# Patent

## Title
Surgical instrument with trigger assembly for generating multiple actuation motions

## Abstract

A surgical instrument that has an actuation system that is configured to generate at least two separate actuation motions. A clutch assembly is movable between an engaged position wherein the clutch assembly is in operable engagement with the actuation system and an unengaged position. In various forms, the surgical instrument includes a manually actuatable trigger assembly that interfaces with the clutch assembly and the actuation system such that a first stroke of the trigger assembly causes the actuation system to generate a first one of the actuation motions and moves the clutch assembly from the unengaged position to the engaged position whereupon a second stroke of the trigger assembly causes the actuation system to generate another one of the actuation motions.

## Background
CROSS-REFERENCE TO RELATED APPLICATIONS
This non-provisional patent application claims priority from and the benefit of U.S. Provisional Application No. 61/386,094, filed Sep. 24, 2010, the entire disclosure of which is herein incorporated by reference.
TECHNICAL FIELD
The present invention relates to surgical instruments and, in various embodiments, to hand-actuated surgical cutting and stapling instruments.
BACKGROUND
Endoscopic surgical instruments are often preferred over traditional open surgical devices since a smaller incision tends to reduce the post-operative recovery time and complications. Consequently, significant development has gone into a range of endoscopic surgical instruments that are suitable for precise placement of a distal end effector at a desired surgical site through a cannula of a trocar. These distal end effectors engage the tissue in a number of ways to achieve a diagnostic or therapeutic effect (e.g., endocutter, grasper, cutter, staplers, clip applier, access device, drug/gene therapy delivery device, and energy device using ultrasound, RF, laser, etc.).
In many endoscopic surgical applications, it is desirable to employ end effectors that are only as large as necessary to complete a particular surgical procedure. Smaller end effectors provide better visualization of the surgical site. Smaller end effectors also allow for better access and manipulation in tight spaces. Designers of such end effectors face many challenges when trying to develop small end effectors. The ability to manufacture small end effectors and, more particularly, small endocutters that are designed to cut and staple tissue is hampered by the magnitude of the actuation forces that are generally required to form lines of staples and cut tissue. Such actuation forces can also vary with the thickness and composition of the tissue being treated. For example, larger actuation forces are commonly required to cut and staple thick tissues. Whereas, the magnitude of the actuation forces required to cut and staple thinner tissues in general are smaller. Thus, many existing endocutters typically employ robust anvil closure systems and staple driving systems that are configured to accommodate a specific range of tissue thicknesses. Such devices, however, are often not well-suited for treating thinner tissues.
Prior endocutter devices also generally cut the tissue as the staples are driven and formed in the tissue on each side of the cut. While such devices are very effective for those procedures that require the tissue to be cut and fastened, they do not provide the surgeon with the option of installing fasteners without cutting tissue. Likewise, while various forms of articulating endocutters have been developed to improve access, the components generally employed in such devices must be substantial enough to accommodate structures that can generate and transmit sufficient firing and closure forces to the end effector from the handle of the device. Thus, such end effectors are often too large to effectively access tight spaces in the body. Further, there is a need for an end effector that may be effectively operated with a single hand. There is also a need for surgical instruments that may address one or more of the forgoing challenges which can also selectively articulate the end effector.
Accordingly, there is a need for surgical cutting and stapling instruments and staple cartridge arrangements that address many of the challenges discussed above.
The foregoing discussion is intended only to illustrate some of the shortcomings present in the field of the invention at the time, and should not be taken as a disavowal of claim scope.
SUMMARY
In at least one form, a surgical instrument is provided. In various embodiments, the surgical instrument comprises a handle assembly that operably supports an actuation system that is configured to generate at least two separate actuation motions. A clutch assembly is movable between an engaged position wherein the clutch assembly is in operable engagement with the actuation system and an unengaged position. A trigger assembly is operably supported on the handle assembly and is configured to operably interface with the clutch assembly and the actuation system such that a first stroke of the trigger assembly causes the actuation system to generate a first one of the actuation motions and moves the clutch assembly from the unengaged position to the engaged position whereupon a second stroke of the trigger assembly causes the actuation system to generate another one of the actuation motions.
In connection with another general aspect of at least one form, there is provided a surgical instrument that includes a surgical end effector that comprises an elongated channel and an anvil that is movably supported relative to the elongated channel. The anvil is selectively movable from an open position to closed positions relative to the elongated channel upon application of first actuation motions thereto. The end effector further includes a surgical staple cartridge that is operably supported in the elongated channel. A tissue cutting member is operably supported relative to the staple cartridge and is movable from a proximal end of the elongated channel to a distal end of the elongated channel upon application of a second actuation motion thereto. In various forms, the surgical instrument further comprises a handle assembly that operably supports an actuation system that is configured to generate at least two separate actuation motions. A clutch assembly is movable between an engaged position wherein the clutch assembly is in operable engagement with the actuation system and an unengaged position. A trigger assembly is operably supported on the handle assembly and is configured to operably interface with the clutch assembly and the actuation system such that a first stroke of the trigger assembly causes the actuation system to generate the first actuation motions and moves the clutch assembly from the unengaged position to the engaged position whereupon a second stroke of the trigger assembly causes the actuation system to generate the second actuation motion. An elongated shaft assembly protrudes from the handle assembly and operably interfaces with the surgical end effector. The elongated shaft assembly operably interfaces with the actuation system to apply the first actuation motions to the anvil and the second actuation motion to the tissue cutting member.
In accordance with yet another general aspect of at least one form, there is provided a method of cutting and stapling target tissue. In various forms, the method includes providing a surgical stapling instrument that comprises a surgical end effector that has an elongated channel and an anvil that is movably supported relative to the elongated channel. The anvil is selectively movable from an open position to closed positions relative to the elongated channel upon application of first actuation motions thereto. The end effector further includes a surgical staple cartridge that is operably supported in the elongated channel. A tissue cutting member is operably supported relative to the staple cartridge and is movable from a proximal end of the elongated channel to a distal end of the elongated channel upon application of a second actuation motion thereto. The surgical instrument further includes a handle assembly that operably supports an actuation system that is configured to generate at least two separate actuation motions. A clutch assembly is movable between an engaged position wherein the clutch assembly is in operable engagement with the actuation system and an unengaged position. A trigger assembly is operably supported on the handle assembly and is configured to operably interface with the clutch assembly and the actuation system such that a first stroke of the trigger assembly causes the actuation system to generate the first actuation motions and moves the clutch assembly from the unengaged position to the engaged position whereupon a second stroke of the trigger assembly causes the actuation system to generate the second actuation motion. Various forms of the method further include manipulating the end effector such that the target tissue is located between the anvil and the surgical staple cartridge and applying a first stroke to the trigger assembly to cause the target tissue to be clamped between the anvil and the surgical staple cartridge. The method further includes applying a second stroke to the trigger assembly to cause the tissue cutting member to cut the clamped target tissue and fire the surgical staples in the surgical staple cartridge into the cut target tissue and into forming contact with the anvil.



