherein the second support column comprises a second fastener-supporting cradle; and a bridge extending between the first support column and the second support column.
• Example 2—The fastener cartridge of Example 1, wherein cavities are defined in the body, and wherein the cavities comprise: a first cavity comprising first lateral guide surfaces configured to slidably engage the first support column; and a second cavity comprising second lateral guide surfaces configured to slidably engage the second support column.
• Example 3—The fastener cartridge of Example 2, wherein the first support column comprises first sidewalls configured to slidably engage the first lateral guide surfaces, wherein the first width is defined between the first sidewalls, wherein the second support column comprises second sidewalls configured to slidably engage the second lateral guide surfaces, and wherein the second width is defined between the second sidewalls.
• Example 4—The fastener cartridge of any one of Examples 1, 2, and 3, wherein the first width is narrower than the second width.
• Example 5—The fastener cartridge of any one of Examples 1, 2, 3, and 4, wherein the first driver further comprises: a third support column laterally outboard from the second support column and defining a third width, wherein the third width is different than the second width, and wherein the third support column comprises a third fastener-supporting cradle; and a second bridge extending between the second support column and the third support column.
• Example 6—The fastener cartridge of Example 5, wherein the third width is intermediate the first width and the second width.
• Example 7—The fastener cartridge of any one of Examples 5 and 6, wherein the first width, the second width, and the third width are different widths.
• Example 8—The fastener cartridge of any one of Examples 5, 6, and 7, further comprising a sled configured to move along the longitudinal axis during a firing stroke, wherein the sled comprises: a central portion aligned with the longitudinal axis; a first rail configured to drivingly engage the bridge; and a second rail configured to drivingly engage the second bridge.
• Example 9—The fastener cartridge of any one of Examples 5, 6, 7, and 8, wherein the fasteners are arranged in longitudinal rows comprising: a first row comprising a first fastener; a second row spaced laterally outward from the first row by a distance and comprising a second fastener; and a third row spaced laterally outward from the second row by the distance and comprising a third fastener; wherein the first fastener-supporting cradle is configured to support the first fastener, wherein the second fastener-supporting cradle is configured to support the second fastener, and wherein the third fastener-supporting cradle is configured to support the third fastener.
• Example 10—The fastener cartridge of any one of Examples 1, 2, 3, 4, 5, 6, 7, 8, and 9, further comprising a rotary drive screw extending along the longitudinal axis distally beyond a plurality of the fasteners, wherein the first support column is adjacent to the rotary drive screw, and wherein the first support column comprises a base comprising a chamfered edge configured to accommodate the rotary drive screw.
• Example 11—The fastener cartridge of any one of Examples 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10, further comprising a laterally-curved tissue-supporting surface, wherein the laterally-curved tissue-supporting surface comprises a peak.
• Example 12—The fastener cartridge of Example 11, wherein the first support column is adjacent to the peak of the laterally-curved tissue-supporting surface, and wherein the first driver comprises a gusset extending between the bridge and the first support column.
• Example 13—A fastener cartridge, comprising: a body extending along a longitudinal axis; fasteners removably positioned in the body; and drivers movably supporting the fasteners, wherein the drivers comprise a first driver comprising: a first support column defining a first width; a second support column laterally outboard from the first support column and defining a second width; and a third support column laterally outboard from the second support column and defining a third width, wherein the first width, the second width, and the third width are different widths.
• Example 14—The fastener cartridge of Example 13, wherein the first width is less than the second width and the third width.
• Example 15—The fastener cartridge of Example 14, wherein the second width is greater than the third width.
• Example 16—The fastener cartridge of any one of Examples 13, 14, and 15, wherein the first driver further comprises: a first bridge extending between the first support column and the second support column, wherein the first bridge comprises a first ramped underside; and a second bridge extending between the second support column and the third support column, wherein the second bridge comprises a second ramped underside.
• Example 17—The fastener cartridge of Example 16, further comprising a sled configured to move along the longitudinal axis during a firing stroke, wherein the sled comprises: a central portion aligned with the longitudinal axis; a first rail configured to driving engage the first ramped underside; and a second rail configured to drivingly engage the second ramped underside.
• Example 18—The fastener cartridge of any one of Examples 13, 14, 15, 16, and 17, further comprising a rotary drive screw extending along the longitudinal axis, wherein the first support column is adjacent to the rotary drive screw, and wherein the first support column comprises a base comprising a chamfered edge configured to accommodate the rotary drive screw.
• Example 19—The fastener cartridge of any one of Examples 13, 14, 15, 16, 17, and 18, wherein the fasteners are arranged in longitudinal rows, comprising: a first row extending along a first row axis, wherein the first row comprises a first fastener supported by the first support column; a second row extending along a second row axis, wherein the second row comprises a second fastener supported by the second support column; and a third row extending along a third row axis, wherein the third row comprises a third fastener supported by the third support column, and wherein the second row axis is equilaterally spaced from the first row axis and the third row axis.
