United States Patent
`Millimanetal.
`
`5:5
`
`US005865361A
`[11] Patent Number:
`[45] Date of Patent:
`
`5,865,361
`Feb. 2, 1999
`
`[54]
`
`[75]
`
`SURGICAL STAPLING APPARATUS
`
`Inventors: Keith L. Milliman, Bethel; Frank J.
`Viola, Sandy Hook; Joseph Orban,
`Norwalk; Randolph F. Lehn, Stratford,
`all of Conn.
`
`[73] Assignee: United States Surgical Corporation,
`Norwalk, Conn.
`
`[21] Appl. No.: 935,980
`
`[22]
`
`Filed:
`
`Sep. 23, 1997
`
`Intel? sacuincainusccasssania AG61B 17/068
`(Sl)
`[B2) US Chi vsssiasctssasccs 227/176.1; 227/19; 227/178.1
`[58]
`Field of Searchr .........cccccccsesscescsees 227/19, 175.1,
`227/176.1, 175.3, 178.1, 179.1
`aang
`References Cited
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`
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`6/1994 Green et al. .
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`7/1994 Greenetal. .
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`.
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`.
`
`.
`
`1/1994 Fox et al. .
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`3/1963 Bobrovetal. .
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`1/1970 Green et al. .
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`1/1981 Kapitanovet al. .
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`2/1984 Green .
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`6/1985 Green
`4,520,817
`5/1986 Malyshevet al.
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`8/1986 Rothfuss etal. .
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`9/1986 Rothfuss etal. .
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`9/1986 Rothfuss et al. .
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`.
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`.
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`4,978,049 12/1990 Green .
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`2/1991 Mericle .
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`8/1991 Greenet al. .
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`5,074,454 12/1991 Peters .
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`1/1992 Foslien et al. .
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`7/1992 Schulze et al.
`.
`
`(List continued on next page.)
`see
`scien
`sinieatigerries
`FOREIGN EXTENT DOPUMENTS
`0 484.677
`5/1992
`European Pat. Off. .
`0589 306
`3/1994
`European Pat. Off..
`0591 946
`4/1994
`European Pat. Off. .
`0.592 243
`4/1994
`European Pat. Off. .
`0656 188
`6/1994
`European Pat. Off. .
`0621009 10/1994
`European Pat. Off. .
`2681775 10/1991
`France .
`43.00 307
`7/1994 Germany .
`980703
`12/1982 Russian Federation .
`990220
`1/1983 Russian Federation .
`.
`“
`.
`Primary Examiner—Scott A. Smith
`[57]
`ABSTRACT
`
`Asurgical stapling device particularly suited for endoscopic
`procedures is described. The device can be used with both
`articulating and non-articulating disposable loading units
`and has a sensing mechanism for sensing the type of
`disposable loading unit secured to the device.
`
`.
`
`4 Claims, 39 Drawing Sheets
`
`IS 1006
`
` 4
`
`IS 1006
`
`1
`
`

`

`5,865,361
`Page 2
`
`
`U.S. PATENT DOCUMENTS
`
`5,474,571
`5,484,451
`5,486,185
`5,487,500
`
`12/1995 Lang .
`1/1996 Akopovet al. .
`1/1996 Freitas et al. .
`1/1996 Knodelet al. .
`
`4/1996 Young etal. .
`5,507,426
`7/1996 Boiarski et al.
`5,535,937
`5,582,617 12/1996 Klieman etal. .
`3/1997 Smith et al. coceeceeccsccseeee 227/176.1
`5,607,095
`
`4/1997 Viola wes
`ws 227/176.1
`§,615,820
`
`..scccssseseeceseeee 2QA/TIS.L
`$,651,491
`7/1997 Heaton et ab.
`
`...ccsccesceceneeene 227/19
`
`2
`
`

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`U.S. Patent
`
`Feb. 2, 1999
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`5,865,361
`
`1
`SURGICAL STAPLING APPARATUS
`
`BACKGROUND
`
`1. Technical Field
`
`This application relates to a surgical stapling apparatus,
`and more particularly, to an articulating mechanism for use
`with an endoscopic surgical stapling apparatus for sequen-
`tially applying a plurality of surgical fasteners to body tissue
`and optionally incising fastened tissue.
