Patent Publication Number: US-2017354413-A1

Title: Stapling head assembly and suturing and cutting apparatus for endoscopic surgery

Description:
CROSS-REFERENCES TO RELATED APPLICATIONS 
     This patent application is a 371 of International Application No. PCT/CN2015/099936, filed Dec. 30, 2015 which claims the priority of Chinese Application No. 201420858544.7, filed Dec. 30, 2014 and Chinese Application No. 201410843332.6, filed Dec. 30, 2014, each of which are incorporated herein by reference in their entirety. 
    
    
     TECHNICAL FIELD 
     The invention relates to the field of medical instruments, particularly, to a stapling head assembly with a lockout mechanism preventing from being fired for a second time and a suturing and cutting apparatus for endoscopic surgery with the stapling head assembly. 
     BACKGROUND 
     A suturing and cutting apparatus for surgery has been widely used for suturing wounds, suturing and cutting internal tissues. The surgery having developed so far has an increasing tendency to be minimally invasive surgery. Generally speaking, minimally invasive surgery means all operations which can decrease wounds; narrowly speaking, minimally invasive surgery means the operations processed under endoscope. Generally, a few small holes are needed to be opened on the patient&#39;s body for endoscopic surgery, so the cutting and suturing instruments and assistant instruments can be used for operation by going into the patient&#39;s body through the small holes. With the little wounds caused from the minimally invasive surgery, the patients can recover in a very short time, so the minimally invasive surgery has gotten more and more attention. 
     The linear suturing and cutting apparatus for endoscopic surgery used in minimally invasive surgery in the existing technology, comprise an instrument body, said instrument body comprises a sleeve and an actuating handle pivoted to the sleeve, there is an actuating rod removable set in the sleeve, said stapling head assembly at the front end of the sleeve can be pushed by the actuating rod to process suturing and cutting. Specifically, said stapling head assembly comprises a cartridge support, and an anvil pivotally connected to the cartridge support. There is a cartridge detachably set on the cartridge support; there is a group of staple holes accommodating staple pushers and staples inside, generally 4 rows or 6 rows of staple holes. There are grooves for staple deformation set on said anvil relative to said staple holes. Said stapling head assembly further comprises a cutter pushing rod which is set movably in a connecting tube of the stapling head assembly and connects with the actuating rod, there is an I-shaped cutter at the distal end of the cutter pushing rod, the cartridge and the anvil move close to each other during the advancing process of the I-shaped cutter. A blade is set at the distal end of the cutter, and during its advancing process, the tissues between the cartridge and anvil are cut off. There is an actuating block in the cartridge, during the advancing process of the I-shaped cutter, the staple pushers are pushed in a sequence in the cartridge by the actuating block under the actuation of the I-shaped cutter, then the staples are pushed out of the cartridge by the staple pushers and staple the tissues. In the existing technology, after the above action of suturing and cutting being finished by the doctor, the instrument is needed to be reset, and then the cartridge is needed to be changed, so the suturing and cutting apparatus for endoscopic surgery can be used for the next suturing and cutting operation. 
     But some careless doctors or some doctors with lack of experience, may process the next suturing and cutting operation without changing the cartridge which has been fired, which will lead to a medical negligence, that is, cutting is processed without suturing. To prevent from this kind of negligence, a theory of preventing from being fired for a second time using a lockout mechanism is raised, that is, the actuating handle cannot be pressed without changing the cartridge which has been fired. Then, it prevents fundamentally from the medical negligence caused by the incorrect operation of the doctor. 
     SUMMARY 
     The invention provides a stapling head assembly and a suturing and cutting apparatus for endoscopic surgery, which can prevent the suturing and cutting apparatus from being fired for a second time without changing the fired cartridge. 
