Surgical stapling apparatus comprising a tissue stop

A surgical stapling apparatus is disclosed. The surgical stapling apparatus comprises a cartridge body. The cartridge body comprises a deck comprising a tissue-supporting surface, a slot defined in the deck, and a plurality of staple cavities. The slot extends from a proximal end toward a distal end. The surgical stapling apparatus further comprises a plurality of staples removably stored in the staple cavities and a tissue stop positioned in the slot. The tissue stop comprises a detent releasably engaged with the cartridge body. The detent is configured to release from the cartridge body to permit the tissue stop to move from an undisplaced position to a displaced position.

BACKGROUND

The present invention relates to stapling instruments and, in various embodiments, to a surgical stapling instrument for producing one or more rows of staples.

A stapling instrument can include a pair of cooperating elongate jaw members, wherein each jaw member can be adapted to be inserted into a patient and positioned relative to tissue that is to be stapled and/or incised. In various embodiments, one of the jaw members can support a staple cartridge with at least two laterally spaced rows of staples contained therein, and the other jaw member can support an anvil with staple-forming pockets aligned with the rows of staples in the staple cartridge. Generally, the stapling instrument can further include a pusher bar and a knife blade which are slidable relative to the jaw members to sequentially eject the staples from the staple cartridge via camming surfaces on the pusher bar and/or camming surfaces on a wedge sled that is pushed by the pusher bar. In at least one embodiment, the camming surfaces can be configured to activate a plurality of staple drivers carried by the cartridge and associated with the staples in order to push the staples against the anvil and form laterally spaced rows of deformed staples in the tissue gripped between the jaw members. In at least one embodiment, the knife blade can trail the camming surfaces and cut the tissue along a line between the staple rows. Examples of such stapling instruments are disclosed in U.S. Pat. No. 7,794,475, entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, the entire disclosure of which is hereby incorporated by reference herein.

The foregoing discussion is intended only to illustrate various aspects of the related art in the field of the invention at the time, and should not be taken as a disavowal of claim scope.

DETAILED DESCRIPTION

A surgical stapling system100is depicted inFIGS. 1-7. Referring primarily toFIG. 1, the surgical stapling system100comprises a shaft120and an end effector110extending from the shaft120. The end effector110comprises a first jaw112and a second jaw114. The first jaw112comprises a staple cartridge140. The staple cartridge140is insertable into and removable from the first jaw112; however, other embodiments are envisioned in which a staple cartridge is not removable from, or at least readily replaceable from, the first jaw112. The second jaw114comprises an anvil130configured to deform staples ejected from the staple cartridge140. The second jaw114is pivotable relative to the first jaw112about a closure axis131; however, other embodiments are envisioned in which first jaw112is pivotable relative to the second jaw114. The surgical stapling system100further comprises an articulation joint150configured to permit the end effector110to be rotated, or articulated, relative to the shaft120. The end effector110is rotatable about an articulation axis151extending through the articulation joint150. The articulation axis151is orthogonal to a longitudinal axis121of the shaft120and a longitudinal axis111of the end effector110.

Referring primarily toFIG. 2, the staple cartridge140comprises a cartridge body142. The cartridge body142includes a proximal end148, a distal end149, and a deck141extending between the proximal end148and the distal end149. In use, the staple cartridge140is positioned on a first side of the tissue to be stapled and the anvil130is positioned on a second side of the tissue. The anvil130is moved toward the staple cartridge140to compress and clamp the tissue against the deck141. Thereafter, staples removably stored in the cartridge body142can be deployed into the tissue. The cartridge body142includes staple cavities145defined therein wherein staples185(FIG. 10) are removably stored in the staple cavities145. The staple cavities145are arranged in six longitudinal rows. Three rows of staple cavities145are positioned on a first side of a longitudinal slot143and three rows of staple cavities145are positioned on a second side of the longitudinal slot143. Other arrangements of staple cavities145and staples185may be possible.

Referring again toFIG. 2, the staples185are supported by staple drivers180in the cartridge body142. The drivers180are movable between a first, or unfired position, and a second, or fired, position to eject the staples185from the staple cavities145. The drivers180are retained in the cartridge body142by a retainer144which extends around the bottom of the cartridge body142and includes resilient members147configured to grip the cartridge body142and hold the retainer144to the cartridge body142. The drivers180are movable between their unfired positions and their fired positions by a sled170. The sled170is movable between a proximal position adjacent the proximal end148and a distal position adjacent the distal end149. The sled170comprises a plurality of ramped surfaces175configured to slide under the drivers180and lift the drivers180, and the staples185supported thereon, toward the anvil130.

Further to the above, the sled170is moved distally by a firing member160. The firing member160is configured to contact the sled170and push the sled170toward the distal end149. The longitudinal slot143defined in the cartridge body142is configured to receive the firing member160. Referring primarily toFIG. 5, the anvil130also includes a slot134configured to receive the firing member160. The firing member160further comprises a first cam162which engages the first jaw112and a second cam164which engages the second jaw114. As the firing member160is advanced distally, the first cam162and the second cam164can control the distance, or tissue gap, between the deck141of the staple cartridge140and the anvil130. The firing member160also comprises a knife163configured to incise the tissue captured intermediate the staple cartridge140and the anvil130. It is desirable for the knife163to be positioned at least partially proximal to the ramped surfaces175such that the staples185are ejected ahead of the knife163.

