WO2016000255A1 - Appareil d'application d'agrafes chirurgicales et procédés pour procédures endoscopiques - Google Patents

Appareil d'application d'agrafes chirurgicales et procédés pour procédures endoscopiques Download PDF

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Publication number
WO2016000255A1
WO2016000255A1 PCT/CN2014/081646 CN2014081646W WO2016000255A1 WO 2016000255 A1 WO2016000255 A1 WO 2016000255A1 CN 2014081646 W CN2014081646 W CN 2014081646W WO 2016000255 A1 WO2016000255 A1 WO 2016000255A1
Authority
WO
WIPO (PCT)
Prior art keywords
gear
minimally invasive
surgical device
invasive surgical
clutch
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/CN2014/081646
Other languages
English (en)
Inventor
Jiangfeng ZHANG
Shunhong Xu
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Covidien China Medical Devices Technology Co Ltd
Covidien LP
Original Assignee
Covidien China Medical Devices Technology Co Ltd
Covidien LP
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Covidien China Medical Devices Technology Co Ltd, Covidien LP filed Critical Covidien China Medical Devices Technology Co Ltd
Priority to CN201480080258.5A priority Critical patent/CN106470630B/zh
Priority to PCT/CN2014/081646 priority patent/WO2016000255A1/fr
Publication of WO2016000255A1 publication Critical patent/WO2016000255A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
    • A61B2017/00407—Ratchet means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B2017/0647—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks
    • A61B2017/0648—Surgical staples, i.e. penetrating the tissue having one single leg, e.g. tacks threaded, e.g. tacks with a screw thread
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2912—Handles transmission of forces to actuating rod or piston
    • A61B2017/2923—Toothed members, e.g. rack and pinion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A61B17/2909—Handles
    • A61B2017/2925—Pistol grips

Definitions

  • the present disclosure relates to a surgical apparatus, device, and/or system for performing surgical procedures and methods of use thereof. More specifically, the present disclosure relates to a surgical fastener applying apparatus, device, and/or system for performing minimally invasive surgical procedures, which is loadable with disposable loading units containing absorbable or permanent surgical fasteners, and methods of use thereof.
  • Various surgical procedures require instruments capable of applying fasteners to tissue to form tissue connections or to secure objects to tissue.
  • tissue connections For example, during hernia repair it is often desirable to fasten a mesh to body tissue.
  • hernias such as direct or indirect inguinal hernias
  • a part of the intestine protrudes through a defect in the abdominal wall to form a hernial sac.
  • the defect may be repaired using an open surgery procedure in which a relatively large incision is made and the hernia is closed outside the abdominal wall by suturing.
  • the mesh is attached with sutures over the opening in the abdominal wall to provide reinforcement.
  • Laparoscopic and endoscopic procedures are currently available to repair a hernia.
  • laparoscopic procedures surgery is performed in the abdomen through a small incision while in endoscopic procedures, surgery is performed through narrow endoscopic tubes or cannulas inserted through small incisions in the body.
  • Laparoscopic and endoscopic procedures generally utilize long and narrow instruments capable of reaching remote regions within the body and are configured to form a seal with the incision or tube they are inserted through. Additionally, the instruments are typically capable of being actuated remotely, that is, from outside the body.
  • surgical fasteners e.g., surgical tacks, staples, and clips
  • Surgical fasteners are often applied through an elongate instrument for delivery to the mesh, and are manipulated from outside a body cavity.
  • the minimally invasive instruments are typically loaded with either permanent fasteners or bioabsorbable fasteners. Additionally, following a surgical procedure, these instruments are either re-sterilized for re-use or are disposed.
  • the present disclosure relates to surgical devices for performing minimally invasive surgical procedures which are loadable with disposable loading units loaded with absorbable or permanent surgical fasteners and methods of use thereof.
  • a minimally invasive surgical device includes a handle assembly and an endoscopic assembly selectively connectable to the handle assembly and including surgical anchors loaded within a lumen thereof.
