Patent Description:
Examples of endoscopic surgical instruments include surgical staplers. Some such staplers are operable to clamp down on layers of tissue, cut through the clamped layers of tissue, and drive staples through the layers of tissue to substantially seal the severed layers of tissue together near the severed ends of the tissue layers. Merely exemplary surgical staplers are disclosed in <CIT>; <CIT>; and <CIT>. <CIT> discloses a method of applying a buttress to a surgical stapler end effector.

Surgical staplers may also be used in open procedures and/or other non-endoscopic procedures. By way of example only, a surgical stapler may be inserted through a thoracotomy and thereby between a patient's ribs to reach one or more organs in a thoracic surgical procedure that does not use a trocar as a conduit for the stapler. For instance, the vessels leading to an organ may be severed and closed by a stapler before removal of the organ from the thoracic cavity. Of course, surgical staplers may be used in various other settings and procedures.

Certain optional features of the invention are defined in the dependent claims. The present invention provides an apparatus for applying at least one adjunct element to at least one of opposing first and second jaws of an end effector of a surgical stapler as recited in claim <NUM>. The present invention also provides a method of securing an adjunct element to an end effector of a surgical stapler having opposing first and second jaws as recited in claim <NUM>. Optional features are recited in the dependent claims.

For clarity of disclosure, the terms "proximal" and "distal" are defined herein relative to a human or robotic operator of the surgical instrument. The term "proximal" refers the position of an element closer to the human or robotic operator of the surgical instrument and further away from the surgical end effector of the surgical instrument. The term "distal" refers to the position of an element closer to the surgical end effector of the surgical instrument and further away from the human or robotic operator of the surgical instrument. In addition, the terms "upper," "lower," "lateral," "transverse," "bottom," "top," are relative terms to provide additional clarity to the figure descriptions provided below. The terms "upper," "lower," "lateral," "transverse," "bottom," "top," are thus not intended to unnecessarily limit the invention described herein.

<FIG> depict an exemplary surgical stapling and severing instrument (<NUM>) that is sized for insertion through a trocar cannula or an incision (e.g., thoracotomy, etc.) to a surgical site in a patient for performing a surgical procedure. Instrument (<NUM>) of the present example includes a handle portion (<NUM>) connected to a shaft (<NUM>), which distally terminates in an articulation joint (<NUM>), which is further coupled with an end effector (<NUM>). Once articulation joint (<NUM>) and end effector (<NUM>) are inserted through the cannula passageway of a trocar, articulation joint (<NUM>) may be remotely articulated, as depicted in phantom in <FIG>, by an articulation control (<NUM>), such that end effector (<NUM>) may be deflected from the longitudinal axis (LA) of shaft (<NUM>) at a desired angle (α). End effector (<NUM>) of the present example includes a lower jaw (<NUM>) that includes a staple cartridge (<NUM>), and an upper jaw in the form of a pivotable anvil (<NUM>).

Handle portion (<NUM>) includes a pistol grip (<NUM>) and a closure trigger (<NUM>). Closure trigger (<NUM>) is pivotable toward pistol grip (<NUM>) to cause clamping, or closing, of the anvil (<NUM>) toward lower jaw (<NUM>) of end effector (<NUM>). Such closing of anvil (<NUM>) is provided through a closure tube (<NUM>) and a closure ring (<NUM>), which both longitudinally translate relative to handle portion (<NUM>) in response to pivoting of closure trigger (<NUM>) relative to pistol grip (<NUM>). Closure tube (<NUM>) extends along the length of shaft (<NUM>); and closure ring (<NUM>) is positioned distal to articulation joint (<NUM>). Articulation joint (<NUM>) is operable to communicate/transmit longitudinal movement from closure tube (<NUM>) to closure ring (<NUM>).

As shown in <FIG>, handle portion (<NUM>) also includes a firing trigger (<NUM>). An elongate member (not shown) longitudinally extends through shaft (<NUM>) and communicates a longitudinal firing motion from handle portion (<NUM>) to a firing beam (<NUM>) in response to actuation of firing trigger (<NUM>). This distal translation of firing beam (<NUM>) causes the stapling and severing of clamped tissue in end effector (<NUM>), as will be described in greater detail below.