BRIEF DESCRIPTION OF DRAWINGS
The above-mentioned and other features and advantages of this invention, and the manner of attaining them, will become more apparent and the invention itself will be better understood by reference to the following description of embodiments of the invention taken in conjunction with the accompanying drawings, wherein:
FIG. 1 is a perspective view of one surgical instrument embodiment of the present invention;
FIG. 2 is another perspective view of the surgical instrument of FIG. 1, with a handle case removed from the handle assembly;
FIG. 3 is an exploded assembly view of the surgical instrument embodiment of FIGS. 1 and 2;
FIG. 4 is an exploded assembly view of a portion of the shaft assembly and end effector of the surgical instrument embodiment depicted in FIGS. 1-3;
FIG. 5 is another exploded assembly view of another portion of the shaft assembly and end effector of FIG. 4;
FIG. 6 is a partial cross-sectional view of an end effector and portion of a shaft assembly embodiment of the present invention;
FIG. 7 is a partial cross-sectional perspective view of a portion of the end effector and shaft assembly of FIG. 6;
FIG. 8 is another perspective view of the surgical instrument of FIGS. 1-3 with a handle casing and outer shaft members removed for clarity;
FIG. 9 is a top view of a portion of the surgical instrument of FIG. 8 in an unarticulated position;
FIG. 10 is another top view of the portion of the surgical instrument of FIG. 9 in a first articulated position;
FIG. 11 is another top view of the portion of the surgical instrument of FIGS. 9 and 10 in a second articulated position;
FIG. 12 is a right side view of the surgical instrument embodiment of FIG. 8 with the left side handle casing removed and the end effector thereof in an open position;
FIG. 13 is a left side view of the surgical instrument embodiment of FIG. 12 with the right side handle casing removed;
FIG. 14 is a partial rear perspective view of the surgical instrument embodiment of FIG. 13;
FIG. 15 is another partial rear perspective view of the surgical instrument embodiment of FIGS. 13 and 14;
FIG. 16 is a right side view of the surgical instrument embodiment of FIGS. 12-15 with the left side handle casing removed and illustrating an initial actuation of the trigger assembly thereof to close the end effector;
FIG. 17 is a left side view of the surgical instrument embodiment of FIG. 16 with the right side handle casing removed;
FIG. 18 is a partial rear perspective view of the surgical instrument embodiment of FIG. 17;
FIG. 19 is another partial rear perspective view of the surgical instrument embodiment of FIGS. 17 and 18;
FIG. 20 is a right side view of the surgical instrument embodiment of FIGS. 12-19 with the left side handle casing removed and illustrating the end effector locked in the closed position;
FIG. 21 is a left side view of the surgical instrument embodiment of FIG. 20 with the right side casing removed;
FIG. 22 is a partial rear perspective view of the surgical instrument embodiment of FIG. 21;
FIG. 23 is another partial rear perspective view of the surgical instrument embodiment of FIGS. 21 and 22;
FIG. 24 is a right side view of the surgical instrument embodiment of FIGS. 12-23 with the left side handle casing removed and illustrating the trigger assembly illustrating a second actuation of the trigger assembly to apply the second actuation motion to the end effector;
FIG. 25 is a left side view of the surgical instrument embodiment of FIG. 24 with the right side casing removed;
FIG. 26 is a partial rear perspective view of the surgical instrument embodiment of FIG. 25;
FIG. 27 is another partial rear perspective view of the surgical instrument embodiment of FIGS. 25 and 26;
FIG. 28 is another right side view of the surgical instrument embodiment of FIGS. 12-27 with the left side handle casing removed and illustrating the trigger assembly after the surgeon has released it after applying the second actuation motion to the end effector;
FIG. 29 is a left side view of the surgical instrument embodiment of FIG. 28 with the right side casing removed;
FIG. 30 is a partial rear perspective view of the surgical instrument embodiment of FIG. 29;
FIG. 31 is another partial rear perspective view of the surgical instrument embodiment of FIGS. 29 and 30;
FIG. 32 is another right side view of the surgical instrument embodiment of FIGS. 12-31 with the left side handle casing removed and illustrating the trigger assembly after the secondary trigger has been returned to its starting position;
FIG. 33 is a left side view of the surgical instrument embodiment of FIG. 32 with the right side casing removed;
FIG. 34 is a perspective view of another surgical instrument embodiment of the present invention;
FIG. 35 is another perspective view of the surgical instrument of FIG. 34 with a handle casing removed for clarity;
FIG. 36 is an exploded perspective assembly view of the surgical instrument of FIGS. 34 and 35;
FIG. 37 is a partial exploded perspective view of an end effector and portion of an elongated shaft assembly embodiment of various surgical instrument embodiments of the present invention;
FIG. 38 is a side elevational view of a surgical instrument embodiment of the present invention with a portion of the handle housing omitted for clarity and showing the end effector thereof in an open position;
FIG. 39 is another side elevational view of the surgical instrument embodiment of FIG. 38 with a portion of the handle housing omitted for clarity and showing the end effector upon initial application of an actuation force to the firing trigger;
FIG. 40 is another side elevational view of the surgical instrument embodiment of FIGS. 38 and 39 with a portion of the handle housing omitted for clarity and showing the end effector upon further application of the actuation force to the firing trigger;
FIG. 41 is another side elevational view of the surgical instrument embodiment of FIGS. 38-40 with a portion of the handle housing omitted for clarity and showing the end effector upon actuation of the locking trigger;
FIG. 42 is another side elevational view of the surgical instrument embodiment of FIGS. 38-41 with a portion of the handle housing omitted for clarity and showing the end effector upon complete actuation of the firing trigger;
FIG. 43 is a top cross-sectional view of a surgical instrument embodiment of the present invention in a neutral articulation position;
FIG. 44 is a side elevational view of the surgical instrument of FIG. 43 with a portion of the handle housing omitted for clarity;
FIG. 45 is a top cross-sectional view of a surgical instrument embodiment of FIGS. 43 and 44 with the end effector thereof articulated in a first articulation direction relative to the longitudinal axis;
FIG. 46 is a side elevational view of the surgical instrument of FIG. 45 with a portion of the handle housing omitted for clarity;
FIG. 47 is a top cross-sectional view of a surgical instrument embodiment of FIGS. 43-46 with the end effector thereof articulated in a second articulation direction relative to the longitudinal axis; and
FIG. 48 is a side elevational view of the surgical instrument of FIG. 47 with a portion of the handle housing omitted for clarity.



Corresponding reference characters indicate corresponding parts throughout the several views. The exemplifications set out herein illustrate preferred embodiments of the invention, in one form, and such exemplifications are not to be construed as limiting the scope of the invention in any manner.
DETAILED DESCRIPTION
The Applicant of the present application also owns the U.S. Patent Applications identified below which were filed on even date herewith and which are each herein incorporated by reference in their respective entirety:

    U.S. patent application Ser. No. 13/241,629, entitled “Surgical Instrument with Selectively Articulatable End Effector”, U.S. Patent Application Publication No. US 2012-0074200 A1;
    U.S. patent application Ser. No. 13/241,922, entitled “Surgical Stapler with Stationary Staple Drivers”, U.S. Patent Application Publication No. US 2013-0075449 A1;
    U.S. patent application Ser. No. 13/242,029, entitled “Surgical Stapler with Floating Anvil”, U.S. Patent Application Publication No. US 2012-0080493 A1;
    U.S. patent application Ser. No. 13/241,912, entitled “Staple Cartridge Including Collapsible Deck Arrangement”, U.S. Patent Application Publication No. US 2013-0075448 A1;
    U.S. patent application Ser. No. 13/242,086, entitled “Staple Cartridge Including Collapsible Deck”, U.S. Patent Application Publication No. US 2013-0075450 A1; and
    U.S. patent application Ser. No. 13/242,066, entitled “Curved End Effector for a Stapling Instrument”, U.S. Patent Application Publication No. US 2012-0080498 A1.


