SURGICAL CUTTING AND STAPLING METHODS

• US 20150173756A1
• Filed: 12/23/2013
• Published: 06/25/2015
• Est. Priority Date: 12/23/2013
• Status: Abandoned Application

• Current Assignee: Cilag Gmbh International (Johnson & Johnson)
• Original Assignee: Ethicon Endo-Surgery, Inc. (Johnson & Johnson)
• Inventors: Baxter, Chester O. III, Shelton, Frederick E. IV, Morgan, Jerome R.
• Application Number:
  US14/138,516
• Publication Number:
  US 20150173756A1
• Time in Patent Office: Days
• US Class Current: 1/1
• CPC Class Codes: A61B 17/064 Surgical staples, i.e. penetrating the tissue
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 2017/00309 Cut-outs or slits
• CPC Class Codes: A61B 2017/00327 with actuating members moving in opposite directions
• CPC Class Codes: A61B 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2017/00526 Methods of manufacturing
• CPC Class Codes: A61B 2017/07228 Arrangement of the staples
• CPC Class Codes: A61B 2017/07257 characterised by its anvil
• CPC Class Codes: A61B 2017/07271 characterised by its cartridge
• CPC Class Codes: A61B 2017/07278 characterised by its sled or its staple holder

Abstract

Surgical methods for cutting and fastening tissue are disclosed. The methods may include employing a surgical end effector that includes a pair of jaws wherein an upper jaw is movable relative to a lower jaw that supports a surgical fastener cartridge. The methods may include manipulating the end effector to a compact configuration to facilitate its insertion through a trocar port and then manipulating and actuating the end effector to treat target tissue.

Claims

1. A surgical method for treating target tissue within a patient, the method comprising the steps of:

installing a hollow trocar port into a patient;

providing a surgical end effector comprising;

an elongated shaft assembly defining a longitudinal tool axis;

a lower jaw operably coupled to the elongated shaft assembly, the lower jaw including elastic biasing means;

an upper jaw supported for movement relative to the lower jaw upon application of actuation motions thereto, the upper jaw being movable between a first insertion position wherein the upper jaw is compressible against the biasing means on the lower jaw to provide the surgical end effector with a smallest cross-sectional shape to facilitate passage of the surgical end effector through the hollow trocar port into the patient and a primary opened position whereupon application of an actuation motion thereto, the upper jaw is movable into a fully open position for admitting target tissue between the upper and lower jaws and upon application of another actuation motion to the upper jaw, the upper jaw is moved to a fully clamped position wherein the target tissue is clamped between the upper and lower jaws; and

a firing member operably supported for selective operable travel within the surgical end effector upon application of a firing motion thereto and wherein the surgical method further comprises;

inserting the surgical end effector into the hollow trocar port such that an inner surface of the hollow trocar port compresses the upper jaw into the insertion position until the surgical end effector has exited the distal end of the trocar port whereupon the biasing means moves the upper jaw into the primary opened position;

applying the actuation motion to the upper jaw to move the upper jaw to the fully opened position;

manipulating the end effector such that the target tissue is positioned between the upper and lower jaws;

applying the another actuation motion to the upper jaw to move the upper jaw into the fully clamped position; and

applying the firing motion to the firing member to cause the firing member to travel from a starting position to an ending position within the end effector.

2. The surgical method of claim 1 wherein the firing member comprises a body that includes an upper portion that is configured to engage the upper jaw and a lower portion that is configured to engage the lower jaw and wherein the upper portion is movable relative to the lower portion between a collapsed position when the surgical end effector has the smallest cross-sectional shape and an operating position when the surgical end effector has exited the trocar port to enable the firing member to move from the starting position to the ending position upon application of the firing motion thereto.

3. The surgical method of claim 2 wherein the upper portion of the firing member includes a tissue cutting edge.

4. The surgical method of claim 3 wherein the lower jaw supports a surgical staple cartridge including a plurality of unformed surgical staples operably supported therein and wherein the upper jaw comprises an anvil and wherein the firing member cuts the target tissue clamped between the anvil and the surgical staple cartridge and drives the unformed surgical staples within the surgical staple cartridge into forming contact with the anvil as the firing member travels from the starting position to the ending position within the end effector.

5. The surgical method of claim 4 wherein the anvil comprises an anvil body including an anvil mounting portion, the anvil mounting portion movably engaging a control insert movably supported in the lower jaw for travel along an insert axis that is transverse to the longitudinal tool axis between a first position corresponding to the insertion position and a second position corresponding to the primary opened position, the anvil mounting portion automatically moving along the insert axis from the first position to the second position after the surgical end effector has exited the trocar port.

6. The surgical method of claim 5 wherein the control insert is biased into the second position by a biasing member supported on the lower jaw.

7. The surgical method of claim 4 further comprising the step of applying a retraction motion to the firing member to move the firing member from the ending position back to the starting position.

8. The surgical method of claim 7 further comprising the step of re-applying the actuation motion to the anvil to enable the target tissue to be released from the end effector.

9. The surgical method of claim 8 further comprising the steps of:

discontinuing the re-application of the actuation motion to the anvil to enable the anvil to return to the primary opened position; and

withdrawing the surgical end effector back through the trocar port such that the inner surface of the trocar port compresses the anvil into the first insertion position.

10. The surgical method of claim 1 wherein the elastic biasing means comprises compressible foam attached to the lower jaw.

