Patent Application
20190046188
The present disclosure relates to surgical instruments and, more specifically, staple retention systems for surgical stapling instruments.
Surgical staplers are used during surgical procedures to join segments of transected tissue and/or organs. During some surgical procedures, a surgical stapler is used to join tissue and/or organs that do not extend the full length of a stapler cartridge of the surgical stapler. In these situations, “remnant” staples, which are staples not deployed into tissue and/or organs, may fall into a body cavity or surrounding tissue. When traditional staples are used, these remnant staples are not a concern.
During some surgical procedures, e.g., brachytherapy, radioactive staples can be deployed to treat tissue and/or organs in which the radioactive staples are deployed. In these procedures, it may be preferable to avoid leaving “remnant” staples in a body cavity adjacent tissue and/or organs unintended for radiotherapy. It will be appreciated that manually retrieving individual “remnant” staples would be burdensome, time consuming, and/or impossible.
Accordingly, there is a need for a surgical stapler that does not leave “remnant” staples within a body cavity after a surgical procedure.
In an aspect of the present disclosure, a method of stapling tissue includes clamping tissue between a cartridge assembly and an anvil assembly of a loading unit, firing the loading unit such that the fasteners secured in the cartridge assembly pass through a body portion of a first buttress that is positioned between the clamped tissue and one of the cartridge assembly or the anvil assembly, trimming a first portion of the first buttress that is adjacent a first edge of the tissue, and removing the first portion of the first buttress from a surgical site. The first buttress captures fasteners that are fired from a portion of the cartridge assembly which extends beyond the tissue. The first portion of the first buttress includes at least one remnant fastener.
In aspects, trimming the first portion of the first buttress adjacent the first edge of the tissue includes trimming the first portion of the first buttress adjacent a distal end of the first buttress or a proximal end of the first buttress.
In some aspects, the method includes trimming a second portion of the first buttress adjacent a second edge of the tissue which is adjacent a proximal end of the first buttress and removing the second portion of the first buttress from the surgical site which includes at least one remnant fastener.
In certain aspects, firing the loading unit includes the fasteners piercing a body portion of a second buttress which is positioned between the clamped tissue and the anvil assembly while the first buttress is positioned between the clamped tissue and the cartridge assembly. The method may include trimming a first portion of the second buttress that is adjacent the first edge of the tissue.
In another aspect of the present disclosure, a loading unit includes a cartridge assembly, an anvil assembly, a first buttress, and a sled. The cartridge assembly has a first tissue contacting surface and fasteners which are disposed therein. The anvil assembly has a second tissue contacting surface that opposes the first tissue contacting surface. The cartridge and anvil assemblies have a first position in which the first and second tissue contacting surfaces are spaced apart from one another and a second position in which at least one of the first and second tissue contacting surfaces are approximated relative to the other to clamp tissue therebetween. The first buttress is operatively secured to one of the first or second tissue contacting surfaces. The sled is translatable through the cartridge assembly to fire the fasteners from the cartridge assembly towards the anvil assembly. The fasteners are configured to pass through the first buttress and form upon contact with the anvil. The first buttress is configured to capture at least one of the formed fasteners.
In aspects, the first buttress is configured to capture each formed fastener. The sled may be configured to sequentially fire the fasteners. The fasteners may be radioactive fasteners such that the fasteners are configured to emit energy to tissue.
In some aspects, the first buttress is operatively secured to the first tissue contacting surface. The loading unit may include a second buttress that is operatively secured to the second tissue contacting surface. The fasteners may be configured to pass through the second buttress and form upon contact with the anvil. The second buttress may be configured to capture each formed fastener. The first buttress may be secured to the first tissue contacting surface.
In another aspect of the present disclosure, a surgical instrument includes a handle assembly, an elongate body, and a loading unit. The elongate body extends from the handle assembly. The loading unit is supported by a distal portion of the elongate body. The loading unit includes a cartridge assembly, an anvil assembly, a first buttress, and a sled. The cartridge assembly has a first tissue contacting surface and fasteners disposed therein. The anvil assembly has a second tissue contacting surface. The cartridge and anvil assemblies have a first position in which the first and second contacting surfaces are spaced apart from one another and a second position in which at least one of the first and second tissue contacting surfaces are approximated relative to the other to clamp tissue therebetween. The first buttress is operatively secured to one of the first or second tissue contacting surfaces. The sled is translatable through the cartridge assembly to fire the fasteners from the cartridge assembly towards the anvil assembly. The fasteners are configured to pass through the first buttress and form upon contact with the anvil. The first buttress is configured to capture at least one of the formed fasteners. The handle assembly may be manually actuated.
