Patent Publication Number: US-2023157694-A1

Title: Surgical stapling apparatus with tissue gap lock

Description:
TECHNICAL FIELD 
     This disclosure relates to surgical stapling apparatus and, more particularly, to structures and methods for locking tissue gap. 
     BACKGROUND 
     Fasteners have traditionally been used to replace suturing when joining various body structures such as, for example, the bowel or bronchus. Surgical stapling apparatus employed to apply these fasteners are generally designed to simultaneously cut and seal tissue to reduce the time and risks involved with anastomosis procedures. 
     Circular surgical stapling apparatus are employed by surgeons to apply one or more surgical fasteners, e.g., staples or two-part fasteners, to body tissue for the purpose of joining segments of body tissue together and/or for the creation of anastomoses. Circular surgical stapling apparatus generally include an annular fastener cartridge assembly that supports a plurality of annular rows of fasteners, an annular anvil assembly operatively associated with the fastener cartridge assembly which provides a surface against which the fasteners are formed upon a firing of the circular stapling apparatus, and an annular blade for cutting tissue. 
     SUMMARY 
     According to one aspect, a surgical stapling apparatus includes a handle assembly, an elongated central body portion extending distally from the handle assembly to a distal end portion, and an end effector supported on the distal end portion of the elongated central body portion. The handle assembly includes a stationary handle and a trigger. The handle assembly further includes a trigger lock that is pivotably coupled to the stationary handle and selectively engageable with the trigger to prevent movement of the trigger relative to the stationary handle. The trigger is coupled to a firing link having a catch thereon. The trigger lock has a latch assembly. The end effector has an anvil assembly and a cartridge assembly. The anvil and cartridge assemblies are positionable between an unclamped position and a clamped position to selectively grasp tissue therebetween. The trigger lock and the latch assembly are selectively engageable to lock the anvil and cartridge assemblies in the clamped position. 
     In aspects, the firing link may be pivotably coupled to the trigger on a first end portion thereof. The catch may be disposed on a second end portion of the firing link. The latch assembly may include a support wall and a latch extending from the support wall. The catch may define a capture recess that is configured to receive the latch therein. 
     In various aspects, a drive screw assembly may be operatively coupled to the anvil assembly to enable the anvil assembly to move relative to the cartridge assembly. A screw stop may be supported on the drive screw assembly. The screw stop may be positioned to engage a pivot member supported by the firing link. The screw stop may include an engagement tooth depending therefrom. The engagement tooth may be positioned to engage a shaft of the pivot member in a screw stop channel defined in the firing link. The pivot member may prevent the screw stop from advancing distally to lock the anvil and cartridge assemblies in the clamped position when the trigger lock is disengaged from the trigger. An approximation knob may be rotatable to axially move the screw stop relative to the stationary handle. 
     According to another aspect, a circular stapling apparatus includes a stationary handle, a trigger pivotably coupled to the stationary handle, a trigger lock, and a firing link coupled to the trigger. The trigger lock is selectively engageable with the trigger and has a latch assembly. The firing link has a catch thereon that is selectively engageable with the latch assembly. 
     In aspects, the firing link may be pivotably coupled to the trigger. 
     In various aspects, the catch may be in the form of a hook. 
     Other aspects, features, and advantages will be apparent from the description, the drawings, and the claims that follow. 
    
    
     
       BRIEF DESCRIPTION OF DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate aspects of the disclosure and, together with a general description of the disclosure given above and the detailed description given below, serve to explain the principles of this disclosure, wherein: 
         FIG.  1    is a perspective view of a surgical stapling apparatus in accordance with the principles of this disclosure with an end effector thereof shown in an unclamped position; 
         FIG.  2    is an enlarged, perspective view of a proximal end portion of the surgical stapling apparatus of  FIG.  1    with portions of the proximal end portion removed for clarity and a trigger lock of the proximal end portion shown in a first position; 
         FIG.  3    is a perspective view, with parts separated, of various components of the proximal end portion of the surgical stapling apparatus of  FIG.  2   ; 
         FIG.  4    is an enlarged view of the indicated area of detail shown in  FIG.  2   ; 
         FIG.  5    is an enlarged, side view of the end effector of  FIG.  1    shown in a clamped position; 
         FIG.  6    is an enlarged, side view of the proximal end portion of  FIG.  2    with the trigger lock shown in a second position; 
         FIG.  7    is an enlarged view of the indicated area of detail shown in  FIG.  6   ; and 
         FIG.  8    is a side view, in longitudinal cross-section, of the proximal end portion shown in  FIG.  6   . 