• Example 20—A fastener cartridge, comprising: a body extending along a longitudinal axis; rows of fasteners, comprising: an inner row on a first side of the longitudinal axis, wherein the inner row comprises an inner fastener; an intermediate row on the first side of the longitudinal axis, wherein the intermediate row comprises an intermediate fastener; and an outer row on the first side of the longitudinal axis, wherein the outer row comprises an outer fastener, wherein the intermediate row is equilaterally spaced from the inner row and the outer row; and a triple driver comprising an asymmetric body, wherein the asymmetric body is asymmetric relative to a longitudinal centerline through the triple driver, wherein the longitudinal centerline is oriented parallel to the longitudinal axis, and wherein the triple drive comprises: an inner support column defining a first width, wherein the inner support column is configured to support the inner fastener; an intermediate support column defining a second width, wherein the intermediate support column is configured to support the intermediate fastener; and an outer support column defining a third width, wherein the outer support column is configured to support the outer fastener, and wherein the first width is less than the second width and the third width.
• Example 21—A fastener cartridge, comprising: a body comprising a tissue-supporting deck, wherein fastener cavities are defined through the tissue-supporting deck in the body, wherein the fastener cavities comprise a first cavity, and wherein the tissue-supporting deck comprises: a tissue-facing side; and an underside opposite the tissue-facing side, wherein the underside comprises an underside surface contour adjacent to the first cavity; fasteners removably positioned in the fastener cavities; and drivers movably supporting the fasteners and configured to move through a portion of the fastener cavities to fired positions to eject the fasteners from the fastener cavities, wherein the drivers comprise a first driver, comprising: a support column comprising a fastener cradle; and a base extending laterally from the support column, wherein the base comprises a top surface contour configured to mate with the underside surface contour when the first driver is in the fired position.
• Example 22—The fastener cartridge of Example 21, wherein the underside surface contour comprises a recess, and wherein the top surface contour comprises a protrusion configured to nest in the recess when the first driver is in the fired position.
• Example 23—The fastener cartridge of any one of Examples 21 and 22, wherein the fastener cavities comprise openings in the tissue-facing side, and wherein the tissue-facing side comprises ridges extending around at least a portion of the openings.
• Example 24—The fastener cartridge of Example 23, wherein the ridges comprise a first ridge comprising a laterally-varying height.
• Example 25—The fastener cartridge of any one of Examples 23 and 24, wherein the ridges span at least two openings across adjacent rows of fastener cavities.
• Example 26—The fastener cartridge of any one of Examples 21, 22, 23, 24, and 25, wherein the support column comprises a first support column, wherein the first driver further comprises a second support column laterally-offset from the first support column, wherein the base forms a bridge between the first support column and the second support column, and wherein a top portion of the bridge comprises the top surface contour.
• Example 27—The fastener cartridge of Example 26, further comprising a sled comprising a sled rail configured to moving along a firing path during a firing stroke to drivingly engage the first driver, wherein the top portion of the bridge is asymmetric relative to the firing path.
• Example 28—The fastener cartridge of Example 27, wherein the first driver is overdriven by the sled to the fired position in which the fastener cradle extends beyond the tissue-supporting deck out of the fastener cartridge.
• Example 29—The fastener cartridge of Example 26, wherein the bridge comprises a first bridge, wherein the fastener cavities further comprise a second cavity, wherein the underside further comprises a second underside surface contour adjacent to the first cavity, and wherein the first driver further comprises: a third support column laterally-offset from the first support column and the second support column; and a second bridge between the second support column and the third support column, wherein a top surface of the second bridge comprises a second top surface contour configured to mate with the second underside surface contour when the first driver is in the fired position.
• Example 30—The fastener cartridge of Example 29, further comprising a sled, comprising: a first sled rail configured to moving along a first firing path during a firing stroke to drivingly engage the first bridge; and a second sled rail configured to move along a second firing path during the firing stroke to drivingly engage the second bridge, wherein the top portion of the bridge is asymmetric relative to the firing path.
• Example 31—A fastener cartridge, comprising: a body comprising a tissue-supporting deck, wherein fastener cavities are defined through the tissue-supporting deck in the body, and wherein the tissue-supporting deck comprises: a tissue-facing side comprising a bumpy surface; and an underside opposite the tissue-facing side, wherein the underside comprises a rutted surface; fasteners removably positioned in the fastener cavities; and drivers movably supporting the fasteners and configured to move through a portion of the fastener cavities to fired positions to eject the fasteners from the fastener cavities, wherein each driver comprises a base housed in the fastener cartridge and comprising surface contours configured to mate with the rutted surface on the underside of the tissue-supporting deck when each driver is in its fired position.
• Example 32—The fastener cartridge of Example 31, wherein the rutted surface comprises a plurality of recesses, and wherein the surface contours are configured to nest in the recesses when the drivers are in the fired positions.
• Example 33—The fastener cartridge of any one of Examples 31 and 32, wherein the fastener cavities comprise openings in the tissue-facing side, and wherein the tissue-facing side comprises ridges extending around at least a portion of the openings.
• Example 34—The fastener cartridge of any one of Examples 31, 32, and 33, wherein the ridges span at least two openings across laterally-spaced rows of fastener cavities.