As shown in <FIG>, end effector (<NUM>) employs a firing beam (<NUM>) that includes a transversely oriented upper pin (<NUM>), a firing beam cap (<NUM>), a transversely oriented middle pin (<NUM>), and a distally presented cutting edge (<NUM>). Upper pin (<NUM>) is positioned and translatable within a longitudinal anvil slot (<NUM>) of anvil (<NUM>). Firing beam cap (<NUM>) slidably engages a lower surface of lower jaw (<NUM>) by having firing beam (<NUM>) extend through lower jaw slot (<NUM>) (shown in <FIG>) that is formed through lower jaw (<NUM>). Middle pin (<NUM>) slidingly engages a top surface of lower jaw (<NUM>), cooperating with firing beam cap (<NUM>).

<FIG> shows firing beam (<NUM>) of the present example proximally positioned and anvil (<NUM>) pivoted to an open configuration, allowing an unspent staple cartridge (<NUM>) to be removably installed into a channel of lower jaw (<NUM>). As best seen in <FIG>, staple cartridge (<NUM>) of the present example includes a cartridge body (<NUM>), which presents an upper deck (<NUM>) and is coupled with a lower cartridge tray (<NUM>). As best seen in <FIG>, a vertical slot (<NUM>) extends longitudinally through a portion of staple cartridge body (<NUM>). As also best seen in <FIG>, three rows of staple apertures (<NUM>) are formed through upper deck (<NUM>) on each lateral side of vertical slot (<NUM>). As shown in <FIG>, a wedge sled (<NUM>) and a plurality of staple drivers (<NUM>) are captured between cartridge body (<NUM>) and tray (<NUM>), with wedge sled (<NUM>) being located proximal to staple drivers (<NUM>). Wedge sled (<NUM>) is movable longitudinally within staple cartridge (<NUM>); while staple drivers (<NUM>) are movable vertically within staple cartridge (<NUM>). Staples (<NUM>) are also positioned within cartridge body (<NUM>), above corresponding staple drivers (<NUM>). Each staple (<NUM>) is driven vertically within cartridge body (<NUM>) by a staple driver (<NUM>) to drive staple (<NUM>) out through an associated staple aperture (<NUM>). As best seen in <FIG> and <FIG>, wedge sled (<NUM>) presents inclined cam surfaces that urge staple drivers (<NUM>) upwardly as wedge sled (<NUM>) is driven distally through staple cartridge (<NUM>).

With end effector (<NUM>) closed, as depicted in <FIG> by distally advancing closure tube (<NUM>) and closure ring (<NUM>), firing beam (<NUM>) is then advanced distally into engagement with anvil (<NUM>) by having upper pin (<NUM>) enter longitudinal anvil slot (<NUM>). A pusher block (<NUM>) (shown in <FIG>) located at the distal end of firing beam (<NUM>) pushes wedge sled (<NUM>) distally as firing beam (<NUM>) is advanced distally through staple cartridge (<NUM>) when firing trigger (<NUM>) is actuated. During such firing, cutting edge (<NUM>) of firing beam (<NUM>) enters vertical slot (<NUM>) of staple cartridge (<NUM>), severing tissue clamped between staple cartridge (<NUM>) and anvil (<NUM>). As shown in <FIG>, middle pin (<NUM>) and pusher block (<NUM>) together actuate staple cartridge (<NUM>) by entering into vertical slot (<NUM>) within staple cartridge (<NUM>), driving wedge sled (<NUM>) into upward camming contact with staple drivers (<NUM>), which in turn drives staples (<NUM>) out through staple apertures (<NUM>) and into forming contact with staple forming pockets (<NUM>) (shown in <FIG>) on the inner surface of anvil (<NUM>). <FIG> depicts firing beam (<NUM>) fully distally translated after completing severing and stapling of tissue. Staple forming pockets (<NUM>) are intentionally omitted from the view in <FIG> but are shown in <FIG>. Anvil (<NUM>) is intentionally omitted from the view in <FIG>.

<FIG> shows end effector (<NUM>) having been actuated through a single firing stroke through tissue (<NUM>). Cutting edge (<NUM>) (obscured in <FIG>) has cut through tissue (<NUM>), while staple drivers (<NUM>) have driven three alternating rows of staples (<NUM>) through the tissue (<NUM>) on each side of the cut line produced by cutting edge (<NUM>). After the first firing stroke is complete, end effector (<NUM>) is withdrawn from the patient, spent staple cartridge (<NUM>) is replaced with a new staple cartridge (<NUM>), and end effector (<NUM>) is then again inserted into the patient to reach the stapling site for further cutting and stapling. This process may be repeated until the desired quantity and pattern of firing strokes across the tissue (<NUM>) has been completed.

