Patent Application
20200129174
The present disclosure relates to devices, systems, tools, and/or methods useful for connecting, sealing, fastening, and/or attaching to itself or other tissue and/or non-tissue structures, and/or sealing the flow of fluid at and/or between structures such as tissue and vessel structures of a human or non-human mammal.
In the discussion of the background that follows, reference is made to certain structures and/or methods. However, the following references should not be construed as an admission that these structures and/or methods constitute prior art. Applicant expressly reserves the right to demonstrate that such structures and/or methods do not qualify as prior art.
Various devices and tools are known in the medical arts for sealing the flow of fluid through tissue structures in a patient. Common examples include bipolar, monopolar, and other radiofrequency (RF) and thermal energy sealers, staplers, and two-part fasteners. While these devices generally work for their intended uses, each solution is not without its tradeoffs. For example, RF and thermal energy sealers require the availability of a source of energy as well as high power requirements and can scorch or burn tissue due to overheating. Medical staplers and two-part fastener appliers must be accurately and precisely toleranced during manufacture and aligned during use in order to ensure proper engagement and functioning with respect to the tissue chosen for stapling. Medical staplers and two-part fastener appliers are also generally configured for certain tissue sizes and thicknesses and do not accommodate easily various tissue thicknesses. In view of these and other tradeoffs, there is the ever-present desire for new and alternate devices and tools for connecting tissue to itself or other tissue and non-tissue structures, and/or sealing the flow of fluid at and/or between tissue structures of a patient.
A surgical implant according to an example embodiment of the present disclosure comprises a deployment member having a first base with a first tissue contacting surface. At least one fastener is disposed within the deployment member. A receiver member has a second base with a second tissue contacting surface facing the first tissue contacting surface of the deployment member. A retainer is embedded within the second base of the receiver member. The fastener is movable with respect to and penetrable through the deployment member, receiver member and any tissue located therebetween to engage the retainer, and wherein engagement of fastener and the retainer couples the deployment and receiver members together.
A surgical implant according to another example embodiment of the present disclosure comprises a base having a tissue contacting surface and a first thickness. A suspension having a second thickness extends from the base opposite to the tissue contacting surface. A fastener, movable with respect to the base, is coupled to the suspension to compress the suspension as the fastener is inserted into the base.
According to the example embodiment, the suspension can be a resilient, compressible member configured as a tower.
A surgical apparatus according to another example embodiment of the present disclosure comprises a body and a shaft extending distally from the body. An end effector disposed at a distal end of the shaft includes a first jaw and a second jaw. The first jaw is receivable of a first portion of a surgical implant, and the second jaw is receivable of a second portion of a surgical implant. The first and second jaws are relatively movable with respect to one another between an open position wherein the first and second jaws are spaced apart and a closed position wherein the first and second jaws are proximate to one another. A driver for transitioning the first and second jaws to the closed position engages the first and second jaws, wherein moving the driver distally with respect to the first and second jaws compresses the first and second jaws with respect to one another. An actuator coupled to the driver transfers an actuation force to the driver to transition the first and second jaws to the closed position via tension.
A surgical implant applicator according to another example embodiment of the present disclosure comprises a main body and a shaft extending distally from the main body. First and second jaws disposed at a distal end of the shaft are relatively movable with respect to one another. A driver is movably mounted to the first and second jaws for closing the jaws and deploying tissue fasteners of a surgical implant positionable within the first and second jaws. A trigger is operatively associated with the driver, wherein actuation of the trigger closes the jaws as well as advances the driver towards a distal end of the first and second jaws. Subsequent actuation of the trigger after the driver has reached the distal end of the first and second jaws induces movement of the driver towards a proximal end of the first and second jaws.
According to an example embodiment, the driver can further include a blade positioned to engage and sever tissue as the driver is moved along the first and second jaws.
According to an example embodiment, the applicator can further include a safety mechanism comprising a user actuation rod. When oriented in a first safety position, the rod inhibits movement of the driver until the first and second jaws are closed.
According to an example embodiment, the rod is spring biased to assume the first position.
According to an example embodiment, the rod is locked in a second position to allow the driver to advance from the proximal end to the distal end of the first and second jaws.
According to an example embodiment, the applicator further includes a drive mechanism operatively associated with the trigger, driver and safety mechanism. The drive mechanism comprises a flange having a shoulder that abuts the rod when the rod is oriented in the first position. The drive mechanism further includes two ratchet gears coupled to the trigger and positioned on opposite sides of the flange that induces rotation of the flange upon actuation of the trigger. Cables operatively associated with the ratchet gears and operatively associated with the driver and/or one of the first and second jaws transmit force between therebetween.
According to an example embodiment, the rod has a variable diameter along its length to selectively impede the rotation of the flange.
According to an example embodiment, the applicator can further comprise a quarter gear positioned between the two ratchet gears.
A method for using a surgical implant applicator according to another example embodiment of the present disclosure comprises the steps of actuating a trigger to (i) advance a driver towards a distal end of first and second jaws of the applicator and (ii) deploy tissue fasteners of a surgical implant positioned within the first and second jaws, wherein the driver is movably mounted to the first and second jaws. The method further includes subsequently actuating the trigger after the driver has reached the distal end of the first and second jaws to move the driver towards a proximal end of the first and second jaws.
According to an example embodiment, the method can further include orienting a rod of a safety mechanism in a first safety position to prevent movement of the driver until the first and second jaws axe closed.
According to an example embodiment, the method can further comprise positioning the rod in a second position to allow the driver to advance from the proximal end to the distal end of the first and second jaws.
According to an example embodiment, the method can further include actuating a blade along a slot of the first and second jaws and severing tissue as the driver is advanced towards a distal end of the first and second jaws.
According to an example embodiment, the blade is actuated after the tissue fasteners on opposite sides of the blade have been deployed and secure the tissue.
According to an example embodiment, the method can further comprise severing a portion of the surgical implant upon actuation of the blade.
According to an example embodiment, the method can further comprise compressing the surgical implant between the first and second jaws upon closure of the jaws and subsequently further compressing the surgical implant between the closed first and second jaws upon advancing the driver towards the distal end the jaws.
According to another embodiment, a surgical implant is provided including a fastener supporting member having a first surface. At least one fastener is supported by the fastener supporting member. A receiver member has a second surface facing the first surface of the fastener supporting member. A retainer is positioned within the receiver member. At least one fastener is deployable from the fastener supporting member toward the receiver member to engage the retainer within the receiver member. Engagement of the retainer by the at least one fastener couples the fastener supporting member and the receiver member together.
According to another embodiment, a surgical implant is provided including a fastener carrying member supporting a plurality of fasteners having penetrating tips, the fastener carrying member having a first tissue contacting surface. A receiver member has a second tissue contacting surface. The first and second tissue contacting surfaces are positionable opposite each other so that tissue to receive the plurality of fasteners is positionable between the first and second tissue contacting surfaces. Deployment of the fasteners moves the penetrating tips of the fasteners through the fastener carrying member and through the tissue between the first and second tissue contacting surfaces and into the receiver member to couple the receiver member and fastener carrying member.
According to another embodiment, a surgical implant is provided including a fastener supporting member having a first surface. At least one fastener is supported by the fastener supporting member. At least one compressible member extends from the fastener supporting member. A receiver member has a second surface facing the first surface of the fastener supporting member. Deployment of the at least one fastener toward the receiver member compresses the at least one compressible member.
According to another embodiment, a surgical implant is provided comprising a fastener carrying member supporting a plurality of fasteners and a plurality of compressible members, each of the fasteners engageable with one of the compressible members. The plurality of fasteners are deployable through the fastener carrying member, wherein deployment of the plurality of fasteners compresses the compressible members.
According to another embodiment, a surgical implant is provided including a fastener supporting member and a plurality of fasteners arranged along a longitudinally extending row substantially parallel to a longitudinal axis of the implant. A retainer is positioned in the fastener supporting member and has a plurality of openings. The plurality of fasteners are retained by engagement with the plurality of openings in the retainer. A plurality of compressible members are engageable by the plurality of fasteners, and the plurality of compressible members are compressed by the plurality of fasteners.
According to another embodiment, a surgical implant is provided configured to accommodate a range of tissue thicknesses, the implant including first and second fasteners and first and second compressible members. The first fastener is engageable with the first compressible member and the second fastener is engageable with the second compressible member. The first compressible member is compressible in accordance with a distance of advancement of the first fastener and the second compressible member is compressible in accordance with a distance of advancement of the second fastener. The distances of advancement of the first and second fasteners are dependent on a tissue thickness through which the fasteners advance.
According to another embodiment, a surgical implant is provided including a fastener supporting member having a first surface. A plurality of fasteners are supported by the fastener supporting member. The plurality of fasteners have a penetrating tip and are deployable in a first direction. A receiver member is configured to receive the plurality of fasteners. A plurality of counterforce members extend from the fastener supporting member to apply a counterforce on the plurality of fasteners when the plurality of fasteners have been deployed. The counterforce members apply a force against the plurality of fasteners in a second direction opposite a first direction of deployment of the plurality of fasteners.
According to another embodiment, a surgical implant is provided including a receiver member, a fastener supporting member and a plurality of fasteners supported on the fastener supporting member and arranged along a longitudinally extending row substantially parallel to a longitudinal axis of the fastener supporting member. The fasteners are engageable with the receiver member. The fastener supporting member and the receiver member have a width and length exceeding the width, and the fasteners couple the fastener supporting member and the receiver member together and pull the receiver member toward the fastener supporting member after coupling the fastener supporting member and receiver member.
According to another embodiment, a surgical method of sealing tissue is provided including providing a fastener supporting member supporting a plurality of fasteners and having a plurality of compressible members. The method further includes providing a receiver member and clamping tissue between a first surface on the fastener supporting member and a second surface on the receiver member. The fasteners are advanced into the receiver member and compress the compressible members in accordance with a distance of advancement of the fasteners, the distance relating to a thickness of tissue between the first and second surfaces.
According to another embodiment, a surgical method of fastening parenchyma is provided including providing a fastener supporting member supporting a plurality of fasteners and a receiver member to receive the plurality of fasteners when advanced from the fastener supporting member. Parenchyma is clamped between a first surface on the fastener supporting member and a second surface on the receiver member. The fasteners are advanced in a first direction from the fastener supporting member into the receiver member to couple the fastener supporting member and the receiver member, wherein a counterforce is applied to each of the fasteners in a direction opposite to the first direction of advancement of the plurality of fasteners thereby accommodating for variations in tissue thickness.
According to another embodiment, a surgical method of forming an anastomosis between a first structure and a second structure within a body of a patient is provided, the method including providing a fastener supporting member supporting a plurality of fasteners, positioning the fastener supporting member adjacent the first structure, providing a receiver member and positioning the receiver member adjacent the second structure. The fasteners are advanced through the fastener supporting member and into the receiver member to couple together the fastener supporting member and the receiver member.
According to another embodiment, an end effector assembly of a surgical device is provided, the end effector assembly including a first jaw and a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported by the first jaw. A plurality of fasteners is supported by the fastener supporting member and a receiver member supported by the second jaw. A retainer is positioned in the second jaw. A drive assembly is movable with respect to the first jaw to advance the plurality of fasteners toward the receiver member and into engagement with the retainer to couple together the fastener supporting member and the receiver member.
According to another embodiment, an end effector assembly of a surgical device is provided. The end effector assembly includes a first jaw and a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp tissue when in the closed configuration. A fastener supporting member is supported by the first jaw. A plurality of fasteners is supported by the fastener supporting member. A plurality of compressible members is supported by the first jaw and engageable by the fasteners. A receiver member is supported by the second jaw. A drive assembly is movable with respect to the first jaw to advance the plurality of fasteners toward the receiver member. The plurality of fasteners compress the plurality of compressible members in accordance with a thickness of tissue clamped between the first and second jaws.
According to another embodiment, an end effector assembly of a surgical device is provided. The end effector assembly includes a first jaw and a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp tissue when in the closed configuration. A fastener supporting member is supported by the first jaw, a plurality of fasteners is supported by the fastener supporting member, and a receiver member is supported by the second jaw. A drive assembly is movable with respect to the first jaw to advance the plurality of fasteners in a first direction toward the receiver member against a counterforce applied to the plurality of fasteners. The fasteners are engageable with the receiver member and the counterforce applies a force to the fasteners in a second direction opposite the first direction when the fasteners are engaged with the receiver member.
According to another embodiment, a surgical device is provided including a handle portion at a proximal portion of the device. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. A fastener supporting member of a surgical implant is supported in the first jaw, the fastener supporting member supporting a plurality of surgical fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. A drive assembly is actuable from the handle portion to advance the plurality of fasteners. The fasteners are advanced in a first direction toward the receiver member and engageable therewith to couple the fastener supporting member and receiver member and to exert a force to pull the receiver member toward the fastener supporting member after engagement of the plurality of fasteners with the receiver member.
According to another embodiment, a surgical device is provided including a handle portion at a proximal portion of the device. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at a distal portion of the device. A fastener supporting member of a surgical implant is supported in the first jaw, the fastener supporting member supporting a plurality of surgical fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. A plurality of compressible members interact with the plurality of fasteners. The compressible members have a first configuration prior to advancement of the plurality of fasteners and a second configuration subsequent to advancement of the plurality of fasteners. A drive assembly is actuable from the handle portion to sequentially advance the plurality of fasteners against the plurality of compressible members. The plurality of fasteners moves at least some of the plurality of compressible members to the second configuration.
According to another embodiment, a surgical device is provided including a handle portion at a proximal portion of the device. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. A fastener supporting member of a surgical implant is supported in the first jaw. A plurality of fasteners is supported by the fastener supporting member, and a fastener receiver member of the surgical implant is supported in the second jaw. A retainer is included, and a drive assembly actuable from the handle portion advances the plurality of fasteners toward and into engagement with the retainer. The fasteners are engageable with the retainer to couple the fastener supporting member and receiver member.
According to another embodiment, a surgical device is provided including a handle portion at a proximal portion of the device and an actuator. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. At least one of the first jaw and the second jaw is movable to transition the first and second jaws between an open position and a closed position. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open position and to clamp tissue when in the closed position. A plurality of fasteners is supported by the first jaw. A drive assembly is operably connected to the actuator and actuable by the actuator to advance the plurality of fasteners from the first jaw toward the second jaw. The drive assembly includes a drive member movable with respect to the first jaw. The drive member is movable in a first direction to advance the plurality of fasteners and movable in a second direction opposite the first direction after movement in the first direction to further advance at least one of the plurality of fasteners.