`2. Background of Related Art
`Surgical devices wherein tissueis first grasped or clamped
`between opposing jaw structure andthen joined by surgical
`fasteners are well known in the art. In some instruments a
`knife is providedto cut the tissue which has been joined by
`the fasteners. The fasteners are typically in the form of
`surgical staples but two part polymeric fasteners can also be
`utilized.
`
`15
`
`30
`
`toeon
`
`40
`
`Instruments for this purpose can include two elongated
`members which are respectively used to capture or clamp *
`tissue. Typically, one of the members carries a staple car-
`tridge which housesa plurality of staples arranged in at least
`two lateral rows while the other member has an anvil that
`defines a surface for formingthestaple legs as the staples are
`driven from the staple cartridge. Generally,
`the stapling
`operation is effected by cam bars that travel longitudinally
`through the staple cartridge, with the cam bars acting upon
`staple pushers to sequentially eject
`the staples from the
`staple cartridge. A knife can travel between the staple rows
`to longitudinally cut and/or open the stapled tissue between
`the rows of staples, Such instruments are disclosed, for
`example,
`in U.S. Pat. No. 3,079,606 and U.S. Pat. No.
`3,490,675.
`A later stapler disclosed in U.S, Pat. No. 3,499,591
`applies a double row of staples on eachside ofthe incision.
`This is accomplished by providing a disposable loading unit
`in which a cam member moves through an elongate guide
`path between twosets of staggered staple carrying grooves.
`Staple drive members are located within the grooves and are
`positioned in such a manner so as to be contacted by the
`longitudinally moving cam member to effect ejection of the
`staples from the staple cartridge of the disposable loading
`unit. Other examples of such staplers are disclosed in U.S.
`Pat. Nos. 4,429,695 and 5,065,929.
`Each ofthe instruments described above were designed
`for use in conventional surgical procedures wherein sur-
`geons have direct manual access to the operative sile.
`However, in endoscopic or laparoscopic procedures, surgery
`is performed through a small incision or through a narrow
`cannula inserted through small entrance woundsin the skin.
`In order to address the specific needs of endoscopic and/or
`laparoscopic surgical procedures, endoscopic surgical sta-
`pling devices have been developed and are disclosed in, for
`example, U.S. Pat. Nos. 5,040,715 (Green, et al.); 5,307,976
`(Olson, et al.); 5,312,023 (Green,et al.); 5,318,221 (Green,
`et al.); 5,326,013 (Green, et al.); and 5,332,142 (Robinson,
`et al.).
`U.S. Surgical, the assignee of the present application, has
`manufactured and marketed endoscopic stapling
`instruments, such as the Multifire ENDO GIA* 30 and
`Multifire ENDO GIA* 60 instruments, for several years.
`These instruments have provided significant clinical ben-
`efits. Nonetheless, improvements are possible, for example,
`by reducing the cost and complexity of manufacture.
`Current laparoscopic linear stapling devices are config-
`ured to operate with disposable loading units (U.S. Surgical)
`
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`and staple cartridges (Ethicon) of only one size. For
`example, individual linear staplers are presently available
`for applying parallel rows of staples measuring 30 mm, 45
`mm and 60 mm in length. Thus, during a normal operation,
`a surgeon may be required to utilize several different sta-
`pling instruments to perform a single laparoscopic surgical
`procedure. Such practices increase the time, complexity and
`overall costs associated with laparoscopic surgical proce-
`dures. In addition, costs are greater in designing and manu-
`facturing multiple stapler sizes, as opposed to creating a
`single, multipurpose stapler.
