Apparatus and method for placing staples in laparoscopic or endoscopic procedures

• US 5,425,745 A
• Filed: 10/29/1993
• Issued: 06/20/1995
• Est. Priority Date: 05/26/1989
• Status: Expired due to Term

• Current Assignee: United States Surgical Corporation (Medtronic Plc)
• Original Assignee: United States Surgical Corporation (Medtronic Plc)
• Inventors: Bolanos, Henry, Ratcliff, Keith, Alesi, Daniel E., Green, David T., Sherts, Charles R.
• Primary Examiner(s): ASHLEY, BOYER DOLINGER
• Application Number:
  US08/145,727
• Time in Patent Office: 599 Days
• Field of Search: 227/175, 227/176, 227/178, 227/180, 227/19, 606/219, 606/139
• US Class Current: 606/219
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/07207 the staples being applied sequentially
• CPC Class Codes: A61B 2017/07214 Stapler heads

Abstract

A surgical stapler for placing lateral lines of staples and making an incision, all through an endoscopic tube, includes an anvil member which is mounted to the distal end of an elongated housing. A tubular collar disposed around the arm of the anvil member is movable to a distal position to bias the anvil member and a cartridge assembly into cooperative alignment, thereby clamping body tissue to be fastened between the anvil member and cartridge assembly.

Claims

1. A method of endoscopically driving fasteners into body tissue comprising the steps of:

providing an endoscopic opening into a body for accessing tissue to be fastened;

providing a surgical apparatus for driving surgical fasteners into body tissue including;

a frame;

an endoscopic portion defining a longitudinal axis and extending distally from said frame, said endoscopic portion including;

i) an elongated support for receiving a cartridge assembly, the cartridge assembly having a distal end and a proximal end and including a plurality of surgical fasteners slidably mounted therein, and having a tissue engaging surface;

ii) a jaw member having a distal end and a proximal end, said proximal end of said jaw member being pivotally retained in said elongated support such that the jaw member is movable between an open position and a closed position in close cooperative alignment with the tissue engaging surface of the cartridge assembly and said distal end of said jaw member is in juxtaposed alignment with said distal end of said cartridge assembly;

iii) a closure member for moving the jaw member between the open position and the closed position comprising a collar operatively associated with at least a portion of said support and said jaw member, said collar having a camming edge and being movable between a first position in which said camming edge is located proximally to the proximal end of said jaw member, and a second position in which said camming edge is located distally to the proximal end of said jaw member, said collar cooperating with said jaw member such that when said collar is moved from said first position to said second position, said jaw member is urged to said closed position;

iv) pusher elements for ejecting the surgical fasteners from the cartridge assembly through tissue; and

v) an elongated member which translates with respect to said endoscopic portion independent of said closure member for actuating said pusher elements;

linkage for moving said collar between said first position and said second position; and

a seal member for sealing said endoscopic portion to effect an internal seal therewithin;

translating the closure member to the second position to approximate said jaw member towards said cartridge assembly prior to inserting said jaw member and cartridge assembly into said encloseopic opening;

inserting said approximated jaw member and cartridge assembly of said surgical apparatus into said endoscopic opening;

translating the closure member from the second position to the first position to open said approximated jaw member and said cartridge assembly to define a tissue receiving space therebetween;

positioning body tissue into which said fasteners are to be driven such that said body tissue enters said tissue receiving space between said jaw member and said cartridge assembly in a direction extending from a distal to a proximal end of said jaw member and said cartridge assembly;

translating the closure member back to the second position to cause said jaw member to move said jaw member from said open position to said closed position; and

remotely manipulating said elongated member independent of the closure member for actuating said pusher elements for ejecting said surgical fasteners from said cartridge assembly to drive said surgical fasteners into said body tissue.

2. The method of claim 1 further comprising the steps of:

releasing said jaw member to return said jaw member to said open position; and

withdrawing said endoscopic portion from said endoscopic opening.

