WO2013122739A2 - Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status - Google Patents
Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status Download PDFInfo
- Publication number
- WO2013122739A2 WO2013122739A2 PCT/US2013/023721 US2013023721W WO2013122739A2 WO 2013122739 A2 WO2013122739 A2 WO 2013122739A2 US 2013023721 W US2013023721 W US 2013023721W WO 2013122739 A2 WO2013122739 A2 WO 2013122739A2
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- WO
- WIPO (PCT)
- Prior art keywords
- resistive member
- surgical
- firing element
- surgical instrument
- end effector
- Prior art date
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- 0 CC1*CCC1 Chemical compound CC1*CCC1 0.000 description 2
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/70—Manipulators specially adapted for use in surgery
- A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/10—Surgical instruments, devices or methods, e.g. tourniquets for applying or removing wound clamps, e.g. containing only one clamp or staple; Wound clamp magazines
- A61B17/105—Wound clamp magazines
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00115—Electrical control of surgical instruments with audible or visual output
- A61B2017/00128—Electrical control of surgical instruments with audible or visual output related to intensity or progress of surgical action
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00681—Aspects not otherwise provided for
- A61B2017/00685—Archimedes screw
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07285—Stapler heads characterised by its cutter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2901—Details of shaft
- A61B2017/2902—Details of shaft characterized by features of the actuating rod
- A61B2017/2903—Details of shaft characterized by features of the actuating rod transferring rotary motion
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
Definitions
- the present invention relates to surgical instruments and, more particularly, to surgical cutting and fastening instruments with an electronic sensor capable of determining cartridge and firing motion status.
- Surgical instruments often comprise a distal end effector that engages tissue at a surgical site to achieve a diagnostic or therapeutic effect (e.g., endocutter, grasper, cutter, staplers, clip applier, access device, drug/gene therapy delivery device, and energy device using ultrasound, RF, laser, etc.).
- a diagnostic or therapeutic effect e.g., endocutter, grasper, cutter, staplers, clip applier, access device, drug/gene therapy delivery device, and energy device using ultrasound, RF, laser, etc.
- known surgical staplers include an end effector that simultaneously makes a longitudinal incision in tissue and applies lines of staples on opposing sides of the incision.
- Such surgical staplers often have a firing bar that translates in the end effector in response to manual or motorized drive motions. The firing bar drives a cutting element through tissue held in the end effector and drives a plurality of wedges against drivers that support the staples to effect the firing of the staples from the end effector.
- Surgical instruments generally do not provide sufficient user feedback during operation.
- many robotically-controlled surgical staplers do not alert the user to the deployment forces and position of the cutting element during the cutting and stapling operations. Consequently, motor-driven endocutters where the drive motions are actuated by merely pressing a button are generally not accepted by physicians. Accordingly, there is a need in the art for surgical instruments that address some of these shortcomings.
- a surgical instrument comprising a surgical end effector comprising an elongate channel having a proximal end and a distal end; a firing element configured to selectively translate between said proximal end of said elongate channel and said distal end of said elongate channel upon application of a driving motion thereto; a resistive member supported for moving contact by said firing element as said firing element is driven from said proximal end to said distal end of said elongate channel such that said resistive member generates output signals indicative of positions of said firing element within said elongate channel; and a memory device operably communicating with said resistive member and configured to record said output signals as said firing element translates through said elongate channel.
- various embodiments of the present invention are directed to a surgical instrument, comprising a robotic system comprising a processor and a surgical end effector operably interfacing with said robotic system to receive drive motions therefrom.
- the surgical end effector comprises an elongate channel having a proximal end and a distal end; a firing element configured to selectively translate between said proximal end of said elongate channel and said distal end of said elongate channel upon application of a driving motion thereto from said robotic system; and a resistive member supported for moving contact by said firing element as said firing element is driven from said proximal end to said distal end of said elongate channel such that said resistive member generates output signals indicative of positions of said firing element within said elongate channel and communicates said output signals to said processor.
- FIG. 1 is a perspective view of a surgical cutting and fastening instrument according to various embodiments.
- FIG. 2 is another perspective view of a surgical cutting and fastening instrument according to various embodiments.
- FIGS. 3-5 are exploded views of an end effector and shaft of the instrument according to various embodiments.
- FIG. 6 is a side view of the end effector according to various embodiments.
- FIG. 7 is an exploded view of the handle of the instrument according to various embodiments.
- FIG. 10 is a side view of the handle according to various embodiments.
- FIG. 11 is a schematic diagram of a circuit used in the instrument according to various embodiments.
- FIG. 12 is a top view of an end effector showing an electronic sensor in the elongate channel according to various embodiments.
- FIG. 13 is a bottom perspective view of a staple cartridge having an electronic sensor according to various embodiments.
- FIG. 14 is a top view of an electronic sensor according to various embodiments.
- FIG. 15 is a perspective view of one robotic controller according to various aspects
- FIG. 16 is a perspective view of one robotic surgical arm cart/manipulator of a robotic system operably supporting a plurality of surgical tool embodiments.
- FIG. 17 is a side view of the robotic surgical arm cart/manipulator depicted in FIG. 16 according to various embodiments.
- FIG. 18 is a perspective view of an exemplary cart structure with positioning linkages for operably supporting robotic manipulators that may be used with various surgical tool embodiments.
- FIG. 19 is a perspective view of a surgical tool according to various embodiments.
- FIG. 20 is an exploded assembly view of an adapter and tool holder arrangement for attaching various surgical tool embodiments to a robotic system.
- FIG. 21 is a side view of the adapter shown in FIG. 20.
- FIG. 22 is a bottom view of the adapter shown in FIG. 20.
- FIG. 23 is a top view of the adapter of FIGS. 20 and 21.
- FIG. 24 is a partial bottom perspective view of the surgical tool embodiment of FIG. 19.
- FIG. 25 is a partial exploded view of a portion of an articulatable surgical end effector according to various embodiments.
- FIG. 26 is a perspective view of the surgical tool embodiment of FIG. 10 with the tool mounting housing removed.
- FIG. 27 is a rear perspective view of the surgical tool embodiment of FIG. 24 with the tool mounting housing removed.
- FIG. 29 is a partial exploded perspective view of the surgical tool embodiment of FIG. 28.
- FIG. 30 is a partial cross-sectional side view of the surgical tool embodiment of FIG. 24.
- FIG. 32 is an exploded perspective view of a portion of the tool mounting portion of the surgical tool embodiment depicted in FIG. 24.
- FIG. 33 is an enlarged exploded perspective view of a portion of the tool mounting portion of FIG. 32.
- FIG. 35 is a top view of an end effector showing an electronic sensor in the elongate channel according to various embodiments.
- tissue-fastening techniques may also be used.
- different types of end effectors may be used, such as end effectors for other types of surgical devices, such as graspers, cutters, staplers, clip appliers, access devices, drug/gene therapy devices, ultrasound, RF or laser devices, etc.
- Figures 1 and 2 depict a motor-driven, power-assist surgical cutting and fastening instrument 10 according to various embodiments of the present invention.
- the illustrated embodiment is an endoscopic surgical instrument 10 and in general, the embodiments of the instrument 10 described herein are endoscopic surgical cutting and fastening instruments. It should be noted, however, that according to other embodiments of the present invention, the instrument 10 may be a non-endoscopic surgical cutting instrument, such as a laproscopic instrument. Additionally, the person of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, in connection with open surgical procedures.
- the various instruments disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, etc.
- the working portions or end effector portions of the instruments can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end effector and elongated shaft of a surgical instrument can be advanced.
- the surgical instrument 10 depicted in Figures 1 and 2 comprises a handle 6, a shaft 8, and an articulating end effector 12 pivotally connected to the shaft 8 at an articulation pivot 14.