According to another embodiment, a surgical device is provided including a handle portion at a proximal portion of the device. The handle portion includes a movable handle member and an elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. At least one of the first jaw and the second jaw is movable to transition the first and second jaws between an open position and a closed position. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open position and to clamp tissue when in the closed position. A plurality of fasteners is supported by the first jaw. First and second rotatable spools are included for moving a drive member. A first gear is operably connected to the handle member and operably connected to at least one of the first and second rotatable spools. Movement of the handle member rotates the first gear which rotates at least one of the first and second rotatable spools to move the drive member to advance the plurality of fasteners into tissue.
According to another embodiment, a surgical device is provided for applying fasteners including a handle portion at a proximal portion of the device and including an actuator. An elongated portion extends distally from the handle portion. A first jaw and a second jaw are at the distal portion of the device. At least one of the first jaw and the second jaw is movable to transition the first and second jaws between an open position and a closed position. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open position and to clamp tissue when in the closed position. A plurality of fasteners is supported by the first jaw. A drive assembly is operably connected to the actuator and actuable by the actuator to advance the plurality of fasteners from the first jaw toward the second jaw. The drive assembly includes a first tensioning member, a second tensioning member and a pulley. The first tensioning member interacts with the pulley to effect advancement of the plurality of fasteners toward the second jaw.
According to another embodiment, a surgical implant is provided comprising a fastener supporting member having a first surface and at least one fastener supported by the fastener supporting member. A receiver member has a second surface facing the first surface of the fastener supporting member. A retainer is positioned within the receiver member. A flexible flap extends from one or both of the fastener supporting member and the receiver member, wherein the at least one fastener is deployable from the fastener supporting member toward the receiver member to engage the retainer within the receiver member, wherein engagement of the retainer by the at least one fastener couples the fastener supporting member and the receiver member together.
In some embodiments, the flap extends radially from both sides of the receiver member and the fastener supporting member. In some embodiments, the flap is formed integrally with the fastener supporting member and receiver member. In some embodiments, the receiver member is formed of a first material and the retainer is formed of a more rigid material than the first material of the receiver member, and the retainer extends into the flap.
In some embodiments, the at least one fastener is deployable through the fastener supporting member and the retainer restricts movement of the least one fastener in a direction opposite to a direction of deployment of the at least one fastener after the at least one fastener engages the retainer. The retainer can include a mesh having a plurality of openings, wherein the at least one fastener is receivable within one of the openings. In some embodiments, the at least one fastener is deployed in a first direction toward the receiver member and is biased in a second direction opposite the first direction.
In accordance with another embodiment, a surgical implant is provided comprising a fastener carrying member supporting a plurality of fasteners having penetrating tips and having a first tissue contacting surface and a first radially extending flexible flap extending from opposing sides of the fastener carrying member. A receiver member has a second tissue contacting surface and a second radially extending flexible flap extending from opposing sides of the receiver member. The first and second tissue contacting surfaces are positionable opposite each other so that tissue to receive the plurality of fasteners is positionable between the first and second tissue contacting surfaces, wherein deployment of the plurality of fasteners moves the penetrating tips of the fasteners through the fastener carrying member and through the tissue between the first and second tissue contacting surfaces and into the receiver member to couple the receiver member and fastener carrying member.
In some embodiments, a first retainer is positioned within the receiver member and/or a second retainer is positioned in the fastener carrying member, and the penetrating tips of the fasteners extend through the retainers. The fastener carrying member can further include a plurality of compressible members compressed by the plurality of fasteners when the fasteners are deployed.
In some embodiments, the first and second retainers extend into the flaps. The first flap in some embodiments can be formed of the same material as the fastener carrying member and/or the second flap can be formed of the same material as the receiver member.
In accordance with another embodiment, an end effector assembly of a surgical device is provided comprising a first jaw, a second jaw, at least one of the first and second jaws movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration, The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported by the first jaw, a plurality of fasteners are supported by the fastener supporting member, and a receiver member is supported by the second jaw. A retainer is positioned in the second jaw and a drive assembly is movable with respect to the first jaw to advance the plurality of fasteners toward the receiver member and into engagement with the retainer to couple together the fastener supporting member and the receiver member. The drive assembly includes a driver having a camming surface directly engageable with the fasteners during distal movement thereof to advance the plurality of fasteners toward the receiver member.
In some embodiments, the plurality of fasteners have a base and a pair of legs extending from the base, and the base is aligned substantially parallel to a longitudinal axis of the fastener supporting member.
In some embodiments, the plurality of fasteners have a curved surface directly engageable by the driver. A plurality of compressible members can be provided in some embodiments positioned in the first jaw, wherein advancement of the plurality of fasteners compresses the plurality of compressible members.
In some embodiments, the plurality of fasteners are arranged in at least two rows substantially parallel to a longitudinal axis of the fastener supporting member, and a cutting blade is movable between the rows of fasteners to sever tissue.
In some embodiments, a first cable and a second cable are provided, wherein the first cable effects movement of the driver in a distal direction and the second cable effects movement of the driver in a proximal direction.
According to another embodiment, an end effector assembly of a surgical device is provided comprising a first jaw, a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration. The first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported by the first jaw and a plurality of fasteners are supported by the fastener supporting member. A receiver member is supported by the second jaw and a drive assembly is movable with respect to the first jaw to advance the plurality of fasteners into the receiver member to couple together the fastener supporting member and the receiver member. The drive assembly includes a driver having a distal camming surface and a proximal camming surface, the distal camming surface directly engageable with the plurality of fasteners during distal movement thereof to advance the plurality of fasteners and the proximal camming surface directly engageable with the plurality of fasteners during proximal movement thereof to further advance the plurality of fasteners.
In some embodiments, the plurality of fasteners have a base and a pair of legs extending from the base, the base aligned substantially parallel to a longitudinal axis of the fastener supporting member.
In some embodiments, the distal camming surface has a first region having a first curve and a second region having a second different curve. In some embodiments, the first curve reduces the firing force on initial advancement of the fastener and the second curve reduces the firing force on final advancement of the fastener.
In some embodiments, the fasteners have a curved surface directly engageable by the driver. In some embodiments, a plurality of compressible members are positioned in the first jaw, wherein advancement of the fasteners compresses the compressible members. The compressible members can in some embodiments be in the form of towers, the towers having a channel therein to decrease lateral expansion of the towers when compressed by the fasteners The end effector assembly can include guide surfaces which are in contact with a side of the fastener opposite a side of the fastener contacted by the distal camming surface.
The end effector assembly can further include a retainer positioned in the receiver member and the plurality of fasteners are advanced into engagement with the retainer. The retainer can, in some embodiments, restrict movement of the least one fastener in a direction opposite to a direction of deployment of the at least one fastener after the at least one fastener engages the retainer.
In some embodiments, the end effector assembly of includes a plurality of channels through which the distal and proximal camming surfaces travel.
A first cable and a second cable can be provided wherein the first cable effects movement of the driver in a distal direction and the second cable effects movement of the driver in a proximal direction.
In some embodiments, the fastener supporting member and receiver member each have a flap extending radially from each side of the receiver member and the fastener supporting member. In some embodiments, the fasteners are deployable through the fastener supporting member.
According to another embodiment, an end effector assembly of a surgical device is provided comprising a first jaw and a second jaw. At least one of the first and second jaws is movable toward the other jaw to transition the first and second jaws between an open configuration and a closed configuration, wherein the first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported by the first jaw and a plurality of fasteners are supported by the fastener supporting member. A receiver member is supported by the second jaw. A drive assembly is movable with respect to the first jaw to advance the plurality of fasteners into the receiver member to couple together the fastener supporting member and the receiver member, the drive assembly including a driver having a camming surface having a first region having a first curve and a second region having a second different curve, wherein the first curve reduces a firing force on initial advancement of the fastener and the second curve reduces the firing force on final advancement of the fastener.
According another embodiment, a surgical implant is provided comprising a fastener supporting member having a first surface, a plurality of fasteners supported by the fastener supporting member, a receiver member having a second surface facing the first surface of the fastener supporting member, and a plurality of compressible members extending from the fastener supporting member. The compressible members have a solid region extending in a direction away from the receiver member and a channel formed within the solid region, wherein deployment of the at least one fastener toward the receiver member compresses the at least one compressible member.
In some embodiments, the surgical implant has a first tissue contacting surface on a first side of the fastener supporting member and the compressible members extend from a second opposite side of the fastener supporting member. In some embodiments, the compressible members are in the form of a tower having a base and fasteners have a base engageable with the base of the compressible members, the base of fasteners applying a force to the base of the compressible members to deform the at least one compressible member.
In some embodiments, the receiver member includes a plurality of shields arranged along a row substantially parallel to a longitudinal axis of the receiver, each of the plurality of shields being positioned opposite a fastener. The extent of compression of the compressible members in some embodiments is dependent on a thickness of tissue clamped between the fastener supporting member and the receiver member, and the compressible members apply a counterforce to the fasteners in a direction opposite a direction in which the fasteners are deployed.
According to another embodiment, an end effector assembly of a surgical device is provided comprising a first jaw and a second jaw movable toward the first jaw between an open configuration and a closed configuration, wherein the first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported in the second jaw and a plurality of fasteners are supported by the fastener supporting member. A receiver member is supported by the first jaw and a drive assembly is movable with respect to the second jaw to advance the plurality of fasteners into the receiver member to couple together the fastener supporting member and the receiver member,
In some embodiments, the drive assembly includes a driver having a distal camming surface and a proximal camming surface, the distal camming surface advancing the plurality of fasteners during distal movement and the proximal camming surface advancing the plurality of fasteners during proximal movement to further advance the plurality of fasteners. In some embodiments, the second jaw has first and second protrusions, the first protrusion engageable with a first opening in the first jaw and the second protrusion engageable with a second opening in the first jaw, wherein the first and second protrusions can be configured to snap over and into the first and second openings.
In some embodiments the end effector assembly further comprises a plurality of compressible members positioned in the second jaw, wherein advancement of the plurality of fasteners compresses the plurality of compressible members. In some embodiments, the drive assembly is advanceable at an angle of up to about 90 degrees to advance the plurality of fasteners.
In some embodiments, the end effector assembly further comprises a retainer positioned in the receiver member and the plurality of fasteners are advanced into engagement with the retainer, wherein the retainer can be configured to restrict movement of the fasteners in a direction opposite to a direction of deployment of the fasteners after the fasteners engage the retainer. In some embodiments, the plurality of fasteners are deployable through the fastener supporting member.
In some embodiments, the drive system includes a first cable and a second cable, the first cable effects movement of the driver in a distal direction and the second cable effects movement of the driver in a proximal direction. In some embodiments, the drive system includes a driver, and a pull force that moves the driver proximally is on an opening side of a moving jaw pivot to create a jaw opening moment and a pull force that moves the driver distally is below the moving jaw pivot to create a jaw closing moment during advancement of the fasteners.
According to another embodiment, an end effector assembly of a surgical device is provided comprising a first jaw and a second jaw movable toward the first jaw between an open configuration and a closed configuration, wherein the first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A plurality of fasteners are supported in the second jaw. A driver is movable with respect to the first and second jaws, the driver movable along a first plane in a distal direction to advance the plurality of fasteners toward the first jaw and subsequently movable in a second plane in a proximal direction to return to a proximal position,
In some embodiments, the driver is operable to transition the first and second jaws between the open configuration and the closed configuration. In some embodiments, when the driver is moved to a distal position, the jaws can move to a slightly open position. In some embodiments, the driver can include a tab and the first jaw can include a first camming surface, the tab engaging the first camming surface to maintain the jaws in the closed configuration as the driver is advanced in the distal direction. In some embodiments, the first jaw has an opening at a distal portion to receive the tab so the driver can move from the first plane to the second plane.
In some embodiments, the driver advances the plurality of fasteners toward a receiver member in the first jaw and into engagement with a retainer in the receiver member, and the second jaw supports a plurality of compressible members, wherein advancement of the plurality of fasteners compresses the plurality of compressible members.
According to another embodiment an end effector assembly of a surgical device is provided comprising a first jaw and a second jaw movable toward the first jaw between an open configuration and a closed configuration, wherein the first jaw and the second jaw are arranged to receive tissue therebetween when in the open configuration and to clamp the tissue when in the closed configuration. A fastener supporting member is supported in the second jaw and a plurality of fasteners are supported in the fastener supporting member. A receiver member is supported by the first jaw. A driver is movable with respect to the first and second jaws to advance the plurality of fasteners into the receiver member to couple the fastener supporting member and the receiver member together, the driver engageable with the first and second jaws as it travels distally to hold the first and second jaws together and engageable with a surface of the first jaw to push the first jaw open as it moves proximally.
In some embodiments, when the driver moves to the distal position, the driver moves in a direction away from the second jaw to allow the first jaw to spring slightly open. In some embodiments, the driver includes a tab engageable with a camming surface of the first jaw to hold the jaws together.
In accordance with another embodiment, a loading assembly for a surgical applicator is provided having a first jaw and a second jaw. The loading assembly comprises a housing and an implant contained within the housing. The implant has a first portion and a second portion, the first portion having a fastener supporting member supporting a plurality fasteners and a plurality of compressible members. The second portion has a receiver member and a retainer positioned within the receiver member. The housing is positionable within the jaws of the applicator to transfer the first portion to the first jaw and the second portion to the second jaw.
In some embodiments, the housing is separable from the implant to leave the implant in the first and second jaws. In some embodiments, transitioning of the first and second jaws to the closed position transfers the implant to the first and second jaws.
In some embodiments, the plurality of fasteners are deployable from the fastener supporting member toward the receiver member to engage the retainer within the receiver member to couple the fastener supporting member and the receiver member together. The plurality of fasteners can include a plurality of fasteners arranged along at least one row substantially parallel to a longitudinal axis of the fastener supporting member. The receiver member can include a plurality of shields arranged along at least one row substantially parallel to a longitudinal axis of the receiver member with each shield positioned opposite one of the plurality of fasteners. In some embodiments, the retainer is embedded in the receiver member and includes a plurality of strands and a plurality of openings between the strands to receive the plurality of fasteners. In some embodiments, the receiver member is at least partially composed of silicone rubber
In some embodiments, the loading assembly has a slot at a proximal portion to engage a tab of the first jaw and/or at least one protrusion to snap into a slot of the first jaw.
In accordance with another embodiment, a loading assembly for reloading an end effector of a surgical applicator is provided, the end effector having a first jaw movable toward the second jaw to transition the jaws from an open configuration to a closed configuration. The loading assembly comprises an implant having a first portion and a second portion, the first portion having a fastener supporting member supporting a plurality fasteners and the second portion having a receiver member. The implant is mountable within the first and second jaws of the applicator upon placement of the first portion in the first jaw and subsequent movement of the first jaw toward the second jaw.