Further to the above, the knife163applies a longitudinal force to the tissue as the firing member160is moved distally toward the distal end149. It should be understood that, while the knife163transects the tissue as the firing member160is moved distally, the knife163may also push the tissue distally toward the distal end149of the staple cartridge140. In various circumstances, as a result, a portion of the tissue that the surgeon intended to staple may not be stapled. As discussed in greater detail below, the surgical stapling system100includes a tissue stop configured to impede and/or prevent the flow of tissue out of the distal end of the surgical stapling system100.

Referring primarily toFIGS. 3 and 4, the staple cartridge140includes a tissue stop190. The tissue stop190is positioned in the longitudinal slot143defined in the cartridge body142. More specifically, the tissue stop190includes a pin portion198positioned in a pin aperture146defined in the longitudinal slot143. The pin portion198is closely received in the pin aperture146. The tissue stop190further includes a head192which extends above the deck141. In various instances, referring primarily toFIG. 6, the anvil130can directly contact, or abut, the head192of the tissue stop190. In such instances, the tissue stop190can comprise an anvil stop. In some such instances, which are described in greater detail further below, the anvil130and the tissue stop190can trap tissue between the anvil130and the staple cartridge140when the anvil130is moved into a closed position. In other circumstances, tissue may be positioned intermediate the head192of the tissue stop190and the anvil130. In some such circumstances, the anvil130can compress the tissue against the tissue stop190when the anvil130is moved into a closed position. Alternative embodiments are envisioned in which the staple cartridge is movable relative to the anvil. In such circumstances, the tissue stop can be moved toward the tissue when the surgical stapling system is closed.

As discussed above, the knife163can push the tissue toward the tissue stop190as the knife163transects the tissue. The tissue stop190can inhibit and/or prevent the longitudinal flow of the tissue. The tissue stop190can dam the longitudinal flow of tissue. When the firing member160is moved from its proximal-most position toward its distal-most position (FIG. 5), the tissue can be pushed against the tissue stop190wherein an internal pressure and/or structural impedance can be generated within the tissue. The tissue stop190can provide a backstop. The head192of the tissue stop190is longitudinally-aligned with the knife163such that the tissue stop190can stop the flow of tissue along the cutting path of the knife163. The tissue stop190includes a detent196configured to hold the tissue stop190in the pin aperture146. The detent196can comprise one or more annular lips extending around the tissue stop190which are engaged with an edge defined on the cartridge body142, for example. The detent196can inhibit the tissue stop190from lifting out of the pin aperture146. In various embodiments, the tissue stop190and the pin aperture146can be configured and arranged such that the tissue stop190does not move relative to the cartridge deck141. Other embodiments are envisioned in which the tissue stop190can move relative to the cartridge deck141.

As the firing member160is advanced distally toward the tissue stop190, as discussed above, the knife163can approach the tissue stop190. The tissue stop190comprises a slot, or catch,194defined therein configured to at least partially receive the knife163. In various instances, the knife163can abut the head192of the tissue stop190when the firing member160has reached its distal-most position. When the knife163contacts the tissue stop190, the tissue stop190can also serve as a knife stop. When the knife163is in contact with the tissue stop190, the firing member160can be prevented from being advanced further distally. In the event that the firing member160is being advanced by a manually-actuated firing trigger extending from the handle of the surgical instrument, the surgeon operating the surgical instrument can sense that the firing member160has been fully advanced when the knife163contacts the tissue stop160. At such point, the surgeon can operate the surgical instrument to retract the firing member160. In the event that the firing member160is being advanced by an electric motor, a computer or processor operating the electric motor can be configured to detect a sudden increase in force experienced by the firing member160and/or a sudden increase in torque generated by the electric motor and, in response thereto, determine that the firing stroke of the firing member160has been completed and/or automatically retract the firing member160proximally.

The tissue stop190is comprised of plastic, for example; however, the tissue stop190can be comprised of any suitable material. When the tissue stop190is configured to serve as a knife stop, the tissue stop190can be comprised of a material that can resist, or at least substantially resist, the incising force applied thereto by the knife163. When the knife163is not readily replaceable, it is desirable to fabricate the tissue stop190out of a material that will not damage the knife163. The knife163may not be readily replaceable when the knife163is part of the surgical stapling instrument, and not part of the replaceable cartridge. When the knife163is, in fact, part of the replaceable cartridge, damage to the knife163from contacting the tissue stop190may be less of a concern as the damage to the knife163would not occur until the end of the firing stroke and the knife163would not be used to cut tissue thereafter.

In addition to or in lieu of the tissue stop190acting as a knife stop, referring again toFIG. 5, the distal end149of the cartridge body142can serve as a distal stop for the firing member160. More specifically, the firing member160can push the sled170distally until it contacts an interior distal wall172of the distal end149and, at such point, the distal advancement of the firing member160, and the sled170, can be impeded.