- An articulation control 16 may be provided adjacent to the handle 6 to effect rotation of the end effector 12 about the articulation pivot 14. It will be appreciated that various embodiments may include a non-pivoting end effector, and therefore may not have an articulation pivot 14 or articulation control 16.
- the handle 6 of the instrument 10 may include a closure trigger 18 and a firing trigger 20 for actuating the end effector 12. It will be appreciated that instruments having end effectors directed to different surgical tasks may have different numbers or types of triggers or other suitable controls for operating the end effector 12.
- the end effector 12 is shown separated from the handle 6 by a preferably elongate shaft 8.
- a clinician or operator of the instrument 10 may articulate the end effector 12 relative to the shaft 8 by utilizing the articulation control 16, as described in more detail in pending United States Patent No.
- the end effector 12 includes, among other things, a staple channel 22 and a pivotally translatable clamping member, such as an anvil 24, which are maintained at a spacing that assures effective stapling and severing of tissue clamped in the end effector 12.
- the handle 6 includes a pistol grip 26 toward which a closure trigger 18 is pivotally drawn by the clinician to cause clamping or closing of the anvil 24 towards the staple channel 22 of the end effector 12 to thereby clamp tissue positioned between the anvil 24 and channel 22.
- the firing trigger 20 is farther outboard of the closure trigger 18. Once the closure trigger 18 is locked in the closure position as further described below, the firing trigger 20 may rotate slightly toward the pistol grip 26 so that it can be reached by the operator using one hand. Then the operator may pivotally draw the firing trigger 20 toward the pistol grip 26 to cause the stapling and severing of clamped tissue in the end effector 12.
- different types of clamping members besides the anvil 24 could be used, such as, for example, an opposing jaw, etc.
- proximal and distal are used herein with reference to a clinician manipulating the handle portion of the surgical instrument.
- proximal referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician.
- distal referring to the portion located away from the clinician.
- spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings.
- surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
- the closure trigger 18 may be actuated first. Once the clinician is satisfied with the positioning of the end effector 12, the clinician may draw back the closure trigger 18 to its fully closed, locked position proximate to the pistol grip 26. The firing trigger 20 may then be actuated. The firing trigger 20 returns to the open position (shown in Figures 1 and 2) when the clinician removes pressure, as described more fully below. A release button on the handle 6, when depressed may release the locked closure trigger 18.
- Figures 3-6 show embodiments of a rotary-driven end effector 12 and shaft 8 according to various embodiments.
- Figure 3 is an exploded view of the end effector 12 according to various embodiments.
- the end effector 12 may include, in addition to the previously-mentioned channel 22 and anvil 24, a cutting instrument 32, a sled 33, a staple cartridge 34 that is removably seated in the channel 22, and a helical screw shaft 36.
- the cutting instrument 32 may be, for example, a knife.
- the anvil 24 may be pivotably opened and closed at pivot pins 25 connected to the proximate end of the channel 22.
- the sled 33 may be an integral component of the cartridge 34.
- United States Pat. No. 6,978,921 entitled "SURGICAL STAPLING INSTRUMENT
- the sled 33 may be part of the cartridge 34, such that when the knife 32 retracts following the cutting operation, the sled 33 does not retract.
- Figures 4 and 5 are exploded views and Figure 6 is a side view of the end effector 12 and shaft 8 according to various embodiments.
- the shaft 8 may include a proximate closure tube 40 and a distal closure tube 42 pivotably linked by a pivot link 44.
- the distal closure tube 42 includes an opening 45 into which the tab 27 on the anvil 24 is inserted in order to open and close the anvil 24, as further described below.
- Disposed inside the closure tubes 40, 42 may be a proximate spine tube 46.
- Disposed inside the proximate spine tube 46 may be a main rotational (or proximate) drive shaft 48 that communicates with a secondary (or distal) drive shaft 50 via a bevel gear assembly 52.
- the secondary drive shaft 50 is connected to a drive gear 54 that engages a proximate drive gear 56 of the helical screw shaft 36.
- the vertical bevel gear 52b may sit and pivot in an opening 57 in the distal end of the proximate spine tube 46.
- a distal spine tube 58 may be used to enclose the secondary drive shaft 50 and the drive gears 54, 56.
- a bearing 38 positioned at a distal end of the staple channel 22, receives the helical drive screw 36, allowing the helical drive screw 36 to freely rotate with respect to the channel 22.
- the helical screw shaft 36 may interface with a threaded opening (not shown) of the knife 32 such that rotation of the shaft 36 causes the knife 32 to translate distally or proximately (depending on the direction of the rotation) through the staple channel 22.
- the bevel gear assembly 52a-c causes the secondary drive shaft 50 to rotate, which in turn, because of the engagement of the drive gears 54, 56, causes the helical screw shaft 36 to rotate, which causes the knife driving member 32 to travel longitudinally along the channel 22 to cut any tissue clamped within the end effector 12.
- the staple channel 22 has a proximal end 23a and a distal end 23b and the knife or cutting element 32 is configured to travel longitudinally through the channel 22 between the proximal end 23a and the distal end 23b when a driving motion is applied to the cutting element 32.
- the staple channel 22 has an interior surface 28 and a slot 30 that extends through the interior surface 28. See Figure 12.
- the knife 32 can translate along the slot 30 as it travels longitudinally through the staple channel 22.
- the sled 33 may be made of, for example, plastic, and may have a sloped distal surface.
- the sloped forward surface may push up or drive the staples in the staple cartridge through the clamped tissue and against the anvil 24.
- the anvil 24 turns the staples, thereby stapling the severed tissue.
- the knife 32 and sled 33 may become disengaged, thereby leaving the sled 33 at the distal end of the channel 22 or the sled may return with the knife.
- embodiments of the present invention provide a motor-driven endocutter with user-feedback of the deployment, force and/or position of the cutting instrument 32 in end effector 12.
- Figures 7- 10 illustrate an exemplary embodiment of a motor-driven endocutter, and in particular the handle thereof, that provides user- feedback regarding the deployment and loading force of the cutting instrument 32 in the end effector 12.
- the embodiment may use power provided by the user in retracting the firing trigger 20 to power the device (a so-called "power assist" mode).
- the embodiment may be used with the rotary driven end effector 12 and shaft 8 embodiments described above.
- the handle 6 includes exterior lower side pieces 59, 60 and exterior upper side pieces 61 , 62 that fit together to form, in general, the exterior of the handle 6.
- a battery 64 such as a Li ion battery, may be provided in the pistol grip portion 26 of the handle 6.
- the battery 64 powers a motor 65 disposed in an upper portion of the pistol grip portion 26 of the handle 6.
- the motor 65 may be a DC brushed driving motor having a maximum rotation of, approximately, 5000 RPM.
- the motor 65 may drive a 90° bevel gear assembly 66 comprising a first bevel gear 68 and a second bevel gear 70.
- the bevel gear assembly 66 may drive a planetary gear assembly 72.
- the planetary gear assembly 72 may include a pinion gear 74 connected to a drive shaft 76.
- the pinion gear 74 may drive a mating ring gear 78 that drives a helical gear drum 80 via a drive shaft 82.
- a ring 84 may be threaded on the helical gear drum 80.
- the handle 6 may also include a run motor sensor 1 10 (see Figure 10) in
- the sensor 1 10 may be a proportional sensor such as, for example, a rheostat or variable resistor.
- the sensor 1 10 detects the movement, and sends an electrical signal indicative of the voltage (or power) to be supplied to the motor 65.
- the rotation of the motor 65 may be generally proportional to the amount of movement of the firing trigger 20.
- the rotation of the motor 65 is relatively low.