  • the handle assembly includes a trigger operatively connected to a handle housing.
  • a clutch gear, a transmission gear, and a pinion gear are disposed within the handle housing.
  • the clutch gear is rotatable about a pivot shaft by actuation of the trigger.
  • the clutch gear includes a gear wheel having gear teeth and a gear plate including a spring-loaded dial pin extending radially outward of the gear plate.
  • a bevel gear is rotatable about the pivot shaft and includes a tapering arc-shaped cam block disposed radially inward of gear teeth formed on a first face of the bevel gear.
  • the cam block has a wall for selectively engaging the dial pin of the clutch gear.
  • a pinion gear is non-rotatably secured to a drive shaft extending distally from the handle housing and includes gear teeth operatively engaged with gear teeth of the bevel gear.
  • the dial pin may be biased to extend radially outward of the gear plate and may be movable to an unbiased position when rotated under the cam block of the bevel gear.
  • the dial pin of the clutch gear includes a shouldered end having a camming surface that is selectively engageable with the wall of the bevel gear when the clutch gear is rotated in a first direction.
  • the shouldered end of the clutch gear may have a tapered surface shaped to slide under the cam block of the bevel gear and be compressed into a slot formed in the gear plate when the clutch gear is rotated in a second direction.
  • the handle assembly may further include a ratchet mechanism including a spring clip having a resilient finger configured for engagement with ratchet teeth formed on a second face of the bevel gear.
  • the handle housing may include a drive gear keyed to a pivot end of the trigger.
  • the handle assembly may further include a biasing member having a first end fixedly connected to the handle housing and a second end connected to a stopper extending from a proximal surface of the drive gear.
  • the drive gear includes gear teeth disposed within an opening defined within the drive gear and extending along an arcuate length of the drive gear.
  • the gear wheel of the clutch gear is at least partially disposed within the opening such that the gear teeth of the clutch gear are in meshing engagement with the gear teeth of the drive gear.
  • the gear teeth of the drive gear are disposed along an inner, upper edge of the opening and the gear wheel is disposed in a distal portion of the opening defined within the drive gear.
  • the handle assembly further includes a transmission gear assembly including a first transmission gear operatively engaged with the drive gear and a second transmission gear operative engaged with the gear wheel of the clutch gear.
  • the first transmission gear includes gear teeth meshingly engaged with gear teeth of the drive gear and the second transmission gear includes gear teeth meshingly engaged with the gear teeth of the gear wheel of the clutch gear.
  • the endoscopic assembly may include an outer tube, an inner tube rotatably supported in the outer tube, the inner tube defining the lumen in which the plurality of surgical anchors are loaded, and a connector.
  • the connector has an outer connector member non-rotatably connected to the proximal end of the outer tube and being non-rotatably connectable to the handle assembly, and an inner connector member non-rotatably connected to the proximal end of the inner tube and being rotatably connectable to the gear train, wherein the outer connector member and the inner connector member are rotatable with respect to one another.
  • the drive shaft may be keyed for selective connection to the inner connector member supported at the proximal end of the inner tube.
  • FIG. 1 is a perspective view of a surgical anchor for use in a surgical device in accordance with the present disclosure
  • FIG. 2 is a side, elevational view of the surgical anchor of FIG. 1;
  • FIG. 3 is a distal, end view of the surgical anchor of FIG. 1;
  • FIG. 4 is a side, elevational view, partially broken away, of the surgical anchor of FIG. 1;
  • FIG. 5 is a perspective view of a surgical device according to an aspect of the present disclosure.
  • FIG. 6 is a left sectional, perspective view of the surgical device of FIG. 5, illustrating a half-section of the handle assembly removed therefrom;
  • FIG. 7 is a right sectional, perspective view of the surgical device of FIG. 5, illustrating a half-section of the handle assembly removed therefrom;
  • FIG. 8 is an enlarged, partial side view of a gear train of FIG. 5;
  • FIG. 9 is a front, perspective view of a clutch gear of the surgical device of FIG. 5;
  • FIG. 10 is a back, perspective view of the clutch gear of FIG. 9;
  • FIG. 11 is a left sectional, perspective view of a surgical device in accordance with an embodiment of the present disclosure.
