US20070027473A1 - Luminal anastomotic device and method - Google Patents

Luminal anastomotic device and method Download PDF

Info

Publication number
US20070027473A1
US20070027473A1 US11/458,134 US45813406A US2007027473A1 US 20070027473 A1 US20070027473 A1 US 20070027473A1 US 45813406 A US45813406 A US 45813406A US 2007027473 A1 US2007027473 A1 US 2007027473A1
Authority
US
United States
Prior art keywords
stapler
stapling
tissue
anvil
lumen
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Abandoned
Application number
US11/458,134
Inventor
Susan Vresh
Blynn Shideler
Krisanne Shideler
Kevin Vresh
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Individual
Original Assignee
Individual
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Individual filed Critical Individual
Priority to US11/458,134 priority Critical patent/US20070027473A1/en
Publication of US20070027473A1 publication Critical patent/US20070027473A1/en
Abandoned legal-status Critical Current

Links

Images

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • A61B17/1152Staplers for performing anastomosis in a single operation applying the staples on the outside of the lumen
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/115Staplers for performing anastomosis in a single operation
    • A61B17/1155Circular staplers comprising a plurality of staples
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00349Needle-like instruments having hook or barb-like gripping means, e.g. for grasping suture or tissue
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B2017/1132End-to-end connections

Definitions

  • the present invention relates to surgical anastomotic stapling devices. More particularly, the present invention relates to end to end anastomotic surgical staplers avoiding minimal constrictive area at the anastomosis site.
  • Surgical staplers have been developed to assist and improve a wide variety of surgical procedures. Surgical staplers provide precision in the placement of staples as well as decrease the time of given surgical procedures. A wide variety of surgical staplers have been developed for vascular, gastric, esophageal and intestinal surgery, to name but a few. These known staplers are often used in anastomosis procedures.
  • In performing surgical anastomotic stapling generally the two pieces of lumen are attached by a ring of staples with a closed loop stapler.
  • the anastomosis of the lumen may be performed in a side to side, side to end or end to end manner which describes the relative orientation of the lumen sections.
  • the surgical staplers for performing end to end anastomosis are generally intraluminal surgical staplers that fire a pair of staggered rings of staples. These types of surgical staplers are often referred to as EEA's, which stands for “End to End Anastomosis”. During this procedure, a circular knife blade is used to separate tissue which is held within the circular ring. The separated tissue is then removed with the stapler so that a circular opening within the lumen is completed along the surgical stapling line.
  • the tissue stapled together with an EEA leaves a smaller opening than the original lumen into which the anvil and stapler head were inserted.
  • an anvil which can be collapsed to introduce the anvil into the body through a relatively small incision.
  • An example of a surgical stapler having a variable diameter anvil is illustrated in U.S. Pat. No. 4,505,414 disclosing an anvil, integral with a surgical stapler, which can be collapsed and inserted through a small incision in a patient's body and expanded outwardly after placement inside the patients body to staple the wall of an organ to the abdominal wall or an external tissue layer of the patient's body.
  • the anvil is not detachable from the stapler and thus cannot provide a continuous stapler line, but rather applies a broken, discontinuous line to “tack” the tissue in a circular line.
  • This patent also does not provide an anvil which can be placed remotely within the body for subsequent attachment to a stapler head.
  • anvils which are capable of collapsing to a reduced diameter after stapling to facilitate removal from the body are shown in U.S. Pat. Nos. 4,752,024; 4,893,622; 4,700,703 and 4,903,697. These anvils are introduced into the body through a relatively large incision.
  • U.S. Pat. No. 5,239,639 also shows a collapsible anvil assembly and applicator instrument for a surgical stapler apparatus.
  • U.S. Pat. No. 6,503,259 is relevant to the present invention in that it discloses a surgical anastomotic fastener array (10 in the '259 patent) comprising a plurality of fasteners (11 of the '259 patent) each having a tissue piercing element (12 of the '259 patent), wherein the fasteners are aligned in an annular array of a first diameter at least prior to anastomosis and are designed to expand to form an annular array of a second larger diameter and then contract as needed after anastomosis.
  • the '259 patent is addressing the same broad concern of the resulting anastomotic ring, but the earliest filing date of the '259 patent is, however, not earlier than the conception date of the present invention.
  • the anastomotic device according to the present invention is a surgical stapler that will form an anastomosis between existing lumen sections in an end to end alignment forming the anastomosis site with a minimal diameter generally equal to or greater than the normal inner diameter of the anastomized lumen sections, with the lumen sections in a normal relaxed condition.
  • the anastomotic device of the present invention will preferably utilize conventional staples formed in a pair of offset annular arrays of staples to couple the end of a first lumen section to the end of a second lumen section.
  • a first embodiment of the present invention forms the anastomotic device as an intraluminal end to end surgical stapler.
  • the intraluminal surgical stapler fires staples, or other fastening devices, from a stapling head to an adjacent anvil.
  • both the head and the anvil can be moved from a retracted position having a first relative diameter to an expanded position of a second larger diameter.
  • the expansion of both the head and the anvil allows the anastomotic device to be positioned in the lumen to be attached with minimal interference and then expanded to an enlarged firing position, wherein when fired the anastomotic ring formed by the array of staples is positioned at a diameter preferably at least as large as the minimum diameter of the adjacent lumen sections.
  • the head and anvil of the stapler of present invention can both be retracted to allow for easy withdrawal of the stapler from the anastomized lumen.
  • the head will be formed of a plurality of wedge-shaped arc segments which move radially and align in an expanded position to form the annular head.
  • the arc segments may be in the form of inner wedge-shaped segments moved by an actuator and outer segments guided by the inner wedge-shaped segments.
  • the wedge-shaped segments may be moved into the expanded or retracted positions by being coupled to the actuator in the form of axially movable wedges controlled by the user.
  • Another embodiment of the present invention will form the annular head as a plurality of arc segments that slide together with the segments formed in an overlapped position in the retracted state and rotate into contracted and expanded positions.
  • a further embodiment of the present invention will hinge various arc segments together to allow the segments to pivot between a retracted position of a minimal diameter and an expanded position forming the annular head ready for firing.
  • Each individual arc segment of the head portion will include staples which combine to form the array of staples in the expanded position.
  • each arc segment has a separate firing mechanism as well as a knife actuating mechanism independently associated with each segment.
  • Each segment will have an arcuate knife portion which will combine and overlap with the knife portions of adjacent segments to form a continuous annular knife arrangement when the head is in the expanded position. In this manner, the knife portions and staples of each individual segment will combine to form the dual stapling array and annular knife well-known to those skilled in the art (except of a larger diameter relative to the body of the stapler).
  • each individual segment is additionally coupled to the controller of the stapler in a manner which accommodates movement of the individual segments between the retracted and expanded positions.
  • This construction of the segments allows for the segments to be formed in the hinged arrangements, spirally attached arrangements or wedge arrangements discussed above. Many other possible relatively movable combinations may be constructed with the individual segment construction of the stapler of the present invention.
  • Another aspect of the present invention is to form an external end to end anastomotic surgical stapler.
  • the external stapler according to the present invention is designed to clamp around lumen sections to be attached.
  • the extraluminal stapler according to the present invention is designed to form an anastomizing ring of sutures external to the connected lumen sections.
  • the external stapler according to the present invention forms a pair of annular arrays of staples around an outwardly extending flange of the connected lumen sections.
  • the extraluminal stapler is formed of two opposed stapler units with each stapler unit formed of two halves hinged together.
  • the extraluminal stapler will include a mechanism for pulling the lumen to be attached around the stapling face of each stapling unit.
  • the extraluminal stapler according to the present invention will additionally include a mechanism for aligning the stapling head and anvil portions of the opposed stapling units with each other as well as a firing mechanism for firing the arrays of staples in the stapling units.
  • One embodiment of the present invention will form each stapling unit as an anvil and head portion hinged together which couples with an adjacent hinged anvil and head portion of the opposed stapling unit.
  • the present invention would be particularly applicable for bowel resections as will be understood by those of ordinary skill in the art, but is not intended to be limited thereto. It can be used in many other applications such as, but not limited to, vascular anastomosis, gastrointestinal anastomosis, esophageal anastomosis and essentially any hollow lumen within the body. Further, the specific embodiments of the invention include a variety of unique features that can be incorporated separately or in various combinations into other stapling and surgical devices for improving those devices.
  • One advantage of the present invention is a minimally invasive surgical stapler that will assist in stapler placement because the diameter of the stapler (i.e. the largest diameter portion, specifically the head and anvil of the stapler) is smaller during insertion and retraction than at firing.
  • Another advantage of the present invention is having a closed loop EEA stapler with the trimming knife formed by individual knife segments. This feature of the present invention may be utilized for firing the knife segments individually, or in a given sequence, or simultaneously (as utilized in the illustrated embodiments of the present invention.
  • Another feature of the present invention is the accommodation of multiple anvil and multiple head controls in a surgical stapler.
  • One present illustrated embodiments provide separate controls for expansion/retraction of the anvil and for axial movement of the anvil.
  • This illustrated embodiment further provides independent control for expansion/retraction of the head and for firing of the knife blade and staples.
  • This system of multiple independent control may be modified to perform a variety of separate control features for the anvil and head portions of an EEA stapler.
  • Another feature of the present invention is the provision of an EEA stapler with a staple and knife firing mechanism that accommodates relative motion of the head portion containing the staples and the firing mechanism.
  • Another feature of the present invention is the provision of an alignment mechanism that aligns and locks the anvil and head portion together prior to the firing of the staples or the knife.
  • Another feature of the present invention is the provision of a closed loop surgical stapler for end to end anastomosis in which the stapler extends around the outside of the lumen portions being anastomised.
  • FIG. 1 a is a side view, partially in section, of a pair of lumen sections anastomized using existing intraluminal anastomotic staplers;
  • FIG. 1 b is a side view, partially in section, of a pair of lumen sections anastomized with an anastomotic stapler according to a first embodiment of the present invention
  • FIG. 1 c is a side view, partially in section, of a pair of lumen sections anastomized using an anastomotic stapler according to a second embodiment of the present invention
  • FIG. 2 a is a schematic plan view of an intraluminal end to end anastomotic stapling head according to the first embodiment of the present invention with the head in the expanded, firing position;
  • FIG. 2 b schematically illustrates the head illustrated in FIG. 2 a in the retracted position
  • FIG. 3 a schematically illustrates an expandable anvil associated with the anastomotic stapler having the expandable head illustrated in FIGS. 2 a and 2 b;
  • FIG. 3 b schematically illustrates the anvil portion of FIG. 3 a in a retracted position
  • FIG. 4 a schematically illustrates a spirally retracted and expandable head for an intraluminal end to end surgical stapler according to a second embodiment of the present invention
  • FIG. 4 b schematically illustrates a hinged expandable and retractable head for an intraluminal end to end surgical stapler according to a third embodiment of the present invention
  • FIG. 5 a is a plan view of an individual outer head segment of the head illustrated in FIGS. 2 a and 2 b;
  • FIG. 5 b is a radially inner side view of the head segment illustrated in FIG. 5 a;
  • FIG. 5 c is a sectional view of the head segment illustrated in FIG. 5 a taken along line Vc-Vc;
  • FIG. 5 d is a sectional view of the head segment illustrated in FIG. 5 a taken along line Vd-Vd;
  • FIG. 5 e is a top plan view of an inner head segment illustrated in FIGS. 2 a and 2 b;
  • FIG. 5 f is a radially inner side view of the inner head segment illustrated in FIG. 5 e;
  • FIG. 5 g is a sectional view of the inner head segment shown in FIG. 5 e taken along line Vg-Vg;
  • FIG. 6 a is a perspective view of an intraluminal anastomotic surgical stapler utilizing the expandible head illustrated in FIGS. 2 a and 2 b and the expandible anvil illustrated in FIGS. 3 a and 3 b;
  • FIG. 6 b is a partial section of a portion of the stapler illustrated in FIG. 6 a taken along line VIb-VIb in FIG. 6 a;
  • FIG. 6 c is a cross-sectional view of the stapler illustrated in FIG. 6 b taken along line VIc-VIc;
  • FIG. 6 d is a cross-sectional view of the stapler illustrated in FIG. 6 b taken along line VId-VId;
  • FIG. 6 e is a side view partially in section of a distal end of the stapler illustrated in FIG. 6 a;
  • FIG. 7 a is a perspective view partially in section of a first half of an extraluminal end to end surgical stapler according to the present invention
  • FIG. 7 b is a side view of the complete extraluminal surgical stapler illustrated in FIG. 7 a;
  • FIG. 8 a is a perspective view of a lumen section to be anastomized utilizing flexible clips associated with the surgical stapler illustrated in FIGS. 7 a and 7 b;
  • FIG. 8 b is an end view of the lumen and clips illustrated in FIG. 8 a;
  • FIG. 8 c is a side view of the clips utilized in FIGS. 8 a and 8 b in the open position;
  • FIG. 8 d is a plan view with the clips in the open position of the clip illustrated in FIG. 8 c;
  • FIG. 8 e is a cross-section of the clips illustrated in FIGS. 8 c and 8 d with the clip in a partially closed position;
  • FIG. 9 is a sectional schematic view of an alignment mechanism for use in a stapler of the present invention.
  • FIG. 10 is a sectional schematic view of a motion accommodation mechanism for the anvil expansion mechanism of a stapler according to the present invention.
  • FIG. 11 is a schematic plan view of a lock and release transmission for an anvil stem and an anvil expansion rod of a stapler according to the present invention.
  • FIG. 1 a illustrates lumen sections 10 and 12 anastomized with a conventional intraluminal anastomotic stapler (i.e. an EEA).
  • the first lumen section 10 and second lumen section 12 will have a nominal diameter d.sub. 1 .
  • the anastomosis site sometimes referred to as an anastomosis ring
  • the anastomosis site formed by an array of staples 14 will have a smaller diameter d.sub. 2 than the nominal luminal diameter d.sub. 1 .
  • this constricture or constriction will have greater rigidity, i.e., less flexibility, than the associated lumen tissue.
  • the object of the present invention is to avoid this constrictive point and the possible detrimental effects associated therewith.
  • the detrimental effects associated with a more rigid constricture in an anastomized lumen would depend on the particular lumen which is coupled together.
  • connecting together a bowel in vascular anastomosis, or connecting any lumen within the body such constrictures are universally undesirable.
  • FIG. 1 b illustrates the anastomosis of lumen sections 10 and 12 with a surgical stapler 100 according to a first embodiment of the present invention.
  • the anastomotic stapler 100 of the invention associated with the results shown in FIG. 1 b is described in detail in FIGS. 2 a and 2 b , 3 a and 3 b , 4 a and 4 b , 5 a - 5 g , and 6 a - 6 e .
  • the anastomotic ring or suture site formed by the array of staples 14 has an inner diameter d.sub. 3 , which is relatively larger than the diameter d.sub. 2 associated with conventional staplers.
  • the diameter d.sub. 3 at the anastomotic ring be at least as great, or greater than the nominal diameter d.sub. 1 of the associated lumens to avoid any problems with constricture.
  • tissue flexibility of the lumen sections for which the particular stapler is designed For example, tissue forming a bowel (relatively flexible) and tissue forming vascular lumens (less flexible compared to the bowel) would accommodate different relative dimensions for d.sub. 3 compared to d.sub. 1 at the anastomotic site.
  • tissue forming a bowel relatively flexible
  • tissue forming vascular lumens less flexible compared to the bowel
  • FIG. 1 c illustrates an end to end anastomosis of two lumens 10 and 12 with an array of staples 14 utilizing an extraluminal surgical stapler according to a second embodiment of the present invention.
  • the stapler according to the second embodiment of the present invention forms an outer anastomotic ring with the array of staples having a diameter greater than d.sub. 1 , the normal diameter of the lumen, such that the anastomosis site forms no constricture.
  • the relative positioning of the array of staples 14 will again depend on the particular lumen being anastomized. Examples of the stapler forming this anastomosis are illustrated in FIGS. 7 a , 7 b , and 8 a - 8 e below.
  • FIGS. 2 a and 2 b schematically illustrate an expandable head 90 for the intraluminal anastomotic stapler 100 according a first embodiment of the present invention.
  • the expandable head 90 is formed of a plurality of arc segments which interconnect in an outer firing position to form the annular expanded head 90 as shown in FIG. 2 a .
  • the individual segments shown in the embodiment illustrated in FIGS. 2 a and 2 b comprise outer wedge-shaped segments 102 and inner wedge-shaped segments 104 .
  • the inner segments 104 are moved radially inwardly and outwardly by individually associated wedge elements 106 .
  • the side wedge-shaped engaging surfaces of the inner segments 104 will force the outer segments 102 into the expanded condition.
  • the inner segments 104 can be pinned to the outer segments 102 in a manner to be described later such that retraction of the inner segments 104 to the retracted position shown in FIG. 2 b will also pull the outer segments 102 toward the retracted position.
  • each segment 102 , 104 includes a plurality of staple receiving slots 108 in a staggered annular array consisting of both an outer ring and an inner ring of staples receiving slots 108 .
  • the division between adjacent segments 102 , 104 needs to be accomplished between the staple receiving slots 108 .
  • the segments 102 , 104 combine to form a standard annular array of staples 14 in an offsetting overlapping arrangement.
  • each segment 102 , 104 includes, at a radial inner side thereof, with knife portions 110 which combine in the expanded position to form an annular knife which provides a trimmed inner edge to the anastomized lumen as is conventional.
  • knife portions 110 of the inner segments 104 overlap with the knife portions of the adjacent outer segments 102 as generally illustrated in the figures.
  • the wedge-shaped interacting arc segments 102 , 104 of the head 90 will allow it to be moved between retracted and expanded positions. It should be evident that the present invention is not intended to be limited to the specific number of segments illustrated in FIGS.
  • a minimization of the diameter in the retracted position can be obtained with as little as three inner wedge-shaped segments 104 spaced about the periphery of the head 90 .
  • the number, positioning and specific shape of the segments 102 , 104 can be changed as desired in order to allow for the desired degree of expansion.
  • Other factors affecting the number and shape of the individual segments 102 , 104 will be the number and length of the specific staples 14 utilized in the inner and outer rings. All of these factors can be considered in designing a specific expanding head 90 which expands to the degree desired.
  • FIGS. 3 a and 3 b illustrate the expanding anvil 120 utilized with the stapler 100 according to the present invention.
  • the anvil 120 is formed of inner segments 122 and outer segments 124 similar to the inner segments 104 and outer segments 102 of the head 90 .
  • the anvil 120 in the expanded position forms an annular ring with conventional staple engaging grooves 126 which will correspond to the staple receiving slots 108 of the head 90 for cinching the fired staples 14 as known in the art.
  • the inner and outer segments 122 , 124 can be pinned together and the inner segments 122 can be moved by a wedge 128 similar to the mechanism for the head 90 .
  • the anvil 120 construction is significantly simpler than the head 90 construction for a variety of reasons.
  • the anvil 120 construction is not limited to forming the staple engaging grooves 126 entirely on one segment 122 or 124 .
  • These expanding anvil segments 122 , 124 can be formed essentially in any position even dividing a staple receiving groove 126 . This provides significantly greater flexibility in deciding where to put the inner and outer segments 122 , 124 .
  • An additional aspect to making the anvil 120 significantly easier to design and operate is that there is no knife or staple firing mechanisms which needs to be incorporated into the expanding and retracting anvil 120 .
  • the prior art illustrates that expanding anvils have been well-known in the art, and many of these constructions can also be incorporated into the design of the present invention.
  • the design of the anvil 120 is essentially the same as the design of the expanding head 90 illustrated in FIGS. 2 a and 2 b.
  • FIGS. 4 a and 4 b are intended to illustrate alternative expanding head mechanisms according to the present invention.
  • FIG. 4 a illustrates an expanding head 140 according to one embodiment of the present invention in which the head 140 is formed of individual segments 142 which can slide past each other in an overlapping arrangement to contract in a spiral fashion as illustrated by the arrows.
  • the actuating mechanism may be a rotating cam type operator, although a variety of segment 142 moving mechanisms can be envisioned.
  • FIG. 4 b illustrates yet another embodiment for an expanding head 150 for a stapler 100 of the present invention in which individual segments 152 of the head 150 are hinged together by hinges 154 to move between expanded and contracted positions.
  • This embodiment illustrates three hinges 154 and one open connection which can have these segments 152 snap together to form the continuous ring.
  • the number of individual segments 152 may be selected as desired.
  • the hinges 154 may include spring-biasing to help move the segment 152 to either the expanded or retracted positions.
  • a mechanical actuator linearly moving along the length of the stapler 100 would be used to move the segments 152 .
  • FIGS. 5 a - 5 g illustrate the details of the individual arc segments 102 , 104 forming the expandable head 90 illustrated in FIGS. 2 a and 2 b .
  • the segments 102 , 104 are discussed in detail and illustrated associated with the specific expanding head 90 illustrated in FIGS. 2 a and 2 b .
  • the general concepts of these individual segments 102 , 104 can be easily extrapolated for many different embodiments, such as those illustrated in FIGS. 4 a and 4 b .
  • the key features of the arc segments 102 , 104 for the expanding head 90 according to the present invention is that the individual segments 102 , 104 have independent firing mechanisms for the staples 14 and the knife portions 110 that are associated with that segment 102 , 104 .
  • the firing mechanism accommodates the relative motion of the segments 102 , 104 between the retracted and expanded positions.
  • these components utilized in the segments 102 , 104 of the present invention can be utilized in the expanding heads 140 and 150 illustrated in FIGS. 4 a and 4 b as well as a wide variety of other configurations for an expanding head having separate segments the user may contemplate.
  • FIG. 5 a illustrates a plan view of the outer segment 102 of the expanding head 90 illustrated in FIG. 2 a .
  • the outer segment 102 includes a plurality of slots 108 for receiving staples 14 therein as shown in FIGS. 5 c and 5 d .
  • On the radial inner side of the segment 102 is a groove 160 extending across the entire segment 102 .
  • the arcuate knife portion 110 is positioned in the groove 160 .
  • the knife portion 110 and staples 14 are all fired through a common firing mechanism which can be best seen in FIGS. 5 c and 5 d .
  • a base plate 162 is positioned in a recess 164 extending along the length of the segment 102 .
  • the base plate 162 includes a plurality of pusher bars 166 extending into the individual staple receiving slots 108 for supporting and firing the staples 14 . As illustrated in FIG. 5 c , the base plate 162 is positioned in the recess 164 with enough room for movement (longitudinally of the stapler 100 ) for allowing the firing of the staples 14 and the knife portion 110 . Additionally, the knife portion 110 is attached to the base plate 162 through a series of L-shaped arms 168 at spaced locations along the base plate 162 . The L-shaped arms 168 extend through slots 170 in the segment 102 . The base plate 162 is secured to an actuation rod 172 at the bottom thereof for moving the base plate 162 in the segment 102 for firing of the staples 14 and actuation of the individual knife portion 110 .
  • the individual knife portions of the various segments 102 , 104 will overlap to assure that a complete annular circle is formed and cut by the combined knife portions 110 .
  • the outer segments 102 are provided with pin receiving grooves 176 for pinning the outer segments 102 to the inner segments 104 .
  • the grooves 176 will allow the inner segments 104 to follow a defined path of movement during the expansion and contraction as well as pull the outer segments 102 towards the retracted position when the inner segment pin 178 reaches the radially inner extent of the groove 176 during the retraction of the expandable head 90 .
  • the segments 102 , 104 may most easily be formed of an injection molded plastic design, however, any construction technique and material is contemplated.
  • FIG. 5 e illustrates a plan view of the inner segments 104 for the expandable head 90 in FIGS. 2 a and 2 b .
  • the inner segment 104 additionally includes staple receiving slots 108 in two annular arrays similar to the staple receiving slots 108 formed in the outer segment 102 .
  • the inner segment 104 includes a groove 160 on the radially inner edge thereof receiving an annular knife portion. As illustrated in FIGS. 5 e and 5 f , the annular knife portion 110 of the inner segment 104 extends beyond the edges of the segment 104 to provide on overlapping blade section which would be received in the recess 174 of the outer segments 102 shown in FIG. 5 a .
  • the inner segments 102 will additionally include the pins on the sides thereof for engaging with grooves 160 formed on the sides of the outer segment 102 thereby keying the segments 102 , 104 together.
  • the inner segment 104 will additionally include a firing mechanism comprised of a base plate 162 with staple projections extending vertically upward into the staple receiving slots 108 .
  • the base plate 162 will also be coupled to the knife portion 110 at spaced locations by L-shaped arms (not shown) extending through slots (not shown) in the same manner as in the outer segments 102 disclosed above in FIGS. 5 a and 5 c.
  • the inner segments 104 additionally include a beveled T-shaped slot 180 receiving a wedge rod 182 and wedge element 106 therein which operates to move the inner segments 104 and the outer segments 102 for expanding and contracting the head 90 .
  • the T-shaped slot 180 is intended to be just one configuration for tying the movement of the segments 102 , 104 , both in the expansion and retraction mode, to the movement of the controlling wedge rod 182 and attached wedge element 106 .
  • Other mechanical connections and actuation mechanisms are contemplated within the scope of the present invention. However, it is believed that the simple mechanical coupling of the components as illustrated is generally preferable to a spring-biasing operation which may not be successful if the forces of the operating spring do not overcome friction or other forces in the stapling environment. Consequently, it is believed that the operating mechanism of the present invention provides a mechanically simple and highly reliable method for actuating and moving the expandable head 90 .
  • inner and outer segments 102 , 104 are not limited to the shapes illustrated.
  • the general construction can be expanded to any segment shape such as those illustrated in FIGS. 4 a , 4 b or many other shapes that can be contemplated for forming an expandable head 90 for a stapler 100 .
  • FIGS. 6 a - 6 e illustrate the details of an intraluminal anastomotic stapler 100 with an expanding head 90 illustrated in FIGS. 2 a and 2 b as well as an expanding anvil 120 illustrated in FIGS. 3 a and 3 b .
  • the stapler 100 looks essentially like a conventional EEA stapler having an elongated body 190 of generally circular cross-section further including the expanding head 90 and anvil 120 at a distal end thereof.
  • the expanding anvil 120 will have a length slightly longer than an anvil of a conventional EEA to accommodate the expanding anvil mechanism.
  • the stapler 100 will have generally conventionally shaped controls 192 , 194 for advancing and retracting the anvil 120 relative to the head 90 and for firing of the staples 14 .
  • a rotatable controller 192 is utilized for expanding and contracting the anvil 120 and clamping the lumen sections 10 and 12 together and a pair of pivoted firing grips 194 are utilized for firing the staples 14 .
  • the stapler 100 may include a known safety release (not shown) which does not allow the staples 14 to be fired unless the anvil 120 is in an acceptable proximity of the head 90 .
  • This safety mechanism may also be tied to the expanding mechanism, to be described, such that the firing of the staples 14 would not be possible unless the head 90 and anvil 120 are also expanded to the appropriate expanded, firing positions.
  • a pair of finger grip controllers 196 extend from opposite sides of the housing or body 190 extending from a Z-shaped slot 198 .
  • the user can grip one or both expansion controllers 196 , pivot them slightly out of the retracted position (i.e., one leg of the z-shaped slot 198 ) moving axially along the length of the housing in a axial portion of the Z-shaped slot 198 and then when fully expanded move the controllers 196 into the upper leg of the Z-shaped slot 198 to hold the anvil 120 and head 90 in the fully expanded position.
  • the process can be reversed for retracting both the anvil 120 and head 90 .
  • the outer diameter of the body 190 can be formed approximately equal with the diameter d.sub. 1 of the lumen sections 10 and 12 to be anastomized. It will be understood that the expanded head 90 and anvil 120 will expand the lumen sections to a stretched condition such that the anastomized ring will be formed at a diameter d.sub. 3 , preferably at least as great as the normal unstretched diameter d.sub. 1 of the lumen sections 10 and 12 to be anastomized.
  • FIG. 6 b is a sectional view of the controlling portion taken along two radial sections offset 90 degrees to best illustrate the expansion, clamping and firing controls ( 196 , 192 , 194 ) of the present invention.
  • the operating mechanisms are formed of a series of concentric independently operated sleeves for controlling the various functions of the stapler 100 of the present invention.
  • the sleeves are intended for limited axial motion along the length of the body 190 and may be formed of either a rigid or slightly flexible material.
  • the body 190 may have a certain curvature along its length, as is known in the art, and the operating mechanism can be made of a material to accommodate such curvature.
  • a firing ring 200 which is utilized for actuating the firing mechanisms in the individual head segments 102 , 104 .
  • a series of the firing or actuation rods 172 are attached which extend from the firing ring 200 to each individual base plate 162 of each individual segment 102 , 104 .
  • the firing rods 172 can be pivotally attached to the firing ring 200 and segments 102 , 104 or the rods 172 can be formed sufficiently flexible to accommodate the outward movement of the associated segments 102 , 104 .
  • the opposite end of the firing ring 200 includes a pair of L-shaped legs 202 , only one of which is shown in FIG.
  • an independently movable wedge ring 210 for moving the head segments 102 , 104 as will be discussed.
  • a forward end of the wedge ring 210 are a series of the longitudinally extending wedge rods 182 .
  • the wedge rods 182 and wedge elements 206 combined have a beveled T-shape which is engaged in the T-shaped slot 180 of the inner segments 104 for radially moving the segments 102 , 104 as the associated wedge rod 182 and wedge element 106 are moved longitudinally back and forth along the body 190 .
  • the wedge ring 210 is secured to the pair of opposite extending controllers 196 , only one of which is shown in FIG. 6 b , by an arm 212 or a linkage, again only one of which is shown in FIG. 6 b .
  • longitudinal movement of the controller 196 will move the connecting linkage arm 212 , the wedge ring 210 and the associated wedge rod 182 and wedge element 106 for radially moving the head segments 102 , 104 between the fully extended position shown in FIG. 2 a and the fully retracted position illustrated in FIG. 2 b.
  • anvil stem rod 220 Moving linearly in the body 190 for moving the anvil 120 into and out of a clamping position relative to the head 90 .
  • At one end of the anvil stem rod 220 is a generally disc-shaped actuator 222 threadedly engaging inner threads 224 on the rotatable controller 192 .
  • the rotatable controller 192 is attached to the housing in a manner that allows for rotation such that rotation of the controller 192 will axially move the actuator 222 and the anvil stem rod 220 for moving the anvil 120 essentially in a conventional fashion.
  • a distal end of the anvil stem rod 220 has a snap fit connection 226 with an annular anvil connector 228 allowing the anvil 120 to be released from the body as known in the art.
  • the innermost control mechanism is an anvil expanding rod 230 axially movable in the body 90 and adapted for expanding the anvil segments 102 , 104 between the retracted and expanded positions.
  • the control end of the anvil rod 230 is connected to the expanding controller 196 through a pivoting linkage 232 and a connecting arm 234 .
  • This mechanism allows the axial movement of the controller 196 to be associated with an opposite movement of the expanding anvil rod 230 .
  • a distal end of the expanding anvil rod 230 includes a connector 236 having a bayonet type connection with an anvil wedge rod 238 as shown in FIG. 6 e .
  • the anvil wedge rod 238 is associated with four wedge rod elements 240 which support the wedges 128 received in grooves in the inner anvil expanding segments 122 as shown in FIG. 6 e . It will be appreciated that in the illustrated embodiment the expanding anvil rod 230 and the anvil wedge rod 238 will only be in a secure fitting relationship when the anvil 120 is appropriately clamped against the head 90 . With this construction, it may be helpful to have the anvil wedge rod 238 and the associated segments 102 , 104 be spring-biased to the retracted position so that there is a retracting biasing force when the expanding anvil rod 230 is not engaged with the anvil wedge rod 238 .
  • the connecting arm 234 as a telescoping rod having first and second portions 234 A and 234 B, respectively.
  • the first and second portions 234 A and 234 B are releasably pinned together with a spring-biased release pin 235 being released by a button 237 (upon which the spring 241 acts) on the body 190 when the controller 192 is desired to be rotated.
  • a button 237 upon which the spring 241 acts
  • the pin 235 is automatically reinserted to connect the first and second telescoping portions 234 A and 234 B of the arm 234 such that the connecting arm 234 would accommodate the changed length.
  • This embodiment additionally illustrates the use of a releasable lock or transmission between the expanding anvil rod 230 and the anvil stem rod 220 .
  • the releasable transmission or lock is in the form of a mating pin 247 extending from the lower end of the controller 196 .
  • the mating pin 247 extends into generally identically shaped slots 249 formed in both the expanding anvil rod 230 and the anvil stem rod 220 .
  • the edges of the slot 249 include mating surfaces that will engage and mechanically lock with the mating pin 247 .
  • the slots are designed such that the locking or mating will occur when the controller 196 is in the far left or right radial positions in the z-shaped slot (e.g.
  • the intraluminal end to end anastomotic surgical stapler 100 illustrated in FIG. 6 a is utilized in essentially the same manner as existing anastomotic devices with the addition of an expansion and retraction step.
  • the stapler 100 is inserted into one lumen section 10 or 12 to be anastomized with the anvil 120 and head 90 either spaced apart or separated as desired by the user.
  • Purse strings attached to the lumen sections 10 and 12 can secure the segments 10 and 12 around the anvil stem rod 220 and/or the anvil connector 228 .
  • the controller 196 is rotated to move the anvil 120 and head 90 into at least an initial clamped position.
  • the anvil 120 and head 90 can be expanded to their extended positions and the staples 14 fired. Following firing, the staples 14 will form a enlarged anastomotic ring in the connected lumen sections 10 and 12 with the knife portions 110 trimming off the inner diameter of the lumen sections 10 and 12 secured to the stapler 100 with the purse strings.
  • the head 90 and anvil 120 can be returned to the retracted position following the loosening of the clamped sections to allow the removal of the stapler 100 .
  • the present invention operates essentially the same as existing end to end anastomotic devices with a significantly enlarged anastomosis ring. Specifically, the area at the anastomosis site is not decreased or reduced relative to the normal diameter of the anastomized sections.
  • FIGS. 7 a and 7 b illustrate an extraluminal end to end surgical stapler 300 according to the present invention.
  • the stapler 300 is intended to form anastomized lumen sections with an externally located anastomosis ring relative to the lumen sections 10 and 12 illustrated in FIG. 1 c.
  • the stapler 300 includes two separate stapling units 310 , with each stapling unit 310 generally including two semi-circular sections 320 , 322 hinged together by a hinge 324 extending along the length of the stapling unit.
  • One stapling unit 310 is shown in FIG. 7 a .
  • one half of each stapling unit 310 is formed as an anvil 320 having conventionally positioned staple receiving grooves 126 staggered thereon.
  • the other semi-circular section 322 includes staples 14 and knife portion 110 .
  • the section 322 includes a series of staple receiving slots 108 for the staples 14 and a knife receiving groove 160 with the semi-circular knife portion 110 received in the groove 160 .
  • the staples 14 and knife portions 110 can be fired with a firing mechanism essentially the same as illustrated in the segments 102 , 104 shown in FIGS. 5 a - 5 g and therefore need not be discussed in detail.
  • One difference is that the groove 160 is at the radially outer edge rather than on the radially inner edge.
  • a firing rod 172 is attached to a base plate 162 , not shown, and can be directly connected through the housing 333 to a linkage (not shown) associated with a firing trigger.
  • the anvil and head sections 320 and 322 shown in FIG. 7 a form one entire stapling unit 310 which forms one-half of the stapler 300 .
  • Another identical stapling unit 310 would be attached in an opposite face to face engagement (as shown in FIG.
  • Each staple and knife firing head section 322 is associated with the anvil section 320 of the opposite stapling unit 310 , and vice versa. In other words, half of the staples 14 of the complete anastomosis ring would be fired from one direction and the other half would be fired by the other stapling unit 310 in the opposite direction.
  • Each stapling unit 310 includes alignment mechanisms for combining with the opposite stapling unit 310 to complete the pair of the stapler 300 .
  • the alignment mechanisms can be easily constructed as a rod 330 extending from one section 320 which is received in a locking projection 332 formed on an opposite section 322 . This construction will allow for easy alignment and attachment of the opposed stapling units 310 .
  • each stapling unit 310 includes a plurality of tissue retraction members 340 spaced around the periphery of each stapling unit 310 .
  • the tissue retraction members 340 are in the form of hooks 342 formed at the end of cables 344 at circumferentially spaced locations.
  • the cables 344 extend along grooves formed in the body 190 back to a central controlling structure 350 in the form of an axially movable stud 352 controlled by a rotatable controller 354 journaled to the body 190 . It should be evident that rotation of the controller 354 will axially move the stud 352 allowing the cables 344 to be pulled out of the body 190 or retracted back into the body 190 . With this construction, the hooks 342 can be pulled out and clipped onto the tissues at circumferentially spaced locations around the lumen section 10 or 12 and the controller 354 can be rotated to pull the hooks 342 and the associated tissue back until tissue is surrounding the operating face of the one stapling unit 310 .
  • the present invention contemplates flexible clips 360 attached to the edge of the lumen sections 10 or 12 such as shown in FIGS. 8 a - 8 e .
  • the clips 360 are formed of a flexible hinged strip of material that can be secured around the edge of the resected lumen section.
  • one simple construction for forming the clips 360 is to provide a series of piercing projections 362 on one side of the clip 360 which engage in snap fit receiving holes 364 on the opposite side of the clips 360 such that the clips 360 can be easily press fit in position in a fast and secure manner.
  • the clips 360 include a pair of eyelets 366 at spaced locations thereon with the eyelets 366 forming a connection point for the associated hooks 342 of each stapling unit 310 .
  • the purpose of the clips 360 is to provide rigidity to the end of the lumen sections 10 or 12 being pulled and to distribute the stresses of pulling on the lumen section 10 or 12 across a greater area to avoid damaging the lumen section 10 or 12 and to easily pull the lumen section 10 or 12 into the extended position around the face of a stapling unit 310 .
  • the extraluminal stapler 300 illustrated in FIGS. 7 a and 7 b operates as follows. After the resected portion of the lumen is removed and the two remaining lumen sections 10 and 12 are to be attached, two separate stapling units 310 forming a combined stapler 300 are attached with one unit 310 around each lumen section 10 or 12 .
  • Clips 360 are positioned around the edge of each lumen section 10 or 12 as illustrated in FIG. 8 a and the controller 354 is rotated to release the cables 344 to allow enough slack to attach the hooks 342 to the eyelets 366 of the clips 360 .
  • the controller 354 can be rotated retract the cables 344 , the hooks 342 and the associate clips 360 properly positioning the lumen section 10 or 12 over the operating face of the associated stapling unit 310 .
  • the stapler 300 of the present invention allows for visual inspection to assure that the lumen is properly positioned prior to snapping the two stapling units 310 together using the alignment mechanisms formed by rod 330 and locking projection 332 .
  • the alignment mechanisms will preferably snap or hold the two stapling units 310 together at a position sufficient for firing. It will be understood that an appropriate safety mechanism can be associated so that the staples 14 could not be fired until the opposing stapling unit 310 is secured thereto.
  • the staplers 14 on both halves i.e., in both stapling units 310
  • the staplers 14 on both halves can be fired performing the anastomosis.
  • the two stapling units 310 can be removed from each other and each independently opened and the external stapler is removed from the anastomized lumen.
  • the alignment mechanism 400 essentially includes a plurality of locking pins 402 associated with each head segment 102 and 104 .
  • the locking pins 402 are received in mating holes 404 on the associated anvil segments 122 or 124 .
  • the holes 404 preferably have a beveled outer surface to receive and guide the locking pins 402 into the holes 404 .
  • the pins 402 With the locking pins 402 received in the holes 404 the head and anvil portion of the stapler will be properly aligned.
  • the pins 402 may be moved by the same firing mechanism as the staples and the blade as shown in FIG. 9 .
  • a separate pin movement mechanism may also be provided. It is important that the pins 402 be engaged with the holes 404 prior to the engagement of the staples or the knife blade with the lumen tissue, since it is the pins 402 which are assuring the alignment of the head and anvil portions. Consequently where a single firing mechanism is utilized the pins 402 should be axially ahead of the staple and knife blade portions as shown in an exagerated fashion in FIG. 9 .
  • Another feature of the present invention is to offset the anvil segments and the head segments such that the pins 402 of each head segment will lock the head segment to two corresponding overlapping anvil segments. This will effectively interlock all of the head and anvil segments during firing to provide a conventional solid hoop structure for these components during the staple firing and knife trimming operation. It should be apparent that this alignment mechanism 400 will be applicable to EEA devices that do not have separate head and anvil segments.
  • additional clamping between the stapling units 310 may be accomplished by having the alignment mechanism on each stapling unit 310 (i.e., the rod 330 and locking projection 332 ) be independently axially movable such that when the two stapling units 310 are clamped together, axial movement of the associated alignment mechanism will move the two stapling units 310 closer together (or farther apart) to accommodate the desired clamping.
  • the alignment mechanism on each stapling unit 310 i.e., the rod 330 and locking projection 332
  • Another modification of the present invention would be to connect the firing of one stapling unit 310 to the firing of the other stapling unit 310 , such as through the associated alignment mechanism, so that the user need only pull one trigger 334 to fire the two halves of staples 14 .
  • Another modification to the present invention would be to form the separate units as having an entire array of staples on one stapling unit 310 and two anvil portions on the other stapling unit 310 .
  • the present invention simplifies the manufacturing of the stapler 300 by forming an entire stapler 300 of two identical stapling units 310 .
  • the staples 14 could be replaced with another type of fastener.
  • the described embodiments are merely intended to be illustrative of the present invention and not restrictive thereof. The scope of the present invention is intended to be defined by the appended claims and equivalents thereof.