Certain exemplary embodiments will now be described to provide an overall understanding of the principles of the structure, function, manufacture, and use of the devices and methods disclosed herein. One or more examples of these embodiments are illustrated in the accompanying drawings. Those of ordinary skill in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying drawings are non-limiting exemplary embodiments and that the scope of the various embodiments of the present invention is defined solely by the claims. The features illustrated or described in connection with one exemplary embodiment may be combined with the features of other embodiments. Such modifications and variations are intended to be included within the scope of the present invention.
Reference throughout the specification to “various embodiments,” “some embodiments,” “one embodiment,” or “an embodiment”, or the like, means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment. Thus, appearances of the phrases “in various embodiments,” “in some embodiments,” “in one embodiment”, or “in an embodiment”, or the like, in places throughout the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined, in whole or in part, with the features structures, or characteristics of one or more other embodiments without limitation. Such modifications and variations are intended to be included within the scope of the present invention.
The terms “proximal” and “distal” are used herein with reference to a clinician manipulating the handle portion of the surgical instrument. The term “proximal” referring to the portion closest to the clinician and the term “distal” referring to the portion located away from the clinician. It will be further appreciated that, for convenience and clarity, spatial terms such as “vertical”, “horizontal”, “up”, and “down” may be used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and/or absolute.
Various exemplary devices and methods are provided for performing laparoscopic and minimally invasive surgical procedures. However, the person of ordinary skill in the art will readily appreciate that the various methods and devices disclosed herein can be used in numerous surgical procedures and applications including, for example, in connection with open surgical procedures. As the present Detailed Description proceeds, those of ordinary skill in the art will further appreciate that the various instruments disclosed herein can be inserted into a body in any way, such as through a natural orifice, through an incision or puncture hole formed in tissue, etc. The working portions or end effector portions of the instruments can be inserted directly into a patient's body or can be inserted through an access device that has a working channel through which the end effector and elongated shaft of a surgical instrument can be advanced.
Turning to the Drawings wherein like numerals denote like components throughout the several views, FIG. 1 depicts a surgical instrument 10 that is capable of practicing several unique benefits of the present invention. The surgical instrument 10 is designed to manipulate and/or actuate various forms and sizes of end effectors 12 that are operably attached thereto. In the depicted embodiment, for example, the end effector 12 comprises a surgical stapling device that has openable and closable jaws 13 and 15. More specifically, the end effector 12 includes an elongated channel 14 that forms a lower jaw 13 of the end effector 12. The elongated channel 14 is configured to support a staple cartridge 30 and also movably supports an anvil 20 that functions as an upper jaw 15 of the end effector 12. The end effector 12 may comprise, for example, an end effector of the types disclosed in co-pending U.S. patent application Ser. No. 13/242,066, entitled “Curved End Effector for a Stapling Instrument”, U.S. Patent Application Publication No. US 2012-0080498 A1, U.S. patent application Ser. No. 13/242,029, entitled “Surgical Stapler with Floating Anvil”, U.S. Patent Application Publication No. US 2012-0080493 A1, and U.S. patent application Ser. No. 13/241,922, entitled “Surgical Stapler with Stationary Staple Drivers”, U.S. Patent Application Publication No. US 2013-0075449 A1, the entire disclosures of each which have been herein incorporated by reference. However, it is conceivable that the surgical instrument 10 may be employed to activate a variety of different surgical end effectors that require at least two actuation motions to perform one or more surgical activities/actions. For example, the unique and novel features of various embodiments may be successfully employed in connection with those end effectors that are configured to apply radio frequency “RF” energy to tissue clamped or otherwise engaged therein. Thus, the various embodiment of the surgical instruments disclosed herein should not be limited to use solely in connection with the types and forms of end effector depicted in the appended Figures.
In various implementations, the end effector 12 is configured to be operably coupled to an elongated shaft assembly 100 that protrudes from a handle assembly 400. The end effector 12 (when closed) and the elongated shaft assembly 100 may have similar cross-sectional shapes and be sized to operably pass through a trocar tube or working channel in another form of access instrument. As used herein, the term “operably pass” means that the end effector 12 and at least a portion of the elongated shaft assembly 100 may be inserted through or passed through the channel or tube opening and can be manipulated therein as needed to complete the surgical procedure. In some embodiments, when in a closed position, the jaws 13 and 15 of the end effector 12 may provide the end effector with a roughly circular cross-sectional shape that facilitates its passage through a circular passage/opening. However, the end effectors of various embodiments of the present invention, as well as the elongated shaft assembly embodiments, could conceivably be provided with other cross-sectional shapes that could otherwise pass through access passages and openings that have non-circular cross-sectional shapes. Thus, an overall size of a cross-section of a closed end effector will be related to the size of the passage or opening through which it is intended to pass. Thus, one end effector for example, may be referred to as a “5 mm” end effector which means it can operably pass through an opening that is at least approximately 5 mm in diameter.
In various embodiments, the elongated shaft assembly 100 may have an outer diameter that is substantially the same as the outer diameter of the end effector 12 when in a closed position. For example, a 5 mm end effector may be coupled to an elongated shaft assembly 100 that has 5 mm cross-sectional diameter. However, as the present Detailed Description proceeds, it will become apparent that various embodiments of the present may be effectively used in connection with different sizes of end effectors. For example, a 10 mm end effector may be attached to an elongated shaft that has a 5 mm cross-sectional diameter. Conversely, for those applications wherein a 10 mm or larger access opening or passage is provided, the elongated shaft assembly 100 may have a 10 mm (or larger) cross-sectional diameter, but may also be able to actuate a 5 mm or 10 mm end effector. Accordingly, the elongated shaft assembly 100 may have an outer diameter that is the same as or is different from the outer diameter of a closed end effector 12 attached thereto.
The elongated shaft assembly 100 may be similar in construction to those articulatable shaft arrangements described in U.S. Pat. No. 5,713,505 to Huitema and U.S. Pat. No. 5,704,534 to Huitema et al., the entire disclosures of which are each herein incorporated by reference in their respective entireties. Referring to FIGS. 1 and 2, in at least one form, the surgical instrument 10 has an articulation transmission 200 that couples the elongated shaft assembly 100 to the handle assembly 300. However, as the present Detailed Description proceeds, those of ordinary skill in the art will understand that various unique and novel features of the present invention may be employed in connection with elongated shaft assembly arrangements that are not articulatable.
When the articulation transmission assembly 200 is actuated, it causes the remote articulation of the end effector 12 relative to the longitudinal axis L-L defined by the elongated shaft assembly 100. In at least one form, the elongated shaft assembly 100 includes a flexible neck assembly 110. Various flexible neck assemblies are disclosed in U.S. Provisional Patent Application Ser. No. 61/386,117, filed Sep. 24, 2010, the entire disclosure of which is herein incorporated by reference. The flexible neck assembly 110 may be composed of a rigid thermoplastic polyurethane sold commercially as ISOPLAST grade 2510 by the Dow Chemical Company. The flexible neck assembly 110 has flexible neck segment 111 that comprises first and second flexible neck portions, 112 and 114. These neck portions 112, 114 are separated by a central longitudinal rib 116. The neck portions 112, 114 each have a plurality of neck ribs 118 configured essentially as semi-circular disks which together generally form a cylindrical configuration. A side slot 120 extends through each of the neck ribs 118 to provide a passage through the first and second flexible neck portions 112, 114 for receiving flexible transmission band assemblies 150, 170. See, for example, FIG. 7. In a similar fashion, the central longitudinal rib 116 that separates the first and second flexible neck portions 112, 114 has a central longitudinal slot 122 for providing a passage to receive a knife bar 180.
First and second support guide surfaces 124 and 126 extend proximally from the flexible neck segment 111 for supporting the reciprocating movement of the flexible transmission band assemblies 150, 170. As can be seen in FIG. 4, a channel guide 128 extends from the distal end of the flexible neck segment 111 for guiding the reciprocatable movement of the knife bar 180 as will be discussed in further detail below.
As can be seen in FIG. 3, the first transmission band assembly 150 includes a first transmission band 152 and the second transmission band assembly 170 includes a second transmission band 172. In addition, the first transmission band 150 has a first elongated structural portion 154 and the second transmission band 170 has a second elongated structural portion 174. When the first and second transmission bands 150, 170 are brought into contact with each other during assembly of the instrument, they form an elongated cylinder which has a longitudinal cavity 160 extending concentrically through it to operably receive a firing rod 530 therethrough. The first structural portion 154 of the first transmission band 152 has a first articulation rack 156 formed thereon and the second structural portion 174 of the second transmission band 172 has a second articulation rack 176 formed thereon which, as will be discussed in further detail below, drivingly interface with articulation transmission assembly 200.
Also in various forms, the first transmission band 152 has a first exterior reinforcement band portion 157 that extends distally from the first structural portion 156. See FIG. 3. Likewise, the second transmission band 172 has a second exterior reinforcement band portion 177 that extends distally from the second structural portion 176. Each exterior reinforcement band portion 157, 177 has a plurality of attachment lugs 162 for securing first and second interior articulation bands thereto. For example, the first transmission band 152 has a first interior articulation band 158 attached thereto and the second transmission band 172 has a second interior articulation band 178 attached thereto. The first and second transmission bands 152, 172 may be composed of a plastic, especially a glass fiber-reinforced amorphous polyamide, sold commercially under the trade name Grivory GV-6H by EMS-American Grilon. In contrast, the interior articulation bands 158, 178 of the transmission band assembly may be composed of a metal, advantageously full hard 301 stainless steel or its equivalent. The attachment lugs 162 on the exterior reinforcement band portions 157, 177 of the transmission bands 152, 172, respectively, are received into and secured within a plurality of lug holes 164 on the corresponding interior articulation band 158, 178. See FIG. 3.
In at least one embodiment, the proximal end of the elongated cartridge channel 14 is provided with a pair of band connector ears 50. These band connector ears 50 are inserted into and through connector loops 159, 179 on the distal end of the interior articulation bands 158, 178, respectively. In this manner, the cartridge channel 14, which operably supports a staple cartridge 30 is coupled to the interior articulation bands 158, 178 of the flexible neck assembly 110. Specifically, the reciprocation of the first and second flexible transmission band assemblies 150, 170 in opposite directions causes the interior articulation bands 158, 178 received in the side slots 120 of the neck ribs 118 on the flexible neck segment 111 to reciprocate in a like manner. Upon reciprocation of the interior articulation bands 158, 178, in particular when the first band 158 is moved proximally in tandem with the second band 178 moving distally, the first and second flexible neck portions 114, 116 bend as the neck ribs 118 of the first flexible neck portion 114 move toward each other and the neck ribs 118 of the second flexible neck rib portion 116 concurrently move away from each other. The coupling of the interior articulation bands 158, 178 to the exterior reinforcement band portions 157, 177 of the transmission bands 152, 172, respectively prevents the interior articulation bands 158, 178 from buckling between adjacent neck ribs.
Movement of the first and second transmission bands 152, 172 is controlled by the articulation transmission 200. The component parts of one form of the articulation transmission assembly 200 are illustrated in FIG. 3. The assembly 200 includes an actuator 210, an articulation body 220 and a nozzle 250. Rotational movement of the actuator 210 causes corresponding rotation of the articulation body 220 within the nozzle 250. The first and second elongated transmission bands, 152 and 172, consequently reciprocate axially in opposite directions parallel to the longitudinal axis L-L of the elongated shaft assembly 100 to cause the remote articulation of the end effector 12.
