Patent Description:
Various surgical procedures require instruments capable of applying fasteners to tissue to form tissue connections or to secure objects to tissue. For example, during hernia repair it is often desirable to fasten a mesh to tissue. In certain hernias, such as direct or indirect inguinal hernias, a part of the intestine protrudes through a defect in the abdominal wall to form a hernial sac. The defect may be repaired using an open surgery procedure in which a relatively large incision is made and the hernia is closed outside the abdominal wall by suturing. The mesh is attached with sutures over the opening in the abdominal wall to provide reinforcement. However, this may also be accomplished through the use of minimally invasive surgical fasteners such as, e.g., surgical tacks.

Accordingly, a need exists for a surgical tack applier including a reusable power module that meets performance requirements of various surgical instruments, while inhibiting premature ejection of tacks and timing issues when attempting to eject tacks.

<CIT> discloses a handle assembly for use with a surgical tack applier which includes an actuation assembly and an articulation lever assembly configured to articulate an articulation portion of the surgical tack applier. The actuation assembly includes a motor, an actuation rod, and an actuation switch configured to actuate the motor. The actuation rod has a first end operatively coupled to an output shaft of the motor for concomitant rotation therewith, and a second end operatively coupled to a loading unit of the surgical tack applier such that rotation of the actuation rod ejects a surgical tack from the loading unit. The articulation lever assembly includes an articulation rod operatively coupled with an articulation portion of the surgical tack applier such that axial displacement of the articulation rod causes articulation of the articulation portion, and an articulation lever operatively coupled with the articulation rod.

<CIT> discloses adapter assemblies for use with electrically and mechanically interconnect electromechanical surgical devices and surgical loading units, and to surgical systems including handheld electromechanical surgical devices and adapter assemblies for connecting surgical loading units to the handheld electromechanical surgical devices.

<CIT> discloses a surgical instrument for applying tacks to tissue. The surgical instrument includes a handle assembly, an elongated portion, an outer tube, an end effector, a rotation assembly, and a rotation-limiting structure. The rotation assembly is configured to rotate at least a portion of the outer tube about a first longitudinal axis and with respect to the handle assembly. The rotation assembly includes a rotation knob rotationally fixed to a proximal portion of the outer tube. The rotation-limiting structure is disposed in mechanical cooperation with at least one of the rotation assembly and the handle assembly, and is configured to limit an amount of rotation of the outer tube with respect to the handle assembly.

The disclosure describes a device for applying surgical tacks that demonstrates a practical approach to meeting the performance requirements and overcoming usability challenges associated with applying surgical tacks through a surgical mesh and into tissue.

In accordance with the disclosure, a handle assembly for use with a surgical tack applier includes an actuation assembly and an articulation lever assembly. The actuation assembly includes a motor, an actuation rod, and an actuation switch configured to actuate the motor. In particular, the actuation rod has a first end operatively coupled to an output shaft of the motor for concomitant rotation therewith, and a second end operatively coupled to a loading unit of the surgical tack applier such that rotation of the actuation rod ejects a surgical tack from the loading unit. The articulation lever assembly is configured to articulate an articulation portion of the surgical tack applier. The articulation lever assembly includes an articulation rod operatively coupled with an articulation portion of the surgical tack applier such that axial displacement of the articulation rod causes articulation of the articulation portion, and an articulation lever operatively coupled with the articulation rod.

In an aspect, the actuation assembly may further include a processor configured to control the motor.

In another aspect, the actuation assembly may further include an optical motor encoder configured to count turns of the motor output shaft to ensure a proper number of turns are made to insert a surgical tack into tissue. The optical motor encoder may be operatively connected to the actuation rod and the processor.

In another aspect, the actuation assembly may further include an encoder wheel configured to ensure correct clocking of a distal end of the actuation rod relative to the loading unit.

In yet another aspect, the actuation assembly may further include a light emitting diode coupled with the processor to indicate status of ejection of the surgical tack from the loading unit.

In still yet another aspect, the articulation rod may define a transverse bore dimensioned to receive a drive pin coupled with the articulation lever. The drive pin may define a bore dimensioned to receive the actuation rod therethrough. In an aspect, the handle assembly may further include a battery pack electrically coupled to the motor and the processor.

In an aspect, the actuation assembly may further include a piezoelectric element configured to provide audible tone for proper ejection of the surgical tack from the loading unit.

In another aspect, the handle assembly may further include a housing pivotably supporting the articulation lever.

In yet another aspect, the articulation lever may include a housing portion and an engaging portion slidably disposed on an engaging surface of the housing.

In still yet another aspect, the engaging surface may define an arcuate profile to enable sliding of the engaging portion in an arc.

In still yet another aspect, the articulation lever assembly may include a biasing member configured to bias the engaging portion of the articulation lever away from the housing of the handle assembly.

In another aspect, the housing may include a detent portion configured to secure a position of the articulation lever relative to the housing of the handle assembly.

In an aspect, the articulation lever assembly may further include articulation pivot arms pivotably secured to the housing of the handle assembly. The articulation pivot arms may be configured to receive the biasing member therebetween.

In another aspect, the articulation pivot arms may be received in the housing portion of the articulation lever.

In yet another aspect, the articulation rod may define a lumen dimensioned to receive the actuation rod therethrough.

In accordance with another aspect of the disclosure, a surgical tack applier includes a handle assembly and an elongate member. The handle assembly includes an actuation assembly and an articulation lever assembly. The actuation assembly includes a motor, an actuation rod having a first end operatively coupled to an output shaft of the motor for concomitant rotation therewith, and an actuation switch configured to actuate the motor. The articulation lever assembly includes an articulation rod and an articulation lever operatively coupled with the articulation rod. The elongate member extends distally from the handle assembly. The elongate member includes a loading unit having a plurality of surgical tacks, and an articulation portion configured to pivot with respect to a longitudinal axis defined by the elongate member. The articulation rod is operatively coupled with the articulation portion of the elongate member such that axial displacement of the articulation rod causes articulation of the articulation portion. A second end of the actuation rod is operatively coupled to the loading unit such that rotation of the actuation rod ejects a surgical tack from the loading unit. The actuation rod extends through the articulation rod.

In another aspect, the actuation assembly may include an encoder wheel configured to ensure correct clocking of a distal end of the actuation rod relative to the loading unit.