Abstract

An end to end anastomotic stapling device connects two lumen sections avoiding constriction at the anastomotic ring. An intraluminal end to end anastomotic stapler includes an expanding head and anvil designed to fire an anastomotic ring having an inner diameter at least equal to the nominal inner diameter of the remaining lumen sections. An extraluminal end to end lumen stapler is described attaching the lumen sections with an exterior flange type connection having anastomotic rings with a diameter larger than the inner diameter of the lumen sections whereby the anastomotic site has a diameter at least as great as the adjacent lumen sections

Description

    CROSS-REFERENCE TO RELATED APPLICATION
  • This application is a continuation of and claims the benefit of U.S. patent application Ser. No. 10/910,777, filed on Aug. 2, 2004 and entitled “Luminal Anastomotic Device”, now U.S. Pat. No. 7,080,769 and which published Mar. 31, 2005 as Publication number 2005-0067454. U.S. patent application Ser. No. 10/910,777 is a continuation of and claims the benefit of U.S. patent application Ser. No. 10/114,421, filed on Apr. 2, 2002 and entitled “Luminal Anastomotic Device and Method”, now U.S. Pat. No. 6,769,590 and which published Dec. 12, 2002 as Publication number 2002-0185517 and which claimed the benefit of Provisional Patent Application Ser. No. 60/280,785 entitled, “Luminal Anastomotic Device and Method” filed Apr. 2, 2001. These patents and associated patent publications are incorporated herein by reference in their entirety.
  • BACKGROUND OF THE INVENTION
  • 1. Field of the Invention
  • The present invention relates to surgical anastomotic stapling devices. More particularly, the present invention relates to end to end anastomotic surgical staplers avoiding minimal constrictive area at the anastomosis site.
  • 2. Background Information
  • Surgical staplers have been developed to assist and improve a wide variety of surgical procedures. Surgical staplers provide precision in the placement of staples as well as decrease the time of given surgical procedures. A wide variety of surgical staplers have been developed for vascular, gastric, esophageal and intestinal surgery, to name but a few. These known staplers are often used in anastomosis procedures. In performing surgical anastomotic stapling, generally the two pieces of lumen are attached by a ring of staples with a closed loop stapler. The anastomosis of the lumen may be performed in a side to side, side to end or end to end manner which describes the relative orientation of the lumen sections.
  • The surgical staplers for performing end to end anastomosis are generally intraluminal surgical staplers that fire a pair of staggered rings of staples. These types of surgical staplers are often referred to as EEA's, which stands for “End to End Anastomosis”. During this procedure, a circular knife blade is used to separate tissue which is held within the circular ring. The separated tissue is then removed with the stapler so that a circular opening within the lumen is completed along the surgical stapling line.
  • In performing these surgical procedures with EEA's it has become desirable to separate the anvil on which the staplers are clinched from the stapling head portion from which the staples are expelled. It has been typical in the past that the stapling head is attached to the anvil and the tissue is secured through a “purse stringed” gathering of tissue.
  • Generally, the tissue stapled together with an EEA leaves a smaller opening than the original lumen into which the anvil and stapler head were inserted. Frequently, it is desirable to provide an anvil which can be collapsed to introduce the anvil into the body through a relatively small incision. An example of a surgical stapler having a variable diameter anvil is illustrated in U.S. Pat. No. 4,505,414 disclosing an anvil, integral with a surgical stapler, which can be collapsed and inserted through a small incision in a patient's body and expanded outwardly after placement inside the patients body to staple the wall of an organ to the abdominal wall or an external tissue layer of the patient's body. The anvil is not detachable from the stapler and thus cannot provide a continuous stapler line, but rather applies a broken, discontinuous line to “tack” the tissue in a circular line. This patent also does not provide an anvil which can be placed remotely within the body for subsequent attachment to a stapler head.
  • Other examples of anvils which are capable of collapsing to a reduced diameter after stapling to facilitate removal from the body are shown in U.S. Pat. Nos. 4,752,024; 4,893,622; 4,700,703 and 4,903,697. These anvils are introduced into the body through a relatively large incision.
  • U.S. Pat. No. 5,239,639 also shows a collapsible anvil assembly and applicator instrument for a surgical stapler apparatus. U.S. Pat. No. 6,503,259 is relevant to the present invention in that it discloses a surgical anastomotic fastener array (10 in the '259 patent) comprising a plurality of fasteners (11 of the '259 patent) each having a tissue piercing element (12 of the '259 patent), wherein the fasteners are aligned in an annular array of a first diameter at least prior to anastomosis and are designed to expand to form an annular array of a second larger diameter and then contract as needed after anastomosis. The '259 patent is addressing the same broad concern of the resulting anastomotic ring, but the earliest filing date of the '259 patent is, however, not earlier than the conception date of the present invention.
  • The retractable anvil EEA's discussed above do not address the fundamental problem of the constrictive point formed after luminal anastomosis. These prior art devices simply address the problem of post operative tool removal.
  • It is the object of the present invention to avoid the drawbacks of the prior art by avoiding the minimal constriction formed at luminal anastomotic sites using anastomotic staplers (i.e., EEA's). It is a further object of the present invention to provide anastomotic staplers which are easy to manufacture and utilize. A further object of the present invention is to provide both intraluminal anastomotic end to end staplers and extraluminal anastomotic end to end staplers.
  • SUMMARY OF THE INVENTION
  • The above objects are achieved with the anastomotic device according to the present invention. The anastomotic device according to the present invention is a surgical stapler that will form an anastomosis between existing lumen sections in an end to end alignment forming the anastomosis site with a minimal diameter generally equal to or greater than the normal inner diameter of the anastomized lumen sections, with the lumen sections in a normal relaxed condition. The anastomotic device of the present invention will preferably utilize conventional staples formed in a pair of offset annular arrays of staples to couple the end of a first lumen section to the end of a second lumen section.
  • A first embodiment of the present invention forms the anastomotic device as an intraluminal end to end surgical stapler. The intraluminal surgical stapler fires staples, or other fastening devices, from a stapling head to an adjacent anvil. In accordance with the present invention, both the head and the anvil can be moved from a retracted position having a first relative diameter to an expanded position of a second larger diameter. The expansion of both the head and the anvil allows the anastomotic device to be positioned in the lumen to be attached with minimal interference and then expanded to an enlarged firing position, wherein when fired the anastomotic ring formed by the array of staples is positioned at a diameter preferably at least as large as the minimum diameter of the adjacent lumen sections. After firing, the head and anvil of the stapler of present invention can both be retracted to allow for easy withdrawal of the stapler from the anastomized lumen.
  • In one embodiment of the present invention, the head will be formed of a plurality of wedge-shaped arc segments which move radially and align in an expanded position to form the annular head. The arc segments may be in the form of inner wedge-shaped segments moved by an actuator and outer segments guided by the inner wedge-shaped segments. The wedge-shaped segments may be moved into the expanded or retracted positions by being coupled to the actuator in the form of axially movable wedges controlled by the user.
  • Another embodiment of the present invention will form the annular head as a plurality of arc segments that slide together with the segments formed in an overlapped position in the retracted state and rotate into contracted and expanded positions. A further embodiment of the present invention will hinge various arc segments together to allow the segments to pivot between a retracted position of a minimal diameter and an expanded position forming the annular head ready for firing.
  • Each individual arc segment of the head portion will include staples which combine to form the array of staples in the expanded position. One key aspect of the present invention is that each arc segment has a separate firing mechanism as well as a knife actuating mechanism independently associated with each segment. Each segment will have an arcuate knife portion which will combine and overlap with the knife portions of adjacent segments to form a continuous annular knife arrangement when the head is in the expanded position. In this manner, the knife portions and staples of each individual segment will combine to form the dual stapling array and annular knife well-known to those skilled in the art (except of a larger diameter relative to the body of the stapler). The firing mechanism of each individual segment is additionally coupled to the controller of the stapler in a manner which accommodates movement of the individual segments between the retracted and expanded positions. This construction of the segments allows for the segments to be formed in the hinged arrangements, spirally attached arrangements or wedge arrangements discussed above. Many other possible relatively movable combinations may be constructed with the individual segment construction of the stapler of the present invention.
  • Another aspect of the present invention is to form an external end to end anastomotic surgical stapler. The external stapler according to the present invention is designed to clamp around lumen sections to be attached. The extraluminal stapler according to the present invention is designed to form an anastomizing ring of sutures external to the connected lumen sections. The external stapler according to the present invention forms a pair of annular arrays of staples around an outwardly extending flange of the connected lumen sections.
  • In one embodiment according to the present invention, the extraluminal stapler is formed of two opposed stapler units with each stapler unit formed of two halves hinged together. The extraluminal stapler will include a mechanism for pulling the lumen to be attached around the stapling face of each stapling unit. The extraluminal stapler according to the present invention will additionally include a mechanism for aligning the stapling head and anvil portions of the opposed stapling units with each other as well as a firing mechanism for firing the arrays of staples in the stapling units. One embodiment of the present invention will form each stapling unit as an anvil and head portion hinged together which couples with an adjacent hinged anvil and head portion of the opposed stapling unit.
  • The present invention would be particularly applicable for bowel resections as will be understood by those of ordinary skill in the art, but is not intended to be limited thereto. It can be used in many other applications such as, but not limited to, vascular anastomosis, gastrointestinal anastomosis, esophageal anastomosis and essentially any hollow lumen within the body. Further, the specific embodiments of the invention include a variety of unique features that can be incorporated separately or in various combinations into other stapling and surgical devices for improving those devices.
  • One advantage of the present invention is a minimally invasive surgical stapler that will assist in stapler placement because the diameter of the stapler (i.e. the largest diameter portion, specifically the head and anvil of the stapler) is smaller during insertion and retraction than at firing.
  • Another advantage of the present invention is having a closed loop EEA stapler with the trimming knife formed by individual knife segments. This feature of the present invention may be utilized for firing the knife segments individually, or in a given sequence, or simultaneously (as utilized in the illustrated embodiments of the present invention.
  • Another feature of the present invention is the accommodation of multiple anvil and multiple head controls in a surgical stapler. One present illustrated embodiments provide separate controls for expansion/retraction of the anvil and for axial movement of the anvil. This illustrated embodiment further provides independent control for expansion/retraction of the head and for firing of the knife blade and staples. This system of multiple independent control may be modified to perform a variety of separate control features for the anvil and head portions of an EEA stapler.
  • Another feature of the present invention is the provision of an EEA stapler with a staple and knife firing mechanism that accommodates relative motion of the head portion containing the staples and the firing mechanism.
  • Another feature of the present invention is the provision of an alignment mechanism that aligns and locks the anvil and head portion together prior to the firing of the staples or the knife.
  • Another feature of the present invention is the provision of a closed loop surgical stapler for end to end anastomosis in which the stapler extends around the outside of the lumen portions being anastomised.
  • These and other advantages of the present invention will be clarified in reviewing the detailed description of the preferred embodiments taken together with the attached figures wherein like reference numerals represent like elements throughout.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • FIG. 1 a is a side view, partially in section, of a pair of lumen sections anastomized using existing intraluminal anastomotic staplers;
  • FIG. 1 b is a side view, partially in section, of a pair of lumen sections anastomized with an anastomotic stapler according to a first embodiment of the present invention;
  • FIG. 1 c is a side view, partially in section, of a pair of lumen sections anastomized using an anastomotic stapler according to a second embodiment of the present invention;
  • FIG. 2 a is a schematic plan view of an intraluminal end to end anastomotic stapling head according to the first embodiment of the present invention with the head in the expanded, firing position;
  • FIG. 2 b schematically illustrates the head illustrated in FIG. 2 a in the retracted position;
  • FIG. 3 a schematically illustrates an expandable anvil associated with the anastomotic stapler having the expandable head illustrated in FIGS. 2 a and 2 b;
  • FIG. 3 b schematically illustrates the anvil portion of FIG. 3 a in a retracted position;
  • FIG. 4 a schematically illustrates a spirally retracted and expandable head for an intraluminal end to end surgical stapler according to a second embodiment of the present invention;
  • FIG. 4 b schematically illustrates a hinged expandable and retractable head for an intraluminal end to end surgical stapler according to a third embodiment of the present invention;
  • FIG. 5 a is a plan view of an individual outer head segment of the head illustrated in FIGS. 2 a and 2 b;
  • FIG. 5 b is a radially inner side view of the head segment illustrated in FIG. 5 a;
  • FIG. 5 c is a sectional view of the head segment illustrated in FIG. 5 a taken along line Vc-Vc;
  • FIG. 5 d is a sectional view of the head segment illustrated in FIG. 5 a taken along line Vd-Vd;
  • FIG. 5 e is a top plan view of an inner head segment illustrated in FIGS. 2 a and 2 b;
  • FIG. 5 f is a radially inner side view of the inner head segment illustrated in FIG. 5 e;
  • FIG. 5 g is a sectional view of the inner head segment shown in FIG. 5 e taken along line Vg-Vg;
  • FIG. 6 a is a perspective view of an intraluminal anastomotic surgical stapler utilizing the expandible head illustrated in FIGS. 2 a and 2 b and the expandible anvil illustrated in FIGS. 3 a and 3 b;
  • FIG. 6 b is a partial section of a portion of the stapler illustrated in FIG. 6 a taken along line VIb-VIb in FIG. 6 a;
  • FIG. 6 c is a cross-sectional view of the stapler illustrated in FIG. 6 b taken along line VIc-VIc;
  • FIG. 6 d is a cross-sectional view of the stapler illustrated in FIG. 6 b taken along line VId-VId;
  • FIG. 6 e is a side view partially in section of a distal end of the stapler illustrated in FIG. 6 a;
  • FIG. 7 a is a perspective view partially in section of a first half of an extraluminal end to end surgical stapler according to the present invention;
  • FIG. 7 b is a side view of the complete extraluminal surgical stapler illustrated in FIG. 7 a;
  • FIG. 8 a is a perspective view of a lumen section to be anastomized utilizing flexible clips associated with the surgical stapler illustrated in FIGS. 7 a and 7 b;
  • FIG. 8 b is an end view of the lumen and clips illustrated in FIG. 8 a;
  • FIG. 8 c is a side view of the clips utilized in FIGS. 8 a and 8 b in the open position;
  • FIG. 8 d is a plan view with the clips in the open position of the clip illustrated in FIG. 8 c;
  • FIG. 8 e is a cross-section of the clips illustrated in FIGS. 8 c and 8 d with the clip in a partially closed position;
  • FIG. 9 is a sectional schematic view of an alignment mechanism for use in a stapler of the present invention;
  • FIG. 10 is a sectional schematic view of a motion accommodation mechanism for the anvil expansion mechanism of a stapler according to the present invention; and
  • FIG. 11 is a schematic plan view of a lock and release transmission for an anvil stem and an anvil expansion rod of a stapler according to the present invention.
  • DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • The objects and advantages of the present invention can be best clarified in reviewing the surgical results illustrated in FIGS. 1 a, 1 b and 1 c with the prior art surgical staplers (FIG. 1 a) and various embodiments of surgical staplers (FIGS. 1 b and 1 c) of the present invention, respectively. FIG. 1 a illustrates lumen sections 10 and 12 anastomized with a conventional intraluminal anastomotic stapler (i.e. an EEA). The first lumen section 10 and second lumen section 12 will have a nominal diameter d.sub.1. With existing end to end anastomotic staplers, the anastomosis site, sometimes referred to as an anastomosis ring, formed by an array of staples 14 will have a smaller diameter d.sub.2 than the nominal luminal diameter d.sub.1. In addition to the constrictive point formed by the smaller diameter d.sub.2, with the existence of (1) the array of staples 14, (2) the additional tissue formed by the coupled lumen sections at the anastomosis site, and (3) the scar tissue forming around the anastomotic ring, this constricture or constriction will have greater rigidity, i.e., less flexibility, than the associated lumen tissue. As discussed above, the object of the present invention is to avoid this constrictive point and the possible detrimental effects associated therewith. Of course, the detrimental effects associated with a more rigid constricture in an anastomized lumen would depend on the particular lumen which is coupled together. However, whether connecting together a bowel in vascular anastomosis, or connecting any lumen within the body such constrictures are universally undesirable.
  • FIG. 1 b illustrates the anastomosis of lumen sections 10 and 12 with a surgical stapler 100 according to a first embodiment of the present invention. The anastomotic stapler 100 of the invention associated with the results shown in FIG. 1 b is described in detail in FIGS. 2 a and 2 b, 3 a and 3 b, 4 a and 4 b, 5 a-5 g, and 6 a-6 e. As illustrated in FIG. 1 b, the anastomotic ring or suture site formed by the array of staples 14 has an inner diameter d.sub.3, which is relatively larger than the diameter d.sub.2 associated with conventional staplers. The diameter d.sub.3 is preferable formed at least as great as diameter d.sub.1 of the adjacent lumen sections. In this manner, the detrimental effects of the constricture site can be minimized. It should be appreciated that the inner area of the anastomized lumen is associated with the square of the diameter such that minimal improvements in the diameter of d.sub.3 over d.sub.2 of the prior art will result in substantial increases in the area of the lumen. It is preferred that in the present invention, the diameter d.sub.3 at the anastomotic ring be at least as great, or greater than the nominal diameter d.sub.1 of the associated lumens to avoid any problems with constricture. The relative increase or expansion of the anastomotic ring possible with the device according to the present invention will be associated with the tissue flexibility of the lumen sections for which the particular stapler is designed. For example, tissue forming a bowel (relatively flexible) and tissue forming vascular lumens (less flexible compared to the bowel) would accommodate different relative dimensions for d.sub.3 compared to d.sub.1 at the anastomotic site. However, the general operative concepts of an intraluminal bowel stapler according to the present invention is the same as an intraluminal vascular stapler according to the present invention.
  • FIG. 1 c illustrates an end to end anastomosis of two lumens 10 and 12 with an array of staples 14 utilizing an extraluminal surgical stapler according to a second embodiment of the present invention. The stapler according to the second embodiment of the present invention forms an outer anastomotic ring with the array of staples having a diameter greater than d.sub.1, the normal diameter of the lumen, such that the anastomosis site forms no constricture. The relative positioning of the array of staples 14 will again depend on the particular lumen being anastomized. Examples of the stapler forming this anastomosis are illustrated in FIGS. 7 a, 7 b, and 8 a-8 e below.
  • FIGS. 2 a and 2 b schematically illustrate an expandable head 90 for the intraluminal anastomotic stapler 100 according a first embodiment of the present invention. The expandable head 90 is formed of a plurality of arc segments which interconnect in an outer firing position to form the annular expanded head 90 as shown in FIG. 2 a. The individual segments shown in the embodiment illustrated in FIGS. 2 a and 2 b comprise outer wedge-shaped segments 102 and inner wedge-shaped segments 104. The inner segments 104 are moved radially inwardly and outwardly by individually associated wedge elements 106. The side wedge-shaped engaging surfaces of the inner segments 104 will force the outer segments 102 into the expanded condition. The inner segments 104 can be pinned to the outer segments 102 in a manner to be described later such that retraction of the inner segments 104 to the retracted position shown in FIG. 2 b will also pull the outer segments 102 toward the retracted position.
  • The structure of the individual segments 102, 104 be discussed later in greater detail. Generally speaking, each segment 102, 104 includes a plurality of staple receiving slots 108 in a staggered annular array consisting of both an outer ring and an inner ring of staples receiving slots 108. As clearly evident in the figures, it is an important aspect of the present invention that the division between adjacent segments 102, 104 needs to be accomplished between the staple receiving slots 108. As can be seen in the figures, in the expanded position, the segments 102, 104 combine to form a standard annular array of staples 14 in an offsetting overlapping arrangement. Additionally, each segment 102, 104 includes, at a radial inner side thereof, with knife portions 110 which combine in the expanded position to form an annular knife which provides a trimmed inner edge to the anastomized lumen as is conventional. In order to ensure a complete annular knife in the firing position, and therefore a complete annular smooth cut to the lumen, knife portions 110 of the inner segments 104 overlap with the knife portions of the adjacent outer segments 102 as generally illustrated in the figures. As can be seen in FIGS. 2 a and 2 b, the wedge-shaped interacting arc segments 102, 104 of the head 90 will allow it to be moved between retracted and expanded positions. It should be evident that the present invention is not intended to be limited to the specific number of segments illustrated in FIGS. 2 a and 2 b. A minimization of the diameter in the retracted position can be obtained with as little as three inner wedge-shaped segments 104 spaced about the periphery of the head 90. The number, positioning and specific shape of the segments 102, 104 can be changed as desired in order to allow for the desired degree of expansion. Other factors affecting the number and shape of the individual segments 102, 104 will be the number and length of the specific staples 14 utilized in the inner and outer rings. All of these factors can be considered in designing a specific expanding head 90 which expands to the degree desired.
  • FIGS. 3 a and 3 b illustrate the expanding anvil 120 utilized with the stapler 100 according to the present invention. These figures illustrate that the anvil 120 is formed of inner segments 122 and outer segments 124 similar to the inner segments 104 and outer segments 102 of the head 90. The anvil 120 in the expanded position forms an annular ring with conventional staple engaging grooves 126 which will correspond to the staple receiving slots 108 of the head 90 for cinching the fired staples 14 as known in the art. The inner and outer segments 122, 124 can be pinned together and the inner segments 122 can be moved by a wedge 128 similar to the mechanism for the head 90. The anvil 120 construction is significantly simpler than the head 90 construction for a variety of reasons. First, the anvil 120 construction is not limited to forming the staple engaging grooves 126 entirely on one segment 122 or 124. These expanding anvil segments 122, 124 can be formed essentially in any position even dividing a staple receiving groove 126. This provides significantly greater flexibility in deciding where to put the inner and outer segments 122, 124. An additional aspect to making the anvil 120 significantly easier to design and operate is that there is no knife or staple firing mechanisms which needs to be incorporated into the expanding and retracting anvil 120. In fact, the prior art illustrates that expanding anvils have been well-known in the art, and many of these constructions can also be incorporated into the design of the present invention. For the sake of simplicity, however, the design of the anvil 120 is essentially the same as the design of the expanding head 90 illustrated in FIGS. 2 a and 2 b.
  • FIGS. 4 a and 4 b are intended to illustrate alternative expanding head mechanisms according to the present invention. FIG. 4 a illustrates an expanding head 140 according to one embodiment of the present invention in which the head 140 is formed of individual segments 142 which can slide past each other in an overlapping arrangement to contract in a spiral fashion as illustrated by the arrows. In place of an actuating wedge, the actuating mechanism may be a rotating cam type operator, although a variety of segment 142 moving mechanisms can be envisioned.
  • FIG. 4 b illustrates yet another embodiment for an expanding head 150 for a stapler 100 of the present invention in which individual segments 152 of the head 150 are hinged together by hinges 154 to move between expanded and contracted positions. This embodiment illustrates three hinges 154 and one open connection which can have these segments 152 snap together to form the continuous ring. The number of individual segments 152 may be selected as desired. The hinges 154 may include spring-biasing to help move the segment 152 to either the expanded or retracted positions. A mechanical actuator linearly moving along the length of the stapler 100 would be used to move the segments 152.
  • FIGS. 5 a-5 g illustrate the details of the individual arc segments 102, 104 forming the expandable head 90 illustrated in FIGS. 2 a and 2 b. The segments 102, 104 are discussed in detail and illustrated associated with the specific expanding head 90 illustrated in FIGS. 2 a and 2 b. However, the general concepts of these individual segments 102, 104 can be easily extrapolated for many different embodiments, such as those illustrated in FIGS. 4 a and 4 b. The key features of the arc segments 102, 104 for the expanding head 90 according to the present invention is that the individual segments 102, 104 have independent firing mechanisms for the staples 14 and the knife portions 110 that are associated with that segment 102, 104. Additionally, the firing mechanism accommodates the relative motion of the segments 102, 104 between the retracted and expanded positions. As will be evident in the description of FIGS. 5 a-5 g, these components utilized in the segments 102, 104 of the present invention can be utilized in the expanding heads 140 and 150 illustrated in FIGS. 4 a and 4 b as well as a wide variety of other configurations for an expanding head having separate segments the user may contemplate.
  • FIG. 5 a illustrates a plan view of the outer segment 102 of the expanding head 90 illustrated in FIG. 2 a. The outer segment 102 includes a plurality of slots 108 for receiving staples 14 therein as shown in FIGS. 5 c and 5 d. On the radial inner side of the segment 102 is a groove 160 extending across the entire segment 102. The arcuate knife portion 110 is positioned in the groove 160. The knife portion 110 and staples 14 are all fired through a common firing mechanism which can be best seen in FIGS. 5 c and 5 d. Essentially, a base plate 162 is positioned in a recess 164 extending along the length of the segment 102. The base plate 162 includes a plurality of pusher bars 166 extending into the individual staple receiving slots 108 for supporting and firing the staples 14. As illustrated in FIG. 5 c, the base plate 162 is positioned in the recess 164 with enough room for movement (longitudinally of the stapler 100) for allowing the firing of the staples 14 and the knife portion 110. Additionally, the knife portion 110 is attached to the base plate 162 through a series of L-shaped arms 168 at spaced locations along the base plate 162. The L-shaped arms 168 extend through slots 170 in the segment 102. The base plate 162 is secured to an actuation rod 172 at the bottom thereof for moving the base plate 162 in the segment 102 for firing of the staples 14 and actuation of the individual knife portion 110.
  • As discussed previously, the individual knife portions of the various segments 102, 104 will overlap to assure that a complete annular circle is formed and cut by the combined knife portions 110. In order to easily accommodate the overlapping of the outer edges of the segments 102 near the groove 160 are cut out at recess 174 to allow the overlapping portions of the knife portions 110 of the inner segments 104 discussed below to easily overlap the knife portions 110 of the outer segments 102 when the inner segments 104 are pushed into position. Additionally, the outer segments 102 are provided with pin receiving grooves 176 for pinning the outer segments 102 to the inner segments 104. The grooves 176 will allow the inner segments 104 to follow a defined path of movement during the expansion and contraction as well as pull the outer segments 102 towards the retracted position when the inner segment pin 178 reaches the radially inner extent of the groove 176 during the retraction of the expandable head 90.
  • In view of the complex shape, it is expected that the segments 102, 104 may most easily be formed of an injection molded plastic design, however, any construction technique and material is contemplated.
  • FIG. 5 e illustrates a plan view of the inner segments 104 for the expandable head 90 in FIGS. 2 a and 2 b. The inner segment 104 additionally includes staple receiving slots 108 in two annular arrays similar to the staple receiving slots 108 formed in the outer segment 102. Furthermore, the inner segment 104 includes a groove 160 on the radially inner edge thereof receiving an annular knife portion. As illustrated in FIGS. 5 e and 5 f, the annular knife portion 110 of the inner segment 104 extends beyond the edges of the segment 104 to provide on overlapping blade section which would be received in the recess 174 of the outer segments 102 shown in FIG. 5 a. As discussed above, this construction ensures the overlapping of the knife portions 110 to form a complete annular knife blade ring 178. The inner segments 102 will additionally include the pins on the sides thereof for engaging with grooves 160 formed on the sides of the outer segment 102 thereby keying the segments 102, 104 together.
  • As shown in FIG. 5 g, the inner segment 104 will additionally include a firing mechanism comprised of a base plate 162 with staple projections extending vertically upward into the staple receiving slots 108. The base plate 162 will also be coupled to the knife portion 110 at spaced locations by L-shaped arms (not shown) extending through slots (not shown) in the same manner as in the outer segments 102 disclosed above in FIGS. 5 a and 5 c.
  • The inner segments 104 additionally include a beveled T-shaped slot 180 receiving a wedge rod 182 and wedge element 106 therein which operates to move the inner segments 104 and the outer segments 102 for expanding and contracting the head 90. The T-shaped slot 180 is intended to be just one configuration for tying the movement of the segments 102, 104, both in the expansion and retraction mode, to the movement of the controlling wedge rod 182 and attached wedge element 106. Other mechanical connections and actuation mechanisms are contemplated within the scope of the present invention. However, it is believed that the simple mechanical coupling of the components as illustrated is generally preferable to a spring-biasing operation which may not be successful if the forces of the operating spring do not overcome friction or other forces in the stapling environment. Consequently, it is believed that the operating mechanism of the present invention provides a mechanically simple and highly reliable method for actuating and moving the expandable head 90.
  • It will be appreciated that the specific construction of the inner and outer segments 102, 104 are not limited to the shapes illustrated. The general construction can be expanded to any segment shape such as those illustrated in FIGS. 4 a, 4 b or many other shapes that can be contemplated for forming an expandable head 90 for a stapler 100.
  • FIGS. 6 a-6 e illustrate the details of an intraluminal anastomotic stapler 100 with an expanding head 90 illustrated in FIGS. 2 a and 2 b as well as an expanding anvil 120 illustrated in FIGS. 3 a and 3 b. The stapler 100 looks essentially like a conventional EEA stapler having an elongated body 190 of generally circular cross-section further including the expanding head 90 and anvil 120 at a distal end thereof. The expanding anvil 120 will have a length slightly longer than an anvil of a conventional EEA to accommodate the expanding anvil mechanism. At the opposite end of the body 190, the stapler 100 will have generally conventionally shaped controls 192, 194 for advancing and retracting the anvil 120 relative to the head 90 and for firing of the staples 14. Specifically, a rotatable controller 192 is utilized for expanding and contracting the anvil 120 and clamping the lumen sections 10 and 12 together and a pair of pivoted firing grips 194 are utilized for firing the staples 14. Additionally, the stapler 100 may include a known safety release (not shown) which does not allow the staples 14 to be fired unless the anvil 120 is in an acceptable proximity of the head 90. This safety mechanism may also be tied to the expanding mechanism, to be described, such that the firing of the staples 14 would not be possible unless the head 90 and anvil 120 are also expanded to the appropriate expanded, firing positions.
  • With regard to the expansion control, a pair of finger grip controllers 196 extend from opposite sides of the housing or body 190 extending from a Z-shaped slot 198. When desired to expand, the user can grip one or both expansion controllers 196, pivot them slightly out of the retracted position (i.e., one leg of the z-shaped slot 198) moving axially along the length of the housing in a axial portion of the Z-shaped slot 198 and then when fully expanded move the controllers 196 into the upper leg of the Z-shaped slot 198 to hold the anvil 120 and head 90 in the fully expanded position. After firing, the process can be reversed for retracting both the anvil 120 and head 90. It will be appreciated that within this construction, the outer diameter of the body 190 can be formed approximately equal with the diameter d.sub.1 of the lumen sections 10 and 12 to be anastomized. It will be understood that the expanded head 90 and anvil 120 will expand the lumen sections to a stretched condition such that the anastomized ring will be formed at a diameter d.sub.3, preferably at least as great as the normal unstretched diameter d.sub.1 of the lumen sections 10 and 12 to be anastomized.
  • FIG. 6 b is a sectional view of the controlling portion taken along two radial sections offset 90 degrees to best illustrate the expansion, clamping and firing controls (196, 192, 194) of the present invention.
  • As shown in FIGS. 6 b and 6 c, for at least a portion of the housing or body 190, the operating mechanisms are formed of a series of concentric independently operated sleeves for controlling the various functions of the stapler 100 of the present invention. It should be understood that the sleeves are intended for limited axial motion along the length of the body 190 and may be formed of either a rigid or slightly flexible material. In other words, the body 190 may have a certain curvature along its length, as is known in the art, and the operating mechanism can be made of a material to accommodate such curvature.
  • Beginning next to the annular housing or body 190 is a firing ring 200 which is utilized for actuating the firing mechanisms in the individual head segments 102, 104. At one end of the axially movable firing ring 200, a series of the firing or actuation rods 172 are attached which extend from the firing ring 200 to each individual base plate 162 of each individual segment 102, 104. The firing rods 172 can be pivotally attached to the firing ring 200 and segments 102, 104 or the rods 172 can be formed sufficiently flexible to accommodate the outward movement of the associated segments 102, 104. The opposite end of the firing ring 200 includes a pair of L-shaped legs 202, only one of which is shown in FIG. 6 b, attached to the individual firing grips 194. As can be easily understood by viewing FIG. 6 b, when the firing grips 194 are pulled, the legs 202 in the firing ring 200 will be moved axially along the body 190 moving the rods 172, axially along the body thereby pushing the associated base plates 162, firing the individual staples 14 and actuating the individual knife portions 110. It should be appreciated by those of ordinary skill in the art that a wide variety of changes to the firing mechanism can be envisioned. For example, a pull trigger could easily replace the firing grips 194. The firing grips 194 are illustrated since this represents a known acceptable operating mechanism. As discussed above, a safety latch mechanism can be incorporated, if desired, to avoid premature firing of the staples 14. The construction of such safety devices is certainly known to those of ordinary skill in the art.
  • Radially adjacent the firing ring 200 is an independently movable wedge ring 210 for moving the head segments 102, 104 as will be discussed. At a forward end of the wedge ring 210 are a series of the longitudinally extending wedge rods 182. The wedge rods 182 and wedge elements 206 combined have a beveled T-shape which is engaged in the T-shaped slot 180 of the inner segments 104 for radially moving the segments 102, 104 as the associated wedge rod 182 and wedge element 106 are moved longitudinally back and forth along the body 190. As illustrated in FIG. 6 d, there is one wedge element 106 associated with each inner segment 104. On the opposite end of the wedge ring 210 the wedge ring 210 is secured to the pair of opposite extending controllers 196, only one of which is shown in FIG. 6 b, by an arm 212 or a linkage, again only one of which is shown in FIG. 6 b. As can be most apparent in FIG. 6 b, longitudinal movement of the controller 196 will move the connecting linkage arm 212, the wedge ring 210 and the associated wedge rod 182 and wedge element 106 for radially moving the head segments 102, 104 between the fully extended position shown in FIG. 2 a and the fully retracted position illustrated in FIG. 2 b.
  • Radially adjacent the wedge ring 210 is an anvil stem rod 220 moving linearly in the body 190 for moving the anvil 120 into and out of a clamping position relative to the head 90. At one end of the anvil stem rod 220 is a generally disc-shaped actuator 222 threadedly engaging inner threads 224 on the rotatable controller 192. The rotatable controller 192 is attached to the housing in a manner that allows for rotation such that rotation of the controller 192 will axially move the actuator 222 and the anvil stem rod 220 for moving the anvil 120 essentially in a conventional fashion. As shown in FIG. 6 e, a distal end of the anvil stem rod 220 has a snap fit connection 226 with an annular anvil connector 228 allowing the anvil 120 to be released from the body as known in the art.
  • Finally, returning to FIG. 6 b, the innermost control mechanism is an anvil expanding rod 230 axially movable in the body 90 and adapted for expanding the anvil segments 102, 104 between the retracted and expanded positions. The control end of the anvil rod 230 is connected to the expanding controller 196 through a pivoting linkage 232 and a connecting arm 234. This mechanism allows the axial movement of the controller 196 to be associated with an opposite movement of the expanding anvil rod 230. A distal end of the expanding anvil rod 230 includes a connector 236 having a bayonet type connection with an anvil wedge rod 238 as shown in FIG. 6 e. The anvil wedge rod 238 is associated with four wedge rod elements 240 which support the wedges 128 received in grooves in the inner anvil expanding segments 122 as shown in FIG. 6 e. It will be appreciated that in the illustrated embodiment the expanding anvil rod 230 and the anvil wedge rod 238 will only be in a secure fitting relationship when the anvil 120 is appropriately clamped against the head 90. With this construction, it may be helpful to have the anvil wedge rod 238 and the associated segments 102, 104 be spring-biased to the retracted position so that there is a retracting biasing force when the expanding anvil rod 230 is not engaged with the anvil wedge rod 238.
  • It should be appreciated that other constructions are certainly anticipated, such as having the wedge rod 238 and the expanding anvil rod 230 always coupled when the anvil stem rod 220 and annular anvil connector 228 are connected. In this modification, the anvil expanding rod 230 and the anvil stem rod 220 will need to be moved together. The anvil stem rod 220 is moved relative to the body 190 by rotation of the controller 192. In this modification, the movement of the anvil stem rod 220 can be accommodated by moving the pivoting linkage 232 and the expanding anvil rod 230 with the anvil stem rod 220 and having a lost motion or motion accommodating mechanism be added to the connecting arm 234 to accommodate the change in relative position. One simple example of such a mechanism is illustrated in FIGS. 10 and 11 and essentially includes forming the connecting arm 234 as a telescoping rod having first and second portions 234A and 234B, respectively. The first and second portions 234A and 234B are releasably pinned together with a spring-biased release pin 235 being released by a button 237 (upon which the spring 241 acts) on the body 190 when the controller 192 is desired to be rotated. With such a spring-biased release button 237 and pin 235, the pin 235 is automatically reinserted to connect the first and second telescoping portions 234A and 234B of the arm 234 such that the connecting arm 234 would accommodate the changed length. This embodiment additionally illustrates the use of a releasable lock or transmission between the expanding anvil rod 230 and the anvil stem rod 220. The releasable transmission or lock is in the form of a mating pin 247 extending from the lower end of the controller 196. The mating pin 247 extends into generally identically shaped slots 249 formed in both the expanding anvil rod 230 and the anvil stem rod 220. As shown in FIG. 11 the edges of the slot 249 include mating surfaces that will engage and mechanically lock with the mating pin 247. The slots are designed such that the locking or mating will occur when the controller 196 is in the far left or right radial positions in the z-shaped slot (e.g. when the controller 196 is in the top or bottom leg portions of the z shaped slot) as shown in positions A and B in FIG. 11. When the controller 196 is in the center of the Z-shaped slot for longitudinal movement the pin 247 will be disengaged from the edges of the slot 249 as shown in position C allowing for the relative movement between the expanding anvil rod 230 and the anvil stem rod 220. It will be understood that this transmission will require modification of the Z-shaped slot to accommodate movement of the controller due to axial movement of the anvil, such as increasing the width of the bottom leg of the z in the z shaped slot. This will additionally provide a visual indicator of the relative axial position of the stem prior to expansion of the anvil. This embodiment could utilize the motion accommodating mechanism without the mechanical lock or transmission or the mechanical lock may be used in other EEA staplers as merely a stem position indicating mechanism. This embodiment is described to show the possibility of such a construction.
  • It should be appreciated that the intraluminal end to end anastomotic surgical stapler 100 illustrated in FIG. 6 a is utilized in essentially the same manner as existing anastomotic devices with the addition of an expansion and retraction step. Specifically, the stapler 100 is inserted into one lumen section 10 or 12 to be anastomized with the anvil 120 and head 90 either spaced apart or separated as desired by the user. Purse strings attached to the lumen sections 10 and 12 can secure the segments 10 and 12 around the anvil stem rod 220 and/or the anvil connector 228. The controller 196 is rotated to move the anvil 120 and head 90 into at least an initial clamped position. At this point, the anvil 120 and head 90 can be expanded to their extended positions and the staples 14 fired. Following firing, the staples 14 will form a enlarged anastomotic ring in the connected lumen sections 10 and 12 with the knife portions 110 trimming off the inner diameter of the lumen sections 10 and 12 secured to the stapler 100 with the purse strings. The head 90 and anvil 120 can be returned to the retracted position following the loosening of the clamped sections to allow the removal of the stapler 100.
  • The present invention operates essentially the same as existing end to end anastomotic devices with a significantly enlarged anastomosis ring. Specifically, the area at the anastomosis site is not decreased or reduced relative to the normal diameter of the anastomized sections.
  • FIGS. 7 a and 7 b illustrate an extraluminal end to end surgical stapler 300 according to the present invention. The stapler 300 is intended to form anastomized lumen sections with an externally located anastomosis ring relative to the lumen sections 10 and 12 illustrated in FIG. 1 c.
  • The stapler 300 according to the present invention includes two separate stapling units 310, with each stapling unit 310 generally including two semi-circular sections 320, 322 hinged together by a hinge 324 extending along the length of the stapling unit. One stapling unit 310 is shown in FIG. 7 a. In a preferred embodiment of the present invention, one half of each stapling unit 310 is formed as an anvil 320 having conventionally positioned staple receiving grooves 126 staggered thereon. The other semi-circular section 322 includes staples 14 and knife portion 110. The section 322 includes a series of staple receiving slots 108 for the staples 14 and a knife receiving groove 160 with the semi-circular knife portion 110 received in the groove 160. The staples 14 and knife portions 110 can be fired with a firing mechanism essentially the same as illustrated in the segments 102, 104 shown in FIGS. 5 a-5 g and therefore need not be discussed in detail. One difference is that the groove 160 is at the radially outer edge rather than on the radially inner edge. A firing rod 172 is attached to a base plate 162, not shown, and can be directly connected through the housing 333 to a linkage (not shown) associated with a firing trigger. The anvil and head sections 320 and 322 shown in FIG. 7 a form one entire stapling unit 310 which forms one-half of the stapler 300. Another identical stapling unit 310 would be attached in an opposite face to face engagement (as shown in FIG. 7 b.). Each staple and knife firing head section 322 is associated with the anvil section 320 of the opposite stapling unit 310, and vice versa. In other words, half of the staples 14 of the complete anastomosis ring would be fired from one direction and the other half would be fired by the other stapling unit 310 in the opposite direction. Each stapling unit 310 includes alignment mechanisms for combining with the opposite stapling unit 310 to complete the pair of the stapler 300. The alignment mechanisms can be easily constructed as a rod 330 extending from one section 320 which is received in a locking projection 332 formed on an opposite section 322. This construction will allow for easy alignment and attachment of the opposed stapling units 310.
  • Another key aspect of the present invention is a tissue holding mechanism for pulling the tissue of the lumen sections 10 or 12 to be attached over the operating face of the stapling units 310. As will be appreciated by those of ordinary skill in the art, with such an extraluminal stapler 300 as disclosed, purse strings would not be very efficient for positioning of the lumen sections 10 and 12 to be attached on the stapler 300. To accomplish the positioning of the tissue, each stapling unit 310 includes a plurality of tissue retraction members 340 spaced around the periphery of each stapling unit 310. The tissue retraction members 340 are in the form of hooks 342 formed at the end of cables 344 at circumferentially spaced locations. The cables 344 extend along grooves formed in the body 190 back to a central controlling structure 350 in the form of an axially movable stud 352 controlled by a rotatable controller 354 journaled to the body 190. It should be evident that rotation of the controller 354 will axially move the stud 352 allowing the cables 344 to be pulled out of the body 190 or retracted back into the body 190. With this construction, the hooks 342 can be pulled out and clipped onto the tissues at circumferentially spaced locations around the lumen section 10 or 12 and the controller 354 can be rotated to pull the hooks 342 and the associated tissue back until tissue is surrounding the operating face of the one stapling unit 310.
  • It is anticipated that certain tissue may not be efficiently stretched by a hook 342 attached at a single location (i.e., it may tear). To eliminate this, the present invention contemplates flexible clips 360 attached to the edge of the lumen sections 10 or 12 such as shown in FIGS. 8 a-8 e. The clips 360 are formed of a flexible hinged strip of material that can be secured around the edge of the resected lumen section. As shown in FIGS. 8 c-8 e, one simple construction for forming the clips 360 is to provide a series of piercing projections 362 on one side of the clip 360 which engage in snap fit receiving holes 364 on the opposite side of the clips 360 such that the clips 360 can be easily press fit in position in a fast and secure manner. The clips 360 include a pair of eyelets 366 at spaced locations thereon with the eyelets 366 forming a connection point for the associated hooks 342 of each stapling unit 310. The purpose of the clips 360 is to provide rigidity to the end of the lumen sections 10 or 12 being pulled and to distribute the stresses of pulling on the lumen section 10 or 12 across a greater area to avoid damaging the lumen section 10 or 12 and to easily pull the lumen section 10 or 12 into the extended position around the face of a stapling unit 310.
  • In operation, the extraluminal stapler 300 illustrated in FIGS. 7 a and 7 b operates as follows. After the resected portion of the lumen is removed and the two remaining lumen sections 10 and 12 are to be attached, two separate stapling units 310 forming a combined stapler 300 are attached with one unit 310 around each lumen section 10 or 12. Clips 360 are positioned around the edge of each lumen section 10 or 12 as illustrated in FIG. 8 a and the controller 354 is rotated to release the cables 344 to allow enough slack to attach the hooks 342 to the eyelets 366 of the clips 360. Once the eyelets 366 are attached to the associated clips 360, the controller 354 can be rotated retract the cables 344, the hooks 342 and the associate clips 360 properly positioning the lumen section 10 or 12 over the operating face of the associated stapling unit 310. Following this, the stapler 300 of the present invention allows for visual inspection to assure that the lumen is properly positioned prior to snapping the two stapling units 310 together using the alignment mechanisms formed by rod 330 and locking projection 332. The alignment mechanisms will preferably snap or hold the two stapling units 310 together at a position sufficient for firing. It will be understood that an appropriate safety mechanism can be associated so that the staples 14 could not be fired until the opposing stapling unit 310 is secured thereto. Once the opposing stapling unit 310 is secured, the staplers 14 on both halves (i.e., in both stapling units 310) can be fired performing the anastomosis. Following this, the two stapling units 310 can be removed from each other and each independently opened and the external stapler is removed from the anastomized lumen.
  • The use of an alignment mechanism for aligning the head and anvil portions of EEA staplers such as shown in staplers units 310 would also be beneficial for internal EEA staplers such as shown in FIGS. 6 a-e. The present invention contemplates an alignment mechanism 400 associated with such an EEA stapler as schematically shown in FIG. 9. The alignment mechanism 400 essentially includes a plurality of locking pins 402 associated with each head segment 102 and 104. The locking pins 402 are received in mating holes 404 on the associated anvil segments 122 or 124. The holes 404 preferably have a beveled outer surface to receive and guide the locking pins 402 into the holes 404. With the locking pins 402 received in the holes 404 the head and anvil portion of the stapler will be properly aligned. The pins 402 may be moved by the same firing mechanism as the staples and the blade as shown in FIG. 9. A separate pin movement mechanism may also be provided. It is important that the pins 402 be engaged with the holes 404 prior to the engagement of the staples or the knife blade with the lumen tissue, since it is the pins 402 which are assuring the alignment of the head and anvil portions. Consequently where a single firing mechanism is utilized the pins 402 should be axially ahead of the staple and knife blade portions as shown in an exagerated fashion in FIG. 9. Another feature of the present invention is to offset the anvil segments and the head segments such that the pins 402 of each head segment will lock the head segment to two corresponding overlapping anvil segments. This will effectively interlock all of the head and anvil segments during firing to provide a conventional solid hoop structure for these components during the staple firing and knife trimming operation. It should be apparent that this alignment mechanism 400 will be applicable to EEA devices that do not have separate head and anvil segments.
  • Various modifications to this invention are contemplated within the scope of the present invention. For example, additional clamping between the stapling units 310 may be accomplished by having the alignment mechanism on each stapling unit 310 (i.e., the rod 330 and locking projection 332) be independently axially movable such that when the two stapling units 310 are clamped together, axial movement of the associated alignment mechanism will move the two stapling units 310 closer together (or farther apart) to accommodate the desired clamping. Another modification of the present invention would be to connect the firing of one stapling unit 310 to the firing of the other stapling unit 310, such as through the associated alignment mechanism, so that the user need only pull one trigger 334 to fire the two halves of staples 14. Another modification to the present invention would be to form the separate units as having an entire array of staples on one stapling unit 310 and two anvil portions on the other stapling unit 310. However, the present invention simplifies the manufacturing of the stapler 300 by forming an entire stapler 300 of two identical stapling units 310. Regardless, these and other modifications make it clear that various changes to the present invention can be accomplished without departing from the spirit and scope thereof. For example, the staples 14 could be replaced with another type of fastener. The described embodiments are merely intended to be illustrative of the present invention and not restrictive thereof. The scope of the present invention is intended to be defined by the appended claims and equivalents thereof.