In various instances, further to the above, the tissue stop190may not deflect or displace downwardly within the pin aperture146. In such instances, the tissue stop190can withstand the downward clamping force applied thereto when the anvil130is moved into a closed position and, in addition, the downward compression force applied thereto when the anvil130is moved downwardly toward the cartridge140by the firing member160. As discussed above, the firing member160comprises a first cam162configured to engage the first jaw112and a second cam164configured to engage the second jaw114wherein, when the firing member160is advanced distally, the firing member160can pull the anvil130toward the cartridge140and apply a compressive force to, one, the tissue captured between the anvil130and the cartridge140and, two, the tissue stop190. The compressive force applied to the tissue stop190by the firing member160can increase as the firing member160is advanced distally. For instance, the firing member160can apply an initial compressive force to the tissue stop190at the beginning of the firing stroke and a maximum compressive force to the tissue stop190when the firing member160reaches the end of its firing stroke. The interaction between the detent196and the cartridge body142can be sufficient to support the tissue stop190in position throughout the firing stroke of the firing member160.

In various other instances, further to the above, the tissue stop190may deflect and/or displace downwardly within the pin aperture146. The tissue stop190can be slidably mounted in the pin aperture146, for example. In at least one instance, the tissue stop190can withstand the downward clamping force applied thereto when the anvil130is moved into a closed position and then deflect and/or displace downwardly during the firing stroke of the firing member160. In some instances, the tissue stop190can deflect and/or displace downwardly as a result of the initial compressive force applied to the tissue stop190at the beginning of the firing stroke of the firing member160. In such instances, the tissue stop190comprises a feature which resists recessing under a load less than the load experienced during the firing stroke. In certain instances, the tissue stop190can deflect and/or displace downwardly as a result of the maximum compressive force applied to the tissue stop190at the end of the firing stroke of the firing member160. In other instances, the tissue stop190can deflect and/or displace downwardly when the firing member160is between the beginning and the end of the firing stroke. In embodiments including the detent196, the detent196can be configured to hold the tissue stop190in position until the compressive force applied to the tissue stop190exceeds a threshold force. At such point, the detent196can be defeated and the tissue stop190can move downwardly into the pin aperture146. In various embodiments, the head192of the tissue stop190may recede entirely below the deck141of the cartridge140while, in other embodiments, the head192may not recede entirely below the deck141. Even though the tissue stop190may give way during the firing stroke of the firing member160, the tissue stop190may still perform the function of preventing and/or limiting the distal flow of the tissue before it gives way. At such point, a portion of the firing stroke, and possibly a large portion of the firing stroke, may have been completed.

In addition to or in lieu of the detent196, a support can be positioned under the tissue stop190to prevent the tissue stop190from deflecting and/or displacing downwardly. The support can be pushed distally by the firing member160during the firing stroke of the firing member160such that the support no longer supports the tissue stop190and, as a result, the tissue stop190can give way or recess during the firing stroke of the firing member160, as discussed above. In various instances, the support can be pushed out of the way at the end of the firing stroke of the firing member160, for example. In other instances, the support can be pushed out of the way prior to the end of the firing stroke of the firing member160. The support can be comprised of foam, for example. In various instances, the support can be comprised of a resilient material which can permit the tissue stop190to partially recess under a compressive load until the support is pushed out from underneath the tissue stop190. In certain instances, the support can be comprised of a rigid material which does not permit the tissue stop190to recess, or at least substantially recess, until the support is pushed out from underneath the tissue stop190.

The tissue stop190further comprises a slot193defined therein. The slot193is a clearance slot configured to receive a portion of the firing member160as the firing member160moves distally.

The head192of the tissue stop190can comprise any suitable configuration. In various instances, the head192can comprise a substantially cylindrical configuration, for example. In some instances, the head192can comprise a substantially rectangular configuration, for example. Such a rectangular shape can utilize the space in between the innermost rows of drivers and can be guided by the side walls of the cartridge slot143. The head192can comprise rounded edges and/or surfaces which can reduce the pressure or stress applied to the tissue.

Referring again to the staple cartridge140depicted inFIG. 2, the staple cavities145defined in the staple cartridge140are arranged in three parallel rows on a first side of the longitudinal slot143which are parallel to the longitudinal slot143and three parallel rows on a second side of the longitudinal slot143which are also parallel to the longitudinal slot143. On each side of the longitudinal slot143, a first row of staple cavities184′ is adjacent the longitudinal slot143, a second row of staple cavities184″ is adjacent the first row of staple cavities184′, and a third row of staple cavities184′″ is adjacent the second row of staple cavities184″. The staple cavities145deploy an array of staples which include overlapping staples. With particular regard to the staple cavities145in the first row of staple cavities184′, a gap is present between adjacent staple cavities145within the first row184′; however, such gaps are laterally overlapped by staple cavities145in the second row of staple cavities184″. Similarly, a gap is present between adjacent staple cavities145in the second row of staple cavities184″ wherein such gaps are laterally overlapped by staple cavities185in the third row of staple cavities184′″.