  • FIG. 12 is a perspective view, with parts separated, of an endoscopic assembly of a surgical device in accordance with the present disclosure
  • FIG. 13 is a rear, perspective view of the endoscopic assembly of FIG. 12.
  • FIG. 14 is a cross-sectional view of a distal end portion of an endoscopic assembly of FIG. 12, illustrating the endoscopic assembly during a firing stroke of a surgical device in accordance with the present disclosure.
  • distal refers to that portion of the surgical device that is farther from the user
  • proximal refers to that portion of the surgical device that is closer to the user.
  • anchor 100 for use with a minimally invasive surgical device of the present disclosure is illustrated and generally designated as anchor 100.
  • anchor 100 includes a head section 110, a mesh retention section 120, and a threaded tissue - snaring section 130.
  • Head section 110 includes a pair of opposing threaded sections 112a, 112b having respective radially, outer, helical head threads 114a, 114b, and a pair of opposing open or slotted sections 116a, 116b.
  • a distal surface of head section 110 is formed onto or integral with a proximal end of mesh retention section 120.
  • Mesh retention section 120 of anchor 100 extends from and between a distal end or surface of head section 110 and a proximal end of tissue-snaring section 130.
  • Mesh retention section 120 functions to lock, anchor, or otherwise retain a surgical mesh (not shown) on to anchor 100 when anchor 100 is screwed into the mesh to a depth past a proximal-most segment 138 of tissue-snaring thread 132 of tissue-snaring section 130. This is achieved because there is no thread located in mesh retention section 120 that would allow anchor 100 to be unscrewed or backed out from the mesh.
  • Mesh retention section 120 has a cylindrical or conical transverse cross-sectional profile.
  • Mesh retention section 120 includes a transverse radial dimension, relative to a central longitudinal axis of anchor 100, that is smaller than a transverse radial dimension of head section 110, and smaller than a transverse radial dimension of proximal-most segment 138 of tissue-snaring thread 138.
  • Threaded tissue-snaring section 130 of anchor 100 includes helical threads 132 formed onto a tapered truncated body section 134.
  • a distal point or tip 136 defines the terminus of the distal most tissue-snaring thread 132.
  • body section 134 of tissue-snaring section 130 is tapered, i.e., becoming smaller toward the distal end of threaded tissue-snaring section 130, and terminates or truncates to a distal truncation point, prior to reaching an apex or tip of anchor 100.
  • Body section 134 includes a concave taper such that, for a given length, a minimum diameter body section 134 is defined upon truncation thereof which, in embodiments, is approximately less than 0.01 inches.
  • Anchor 100 includes a transverse dimension "D", of a distal -most thread in the threaded tissue-snaring section 130 which is as large as design constraints will allow, and in embodiments, approximately greater than 0.040 inches.
  • D transverse dimension
  • the tissue- snaring threads 132 terminate at distal tip 136, which is distal of the truncation point of body section 134.
  • Anchor 100 is non-cannulated and is constructed from a suitable bioabsorbable material, such as, for example, polylactide and/or polyglycolide.
  • anchor 100 is formed from a proprietary biocompatible copolymer (Lactomer USS LI, Boehringer Ingelheim LR 704 S, or Boehringer Ingelheim LG-857).
  • Anchor may also be constructed from suitable non- bioabsorbable materials, or permanent material, such as, for example, stainless steel, titanium, and the like.
  • Tack applier 200 includes a handle assembly 210, and a removable endoscopic assembly 300 (e.g., single use loading unit SULU) extending from handle assembly 210 and configured to store and selectively release or fire a plurality of anchors 100 (FIG. 1) therefrom.
  • SULU single use loading unit
  • Handle assembly 210 includes a handle housing 212 formed from a first half-section 212a and a second half section 212b joined to one another.