• Example 35—The fastener cartridge of any one of Examples 31, 32, 33, and 34, wherein each driver comprises: a first support column; a second support column laterally-offset from the first support column; and a bridge extending between the first support column and the second support column, wherein a top portion of the bridge comprises the surface contours configured to mate with the rutted surface on the underside of the tissue-supporting deck.
• Example 36—The fastener cartridge of Example 35, further comprising a sled comprising a sled rail configured to move along a firing path during a firing stroke to drivingly engage at least one driver, wherein the top portion of each bridge along the firing path is asymmetric relative to the firing path.
• Example 37—The fastener cartridge of Example 36, wherein the drivers are overdriven by the sled to the fired positions in which a portion of the driver extends beyond the tissue-supporting deck.
• Example 38—A fastener cartridge, comprising: a body comprising a tissue-supporting deck, wherein fastener cavities are defined through the tissue-supporting deck in the body, and wherein the tissue-supporting deck comprises: a tissue-facing side comprising an arrangement of protrusions; and a contoured underside opposite the tissue-facing side; fasteners removably positioned in the fastener cavities; and drivers movably supporting the fasteners and configured to move through a portion of the fastener cavities to fired positions to eject the fasteners from the fastener cavities, wherein each driver comprises: a first support column comprising a first fastener cradle defining a first longitudinal axis; a second support column comprising a second fastener cradle defining a second longitudinal axis; and a bridge connecting the first support column and the second support column within the body, wherein the bridge is asymmetric relative to a longitudinal centerline equidistant between the first longitudinal axis and the second longitudinal axis.
• Example 39—The fastener cartridge of Example 38, wherein at least one bridge comprises a laterally-sloped top surface configured to complement a portion of the contoured underside.
• Example 40—The fastener cartridge of Example 38, wherein at least one bridge comprises a contoured top surface configured to complement a portion of the contoured underside.
• Example 41—A stapling assembly, comprising: a fastener cartridge, comprising: a cartridge body comprising an alignment surface and a lug; fasteners removably positioned in the cartridge body; and drivers movably supporting the fasteners; and a channel dimensioned to receive the fastener cartridge, wherein the channel comprises a sidewall, comprising: a notch dimensioned to receive the lug; and a longitudinal stop, wherein the notch is aligned with the lug on the cartridge body when the alignment surface is leveraged against the longitudinal stop.
• Example 42—The stapling assembly of Example 41, wherein the channel comprises a first sidewall and a second sidewall, wherein the channel is dimensioned to receive the fastener cartridge between the first sidewall and the second sidewall, and wherein the notch and the longitudinal stop are defined in the first sidewall.
• Example 43—The stapling assembly of Example 42, wherein the notch is positioned distal to the longitudinal stop in the first sidewall.
• Example 44—The stapling assembly of any one of Examples 41, 42, and 43, wherein the longitudinal stop comprises a curved abutment surface upon which the cartridge body is leveraged during an insertion motion.
• Example 45—The stapling assembly of any one of Examples 42 and 43, wherein the longitudinal stop comprises a first longitudinal stop and the notch comprises a first notch, wherein the second sidewall further comprises a second longitudinal stop and a second notch longitudinally offset from the second longitudinal stop.
• Example 46—The stapling assembly of Example 45, wherein the alignment surface comprises a first alignment surface and the lug comprises a first lug, and wherein the cartridge body further comprising a second alignment surface and a second lug, wherein the second notch is aligned with the second lug when the second alignment surface abuts the second longitudinal stop.
• Example 47—The stapling assembly of any one of Examples 41, 42, 43, 44, 45, and 46, wherein the notch comprises a proximal upright surface and a distal upright surface, wherein the lug is dimensioned to fit between the proximal upright surface and the distal upright surface, and wherein the proximal upright surface and the distal upright surface are non-parallel.
• Example 48—The stapling assembly of Example 47, further comprising a spring, wherein the distal upright surface comprises a ramped surface, wherein the lug comprises a ramped distal end, and wherein the spring is configured to bias the ramped distal end into mating contact with the ramped surface upon installation of the fastener cartridge into the channel.
• Example 49—The stapling assembly of Example 48, wherein the spring is compressed between the proximal upright surface and a proximal end of the lug when the alignment surface abuts the longitudinal stop and the fastener cartridge moves toward installation in the channel.
• Example 50—The stapling assembly of any one of Examples 48 and 49, wherein the spring comprises a flat spring.
• Example 51—The stapling assembly of any one of Examples 48, 49, and 50, wherein the spring is positioned and structured to bias the fastener cartridge distally relative to the channel into a fully seated position.
• Example 52—The stapling assembly of any one of Examples 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, and 51, further comprising a firing element configured to move distally through the fastener cartridge during a firing stroke, wherein the firing element is configured to bias the fastener cartridge distally relative to the channel into a fully seated position during the firing stroke.
• Example 53—The stapling assembly of Example 52, wherein the cartridge body further comprises a laterally-extending pin, and wherein the channel further comprises a slot dimensioned to receive the laterally-extending pin upon insertion of the fastener cartridge into the channel, and wherein the slot comprises: a V-shaped entry portion extending parallel to an insertion direction of the cartridge body; and a second portion extending parallel to a longitudinal axis of the cartridge body.