`to provide a surgical
`It would be extremely beneficial
`device for use during laparoscopic and/or endoscopic sur-
`gical procedures that can be employed with severaldifferent
`sized disposable loading units to reduce the overall costs
`associated with such procedures. It would also be particu-
`larly beneficial if the device could perform multiple tasks,
`using disposable loading units of varying size and of varying
`purpose, such as, for example,
`to staple, clip, cut and/or
`articulate.
`
`In making improvements or modifications to the current
`instruments, it would be highly desirable not to sacrifice any
`of the important benefits of the MULTIFIRE ENDO GIA*
`30 and 60 instruments as compared to other commercially
`available products,e.g., the endoscopic stapling instruments
`manufactured and marketed by Ethicon, Inc. For example,
`any improvement should advantageously provide a fresh
`knife blade for each firing of the instrument and ensure that
`the disposable loading unit
`is securely retained in the
`stapling instrument unless and until
`the operating team
`chooses to remove it. These advantages have historically
`been found in the U.S. Surgical instruments, but not in the
`Ethicon instruments.
`
`SUMMARY
`
`In accordance with the present disclosure, a surgical
`stapling apparatus for sequentially applying a plurality of
`fasteners to body tissue and simultaneously incising tissue is
`provided. The surgical stapling apparatus is adapted to
`receive disposable loading units having rows ofstaples
`having a linear length of between 30 mm and 60 mm. The
`surgical stapling apparatus is also adapted to receive articu-
`lating and non-articulating disposable loading units.
`The surgical stapling apparatus includes a handle assem-
`bly having a movable handle and a stationary handle. The
`movable handle is movable through an actuation stroke to
`clamp tissue and to effect ejection of staples from the
`disposable loading unit. An elongated body extends distally
`from the handle assembly and defines a longitudinal axis. An
`actuation shaft having a toothed rack is operably associated
`with the movable handle by a pawl mechanism. The distal
`end of the actuation shaft
`is connected to a control rod
`having a distal end adapted to operatively engage an axial
`drive assembly located within a disposable loading unit.
`The stapling apparatus includes an articulation mecha-
`nism having an articulation lever operatively engaged with
`acam memberhaving a stepped camming channel. The cam
`member is engaged with a
`translation member which
`includes a pin dimensionedto be received within the stepped
`camming channel such that pivotable movement of the lever
`causes linear movement of the translation member. A first
`articulation link includes a proximal end adapted to engage
`the translation member and a distal end adapted to engage a
`second articulation link positioned within the disposable
`loading unit. Linear movement ofthe translation member
`causes linear movement of the articulation links to cause
`articulation of a tool assemblyof the disposable loadingunit.
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`The surgical stapling apparatus also preferably includes a
`sensing mechanism for sensing the type of disposable load-
`ing unit secured to the elongated body of the apparatus. The
`sensing mechanism includes a sensing tube positioned
`within the elongated body to engage a disposable loading
`unit secured to the elongated body. A sensing cylinder
`connected to the sensing tube engages a locking ring having
`a tab portion configured to engage the articulation mecha-
`nism in a first position to prevent movementofthe articu-
`lation lever. The locking ring is moved by the sensing
`cylinder when an articulating disposable loading unit
`is
`secured to the elongated body ofthe stapling apparatus to a
`second position to disengage the tab portion from the
`articulation mechanism to permit movement of the articu-
`lation lever. In contrast, a non-articulating disposable load-
`ing unit will not unlock the articulation lever.
`BRIEF DESCRIPTION OF THE DRAWINGS
`
`Various preferred embodiments are described herein with
`reference to the drawings:
`FIG. 1 is a perspective view ofone preferred embodiment
`of the presently disclosed surgical stapling apparatus;
`FIG, 2 is a top view of the surgical apparatus shown in
`FIG. 1;
`FIG. 3 is a side view of the surgical apparatus shown in
`FIG. 1;
`FIG, 4 is a perspective view with parts separated of the
`handle assembly ofthe surgical apparatus shownin FIG. 1;
`FIG, 5 is a cross-sectional view of a portion ofthe firing
`lockout mechanism shown in FIG. 4;
`FIG, 6 is a perspectiveof the slide plate of the anti-reverse
`clutch mechanism of the surgical apparatus;
`FIG. 7 is an enlarged perspective view of the anti- reverse
`clutch mechanism shown in FIG. 1;
`FIG, 8 is a side cross-sectional view of the surgical
`stapling apparatus shown in FIG. 1 in the non-actuated
`position with the disposable loading unit removed;
`FIG. 9 is a perspective view with parts separated of the
`rotation member, the articulation mechanism, and the elon-
`gated bodyof the surgical stapling apparatus shown in FIG.