Further, to the extent consistent, any of the aspects described herein may be used in conjunction with any or all of the other aspects described herein.
Various aspects of the present disclosure are described hereinbelow with reference to the drawings, which are incorporated in and constitute a part of this specification, wherein:
Embodiments of the present disclosure are now described in detail with reference to the drawings in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “clinician” refers to a doctor, a nurse, or any other care provider and may include support personnel. Throughout this description, the term “proximal” refers to the portion of the device or component thereof that is closest to the clinician and the term “distal” refers to the portion of the device or component thereof that is farthest from the clinician.
This disclosure relates generally to a buttress for loading units of surgical instruments that are configured to capture “remnant” staples during a surgical procedure to prevent the “remnant” staples from remaining within a body cavity of a patient.
Referring now to
The surgical stapling instrument 10 generally includes a handle assembly 12 and an elongate body 14 extending distally from the handle assembly 12. A DLU 100 is releasably secured to a distal portion of the elongate body 14. The DLU 100 includes a cartridge assembly 200 housing a plurality of surgical fasteners or staples 223 (
As detailed above, the handle assembly 12 is a manually actuated handle assembly. It is envisioned that the DLU 100 may be part of an electromechanical or powered surgical system including a powered handle assembly and/or an adapter extending form the powered handle assembly that supports the DLU 100. Such a powered surgical system is described in U.S. Patent Publication No. 2014/0180000, the entire contents of which are hereby incorporated by reference.
With reference to
The anvil assembly 300 includes an anvil plate 310 having a plurality of staple deforming pockets/cavities (not explicitly shown) and a cover plate 320 secured to a top surface of anvil plate 310. The anvil assembly 300 further includes a knife blade 330 operatively interposed within the cavity defined between the anvil plate 310 and the cover plate 320.
During operation of the surgical stapling instrument 10, an actuation sled 228 translates through the staple cartridge 220 to advance upstanding cam wedges of the actuation sled 228 into sequential contact with pushers 226, to cause the pushers 226 to translate vertically within the retention slots 222 and to urge staples 223 from slots 222 into staple forming cavities of anvil plate 310 of the anvil assembly 300. A lower surface of the staple cartridge 220 defines longitudinal slots that are spaced apart from one another and that extend through the staple cartridge 220 to accommodate the cam wedges of the actuation sled 228.
For a detailed description of the construction and operation of an exemplary surgical stapling apparatus, cartridge assembly, and/or anvil assembly 300 reference may be made to U.S. Pat. No. 8,011,555, the entire contents of which are hereby incorporated herein by reference.
Continuing to refer to
The anvil plate 310 defines a proximal pair of recesses or attachment points 316 formed near a proximal end of the anvil plate 310 and disposed, one each, on opposed sides of the longitudinal slot 314. The anvil plate 310 defines a distal pair of recesses or attachment points 318 formed near a distal end of the anvil plate 310 and disposed, one each, on opposed sides of the longitudinal slot 314. At least one recess of the proximal pair of recesses or attachment points 316 and the distal pair of recesses or attachment points 318 is in the form of a slot or notch having a constricting profile so as to frictionally engage and/or pinch a suture, e.g., suture “S3” or “S4”. The anvil assembly 300 further includes a surgical anvil buttress 600.
The anvil buttress 600 is secured to a lower surface of anvil plate 310, by sutures“S3”, “S4”, to overlie at least some of the anvil pockets and/or at least a portion of a length of the longitudinal slot 314. In particular, the suture “S3” is threaded across a distal portion of the anvil buttress 600 and each of a corresponding distal pair of recesses or attachment points 318, and the suture “S4” is threaded across a proximal portion of the anvil buttress 500 and each of a corresponding proximal pair of recesses or attachment points 316.
The cartridge buttress 500 and/or the anvil buttress 600 may be pre-loaded, e.g., from a manufacturer, onto the cartridge assembly 200 or the anvil assembly 300, respectively. Additional or replacement buttresses for the cartridge assembly 200 and/or the anvil assembly 300 may be secured as needed or desired. It is contemplated that the cartridge buttress 500 and/or the anvil buttress 600 can be attached by other means. For example, the buttresses 500, 600 can be attached using adhesives, welding, and/or attachment features incorporated in the buttress material.
With reference to
The buttress 500 has a uniform thickness and includes a head portion 510, a neck portion 512, a body portion 520, and a tail portion 530. The neck portion 512 extends from the head portion 510 to the body portion 520 to interconnect the head and body portions 510, 520. The tail portion 530 extends proximally from the body portion 520.