Claims (25)

1.-75. (canceled)
76. An external anastomotic stapler comprising two substantially identical, separate stapling units received around the lumen portions and coupled together with an alignment mechanism, wherein each stapling unit includes at least two sections, connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.
77. The anastomotic stapler of claim 76, wherein each stapling unit includes two semi-circular sections connected longitudinally by a hinge, said hinge extending longitudinally along the length of the stapling unit.
78. The anastomotic stapler of claim 77, wherein a first semi-circular section is formed as an anvil, and a second semi-circular section comprises a stapling mechanism and a knife portion.
79. The anastomotic stapler of claim 78, wherein the first semi-circular section includes a series of staple receiving slots and a knife receiving groove, said knife receiving groove situated at the radially outer edge of the first semi-circular section, and wherein the second semi-circular section includes the knife portion situated at the radially outer edge thereof.
80. The anastomotic stapler of claim 78, wherein the separate stapling units may be engaged face-to-face such that staples fired from the stapling mechanism of a first stapling unit may be received in the anvil of a second stapling unit upon firing, and staples fired from the stapling mechanism of a second stapling unit may be received in the anvil of the first stapling unit upon firing in the opposite direction.
81. The anastomotic stapler of claim 80, further comprising at least pin forming the alignment and allowing for alignment of the separate stapling units when engaged face-to-face.
82. The anastomotic stapler of claim 76, wherein said stapler may be fired from one end of the device.
83. The anastomotic stapler of claim 76, wherein each stapling unit further comprises a plurality of tissue retraction members spaced around the periphery of each stapling unit.
84.-88. (canceled)
89. An extraluminal intestinal stapler for end to end anastomosis formed of two opposed stapling units; each unit clamping around a lumen section to be anastomized; wherein each said stapling unit comprises two halves hinged together, and wherein one half of each unit is a stapling unit and the other half is an anvil portion.
90. The stapler of claim 89, further including a mechanism for pulling the lumen to be attached across the stapling face of each stapling unit.
91. The stapler of claim 89, further including an alignment mechanism for aligning the two adjacent stapling units prior to firing a ring of staples.
92.-188. (canceled)
189. An extraluminal stapler for end to end anastomosis formed of two opposed generally identical, opposed stapling units; each unit clamping around a lumen section to be anastomized; wherein each said stapling unit comprises two halves, and wherein one half of each unit is a stapling unit and the other half is an anvil portion.
190. The stapler of claim 189, further including a mechanism for pulling the lumen to be attached across the stapling face of each stapling unit.
191. The stapler of claim 190, further including an alignment mechanism for aligning the two adjacent stapling units prior to firing a ring of staples.
192. The stapler of claim 190 wherein the tissue pulling mechanism includes a tissue grasping and positioning mechanism for positioning a lumen portion to be anastomized across the stapling face of the stapler in end to end anastomosis.
193. The stapler of claim 190 wherein the tissue pulling mechanism includes a series of identical tissue grasping clips, each clip formed of a flexible strip of material, the clips being secured around the edge of a lumen portion to be anastomized through snap fit connections with the clips providing for grasping and for positioning the lumen portion across the stapling face of a surgical sapling unit.
194.-200. (canceled)
201. The stapler of claim 190 wherein the tissue pulling mechanism includes a tissue manipulator for attachment to tissue to be manipulated by a surgeon, the tissue manipulator comprising:
A) an elongated band attachable to the tissue;
B) a tissue attachment mechanism on a first side of the elongated band for attaching the tissue manipulator to the tissue; and
C) at least one manipulator on a second side of the elongated band, whereby the surgeon manipulates the tissue through the at least one manipulator that transfers the manipulation forces to the tissue generally evenly along the elongated band to minimize tissue damage.
202. The stapler of claim 201, wherein the elongated band is a flexible member adapted to be folded along an axis thereof about the tissue.
203. The stapler of claim 202, wherein the tissue attachment mechanism includes a plurality of snap fit connections.
204. The stapler of claim 202, wherein the tissue attachment mechanism includes adhesive on the first side of the elongated band.
205.-207. (canceled)
US11/458,134 2001-04-02 2006-07-18 Luminal anastomotic device and method Abandoned US20070027473A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US11/458,134 US20070027473A1 (en) 2001-04-02 2006-07-18 Luminal anastomotic device and method

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US28078501P 2001-04-02 2001-04-02
US10/114,421 US6769590B2 (en) 2001-04-02 2002-04-02 Luminal anastomotic device and method
US10/910,777 US7080769B2 (en) 2001-04-02 2004-08-02 Luminal anastomotic device
US11/458,134 US20070027473A1 (en) 2001-04-02 2006-07-18 Luminal anastomotic device and method

Related Parent Applications (2)

Application Number Title Priority Date Filing Date
US10/114,421 Continuation US6769590B2 (en) 2001-04-02 2002-04-02 Luminal anastomotic device and method
US10/910,777 Continuation US7080769B2 (en) 2001-04-02 2004-08-02 Luminal anastomotic device

Publications (1)

Publication Number Publication Date
US20070027473A1 true US20070027473A1 (en) 2007-02-01

Family

ID=26812165

Family Applications (3)

Application Number Title Priority Date Filing Date
US10/114,421 Expired - Fee Related US6769590B2 (en) 2001-04-02 2002-04-02 Luminal anastomotic device and method
US10/910,777 Expired - Fee Related US7080769B2 (en) 2001-04-02 2004-08-02 Luminal anastomotic device
US11/458,134 Abandoned US20070027473A1 (en) 2001-04-02 2006-07-18 Luminal anastomotic device and method

Family Applications Before (2)

Application Number Title Priority Date Filing Date
US10/114,421 Expired - Fee Related US6769590B2 (en) 2001-04-02 2002-04-02 Luminal anastomotic device and method
US10/910,777 Expired - Fee Related US7080769B2 (en) 2001-04-02 2004-08-02 Luminal anastomotic device

Country Status (1)

Country Link
US (3) US6769590B2 (en)

Cited By (167)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20060097025A1 (en) * 2002-10-04 2006-05-11 Tyco Healthcare Graoup Llp Surgical stapling device
US20100089971A1 (en) * 2008-09-10 2010-04-15 Milliman Keith L Surgical stapling device
US20110042443A1 (en) * 2009-08-19 2011-02-24 Milliman Keith L Surgical stapler
US20110095070A1 (en) * 2009-10-28 2011-04-28 Nihir Patel Surgical stapling instrument
US20110095069A1 (en) * 2009-10-28 2011-04-28 Nihir Patel Surgical fastening apparatus
US7975895B2 (en) 2004-03-19 2011-07-12 Tyco Healthcare Group L.P. Tissue tensioner assembly and approximation mechanism for surgical stapling device
US20110180584A1 (en) * 2010-01-26 2011-07-28 Andreas Tzakis Stapling apparatus for performing anastomosis on hollow organs
US20110184443A1 (en) * 2010-01-26 2011-07-28 Andreas Tzakis Stapling apparatus for performing anastomosis on hollow organs
WO2011093986A1 (en) * 2010-01-26 2011-08-04 Zakease Surgical Inc. Stapling apparatus for performing anastomosis on hollow organs
US8011554B2 (en) 2008-01-09 2011-09-06 Tyco Healthcare Group, Lp Raised boss for staple guide
US8146790B2 (en) 2009-07-11 2012-04-03 Tyco Healthcare Group Lp Surgical instrument with safety mechanism
US20120080492A1 (en) * 2010-10-01 2012-04-05 Paul Scirica Surgical Stapling Device For Performing Circular Anastomosis And Surgical Staples For Use Therewith
US8231042B2 (en) 2008-11-06 2012-07-31 Tyco Healthcare Group Lp Surgical stapler
US8281974B2 (en) 2009-01-14 2012-10-09 Tyco Healthcare, Group LP Surgical stapler with suture locator
US8453913B2 (en) 2009-02-06 2013-06-04 Covidien Lp Anvil for surgical stapler
US8540132B2 (en) 2006-05-16 2013-09-24 Covidien Lp Tilt anvil assembly
WO2013177109A1 (en) * 2012-05-21 2013-11-28 Medplate Lifesciences Corporation Collapsible, shape memory alloy structures and folding fixtures for collapsing same
US8708212B2 (en) 2011-10-18 2014-04-29 Covidien Lp Tilt top anvil with torsion spring
US8998061B2 (en) 2010-10-01 2015-04-07 Covidien Lp Surgical fastener applying apparatus
US9010605B2 (en) 2012-01-12 2015-04-21 Covidien Lp Sliding sleeve for circular stapling instrument reloads
US9016547B2 (en) 2011-10-26 2015-04-28 Covidien Lp EEA tilt top anvil with ratchet/locking mechanism
US9022274B2 (en) 2012-02-15 2015-05-05 Covidien Lp Circular stapler with increased lumen diameter
US9119606B2 (en) 2013-01-21 2015-09-01 Ethicon, Inc. Sealant delivery device for anastomotic stapler
US9351724B2 (en) 2013-01-11 2016-05-31 Covidien Lp Circular stapling instrument
US9351734B2 (en) 2012-06-19 2016-05-31 Covidien Lp Spring loaded anvil retainer
US9517070B2 (en) 2013-11-13 2016-12-13 Covidien Lp Anvil assembly and delivery system
US9532780B2 (en) 2013-06-12 2017-01-03 Covidien Lp EEA anvil snap ring activator
US9554802B2 (en) 2013-11-13 2017-01-31 Covidien Lp Anvil assembly with frangible retaining member
US9572572B2 (en) 2012-11-09 2017-02-21 Covidien Lp Circular stapler mechanical lockout
US9592056B2 (en) 2013-03-14 2017-03-14 Covidien Lp Powered stapling apparatus
US9668740B2 (en) 2013-06-14 2017-06-06 Covidien Lp Anvil assembly with sliding sleeve
US9675359B2 (en) 2012-10-10 2017-06-13 Covidien Lp Surgical instrument with preload assembly
US9693773B2 (en) 2013-09-11 2017-07-04 Covidien Lp Anvil assembly with sliding sleeve
US9750503B2 (en) 2013-07-11 2017-09-05 Covidien Lp Methods and devices for performing a surgical anastomosis
US9757133B2 (en) 2014-07-09 2017-09-12 Covidien Lp Methods and devices for performing a surgical anastomosis
US9855045B2 (en) 2014-12-09 2018-01-02 Covidien Lp Anvil assembly delivery system
US9861367B2 (en) 2014-06-24 2018-01-09 Covidien Lp Anvil assembly delivery systems
US9867619B2 (en) 2014-06-24 2018-01-16 Covidien Lp System for delivering an anvil assembly to a surgical site
US9913643B2 (en) 2014-05-09 2018-03-13 Covidien Lp Interlock assemblies for replaceable loading unit
US9974536B2 (en) 2015-07-02 2018-05-22 Covidien Lp Anvil assemblies and delivery systems
US9980730B2 (en) 2015-09-21 2018-05-29 Covidien Lp Loading unit locking collar with rotational actuated release
US9987001B2 (en) 2015-06-12 2018-06-05 Covidien Lp Surgical anastomosis apparatus
US10022126B2 (en) 2015-01-07 2018-07-17 Covidien Lp Loading unit locking collar
US10039549B2 (en) 2015-01-07 2018-08-07 Covidien Lp Loading unit retention clip for surgical stapling instrument
US10085744B2 (en) 2014-12-08 2018-10-02 Covidien Lp Loading unit attachment band for surgical stapling instrument
US10085756B2 (en) 2015-07-24 2018-10-02 Covidien Lp Anvil assembly and anvil assembly delivery system
US10111684B2 (en) 2015-09-25 2018-10-30 Covidien Lp Adapter assembly including a removable trocar assembly
US10111668B2 (en) 2015-07-02 2018-10-30 Covidien Lp Anvil assembly with snap backup ring
US10117656B2 (en) 2015-01-07 2018-11-06 Covidien Lp Loading unit locking collar
US10117675B2 (en) 2015-07-28 2018-11-06 Covidien Lp Trocar tip protector
US10117655B2 (en) 2015-07-22 2018-11-06 Covidien Lp Loading unit locking band for surgical stapling instrument
US20180368851A1 (en) * 2017-06-27 2018-12-27 Ethicon Llc Powered circular stapler with reciprocating drive member to provide independent stapling and cutting of tissue
US10178994B2 (en) 2013-03-15 2019-01-15 Covidien Lp Surgical stapling apparatus with reusable components
US10213205B2 (en) 2012-07-06 2019-02-26 Covidien Lp T-slot tilt anvil for circular stapling instrument
US10271843B2 (en) 2013-06-17 2019-04-30 Covidien Lp Surgical instrument with lockout mechanism
US10342534B2 (en) 2017-03-23 2019-07-09 Covidien Lp Surgical stapling device with releasable knife carrier
US10390835B2 (en) 2015-12-10 2019-08-27 Covidien Lp Surgical fastener apparatus with linear position sensor
US10398439B2 (en) 2016-02-10 2019-09-03 Covidien Lp Adapter, extension, and connector assemblies for surgical devices
US10405864B2 (en) 2014-07-04 2019-09-10 Covidien Lp Loading unit with shipping member for surgical stapling device
US10426470B2 (en) 2016-11-04 2019-10-01 Covidien Lp Stapling device with releasable knife carrier
US10426480B2 (en) 2015-04-29 2019-10-01 Covidien Lp Cutting ring assembly with rigid cutting member
US10499916B2 (en) 2014-12-11 2019-12-10 Covidien Lp Surgical stapling loading unit
US10499922B2 (en) 2016-11-04 2019-12-10 Covidien Lp Stapling device with self-releasing knife carrier pusher
US10507022B2 (en) 2014-06-12 2019-12-17 Covidien Lp Surgical stapling apparatus
US10512466B2 (en) 2015-11-05 2019-12-24 Covidien Lp Adapter assembly for surgical device
US10517601B2 (en) 2015-02-15 2019-12-31 Covidien Lp Surgical stapling device with firing indicator of unitary construction
US10524797B2 (en) 2016-01-13 2020-01-07 Covidien Lp Adapter assembly including a removable trocar assembly
US10542992B2 (en) 2015-10-19 2020-01-28 Covidien Lp Loading unit with stretchable bushing
US10542993B2 (en) 2017-02-24 2020-01-28 Covidien Lp Anvil assembly of circular stapling device including alignment splines
US10542985B2 (en) 2014-12-17 2020-01-28 Covidien Lp Surgical stapling device with firing indicator
US10595871B2 (en) 2016-05-10 2020-03-24 Covidien Lp Insertion instrument, adapter assemblies and protector assemblies for a flexible circular stapler
US10603042B2 (en) 2016-02-10 2020-03-31 Covidien Lp Flexible circular stapler
CN110974330A (en) * 2019-12-09 2020-04-10 杭州市第一人民医院 Nail anvil seat of folding tubular anastomat placed through oral cavity
US10695069B2 (en) 2017-08-23 2020-06-30 Covidien Lp Circular stapling device with offset spline tip
US10772627B2 (en) 2014-12-11 2020-09-15 Covidien Lp Stapler with auto-matic lockout mechanism
US10828026B2 (en) 2017-08-08 2020-11-10 Covidien Lp Tiltable anvil assembly
US10842495B2 (en) 2015-10-21 2020-11-24 Covidien Lp Annular knife for a surgical stapler
US10874399B2 (en) 2016-02-04 2020-12-29 Covidien Lp Circular stapler with visual indicator mechanism
US10881411B2 (en) 2018-03-28 2021-01-05 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US10881409B2 (en) 2017-05-02 2021-01-05 Covidien Lp Rotation assembly for a surgical device
US10881408B2 (en) 2015-04-22 2021-01-05 Covidien Lp Interlock assembly for replaceable loading units
US10932784B2 (en) 2017-06-09 2021-03-02 Covidien Lp Handheld electromechanical surgical system
US10932783B2 (en) 2015-11-13 2021-03-02 Covidien Lp Circular stapler with audible indicator mechanism
US10952734B2 (en) 2018-04-23 2021-03-23 Covidien Lp Stapling device with cut ring biasing member
US10973544B2 (en) 2018-10-02 2021-04-13 Covidien Lp Retaining mechanism for trocar assembly
US10973522B2 (en) 2015-10-20 2021-04-13 Covidien Lp Circular stapler with tissue gap indicator assembly
US10987107B2 (en) 2017-07-05 2021-04-27 Covidien Lp Surgical stapling device
US11020119B2 (en) 2015-12-07 2021-06-01 Covidien Lp Anvil assembly and delivery system
US11045199B2 (en) 2017-06-09 2021-06-29 Covidien Lp Handheld electromechanical surgical system
US11065005B2 (en) 2018-11-07 2021-07-20 Covidien Lp Reload assembly for a circular stapling device
US11071549B2 (en) 2017-03-23 2021-07-27 Covidien Lp Circular stapling device with alignment splines
US11090054B2 (en) 2017-08-07 2021-08-17 Covidien Lp Stapling device with resettable tilt anvil assembly
US11116507B2 (en) 2017-03-09 2021-09-14 Covidien Lp End effector assembly for a circular stapler apparatus
US11123101B2 (en) 2019-07-05 2021-09-21 Covidien Lp Retaining mechanisms for trocar assemblies
US11141162B2 (en) 2016-07-08 2021-10-12 Covidien Lp Loading unit locking collar with linearly actuated release
US11141163B2 (en) 2018-10-04 2021-10-12 Covidien Lp Circular stapling device with anvil rotation locking structure
US11147561B2 (en) 2018-11-28 2021-10-19 Covidien Lp Reload assembly for a circular stapling device
US11166728B2 (en) 2019-02-08 2021-11-09 Covidien Lp Reload assembly for a circular stapling device
US11192227B2 (en) 2019-07-16 2021-12-07 Covidien Lp Reload assembly for circular stapling devices
US11197676B2 (en) 2018-06-28 2021-12-14 Covidien Lp Tie-down method for anvil assembly delivery system
US11234703B2 (en) 2017-09-01 2022-02-01 Covidien Lp Circular stapling device with position ribs
US11241232B2 (en) 2017-01-24 2022-02-08 Covidien Lp Surgical stapling device with resettable anvil assembly
US11241234B2 (en) 2018-08-14 2022-02-08 Covidien Lp Anvil assembly with self-retaining backup member
US11246599B2 (en) 2019-04-25 2022-02-15 Covidien Lp End effector for circular stapling instrument
US11253255B2 (en) 2019-07-26 2022-02-22 Covidien Lp Knife lockout wedge
US11272998B2 (en) 2020-03-04 2022-03-15 Covidien Lp Strain gage fixation in tension
US11298152B2 (en) 2020-02-28 2022-04-12 Covidien Lp Trocar retaining mechanism including band support
US11317945B2 (en) 2019-04-16 2022-05-03 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11324507B2 (en) 2017-11-03 2022-05-10 Covidien Lp Device and method for attachment of a stomal sleeve
US11331782B2 (en) 2019-03-01 2022-05-17 Covidien Lp Reload assembly for a circular stapling device
US11337701B2 (en) 2019-03-01 2022-05-24 Covidien Lp Devices and methods for assembling adapter assemblies
US11344330B2 (en) 2019-04-16 2022-05-31 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11350939B2 (en) 2020-03-24 2022-06-07 Covidien Lp Retaining mechanisms for trocar assemblies
US11357509B2 (en) 2019-07-11 2022-06-14 Covidien Lp Reload assembly for a circular stapling device
US11382629B2 (en) 2017-03-09 2022-07-12 Covidien Lp Surgical stapling device with audible indicator mechanism
US11382630B2 (en) 2020-02-25 2022-07-12 Covidien Lp Surgical stapling device with two part knife assembly
US11389263B2 (en) 2018-12-13 2022-07-19 Covidien Lp Lockout mechanisms for surgical instruments
US11399825B2 (en) 2019-10-28 2022-08-02 Covidien Lp Reload assembly with knife carrier lockout
US11399838B2 (en) 2019-04-22 2022-08-02 Covidien Lp Reload assembly for circular stapling devices
US11419631B2 (en) 2019-04-16 2022-08-23 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11426170B2 (en) 2020-03-24 2022-08-30 Covidien Lp Retaining mechanisms for trocar assemblies
US11426169B2 (en) 2020-03-24 2022-08-30 Covidien Lp Retaining mechanisms for trocar assemblies
US11446035B2 (en) 2019-06-24 2022-09-20 Covidien Lp Retaining mechanisms for trocar assemblies
US11452522B2 (en) 2016-08-15 2022-09-27 Covidien Lp Circular stapling device with articulating anvil retainer assembly
US11457921B2 (en) 2019-03-26 2022-10-04 Covidien Lp Anvil assembly for surgical stapling instrument
US11464510B2 (en) 2019-07-26 2022-10-11 Covidien Lp Reload assembly with knife carrier lockout
US11490894B1 (en) 2021-05-12 2022-11-08 Covidien Lp Surgical device with grease filter
US11497501B2 (en) 2018-03-26 2022-11-15 Covidien Lp Circular stapling device with A-frame splines
US11517317B2 (en) 2020-01-06 2022-12-06 Covidien Lp Trocar release assemblies for a surgical stapler
US11523828B2 (en) 2020-01-28 2022-12-13 Covidien Lp Sealed reload assembly for stapling device
US11529144B2 (en) 2019-02-22 2022-12-20 Covidien Lp Encapsulated plug assembly for electromechanical surgical devices
US11534164B2 (en) 2019-04-05 2022-12-27 Covidien Lp Strain gauge stabilization in a surgical device
US11547438B2 (en) 2020-02-24 2023-01-10 Covidien Lp Tip protector for ensuring trocar insertion
US11547411B2 (en) 2019-02-22 2023-01-10 Covidien Lp Anastomosis wound protector
US11547412B2 (en) 2020-07-22 2023-01-10 Covidien Lp Surgical instruments and methods of assembly
US11547405B2 (en) 2020-05-22 2023-01-10 Covidien Lp Surgical stapling device
US11553921B2 (en) 2020-07-15 2023-01-17 Covidien Lp Surgical stapling device with flexible shaft
US11553920B2 (en) 2021-05-03 2023-01-17 Covidien Lp Trocar retainer assembly for surgical stapler
US11553918B2 (en) 2019-12-16 2023-01-17 Covidien Lp Reload assembly with knife carrier lockout
US11564691B2 (en) 2018-08-24 2023-01-31 Covidien Lp Powered circular stapling device
US11596400B2 (en) 2017-06-09 2023-03-07 Covidien Lp Handheld electromechanical surgical system
US11596410B2 (en) 2019-04-05 2023-03-07 Covidien Lp Surgical stapling device
US11612400B2 (en) 2021-05-24 2023-03-28 Covidien Lp Trocar assembly with bearing assembly for load sharing
US11622767B2 (en) 2020-02-19 2023-04-11 Covidien Lp Sealed trocar assembly for stapling device
US11627967B2 (en) 2020-11-23 2023-04-18 Covidien Lp Trans-anastomotic insertion device
US11627966B2 (en) 2020-08-26 2023-04-18 Covidien Lp Surgical stapling device
WO2023076499A1 (en) * 2021-10-29 2023-05-04 The Regents Of The University Of California Devices and methods for forming an anastomosis between two lumens
US11642131B2 (en) 2021-05-17 2023-05-09 Covidien Lp Devices and methods for shortening a rectal stump during a lower anterior resection procedure
US11653925B2 (en) 2020-05-21 2023-05-23 Covidien Lp Tissue relaxation monitoring for optimized tissue stapling
US11660116B2 (en) 2019-04-16 2023-05-30 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11678885B2 (en) 2017-01-25 2023-06-20 Covidien Lp Circular stapling device and method of use
US11690624B2 (en) 2019-06-21 2023-07-04 Covidien Lp Reload assembly injection molded strain gauge
US11712509B2 (en) 2020-10-02 2023-08-01 Covidien Lp Seal assembly for circular stapling instrument
US11717299B2 (en) 2021-10-12 2023-08-08 Covidien Lp Surgical stapling device with probiotics
US11730481B2 (en) 2020-01-06 2023-08-22 Covidien Lp Assemblies for retaining a trocar assembly
US11737759B2 (en) 2021-08-05 2023-08-29 Covidien Lp Surgical stapling device accommodating prolapsed tissue
US11744592B2 (en) 2021-08-05 2023-09-05 Covidien Lp Handheld electromechanical stapler with tissue thickness detection
US11779343B2 (en) 2020-02-26 2023-10-10 Covidien Lp Staple reload assembly with releasable knife
US11786241B2 (en) 2021-02-16 2023-10-17 Covidien Lp Surgical stapling device including a hydraulic staple formation mechanism
US11801054B2 (en) 2020-09-22 2023-10-31 Covidien Lp Surgical stapler with oval tool assembly
US11819208B2 (en) 2021-08-05 2023-11-21 Covidien Lp Handheld electromechanical surgical device with strain gauge drift detection
US11839378B2 (en) 2019-04-19 2023-12-12 Covidien Lp Circular stapling instruments
US11877744B2 (en) 2020-08-14 2024-01-23 Covidien Lp Low-cost powered stapler with end stop selection
US11877750B2 (en) 2021-01-21 2024-01-23 Covidien Lp Surgical stapler with powered and manual functions
US11883028B2 (en) 2021-09-08 2024-01-30 Covidien Lp Systems and methods for post-operative anastomotic leak detection
US11896233B2 (en) 2019-05-31 2024-02-13 Covidien Lp Circular stapling device
US11911038B2 (en) 2020-01-13 2024-02-27 Covidien Lp Cut optimization for excessive tissue conditions