- the rotation of the motor 65 is at its maximum. In other words, the harder the user pulls on the firing trigger 20, the more voltage is applied to the motor 65, causing greater rates of rotation.
- the handle 6 may include a middle handle piece 104 adjacent to the upper portion of the firing trigger 20.
- the handle 6 also may comprise a bias spring 1 12 connected between posts on the middle handle piece 104 and the firing trigger 20.
- the bias spring 1 12 may bias the firing trigger 20 to its fully open position. In that way, when the operator releases the firing trigger 20, the bias spring 1 12 will pull the firing trigger 20 to its open position, thereby removing actuation of the sensor 1 10, thereby stopping rotation of the motor 65.
- the bias spring 1 12 any time a user closes the firing trigger 20, the user will experience resistance to the closing operation, thereby providing the user with feedback as to the amount of rotation exerted by the motor 65. Further, the operator could stop retracting the firing trigger 20 to thereby remove force from the sensor 1 10, to thereby stop the motor 65. As such, the user may stop the deployment of the end effector 12, thereby providing a measure of control of the
- the slotted arm 90 has an opening 92 in its opposite end 94 that receives a pivot pin 96 that is connected between the handle exterior side pieces 59, 60.
- the pivot pin 96 is also disposed through an opening 100 in the firing trigger 20 and an opening 102 in the middle handle piece 104.
- the handle 6 may include a reverse motor sensor (or end-of-stroke sensor) 130 and a stop motor (or beginning-of-stroke) sensor 142.
- the reverse motor sensor 130 may be a limit switch located at the distal end of the helical gear drum 80 such that the ring 84 threaded on the helical gear drum 80 contacts and activates the reverse motor sensor 130 when the ring 84 reaches the distal end of the helical gear drum 80.
- the reverse motor sensor 130 when activated, sends a signal to the motor 65 to reverse its rotation direction, thereby withdrawing the knife 32 of the end effector 12 following the cutting operation.
- the sensor 1 10 detects the deployment of the firing trigger 20 and sends a signal to the motor 65 to cause forward rotation of the motor 65, for example, at a rate proportional to how hard the operator pulls back the firing trigger 20.
- the forward rotation of the motor 65 in turn causes the ring gear 78 at the distal end of the planetary gear assembly 72 to rotate, thereby causing the helical gear drum 80 to rotate, causing the ring 84 threaded on the helical gear drum 80 to travel distally along the helical gear drum 80.
- the rotation of the helical gear drum 80 also drives the main drive shaft assembly as described above, which in turn causes deployment of the knife 32 in the end effector 12.
- the knife 32 and sled 33 are caused to traverse the channel 22 longitudinally, thereby cutting tissue clamped in the end effector 12. Also, the stapling operation of the end effector 12 is caused to happen in embodiments where a stap ling-type end effector 12 is used.
- the ring 84 on the helical gear drum 80 will have reached the distal end of the helical gear drum 80, thereby causing the reverse motor sensor 130 to be activated, which sends a signal to the motor 65 to cause the motor 65 to reverse its rotation. This in turn causes the knife 32 to retract, and also causes the ring 84 on the helical gear drum 80 to move back to the proximate end of the helical gear drum 80.
- the middle handle piece 104 ( Figure 7) includes a backside shoulder 106 that engages the slotted arm 90, as best shown in Figure 8.
- the middle handle piece 104 also has a forward motion stop 107 that engages the firing trigger 20. See Figure 10.
- the movement of the slotted arm 90 is controlled, as explained above, by rotation of the motor 65.
- the middle handle piece 104 will be free to rotate counter clockwise.
- the firing trigger 20 will engage the forward motion stop 107 of the middle handle piece 104, causing the middle handle piece 104 to rotate counter clockwise.
- the middle handle piece 104 will only be able to rotate counter clockwise as far as the slotted arm 90 permits. In that way, if the motor 65 should stop rotating for some reason, the slotted arm 90 will stop rotating, and the user will not be able to further draw in the firing trigger 20 because the middle handle piece 104 will not be free to rotate counter clockwise due to the slotted arm 90.
- the distance “b" between the electrodes 282, 284 is directly related to the impedance between the electrodes 282, 284, the greater the distance the more impedance, and the closer the distance the less impedance. In that way, the amount that the dielectric 286 is compressed due to retraction of the firing trigger 20 (denoted as force "F” in Figure 42) is proportional to the impedance between the electrodes 282, 284, which can be used to proportionally control the motor 65.
- the closure system includes a yoke 250 connected to the closure trigger 18 by a pivot pin 251 inserted through aligned openings in both the closure trigger 18 and the yoke 250.
- a pivot pin 252 about which the closure trigger 18 pivots, is inserted through another opening in the closure trigger 18 which is offset from where the pin 251 is inserted through the closure trigger 18.
- the distal end of the yoke 250 is connected, via a pin 254, to a first closure bracket 256.
- the first closure bracket 256 connects to a second closure bracket 258.
- the closure brackets 256, 258 define an opening in which the proximate end of the proximate closure tube 40 (see Figure 4) is seated and held such that longitudinal movement of the closure brackets 256, 258 causes longitudinal motion by the proximate closure tube 40.
- the instrument 10 also includes a closure rod 260 disposed inside the proximate closure tube 40.
- the closure rod 260 may include a window 261 into which a post 263 on one of the handle exterior pieces, such as exterior lower side piece 59 in the illustrated embodiment, is disposed to fixedly connect the closure rod 260 to the handle 6. In that way, the proximate closure tube 40 is capable of moving longitudinally relative to the closure rod 260.
- the closure rod 260 may also include a distal collar 267 that fits into a cavity 269 in proximate spine tube 46 and is retained therein by a cap 271 (see Figure 4).
- the closure brackets 256, 258 cause the proximate closure tube 40 to move distally (i.e., away from the handle end of the instrument 10), which causes the distal closure tube 42 to move distally, which causes the anvil 24 to rotate about the pivot pins 25 into the clamped or closed position.
- FIG. 1 1 is a schematic diagram of an electrical circuit of the instrument 10 according to various embodiments of the present invention.
- the sensor 1 10 When an operator initially pulls in the firing trigger 20 after locking the closure trigger 18, the sensor 1 10 is activated, allowing current to flow therethrough. If the normally-open reverse motor sensor switch 130 is open (meaning the end of the end effector stroke has not been reached), current will flow to a single pole, double throw relay 132. Since the reverse motor sensor switch 130 is not closed, the inductor 134 of the relay 132 will not be energized, so the relay 132 will be in its non-energized state.
- the circuit also includes a cartridge lockout sensor 136. If the end effector 12 includes a staple cartridge 34, the sensor 136 will be in the closed state, allowing current to flow. Otherwise, if the end effector 12 does not include a staple cartridge 34, the sensor 136 will be open, thereby preventing the battery 64 from powering the motor 65.
- the sensor 136 When the staple cartridge 34 is present, the sensor 136 is closed, which energizes a single pole, single throw relay 138. When the relay 138 is energized, current flows through the relay 136, through the variable resistor sensor 1 10, and to the motor 65 via a double pole, double throw relay 140, thereby powering the motor 65 and allowing it to rotate in the forward direction.
- the reverse motor sensor 130 When the end effector 12 reaches the end of its stroke, the reverse motor sensor 130 will be activated, thereby closing the switch 130 and energizing the relay 134. This causes the relay 134 to assume its energized state (not shown in Figure 1 1), which causes current to bypass the cartridge lockout sensor 136 and variable resistor 1 10, and instead causes current to flow to both the normally-closed double pole, double throw relay 142 and back to the motor 65, but in a manner, via the relay 140, that causes the motor 65 to reverse its rotational direction.