`1;
`
`PIG. 10 is an enlarged view of the indicated area of detail
`shown in FIG, 8;
`FIG. 10a is a perspective view ofthe translation member
`of the articulating mechanism and the proximal end of the
`elongated body of the surgical stapling apparatus shown in
`FIG. 1;
`FIG. 10b is an enlarged cross-sectional view of the
`indicated area of detail of FIG. 8;
`FIG. 10c is a cross-sectional view along section line
`10c—10c of FIG. 8;
`FIG, 11 is a perspective view of the cam member of the
`articulation mechanism of the surgical stapling apparatus
`shown in FIG. 1;
`FIG. 12 is a top view of the cam member of the articu-
`lation mechanism of the surgical stapling apparatus shown
`in FIG. 1;
`FIG. 12a is a perspective view of a non-articulating
`disposable loading unit usable with the surgical stapling
`apparatus shownin FIG. 1;
`FIG, 126 is a perspective view of the preferredarticulat-
`ing disposable loading unit ofthe surgical stapling apparatus
`shown in FIG, 1;
`FIG. 13 is a cross-sectional viewtaken along section line
`13—13 of FIG. 10;
`
`4
`FIG. 14 is a cross-sectional view taken along section line
`14—14 ofFIG. 10;
`FIG. 15 is a cross-sectional view taken along section line
`15—15 of FIG. 10;
`FIG, 16 is an enlarged view ofthe indicated area of detail
`shown in FIG. 8;
`FIG, 17 is a side perspective view of the blocking plate of
`the surgical stapling apparatus shown in FIG. 1;
`FIG. 18 is a top perspective view of the blocking plate of
`the surgical stapling apparatus shown in FIG. 1;
`FIG, 19 is a perspective view ofa disposable loading unit
`usable with the surgical stapling apparatus of FIG. 1;
`FIG, 20 is another perspective view of a disposable
`loading unit usable with the surgical stapling apparatus of
`FIG. 1;
`FIG, 21 is a perspective view of the tool assembly of the
`surgical stapling apparatus of FIG. 1 with parts separated;
`FIG, 22 is an enlarged perspective view of the distal end
`of the anvil assembly showing a plurality of staple deform-
`ing cavities;
`FIG. 23 is an enlarged perspective view of the distal end
`of the staple cartridge of the surgical stapling apparatus
`shown in FIG. 1;
`FIG, 24 is a side cross-sectional view taken along section
`line 24—24 of FIG. 23;
`FIG. 25 is a bottom perspective view of the staple
`cartridge shownin FIG. 21;
`FIG. 26 is an enlarged perspective view of the actuation
`sled, the pushers and the fasteners shown in FIG. 21;
`FIG, 27 is an enlarged perspective view with parts sepa-
`rated of the proximal housing portion and mounting assem-
`bly of the disposable loading unit shown in FIG, 19;
`FIG, 28 is an enlarged perspective view of the mounting
`assembly of the disposable loading unit shown in FIG, 19
`mounted to a distal end portion of the proximal housing
`portion;
`FIG. 29 is an enlarged perspective view of the proximal
`housing portion and the mounting assembly of the dispos-
`able loading unit shown in FIG. 19 with the upper housing
`half removed;
`FIG. 30 is a perspective view of the proximal housing
`portion and the mounting assembly of the disposable loading
`unit shown in FIG, 19 with the upper housing half removed;
`FIG, 31 is a perspective view with parts separated of the
`axial drive assembly;
`FIG. 32 is an enlarged perspective view of the axial drive
`assembly shown in FIG. 31;
`FIG, 33 is an enlarged perspective view of the proximal
`end ofthe axial drive assembly shownin FIG. 31 including
`the locking device;
`FIG, 34 is an enlarged perspective view of the distal end
`of the axial drive assembly shown in FIG. 31;
`FIG, 35 is an enlarged perspective view of the distal end
`of the elongated body of the stapling apparatus shown in
`FIG. 1;
`FIG. 36 is an enlarged perspective view of the locking
`device shown in FIG. 33;
`FIG. 37 is an enlarged perspective view of a lower
`housing half of the proximal housing portion of the dispos-