In some embodiments, subsequent movement of the first jaw toward the second jaw transfers the first portion of the implant to the first jaw and the second portion of the implant to the second jaw.
In some embodiments, the fastener supporter member includes a plurality of compressible members compressible by the plurality of fasteners. A retainer can be positioned within the receiver member.
In some embodiments, the loading assembly includes a housing and the implant is removably positioned within the housing and transferable from the housing into the first and second jaws. In some embodiments, the loading assembly has at least one protrusion which snaps into a slot of the first jaw.
In accordance with another embodiment, a method of loading a surgical implant into a surgical applicator is provided comprising the steps of providing a housing having an implant including a plurality of fasteners and removably supported by the housing; placing the housing into a first jaw of the applicator; closing the first jaw of the applicator; and removing the housing from the implant to leave the implant within the first jaw of the surgical applicator.
In some embodiments the implant includes a receiver member, and the step of closing the first jaw transfers the receiver member to the second jaw. In some embodiments, the method further includes the steps of placing a proximal portion of the housing in engagement with a tab of the first jaw and subsequently rotating the housing toward the first jaw. In some embodiments, the receiver is frictionally retained in the second jaw upon closing of the first jaw.
In accordance with another embodiment, a surgical device is provided comprising a handle portion at a proximal portion of the device, an elongated portion extending distally from the handle portion, and an end effector connected to a distal portion of the elongated portion and having a first jaw and a second jaw. At least one of the jaws is movable toward the other jaw to effect transition of the jaws from an open to a closed configuration. The end effector is connected for articulation with respect to the elongated portion about a first axis and about a second axis, the first and second axes intersecting.
In some embodiments, the device includes a first pair of tension ribbons to effect articulation about the first axis and/or a second pair of tension ribbons to effect articulation about the second axis. In some embodiments, pulling a first ribbon of the first pair of ribbons in a proximal direction allows the second ribbon of the first pair of ribbons to extend articulating the end effector in a first direction and pulling the second ribbon of the first pair of ribbons in a proximal direction allows the first ribbon of the first pair of ribbons to extend articulating the end effector in a second direction opposite the first direction. In some embodiments, pulling a first ribbon of the second pair of ribbons in a proximal direction allows the second ribbon of the second pair of ribbons to extend articulating the end effector in a third direction different than the first and second directions and pulling the second ribbon of the second pair of ribbons in a proximal direction allows the first ribbon of the second pair of ribbons to extend articulating the end effector in a fourth direction opposite the third direction. In some embodiments, the first axis is a yaw axis and the second axis is a pitch axis and the yaw and pitch axes intersect at a central point. In some embodiments, the first and second axes are substantially orthogonal to each other. In some embodiments, a rotatable joint is connected to the first and second jaws and the first pair of ribbons attach to the rotatable joint in line with the second axis.
In some embodiments, the device includes a driver movable within the jaws to advance fasteners supported in one of the jaws, a first cable and a second cable, wherein the first cable effects movement of the driver in a distal direction and the second cable effects movement of the driver in the proximal direction, and the first and second cables. In some embodiments, the first and second cables are contained in a tube which extends through the intersection of the first and second axes.
In some embodiments, the handle portion includes a movable handle, and initial movement of the movable handle moves the drive assembly to transition the first and second jaws to a closed configuration and further movement of the movable handle advances fasteners in the first jaw toward a receiver member in the second jaw.
In some embodiments, a fastener supporting member of a surgical implant is supported in the first jaw and supports a plurality of fasteners, and a fastener receiver member of the surgical implant is supported in the second jaw. In some embodiments a plurality of compressible members interact with the plurality of fasteners, the plurality of compressible members having a first configuration prior to advancement of the plurality of fasteners and a second deformed configuration subsequent to advancement of the plurality of fasteners.
In accordance with another embodiment, a surgical device is provided comprising a handle portion at a proximal portion of the device, an elongated portion extending distally from the handle portion, and an end effector connected to a distal portion of the elongated portion and having a first jaw and a second jaw, at least one of the jaws movable toward the other jaw to effect transition of the jaws from an open to a closed configuration. A fastener supporting member of a surgical implant is supported in the first jaw and supports a plurality of fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. The end effector is articulatable with respect to the elongated portion for movement in first and second opposite directions and third and fourth opposite directions.
In some embodiments, a first pair of tension ribbons and/or a second pair of tension ribbons are provided, wherein the first pair of tension ribbons are positioned on opposing sides of a longitudinal axis of the elongated portion and the second pair of tension ribbons are positioned on opposing sides of the longitudinal axis. In some embodiments, a) pulling a first ribbon of the first pair of ribbons in a proximal direction allows the second ribbon of the first pair of ribbons to extend articulating the end effector in a first direction, b) pulling the second ribbon of the first pair of ribbons in a proximal direction allows the first ribbon of the first pair of ribbons to extend articulating the end effector in a second direction opposite the first direction, c) pulling a first ribbon of the second pair of ribbons in a proximal direction allows the second ribbon of the second pair of ribbons to extend articulating the end effector in a third direction different than the first and second directions and/or d) pulling the second ribbon of the second pair of ribbons in a proximal direction allows the first ribbon of the second pair of ribbons to extend articulating the end effector in a fourth direction opposite the third direction.
In some embodiments, a plurality of compressible members interacting with the plurality of fasteners are provided, the plurality of compressible members having a first configuration prior to advancement of the plurality of fasteners and a second configuration subsequent to advancement of the plurality of fasteners.
In accordance with another embodiment, an articulation mechanism for an end effector of a surgical device is provided. The articulation mechanism comprises a pivot, first and second pitch ribbons connected to first and second portions of the pivot and third and fourth yaw ribbons connected to third and fourth portions of the pivot. The first and second ribbons are selectively tensionable to effect articulation of the end effector about a pitch axis and the third and fourth ribbons are selectively tensionable to effect articulation of the end effector about a pitch axis.
In some embodiments, the pitch and yaw axis intersect at a central point. In some embodiments, the third and fourth ribbons attach to the pivot in line with the pitch axis.
In accordance with another embodiment, a surgical device is provided comprising a handle portion at a proximal portion of the device including a movable handle, an elongated portion extending distally from the handle portion, and a first jaw and a second jaw at a distal portion of the device. At least one of the jaws is movable toward the other jaw to transition the first and second jaws from an open configuration to a closed configuration. A fastener supporting member of a surgical implant is supported in the first jaw and supports a plurality of surgical fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. A drive assembly is actuable by the movable handle to transition the first and second jaws between the open and closed configurations and to advance the plurality of fasteners in a first direction into engagement with the fastener receiver member to couple the fastener supporting member and receiver member. A release is operatively associated with the movable handle, the release movable from a first position to a second position to enable the movable handle to actuate the drive assembly to advance the plurality of fasteners.
In some embodiments, the release is movable to a third position, the third position being between the first and second positions, wherein in the third position the movable handle can be returned to an initial position to transition the first and second jaws from the closed configuration back to the open configuration. In some embodiments, the movable handle is movable from an initial position to a second position to effect transition of the first and second jaws to the closed configuration, and the movable handle can have a hook engageable with a hook receiving member to retain the movable handle in the second position. In some embodiments, movement of the release to the third position releases engagement of the hook with the hook receiving member but prevents movement of the movable handle to actuate the drive assembly. In some embodiments, upon movement of the release to the second position, the first and second jaws cannot be transitioned to the open configuration until the plurality of fasteners are advanced into the receiver member.
In some embodiments, the movable handle is pivotable toward a stationary handle and the hook is positioned between the movable handle and the stationary handle. In some embodiments, the release is actuable by a button positioned on the movable handle. The button can be biased in a counterclockwise direction.
The device can further include a ratchet wheel, and the ratchet wheel can include a ridge to disengage a handle catch from the ratchet wheel. In some embodiments, the handle catch is biased against the ratchet wheel.
In some embodiments, a plurality of counterforce members are supported within the first jaw, the plurality of fasteners engageable with the plurality of counterforce members, and the plurality of counterforce members biasing the plurality of fasteners in a second direction opposite the first direction. In some embodiments, the fasteners exert a force to pull the receiver member toward the fastener supporting member after engagement of the plurality fasteners with the receiver member.
In some embodiments, the drive assembly is movable in a distal direction to advance the plurality of fasteners and movable in a proximal direction to further advance at least one of the plurality of fasteners in the first direction, The device can include a first cable and a second cable, the first cable effecting movement of the drive assembly in a distal direction and the second cable effecting movement of the drive assembly in the proximal direction.
According to another embodiment, a surgical device is provided comprising a handle portion at a proximal portion of the device including a movable handle, an elongated portion extending distally from the handle portion, a first jaw and a second jaw at a distal portion of the device. At least one of the jaws is movable toward the other jaw to transition the first and second jaws from an open configuration to a closed configuration. A fastener supporting member of a surgical implant is supported in the first jaw and the fastener supporting member supports a plurality of fasteners. A fastener receiver member of the surgical implant is supported in the second jaw. A drive assembly is actuable by the movable handle to transition the first and second jaws between the open and closed configurations and to advance the plurality of fasteners in a first direction into engagement with the fastener receiver member to couple the fastener supporting member and fastener receiver member. A release is operatively associated with the movable handle. The movable handle is movable from a first position to a second position to transition the jaws to the closed configuration, the movable handle locked in the second position and the release actuable to release the movable handle to enable movement back to the first position.
According to another embodiment, a surgical device is provided comprising a handle portion at a proximal portion of the device including a movable handle, an elongated portion extending distally from the handle portion, and a first jaw and a second jaw at a distal portion of the device. At least one of the jaws is movable toward the other jaw to transition the first and second jaws from an open configuration to a closed configuration. A plurality of surgical fasteners are supported in the first jaw. A drive assembly is movable from a proximal position to a distal position to advance the plurality of fasteners from the first jaw toward the second jaw, the movable handle operatively associated with the drive assembly, wherein the movable handle is actuable to transition the first and second jaws from the open configuration to the closed configuration and to advance the driver to advance the plurality of fasteners. A release is operatively associated with the movable handle and has a first release position enabling movement of the movable handle to transition the jaws from the closed configuration back to the open configuration and has a second release position enabling the movable handle to effect advancement of the drive assembly to advance the plurality of fasteners.
In some embodiments, the drive assembly is movable in distal and proximal directions, wherein distal movement of the drive assembly advances the plurality of fasteners and proximal movement of the drive assembly further advances at least one of the plurality of fasteners. The device may further include a first tensioning member connected to the drive assembly and a second tensioning member connected to the drive assembly, wherein the first tensioning member moves the drive member distally in the first direction and the second tensioning member moves the drive member proximally in the second direction, and the first tensioning member extends from a first drive spool and the second tensioning member extends from a second drive spool.
In some embodiments, upon movement of the release to the first position, further actuation of the movable handle to effect advancement of the drive assembly is blocked. In some embodiments, wherein upon movement of the release to the second position, the jaws cannot be transitioned to the open configuration until the plurality of fasteners are advanced. In some embodiments, the movable handle is pivotable toward a stationary handle and a hook is positioned between the movable handle and the stationary handle which locks the movable handle. In some embodiments, the release is actuable by a button positioned on the movable handle.
The following descriptions should not be considered limiting in any way. With reference to the accompanying drawings, like elements are numbered alike:
A detailed description of one or more embodiments of the disclosed apparatus, implant and method are presented herein by way of exemplification and not limitation with reference to the Figures.
Various embodiments of surgical implants and tools (apparatus) for installing such implants are described below and illustrated throughout the drawings. For purposes of the description hereinafter, the words “upper,” “lower,” “right,” “left,” “vertical,” “horizontal,” “top,” “bottom,” “lateral,” “longitudinal,” “axial,” and like terms, if used, shall relate to the apparatus and/or implant, as it is oriented in the drawing figures. When appropriate, the terms “proximal” and “distal” are in reference to a user that uses the tool to deploy the implant, typically towards a portion of a patient's anatomy. The term “distal” shall for instance mean situated further away from the user, while the term “proximal” shall mean situated more towards the user. The phrases “installing/installed on”, “installing/installed about”, “installing/installed through”, and other similar phrases are generally intended to be interchangeable and refer to an implant being used to secure, connect, seal, clamp, compress, and/or fasten various tissue and non-tissue structures, including those internal to a mammalian body cavity as well as those external (e.g., postpartum umbilical cord). The term “surgical structure” as used herein refers to any tissue or non-tissue structure on which an implant is, is to be, or is intended or desired to be secured. The terms “seal”, “sealed” “sealing”, etc., as used herein refer to slowing, hindering, blocking, and/or otherwise impeding the flow of fluid through, by, past, beyond, or between surgical structures on which an implant is installed. As used herein, the terms “ventrum” and “ventral side” refers to the side of a component (e.g., part of an implant or a tool for installing an implant) that generally faces toward, or abuts, the surgical structure. “Ventrally” likewise refers to the direction generally toward the surgical structure. Oppositely, the terms “dorsum” and “dorsal side” refer to the side opposite from the ventrum, i.e., the side generally facing away from the surgical structure. Likewise, “dorsally” refers to the direction generally away from the surgical structure.
Referring now to
Examples of tissue structures include, but are not limited to, blood vessels such as the aorta, superior vena cava, inferior vena cava, lobar vessels, the renal artery, organ parenchyma including pulmonary parenchyma, bronchii, lobar bronchi, trachea, atrial appendages, gastrointestinal structures, colon, spleen, liver tissue, etc. The implant 10 can be useful for establishing hemostasis, pneumostasis, or to seal off the flow of other fluids through various other tissue structures within a patient, as well as to connect these tissues and other tissue and non-tissue structures together with or without fluid sealing. Examples of non-tissue structures include PTFE, ePTFE, grafts, stents, textile weaves, braids, and knits, meshes, plugs, gastro-intestinal sleeves, etc. In each of the disclosed embodiments, when the implant 10 is located about two or more structures, the structures may be either the same (e.g., vessel tissue to vessel tissue, bronchii tissue to bronchii tissue, non-tissue to non-tissue, etc.) or different (e.g., bronchii tissue to non-bronchii tissue (including for instance PTFE), gastrointestinal tissue to non-gastrointestinal tissue or structures such as textile or PTFE sleeves, etc.).