  • First half-section 212a and second half section 212b of handle housing 212 may be joined to one another using know methods by those of skill in the art, including and not limited to ultrasonic welding, fasteners (i.e., screws), elastic sealing rubber, adhesives, and the like.
  • First half-section 212a and second half section 212b of handle housing 212 are joined to one another such that a fluid- tight seal is provided therebetween.
  • Handle assembly 210 includes a trigger 214 pivotably connected to handle housing 212, at a pivot point disposed within handle housing 212.
  • Trigger 214 includes a free end 214a spaced a distance from a fixed handle portion 216 of handle housing 212 when trigger 214 is in an extended or un- actuated condition.
  • Trigger 214 includes a pivot end 214b extending therefrom and extending into handle housing 212 through a side of handle housing 212.
  • a fluid-tight seal may be provided between pivot end 214b of trigger 214 and handle housing 212.
  • an X-ring or the like, including an o-ring, etc., may be used between pivot end 214b of trigger 214 and handle housing 212.
  • Handle assembly 210 includes a ferrule or collar 218 rotatably and removably supported on handle housing 212.
  • Handle housing 212 and ferrule 218 may include complementary inter-engaging features and/or structures which lock or fix a position/orientation of ferrule 218 relative to handle housing 212.
  • ferrule 218 may be rotatable between a lock position (endoscopic assembly 300 is locked to handle assembly 212, and tacker 200 is ready to fire); an exchange position (endoscopic assembly 300 can be connected/disconnected to/from handle assembly 212, and tacker 200 cannot be fired); and a ferrule release position (ferrule 218 can be removed from handle housing 212, and handle housing 212 may be cleaned or sterilized).
  • Handle housing 212 may also include a safety lock assembly.
  • exemplary ferrule and safety lock configurations for use with handle housing 212 reference may be made to International Patent Application Serial No. PCT/CN2014/074583, filed on April 2, 2014, and PCT/CN2014/081618, the entire contents of each of which are incorporated herein by reference.
  • handle assembly 210 supports a gear train 220 within handle housing 212.
  • Gear train 220 includes a trigger or drive gear 222 keyed to or non-rotatably connected to pivot end 214b of trigger 214.
  • Drive gear 222 is a two tiered gear including a first drive gear 222a and a second drive gear 222b.
  • First drive gear 222a may be in the form of a quadrant gear or the like having a plurality of gear teeth 222a i formed along a radial outer edge thereof and extending along an arcuate length of first drive gear 222a.
  • First drive gear 222a includes a stem or stopper 223a extending radially therefrom, at a location proximal of gear teeth 222ai.
  • Second drive gear 222b defines a plurality of gear teeth 222b i formed along a radial outer edge thereof.
  • Stopper 223 a is connected to a biasing member 225 of handle assembly 210.
  • Biasing member 225 is configured for maintaining trigger 214 in an extended or un-actuated position.
  • Biasing member 225 is also configured to have a spring constant sufficient to return trigger 214 to an un-actuated position following a partial or complete actuation of trigger 214.
  • Biasing member 225 includes a first end 225a fixedly connected in handle housing 212 and a second end 225b connected to stopper 223 a extending from first drive gear 222a.
  • Gear train 220 further includes a transmission gear assembly 224 pivotably supported in handle housing 212.
  • Transmission gear assembly 224 is a three tiered gear including a first transmission gear 224a, a second transmission gear 224b, and a third transmission gear 224c each rotatably supported on a common pivot axis.
  • First transmission gear 224a may be in the form of a pinion gear or the like having a plurality of gear teeth 224a i formed along a radial outer edge thereof and being in meshing engagement with gear teeth 222ai of first drive gear 222a.
  • Second transmission gear 224b may be in the form of a quadrant gear or the like having a plurality of gear teeth 224b i formed along a radial outer edge thereof and extending along an arcuate length of second transmission gear 224b.