A staple cartridge240is depicted inFIG. 8. The staple cartridge240is similar to the staple cartridge140in many respects and can be used as part of the surgical stapling system100discussed above. When a staple cartridge240is used with the surgical stapling system100, such a system can be referred to as a surgical stapling system200(FIG. 9). The staple cartridge240comprises a cartridge body242, a deck241defined on the cartridge body242, a longitudinal slot243, a proximal end248, and a distal end249. The cartridge body242includes a plurality of first staple cavities245a, a plurality of second staple cavities245b, and a plurality of third staple cavities245cdefined therein. The first staple cavities245aeach include a first staple285aremovably stored therein. The second staple cavities245beach include a second staple285bremovably stored therein. The third staple cavities245ceach include a third staple285cremovably stored therein. The first staples285aare different than the second staples285band the third staples285c. The second staples285bare different than the third staples285c. The first staples285a, the second staples285b, and the third staples285cdefine an advantageous staple pattern, as described in greater detail further below.

The staple cavities245a-245c, and the staples285a-285cpositioned therein, are arranged in three longitudinal rows on a first side of the longitudinal slot243and three longitudinal rows on a second side of the longitudinal slot243. The three longitudinal rows of staple cavities245a-245c, and staples285a-285c, on the second side of the longitudinal slot243are a mirror image of three longitudinal rows of staple cavities245a-245c, and staples285a-285c, on the first side of the longitudinal slot243; however, alternative embodiments are envisioned in which the second side is not a mirror image of the first side. Referring again toFIG. 8, a first longitudinal row of staple cavities284′ is adjacent the longitudinal slot283, a second longitudinal row of staple cavities284″ is adjacent the first longitudinal row of staple cavities284′, and a third longitudinal row of staple cavities284′″ is adjacent the second longitudinal row of staple cavities284″. The first longitudinal row284′, the second longitudinal row284″, and the third longitudinal row284′″ are parallel to each other and to the longitudinal slot243; however, alternative embodiments are envisioned in which the first longitudinal row284′, the second longitudinal row284″, and/or the third longitudinal row284′″ are not parallel to each other and/or to the longitudinal slot243.

The first longitudinal row284′ comprises two first staple cavities245aat a proximal end thereof and, in addition, two first staple cavities245aat a distal end thereof. A large longitudinal gap is present between the proximal first staple cavities245aand the distal first staple cavities245ain the first row284′. This large longitudinal gap is large enough such that more than one first staple cavity245acould be positioned therein. Stated another way, if a pattern of first staple cavities245awere arranged in the first row284′ at regular intervals, several of the first staple cavities245aare missing, or not present, within the large longitudinal gap. The first longitudinal row of staple cavities284′ comprises an interruption in the pattern of staple cavities. The interruption comprises an absence of staple cavities. As a result, the first longitudinal row of staples comprises an interruption in the pattern of staples. This interruption comprises an absence of staples.

Similar to the above, the second longitudinal row284″ comprises two first staple cavities245aat a proximal end thereof and, in addition, two first staple cavities245aat a distal end thereof. A large longitudinal gap is present between the proximal first staple cavities245aand the distal first staple cavities245ain the second row284″. This large longitudinal gap is large enough such that more than one first staple cavity245acould be positioned therein. Stated another way, if a pattern of first staple cavities245awere arranged in the second row284″ at regular intervals, several of the first staple cavities245aare missing, or not present, within the large longitudinal gap. The second longitudinal row of staple cavities284″ comprises an interruption in the pattern of staple cavities. The interruption comprises and an absence of staple cavities. As a result, the second longitudinal row of staples comprises an interruption in the pattern of staples. This interruption comprises an absence of staples.

The third longitudinal row284′″ comprises two second staple cavities245bat a proximal end thereof and, in addition, two second staple cavities245bat a distal end thereof. The third row284′″ further comprises third staple cavities245cpositioned intermediate the proximal second staple cavities245band the distal second staple cavities245b. As illustrated inFIG. 8, the third staple cavities245care longitudinally wider than the second staple cavities245b. The wider third staple cavities245ccomprise a disruption in the pattern of second staple cavities245bin the third row284″. The second staple cavities245band the third staple cavities245ccomprise a continuous, albeit disrupted, pattern of staple cavities. As also illustrated inFIG. 8, the third staples285care longitudinally wider than the second staples285b. The wider third staples285ccomprise a disruption in the pattern of second staples285bin the third row284″. The second staples285band the third staples285ccomprise a continuous, albeit disrupted, pattern of staples.

Further to the above, and referring again toFIG. 8, the interruption, or longitudinal gap, in the first row of staple cavities284′ is aligned, or at least substantially aligned, with the interruption, or longitudinal gap, in the second row of staple cavities284″. As also illustrated inFIG. 8, the disruption in the third row of staple cavities284′″ is aligned, or at least substantially aligned, with the interruption, or longitudinal gap, in the second row of staple cavities284″ and the interruption, or longitudinal gap, in the first row of staple cavities284′. The third row of staple cavities284′″ includes staple cavities which span from the proximal end248to the distal end249of the staple cartridge240while the first row284′ and the second row284″ do not.