In an exemplary embodiment, the receiver member 12 includes a receiver base 16 having a surgical structure contacting surface 18 located at one side thereof, which may be referred to herein as its ventrum or ventral side. As can be seen, for example in
Each of the segments 28 is shown to include a resilient and/or compressible member, suspension, spring, or biasing element, represented generally as a tower 30 (or tower-like structure) extending dorsally from the base 24 in a direction substantially perpendicular to the base 24 of the fastener supporting member 14 and a clip, anchor, or fastener 32 disposed with each of the towers 30. As shown, the fastener 32 straddles a respective tower 30 so the base of the fastener 32 exerts a force against the base of the tower 30 when deployed to compress and deform the tower 30. As described in more detail below, each tower 30 is compressible in accordance with the distance of advancement of the fastener engageable with the tower, and the distance of advancement is dependent on a thickness of tissue or other surgical structure clamped between tissue contacting surfaces of the receiver member 12 and deployment member 14, through which the fasteners 32 advance. The segments 20 and 28 are preferably arranged in pairs, with each pair of segments 20 and 28 forming a fastener subassembly 34. It is to be appreciated that any number of the subassemblies 34 can be repeated in either patterns or randomized series in order to form the implant 10 in a variety of differently sizes and/or shapes to accommodate a variety of different tissue types, geometries, sizes, and shapes. For example, the number of the subassemblies 34 can be increased or decreased in order to change the length of the implant 10. For example, in one embodiment, an implant may be formed as a single one of the subassemblies 34 and used for tacking or securing surgical structures together. In another embodiment, an implant includes a single one of the subessemblies 34 and is used for tacking a hernia mesh to an underlying muscle tissue structure. Additionally, it is noted that if the implant 10 is longer than necessary or desired than the length required to complete a task (e.g., the implant 10 exceeds the width of the surgical structure), any excess ones of the subassemblies 34 (i.e., those that do not have any tissue positioned between the members 12 and 14) can be cut or trimmed off as desired. Unlike staples, which may be left behind in great number inside of a patient, the aforementioned approach can be used, for example, to limit the amount of excess material left within a patient after a surgical procedure. It is also noted that multiples of the implant 10 can be installed sequentially, e.g., in a head-to-tail or tail-to-head sequence. For example, it some situations it may be unfeasible or undesirable to manufacture, install, or handle extraordinarily long implants (e.g., having dozens of the subassemblies 34), so multiple shorter implants may be used instead and may be installed in series. As another example, it may be desirable to install implants along a non-linear path, and thus multiples of the implant 10 may be installed in series, but at angles with respect to each other. As one example, the implants 10 may be installed in this sequential or head-to-tail arrangement during a lung resection procedure, which may require both a relatively long and non-linear section of tissue to be sealed.
The subassemblies 34 in the illustrated embodiment as shown for example in
One of the fastener subassemblies 34 is shown according to one embodiment in more detail in the exploded views of
During installation of the implant 10 on or about a structure, the fasteners 32 are driven or actuated toward the towers 30 against a reactionary resilient force exerted by the towers 30. Forces applied to the fastener 32 therefore compress (and deform) the towers 30 toward the base 24 or deployment member 14 as the base of the fasteners 32 engages the base of towers 30 to apply a force thereto to compress and deform the respective towers 30 so the towers 30 move from a first configuration to a second configuration. Actuation of the fasteners results in the tips 40 of the fasteners 32 being driven out from the base 24 of the deployment member 14, through any surgical structure on which the implant 10 is installed, and into the receiver base 16 of the receiver member 12. In various embodiments, the receiver base 16 may include a retainer 44 disposed therewith, e.g., disposed on and/or embedded therein as shown throughout the Figures. A representative portion of the retainer 44 (with the bases 16 and 24 removed for clarity) is shown schematically in
In various embodiments, the tips 40 may protrude through the opposite (i.e., dorsal) side of the base 16 from the surgical structure contacting (i.e., ventrally located) surface 18 when engaged with the retainer 44. As shown in the Figures, one or more shields 22, each having one or more cavities or pockets 45 that receive the tip(s) 40 when the tips 40 are so protruding, are positioned opposite the fasteners 32 and are generally aligned with the legs 36 of the fasteners 32. In this way, the shields 22 can provide protection from the tips 40, e.g., protection to shield from inadvertent contact of the tips 40 by a medical professional or other tissue structures within the patient if the implant 10 is to be left inside of the patient. In one embodiment, the shields 22 do not include the pockets 45, such that the tips 30 are completely surrounded by and embedded within the shields 22.
In the illustrated embodiment, the retainer 44 includes longitudinal or lengthwise strands 46a and transverse or widthwise strands 46b (collectively “the strands 46”) with a plurality of interstices or openings 48 formed by spacing between the plurality of strands. It is to be understood that the strands 46 generally represent any wire, bar, cord, slat, strut, spoke, fiber, thread, tine, filament, cable, or other elongated element. In one embodiment, the retainer 44 is a woven, knitted, or braided mesh, or other grid-like structure. In one embodiment, the strands 46 are arranged in a random or irregular pattern, such as a felt, or a non-woven pattern, such as TYVEK brand material made commercial available by DuPont. The strands 46a may be separate from each other and/or separate from the strands 46b. Alternatively, the strands 46 may be integrally formed, fused, or affixed together. In
In various embodiments, the towers 30 are integral to or unitary with the base 24, while it is contemplated in other embodiments that towers may be formed separately from the base. The towers 30 are configured with a structural shape and of a material that allows for a suitable degree of compressibility, such that when force is exerted on the towers 30 towards the base 24 (i.e., ventrally) by the base 38 of the fasteners 32, either directly or indirectly, the strain of the towers 30 is more than any strain encountered by the base 24. The towers 30 may be formed of a resilient material, such that upon removing the actuation force from the fasteners 32, the towers 30 attempt to revert back to their original shapes and exert a corresponding tensile force on the fasteners 32 in a direction opposite to actuation. That is, the towers 30 form biasing or counterforce members to exert a counterforce in a direction opposite to the direction in which the fasteners 32 are deployed (advanced). In this way, the towers 30 function similarly to compression springs, and in fact, may be replaced or supplemented by such springs (e.g., see
The fastener 32 and its related components can be arranged with a variety of dimensions to allow for the system to function appropriately. For example, the maximum amount of strain allowed for a tower in addition to the strain of each of the bases when compressed may be larger than or equal to the sum of (i) the amount of distance the barbs must travel to reach the tissue contact surface of the deployment member, (ii) the thickness of the compressed surgical structure, and (iii) the amount of distance the barbs must pass through the receiver member 12 in order to extend through the structure positioned between the halves of the implant 10 and latch onto the retainer member 44.
Advantageously, the resiliency and/or spring-like nature of the towers 30 provides for suitable tension to be maintained between the halves of the implant (e.g., the members 12 and 14) to suitably handle variable pressure fluctuations that may lead to a burst condition within the structure being secured or sealed by the implant 10. For example, if the implant 10 is installed on a structure to provide fluid sealing, and the seal produced therefrom experiences a pressure spike, e.g., due to the patient coughing following a lung resection procedure with the implant 10, or some other event, the towers 30 are sufficiently elastic to allow for strain, and will thus flex and/or compress to assist in absorbing excess forces. This helps to accommodate the spike in the pressure without damaging the implant 10. Furthermore, even if the seal is breached due to the pressure burst, such that fluid leaks through the seal made by the implant 10, the resiliency of the towers 30 will cause the towers 30 to continue to exert a clamping pressure between the members 12 and 14. This will result in the implant 10 resealing the tissue or surgical structure once the pressure spike has subsided. Oppositely, known staples from known stapling techniques are not sufficiently elastic, and are highly likely to rip or tear out during high pressure events, and thus be completely unable to reseal after experiencing a pressure spike, which may require an additional surgery to be performed in order to re-staple the damaged area.
It is additionally noted that the forces exerted by the towers 30 on the fasteners 32, which is communicated to the surgical structure via the fasteners 32 engaging the retainer 44 in the member 12 and pulling the members 12 and 14 toward each other, can be set in a range sufficiently high to promote sealing and/or closure, while not being so high as to cause necrosis of tissue on which the implant 10 is installed. For example, in one embodiment, the forces exerted by the towers 30 on the fasteners 32 causes the pressure exerted on surgical structures by the members 12 and 14 at the tissue contacting surfaces 18 and 26 to be in the range of about 3 g/mm2 to 25 g/mm2, or more preferably in the range of about 5 g/mm2 to about 15 g/mm2, although other ranges can also be utilized if desired. For example, some tissue types, e.g., bronchii, may benefit from larger pressures, e.g., 10 g/mm2 and greater, while other tissue types, e.g., blood vessels, may benefit from smaller pressures, e.g., between about 5 g/mm2 and 7 g/mm2. It is also noted that since the towers 30 function akin to springs, the spring constant, resiliency, stiffness, and/or rigidity of the towers 30 can be set to variably alter the force exerted by the towers 30 depending on the amount the towers 30 are compressed. Since increased compression of the towers 30 occurs when installing the implant 10 on thicker structures, setting the variable force exerted by the towers 30 can be useful, e.g., for setting a first, relatively lower pressure at relatively small thicknesses for smaller and/or more delicate structures, such as blood vessels (e.g., 5 g/mm2 and 7 g/mm2), and a second, relatively greater pressure at relatively large thicknesses for larger and/or more robust structures, such as bronchii (e.g., 10 g/mm2 or greater).
It is noted that by way of the resiliency and/or compressibility of the towers 30, the implant 10 is able to accommodate a range of surgical structure thicknesses approximately equal to the compressible height of the towers 30 (e.g., the distance between the initial height h1 as shown for example in
It is also noted that while the height of the towers 30 assists in defining the thickness range that can be accommodated, e.g., a 2.5 mm range, the length of the legs 36 of the fasteners 32 helps to set the start and end points for the range. For example, the length of the legs 36 between the body or base 38 and the end of the tips 42 can be set to be approximately equal to, and/or slightly shorter than the initial height of the tower 30, such as in the illustrated embodiment. In this way, the fasteners 32 will be able to slightly compress the towers 30 and thus the tips 42 catch, latch, or grab the retainer 44 in the member 12 even if there is no tissue or other surgical structures located between the members 12 and 14. In this embodiment, setting the compressible height, e.g., h1, of the towers 30 to the aforementioned 2.5 mm will set the 2.5 mm range to span between 0 (no surgical structure) and about 2.5 mm. Consider, as one example, increasing the length of the legs 36 by “x” units of distance. In this embodiment, if there is no tissue positioned between the members 12 and 14, the tips 42 would protrude through and extend past the retainer 44 by a distance approximately equal to “x” without compressing the towers 30 (and without compression, the tips 42 would not be pulled against the retainer 44 for maintaining the members 12 and 14 of the implant closed or secured together). Suitable compression of the towers 30 to engage the tips 42 with the retainer 44 would not occur in this embodiment until the thickness between the members 12 and 14 is increased in an amount equal to “x”. That is, increasing the length of the legs 36 by “x” distance will shift the start and end points of the range by this distance “x”, but while maintaining the same magnitude for the range. For example, if the compressible height of the towers 30 is again about 0.1″ (thereby enabling the implant to accommodate a 2.5 mm range), and the amount “x” is about 1 mm, then the implant in this embodiment would seal from about 1 mm to about 3.5 mm (i.e., the range still having a magnitude of about 2.5 mm, but shifted up by 1 mm due to the increase in length of the legs 36). In this way, those of ordinary skill in the art will appreciate that by changing the compressible height of the towers 30, as well as the length of the legs 36 relative to the initial height h1 of the towers 30, both the magnitude of the range and the starting/ending points of the range can be selected as desired and/or required for various procedures.
Advantageously, it would require many differently sized prior art staples in order to accommodate this same tissue thickness range (e.g., a 2.5 mm range) that may be handled by the presently disclosed implants. It is noted that the compressible tower height of approximately 0.1″ is one example only and that other heights may be selected. Further, the tower height may be selected such that the implant 10, with an accompanying applicator device (e.g., such as those discussed below), are together capable of fitting within a desired cannula size, e.g., a 12 mm port suitable for minimally invasive procedures. In other embodiments, the height of the towers 30 may be increased or decreased to change the magnitude of the range, thereby creating variable ranges of thicknesses that can be accommodated. For example, an approximately 0.2″ compressible tower height may fit in a 15 mm sized cannula and accommodate an approximately 5 mm thickness range, or an approximately 0.05″ compressible tower height may accommodate an approximately 1.25 mm range. Additionally, the length of the legs 36 relative to the initial height of the towers 30 may be set as described above to set the start and/or ending points for the range of any given magnitude. For example, the length of the legs 36 may be increased by a distance “x” to increase the minimum thickness that can be sealed or closed by the implant by “x”, or decrease by a distance “y” in order to decrease the minimum thickness that can be sealed or closed by the implant by “y” (down to the minimum of 0 thickness, or no surgical structure).
In one embodiment, the bases 16 and 24 of the deployment (fastener supporting) member 14 and receiver member 12, respectively, are made of a relatively soft, flexible, penetratable and/or puncturable, but also resilient material, such as silicone rubber. This enables the tips 40 of the fasteners 32 to be actuated into and/or through the bases 16 and 24 without significantly degrading the integrity of the implant 10. It is noted that the bases 16 and 24 may, alternatively or additionally, be made of one or more other biocompatible materials suitable for implantation, such as, but not limited to, polyurethane, thermoplastic elastomer (TPE), natural rubber, latex, bio-absorbable polymers, or other polymers or elastomers. The towers 30 may also be made of any combination of these or other materials. In one embodiment, the retainer 44 is made from a relatively stronger material, such as polyethylene terephthalate (PET), polyetheretherketone (PEEK), nylon, or other polymers, as well as fibrous materials such as cotton, KEVLAR brand synthetic fibers made commercially available from DuPont, etc., in order to lend additional strength, e.g., tensile strength, stiffness, rigidity, and/or resistance to bending, to the implant 10, as well as to suitably engage with and retain the fasteners 32 via the barbs 42. Other materials for the retainer 44 include various relatively high tensile strength polymers, as well as biocompatible metals such as stainless steel, titanium, nitinol, etc., although those of ordinary skill in the art will recognize biocompatible materials other than those listed herein that would perform suitably for the bases 16 and 24, the towers 30, and/or the retainers 44.
The difference in the material properties including the use of different materials of the retainer 44 and the bases 16 and 24 provides many benefits appreciable by those of ordinary skill in the art. For example, relatively stiff materials, such as buttresses used in the stapler arts, have been known to cause abrasions between the relatively stiff materials and the tissue surrounding their implantation. Advantageously, providing the retainer 44 as a relatively stiffer material and embedding the retainer 44 within base 16 and/or base 24 in certain embodiments disclosed herein enables the implant 10 to obtain both the stiffening properties of the retainer 44 and the low-abrasion and compliable properties of the bases 16 and/or 24.