In various embodiments, the articulation body 220 has a deck 222 consisting of first and second spaced-apart, semicircular deck halves, 224, 226. The deck halves are mutually opposed to each other and essentially represent mirror images of each other. The first and second deck halves 224, 226 have protruding from their surfaces mutually opposed first and second detents 225, 227, respectively. Each deck half 224, 226 has a set of deck teeth 228 spaced about 180 degrees from the set of deck teeth on the other deck half. The articulation body 220 has a pair of rotation stops 230 descending from its surface as well as a pair of finger recesses 232. A drive gear 240 descends from the articulation body 22. The drive gear 240 has a flared opening 242 through it, and a lower pivot 244. Within the flared opening 242 of the drive gear 240, there is a firing rod orifice (not shown) for receiving the firing rod 550 therethrough enabling the application of a firing motion to the end effector 12. The drive gear 240 is configured to intermesh with the first and second drive racks 156, 176, respectively to effect the desired reciprocating movement of the first and second transmission bands 152, 172.
The nozzle 250 of the articulation transmission assembly 200 includes a nozzle body 252. The nozzle body 252 has an axial bore 254 therethrough that facilitates the passage of the first transmission band assembly 150 and the second transmission band assembly 170 as well as for the firing rod 530 and other operative components of the instrument 10. The nozzle body 252 also has a frame groove 256 and flange 258 to fasten the nozzle body 252 to the handle assembly 300 (see FIG. 8). In various forms, a detent housing 260 comprises a portion of the nozzle body 252. An annular array of detent teeth 262 is formed within the detent housing 260. A detent housing floor 264 is spaced from the detent teeth 262. The floor 264 has a pair of ledges 266 which interact within the rotation stops 230 of the articulation body 220 to limit the degree of rotation. When the articulation body 220 is inserted into the detent housing 260, the base of the articulation body 220 is supported on the floor 264 within the detent housing 260, and the deck teeth 228 of the first and second deck halves, 224, 226 are aligned for meshing engagement with the detent teeth 262 of the detent housing 260. A spring member 268 is supported within the articulation body to bias the deck teeth 228 into meshing engagement with the detent teeth 262.
In various forms, the actuator 210 consists of a lever arm 212, a cap 214 and a pair of retaining fingers 216. The lever arm 212 is mounted on the top of the cap 214. The pair of retaining fingers 216 descend downwardly from the underside of the cap 214. Each of the retaining fingers 216 has a retaining clip. The retaining fingers 216 are received within the finger recesses 232 of the articulation body 220. The first and second detents, 225, 227, of the deck halves of the articulation body are inserted into a slot depression within the underside of the circular cap 214. Advantageously, each of the three significant components of the articulation transmission assembly, namely the actuator, articulation body and nozzle, may be injection molded components. Such components, for example, may be fabricated from a glass fiber-reinforced amorphous polyamide, sold commercially under the trade name Grivory GV-4H by EMS—American Grilon. 150.
FIG. 3, in combination with FIGS. 9-11, illustrate the actuation of the articulation transmission assembly 200. Ratcheting rotation of the actuator 210 causes articulation of the end effector 12 in a plurality of discrete positions angled from the longitudinal axis L-L of the endoscopic shaft assembly 100. FIG. 9 illustrates the end effector 12 in an unarticulated position. In FIG. 10, the drive gear 240 on the articulation body 220 of the articulation transmission 200 has been rotated to drive the first transmission band assembly 150 distally in the “DD” direction and the second transmission bar assembly 170 proximally in the proximal direction “PD” which causes the end effector 12 to articulate in a first direction “FD” relative to the longitudinal axis L-L. In FIG. 11, the drive gear 240 on the articulation body 220 of the articulation transmission 200 has been rotated to drive the second articulation band assembly 170 in the distal direction “DD” and the first articulation band assembly 150 in the proximal direction “PD” to cause the end effector 12 to pivot in a second direction “SD” relative to the longitudinal axis L-L.
As can be seen in FIGS. 3-7, the elongated shaft assembly 100 further includes a distal closure tube segment 190 that is slid over the channel guide 128 of the flexible neck assembly 110. The proximal end 191 of the distal closure tube segment 190 has a pair of diametrically opposed slots 192 therein for receiving distally protruding lugs 113 protruding from the flexible neck portion 111 to prevent rotation of the distal closure tube segment 190 relative to the flexible neck portion 111. In various embodiments, a fastener hole 129 is provided in the channel guide 128. The distal closure tube segment 190 is retained on the channel guide 128 by a retention tab 193 that extends into the fastener hole 129. See FIGS. 6 and 7. Such arrangement causes the closure tube segment 190 to move axially with the flexible neck assembly 110. Movement of the closure tube segment 190 distally into contact with the anvil 20 causes the anvil 20 to move to a closed position as described in further detail in co-pending U.S. patent application Ser. No. 13/242,029, entitled “Surgical Stapler With Floating Anvil”, U.S. Patent Application Publication No. US 2012-0080493 A1, the entire disclosure of which has been incorporated by reference herein.
As described in further detail in the above-referenced patent application, the anvil 20 has a mounting portion 22 that protrudes from its proximal end 21. The mounting portion 22 has a pair of trunnion pivots 24 thereon that are configured to be pivotally received in corresponding cradles 15 in the elongated channel 14. See FIGS. 5-7. For assembly purposes, the distal closure tube segment 190 is provided with a bottom slit 195. To assemble the anvil 20 to the elongated channel 14, the trunnion pivots 24 are placed in the corresponding cradles 15 in the elongated channel 14 and the distal closure tube segment 190 is then snapped onto the channel guide 128. Such arrangement serves to movably retain the anvil 20 on the elongated channel 14 and facilitates its movement relative to the staple cartridge 30. In various implementations, the anvil 20 may be moved towards the surgical staple cartridge 30 by axially advancing the distal closure tub segment 190 in the distal direction “DD” to bring the distal end 196 of the closure tube segment 190 into contact with the proximal end 21 of the anvil 20. Prior to firing (distally advancing) the knife bar 180, the anvil 20 may be pivoted to the open position (FIG. 6) by axially advancing the distal closure tube segment 190 in the proximal direction “PD” as will be discussed in further detail below. Such actuation of the anvil 20 is accomplished by a distal tab 196 on the distal closure tube segment 190 that extends into an elongated slot 25 in the anvil mounting portion 22. As the distal tab 196 is drawn proximally in the slot 25, it eventually contacts the proximal end wall of the slot 25 and causes the anvil 20 to move to the open position.
As can be seen in FIGS. 3 and 6, the elongated shaft assembly 100 further includes a proximal outer shaft segment 300 that is attached to the flexible neck assembly 110. The proximal outer shaft segment 300 is substantially rigid and may be attached to the flexible neck portion 111 of the flexible neck assembly 110 by, for example, a press fit, adhesive or other suitable fastener arrangement. As can be seen in FIG. 3, in at least one embodiment, the distal end 302 of the proximal outer shaft segment 300 has a pair of opposed notches 304 therein that are adapted to receive corresponding lugs 115 protruding from the flexible neck portion 111 such that rotation of the proximal outer shaft segment 300 results in rotation of the flexible neck assembly 110 and ultimately of the end effector 12.
In at least one embodiment, the proximal outer shaft segment 300 has a proximal end 306 that has a slot 308 for receiving the drive gear 240 therethrough such that the proximal outer shaft segment 300 may move axially relative thereto. In addition, the proximal end 306 of the proximal outer shaft segment 300 has a flange 310 formed thereon that facilitates rotational attachment to a closure carriage 420 of an actuation system 410 that is operably supported within the handle assembly 400. In various embodiments, the closure carriage 420 may comprise two carriage segments 422 that are interconnected together by adhesive, snap features, screws, etc. As can be seen in FIG. 3, in at least one form, the closure carriage 420 has a distal end 424 that has a groove arrangement 426 that is adapted to receive the flanged end 310 of the proximal outer shaft segment 300. Such arrangement serves to attach the proximal end 306 of the proximal outer shaft segment 300 to the closure carriage 420 while facilitating its selective rotation of the proximal outer shaft segment 300 relative to the closure carriage 420. Therefore, the elongated shaft assembly 100 and the end effector 12 that is operably coupled thereto may be selectively rotated about the longitudinal axis L-L relative to the handle assembly 400.
In various embodiments, the handle assembly 400 comprises a pistol-shaped housing that may be fabricated in two or more pieces for assembly purposes. For example, the handle assembly 400 as shown comprises a right hand case member 402 and a left hand case member 404 (FIG. 1) that are molded or otherwise fabricated from a polymer or plastic material and are designed to mate together. Such case members 402 and 404 may be attached together by snap features, pegs and sockets molded or otherwise formed therein and/or by adhesive, screws, etc. When assembled, the handle assembly 400 movably supports the closure carriage 420 for selective axial travel therein in response to actuation motions from a trigger assembly, generally designated as 430.
In at least one embodiment, the trigger assembly 430 comprises a primary trigger 440 and a secondary trigger 460. The primary and secondary triggers 440 and 460 are pivotally journaled on a pivot pin assembly 430 formed in the handle assembly 400 such that the triggers 440 and 460 may essentially move relative to each other. Such arrangement permits the trigger assembly 430 to pivot relative to the handle assembly 400 about pivot axis PA-PA. See FIG. 3. The primary trigger 440 has an elongated, grippable primary trigger paddle 442 that protrudes from a primary drive portion 444 that has a firing rack 446 formed thereon. In one embodiment, the secondary trigger 460 has a secondary trigger paddle 462 that protrudes from a secondary drive portion 464 that is pivotally journaled on the pivot pin assembly 430. The primary drive portion 444 has a slot 448 that is adapted to receive the secondary drive portion 464 of the secondary trigger 460 therein as the primary trigger paddle 442 is pivoted towards a pistol grip portion 406 of the handle assembly 400. Such arrangement essentially enables the secondary trigger 460 to “nest” within the primary trigger 440 during actuation. As will be discussed in detail below, the secondary trigger 460 is pivotally actuated by pivoting the primary trigger 440. Thus, in other embodiments, the secondary trigger 460 may lack the secondary trigger paddle 442. In various forms, the trigger assembly 430 is biased into the unactuated position shown in FIGS. 1, 2, 8, and 12-15 by a trigger spring 432 (shown in FIGS. 3, 8, 12, and 13).
As can be seen in FIGS. 3 and 13, the secondary drive portion 464 of the secondary trigger 460 has a closure gear segment 466 formed thereon that is configured for meshing engagement with a carriage gear rack 423 formed on the underside of the closure carriage 420. Thus, when the secondary trigger 460 is pivoted toward the pistol grip 406, the closure carriage 420 is driven in the distal direction “DD”.
In various embodiments, the actuation system 410 further includes an actuation bar 470. The actuation bar 470 has a first actuation rack 472 formed thereon that is configured for meshing engagement with the primary gear segment 446 on the primary trigger 440. Thus, when the primary gear segment 446 is in meshing engagement with the first actuation rack 472, the actuation bar 470 is driven in the distal direction “DD” when the primary trigger 440 is pivoted toward the pistol grip 406. As can also be seen in FIGS. 3, 8, and 12, the actuation bar 470 has a second actuation rack 474 formed thereon configured to meshingly engage clutch teeth 484 on a clutch shaft 482 of a clutch assembly 480. In various embodiments, the clutch shaft 482 is rotatably is supported within the handle assembly 400 and is also laterally movable therein. The clutch shaft 482 has a hub portion 486 that has a plurality of spaced teeth 488 that are configured to drivingly engage teeth openings 492 in a drive gear 490 that is rotatably supported on the clutch shaft 482. The drive gear 490 has a segment of drive gears 494 on a portion of its circumference that are adapted for meshing engagement with a firing rack 500 that is movably supported in the handle assembly 400.
Various embodiments of the clutch assembly 480 further comprise a clutch plate 510 that is slidably journaled on a clutch pin 449 provided on the primary drive portion 444 of the primary trigger 440. As can be seen in FIGS. 13 and 15, for example, the clutch pin 449 is movably received within a vertical slot 512 in the clutch plate 510. The clutch plate 510 also has a distally-extending clutch arm 514 that is adapted to actuatably engage a bevel plate 489 formed on the clutch shaft 482. In addition, a clutch spring 520 is employed to bias the clutch shaft 480 laterally such that the teeth 488 on the clutch shaft 482 are brought into meshing engagement with the teeth openings 492 in the drive gear 490.