The buttress 500 is configured to be detachably secured to any size cartridge assembly 200. The body portion 520 defines a pair of opposing distal recesses 524 on transverse edges in a distal section 522 of the body portion 520. The pair of opposing distal recesses 524 may be utilized to secure body portion 520 to a distal region of the cartridge assembly 200, e.g., through a use of the suture “S1”. The distal section 522 of the body portion 520 has a reduced transverse dimension, e.g., angled, arcuate, so as to be suitable for various shapes of cartridge assemblies.
The tail portion 530 of the buttress 500 defines a pair of opposing proximal recesses 526a formed therein. The pair of the opposing proximal recesses 526a is disposed on a transverse side of tail portion 530 near the proximal edge thereof. The opposing proximal pair of recesses 526a detachably secures the tail portion 530 of the buttress 500 to a proximal region of the cartridge assembly 200. The pair of opposing proximal recesses 526a may be substantially v-shaped.
To accommodate various cartridge assemblies, the tail portion 530 of the buttress 500 may include multiple pairs of opposing proximal recesses 526a, e.g., a first pair of opposing proximal recesses 526a and a second pair of opposing proximal recesses 526b (located distal of the first pair of opposing proximal recesses 526a). For example, when buttress 500 is to be used with a relatively long cartridge assembly 200, then the suture “S2” is extended across the tail portion 530 of buttress 500, passed through the first pair of opposing proximal recesses 526a of the buttress 500, and secured to the recesses 236 of the cartridge assembly 200. Alternatively, when buttress 500 is to be used with a relatively short cartridge assembly 200, then the suture “S2” is extended across the tail portion 530 of buttress 500, passed through the second pair of opposing proximal recesses 526b of the buttress 500, and secured to respective recess 316 of anvil assembly 300 and/or recesses 236 of cartridge assembly 200. Additionally, the buttress 500 may be secured to the cartridge assembly 200 with a suture, e.g., suture “S2” passed through each pair of proximal recesses 526a, 526b.
As detailed below, when the staples 223 are fired or ejected from the staple cartridge 220, each of the staples 223 pierce through the buttresses 500, 600 such that the staples 223 are captured in the buttresses 500, 600. The buttresses 500, 600 may also reinforce and seal staple lines formed by the staples 223. The buttresses 500, 600 may be utilized to retard or prevent tissue ingrowth from surrounding tissues thereby acting as an adhesion barrier and preventing the formation of unwanted scar tissue.
The buttresses 500, 600 may be formed of one or more layers. At least one of the layers of the buttresses 500, 600 is formed of a material which permits the staples 223 to penetrate through the layer of the respective buttress 500, 600 and resists tearing after the staples 223 pass through the layer. The buttresses 500, 600 may be formed from bioabsorbable or non-bioabsorbable materials. It should be understood that any combination of natural, synthetic, bioabsorbable, and non-bioabsorbable materials may be used to form the buttress material. The buttress material may be porous or non-porous, or a combination of porous and non-porous layers. The buttresses 500, 600 may also include layers or coatings including mendicants to be delivered to tissue surrounding the buttresses 500, 600. The mendicants may be released when the staples 223 penetrate through the respective buttress 500, 600 and/or may be released over a period of time after the staples penetrate through the respective buttress 500, 600.
For additional materials that may form one or more layers of the buttresses 500, 600, references can be made to commonly assigned U.S. Pat. Nos. 5,542,594; 5,908,427; 5,964,774; 6,045,560; 7,823,592; and 7,938,307 and U.S. Patent Publication No. 2015/0231409, the entire contents of each are hereby incorporated by reference.
Referring to
Once the cartridge assembly 200 and the anvil assembly 300 are clamped onto tissue, the surgical stapling apparatus 10 is fired. In firing the surgical stapling apparatus 10, a drive bar (not shown) is advanced from a proximal-most position to a distal-most position of the DLU 100. In so doing, the sled 228 (
Additionally, as the drive bar approaches the distal-most position, the drive bar and/or the knife blade engage a suture cutting assembly or suture release assembly to thereby sever or release distal sutures “S1” and/or “S3” and thus release a distal end of the buttresses 500, 600. For an exemplary suture cutting assembly reference can be made to U.S. Pat. No. 8,011,555, the entire contents of which are hereby incorporated by reference.
With particular reference to
As shown in
Additionally or alternatively, a clinician grasps a tail portion 590, 690 of one or both of the buttresses 500, 600, e.g., tail portion 530 of the cartridge buttress 500, and uses the cutting instrument (not shown) to cut through portions 590, 690 of the buttresses 500, 600 that extend beyond the tissue. The portions 590, 690 are then removed from the surgical site. The portions 590, 690 of the buttresses 500, 600 include “remnant” staples 223 which were captured during the firing of the surgical stapling apparatus 10.