Families Citing this family (572)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
NL1007349C2 (en) * 1997-10-24 1999-04-27 Suyker Wilhelmus Joseph Leonardus System for the mechanical production of anastomoses between hollow structures; as well as device and applicator for use therewith.
US6966917B1 (en) * 2000-11-09 2005-11-22 Innovation Interventional Technologies B.V. Deformable connector for mechanically connecting hollow structures
US6769590B2 (en) * 2001-04-02 2004-08-03 Susan E. Vresh Luminal anastomotic device and method
US20070060952A1 (en) * 2005-09-02 2007-03-15 Roby Mark S Surgical stapling device with coated knife blade
WO2003030745A1 (en) * 2001-10-05 2003-04-17 Tyco Healthcare Group Lp Tilt top anvil for a surgical fastener device
ES2364043T3 (en) 2002-07-31 2011-08-23 Tyco Healthcare Group Lp TOOL COATING ELEMENT AND COATING DEPLOYMENT DEVICE.
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
US20070084897A1 (en) 2003-05-20 2007-04-19 Shelton Frederick E Iv Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism
US7168604B2 (en) * 2003-06-20 2007-01-30 Tyco Healthcare Group Lp Surgical stapling device
JP4604040B2 (en) 2003-10-17 2010-12-22 タイコ ヘルスケア グループ リミテッド パートナーシップ Surgical stapling device
AU2005226643B2 (en) * 2004-03-19 2010-07-22 Covidien Lp Anvil assembly with improved cut ring
US11890012B2 (en) 2004-07-28 2024-02-06 Cilag Gmbh International Staple cartridge comprising cartridge body and attached support
US8215531B2 (en) 2004-07-28 2012-07-10 Ethicon Endo-Surgery, Inc. Surgical stapling instrument having a medical substance dispenser
US7938307B2 (en) * 2004-10-18 2011-05-10 Tyco Healthcare Group Lp Support structures and methods of using the same
US20060201989A1 (en) * 2005-03-11 2006-09-14 Ojeda Herminio F Surgical anvil and system for deploying the same
US7674271B2 (en) * 2005-05-04 2010-03-09 InTailor Surgical, Inc. Endoluminal gastric ring and method
US10159482B2 (en) 2005-08-31 2018-12-25 Ethicon Llc Fastener cartridge assembly comprising a fixed anvil and different staple heights
US11484312B2 (en) 2005-08-31 2022-11-01 Cilag Gmbh International Staple cartridge comprising a staple driver arrangement
US8800838B2 (en) 2005-08-31 2014-08-12 Ethicon Endo-Surgery, Inc. Robotically-controlled cable-based surgical end effectors
US9237891B2 (en) 2005-08-31 2016-01-19 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical stapling devices that produce formed staples having different lengths
US11246590B2 (en) 2005-08-31 2022-02-15 Cilag Gmbh International Staple cartridge including staple drivers having different unfired heights
US7673781B2 (en) 2005-08-31 2010-03-09 Ethicon Endo-Surgery, Inc. Surgical stapling device with staple driver that supports multiple wire diameter staples
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US7934630B2 (en) 2005-08-31 2011-05-03 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US20070106317A1 (en) 2005-11-09 2007-05-10 Shelton Frederick E Iv Hydraulically and electrically actuated articulation joints for surgical instruments
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US11793518B2 (en) 2006-01-31 2023-10-24 Cilag Gmbh International Powered surgical instruments with firing system lockout arrangements
US7753904B2 (en) 2006-01-31 2010-07-13 Ethicon Endo-Surgery, Inc. Endoscopic surgical instrument with a handle that can articulate with respect to the shaft
US20110024477A1 (en) 2009-02-06 2011-02-03 Hall Steven G Driven Surgical Stapler Improvements
US8763879B2 (en) 2006-01-31 2014-07-01 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of surgical instrument
US20110290856A1 (en) 2006-01-31 2011-12-01 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical instrument with force-feedback capabilities
US7766210B2 (en) 2006-01-31 2010-08-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with user feedback system
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US8820603B2 (en) 2006-01-31 2014-09-02 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US8708213B2 (en) 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US11278279B2 (en) 2006-01-31 2022-03-22 Cilag Gmbh International Surgical instrument assembly
US11224427B2 (en) 2006-01-31 2022-01-18 Cilag Gmbh International Surgical stapling system including a console and retraction assembly
US9861359B2 (en) 2006-01-31 2018-01-09 Ethicon Llc Powered surgical instruments with firing system lockout arrangements
US7770775B2 (en) 2006-01-31 2010-08-10 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with adaptive user feedback
US8161977B2 (en) 2006-01-31 2012-04-24 Ethicon Endo-Surgery, Inc. Accessing data stored in a memory of a surgical instrument
US20120292367A1 (en) 2006-01-31 2012-11-22 Ethicon Endo-Surgery, Inc. Robotically-controlled end effector
US8236010B2 (en) 2006-03-23 2012-08-07 Ethicon Endo-Surgery, Inc. Surgical fastener and cutter with mimicking end effector
US8992422B2 (en) 2006-03-23 2015-03-31 Ethicon Endo-Surgery, Inc. Robotically-controlled endoscopic accessory channel
BRPI0603438A (en) * 2006-06-06 2008-02-12 Luiz Gonzaga Granja Jr laparoscopic anastomosis prosthesis
US8322455B2 (en) 2006-06-27 2012-12-04 Ethicon Endo-Surgery, Inc. Manually driven surgical cutting and fastening instrument
US7740159B2 (en) 2006-08-02 2010-06-22 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with a variable control of the actuating rate of firing with mechanical power assist
US7506791B2 (en) 2006-09-29 2009-03-24 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with mechanical mechanism for limiting maximum tissue compression
US10130359B2 (en) 2006-09-29 2018-11-20 Ethicon Llc Method for forming a staple
US10568652B2 (en) 2006-09-29 2020-02-25 Ethicon Llc Surgical staples having attached drivers of different heights and stapling instruments for deploying the same
US7738971B2 (en) 2007-01-10 2010-06-15 Ethicon Endo-Surgery, Inc. Post-sterilization programming of surgical instruments
US7721931B2 (en) 2007-01-10 2010-05-25 Ethicon Endo-Surgery, Inc. Prevention of cartridge reuse in a surgical instrument
US7721936B2 (en) * 2007-01-10 2010-05-25 Ethicon Endo-Surgery, Inc. Interlock and surgical instrument including same
US7900805B2 (en) 2007-01-10 2011-03-08 Ethicon Endo-Surgery, Inc. Surgical instrument with enhanced battery performance
US8652120B2 (en) 2007-01-10 2014-02-18 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and sensor transponders
US11291441B2 (en) 2007-01-10 2022-04-05 Cilag Gmbh International Surgical instrument with wireless communication between control unit and remote sensor
US8684253B2 (en) 2007-01-10 2014-04-01 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US7954682B2 (en) 2007-01-10 2011-06-07 Ethicon Endo-Surgery, Inc. Surgical instrument with elements to communicate between control unit and end effector
US8459520B2 (en) 2007-01-10 2013-06-11 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between control unit and remote sensor
US20080169332A1 (en) 2007-01-11 2008-07-17 Shelton Frederick E Surgical stapling device with a curved cutting member
US11039836B2 (en) 2007-01-11 2021-06-22 Cilag Gmbh International Staple cartridge for use with a surgical stapling instrument
DE602007012771D1 (en) 2007-03-07 2011-04-07 Covidien Ag CLAMP DEVICE FOR MUCOSEKTOMY
US20090001130A1 (en) 2007-03-15 2009-01-01 Hess Christopher J Surgical procedure using a cutting and stapling instrument having releasable staple-forming pockets
US8893946B2 (en) 2007-03-28 2014-11-25 Ethicon Endo-Surgery, Inc. Laparoscopic tissue thickness and clamp load measuring devices
US8056787B2 (en) * 2007-03-28 2011-11-15 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting instrument with travel-indicating retraction member
US7823761B2 (en) 2007-05-16 2010-11-02 The Invention Science Fund I, Llc Maneuverable surgical stapler
US7798385B2 (en) * 2007-05-16 2010-09-21 The Invention Science Fund I, Llc Surgical stapling instrument with chemical sealant
US7810691B2 (en) * 2007-05-16 2010-10-12 The Invention Science Fund I, Llc Gentle touch surgical stapler
US8485411B2 (en) 2007-05-16 2013-07-16 The Invention Science Fund I, Llc Gentle touch surgical stapler
US7922064B2 (en) * 2007-05-16 2011-04-12 The Invention Science Fund, I, LLC Surgical fastening device with cutter
US7832611B2 (en) * 2007-05-16 2010-11-16 The Invention Science Fund I, Llc Steerable surgical stapler
US7810693B2 (en) * 2007-05-30 2010-10-12 Ethicon Endo-Surgery, Inc. Surgical stapling and cutting instrument with articulatable end effector
US7798386B2 (en) * 2007-05-30 2010-09-21 Ethicon Endo-Surgery, Inc. Surgical instrument articulation joint cover
US8157145B2 (en) 2007-05-31 2012-04-17 Ethicon Endo-Surgery, Inc. Pneumatically powered surgical cutting and fastening instrument with electrical feedback
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
US7905380B2 (en) 2007-06-04 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a multiple rate directional switching mechanism
US7819299B2 (en) 2007-06-04 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical instrument having a common trigger for actuating an end effector closing system and a staple firing system
US7832408B2 (en) * 2007-06-04 2010-11-16 Ethicon Endo-Surgery, Inc. Surgical instrument having a directional switching mechanism
US11857181B2 (en) 2007-06-04 2024-01-02 Cilag Gmbh International Robotically-controlled shaft based rotary drive systems for surgical instruments
US8534528B2 (en) 2007-06-04 2013-09-17 Ethicon Endo-Surgery, Inc. Surgical instrument having a multiple rate directional switching mechanism
US7510107B2 (en) 2007-06-18 2009-03-31 Ethicon Endo-Surgery, Inc. Cable driven surgical stapling and cutting instrument with apparatus for preventing inadvertent cable disengagement
US8308040B2 (en) 2007-06-22 2012-11-13 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with an articulatable end effector
US7753245B2 (en) 2007-06-22 2010-07-13 Ethicon Endo-Surgery, Inc. Surgical stapling instruments
US11849941B2 (en) 2007-06-29 2023-12-26 Cilag Gmbh International Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis
US20090143816A1 (en) * 2007-11-30 2009-06-04 Searete Llc, A Limited Liability Corporation Of The State Of Delaware Grasper with surgical sealant dispenser
US8561870B2 (en) 2008-02-13 2013-10-22 Ethicon Endo-Surgery, Inc. Surgical stapling instrument
US7766209B2 (en) 2008-02-13 2010-08-03 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US8540133B2 (en) 2008-09-19 2013-09-24 Ethicon Endo-Surgery, Inc. Staple cartridge
US7905381B2 (en) 2008-09-19 2011-03-15 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with cutting member arrangement
US8453908B2 (en) 2008-02-13 2013-06-04 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with improved firing trigger arrangement
US8657174B2 (en) 2008-02-14 2014-02-25 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument having handle based power source
US7819296B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with retractable firing systems
US7913891B2 (en) 2008-02-14 2011-03-29 Ethicon Endo-Surgery, Inc. Disposable loading unit with user feedback features and surgical instrument for use therewith
US7810692B2 (en) 2008-02-14 2010-10-12 Ethicon Endo-Surgery, Inc. Disposable loading unit with firing indicator
US7793812B2 (en) 2008-02-14 2010-09-14 Ethicon Endo-Surgery, Inc. Disposable motor-driven loading unit for use with a surgical cutting and stapling apparatus
US8584919B2 (en) 2008-02-14 2013-11-19 Ethicon Endo-Sugery, Inc. Surgical stapling apparatus with load-sensitive firing mechanism
US7819297B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with reprocessible handle assembly
US8459525B2 (en) 2008-02-14 2013-06-11 Ethicon Endo-Sugery, Inc. Motorized surgical cutting and fastening instrument having a magnetic drive train torque limiting device
US8573465B2 (en) 2008-02-14 2013-11-05 Ethicon Endo-Surgery, Inc. Robotically-controlled surgical end effector system with rotary actuated closure systems
US8636736B2 (en) 2008-02-14 2014-01-28 Ethicon Endo-Surgery, Inc. Motorized surgical cutting and fastening instrument
US7857185B2 (en) 2008-02-14 2010-12-28 Ethicon Endo-Surgery, Inc. Disposable loading unit for surgical stapling apparatus
US7861906B2 (en) 2008-02-14 2011-01-04 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with articulatable components
JP5410110B2 (en) 2008-02-14 2014-02-05 エシコン・エンド−サージェリィ・インコーポレイテッド Surgical cutting / fixing instrument with RF electrode
US8622274B2 (en) 2008-02-14 2014-01-07 Ethicon Endo-Surgery, Inc. Motorized cutting and fastening instrument having control circuit for optimizing battery usage
US7866527B2 (en) 2008-02-14 2011-01-11 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with interlockable firing system
US7819298B2 (en) 2008-02-14 2010-10-26 Ethicon Endo-Surgery, Inc. Surgical stapling apparatus with control features operable with one hand
US8758391B2 (en) 2008-02-14 2014-06-24 Ethicon Endo-Surgery, Inc. Interchangeable tools for surgical instruments
US8752749B2 (en) 2008-02-14 2014-06-17 Ethicon Endo-Surgery, Inc. Robotically-controlled disposable motor-driven loading unit
US9179912B2 (en) 2008-02-14 2015-11-10 Ethicon Endo-Surgery, Inc. Robotically-controlled motorized surgical cutting and fastening instrument
US9770245B2 (en) 2008-02-15 2017-09-26 Ethicon Llc Layer arrangements for surgical staple cartridges
US7980443B2 (en) 2008-02-15 2011-07-19 Ethicon Endo-Surgery, Inc. End effectors for a surgical cutting and stapling instrument
US11272927B2 (en) 2008-02-15 2022-03-15 Cilag Gmbh International Layer arrangements for surgical staple cartridges
US20090206139A1 (en) 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. Buttress material for a surgical instrument
US7959051B2 (en) * 2008-02-15 2011-06-14 Ethicon Endo-Surgery, Inc. Closure systems for a surgical cutting and stapling instrument
US20090206131A1 (en) 2008-02-15 2009-08-20 Ethicon Endo-Surgery, Inc. End effector coupling arrangements for a surgical cutting and stapling instrument
US20090242609A1 (en) * 2008-03-31 2009-10-01 Medtronic Vascular, Inc. Vascular Puncture Closure Staple With Tip Protection
US7922061B2 (en) 2008-05-21 2011-04-12 Ethicon Endo-Surgery, Inc. Surgical instrument with automatically reconfigurable articulating end effector
US8083120B2 (en) 2008-09-18 2011-12-27 Ethicon Endo-Surgery, Inc. End effector for use with a surgical cutting and stapling instrument
US7837080B2 (en) 2008-09-18 2010-11-23 Ethicon Endo-Surgery, Inc. Surgical stapling instrument with device for indicating when the instrument has cut through tissue
US9005230B2 (en) 2008-09-23 2015-04-14 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US9050083B2 (en) 2008-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US9386983B2 (en) 2008-09-23 2016-07-12 Ethicon Endo-Surgery, Llc Robotically-controlled motorized surgical instrument
US11648005B2 (en) 2008-09-23 2023-05-16 Cilag Gmbh International Robotically-controlled motorized surgical instrument with an end effector
US8210411B2 (en) 2008-09-23 2012-07-03 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument
US8279242B2 (en) * 2008-09-26 2012-10-02 Microsoft Corporation Compensating for anticipated movement of a device
US8070038B2 (en) 2008-10-10 2011-12-06 Tyco Healthcare Group, Lp Surgical instrument with pivotable jaw member
US8608045B2 (en) 2008-10-10 2013-12-17 Ethicon Endo-Sugery, Inc. Powered surgical cutting and stapling apparatus with manually retractable firing system
US8020743B2 (en) 2008-10-15 2011-09-20 Ethicon Endo-Surgery, Inc. Powered articulatable surgical cutting and fastening instrument with flexible drive member
US8517239B2 (en) 2009-02-05 2013-08-27 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising a magnetic element driver
US8485413B2 (en) 2009-02-05 2013-07-16 Ethicon Endo-Surgery, Inc. Surgical stapling instrument comprising an articulation joint
US8397971B2 (en) 2009-02-05 2013-03-19 Ethicon Endo-Surgery, Inc. Sterilizable surgical instrument
US8414577B2 (en) 2009-02-05 2013-04-09 Ethicon Endo-Surgery, Inc. Surgical instruments and components for use in sterile environments
CN102341048A (en) 2009-02-06 2012-02-01 伊西康内外科公司 Driven surgical stapler improvements
US8444036B2 (en) 2009-02-06 2013-05-21 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with mechanisms for adjusting a tissue gap within the end effector
US8453907B2 (en) 2009-02-06 2013-06-04 Ethicon Endo-Surgery, Inc. Motor driven surgical fastener device with cutting member reversing mechanism
US20110011916A1 (en) * 2009-07-16 2011-01-20 New York University Anastomosis device
US8141762B2 (en) 2009-10-09 2012-03-27 Ethicon Endo-Surgery, Inc. Surgical stapler comprising a staple pocket
US8348128B2 (en) * 2009-11-11 2013-01-08 Biorep Technologies, Inc. Anastomosis system and method
US8353439B2 (en) 2009-11-19 2013-01-15 Ethicon Endo-Surgery, Inc. Circular stapler introducer with radially-openable distal end portion
US8136712B2 (en) 2009-12-10 2012-03-20 Ethicon Endo-Surgery, Inc. Surgical stapler with discrete staple height adjustment and tactile feedback
US8220688B2 (en) 2009-12-24 2012-07-17 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting instrument with electric actuator directional control assembly
US8851354B2 (en) 2009-12-24 2014-10-07 Ethicon Endo-Surgery, Inc. Surgical cutting instrument that analyzes tissue thickness
US8267300B2 (en) 2009-12-30 2012-09-18 Ethicon Endo-Surgery, Inc. Dampening device for endoscopic surgical stapler
US8608046B2 (en) 2010-01-07 2013-12-17 Ethicon Endo-Surgery, Inc. Test device for a surgical tool
WO2011146816A1 (en) * 2010-05-20 2011-11-24 The Trustees Of Columbia University In The City Of New York Anastomosis device and method
US8783543B2 (en) 2010-07-30 2014-07-22 Ethicon Endo-Surgery, Inc. Tissue acquisition arrangements and methods for surgical stapling devices
US8789740B2 (en) 2010-07-30 2014-07-29 Ethicon Endo-Surgery, Inc. Linear cutting and stapling device with selectively disengageable cutting member
US8801734B2 (en) * 2010-07-30 2014-08-12 Ethicon Endo-Surgery, Inc. Circular stapling instruments with secondary cutting arrangements and methods of using same
US8360296B2 (en) 2010-09-09 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical stapling head assembly with firing lockout for a surgical stapler
US9877720B2 (en) 2010-09-24 2018-01-30 Ethicon Llc Control features for articulating surgical device
US8733613B2 (en) 2010-09-29 2014-05-27 Ethicon Endo-Surgery, Inc. Staple cartridge
US9332974B2 (en) 2010-09-30 2016-05-10 Ethicon Endo-Surgery, Llc Layered tissue thickness compensator
US9301753B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Expandable tissue thickness compensator
US9232941B2 (en) 2010-09-30 2016-01-12 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising a reservoir
US9055941B2 (en) 2011-09-23 2015-06-16 Ethicon Endo-Surgery, Inc. Staple cartridge including collapsible deck
US9301752B2 (en) 2010-09-30 2016-04-05 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprising a plurality of capsules
US9320523B2 (en) 2012-03-28 2016-04-26 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprising tissue ingrowth features
US9629814B2 (en) 2010-09-30 2017-04-25 Ethicon Endo-Surgery, Llc Tissue thickness compensator configured to redistribute compressive forces
US8893949B2 (en) 2010-09-30 2014-11-25 Ethicon Endo-Surgery, Inc. Surgical stapler with floating anvil
US11298125B2 (en) 2010-09-30 2022-04-12 Cilag Gmbh International Tissue stapler having a thickness compensator
US11812965B2 (en) 2010-09-30 2023-11-14 Cilag Gmbh International Layer of material for a surgical end effector
US8777004B2 (en) 2010-09-30 2014-07-15 Ethicon Endo-Surgery, Inc. Compressible staple cartridge comprising alignment members
US9364233B2 (en) 2010-09-30 2016-06-14 Ethicon Endo-Surgery, Llc Tissue thickness compensators for circular surgical staplers
US10945731B2 (en) 2010-09-30 2021-03-16 Ethicon Llc Tissue thickness compensator comprising controlled release and expansion
US9220500B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensator comprising structure to produce a resilient load
US9314246B2 (en) 2010-09-30 2016-04-19 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorporating an anti-inflammatory agent
US9241714B2 (en) 2011-04-29 2016-01-26 Ethicon Endo-Surgery, Inc. Tissue thickness compensator and method for making the same
US9220501B2 (en) 2010-09-30 2015-12-29 Ethicon Endo-Surgery, Inc. Tissue thickness compensators
US9788834B2 (en) 2010-09-30 2017-10-17 Ethicon Llc Layer comprising deployable attachment members
AU2011308701B2 (en) 2010-09-30 2013-11-14 Ethicon Endo-Surgery, Inc. Fastener system comprising a retention matrix and an alignment matrix
US9044228B2 (en) 2010-09-30 2015-06-02 Ethicon Endo-Surgery, Inc. Fastener system comprising a plurality of fastener cartridges
US11925354B2 (en) 2010-09-30 2024-03-12 Cilag Gmbh International Staple cartridge comprising staples positioned within a compressible portion thereof
US9307989B2 (en) 2012-03-28 2016-04-12 Ethicon Endo-Surgery, Llc Tissue stapler having a thickness compensator incorportating a hydrophobic agent
US8695866B2 (en) 2010-10-01 2014-04-15 Ethicon Endo-Surgery, Inc. Surgical instrument having a power control circuit
US8858590B2 (en) 2011-03-14 2014-10-14 Ethicon Endo-Surgery, Inc. Tissue manipulation devices
US8800841B2 (en) 2011-03-15 2014-08-12 Ethicon Endo-Surgery, Inc. Surgical staple cartridges
US9370362B2 (en) 2011-04-07 2016-06-21 Wake Forest University Health Sciences Surgical staplers with tissue protection and related methods
BR112013027794B1 (en) 2011-04-29 2020-12-15 Ethicon Endo-Surgery, Inc CLAMP CARTRIDGE SET
US9072535B2 (en) 2011-05-27 2015-07-07 Ethicon Endo-Surgery, Inc. Surgical stapling instruments with rotatable staple deployment arrangements
US11207064B2 (en) 2011-05-27 2021-12-28 Cilag Gmbh International Automated end effector component reloading system for use with a robotic system
US9198661B2 (en) 2011-09-06 2015-12-01 Ethicon Endo-Surgery, Inc. Stapling instrument comprising a plurality of staple cartridges stored therein
US9050084B2 (en) 2011-09-23 2015-06-09 Ethicon Endo-Surgery, Inc. Staple cartridge including collapsible deck arrangement
US9113866B2 (en) 2011-12-15 2015-08-25 Ethicon Endo-Surgery, Inc. Devices and methods for endoluminal plication
US9173657B2 (en) 2011-12-15 2015-11-03 Ethicon Endo-Surgery, Inc. Devices and methods for endoluminal plication
US9044230B2 (en) 2012-02-13 2015-06-02 Ethicon Endo-Surgery, Inc. Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status
US8992547B2 (en) 2012-03-21 2015-03-31 Ethicon Endo-Surgery, Inc. Methods and devices for creating tissue plications
US9078653B2 (en) 2012-03-26 2015-07-14 Ethicon Endo-Surgery, Inc. Surgical stapling device with lockout system for preventing actuation in the absence of an installed staple cartridge
US9198662B2 (en) 2012-03-28 2015-12-01 Ethicon Endo-Surgery, Inc. Tissue thickness compensator having improved visibility
CN104334098B (en) 2012-03-28 2017-03-22 伊西康内外科公司 Tissue thickness compensator comprising capsules defining a low pressure environment
MX353040B (en) 2012-03-28 2017-12-18 Ethicon Endo Surgery Inc Retainer assembly including a tissue thickness compensator.
RU2014143258A (en) 2012-03-28 2016-05-20 Этикон Эндо-Серджери, Инк. FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS
US9101358B2 (en) 2012-06-15 2015-08-11 Ethicon Endo-Surgery, Inc. Articulatable surgical instrument comprising a firing drive
JP6290201B2 (en) 2012-06-28 2018-03-07 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. Lockout for empty clip cartridge
BR112014032776B1 (en) 2012-06-28 2021-09-08 Ethicon Endo-Surgery, Inc SURGICAL INSTRUMENT SYSTEM AND SURGICAL KIT FOR USE WITH A SURGICAL INSTRUMENT SYSTEM
US8747238B2 (en) 2012-06-28 2014-06-10 Ethicon Endo-Surgery, Inc. Rotary drive shaft assemblies for surgical instruments with articulatable end effectors
US9119657B2 (en) 2012-06-28 2015-09-01 Ethicon Endo-Surgery, Inc. Rotary actuatable closure arrangement for surgical end effector
US9282974B2 (en) 2012-06-28 2016-03-15 Ethicon Endo-Surgery, Llc Empty clip cartridge lockout
US20140005718A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Multi-functional powered surgical device with external dissection features
US9561038B2 (en) 2012-06-28 2017-02-07 Ethicon Endo-Surgery, Llc Interchangeable clip applier
US9125662B2 (en) 2012-06-28 2015-09-08 Ethicon Endo-Surgery, Inc. Multi-axis articulating and rotating surgical tools
US9289256B2 (en) 2012-06-28 2016-03-22 Ethicon Endo-Surgery, Llc Surgical end effectors having angled tissue-contacting surfaces
US9028494B2 (en) 2012-06-28 2015-05-12 Ethicon Endo-Surgery, Inc. Interchangeable end effector coupling arrangement
US11202631B2 (en) 2012-06-28 2021-12-21 Cilag Gmbh International Stapling assembly comprising a firing lockout
US20140001231A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Firing system lockout arrangements for surgical instruments
US9101385B2 (en) 2012-06-28 2015-08-11 Ethicon Endo-Surgery, Inc. Electrode connections for rotary driven surgical tools
US9072536B2 (en) 2012-06-28 2015-07-07 Ethicon Endo-Surgery, Inc. Differential locking arrangements for rotary powered surgical instruments
US9408606B2 (en) 2012-06-28 2016-08-09 Ethicon Endo-Surgery, Llc Robotically powered surgical device with manually-actuatable reversing system
US9700310B2 (en) 2013-08-23 2017-07-11 Ethicon Llc Firing member retraction devices for powered surgical instruments
US9498222B2 (en) 2012-11-29 2016-11-22 Ethicon Endo-Surgery, Llc Pivoting anvil for surgical circular stapler
US20140158747A1 (en) * 2012-12-06 2014-06-12 Ethicon Endo-Surgery, Inc. Surgical stapler with varying staple widths along different circumferences
US9386984B2 (en) 2013-02-08 2016-07-12 Ethicon Endo-Surgery, Llc Staple cartridge comprising a releasable cover
US10092292B2 (en) 2013-02-28 2018-10-09 Ethicon Llc Staple forming features for surgical stapling instrument
US9326767B2 (en) 2013-03-01 2016-05-03 Ethicon Endo-Surgery, Llc Joystick switch assemblies for surgical instruments
JP6382235B2 (en) 2013-03-01 2018-08-29 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. Articulatable surgical instrument with a conductive path for signal communication
JP6345707B2 (en) 2013-03-01 2018-06-20 エシコン・エンド−サージェリィ・インコーポレイテッドEthicon Endo−Surgery,Inc. Surgical instrument with soft stop
US9345481B2 (en) 2013-03-13 2016-05-24 Ethicon Endo-Surgery, Llc Staple cartridge tissue thickness sensor system
US9629629B2 (en) 2013-03-14 2017-04-25 Ethicon Endo-Surgey, LLC Control systems for surgical instruments
US9687230B2 (en) 2013-03-14 2017-06-27 Ethicon Llc Articulatable surgical instrument comprising a firing drive
WO2014149011A1 (en) * 2013-03-21 2014-09-25 Şahi̇n Mustafa A circular stapler having a foldable anvil
US9554795B2 (en) * 2013-03-26 2017-01-31 Mustafa SAHIN Anvil cap of a multiple umbrella type for circular staplers
US9572577B2 (en) 2013-03-27 2017-02-21 Ethicon Endo-Surgery, Llc Fastener cartridge comprising a tissue thickness compensator including openings therein
US9795384B2 (en) 2013-03-27 2017-10-24 Ethicon Llc Fastener cartridge comprising a tissue thickness compensator and a gap setting element
US9332984B2 (en) 2013-03-27 2016-05-10 Ethicon Endo-Surgery, Llc Fastener cartridge assemblies
BR112015026109B1 (en) 2013-04-16 2022-02-22 Ethicon Endo-Surgery, Inc surgical instrument
US9649110B2 (en) 2013-04-16 2017-05-16 Ethicon Llc Surgical instrument comprising a closing drive and a firing drive operated from the same rotatable output
US9574644B2 (en) 2013-05-30 2017-02-21 Ethicon Endo-Surgery, Llc Power module for use with a surgical instrument
US9561029B2 (en) * 2013-08-15 2017-02-07 Ethicon Endo-Surgery, Llc Surgical stapler with rolling anvil
MX369362B (en) 2013-08-23 2019-11-06 Ethicon Endo Surgery Llc Firing member retraction devices for powered surgical instruments.
US20140171986A1 (en) 2013-09-13 2014-06-19 Ethicon Endo-Surgery, Inc. Surgical Clip Having Comliant Portion
BR112016014154B1 (en) 2013-12-17 2022-08-23 Standard Bariatrics, Inc. GUIDE TO GUIDING A MEDICAL INSTRUMENT DURING A MEDICAL PROCEDURE AND MEDICAL DEVICE
US9681870B2 (en) 2013-12-23 2017-06-20 Ethicon Llc Articulatable surgical instruments with separate and distinct closing and firing systems
US9968354B2 (en) 2013-12-23 2018-05-15 Ethicon Llc Surgical staples and methods for making the same
US9642620B2 (en) 2013-12-23 2017-05-09 Ethicon Endo-Surgery, Llc Surgical cutting and stapling instruments with articulatable end effectors
US9724092B2 (en) 2013-12-23 2017-08-08 Ethicon Llc Modular surgical instruments
US20150173756A1 (en) 2013-12-23 2015-06-25 Ethicon Endo-Surgery, Inc. Surgical cutting and stapling methods
US9839428B2 (en) 2013-12-23 2017-12-12 Ethicon Llc Surgical cutting and stapling instruments with independent jaw control features
US9962161B2 (en) 2014-02-12 2018-05-08 Ethicon Llc Deliverable surgical instrument
JP6462004B2 (en) 2014-02-24 2019-01-30 エシコン エルエルシー Fastening system with launcher lockout
US20140166725A1 (en) 2014-02-24 2014-06-19 Ethicon Endo-Surgery, Inc. Staple cartridge including a barbed staple.
US20150272557A1 (en) 2014-03-26 2015-10-01 Ethicon Endo-Surgery, Inc. Modular surgical instrument system
BR112016021943B1 (en) 2014-03-26 2022-06-14 Ethicon Endo-Surgery, Llc SURGICAL INSTRUMENT FOR USE BY AN OPERATOR IN A SURGICAL PROCEDURE
US10013049B2 (en) 2014-03-26 2018-07-03 Ethicon Llc Power management through sleep options of segmented circuit and wake up control
US9913642B2 (en) 2014-03-26 2018-03-13 Ethicon Llc Surgical instrument comprising a sensor system
US20150272571A1 (en) 2014-03-26 2015-10-01 Ethicon Endo-Surgery, Inc. Surgical instrument utilizing sensor adaptation
WO2015153340A2 (en) 2014-03-29 2015-10-08 Standard Bariatrics, Inc. End effectors surgical stapling devices, and methods of using same
US9936953B2 (en) 2014-03-29 2018-04-10 Standard Bariatrics, Inc. End effectors, surgical stapling devices, and methods of using same
JP6636452B2 (en) 2014-04-16 2020-01-29 エシコン エルエルシーEthicon LLC Fastener cartridge including extension having different configurations
US10327764B2 (en) 2014-09-26 2019-06-25 Ethicon Llc Method for creating a flexible staple line
US10299792B2 (en) 2014-04-16 2019-05-28 Ethicon Llc Fastener cartridge comprising non-uniform fasteners
BR112016023807B1 (en) 2014-04-16 2022-07-12 Ethicon Endo-Surgery, Llc CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT
US20150297223A1 (en) 2014-04-16 2015-10-22 Ethicon Endo-Surgery, Inc. Fastener cartridges including extensions having different configurations
CN106456158B (en) 2014-04-16 2019-02-05 伊西康内外科有限责任公司 Fastener cartridge including non-uniform fastener
US10045781B2 (en) 2014-06-13 2018-08-14 Ethicon Llc Closure lockout systems for surgical instruments
US11311294B2 (en) 2014-09-05 2022-04-26 Cilag Gmbh International Powered medical device including measurement of closure state of jaws
BR112017004361B1 (en) 2014-09-05 2023-04-11 Ethicon Llc ELECTRONIC SYSTEM FOR A SURGICAL INSTRUMENT
US10111679B2 (en) 2014-09-05 2018-10-30 Ethicon Llc Circuitry and sensors for powered medical device
US10105142B2 (en) 2014-09-18 2018-10-23 Ethicon Llc Surgical stapler with plurality of cutting elements
MX2017003960A (en) 2014-09-26 2017-12-04 Ethicon Llc Surgical stapling buttresses and adjunct materials.
US11523821B2 (en) 2014-09-26 2022-12-13 Cilag Gmbh International Method for creating a flexible staple line
US10076325B2 (en) 2014-10-13 2018-09-18 Ethicon Llc Surgical stapling apparatus comprising a tissue stop
US9924944B2 (en) 2014-10-16 2018-03-27 Ethicon Llc Staple cartridge comprising an adjunct material
US10517594B2 (en) 2014-10-29 2019-12-31 Ethicon Llc Cartridge assemblies for surgical staplers
US11141153B2 (en) 2014-10-29 2021-10-12 Cilag Gmbh International Staple cartridges comprising driver arrangements
US9844376B2 (en) 2014-11-06 2017-12-19 Ethicon Llc Staple cartridge comprising a releasable adjunct material
US10898196B2 (en) 2014-11-21 2021-01-26 Covidien Lp Cleaning apparatus for surgical instruments
US10736636B2 (en) 2014-12-10 2020-08-11 Ethicon Llc Articulatable surgical instrument system
US10085748B2 (en) 2014-12-18 2018-10-02 Ethicon Llc Locking arrangements for detachable shaft assemblies with articulatable surgical end effectors
US10188385B2 (en) 2014-12-18 2019-01-29 Ethicon Llc Surgical instrument system comprising lockable systems
US9943309B2 (en) 2014-12-18 2018-04-17 Ethicon Llc Surgical instruments with articulatable end effectors and movable firing beam support arrangements
US9844375B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Drive arrangements for articulatable surgical instruments
US9844374B2 (en) 2014-12-18 2017-12-19 Ethicon Llc Surgical instrument systems comprising an articulatable end effector and means for adjusting the firing stroke of a firing member
US9987000B2 (en) 2014-12-18 2018-06-05 Ethicon Llc Surgical instrument assembly comprising a flexible articulation system
BR112017012996B1 (en) 2014-12-18 2022-11-08 Ethicon Llc SURGICAL INSTRUMENT WITH AN ANvil WHICH IS SELECTIVELY MOVABLE ABOUT AN IMMOVABLE GEOMETRIC AXIS DIFFERENT FROM A STAPLE CARTRIDGE
US10117649B2 (en) 2014-12-18 2018-11-06 Ethicon Llc Surgical instrument assembly comprising a lockable articulation system
US10226250B2 (en) 2015-02-27 2019-03-12 Ethicon Llc Modular stapling assembly
US11154301B2 (en) 2015-02-27 2021-10-26 Cilag Gmbh International Modular stapling assembly
US20160249910A1 (en) 2015-02-27 2016-09-01 Ethicon Endo-Surgery, Llc Surgical charging system that charges and/or conditions one or more batteries
US10180463B2 (en) 2015-02-27 2019-01-15 Ethicon Llc Surgical apparatus configured to assess whether a performance parameter of the surgical apparatus is within an acceptable performance band
US9808246B2 (en) 2015-03-06 2017-11-07 Ethicon Endo-Surgery, Llc Method of operating a powered surgical instrument
US10245033B2 (en) 2015-03-06 2019-04-02 Ethicon Llc Surgical instrument comprising a lockable battery housing
US9895148B2 (en) 2015-03-06 2018-02-20 Ethicon Endo-Surgery, Llc Monitoring speed control and precision incrementing of motor for powered surgical instruments
US10548504B2 (en) 2015-03-06 2020-02-04 Ethicon Llc Overlaid multi sensor radio frequency (RF) electrode system to measure tissue compression
US10617412B2 (en) 2015-03-06 2020-04-14 Ethicon Llc System for detecting the mis-insertion of a staple cartridge into a surgical stapler
US9924961B2 (en) 2015-03-06 2018-03-27 Ethicon Endo-Surgery, Llc Interactive feedback system for powered surgical instruments
US10687806B2 (en) 2015-03-06 2020-06-23 Ethicon Llc Adaptive tissue compression techniques to adjust closure rates for multiple tissue types
JP2020121162A (en) 2015-03-06 2020-08-13 エシコン エルエルシーEthicon LLC Time dependent evaluation of sensor data to determine stability element, creep element and viscoelastic element of measurement
US9901342B2 (en) 2015-03-06 2018-02-27 Ethicon Endo-Surgery, Llc Signal and power communication system positioned on a rotatable shaft
US10045776B2 (en) 2015-03-06 2018-08-14 Ethicon Llc Control techniques and sub-processor contained within modular shaft with select control processing from handle
US9993248B2 (en) 2015-03-06 2018-06-12 Ethicon Endo-Surgery, Llc Smart sensors with local signal processing
US10213201B2 (en) 2015-03-31 2019-02-26 Ethicon Llc Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw
US10335149B2 (en) 2015-06-18 2019-07-02 Ethicon Llc Articulatable surgical instruments with composite firing beam structures with center firing support member for articulation support
US10835249B2 (en) 2015-08-17 2020-11-17 Ethicon Llc Implantable layers for a surgical instrument
US10213203B2 (en) 2015-08-26 2019-02-26 Ethicon Llc Staple cartridge assembly without a bottom cover
CN108348233B (en) 2015-08-26 2021-05-07 伊西康有限责任公司 Surgical staple strip for allowing changing staple characteristics and achieving easy cartridge loading
US10238390B2 (en) 2015-09-02 2019-03-26 Ethicon Llc Surgical staple cartridges with driver arrangements for establishing herringbone staple patterns
MX2022006191A (en) 2015-09-02 2022-06-16 Ethicon Llc Surgical staple configurations with camming surfaces located between portions supporting surgical staples.
US10238386B2 (en) 2015-09-23 2019-03-26 Ethicon Llc Surgical stapler having motor control based on an electrical parameter related to a motor current
US10085751B2 (en) 2015-09-23 2018-10-02 Ethicon Llc Surgical stapler having temperature-based motor control
US10105139B2 (en) 2015-09-23 2018-10-23 Ethicon Llc Surgical stapler having downstream current-based motor control
US10076326B2 (en) 2015-09-23 2018-09-18 Ethicon Llc Surgical stapler having current mirror-based motor control
US10363036B2 (en) 2015-09-23 2019-07-30 Ethicon Llc Surgical stapler having force-based motor control
US10327769B2 (en) 2015-09-23 2019-06-25 Ethicon Llc Surgical stapler having motor control based on a drive system component
US10299878B2 (en) 2015-09-25 2019-05-28 Ethicon Llc Implantable adjunct systems for determining adjunct skew
US11890015B2 (en) 2015-09-30 2024-02-06 Cilag Gmbh International Compressible adjunct with crossing spacer fibers
US10980539B2 (en) 2015-09-30 2021-04-20 Ethicon Llc Implantable adjunct comprising bonded layers
US10478188B2 (en) 2015-09-30 2019-11-19 Ethicon Llc Implantable layer comprising a constricted configuration
US10736633B2 (en) 2015-09-30 2020-08-11 Ethicon Llc Compressible adjunct with looping members
US10292704B2 (en) 2015-12-30 2019-05-21 Ethicon Llc Mechanisms for compensating for battery pack failure in powered surgical instruments
US10265068B2 (en) 2015-12-30 2019-04-23 Ethicon Llc Surgical instruments with separable motors and motor control circuits
US10368865B2 (en) 2015-12-30 2019-08-06 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
JP6911054B2 (en) 2016-02-09 2021-07-28 エシコン エルエルシーEthicon LLC Surgical instruments with asymmetric joint composition
US10588625B2 (en) 2016-02-09 2020-03-17 Ethicon Llc Articulatable surgical instruments with off-axis firing beam arrangements
US11213293B2 (en) 2016-02-09 2022-01-04 Cilag Gmbh International Articulatable surgical instruments with single articulation link arrangements
US10258331B2 (en) 2016-02-12 2019-04-16 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
US11224426B2 (en) 2016-02-12 2022-01-18 Cilag Gmbh International Mechanisms for compensating for drivetrain failure in powered surgical instruments
US10448948B2 (en) 2016-02-12 2019-10-22 Ethicon Llc Mechanisms for compensating for drivetrain failure in powered surgical instruments
EP3422986B1 (en) 2016-03-04 2023-12-27 Covidien LP Robotic surgical assemblies
US11064997B2 (en) 2016-04-01 2021-07-20 Cilag Gmbh International Surgical stapling instrument
US11045191B2 (en) 2016-04-01 2021-06-29 Cilag Gmbh International Method for operating a surgical stapling system
US11284890B2 (en) 2016-04-01 2022-03-29 Cilag Gmbh International Circular stapling system comprising an incisable tissue support
US10531874B2 (en) 2016-04-01 2020-01-14 Ethicon Llc Surgical cutting and stapling end effector with anvil concentric drive member
US10617413B2 (en) 2016-04-01 2020-04-14 Ethicon Llc Closure system arrangements for surgical cutting and stapling devices with separate and distinct firing shafts
US10405859B2 (en) 2016-04-15 2019-09-10 Ethicon Llc Surgical instrument with adjustable stop/start control during a firing motion
US10828028B2 (en) 2016-04-15 2020-11-10 Ethicon Llc Surgical instrument with multiple program responses during a firing motion
US11179150B2 (en) 2016-04-15 2021-11-23 Cilag Gmbh International Systems and methods for controlling a surgical stapling and cutting instrument
US10456137B2 (en) 2016-04-15 2019-10-29 Ethicon Llc Staple formation detection mechanisms
US10426467B2 (en) 2016-04-15 2019-10-01 Ethicon Llc Surgical instrument with detection sensors
US10335145B2 (en) 2016-04-15 2019-07-02 Ethicon Llc Modular surgical instrument with configurable operating mode
US10492783B2 (en) 2016-04-15 2019-12-03 Ethicon, Llc Surgical instrument with improved stop/start control during a firing motion
US11607239B2 (en) 2016-04-15 2023-03-21 Cilag Gmbh International Systems and methods for controlling a surgical stapling and cutting instrument
US10357247B2 (en) 2016-04-15 2019-07-23 Ethicon Llc Surgical instrument with multiple program responses during a firing motion
US11317917B2 (en) 2016-04-18 2022-05-03 Cilag Gmbh International Surgical stapling system comprising a lockable firing assembly
US10433840B2 (en) 2016-04-18 2019-10-08 Ethicon Llc Surgical instrument comprising a replaceable cartridge jaw
US20170296173A1 (en) 2016-04-18 2017-10-19 Ethicon Endo-Surgery, Llc Method for operating a surgical instrument
US10299795B2 (en) 2016-04-28 2019-05-28 Mayo Foundation For Medical Education And Research Devices and methods for esophageal lengthening and anastomosis formation
USD847989S1 (en) 2016-06-24 2019-05-07 Ethicon Llc Surgical fastener cartridge
USD822206S1 (en) 2016-06-24 2018-07-03 Ethicon Llc Surgical fastener
US10675024B2 (en) 2016-06-24 2020-06-09 Ethicon Llc Staple cartridge comprising overdriven staples
JP6957532B2 (en) 2016-06-24 2021-11-02 エシコン エルエルシーEthicon LLC Staple cartridges including wire staples and punched staples
USD826405S1 (en) 2016-06-24 2018-08-21 Ethicon Llc Surgical fastener
USD850617S1 (en) 2016-06-24 2019-06-04 Ethicon Llc Surgical fastener cartridge
US10758398B2 (en) * 2016-11-01 2020-09-01 Covidien Lp Apparatus and associated methodologies for creating a stoma
US20180168647A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling instruments having end effectors with positive opening features
US10588632B2 (en) 2016-12-21 2020-03-17 Ethicon Llc Surgical end effectors and firing members thereof
US11419606B2 (en) 2016-12-21 2022-08-23 Cilag Gmbh International Shaft assembly comprising a clutch configured to adapt the output of a rotary firing member to two different systems
US10675025B2 (en) 2016-12-21 2020-06-09 Ethicon Llc Shaft assembly comprising separately actuatable and retractable systems
US11684367B2 (en) 2016-12-21 2023-06-27 Cilag Gmbh International Stepped assembly having and end-of-life indicator
US20180168598A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Staple forming pocket arrangements comprising zoned forming surface grooves
US10675026B2 (en) 2016-12-21 2020-06-09 Ethicon Llc Methods of stapling tissue
JP6983893B2 (en) 2016-12-21 2021-12-17 エシコン エルエルシーEthicon LLC Lockout configuration for surgical end effectors and replaceable tool assemblies
US10980536B2 (en) 2016-12-21 2021-04-20 Ethicon Llc No-cartridge and spent cartridge lockout arrangements for surgical staplers
US11134942B2 (en) 2016-12-21 2021-10-05 Cilag Gmbh International Surgical stapling instruments and staple-forming anvils
US20180168615A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Method of deforming staples from two different types of staple cartridges with the same surgical stapling instrument
JP7010956B2 (en) 2016-12-21 2022-01-26 エシコン エルエルシー How to staple tissue
US10524789B2 (en) 2016-12-21 2020-01-07 Ethicon Llc Laterally actuatable articulation lock arrangements for locking an end effector of a surgical instrument in an articulated configuration
US10945727B2 (en) 2016-12-21 2021-03-16 Ethicon Llc Staple cartridge with deformable driver retention features
US20180168608A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical instrument system comprising an end effector lockout and a firing assembly lockout
JP2020501779A (en) 2016-12-21 2020-01-23 エシコン エルエルシーEthicon LLC Surgical stapling system
US10426471B2 (en) 2016-12-21 2019-10-01 Ethicon Llc Surgical instrument with multiple failure response modes
US20180168625A1 (en) 2016-12-21 2018-06-21 Ethicon Endo-Surgery, Llc Surgical stapling instruments with smart staple cartridges
US10588631B2 (en) 2016-12-21 2020-03-17 Ethicon Llc Surgical instruments with positive jaw opening features
US10993715B2 (en) 2016-12-21 2021-05-04 Ethicon Llc Staple cartridge comprising staples with different clamping breadths
US10888322B2 (en) 2016-12-21 2021-01-12 Ethicon Llc Surgical instrument comprising a cutting member
US10687810B2 (en) 2016-12-21 2020-06-23 Ethicon Llc Stepped staple cartridge with tissue retention and gap setting features
US10485543B2 (en) 2016-12-21 2019-11-26 Ethicon Llc Anvil having a knife slot width
US10835246B2 (en) 2016-12-21 2020-11-17 Ethicon Llc Staple cartridges and arrangements of staples and staple cavities therein
US10881399B2 (en) 2017-06-20 2021-01-05 Ethicon Llc Techniques for adaptive control of motor velocity of a surgical stapling and cutting instrument
US10307170B2 (en) 2017-06-20 2019-06-04 Ethicon Llc Method for closed loop control of motor velocity of a surgical stapling and cutting instrument
US10390841B2 (en) 2017-06-20 2019-08-27 Ethicon Llc Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation
US10646220B2 (en) 2017-06-20 2020-05-12 Ethicon Llc Systems and methods for controlling displacement member velocity for a surgical instrument
USD879809S1 (en) 2017-06-20 2020-03-31 Ethicon Llc Display panel with changeable graphical user interface
US10779820B2 (en) 2017-06-20 2020-09-22 Ethicon Llc Systems and methods for controlling motor speed according to user input for a surgical instrument
US10368864B2 (en) 2017-06-20 2019-08-06 Ethicon Llc Systems and methods for controlling displaying motor velocity for a surgical instrument
US11071554B2 (en) 2017-06-20 2021-07-27 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on magnitude of velocity error measurements
US10327767B2 (en) 2017-06-20 2019-06-25 Ethicon Llc Control of motor velocity of a surgical stapling and cutting instrument based on angle of articulation
USD890784S1 (en) 2017-06-20 2020-07-21 Ethicon Llc Display panel with changeable graphical user interface
US11090046B2 (en) 2017-06-20 2021-08-17 Cilag Gmbh International Systems and methods for controlling displacement member motion of a surgical stapling and cutting instrument
US10888321B2 (en) 2017-06-20 2021-01-12 Ethicon Llc Systems and methods for controlling velocity of a displacement member of a surgical stapling and cutting instrument
US10881396B2 (en) 2017-06-20 2021-01-05 Ethicon Llc Surgical instrument with variable duration trigger arrangement
US11382638B2 (en) 2017-06-20 2022-07-12 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified displacement distance
US10624633B2 (en) 2017-06-20 2020-04-21 Ethicon Llc Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument
US11517325B2 (en) 2017-06-20 2022-12-06 Cilag Gmbh International Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured displacement distance traveled over a specified time interval
US10813639B2 (en) 2017-06-20 2020-10-27 Ethicon Llc Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on system conditions
US10980537B2 (en) 2017-06-20 2021-04-20 Ethicon Llc Closed loop feedback control of motor velocity of a surgical stapling and cutting instrument based on measured time over a specified number of shaft rotations
US11653914B2 (en) 2017-06-20 2023-05-23 Cilag Gmbh International Systems and methods for controlling motor velocity of a surgical stapling and cutting instrument according to articulation angle of end effector
USD879808S1 (en) 2017-06-20 2020-03-31 Ethicon Llc Display panel with graphical user interface
US10772629B2 (en) 2017-06-27 2020-09-15 Ethicon Llc Surgical anvil arrangements
US11141154B2 (en) 2017-06-27 2021-10-12 Cilag Gmbh International Surgical end effectors and anvils
US11266405B2 (en) 2017-06-27 2022-03-08 Cilag Gmbh International Surgical anvil manufacturing methods
US11324503B2 (en) 2017-06-27 2022-05-10 Cilag Gmbh International Surgical firing member arrangements
US10856869B2 (en) 2017-06-27 2020-12-08 Ethicon Llc Surgical anvil arrangements
US10993716B2 (en) 2017-06-27 2021-05-04 Ethicon Llc Surgical anvil arrangements
EP4070740A1 (en) 2017-06-28 2022-10-12 Cilag GmbH International Surgical instrument comprising selectively actuatable rotatable couplers
USD854151S1 (en) 2017-06-28 2019-07-16 Ethicon Llc Surgical instrument shaft
US11564686B2 (en) 2017-06-28 2023-01-31 Cilag Gmbh International Surgical shaft assemblies with flexible interfaces
US11259805B2 (en) 2017-06-28 2022-03-01 Cilag Gmbh International Surgical instrument comprising firing member supports
USD851762S1 (en) 2017-06-28 2019-06-18 Ethicon Llc Anvil
US20190000461A1 (en) 2017-06-28 2019-01-03 Ethicon Llc Surgical cutting and fastening devices with pivotable anvil with a tissue locating arrangement in close proximity to an anvil pivot axis
US10211586B2 (en) 2017-06-28 2019-02-19 Ethicon Llc Surgical shaft assemblies with watertight housings
US10903685B2 (en) 2017-06-28 2021-01-26 Ethicon Llc Surgical shaft assemblies with slip ring assemblies forming capacitive channels
US10765427B2 (en) 2017-06-28 2020-09-08 Ethicon Llc Method for articulating a surgical instrument
US10716614B2 (en) 2017-06-28 2020-07-21 Ethicon Llc Surgical shaft assemblies with slip ring assemblies with increased contact pressure
US11246592B2 (en) 2017-06-28 2022-02-15 Cilag Gmbh International Surgical instrument comprising an articulation system lockable to a frame
USD906355S1 (en) 2017-06-28 2020-12-29 Ethicon Llc Display screen or portion thereof with a graphical user interface for a surgical instrument
US11058424B2 (en) 2017-06-28 2021-07-13 Cilag Gmbh International Surgical instrument comprising an offset articulation joint
USD869655S1 (en) 2017-06-28 2019-12-10 Ethicon Llc Surgical fastener cartridge
US10258418B2 (en) 2017-06-29 2019-04-16 Ethicon Llc System for controlling articulation forces
US10898183B2 (en) 2017-06-29 2021-01-26 Ethicon Llc Robotic surgical instrument with closed loop feedback techniques for advancement of closure member during firing
US11007022B2 (en) 2017-06-29 2021-05-18 Ethicon Llc Closed loop velocity control techniques based on sensed tissue parameters for robotic surgical instrument
US10932772B2 (en) 2017-06-29 2021-03-02 Ethicon Llc Methods for closed loop velocity control for robotic surgical instrument
US10398434B2 (en) 2017-06-29 2019-09-03 Ethicon Llc Closed loop velocity control of closure member for robotic surgical instrument
US11471155B2 (en) 2017-08-03 2022-10-18 Cilag Gmbh International Surgical system bailout
US11304695B2 (en) 2017-08-03 2022-04-19 Cilag Gmbh International Surgical system shaft interconnection
WO2019036490A1 (en) 2017-08-14 2019-02-21 Standard Bariatrics, Inc. End effectors, surgical stapling devices, and methods of using same
US10905417B2 (en) 2017-08-29 2021-02-02 Ethicon Llc Circular stapler
US10912567B2 (en) * 2017-08-29 2021-02-09 Ethicon Llc Circular stapler
US10743872B2 (en) 2017-09-29 2020-08-18 Ethicon Llc System and methods for controlling a display of a surgical instrument
US11399829B2 (en) 2017-09-29 2022-08-02 Cilag Gmbh International Systems and methods of initiating a power shutdown mode for a surgical instrument
US10796471B2 (en) 2017-09-29 2020-10-06 Ethicon Llc Systems and methods of displaying a knife position for a surgical instrument
USD917500S1 (en) 2017-09-29 2021-04-27 Ethicon Llc Display screen or portion thereof with graphical user interface
USD907648S1 (en) 2017-09-29 2021-01-12 Ethicon Llc Display screen or portion thereof with animated graphical user interface
USD907647S1 (en) 2017-09-29 2021-01-12 Ethicon Llc Display screen or portion thereof with animated graphical user interface
US10729501B2 (en) 2017-09-29 2020-08-04 Ethicon Llc Systems and methods for language selection of a surgical instrument
US10765429B2 (en) 2017-09-29 2020-09-08 Ethicon Llc Systems and methods for providing alerts according to the operational state of a surgical instrument
US11134944B2 (en) 2017-10-30 2021-10-05 Cilag Gmbh International Surgical stapler knife motion controls
US11090075B2 (en) 2017-10-30 2021-08-17 Cilag Gmbh International Articulation features for surgical end effector
US10842490B2 (en) 2017-10-31 2020-11-24 Ethicon Llc Cartridge body design with force reduction based on firing completion
US10779903B2 (en) 2017-10-31 2020-09-22 Ethicon Llc Positive shaft rotation lock activated by jaw closure
WO2019094619A1 (en) * 2017-11-08 2019-05-16 The Regents Of The University Of Colorado, A Body Corporate Ventricular assist assembly, system, and method
US10727401B2 (en) * 2017-11-10 2020-07-28 Taiwan Semiconductor Manufacturing Co., Ltd. Magnetic random access memory
US10966718B2 (en) 2017-12-15 2021-04-06 Ethicon Llc Dynamic clamping assemblies with improved wear characteristics for use in connection with electromechanical surgical instruments
US10869666B2 (en) 2017-12-15 2020-12-22 Ethicon Llc Adapters with control systems for controlling multiple motors of an electromechanical surgical instrument
US10743875B2 (en) 2017-12-15 2020-08-18 Ethicon Llc Surgical end effectors with jaw stiffener arrangements configured to permit monitoring of firing member
US11006955B2 (en) 2017-12-15 2021-05-18 Ethicon Llc End effectors with positive jaw opening features for use with adapters for electromechanical surgical instruments
US10779826B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Methods of operating surgical end effectors
US10687813B2 (en) 2017-12-15 2020-06-23 Ethicon Llc Adapters with firing stroke sensing arrangements for use in connection with electromechanical surgical instruments
US10743874B2 (en) 2017-12-15 2020-08-18 Ethicon Llc Sealed adapters for use with electromechanical surgical instruments
US10779825B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Adapters with end effector position sensing and control arrangements for use in connection with electromechanical surgical instruments
US11033267B2 (en) 2017-12-15 2021-06-15 Ethicon Llc Systems and methods of controlling a clamping member firing rate of a surgical instrument
US11197670B2 (en) 2017-12-15 2021-12-14 Cilag Gmbh International Surgical end effectors with pivotal jaws configured to touch at their respective distal ends when fully closed
US10828033B2 (en) 2017-12-15 2020-11-10 Ethicon Llc Handheld electromechanical surgical instruments with improved motor control arrangements for positioning components of an adapter coupled thereto
US11071543B2 (en) 2017-12-15 2021-07-27 Cilag Gmbh International Surgical end effectors with clamping assemblies configured to increase jaw aperture ranges
US11045270B2 (en) 2017-12-19 2021-06-29 Cilag Gmbh International Robotic attachment comprising exterior drive actuator
US10716565B2 (en) 2017-12-19 2020-07-21 Ethicon Llc Surgical instruments with dual articulation drivers
US10729509B2 (en) 2017-12-19 2020-08-04 Ethicon Llc Surgical instrument comprising closure and firing locking mechanism
USD910847S1 (en) 2017-12-19 2021-02-16 Ethicon Llc Surgical instrument assembly
US11020112B2 (en) 2017-12-19 2021-06-01 Ethicon Llc Surgical tools configured for interchangeable use with different controller interfaces
US10835330B2 (en) 2017-12-19 2020-11-17 Ethicon Llc Method for determining the position of a rotatable jaw of a surgical instrument attachment assembly
US11076853B2 (en) 2017-12-21 2021-08-03 Cilag Gmbh International Systems and methods of displaying a knife position during transection for a surgical instrument
US11129680B2 (en) 2017-12-21 2021-09-28 Cilag Gmbh International Surgical instrument comprising a projector
US10682134B2 (en) 2017-12-21 2020-06-16 Ethicon Llc Continuous use self-propelled stapling instrument
US11311290B2 (en) 2017-12-21 2022-04-26 Cilag Gmbh International Surgical instrument comprising an end effector dampener
US10779821B2 (en) 2018-08-20 2020-09-22 Ethicon Llc Surgical stapler anvils with tissue stop features configured to avoid tissue pinch
US11039834B2 (en) 2018-08-20 2021-06-22 Cilag Gmbh International Surgical stapler anvils with staple directing protrusions and tissue stability features
US11207065B2 (en) 2018-08-20 2021-12-28 Cilag Gmbh International Method for fabricating surgical stapler anvils
US11291440B2 (en) 2018-08-20 2022-04-05 Cilag Gmbh International Method for operating a powered articulatable surgical instrument
US10842492B2 (en) 2018-08-20 2020-11-24 Ethicon Llc Powered articulatable surgical instruments with clutching and locking arrangements for linking an articulation drive system to a firing drive system
USD914878S1 (en) 2018-08-20 2021-03-30 Ethicon Llc Surgical instrument anvil
US11324501B2 (en) 2018-08-20 2022-05-10 Cilag Gmbh International Surgical stapling devices with improved closure members
US10912559B2 (en) 2018-08-20 2021-02-09 Ethicon Llc Reinforced deformable anvil tip for surgical stapler anvil
US11045192B2 (en) 2018-08-20 2021-06-29 Cilag Gmbh International Fabricating techniques for surgical stapler anvils
US10856870B2 (en) 2018-08-20 2020-12-08 Ethicon Llc Switching arrangements for motor powered articulatable surgical instruments
US11253256B2 (en) 2018-08-20 2022-02-22 Cilag Gmbh International Articulatable motor powered surgical instruments with dedicated articulation motor arrangements
US11083458B2 (en) 2018-08-20 2021-08-10 Cilag Gmbh International Powered surgical instruments with clutching arrangements to convert linear drive motions to rotary drive motions
US11737745B2 (en) 2018-10-24 2023-08-29 Mayo Foundation For Medical Education And Research Medical devices and methods for body conduit lengthening and anastomosis formation
US11696761B2 (en) 2019-03-25 2023-07-11 Cilag Gmbh International Firing drive arrangements for surgical systems
US11147551B2 (en) 2019-03-25 2021-10-19 Cilag Gmbh International Firing drive arrangements for surgical systems
US11147553B2 (en) 2019-03-25 2021-10-19 Cilag Gmbh International Firing drive arrangements for surgical systems
US11172929B2 (en) 2019-03-25 2021-11-16 Cilag Gmbh International Articulation drive arrangements for surgical systems
US11452528B2 (en) 2019-04-30 2022-09-27 Cilag Gmbh International Articulation actuators for a surgical instrument
US11903581B2 (en) 2019-04-30 2024-02-20 Cilag Gmbh International Methods for stapling tissue using a surgical instrument
US11471157B2 (en) 2019-04-30 2022-10-18 Cilag Gmbh International Articulation control mapping for a surgical instrument
US11648009B2 (en) 2019-04-30 2023-05-16 Cilag Gmbh International Rotatable jaw tip for a surgical instrument
US11253254B2 (en) 2019-04-30 2022-02-22 Cilag Gmbh International Shaft rotation actuator on a surgical instrument
US11432816B2 (en) 2019-04-30 2022-09-06 Cilag Gmbh International Articulation pin for a surgical instrument
US11426251B2 (en) 2019-04-30 2022-08-30 Cilag Gmbh International Articulation directional lights on a surgical instrument
US11399837B2 (en) 2019-06-28 2022-08-02 Cilag Gmbh International Mechanisms for motor control adjustments of a motorized surgical instrument
US11771419B2 (en) 2019-06-28 2023-10-03 Cilag Gmbh International Packaging for a replaceable component of a surgical stapling system
US11246678B2 (en) 2019-06-28 2022-02-15 Cilag Gmbh International Surgical stapling system having a frangible RFID tag
US11426167B2 (en) 2019-06-28 2022-08-30 Cilag Gmbh International Mechanisms for proper anvil attachment surgical stapling head assembly
US11241235B2 (en) 2019-06-28 2022-02-08 Cilag Gmbh International Method of using multiple RFID chips with a surgical assembly
US11684434B2 (en) 2019-06-28 2023-06-27 Cilag Gmbh International Surgical RFID assemblies for instrument operational setting control
US11523822B2 (en) 2019-06-28 2022-12-13 Cilag Gmbh International Battery pack including a circuit interrupter
US11638587B2 (en) 2019-06-28 2023-05-02 Cilag Gmbh International RFID identification systems for surgical instruments
US11478241B2 (en) 2019-06-28 2022-10-25 Cilag Gmbh International Staple cartridge including projections
US11219455B2 (en) 2019-06-28 2022-01-11 Cilag Gmbh International Surgical instrument including a lockout key
US11464601B2 (en) 2019-06-28 2022-10-11 Cilag Gmbh International Surgical instrument comprising an RFID system for tracking a movable component
US11660163B2 (en) 2019-06-28 2023-05-30 Cilag Gmbh International Surgical system with RFID tags for updating motor assembly parameters
US11298132B2 (en) 2019-06-28 2022-04-12 Cilag GmbH Inlernational Staple cartridge including a honeycomb extension
US11051807B2 (en) 2019-06-28 2021-07-06 Cilag Gmbh International Packaging assembly including a particulate trap
US11259803B2 (en) 2019-06-28 2022-03-01 Cilag Gmbh International Surgical stapling system having an information encryption protocol
US11224497B2 (en) 2019-06-28 2022-01-18 Cilag Gmbh International Surgical systems with multiple RFID tags
US11291451B2 (en) 2019-06-28 2022-04-05 Cilag Gmbh International Surgical instrument with battery compatibility verification functionality
US11627959B2 (en) 2019-06-28 2023-04-18 Cilag Gmbh International Surgical instruments including manual and powered system lockouts
US11497492B2 (en) 2019-06-28 2022-11-15 Cilag Gmbh International Surgical instrument including an articulation lock
US11298127B2 (en) 2019-06-28 2022-04-12 Cilag GmbH Interational Surgical stapling system having a lockout mechanism for an incompatible cartridge
US11376098B2 (en) 2019-06-28 2022-07-05 Cilag Gmbh International Surgical instrument system comprising an RFID system
US11553971B2 (en) 2019-06-28 2023-01-17 Cilag Gmbh International Surgical RFID assemblies for display and communication
MX2022005311A (en) 2019-11-04 2022-05-26 Standard Bariatrics Inc Systems and methods of performing surgery using laplace's law tension retraction during surgery.
US11701111B2 (en) 2019-12-19 2023-07-18 Cilag Gmbh International Method for operating a surgical stapling instrument
US11446029B2 (en) 2019-12-19 2022-09-20 Cilag Gmbh International Staple cartridge comprising projections extending from a curved deck surface
US11607219B2 (en) 2019-12-19 2023-03-21 Cilag Gmbh International Staple cartridge comprising a detachable tissue cutting knife
US11529139B2 (en) 2019-12-19 2022-12-20 Cilag Gmbh International Motor driven surgical instrument
US11234698B2 (en) 2019-12-19 2022-02-01 Cilag Gmbh International Stapling system comprising a clamp lockout and a firing lockout
US11304696B2 (en) 2019-12-19 2022-04-19 Cilag Gmbh International Surgical instrument comprising a powered articulation system
US11911032B2 (en) 2019-12-19 2024-02-27 Cilag Gmbh International Staple cartridge comprising a seating cam
US11464512B2 (en) 2019-12-19 2022-10-11 Cilag Gmbh International Staple cartridge comprising a curved deck surface
US11576672B2 (en) 2019-12-19 2023-02-14 Cilag Gmbh International Surgical instrument comprising a closure system including a closure member and an opening member driven by a drive screw
US11504122B2 (en) 2019-12-19 2022-11-22 Cilag Gmbh International Surgical instrument comprising a nested firing member
US11844520B2 (en) 2019-12-19 2023-12-19 Cilag Gmbh International Staple cartridge comprising driver retention members
US11291447B2 (en) 2019-12-19 2022-04-05 Cilag Gmbh International Stapling instrument comprising independent jaw closing and staple firing systems
US11529137B2 (en) 2019-12-19 2022-12-20 Cilag Gmbh International Staple cartridge comprising driver retention members
US11559304B2 (en) 2019-12-19 2023-01-24 Cilag Gmbh International Surgical instrument comprising a rapid closure mechanism
USD975850S1 (en) 2020-06-02 2023-01-17 Cilag Gmbh International Staple cartridge
USD976401S1 (en) 2020-06-02 2023-01-24 Cilag Gmbh International Staple cartridge
USD967421S1 (en) 2020-06-02 2022-10-18 Cilag Gmbh International Staple cartridge
USD975851S1 (en) 2020-06-02 2023-01-17 Cilag Gmbh International Staple cartridge
USD975278S1 (en) 2020-06-02 2023-01-10 Cilag Gmbh International Staple cartridge
USD974560S1 (en) 2020-06-02 2023-01-03 Cilag Gmbh International Staple cartridge
USD966512S1 (en) 2020-06-02 2022-10-11 Cilag Gmbh International Staple cartridge
US20220031351A1 (en) 2020-07-28 2022-02-03 Cilag Gmbh International Surgical instruments with differential articulation joint arrangements for accommodating flexible actuators
US11717289B2 (en) 2020-10-29 2023-08-08 Cilag Gmbh International Surgical instrument comprising an indicator which indicates that an articulation drive is actuatable
US11452526B2 (en) 2020-10-29 2022-09-27 Cilag Gmbh International Surgical instrument comprising a staged voltage regulation start-up system
USD980425S1 (en) 2020-10-29 2023-03-07 Cilag Gmbh International Surgical instrument assembly
US11896217B2 (en) 2020-10-29 2024-02-13 Cilag Gmbh International Surgical instrument comprising an articulation lock
US11517390B2 (en) 2020-10-29 2022-12-06 Cilag Gmbh International Surgical instrument comprising a limited travel switch
US11534259B2 (en) 2020-10-29 2022-12-27 Cilag Gmbh International Surgical instrument comprising an articulation indicator
USD1013170S1 (en) 2020-10-29 2024-01-30 Cilag Gmbh International Surgical instrument assembly
US11844518B2 (en) 2020-10-29 2023-12-19 Cilag Gmbh International Method for operating a surgical instrument
US11779330B2 (en) 2020-10-29 2023-10-10 Cilag Gmbh International Surgical instrument comprising a jaw alignment system
US11617577B2 (en) 2020-10-29 2023-04-04 Cilag Gmbh International Surgical instrument comprising a sensor configured to sense whether an articulation drive of the surgical instrument is actuatable
US11849943B2 (en) 2020-12-02 2023-12-26 Cilag Gmbh International Surgical instrument with cartridge release mechanisms
US11653920B2 (en) 2020-12-02 2023-05-23 Cilag Gmbh International Powered surgical instruments with communication interfaces through sterile barrier
US11737751B2 (en) 2020-12-02 2023-08-29 Cilag Gmbh International Devices and methods of managing energy dissipated within sterile barriers of surgical instrument housings
US11890010B2 (en) 2020-12-02 2024-02-06 Cllag GmbH International Dual-sided reinforced reload for surgical instruments
US11627960B2 (en) 2020-12-02 2023-04-18 Cilag Gmbh International Powered surgical instruments with smart reload with separately attachable exteriorly mounted wiring connections
US11678882B2 (en) 2020-12-02 2023-06-20 Cilag Gmbh International Surgical instruments with interactive features to remedy incidental sled movements
US11744581B2 (en) 2020-12-02 2023-09-05 Cilag Gmbh International Powered surgical instruments with multi-phase tissue treatment
US11653915B2 (en) 2020-12-02 2023-05-23 Cilag Gmbh International Surgical instruments with sled location detection and adjustment features
CN115517731B (en) * 2021-01-08 2023-04-18 薛建新 Anastomat
US11123542B1 (en) 2021-02-11 2021-09-21 Regents Of The University Of Colorado Axial compression apical cuff attachment assembly, system and method
US11793514B2 (en) 2021-02-26 2023-10-24 Cilag Gmbh International Staple cartridge comprising sensor array which may be embedded in cartridge body
US11751869B2 (en) 2021-02-26 2023-09-12 Cilag Gmbh International Monitoring of multiple sensors over time to detect moving characteristics of tissue
US11723657B2 (en) 2021-02-26 2023-08-15 Cilag Gmbh International Adjustable communication based on available bandwidth and power capacity
US11730473B2 (en) 2021-02-26 2023-08-22 Cilag Gmbh International Monitoring of manufacturing life-cycle
US11744583B2 (en) 2021-02-26 2023-09-05 Cilag Gmbh International Distal communication array to tune frequency of RF systems
US11812964B2 (en) 2021-02-26 2023-11-14 Cilag Gmbh International Staple cartridge comprising a power management circuit
US11696757B2 (en) 2021-02-26 2023-07-11 Cilag Gmbh International Monitoring of internal systems to detect and track cartridge motion status
US11701113B2 (en) 2021-02-26 2023-07-18 Cilag Gmbh International Stapling instrument comprising a separate power antenna and a data transfer antenna
US11749877B2 (en) 2021-02-26 2023-09-05 Cilag Gmbh International Stapling instrument comprising a signal antenna
US11925349B2 (en) 2021-02-26 2024-03-12 Cilag Gmbh International Adjustment to transfer parameters to improve available power
US11737749B2 (en) 2021-03-22 2023-08-29 Cilag Gmbh International Surgical stapling instrument comprising a retraction system
US11806011B2 (en) 2021-03-22 2023-11-07 Cilag Gmbh International Stapling instrument comprising tissue compression systems
US11723658B2 (en) 2021-03-22 2023-08-15 Cilag Gmbh International Staple cartridge comprising a firing lockout
US11826012B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Stapling instrument comprising a pulsed motor-driven firing rack
US11759202B2 (en) 2021-03-22 2023-09-19 Cilag Gmbh International Staple cartridge comprising an implantable layer
US11826042B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Surgical instrument comprising a firing drive including a selectable leverage mechanism
US11717291B2 (en) 2021-03-22 2023-08-08 Cilag Gmbh International Staple cartridge comprising staples configured to apply different tissue compression
US11744603B2 (en) 2021-03-24 2023-09-05 Cilag Gmbh International Multi-axis pivot joints for surgical instruments and methods for manufacturing same
US11832816B2 (en) 2021-03-24 2023-12-05 Cilag Gmbh International Surgical stapling assembly comprising nonplanar staples and planar staples
US11896218B2 (en) 2021-03-24 2024-02-13 Cilag Gmbh International Method of using a powered stapling device
US11849945B2 (en) 2021-03-24 2023-12-26 Cilag Gmbh International Rotary-driven surgical stapling assembly comprising eccentrically driven firing member
US11849944B2 (en) 2021-03-24 2023-12-26 Cilag Gmbh International Drivers for fastener cartridge assemblies having rotary drive screws
US11786239B2 (en) 2021-03-24 2023-10-17 Cilag Gmbh International Surgical instrument articulation joint arrangements comprising multiple moving linkage features
US11786243B2 (en) 2021-03-24 2023-10-17 Cilag Gmbh International Firing members having flexible portions for adapting to a load during a surgical firing stroke
US11896219B2 (en) 2021-03-24 2024-02-13 Cilag Gmbh International Mating features between drivers and underside of a cartridge deck
US11903582B2 (en) 2021-03-24 2024-02-20 Cilag Gmbh International Leveraging surfaces for cartridge installation
US11793516B2 (en) 2021-03-24 2023-10-24 Cilag Gmbh International Surgical staple cartridge comprising longitudinal support beam
US11857183B2 (en) 2021-03-24 2024-01-02 Cilag Gmbh International Stapling assembly components having metal substrates and plastic bodies
US20220378424A1 (en) 2021-05-28 2022-12-01 Cilag Gmbh International Stapling instrument comprising a firing lockout
US20230000495A1 (en) * 2021-06-30 2023-01-05 Covidien Lp Circular stapling device with tissue grasping members
US11911039B2 (en) * 2021-08-13 2024-02-27 Cilag Gmbh International Circular surgical stapler having staples with expandable crowns
US11877745B2 (en) 2021-10-18 2024-01-23 Cilag Gmbh International Surgical stapling assembly having longitudinally-repeating staple leg clusters