     One aspect of the invention provides a stapling head assembly, and said stapling head assembly comprises: a cartridge support, equipped detachably with a cartridge; a cutter, movable at least between a first position and a second position along the longitudinal direction of said cartridge support, said actuating block is pushed to move by said cutter; a lockout mechanism, said lockout mechanism comprises: a lockout block, set in said cartridge support, and movable between a third position and a fourth position along the transversal direction of said cartridge support relative to said cartridge support; a flexible component, set between said cartridge support and said lockout block, and actuating said lockout block to move from said third position to said fourth position; before said actuating block being actuated to move by said cutter, said unlocking component squeezes said lockout block transversally to be at said third position, when said flexible component is under compression status, said cutter can move from said first position to said second position; after the actuating block being actuated to move by said cutter, said lockout block moves to said fourth position under the action of said flexible component, said cutter is prevented from moving from said first position to said second position by said lockout block. 
     In one embodiment of the invention, said cartridge support comprises a first limiting groove along the longitudinal direction thereof, said cutter and said actuating block are movable along said first limiting groove. 
     In another embodiment cartridge support further comprises a second limiting groove along the transversal direction thereof, said second limiting groove communicates with said first limiting groove, said lockout mechanism is set in said second limiting groove, said lockout block moves in said second limiting groove, and said third position is farther away from said first limiting groove than said fourth position. 
     In another embodiment of the invention, after said actuating block being actuated to move by said cutter, said lockout block extends into said first limiting groove under the action of said flexible component, and then reaches said fourth position, between the first position and the second position of said cutter, and said cutter is located at the distal end of said lockout block; after said cutter being pulled back to the proximal end of said cartridge, said lockout block is kept at said fourth position under the action of said flexible component, said cutter is located at a side of the proximal end of said lockout block. 
     In another embodiment of the invention, said flexible component is a flexible block, said flexible block is farther away from said first limiting groove than said lockout block, and one end thereof connects to the inner wall of said cartridge support, the other end connects to said lockout block. 
     In another embodiment of the invention, said unlocking component is a bump set protruded at the bottom of the proximal end of said actuating block. 
     In another embodiment of the invention, there is one said second limiting groove on each of the two sides of said first limiting groove, said stapling head assembly comprises two lockout mechanisms set separately in each said second limiting groove, when said lockout blocks are both set at the fourth position, the space between said lockout blocks is smaller than the transversal thickness of said cutter. 
     In another embodiment of the invention, said lockout block further comprises a first guiding portion, when said cutter moves from said second position to said first position, the lockout block is guided to move from said fourth position towards the direction of the third position. 
     In another embodiment of the invention, wherein, said first guiding portion is a first slope, said first slope is set at the distal end of said lockout block, and inclines protruded from the distal end of said lockout block towards the direction of said first limiting groove. 
     In another embodiment of the invention, said lockout block comprises a third guiding portion, when said cartridge is mounted, said lockout block is guided to move from said fourth position towards the direction of the third position. 
     In another embodiment of the invention, said third guiding portion is a third slope, said third slope is set on the top surface of said lockout block, and inclines protruded from the top surface of said lockout block towards the direction of the first limiting groove. 
     In another embodiment of the invention, said lockout mechanism further comprises a fixing cover, said lockout block and said flexible component are covered between said fixing cover and said cartridge support. 
     In another embodiment of the invention, said fixing cover for lockout mechanism has a concave portion, said lockout block is further equipped with a protruded portion, said protruded portion is set on the top surface of said lockout block, and extends accordingly into said concave portion. 
     Another aspect of the invention provides a suturing and cutting apparatus for endoscopic surgery, wherein, comprising the stapling head portion above. 
     With the stapling head assembly and the suturing and cutting apparatus for endoscopic surgery of the invention, a next operation by the doctor without changing a cartridge having been fired is prevented effectively, and medical negligence is avoided, and the structure of the suturing and cutting apparatus is simple and effective. 