- stop motor sensor switch 142 Because the stop motor sensor switch 142 is normally-closed, current will flow back to the relay 134 to keep it closed until the switch 142 opens. When the knife 32 is fully retracted, the stop motor sensor switch 142 is activated, causing the switch 142 to open, thereby removing power from the motor 65.
- an on-off type sensor could be used.
- the rate of rotation of the motor 65 would not be proportional to the force applied by the operator. Rather, the motor 65 would generally rotate at a constant rate. But the operator would still experience force feedback because the firing trigger 20 is geared into the gear drive train.
- the surgical cutting and fastening instrument 10 may not comprise a run motor sensor 110, reverse motor sensor 130, and/or stop motor sensor 142, as described above.
- the surgical instrument 10 may employ an electronic sensor 150 for determining the position of a firing element in the end effector 12 and/or the status or presence of a staple cartridge 34 in the end effector 12.
- the cutting element 32, sled 33, drive bar 36 and other elements configured to translate in the end effector 12 are collectively referred to herein as firing elements.
- the electronic sensor 150 comprises a resistive member 152 that is supported within the end effector 12 of the surgical instrument 10.
- the resistive member 152 can be positioned on the interior surface 28 of the staple channel 22 such that a firing element contacts the resistive member 152 as the firing element travels longitudinally through the staple channel 22.
- the resistive member 152 is supported by or otherwise attached to the staple cartridge 34.
- the resistive member 152 can be supported by the cartridge body 35 of the staple cartridge 34.
- the resistive member 152 may be attached to a bottom surface of the cartridge body 35 by an appropriate adhesive.
- the resistive member 152 may be supported in a slot arrangement (not shown) formed in the bottom surface of the cartridge body 35 or otherwise be retained in position by attachment features formed therein.
- the resistive member 152 is positioned on the cartridge body 35 of the staple cartridge 34 such that a portion of the firing element contacts the resistive member 152 as the firing element travels longitudinally through the staple channel 22.
- the resistive member 152 of the electronic sensor 150 comprises a resistor 154 or a plurality of resistors 154.
- the resistive member 152 can comprise a circuit with a plurality of resistors 154a, 154b, 154c, etc. and a plurality of nodes 156a, 156b, 156c, etc.
- a node 156 can be positioned intermediate each resistor 154.
- a first node 156a is positioned intermediate a first resistor 154a and a second resistor 154b; a second node 156b is positioned intermediate the second resistor 154b and a third resistor 154c; and a third node 156c is positioned intermediate the third resistor 154c and a fourth resistor 154d; etc.
- a node 156 can be positioned between each successive resistor 154 in a circuit in the resistive member 152.
- the voltage throughout each node 156 is uniform, or substantially uniform. While the resistors 156 are intact, the voltage at each node 156 is different than the voltage at other nodes 156.
- the resistors 154a, 154b, 154c, ... , 154z can be arranged in a series configuration such that the equivalent resistance (REq) of the resistive member 152 can be computed according to:
- a firing element in end effector 12 is in moving contact with the resistive member 152 as the firing element translates between the proximal end 23 a of the staple channel 22 and the distal end 23b of the staple channel 22.
- the firing element can slide along a surface of the resistive member 152 as the sled 33 and knife 32 are driven through the elongate channel 22.
- the firing element can contact protrusions on the resistive member 152 as the sled 33 and knife 32 are driven through the elongate channel 22.
- the resistive member 152 As the firing element translates through the staple channel 22 and movingly contacts the resistive member 152, the resistive member 152 generates output signals indicative of the position of the firing element within the elongate channel 22.
- the output signals generated by the resistive member 152 can be measurements of voltage (or power) along the resistive member 152.
- the resistive member 152 could generate a signal indicative of voltage at each node 156 between successive resistors 154.
- the firing element can movingly contact the resistive member 152 such that the firing element severs portions of the resistive member 152.
- the cutting element 32 can traverse through portions of the resistive member 152 as the cutting element 32 travels longitudinally through the elongate channel 22 in response to driving motions applied thereto.
- the resistive member 152 can be positioned on the interior surface 28 of the elongate channel 22 and oriented such that the resistive member 152 at least partially overlies the slot 30 through the interior surface 28 of the channel 22.
- the slot 30 can be configured to receive cutting element 32 when the firing trigger 20 is actuated causing the cutting element 32 and sled 33 to travel longitudinally along the channel 22.
- the cutting element 32 can travel from a first position at a proximate location along slot 30 to a second position at an intermediate location along slot 30 and from the second position to a third position at a distal location along slot 30.
- the first position can correspond with a first node 156a
- the second position can correspond with another node 156m
- the third position can correspond with another node 156z.
- the cutting element 32 severs the tissue clamped between the channel 22 and anvil 20.
- the cutting element 32 also severs portions of the resistive strip 152 that overlie the portion of slot 30 through which the cutting element 32 translates.
- the cutting element 32 is positioned intermediate to the proximal end 23 a of the elongate channel 22 and the distal end 23b of the channel 22.
- the cutting element 32 has traversed nodes 156a, 156b, and 156c.
- the cutting element 32 has severed proximal resistors 154a, 154b, and 154c; however, intermediate and distal resistors 154m, 154n, and 154z, among others, are still intact.
- the cutting element 32 severs portions of the resistive strip 152, the cutting element can sever resistors 154 arranged along part of a circuit in the resistive member 152.
- the cutting element 32 can sever resistor 154a, then resistor 154b, followed by resistor 154c, and so on, until the firing element reaches the distal end 23b of the elongate channel 22.
- Resistors 154a, 154b, 154c, ... , 154z. can be arranged in parallel, as shown in Figure 14.
- resistors 154a, 154b, 154c, and so on can be arranged in a series.
- the equivalent resistance of the resistor member 152 can decrease as each successive resistor is severed by the cutting element 32 according to the relationship:
- the voltage across the resistive member 152 can be determined by Ohm's law, which provides:
- V I x R Eq , where V represents voltage, I represents current, and REq represents the equivalent resistance. Voltage can be measured in volts (V), current can be measured in amperes (A), and resistance can be measured in ohms ( ⁇ ). Assuming a constant current through the resistive member 152, as the equivalent resistance changes with the severance of resistors 154, the voltage in the resistive member correspondingly changes. Accordingly, the position of the cutting element 32 as it translates along the resistive member 152 can be determined from the output signals indicative of voltage generated by the resistive member 152 as the resistors 154 are cut.
- the cutting element 32 can travel from a first position at a proximate location along slot 37 to a second position at an intermediate location along slot 37 and from the second position to a third position at a distal location along slot 37.
- the cutting element 32 severs the tissue clamped between the channel 22 and anvil 20.
- the cutting element 32 also severs portions of the resistive strip 152 that overlie the portion of slot 37 in the staple cartridge 34 through which the cutting element 32 translates. Similar to the above, as the cutting element cuts resistors 154 in the resistive member 152, the equivalent resistance in the resistive member 152 changes, which results in a corresponding change in voltage across the resistive member 152.
- the staple channel 22 may include a contact pad, portion, point, or surface 158.
- the contact pad 158 can be positioned on the interior surface 28 of the staple channel 22.
- the contact pad 158 in the channel 22 can be configured to contact a portion of the resistive member 152.
- the contact pad 158 can contact a circuit of the resistive member 152, a wire 168 extending from the resistive member 152, or a contact pad operably engaged with the resistive member.
- the contact pad 158 can communicate with the conductive members 170, 172 and / or the memory device 160 via a wired or wireless connection, as described in greater detail below.
- the surgical instrument also comprises a memory device 160 that operably
- the resistive member 152 provides a signal to the memory device 160, which records the signal as described in more detail below.