Citations (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3636742A (en) * 1970-05-22 1972-01-25 Filley Enterprises Inc Lock-out key holder
US3894326A (en) * 1973-09-25 1975-07-15 Augustus Lyons Merriman Clamp for longitudinally aligning pipe sections
US3910602A (en) * 1974-04-12 1975-10-07 Henry Lindner Means for storing bicycle security cable
US4505414A (en) * 1983-10-12 1985-03-19 Filipi Charles J Expandable anvil surgical stapler
US4700703A (en) * 1986-03-27 1987-10-20 Semion Resnick Cartridge assembly for a surgical stapling instrument
US4752024A (en) * 1986-10-17 1988-06-21 Green David T Surgical fastener and surgical stapling apparatus
US4838059A (en) * 1988-07-11 1989-06-13 Johnson Gordon E Combined cover and attaching means for concealing a deadbolt lock
US5219111A (en) * 1991-03-11 1993-06-15 Ethicon, Inc. Pneumatically actuated linear stapling device
US5669918A (en) * 1995-03-16 1997-09-23 Deutsche Forschungsanstalt Fur Luft-Und Raumfahrt E.V. Surgical instrument for preparing an anastomosis in minimally invasive surgery
US5732872A (en) * 1994-06-17 1998-03-31 Heartport, Inc. Surgical stapling instrument
US5855312A (en) * 1996-07-25 1999-01-05 Toledano; Haviv Flexible annular stapler for closed surgery of hollow organs
US5951576A (en) * 1998-03-02 1999-09-14 Wakabayashi; Akio End-to-side vascular anastomosing stapling device
US6099537A (en) * 1996-02-26 2000-08-08 Olympus Optical Co., Ltd. Medical treatment instrument
US6117148A (en) * 1997-10-17 2000-09-12 Ravo; Biagio Intraluminal anastomotic device
US6503259B2 (en) * 2000-12-27 2003-01-07 Ethicon, Inc. Expandable anastomotic device
US6569173B1 (en) * 1999-12-14 2003-05-27 Integrated Vascular Interventional Technologies, L.C. Compression plate anastomosis apparatus
US6736825B2 (en) * 1999-12-14 2004-05-18 Integrated Vascular Interventional Technologies, L C (Ivit Lc) Paired expandable anastomosis devices and related methods
US6769590B2 (en) * 2001-04-02 2004-08-03 Susan E. Vresh Luminal anastomotic device and method
US6957758B2 (en) * 2001-10-05 2005-10-25 Tyco Healthcare Group, Lp Tilt top anvil for a surgical fastener device

