Abstract:
An end effector includes first and second jaws, first and second buttresses, and an ultrasonic blade. The first jaw includes a fastener cartridge having a first tissue contacting surface and a plurality of fasteners arranged in rows parallel to a longitudinal axis of the first jaw. The first buttress is attached to the first tissue contacting surface and the second buttress is attached to a second tissue contracting surface of the second jaw. The first and second jaws are movable relative to one another and are configured to grasp tissue therebetween. The ultrasonic is activatable to weld the first buttress to the second buttress and to subsequently cut the welded first and second buttresses and tissue grasped between the first and second jaws.

Description:
BACKGROUND 
       [0001]    1. Technical Field 
         [0002]    The present disclosure relates generally to surgical stapling instruments. More specifically, the present disclosure relates to stapling instruments including ultrasonic energy delivery. 
         [0003]    2. Background of Related Art 
         [0004]    Surgical stapling instruments configured to join tissue portions during a surgical procedure are well known. These stapling instruments include linear end effectors which are oriented parallel or transverse to a longitudinal axis of the instrument. These stapling instruments also include circular end effectors. 
         [0005]    Stapling instruments can include a knife that cuts tissue between staple lines. Alternatively, some stapling instruments include ultrasonic blades that cut tissue between the staple lines. 
         [0006]    Surgical buttress material may be used in combination with stapling instruments to reinforce the staple lines to promote proper staple formation, reduce bleeding, and promote anastomosis of tissue. 
       SUMMARY 
       [0007]    In an aspect of the present disclosure, an end effector includes first and second jaws, first and second buttresses, and an ultrasonic blade. The first jaw includes a fastener cartridge that has a first tissue contacting surface and a plurality of fasteners arranged in rows parallel to a longitudinal axis of the first jaw. The second jaw includes a section tissue contacting surface. The first and second jaws are moveable relative to one another and are configured to grasp tissue therebetween. The first buttress is attached to the first tissue contacting surface. The second buttress is attached to the second tissue contacting surface. The ultrasonic blade is activatable to weld the first buttress to the second buttress and to subsequently cut the welded first and second buttresses and tissue grasped between the first and second jaws. 
         [0008]    In aspects, the ultrasonic blade has a first portion that is disposed on the first tissue contacting surface between two rows of the plurality of fasteners. The ultrasonic blade may have a second portion that is disposed on the second tissue contacting surface opposing the first portion of the ultrasonic blade. The second portion may be parallel to a longitudinal axis of the second jaw. 
         [0009]    In some aspects, the plurality of fasteners are ejectable from the fastener cartridge and are configured to secure the first and second buttresses about tissue grasped between the first and second jaws. The plurality of fasteners may be staples and the second jaw may include an anvil for deforming the staples as the staples are ejected from the fastener cartridge. 
         [0010]    In another aspect of the present disclosure, an end effector includes a first jaw, a second jaw, and an ultrasonic blade. The first jaw includes a fastener cartridge that has a first tissue contacting surface and a plurality of fasteners that are arranged in rows parallel to a longitudinal axis of the first jaw. The fastener cartridge defines a blade channel along its longitudinal axis. The second jaw includes a second tissue contacting surface and a protrusion that opposes the blade channel. The first and second jaws are moveable relative to one another and are configured to grasp tissue therebetween. The ultrasonic blade has first and second portions that are disposed within the blade channel. The first and second portions are each adjacent one of the opposing walls defining the blade channel. The first and second portions define a gap therebetween along the longitudinal axis of the first jaw. The protrusion is disposed within the gap when the first and second jaws are in an approximated configuration. 
         [0011]    In aspects, the end effector includes a first buttress attached to the first tissue contacting surface and a second buttress attached to the second tissue contacting surface. The plurality of fasteners may be staples and the second jaw may include an anvil for deforming the staples as the staples are ejected from the fasteners cartridge. 