     
    
    
     DETAILED DESCRIPTION 
     Aspects of the disclosed surgical stapling apparatus are 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 commonly known, the term “clinician” refers to a doctor, a nurse, or any other care provider and may include support personnel. Additionally, the term “proximal” refers to the portion of structure that is closer to the clinician and the term “distal” refers to the portion of structure that is farther from the clinician. In addition, directional terms such as front, rear, upper, lower, top, bottom, and the like are used simply for convenience of description and are not intended to limit the disclosure attached hereto. 
     In the following description, well-known functions or constructions are not described in detail to avoid obscuring this disclosure in unnecessary detail. 
     Further, although the surgical instrument described herein is provided in connection with a manual surgical stapling apparatus for brevity, the disclosed surgical instrument can include any powered, manual, or robotically-controlled surgical instruments such as a clip applier, stitching device, energy-based device (e.g., a bipolar or monopolar forceps) or the like, and/or other surgical stapling apparatus such as a laparoscopic stapler, a transverse stapler, or an open stapler. For a detailed description of the structure and function of exemplary surgical stapling apparatus, one or more components of which may be included, or modified for use with the disclosed aspects, reference may be made to U.S. Patent Application Publication No. 2020/0029969 or U.S. Pat. Nos. 9,504,470; 9,414,839; 8,272,552, 8,256,656; 8,157,152; 8,109,426; 7,819,896; 7,334,717; 7,128,253; 5,964,394; and 5,915,616, the entire contents of each of which is incorporated herein by reference. 
     Briefly, a trigger lock of a circular stapling apparatus engages a trigger of the circular stapling apparatus to obstruct the trigger and prevent the circular stapling apparatus from inadvertently firing. To fire the circular stapling apparatus, the trigger lock can be moved to an open position to enable the trigger of the circular stapling apparatus to actuate for firing the circular stapling apparatus. Before firing, however, it is desirable to lock a tissue gap defined between anvil and cartridge assemblies to improve staple formation. Unfortunately, internal space within the circular stapling apparatus is limited. The disclosed circular stapling apparatus provides a solution for locking the tissue gap without adding internal components. More specifically, this disclosure details a solution in the handle that enables the circular stapling apparatus to lock the tissue gap after the trigger lock is opened, but before the circular stapling apparatus is fired. Setting the tissue gap to a predetermined or fixed size when the trigger lock is opened improves staple formation. This solution also provides a reduction in the span of the trigger relative to the stationary handle resulting in better ergonomics and usability. 
     Turning now to  FIGS.  1 - 8   , a surgical stapling apparatus, generally referred to as  10 , is illustrated. Surgical stapling device  10  defines a centerline “CL” and includes a proximal handle assembly  12 , an elongated central body portion  14  that extends distally from the proximal handle assembly  12 , and an end effector or a distal tool assembly  16  supported on a distal end portion of the elongated central body portion  14 . The distal tool assembly  16  includes a cartridge or shell assembly  16   a  and an anvil assembly  16   b  that cooperate to fasten tissue together. In particular, the shell assembly  16   a  and the anvil assembly  16   b  are positionable between an unclamped or unapproximated position (see  FIG.  1   ) and a clamped or approximated position (see  FIG.  5   ) to selectively secure tissue therebetween for selectively stapling and/or cutting the clamped tissue. 
     The handle assembly  12  of the surgical stapling device  10  includes a stationary handle  18 , a firing trigger  20 , and a rotatable approximation knob  22 . The stationary handle  18  of the handle assembly  12  is formed from handle sections  18   a  and  18   b,  which, when secured together, define a housing for the internal components of the handle assembly  12 . The handle assembly  12  further includes a pivotally mounted trigger lock  24  fastened to the handle sections  18   a  and  18   b  on a first end portion  24   a  of the trigger lock  24 ; a second end portion  24   b  of trigger lock  24  is free. The first end portion  24   a  of the trigger lock  24  includes a latch assembly  25  that is selectively engageable with a firing link  44  of the surgical stapling device  10 . Latch assembly  25  includes a support wall  25   a  that extends outwardly from the trigger lock  24  and a latch  25   b  that extends laterally from an upper portion of the support wall  25   a.  The second end portion  24   b  (e.g., a lower free end portion) of the trigger lock  24  is manually positioned in engagement with a trigger lock mount  20   x  on the firing trigger  20  to obstruct movement of the firing trigger  20  and prevent inadvertent firing of the stapling device  10 . The stationary handle  18  includes a bulbous indicator  19  that is supported on an upper surface of the stationary handle  18  to provide an indication to the clinician when the shell assembly  16   a  and the anvil assembly  16   b  of the distal tool assembly  16  of the stapling device  10  are approximated and in a fire-ready or clamped position. 
