# Patent

## Title
True multi-fire surgical stapler with two-sided staple deployment

## Abstract

One example of a surgical stapler may include a first staple holder, a second staple holder opposed to the first staple holder; a first feeder belt extending into the first staple holder, a second feeder belt extending into the second staple holder; and staples affixed to and frangibly separable from each feeder belt. Another example of a surgical stapler may include an anvilless end effector that in turn includes two opposed staple holders; at least one feeder belt extending into each staple holder, and staples frangibly affixed to each feeder belt.

## Background
This application claims priority to U.S. Provisional Patent Application Ser. No. 61/182,630, filed on May 29, 2009, which is herein incorporated by reference in its entirety.


FIELD OF THE INVENTION
The invention generally relates to surgical staplers and stapling.
BACKGROUND
An endocutter is a surgical tool that staples and cuts tissue to transect that tissue while leaving the cut ends hemostatic. An endocutter is small enough in diameter for use in minimally invasive surgery, where access to a surgical site is obtained through a trocar, port, or small incision in the body. A linear cutter is a larger version of an endocutter, and is used to transect portions of the gastrointestinal tract. A typical endocutter receives at its distal end a disposable single-use cartridge with several rows of staples, and includes an anvil opposed to the cartridge. During actuation of an endocutter, the cartridge fires all of the staples that it holds. In order to deploy more staples, the endocutter must be moved away from the surgical site and removed from the patient, after which the old cartridge is exchanged for a new cartridge. The endocutter is then reinserted into the patient. However, it can be difficult and/or time-consuming to located the surgical site after reinsertion. Further, the process of removing the endocutter from the patient after each use, replacing the cartridge, and then finding the surgical site again is tedious, inconvenient and time-consuming, particularly where a surgical procedure requires multiple uses of the endocutter.
In order to overcome these difficulties, Cardica, Inc. of Redwood City, Calif. has developed a true multi-fire endocutter that is capable of firing multiple times without the need to utilize single-use-cartridges. Such an endocutter is described in, for example, U.S. Patent Application Publication No. 2009/0065552, published on Mar. 12, 2009 (the “Endocutter Publication”), which is hereby incorporated by reference herein in its entirety.



BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a cutaway side view of an endocutter in an open position, utilizing dual staple holders.
FIG. 2 is a cutaway side view of the endocutter of FIG. 1 in a closed position.



The use of the same reference symbols in different figures indicates similar or identical items.
DETAILED DESCRIPTION
Referring to FIGS. 1-2, an end effector 2 of a surgical stapler may include two staple holders 4a, 4b, where at least one is movable relative to the other to compress tissue therebetween. For example, one or both of the staple holders 4a, 4b may be pivotable relative to the other. Each staple holder 4 may be configured substantially as described in the Endocutter Publication, and may be configured to deploy a plurality of staples that are fixed to and frangibly separable from at least one feeder belt substantially as described in the Endocutter Publication, with the following differences. The end effector 2 does not utilize a separate anvil; instead, staples 6 are deployed out of each staple holder 4 toward the other. Those staples 6 may be deformed and closed in any suitable manner. As one example, the staple holders 4a, 4b may be slightly offset relative to one another, and staple forming pockets may be defined in the surface of each staple holder 4a, 4b oriented toward the other. In this way, as staples 6 are ejected from one staple holder 4, those staples 6 encounter corresponding staple forming pockets on the surface of the other staple holder 4, causing those staples 6 to deform and close. The staple forming pockets are offset from apertures or other openings in the staple holder 4, such that deployment of staples 6 from one staple holder 4 toward the other, even at substantially the same time as deployment of staples 6 in the opposite direction from the other staple holder, does not result in interference between the staples 6 deployed from different staple holders 4. Alternately, the staple holders 4a, 4b need not be offset relative to one another to prevent interference between staples 6; instead, the apertures or other openings in one staple holder 4a may be offset from the corresponding apertures or other openings in the other staple holder 4b. Correspondingly, the feeder belt in each staple holder 4 may be configured differently from the feeder belt in the other staple holder 4 in order to deploy staples 6 from differently-positioned apertures. For example, one staple holder 4a may hold one or more feeder belts of a first width, where the staples 6 extend from the edges of each feeder belt, and the other staple holder 4b may hold one or more feeder belts of a second width that is less than the first width, where the staples 6 extend from the edges of each feeder belt. In this way, the staples 6 are offset without the need to offset the staple holders 4 themselves.
As another example of staple 6 deformation and closure, staples 6 deployed from one staple holder 4a may be deployed into contact with staples 6 from the other staple holder 4b intentionally. Opposed staples 6 may be deployed against one another, such that the staples 6 remain separate and independent after deployment and closure. Alternately, opposed staples 6 may be deployed into each other to create a single locking implant. If so, at least one staple 6 may include an aperture or other feature configured to receive the free end of an opposed staple 6 during deployment of those staples 6. Deployment of staples 6 from one staple holder 4a optionally may be timed differently than deployment of staples 6 from the other staple holder 4b, in order to deform or even completely close a staple 6 with an aperture or other interlocking feature outward first; as a result, the free end of the opposing staple 6 can then enter or otherwise engage that aperture or other interlocking feature during its deployment.
Deployment and closure of the staples 6 in each staple holder 4 may be substantially as set forth in the Endocutter Publication.
While the invention has been described in detail, it will be apparent to one skilled in the art that various changes and modifications can be made and equivalents employed, without departing from the present invention. It is to be understood that the invention is not limited to the details of construction, the arrangements of components, and/or the steps of performing anastomosis set forth in the above description or illustrated in the drawings. Therefore, the invention is not to be restricted or limited except in accordance with the following claims and their legal equivalents.

## Claims

1. A surgical stapler, comprising:
a first staple holder;
a second staple holder opposed to said first staple holder;
at least a first feeder belt extending into said first staple holder;
at least a second feeder belt extending into said second staple holder; and
a plurality of staples affixed to and frangibly separable from each said feeder belt;
further comprising staple forming pockets defined on the surface of said first staple holder, facing said second staple holder; and further comprising staple forming pockets defined on the surface of said second staple holder, facing said first staple holder.

2. The surgical stapler of claim 1, wherein said first feeder belt is advanceable within said first staple holder, and wherein said second feeder belt is advanceable within said second staple holder.

3. The surgical stapler of claim 1, wherein said first feeder belt and said second feeder belt are arranged relative to one another such that a plurality of said staples affixed to said first feeder belt contact a plurality of said staples affixed to said second feeder belt during deployment.

4. The surgical stapler of claim 1, wherein said first feeder belt and said second feeder belt are arranged relative to one another such that, during deployment, at least one said staple affixed to said first feeder belt contacts and interlocks with a corresponding said staple affixed to said second feeder belt.

5. The surgical stapler of claim 1, wherein said first feeder belt and said second feeder belt have different widths.

6. The surgical stapler of claim 1, wherein at least one said staple within said first staple holder is located at a different lateral position than at least one said staple within said second staple holder.

7. The surgical stapler of claim 1, wherein said first staple holder is offset relative to said second staple holder.

8. The surgical stapler of claim 1, wherein deployment of said staples from said first staple holder is timed differently from deployment of said staples from said second staple holder.