Instrument (<NUM>) may be further constructed and operable in accordance with any of the teachings of the following references: <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; <CIT>; and/or <CIT>.

In some instances, it may be desirable to equip end effector (<NUM>) of surgical instrument (<NUM>) with an adjunct material, such as a buttress, to reinforce the mechanical fastening of tissue provided by staples (<NUM>). Such a buttress may prevent the applied staples (<NUM>) from pulling through the tissue and may otherwise reduce a risk of tissue tearing at or near the site of applied staples (<NUM>). In addition to or as an alternative to providing structural support and integrity to a line of staples (<NUM>), a buttress may provide various other kinds of effects such as spacing or gap-filling, administration of therapeutic agents, and/or other effects. In some instances, a buttress may be provided on upper deck (<NUM>) of staple cartridge (<NUM>). As described above, deck (<NUM>) houses staples (<NUM>), which are driven by staple driver (<NUM>). In some other instances, a buttress may be provided on the surface of anvil (<NUM>) that faces staple cartridge (<NUM>). It should also be understood that a first buttress may be provided on upper deck (<NUM>) of staple cartridge (<NUM>) while a second buttress is provided on anvil (<NUM>) of the same end effector (<NUM>).

Various examples of forms that a buttress may take will be described in greater detail below. Various ways in which a buttress may be secured to a staple cartridge (<NUM>) or an anvil (<NUM>) will also be described in greater detail below. Exemplary buttress assemblies, exemplary materials and techniques for applying buttress assemblies, and exemplary buttress applier cartridges may be configured in accordance with at least some of the teachings of <CIT>; and/or in <CIT>.

<FIG> shows an exemplary pair of buttress assemblies (<NUM>, <NUM>) (each also referred to individually as a "buttress"). Buttress assembly (<NUM>) of this example comprises a buttress body (<NUM>) and an upper adhesive layer (<NUM>). Similarly, buttress assembly (<NUM>) comprises a buttress body (<NUM>) and a lower adhesive layer (<NUM>). In the present example, each buttress body (<NUM>, <NUM>) comprises a strong yet flexible material configured to structurally support a line of staples (<NUM>). By way of example only, each buttress body (<NUM>, <NUM>) may comprise a mesh of polyglactin <NUM> material by Ethicon, Inc. of Somerville, New Jersey. Alternatively, any other suitable materials or combinations of materials may be used in addition to or as an alternative to polyglactin <NUM> material to form each buttress body (<NUM>, <NUM>).

Each buttress body (<NUM>, <NUM>) may comprise a material including, for example, a hemostatic agent such as fibrin to assist in coagulating blood and reduce bleeding at the severed and/or stapled surgical site along tissue (T<NUM>, T<NUM>). As another merely illustrative example, each buttress body (<NUM>, <NUM>) may comprise other adjuncts or hemostatic agents such as thrombin may be used such that each buttress body (<NUM>, <NUM>) may assist to coagulate blood and reduce the amount of bleeding at the surgical site. Other adjuncts or reagents that may be incorporated into each buttress body (<NUM>, <NUM>) may further include but are not limited to medical fluid or matrix components.

In the present example, adhesive layer (<NUM>) is provided on buttress body (<NUM>) to adhere buttress body (<NUM>) to underside (<NUM>) of anvil (<NUM>). Similarly, adhesive layer (<NUM>) is provided on buttress body (<NUM>) to adhere buttress body (<NUM>) to upper deck (<NUM>) of staple cartridge (<NUM>). Such an adhesive material may provide proper positioning of buttress body (<NUM>, <NUM>) before and during actuation of end effector (<NUM>); then allow buttress body (<NUM>, <NUM>) to separate from end effector (<NUM>) after end effector (<NUM>) has been actuated, without causing damage to buttress body (<NUM>, <NUM>) that is substantial enough to compromise the proper subsequent functioning of buttress body (<NUM>, <NUM>).