In accordance with yet another aspect of the disclosure, a power surgical tack applier includes a handle assembly, an elongate member, and a power module. The handle assembly includes an actuation assembly and an articulation lever assembly. The actuation assembly includes an actuation rod and an actuation switch. The articulation lever assembly includes an articulation rod and an articulation lever operatively coupled with the articulation rod. The elongate member extends distally from the handle assembly. The elongate member includes a loading unit and an articulation portion. The loading unit has a plurality of surgical tacks. The loading unit is operatively coupled to the actuation rod of the actuation assembly such that rotation of the actuation rod deploys a surgical tack of the plurality of surgical tacks from the loading unit. The articulation portion is pivotable with respect to a longitudinal axis defined by the elongate member. The articulation portion is operatively coupled to the articulation rod of the handle assembly such that axial displacement of the articulation rod articulates the articulation portion. The power module is removably received in the handle assembly. The power module includes a motor, a battery, and a gear box. The motor is operatively coupled to the actuation rod of the actuation assembly to rotate the actuation rod. The battery is electrically coupled to the motor to supply power to the motor. The gear box includes a main sun gear, a first planetary gear assembly, a second planetary gear assembly, a drive shaft, a third planetary gear assembly, a fourth planetary gear assembly, and a high-speed output. The main sun gear is fixed to an output shaft of the motor for concomitant rotation with the output shaft. The first planetary gear assembly is operably coupled to the main sun gear such that the first planetary gear assembly rotates about a longitudinal axis defined by the output shaft in response to rotation of the main sun gear. The second planetary gear assembly is operably coupled to the first planetary gear assembly such that the second planetary gear assembly rotates in response to the rotation of the first planetary gear assembly. The drive shaft is coupled to the second planetary gear assembly such that the drive shaft rotates with the second planetary gear assembly. The third planetary gear assembly is operably coupled to the second planetary gear assembly such that the third planetary gear assembly rotates in response to the rotation of the second planetary gear assembly. The fourth planetary gear assembly is operably coupled to the third planetary gear assembly such that the fourth planetary gear assembly rotates in response to the rotation of the third planetary gear assembly. The high-speed output is coupled to the drive shaft for concomitant rotation therewith. The high-speed output is operably coupled to the actuation rod of the handle assembly.

In an aspect, the gear box of the power module may further include a high-torque output being non-rotatably coupled to the fourth planetary gear assembly such that the high-torque output rotates with the fourth planetary gear assembly.

In another aspect, the high-speed output may be concentrically disposed within the high-torque output.

In yet another aspect, the high-speed and high-torque outputs may be simultaneously rotatable in response to activation of the motor.

In still yet another aspect, the drive shaft may extend longitudinally through the third and fourth planetary gear assemblies.

In still yet another aspect, the drive shaft may have a proximal end portion fixed to the second planetary gear assembly, and a distal end portion rotatable relative to the high-torque output within the high-torque output.

In an aspect, the high-torque output may define a cavity dimensioned to receive the high-speed output therein.

In another aspect, the actuation assembly may further include a processor configured to control the motor.

In yet another aspect, the actuation assembly may further include an optical motor encoder configured to count number of turns of the output shaft of the motor to ensure a desired number of turns are made to insert a surgical tack into tissue. The optical motor encoder may be operatively connected to the actuation rod and the processor.

In yet another aspect, the actuation assembly may further include an encoder wheel configured to ensure correct clocking of a distal end of the actuation rod relative to the loading unit.

In still yet another aspect, the gear box of the power module may further include an elongate ring gear in engagement with the first, second, third and fourth planetary gear assemblies.

In still yet another aspect, the first, second, third, and fourth planetary gear assemblies may be disposed within the elongate ring gear.

In still yet another aspect, the elongate ring gear may be rotationally fixed relative to the motor.

In accordance with yet another aspect of the disclosure, a powered surgical tack applier includes a handle assembly, an elongate member, and a power module. The handle assembly includes an actuation assembly and an articulation lever assembly. The actuation assembly includes an actuation rod. The articulation lever assembly includes an articulation rod and an articulation lever operatively coupled with the articulation rod. The elongate member extends distally from the handle assembly. The elongate member includes a loading unit and an articulation portion. The loading unit has a plurality of surgical tacks. The loading unit is operatively coupled to the actuation rod of the actuation assembly such that rotation of the actuation rod deploys a surgical tack of the plurality of surgical tacks from the loading unit. The articulation portion is pivotable with respect to a longitudinal axis defined by the elongate member. The articulation portion is operatively coupled to the articulation rod of the handle assembly such that axial displacement of the articulation rod articulates the articulation portion. The power module is removably received in the handle assembly. The power module includes a motor having an output shaft, a main sun gear, a first planetary gear assembly, a second planetary gear assembly, a drive shaft, a high-speed output, and a high-torque output. The main sun gear is fixed to the output shaft and configured to rotate with the output shaft. The first planetary gear assembly is operably coupled to the main sun gear such that the first planetary gear assembly rotates about the longitudinal axis in response to a rotation of the main sun gear. The second planetary gear assembly is operably coupled to the first planetary gear assembly such that the second planetary gear assembly rotates in response to the rotation of the first planetary gear assembly. The drive shaft has a proximal end portion coupled to the second planetary gear assembly for concomitant rotation therewith. The high-speed output is configured to rotate the actuation rod. The high-speed output is coupled to the drive shaft for concomitant rotation therewith. The high-torque output is configured to be operably coupled to a driven member of a surgical end effector. The high-torque output is operably coupled to the motor.

In an aspect, the high-speed output may be concentrically disposed within the high-torque output.

In another aspect, the distal end portion of the drive shaft may be disposed within and rotatable relative to the high-torque output.

In yet another aspect, the high-torque output may define a cavity therein, and the high-speed output may be received in the cavity.

In still yet another aspect, the gear box of the power module may further include a biasing member captured between the high-speed output and an inner surface of the high-torque output.

In an aspect, the biasing member may be configured to distally-bias the high-speed output.

In accordance with still yet another aspect of the disclosure, a handle assembly for use with a powered surgical tack applier includes an actuation assembly, an articulation lever assembly, and a power module. The actuation assembly includes an actuation rod and an actuation switch. The articulation lever assembly includes an articulation rod and an articulation lever operatively coupled with the articulation rod. The power module includes a motor having an output shaft, a battery supplying power to the motor, a printed circuit board in communication with the battery and the motor, and a gear box. The gear box includes a main sun gear fixed to the output shaft, a first planetary gear assembly, a second planetary gar assembly, a drive shaft, a high-torque output, and a high-speed output. The first planetary gear assembly is operably coupled to the main sun gear such that the first planetary gear assembly rotates about the longitudinal axis in response to rotation of the main sun gear. The second planetary gear assembly is operably coupled to the first planetary gear assembly such that the second planetary gear assembly rotates in response to rotation of the first planetary gear assembly. The drive shaft has a proximal end portion non-rotatably coupled to the second planetary gear assembly, and a distal end portion. The drive shaft is configured to rotate with the second planetary gear assembly. The high-torque output is operably coupled to the motor. The high-speed output is coupled to the distal end portion of the drive shaft for concomitant rotation therewith.