• Example 54—A stapling assembly, comprising: a fastener cartridge, comprising: a cartridge body defining a longitudinal axis, wherein the cartridge body comprises a proximal cartridge alignment feature and a distal cartridge alignment feature; fasteners removably positioned in the cartridge body; and drivers movably supporting the fasteners; a channel dimensioned to receive the fastener cartridge, wherein the channel comprises a sidewall comprising a proximal channel alignment feature and a distal channel alignment feature positioned to receive the distal cartridge alignment feature upon positioning the proximal cartridge alignment feature in abutting engagement with the proximal channel alignment feature and moving the fastener cartridge along an insertion axis to a first position in the channel, wherein the insertion axis is perpendicular to the longitudinal axis; and a spring configured to bias the fastener cartridge distally within the channel along the longitudinal axis from the first position to a fully seated position.
• Example 55—The stapling assembly of Example 54, wherein the spring comprises a cantilevered flat spring.
• Example 56—The stapling assembly of any one of Examples 54 and 55, wherein the spring further comprises: a first end mounted to the distal cartridge alignment feature; a second end opposite the first end; and an S-curve intermediate the first end and the second end.
• Example 57—The stapling assembly of any one of Examples 54, 55, and 56, wherein the cartridge body further comprises a nose, comprising: a latch movable between a first position, in which the latch secures the nose to the channel, and a second position, in which the latch releases the nose from the channel; and a user-activated release button configured to move the latch from the first position to the second position.
• Example 58—The stapling assembly of Example 57, wherein the latch comprises an arm, and wherein the channel comprises a distal ledge configured to receive the arm when the latch is in the first position.
• Example 59—A stapling assembly, comprising: a fastener cartridge, comprising: a cartridge body defining a longitudinal axis, wherein the cartridge body comprises a cartridge alignment contour and a lug; fasteners removably positioned in the cartridge body; and drivers movably supporting the fasteners; and a channel dimensioned to receive the fastener cartridge, wherein the channel comprises a sidewall comprising a channel alignment contour and a cutout positioned to receive the lug upon positioning the cartridge alignment contour against the channel alignment contour and moving the fastener cartridge along an insertion axis into the channel, wherein the insertion axis is perpendicular to the longitudinal axis; wherein the lug is configured to shift distally in the cutout to a fully seated position upon installation of the fastener cartridge in the channel.
• Example 60—The stapling assembly of Example 59, wherein the cartridge body is leveraged against the channel alignment contour as the fastener cartridge moves along the insertion axis into the channel, and wherein a biasing element is positioned to bias the lug distally in the cutout to the fully seated position.
• Example 61—A linear fastener cartridge, comprising: a cartridge body comprising a tissue-supporting deck, wherein a longitudinal axis extends through the cartridge body; inner fastener cavities defined through the tissue-supporting deck into the cartridge body, wherein the inner fastener cavities are arranged in an inner longitudinal row on a first side of the longitudinal axis, and wherein the inner longitudinal row comprises an inner proximal-most fastener cavity; intermediate fastener cavities defined through the tissue-supporting deck into the cartridge body, wherein the intermediate fastener cavities are arranged in an intermediate longitudinal row on the first side of the longitudinal axis, and wherein the intermediate longitudinal row comprises an intermediate proximal-most fastener cavity; and outer fastener cavities defined through the tissue-supporting deck into the cartridge body, wherein the outer fastener cavities are arranged in an outer longitudinal row on the first side of the longitudinal axis, and wherein the outer longitudinal row comprises an outer proximal-most fastener cavity; drivers positioned in the inner fastener cavities, the intermediate fastener cavities, and the outer fastener cavities; and fasteners supported by the drivers, wherein each fastener comprises a crown comprising a proximal end and a distal end, a proximal leg extending from the proximal end, and a distal leg extending from the distal end, wherein the crowns define a uniform length across the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row; wherein the inner proximal-most fastener cavity, the intermediate proximal-most fastener cavity, and the outer proximal-most fastener cavity are longitudinally offset, and wherein the inner proximal-most fastener cavity is longitudinally offset from the outer proximal-most fastener cavity by a longitudinal length that is less than half the uniform length of the crowns.
• Example 62—The linear fastener cartridge of Example 61, wherein the inner fastener cavities in the inner longitudinal row are longitudinally spaced apart by a first distance, wherein the intermediate fastener cavities in the intermediate longitudinal row are longitudinally spaced apart by a second distance, wherein the outer fastener cavities in the outer longitudinal row are longitudinally spaced apart by a third distance, and wherein the first distance, the second distance, and the third distance are the same distance.
• Example 63—The linear fastener cartridge of any one of Examples 61 and 62, wherein the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row comprise the same number of fastener cavities, and wherein each row is laterally offset from the other rows by a different amount.
• Example 64—The linear fastener cartridge of Example 61, wherein the inner longitudinal row is laterally spaced apart from the intermediate longitudinal row by a first lateral distance, wherein the intermediate longitudinal row is laterally spaced apart from the outer longitudinal row by a second lateral distance, and wherein the first lateral distance is different than the second lateral distance.