    
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
       By reading of the detailed description of the nonrestrictive embodiments referring to the figures following, the other technical features, objective and advantages will be more apparent: 
         FIG. 1  is a stereoscopic view of the stapling head assembly of the invention; 
         FIG. 2 a    is an explosive view of the stapling head assembly of the invention; 
         FIG. 2 b    is front view of the actuating block of the stapling head assembly of the invention; 
         FIG. 3  is a structural schematic view of the longitudinal section of the stapling head assembly before being actuated; 
         FIG. 4  is a structural schematic view of the A-A section of  FIG. 3  before the stapling head assembly being actuated; 
         FIG. 5  is a structural schematic view of the B-B section of  FIG. 3  before the stapling head assembly being actuated; 
         FIG. 6  is a structural schematic view of the A-A section of  FIG. 3  during the stapling head assembly being actuated; 
         FIG. 7  is a structural schematic view of the B-B section of  FIG. 3  during the stapling head assembly being actuated; 
         FIG. 8 a    is a structural schematic view of the B-B section of  FIG. 3  during the reset process of the cutter after the stapling head assembly being actuated; 
         FIG. 8 b    is a locally enlarged schematic view of the position D of  FIG. 8 a   ; and 
         FIG. 9  is a structural schematic view of the B-B section of  FIG. 3  after the reset process of the cutter of the stapling head assembly. 
     
    
    
     DETAILED DESCRIPTION 
     The descriptions of the proximal end and the distal end, all refer to the operator of the instrument, the proximal end is the end close to the operator, and the distal end is the end far from the operator. The longitudinal direction of the invention means the direction of length of the component, generally the direction from the distal end to the proximal end. The transversal direction means the direction vertical to the longitudinal direction. The descriptions of direction or position like top/up, bottom/down, vertical, horizontal and so on are descriptions using the figures as an example, and can be changed according to different requirements; the changes made are all included in the protection scope of the invention. Besides, the terms first, second, third, fourth and so on are only for description, cannot be understood to indicate or imply relative significance or imply the numbers of the technical features indicated. 
     According to the conception of the purport, the stapling head assembly comprises a cartridge support, an anvil, a cartridge, an actuating block, a cutter pushing rod, a cutter and a lockout mechanism. There is a cartridge detachably set on said cartridge support; the anvil can pivot and move relatively close to the cartridge; the actuating block is set movably inside the cartridge, there is an unlocking component set on said actuating block; said cutter can at least move between a first position and a second position relative to said cartridge support and along the longitudinal direction thereof, there is a cutter pushing rod at the proximal end of said cutter, there is a blade at the distal end of said cutter, under the push of the cutter pushing rod, said actuating block is pushed to move by said cutter; said lockout mechanism comprises: a lockout block, said lockout block is set inside the cartridge support, and can move between a third position and a fourth position along the longitudinal direction of said cartridge support relative to said cartridge support; a flexible component, is set between said cartridge and said lockout block, actuating the lockout block to move from said third position to said fourth position; before said actuating block being actuated to move by said cutter, said unlocking component squeezes said lockout block transversally to make it be at the third position, said flexible portion is under compression status, said cutter can move from said first position to said second position; after said actuating block being actuated to move by said cutter, said lockout block moves to said fourth position under the action of said flexible component, said cutter is prevented from moving from said first position to said second position by said lockout block. 
     Below the technical contents of the invention are further illustrated combining the figures and embodiments: 
     Referring to  FIG. 1 - FIG. 5  together, which show separately a stereoscopic view, an explosive view of the stapling head assembly and structural schematic views of sections of the stapling head assembly before being actuated. Wherein, as the anvil of the stapling head assembly is not a part of the innovations of the invention, so, to show the structure of the stapling head assembly more clearly, the anvil of the stapling head assembly is ignored in the figures. In one embodiment of the invention, the stapling head assembly comprises: a cartridge support  1 , an anvil (not shown), a cartridge  2 , an actuating block  3 , a cutter pushing rod  4 , a cutter  5 , a connecting tube  7  and a lockout mechanism. Wherein, said anvil connects to the top of the cartridge support  1 , the proximal end of the anvil pivots with the proximal end  11  of the cartridge support  1 . 