  • Third transmission gear 224c may be in the form of a pinion gear or the like having a plurality of gear teeth 224c i formed along a radial outer edge thereof and being in meshing engagement with gear teeth 222bi of second drive gear 222b.
  • Gear train 220 also includes a clutch gear 226 pivotably and slidably supported on a pivot shaft 221 in handle housing 212.
  • clutch gear 226 includes a gear wheel 226a integrally formed or fixedly attached to a first side 226b i of a gear plate 226b such that the clutch gear 226 has a one-piece construction.
  • Gear wheel 226a and gear plate 226b are concentrically arranged with respect to one another about pivot shaft 221.
  • Gear wheel 226a may be in the form of a pinion gear or the like having a plurality of gear teeth 226ai formed along a radial outer edge thereof and being in meshing engagement with gear teeth 224b i of second transmission gear 224b.
  • Second side 226b 2 of gear plate 226b includes a slot 226c in which a spring- loaded dial pin 227 is disposed.
  • Dial pin 227 includes a shouldered end 227a including a flat camming surface 227ai and a tapered surface 227a 2 . Shouldered end 227a is biased to extend radially outward from gear plate 226b by spring 226d.
  • Gear train 220 further includes a bevel gear 228 pivotably supported on pivot shaft 221 in handle housing 212.
  • Bevel gear 228 may be in the form of a crown gear or the like.
  • Bevel gear 228 is operatively engaged/associated with clutch gear 226.
  • Bevel gear 228 includes a tapering arc-shaped cam block 228a formed on a first face 228b thereof disposed radially inward of gear teeth 228c.
  • Cam block 228a includes a wall or shoulder 228d for selectively engaging camming surface 227ai of clutch gear 226.
  • Gear train 220 further includes a pinion gear 230 rotatably supported in a distal end of handle housing 212.
  • Pinion-bevel gear 230 includes gear teeth 230a operatively engaged or meshed with gear teeth 228c of bevel gear 228.
  • Pinion-bevel gear 230 is non-rotatably secured to a drive shaft 232 extending distally from handle housing 212.
  • Drive shaft 232 is configured and dimensioned to engage an inner connector member 344 (FIG. 12) of endoscopic assembly 300.
  • trigger 214 of tacker 200 is actuated, trigger 214 causes drive gear 222 to be rotated, in a first direction.
  • drive gear 222 As drive gear 222 is rotated in the first direction, drive gear 222 causes first transmission gear 224a and second transmission gear 224b to be rotated, in a first direction, about the pivot axis thereof. As second transmission gear 224b is rotated in the first direction, second transmission gear 224b causes clutch gear 226 to be rotated, in a first direction, about a pivot axis thereof.
  • dial pin 227 of clutch gear 226 is rotated in a first direction until camming surface 227ai thereof engages or contacts wall 228d of bevel gear 228.
  • camming surface 227ai of clutch gear 226 engages or contacts wall 228d of bevel gear 228, continued rotation of clutch gear 226, in the first direction, results in concomitant rotation of bevel gear 228 in a first direction.
  • bevel gear 228 continues to rotate in the first direction so long as trigger 214 is being actuated to a closed or fully actuated condition.
  • Rotation of bevel gear 228 causes pinion gear 230 to rotate in a first direction.
  • pinion gear 230 transmits the rotation to inner tube 320 of endoscopic assembly 300.
  • trigger 214 When actuation of trigger 214 is stopped, either prior to complete actuation or following complete actuation, rotation of bevel gear 228, in the first direction, is also stopped.
  • trigger 214 causes drive gear 222 to be rotated, in a second direction (opposite the first direction).
  • drive gear 222 As drive gear 222 is rotated in the second direction, drive gear 222 causes first transmission gear 224a and second transmission gear 224b to be rotated, in a second direction, about the pivot axis thereof.
  • second transmission gear 224b As second transmission gear 224b is rotated in the second direction, second transmission gear 224b causes clutch gear 226 to be rotated, in a second direction, about pivot shaft 221.