As can be seen in FIG. 3, the firing rack 500 is coupled to a firing rod 530 that is attached to the proximal end of the knife bar 180. In various embodiments, the knife bar 180 may be of laminated construction to enable it to flex as the end effector 12 is articulated, while remaining sufficiently rigid to be driven distally through the shaft assembly 100. In the depicted embodiment, the knife bar 180 terminates in an E-beam cutting head 182 that has a tissue-cutting surface 184 thereon. A variety of forms of cutting head configurations are known and may be employed—depending upon the particular configuration of end effector used. The depicted embodiment, for example, includes upper guide fins 186 that are configured to enter corresponding slots in the anvil 20 to verify and assist in maintaining the anvil 20 in a closed state during staple formation and severing. Spacing between the elongated channel 14 and anvil 20 may be further maintained by the cutting head 182 by middle pins 187 on the cutting head 182 that slide along a portion of the elongated channel 14 while a bottom foot 188 formed on the cutting head 182 opposingly slides along the undersurface of the elongated channel 14 in a known manner. The distally presented tissue-cutting surface 184, which is between the upper guide fins 186 and middle pin 187, severs clamped tissue while causing the staples within the staple cartridge 30 to be formed into the tissue clamped within the end effector 12. The proximal end of the knife bar 180 is provided with a proximal socket 189 that is configured to receive a distal end portion 532 of the firing rod 530. As will be discussed in further detail below, the firing rod 530 facilitates the application of firing and retraction motions to the knife bar 180 by the actuation system 410. In various arrangements, the firing rod 530 extends through a closure bushing 540 that is mounted within the handle assembly 400. In at least one form, a pair of mounting studs 407 protrude from the handle casings 402, 404 and extend through corresponding slots in the closure carriage 420 to be received in a retaining slot in the bushing 540. A closure spring 550 that is attached to a retainer clip 552 is journaled on the closure bushing 540. The closure spring 550 extends between the nozzle body 252 and an internal wall 425 in the closure carriage 420. Thus, the closure spring 550 serves to bias the closure carriage 420 in the proximal direction “PD”.
Various embodiments also include a releasable closure locking assembly 560 that interfaces with the closure carriage 420 to selectively retain the closure carriage 420 in its distal-most closed or clamped position. In at least one form, the closure locking assembly 560 includes a locking button 562 that is pivotally supported in the handle assembly 400. The locking button 562 has a latch arm 564 that is configured to abut a locking ledge 426 formed on the closure carriage 420 when the button 562 is in the locked position. In addition, the latch arm 564 has a catch 566 formed thereon that is configured to releasably latch with a locking latch 502 on the proximal end of the firing rack 500. A locking spring 568 serves to bias the locking button 562 into the locked position. See FIG. 16.
Operation of the surgical instrument 10 will now be described with reference to FIGS. 12-33. FIGS. 12 and 13 illustrate the jaws 13 and 15 of the end effector 12 in an open position. As can be seen in FIG. 12, when the instrument 100 is in the open position, the latch arm 564 is located on top of the locking ledge 426 formed on the closure carriage 420 such that the catch 566 of the latch arm 564 is in retaining engagement with the locking latch 502 on the firing rack 500. Thus, when in this initial starting position, the knife bar 180 cannot be inadvertently actuated. FIGS. 13-15 also depict the surgical instrument 10 in the initial unactuated position. As can be seen in those Figures, the clutch plate 510 is in its proximal-most unactuated position. In addition, the closure carriage 420 is in its proximal-most starting or unactuated position. When in that position, the clutch drive bevel 489 on the clutch shaft 482 is in contact with a portion of the closure carriage 420, which prevents the clutch shaft 482 from laterally moving into meshing engagement with the drive gear 490 under the bias of the clutch spring 520.
FIGS. 16-19 illustrate the surgical instrument 10 after a first stroke has been applied to the trigger assembly 430. That is, the trigger assembly 430 has been initially pivoted toward the pistol grip 406. Such pivoting action serves to drive the closure carriage 420 in the distal direction “DD” by virtue of the meshing engagement between the closure gear segment 466 on the secondary trigger 460 and the carriage rack 423 formed on the underside of the closure carriage 420. Such distal movement of the closure carriage 420 also axially advances the proximal outer shaft segment 300 and the distal closure tube segment 190 in the distal direction “DD”. As the distal closure tube segment 190 moves distally, the distal end 196 thereof contacts the proximal end 21 of the anvil 20 to move the anvil 20 towards the surgical staple cartridge 30. If the surgeon desires to simply grasp and manipulate tissue prior to clamping it between the anvil 20 and the surgical staple cartridge 30, the trigger assembly 430 may be pivoted to open and close the anvil 20 without fully pivoting the trigger assembly 430 to the fully closed position depicted in FIG. 16.
Those of ordinary skill in the art will understand that, as the trigger assembly 430 is pivoted toward the pistol grip 406, the actuation bar 470 will necessarily also be driven distally by virtue of the meshing engagement between the primary gear segment 446 on the primary trigger 440 and the first actuation rack 472 on the actuation bar 470. The distal movement of the actuation bar 470 will also result in the an application of a rotary actuation motion to the clutch shaft 482 by virtue of the meshing engagement between the clutch teeth 484 on the clutch shaft 482 and the second actuation rack 474 on the actuation bar 470. However, such rotary motion is not applied to the drive gear 490 because the clutch arm 514 of the clutch plate 510, in contact with the clutch drive bevel 489 on the clutch shaft 482, prevents the axial movement of the clutch shaft 482 into meshing engagement with the drive gear 490. Thus, the clutch shaft 482 freely rotates relative to the drive gear 490. Accordingly, the clutch assembly 480 automatically prevents the activation of the firing rack 500 during the initial actuation of the trigger assembly 430.
Once the trigger assembly 430 has been initially fully compressed into the closed position (FIG. 16), the anvil 20 will be retained in the locked or clamped position by the closure locking assembly 560 which prevents the proximal movement of the closure carriage 420. More specifically, as can be seen in FIG. 16, when the trigger assembly 430 is initially pivoted to the closed position, the latch arm 564 of the locking button 562 pivots off of the locking ledge 426 formed on the closure carriage 420 and thereby prevents the closure carriage 420 from moving in the proximal direction “PD” under the bias the of closure spring 550. Thus, the closure carriage 420 and the end effector 12 are retained in the locked or clamped position when the surgeon releases the trigger assembly 430. After the surgeon releases the trigger assembly 430, the primary trigger 440 returns to its starting position under the biasing force of the trigger spring 432. The secondary trigger 460 is retained in its locked position by virtue of the meshing engagement between the closure rack 466 on the secondary trigger 460 and the carriage rack 423 formed on the underside of the closure carriage 420. The actuation system 410 is now ready to apply the second actuation motion to the end effector 12 to cut and staple the tissue clamped therein.
FIGS. 20-23 illustrate the surgical instrument 10 in its “ready-to-fire” position. As can be seen in FIG. 20, when in the ready-to-fire position, the catch 566 on the latch arm 564 is disengaged from the locking latch 502 on the firing rack 500. As can be seen in FIG. 21, when the closure carriage 420 has been advanced to its distal-most, closed position, it no longer contacts the clutch drive bevel 489 on the clutch shaft 482. When the surgeon releases the trigger assembly 430, the spring 432 causes the primary trigger 440 to return to its unactuated, starting position. As the primary trigger 440 pivots to the starting position, the clutch pin 449, by virtue of its sliding engagement in slot 512 in the clutch plate 510, causes the clutch plate 510 to move in the proximal direction “PD”. As the clutch arm 514 moves proximally, an arcuate relief 516 in the shaft arm 514 coincides with the clutch drive bevel 489 to thereby permit the clutch spring 520 to laterally bias the clutch shaft 482 into meshing engagement with the drive gear 490. See FIGS. 22 and 23. Once the clutch shaft 482 is in meshing engagement with the drive gear 490, further actuation of the primary trigger 440 will cause the firing rack 500 to be driven distally.
FIGS. 24-27 illustrate the firing of the instrument 10. In particular, to drive the knife bar 180 distally through the tissue clamped in the end effector 12, the surgeon again pivots the primary trigger 440 toward the pistol grip 406 of the handle assembly 400. As the primary trigger 440 is pivoted, the firing rack 500, the firing rod 530, and the knife bar 180 are driven in the distal direction “DD”. After the knife bar 180 has been driven through the tissue clamped in the end effector 12, the surgeon then releases the primary trigger 440 to thereby permit the primary trigger 440 to pivot to its unactuated position under the bias of the firing spring 432. As the primary trigger 440 pivots back to the starting position, the firing rack 500, firing rod 530, and knife bar 180 are drawn proximally back to their respective starting positions. The end effector 12 remains in its clamped position as shown in FIGS. 28-31. As the primary trigger 440 pivots back to the starting position, the clutch pin 449 moves the clutch plate 510 to again bring the relief 516 in the shaft arm 514 of the clutch plate 510 into alignment with the clutch drive bevel 489 as shown in FIGS. 29-31. The closure carriage 420 remains in the locked position.
To unlock the closure carriage 420 and the secondary trigger 460, the surgeon depresses the locking button 562. As the locking button 562 is depressed, the locking arm 564 is pivoted out of abutting engagement with the locking ledge 426 on the closure carriage 420 as shown in FIG. 32. Such action permits the closure carriage 420 to be biased in the proximal direction “PD” by the closure spring 550. As the closure carriage 420 moves in the proximal direction “PD”, the secondary trigger 460 is driven to the starting position. As closure carriage 420 moves proximally, a sloped surface 421 thereon contacts the clutch drive bevel 489 and laterally biases the clutch drive shaft 482 out of meshing engagement with the drive gear 490. When in the starting position as shown in FIG. 33, the closure carriage 420 retains the clutch drive shaft 482 out of meshing engagement with the drive gear 490. As the closure carriage 420 moves proximally, the proximal outer shaft segment 300, the flexible neck assembly 110, and the distal closure tube segment 190 are drawn proximally. As the distal closure tube segment 190 moves proximally, the distal tab 196 thereon contacts the proximal end wall of the slot 25 in the anvil assembly 20 and causes the anvil assembly 20 to pivot to the open position as shown.
Thus, as can be appreciated from the foregoing, at least one surgical instrument embodiment of the present invention is manually actuatable by sequential actuation of the trigger assembly. That is, at least one form of the surgical instrument disclosed herein employs an actuation system that is configured to apply at least two actuation motions to an end effector that is coupled thereto upon sequential actuations of the trigger assembly of the instrument. One of the actuation motions comprises a first axial closure motion that is applied to the closure carriage and proximal outer shaft segment that ultimately results in the closure of the end effector jaws. The second actuation motion comprises another axial motion that is applied to the end effector upon an application of a second actuation (“stroke”) of the trigger assembly. In at least one form, the second axial motion is applied to a knife bar that is driven axially through the end effector to cut tissue and fire the staples operably supported in the end effector. While the various embodiments of the surgical instruments disclosed herein have been described in connection with the use and actuation of end effectors that are configured to cut and staple tissue, those of ordinary skill in the art will appreciate that the various surgical instruments disclosed herein and their equivalent structures may be effectively employed in connection with other surgical end effectors that may be actuatable by the application of at least one axial actuation motion thereto.