<FIG> show an exemplary sequence in which surgical stapler end effector (<NUM>), which has been loaded with buttress assemblies (<NUM>, <NUM>), is actuated to drive staples (<NUM>) through two opposed layers of tissue (T<NUM>, T<NUM>), with buttress assemblies (<NUM>, <NUM>) being secured to the same layers of tissue (T<NUM>, T<NUM>) by staples (<NUM>). In particular, <FIG> shows layers of tissue (T<NUM>, T<NUM>) positioned between anvil (<NUM>) and staple cartridge (<NUM>), with anvil (<NUM>) in the open position. Buttress assembly (<NUM>) is adhered to underside (<NUM>) of anvil (<NUM>) via adhesive layer (<NUM>); while buttress assembly (<NUM>) is adhered to upper deck (<NUM>) of staple cartridge (<NUM>) via adhesive layer (<NUM>). Layers of tissue (T<NUM>, T<NUM>) are thus interposed between buttress assemblies (<NUM>, <NUM>). Next, closure trigger (<NUM>) is pivoted toward pistol grip (<NUM>) to drive closure tube (<NUM>) and closure ring (<NUM>) distally. This drives anvil (<NUM>) to the closed position as shown in <FIG>. At this stage, layers of tissue (T<NUM>, T<NUM>) are compressed between anvil (<NUM>) and staple cartridge (<NUM>), with buttress assemblies (<NUM>, <NUM>) engaging opposite surfaces of tissue layers (T<NUM>, T<NUM>). End effector (<NUM>) is then actuated as described above, driving staple (<NUM>) through buttress assemblies (<NUM>, <NUM>) and tissue (T<NUM>, T<NUM>). As shown in FIG. 13C, crown (<NUM>) of driven staple (<NUM>) captures and retains buttress assembly (<NUM>) against layer of tissue (T<NUM>). Deformed legs (<NUM>) of staple (<NUM>) capture and retain buttress assembly (<NUM>) against layer of tissue (T<NUM>).

A series of staples (<NUM>) similarly capture and retain buttress assemblies (<NUM>, <NUM>) against layers of tissue (T<NUM>, T<NUM>), thereby securing buttress assemblies (<NUM>, <NUM>) to tissue (T<NUM>, T<NUM>) as shown in <FIG>. As end effector (<NUM>) is pulled away from tissue (T<NUM>, T<NUM>) after deploying staples (<NUM>) and buttress assemblies (<NUM>, <NUM>), buttress assemblies (<NUM>, <NUM>) disengage end effector such that buttress assemblies (<NUM>, <NUM>) remain secured to tissue (T<NUM>, T<NUM>) with staples (<NUM>). Buttresses (<NUM>, <NUM>) thus provides structural reinforcement to the lines of staples (<NUM>) formed in tissue (T<NUM>, T<NUM>). As can also be seen in <FIG>, distally presented cutting edge (<NUM>) of firing beam (<NUM>) also cuts through a centerline of buttress tissue assemblies (<NUM>, <NUM>), separating each buttress assembly (<NUM>, <NUM>) into a corresponding pair of sections, such that each section remains secured to a respective severed region of tissue (T<NUM>, T<NUM>).

Because end effector (<NUM>) of surgical instrument (<NUM>) may be actuated multiple times during a single surgical procedure, it may be desirable to enable an operator to repeatedly and easily load buttress assemblies (<NUM>, <NUM>) onto end effector jaws (<NUM>, <NUM>) during that single surgical procedure. <FIG> show an exemplary buttress applier cartridge (<NUM>) (also referred to as a "buttress applicator") that may be used to support, protect, and apply adjunct material, such as buttress assemblies (<NUM>, <NUM>), to end effector (<NUM>). As best seen in <FIG>, cartridge (<NUM>) of this example comprises an open end (<NUM>) and a closed end (<NUM>). Open end (<NUM>) is configured to receive end effector (<NUM>) as will be described in greater detail below. Cartridge (<NUM>) further includes a first housing (216a) and a second housing (216b), which each collectively generally define a "U" shape to present open end (<NUM>). A platform (<NUM>) and a sled retainer (<NUM>) are interposed between first and second housings (216a, 216b).

Platform (<NUM>) of the present example is configured to support a pair of buttress assemblies (<NUM>) on one side of platform (<NUM>) and another pair of buttress assemblies (<NUM>) on the other side of platform (<NUM>). Platform (<NUM>) is exposed in recesses that are formed between the prongs of the "U" configuration of first and second housings (216a, 216b). Each buttress assembly (<NUM>, <NUM>) is provided in a respective pair of portions that are separated to avoid spanning across slots (<NUM>, <NUM>) of anvil (<NUM>) and staple cartridge (<NUM>), respectively, though platform (<NUM>) may just as easily support wide versions of buttress assemblies (<NUM>, <NUM>) that unitarily span across slots (<NUM>, <NUM>) of anvil (<NUM>) and staple cartridge (<NUM>), respectively. More specifically, the outer edges of platform (<NUM>) include retention features (<NUM>) in the form of ridges that further engage first and second housings (216a, 216b) to prevent platform (<NUM>) from sliding relative to first and second housings (216a, 216b).