`able loading unit shown in FIG, 27;
`FIG, 38 is a side cross-sectional view ofthe disposable
`loading unit shown in FIG, 20;
`FIG. 39 is an enlarged view of the indicated area ofdetail
`shown in FIG. 38;
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`FIG. 40 is a perspective view of the surgical stapling
`apparatus shown in FIG. 1 with the disposable loading unit
`of FIG. 19 detached from the elongated body;
`FIG, 41 is an enlarged perspective view of the disposable
`loading unit of FIG. 19 during attachment to the elongated
`body of the surgical stapling apparatus shown in FIG. 1;
`FIG. 42 is another enlarged perspective view of the
`disposable loading unit of FIG. 19 during attachment to the
`elongated body of the surgical stapling apparatus shown in
`FIG, 1;
`FIG, 43 is a cross-sectional view taken along section line
`43—43 of FIG. 41;
`FIG. 43a is a side cross-sectional view of the rotation
`knob, articulation mechanism, and sensing mechanism dur-
`ing insertion of a disposable loading unit into the elongated
`body of the surgical stapling apparatus;
`FIG. 44is a cross-sectional view taken along section line
`44—44 ofFIG. 42;
`FIG. 45is a side cross-sectional view ofthe distal end of
`the disposable loading unit of FIG. 1 with tissue positioned
`between the anvil and clamp assemblies;
`FIG. 46 is a side cross-sectional view of the handle
`assembly with the movable handle in an actuated position;
`FIG. 47 is an enlarged view of the indicated area of detail
`shown in FIG. 46;
`FIG. 48 is a cross-sectional view of the proximal end of
`the disposable loading unit of FIG. 19 and the distal end of
`the elongated body of the surgical stapling apparatus shown
`in FIG,
`1 with the control rod in a partially advanced
`position;
`FIG, 49 is a cross-sectional view of the tool assembly of
`the surgical stapling apparatus shown in FIG. 1 positioned
`about tissue in the clamped position;
`FIG, 50 is a cross-sectional view of the handle assembly
`of the stapling apparatus of FIG. 1 during the clamping
`stroke of the apparatus;
`FIG. 51 is a side cross-sectional view of the distal end of
`the tool assembly ofthe stapling apparatus shown in FIG. 1
`during firing of the apparatus;
`FIG. 52 is a side cross-sectional view of the distal end of
`the tool assembly ofthe stapling apparatus shown in FIG, 1
`after firing of the apparatus;
`FIG, 53 is a side cross-sectional view of the handle
`assembly ofthe apparatus during retraction ofthe actuation
`shaft;
`FIG. 54 is a side cross-sectional view of the handle
`assembly of the stapling apparatus during actuation of the
`emergency release button;
`FIG, 35 is a top view of the articulation mechanism ofthe
`surgical stapling apparatus;
`FIG. 56 is a side cross-sectional view of the articulation
`mechanism and rotation member of the surgical stapling ~~
`apparatus shown in FIG. 1;
`FIG. 57 is a top view ofthe distal end of the elongated
`body, the mounting assembly, and the proximal end of the
`tool assembly during articulation of the stapling apparatus;
`FIG. 58 is a perspective view of the surgical stapling
`apparatus during articulation of the tool assembly;
`FIG, 59 is a perspective view of the surgical stapling
`apparatus during articulation and rotation ofthe tool assem-
`bly;
`FIG. 60 is a top view ofthe distal end of the disposable
`loading unit immediately priorto articulation;
`
`At
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`FIG. 61 is a top view ofthe distal end of the elongated
`body, the mounting assembly, and the proximal end of the
`tool assembly during articulation of the stapling apparatus;
`FIG, 62 is a partial cross-sectional view of a portion of the
`disposable loading unit during retraction of the locking
`device; and
`FIG. 63 is a partial cross-sectional view of a portion ofthe
`disposable loading unit with the locking device in the locked
`position.