     As shown in  FIG. 2 a    and  FIG. 5 , there is a first limiting groove (cutting groove)  13  and a second limiting groove  14  on the cartridge support  1 . The first limiting groove  13  is set along the direction from the proximal end  11  to the distal end  12  of the cartridge support  1 . The second limiting groove  14  is set at a side portion of the first limiting groove  13  and communicates with the first limiting groove  13 . In the embodiment shown in  FIG. 2 a   , a second limiting groove  14  is set on each of the two sides of the first limiting groove  13 , and the two of the second limiting grooves  14  are in symmetry with each other relative to the first limiting groove  13 . 
     The cartridge  2  is set between the cartridge support  1  and said anvil, and connects detachably to the cartridge support  1 . More specifically, there are staple holes in the cartridge  2  for accommodating the staple pushers and staples, generally there are 4 rows or 6 rows of staple holes, there are grooves for staple deformation set on said anvil relative to said staple holes of the cartridge, by which suturing can be operated. 
     The distal end  71  of the connecting tube  7  connects to the proximal end  11  of the cartridge support  1 . As shown in  FIG. 2 a   , the connecting tube  7  may be formed with an upper connecting component  72  and a lower connecting component  73  joining with each other. 
     The cutter pushing rod  4  is set movably in the connecting tube  7 , the distal end  41  of the cutter pushing rod  4  is connected with a cutter  5 . The distal end  52  of the cutter  5  is set with a blade. During the process of the cutter  5  being pushed to move towards the distal end by said cutter pushing rod  4 , the tissues between the anvil and the cartridge  2  can be cut off by the blade, meanwhile, the actuating block  3  can be pushed to move by the cutter  5 , so the staple pushers are pushed out of the cartridge  2  in sequence, then the staples are pushed out of the cartridge  2  and stapled on the tissues. In the embodiment, the longitudinal section of the cutter  5  is in a shape of “I”, during the process of the cutter  5  being pushed to move towards the distal end by said cutter pushing rod  4 , the I-shaped cutter  5  drives the anvil and the cartridge  2  to move close to each other. 
     As shown in  FIG. 3  and  FIG. 5 , the cutter  5  moves along the first limiting groove  13 , the cutter  5  can at least move from the first position to the second position relative to the cartridge support  1  along the longitudinal direction thereof, the first position and the second position are two positions along the longitudinal direction of the cartridge support  1 , and the first position is closer to the proximal end  11  of the cartridge support  1  than the second position. The position of the cutter  5  shown in  FIG. 5  is the first position, that is, after the cartridge  2  being mounted on the cartridge support  1 , the cutter  5  is set at the initial position of proximal end of the cartridge support  1 ; the position of the cutter  5  shown in  FIG. 7  is the second position, that is, the position when the cutter  5  moves to the distal end of the cartridge support  1  under the action of the cutter pushing rod  4  and cannot move further towards the distal end. 
     The actuating block  3  is set movably in the cartridge  2 . The actuating block  3  comprises an unlocking component. Said unlocking component is set in the first limiting groove  13 . As shown in  FIG. 2 b   , said unlocking component is a bump  32  set protruded at the bottom of the proximal end  31  of the actuating block  3 . The specific function of the bump  32  can be seen as below. 
     The lockout mechanism is set in the second limiting groove  14 ; said lockout mechanism comprises a lockout block  61  and a flexible component. 
     The lockout block  61  is set in the cartridge support  1 , and movable can move between the third position and the fourth position relative to the cartridge support  1 , when the lockout block  61  is set at said third position, the cutter  5  can move from said first position to said second position, when the lockout block  61  is located at said fourth position, the cutter  5  is prevented from moving from said first position to said second position by the lockout block  61 . 