Patent Citations (20)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3636742A (en) * 1970-05-22 1972-01-25 Filley Enterprises Inc Lock-out key holder
US3894326A (en) * 1973-09-25 1975-07-15 Augustus Lyons Merriman Clamp for longitudinally aligning pipe sections
US3910602A (en) * 1974-04-12 1975-10-07 Henry Lindner Means for storing bicycle security cable
US4505414A (en) * 1983-10-12 1985-03-19 Filipi Charles J Expandable anvil surgical stapler
US4700703A (en) * 1986-03-27 1987-10-20 Semion Resnick Cartridge assembly for a surgical stapling instrument
US4752024A (en) * 1986-10-17 1988-06-21 Green David T Surgical fastener and surgical stapling apparatus
US4838059A (en) * 1988-07-11 1989-06-13 Johnson Gordon E Combined cover and attaching means for concealing a deadbolt lock
US5219111A (en) * 1991-03-11 1993-06-15 Ethicon, Inc. Pneumatically actuated linear stapling device
US5732872A (en) * 1994-06-17 1998-03-31 Heartport, Inc. Surgical stapling instrument
US5669918A (en) * 1995-03-16 1997-09-23 Deutsche Forschungsanstalt Fur Luft-Und Raumfahrt E.V. Surgical instrument for preparing an anastomosis in minimally invasive surgery
US6099537A (en) * 1996-02-26 2000-08-08 Olympus Optical Co., Ltd. Medical treatment instrument
US5855312A (en) * 1996-07-25 1999-01-05 Toledano; Haviv Flexible annular stapler for closed surgery of hollow organs
US6117148A (en) * 1997-10-17 2000-09-12 Ravo; Biagio Intraluminal anastomotic device
US5951576A (en) * 1998-03-02 1999-09-14 Wakabayashi; Akio End-to-side vascular anastomosing stapling device
US6569173B1 (en) * 1999-12-14 2003-05-27 Integrated Vascular Interventional Technologies, L.C. Compression plate anastomosis apparatus
US6736825B2 (en) * 1999-12-14 2004-05-18 Integrated Vascular Interventional Technologies, L C (Ivit Lc) Paired expandable anastomosis devices and related methods
US6503259B2 (en) * 2000-12-27 2003-01-07 Ethicon, Inc. Expandable anastomotic device
US6769590B2 (en) * 2001-04-02 2004-08-03 Susan E. Vresh Luminal anastomotic device and method
US7080769B2 (en) * 2001-04-02 2006-07-25 Vresh Susan E Luminal anastomotic device
US6957758B2 (en) * 2001-10-05 2005-10-25 Tyco Healthcare Group, Lp Tilt top anvil for a surgical fastener device