- the memory device 160 can be integrated into the electronic sensor 150. In another embodiment, the memory device 160 can be external to the electronic sensor and can be positioned near the resistive member 152, such as in the elongate channel 22 of the end effector 12. In other embodiments, referring to Figure 1 , the memory device 160 can be positioned farther from the resistive member 152, such as in the handle 6 of the instrument 10.
- the memory device 160 may be any kind of device capable of storing or recording sensor signals.
- the memory device 160 may include a microprocessor, an Electrically Erasable Programmable Read Only Memory (EEPROM), or any other suitable storage device.
- EEPROM Electrically Erasable Programmable Read Only Memory
- the memory device 160 may record the signals provided by the resistive member 152 in any suitable way.
- the memory device 160 may record the signal from the resistive member 152 when that signal changes, such as when the cutting element 32 severs a resistor 154 in the resistive member 152 resulting in a change in the equivalent resistance and a corresponding change in the voltage across the resistive member 152.
- the memory device 160 may record the state of the resistive member 152 and signals from other sensors, such as the run motor sensor 1 10, reverse motor sensor 130, and/or stop motor sensor 142 in the surgical instrument 10, when the signal from any sensor changes states. This may provide a snap-shot of the state of the instrument 10.
- the memory device 160 and/or sensor(s) may be implemented to include 1-WIRE bus products available from DALLAS SEMICONDUCTOR such as, for example, a 1 -WIRE EEPROM.
- the memory device 160 is externally accessible, allowing an outside device, such as a computer, to access the instrument conditions recorded by the memory device 160.
- the memory device 160 may include a data port 162.
- the data port 162 may provide the stored instrument conditions according to any wired or wireless communication protocol in, for example, serial or parallel format.
- the memory device 160 may also include a removable medium 164 in addition to or instead of the output port 162.
- the removable medium 164 may be any kind of suitable data storage device that can be removed from the instrument 10.
- the removable medium 164 may include any suitable kind of flash memory, such as a Personal Computer Memory Card International Association
- the removable medium 164 may also include any suitable kind of disk-based storage including, for example, a portable hard drive, a compact disk (CD), a digital video disk (DVD), etc.
- the output from the resistive member 152 may be provided to the memory device 160, for example, via an analog-to-digital converter (not shown).
- output signals from the resistive member 152 may first be transmitted to an integrated circuit (not shown) for amplification of the signal. Further, the output may be encoded and/or modulated according to a modulation scheme.
- the output from the electronic sensor 150 may be provided to the memory device 160 by a wired communication.
- insulated wires or similar conductors 168 may transmit an electrical signal indicative of the position of the firing element in the end effector 12 to the memory device 160.
- the wires 168 may be made of an electrically conductive polymer and/or metal (e.g. copper) and may be sufficiently flexible to pass through an articulation pivot 14 and not be damaged by articulation.
- the signal may be wirelessly transmitted to the memory device 160.
- the resistive member 152 may comprise a conductive element 170 that acts as a transmitting antenna.
- the conductive element 170 may both transmit signals from the resistive member 152 and receive power from a power source, such as a battery, external or internal to the surgical instrument 10.
- the conductive element 170 of the resistive member 152 is preferably insulated from the electrically conductive outer shaft 8 of the instrument 10.
- the conductive element 170 may comprise components of the end effector 12 and shaft 8.
- the resistive member 152 is electrically connected to the shaft 8 and the memory device is insulated from the shaft.
- the interior surface 30 of the elongate channel 22 may comprise a conductive material, which in turn may be electrically coupled to conductive elements of the shaft 8 (such as closure tubes 40, 42) by either direct or indirect electrical contact.
- the shaft 8 may be grounded by the exterior lower and upper side pieces 59-62, which may be made of non-electrically conductive material, such as plastic. Additional components of the end effector 12 may comprise non-conductive material and the memory device 160 is insulated from the shaft 8.
- the components of the end effector 12 and shaft 8 electrically connected to the conductive element 170 of the sensor 150 may serve as part of an antenna for transmitting signals indicative from the resistive member 152 to the memory device 160.
- the memory device 160 may be in electrical communication with select components of the end effector 12 and shaft 8 and the resistive member 152 may be insulated.
- the select components of the end effector 12 and shaft electrically connected to the memory device 160 may serve as part of an antenna for receiving signals from the sensor 150.
- the resistive member 152 may be insulated by positioning it on the interior surface 28 of the elongate channel 22, which is made of a non-electrically conductive material, such as plastic.
- the surgical instrument 10 may comprise multiple conductive elements for transmitting signals from the resistive member 152 to the memory device 160.
- the resistive member 152 may transmit a signal to a conductive element 170.
- the signal may be transmitted by an insulated wire 168.
- Such an intermediate conductive element 170 could be located, for example, in the end effector 12, along the shaft 8, or on the handle 6 of the instrument 10.
- the conductive element 170 may relay the signal to a distal intermediate conductive element 172a, which may then relay the signal to a proximal intermediate conductive element 172b or to the memory device 160 (shown in diagrammatic form in Figure 1).
- the distance between the conductive elements 170, 172 may be reduced and a weaker signal may be utilized to transmit the signal. Alternatively, if fewer conductive couplings are in place, a stronger signal may be required due to the greater transmission distances. Because the distances between the conductive elements 170, 172 can be fixed and known, the power levels could be optimized for low levels to thereby minimize interference with other systems in the environment of the instrument 10.
- the end effector 12 may include a wire 168 that connects the resistive member 152 to a distal intermediate conductive element 172a on the shaft 6 of the instrument.
- the signal may then be wirelessly transmitted from the distal intermediate conductive element 172a to a proximal intermediate conductive element 172b.
- the proximal intermediate conductive element 172b may transmit the signal to the memory device 160 via a conductive wire 168 or wirelessly.
- the resistive member 152 may communicate with the memory device 160 using any suitable frequency (e.g., an ISM band). Also, the resistive member 152 may transmit signals at a different frequency range than the frequency range of the received signals from the memory device 160. Also, though only one antenna is discussed above with regard to electronic sensor 150, in other embodiments the electronic sensor 150 may comprise separate receiving and transmitting antennas.
- the surgical instrument 10 can also comprise a processor 180 that operably interfaces with the memory device 160.
- the processor 180 and memory device 160 can comprise an integral component.
- the processor 180 and memory device 160 are discrete components of the surgical instrument.
- the processor 180 determines the position of the firing element in the end effector 12 from the output from the resistive member 152.
- the processor 180 computes the position of the cutting element 32 in the end effector 12 from signals indicative of voltage from the resistive member 152. For example, if the resistors 154 of the resistive strip 152 are connected in parallel, the equivalent resistance of the resistive member 152 increases as each successive resistor 154 is cut. The corresponding changes in voltage across the resistive member 152 indicates the nodal position of the cutting element 32 along the resistive strip 152, which further corresponds to the location of the cutting element 32 in the elongate channel 22.
- the unique and novel aspects of the various embodiments of the present disclosure utilize an electronic sensor to determine the position of a firing element in the end effector of a surgical instrument and / or the status of a staple cartridge in the end effector.
- the unique arrangements and principles of various embodiments of the present disclosure may enable a variety of different forms of the electronic sensor disclosed and claimed herein to be effectively employed in connection with other types and forms of surgical instruments, end effectors and staple cartridges used in conjunction with a firing element.
- the foregoing discussion describes a motor-driven, power-assist surgical cutting and fastening instrument according to some embodiments of the present disclosure.
- a surgical instrument may be powered and controlled in an alternative manner, such as by manual force or robotic controls.
- the end effector 12 described above may be powered and controlled by a robotic system, such as robotic system 1000 described in greater detail below.
