USOO7510107B2
`
`(12) Unlted States Patent
`(10) Patent No.:
`US 7,510,107 B2
`
`Timm et al.
`(45) Date of Patent:
`Mar. 31, 2009
`
`(54) CABLE DRIVEN SURGICAL STAPLINGAND
`CUTTING INSTRUMENT WITH APPARATUS
`FOR PREVENTING INADVERTENT CABLE
`DISENGAGEMENT
`
`(75)
`
`Inventors: Richard W. Timm, Cincinnati, OH
`.
`_
`(Us): Fredemk E- Shelton: IV: New
`Vlennas OH (US)
`
`.
`.
`.
`.
`(73) ASSlgneei Ethicon EndO-Surgel'ys Inca Clncmnatl,
`OH (US)
`
`( * ) Notice:
`
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`US.C. 1 54(b) by 0 days.
`
`(21) Appl.No.: 11/820,161
`
`(22)
`
`Filed:
`
`Jun. 18, 2007
`
`............. 606/139
`............. 606/139
`
`2/1999 McGuckin, Jr.
`5,868,760 A *
`4/1999 Bolanos et al.
`5,897,562 A *
`6/2001 Green et a1.
`6,250,532 Bl
`............ 227/l76.l
`10/2001 Adams et a1.
`6,302,311 B1 *
`12/2001 Milliman et a1.
`6,330,965 B1
`.
`*
`3388: ghlmlan et 31' """""" 606/219
`22%;? g: *
`
`aI‘thCk ...........
`227/176.1
`,
`,
`............. 227/1761
`11/2003 Green et al.
`6,644,532 B2 *
`6,835,199 B2* 12/2004 McGuckin etal.
`.......... 606/142
`.......
`6,877,647 132*
`4/2005 Green etal.
`227/176.1
`
`......... 451/6
`6,899,593 B1*
`5/2005 Moeller et al.
`..
`7/2006 Whitman .................... 606/219
`7,077,856 132*
`
`(Continued)
`
`CA
`
`FOREIGN PATENT DOCUMENTS
`2458946 A1
`3/2003
`
`(Continued)
`OTHER PUBLICATIONS
`
`(65)
`
`Prior PUblication Data
`
`U.S.App1. No. 11/820,049, filed Jun. 18, 2007.
`
`US 2008/0308604 A1
`
`Dec. 18, 2008
`
`(Continued)
`
`(51)
`
`Int. Cl.
`(2006.01)
`A6IB 17/068
`(52) US. Cl.
`................... 227/180.1; 227/19; 227/176.1;
`606/139; 606/219
`(58) Field of Classification Search ................... 227/19,
`227/176.1,180.1,175.1,178.1; 606/139,
`606/219, 153
`See application file for complete search history.
`
`(56)
`
`References Cited
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`
`Primary Examineriscott A. Smith
`
`(57)
`
`ABSTRACT
`
`A cable dnven surgical instrument that has an elongate chan-
`nel assembly that is constructed to operably support a staple
`cartridge assembly therein. The instrument may have a knife
`assembly that is oriented for travel within the elongate chan-
`nel assembly and at least one cable transition support that is
`operably mounted to at least one of the elongate channel
`assembly and the knife assembly. A drive cable operably
`extends around at least a portion of the cable transition sup-
`port and interfaces with a cable drive system to drive the knife
`assembly within the elongate channel. A cable retention
`arrangement may be included for retaining the drive cable
`around at least a portion of the cable transition support.
`
`19 Claims, 71 Drawing Sheets
`
`
`
`
`
`
`
`IS 1011
`
`1
`
`IS 1011
`
`

`

`US 7,510,107 132
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`U.S. PATENT DOCUMENTS
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`
`* cited by examiner
`
`3
`
`

`

`US. Patent
`
`Mar. 31, 2009
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`Sheet 1 of 71
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`US 7,510,107 B2
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`4
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`

