US007510107B2
`
`US 7,510,107 B2
`(10) Patent No.:
`a2) United States Patent
`Timmet al.
`(45) Date of Patent:
`Mar.31, 2009
`
`
`(54) CABLE DRIVEN SURGICAL STAPLING AND
`CUTTING INSTRUMENT WITH APPARATUS
`FOR PREVENTING INADVERTENT CABLE
`DISENGAGEMENT
`Inventors: Richard W. Timm,Cincinnati, OH
`;
`.
`(US); Frederick E. Shelton, IV, New
`Vienna, OH (US)
`
`(75)
`
`oo
`(73) Assignee: Ethicon Endo-Surgery, Inc., Cincinnati,
`OH (US)
`
`5,868,760 A *
`2/1999 McGuckin, Jr... 606/139
`5,897,562 A *
`4/1999 Bolanosetal.
`............. 606/139
`6,250,532 Bl
`6/2001 Greenetal.
`6,302,311 Bl *
`10/2001 Adamsetal. ............ 227/176.1
`6,330,965 Bl
`12/2001 Milliman etal.
`ore bo , ooo: pana etal.eee 606/219
`
`.. 227/176.1
`578,
`artwick vee.
`csseecssse-- 227/176.1
`6,644,532 B2* 11/2003 Greenet al.
`6,835,199 B2* 12/2004 McGuckinetal.
`.......... 606/142
`.......
`.. 227/176.1
`6,877,647 B2*
`4/2005 Greenetal.
`
`...c.sccceses 451/6
`6,899,593 BL*
`5/2005 Moeller et al.
`7/2006 Whitman oo... 606/219
`7,077,856 B2*
`
`(*) Notice:
`
`Subject to any disclaimer, the term of this
`patent is extended or adjusted under 35
`US.C. 154(b)by 0 days.
`
`(Continued)
`FOREIGN PATENT DOCUMENTS
`2458946 Al
`3/2003
`
`CA
`
`(21) Appl. No.: 11/820,161
`
`(22)
`
`Filed:
`
`Jun. 18, 2007
`
`(51)
`
`(65)
`
`Prior Publication Data
`US 2008/0308604 Al
`Dec.18, 2008
`Int. Cl.
`(2006.01)
`AGIB 17/068
`(52) US. Ch cece 227/180.1; 227/19; 227/176.1;
`606/139; 606/219
`(58) Field of Classification Search ..........00...... 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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`(Continued)
`OTHER PUBLICATIONS
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`USS. Appl. No. 11/820,049.filed Jun. 18, 2007.
`(Continued)
`Primary Examiner—Scott A. Smith
`
`(57)
`
`ABSTRACT
`
` Acable driven surgical instrumentthat 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 andat least one cable transition support thatis
`operably mounted to at least one of the elongate channel
`assembly and the knife assembly. A drive cable operably
`extends aroundat least a portion of the cable transition sup-
`port andinterfaces 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
`aroundat least a portion of the cable transition support.
`
`19 Claims, 71 Drawing Sheets
`
`
`
`
`
`
`
`IS 1011
`
`1
`
`IS 1011
`
`

`

`US 7,510,107 B2
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`U.S. PATENT DOCUMENTS
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`FOREIGN PATENT DOCUMENTS
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`US 7,510,107 B2
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`OTHER PUBLICATIONS
`
`* cited by examiner
`
`3
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`5
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`US 7,510,107 B2
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`US 7,510,107 B2
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`Sheet 6 of 71
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`FIG.7
`
`9
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`