In one embodiment, strands of retainer 44 are arranged in a direction generally perpendicular to a first orientation of tip(s) 40 (
Advantageously, the use of the retainer 44 and the fasteners 32 may help to avoid the need for accurate alignment between the members 12 and 14, the retainer 44 and the fasteners 32, etc., or for strict manufacturing tolerances for any of the components of the implant 10 in some embodiments. For example, by setting the width w1 between each set of adjacent strands 46 of the retainer 44 to be smaller than the widths of the tips 40 at the barbs 42, the fasteners 32 do not need to be accurately aligned with the retainer 44 before actuating the fasteners 32. That is, the barbs 42 will engage any part of the retainer 44, so it is unimportant where the tips 40 of the fasteners 32 are received by the receiver member 12 and penetrate into the base 16. For example, even if the members 12 and 14, are slightly misaligned during manufacture, and may become slightly misaligned during firing, the legs 36 of the fastener 32 become slightly tilted or bent (e.g., due to actuation through tissue or through the bases 16 and/or 24), or if there are manufacturing variances or loose tolerances in the size of the components of the implant 10 or positioning of the retainer within the base 16 (e.g., the interstices 48 are not exactly centered on the tips 40), etc., the barbs 42 will regardless catch on some portion of the retainer 44 and maintain the position shown for example in
The implant 10 is designed to be installable on a range of different surgical structures including those varying in size and/or type. As noted above, the towers 30 are compressed by the fasteners 32 when the fasteners 32 are actuated toward the receiver member 12. Advantageously, the range that the towers 30 can be compressed (i.e., the strain applied) enables the implant 10 to accommodate a corresponding variable range of surgical structure thicknesses between the structure contacting surfaces 18 and 26. For example, as illustrated in
The offset between the barbs 42a and 42b along the length of the legs 36 can also facilitate the accommodation of each size of the fasteners 32 to be usable for a range of surgical structure thicknesses. This functionality can be appreciated by comparing
It is additionally noted with respect to
It is noted that the towers 30 are shown schematically in their compressed states throughout many of the Figures for clarity of illustration, but that in actual use some degree of buckling, twisting, bending, or bulging of the towers 30 may occur during compression by the fasteners 32. One such example of the compression of one of the towers 30 is illustrated in
The implant 10 is illustrated in a variety of disclosed embodiments to be essentially longitudinally straight and elongate, having a first end and a second end (e.g., see
An implant 68 is illustrated in
It is also to be understood that the retainer 44 can take a plurality of other forms embedded or supported within the base of a receiver member. For example,
An exemplary receiver base 70 in
In the illustrated embodiment, the flaps 752 are a continuation of the implant material itself, such as a continuation of the silicon and retainer, e.g., mesh, and are formed with sufficient stiffness to distribute the sealing pressure over a greater distance than would be distributed in the absence of the flaps. In some embodiments, the flaps 752 can distribute the sealing pressure on vessel 118 over a distance of approximately 3 mm, although other sizes, configurations and structure of the flaps are also contemplated to distribute pressure over different distances. The end view of
As can be appreciated, with the provision of the flaps 752, which extend radially from the implant 750, and illustratively extend along the length of the implant 750, instead of going from sealing pressure to no pressure in a short distance which can increase the risk of tearing tissue, the flaps 752 spread the pressure gradient from sealing to no pressure over a greater distance to thereby reduce stress on tissue. In order to seal tissue, the tissue (or other surgical structure being clamped between the deployment and receiver members) needs to be brought into approximation, and this transition from bulk tissue to sealed tissue creates significant stresses on the tissue. The amount of stress is dependent on how quickly the sealing pressure is developed. The sharper the change in pressure, the greater the stress of the tissue, and the greater the stress on the tissue, the greater the chance that the tissue can tear and create a leak. An example of such occurrence is in lung parenchyma which in certain applications can transition from bulk tissue of about 30 mm thickness to sealed tissue at less than 4 mm thickness. Lung parenchyma is also fragile, and if such change occurs over too short a distance, the tissue may be overstressed and can tear, which can adversely affect the sealing function. Such abrupt transition is not fully accounted for in current staples.
The stiffness of the flaps 752 can be varied to provide increased stiffness for use, for example, in stiffer tissue. The length of the flaps can also be varied, e.g., extending the entire length of the implant or over less than the entire length. Moreover, the flaps 752 as described above are a continuation of the implant composed for example of silicon, e.g., the same material as the deployment member 756 (which can be the same materials used for deployment member 14) and the receiver member 754 (which can be the same materials as used for the receiver member 12), with a portion of the retainer, e.g., mesh, contained (e.g., embedded) therein. Alternatively, the flaps could not include the retainer therein and/or the flaps could be made of a different material than the deployment member 756 and/or the receiver member 754. The flaps 752 also could be separate components and not integral with the implant material, i.e., not integral with the deployment member 756 and/or the receiver member 754. Alternatively, the flap could be provided on only one of the receiver member 754 or deployment (fastener supporting) member 756 and not on both the receiver member and deployment member as described above.
As also shown in the embodiment of
Referring back to implant 10, in order to facilitate removal of a portion of the tissue structure in which the implants disclosed herein are installed, e.g., for harvesting a portion of the vessel 118, removing cancerous tissue or tumors, performing a gastric bypass, etc., the implant 10 in the illustrated embodiment includes the two rows 35a and 35b. A channel 124 is formed between the two rows 35. By first actuating the fasteners 32 in both of the rows 35 and then cutting the tissue along the channel 124 between the rows 35, the tissue structure on both sides of the cut will be sealed by the implant 10. The bridge(s) 37 (see
A seal 125 in the tissue or vessel 118 formed by the implant 10 can be seen in
An implant 128 according to another exemplary embodiment is shown in
It is again to be appreciated that blood vessels are only one type of tissue structure that can be fastened and/or sealed and blood flow is only one example of a fluid flow that can be impeded by use of the implant 10. In one embodiment, the implant 10 is installed in organ parenchyma in order to facilitate the removal of a portion of the organ, e.g., a tumor or cancerous growth. In another embodiment, the implant 10 is used to complete a gastrointestinal bypass. In one embodiment, one or more of the implants 10 are installed in a patient's lung parenchyma in order to prevent the leaking of air while removing a portion of the patient's lung. It is appreciated by those of ordinary skill in the art that the implants 10 can be used for not only hemostasis and pneumostasis, but to seal off the flow of other desired fluids from various tissue structures. One example embodiment for connecting a first surgical structure 132 to a second surgical structure 133 is shown in
Implant Method of Manufacture and Fabrication
Implants consistent with the present disclosure may be constructed in a variety of ways. In certain embodiments for example, fabrication of the implant may involve (i) molding at least two implant halves (e.g., the receiver member 12 and/or the deployment member 14) or bases (e.g., the base 16 and/or the base 24 of the deployment member 14) with one or more molding steps, (ii) assembling one or more fasteners (e.g., the fasteners 32) to (or alternatively molding with) the one or more bases and/or implant halves. (iii) placing the one or more bases and/or implant halves in alignment with an end effector (e.g., jaws of an applicator, device, instrument, or mechanism for installing implants, such as those discussed below in more detail) and/or the other of the one or more bases and/or implant halves, and (iv) sterilizing the one or more bases and/or implant halves. The molding step may involve co-molding or over-molding with the base one or more strands, web structure, knit structure, woven structure, mesh, and/or any other structure suitable for a retainer (e.g., the retainer 44) or to impart stiffening properties to the base. The mold cavity(ies) are configured based on both the desired shapes of the bases (e.g., the bases 16 and/or 24) and/or implant halves (e.g., the receiver member 12 and/or the deployment member 14) as well as the shrinkage characteristics of the molded material to produce one or more bases and/or implant halves. The bases and/or implant halves may for instance have the same, similar, or even different structures, as exemplified by the drawings of the present disclosure. The mold cavities forming the ventrum surface(s) of the bases and/or implant halves may have one or more protrusions that assist in placing a retainer (e.g., the retainer 44) and/or retaining elements such as strands/knit/mesh/weave, etc. (e.g., the strands 46) a predetermined distance away from the ventrum surface (e.g., the surfaces 18 and/or 26) of the implant (e.g., the implant 10). This may be formed by example via the use of one or more lengthwise protrusions, and may result in one or more corresponding grooves 17, (best shown in
The bases and/or implant halves are preferably formed of a relatively soft, flexible, penetrable and/or puncturable, but also resilient material, such as silicone rubber, as discussed above. The silicone rubber or other material may be injection molded or cast. The towers 30 formed within the implant may be molded of the same material as the bases, or alternatively may be co-molded or over-molded of a different material, or optionally of the same material family but having different specific properties such as elasticity and/or Shore A hardness.
Additionally, the mold cavities/core pins, etc. used for forming the bases and/or implant halves are sized and shaped such that when the implant 10 is represented as a beam, each half thereof (e.g., the receiver member 12 and/or the deployment member 14) will have a neutral axis 172, 174 (i.e., theoretical location where bending stress is zero) along the length of each half and that is closer to the ventrum (or plane of contact 170 when no tissue or structure is disposed between the halves) than the dorsum portion of each half (see
The strands (e.g., the strands 46) of the retainer may be formed as either unique strands, or optionally as a portion of a knit, mesh, weave or similar structure, of which the material chosen may be polypropylene, polyester (PET), PEEK, Nylon, or the other materials discussed above, and/or combinations thereof. When multiple connected or formed strands are used (such as in a mesh), a variety of spacings or openings may be chosen depending on the size of the fastener selected. Openings (e.g., the interstices 48) may be for example anywhere from 0.500 inches to 0.001 inches, more preferably 0.250 inches to 0.005 inches, even more preferably 0.100 inches to 0.010 inches, and even more preferably 0.050 to 0.020 inches, and yet further between 0.025 inches to 0.030 inches. The open areas (e.g., the interstices 48) between crisscrossing strands (e.g., the strands 46) when utilized are preferably sized in accordance with the size and shape of the fastener (e.g., the fastener 32) chosen. Examples may include, for instance, ranges between 0.001 sq·in. to 0.100 sq·in., more preferably 0.0001 sq·in. to 0.0080 sq·in., even more preferably 0.0002 sq·in. to 0.0020 sq. in., 0.0003 sq·in, to 0.0012 sq·in., and most preferably about 0.0005 sq·in. to 0.0010 sq·in. Such open spaces (e.g., the interstices 48) may be square, rectangular, diamond-shaped, and/or other types of polygonal shapes may be utilized. Triangular and circular or elliptical shapes are also contemplated, as well as any of the shapes and structures shown by example in
In a sample embodiment, a mesh having a crisscrossing construction forming generally square openings of a precision polyester is chosen (see for example
After the mold cavity has been set and filled, the liquefied silicone is cured and removed for subsequent assembly with a fastener. Before, during, or after the process of forming the halves, one or more fasteners (e.g., the fasteners 32) are fabricated for being joined or integrated with at least one of the halves. In an example embodiment, the fasteners 32 are first formed in a strip 140 of metal (e.g., 304 or 301 stainless steel) through a chemical etching process, although other machining processes such as wire EDM and stamping/punching and/or die cutting may be used. The resulting strip 140 is illustrated in
The strip 140 is then placed in a forming tool (not shown) which aligns the strip 140 with one or more anvils (not shown) to facilitate bending of the one or more of the legs 36 to an orientation generally normal/perpendicular to the plane of the strip 140. Alignment with the forming tool may be achieved with the assistance of alignment apertures 31. Sufficient pressure is then applied against the legs 36 to transform the flat-formed fastener body 33 shown in
The tips 40 of the shaped fastener(s) 32 may optionally then be sharpened on one or more of their edges to achieve a sufficient reduction in penetrating forces depending on the material(s) of the bases 16 and/or 24, as well as the tissue or structure intended to be pierced. As shown in the embodiment of
One or both of the towers 30 and fasteners 32 may be lubricated to facilitate reciprocal movement of each structure with respect to the other. In some instances, the fastener 32 may be dip coated into PTFE to reduce the friction should contact occur between the fastener 32 and tower 30. Other lubricants may also be suitable.
Each fastener 32 may subsequently be aligned with a corresponding one of the towers 30. This may be achieved individually or simultaneously with a plurality of the fasteners 32. For instance, when the bent fasteners 32 are still interconnected in the strip format 140, the strip 140 can be used as an alignment tool for facilitating assembly of the fasteners 32 simultaneously onto multiple ones of the towers 30 of a deployment member 14. The alignment apertures 25 (see
When assembled via the strip 140, a post-assembly process involving the cutting of the fasteners 32 from the strip outside edges is performed. Instead of a post-assembly process, separation of the fasteners can occur before attachment to the corresponding base (e.g., the bases 16 and/or 24) and/or implant halve(s) (e.g., the deployment member 14). This may allow for in-mold assembly of the fastener with the base and/or half as well as in other embodiments co-molding or over-molding of the fastener (e.g., the fastener 32) to the bases and/or halve(s).
The aligned barbs of
The fastener 800 can also be designed with other features to reduce the force to drive the fastener 800 through tissue. For example, the fastener can be coated with material such as PTFE and can be electropolished to remove any burrs or surface roughness. In some embodiments, the penetrating tip can be sharpened to an angle of about 35 degrees (see angle B of
In the alternate embodiment of
The advantage of the extended hook portion can be understood in terms of an example. As shown in
To fit thicker tissue, the cartridge containing the fasteners 820 can be set back from the issue contacting surface of the deployment member 14. In one example, it is set back about 0.050 inches. When the jaws are closed to approximate the receiver member 12 and deployment member 14 and clamp thick tissue structure between the tissue contacting surfaces of the deployment 14 and receiver member 12, the deployment member 14 is pushed back against the cartridge containing the fasteners 820 up to this 0.50 mm. This also provides the benefit that as the thick tissue is compressed, the tips 826 of fasteners 820 can be slightly exposed from the cartridge to keep the tissue from being squeezed out of the jaws.
In the next manufacturing step after formation of strip 812, the fasteners 800 are bent to the position of
Note the positioning of the fasteners 800 perpendicular in the strips 812 allows the entire set of fasteners to be bent to the position of
Various materials are described herein for the retainer. In one embodiment, for use with the fastener 800 or other fasteners described herein, the retainer in the form of a mesh can be composed of polyester (as noted above) to increase the strength of the mesh. Further, if desired to further increase the strength of the mesh, the weave of the mesh can be reduced. A tighter weave can increase the resilience of the mesh to reform after the barbs 808a, 808b pass therethrough, thus being caught under the barbs 808a, 808b.
In addition to the aforementioned embodiments, additional embodiments are contemplated.