In an aspect, the power module may be removably received in a cavity of the handle assembly in a sealing relation.

Various aspects of the disclosure are described hereinbelow with reference to the drawings, which are a part of this specification, wherein:.

The disclosed surgical instrument is 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 "distal," as is conventional, will refer to that portion of the instrument, apparatus, device, or component thereof which is farther from the user, while the term "proximal" will refer to that portion of the instrument, apparatus, device, or component thereof which is closer to the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the disclosure in unnecessary detail.

With reference to <FIG>, a handle assembly for use with a surgical tack applier for applying a surgical tack <NUM> suitable for insertion through a surgical mesh "M" and tissue "T" is shown generally as a handle assembly <NUM>. The surgical tack applier generally includes the handle assembly <NUM>, an elongate member <NUM> having an articulation portion <NUM>, and a loading unit <NUM> selectably connectable to a distal end of the elongate member <NUM>. The loading unit <NUM> is electro-mechanically coupled to the handle assembly <NUM> and supports a plurality of surgical tacks <NUM>.

The loading unit <NUM> includes an outer tube <NUM> defining a lumen (not shown), a spiral or coil <NUM> fixedly disposed within the outer tube <NUM>, and an inner tube <NUM> rotatably disposed within the coil <NUM>. The inner tube <NUM> defines a lumen therethrough and includes a first portion 38a and a splined second portion 38b. The second portion 38b of the inner tube <NUM> is slotted, defining a pair of tines 38b<NUM> and a pair of channels 38b<NUM>. The second portion 38b of the inner tube <NUM> is configured to support the plurality of surgical tacks <NUM> within the inner tube <NUM>. In particular, the surgical tacks <NUM> are loaded into the loading unit <NUM> such that the pair of opposing threaded sections 112a of the surgical tacks <NUM> extend through respective channels 38b<NUM> of the second portion 38b of the inner tube <NUM> and are slidably disposed within the groove of the coil <NUM>, and the pair of tines 38b<NUM> of the second portion 38b of the inner tube <NUM> are disposed within the pair of slotted sections 116a of the surgical tack <NUM>. In use, as the inner tube <NUM> is rotated about a longitudinal axis "X-X" thereof, relative to the coil <NUM>, the pair of tines 38b<NUM> of the inner tube <NUM> transmits the rotation to the surgical tacks <NUM> and advance the surgical tacks <NUM> distally as the head threads 114a of the surgical tacks <NUM> engage with the coil <NUM>.

With particular respect to <FIG>, the surgical tack applier includes an articulation portion <NUM> operatively coupled with an articulation lever assembly <NUM> (<FIG>) supported in the handle assembly <NUM>. The articulation portion <NUM> may include a drive assembly (not shown) having a slidable tube and an articulation arm pivotally coupled to the slidable tube. The articulation lever assembly <NUM> is coupled to the slidable tube so that when the articulation lever assembly <NUM> is actuated the slidable tube is displaced through the elongated member <NUM>. Longitudinal translation of the slidable tube moves the articulation arm to enable the loading unit <NUM> to articulate relative to the longitudinal axis "X-X" (<FIG>). Reference may be made to <CIT> and <CIT>, and <CIT>, for a more detailed discussion of the structure and operation of a surgical tack applier including an articulation portion and a loading unit.

With reference now to <FIG>, the handle assembly <NUM> includes a housing <NUM>, an articulation lever assembly <NUM> configured to articulate the articulation portion <NUM> (<FIG>) of the elongate member <NUM>, an actuation assembly <NUM> configured to eject the surgical tack <NUM> out of the loading unit <NUM> of the elongate member <NUM>, and a battery pack <NUM> removably attached to the housing <NUM>. The housing <NUM> includes an ergonomic structure providing comfort, ease of use, and intuitiveness such that when the housing <NUM> is gripped by a clinician, e.g., a thumb, may be positioned to slide the articulation lever assembly <NUM> and, e.g., an index finger, may be positioned to trigger an actuation switch <NUM> of the actuation assembly <NUM>. Actuation of the actuation assembly <NUM> ejects a surgical tack <NUM> (<FIG>) out of the loading unit <NUM> through mesh "M" (<FIG>) and into body tissue "T".

With reference to <FIG> and <FIG>, the articulation lever assembly <NUM> includes an articulation rod <NUM> and articulation lever <NUM> operatively coupled with the articulation rod <NUM>. The articulation rod <NUM> is operatively coupled with the articulation portion <NUM> (<FIG>) of the elongate member <NUM> of the surgical tack applier. The articulation rod <NUM> is slidably supported on the housing <NUM> of the handle assembly <NUM> by a mounting plate <NUM> defining a channel <NUM> (<FIG>) configured to enable axial displacement of the articulation rod <NUM> therethrough, which, causes articulation of the articulation portion <NUM> (<FIG>) based on the axial position of the articulation rod <NUM>. In particular, the articulation rod <NUM> has an annular structure defining a channel <NUM> (<FIG>) dimensioned to receive the actuation rod <NUM> of the articulation assembly <NUM> therein. The articulation rod <NUM> further defines a transverse bore <NUM> dimensioned to receive an articulation drive pin <NUM> coupled with the articulation lever <NUM>.