     More specifically, there is a third guiding portion at the top surface of the lockout block  61 , in the embodiment, the third guiding portion is an inclined third slope  612  set on the top surface of the lockout block  61 , and inclines and protrudes along the direction from the top surface of the lockout block  61  to the first limiting groove  13 . The third slope  612  cooperates with the bump  32  of the actuating block  3 , to make it easier for inserting the actuating block  3  during the cartridge  2  being mounted on the cartridge support  1 . The lockout block  61  moves in the second limiting groove  14 , said fourth position is closer to the first limiting groove  13  than said third position, the position of the lockout block  61  shown in  FIG. 4  and  FIG. 5  is the third position, that is, during the process of the cartridge  2  being mounted on the cartridge support  1 , the bump  32  of the actuating block  3  set at the proximal end of the cartridge  2  squeezes transversally the lockout block  61  along the third slope  612 , then the flexible component is squeezed by the lockout block  61  to happen a flexible deformation, and eventually the lockout block  61  is away from the moving path of the cutter  5  from the first position to the second position, the position now of the lockout block  61  is the third position; the position of the lockout block  61  shown in  FIG. 7  is the fourth position, specifically, during the process of the cutter  5  being driven by the pushing of the cutter pushing rod  4  from the first position to the second position, the actuating block  3  is pushed to move towards the distal end of the cartridge  2  by the cutter  5  at the same time, so the squeezing action from the actuating block  3  to the lockout block  61  is decreased gradually, when the actuating block  3  and the cutter  5  keep moving towards the distal end until they won&#39;t have interactions with the lockout block  61 , the lockout block  61  won&#39;t be limited at all, and moves along the second limiting groove  14  under the action of the flexible component, and part of the lockout block  61  enters into the first limiting groove  13 , so the lockout block  61  is a block on the moving path of the cutter  5  between the first position and the second position. As shown in  FIG. 4  and  FIG. 5 , said stapling head assembly may comprise two lockout mechanisms, set separately in the two second limiting grooves  14  at the two sides of the first limiting groove  13 . 
     The flexible component is set in the cartridge support  1 , and drives the lockout block  61  to move from the third position to the fourth position. As shown in  FIG. 5 , the flexible component is farther away from the first limiting groove  13  than the lockout block  61 , one end of the flexible component connects to the second limiting groove  14 , and the other end connects to the lockout block  61 . The flexible component may be a flexible block  62 . The flexible block  62  is set in the second limiting groove  14 , one end of the flexible block  62  connects to the inner wall of the cartridge support  1 , and the other end connects to the lockout block  61 . The technicians in the art should understand that, in some embodiments, the flexible component can be different, such as, the flexible component can be a spring which is set between the second limiting groove  14  and the lockout block  61 . No unnecessary details are given here. 
     In the embodiment shown in  FIG. 2 a   , the lockout mechanism further comprises a fixing cover  63  for lockout mechanism, the lockout block  61  and the flexible component (that is, the flexible block  62 ) are covered by the fixing cover  63  and set between the fixing cover  63  and the second limiting groove  14  of the cartridge support  1 . There are holes set on the fixing cover  63 , so the fixing cover  63  can be fixed in the second limiting groove  14  by fixing at least one bolt into the holes. Further, in the embodiment shown in  FIG. 4 , there is a concave portion on the fixing cover  63 , the lockout block  61  further comprises a protruded portion  613 , and the protruded portion  613  is set on the top surface of the lockout block  61 , the concave portion is set on the lower bottom of the fixing cover  63  relative to the protruded portion  613 . The protruded portion  613  extends upwards into the concave portion of the fixing cover  63 , the protruded portion  613  can effectively prevent from the condition that the third slope  612  is installed reversely if the lockout block  61  is assembled reversely, then the third slope  612  will lose the guiding function, result in that the cartridge  2  could not be mounted in place smoothly. 
     Referring to  FIG. 4  and  FIG. 5 , after the cartridge  2  is mounted on the cartridge support  1  and before the stapling head assembly is actuated, the cutter  5  is located at the first position, the unlocking component (that is the bump  32 ) of the actuating block  3  at the proximal end of the cartridge  2  squeezes the lockout block  61  transversally to move to the third position, the lockout block  61  is restricted by the bump  32 , so the flexible component (that is the flexible block  62 ) is under compression status, at the moment, the cutter pushing rod  4  can be pushed to actuate the cutter  5  and the actuating block  3  to move towards the distal end, so the tissue can be cut and sutured. 