Referring again toFIG. 8, the first staples285aare comprised of wire, for example. The wire can be comprised of stainless steel and/or titanium, for example. The wire has a circular cross-section; however, alternative cross-sections may be utilized. Each first staple285acan comprise any suitable configuration such as, for example, a V-shaped configuration or a U-shaped configuration. A first staple285acomprising a V-shaped configuration can include a base, a first leg extending from a first end of the base, and a second leg extending from a second end of the base, wherein the first leg and the second leg extend in directions which are non-parallel to one another. A first staple285acomprising a U-shaped configuration can include a base, a first leg extending from a first end of the base, and a second leg extending from a second end of the base, wherein the first leg and the second leg extend in directions which are parallel to one another.

The second staples285bare comprised of wire, for example. The wire can be comprised of stainless steel and/or titanium, for example. The wire has a rectangular cross-section; however, alternative cross-sections may be utilized. Each second staple285bcan comprise any suitable configuration such as, for example, a V-shaped configuration or a U-shaped configuration. A second staple285bcomprising a V-shaped configuration can include a base, a first leg extending from a first end of the base, and a second leg extending from a second end of the base, wherein the first leg and the second leg extend in directions which are non-parallel to one another. A second staple285bcomprising a U-shaped configuration can include a base, a first leg extending from a first end of the base, and a second leg extending from a second end of the base, wherein the first leg and the second leg extend in directions which are parallel to one another.

The third staples285care comprised of wire, for example. The wire can be comprised of stainless steel and/or titanium, for example. The wire has a circular cross-section; however, alternative cross-sections may be utilized. Each third staple285ccan comprise any suitable configuration such as, for example, a V-shaped configuration or a U-shaped configuration. A third staple285ccomprising a V-shaped configuration can include a base, a first leg extending from a first end of the base, and a second leg extending from a second end of the base, wherein the first leg and the second leg extend in directions which are non-parallel to one another. A third staple285ccomprising a U-shaped configuration can include a base, a first leg extending from a first end of the base, and a second leg extending from a second end of the base, wherein the first leg and the second leg extend in directions which are parallel to one another.

As discussed above, the third staples285care longitudinally wider than the second staples285b. In various instances, the third staples285care twice as wide, longitudinally, than the second staples285b, for example. The third staples285ccan be at least twice as wide, longitudinally, than the second staples285b, for example. In some instances, the third staples285care thrice as wide, longitudinally, than the second staples285b, for example. Similar to the above, the third staples285care longitudinally wider than the first staples285a. In various instances, the third staples285care twice as wide, longitudinally, than the first staples285a, for example. The third staples285ccan be at least twice as wide, longitudinally, than the first staples285a, for example. In some instances, the third staples285care thrice as wide, longitudinally, than the first staples285a, for example. Other embodiments are envisioned in which the first staples285a, the second staples285b, and the third staples285ccomprise any suitable width.

The second staples285bare laterally wider than the third staples285c. In various instances, the second staples285bare twice as wide, laterally, than the third staples285c, for example. The second staples285bcan be at least twice as wide, laterally, than the third staples285c, for example. In some instances, the second staples285bare thrice as wide, longitudinally, than the third staples285c, for example. Similar to the above, the second staples285bare laterally wider than the first staples285a. In various instances, the second staples285bare twice as wide, laterally, than the first staples285a, for example. The second staples285bcan be at least twice as wide, laterally, than the first staples285a, for example. In some instances, the second staples285bare thrice as wide, laterally, than the first staples285a, for example. The second staples285bare comprised of thicker wire stock than the first staples285aand the third staples285c; however, other embodiments are envisioned in which the first staples285a, the second staples285b, and the third staples285ccomprise any suitable thickness.

The first staples285a, the second staples285b, and the third staples285chave the same unformed height; however, other embodiments are envisioned in which the first staples285ahave a different unformed height than the second staples and/or the third staples. Similarly, other embodiments are envisioned in which the second staples285bhave a different unformed height than the third staples285c. The first staples285a, the second staples285b, and the third staples285chave the same deformed height; however, other embodiments are envisioned in which the first staples285ahave a different deformed height than the second staples and/or the third staples. Similarly, other embodiments are envisioned in which the second staples285bhave a different deformed height than the third staples285c. The disclosures of U.S. Pat. No. 7,866,528, entitled STAPLE DRIVE ASSEMBLY, which issued on Jan. 1, 2011; U.S. Pat. No. 7,726,537, entitled SURGICAL STAPLER WITH UNIVERSAL ARTICULATION AND TISSUE PRE-CLAMP, which issued on Jun. 1, 2010; U.S. Pat. No. 7,641,091, entitled STAPLE DRIVE ASSEMBLY, which issued on Jan. 5, 2010; U.S. Pat. No. 7,635,074, entitled STAPLE DRIVE ASSEMBLY, which issued on Dec. 22, 2009; and U.S. Pat. No. 7,997,469, entitled STAPLE DRIVE ASSEMBLY, which issued on Aug. 16, 2011, are hereby incorporated by reference herein in their respective entireties.