FIGS. 34-48 depict another surgical instrument embodiment 610. The surgical instrument 610 is designed to manipulate and/or actuate various forms and sizes of end effectors 612 that are operably attached thereto. In the depicted embodiment, for example, the end effector 612 comprises a surgical stapling device that has openable and closable jaws 613 and 615. More specifically, the end effector 612 includes an elongated channel 614 that forms a lower jaw 613 of the end effector 612. The elongated channel 614 is configured to support a compressible staple cartridge 630 that may be of the type and construction disclosed in co-pending U.S. patent application Ser. No. 13/242,086, entitled “Staple Cartridge Including Collapsible Deck”, U.S. Patent Application Publication No. US 2013-0075450 A1 and U.S. patent application Ser. No. 13/241,912, entitled “Staple Cartridge Including Collapsible Deck Arrangement”, U.S. Patent Application Publication No. US 2013-0075448 A1, and U.S. patent application Ser. No. 12/894,351, entitled “Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems”, U.S. Patent Application Publication No. US 2012-0080502 A1 the disclosures of which are each herein incorporated by reference in their respective entireties. However, it is conceivable that the surgical instrument 610 may be employed to activate a variety of different surgical end effectors. For example, the unique and novel features of various embodiments may be successfully employed in connection with those end effectors that are configured to apply radio frequency “RF” energy to tissue clamped or otherwise engaged therein. Thus, the various embodiment of the surgical instruments disclosed herein should not be limited to use solely in connection with the types and forms of end effector depicted in the appended Figures.
In various implementations, the end effector 612 is configured to be operably coupled to an elongated shaft assembly 700 that protrudes from a handle assembly 900. The end effector 612 (when closed) and the elongated shaft assembly 700 may have similar cross-sectional shapes and be sized to operably pass through a trocar tube or working channel in another form of access instrument. As used herein, the term “operably pass” means that the end effector 612 and at least a portion of the elongated shaft assembly 700 may be inserted through or passed through the channel or tube opening and can be manipulated therein as needed to complete the surgical procedure. In some embodiments, when in a closed position, the jaws 613 and 615 of the end effector 612 may provide the end effector with a roughly circular cross-sectional shape that facilitates its passage through a circular passage/opening. However, the end effectors of various embodiments of the present invention, as well as the elongated shaft assembly embodiments, could conceivably be provided with other cross-sectional shapes that could otherwise pass through access passages and openings that have non-circular cross-sectional shapes. Thus, an overall size of a cross-section of a closed end effector will be related to the size of the passage or opening through which it is intended to pass. Thus, one end effector for example, may be referred to as a “5 mm” end effector which means it can operably pass through an opening that is at least approximately 5 mm in diameter.
In various embodiments, the elongated shaft assembly 700 may have an outer diameter that is substantially the same as the outer diameter of the end effector 612 when in a closed position. For example, a 5 mm end effector may be coupled to an elongated shaft assembly 100 that has 5 mm cross-sectional diameter. However, as the present Detailed Description proceeds, it will become apparent that various embodiments of the present may be effectively used in connection with different sizes of end effectors. For example, a 10 mm end effector may be attached to an elongated shaft that has a 5 mm cross-sectional diameter. Conversely, for those applications wherein a 10 mm or larger access opening or passage is provided, the elongated shaft assembly 700 may have a 10 mm (or larger) cross-sectional diameter, but may also be able to actuate a 5 mm or 10 mm end effector. Accordingly, the elongated shaft assembly 700 may have an outer diameter that is the same as or is different from the outer diameter of a closed end effector 612 attached thereto.
As can be seen in FIGS. 34-37, in at least one embodiment, the elongated shaft assembly 700 includes a flexible articulation joint segment 720. In various embodiments, the flexible articulation joint segment 720 comprises a fenestrated shaft that is fabricated in two pieces for assembly purposes. That is, the flexible articulation joint segment 720 comprises a fenestrated upper joint segment 730 and a fenestrated lower joint segment 740 that are interconnected by snap features, adhesive, fasteners, etc. The flexible articulation joint segment 720 may be composed of, for example, a rigid thermoplastic polyurethane sold commercially as ISOPLAST grade 2510 by the Dow Chemical Company. As can be seen in FIG. 37, in at least one embodiment, the upper joint segment 730 has a flexible upper neck segment 731 that comprises first and second upper flexible neck portions, 732 and 733. These upper neck portions 732, 733 are separated by a central longitudinal upper rib 734. Likewise, the lower joint segment 740 has a flexible lower neck segment 741 that comprises first and second lower flexible neck portions 742, 743. These lower neck portions 742, 743 are separated by a central longitudinal lower rib 744. The upper neck portions 732, 734 each have a plurality of upper neck ribs 735. The lower neck portions 742 and 743 each have a plurality of lower neck ribs 745. The upper and lower neck ribs 735, 745 are configured essentially as semi-circular disks which together generally form a cylindrical configuration when the upper joint segment 730 is joined with the lower joint segment 740.
In various embodiments, the upper joint segment 730 further has an upper tubular portion 736 and the lower joint segment 740 has a lower tubular portion 746. When joined together, the upper and lower tubular portions 736, 746 serve to receive therein two distally protruding attachment arms 616 that protrude proximally from the elongated channel 614. The attachment arms 616 have attachment tabs 618 thereon that engage the upper tubular portion 736 to affix the elongated channel 614 to the elongated shaft assembly 700. Other methods of attaching the elongated channel 614 to the elongated shaft assembly 700 may also be employed.
In at least one embodiment, the elongated shaft assembly 700 includes a substantially rigid proximal outer shaft segment 760 that has a distal end 762 is coupled to the flexible articulation joint 720 by, for example, pins or a tongue and groove slot arrangement. The proximal outer shaft segment 760 further has a proximal end 764 that is non-rotatably coupled to a nozzle assembly 770 that is rotatably supported on the handle assembly 900. In various embodiments, the handle assembly 900 comprises a pistol-shaped housing 902 that may be fabricated in two or more pieces for assembly purposes. For example, the handle assembly 900 as shown comprises a right hand case member 904 and a left hand case member 906 (FIG. 34) that are molded or otherwise fabricated from a polymer or plastic material and are designed to mate together. Such case members 904 and 906 may be attached together by snap features, pegs and sockets molded or otherwise formed therein and/or by adhesive, screws, etc. and form a handle assembly with a pistol grip portion 908.
In various embodiments, the nozzle assembly 770 comprises a nozzle member 772 that is non-rotatably attached to a nozzle bushing 774 by, for example, welding, gluing, press fit, etc. In at least one form, the nozzle bushing 774 has a pair of flanges that are rotatably supported within corresponding cavities provided in the housing 900. Such arrangement permits the nozzle member 772 to be selectively rotated relative to the handle housing 902. The proximal end 764 of the outer shaft segment 760 extends through the nozzle member 772 and nozzle bushing 774 and is attached thereto by, for example, welding, gluing, press fit, etc. Such arrangement permits the surgeon to rotate the end effector 612 about the longitudinal axis L-L by rotating the nozzle member 772 relative to the handle housing 902.
In addition, the upper and lower portions 730, 740 of the flexible articulation joint segment 720, when joined together, form a passage 750 for receiving a knife bar assembly 780. In various forms, the knife bar assembly 780 includes a distal knife bar portion 782 that may be of laminated construction to enable it to flex through the flexible articulation joint segment 720. In the depicted embodiment, the distal knife bar portion 782 terminates in a cutting head 784 that has a tissue-cutting surface 786 thereon.
Various embodiments of the end effector 612 include an anvil 620 that has a pair of trunnions 622 that are configured to be movably received in cavities 619 in the elongated channel 614. In the depicted embodiment, the cutting head 784 is configured to operably retain the anvil 620 in movable engagement with the elongated channel 614. For example, in at least one embodiment, the cutting head 784 includes upper guide fins 787 that are configured to extend into a pocket 623 formed in the anvil 620 and serve to retain the anvil 620 on the elongated channel 614. The anvil 620 is pivoted between an open position (FIG. 38) and closed positions (FIGS. 39-41) by virtue of the axial movement of the knife bar assembly 780 in the distal direction “DD”. The cutting head 784 further has lower guide fins 787 formed thereon such that, as the cutting head 784 is driven distally, the anvil 620 is pressed into the crushable implantable cartridge 630 that is operably supported in the elongated channel 614. As the anvil 620 is pressed into the cartridge 630, the staples that are supported within the cartridge are pressed and formed into the tissue clamped in the end effector 612 on both sides of the tissue cutline. After the tissue has been cut and the staples formed, the cutting head 784 is withdrawn in the proximal direction “PD” to the starting position wherein the cutting head 784 interacts with the anvil 620 to move the anvil 620 to the open position as shown in FIG. 38.
As will be discussed in further detail below, in at least one embodiment, the axial advancement and withdrawal of the knife bar assembly 780 is controlled by the manual activation of a firing trigger that is operably supported on the handle assembly 900. As can be seen in FIG. 36, a connector member 790 is coupled to a proximal end 781 of the distal knife bar portion 782. In at least one embodiment, for example, the connector member 790 is pinned to the proximal end 781 of the distal knife bar portion 782 and has a proximally protruding attachment feature 792 that is configured to be coupled to a distal end 802 of a hollow knife tube 800. The hollow knife tube 800 extends through the outer shaft segment 760 and into the handle housing 902 and is attached to a carriage assembly 810. In various embodiments, for example, the carriage assembly 810 comprises a flanged carriage bushing 812 that is press fit onto a portion of the knife tube 800. The carriage assembly 810 further comprises a firing carriage 814 that has a saddle formed therein configured to extend over the carriage bushing 812 between the bushing flanges 813. In at least one form, the firing carriage 814 also has a pair of laterally extending portions 816 that each have a support tab 818 formed thereon. The support tabs 818 are configured to be slidably received in a corresponding slide passage (not shown) formed in the handle housing 902. Such arrangement permits the firing carriage 814 to move axially within the handle assembly 900 and thereby apply axial actuation motions to the knife tube 800 while permitting the knife tube 800 to rotate about the longitudinal axis L-L relative to the firing carriage 824 as the nozzle assembly 770 is rotated.
In at least one embodiment, actuation motions may be manually applied to the firing carriage 814 by a firing trigger assembly 820 that is pivotally supported on the handle assembly 900. The firing trigger assembly 820 includes a firing trigger 822 that has an attachment plate 824 that is configured to operably interface with a pair of actuation plates 826. As can be seen in FIG. 36, the attachment plate 824 is located between the actuation plates 826 and is pivotally pinned thereto by a first pivot pin 828 that extends through slots 830 in the actuation plates 826 and a hole 825 in the attachment plate 824. A second pivot pin 832 is received within or is supported by mounting lugs in the handle cases 904, 906 and extends between holes 834 in the actuation plates 826. Each of the actuation plates 826 have a lug 836 that extends into a corresponding pocket or opening 815 in the firing carriage 814. Such arrangement facilitates the application of axial actuation motions to the knife tube 800 by pivoting the firing trigger 822 relative to the handle housing 902. As the firing trigger 822 is pivoted towards the pistol grip portion 908 of the handle housing 902, the firing carriage 814 is driven in the distal direction “DD”. As the firing trigger 822 is pivoted away from the pistol grip portion 908 of the handle housing 902, the firing carriage 814 draws the knife tube 800 in the proximal direction “PD”.
Various embodiments of the surgical instrument 610 further include a locking system 840 that includes a locking trigger 842 that is pivotally coupled to the handle housing 902. The locking trigger 842 includes a locking bar portion 844 that is configured to operably engage a locking member 846 that is pivotally attached to the attachment plate 824 of the firing trigger 822 by pin 849. When the locking trigger 842 is in the unactuated position, the locking bar 842 prevents the locking member 846 from pivoting beyond the point illustrated in FIG. 40.
Actuation of the end effector 612 will now be explained with reference to FIGS. 37-42. FIG. 37 illustrates the surgical instrument 610 in the unfired position with the end effector 612 in an open position. While grasping the pistol grip portion 908 of the handle assembly 900, the surgeon may apply a closing motion to the anvil 620 of the end effector 612 by applying an actuation force “F” to the firing trigger 822 as shown in FIG. 39. Such action results in the application of an actuation motion to the firing carriage 814 by the actuation plates 826 which ultimately results in the axial displacement of the knife tube 800 in the distal direction “DD”. As the knife tube 800 is advanced in the distal direction “DD”, the knife bar assembly 780 is likewise driven in the distal direction “DD”. As the knife bar assembly 780 and, more particularly the cutting head 784, is driven in the distal direction “DD”, the cutting head 784 advances out of the pocket 623 in the anvil 620 and contacts a sloped surface feature 625 on the anvil 620 to start to apply a closing motion to the anvil 620. Further application of the actuation force “F” to the firing trigger 822 results in further axial displacement of the knife tube 800 and the cutting head 784 as shown in FIG. 40. Such action further moves the anvil 620 towards the elongated channel 614. As the firing trigger 822 is pivoted towards the pistol grip portion 908 of the handle assembly 900, the locking member 848 also pivots in the counterclockwise “CCW” direction about the pin 849. At this point, the cutting head 784 is prevented from moving any further in the distal direction “DD” by virtue of the locking system 840. More particularly, as can be seen in FIG. 40, the distal end of the locking member 848 is prevented from pivoting any further in the counterclockwise “CCW” direction about pin 849 by the locking bar portion 844 of the locking trigger 842. Thus, the surgeon may move the anvil 620 to capture and manipulate tissue in the end effector 612 without risk of actually “firing” the end effector 612 (i.e., or cutting the tissue and forming the staples).