  • dial pin 227 is also rotated in a second direction relative to bevel gear 228, and, if the rotation in the second direction is sufficient, dial pin 227 slides under cam block 228a of bevel gear 228 such that shouldered end 227a of dial pin 227 is pressed into slot 227c.
  • trigger 214 If trigger 214 is fully actuated, a complete release of trigger 214, will result in clutch gear 226 making a complete revolution, in the second direction, until shouldered end 227a of dial pin 227 of clutch gear 226 clears cam block 228a of bevel gear 228 and returns to its biased position via spring 226d as shown in FIG. 6.
  • handle assembly 210 of tack applier 200 is provided with a ratchet mechanism 260 which is configured to inhibit or prevent inner tube 320 from backing-out or reversing after anchor 100 (FIG. 1) has been at least partially driven into tissue.
  • Ratchet mechanism 260 includes a series of ratchet teeth 228e formed on a second face 228f of bevel gear 228.
  • Ratchet mechanism 260 further includes a spring clip 262 secured within handle assembly 210.
  • Spring clip 262 includes a resilient finger 262a configured for engagement with ratchet teeth 228e of bevel gear 228.
  • resilient finger 262a of spring clip 262 engages with ratchet teeth 228e of bevel gear 228 in such a manner that as bevel gear 228 is rotated, in a first direction, resilient finger 262a of spring clip 262 cams over ratchet teeth 228e and permits rotation of bevel gear 228. Also, if bevel gear 228 starts to rotate in a second direction (opposite to the first direction), resilient finger 262a of spring clip 262 stops along ratchet teeth 228e thereby preventing or inhibiting bevel gear 228 from rotating in the second direction. As such, any- reverse rotation or "backing-out" of anchor 100 or inner tube 320 of endoscopic assembly 300 (tending to cause bevel gear 228 to rotate in the second direction), during a driving or firing stroke, is inhibited or prevented.
  • handle assembly 210 may also include an audible/tactile feedback mechanism 219 supported within handle housing 212 and in operative association with drive gear 222 as also described, for example, in International Patent Application Serial No. PCT/CN2014/074583, previously incorporated herein by reference.
  • FIG. 11 illustrates a gear train of a surgical device in accordance with another embodiment of the present disclosure.
  • Gear train 220' is substantially similar to gear train 220, and therefore will only be described with respect to the differences therebetween.
  • gear train 220' includes a single drive gear 222', a clutch gear 226, a bevel gear 228, and a pinion gear 230.
  • Drive gear 222' is keyed, or non-rotatably connected, to pivot end 214b of trigger 214.
  • Drive gear 222' which may be in the form of a quadrant gear or the like, has a plurality of gear teeth 222a' formed along an inner, upper edge defined in of an opening 222b' defined within the drive gear 222', and extending along an arcuate length of, the drive gear 222'.
  • Gear wheel 226a of clutch gear 226 is at least partially disposed within opening 222' of drive gear 222'. Accordingly, in such embodiments, transmission gear 224 is omitted.
  • trigger causes drive gear 222' to be rotated, in a first direction, which in turn, causes clutch gear 226 to be rotated in a first direction such that dial pin 227 of clutch gear 226 is rotated in a first direction until camming surface 227ai engages or contacts wall 228d of bevel gear 228, as described in detail above.
  • endoscopic assembly 300 includes an outer tube 310, an inner tube 320 rotatably disposed within outer tube 310, a guide coil or spring 330 disposed between outer tube 310 and inner tube 320, a plurality of anchors 100 loaded within inner tube 310, and a connector 340 supported at a proximal end of outer tube 310 and inner tube 320.
  • Outer tube 310 of endoscopic assembly 300 includes a proximal end 310a and a distal end 310b, and defines a lumen 310c therethrough. As described briefly above, endoscopic assembly 300 further includes a guide coil or spring 330 fixedly disposed within at least a distal portion of outer tube 310.
  • Inner tube 320 includes a proximal end portion 320a and a splined distal end portion 320b, and defines a lumen 320c therethrough.