The first staples285aand the second staples285bat the proximal ends of the rows284′,284″, and284′″ comprise a proximal sealing cluster configured to seal tissue positioned over the proximal end of the staple cartridge240. The first staples285aand the second staples285bat the distal ends of the rows284′,284″, and284′″ comprise a distal sealing cluster configured to seal tissue positioned over the distal end of the staple cartridge240. A sealing cluster of staples is configured to clamp the tissue and limit the flow of fluids, such as blood, for example, therethrough. A sealing cluster can also hold or bind the tissue together. The third staples285ccomprise a holding or binding cluster configured to hold or bind the tissue together. The holding or binding cluster may also seal the tissue; however, the hemostasis that can be achieved with only one row of staples can be limited in certain circumstances.

Referring again toFIG. 8, the staple cartridge240also includes a tissue stop190which is configured to perform the same function as the tissue stop190of the staple cartridge140, which is illustrated inFIG. 2. Referring again toFIG. 2, the distal-most staple cavities145and, thus, the distal-most staples185, are positioned laterally with respect to the tissue stop190. The tissue stop190extends proximally with respect to the distal ends of the first staple cavity row184′ and the third staple cavity row184′″. Such an arrangement stops the knife163proximally with respect to the distal-most staples185such that the knife163does not cut beyond the distal ends of the staple lines. Similarly, referring again toFIG. 8, the distal-most staple cavities245a-245cand, thus, the distal-most staples285a-285c, are positioned laterally with respect to the tissue stop190. The tissue stop extends proximally with respect to the distal end of at least one staple cavity row284′,284″, and284″. Such an arrangement stops the knife163proximally with respect to the distal-most staples285a-285csuch that the knife163does not cut beyond the distal ends of the staple lines. In various instances, the tissue stop190comprises a pin that extends or reaches into the staple pattern.

Turning now toFIGS. 9-12, a surgical technique for performing a surgical anastomosis is disclosed. In various instances, an anastomosis is performed to remove a section of a patient's gastrointestinal (GI) tract. As illustrated inFIG. 9, a surgical stapling system100can be attached to a surgical instrument101and inserted laparoscopically into the patient. The anvil130can be opened such that the anvil130and the staple cartridge140of the stapling system100are positioned relative to the patient's colon C. When the anvil130is moved into a closed position, the anvil130can clamp the colon C against the staple cartridge140. In various instances, the tissue stop190can be positioned on one side of the colon C such that, when the anvil130is closed, the colon C can be entirely trapped within the stapling system100.

As also illustrated inFIG. 9, a surgical stapling system200can be attached to a surgical instrument201and inserted laparoscopically into the patient. The anvil130can be opened such that the anvil130and the staple cartridge240of the stapling system200are positioned relative to the patient's colon C. When the anvil130is moved into a closed position, the anvil130can clamp the colon C against the staple cartridge240. In various instances, the tissue stop190can be positioned on one side of the colon C such that, when the anvil130is closed, the colon C can be entirely trapped within the stapling system200. At such point, a section C′ of the colon C can be intermediate the clamped first stapling system100and the clamped second stapling system200.

Turning now toFIG. 10, the first stapling system100can be operated to completely transect and staple the colon C at a first, or upper, location. Three rows184of the staples185are implanted on the upper side of the transection and three rows of the staples185are implanted in the colon section C′. The second stapling system200can be operated to completely transect and staple the colon C at a second, or lower, location. Three rows of staples, i.e., a first row284a, a second row285b, and a third row285c, are implanted on the lower side of the transection and three rows of staples, i.e., a first row284a, a second row285b, and a third row285c, are implanted in the colon section C′. Once the colon has been transected and stapled at the upper location and the lower location, the colon section C′ can be removed from the patient, as illustrated inFIG. 10.

Referring again toFIG. 10, a surgical stapling system300can be utilized to reconnect the upper portion and the lower portion of the colon C. A staple cartridge portion340of the stapling system300is inserted into the rectum R of the patient into the lower portion of the colon C. A connecting rod310extending from the stapling system300is then inserted through the staple line284cand the interruptions in the staples284aand284b. An anvil portion330of the stapling system300is positioned in the upper portion of the colon C. In various instances, the sidewall of the upper portion of the colon C can be incised and the anvil portion330can then be positioned inside the upper portion. A connection portion331of the anvil330can positioned such that it protrudes through the sidewall of the upper colon portion and can be connected to the connecting rod310of the staple cartridge portion340. Referring now toFIG. 11, the connecting rod310can be retracted to pull the anvil portion330toward the staple cartridge portion340and the upper colon portion toward the lower colon portion. The anvil portion330can be retracted until the tissue of the upper colon portion and the lower colon portion are compressed against the staple cartridge340.