Once the surgeon desires to cut tissue and form staples, a second actuation force “F′” is applied to the locking trigger 842 as shown in FIG. 41. As can be seen in that Figure, when the locking trigger 842 is depressed, the locking bar portion 844 pivots to a forward position which thereby permits the locking member 848 to continue to pivot in the counterclockwise direction as the surgeon continues to apply the actuation force “F” to the trigger 822. Such actuation of the firing trigger 822 results in the axial displacement of the cutting head 784 through the anvil 620. As the cutting head 784 moves distally through the end effector 612, the cutting surface 786 cuts tissue and the anvil 620 is pressed into the cartridge 630 by the fins 787, 788. As the anvil 620 is compressed into the cartridge 630, the staples supported therein are formed into the tissue on each side of the tissue cut line.
After completing the cutting and stapling process, the firing trigger 822 may be released. A return spring (not shown) attached to the firing trigger 822 returns the firing trigger 822 to the unactuated position. Alternative, the user can use the hook feature of the trigger to “pull” open the trigger if no spring is used. As the firing trigger 822 moves in the clockwise “CW” direction, the firing carriage 814 is moved in the proximal direction “PD” which also moves the knife bar assembly 780 in the proximal direction “PD”. As the cutting head 784 re-enters the pocket 623 in the anvil 620, the anvil 620 is once again pivoted to the open position.
Various forms of the present invention further employ a unique and novel articulation system generally designated as 1000 for articulating the end effector 612 about the flexible articulation joint 720. In at least one embodiment, the articulation system 1000 comprises first and second articulation band assemblies 1010 and 1020. It will be understood, however, in alternative embodiments, only one articulation band assembly is employed. In at least one embodiment, the first articulation band assembly 1010 comprises a flexible first distal segment 1012 that is fabricated from, for example, spring steel, 420 stainless steel, titanium, 400 or 300 grade stainless steel and has a first hook 1014 formed in its distal end. The first hook 1014 is configured to hookingly engage a first hook-receiving feature 748 formed in the lower tube portion 746 of the flexible articulation joint 720 on a first side of the longitudinal axis L-L. The first articulation band assembly 1010 further includes a first structural band portion 1016 that is attached to (e.g., pinned) to the first distal segment 1012. The first structural band portion 1016 may be fabricated from, for example, spring steel, 420 stainless steel, titanium. Likewise, the second articulation band assembly 1020 comprises a flexible second distal segment 1022 that is fabricated from, for example, spring steel, 420 stainless steel, titanium and has a second hook 1024 formed in its distal end. See FIG. 36. The second hook 1024 is configured to hookingly engage a second hook-receiving feature 749 formed in the lower tube portion 746 of the flexible articulation joint 720 on a second side of the longitudinal axis L-L. The second articulation band assembly further includes a second structural band portion 1026 that is attached to (e.g., pinned) to the second distal segment 1022. The second structural band portion 1026 may be fabricated from, for example, 400 or 300 grade stainless steel.
Various embodiments of the articulation system 1000 include a novel articulation transmission 1030 that is supported within the handle assembly 900 for applying articulation motions to the first and second articulation band assemblies 1010, 1020. In various forms, the articulation transmission 1030 includes an actuator wheel 1040 that is rotatably supported on the handle assembly 900 for selective rotation about an actuation axis. In at least one embodiment, the actuation axis coincides with or is substantially coaxial with the longitudinal axis L-L. Thus the actuation axis does not transversely intersect the longitudinal axis. In other embodiments, the actuation axis may be substantially parallel to the longitudinal axis. To facilitate ease of assembly and manufacturing, the actuator wheel 1040 is fabricated in two pieces 1040A, 1040B that may be attached together by screws, snap features, adhesive etc. When assembled, the actuator wheel 1040 has a first set of actuator threads 1042 which are configured in a first direction for threaded engagement with a first thread nut assembly 1060. In addition, the actuator wheel also has a second set of actuator threads 1044 which are configured in a second direction that differs from the first direction. For example, the first threads 1042 may comprise “right hand” threads and the second threads 1044 may comprise ‘left hand” threads or visa versa. The second threads 1044 are adapted to threadably engage a second threaded nut assembly 1070.
In various embodiments, the first threaded nut assembly 1060 comprises a first disc 1062 that has first threads 1064 formed thereon. The first disc 1062 is supported on the knife tube 800 by a first bearing bushing 1066. The first bearing bushing 1066 facilitates movement of the first disc 1062 relative to the knife tube 800. Similarly, the second threaded nut assembly 1070 comprises a second disc 1072 that has second threads 1074 formed thereon. The second disc 1072 is supported on the knife tube 800 by a second bearing bushing 1076 that facilitates movement of the second disc 1072 relative to the knife tube 800. The first and second discs 1062, 1072 are also movably supported on upper and lower nut rails 1050, 1052 that are mounted to standoff posts 905 molded into the handle cases 904, 906. See FIG. 36. The upper and lower nut rails 1050, 1052 serve to prevent the first and second discs 1062, 1072 from rotating relative to the handle housing 902 and therefore, as the actuator wheel 1040 is rotated relative to the handle housing 902, the first and second bearing bushings 1066, 1076 move axially on the knife tube 800 in different directions.
The first and second band assemblies 1010, 1020 are controlled by rotating the actuator wheel 1040 relative to the handle housing 902. To facilitate the application of such control motions, the first structural band portion 1016 has a first catch member configured to retainingly engage the first bearing bushing 1066 and the second structural band portion 1026 has a second catch member configured to retainingly engage the second bearing bushing 1076. In addition, the articulation system 1000 in at least one form includes an elongated support beam 1080 that extends longitudinally within the knife tube 800 to provide lateral support to the first and second structural band portions 1016, 1026 within the knife tube 800. The support beam 1080 may be fabricated from, for example, 400 or 300 grade stainless steel and is configured to facilitate axial movement of the first and second structural band portions 1016, 1026 while providing lateral support thereto.
Operation of the articulation system 1000 may be understood from reference to FIGS. 43-48. FIGS. 43 and 44 illustrate the surgical instrument 610 in an unarticulated position. That is, when in an unarticulated position, the end effector 612 is substantially axially aligned on the longitudinal axis L-L as shown in FIG. 43. When in that “neutral” position, the first and second discs 1062, 1072 are spaced away from each other in the position shown in FIG. 44. To provide the surgeon with an indication when the articulation system 1000 has been parked in the neutral position, a detent assembly 1090 is mounted within the handle housing 902. The detent assembly 1090 into the housing 902 and is adapted to engage a recess (not shown) in the hub portion 1041 of the actuator wheel 1040. See FIG. 36. The detent assembly 902 is configured to engage the recess when the actuator wheel 1040 is in the neutral position. When the detent 1090 engages the recess, the surgeon may receive a tactile and/or audible indication.
FIGS. 45 and 46 illustrate the articulation of the end effector 612 relative to the longitudinal axis L-L in a first articulation direction “FAD”. The articulation system 1000 articulates the end effector 612 about the flexible articulation joint 720 in the following manner. First, the surgeon rotates the articulation actuator wheel 1040 in a first direction which causes the first and second discs 1062, 1072 to move toward each other to the position shown in FIG. 46. As the first disc 1062 moves in the proximal direction “PD”, the first articulation band assembly 1010 is pulled in the proximal direction “PD” by virtue of the first catch feature 1017 which is coupled to the first bearing bushing 1066. Likewise, as the second disc 1072 moves in the distal direction “DD”, the second articulation band assembly 1020 is pushed in the distal direction “DD” by virtue of the second catch feature 1027 which is coupled to the second bearing bushing 1076. Such action of the first and second articulation band assemblies 1010, 1020 causes the end effector 612 to articulate in the first articulation direction “FAD” by virtue of the first and second articulation bands 1010, 1020 interconnection with the lower tube portion 746 of the flexible articulation joint 720 which is coupled to the end effector 612.
FIGS. 47 and 48 illustrate the articulation of the end effector 612 relative to the longitudinal axis L-L in a second articulation direction “SAD”. The articulation system 1000 articulates the end effector 612 about the flexible articulation joint 720 in the following manner. First, the surgeon rotates the articulation actuator wheel 1040 in a second direction which causes the first and second discs 1062, 1072 to move away from each other to the position shown in FIG. 48. As the first disc 1062 moves in the distal direction “DD”, the first articulation band assembly 1010 is pushed in the distal direction “PD” by virtue of the first catch feature 1017 which is coupled to the first bearing bushing 1066. Likewise, as the second disc 1072 moves in the proximal direction “PD”, the second articulation band assembly 1020 is pulled in the proximal direction “PD” by virtue of the second catch feature 1027 which is coupled to the second bearing bushing 1076. Such action of the first and second articulation band assemblies 1010, 1020 causes the end effector 612 to articulate in the second articulation direction “SAD” by virtue of the first and second articulation bands 1010, 1020 interconnection with the lower tube portion 746 of the flexible articulation joint 720 which is coupled to the end effector 612.
The devices disclosed herein can be designed to be disposed of after a single use, or they can be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of the steps of disassembly of the device, followed by cleaning or replacement of particular pieces, and subsequent reassembly. In particular, the device can be disassembled, and any number of the particular pieces or parts of the device can be selectively replaced or removed in any combination. Upon cleaning and/or replacement of particular parts, the device can be reassembled for subsequent use either at a reconditioning facility, or by a surgical team immediately prior to a surgical procedure. Those skilled in the art will appreciate that reconditioning of a device can utilize a variety of techniques for disassembly, cleaning/replacement, and reassembly. Use of such techniques, and the resulting reconditioned device, are all within the scope of the present application.
Preferably, the invention described herein will be processed before surgery. First, a new or used instrument is obtained and if necessary cleaned. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a plastic or TYVEK bag. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high-energy electrons. The radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in the sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.
Any patent, publication, or other disclosure material, in whole or in part, that is said to be incorporated by reference herein is incorporated herein only to the extent that the incorporated materials does not conflict with existing definitions, statements, or other disclosure material set forth in this disclosure. As such, and to the extent necessary, the disclosure as explicitly set forth herein supersedes any conflicting material incorporated herein by reference. Any material, or portion thereof, that is said to be incorporated by reference herein, but which conflicts with existing definitions, statements, or other disclosure material set forth herein will only be incorporated to the extent that no conflict arises between that incorporated material and the existing disclosure material.
While this invention has been described as having exemplary designs, the present invention may be further modified within the spirit and scope of the disclosure. This application is therefore intended to cover any variations, uses, or adaptations of the invention using its general principles. Further, this application is intended to cover such departures from the present disclosure as come within known or customary practice in the art to which this invention pertains.