11. A surgical method for treating target tissue within a patient, the method comprising the steps of:

installing a hollow trocar port into a patient;

providing a surgical end effector comprising;

an elongated shaft assembly;

a lower jaw operably coupled to the elongated shaft assembly, the lower jaw including elastic biasing means;

an upper jaw supported for movement relative to the lower jaw upon application of actuation motions thereto, the upper jaw being movable between a first insertion position wherein the upper jaw is compressible against the elastic biasing means to provide the surgical end effector with a smallest cross-sectional shape to facilitate passage of the surgical end effector through the trocar port into the patient and a primary opened position and whereupon application of an actuation motion thereto, the upper jaw is movable into a fully open position for admitting target tissue between the upper and lower jaws and upon application of another actuation motion thereto, the upper jaw is moved to a fully clamped position wherein the target tissue is clamped between the upper and lower jaws;

a control insert operably supporting a portion of the upper jaw therein and being selectively movably supported in the lower jaw for travel between a first position corresponding to the insertion position and a second position corresponding to the primary opened position;

means for moving the control insert between the first and second positions; and

a firing member operably supported for selective operable travel within the surgical end effector upon application of a firing motion thereto and wherein the surgical method further comprises;

moving the control insert into the first position;

inserting the surgical end effector through the hollow trocar port into the patient;

moving the control insert to the second position to enable the biasing means to move the upper jaw into the primary opened position;

applying the actuation motion to the upper jaw to move the upper jaw to the fully opened position;

manipulating the end effector such that the target tissue is positioned between the upper and lower jaws;

applying the another actuation motion to the upper jaw to move the upper jaw into the fully clamped position; and

applying the firing motion to the firing member to cause the firing member to travel from a starting position to an ending position within the end effector.

12. The surgical method of claim 11 wherein the firing member comprises a body that includes an upper portion that is configured to engage the upper jaw and a lower portion that is configured to engage the lower jaw and wherein the upper portion is movable relative to the lower portion between a collapsed position when the surgical end effector has the smallest cross-sectional shape and an operating position when the surgical end effector has exited the trocar port to enable the firing member to move from the starting position to the ending position upon application of the firing motion thereto.

13. The surgical method of claim 12 wherein the upper portion of the firing member includes a tissue cutting edge.

14. The surgical method of claim 13 wherein the lower jaw supports a surgical staple cartridge including a plurality of unformed surgical staples operably supported therein and wherein the upper jaw comprises an anvil and wherein the firing member cuts the target tissue clamped between the anvil and the surgical staple cartridge and drives the unformed surgical staples within the surgical staple cartridge into forming contact with the anvil as the firing member travels from the starting position to the ending position within the end effector.

15. The surgical method of claim 14 further comprising the step of applying a retraction motion to the firing member to move the firing member from the ending position back to the starting position.

16. The surgical method of claim 15 further comprising the step of re-applying the actuation motion to the anvil to enable the target tissue to be released from the end effector.

17. The surgical method of claim 16 further comprising the steps of:

discontinuing the re-application of the actuation motion to the anvil to enable the anvil to return to the primary opened position;

returning the control insert to the first position; and

withdrawing the surgical end effector back through the trocar port.

18. A surgical method for treating target tissue within a patient, the method comprising the steps of:

installing a hollow trocar port into a patient;

providing a surgical end effector comprising;

a lower jaw;

an upper jaw supported for movement relative to the lower jaw between a first insertion position wherein the upper jaw is compressible against the lower jaw to provide the surgical end effector with a smallest cross-sectional shape to facilitate passage of the surgical end effector through the hollow trocar port into the patient and a primary opened position whereupon application of an actuation motion thereto, the upper jaw is movable into a fully open position for admitting target tissue between the upper and lower jaws and upon application of another actuation motion to the upper jaw, the upper jaw is moved to a fully clamped position wherein the target tissue is clamped between the upper and lower jaws; and

a firing member operably supported for selective operable travel within the surgical end effector upon application of a firing motion thereto and wherein the surgical method further comprises;

operably coupling an elongated shaft assembly to the surgical end effector, the elongated shaft assembly defining a longitudinal tool axis and including a distal closure tube portion supported for axial travel relative to the upper jaw to apply the actuation motions thereto, the distal closure tube portion including biasing means to automatically bias the upper jaw to the primary opened position upon exiting of the upper jaw from the trocar port;

inserting the surgical end effector into the hollow trocar port such that an inner surface of the hollow trocar port compresses the upper jaw into the insertion position until the surgical end effector has exited the distal end of the trocar port whereupon the biasing means moves the upper jaw into the primary opened position;

applying the actuation motion to the upper jaw to move the upper jaw to the fully opened position;

manipulating the end effector such that the target tissue is positioned between the upper and lower jaws;

applying the another actuation motion to the upper jaw to move the upper jaw into the fully clamped position; and

applying the firing motion to the firing member to cause the firing member to travel from a starting position to an ending position within the end effector.

19. The surgical method of claim 18 wherein the firing member comprises a body that includes an upper portion that is configured to engage the upper jaw and a lower portion that is configured to engage the lower jaw and wherein the upper portion is movable relative to the lower portion between a collapsed position when the surgical end effector has the smallest cross-sectional shape and an operating position when the surgical end effector has exited the trocar port to enable the firing member to move from the starting position to the ending position upon application of the firing motion thereto.

20. The surgical method of claim 19 wherein the upper portion of the firing member includes a tissue cutting edge.