         [0012]    In yet another aspect of the present disclosure, a method of dissecting tissue includes clamping tissue between opposing jaws of an end effector, ejecting fasteners from one of the opposing jaws, and activating an ultrasonic blade. Each of the opposing jaws may include a buttress attached to a tissue contacting surface. Ejecting the fasteners from one of the opposing jaws includes ejecting the fasteners through each of the buttresses to fasten the clamped tissue together. The fasteners are disposed in rows parallel to a longitudinal axis of the end effector. The ultrasonic blade is disposed in a blade channel disposed along the longitudinal axis of the end effector. Activating the ultrasonic blade cuts the tissue and welds the buttresses together. Clamping tissue between the opposing jaws of the end effector may include a protrusion on one jaw urging a portion of the tissue into the blade channel of the opposing jaw. 
         [0013]    Further, to the extent consistent, any of the aspects described herein may be used in conjunction with any or all of the other aspects described herein. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0014]    Various aspects of the present disclosure are described hereinbelow with reference to the drawings, which are incorporated in and constitute a part of this specification, wherein: 
           [0015]      FIG. 1A  is a perspective view of a manually actuated handle assembly and a loading unit in accordance with the present disclosure; 
           [0016]      FIG. 1B  is a perspective view of an electromechanical instrument, an adaptor, and the loading unit of  FIG. 1A ; 
           [0017]      FIG. 2  is an enlarged view of the indicated area of detail of  FIG. 1A ; 
           [0018]      FIG. 3  is a cross-sectional view taken along the section line  3 - 3  with jaws approximated of  FIG. 2 ; 
           [0019]      FIG. 4  is a cross-sectional view taken along the section line  4 - 4  of  FIG. 3 ; 
           [0020]      FIG. 5  is a side cross-sectional view of tissue joined with the end effector of  FIG. 2 ; and 
           [0021]      FIG. 6  is a cross-sectional view similar to  FIG. 4  of another end effector provided in accordance with the present disclosure. 
       
    
    
     DETAILED DESCRIPTION OF EMBODIMENTS 
       [0022]    Embodiments of the present disclosure are now described in detail with reference to the drawings in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “clinician” refers to a doctor, a nurse, or any other care provider and may include support personnel. Throughout this description, the term “proximal” refers to the portion of the device or component thereof that is closest to the clinician and the term “distal” refers to the portion of the device or component thereof that is farthest from the clinician. 
         [0023]      FIGS. 1A and 1B  illustrate a loading unit  10  having an end effector  20  in accordance with an embodiment of the present disclosure. The loading unit  10  is configured for connection to a manually actuated handle assembly or stapling instrument  100  such as described in U.S. Pat. No. 8,789,737 (“the &#39;737 patent”), which is incorporated herein by reference. Alternatively, the loading unit  10  can be configured for selective connection to a powered hand held electromechanical instrument  200  via the adaptor  210 . In such an embodiment, the adaptor  210  of the electromechanical instrument  200  may have a configuration similar to that of the elongated body portion  110  of the stapling instrument  100  as shown in  FIG. 1A . The loading unit  10  is releasably coupled to a distal end  112  of the elongated body portion  110  of the manually actuated handle assembly  100  or to a distal end  212  of the adaptor  210  of the electromechanical instrument  200 . The end effector  20  is operatively associated with an ultrasonic generator  300 . As shown in  FIG. 1A , the ultrasonic generator  300  may be external to the stapling instrument (e.g., stapling instrument  100  or electromechanical instrument  200 ). Alternatively, as shown in  FIG. 1B , the ultrasonic generator  300  may be incorporated into the stapling instrument (e.g., stapling instrument  100  or electromechanical instrument  200 ). 
         [0024]    For a detailed description of the structure and function of an exemplary adaptor and loading unit, please refer to commonly owned U.S. Patent Publication No. 2012/0089131. For a detailed description of the structure and function of an exemplary electromechanical instrument, please refer to commonly owned U.S. Patent Publication Nos. 2012/0253329 and 2012/0323226. For a detailed description of the structure and function of an exemplary ultrasonic generator, please refer to commonly owned U.S. Pat. No. 8,419,758. Each of these disclosures is incorporated herein by reference in its entirety. 