3. A method of endoscopically driving fasteners into body tissue comprising the steps of:

providing an endoscopic tube for insertion into a body to access body tissue to be fastened;

providing a surgical apparatus for driving surgical fasteners into body tissue, said apparatus including;

a frame;

an endoscopic portion defining a longitudinal axis and extending distally from said frame, said endoscopic portion including;

i) an elongated support for receiving a cartridge assembly, the cartridge assembly having a distal end and a proximal end and including a plurality of surgical fasteners slidably mounted therein, and having a tissue engaging surface;

ii) a jaw member having a distal end and a proximal end joined by a ramped camming portion, said proximal end of said jaw member being pivotally retained in said elongated support such that the jaw member is movable between an open position and closed position in close cooperative alignment with the tissue engaging surface of the cartridge assembly and said distal end of said jaw member is in juxtaposed alignment with said distal end of said cartridge assembly;

iii) a closure member for moving the jaw member between the open position and the closed position, said closure member slidably mounted for movement between a first position and a second position relative to at least a portion of said support and said jaw member, said closure member having a camming edge transverse to said longitudinal axis and being movable between said first position in which said camming edge is located proximally to the ramped camming portion of said jaw member, and said second position in which said camming edge is in engagement with the ramped camming portion of said jaw member, said closure member cooperating with said jaw member such that when said closure member is moved from said first position to said second position, said jaw member is urged to said closed position; and

iv) pusher elements for ejecting the surgical fasteners from the cartridge assembly, into tissue;

v) an elongated member which translates with respect to said endoscopic portion independent of said closure member for actuating said pusher elements;

linkage for moving said closure member between said first position and said second position;

inserting said endoscopic tube into said body to access tissue to be fastened;

translating the closure member toward second position to approximate said jaw member towards said cartridge assembly a distance sufficient to facilitate insertion prior to insertion of the jaw member and cartridge assembly of said endoscopic portion into said endoscopic tube;

inserting said approximated jaw member and cartridge assembly of said surgical apparatus into said endoscopic tube;

translating the closure member to the first position to open said jaw member and said cartridge assembly to define a tissue receiving space therebetween;

positioning said tissue to be fastened in said tissue receiving space between said jaw member and said cartridge assembly whereby said tissue enters said tissue receiving space from a distal to a proximal end of said jaw member and said cartridge assembly;

translating the closure member to the second position to move said jaw member to said closed position; and

remotely manipulating said elongated member independent of the closure member for actuating said pusher elements for ejecting the surgical fasteners from the cartridge assembly into the tissue positioned between said jaw member and said cartridge assembly.

4. A method of endoscopically driving fasteners into body tissue comprising the steps of:

providing an endoscopic opening into a body for accessing tissue to be fastened;

providing a surgical apparatus for driving surgical fasteners into body tissue including;

a frame;

an endoscopic portion defining a longitudinal axis and extending distally from said frame, said endoscopic portion including;

i) an elongated support adapted to receive a cartridge assembly;

ii) a cartridge assembly having a distal end and a proximal end and including a plurality of surgical fasteners slidably mounted therein, and having a tissue engaging surface, said plurality of surgical fasteners being arranged in at least three rows;

iii) a jaw member having a distal end and a proximal end, said proximal end of said jaw member being pivotally mounted with respect to said elongated support such that the jaw member is biased into an open position and is movable between said open position and a dosed position in close cooperative alignment with the tissue engaging surface of the cartridge assembly and said distal end of said jaw member is in juxtaposed alignment with said distal end of said cartridge assembly;

iv) closure means for moving said jaw member between the open and closed positions;

v) means for ejecting said surgical fasteners from said cartridge assembly; and

vi) an elongated member which translates with respect to said endoscopic portion independent of said closure means for actuating said means for ejecting surgical fasteners;

approximating said jaw member towards said cartridge assembly prior to insertion into said endoscopic opening;

inserting said approximated jaw member and cartridge assembly of said surgical apparatus into said endoscopic opening;

opening said approximated jaw member and said cartridge assembly after insertion to define a tissue receiving space therebetween;

positioning body tissue in said tissue receiving space between said jaw member and said cartridge assembly;

remotely reactuating the closure means for moving said jaw member to move said jaw member into close cooperative alignment with the tissue engaging surface of the cartridge assembly such that the distal end of said jaw member is in juxtaposed alignment with the distal end of said cartridge assembly; and

manipulating said elongated member independent of the closure means for actuating said means for ejecting said surgical fasteners from said cartridge assembly to drive said surgical fasteners from said cartridge assembly such that surgical fasteners in each of said at least three rows are sequentially formed in said body tissue.