- the master controller 1001 generally includes a control system (generally represented as 1003 in FIG. 15) which are grasped by the surgeon and manipulated in space while the surgeon views the procedure via a stereo display 1002.
- the master controllers 1001 generally comprise manual input devices which preferably move with multiple degrees of freedom, and which often further have an actuatable handle for actuating tools (for example, for closing grasping jaws, applying an electrical potential to an electrode, or the like).
- actuatable handle for actuating tools for example, for closing grasping jaws, applying an electrical potential to an electrode, or the like.
- the robotic arm cart 1 100 is configured to actuate a plurality of surgical tools, generally designated as 1200.
- a plurality of surgical tools generally designated as 1200.
- the robotic arm cart 1 100 includes a base 1 102 from which, in the illustrated embodiment, three surgical tools 1200 are supported.
- the surgical tools 1200 are each supported by a series of manually articulatable linkages, generally referred to as set-up joints 1 104, and a robotic manipulator 1 106.
- robotic manipulators 1 106 may include a linkage 1 108 that constrains movement of the surgical tool 1200.
- linkage 1 108 includes rigid links coupled together by rotational joints in a parallelogram arrangement so that the surgical tool 1200 rotates around a point in space 1 1 10, as more fully described in issued U.S. Pat. No. 5,817,084, the full disclosure of which is herein incorporated by reference.
- the parallelogram arrangement constrains rotation to pivoting about an axis 1 1 12a, sometimes called the pitch axis.
- the links supporting the parallelogram linkage are pivotally mounted to set-up joints 1 104 (FIG.
- the surgical tool 1200 may have further degrees of driven freedom as supported by manipulator 1 106, including sliding motion of the surgical tool 1200 along the longitudinal tool axis "LT- LT". As the surgical tool 1200 slides along the tool axis LT-LT relative to manipulator 1 106 (arrow 1 1 12c), remote center 1 1 14 remains fixed relative to base 1 1 16 of manipulator 1 106. Hence, the entire manipulator is generally moved to re-position remote center 1 1 14.
- Linkage 1 108 of manipulator 1 106 is driven by a series of motors 1 120. These motors actively move linkage 1 108 in response to commands from a processor of a control system. As will be discussed in further detail below, motors 1 120 are also employed to manipulate the surgical tool 1200.
- FIG. 18 An alternative set-up joint structure is illustrated in FIG. 18. In this embodiment, a surgical tool 1200 is supported by an alternative manipulator structure 1 106' between two tissue manipulation tools.
- Those of ordinary skill in the art will appreciate that various embodiments of the present invention may incorporate a wide variety of alternative robotic structures, including those described in U.S. Pat. No. 5,878,193, entitled "Automated Endoscope System For Optimal Positioning", the full disclosure of which is incorporated herein by reference.
- a robotic component and the processor of the robotic surgical system is primarily described herein with reference to communication between the surgical tool 1200 and the master controller 1001 , it should be understood that similar communication may take place between circuitry of a manipulator, a set-up joint, an endoscope or other image capture device, or the like, and the processor of the robotic surgical system for component compatibility verification, component-type identification, component calibration (such as off-set or the like) communication, confirmation of coupling of the component to the robotic surgical system, or the like.
- FIG. 19 An exemplary non-limiting surgical tool 1200 that is well-adapted for use with a robotic system 1000 that has a tool drive assembly 1010 (FIG. 20) that is operatively coupled to a master controller 1001 that is operable by inputs from an operator (i.e., a surgeon) is depicted in FIG. 19.
- the surgical tool 1200 includes a surgical end effector 2012 that comprises an endocutter.
- the surgical tool 1200 generally includes an elongated shaft assembly 2008 that has a proximal closure tube 2040 and a distal closure tube 2042 that are coupled together by an articulation joint 201 1.
- Interface 1230 includes an adaptor portion 1240 that is configured to mountingly engage the mounting plate 1302 as will be further discussed below.
- the adaptor portion 1240 may include an array of electrical connecting pins 1242 (FIG. 22) which may be coupled to a memory structure by a circuit board within the tool mounting portion 1300. While interface 1230 is described herein with reference to mechanical, electrical, and magnetic coupling elements, it should be understood that a wide variety of telemetry modalities might be used, including infrared, inductive coupling, or the like.
- the adapter portion 1240 generally includes a tool side 1244 and a holder side 1246.
- a plurality of rotatable bodies 1250 are mounted to a floating plate 1248 which has a limited range of movement relative to the surrounding adaptor structure normal to the major surfaces of the adaptor 1240.
- Axial movement of the floating plate 1248 helps decouple the rotatable bodies 1250 from the tool mounting portion 1300 when the levers 1303 along the sides of the tool mounting portion housing 1301 are actuated (See FIG. 19).
- Other mechanisms/arrangements may be employed for releasably coupling the tool mounting portion 1300 to the adaptor 1240.
- rotatable bodies 1250 are resiliently mounted to floating plate 1248 by resilient radial members which extend into a circumferential indentation about the rotatable bodies 1250.
- the rotatable bodies 1250 can move axially relative to plate 1248 by deflection of these resilient structures.
- first axial position toward tool side 1244
- the rotatable bodies 1250 are free to rotate without angular limitation.
- tabs 1252 extending radially from the rotatable bodies 1250 laterally engage detents on the floating plates so as to limit angular rotation of the rotatable bodies 1250 about their axes.
- This limited rotation can be used to help drivingly engage the rotatable bodies 1250 with drive pins 1272 of a corresponding tool holder portion 1270 of the robotic system 1000, as the drive pins 1272 will push the rotatable bodies 1250 into the limited rotation position until the pins 1234 are aligned with (and slide into) openings 1256'.
- Openings 1256 on the tool side 1244 and openings 1256' on the holder side 1246 of rotatable bodies 1250 are configured to accurately align the driven elements 1304 (FIG. 24) of the tool mounting portion 1300 with the drive elements 1271 of the tool holder 1270.
- the openings 1256, 1256' are at differing distances from the axis of rotation on their respective rotatable bodies 1250 so as to ensure that the alignment is not 180 degrees from its intended position. Additionally, each of the openings 1256 is slightly radially elongated so as to fittingly receive the pins 1306 in the circumferential orientation. This allows the pins 1306 to slide radially within the openings 1256, 1256' and accommodate some axial misalignment between the tool 1200 and tool holder 1270, while minimizing any angular misalignment and backlash between the drive and driven elements. Openings 1256 on the tool side 1244 are offset by about 90 degrees from the openings 1256' (shown in broken lines) on the holder side 1246, as can be seen most clearly in FIG. 23.
- Various embodiments may further include an array of electrical connector pins 1242 located on holder side 1246 of adaptor 1240, and the tool side 1244 of the adaptor 1240 may include slots 1258 (FIG. 23) for receiving a pin array (not shown) from the tool mounting portion 1300.
- at least some of these electrical connections may be coupled to an adaptor memory device 1260 (FIG. 22) by a circuit board of the adaptor 1240.
- a detachable latch arrangement 1239 may be employed to releasably affix the adaptor 1240 to the tool holder 1270.
- the term "tool drive assembly" when used in the context of the robotic system 1000 at least encompasses various embodiments of the adapter 1240 and tool holder 1270 and which has been generally designated as 1010 in FIG. 20.
- the tool holder 1270 may include a first latch pin
- a latch assembly 1245 is movably supported on the adapter 1240 and is biasable between a first latched position wherein the latch pins 1276 are retained within their respective latch clevis 1243 and an unlatched position wherein the second latch pins 1276 may be into or removed from the latch clevises 1243.
- a spring or springs (not shown) are employed to bias the latch assembly into the latched position.
- a lip on the tool side 1244 of adaptor 1240 may slidably receive laterally extending tabs of tool mounting housing 1301.