The stapling assembly300comprises a circular stapling assembly. A circular stapling assembly can form one or more circular rings of staples in the tissue captured between the anvil portion330and the staple cartridge portion340. The staple cartridge340comprises a plurality of staples385removably stored therein which are pushed toward the anvil330by staple pushers380. The pushers380are pushed toward the anvil portion330by a firing member movably positioned in a shaft320of the stapling assembly300. The firing member also pushes a circular knife363toward the anvil portion330to transect the tissue positioned radially inwardly with respect to the staple lines created by the staple cartridge portion340. After the staples385have been fired and the tissue has been transected, the anvil portion330is disconnected from the connecting rod310. The cartridge portion340of the stapling assembly300is then withdrawn from the patient's rectum. The anvil portion330is removed from the patient's colon and the incision used to insert the anvil portion330into the colon is closed via suturing, for example. The transected tissue, discussed above, often takes the shape of an annular ring which passes naturally through the patient's GI tract. The disclosure of U.S. Pat. No. 8,360,297, entitled SURGICAL CUTTING AND STAPLING INSTRUMENT WITH SELF ADJUSTING ANVIL, which issued on Jan. 29, 2013, is incorporated by reference in its entirety.

As illustrated inFIG. 11, the staples385can be deployed into the colon such that the third staples285care positioned within the ring, or rings, of staples385. In certain circumstances, the ring of staples385may overlap with some of the third staples285c. In various instances, the knife263may transect the tissue such that the third staples285care positioned in the transected ring of tissue. In such instances, all of the third staples285ccan be removed with the transected tissue. In some circumstances, the knife263may transect a third staple285cand, as a result, a portion of a third staple285ccan be left in the remaining colon tissue.

At the end of the surgical technique, referring primarily toFIG. 12, the upper colon portion and the lower colon portion can be held together by the staples385deployed by the third stapling assembly300. The lower colon portion can remain at least partially sealed by the first staples285aand/or the second staples285b. In various instances, some of the first staples285aand/or the second staples285can be removed with the transected ring of tissue. In some instances, the staples385can overlap with the first staples285aand the second staples285b.

Referring again toFIG. 9, the surgical instrument101comprises an articulation joint150about which the stapling assembly100can be articulated. The stapling assembly100is articulatable about the articulation axis151(FIG. 1) which is perpendicular to the rotation axis131(FIG. 1) about which the anvil130is rotated. Similarly, the surgical instrument201comprises an articulation joint250about which the stapling assembly200can be articulated. Also, similarly, the stapling assembly200is articulatable about an articulation axis which is perpendicular to the rotation axis131about which the anvil130is rotated. The disclosure of U.S. Patent Application Publication No. 2013/0168435, entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, which published on Jul. 4, 2013, is incorporated by reference in its entirety.

As discussed above, referring again toFIG. 2, the sled170is advanced distally by a firing member160which is pushed distally by a surgical instrument. In certain other embodiments, referring now toFIG. 13, a sled170′ can be pushed distally by a rotatable firing member360. The sled170′ includes a threaded aperture361which is threadably engaged with a thread362defined on the outside surface of the rotatable firing member360. The sled170′ is constrained from rotating relative to the staple cartridge and, as a result, the rotation of the firing member360displaces the sled170′ proximally or distally, depending on the direction in which the firing member360is rotated. The sled170′ can comprise a nut which is displaced longitudinally by a screw portion of the firing member360. The disclosure of U.S. Patent Publication No. 2007/0175950, entitled DISPOSABLE STAPLE CARTRIDGE HAVING AN ANVIL WITH TISSUE LOCATOR FOR USE WITH A SURGICAL CUTTING AND FASTENING INSTRUMENT AND MODULAR END EFFECTOR SYSTEM THEREFOR, which published on Aug. 2, 2007, is incorporated by reference in its entirety.

The embodiment disclosed inFIG. 13can be utilized in embodiments with articulation joints and without articulation joints. In embodiments with articulation joints, for example the firing member360can include a first rotatable shaft portion positioned proximally with respect to the articulation joint and a second rotatable shaft portion positioned distally with respect to the articulation joint. The first rotatable shaft portion can comprise a first gear, such as a bevel gear, for example, which is engaged with a second gear, such as a bevel gear, for example, to transmit the rotational motion therebetween. The first gear and the second gear can remain operably intermeshed throughout an articulation range of the surgical stapling system. In at least one instance, the articulation joint comprises an articulation axis which is parallel to the rotation axis131about which the anvil130is rotated, for example. In certain instances, the articulation joint can comprise an articulation axis which is not perpendicular to the rotation axis131, for example. In such instances, the surgical stapling system can be maneuvered into positions that may not be reachable utilizing the articulation joint150and/or the articulation joint250. In at least one instance, a surgical stapling system can be rotated into a ninety degree angle with respect to a shaft of a surgical stapling instrument, for example. In such instances, the second rotatable shaft can be orthogonal to the first rotatable shaft.