       FIG. 6  and  FIG. 7  show separately the structural schematic views of the A-A section and B-B section during actuation of the stapling assembly (see  FIG. 3 ). As shown in  FIG. 6  and  FIG. 7 , after the actuating block  3  is pushed by the cutter  5  under the action of the cutter pushing rod  4 , the actuating block  3  moves towards the distal end  12  of the cartridge support  1  along a first limiting groove  13  and departs away from the lockout block  61 . During the process, the cutter  5  moves from the first position to the second position, the lockout block  61  will not be squeezed transversally for that the unlocking component (that is the bump  32 ) of the actuating block  3  is moved, and then moves to a fourth position (such as the lockout blocks  61  at the two sides are closed to each other, the space between the two lockout blocks  61  is smaller than the transversal thickness of the cutter  5 ) under the flexible action of the flexible component (flexible block  62 ). The position of the cutter  5  shown in  FIG. 7  is the second position. Meanwhile, the position of the lockout block  61  shown in  FIG. 6  and  FIG. 7  is the fourth position. As shown in  FIG. 7 , when the lockout block  61  is at the fourth position, part of the lockout block  61  extends into the first limiting groove  13 , and is located between the first position and the second position of the cutter  5 . 
     In one embodiment, the stapling head assembly comprises two lockout mechanisms set at the two sides of the first limiting groove  13 . Hence, in the embodiment, the lockout block  61  being at the fourth position means that the two lockout blocks  61  being all set at the fourth position, that is, partial structures of the two lockout blocks  61  all extend into the first limiting groove  13  and are located between said first position and the second position. As shown in FIG. 
       6 , when the two lockout blocks  61  are all set at the fourth position, the space between the two lockout blocks  61  is smaller than the transversal thickness of the cutter  5 . 
     The transversal thickness of the cutter  5  may be smaller than or equal to the transversal thickness of the bump  32  of the actuating block  3 , which is more beneficial when the bump  32  of the actuating block  3  moves and the cutter  5  can be moved from the first position to the second position before the lockout block  61  moving from the third position to the fourth position. 
     Further, when the cutting and suturing of the tissues are finished, the cutter  5  may need to be reset to go back to the first position before being actuated, and the actuating block  3  stays at the distal end of the cartridge.  FIG. 8 a    and  FIG. 8 b    show the structural schematic view of the B-B section during the reset process of the cutter  5  after the stapling head assembly is fired;  FIG. 8 b    is a locally enlarged schematic view of the position D of  FIG. 8 a   . As shown in  FIGS. 8 a  and 8 b   , the lockout block  61  comprises a first guiding portion, the first guiding portion is used to guide the lockout block  61  to move from the fourth position towards the direction of the third position during movement of the cutter  5  from the second position to the first position. In the embodiment shown in  FIG. 8 b   , said first guiding portion is a first slope  611 . The first slope  611  is set at the distal end of the lockout block  61 . The first slope  611  inclines protruded from the distal end of the lockout block  61  towards the direction of the first limiting groove  13 . For example, the section of the lockout block  61  can be in a shape of a trapezoid, and extends from the distal end of the lockout block  61  to one side of the lockout block  61  close to the first limiting groove  13 . When the cutter  5  moves from the second position towards the direction of the first position to the distal position of the lockout block  61 , the first slope  611  is pushed by the cutter  5 , the lockout block  61  is made to move towards the direction of the third position by the component force along the direction of the second limiting groove  14  caused by the first slope  611 , and the flexible component (that is the flexible block  62 ) is under the compression status again. When the lockout blocks  61  are totally located at the two sides of the cutter  5 , the lockout blocks  61  are at a fifth position. It should be understood that the transversal thickness of the cutter  5  is less than or equal to the transversal thickness of the bump  32  of the actuating block  3 , hence, the fifth position is located between the third position and the fourth position. When the transversal thickness of the cutter  5  is the same with the transversal thickness of the bump  32 , the fifth position is a same position with the third position. 