     With reference to  FIG.  2   , a distal end portion of the approximation knob  22  of the handle assembly  12  is rotatably fixed to a proximal end portion of a rotatable sleeve  26  such that rotation of the knob  22 , as indicated by arrows “R,” causes concurrent rotation of the sleeve  26 . The rotatable sleeve  26  extends distally from the approximation knob  22  and receives a drive screw assembly  28  that is operatively coupled to anvil assembly  16   b  to enable anvil assembly  16   b  to move relative to shell assembly  16   a  in response to rotation of approximation knob  22 . 
     With continued reference to  FIG.  2   , the firing trigger  20  of the handle assembly  12  has a proximal portion  20   a  and a distal portion  20   b.  The distal portion  20   b  of the firing trigger  20  is pivotally connected to an elongated pusher link  40  by a pivot member  42  to facilitate pivotal movement of the firing trigger  20  relative to the stationary handle  18  of the handle assembly  12 . The firing trigger  20  of the handle assembly  12  is pivotally connected to a first end portion  44   a  of a firing link  44  by a pivot member  46 . The firing link  44  includes a second end portion  44   b  that is pivotally secured to the stationary handle  18  by a pivot member  48 . As seen in  FIGS.  3  and  4   , the second end portion  44   b  of firing link  44  further includes catches  45 , which may be in the form of hooks, that are laterally spaced apart from one another to define a screw stop channel  45   x  therebetween. Catches  45  define capture recesses  45   a  that are concave and positioned to receive and selectively capture a latch assembly  25  of trigger lock  24  therein. 
     The elongated pusher link  40  is slidably supported within the central body portion  14  of the surgical stapling device  10  about the drive screw assembly  28  along the central body portion  14  between a retracted, nonfired position and an advanced, fired position. The elongated pusher link  40  supports a spring  52  ( FIG.  3   ) about an outer surface thereof to bias the elongated pusher link  40  proximally toward the retracted, non-fired position. 
     Referring again to  FIG.  3   , the handle assembly  12  of the surgical stapling device  10  slidably supports a lockout member  54  ( FIG.  2   ) within the handle assembly  12  between retracted and advanced positions. The lockout member  54  is biased by a coil spring  56  toward the advanced position to maintain the trigger lock  24  in a locked position to prevent actuation of the firing trigger  20  of the handle assembly  12 . The drive screw assembly  28  includes a screw stop  58  that is axially fixed thereon, and that is movable from an advanced position located adjacent to the elongated pusher link  40  (corresponding to an unclamped position of anvil assembly  16   b ) to a retracted position located adjacent to the rotatable sleeve  26  (corresponding to a clamped position of anvil assembly  16   b ) (see  FIG.  2   ) to control the degree of movement of the anvil assembly  16   b  of the distal tool assembly  16  in relation to the shell assembly  16   a  of the distal tool assembly  16  such as disclosed in U.S. Pat. No. 6,945,444, U.S. Pat. No. 9,307,994, and U.S. Pat. No. 9,492,168, the contents of each of which are incorporated by reference herein in their entirety. Screw stop  58  includes an engagement tooth  58   a  ( FIG.  3   ) depending therefrom that is selectively engageable with a shaft  48   a  of pivot member  48 . 