## Claims

1. A surgical instrument comprising:
a handle assembly;
a trigger assembly comprising:
a primary trigger movably supported on said handle assembly; and
a secondary trigger movably supported relative to said primary trigger and wherein said surgical instrument further comprises:

an actuation system operably supported by said handle assembly and configured to generate at least two separate actuation motions, said actuation system comprising:
a carriage operably supported by said handle assembly for selective axial travel relative thereto from an unactuated position to an actuated position upon application of a first stroke to said primary trigger to generate a first one of said actuation motions; and
a first actuation rack operably supported by said handle assembly and operably interfacing with a clutch assembly to generate a second one of said actuation motions upon application of a second stroke to said primary trigger and wherein said secondary trigger is configured to interface with said primary trigger such that upon application of said first stroke to said primary trigger, said secondary trigger moves said carriage from said unactuated position to said actuated position to enable said clutch assembly to move from an unengaged position to an engaged position.

2. The surgical instrument of claim 1 wherein one of said actuation motions comprises a first axial motion and wherein another one of said actuation motions comprises a second axial motion.

3. The surgical instrument of claim 1 wherein said actuation system further comprises:
a firing rack supported for axial travel within said handle assembly and configured to generate said second one of said actuation motions;
a drive gear in meshing engagement with said firing rack and interfacing with a clutch gear that is movable from said unengaged position wherein said clutch gear is rotatable relative to said drive gear and said engaged position wherein rotation of said clutch gear rotates said drive gear; and
an actuation bar supported for axial travel within said handle assembly and in meshing engagement with said primary trigger and said clutch gear such that upon application of said second stroke to said primary trigger, said actuation bar rotates said clutch gear.

4. The surgical instrument of claim 3 wherein said clutch assembly further comprises a biasing member for biasing said clutch gear into said unengaged position.

5. The surgical instrument of claim 4 wherein said clutch assembly further comprises a clutch plate movable between a first position wherein said clutch plate retains said clutch gear in said unengaged position and a second position wherein said clutch gear is movable to said engaged position by said biasing member, said clutch plate operably interfacing with said primary trigger such that, upon application of said second stroke to said primary trigger, said clutch plate is moved from said first position to said second position.

6. The surgical instrument of claim 3 further comprising a locking assembly operably supported by said handle assembly and configured to interact with said carriage such that when said carriage is in said actuated position, said carriage is releasably retained in said actuated position by said locking assembly.

7. The surgical instrument of claim 6 wherein said locking assembly comprises a locking button movably supported by said handle assembly and movable from a first position wherein said carriage is selectively movable from said unactuated position to said actuated position and said firing rack is prevented from moving and a second position wherein said carriage is retained in said actuated position and said firing rack is selectively movable upon application of said second stroke to said primary trigger.

8. The surgical instrument of claim 1 wherein said secondary trigger is in meshing engagement with said carriage.

9. The surgical instrument of claim 1 further comprising:
a surgical end effector configured to perform a first surgical action upon application of said first one of said actuation motions thereto and a second surgical action upon application of said second one of said actuation motions thereto; and
an elongated shaft assembly protruding from said handle assembly and operably interfacing with said surgical end effector, said elongated shaft assembly operably interfacing with said actuation system to apply said first and second actuation motions to said surgical end effector.

10. The surgical instrument of claim 9 wherein said elongated shaft assembly defines a longitudinal axis and wherein said end effector is selectively articulatable relative to said longitudinal axis.

11. The surgical instrument of claim 10 wherein said elongated shaft assembly has a flexible articulation joint therein and wherein said handle assembly operably supports an articulation control system for applying articulation motions to said end effector through said flexible articulation joint.

12. The surgical instrument of claim 9 wherein said surgical end effector comprises:
an elongated channel;
an anvil movably supported relative to said elongated channel and being selectively movable from an open position to closed positions relative to said elongated channel upon application of said first actuation motions thereto;
a surgical staple cartridge operably supported in said elongated channel;
a tissue cutting member operably supported relative to said staple cartridge and being movable from a proximal end of said elongated channel to a distal end of said elongated channel upon application of said second actuation motion thereto.

13. A method of cutting and stapling target tissue comprising:
providing a surgical instrument of claim 12;
manipulating said surgical end effector such that the target tissue is located between the anvil and the surgical staple cartridge;
applying said first stroke to the primary trigger to cause the target tissue to be clamped between the anvil and the surgical staple cartridge; and
applying said second stroke to the primary trigger to cause the tissue cutting member to cut the clamped target tissue and fire surgical staples in the surgical staple cartridge into the cut target tissue and into forming contact with the anvil.