         [0025]    Referring to  FIGS. 2 and 3 , the loading unit  10  includes a first or lower jaw  22  and a second or upper jaw  24 . The upper and lower jaws  22 ,  24  are moveable relative to one another between a spaced-apart configuration ( FIG. 2 ) and an approximated configuration ( FIG. 3 ). The lower jaw  22  includes a fastener cartridge  30  having a plurality of staples  32  arranged in rows  33  on either side of a knife or lower blade channel  26  ( FIG. 4 ). The fastener cartridge  30  may be releasably coupled to the lower jaw  22 . The upper jaw  24  includes an anvil  40  that is configured to deform the staples  32  into formed staples as the staples  32  are ejected through openings  31  of the fastener cartridge  30  when the jaws  22 ,  24  are in the approximated configuration as detailed below. 
         [0026]    Alternatively, the fastener cartridge  30  of the lower jaw  22  may include a plurality of fasteners (not explicitly shown) and the upper jaw  24  may include a retainer cartridge (not shown) that includes a plurality of retainers (not shown). As the fasteners are ejected from the fastener cartridge  30  of the first jaw  22 , each of the fasteners forms a two-part fastener with one of the retainers of the retainer cartridge. 
         [0027]    With additional reference to  FIG. 4 , the fastener cartridge  30  and the anvil  40  each include a tissue contacting surface  23 ,  25 , respectively. The end effector  20  may include a buttress  50  releasably disposed on each of the tissue contacting surfaces  23 ,  25 . The buttress  50  may be fabricated from a suitable biocompatible and bioabsorbable material. The buttress  50  may be fabricated from a non-absorbent material which does not retain fluid, or the buttress can be made from an absorbent material. For a detailed description of suitable materials for surgical buttresses, please refer to commonly owned U.S. Pat. Nos. 5,542,594; 5,908,427; 5,964,774; 6,045,560; 7,823,592; and 7,938,307, and commonly assigned U.S. Patent Publication No. 2010/0092710, the entire contents of each of which is incorporated herein by reference. As detailed below, the buttress  50  detaches from the tissue contacting surfaces  23 ,  25  of the fastener cartridge  30  and the anvil  40  when the staples  32  are ejected from the fastener cartridge  30 . As discussed in greater detail below, the buttresses  50  may promote anastomosis, reduce bleeding, provide support for the tissue to facilitate a higher burst pressure, and distribute pressure from the fasteners to a larger area of tissue. 
         [0028]    The anvil  40  defines an upper blade channel  28  that opposes the lower blade channel  26  of the fastener cartridge  30 . An ultrasonic blade  54  is disposed in each of the blade channels  26 ,  28 . The ultrasonic blades  54  are operatively associated with an ultrasonic generator  300  ( FIG. 1A ). The ultrasonic generator  300  provides ultrasonic energy to the ultrasonic blades  54  to ultrasonically translate the ultrasonic blades  54  within the blade channels  26 ,  28 . As detailed below, the ultrasonic blades  54  are configured to cut tissue between the jaws  22 ,  24  along a cut line CL ( FIG. 4 ) in the approximated configuration and to weld the buttress  50  attached to the tissue contacting surface  23  of the lower jaw  22  to buttress  50  attached to the tissue contacting surface  25  of the upper jaw  24 . 
         [0029]    Referring to  FIGS. 4 and 5 , the end effector  20  is used to fasten and divide tissue T in accordance with the present disclosure. The jaws  22 ,  24  of the end effector  20  are approximated over tissue T to be fastened and divided. With layers of the tissue T positioned between the jaws  22 ,  24 , the staples  32  are ejected from the fastener cartridge  30  of the lower jaw  22  towards the anvil  40  of the upper jaw  24 . The staples  32  pass through the buttresses  50  and are formed in staple pockets  41  defined by the anvil  40  such that the staples  32  are disposed on either side of the tissue to urge the buttresses  50  towards one another. The staple pockets  41  deform legs of the staples  32  towards one another such that the staples  32  fasten the layers of tissue T to one another. The buttresses  50  compress the layers of tissue T therebetween to promote anastomosis of the tissue T. The ultrasonic blades  54  are then supplied with ultrasonic energy to cut the layers of tissue T between the ultrasonic blades  54  along the cut line CL. As the ultrasonic blades  54  cut the tissue T between the ultrasonic blades  54 , the ultrasonic blades  54  weld the buttresses  50  together adjacent the central cut line CL. The weld W ( FIG. 5 ) of the buttresses  50  helps seal the cut portion of the tissue T. 