With continued reference to <FIG> and <FIG>, the articulation lever <NUM> includes a housing portion <NUM> and an engaging portion <NUM> slidably engaging an engaging surface <NUM> of the housing <NUM>. The engaging surface <NUM> has an arcuate profile enabling the engaging portion <NUM> to travel in, e.g., an arc. The housing portion <NUM> is disposed within the housing <NUM> and is dimensioned to receive articulation pivot arms 366a, 366b mated together to receive a biasing member <NUM> therebetween. Each articulation pivot arm 366a, 366b defines a first bore 370a, 370b, a second bore 372a, 372b, and a slot 374a, 374b. The first bores 370a, 370b are dimensioned to receive an articulation pivot pin <NUM> (<FIG>) pivotably coupling the articulation pivot arms 366a, 366b to the housing <NUM>. The second bores 372a, 372b are dimensioned to receive the articulation drive pin <NUM> extending through the transverse bore <NUM> of the articulation rod <NUM>. Under such a configuration, when the articulation pivot arms 366a, 366b are pivoted about the articulation pivot pin <NUM>, the articulation drive pin <NUM> causes axial displacement of the articulation rod <NUM>. The articulation drive pin <NUM> defines a transverse bore <NUM> dimensioned to receive the actuation rod <NUM> of the actuation assembly <NUM> therethrough. The slots 374a, 374b of the articulation pivot arms 366a, 366b are dimensioned to cammingly receive a cam pin <NUM> biased away from the articulation pivot pin <NUM> by a biasing member <NUM> interposed between the articulation pivot arms 366a, 366b.

With reference now to <FIG>, the housing portion <NUM> of the articulation lever <NUM> is dimensioned to receive the mated articulation pivot arms 366a, 366b. The housing portion <NUM> defines a slot <NUM> dimensioned to cammingly receive the cam pin <NUM> which is cammingly slidable in the slots 374a, 374b of the articulation pivot arms 366a, 366b. In addition, the housing portion <NUM> includes a tooth <NUM> configured to engage a detent portion <NUM> of the housing <NUM> to inhibit movement of the articulation lever <NUM> relative to the housing <NUM>, thereby locking an axial position of the articulation rod <NUM>, which, in turn, locks the orientation of the articulation portion <NUM> (<FIG>) of the surgical tack applier. Under such a configuration, the articulation lever <NUM> is biased away from the articulation pivot pin <NUM> such that the tooth <NUM> of the housing portion <NUM> engages the detent portion <NUM>. When the engaging portion <NUM> of the articulation lever <NUM> is depressed towards the housing <NUM>, the tooth <NUM> is moved away from the detent portion <NUM> enabling the clinician to slidably move the engaging portion <NUM> on the engaging surface <NUM> (<FIG>) of the housing <NUM>, thereby enabling articulation of the articulation portion <NUM> of the surgical tack applier to a desired orientation.

With reference now to <FIG> the articulation lever assembly <NUM> further includes a cam wedge <NUM> having first, second, and third portions 350a, 350b, 350c configured to cammingly engage the cam pin <NUM> which is cammingly slidable in the slots 374a, 374b of the articulation pivot arms 366a, 366b and the slot <NUM> of the articulation lever <NUM>. The first, second, and third portions 350a, 350b, 350c correspond to the respective detent sections 208a, 208b, 208c of the detent portion <NUM>. In this manner, articulation backlash is reduced as the cam pin <NUM> rides along the first, second, and third portions 350a, 350b, 350c of the cam wedge <NUM>.

With reference back to <FIG> and <FIG>, the actuation assembly <NUM> includes an actuation rod <NUM> operatively coupled with the loading unit <NUM> (<FIG>) of the surgical tack applier, a motor <NUM>, an actuation switch <NUM> configured to actuate the motor <NUM> to eject the surgical tacks <NUM> (<FIG>), a printed circuit board <NUM> including a microprocessor (not shown) to control the actuation assembly <NUM>, and a battery pack <NUM> removably attached to the housing <NUM> and electrically connected to the motor <NUM> and the printed circuit board <NUM>. A proximal end of the actuation rod <NUM> is operatively coupled with an output shaft of the motor <NUM> for concomitant rotation therewith such that when the actuation switch <NUM> is triggered by the clinician, the motor <NUM> is actuated to impart axial rotation to the actuation rod <NUM>. A distal end of the actuation rod <NUM> is operatively coupled with the inner tube <NUM> (<FIG>) of the loading unit <NUM> for concomitant rotation therewith.

With reference now to <FIG>, the actuation assembly <NUM> may further include an encoder assembly <NUM> operatively connected to the actuation rod <NUM> and the processor of the printed circuit board <NUM>. The encoder assembly <NUM> may include, e.g., an optical, motor encoder <NUM> configured to keep an accurate count of turns of the motor output shaft or the actuation rod <NUM> to ensure a proper number of turns are made to insert the surgical tack <NUM> through, e.g., the mesh "M", and into tissue "T" (<FIG>). In addition, the encoder assembly <NUM> may further include, e.g., a single notched, encoder wheel <NUM> configured to ensure correct clocking of a distal end of the actuation rod <NUM> relative to the loading unit <NUM> (<FIG>). The encoder assembly <NUM> may further include a light emitting diode ("LED") indicator <NUM> to indicate status of the ejection of each surgical tack <NUM>. For example, a green light may indicate proper application of the surgical tact <NUM> through the mesh "M" and into tissue "T", and a red light may indicate, e.g., improper application of the surgical tack <NUM>, due to an error signal from the optical motor encoder <NUM> or the single notched encoder wheel <NUM>. Alternatively, the encoder assembly <NUM> may further include a piezoelectric element <NUM> (<FIG>) for providing an audible tone for proper application of the surgical tack <NUM>.

With brief reference to <FIG>, the handle assembly <NUM> may further include a release lever <NUM> slidably attached to the housing <NUM>. The release lever <NUM> is operatively coupled with the loading unit <NUM> (<FIG>) such that when the release lever <NUM> is pulled, the loading unit <NUM> is detached from the elongate member <NUM> (<FIG>) of the surgical tack applier.

In use, the loading unit <NUM> is operatively mounted to a distal end of the elongate member <NUM>. The loading unit <NUM> is introduced into a target surgical site while in the non-articulated condition. The clinician may remotely articulate loading unit <NUM> relative the longitudinal axis "X-X" to access the surgical site. Specifically, the clinician may slide the engaging portion <NUM> of the articulation lever <NUM> along the engaging surface <NUM> of the housing <NUM>. As the articulation rod <NUM> is displaced axially, the loading unit <NUM> is moved to an articulated orientation relative to the central longitudinal axis "X-X". Furthermore, the clinician may position the surgical mesh "M" adjacent the surgical site. Once the surgical mesh "M" is properly positioned on the surgical site, the clinician may trigger the actuation switch <NUM> to eject a surgical tack <NUM> through the mesh "M" and into tissue "T". While the articulation rod <NUM> is configured for axial displacement, it is further contemplated that an articulation rod <NUM> may be rotatably supported by a rotor <NUM> such that the articulation rod <NUM> outputs an axial rotation which may be utilized by the loading unit <NUM> to effect articulation thereof, as can be appreciated with reference to <FIG>. It is further contemplated that the articulation assembly <NUM> may further include a transmission assembly to selectively impart rotation of the output shaft of the motor <NUM> to the actuation rod <NUM>.