`DETAILED DESCRIPTION OF PREFERRED
`EMBODIMENTS
`
`Preferred embodiments of the presently disclosed endo-
`scopic surgical stapling apparatus will now be described in
`detail with reference to the drawings, in whichlike reference
`numerals designate identical or corresponding elements in
`each of the several views.
`
`In the drawings and in the description that follows, the
`term “proximal”, asis traditional, will refer to the end of the
`stapling apparatus which is closest to the operator, while the
`term distal will refer to the end of the apparatus which is
`furthest from the operator.
`FIGS. 1-3 illustrate one embodiment of the presently
`disclosed surgical stapling apparatus shown generally as 10.
`Briefly, surgical stapling apparatus 10 includes a handle
`assembly 12 and an elongated body 14. A disposable loading
`unit or DLU 16 is releasably secured to a distal end of
`elongated body 14. Disposable loading unit 16 includes a
`tool assembly 17 having a cartridge assembly 18 housing a
`plurality of surgical staples and an anvil assembly 20 mov-
`ably secured in relation to cartridge assembly 18. Disposable
`loading unit 16 is configured to apply linear rowsof staples
`measuring from about 30 mmto about 60 mm in length.
`Disposable loading units having linear rows of staples of
`other lengths are also envisioned, e.g., 45 mm. Handle
`assembly 12 includes a stationary handle member 22, a
`movable handle member 24, and a barrel portion 26. A
`rotatable member 28 is preferably mounted on the forward
`end of barrel portion 26 to facilitate rotation of elongated
`body 14 with respect to handle assembly 12. An articulation
`lever 30 is also preferably mounted on the forward end of
`barrel portion 26 adjacent rotatable knob 28 to facilitate
`articulation of tool assembly 17. A pair of retraction knobs
`32 are movably positioned along barrel portion 26 to return
`surgical stapling apparatus 10 to a retracted position, as will
`be described in detail below.
`
`Referring to FIG. 4, handle assembly 12 includes housing
`36, which is preferably formed from molded housing half-
`sections 36a@ and 36b, which forms stationary handle mem-
`ber 22 and barrel portion 26 of handle assembly 12 (See FIG.
`1). Movable handle member 24 is pivotably supported
`between housing half-sections 36@ and 36b about pivot pin
`38. A biasing member 40, which is preferably a torsion
`spring, biases movable handle 24 away from stationary
`handle 22, An actuation shaft 46 is supported within barrel
`portion 26 of housing 36 and includes a toothed rack 48. A
`driving pawl 42 having a rack engagement finger 43 with
`laterally extending wings 43a and 43is pivotably mounted
`to one end of movable handle 24 about a pivot pin 44. A
`biasing member 50, which is also preferably a torsion
`spring, is positioned to urge engagementfinger 43 of driving
`pawl 42 towards toothed rack 48 of actuation shaft 46.