         [0030]    By welding the buttresses  50  together adjacent the cut line CL of the tissue T, bleeding of the tissue T may be reduced when compared to anastomosis from stapling alone. Further, by stapling through the buttresses  50  adjacent the cut line CL, the ultrasonic blades  54  may be used to cut and seal tissue T having a greater thickness when compared to an ultrasonic dissector alone. 
         [0031]    Referring now to  FIG. 6 , another end effector  120  is provided in accordance with the present disclosure. The end effector  120  is similar to the end effector  20  detailed above with like structures represented with similar labels, as such only the differences will be discussed in detail below. A lower jaw  122  includes a fastener cartridge  130  and has a stepped tissue contacting surface  123 . It is within the scope of this disclosure, that the tissue contacting surface  125  of the anvil  140  may also have a stepped configuration similar to the stepped configuration of the tissue contacting surface  123  of the fastener cartridge  130 . The stepped configuration of the tissue contacting surfaces  123 ,  125  compress tissue T between the jaws  122 ,  124  in a step like manner which may allow tissue having a greater thickness to be stapled and cut. The fastener cartridge  130  defines a blade channel  126  between rows of fasteners  132 . Two ultrasonic blades  154  are disposed within the blade channel  126  adjacent walls defining the blade channel  126 . 
         [0032]    The tissue contacting surface  125  of the upper jaw  124  includes a protrusion  156  opposing the blade channel  126  of the fastener cartridge  130 . The protrusion  156  extends into the blade channel  126  when the jaws  122 ,  124  are in the approximated configuration as shown in  FIG. 6 . The protrusion  156  urges the tissue T into the blade channel  126  and may compress the tissue T into the blade channel  126 . As shown, the protrusion  156  has a triangular cross-sectional shape; however, the protrusion  156  may have a variety of shapes that fit within the blade channel  126  of the lower jaw  122  (e.g., semi-circular, rectangular, pentagonal, etc.). When the tissue T is within the blade channel  126 , the fasteners  132  are ejected from the fastener cartridge  130  and the ultrasonic blades  154  are activated to cut and seal the tissue T. The protrusion  156  being received within the blade channel  126  may also align the fastener cartridge  130  and the anvil  140 . 
         [0033]    It is contemplated that the tissue contacting surfaces  123 ,  125  of the fastener cartridge  130  and the anvil  140  may include buttresses (not explicitly shown) as detailed above to provide additional support to the tissue T as the tissue is stapled and cut. The buttresses may also be welded together adjacent the cutlines of the ultrasonic blades  154  as detailed above. 
         [0034]    It is also contemplated that the protrusion  156  may include an ultrasonic blade such that after the tissue T is stapled and sealed, the ultrasonic blade of the protrusion  156  is activated to cut the tissue along a tip  156   a  of the protrusion  156 . 
         [0035]    While several embodiments of the disclosure have been shown in the drawings, it is not intended that the disclosure be limited thereto, as it is intended that the disclosure be as broad in scope as the art will allow and that the specification be read likewise. For example, in any of the embodiments disclosed herein, the surgical instrument can include one or more electrosurgical components, such as monopolar or bipolar components for cutting, cauterizing, and/or sealing tissue or buttress material. Any combination of the above embodiments is also envisioned and is within the scope of the appended claims. Therefore, the above description should not be construed as limiting, but merely as exemplifications of particular embodiments. Those skilled in the art will envision other modifications within the scope of the claims appended hereto.