First and second housings (216a, 216b) include integral gripping features (<NUM>) and indicator plates (<NUM>) positioned to correspond with windows (<NUM>) formed in first and second housings (216a, 216b), such that indicator plates (<NUM>) are visible through windows (<NUM>) at different times. Arms (<NUM>) of the present example are configured to selectively secure buttress assemblies (<NUM>, <NUM>) to platform (<NUM>). In the present example, arms (<NUM>) are resilient and are thus configured to resiliently bear against buttress assemblies (<NUM>, <NUM>), thereby pinching buttress assemblies (<NUM>, <NUM>) against platform (<NUM>). Buttress applier cartridge (<NUM>) includes a pair of tapered cam surfaces (<NUM>) and a respective pair of housing engagement features (<NUM>) positioned to engage corresponding surfaces of first and second housings (216a, 216b). First and second housings (216a, 216b) include proximal guide features (<NUM>) and distal guide features (<NUM>) configured to assist in providing proper alignment of end effector (<NUM>) with cartridge (<NUM>).

<FIG> shows cartridge (<NUM>) in a configuration where retainer arms (<NUM>) are positioned to hold buttress assemblies (<NUM>, <NUM>) against platform (<NUM>); while <FIG> shows cartridge (<NUM>) in a configuration where retainer arms (<NUM>) are positioned to release buttress assemblies (<NUM>, <NUM>) from platform (<NUM>). While <FIG> only show buttress assembly (<NUM>) on platform (<NUM>), buttress assembly (<NUM>) would be retained on and released from platform (<NUM>) in an identical fashion. To use cartridge (<NUM>) to load end effector (<NUM>), the operator would first position cartridge (<NUM>) and end effector (<NUM>) such that end effector is aligned with open end (<NUM>) of cartridge (<NUM>) as shown in <FIG>. The operator would then advance end effector (<NUM>) distally, and/or advance cartridge (<NUM>) proximally, to position platform (<NUM>) and buttress assemblies (<NUM>, <NUM>) between anvil (<NUM>) and staple cartridge (<NUM>) as shown in <FIG>. Closure trigger (<NUM>) of instrument (<NUM>) is then squeezed by the operator to close end effector jaws (<NUM>, <NUM>) on platform (<NUM>), thereby adhesively attaching buttress assemblies (<NUM>, <NUM>) to anvil (<NUM>) and staple cartridge (<NUM>), and simultaneously depressing cam surface (<NUM>). Depression of cam surface (<NUM>) actuates retainer arms (<NUM>) laterally outwardly to thereby release buttress assemblies (<NUM>, <NUM>) from platform (<NUM>), such that end effector jaws (<NUM>, <NUM>) may be disengaged from platform (<NUM>) while buttress assemblies (<NUM>, <NUM>) remain adhered to anvil (<NUM>) and staple cartridge (<NUM>).

In some instances, it may be desirable to provide an applicator device that is configured to apply a staple reinforcing adjunct element to one or both jaws of a surgical stapler end effector without closing the jaws via actuation of the stapler's end effector closure system, such as via actuation of closure trigger (<NUM>) of surgical stapler (<NUM>). The exemplary applicator devices described below provide such functionality, such that each applicator device is configured to be manipulated relative to an end effector to apply an adjunct element to one or both jaws without requiring actuated closure of the jaws like that shown in <FIG> described above. Additionally, the exemplary applicator devices described below may be operable to apply a minimum pressure to appropriately seat the adjunct material on the desired jaw (e.g., lower jaw (<NUM>) or anvil (<NUM>)).

It will be appreciated that any of the exemplary applicator devices described below may be configured to apply an adjunct element in the form of a buttress, such as buttresses (<NUM>, <NUM>) described above, or a tissue thickness compensator, for example of the type disclosed in <CIT>. Additionally, application of a staple reinforcement element to an end effector jaw may be achieved with adhesive features as described above and/or with mechanical coupling features, for example of the type disclosed in <CIT>. Furthermore, any of the exemplary applicator devices described below may be suitably constructed for a single use or for multiple uses.