`US. Patent
`
`Mar. 31, 2009
`
`Sheet 2 of 71
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`US 7,510,107 B2
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`US. Patent
`
`Mar. 31, 2009
`
`Sheet 4 of 71
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`US 7,510,107 B2
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`US. Patent
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`Mar. 31, 2009
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`Sheet 5 of 71
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`US 7,510,107 B2
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`US. Patent
`
`Mar. 31, 2009
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`Sheet 6 of 71
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`US 7,510,107 B2
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`FIG.7
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`US. Patent
`
`Mar. 31, 2009
`
`Sheet 7 of 71
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`US 7,510,107 B2
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`US. Patent
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`Sheet 8 of 71
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`US. Patent
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`US 7,510,107 B2
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`1
`CABLE DRIVEN SURGICAL STAPLING AND
`CUTTING INSTRUMENT WITH APPARATUS
`FOR PREVENTING INADVERTENT CABLE
`DISENGAGEMENT
`
`FIELD OF THE INVENTION
`
`The present invention relates in general to endoscopic sur-
`gical instruments including, but not limited to, surgical sta-
`pler instruments that are capable of applying lines of staples
`to tissue while cutting the tissue between those staple lines
`and, more particularly, to improvements relating to firing and
`drive systems therefore.
`
`BACKGROUND
`
`The present application is related to the following com-
`monly-owned US. Patent Applications filed on even date
`herewith, the disclosures ofwhich are hereby incorporated by
`reference in their entirety:
`(1) US. patent application entitled “Surgical Stapling and
`Cutting Instrument With Improved Firing System” to Richard
`W. Timm, Frederick E. Shelton, IV, Eugene L. Timperman,
`and Leslie M. Fugikawa, Ser. No. 11/820,049;
`(2) US. patent application entitled “Surgical Stapling and
`Cutting Instrument With Improved Closure System” to Rich-
`ard W. Timm, Frederick E. Shelton, IV, Eugene L. Timper-
`man, and Leslie M. Fugikawa, Ser No. 11/820,119;
`(3) US. patent application entitled “Cable Driven Surgical
`Stapling and Cutting Instrument With Improved Cable
`Attachment Arrangements” to Frederick E. Shelton, IV and
`Richard W. Timm, Ser. No. 11/820,124;
`(4) US. patent application entitled “Surgical Stapling and
`Cutting Instrument With Improved Anvil Opening Features”
`to Richard W. Timm, Frederick E. Shclton, IV, and Jeffrey S.
`Swayze, Ser. No. 11/820,077; and
`(5) US. patent application entitled “Surgical Stapling and
`Cutting Instruments” to Richard W. Timm, Frederick E. Shel-
`ton, IV, Charles J. Scheib, Christopher J. Schall, Glen A.
`Armstrong, Eugene L. Timperman, and Leslie M. Fugikawa,
`Ser. No. 11/820,121.
`Endoscopic surgical instruments are often preferred over
`traditional open surgical devices since a smaller incision
`tends to reduce the post-operative recovery time and compli-
`cations. Consequently, significant development has gone into
`a range of endoscopic surgical instruments that are suitable
`for precise placement of a distal end effector at a desired
`surgical site through a cannula of a trocar. These distal end
`effectors engage the tissue in a number of ways to achieve a
`diagnostic or therapeutic effect (e.g., endocutter, grasper, cut-
`ter, staplers, clip applier, access device, drug/gene therapy
`delivery device, and energy device using ultrasound, RF,
`laser, etc.).
`Known surgical staplers include an end effector that simul-
`taneously makes a longitudinal incision in tissue and applies
`lines of staples on opposing sides of the incision. The end
`effector includes a pair of cooperating jaw members that, if
`the instrument is intended for endoscopic or laparoscopic
`applications, are capable of passing through a cannula pas-
`sageway. One of the jaw members receives a staple cartridge
`having at least two laterally spaced rows of staples. The other
`jaw member defines an anvil having staple-forming pockets
`aligned with the rows of staples in the cartridge. The instru-
`ment commonly includes a plurality of wedges that, when
`driven distally, pass through openings in the staple cartridge
`and engage drivers supporting the staples to effect the firing of
`the staples toward the anvil.
`
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`An example of such surgical staplers is disclosed in US.
`Patent Publication No. US 2006/0011699 A1 to Olson et al.,
`the disclosure of which is herein incorporated by reference.
`The stapling devices disclosed therein employs a cable or
`cables that are positioned around distally located pins or
`pulleys and are fixed to the knife. The ends of the cables are
`pulled in a proximal direction. Such system, however, suffers
`from a low mechanical advantage and tends to require rela-
`tively high forces to pull the knife through its stroke.
`Thus, there is a need for an improved drive and firing
`system for use with cable driven surgical staplers.
`In addition, such cable fired surgical stapler systems may
`suffer from the inadvertent disengagement of the cable from
`the pulley system which may disable the device. This condi-
`tion may be caused by mechanical vibration during use or
`other shock forced encountered during use or shipping.
`Thus, there is another need for apparatuses, devices and
`systems for ensuring that the cable or cables used to fire a
`surgical stapling device do not become disengaged from their
`respective pulleys or drive members.
`
`SUMMARY
`
`In one aspect of the invention, there is provided a surgical
`instrument comprising an elongate channel assembly that has
`a distal end and a proximal end and is constructed to operably