<FIG> illustrate a powered surgical tack applier <NUM> for applying the surgical tack <NUM> (<FIG>) suitable for insertion through tissue "T" (<FIG>) and the surgical mesh "M" (<FIG>) in accordance with another aspect of the disclosure. The structural and functional features of the powered surgical tack applier <NUM> that are substantially similar to those of the surgical tack applier described hereinabove will not described for the purposes of brevity, and as not to obscure the disclosure in unnecessary detail. The powered surgical tack applier <NUM> includes a disposable portion and a resuable portion. The resuable portion includes a power module <NUM> (<FIG>) having a motor <NUM> (<FIG>), a battery <NUM> (<FIG>), and electronics, as will be discussed below. Under such a configuration, the powered surgical tack applier <NUM> may aseptically receive the power module <NUM>. For example, a non-sterile power module <NUM> may be received in a sealed compartment of the powered surgical tack applier <NUM> such that the non-sterile power module <NUM> is contained within a sealed barrier avoiding any potential contamination. The resuable power module <NUM> may be compatible with various surgical device applications. For examples, other applications may include use in a linear tissue stapler, a circular stapler, and a small diameter stapler. A rechargeable battery has greater capacity than a disposable alternative, and a resuable motor may be of a higher quality and efficiency than would be possible in a fully disposable design. Ergonomics and user controls may be tailored to the particular application. Further, the power module <NUM> enables stable control of the end effector with minimal movement on shaft and tissue. However, it is also contemplated that low-cost disposable power module may be permanently integrated into the handle assembly for a single use device.

<FIG> illustrates the powered surgical tack applier <NUM> including a handle assembly <NUM>, an elongate member <NUM> having an articulation portion <NUM>, and the loading unit <NUM> (<FIG>) selectably connectable to a distal end of the elongate member <NUM>. The loading unit <NUM> is electro-mechanically coupled to the handle assembly <NUM> and supports a plurality of surgical tacks <NUM>. As the inner tube <NUM> of the loading unit <NUM> is rotated about a longitudinal axis "X-X" thereof, relative to the coil <NUM>, the pair of tines 38b<NUM> of the inner tube <NUM> transmits the rotation to the surgical tacks <NUM> and advance the surgical tacks <NUM> distally as the head threads 114a of the surgical tacks <NUM> engage with the coil <NUM>.

<FIG> further illustrates the powered surgical tack applier <NUM> including the articulation portion <NUM> operatively coupled with an articulation lever assembly <NUM> supported in the handle assembly <NUM>. As discussed hereinabove, the articulation portion <NUM> may include a drive assembly having a slidable tube and an articulation arm pivotally coupled to the slidable tube. The articulation lever assembly <NUM> is coupled to the slidable tube so that when the articulation lever assembly <NUM> is actuated the slidable tube is displaced through the elongated member <NUM>. Longitudinal translation of the slidable tube moves the articulation arm to enable the loading unit <NUM> to articulate in a plane defined by the elongate member <NUM> and the loading unit <NUM>.

<FIG> illustrates the handle assembly <NUM> including a housing <NUM>, the articulation lever assembly <NUM> configured to articulate the articulation portion <NUM> (<FIG>) of the elongate member <NUM>, an actuation assembly <NUM> configured to eject the surgical tack <NUM> (<FIG>) out of the loading unit <NUM>, and the power module <NUM> removably secured to the housing <NUM>. The housing <NUM> includes an ergonomic structure such that when the housing <NUM> is gripped by a clinician, e.g., a thumb, may be positioned to slide the articulation lever assembly <NUM> and, e.g., an index finger, may be positioned to trigger an actuation switch <NUM> of the actuation assembly <NUM>. Actuation of the actuation assembly <NUM> ejects a surgical tack <NUM> out of the loading unit <NUM> into body tissue "T" (<FIG>) and through the mesh "M" (<FIG>).

<FIG> and <FIG> illustrate the articulation lever assembly <NUM> including an articulation rod <NUM> and articulation lever <NUM> operatively coupled with the articulation rod <NUM>. The articulation rod <NUM> is operatively coupled with the articulation portion <NUM> of the elongate member <NUM> of the powered surgical tack applier <NUM>. The articulation rod <NUM> is slidable within an outer tube <NUM> supported in the housing <NUM> of the handle assembly <NUM> by a mounting plate <NUM>. Axial displacement of the articulation rod <NUM> causes articulation of the articulation portion <NUM> based on the axial position of the articulation rod <NUM>. In particular, the articulation rod <NUM> has an annular structure defining a channel dimensioned to receive the actuation rod <NUM> of the articulation assembly <NUM> therein. The articulation rod <NUM> further defines a transverse bore <NUM> dimensioned to receive articulation drive pins <NUM> coupled with the articulation lever <NUM>.

<FIG> further illustrates the articulation lever <NUM> including a housing portion <NUM> and an engaging portion <NUM> slidably engaging an engaging surface <NUM> (<FIG>) of the housing <NUM>. The engaging surface <NUM> has an arcuate profile enabling the engaging portion <NUM> to travel in, e.g., an arc. The housing portion <NUM> is disposed within the housing <NUM> and is dimensioned to receive articulation pivot arms 3366a, 3366b mated together to receive a biasing member <NUM> therebetween. Each articulation pivot arm 3366a, 3366b defines a first bore 3370a, 3370b, a second bore 3372a, 3372b, and a slot 3374a, 3374b. The first bores 3370a, 3370b are dimensioned to receive an articulation pivot pin <NUM> pivotably coupling the articulation pivot arms 3366a, 3366b to the housing <NUM>. The second bores 3372a, 3372b are dimensioned to receive the respective articulation drive pins <NUM> extending through the transverse bore <NUM> of the articulation rod <NUM>. Under such a configuration, when the articulation pivot arms 3366a, 3366b are pivoted about the articulation pivot pin <NUM>, the articulation drive pins <NUM> cause axial displacement of the articulation rod <NUM>. The actuation rod <NUM> of the actuation assembly <NUM> extends between the articulation drive pins <NUM>. The slots 3374a, 3374b of the articulation pivot arms 3366a, 3366b are dimensioned to cammingly receive a cam pin <NUM> biased away from the articulation pivot pin <NUM> by a biasing member <NUM> interposed between the articulation pivot arms 3366a, 3366b.