• Example 65—The linear fastener cartridge of any one of Examples 61 and 64, wherein the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row are different from each other.
• Example 66—The linear fastener cartridge of Example 65, wherein the tissue-supporting deck is symmetrical about the longitudinal axis.
• Example 67—The linear fastener cartridge of any one of Examples 61, 62, 63, 64, 65, and 66, wherein the fasteners in the inner longitudinal row define a first unformed height, wherein the fasteners in the intermediate longitudinal row define a second unformed height, wherein the fasteners in the outer longitudinal row define a third unformed height, and wherein at least one of the first unformed height, the second unformed height, and the third unformed height are different.
• Example 68—The linear fastener cartridge of any one of Examples 61, 62, 63, 64, 65, 66, and 67, wherein the fasteners in the inner longitudinal row are configured to assume a first formed height, wherein the fasteners in the intermediate longitudinal row are configured to assume a second formed height, wherein the fasteners in the outer longitudinal row are configured to assume a third formed height, and wherein at least one of the first formed height, the second formed height, and the third formed height are different.
• Example 69—A linear fastener cartridge, comprising: a cartridge body comprising a tissue-supporting deck, wherein a longitudinal axis extends through the cartridge body; a first array of fastener cavities defined through the tissue-supporting deck into the cartridge body on a first side of the longitudinal axis, wherein the first array of fastener cavities comprises a first proximal-most fastener cavity; a second array of fastener cavities defined through the tissue-supporting deck into the cartridge body on a second side of the longitudinal axis, wherein the second array of fastener cavities comprises a second proximal-most fastener cavity; fasteners, wherein each fastener comprises a crown, a proximal leg extending from the crown, and a distal leg extending from the crown; and drivers supporting the fasteners, wherein each driver comprises: an inner support column; an intermediate support column; an outer support column; a first bridge connecting the inner support column and the intermediate support column; and a second bridge connecting the intermediate support column and the outer support column; wherein the first proximal-most fastener cavity is longitudinally offset from the second proximal-most fastener cavity by a distance.
• Example 70—The linear fastener cartridge of Example 69, wherein the first array of fastener cavities and the second array of fastener cavities comprise the same number of fastener cavities.
• Example 71—The linear fastener cartridge of Example 70, wherein the first array of fastener cavities and the second array of fastener cavities comprise the same pattern.
• Example 72—The linear fastener cartridge of any one of Examples 69, 70, and 71, wherein a longitudinal driver length is defined between the proximal-most proximal leg and the distal-most distal leg supported by the same driver, and wherein the distance is less than 50% the longitudinal driver length.
• Example 73—The linear fastener cartridge of Example 72, wherein the distance is approximately 25% the longitudinal driver length.
• Example 74—The linear fastener cartridge of Example 72, wherein the distance is approximately 10% the longitudinal driver length.
• Example 75—A linear fastener cartridge, comprising: a cartridge body comprising a tissue-supporting deck, wherein a longitudinal axis extends through the cartridge body; an inner longitudinal row of fastener cavities on a first side of the longitudinal axis; an intermediate longitudinal row of fastener cavities on the first side of the longitudinal axis, wherein the intermediate longitudinal row of fastener cavities defines an intermediate axis parallel to the longitudinal axis; an outer longitudinal row of fastener cavities on the first side of the longitudinal axis, wherein the inner longitudinal row of fastener cavities and the outer longitudinal row of fastener cavities are asymmetric relative to the intermediate axis; triple drivers spanning the inner longitudinal row of fastener cavities, the intermediate longitudinal row of fastener cavities, and the outer longitudinal row of fastener cavities; and fasteners supported by the triple drivers, wherein each fastener comprises a crown comprising a proximal end and a distal end, a proximal leg extending from the proximal end, and a distal leg extending from the distal end, wherein the crowns define a uniform length across the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row.
• Example 76—The linear fastener cartridge of Example 75, wherein the outer longitudinal row of fastener cavities comprises: an outer fastener cavity comprising a first proximal end; wherein the inner longitudinal row of fastener cavities comprises: a first inner fastener cavity comprising a second proximal end, wherein the first proximal end and the second proximal end are longitudinally aligned; and a second inner fastener cavity comprising a third proximal end, wherein the third proximal end is longitudinally staggered with respect to the proximal ends of all fastener cavities in the outer longitudinal row of fastener cavities.
• Example 77—The linear fastener cartridge of any one of Examples 75 and 76, wherein the inner longitudinal row of fastener cavities is the same length as the outer longitudinal row of fastener cavities.
• Example 78—The linear fastener cartridge of any one of Example 75, 76, and 77, wherein the inner longitudinal row of fastener cavities comprises more fastener cavities than the outer longitudinal row.
• Example 79—The linear fastener cartridge of any one of Examples 75, 76, 77, and 78, wherein the outer longitudinal row comprises a third fastener cavity longitudinally staggered with respect to all other fastener cavities on the first side of the longitudinal axis.
• Example 80—The linear fastener cartridge of any one of Examples 75, 76, 77, 78, and 79, wherein the inner fastener cavities in the inner longitudinal row are longitudinally spaced apart by a first distance, wherein the intermediate fastener cavities in the intermediate longitudinal row are longitudinally spaced apart by a second distance, wherein the outer fastener cavities in the outer longitudinal row are longitudinally spaced apart by a third distance, and wherein at least one of the first distance, the second distance, and the third distance is different than the others.