It is contemplated that the buttresses 500, 600 may only extend beyond tissue adjacent the head portion 510 or the tail portion 530. During such procedures, only the portions of the buttresses 500, 600 extending beyond the tissue adjacent the head portions, e.g., portions 580, 680, or the tail portions, e.g., portions 590, 690, are cut and removed from the surgical site.
After the portions 580, 680 and/or 590, 690 of the buttresses 500, 600, including any “remnant” staples 223, are removed from the surgical site, the buttresses 500, 600 and remaining staples 223 are disposed in tissue to seal the tissue along the staple lines formed by the staples 223 and/or to treat tissue. It will be appreciated that by capturing any “remnant” staples 223 in the portions 580, 590, 680, 690 of the buttresses 500, 600, the buttresses 500, 600 prevent any “remnant” staples 223 from remaining in the body cavity. This may be particularly useful when the staples 223 are coated with a mendicant or emit radioactivity. For example, during a brachytherapy procedure, radioactive staples are deployed in tissue along a resection margin such that the staples emit energy after being deployed to destroy cancer cells at the resection margin. Capturing any of the “remnant” radioactive staples prevents unintended exposure of tissue to the energy emitted from the radioactive staples.
The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the surgeon and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the surgeon during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.
The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of surgeons or nurses may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another surgeon (or group of surgeons) remotely control the instruments via the robotic surgical system. As can be appreciated, a highly skilled surgeon may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.
The robotic arms of the surgical system are typically coupled to a pair of master handles by a controller. The handles can be moved by the surgeon to produce a corresponding movement of the working ends of any type of surgical instrument (e.g., end effectors, graspers, knifes, scissors, etc.) which may complement the use of one or more of the embodiments described herein. The movement of the master handles may be scaled so that the working ends have a corresponding movement that is different, smaller or larger, than the movement performed by the operating hands of the surgeon. The scale factor or gearing ratio may be adjustable so that the operator can control the resolution of the working ends of the surgical instrument(s).
The master handles may include various sensors to provide feedback to the surgeon relating to various tissue parameters or conditions, e.g., tissue resistance due to manipulation, cutting or otherwise treating, pressure by the instrument onto the tissue, tissue temperature, tissue impedance, etc. As can be appreciated, such sensors provide the surgeon with enhanced tactile feedback simulating actual operating conditions. The master handles may also include a variety of different actuators for delicate tissue manipulation or treatment further enhancing the surgeon's ability to mimic actual operating conditions.
Turning to
Robotic surgical system 1000 generally includes a plurality of robot arms 1002, 1003; a control device 1004; and an operating console 1005 coupled with control device 1004. Operating console 1005 may include a display device 1006, which may be set up in particular to display three-dimensional images; and manual input devices 1007, 1008, by means of which a person, e.g., a surgeon, may be able to telemanipulate robot arms 1002, 1003 in a first operating mode. Robotic surgical system 1000 may be configured for use on a patient 1013 lying on a patient table 1012 to be treated in a minimally invasive manner. Robotic surgical system 1000 may further include a database 1014, in particular coupled to control device 1004, in which are stored, for example, pre-operative data from patient 1013 and/or anatomical atlases.
Each of the robot arms 1002, 1003 may include a plurality of members, which are connected through joints, and an attaching device 1009, 1011, to which may be attached, for example, a surgical tool “ST.” One or more of the surgical tools “ST” may include a DLU, e.g., DLU 100, similar to those detailed above, thus providing such functionality on a robotic surgical system 1000.
Robot arms 1002, 1003 may be driven by electric drives, e.g., motors, connected to control device 1004. Control device 1004, e.g., a computer, may be configured to activate the motors, in particular by means of a computer program, in such a way that robot arms 1002, 1003, their attaching devices 1009, 1011, and, thus, the surgical tools “ST” execute a desired movement and/or function according to a corresponding input from manual input devices 1007, 1008, respectively. Control device 1004 may also be configured in such a way that it regulates the movement of robot arms 1002, 1003 and/or of the motors.
While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. Any combination of the above embodiments is also envisioned and is within the scope of the appended claims. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope of the claims appended hereto.
This application claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/544,037 filed Aug. 11, 2017, the entire disclosure of which is incorporated by reference herein.
| Number | Date | Country | |
|---|---|---|---|
| 62544037 | Aug 2017 | US |