The housing portion <NUM> of the articulation lever <NUM> is dimensioned to receive the mated articulation pivot arms 3366a, 3366b. The housing portion <NUM> defines a slot <NUM> dimensioned to cammingly receive the cam pin <NUM> which is cammingly slidable in the slots 3374a, 3374b of the articulation pivot arms 3366a, 3366b. In addition, the housing portion <NUM> includes a tooth <NUM> configured to engage a detent portion <NUM> (<FIG>) of the housing <NUM> to inhibit movement of the articulation lever <NUM> relative to the housing <NUM>, thereby locking an axial position of the articulation rod <NUM>, which, in turn, locks the orientation of the articulation portion <NUM> (<FIG>) of the powered surgical tack applier <NUM>. Under such a configuration, the articulation lever <NUM> is biased away from the articulation pivot pin <NUM> such that the tooth <NUM> of the housing portion <NUM> engages the detent portion <NUM>. When the engaging portion <NUM> of the articulation lever <NUM> is depressed towards the housing <NUM>, the tooth <NUM> is moved away from the detent portion <NUM> enabling the clinician to slidably move the engaging portion <NUM> on the engaging surface <NUM> of the housing <NUM>, thereby enabling articulation of the articulation portion <NUM> of the powered surgical tack applier <NUM> to a desired orientation.

<FIG> illustrate the articulation lever assembly <NUM> further including a cam wedge <NUM> having first, second, and third portions 3350a, 3350b, 3350c configured to cammingly engage the cam pin <NUM> which is cammingly slidable in the slots 3374a, 3374b of the articulation pivot arms 3366a, 3366b and the slot <NUM> of the articulation lever <NUM>. The first, second, and third portions 3350a, 3350b, 3350c correspond to the respective detent sections 3208a, 3208b, 3208c of the detent portion <NUM>. In this manner, articulation backlash is reduced as the cam pin <NUM> rides along the first, second, and third portions 3350a, 3350b, 3350c of the cam wedge <NUM>.

<FIG> and <FIG> illustrate the actuation assembly <NUM> including an actuation rod <NUM> operatively coupled with the loading unit <NUM> (<FIG>), the power module <NUM>, an actuation switch <NUM> configured to actuate a motor <NUM> (<FIG>) of the power module <NUM> to eject the surgical tacks <NUM> from the loading unit <NUM>, a printed circuit board <NUM> including a microprocessor to control the actuation assembly <NUM>, and a battery <NUM> (<FIG>) of the power module <NUM> electrically connected to the motor <NUM> and the printed circuit board <NUM>. A proximal end of the actuation rod <NUM> is operatively coupled with an output shaft <NUM> (<FIG>) of the motor <NUM> such that when the actuation switch <NUM> is triggered by the clinician, the motor <NUM> is actuated to impart axial rotation to the actuation rod <NUM>, as will be discussed below. A distal end of the actuation rod <NUM> is operatively coupled with the inner tube <NUM> (<FIG>) of the loading unit <NUM> for concomitant rotation therewith.

The actuation assembly <NUM> includes an encoder assembly <NUM> operatively connected to the actuation rod <NUM> and the processor of the printed circuit board <NUM>. The encoder assembly <NUM> may include, e.g., an optical, motor encoder <NUM> configured to keep an accurate count of turns of the rotational output shaft <NUM> (<FIG>) of the motor <NUM> or the actuation rod <NUM> to ensure a proper number of turns are made to insert the surgical tack <NUM> into, e.g., tissue "T" (<FIG>) and the mesh "M" (<FIG>). In addition, the encoder assembly <NUM> may further include, e.g., an encoder wheel <NUM>, configured to ensure accurate clocking of a distal end of the actuation rod <NUM> relative to the loading unit <NUM> (<FIG>). For example, the encoder wheel <NUM> may include a magnet thereon and the encoder assembly <NUM> may include a Hall effect sensor. The encoder wheel <NUM> may be concentrically coupled to the actuation rod <NUM> by a pin <NUM> for concomitant rotation. The encoder wheel <NUM> further includes a protuberance 3407a (<FIG>) configured to operatively engage the power module <NUM>, as will be described below. The encoder assembly <NUM> may further include a light emitting diode ("LED") indicator <NUM> to indicate status of the ejection of each surgical tack <NUM>. For example, a green light may indicate proper application of the surgical tact <NUM> through the mesh "M" and into tissue "T", and a red light may indicate, e.g., improper application of the surgical tack <NUM>, due to an error signal from the optical motor encoder <NUM> or the single notched encoder wheel <NUM>. Alternatively, the encoder assembly <NUM> may further include a piezoelectric element for providing an audible tone for proper application of the surgical tack <NUM>.

<FIG> and <FIG> illustrate the handle assembly <NUM> defining a chamber <NUM> configured to removably receive the power module <NUM> therein. The chamber <NUM> provides a seal to hermetically seal the chamber <NUM>. The power module <NUM> may be reusable and is configured to operate various functions of different types of surgical end effectors, such as, for example, the powered surgical tack applier <NUM>, a linear stapler, a circular stapler, and a small-diameter vascular stapler. The power module <NUM> has two outputs with each operably coupled to the same motor of the power module. The outputs are rotated simultaneously by the motor, but each at a different speed and torque from the other. A high-speed/low-torque output may be disposed concentrically within a high-torque/low-speed output. Depending on the surgical instrument in which the power module is received and operably engaged with, either the high-speed/low-torque output or the high-torque/low-speed output of the power module selectively engages a corresponding driven component (e.g., a rod, screw, rack, gear, or the like) of the selected surgical instrument. As such, the same power module may be used in a variety of surgical instruments despite each of the surgical instruments having discrete power and speed requirements.

The handle assembly <NUM> includes a disposable and sterile housing <NUM>. A door <NUM> is pivotably coupled to the housing <NUM>. The door <NUM> is selectively opened and closed to allow for the placement or removal of a non-sterile or sterile power module <NUM>. <FIG> illustrates the power module <NUM> including a sterile outer shell <NUM> (shown in phantom) and a reusable power assembly <NUM> for removable receipt in the outer shell <NUM>. The outer shell <NUM> has a cover <NUM> received in an open proximal end of the outer shell <NUM>, and a spring-loaded pull tab <NUM> to facilitate removal of the cover <NUM>.

