Positioning guide for surgical instruments and surgical instrument systems

A surgical instrument system includes a surgical fastener applier and a positioning guide. The positioning guide includes an implant guide. The implant guide defines a guide channel configured to receive a portion of an implant to support the implant relative to the end effector to enable the surgical fastener applier to fire one or more fasteners through the implant for securing the implant to tissue.

BACKGROUND

Many surgical procedures are performed through small incisions in an effort to reduce a patient's trauma and recovery time. Such procedures are generally referred to as minimally invasive. During a typical minimally invasive procedure, surgical instruments with end effectors, which may be robotic or handheld instruments, are inserted into the patient's body to access a target site in the patient's body, for example, to secure an implant at the target site.

SUMMARY

According to one aspect, this disclosure is directed to a surgical instrument system including a surgical fastener applier and a positioning guide. The surgical fastener applier includes an end effector configured to support one or more fasteners. The positioning guide is selectively mountable to the end effector. The positioning guide includes an implant guide. The implant guide defines a guide channel configured to receive a portion of an implant to support the implant relative to the end effector to enable the surgical fastener applier to fire the one or more fasteners through the implant for securing the implant to tissue.

In embodiments, the positioning guide may include an elongated body with the implant guide supported on a distal end portion of the elongated body. The elongated body may include an arched configuration that defines a passage therethrough positioned to receive the end effector.

In various embodiments, the positioning guide may include a distal abutment configured to act as a limit stop for the end effector when the positioning guide is mounted on the end effector. The positioning guide may include a guide rib supported on the distal abutment.

In some embodiments, the implant guide may have a C-shaped configuration.

In certain embodiments, the positioning guide may have a tubular configuration.

In embodiments, the guide channel is configured to receive one or more wings of the implant. The guide channel is configured to position an aperture defined through the one or more wings of the implant so that the aperture receives the one or more fasteners therethrough.

In various embodiments, the surgical fastener applier may be a tack applier and the one or more fasteners may include one or more tacks.

According to another aspect, this disclosure is directed to a positioning guide for a surgical instrument. The positioning guide includes an elongated body defining a passage therethrough configured to receive an end effector of the surgical instrument therein. The elongated body has a proximal end portion and a distal end portion. The distal end portion supports an implant guide. The implant guide defines a guide channel configured to receive a portion of an implant to support an aperture of the implant in registration with a longitudinal axis of the end effector.

In embodiments, the elongated body may have a tubular configuration.

In various embodiments, the elongated body may include a rail extending along an outer surface thereof. The rail may be connected to the implant guide.

According to yet another aspect, this disclosure is directed to an endoscopic surgical tack applier system. The endoscopic surgical tack applier system includes an endoscopic surgical tack applier and a positioning guide. The endoscopic surgical tack applier includes an end effector configured to support one or more tacks. The positioning guide is selectively removable from the end effector. The positioning guide includes an implant guide configured to support an implant adjacent to a distal end portion of the end effector such that an aperture of a wing of the implant is disposed in registration with the one or more tacks when the one or more tacks are supported by the end effector.

In embodiments, at least the implant guide may include a C-shaped cross-section.

The details of one or more aspects of this disclosure are set forth in the accompanying drawings and the description below. Other aspects, features, and advantages will be apparent from the description, the drawings, and the claims that follow.

DETAILED DESCRIPTION

Embodiments of this disclosure are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As commonly known, the term “clinician” refers to a doctor (e.g., a surgeon), a nurse, or any other care provider and may include support personnel. Additionally, the term “proximal” refers to the portion of structure that is closer to the clinician and the term “distal” refers to the portion of structure that is farther from the clinician.

In the following description, well-known functions or constructions are not described in detail to avoid obscuring this disclosure in unnecessary detail.

With reference toFIGS. 1-8, a surgical fastener applier10, which may be an endoscopic surgical instrument such as a surgical tack applier, generally includes a handle assembly12, an elongate shaft assembly14that extends distally from handle assembly12, and an end effector16supported on distal end portion of elongated shaft assembly14. End effector16is operable to fire one or more fasteners30therefrom upon an actuation of a movable handle12arelative to a stationary handle12bof handle assembly12. Fasteners30, which may be in the form of tacks, can include any suitable tack such as a standard purchase tack or a deep purchase tack.

Surgical fastener applier10can be provided as part of a surgical system. The surgical system further includes an implant40and/or a positioning guide50. Positioning guide50, which may be in the form of a positioning guide cuff, is selectively attachable to an outer surface of end effector16of surgical fastener applier10to facilitate positioning of implant40relative to end effector16for consistently and accurately firing fasteners30through implant40to secure implant40to tissue “T” (seeFIGS. 4-8) such as lumbar fascia. Positioning guide50may be removably attached to an outer surface of end effector16using any suitable technique such as snap-fit, slide-on, friction-fit, clip-on, etc.

As seen inFIG. 3, implant40of the surgical system includes a tubular body42having a first wing44and a second wing46that extend from opposite sides of tubular body42. Tubular body42of implant40may support one or more electrical leads (not shown) for facilitating nerve stimulation. First wing44of implant40defines a first aperture44atherethrough and second wing46of implant40defines a second aperture46atherethrough. First and second apertures44a,46aof respective first and second wings44,46are configured to receive fasteners30of surgical fastener applier10therethrough such that fasteners30contact first and/or second wings44,46to secure implant40to tissue “T.” Positioning guide50of the surgical system can be rotatably positioned on end effector16of surgical fastener applier10, as indicated by arrows “R,” so that positioning guide50can accommodate first and/or second wings44,46of implant40in various orientations relative to tissue “T.” First and/or second wings44,46, which may have a circular or rounded configuration, may be, additionally and/or alternatively sutured to the tissue “T.”