     In an embodiment the proximal end  51  of the cutter  5  also comprises a second guiding portion. The second portion cooperates with the first guiding portion, and guides the lockout block  61  to move from the fourth position towards the direction of the third position. Said second guiding portion can be at least one second slope adapted to the first slope  611 . Said second slopes are set accordingly at the two sides of the proximal end  51  of the cutter  5 . The setting of the second slopes is more beneficial for the proximal end  51  of the cutter  5  to squeeze transversally the lockout blocks  61  to the third position. 
       FIG. 9  shows the structural schematic of the B-B section after the cutter being reset. As shown in  FIG. 9 , during the process of the cutter  5  going back to the first position, when the cutter  5  moves to a position that will not have an interaction force with the lockout block  61 , there will not be any transversal squeezing from the cutter  5  between the two lockout blocks  61 , the lockout blocks  61  move again to the fourth position under the flexible action of the flexible component (flexible block  62 ), and block the cutter between said first position and said second position. As the space between the two lockout blocks  61  is smaller than the transversal thickness of the cutter  5 , and there is no guiding portion at the proximal end of the lockout blocks  61 , so, if a second actuation is processed, the lockout blocks  61  will prevent the cutter  5  from moving from the first position to the second position, and the instrument will not be fired for a second time, and can only be fired normally after a new cartridge is changed. And, when a new cartridge is changed, the bump  32  of the actuating block of the new cartridge can be squeezed between the two lockout blocks  61  from the top of the space between the two lockout blocks  61  by the guiding of the third slopes  612 , and the lockout blocks  61  are forced to go back to the third position again, which is going back to the status shown in  FIG. 5 . Hence, if a new cartridge  2  is not changed, the lockout blocks  61  cannot be squeezed transversally into the second limiting groove  14 , and the cutter  5  is blocked by the lockout blocks  61  and cannot move towards the second position again, so the function of preventing the stapling head assembly from being fired for a second time without changing the fired cartridge is realized. 
     The structure of preventing from being fired for a second time of the embodiment mainly uses the action force of the flexible components (flexible blocks  62 ) set at the two sides of the first limiting groove  13  to the lockout block  61 , after the lockout blocks  61  losing the transversal squeezing of the unlocking component (bump  32 ) of the actuating block  3 , the lockout blocks  61  on two sides come closer with each other, so the firing for a second time after the cutter  5  being pulled back is prevented. 
     Persons with ordinary skill in the art should understand that, in different embodiments of the invention, the function of preventing the stapling head assembly from being fired for a second time can also be realized by one said lockout mechanism. In the alternative embodiment, there is a second limiting groove  14  set at one side of the first limiting groove  13 , the lockout mechanism is set in the second limiting groove  14 , when the lockout block  61  is set at the fourth position, the lockout block  61  protrudes from the second limiting groove  14  towards the direction of the inner wall of one corresponding side of the first limiting groove  13 , and the protruding portion of the lockout block  61  is located at the moving path of the cutter  5  moving from the first position to the second position, so the cutter  5  is restricted from moving towards the distal end, at the moment, the function of preventing from being fired for a second time can also be realized by one said lockout mechanism, which will not be repeated here. 
     The invention further provides a suturing and cutting apparatus for endoscopic surgery. The suturing and cutting apparatus comprises a body and the stapling head assembly. The body comprises a sleeve and an actuating handle set in the sleeve. The stapling head assembly is the stapling head assembly shown in  FIG. 1 - FIG. 9 . The connecting tube  7  and the cutter pushing rod  4  of the stapling head assembly connect to the body. The actuating handle can push the cutter pushing rod  4 , so the cutter  5  is made to move towards the distal end  12  of the cartridge support  1 . 
     Combining with the embodiment shown in  FIG. 1 - FIG. 9 , the persons with ordinary skill in the art should understand that, with the stapling head assembly and the suturing and cutting apparatus for endoscopic surgery of the invention, a next operation by the doctor without changing a cartridge having been fired is effectively prevented, medical negligence is avoided, and the structure of the suturing and cutting apparatus is simple and effective. 
     The specific embodiments of the invention are described above. It should be understood that, the invention is not limited to the specific embodiments above; the technicians in the art can make all kinds of transformation and amendments within the scope of the claims, which will not affect the substantial contents of the invention.