  • Distal end portion 320b of inner tube 320 is slotted, defining a pair of opposed tines 320b i and a pair of opposed channels 320b 2 .
  • Distal end portion 320b of inner tube 320 is capable of accepting a plurality of anchors 100 within inner tube 320.
  • anchors 100 are loaded into endoscopic assembly 300 such that the pair of opposing threaded sections 112a, 112b (FIG.
  • anchors 100 extend through respective channels 320b 2 of distal end portion 320b of inner tube 320 and are slidably disposed within the groove of coil 330, and the pair of tines 320bi of distal end portion 320b of inner tube 320 are disposed within the pair of slotted sections 116a, 116b (FIG. 3) of anchors 100.
  • Connector 340 has an outer connector member 342 non-rotatably connected to proximal end 310a of outer tube 310, and an inner connector member 344 non-rotatably connected to proximal end 320a of inner tube 320.
  • Inner connector member 344 is substantially cylindrical and defines at least one longitudinally extending inner rib 344a projecting radially into a lumen thereof.
  • Inner connector member 344 is nested within outer connector member 342.
  • Outer connector member 342 is substantially cylindrical and defines at least one longitudinally extending outer radial groove 342a that extends through a proximal end thereof, and at least one longitudinally extending inner groove 342b.
  • Outer connector member 342 is sized and shaped to be inserted into a distal opening of ferrule 218 of handle assembly 210, as shown in FIG. 6.
  • the distal end of drive shaft 232 enters into inner connector member 344 such that the at least one longitudinally extending inner rib 344a of inner connector member 344 mechanically engages or meshes with the plurality of axially extending ribs 232a (FIG.
  • Endoscopic assembly 300 includes a shipping wedge, plug or cap 350 configured and adapted for selective connection to connector 340.
  • Cap 350 includes an end wall 352, at least one leg 354 extending from end wall 352 and being configured and dimensioned for selective receipt in a respective longitudinally extending outer radial groove 342a of outer connector member 342, and a stem (not shown) extending from end wall 352 and being configured and dimensioned for selective receipt into inner connector member 344 for engagement with longitudinally extending inner rib(s) 344a of inner connector member 344.
  • the at least one leg 354 and the stem of cap 350 engage outer connector member 342 and inner connector member 344 to prevent their rotation relative to one another.
  • Cap 350 is used to fix the radial position of inner tube 320 relative to outer tube 310 and thus ensure that the stack of surgical anchors 100 are not prematurely advanced through endoscopic assembly 300 prior to connection of endoscopic assembly 300 to handle assembly 210. If the stack of surgical anchors 100 are advanced through endoscopic assembly 300, prior to connection of endoscopic assembly 300 to handle assembly 210, a timing of the firing of tack applier 200 may be effected, whereby each fully stroke of trigger 214 may either not fully fire a surgical anchor 100 from endoscopic assembly 300 or may begin to fire a second surgical anchor 100 from endoscopic assembly 300.
  • the components of surgical tacker 200, and anchors 100 are dimensioned such that a single complete and full actuation of trigger 214 results in a firing of a single anchor 100 (i.e., the distal-most anchor of the stack of anchors 100 loaded in endoscopic assembly 300) from endoscopic assembly 300.
  • Surgical tacker 200 may be repeatedly fired to fire anchors from endoscopic assembly 300 until the surgical procedure is complete or until endoscopic assembly 300 is spent of anchors 100. If endoscopic assembly 300 is spent of anchors 100, and if additional anchors 100 are required to complete the surgical procedure, spent endoscopic assembly 300 may be replaced with a new (i.e., loaded with anchors 100) endoscopic assembly 300. Alternatively, is it is desired to change the types of anchors 100 that are being used in the surgical procedure, non-spent endoscopic assembly 300 (loaded with a first type of anchors 100) may be replaced with another endoscopic assembly 300 (loaded with a second, different type of anchors 100).