- the surgical tool 1200 includes a surgical end effector 2012 that comprises in this example, among other things, at least one component 2024 that is selectively movable between first and second positions relative to at least one other component 2022 in response to various control motions applied thereto as will be discussed in further detail below.
- component 2022 comprises an elongated channel 2022 configured to operably support a surgical staple cartridge 2034 therein and component 2024 comprises a pivotally translatable clamping member, such as an anvil 2024.
- the surgical end effector 2012 are configured to maintain the anvil 2024 and elongated channel 2022 at a spacing that assures effective stapling and severing of tissue clamped in the surgical end effector 2012.
- the surgical end effector 2012 further includes a cutting instrument 2032 and a sled 2033.
- the cutting instrument 2032 may be, for example, a knife.
- the surgical staple cartridge 2034 operably houses a plurality of surgical staples (not show) therein that are supported on movable staple drivers (not shown). As the cutting instrument 2032 is driven distally through a centrally-disposed slot (not shown) in the surgical staple cartridge 2034, it forces the sled 2033 distally as well.
- the sled 2033 As the sled 2033 is driven distally, its "wedge-shaped" configuration contacts the movable staple drivers and drives them vertically toward the closed anvil 2024.
- the surgical staples are formed as they are driven into the forming surface located on the underside of the anvil 2024.
- the sled 2033 may be part of the surgical staple cartridge 2034, such that when the cutting instrument 2032 is retracted following the cutting operation, the sled 2033 does not retract.
- the anvil 2024 may be pivotably opened and closed at a pivot point 2025 located at the proximal end of the elongated channel 2022.
- the anvil 2024 may also include a tab 2027 at its proximal end that interacts with a component of the mechanical closure system (described further below) to facilitate the opening of the anvil 2024.
- the elongated channel 2022 and the anvil 2024 may be made of an electrically conductive material (such as metal) so that they may serve as part of an antenna that communicates with sensor(s) in the end effector, as described above.
- the surgical staple cartridge 2034 could be made of a nonconductive material (such as plastic) and the sensor(s) may be connected to or disposed in the surgical staple cartridge 2034, as was also described above. [0108] As can be seen in FIGS.
- the surgical end effector 2012 is attached to the tool mounting portion 1300 by an elongated shaft assembly 2008 according to various embodiments.
- the shaft assembly 2008 includes an articulation joint generally indicated as 201 1 that enables the surgical end effector 2012 to be selectively articulated about an articulation axis AA-AA that is substantially transverse to a longitudinal tool axis LT-LT. See FIG. 25.
- the articulation joint is omitted.
- the shaft assembly 2008 may include a closure tube assembly 2009 that comprises a proximal closure tube 2040 and a distal closure tube 2042 that are pivotably linked by a pivot links 2044 and operably supported on a spine assembly generally depicted as 2049.
- the spine assembly 2049 comprises a distal spine portion 2050 that is attached to the elongated channel 2022 and is pivotally coupled to the proximal spine portion 2052.
- the closure tube assembly 2009 is configured to axially slide on the spine assembly 2049 in response to actuation motions applied thereto.
- the distal closure tube 2042 includes an opening 2045 into which the tab 2027 on the anvil 2024 is inserted in order to facilitate opening of the anvil 2024 as the distal closure tube 2042 is moved axially in the proximal direction "PD".
- the closure tubes 2040, 2042 may be made of electrically conductive material (such as metal) so that they may serve as part of the antenna, as described above.
- Components of the main drive shaft assembly e.g., the drive shafts 2048, 2050
- the tool mounting portion 1300 includes a rotational transmission assembly 2069 that is configured to receive a corresponding rotary output motion from the tool drive assembly 1010 of the robotic system 1000 and convert that rotary output motion to a rotary control motion for rotating the elongated shaft assembly 2008 (and surgical end effector 2012) about the longitudinal tool axis LT-LT.
- the proximal end 2060 of the proximal closure tube 2040 is rotatably supported on the tool mounting plate 1302 of the tool mounting portion 1300 by a forward support cradle 1309 and a closure sled 2100 that is also movably supported on the tool mounting plate 1302.
- the rotational transmission assembly 2069 includes a tube gear segment 2062 that is formed on (or attached to) the proximal end 2060 of the proximal closure tube 2040 for operable engagement by a rotational gear assembly 2070 that is operably supported on the tool mounting plate 1302. As can be seen in FIG.
- the rotational gear assembly 2070 in at least one embodiment, comprises a rotation drive gear 2072 that is coupled to a corresponding first one of the driven discs or elements 1304 on the adapter side 1307 of the tool mounting plate 1302 when the tool mounting portion 1300 is coupled to the tool drive assembly 1010. See FIG. 24.
- the rotational gear assembly 2070 further comprises a rotary driven gear 2074 that is rotatably supported on the tool mounting plate 1302 in meshing engagement with the tube gear segment 2062 and the rotation drive gear 2072. Application of a first rotary output motion from the tool drive assembly 1010 of the robotic system 1000 to the corresponding driven element 1304 will thereby cause rotation of the rotation drive gear 2072.
- the closure of the anvil 2024 relative to the staple cartridge 2034 is accomplished by axially moving the closure tube assembly 2009 in the distal direction "DD" on the spine assembly 2049.
- the proximal end 2060 of the proximal closure tube 2040 is supported by the closure sled 2100 which comprises a portion of a closure transmission, generally depicted as 2099.
- the closure sled 2100 is configured to support the closure tube 2009 on the tool mounting plate 1320 such that the proximal closure tube 2040 can rotate relative to the closure sled 2100, yet travel axially with the closure sled 2100.
- the closure sled 2100 has an upstanding tab 2101 that extends into a radial groove 2063 in the proximal end portion of the proximal closure tube 2040.
- the closure sled 2100 has a tab portion 2102 that extends through a slot 1305 in the tool mounting plate 1302.
- the tab portion 2102 is configured to retain the closure sled 2100 in sliding engagement with the tool mounting plate 1302.
- the closure sled 2100 has an upstanding portion 2104 that has a closure rack gear 2106 formed thereon.
- the closure rack gear 2106 is configured for driving engagement with a closure gear assembly 21 10. See FIG. 29.
- the closure gear assembly 21 10 includes a closure spur gear 21 12 that is coupled to a corresponding second one of the driven discs or elements 1304 on the adapter side 1307 of the tool mounting plate 1302. See FIG. 24.
- the closure gear assembly 21 10 further includes a closure reduction gear set 21 14 that is supported in meshing engagement with the closure spur gear 2112.
- the closure reduction gear set 21 14 includes a driven gear 21 16 that is rotatably supported in meshing engagement with the closure spur gear 2112.
- the closure reduction gear set 2114 further includes a first closure drive gear 21 18 that is in meshing engagement with a second closure drive gear 2120 that is rotatably supported on the tool mounting plate 1302 in meshing engagement with the closure rack gear 2106.
- the cutting instrument 2032 is driven through the surgical end effector 2012 by a knife bar 2200. See FIGS. 30 and 32.
- the knife bar 2200 may be fabricated from, for example, stainless steel or other similar material and has a substantially rectangular cross-sectional shape.
- Such knife bar configuration is sufficiently rigid to push the cutting instrument 2032 through tissue clamped in the surgical end effector 2012, while still being flexible enough to enable the surgical end effector 2012 to articulate relative to the proximal closure tube 2040 and the proximal spine portion 2052 about the articulation axis AA-AA as will be discussed in further detail below.
- the proximal spine portion 2052 has a rectangular-shaped passage 2054 extending therethrough to provide support to the knife bar 2200 as it is axially pushed therethrough.