<FIG> illustrates the power assembly <NUM> including the motor <NUM>, such as, for example, an electrical drive motor, which is electrically connected or wirelessly connected to a printed circuit board <NUM> and the battery <NUM>. In aspects, the battery <NUM> may include a boost circuit and may be rechargeable (e.g., wirelessly). The battery <NUM> has a card edge connector <NUM> configured for detachable receipt of a card edge header <NUM> (<FIG>) of the handle assembly <NUM> to enable communication between the actuation switch <NUM> and the battery <NUM>. The printed circuit board <NUM> may include a USB charging connector to enable charging of the battery <NUM> to be recharged with a USB charger or wirelessly (e.g., via induction). In aspects, the printed circuit board <NUM> may have a motor controller or a processor. By providing a reusable power module <NUM>, the battery <NUM> may be a rechargeable single cell with a boost circuit to provide the necessary voltage. A rechargeable battery has greater capacity than a disposable alternative. Further, the motor <NUM> may be of a higher quality and higher efficiency than would be possible in a fully disposable design.

<FIG> and <FIG> illustrate the power module <NUM> further including a gearbox <NUM> such as, for example, a planetary gearbox, operably coupled to the motor <NUM>, and first and second outputs <NUM>, <NUM> and configured to rotate about a longitudinal axis defined by the gearbox <NUM>. The gear box <NUM> is configured to transfer power from the motor <NUM> to a rotational output of the first output <NUM> at a high-torque and low-speed, and a rotational output of the second output <NUM> at a high-speed and low-torque. Rotation of the first and second outputs <NUM>, <NUM> may be utilized to perform the operation of end effectors of surgical instruments. In particular, the high-speed/low torque rotation of the second output <NUM> is utilized to effect rotation of the actuation rod <NUM>.

<FIG> illustrates the motor <NUM> having an output shaft <NUM> to which a main sun gear <NUM> is fixed such that the main sun gear <NUM> rotates concomitantly with the output shaft <NUM>. The gear box <NUM> includes a plurality of planetary gear assemblies <NUM>, <NUM>, <NUM>, <NUM> and an elongate ring gear <NUM> operably engaging the plurality of planetary gear assemblies <NUM>, <NUM>, <NUM>, <NUM>.

The first planetary gear assembly <NUM> is operably coupled to the main sun gear <NUM> such that the first planetary gear assembly <NUM> rotates about a longitudinal axis of the output shaft <NUM> of the motor <NUM> in response to rotation of the main sun gear <NUM>. The first planetary gear assembly <NUM> increases the torque output of the motor <NUM> while reducing the output rotational speed. The first planetary gear assembly <NUM> includes a first carrier <NUM>, a first sun gear <NUM>, and a plurality of planetary gears 6156a, 6156b, 6156c. The first carrier <NUM> has a plurality (e.g., three) of pins 6156d, 6156e, 6156f fixed thereto and extending proximally from a proximal side thereof. The first sun gear <NUM> is rotationally fixed to a distal side of the first carrier <NUM> and centrally aligned with the longitudinal axis of the output shaft <NUM>. The planetary gears 6156a, 6156b, 6156c are rotatably coupled to the respective pins 6156d, 6156e, 6156f of the first carrier <NUM>. The planetary gears 6156a, 6156b, 6156c are in meshing engagement with the main sun gear <NUM> to rotate in response to rotation of the main sun gear <NUM>. As will be described, the elongate ring gear <NUM> is rotationally fixed relative to the outer shell <NUM> (<FIG>) such that the first planetary gear assembly <NUM> rotates as a unit about the longitudinally axis of the output shaft <NUM> of the motor <NUM> in response to a rotation of the main sun gear <NUM>.

The second planetary gear assembly <NUM> includes a second carrier <NUM>, a second sun gear <NUM>, and a plurality of planetary gears 6158a, 6158b, 6158c. The second planetary gear assembly <NUM> has an increased torque output and reduced rotational speed output relative to the first planetary gear assembly <NUM>. The second carrier <NUM> has a plurality (e.g., three) of pins 6158d, 6158e, 6158f fixed thereto and extending proximally from a proximal side thereof. The second sun gear <NUM> is rotationally fixed to a distal side of the second carrier <NUM> and centrally aligned with the longitudinal axis of the output shaft <NUM> of the motor <NUM>. The planetary gears 6158a, 6158b, 6158c of the second planetary gear assembly <NUM> are rotatably coupled to the respective pins 6158d, 6158e, 6158f of the second carrier <NUM>. The planetary gears 6158a, 6158b, 6158c are in meshing engagement with the first sun gear <NUM> of the first planetary gear assembly <NUM> and the fixed elongate ring gear <NUM> such that the second planetary gear assembly <NUM> rotates in response to rotation of the first planetary gear assembly <NUM>.

The third planetary gear assembly <NUM> includes a third carrier <NUM>, a third sun gear <NUM>, and a plurality of planetary gears 6160a, 6160b, 6160c. The third planetary gear assembly <NUM> has an increased torque output and reduced rotational speed output relative to the second planetary gear assembly <NUM>. The third carrier <NUM> has a plurality (e.g., three) of pins 6160d, 6160e, 6160f fixed thereto and extending proximally from a proximal side thereof. The third sun gear <NUM> is rotationally fixed to a distal side of the third carrier <NUM> and centrally aligned with the longitudinal axis of the output shaft <NUM> of the motor <NUM>. The planetary gears 6160a, 6160b, 6160c of the third planetary gear assembly <NUM> are rotatably coupled to the respective pins 6160d, 6160e, 6160f of the third carrier <NUM>. The planetary gears 6160a, 6160b, 6160c of the third planetary gear assembly <NUM> are in meshing engagement with the second sun gear <NUM> of the second planetary gear assembly <NUM> and the elongate ring gear <NUM> such that the third planetary gear assembly <NUM> rotates as a unit in response to a rotation of the second planetary gear assembly <NUM>.