`Movable handle 24 is pivotable to move engagement finger
`43 of driving pawl 42 into contact with toothed rack 48 of
`actuation shaft 46 to advance the actuation shaftlinearly in
`the distal direction. The forward end of actuation shaft 46
`
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`Referring to FIGS. 4, 6, and 7, handle mechanism 12 also
`rotatably receives the proximal end 49 ofa control rod 52
`includes an anti-reverse clutch mechanism which includes a
`such that linear advancement of actuation shaft 46 causes
`first gear 94 rotatably mounted onafirst shaft 96, and second
`corresponding linear advancement of control rod 52. A
`locking pawl 54 having a rack engagement member 55 is
`gear 98 mounted on a second shaft 100, and a slide plate 102
`pivotably mounted within housing 36 about pivot pin 57 and
`(FIGS. 6 and 7) slidably mounted within housing 36. Slide
`plate 102 includes an elongated slot 104 dimensioned and
`is biased towards toothed rack 48 by biasing member 56,
`configured to be slidably positioned about locking pawl
`which is also preferably a torsion spring. Engagement mem-
`pivot pin 57, a gear plate 106 configured to mesh with the
`ber 55 of locking pawl 54 is movable into engagement with
`teeth of second gear 98, and a cam surface 108. In the
`toothed rack 48 to retain actuation shaft 46 in a longitudi-
`retracted position, cam surface 108 of slide plate 102
`nally fixed position.
`engages locking pawl 54 to prevent locking pawl 54 from
`A retraction mechanism 58 which includes a pair of
`engaging toothed rack 48. Actuation shaft 46 includes a
`retractor knobs 32 (Sce FIG. 1) is connected to the proximal
`distal set of gear teeth 110@ spaced from a proximal set of
`end of actuation shaft 46 by a coupling rod 60. Coupling rod
`gear teeth 1106 positioned to engagefirst gear 94 of actua-
`60 includes right and left engagement portions 62a and 625
`tion shaft 46 during movement of actuation shaft 46. When
`for receiving retractor knobs 32 and a central portion 62c
`actuation shaft 46 is advanced by pivoting movable handle
`which is dimensioned and configured to translate within a
`24 about pivot pin 38, distal gear teeth 110¢ on actuation
`pair of longitudinal slots 34a formedin actuation shaft 46
`shaft 46 mesh with androtate first gear 94 and first shaft 96.
`adjacent
`the proximal end thereof. A release plate 64 is
`First shaft 96 is connected to second shaft 100 by spring
`operatively associated with actuation shaft 46 and is
`clutch assembly such that rotation of first shaft 96 will cause
`mounted for movement with respect thereto in response to
`corresponding rotation of second shaft 100. Rotation of
`manipulation of retractor knobs 32. A pair of spaced apart
`second shaft 100 causes corresponding rotation of second
`pins 66 extend outwardly from a lateral face of actuation
`gear 98 which is engaged with gear plate 106 on slide plate
`shaft 46 to engage a pair of corresponding angled cam slots
`102 to cause linear advancement ofslide plate 102. Linear
`68 formedin release plate 64. Upon rearward movement of
`advancement of slide plate 102 is limited to the length of
`retractor knobs 32, pins 66 can release plate 64 downwardly 3
`elongated slot 104. When slide plate has been advanced the
`with respect to actuation shaft 46 and with respect to toothed
`length of slot 104, cam surface 108 releases locking pawl 54
`rack 48 such that the bottom portion of release plate 64
`suchthat it is moved into engagement with toothed rack 48.
`extends below toothed rack 48 to disengage engagement
`Continued advancement of actuation shaft 46 eventually
`finger 43 of driving pawl 42 from toothed rack 48. A
`moves gear teeth 1105 into engagement with gear plate 106.
`transverse slot 70 is formed at the proximal end of release
`However, since slide plate 102 is longitudinally fixed in
`plate 64 to accommodatethe central portion 62c of coupling
`position, the spring clutch is forced to release, such that
`rod 60, and elongated slots 34 (See FIG. 1) are defined in the
`continueddistal advancement ofactuation shafi 46 is per-
`barrel section 26 of handle assembly 12 to accommodate the
`mitted,
`longitudinal translation of coupling rod 60 as retraction
`When actuation shaft 46 is returned to the retracted
`knobs 32 are pulled rearwardly to retract actuation shaft 46
`position (by pulling retraction knobs 34 proximally, as
`and thus retract control rod 52 rearwardly. Actuation shaft 46
`discussed above) gear teeth 110b engage first gear 94 to
`is biased proximally by spring