- the proximal spine portion 2052 has a proximal end 2056 that is rotatably mounted to a spine mounting bracket 2057 attached to the tool mounting plate 1032. See Fig. 32. Such arrangement permits the proximal spine portion 2052 to rotate, but not move axially, within the proximal closure tube 2040.
- the distal end 2202 of the knife bar 2200 is attached to the cutting instrument 2032.
- the proximal end 2204 of the knife bar 2200 is rotatably affixed to a knife rack gear 2206 such that the knife bar 2200 is free to rotate relative to the knife rack gear 2206. See FIG. 32.
- the knife rack gear 2206 is slidably supported within a rack housing 2210 that is attached to the tool mounting plate 1302 such that the knife rack gear 2206 is retained in meshing engagement with a knife gear assembly 2220. More specifically and with reference to FIG.
- the knife gear assembly 2220 includes a knife spur gear 2222 that is coupled to a corresponding third one of the driven discs or elements 1304 on the adapter side 1307 of the tool mounting plate 1302. See FIG. 24.
- the knife gear assembly 2220 further includes a knife gear reduction set 2224 that includes a first knife driven gear 2226 and a second knife drive gear 2228.
- the knife gear reduction set 2224 is rotatably mounted to the tool mounting plate 1302 such that the first knife driven gear 2226 is in meshing engagement with the knife spur gear 2222.
- the second knife drive gear 2228 is in meshing engagement with a third knife drive gear 2230 that is rotatably supported on the tool mounting plate 1302 in meshing engagement with the knife rack gear 2206.
- the gears of the knife gear assembly 2220 are sized to generate the forces needed to drive the cutting element 2032 through the tissue clamped in the surgical end effector 2012 and actuate the staples therein.
- the gears of the knife drive assembly 2230 may be sized to generate approximately 40 to 100 pounds.
- FIG 35 illustrates another end effector 2012 that includes an electronic sensor 2150.
- the electronic sensor 2150 similar to sensor 150 described in above, determines the position of a firing element in the end effector 2012 and/or the status or presence of a staple cartridge 2034 in the end effector 2012.
- the cutting element 2032, sled 2033, knife bar 2200 and other elements configured to translate in the end effector 2012 are collectively referred to herein as firing elements.
- the electronic sensor 2150 comprises a resistive member 2152 that is supported within the end effector 2012 of the surgical tool 1200.
- the resistive member 2152 can be supported by the staple channel 2022, clamping member 2024, staple cartridge 2034 or another element in the end effector 2012. As a firing element translates longitudinally through the end effector 2012, the firing element may be in moving contact with the resistive member 2152.
- the resistive member 2152 of the electronic sensor 2150 is supported by the elongate channel 2022.
- the resistive member 2152 is secured to the resistive member 2152 in the elongate channel 2022 by adhesive.
- the resistive member 2152 may be fastened to a component in the elongate channel 2022. Referring one embodiment shown in Figure 35, the resistive member 2152 is positioned on the interior surface 2028 of the staple channel 2022 such that a firing element contacts the resistive member 2152 as the firing element travels longitudinally through the staple channel 2022.
- the resistive member 2152 is supported by the staple cartridge 2034.
- the resistive member 2152 can be supported by the cartridge body 2035 of the staple cartridge 2034. Similar to the above, the resistive member 2152 can be positioned on the cartridge body 2035 of the staple cartridge 2034 such that at least a portion of the firing element contacts the resistive member 2152 as the firing element travels longitudinally through the staple channel 2022.
- the firing element can movingly contact the resistive member 2152 such that the firing element severs portions of the resistive member 2152, as described in greater detail above with regards to resistive member 152. Accordingly, the position of the cutting element 32 as it translates along the resistive member 2152 can be determined from the output signals indicative of voltage generated by the resistive member 2152 as the resistors 2154 are cut.
- memory device 2160 may be any kind of device capable of storing or recording sensor signals and may communicate with the resistive member 2152 of the sensor 2150 by a wired or wireless communication or a combination thereof via wires 168, conductive elements 170, and contact pads 158 ( Figure 3).
- the memory device 2160 may not be integrated into the processor 2180; the memory device may be a discrete component of the robotics system 1000 that operably communicates with the resistive member 2152 of the sensor 2150 and then relays output signals from sensor 2150 to the processor 2180.
- the devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any
- the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure.
- reconditioning of a device can utilize a variety of techniques for disassembly,
- the unique and novel aspects of the various embodiments of the present disclosure utilize an electronic sensor to determine the position of a firing element in the end effector of a surgical instrument and / or the status or presence of a staple cartridge in the end effector.
- the unique arrangements and principles of various embodiments of the present disclosure may enable a variety of different forms of the electronic sensor disclosed and claimed herein to be effectively employed in connection with other types and forms of surgical instruments, end effectors and staple cartridges used in conjunction with a firing element.
Abstract
Description
Claims
Priority Applications (6)
Application Number | Priority Date | Filing Date | Title |
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JP2014556572A JP6174049B2 (en) | 2012-02-13 | 2013-01-30 | Surgical incision and fastening instrument with cartridge and device for determining the status of firing motion |
RU2014137126A RU2631209C2 (en) | 2012-02-13 | 2013-01-30 | Surgical suturing tool with actuating element positioning and cartridge condition determination device |
BR112014020050-5A BR112014020050B1 (en) | 2012-02-13 | 2013-01-30 | SURGICAL INSTRUMENT AND STAPLE CARTRIDGE FOR USE IN CONNECTION WITH A SURGICAL INSTRUMENT |
EP13704674.4A EP2814404B1 (en) | 2012-02-13 | 2013-01-30 | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
CN201380009048.2A CN104135951B (en) | 2012-02-13 | 2013-01-30 | There is surgical cutting and the fastening instrument of the equipment for being used for determining storehouse and firing action state |
MX2014009714A MX349058B (en) | 2012-02-13 | 2013-01-30 | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status. |
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US13/372,205 US9044230B2 (en) | 2012-02-13 | 2012-02-13 | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
US13/372,205 | 2012-02-13 |
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WO2013122739A2 true WO2013122739A2 (en) | 2013-08-22 |
WO2013122739A3 WO2013122739A3 (en) | 2013-11-14 |
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PCT/US2013/023721 WO2013122739A2 (en) | 2012-02-13 | 2013-01-30 | Surgical cutting and fastening instrument with apparatus for determining cartridge and firing motion status |
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US (3) | US9044230B2 (en) |
EP (1) | EP2814404B1 (en) |
JP (1) | JP6174049B2 (en) |
CN (1) | CN104135951B (en) |
BR (1) | BR112014020050B1 (en) |
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RU (1) | RU2631209C2 (en) |
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WO2013122739A3 (en) | 2013-11-14 |
RU2014137126A (en) | 2016-04-10 |
EP2814404A2 (en) | 2014-12-24 |
CN104135951B (en) | 2017-03-15 |
BR112014020050A2 (en) | 2017-06-20 |
JP6174049B2 (en) | 2017-08-02 |
BR112014020050B1 (en) | 2022-01-04 |
US20130206814A1 (en) | 2013-08-15 |
US20150223816A1 (en) | 2015-08-13 |
MX2014009714A (en) | 2014-09-12 |
CN104135951A (en) | 2014-11-05 |
BR112014020050A8 (en) | 2017-07-11 |
EP2814404B1 (en) | 2020-04-01 |
MX349058B (en) | 2017-07-06 |
US9730697B2 (en) | 2017-08-15 |
JP2015512662A (en) | 2015-04-30 |
US9044230B2 (en) | 2015-06-02 |
US10695063B2 (en) | 2020-06-30 |
US20170319209A1 (en) | 2017-11-09 |
RU2631209C2 (en) | 2017-09-19 |
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