The fourth planetary gear assembly <NUM> includes a fourth carrier <NUM> and a plurality of planetary gears 6162a, 6162b, 6162c. The fourth planetary gear assembly <NUM> has an increased torque output and reduced rotational speed output relative to the third planetary gear assembly <NUM>. The fourth carrier <NUM> is connected to, monolithically formed with, or otherwise non-rotatably coupled to a proximal end of the first output <NUM> and has a plurality (e.g., three) of pins 6162d, 6162e, 6162f fixed thereto and extending proximally from a proximal side thereof. The planetary gears 6162a, 6162b, 6162c of the fourth planetary gear assembly <NUM> are rotatably coupled to the respective pins 6162d, 6162e, 6162f of the fourth carrier <NUM>. The planetary gears 6162a, 6162b, 6162c of the fourth planetary gear assembly <NUM> are in meshing engagement with the third sun gear <NUM> of the third planetary gear assembly <NUM> and the elongate ring gear <NUM> such that the fourth planetary gear assembly <NUM> and the first output <NUM> rotate together in response to rotation of the third planetary gear assembly <NUM>. It is contemplated that the gear box <NUM> may include more or less than the four planetary gear assemblies and/or other types of gears.

The first output <NUM> is configured to generate a relatively high torque (e.g., about <NUM> or <NUM> oz-in) and a relatively low speed (e.g., <NUM> rpm) and includes a cylindrical body 6148a received in a distal end portion of the elongate ring gear <NUM>, and a gear 6148b, such as, for example, a pinion gear formed with a distal end portion of the cylindrical body 6148a. The pinion gear 6148b of the first output <NUM> is configured to be selectively operably coupled to a driven member of a first type of surgical end effector, such as, for example, surgical end effector <NUM>. It is contemplated that a handle assembly may have a corresponding driven component (e.g., a gear, rack, or the like) configured to selectively engage the pinion gear 6148b upon receipt of the power module <NUM> in the handle assembly <NUM>.

The power module <NUM> further includes a drive shaft <NUM> having a proximal end portion 6180a non-rotatably coupled to the second planetary gear assembly <NUM> such that the drive shaft <NUM> is configured to rotate with the second planetary gear assembly <NUM>. In particular, the proximal end portion 6180a of the drive shaft <NUM> is received within and rotationally fixed to the second sun gear <NUM> of the second planetary gear assembly <NUM>. The drive shaft <NUM> has a distal end portion 6180b extending longitudinally through the third and fourth planetary gear assemblies <NUM>, <NUM> while being freely rotatable therein. The distal end portion 6180b of the drive shaft <NUM> may have a non-circular cross-sectional shape, such as, for example, a tri-lobe shape.

The second output <NUM> is attached to the distal end portion 6180b of the drive shaft <NUM> and is configured to rotate with the drive shaft <NUM> about a longitudinal axis of the drive shaft <NUM>. The second output <NUM> is configured to generate a relatively low torque (e.g., <NUM> or <NUM> oz-in) and a relatively high speed (e.g., <NUM> rpm) and includes a socket <NUM> that is configured to operably couple to a corresponding driven element of a different type of surgical end effector than the first output <NUM>. The powered surgical tack applier <NUM> demands less torque but higher actuation speed than other surgical instruments such as, e.g., a linear stapler. When the power module <NUM> is inserted into the chamber <NUM> of the handle assembly <NUM>, the socket <NUM> of the second output <NUM> engages a driven element, i.e., the protuberance 3407a (<FIG>) of encoder wheel <NUM>, to provide rotation to the actuation rod <NUM> (<FIG>). It is contemplated that the handle assemblies or other components of the surgical instruments have a corresponding driven component (e.g., a rod) configured to selectively engage the socket <NUM> upon receipt of the power module <NUM> in the handle housing.

The second output <NUM> is concentrically disposed within the first output <NUM> and is configured to rotate simultaneously with the first output <NUM> in response to an activation of the same motor, namely the motor <NUM>. However, as noted above, the first and second outputs <NUM>, <NUM> rotate at different speeds and with different torques from one another. The second output <NUM> is received in an elongate cavity <NUM> defined in the cylindrical body 6148a of the first output <NUM>. A biasing member <NUM> is disposed within the cavity <NUM> and captured between the second output <NUM> and an inner surface of the cylindrical body 6148a of the first output <NUM>. The biasing member <NUM> is configured to distally-bias the second output <NUM> into a position in which the second output <NUM> is concentric within the first output <NUM>.

The elongate ring gear <NUM> of the gear box <NUM> encapsulates each of the planetary gear assemblies <NUM>, <NUM>, <NUM>, <NUM> and is rotationally fixed relative to the sterile outer shell <NUM> (<FIG>) and the motor <NUM>. The elongate ring gear <NUM> has an annular inner surface defining a plurality of longitudinally-extending teeth <NUM> that are in meshing engagement with the planetary gears of each of the planetary gear assemblies <NUM>, <NUM>, <NUM>, <NUM>. A first bushing <NUM> may be provided to capture the first output <NUM> in the elongate ring gear <NUM> and a second bushing <NUM> may be provided to capture the second output <NUM> in the first output <NUM>.

Claim 1:
A powered surgical tack applier (<NUM>) comprising:
a handle assembly (<NUM>) including:
an actuation assembly (<NUM>) including an actuation rod (<NUM>); and
an articulation lever (<NUM>) assembly including an articulation rod (<NUM>) and an articulation lever (<NUM>) operatively coupled with the articulation rod;
an elongate member (<NUM>) extending distally from the handle assembly, the elongate member including:
a loading unit (<NUM>) having a plurality of surgical tacks (<NUM>), the loading unit operatively coupled to the actuation rod of the actuation assembly such that rotation of the actuation rod deploys a surgical tack of the plurality of surgical tacks from the loading unit; and
an articulation portion (<NUM>) pivotable with respect to a longitudinal axis defined by the elongate member, the articulation portion being operatively coupled to the articulation rod of the handle assembly such that axial displacement of the articulation rod articulates the articulation portion;
a power module (<NUM>) including
a motor (<NUM>) having an output shaft (<NUM>); and characterized in that the power module is removably received in the handle assembly and the power module further includes:
a main sun gear (<NUM>) fixed to the output shaft and configured to rotate with the output shaft;
a first planetary gear assembly (<NUM>) operably coupled to the main sun gear such that the first planetary gear assembly rotates about the longitudinal axis in response to a rotation of the main sun gear;
a second planetary gear assembly (<NUM>) operably coupled to the first planetary gear assembly such that the second planetary gear assembly rotates in response to the rotation of the first planetary gear assembly;
a drive shaft (<NUM>) having a proximal end portion (6180a) coupled to the second planetary gear assembly for concomitant rotation therewith;
a high-speed output (<NUM>) configured to rotate the actuation rod, the high-speed output coupled to the drive shaft for concomitant rotation therewith; and
a high-torque output (<NUM>) configured to be operably coupled to a driven member of a surgical end effector, the high-torque output being operably coupled to the motor.