  • endoscopic assemblies 300 may be provided, wherein endoscopic assemblies may be available which are loaded with surgical anchors fabricated from different materials (e.g., bioabsorbable, permanent, etc.), or endoscopic assemblies may be available having different lengths (e.g., short, medium, long, etc.) wherein the particular length endoscopic assembly is loaded with a respective number of surgical anchors.
  • endoscopic assemblies may be available which are loaded with surgical anchors fabricated from different materials (e.g., bioabsorbable, permanent, etc.), or endoscopic assemblies may be available having different lengths (e.g., short, medium, long, etc.) wherein the particular length endoscopic assembly is loaded with a respective number of surgical anchors.
  • the surgeon may select any one or combination of endoscopic assemblies desired or needed, and the surgeon may interchange or exchange endoscopic assemblies as needed or desired during the surgical procedure.

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  • Surgical Instruments (AREA)

Abstract

La présente invention concerne un dispositif chirurgical mini-invasif (200) qui comprend un ensemble poignée (210) et un ensemble endoscopique (300) pouvant être sélectivement raccordé à l'ensemble poignée (210) et comprenant des ancres chirurgicales (100) chargées à l'intérieur d'une lumière de celui-ci. L'ensemble poignée (210) comprend un déclencheur (214) raccordé de manière fonctionnelle à un boîtier de poignée (212). Un engrenage d'embrayage (226) est disposé à l'intérieur du logement de poignée (212) et est rotatif autour d'un arbre de pivotement (221) par l'actionnement de la gâchette (214). L'engrenage d'embrayage (226) comprend une roue d'engrenage ayant des dents d'engrenage (226a 1) et une plaque d'engrenage (226b) comprenant une goupille de sélecteur à ressort (227) s'étendant radialement vers l'extérieur de la plaque d'engrenage (226b). Un engrenage conique (228) est rotatif autour de l'arbre de pivotement (221) et comprend un bloc de came arqué réduisant progressivement (228a) ayant une paroi pour entrer en prise sélective avec la goupille de sélecteur (227) de l'engrenage d'embrayage (226). Un pignon (230) est fixé non rotatif à un arbre d'entraînement (232) s'étendant de manière distale depuis le boîtier de poignée (212) et comprend des dents d'engrenage (230a) en prise fonctionnelle avec les dents d'engrenage (228c) de l'engrenage conique (228).
PCT/CN2014/081646 2014-07-04 2014-07-04 Appareil d'application d'agrafes chirurgicales et procédés pour procédures endoscopiques Ceased WO2016000255A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
CN201480080258.5A CN106470630B (zh) 2014-07-04 2014-07-04 用于内窥镜程序的外科紧固件施加装置和方法
PCT/CN2014/081646 WO2016000255A1 (fr) 2014-07-04 2014-07-04 Appareil d'application d'agrafes chirurgicales et procédés pour procédures endoscopiques

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PCT/CN2014/081646 WO2016000255A1 (fr) 2014-07-04 2014-07-04 Appareil d'application d'agrafes chirurgicales et procédés pour procédures endoscopiques

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WO2016000255A1 true WO2016000255A1 (fr) 2016-01-07

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US10335146B2 (en) * 2014-04-02 2019-07-02 Coviden Lp Surgical fastener applying apparatus, kits and methods for endoscopic procedures
US10159471B2 (en) 2015-05-13 2018-12-25 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US10772613B2 (en) 2015-05-13 2020-09-15 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US11389143B2 (en) 2015-05-13 2022-07-19 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US12048424B2 (en) 2015-05-13 2024-07-30 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US10405858B2 (en) 2015-06-30 2019-09-10 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US11147550B2 (en) 2015-06-30 2021-10-19 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US11751868B2 (en) 2015-06-30 2023-09-12 C.R. Bard, Inc. Actuation lockout for a surgical instrument
US12089839B2 (en) 2015-06-30 2024-09-17 C.R. Bard, Inc. Actuation lockout for a surgical instrument

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