It is to be noted that the barbs 42 or other elements suitable for grabbing, catching, or engaging a retainer may be formed as any structure that protrudes outwardly and is thus so capable of catching, grabbing, or otherwise engaging with a retainer, such as the retainer 44 (which elements are collectively referred to as barbs). For example, in the embodiment of
Embodiments of the present disclosure are further directed to an apparatus and method for delivering and implanting one or more surgical implants, such as any of the previously described embodiments for or related to the surgical implant 10, or other fasteners, clamps, clips or other closure or sealing devices. That is, embodiments of the current invention are directed to various alternative and improved devices, apparatus, systems and methods for implanting a surgical implant to, for example, close a tissue structure of a patient which include but are not limited to blood vessels, parenchyma, bronchi, atrial appendages and the like. Tools and implants according to the present invention can be configured and dimensioned to seal and transect large vessels and bulk tissue up to about 5 mm compressed thickness and may have a configuration and size sufficient to fit through a port, such as a port 20 mm in diameter or less to allow for minimally invasive surgical procedures, and flexible enough to maneuver to an intended surgical target. The surgical implant applicator and system may be designed to well tolerate thickness variations of the tissue to be closed along a length of a surgical implant. The surgical implant applicator of the present invention may advantageously also use smaller, less expensive closing mechanisms than those used in currently known apparatus, as the surgical implant to be implanted by the apparatus do not require the amount of precision for alignment and closing that is required of currently known apparatus. Additionally, the surgical implant applicator can be provided to mount two surgical implants (or a bisectable single surgical implant) and with a cutting element to sever tissue (and the closure device when a single bisectable device is employed) between two locations where the tissue has been closed by the closure device(s). Still further alternatively, the surgical implant applicator can be provided to mount one closure device for implantation in sealing off a location with the single device.
The applicator described below moves, mounts, and/or applies two implants side by side extending generally linearly. It is also contemplated that alternatively, the implant can be arranged non-linearly, including a circular or arcuate arrangement as discussed above. Although the applicator described is for endoscopic or minimally invasive surgical products, it is also contemplated that the implants described herein can be utilized in “open” procedures. Also, the illustrated applicator is shown to have a rigid shaft, but flexible shafts and instruments can also be utilized for use in certain endoscopic procedures. Additionally, applicators without a shaft (i.e., such as a configuration that is “scissor-like” or otherwise resembles the gross structure of a long-nose pliers, with two pivoting grips, each grip operably engaged with either a top or bottom half of the implant to move the halves to and from each other), may be utilized.
Referring now to
In
The end effector assembly 502 of the applicator 500 includes a set of jaws designated with a jaw 504a and a jaw 504b (collectively, “the jaws 504”). Due to the illustrated orientation of the jaws 504 throughout the Figures, the jaw 504a may be referred to herein as the upper jaw, and the jaw 504b as the lower jaw, although it is to be appreciated that this is for the sake of discussion only and that the jaw 504a does not necessary have to be “above” the jaw 504b in other embodiments (or after changing the orientation of the applicator manipulating the jaws 504, e.g., as discussed below).
The end effector 502 is connected to the shaft 508 and thus the proximal assembly 506 via a joint 516 positioned proximate to a distal end of the shaft 508. A positioning assembly 518 is configured to perform articulation of the end effector 502 (that is, e.g., left and right or side-to-side angulation of the end effector 502 relative to a longitudinal axis 520 of the shaft 508). For example,
In one embodiment, the positioning assembly 518 may include a rotation actuator 522 that is mounted to proximal assembly 506, but rotatable with respect thereto. The rotation actuator 522 may include a plurality of ribs or ridges 524 that facilitate gripping thereof by a user. The rotation actuator 522 may be non-rotatably mounted with respect to the shaft 508, with the shaft 508 also rotatably mounted to the housing 510, and the end effector 502 non-rotatably mounted to the shaft 508. In this way, rotation of the actuator 522, e.g., via a user gripping the actuator 522 at the ribs 524 and turning the actuation 522 with respect to the housing 510, causes rotation of the shaft 508 and the attached end effector 502 about the axis 520. In one embodiment, the rotation actuator 522 enables more than about 90° and preferably about 180″ of rotation about the axis 520 in either direction.
As noted above, the end effector 502 (also referenced to as the end effector assembly 502) is pivotally mounted relative to the shaft 508 via the joint 516. For example, the joint 516 may be configured to enable rotation or articulation of the end effector 502 about an axis 526 (
The articulation actuator 528 may include one or more relief features 532, such as scallops, detents, or indents, to provide a predetermined amount of frictional resistance to the articulation actuator 528 that allows it to be rotated by hand by a user, but provides sufficient friction to prevent it from counter-rotating after the user's hand is removed from the articulation actuator 528. The relief features 532 may also provide sufficient friction so that the end effector 502 maintains the desired degree of angulation until the user decides to again operate the articulation actuator 528, e.g., via the knob 530. In the embodiment shown in
An alternate articulation mechanism is illustrated in the embodiment of
Referring initially to
The double articulation enables movement about the yaw axis designated by axis A1 and the pitch axis designated by axis A2. Note these two axes A1, A2 preferably intersect, and preferably intersect at a central point. Such central intersection helps to ensure the pivot joint is secure in all positions and well defined, thus keeping the articulation wrist controllable. Additionally, because of the high tensile force of firing, preferably the drive cable bundle which effects movement of the driver, e.g., driver 1147 to advance (deploy) the fasteners from the jaw, passes through the intersection of the axes A1, A2 Such placement reduces the chances of unwanted articulation, i.e., unwanted pitch and yaw movements, during advancement (firing) of the fasteners and/or retraction of the driver.
Preferably two pairs of tension ribbons are provided, the ribbons preferably only under tensile load. One advantage of using ribbons is they help keep the wrist controllable and are stiffer in comparison to cables or cords because of their lack of braiding. One pair of ribbons 1150a 1150b effect pitch movement (referred to herein collectively as pitch ribbons 1150); another pair of ribbons 1152a, 1152b effect yaw movement (referred to herein collectively as yaw ribbons 1154). When one of the pitch ribbons 1150 is pulled, it allows the other pitch ribbon 1150 to extend so the wrist pitches about the pitch axis A2. When one of the yaw ribbons 1152 is pulled, it allows the other yaw ribbon 1152 to extend so the wrist pitches about the yaw axis A1. In order to minimize the interaction of the two motions, the yaw ribbons 1154 preferably attach to the jaws via rotatable joints in line with the pitch axis A2.
With continued reference to
As noted above, the drive cable bundle for effecting movement of the driver, e.g., the drive cables 544, 546 discussed above are contained within a flexible tubing 1165, composed for example of PTFE, although other materials are also contemplated. As discussed above the drive cable bundle passes through the intersection of the yaw and pitch axes A1, A2. The tubing 1165 helps to reduce friction at large jaw and/or large pitches while keeping the bundle passing through the intersection of axes A1 and A2.
In addition to rotation and articulation of the end effector 502, the surgical implant applicator 500 may be configured to perform additional functions, such as transitioning the jaws between opened and closed configurations, actuating fasteners of an implant (e.g., the fasteners 32 of the implant 10) disposed within the jaws 504, cutting surgical structures positioned between the jaws 504 proximate to the implant 10 (e.g., cutting along the channel 124 of the implant 10 discussed above), etc. In one embodiment, the trigger 514 may be arranged with, or as part of, an end effector driving assembly or mechanism 540 to enable one or more of the above functions of the end effector 502 to occur.
In one embodiment, the mechanism 540 may be arranged to cause actuation of a driver 542 of a drive assembly along the length of the jaws 504. A first tensioning member in the form of a first drive cable 544 and/or a second tensioning member in the form of a second return cable 546 (
According to the illustrated embodiment, each of the cables 544 and 546 extends from a different one of a pair of drive spools 548a and 548b (collectively, “the drive spools 548”) of the mechanism 540 (positioned within housing 510) through the shaft 508, distally past the joint 516 to the end effector 502 through a slot or opening 550 (
In the illustrated embodiment, the cables 544 and 546 are fastened to their respective one of the drive spools 548 via one or more fasteners 564 (
As will be discussed in more detail below, the cables 544 and 546 can be arranged with the spools 548 such that rotation of the spools 548 in one direction (e.g., counter-clockwise with respect to the embodiment illustrated in the Figures) causes tension on the drive cable 544, and rotation of the spools 548 in the opposite direction causes tension of the return cable 546. For example, the drive cable 544 can be wrapped clockwise about the spool 548a, such that counter-clockwise rotation of the spools 548 tightens the cable 544, and the return cable 546 can be wrapped counter-clockwise about the spool 548b, such that clockwise rotation of the spools 548 tightens the cable 546. Due to the inclusion of the pulley 556, tension in the drive cable 544 urges or pulls the driver 542 in the distal direction, while tension in the return cable 546 oppositely urges or pulls the driver 542 in the proximal direction. In this way, rotation of the spool 548 in one direction causes the driver 542 to travel distally along the jaws 504, while rotation of the spool 548 in the opposite direction cause the driver 542 to travel proximally along the jaws 504.
As noted above, the distal driver 542 is configured to perform multiple functions, including closing and opening jaws 504, cutting surgical structures located between the jaws 504 when the jaws 504 are in the closed configuration, installing implants, e.g., the implant 10, disposed with the jaws 504, etc. In order to provide these functions, the device driver 542 may be movably or slidably mounted along a length of the end effector 502. For example, the device driver 542, as shown in
For example, the first, second and third body portions 568, 570, and 572 may give the device driver 542 a shape that resembles an I-beam configuration, as shown best in
A blade, knife, cutter, or cutting implement 580 may be connected to, formed on, integral with, or otherwise form a part of a distal surface of third body portion 572 for purposes of severing tissue, implants such as the surgical implant 10, and/or other surgical structures positioned between the jaws 504 and along the length of the slot 578. For example, cutting of surgical structures can be performed via the cutter 580. For example, as discussed above, if the surgical implant includes two or more rows, e.g., the rows 35, of fastening subassemblies of implant 10 along a length of end effector 502, the cutting implement 580 may be positioned between the rows, such that the cutting operation with the driver 542 acts to sever the installed surgical implant, and the corresponding surgical structure on which the implant is installed, into two portions, one on each side of the cut made by the cutting implement 580 of the driver 542. In one embodiment, with specific reference to the implant 10 being used with the applicator 500, the cutting implement 580 severs the bridge 37, while in other embodiments the cutting implement 580 does not travel down the entire length of the jaws 504, such that the bridge 37 at the distal end of the implant (see e.g.,
It is noted that before cutting occurs, initial distal advancement of the driver 542 from the proximal end of the jaws 504 initially toward the distal end, e.g., by drawing on the cable 544 (e.g., spooling onto the spool 548a while allowing cable 546 to lengthen (e.g., unspooling from the spool 548b), causes the jaws 504 to close, as shown in
For example, as shown best in
One or more shields 584 and/or 585 may be located on the upper and lower jaws 504a and/or 504b, respectively. The shields 584 prevent any tissue or surgical structures from being positioned too deeply into the jaws 504, thereby ensuring that the cutter 580 of the distal driver 542 does not encounter or cut tissue or other surgical structures until after the surgical implant, e.g., the implant 10, is installed via the applicator 500. The cutting implement 580 does not travel past the shields 584 and/or 585 until the jaws have been fully closed by distal travel of the driver 542.
In order to connect the halves of the surgical implant disposed with the jaws 504, e.g., the portion of the implant 10 supported in receiver member 12 and in deployment member 14, the driver 542 may include a driving ramp for each row of fastener subassemblies included by the implant. For example, in the illustrated embodiment, the device driver 542 has a pair of ramps 586a and 586b (collectively, “the ramps 586”), as shown in
The pushers are arranged to engage and/or receive each fastener and/or compressible tower of the deployment segments of the implant being implanted by the applicator 500. For example, the pushers 592 of the applicator 500 include pockets 594 configured to receive the fasteners 32 and the towers 30 of the deployment segments 28 of the deployment member 14 of the implant 10 therein, and preferably receive the base of the fastener 32 and the base of the tower 30.
In one embodiment, the distal ramp surface 588 may rise at a smaller angle than the angle at which the proximal ramp surface 596 falls. Thus, during operation, the distal surface 588 drives each of the pushers 592 at a more gradual rate than the rate at which the ramp 586 enables the pushers 592 to return to their initial positions via the proximal surfaces 596. This may provide a more controlled driving of the fasteners 32 by the pushers 592 through the tissue or other surgical structure and into the opposite member, e.g., the receiving member 12 of the surgical implant 10, while more rapidly enabling the pushers 592 to move away from the surgical implant 10 as the driver 542 is moved proximally. The peak 590 may be arranged as a substantially horizontal (non-sloped) surface that briefly sustains a maximum driving force of the driver 542 and the pushers 592 against the surgical implant 10. It is additionally noted in some embodiments that the proximal surface 596 upon retraction will cause the pushers 592 to again be driven toward the opposite jaw, thereby potentially reapplying the actuation force to the fasteners 32, the towers 30, etc., which reapplication of force may assist in creating a better seal or more secure connection with the implant, and/or to provide a second opportunity to correctly fire any misfired fasteners (e.g., to re-actuate any of the fasteners 32 which did not engage with the retainer 44 into engagement with the retainer 44).
In view of the foregoing, it is to be appreciated that in one example of operating the applicator 500, once the jaws 504 have been located in a desired surgical target area and closed on the surgical target, the distal driver 542 can be advanced distally along the length of the jaws 504 by drawing on or shortening the cable 544 (e.g., spooling the cable 544 about the spool 548a) while simultaneously allowing cable 546 to be pulled and lengthened (e.g., unspooling the cable 546 from the spool 548b). The distal movement of the driver 542 will simultaneously install the surgical implant 10, e.g., due to the pushers 592 engaging and climbing the ramps 586, and cut the tissue or surgical structure clamped between the jaws 504, due to travel of the cutting implement 580 along the length of the jaws 504, in a single operation.
After completion of the connection of the implant halves (e.g., the members 12 and 14 of the implant 10) together through the tissue or surgical structure, thereby closing, securing, and/or sealing the surgical structure with the implant, and cutting the surgical structure, the distal driver 542 may be returned proximally back along the jaws 504 to its initial position at the proximal end of the jaws 504. The return of the distal driver 542 may be driven by shortening the cable 546 (e.g., by spooling the cable 546 about the spool 548b) to cause pulling of the driver 542 in the proximal direction, while at the same time allowing the cable 544 to be pulled and lengthened (e.g., by unspooling the cable 544 from the spool 548a) to enable the return of the driver 542 to its initial position.