• Many of the surgical instrument systems described herein are motivated by an electric motor; however, the surgical instrument systems described herein can be motivated in any suitable manner. In various instances, the surgical instrument systems described herein can be motivated by a manually-operated trigger, for example. In certain instances, the motors disclosed herein may comprise a portion or portions of a robotically controlled system. Moreover, any of the end effectors and/or tool assemblies disclosed herein can be utilized with a robotic surgical instrument system. U.S. patent application Ser. No. 13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535, for example, discloses several examples of a robotic surgical instrument system in greater detail.
• The surgical instrument systems described herein have been described in connection with the deployment and deformation of staples; however, the embodiments described herein are not so limited. Various embodiments are envisioned which deploy fasteners other than staples, such as clamps or tacks, for example. Moreover, various embodiments are envisioned which utilize any suitable means for sealing tissue. For instance, an end effector in accordance with various embodiments can comprise electrodes configured to heat and seal the tissue. Also, for instance, an end effector in accordance with certain embodiments can apply vibrational energy to seal the tissue.
• The entire disclosures of:
• U.S. Pat. No. 5,403,312, entitled ELECTROSURGICAL HEMOSTATIC DEVICE, which issued on Apr. 4, 1995;
• U.S. Pat. No. 7,000,818, entitled SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, which issued on Feb. 21, 2006;
• U.S. Pat. No. 7,422,139, entitled MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK, which issued on Sep. 9, 2008;
• U.S. Pat. No. 7,464,849, entitled ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS, which issued on Dec. 16, 2008;
• U.S. Pat. No. 7,670,334, entitled SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, which issued on Mar. 2, 2010;
• U.S. Pat. No. 7,753,245, entitled SURGICAL STAPLING INSTRUMENTS, which issued on Jul. 13, 2010;
• U.S. Pat. No. 8,393,514, entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, which issued on Mar. 12, 2013;
• U.S. patent application Ser. No. 11/343,803, entitled SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES, now U.S. Pat. No. 7,845,537;
• U.S. patent application Ser. No. 12/031,573, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES, filed Feb. 14, 2008;
• U.S. patent application Ser. No. 12/031,873, entitled END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, filed Feb. 15, 2008, now U.S. Pat. No. 7,980,443;
• U.S. patent application Ser. No. 12/235,782, entitled MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, now U.S. Pat. No. 8,210,411;
• U.S. patent application Ser. No. 12/249,117, entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, now U.S. Pat. No. 8,608,045;
• U.S. patent application Ser. No. 12/647,100, entitled MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY, filed Dec. 24, 2009, now U.S. Pat. No. 8,220,688;
• U.S. patent application Ser. No. 12/893,461, entitled STAPLE CARTRIDGE, filed Sep. 29, 2012, now U.S. Pat. No. 8,733,613;
• U.S. patent application Ser. No. 13/036,647, entitled SURGICAL STAPLING INSTRUMENT, filed Feb. 28, 2011, now U.S. Pat. No. 8,561,870;
• U.S. patent application Ser. No. 13/118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, now U.S. Pat. No. 9,072,535;
• U.S. patent application Ser. No. 13/524,049, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, filed on Jun. 15, 2012, now U.S. Pat. No. 9,101,358;
• U.S. patent application Ser. No. 13/800,025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013, now U.S. Pat. No. 9,345,481;
• U.S. patent application Ser. No. 13/800,067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed on Mar. 13, 2013, now U.S. Patent Application Publication No. 2014/0263552;
• U.S. Patent Application Publication No. 2007/0175955, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, filed Jan. 31, 2006; and
• U.S. Patent Application Publication No. 2010/0264194, entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed Apr. 22, 2010, now U.S. Pat. No. 8,308,040, are hereby incorporated by reference herein.
• Although various devices have been described herein in connection with certain embodiments, modifications and variations to those embodiments may be implemented. Particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined in whole or in part, with the features, structures or characteristics of one or more other embodiments without limitation. Also, where materials are disclosed for certain components, other materials may be used. Furthermore, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. The foregoing description and following claims are intended to cover all such modification and variations.
• The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, a device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps including, but not limited to, the disassembly of the device, followed by cleaning or replacement of particular pieces of the device, and subsequent reassembly of the device. In particular, a reconditioning facility and/or surgical team can disassemble a device and, after cleaning and/or replacing particular parts of the device, the device can be reassembled for subsequent use. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
• The devices disclosed herein may be processed before surgery. First, a new or used instrument may be obtained and, when necessary, cleaned. The instrument may then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument may then be placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, and/or high-energy electrons. The radiation may kill bacteria on the instrument and in the container. The sterilized instrument may then be stored in the sterile container. The sealed container may keep the instrument sterile until it is opened in a medical facility. A device may also be sterilized using any other technique known in the art, including but not limited to beta radiation, gamma radiation, ethylene oxide, plasma peroxide, and/or steam.
• While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles.
• Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials do not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.