`

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`
`US 7,510,107 B2
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`U.S. Patent
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`Mar. 31, 2009
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`Sheet 7 of 71
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`10
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`U.S. Patent
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`12
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`Mar. 31, 2009
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`Sheet 11 of 71
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`US 7,510,107 B2
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`V91
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`_4
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`U.S. Patent
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`14
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`U.S. Patent
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`Sheet12 of 71
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`15
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`U.S. Patent
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`Sheet 13 of 71
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`US 7,510,107 B2
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`1170-1168
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`1
`CABLE DRIVEN SURGICAL STAPLING AND
`CUTTING INSTRUMENT WITH APPARATUS
`FOR PREVENTING INADVERTENT CABLE
`DISENGAGEMENT
`
`FIELD OF THE INVENTION
`
`15
`
`20
`
`30
`
`35
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`40
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`45
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`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 thosestaple lines
`and, more particularly, to improvementsrelatingto firing and
`drive systemstherefore.
`
`BACKGROUND
`
`The present application is related to the following com-
`monly-owned U.S. 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) U.S. patent application entitled “Cable Driven Surgical
`Stapling and Cutting Instrument With Improved Cable
`Attachment Arrangements” to Frederick E. Shelton, [V 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. Shelton, IV, and Jeffrey S.
`Swayze, Ser. No. 11/820,077; and
`(5) U.S. 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 developmenthas 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 ofa 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.).
`Knownsurgical staplers include an endeffectorthat simul-
`taneously makesa longitudinalincision in tissue and applies
`lines of staples on opposing sides of the incision. The end
`effector includes a pair of cooperating jaw membersthat, if
`the instrument is intended for endoscopic or laparoscopic
`applications, are capable of passing through a cannula pas-
`sageway. Oneof the jaw membersreceives a staple cartridge
`havingat least two laterally spaced rowsof staples. The other
`jaw memberdefines an anvil having staple-forming pockets
`aligned with the rowsof staples in the cartridge. The instru-
`ment commonly includes a plurality of wedges that, when
`driven distally, pass through openingsin the staple cartridge
`and engage drivers supporting the staplesto effect the firing of
`the staples toward the anvil.
`
`2
`An example of such surgical staplers is disclosed in U.S.
`Patent Publication No. US 2006/0011699 A] to Olsonetal.,
`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 andarefixed to the knife. The ends of the cables are
`pulled in a proximaldirection. Such system, however, suffers
`from a low mechanical advantage and tends to require rela-
`tively high forces to pull the knife throughits stroke.
`Thus, there is a need for an improved drive and firing
`system for use with cable driven surgicalstaplers.
`In addition, such cable fired surgical stapler systems may
`suffer from the inadvertent disengagementof 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
`surgicalstapling device do not becomedisengaged 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 mountedto at least
`one ofthe elongate channel assembly and the knife assembly.
`A drive cable may extend aroundat least a portion ofat 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 ofthe 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 assemblythat has a distal end and
`a proximalend andis constructed to operably support a staple
`cartridge therein. A knife assembly maybeoriented fortravel
`within the elongate channel assembly. First and seconddistal
`cable transition supports may be provided onthe distal end of
`the elongate channel assembly. A second cable transition
`support maybe provided on the knife assembly. A drive cable
`may extend aroundat least a portion ofthefirst and second
`distal cable transition supports and the secondcabletransition
`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 aroundat least one ofthe first and
`second distal cable transition support and the second cable
`transition support maybe 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 thedetailed description
`of the embodiments given below, serve to explain various
`principles of the present invention.
`
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`US 7,510,107 B2
`
`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 shownin cross-section.
`FIG. 4 is a left side partial cross-sectional view ofthetool
`assembly depicted in FIGS. 2 and3.
`FIG.5 is a bottom perspective view ofa cartridge assembly
`of embodiments of the present invention with someparts
`separated therefrom.
`FIG.6 is an exploded assembly viewof 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 clampedtherein.
`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 proximalportion of the
`elongate channel assembly of FIG. 10.
`FIG. 12 is a perspective view ofdistal 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 membersupported 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 embodimentsof the present invention.
`FIG. 15A is a diagrammatic view of anotherfiring system
`of various embodiments of the present invention.
`FIG. 16 is a diagrammatic top view ofthe firing system of
`FIG. 15.
`
`FIG. 16A is a diagrammatic view ofthe firing system of
`FIG. 15A.
`
`FIG. 17 is a front perspective view of a winch assembly of
`various embodimentsof the present invention.
`FIG. 18 is a rear perspective view of the winch assembly
`embodimentof FIG. 17.
`
`FIG. 19 is aright side clevational view 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 ofa portion of
`the instrumentdepicted in FIG. 22.
`FIG. 25 is a bottom view of another elongate channel
`assembly embodimentof the present invention.
`FIG. 26 is an enlarged view ofa distal end portion of the
`elongate channel assembly of FIG. 25.
`FIG. 27 is a cross-sectional view of a portion ofthe distal
`end of the elongate channel assembly of FIG. 26 taken along
`line 27-27 in FIG.26.
`
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`15
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`20
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`25
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`35
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`40
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`45
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`50
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`55
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`4
`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
`arrangementthat employs a cable tensioning joint of various
`embodiments of the present invention.
`FIG. 31 is another diagrammatical top view of the cable
`arrangement of FIG. 30 with the cable tensioning joint in a
`fully expandedposition.
`FIG. 32 is another diagrammatical top view of the cable
`arrangement of FIGS. 30 and 31 in an articulated position.
`FIG.33 is an enlarged partial view of the cable tensioning
`joint depicted in FIGS. 30-32.
`FIG. 34 is a perspective view of a cable embodimentofthe
`present invention.
`FIG. 35 is an enlarged view of a cable attachment joint
`embodimentof the present invention.
`FIG. 36 is a cross-sectional view of a cable anchor joint
`embodimentof the present invention attached to a dynamic
`clamping assembly.
`FIG.37 is a perspective view of the cable anchorjoint of
`FIG.36.
`FIG. 38 is a cross-sectional view of another cable anchor
`joint embodiment of the present invention attached to a
`dynamic clamping assembly.
`FIG. 39 is a partial view of another cable attachment
`embodimentof the present invention.
`FIG. 40 is a partial view of another cable attachment
`embodimentof the present invention.
`FIG.41 is a partial perspective view of anarticulation joint
`arrangement.
`FIG.42 is a perspective view of a closure tube joint assem-
`bly embodimentof the present invention.
`FIG.43 is a cross-sectional view of the closure tube joint
`assembly embodiment of FIG. 42 taken along line 43-43 in
`FIG. 42.
`
`FIG. 44 is a perspective view of the closure tube joint
`assembly of FIGS. 42 and 43 installed over the articulation
`joint depicted in FIG. 41.
`FIG. 44A isa perspective view of another closure tubejoint
`assembly embodimentofthe present invention installed over
`the articulation joint of FIG. 41.
`FIG. 45 is a perspective view of another anvil assembly
`embodimentof the present invention.
`FIG.46 is an exploded perspective view of a handle assem-
`bly and a closure tube actuation arrangement of an embodi-
`mentof the present invention.
`FIG. 47 is a partial cross-sectional view of a handle assem-
`bly and tool assembly ofan embodimentofthe present inven-
`tion, with some components thereof shownin solid view and
`the anvil assembly in a closed or clamped position.
`FIG.48 is a partial cross-sectional view of a closure tube
`assembly and a tool assembly of an embodiment of the
`present invention with the anvil assembly in a closed or
`clampedposition.
`FIG. 49 is another partial cross-sectional view of the
`handle assembly and tool assembly of FIG. 47 with the anvil
`assembly thereof in an open position.
`FIG. 50 is anotherpartial cross-sectional view of the clo-
`sure tube assembly and tool assembly of FIG. 48 with the
`anvil assembly thereof in an open position.
`
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`

`5
`FIG. 51 is a partial cross-sectional view of a closu