5. The method of claim 4, wherein said plurality of surgical fasteners are arranged in said cartridge assembly in six rows, and said cartridge assembly further includes a knife which is adapted to pass between two of said rows of surgical fasteners, the method further comprising the step of severing tissue disposed between two of said rows of surgical fasteners as said fasteners are being formed.

6. The method of claim 5, wherein said elongated member is further adapted to actuate said knife to pass between the center two of said rows of surgical fasteners, the step of severing tissue occurring sequentially with respect to the formation of said fasteners.

7. A method of endoscopically driving fasteners into body tissue comprising the steps of:

providing an endoscopic opening into a body for accessing tissue to be fastened;

providing a surgical apparatus for driving surgical fasteners into body tissue including;

a frame;

an endoscopic portion defining a longitudinal axis and extending distally from said frame, said endoscopic portion including;

i) an elongated support adapted to receive a cartridge assembly;

ii) a cartridge assembly having a distal end and a proximal end and including a plurality of surgical fasteners slidably mounted therein, and having a tissue engaging surface;

iii) a jaw member having a distal end and a proximal end, said proximal end of said jaw member being pivotally mounted with respect to said elongated support such that the jaw member is movable between an open position and a closed position in close cooperative alignment with the tissue engaging surface of the cartridge assembly and said distal end of said jaw member is in juxtaposed alignment with said distal end of said cartridge assembly;

iv) a closure member for moving said jaw member between the open and closed positions;

v) pusher elements for ejecting said surgical fasteners from said cartridge assembly;

vi) a locking mechanism for preventing actuation of said means for ejecting said surgical fasteners from said cartridge assembly when said jaw member is in said open position; and

vii) an elongated member which translates with respect to said endoscopic portion independent of said closure member for actuating said pusher elements for ejecting surgical fasteners;

pivoting the distal end of the jaw member towards the distal end of the cartridge assembly thereby bringing the jaw member and cartridge assembly into a substantially parallel alignment;

inserting the jaw member and cartridge assembly in the substantially parallel alignment into said endoscopic opening;

pivoting the distal end of the jaw member away from the distal end of the cartridge assembly;

positioning body tissue between said jaw member and said cartridge assembly;

actuating said closure member for moving said jaw member from said open position to said closed position wherein the tissue engaging surface of the cartridge assembly is in close cooperative alignment with said jaw member and said distal end of said jaw member is in juxtaposed alignment with said distal end of said cartridge assembly, such that actuation of said closure member for moving said jaw member deactivates said locking mechanism for preventing actuation; and

remotely manipulating said elongated member from said frame to independently actuate said pusher elements for ejecting said surgical fasteners from said cartridge assembly to drive said surgical fasteners from said cartridge assembly into said body tissue.

8. A method of endoscopically driving fasteners into body tissue comprising the steps:

providing an endoscopic opening into a body;

providing a surgical apparatus which includes (i) a cartridge assembly having a distal end and a proximal end, the cartridge assembly including a plurality of surgical fasteners slidably mounted therein, (ii) a jaw member having a distal end and a proximal end pivotally mounted relative to the proximal end of the cartridge assembly, and (iii) a camming member which translates relative to the cartridge assembly and jaw member to pivot the jaw member relative to the cartridge assembly;

pivoting the distal end of the jaw member towards the distal end of the cartridge assembly, thereby bringing the jaw member and cartridge assembly into a substantially parallel alignment;

inserting the jaw member and the cartridge assembly in the substantially parallel alignment into the endoscopic opening;

pivoting the distal end of the jaw member away from the distal end of the cartridge assembly, thereby defining a tissue receiving space therebetween;

introducing body tissue into the tissue receiving space in a direction extending from the distal end to the proximal end of the jaw member and the cartridge assembly;

translating the camming member distally to pivot the distal end of the jaw member towards the distal end of the cartridge assembly, thereby again bringing the jaw member and cartridge assembly into a substantially parallel alignment and capturing the body tissue between the jaw member and the cartridge assembly;

translating the camming member proximally to pivot the distal end of the jaw member away from the distal end of the cartridge assembly, thereby allowing the body tissue to be repositioned within the tissue receiving space;

translating the camming member distally to pivot the distal end of the jaw member towards the distal end of the cartridge assembly, thereby again bringing the jaw member and cartridge assembly into a substantially parallel alignment, and capturing the repositioned body tissue between the jaw member and the cartridge assembly; and

ejecting the surgical fasteners from the cartridge assembly into the repositioned tissue.