Claims (20)

What is claimed is:

1. A linear fastener cartridge, comprising:

a cartridge body comprising a tissue-supporting deck, wherein a longitudinal axis extends through the cartridge body;

inner fastener cavities defined through the tissue-supporting deck into the cartridge body, wherein the inner fastener cavities are arranged in an inner longitudinal row on a first side of the longitudinal axis, and wherein the inner longitudinal row comprises an inner proximal-most fastener cavity;

intermediate fastener cavities defined through the tissue-supporting deck into the cartridge body, wherein the intermediate fastener cavities are arranged in an intermediate longitudinal row on the first side of the longitudinal axis, and wherein the intermediate longitudinal row comprises an intermediate proximal-most fastener cavity; and

outer fastener cavities defined through the tissue-supporting deck into the cartridge body, wherein the outer fastener cavities are arranged in an outer longitudinal row on the first side of the longitudinal axis, and wherein the outer longitudinal row comprises an outer proximal-most fastener cavity;

drivers positioned in the inner fastener cavities, the intermediate fastener cavities, and the outer fastener cavities; and

fasteners supported by the drivers, wherein each fastener comprises a crown comprising a proximal end and a distal end, a proximal leg extending from the proximal end, and a distal leg extending from the distal end, wherein the crowns define a uniform length across the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row;

wherein the inner proximal-most fastener cavity, the intermediate proximal-most fastener cavity, and the outer proximal-most fastener cavity are longitudinally offset, and wherein the inner proximal-most fastener cavity is longitudinally offset from the outer proximal-most fastener cavity by a longitudinal length that is less than half the uniform length of the crowns.

2. The linear fastener cartridge ofclaim 1, wherein the inner fastener cavities in the inner longitudinal row are longitudinally spaced apart by a first distance, wherein the intermediate fastener cavities in the intermediate longitudinal row are longitudinally spaced apart by a second distance, wherein the outer fastener cavities in the outer longitudinal row are longitudinally spaced apart by a third distance, and wherein the first distance, the second distance, and the third distance are the same distance.

3. The linear fastener cartridge ofclaim 1, wherein the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row comprise the same number of fastener cavities, and wherein each row is laterally offset from the other rows by a different amount.

4. The linear fastener cartridge ofclaim 1, wherein the inner longitudinal row is laterally spaced apart from the intermediate longitudinal row by a first lateral distance, wherein the intermediate longitudinal row is laterally spaced apart from the outer longitudinal row by a second lateral distance, and wherein the first lateral distance is different than the second lateral distance.

5. The linear fastener cartridge ofclaim 1, wherein the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row are different from each other.

6. The linear fastener cartridge ofclaim 5, wherein the tissue-supporting deck is symmetrical about the longitudinal axis.