In the alternate embodiment of
As shown in
Cam surface 588′ of driver 542′ is composed of a compound curve. The first curve 588a on the distal surface reduces the force to start the motion, i.e., advancement, of the fastener 800, and the second curve 588b reduces the firing force during the final drive distance of the fastener 800. The initial and final fastener motion require the highest force so the compound curve reduces the peak forces and thus reduces the overall force to fire the fasteners. The proximal surface of the driver 542′ has a camming surface 588c which contacts the fastener 800 on the proximal return of the driver 542′ after completion of its distal movement, thereby further driving the fastener 800 a greater distance from the jaw 504′.
Higher forces to push the fasteners through tissue or other structure require larger components to handle the higher stress and require the user to apply more force to fire the fasteners. The configuration of the camming surfaces 588a, 588b help reduce the force required to drive the fasteners. The surfaces can have different curves than that shown to further adjust the firing forces. To further reduce the firing force, the fasteners 800, compressible members (e.g., towers 32) and/or the cartridge 902 supporting the fasteners can be coated with low friction coatings such as PTFE. Such coating on the fasteners 800 and/or compressible members can for example reduce the friction between the compressible members, e.g., towers 30, and the fasteners 800. The cartridge material could also be varied and can include for example acetal, polycarbonate, nylon or other polymers with sufficient strength. The cartridge 901, supported in the deployment member, e.g. deployment member 14, can also include fastener guide features to help reduce the firing forces. As shown in
The movement of the driver 542′ to advance the fasteners 800 can best be appreciated in
Referring back to
The driving mechanism 540 includes one or more ratchet assemblies 600, each having a pair of ratchet gears or wheels 602a and 602b (collectively, “the ratchet wheels 602”) and a lock wheel 604. The wheels 602 and 604 may be secured, fixed, locked, or integrally formed together such that they rotate in unison together. The trigger 514 includes one or more drive pawls 606 rotatably mounted thereto that are engageable with the teeth of both of the ratchet wheels 602. As the trigger 514 is pulled, the pawl 606 engages the teeth on both of the ratchet wheels 602 in order to drive the ratchet wheels 602. That is, for example, the teeth of the ratchet wheels 600 are angled to permit movement of the pawls 606 relative to the teeth in one direction, while rotating the wheels 600 due to movement of the pawl 606 in the other direction. In the illustrated embodiment, pulling the trigger 514 toward the handle 512 causes the pawls 606 to grab the teeth of the wheels 602, rotating the wheels 602 (and the lock wheel 604) in the counterclockwise direction with respect to the orientation shown in
The assembly 600 may include an interlock 610, shown best in
The trigger 514 is shown in its initial position in
Rotation of the assemblies 600 causes corresponding rotation of the follower gear 608. For example, the follower gear 608, located between the pair of the assemblies 600 in the illustrated embodiment, may be in operable communication with the assemblies 600 via a dowel 622 that extends between the assemblies 600. Namely, a portion of dowel 622 may extend through and be translatable along a cam slot 624 formed in the follower gear 608. For clarity, the outline of the follower gear 608, including the slot 624, is highlighted in
The follower gear 608 includes teeth that mesh with corresponding teeth of a gear 628. The gear 628 is fixed relative to the spools 548 to cause the spools 548 to rotate about a pin or axle 630. As noted above, rotation of the spools 548 causes the cables 544 and 546 to be spooled and/or unspooled therefrom in order to move the driver 542 along the length of the jaws 504. The rotation of trigger 514 thereby causes the assemblies 600 to rotate, which in turn causes rotation of the follower gear 608, which drives the spools 548 to spool and unspool the cables 544 and 546, and ultimately controls movement of the driver 542 along the jaws 504. In one embodiment, the initial position of the trigger 514 may accordingly be set to position the driver 542 in its initial position at the proximal end of the jaws 504, with the top body portion 570 located in the recess 582. Accordingly, moving the trigger 514 to its first actuation position may cause the driver to be moved a limited distance distally and drive the top body portion 570 against the surface 583a, such that the first actuation position of the trigger 514 corresponds to the closed configuration of the jaws 504. Similarly, releasing actuation force on the trigger 514 and permitting the trigger 514 to return to its initial position (e.g., under the force of the biasing member 598), may cause the driver 542 to be moved proximally back to the initial position, causing the top portion 570 to encounter the surface 583b, thereby reopening the jaws 504. In short, moving the trigger 514 between its initial position and its first actuation position may be used in the illustrated embodiment to open and close the jaws 504.
As noted above, the safety mechanism 616 is provided to establish a first actuation position for the trigger 514 and prevent the trigger 514 from moving further toward the handle 512 from the first actuation position. In this way, before the safety mechanism 616 is released or unlocked, the safety mechanism 616 enables the operator to easily and repeatedly close and open the jaws 504, e.g., for purposes of locating the desired surgical target location prior to implanting the surgical implant 10 and cutting tissue or other surgical structures, as discussed above, without risk of prematurely fully actuating the driver 542. That is, for example, the safety mechanism 616 can prevent the driver 542 from being distally moved to a location at which the ramp 586 engages the pushers 592 and/or at which the cutting implement 580 is moved distally beyond the shields 584 and/or 585, until implant installation and/or cutting operations are desired.
The rod 618 extends through and protrudes out of both sides of the housing 510 of proximal assembly 506, thereby enabling the rod 618 to be actuated from either side of the applicator 500. The safety mechanism 616 can be switched off, disabled, unlocked, or released by pushing in the rod 618 into the housing 510 from either side of the housing 510. The rod 618 may be biased toward its initial, locked, or safety position by one or more biasing members 634, such as springs, such that the safety position is the default. The rod 618 includes larger diameter portions 636 and smaller diameter portions 638 (
The lock wheel 604 may be fixed relative to ratchet wheels 602, which are fixed relative to each other. In the safety mode, the larger diameter portions 636 are aligned with the shoulders 620, so that the shoulders 620 contact and abut against the portions 636 to limit rotation of the lock wheels 604 and therefore the entirety of the assemblies 600 as noted above. By moving the rod 618 in order to turn the safety off, the smaller diameter portions 638 are aligned with the shoulders 620, enabling the shoulders to rotate past the rod 618, thereby enabling the assemblies 600 to be fully rotated. As noted above, in the safety mode, the trigger 514 can advance the ratchet gears 602 only so far as the point where shoulder 620 contacts the larger diameter portion 636 of the rod 618 of the safety mechanism 616, which limits the amount of take-up and let-out of the cables 544 and 546, consequently limiting the possible travel distance of driver 542.
When the shoulders 620 are aligned with the smaller diameter portions 638, the trigger 514 is permitted to be pulled slightly closer to the handle 512, into a second actuation position, which may also be referred to as the fully actuated position. The applicator 500 is illustrated with the trigger 514 in the fully actuated position in
Once the jaws 504 have been positioned as desired, and the safety mechanism 616 is released, the operator of the applicator 500 can direct further operations of the end effector 502 using the trigger 514. For example, once the jaws 504 have been positioned as desired and closed over the surgical target area, the operator can further operate the surgical implant applicator 500 to install the surgical implant(s) 10 and/or cut tissue or other surgical structures. That is, for example, continued rotation of the trigger 514 can be used to actuate the mechanism 540 and spool and unspool the cables 544 and 546 from the spools 548, which causes the driver 542 to traverse along the length of the jaws 504 and provides the implant installation and cutting functions described above.
The drive mechanism 540 may include one or more pawls 640 rotatably mounted to the housing 510 of the proximal assembly 506. Each of the pawls 640 is arranged, unlike the pawl 606, to engage only the ratchet wheel 602a (and thus, not the wheel 602b) of the corresponding assembly 600. The pawls 640 are configured to prevent reverse rotation of the ratchet wheels 602 after the wheels 602 are rotated by the trigger 514. However, the wheel 602a includes a cutout 642 (
After the safety mechanism 616 has been released, e.g., by pushing the rod 618 toward the housing 510, further actuation of the trigger 514 to its fully actuated position will cause the wheels 602 to rotate such that the pawl 640 exits the cutout 642 and can engage with the teeth of the wheel 602a. That is, the teeth of the wheel 602a and the pawl 640 are arranged to permit movement of the teeth relative to the pawl 640 in one direction (e.g., counter-clockwise due to actuation by the trigger 514), but such that the pawl 640 will lockingly engage the teeth of the wheel 602 in the opposite direction. The engagement of the pawls 640 between teeth of the ratchet wheel 602a thereby prevents reverse rotation of the ratchet wheels 602. In this way, repeated release and pulling of the trigger 514 to the fully actuated position incrementally rotates the assemblies 600 as the pawl 640 engages with new teeth of the wheel 602a. It is noted that instead of pulling and releasing the trigger 514 multiple times, actuating the trigger 514 to its fully actuated position may in one embodiment activate a motor to drive the spools 548.
As noted above, the mechanism 540 may include the interlock 610. The interlock 610 may be configured such that when the operator pulls the trigger 514 further toward the handle 512 from the intermediate actuation position, a ramped portion 644 of the interlock 610 is driven against a protrusion 645 of a raised portion 646 on the housing 510 or some other component to which the wheels 602 are mounted (e.g., see
At this stage, repeated pulling and releasing of the trigger 514 relative to the handle 514 drives the ratchet wheels 602 in the counterclockwise direction with respect to the orientation of
In one embodiment, it takes six pulls of the trigger 514 to drive the driver 542 from the initial position of
The handle release system of
Turning initially to
Turning now to the use of the release mechanism, in the open position of
In one embodiment, the halves of the implant (e.g., the receiving member 12 and the deployment member 14 of the implant 10) are directly loaded into the jaws of an applicator (e.g., the jaws 504 of the applicator 500) and supported (mounted) within the jaws. In one embodiment, one or more of the halves are pre-loaded into a loading assembly or loader, which is then loaded into and supported by the jaws. For example,
The loading assembly 650 may be loaded into the jaw 504b by inserting proximal end portions 654 of the carrier 652 beneath a corresponding set of holding features 656, such as hinges, hooks, shoulders, ledges, projections, or the like, provided in the frame 552 of the jaw 504b (e.g., see
Ribs or webbing of the implant held by the jaws 504 of the applicator 500, e.g., the ribs 23 and/or 29 of the implant 10, (see
The surgical implant applicator 500 is configured for the ability to install a sequence of two or more surgical implants 10 in a head-to-tail arrangement (e.g., a proximal end of a second one of the surgical implants 10 adjacent to a distal end of a first of the surgical implants 10), if needed or desired. For example, in a situation where a target surgical site to be sealed and cut is longer than the length of the implant, two or more of the implants can be installed in a head-to-tail arrangement in order to extend the length of the seal and cut resulting therefrom
According to the method outlined in
Next, as illustrated in
In view of the above, it is to be appreciated that the present disclosure is directed to novel systems and methods for sealing and/or connecting tissue and non-tissue structures using the surgical implant 10 and other implants described herein, the applicator 500 and other applicators described herein, and the system 1000 and other systems described herein. In one exemplary method, the implant 10 is installed with the surgical implant applicator 500. The method involves securing together one or more tissue portions via a surgical implant (e.g., the surgical implant 10) such that thickness variations in the tissue as well as wide tissue thickness ranges can be accommodated. Each half of the implant is brought into opposition through an applied clamping pressure generated by resilient and/or compressible members (e.g., the towers 30), which results in a relatively constant and/or more uniform pressure distribution across the tissue contacting surfaces of the implant, regardless of variations in tissue thickness, than would be experienced by other types of fastening mechanisms, such as staples. The system can be used to form a hemostatic seal of various types of tissue and tissues of varying thicknesses. That is, the application of the implant forms a hemostatic seal without inducing an unacceptable degree of necrosis of the clamped or adjoining tissue. By way of example, the system may be used to seal pulmonary parenchyma, or also used to seal the pulmonary artery. In an exemplary embodiment, the method involves loading the implant into an applicator (e.g., the applicator 500); positioning the applicator at the surgical site to join or seal one or more tissue portions or structures; actuating the applicator to deploy fasteners (e.g., the fasteners 32) and install the implant to form a hemostatic seal with or without the severing of adjoining tissue; an optional step of resizing the length of the implant as needed; and another optional step of resetting the applicator to deploy one or more additional implants. In some embodiments, the implant may already be loaded (i.e., pre-loaded) in the applicator such as in a situation in which the implant is loaded at the point of manufacture; in other embodiments, the user loads the implant in the applicator. In a method of fastening parenchyma by way of example, parenchyma is clamped between the tissue contacting (engaging) surface on the fastener supporting (deployment) member 14 and the tissue contacting (engaging) surface on the receiver member 12 and the fasteners (e.g., fasteners 32 or other fasteners disclosed herein) are advanced into the receiver member 12, compressing the compressible members (e.g., towers 30) which then apply a counterforce when the fastener supporting member 14 and receiver member 12 are coupled, by the fasteners, in the manner described above. In another example, an anastomosis between a first structure and a second structure within the body is achieved utilizing the fasteners are described herein to couple together the fastener supporting (deployment) member 14 which is positioned adjacent a first structure and the receiver member 12 which is positioned adjacent a second structure.
In one example of use, an implant (e.g., the implant 10) is fitted within and secured to an end effector (e.g., the end effector 502) of an implant applier assembly (e.g., the applicator 500) such that a deployment member (e.g., deployment member 14 including, e.g., fasteners 32 and towers 30) and a receiving member (e.g., the receiving member 12) are supported by and attached to one or both of a set of jaws (e.g., the jaws 504) and positioned for deployment. In one embodiment, each of the deployment member and the receiver member of the implant is positioned within a removable carrier (e.g., the carrier 652) of a loading assembly (e.g., the loading assembly 650) that is received within a corresponding cavity or receptacle of the jaws. In another embodiment, the receiving members and the deployment member may be directly attached to the jaws at the point of use or manufacture. In an exemplary embodiment, the applicator (e.g., the applicator 500) is inserted into the body with the jaws in the closed position using a minimally invasive procedure involving insertion of its end effector through a trocar or cannula having a diameter of about 5 to about 22 mm, more preferably, about 6 to about 16 mm, and even more preferably about 12 mm. The user may activate the articulation actuator and/or the rotation actuator to orient the end effector (e.g., via the positioning assembly 518) at the desired surgical site, preferably with the jaws in the closed position. The jaws are moved to the open position and the receiving and deployment members are positioned on opposite sides of the tissue defining a defect or other overlapping separate tissue portions such that when deployed, the tips (e.g., the tips 40) of the fasteners (e.g., the fasteners 32) are inserted through the tissue portions and a portion of the receiving member. In other embodiments, it is contemplated that the tips of the fasteners arrive at opposite sides of the tissue without piercing through the tissue, e.g., located adjacent to the tissue or through openings in the tissue.