Positioning guide50of the surgical system includes an elongated body52having a proximal end portion52aand a distal end portion52b. Elongated body52of positioning guide50has an arched configuration (e.g., a C-shaped cross-section along a length of elongated body52) and defines a passage52c, which may be in the form of an open channel, to facilitate selective securement to end effector16of surgical fastener applier10so that end effector16is received within passage52cof positioning guide50. Although shown as having a C-shaped configuration, elongated body52of positioning guide50may have any suitable geometrical configuration for receiving and/or accommodating any suitable geometrical configuration of end effector16of surgical fastener applier10. Positioning guide52further includes an inner surface52dthat defines passage52cand an outer surface52ehaving a rail52fthat extends longitudinally along elongated body52of positioning guide50.

Positioning guide50of the surgical system further includes a distal abutment54at the distal end portion52bof positioning guide50that is configured to engage a distal end of end effector16of surgical fastener applier10for functioning as a limit stop when positioning guide50is mounted on end effector16. Distal abutment54of positioning guide50, which also includes an arched configuration (e.g., C-shaped cross-section), projects radially inward from inner surface52dof elongated body52of positioning guide50to act as a limit stop for a distal end portion of end effector16of surgical fastener applier10. Distal abutment54defines opening54ain registration with passage52cof elongated body52of positioning guide50. Opening54aof distal abutment54is positioned to align with a distal opening16aof end effector16(e.g., concentrically) to enable fasteners30of surgical fastener applier10to be fired therethrough. Distal abutment54includes an inner face54bon a proximal end thereof and an outer face54con a distal end thereof.

Positioning guide50of the surgical system further includes an implant guide56that extends along a portion of an outer edge of elongated body52of positioning guide50distal to distal abutment54thereof. Implant guide56of positioning guide50has an arched configuration (e.g., C-shaped) and includes an inner guide surface56aand an outer surface56b. Implant guide56includes a proximal face56cand a distal face56dconfigured to abut tissue “T.” Implant guide56extends radially outward of outer surface52eof elongated body52of positioning guide50so that proximal face56cof implant guide56is an exposed outer surface. Rail52fof positioning guide52is integrally connected to implant guide56to secure implant guide56to distal end portion52bof positioning guide50. Rail52fis configured to provide support or strength (e.g., longitudinally) to positioning guide50. Implant guide56is positioned relative to distal abutment54so that inner guide surface56aof implant guide56and outer face54cof distal abutment54define a guide channel58. Guide channel58is configured to receive one of first or second wings44,46of implant40so that positioning guide50enables the respective first or second aperture44a,46aof implant40to axially align with a central longitudinal axis “L-L” of surgical fastener applier10(e.g., concentrically) for facilitating securement of fasteners30and implant40to tissue “T.”

In use, with positioning guide50mounted on end effector16of surgical fastener applier10and oriented in a first direction to accommodate first wing44of implant40, first wing44of implant40can be received in guide channel58of positioning guide50so that a first fastener30aof surgical fastener applier10can be fired through first aperture44aof first wing44and into tissue “T.” Positioning guide50can then be rotated about end effector16, as indicated by arrows “R” (FIG. 2), so that implant guide56of positioning guide50is oriented in a second direction, which may be opposite to the first direction (e.g., 180 degree rotation), to accommodate second wing46of implant40. In this position, second wing46can be received in guide channel58of positioning guide50so that a second fastener30bof surgical fastener applier10can be fired through second aperture46aof second wing46and into tissue “T” to further secure implant40to tissue “T.” The positioning guide50can be removed from surgical fastener applier10as desired. The positioning guide50can be disposable and/or reusable.

By way of example, implant40may be an anchor for positioning a therapy device within a desired location of the patient. The desired location may be within or along a spinal canal or cord of a patient or along other desired areas within the patient. Such therapy devices can include, for instance, a pacemaker, a defibrillator, a monitoring device, an infusion device, a neurostimulator, a gastric stimulator, a cochlear device, spinal implant or the like.

With reference toFIGS. 9-11, another embodiment of a positioning guide100, which may be provided in the form a tubular positioning guide, similar to positioning guide50, is configured for selective attachment to end effector16of surgical fastener applier10. Positioning guide100includes a tubular body102supporting an implant guide104on a distal end portion thereof. Tubular body102of positioning guide100includes an inner surface102aand an outer surface102b. Inner surface102adefines a central passage103and includes a tapered portion102con a proximal end portion thereof to facilitate receipt of a distal end portion of end effector16within central passage103of positioning guide100. Positioning guide100further includes a distal abutment106having a guide rib108projecting distally therefrom. Guide rib108, which may include a reversed C-shape, is disposed in opposed relation with implant guide104of positioning guide100and includes a reduce profile relative to implant guide104to facilitate positioning of implant40relative to implant guide104.

In some embodiments, the disclosed implant guides may be selectively removable from the disclosed positioning guides. For example, implant guide104may be selectively secured to positioning guide100using any suitable mechanical securement technique such as snap-fit, fastening, adhesive, magnetics, etc.

The various embodiments disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc.

The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of clinicians may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another clinician (or group of clinicians) remotely controls the instruments via the robotic surgical system. As can be appreciated, a highly skilled clinician may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients.

Securement of any of the components of the disclosed devices may be effectuated using known securement techniques such welding, crimping, gluing, heat-shrinking, fastening, etc.

Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. This disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of this disclosure, and that such modifications and variations are also included within the scope of this disclosure. Accordingly, the subject matter of this disclosure is not limited by what has been particularly shown and described.