Various stapling devices and techniques for removing a diseased portion of a patient's gastrointestinal tract and reconnecting, or stapling, the remaining portions thereof is disclosed above. Certain stapling devices disclosed herein may be utilized to treat a fistula that has developed in a patient's gastrointestinal tract, for example. A fistula is a narrow passage that can form in a patient's colon, for example, which permits waste to exit the gastrointestinal tract into the patient's body. The fistula can be treated by filling and/or sealing the passage. The passage can be filled with fibrin, thrombin, a fibrin/thrombin mix, autologous tissue fragments, and/or cyanoacrylate, for example. A surgical stapling system400for sealing a fistula is disclosed inFIGS. 14 and 15. The surgical stapling system400comprises a staple cartridge440and an anvil. Similar to the above, the staple cartridge440comprises a longitudinal slot443configured to receive a firing member therein. The staple cartridge440can also comprise a plurality of staple cavities445configured to removably store a plurality of staples therein. The staple cavities445are arranged in a plurality of rows on one side of the longitudinal slot443. The staple cavities445are arranged in three longitudinal rows; however, any suitable number of rows can be utilized. Similar to the above, the staples are ejected from the staple cavities445when a sled is advanced distally by the firing member to move the staples toward the anvil. Also, the firing member can comprise a knife configured to incise the tissue at the same time that the tissue is being stapled.

Referring again toFIG. 14, neither staple cavities nor staples are positioned on the opposite side of the longitudinal slot443. Rather, the opposite side of the staple cartridge440includes a channel448extending longitudinally alongside the longitudinal slot443. The channel448comprises a proximal opening defined in the proximal end of the staple cartridge440and a distal opening447defined in a deck surface449of the staple cartridge440. Means for grasping tissue can be movably positioned within the channel448. The means for grasping tissue can comprise a suction tube490, for example, which is slidably positioned in the channel448. The suction tube490can be pushed distally until a distal end491of the suction tube490is brought into contact with the wall of the gastrointestinal tract. The suction tube490can apply a vacuum pressure to the tissue and apply a grasping force thereto. When the suction tube490is retracted into the channel448, the suction tube490can pull the tissue over the staple cavities445of the staple cartridge440. In certain instances, the means for grasping the tissue can comprise a rotatable screw492which is inserted into the tissue, for example. When the suction tube490is retracted, in such instances, the suction tube490can pull the tissue over the staple cartridge440. In some instances, the suction tube490can pull at least a portion of the tissue into the channel448when the suction tube490is retracted into the channel448, as illustrated inFIG. 15.

Further to the above, the deck449of the staple cartridge440comprises staple cavities445defined in a first side of the deck449and a flat, or an at least substantially flat, surface defined on a second side of the deck449. The flat surface on the second side of the deck449can comprise a solid, or an at least substantially solid, surface; however, as discussed above, the second side of the deck449comprises an aperture447defined therein. In various other embodiments, the second side of the deck449can comprise a channel comprising an open upper side configured to slidably receive a grasping instrument therein. In any event, the grasping instrument can be extended to grab the tissue and then retracted to pull the tissue over the deck449. Specifically, the tissue T comprising the fistula F can be pulled over the staple cavities445and the longitudinal slot443. The deck449can support the tissue as the anvil is moved from an open position to a closed position to clamp the tissue against the staple cartridge440. Once the tissue has been clamped, the tissue T comprising the fistula F can be stapled by the staples ejected from the cavities445and incised by a cutting portion of the firing member passing through the longitudinal slot443. The staples can seal the fistula F. The tissue positioned over the second side of the deck449will not be stapled and it will be transected from the stapled tissue. Once the fistula F has been sealed, the anvil can be re-opened and the tissue T can be released. In some instances, the grasping member and/or the anvil can be re-clamped to grasp the transected tissue and remove it from the patient as the stapling assembly400is removed from the patient.

The stapling assembly400can be inserted into the patient in any suitable manner. For instance, the stapling assembly400can be attached to a surgical instrument and then inserted laparoscopically through a trocar into the patient, for example. In other instances, the stapling assembly400can be inserted trans-anally into a patient, for example.

The stapling assembly400comprises a linear staple cartridge440. The staple cavities445are arranged along linear longitudinal rows and the longitudinal slot443is also linear as well. Other embodiments are envisioned in which the stapling assembly400is curved and the staple cavities445are arranged along curved rows. The slot443may also be curved as well. The disclosure of U.S. Patent Application Publication No. 2008/0169332, entitled SURGICAL STAPLING DEVICE WITH A CURVED CUTTING MEMBER, which was filed on Jan. 11, 2007, is incorporated by reference in its entirety. The disclosure of U.S. Patent Application Publication No. 2014/0243865, entitled INTERCHANGEABLE TOOLS FOR SURGICAL INSTRUMENTS, which was filed on May 7, 2014, is incorporated by reference in its entirety.

The entire disclosures of:

U.S. Pat. No. 7,000,818, entitled SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, which issued on Feb. 21, 2006;

U.S. Patent Application Publication No. 2007/0175955, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, filed Jan. 31, 2006; and

Although the various embodiments of the devices have been described herein in connection with certain disclosed embodiments, many modifications and variations to those embodiments may be implemented. Also, where materials are disclosed for certain components, other materials may be used. Furthermore, according to various embodiments, a single component may be replaced by multiple components, and multiple components may be replaced by a single component, to perform a given function or functions. The foregoing description and following claims are intended to cover all such modification and variations.