Cited By (267)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20070075117A1 (en) * 2002-10-04 2007-04-05 Milliman Keith L Surgical stapling device
US20080054045A1 (en) * 2002-10-04 2008-03-06 Tyco Healthcare Group Lp Surgical stapling device
US8348122B2 (en) 2002-10-04 2013-01-08 Tyco Healthcare Group Lp Surgical stapling device
US20060097025A1 (en) * 2002-10-04 2006-05-11 Tyco Healthcare Graoup Llp Surgical stapling device
US7975895B2 (en) 2004-03-19 2011-07-12 Tyco Healthcare Group L.P. Tissue tensioner assembly and approximation mechanism for surgical stapling device
US8540132B2 (en) 2006-05-16 2013-09-24 Covidien Lp Tilt anvil assembly
US8011554B2 (en) 2008-01-09 2011-09-06 Tyco Healthcare Group, Lp Raised boss for staple guide
US8317075B2 (en) 2008-01-09 2012-11-27 Covidien Lp Raised boss for staple guide
US20100089971A1 (en) * 2008-09-10 2010-04-15 Milliman Keith L Surgical stapling device
US9358006B2 (en) 2008-09-10 2016-06-07 Covidien Lp Surgical stapling device
US9113871B2 (en) 2008-09-10 2015-08-25 Covidien Lp Surgical stapling device
US8343185B2 (en) 2008-09-10 2013-01-01 Covidien Lp Surgical stapling device
US8360295B2 (en) 2008-09-10 2013-01-29 Covidien Lp Surgical stapling device
US8181838B2 (en) 2008-09-10 2012-05-22 Tyco Healthcare Group Lp Surgical stapling device
US9629624B2 (en) 2008-11-06 2017-04-25 Covidien Lp Circular surgical stapler with mating anvil and shell assembly
US8231042B2 (en) 2008-11-06 2012-07-31 Tyco Healthcare Group Lp Surgical stapler
US8424535B2 (en) 2008-11-06 2013-04-23 Covidien Lp Circular surgical stapler with mating anvil and shell assembly
US10575847B2 (en) 2008-11-06 2020-03-03 Covidien Lp Circular surgical stapler with mating anvil and shell assembly
US8281974B2 (en) 2009-01-14 2012-10-09 Tyco Healthcare, Group LP Surgical stapler with suture locator
US8453913B2 (en) 2009-02-06 2013-06-04 Covidien Lp Anvil for surgical stapler
US9463018B2 (en) 2009-02-06 2016-10-11 Covidien Lp Anvil for surgical stapler
US8684248B2 (en) 2009-07-11 2014-04-01 Covidien Lp Surgical instrument with safety mechanism
US8833630B2 (en) 2009-07-11 2014-09-16 Covidien Lp Surgical instrument with safety mechanism
US8931680B2 (en) 2009-07-11 2015-01-13 Covidien Lp Surgical instrument with safety mechanism
US8146790B2 (en) 2009-07-11 2012-04-03 Tyco Healthcare Group Lp Surgical instrument with safety mechanism
US8267301B2 (en) 2009-08-19 2012-09-18 Tyco Healthcare Group Lp Surgical stapler
US8453911B2 (en) 2009-08-19 2013-06-04 Covidien Lp Surgical stapler
US20110042443A1 (en) * 2009-08-19 2011-02-24 Milliman Keith L Surgical stapler
US9592051B2 (en) 2009-10-28 2017-03-14 Covidien Lp Surgical stapling instrument
US8905289B2 (en) 2009-10-28 2014-12-09 Covidien Lp Surgical stapling instrument
US8684252B2 (en) 2009-10-28 2014-04-01 Covidien Lp Surgical stapling instrument
US20110095069A1 (en) * 2009-10-28 2011-04-28 Nihir Patel Surgical fastening apparatus
US20110095070A1 (en) * 2009-10-28 2011-04-28 Nihir Patel Surgical stapling instrument
US8322590B2 (en) 2009-10-28 2012-12-04 Covidien Lp Surgical stapling instrument
US8430292B2 (en) 2009-10-28 2013-04-30 Covidien Lp Surgical fastening apparatus
US9421013B2 (en) 2009-10-28 2016-08-23 Covidien Lp Surgical Fastening Apparatus
US8448833B2 (en) * 2010-01-26 2013-05-28 Zakease Surgical Inc. Stapling apparatus for performing anastomosis on hollow organs
US8245897B2 (en) * 2010-01-26 2012-08-21 Zakease Surgical Inc. Stapling apparatus for performing anastomosis on hollow organs
WO2011093986A1 (en) * 2010-01-26 2011-08-04 Zakease Surgical Inc. Stapling apparatus for performing anastomosis on hollow organs
US20110180584A1 (en) * 2010-01-26 2011-07-28 Andreas Tzakis Stapling apparatus for performing anastomosis on hollow organs
US20110184443A1 (en) * 2010-01-26 2011-07-28 Andreas Tzakis Stapling apparatus for performing anastomosis on hollow organs
US20120080492A1 (en) * 2010-10-01 2012-04-05 Paul Scirica Surgical Stapling Device For Performing Circular Anastomosis And Surgical Staples For Use Therewith
US8998061B2 (en) 2010-10-01 2015-04-07 Covidien Lp Surgical fastener applying apparatus
US9750502B2 (en) * 2010-10-01 2017-09-05 Covidien Lp Surgical stapling device for performing circular anastomosis and surgical staples for use therewith
US11357507B2 (en) 2010-10-01 2022-06-14 Covidien Lp Surgical stapling device for performing circular anastomosis and surgical staples for use therewith
US10537331B2 (en) 2010-10-01 2020-01-21 Covidien Lp Surgical stapling device for performing circular anastomosis and surgical staples for use therewith
US11696762B2 (en) 2010-10-01 2023-07-11 Covidien Lp Surgical fastener applying apparatus
US10639040B2 (en) 2010-10-01 2020-05-05 Covidien Lp Surgical fastener applying apparatus
US9987011B2 (en) 2010-10-01 2018-06-05 Covidien Lp Surgical fastener applying apparatus
US8893948B2 (en) 2011-10-18 2014-11-25 Covidien Lp Tilt top anvil with torsion spring
US9113886B2 (en) 2011-10-18 2015-08-25 Covidien Lp Tilt top anvil with torsion spring
US8708212B2 (en) 2011-10-18 2014-04-29 Covidien Lp Tilt top anvil with torsion spring
US9867614B2 (en) 2011-10-18 2018-01-16 Covidien Lp Tilt top anvil with torsion spring
US9016547B2 (en) 2011-10-26 2015-04-28 Covidien Lp EEA tilt top anvil with ratchet/locking mechanism
US9345482B2 (en) 2012-01-12 2016-05-24 Covidien Lp Sliding sleeve for circular stapling instrument reloads
US9010605B2 (en) 2012-01-12 2015-04-21 Covidien Lp Sliding sleeve for circular stapling instrument reloads
US9022274B2 (en) 2012-02-15 2015-05-05 Covidien Lp Circular stapler with increased lumen diameter
WO2013177109A1 (en) * 2012-05-21 2013-11-28 Medplate Lifesciences Corporation Collapsible, shape memory alloy structures and folding fixtures for collapsing same
US9622885B2 (en) 2012-05-21 2017-04-18 Medplate Lifesciences Corporation Collapsible, shape memory alloy structures and folding fixtures for collapsing same
US10980540B2 (en) 2012-06-19 2021-04-20 Covidien Lp Spring loaded anvil retainer
US9351734B2 (en) 2012-06-19 2016-05-31 Covidien Lp Spring loaded anvil retainer
US10285701B2 (en) 2012-06-19 2019-05-14 Covidien Lp Spring loaded anvil retainer
US10213205B2 (en) 2012-07-06 2019-02-26 Covidien Lp T-slot tilt anvil for circular stapling instrument
US10639041B2 (en) 2012-10-10 2020-05-05 Covidien Lp Surgical instrument with preload assembly
US9675359B2 (en) 2012-10-10 2017-06-13 Covidien Lp Surgical instrument with preload assembly
US9572572B2 (en) 2012-11-09 2017-02-21 Covidien Lp Circular stapler mechanical lockout
US9681871B2 (en) 2012-11-09 2017-06-20 Covidien Lp Circular stapler mechanical lockout
US9597083B2 (en) 2013-01-11 2017-03-21 Covidien Lp Circular stapling instrument
US9351724B2 (en) 2013-01-11 2016-05-31 Covidien Lp Circular stapling instrument
US9895150B2 (en) 2013-01-21 2018-02-20 Ethicon, Inc. Sealant delivery device for anastomotic stapler
US9119606B2 (en) 2013-01-21 2015-09-01 Ethicon, Inc. Sealant delivery device for anastomotic stapler
US9592056B2 (en) 2013-03-14 2017-03-14 Covidien Lp Powered stapling apparatus
US10463373B2 (en) 2013-03-14 2019-11-05 Covidien Lp Powered stapling apparatus
US10178994B2 (en) 2013-03-15 2019-01-15 Covidien Lp Surgical stapling apparatus with reusable components
US11083461B2 (en) 2013-03-15 2021-08-10 Covidien Lp Surgical stapling apparatus with reusable components
US10499921B2 (en) 2013-06-12 2019-12-10 Covidien Lp EEA anvil snap ring activator
US9532780B2 (en) 2013-06-12 2017-01-03 Covidien Lp EEA anvil snap ring activator
US9668740B2 (en) 2013-06-14 2017-06-06 Covidien Lp Anvil assembly with sliding sleeve
US11065004B2 (en) 2013-06-14 2021-07-20 Covidien Lp Anvil assembly with sliding sleeve
US10271843B2 (en) 2013-06-17 2019-04-30 Covidien Lp Surgical instrument with lockout mechanism
US11026679B2 (en) 2013-06-17 2021-06-08 Covidien Lp Surgical instrument with lockout mechanism
US9750503B2 (en) 2013-07-11 2017-09-05 Covidien Lp Methods and devices for performing a surgical anastomosis
US10245040B2 (en) 2013-07-11 2019-04-02 Covidien Lp Methods and devices for performing a surgical anastomosis
US11045201B2 (en) 2013-07-11 2021-06-29 Covidien Lp Methods and devices for performing a surgical anastomosis
US11547413B2 (en) 2013-07-11 2023-01-10 Covidien Lp Methods and devices for performing a surgical anastomosis
US10653414B2 (en) 2013-09-11 2020-05-19 Covidien Lp Anvil assembly with sliding sleeve
US9693773B2 (en) 2013-09-11 2017-07-04 Covidien Lp Anvil assembly with sliding sleeve
US11129619B2 (en) 2013-11-13 2021-09-28 Covidien Lp Anvil assembly and delivery system
US9517070B2 (en) 2013-11-13 2016-12-13 Covidien Lp Anvil assembly and delivery system
US10595870B2 (en) 2013-11-13 2020-03-24 Covidien Lp Anvil assembly with frangible retaining member
US9554802B2 (en) 2013-11-13 2017-01-31 Covidien Lp Anvil assembly with frangible retaining member
US9913643B2 (en) 2014-05-09 2018-03-13 Covidien Lp Interlock assemblies for replaceable loading unit
US10507022B2 (en) 2014-06-12 2019-12-17 Covidien Lp Surgical stapling apparatus
US10470772B2 (en) 2014-06-24 2019-11-12 Covidien Lp Anvil assembly delivery systems
US10154845B2 (en) 2014-06-24 2018-12-18 Covidien Lp System for delivering an anvil assembly to a surgical site
US9861367B2 (en) 2014-06-24 2018-01-09 Covidien Lp Anvil assembly delivery systems
US11259812B2 (en) 2014-06-24 2022-03-01 Covidien Lp Anvil assembly delivery systems
US9867619B2 (en) 2014-06-24 2018-01-16 Covidien Lp System for delivering an anvil assembly to a surgical site
US10405864B2 (en) 2014-07-04 2019-09-10 Covidien Lp Loading unit with shipping member for surgical stapling device
US9757133B2 (en) 2014-07-09 2017-09-12 Covidien Lp Methods and devices for performing a surgical anastomosis
US10751049B2 (en) 2014-12-08 2020-08-25 Covidien Lp Loading unit attachment band for surgical stapling instrument
US10085744B2 (en) 2014-12-08 2018-10-02 Covidien Lp Loading unit attachment band for surgical stapling instrument
US9855045B2 (en) 2014-12-09 2018-01-02 Covidien Lp Anvil assembly delivery system
US10779833B2 (en) 2014-12-09 2020-09-22 Covidien Lp Anvil assembly delivery system
US10499916B2 (en) 2014-12-11 2019-12-10 Covidien Lp Surgical stapling loading unit
US10772627B2 (en) 2014-12-11 2020-09-15 Covidien Lp Stapler with auto-matic lockout mechanism
US10542985B2 (en) 2014-12-17 2020-01-28 Covidien Lp Surgical stapling device with firing indicator
US10022126B2 (en) 2015-01-07 2018-07-17 Covidien Lp Loading unit locking collar
US10039549B2 (en) 2015-01-07 2018-08-07 Covidien Lp Loading unit retention clip for surgical stapling instrument
US10117656B2 (en) 2015-01-07 2018-11-06 Covidien Lp Loading unit locking collar
US10517601B2 (en) 2015-02-15 2019-12-31 Covidien Lp Surgical stapling device with firing indicator of unitary construction
US10881408B2 (en) 2015-04-22 2021-01-05 Covidien Lp Interlock assembly for replaceable loading units
US10426480B2 (en) 2015-04-29 2019-10-01 Covidien Lp Cutting ring assembly with rigid cutting member
US9987001B2 (en) 2015-06-12 2018-06-05 Covidien Lp Surgical anastomosis apparatus
US10966714B2 (en) 2015-06-12 2021-04-06 Covidien Lp Surgical anastomosis apparatus
US10111668B2 (en) 2015-07-02 2018-10-30 Covidien Lp Anvil assembly with snap backup ring
US10939903B2 (en) 2015-07-02 2021-03-09 Covidien Lp Anvil assemblies and delivery systems
US11013514B2 (en) 2015-07-02 2021-05-25 Covidien Lp Anvil assembly with snap backup ring
US11540834B2 (en) 2015-07-02 2023-01-03 Covidien Lp Anvil assembly with snap backup ring
US9974536B2 (en) 2015-07-02 2018-05-22 Covidien Lp Anvil assemblies and delivery systems
US11839371B2 (en) 2015-07-02 2023-12-12 Covidien Lp Anvil assemblies and delivery systems
US10751055B2 (en) 2015-07-22 2020-08-25 Covidien Lp Loading unit locking band for surgical stapling instrument
US10117655B2 (en) 2015-07-22 2018-11-06 Covidien Lp Loading unit locking band for surgical stapling instrument
US10085756B2 (en) 2015-07-24 2018-10-02 Covidien Lp Anvil assembly and anvil assembly delivery system
US10881410B2 (en) 2015-07-24 2021-01-05 Covidien Lp Anvil assembly and anvil assembly delivery system
US10117675B2 (en) 2015-07-28 2018-11-06 Covidien Lp Trocar tip protector
US11553917B2 (en) 2015-09-21 2023-01-17 Covidien Lp Loading unit locking collar with rotational actuated release
US10743880B2 (en) 2015-09-21 2020-08-18 Covidien Lp Loading unit locking collar with rotational actuated release
US9980730B2 (en) 2015-09-21 2018-05-29 Covidien Lp Loading unit locking collar with rotational actuated release
US10111684B2 (en) 2015-09-25 2018-10-30 Covidien Lp Adapter assembly including a removable trocar assembly
US10507039B2 (en) 2015-09-25 2019-12-17 Covidien Lp Adapter assembly including a removable trocar assembly
US11278314B2 (en) 2015-09-25 2022-03-22 Covidien Lp Adapter assembly including a removable trocar assembly
US10542992B2 (en) 2015-10-19 2020-01-28 Covidien Lp Loading unit with stretchable bushing
US10973522B2 (en) 2015-10-20 2021-04-13 Covidien Lp Circular stapler with tissue gap indicator assembly
US10842495B2 (en) 2015-10-21 2020-11-24 Covidien Lp Annular knife for a surgical stapler
US10512466B2 (en) 2015-11-05 2019-12-24 Covidien Lp Adapter assembly for surgical device
US10932783B2 (en) 2015-11-13 2021-03-02 Covidien Lp Circular stapler with audible indicator mechanism
US11020119B2 (en) 2015-12-07 2021-06-01 Covidien Lp Anvil assembly and delivery system
US10390835B2 (en) 2015-12-10 2019-08-27 Covidien Lp Surgical fastener apparatus with linear position sensor
US11129620B2 (en) 2016-01-13 2021-09-28 Covidien Lp Adapter assembly including a removable trocar assembly
US10524797B2 (en) 2016-01-13 2020-01-07 Covidien Lp Adapter assembly including a removable trocar assembly
US10874399B2 (en) 2016-02-04 2020-12-29 Covidien Lp Circular stapler with visual indicator mechanism
US10398439B2 (en) 2016-02-10 2019-09-03 Covidien Lp Adapter, extension, and connector assemblies for surgical devices
US10603042B2 (en) 2016-02-10 2020-03-31 Covidien Lp Flexible circular stapler
US10595871B2 (en) 2016-05-10 2020-03-24 Covidien Lp Insertion instrument, adapter assemblies and protector assemblies for a flexible circular stapler
US11376007B2 (en) 2016-05-10 2022-07-05 Covidien Lp Insertion instrument, adapter assemblies and protector assemblies for a flexible circular stapler
US11141162B2 (en) 2016-07-08 2021-10-12 Covidien Lp Loading unit locking collar with linearly actuated release
US11452522B2 (en) 2016-08-15 2022-09-27 Covidien Lp Circular stapling device with articulating anvil retainer assembly
US10426470B2 (en) 2016-11-04 2019-10-01 Covidien Lp Stapling device with releasable knife carrier
US10499922B2 (en) 2016-11-04 2019-12-10 Covidien Lp Stapling device with self-releasing knife carrier pusher
US11241232B2 (en) 2017-01-24 2022-02-08 Covidien Lp Surgical stapling device with resettable anvil assembly
US11678885B2 (en) 2017-01-25 2023-06-20 Covidien Lp Circular stapling device and method of use
US10542993B2 (en) 2017-02-24 2020-01-28 Covidien Lp Anvil assembly of circular stapling device including alignment splines
US11324508B2 (en) 2017-02-24 2022-05-10 Covidien Lp Anvil assembly of circular stapling device including alignment splines
US11382629B2 (en) 2017-03-09 2022-07-12 Covidien Lp Surgical stapling device with audible indicator mechanism
US11116507B2 (en) 2017-03-09 2021-09-14 Covidien Lp End effector assembly for a circular stapler apparatus
US11071549B2 (en) 2017-03-23 2021-07-27 Covidien Lp Circular stapling device with alignment splines
US10342534B2 (en) 2017-03-23 2019-07-09 Covidien Lp Surgical stapling device with releasable knife carrier
US11076852B2 (en) 2017-03-23 2021-08-03 Covidien Lp Surgical stapling device with releasable knife carrier
US10881409B2 (en) 2017-05-02 2021-01-05 Covidien Lp Rotation assembly for a surgical device
US11857194B2 (en) 2017-06-09 2024-01-02 Covidien Lp Handheld electromechanical surgical system
US11864768B2 (en) 2017-06-09 2024-01-09 Covidien Lp Handheld electromechanical surgical system
US10932784B2 (en) 2017-06-09 2021-03-02 Covidien Lp Handheld electromechanical surgical system
US11596400B2 (en) 2017-06-09 2023-03-07 Covidien Lp Handheld electromechanical surgical system
US11045199B2 (en) 2017-06-09 2021-06-29 Covidien Lp Handheld electromechanical surgical system
US20180368851A1 (en) * 2017-06-27 2018-12-27 Ethicon Llc Powered circular stapler with reciprocating drive member to provide independent stapling and cutting of tissue
EP3936063A1 (en) * 2017-06-27 2022-01-12 Cilag GmbH International Powered circular stapler with reciprocating drive member to provide independent stapling and cutting of tissue
WO2019005925A1 (en) * 2017-06-27 2019-01-03 Ethicon Llc Powered circular stapler with reciprocating drive member to provide independent stapling and cutting of tissue
CN110831519A (en) * 2017-06-27 2020-02-21 爱惜康有限责任公司 Motorized circular stapler with reciprocating drive members to provide independent stapling and severing of tissue
US11071548B2 (en) * 2017-06-27 2021-07-27 Cilag Gmbh International Powered circular stapler with reciprocating drive member to provide independent stapling and cutting of tissue
JP2020525123A (en) * 2017-06-27 2020-08-27 エシコン エルエルシーEthicon LLC Motorized circular stapler with reciprocating drive member that provides independent tissue stapling and cutting
JP7221228B2 (en) 2017-06-27 2023-02-13 エシコン エルエルシー A motorized circular stapler with a reciprocating drive member that provides independent tissue stapling and cutting
EP3420973A1 (en) * 2017-06-27 2019-01-02 Ethicon LLC Powered circular stapler with reciprocating drive member to provide independent stapling and cutting of tissue
US10987107B2 (en) 2017-07-05 2021-04-27 Covidien Lp Surgical stapling device
US11090054B2 (en) 2017-08-07 2021-08-17 Covidien Lp Stapling device with resettable tilt anvil assembly
US10828026B2 (en) 2017-08-08 2020-11-10 Covidien Lp Tiltable anvil assembly
US10695069B2 (en) 2017-08-23 2020-06-30 Covidien Lp Circular stapling device with offset spline tip
US11642135B2 (en) 2017-09-01 2023-05-09 Covidien Lp Circular stapling device with position ribs
US11234703B2 (en) 2017-09-01 2022-02-01 Covidien Lp Circular stapling device with position ribs
US11324507B2 (en) 2017-11-03 2022-05-10 Covidien Lp Device and method for attachment of a stomal sleeve
US11497501B2 (en) 2018-03-26 2022-11-15 Covidien Lp Circular stapling device with A-frame splines
US11051820B2 (en) 2018-03-28 2021-07-06 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11730483B2 (en) 2018-03-28 2023-08-22 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11006961B2 (en) 2018-03-28 2021-05-18 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11006960B2 (en) 2018-03-28 2021-05-18 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11751878B2 (en) 2018-03-28 2023-09-12 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US10881411B2 (en) 2018-03-28 2021-01-05 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11832821B2 (en) 2018-03-28 2023-12-05 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11000286B2 (en) 2018-03-28 2021-05-11 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11246598B2 (en) 2018-03-28 2022-02-15 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11653924B2 (en) 2018-03-28 2023-05-23 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US10959733B2 (en) 2018-03-28 2021-03-30 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11033273B2 (en) 2018-03-28 2021-06-15 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11026689B2 (en) 2018-03-28 2021-06-08 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US11006959B2 (en) 2018-03-28 2021-05-18 Covidien Lp Surgical anvil assemblies for surgical stapling instruments
US10952734B2 (en) 2018-04-23 2021-03-23 Covidien Lp Stapling device with cut ring biasing member
US11197676B2 (en) 2018-06-28 2021-12-14 Covidien Lp Tie-down method for anvil assembly delivery system
US11241234B2 (en) 2018-08-14 2022-02-08 Covidien Lp Anvil assembly with self-retaining backup member
US11564691B2 (en) 2018-08-24 2023-01-31 Covidien Lp Powered circular stapling device
US10973544B2 (en) 2018-10-02 2021-04-13 Covidien Lp Retaining mechanism for trocar assembly
US11141163B2 (en) 2018-10-04 2021-10-12 Covidien Lp Circular stapling device with anvil rotation locking structure
US11576678B2 (en) 2018-10-04 2023-02-14 Covidien Lp Circular stapling device with anvil rotation locking structure
US11065005B2 (en) 2018-11-07 2021-07-20 Covidien Lp Reload assembly for a circular stapling device
US11147561B2 (en) 2018-11-28 2021-10-19 Covidien Lp Reload assembly for a circular stapling device
US11389263B2 (en) 2018-12-13 2022-07-19 Covidien Lp Lockout mechanisms for surgical instruments
US11166728B2 (en) 2019-02-08 2021-11-09 Covidien Lp Reload assembly for a circular stapling device
US11547411B2 (en) 2019-02-22 2023-01-10 Covidien Lp Anastomosis wound protector
US11529144B2 (en) 2019-02-22 2022-12-20 Covidien Lp Encapsulated plug assembly for electromechanical surgical devices
US11337701B2 (en) 2019-03-01 2022-05-24 Covidien Lp Devices and methods for assembling adapter assemblies
US11331782B2 (en) 2019-03-01 2022-05-17 Covidien Lp Reload assembly for a circular stapling device
US11457921B2 (en) 2019-03-26 2022-10-04 Covidien Lp Anvil assembly for surgical stapling instrument
US11596410B2 (en) 2019-04-05 2023-03-07 Covidien Lp Surgical stapling device
US11534164B2 (en) 2019-04-05 2022-12-27 Covidien Lp Strain gauge stabilization in a surgical device
US11660116B2 (en) 2019-04-16 2023-05-30 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11317945B2 (en) 2019-04-16 2022-05-03 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11419631B2 (en) 2019-04-16 2022-08-23 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11344330B2 (en) 2019-04-16 2022-05-31 Covidien Lp Trocar assemblies for adapter assemblies for surgical stapling instruments
US11839378B2 (en) 2019-04-19 2023-12-12 Covidien Lp Circular stapling instruments
US11399838B2 (en) 2019-04-22 2022-08-02 Covidien Lp Reload assembly for circular stapling devices
US11246599B2 (en) 2019-04-25 2022-02-15 Covidien Lp End effector for circular stapling instrument
US11896233B2 (en) 2019-05-31 2024-02-13 Covidien Lp Circular stapling device
US11690624B2 (en) 2019-06-21 2023-07-04 Covidien Lp Reload assembly injection molded strain gauge
US11446035B2 (en) 2019-06-24 2022-09-20 Covidien Lp Retaining mechanisms for trocar assemblies
US11123101B2 (en) 2019-07-05 2021-09-21 Covidien Lp Retaining mechanisms for trocar assemblies
US11357509B2 (en) 2019-07-11 2022-06-14 Covidien Lp Reload assembly for a circular stapling device
US11192227B2 (en) 2019-07-16 2021-12-07 Covidien Lp Reload assembly for circular stapling devices
US11518014B2 (en) 2019-07-16 2022-12-06 Covidien Lp Reload assembly for circular stapling devices
US11464510B2 (en) 2019-07-26 2022-10-11 Covidien Lp Reload assembly with knife carrier lockout
US11911029B2 (en) 2019-07-26 2024-02-27 Covidien Lp Knife lockout wedge
US11253255B2 (en) 2019-07-26 2022-02-22 Covidien Lp Knife lockout wedge
US11399825B2 (en) 2019-10-28 2022-08-02 Covidien Lp Reload assembly with knife carrier lockout
CN110974330A (en) * 2019-12-09 2020-04-10 杭州市第一人民医院 Nail anvil seat of folding tubular anastomat placed through oral cavity
US11553918B2 (en) 2019-12-16 2023-01-17 Covidien Lp Reload assembly with knife carrier lockout
US11730481B2 (en) 2020-01-06 2023-08-22 Covidien Lp Assemblies for retaining a trocar assembly
US11517317B2 (en) 2020-01-06 2022-12-06 Covidien Lp Trocar release assemblies for a surgical stapler
US11911038B2 (en) 2020-01-13 2024-02-27 Covidien Lp Cut optimization for excessive tissue conditions
US11523828B2 (en) 2020-01-28 2022-12-13 Covidien Lp Sealed reload assembly for stapling device
US11622767B2 (en) 2020-02-19 2023-04-11 Covidien Lp Sealed trocar assembly for stapling device
US11547438B2 (en) 2020-02-24 2023-01-10 Covidien Lp Tip protector for ensuring trocar insertion
US11382630B2 (en) 2020-02-25 2022-07-12 Covidien Lp Surgical stapling device with two part knife assembly
US11779343B2 (en) 2020-02-26 2023-10-10 Covidien Lp Staple reload assembly with releasable knife
US11298152B2 (en) 2020-02-28 2022-04-12 Covidien Lp Trocar retaining mechanism including band support
US11272998B2 (en) 2020-03-04 2022-03-15 Covidien Lp Strain gage fixation in tension
US11426170B2 (en) 2020-03-24 2022-08-30 Covidien Lp Retaining mechanisms for trocar assemblies
US11350939B2 (en) 2020-03-24 2022-06-07 Covidien Lp Retaining mechanisms for trocar assemblies
US11426169B2 (en) 2020-03-24 2022-08-30 Covidien Lp Retaining mechanisms for trocar assemblies
US11653925B2 (en) 2020-05-21 2023-05-23 Covidien Lp Tissue relaxation monitoring for optimized tissue stapling
US11547405B2 (en) 2020-05-22 2023-01-10 Covidien Lp Surgical stapling device
US11553921B2 (en) 2020-07-15 2023-01-17 Covidien Lp Surgical stapling device with flexible shaft
US11547412B2 (en) 2020-07-22 2023-01-10 Covidien Lp Surgical instruments and methods of assembly
US11877744B2 (en) 2020-08-14 2024-01-23 Covidien Lp Low-cost powered stapler with end stop selection
US11627966B2 (en) 2020-08-26 2023-04-18 Covidien Lp Surgical stapling device
US11801054B2 (en) 2020-09-22 2023-10-31 Covidien Lp Surgical stapler with oval tool assembly
US11712509B2 (en) 2020-10-02 2023-08-01 Covidien Lp Seal assembly for circular stapling instrument
US11627967B2 (en) 2020-11-23 2023-04-18 Covidien Lp Trans-anastomotic insertion device
US11877750B2 (en) 2021-01-21 2024-01-23 Covidien Lp Surgical stapler with powered and manual functions
US11786241B2 (en) 2021-02-16 2023-10-17 Covidien Lp Surgical stapling device including a hydraulic staple formation mechanism
US11553920B2 (en) 2021-05-03 2023-01-17 Covidien Lp Trocar retainer assembly for surgical stapler
US11490894B1 (en) 2021-05-12 2022-11-08 Covidien Lp Surgical device with grease filter
US11642131B2 (en) 2021-05-17 2023-05-09 Covidien Lp Devices and methods for shortening a rectal stump during a lower anterior resection procedure
US11612400B2 (en) 2021-05-24 2023-03-28 Covidien Lp Trocar assembly with bearing assembly for load sharing
US11737759B2 (en) 2021-08-05 2023-08-29 Covidien Lp Surgical stapling device accommodating prolapsed tissue
US11744592B2 (en) 2021-08-05 2023-09-05 Covidien Lp Handheld electromechanical stapler with tissue thickness detection
US11819208B2 (en) 2021-08-05 2023-11-21 Covidien Lp Handheld electromechanical surgical device with strain gauge drift detection
US11883028B2 (en) 2021-09-08 2024-01-30 Covidien Lp Systems and methods for post-operative anastomotic leak detection
US11717299B2 (en) 2021-10-12 2023-08-08 Covidien Lp Surgical stapling device with probiotics
WO2023076499A1 (en) * 2021-10-29 2023-05-04 The Regents Of The University Of California Devices and methods for forming an anastomosis between two lumens

Also Published As

Publication number Publication date
US20050067454A1 (en) 2005-03-31
US20020185517A1 (en) 2002-12-12
US7080769B2 (en) 2006-07-25
US6769590B2 (en) 2004-08-03

Similar Documents

Publication Publication Date Title
US7080769B2 (en) Luminal anastomotic device
US20220330933A1 (en) Anvil assemblies with collapsible frames for circular staplers
JP4346439B2 (en) Inclined top anvil for surgical fastener devices
US7059510B2 (en) End-to-end anastomosis instrument and method for performing same
US7195142B2 (en) End-to-end anastomosis instrument and method for performing same
US7094247B2 (en) Intussusception and anastomosis apparatus
AU2002362751A1 (en) Tilt top anvil for a surgical fastener device
EP1551313B1 (en) Improved intussusception and anastomosis apparatus

Legal Events

Date Code Title Description
STCB Information on status: application discontinuation

Free format text: ABANDONED -- FAILURE TO PAY ISSUE FEE