A user can then actuate a trigger (e.g., the trigger 514) to transition the jaws from the open to the closed position (configuration). Note that in the illustrated embodiment, one of the jaws moves relative to the other jaw which is stationary jaw e.g., the jaw containing the deployment member is stationary. It is also contemplated that the jaw containing the deployment member could move relative to the jaw containing the receiver member which remains stationary. It is also contemplated that both of the jaws could move relative to each toward and away from each other between open and closed positions as discussed above. When closed, a user may then orient and move a safety mechanism (e.g., the safety mechanism 616 having the rod 618) in an unlocked position to enable a driver or actuator (e.g., the driver 542) to slide or move along the length of the end effector. As the driver slides along and over a dorsally facing surface of the jaws, the portion of jaws over which the driver slides may be further compressed together relative to the natural position of jaws in its closed state. As the driver moves over portions of the jaws loaded with the deployment member, the driver may engage and move one or more pushers (e.g., the pushers 592) towards the opposite jaw. The pushers in turn deploy the fasteners away from the deployment member, through the deployment member, through one or more tissue portions and into the one or more receiver members opposite thereto. In this manner, the fasteners are fired and deployed along the length of the implant as the driver moves from a first (e.g., proximal) end to a second (e.g., distal) end of the end effector.
The tissue secured between the deployment member and the receiving member is clamped together at a constant, uniform, normalized, or distributed pressure along the length of the implant sufficient to form a hemostatic seal that does not induce necrosis by virtue of the compliant resilient, biasing, and/or compressible members (e.g., the towers 30). As the properties of the tissue changes over time and/or changes due to different environmental conditions, such as movement of the tissue and/or a build-up of pressure within the tissue, each resilient, biasing, and/or compressible member (e.g., each of the towers 30) may independently function to adjust for and otherwise accommodate the localized pressure disturbance occurring within each fastener subassembly of the implant (e.g., the subassemblies 34). This allows for the implant to maintain a more normalized and/or substantially constant pressure for forming a hemostatic seal than otherwise would be available with other surgical fastener or stapling systems.
In one embodiment, the driver (e.g., the driver 542) includes a cutting blade (e.g., the cutting implement 580) located in a channel formed in and through the end effector. The blade, which is preferably towards the side of the driver that moves towards the clamped tissue, may be secured to a body portion of the driver that causes and/or facilitates maintaining the jaws of fixed predetermined distance apart, and further may function to sever tissue and/or any intervening portions of the implant encountered by the blade when moved along a channel along the length of the jaws.
Upon reaching a second and/or distal end of the end effector, continued actuation of the trigger induces the driver to return to the first and/or proximal end of the end effector. The subsequent return of the driver may function as a safety means for ensuring that all of the pushers and the fasteners are deployed along the entire length of the implant. Once the driver is docked at the proximal end of the end effector, the implant may be released from the jaws.
A user may then cut between the fastener subassemblies (e.g., through the ribs 23 and/or 29 of the implant 10) to remove any excess implant material or otherwise alter the size of the implant. In other words, the implant can be used on tissue lengths shorter than the implant itself. Additional implants may also be used to seal tissue sections longer than a single implant by directly adjoining the prior implant or may otherwise be connected directly to the prior implant. A series of the implants may be arranged to form a hemostatic seal as a stand-alone procedure or alternatively in conjunction with a tissue resection procedure. The aforementioned situations can allow a single or “standard” length of implant to be used on a variety of different lengths or as different length rows.
As noted above, in an alternate embodiment, the deployment member (containing the fasteners) can be positioned on the movable jaw and the receiver member positioned on the stationary jaw as an alternative to the aforedescribed positioning of the receiver member on the movable jaw and the deployment member (containing the fasteners) on the stationary jaw. This embodiment is illustrated in
Placing the deployment member on the movable jaw instead of the stationary jaw has advantages in certain clinical applications where additional tissue dissection is desired. In certain applications, when the user is placing the jaws of the end effector around tissue, there is limited space to place the jaw around the backside as the target tissue structure that is to be transected and sealed is connected to other tissue. Dissection of the target tissue from the other tissue can be difficult without causing collateral damage to the tissue. Therefore, dissection of tissue is often minimized. With minimal dissection, in certain clinical applications, there is little space for the jaw to slide through. Since the jaw containing the receiver member (receiver jaw) is smaller than the jaw containing the deployment member (cartridge jaw) which supports the fasteners, the receiver jaw is the preferred jaw to slide through the dissection opening. However, once this receiver jaw is in place in the dissection, the user does not want to move the jaw which could damage tissue. To keep this smaller receiver jaw stationary, the cartridge jaw would need to be the jaw that moves, e.g., pivots, towards the stationary receiver jaw for subsequent application of the fasteners. Thus, by placing the deployment member on the movable jaw, the smaller receiver jaw can fit through the minimal tissue space.
Turning now to
Lower receiver jaw 1006 has a pair of openings 1020, 1022 formed in upwardly extending ears 1024, 1026, respectively, (see e.g.,
The end effector assembly 1002 can in some embodiments have a relief track for the driver, as shown in the embodiment of
More specifically, stationary jaw 1006 has outer cam surfaces 1060a, 1060b (collectively cam surface 1060) which extends longitudinally along most of its length. The cam surface 1060 (
One advantage of the driver 1050 and relief track is that the driver 1050 does not to be fully retracted past the jaw hinge point in order for the jaws 1004, 1006 to open. In configurations where the driver must be retracted past the hinge point before the jaws can open, abrupt opening of the jaws can occur which can in certain applications cause tissue damage. In this embodiment of
The operation of the driver 1050 is illustrated in
As noted above, in certain embodiments, the surgical applicator can be loaded with a new implant and the new implant applied to the tissue or tissue structure.
As shown in
In the next step, the loading assembly 1100 is moved into engagement with the jaw tab (or tabs) 1113 of the movable jaw 1104 (
It should be appreciated that this method of loading and/or reloading an applicator of
It should further be appreciated that one or more loading assemblies 1100 may be presented for storage and eventual use in a one or more sterile configurations, including for instance: (i) individual package(s) 982 as sterile with a sterile barrier 981 encapsulating a loading assembly 1100 (see
Referring now to
The base of deployment member 202, similar to the base 24 of the deployment member 14, may in some embodiments be made of a soft, flexible material, preferably silicone rubber, but could, alternatively or additionally be composed of one or more of other soft, biocompatible material suitable for implantation, such as, but not limited to polyurethane, thermoplastic elastomer (TPE), natural rubber, latex, bio-absorbable polymers, etc. Deployment member 202 further includes clips, fasteners, or anchors 206, including those of the type described above, that are actuatable to be driven out of deployment member 202, through the tissue 205 and into a receiver or anchor base 208 in receiver member 204. The anchor base 208 includes a retainer 210, generally resembling the retainer 44 (or its variants) discussed above. For example, the retainer 210 in the illustrated embodiment may include a layer of mesh or woven material embedded or molded in the anchor base 208 of the receiver member 204, or is otherwise fixed to the main body of the receiver member 204. Similar to the retainer 44, the retainer 210 may optionally be made of polyethylene terephthalate (PET), polyetheretherketone (PEEK), nylon, or other polymers, cotton, or other fibrous materials, etc. A retainer similar to retainer 210 could also be provided in the deployment member 202 in a similar fashion to some of the embodiments discussed above.
The anchor 206 may include fasteners in the form of one or more legs, shanks, or pins 212 arranged to be actuated through a surgical structure or tissue positioned between the deployment member 202 and the receiver member 204. The pins 212 may be made of stainless steel, titanium or other biocompatible metals, metal alloys, and/or rigid, biocompatible polymers. The pins 212 may extend from a base body 213. Each pin 212 is provided with a series of barbs 214 that are spaced apart along a length of the pin 212. Optionally, the pins 212 and/or the barbs 214 may be over-molded by the material of the deployment member 202, e.g., silicone or other soft polymer. As each pin 212 is driven toward the surgical structure e.g., tissue 205 and into the anchor base 208, each pin 212 passes through one of the mesh openings 216 (see
Alternative forms of barbs discussed herein are also contemplated. For example, the barbs 214, 222, (and 42), etc., that may be employed include, but are not limited to, forming the barb by piercing a “V” or other generally pointed shape into a base structure and bending the “V” or other shape outward; skive barbs formed by sliding a blade, or skive, along the structure and driving the blade into the structure, such as commonly used for fishing hooks; micro barbs, e.g., barbs having a plurality of very small protrusions in the range of approximately 0.010″ or smaller, etc. Further optionally, the pins 212, 220, and/or 221 may be configured so that the free ends/distal tips 230 bend over after deployment to further secure the corresponding anchor from releasing from the retainer, e.g., the retainer 44 and/or 210. It is to be appreciated that any discussion of any component from one embodiment herein generally applies to like-components from other embodiments, whether or not the same name is used to refer to both (and in fact, with reference to some embodiments, different names are purposely used for like-components from different embodiments for the sake of clarity in discussing those particular components). For example, it is to be understood that similarly to the legs 36 of the fasteners 32, the anchors 206, 218, and/or 219 may include a single one of the pins 212, 220, and/or 221, or any number thereof. Likewise, similarly to the pins 212, 220, and/or 221, the legs 36 may be arranged to be bent over after deployment to further secure a surgical structure in place.
Referring back to
Preferably the main body of the deployment member 202 includes a resilient and/or compressible member, suspension, spring, biasing member to provide a biasing force similar to the towers 30 discussed above. In the embodiment of
The deployment member 202 may include grooves 217 (preferably formed by molding, but could be machined or otherwise cut in) to hold the base bodies 213 and thus the anchor 206, prior to deployment. The material portion of the deployment member 202 between the bases 213 and the surgical structure is compliant so that it maintains the anchors 206 in tension against the retainer 210 after deployment and engagement with the retainer 210. The face 236 of the deployment member 202 to be applied to the surgical structure may be provided with ridges 244 extending along the sides, which are raised, relative to the remainder of the face 236 to concentrate sealing action away from the anchors 206 so as to minimize risks of leakage through the holes in the surgical structure formed by piercing through the surgical structure with the anchors 206. Likewise, the face 240 of the receiver member 204 that faces the deployment member 202 may be provided with longitudinally extending ridges similar to the ridges 244 along the side lengths thereof that extend lower than the remainder of the face 240 so as to minimize the risk of leakage due to the holes pierced through the surgical structure by the pins 212 on the receiver member 204 side of the surgical structure. Slots 248 may be provided in the receiver member 204 that may extend from the face 240 of the receiver member 204, and into shields or protrusions 250 extending dorsally from of the receiver member 204. Protrusions 250 are provided to ensure that the pins 212 of the anchors 206 do not extend out of the receiver member 204 after deployment (so the tips do not extend beyond the dorsal surface of receiver member 204). Protrusions 250 are provided with a height sufficient to ensure that the pins 212 cannot extend out of the receiver member 204 after deployment, even if there is no surgical structure provided between the deployment member 202 and the receiver member 204. The protrusions can be solid, or alternatively can form a cavity like a shell.
In the illustrated embodiment, the instrument 300 includes a set of jaws 302a and 302b (collectively, “the jaws 302”) arranged to receive and engage the members 202 and 204. In one embodiment, the jaws 302 and the members 202 and 204 are together configured and dimensioned to provide about a 57 mm sealing length. As already noted, this configuration is not limiting, as the instrument 300 and implant 200 may be configured and dimensioned to provide a sealing length that is less than or greater than 57 mm. As shown, two implants 200 are releasably mounted in the jaws 302 for delivery and deployment thereof. It is to be appreciated that in some embodiments two of the implants 200 may be secured by a bridge, e.g., resembling the bridge 37 of
The proximal end portion of the instrument is not shown, but the instrument 300 includes a shaft 318 extending from the support 306 for the jaws 302 that is connectable to any suitable handle. In one embodiment, the shaft 306 has a diameter in the range of about 5 mm to about 10 mm, preferably about 7 mm. The jaws 302 may be articulated in the manner described above. Other articulation mechanisms are also contemplated. The jaws are actuatable to close down on the tissue/vessel 205 as shown in
Once in the desired position, as shown in
After completing the actuating and severing processes discussed with respect to
The instrument 300 may be low profile and can be configured and dimensioned so as to be delivered through a port for minimally invasive procedures.
While the invention has been described with reference to an exemplary embodiment or embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope thereof. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the claims. Also, in the drawings and the description, there have been disclosed exemplary embodiments of the invention and, although specific terms may have been employed, they are unless otherwise stated used in a generic and descriptive sense only and not for purposes of limitation, the scope of the invention therefore not being so limited. Moreover, the use of the terms first, second, etc. do not denote any order or importance, but rather the terms first, second, etc. are used to distinguish one element from another. Furthermore, the use of the terms a, an, etc. do not denote a limitation of quantity, but rather denote the presence of at least one of the referenced item.
This is application is a continuation-in-part of International Patent Application No. PCT/US15/18839, filed on Mar. 4, 2015, pursuant to 35 USC § 365(c), which in turn claims benefit of priority to U.S. Provisional Application No. 61/947,956, filed on Mar. 4, 2014. This application is also a continuation-in-part of U.S. patent application Ser. No. 14/641,136, filed Mar. 4, 2015 (pending), pursuant to 35 USC § 120, which is a continuation of International Patent Application No. PCT/US15/18839, filed on Mar. 4, 2015, pursuant to 35 USC § 363, which in turn claims benefit of priority to U.S. Provisional Application No. 61/947,956, filed on Mar. 4, 2014. This application is also a continuation-in-part application of U.S. patent application Ser. No. 14/639,113, filed Mar. 4, 2015 (pending), pursuant to 35 USC § 120, which is a continuation of International Patent Application No. PCT/US15/18839, filed on Mar. 4, 2015, pursuant to 35 USC § 363, which in turn claims benefit of priority to U.S. Provisional Application No. 61/947,956, filed on Mar. 4, 2014. This application also claims the benefit of priority to U.S. Provisional Application No. 62/214,190, filed on Sep. 3, 2015 pursuant to 35 USC § 119. The entire disclosures of the afore-listed applications are expressly incorporated by reference herein.
| Number | Date | Country | |
|---|---|---|---|
| 61947956 | Mar 2014 | US | |
| 61947956 | Mar 2014 | US | |
| 61947956 | Mar 2014 | US | |
| 62214190 | Sep 2015 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 15257908 | Sep 2016 | US |
| Child | 16666004 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2015/018839 | Mar 2015 | US |
| Child | 14641136 | US | |
| Parent | PCT/US2015/018839 | Mar 2015 | US |
| Child | 14639113 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | PCT/US2015/018839 | Mar 2015 | US |
| Child | 15257908 | US | |
| Parent | 14641136 | Mar 2015 | US |
| Child | 15257908 | US | |
| Parent | 14639113 | Mar 2015 | US |
| Child | 15257908 | US |