     With continued reference to  FIGS.  1 - 8   , in order to unlock the firing trigger  20  from the trigger lock mount  20   x,  the drive screw assembly  28  and the screw stop  58  are drawn proximally by rotation of the approximation knob  22 . During approximation of the shell assembly  16   a  and the anvil assembly  16   b,  the screw stop  58  moves proximally so that the screw stop  58  contacts the lockout member  54  and drives the lockout member  54  proximally against the bias of (e.g., tension in) the coil spring  56 . The approximation knob  22  can be rotated until the anvil assembly  16   b  are disposed in the clamped position ( FIG.  5   ). Proximal movement of the lockout member  54  separates the lockout member  54  from contact with the trigger lock  24  and enables the second end portion  24   b  of the trigger lock  24  to pivot away from both the trigger lock mount  20   x  and the firing trigger  20 , as indicated by arrow “P” ( FIG.  6   ). As the second end portion  24   b  of the trigger lock  24  pivots toward the stationary handle  18 , the catch recesses  45   a  of catches  45  of firing link  44  capture latch  25   b  of latch assembly  25  of trigger lock  24  as latch  25   b  cams therein as seen in  FIG.  7   . With latch assembly  25  secured to catches  45 , engagement tooth  58   a  of screw stop  58  is distally obstructed by shaft  48   a  of pivot member  48  of firing link  44 , preventing screw stop  58  from moving distally and thereby preventing anvil assembly  16   b  from unapproximating or unclamping to maintain tissue gap “G” ( FIG.  5   ). Indeed, the combination of the latch assembly  25  and the catches  45  provide self-locking structure and function. For instance, when the surgical stapling device  10  is ready for firing, but the clinician mistakenly rotates approximation knob  22  in a direction that attempts to open or unapproximate (e.g., counterclockwise) the cartridge assembly  16   a  and the anvil assembly  16   b,  the capture latch  25   b  will self-lock with the catch recesses  45   a  and the trigger lock  245  will engage with the stationary handle  18  to prevent the cartridge assembly  16   a  and the anvil assembly  16   b  from unapproximating. And, if the capture latch  25   b  is not already disposed within the catch recesses  45   a,  the rotation of the approximation knob  22  will cause the capture latch  25   b  to fall into the catch recesses  45   a    
     Notably, with trigger lock  24  pivoted away from the firing trigger  20 , the span of the firing trigger  20  relative to stationary handle  18  (e.g., firing trigger  20  at smaller angle relative to stationary handle  18 ) reduces so that the firing trigger  20  can be actuated with greater ergonomics/usability and with improved staple formation on account of the fixed or substantially fixed tissue gap “G.” 
     Once firing is complete, trigger lock  24  is pivoted back into engagement with trigger lock mount  20   x  of firing trigger  20  so engagement tooth  58   a  of screw stop  58  is clear of pivot member  48  and approximation knob  22  can be rotated to unapproximate or unclamp the anvil assembly  16   b  and the shell assembly  16   a.    
     Further, the various aspects disclosed herein may also be configured to work with robotic surgical systems and what is commonly referred to as “Telesurgery.” Such systems employ various robotic elements to assist the clinician and allow remote operation (or partial remote operation) of surgical instrumentation. Various robotic arms, gears, cams, pulleys, electric and mechanical motors, etc. may be employed for this purpose and may be designed with a robotic surgical system to assist the clinician during the course of an operation or treatment. Such robotic systems may include remotely steerable systems, automatically flexible surgical systems, remotely flexible surgical systems, remotely articulating surgical systems, wireless surgical systems, modular or selectively configurable remotely operated surgical systems, etc. 
     The robotic surgical systems may be employed with one or more consoles that are next to the operating theater or located in a remote location. In this instance, one team of clinicians may prep the patient for surgery and configure the robotic surgical system with one or more of the instruments disclosed herein while another clinician (or group of clinicians) remotely controls the instruments via the robotic surgical system. As can be appreciated, a highly skilled clinician may perform multiple operations in multiple locations without leaving his/her remote console which can be both economically advantageous and a benefit to the patient or a series of patients. For a detailed description of exemplary medical work stations and/or components thereof, reference may be made to U.S. Patent Application Publication No. 2012/0116416, and PCT Application Publication No. WO2016/025132, the entire contents of each of which are incorporated by reference herein. 
     As can be appreciated, securement of any of the components of the disclosed apparatus can be effectuated using known securement techniques such welding, crimping, gluing, fastening, etc. 
     Persons skilled in the art will understand that the structures and methods specifically described herein and illustrated in the accompanying figures are non-limiting exemplary aspects, and that the description, disclosure, and figures should be construed merely as exemplary of particular aspects. It is to be understood, therefore, that this disclosure is not limited to the precise aspects described, and that various other changes and modifications may be effectuated by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, it is envisioned that the elements and features illustrated or described in connection with one exemplary aspect may be combined with the elements and features of another without departing from the scope of this disclosure, and that such modifications and variations are also intended to be included within the scope of this disclosure. Indeed, any combination of any of the disclosed elements and features is within the scope of this disclosure. Accordingly, the subject matter of this disclosure is not to be limited by what has been particularly shown and described.