`support a staple cartridge assembly therein. The instrument
`may further comprise a knife assembly that is oriented for
`travel within the elongate channel assembly. At least one
`cable transition support may be operably mounted to at least
`one ofthe elongate channel assembly and the knife assembly.
`A drive cable may extend around at least a portion of at least
`one cable transition support and interface with a cable drive
`system to drive the knife assembly within the elongate chan-
`nel. The instrument may further comprise a cable retention
`arrangement for retaining the drive cable around at least a
`portion of the cable transition support.
`In another general aspect of various embodiments of the
`present invention there is provided a surgical instrument com-
`prising an elongate channel assembly that has a distal end and
`a proximal end and is constructed to operably support a staple
`cartridge therein. A knife assembly may be oriented for travel
`within the elongate channel assembly. First and second distal
`cable transition supports may be provided on the distal end of
`the elongate channel assembly. A second cable transition
`support may be provided on the knife assembly. A drive cable
`may extend around at least a portion of the first and second
`distal cable transition supports and the second cable transition
`support on the knife assembly and interface with a cable drive
`system to drive the knife assembly within the elongate chan-
`nel assembly. At least one cable retention arrangement for
`retaining the drive cable around at least one of the first and
`second distal cable transition support and the second cable
`transition support may be provided.
`These and other objects and advantages of the present
`invention shall be made apparent from the accompanying
`drawings and the description thereof.
`
`BRIEF DESCRIPTION OF THE FIGURES
`
`The accompanying drawings, which are incorporated in
`and constitute a part of this specification, illustrate embodi-
`ments ofthe invention, and, together with the general descrip-
`tion ofthe invention given above, and the detailed description
`of the embodiments given below, serve to explain various
`principles of the present invention.
`
`75
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`US 7,510,
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`107 B2
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`3
`FIG. 1 is a perspective view of a surgical stapling and
`severing instrument of various embodiments of the present
`invention.
`
`FIG. 2 is an exploded perspective view of a tool assembly
`depicted in FIG. 1.
`FIG. 3 is a right perspective view of the tool assembly of
`FIG. 1 with some components thereof shown in cross-section.
`FIG. 4 is a left side partial cross-sectional view of the tool
`assembly depicted in FIGS. 2 and 3.
`FIG. 5 is a bottom perspective view of a cartridge assembly
`of embodiments of the present invention with some parts
`separated therefrom.
`FIG. 6 is an exploded assembly view of a sled, staples and
`staple pushers of various embodiments of the present inven-
`tion.
`
`FIG. 7 is a perspective view of an anvil assembly ofvarious
`embodiments of the present invention.
`FIG. 8 is a perspective view of a dynamic clamping mem-
`ber of various embodiments of the present invention.
`FIG. 9 is a side cross-sectional view of the tool assembly
`depicted in FIGS. 1-4 with tissue clamped therein.
`FIG. 10 is a bottom perspective view of an elongate chan-
`nel assembly of various embodiments of the present inven-
`tion.
`
`FIG. 11 is a perspective view of a proximal portion of the
`elongate channel assembly of FIG. 10.
`FIG. 12 is a perspective view of distal portion of the elon-
`gate channel assembly of FIGS. 10 and 11.
`FIG. 13 is a cross-sectional elevational view of a distal
`
`portion ofthe elongate channel assembly of FIGS. 10-12 with
`the dynamic clamping member supported therein.
`FIG. 14 is another bottom view of the elongate channel
`assembly of FIGS. 10-13.
`FIG. 15 is a diagrammatic side view of a firing system of
`various embodiments of the present invention.
`FIG. 15A is a diagrammatic view of another firing system
`of various embodiments of the present invention.
`FIG. 16 is a diagrammatic top view of the firing system of
`FIG. 15.
`
`FIG. 16A is a diagrammatic view of the firing system of
`FIG. 15A.
`
`FIG. 17 is a front perspective view of a winch assembly of
`various embodiments of the present invention.
`FIG. 18 is a rear perspective view of the winch assembly
`embodiment of FIG. 17.
`
`FIG. 19 is a right side elevational vicw of the winch assem-
`bly embodiment of FIGS. 17 and 18.
`FIG. 20 is a cross-sectional view of the winch assembly
`embodiment of FIGS. 17-19 in a neutral position.
`FIG. 21 is a perspective view ofa drive system embodiment
`of the present invention.
`FIG. 22 is a partial cross-sectional view ofanother embodi-
`ment of the present invention that employs an articulation
`joint.
`FIG. 23 is an enlarged partial cross-sectional view of the
`articulation joint depicted in FIG. 22.
`FIG. 24 is an enlarged cross-sectional view of a portion of
`the instrument depicted in FIG. 22.
`FIG. 25 is a bottom view of another elongate channel
`assembly embodiment of the present invention.
`FIG. 26 is an enlarged view of a distal end portion of the
`elongate channel assembly of FIG. 25.
`FIG. 27 is a cross-sectional view of a portion of the distal
`end of the elongate channel assembly of FIG. 26 taken along
`line 27-27 in FIG. 26.
`
`5
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`FIG. 28 is a portion of a bottom view of a distal end of
`another elongate channel assembly embodiment of the
`present invention with some components shown in cross-
`section.
`
`FIG. 29 is a cross-sectional view of the portion of the
`elongate channel assembly depicted in FIG. 28 taken along
`line 29-29 in FIG. 28.
`
`FIG. 30 is a diagrammatical top view of another cable
`arrangement that employs a cable tensioning joint of various
`embodiments of the present invention.
`FIG. 31 is another di