7. The linear fastener cartridge ofclaim 1, wherein the fasteners in the inner longitudinal row define a first unformed height, wherein the fasteners in the intermediate longitudinal row define a second unformed height, wherein the fasteners in the outer longitudinal row define a third unformed height, and wherein at least one of the first unformed height, the second unformed height, and the third unformed height are different.

8. The linear fastener cartridge ofclaim 1, wherein the fasteners in the inner longitudinal row are configured to assume a first formed height, wherein the fasteners in the intermediate longitudinal row are configured to assume a second formed height, wherein the fasteners in the outer longitudinal row are configured to assume a third formed height, and wherein at least one of the first formed height, the second formed height, and the third formed height are different.

9. A linear fastener cartridge, comprising:

a cartridge body comprising a tissue-supporting deck, wherein a longitudinal axis extends through the cartridge body;

a first array of fastener cavities defined through the tissue-supporting deck into the cartridge body on a first side of the longitudinal axis, wherein the first array of fastener cavities comprises a first proximal-most fastener cavity;

a second array of fastener cavities defined through the tissue-supporting deck into the cartridge body on a second side of the longitudinal axis, wherein the second array of fastener cavities comprises a second proximal-most fastener cavity;

fasteners, wherein each fastener comprises a crown, a proximal leg extending from the crown, and a distal leg extending from the crown; and

drivers supporting the fasteners, wherein each driver comprises:

an inner support column;

an intermediate support column;

an outer support column;

a first bridge connecting the inner support column and the intermediate support column; and

a second bridge connecting the intermediate support column and the outer support column;

wherein the first proximal-most fastener cavity is longitudinally offset from the second proximal-most fastener cavity by a distance.

10. The linear fastener cartridge ofclaim 9, wherein the first array of fastener cavities and the second array of fastener cavities comprise the same number of fastener cavities.

11. The linear fastener cartridge ofclaim 10, wherein the first array of fastener cavities and the second array of fastener cavities comprise the same pattern.

12. The linear fastener cartridge ofclaim 9, wherein a longitudinal driver length is defined between the proximal-most proximal leg and the distal-most distal leg supported by the same driver, and wherein the distance is less than 50% the longitudinal driver length.

13. The linear fastener cartridge ofclaim 12, wherein the distance is approximately 25% the longitudinal driver length.

14. The linear fastener cartridge ofclaim 12, wherein the distance is approximately 10% the longitudinal driver length.

15. A linear fastener cartridge, comprising:

a cartridge body comprising a tissue-supporting deck, wherein a longitudinal axis extends through the cartridge body;

an inner longitudinal row of fastener cavities on a first side of the longitudinal axis;

an intermediate longitudinal row of fastener cavities on the first side of the longitudinal axis, wherein the intermediate longitudinal row of fastener cavities defines an intermediate axis parallel to the longitudinal axis;

an outer longitudinal row of fastener cavities on the first side of the longitudinal axis, wherein the inner longitudinal row of fastener cavities and the outer longitudinal row of fastener cavities are asymmetric relative to the intermediate axis;

triple drivers spanning the inner longitudinal row of fastener cavities, the intermediate longitudinal row of fastener cavities, and the outer longitudinal row of fastener cavities; and

fasteners supported by the triple drivers, wherein each fastener comprises a crown comprising a proximal end and a distal end, a proximal leg extending from the proximal end, and a distal leg extending from the distal end, wherein the crowns define a uniform length across the inner longitudinal row, the intermediate longitudinal row, and the outer longitudinal row.

16. The linear fastener cartridge ofclaim 15, wherein the outer longitudinal row of fastener cavities comprises:

an outer fastener cavity comprising a first proximal end; wherein the inner longitudinal row of fastener cavities comprises:

a first inner fastener cavity comprising a second proximal end, wherein the first proximal end and the second proximal end are longitudinally aligned; and

a second inner fastener cavity comprising a third proximal end, wherein the third proximal end is longitudinally staggered with respect to the proximal ends of all fastener cavities in the outer longitudinal row of fastener cavities.

17. The linear fastener cartridge ofclaim 15, wherein the inner longitudinal row of fastener cavities is the same length as the outer longitudinal row of fastener cavities.

18. The linear fastener cartridge ofclaim 15, wherein the inner longitudinal row of fastener cavities comprises more fastener cavities than the outer longitudinal row.

19. The linear fastener cartridge ofclaim 15, wherein the outer longitudinal row comprises a third fastener cavity longitudinally staggered with respect to all other fastener cavities on the first side of the longitudinal axis.

20. The linear fastener cartridge ofclaim 15, wherein the inner fastener cavities in the inner longitudinal row are longitudinally spaced apart by a first distance, wherein the intermediate fastener cavities in the intermediate longitudinal row are longitudinally spaced apart by a second distance, wherein the outer fastener cavities in the outer longitudinal row are longitudinally spaced apart by a third distance, and wherein at least one of the first distance, the second distance, and the third distance is different than the others.

Images