<FIG> show an exemplary buttress applicator (<NUM>) configured to force the jaws of an end effector to close onto a portion of buttress applicator (<NUM>) supporting one or more buttress assemblies (<NUM>, <NUM>), or otherwise "back-drive" the jaws of the end effector for applying buttress assemblies (<NUM>, <NUM>) thereon. Buttress applicator (<NUM>) is similar to buttress applicator (<NUM>) described above except as otherwise described below.

Buttress applicator (<NUM>) of this example comprises a frame (<NUM>) extending between a proximal end (not shown) and a distal end (<NUM>). Frame (<NUM>) includes a handle (<NUM>) positioned at or near the proximal end of frame (<NUM>), a compression pad or platform (<NUM>) positioned at or near the distal end (<NUM>) of frame (<NUM>), and an elongate rail (<NUM>) extending longitudinally therebetween. In the example shown, rail (<NUM>) extends along lateral sides of handle (<NUM>) and platform (<NUM>) such that rail (<NUM>) is capable of being positioned alongside end effector (<NUM>). While a single rail (<NUM>) is shown, frame (<NUM>) may include a pair of opposing rails (<NUM>), for example. Buttress applicator (<NUM>) further comprises a movable member in the form of a translatable sleeve (<NUM>) coupled to frame (<NUM>) and configured to translate longitudinally relative to platform (<NUM>) along rail (<NUM>) as indicated by first arrow (A1) in <FIG>, and to selectively receive end effector (<NUM>) as will be described in greater detail below.

Platform (<NUM>) of the present example is configured to support at least one buttress assembly (<NUM>, <NUM>) on at least one side of platform (<NUM>). In the example shown, platform (<NUM>) supports a wide version of buttress assembly (<NUM>, <NUM>) that unitarily spans across slot (<NUM>, <NUM>) of anvil (<NUM>) or staple cartridge (<NUM>), though buttress assembly (<NUM>, <NUM>) may alternatively be provided in a respective pair of portions that are separated to avoid spanning across slots (<NUM>, <NUM>) of anvil (<NUM>) and staple cartridge (<NUM>), respectively. While platform (<NUM>) is shown supporting buttress assembly (<NUM>, <NUM>) on only a single side of platform (<NUM>), platform (<NUM>) may just as easily support buttress assemblies (<NUM>, <NUM>) on both sides of platform (<NUM>).

Translatable sleeve (<NUM>) has a generally C-shaped cross section and includes a generally C-shaped inner closure surface (<NUM>) configured to selectively mechanically engage an outer external surface of at least one of end effector jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from an open state toward a closed state when platform (<NUM>) is positioned between jaws (<NUM>, <NUM>). In this regard, sleeve (<NUM>) may be sized and configured relative to end effector (<NUM>) such that closure surface (<NUM>) is capable of at least partially circumferentially surrounding or encircling end effector (<NUM>) and to be in contact or near-contact with an outer external surface of at least one of jaws (<NUM>, <NUM>) for constricting end effector (<NUM>) in the closed state. For example, closure surface (<NUM>) may define a cross dimension (e.g., diameter) substantially equal to or slightly greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state. Sleeve (<NUM>) and/or rail (<NUM>) may also be sized and configured to assist in providing proper alignment of end effector (<NUM>) with buttress applicator (<NUM>), such as by allowing rail (<NUM>) to abut a lateral side of end effector (<NUM>) when buttress applicator (<NUM>) is positioned over end effector (<NUM>) with platform (<NUM>) properly positioned between jaws (<NUM>, <NUM>).

<FIG> shows end effector (<NUM>) in the open state and buttress applicator (<NUM>) in a configuration where sleeve (<NUM>) is in a retracted position relative to end effector (<NUM>) such that closure surface (<NUM>) is mechanically disengaged from the outer external surface of upper jaw (<NUM>); while <FIG> shows buttress applicator (<NUM>) in a configuration where sleeve (<NUM>) is in an extended position relative to end effector (<NUM>) such that closure surface (<NUM>) mechanically engages the outer external surface of upper jaw (<NUM>) to thereby transition end effector (<NUM>) from the open state toward the closed state. To use buttress applicator (<NUM>) to load end effector (<NUM>), the operator would first position buttress applicator (<NUM>) and end effector (<NUM>) such that platform (<NUM>) and buttress assembly (<NUM>, <NUM>) are positioned between anvil (<NUM>) and staple cartridge (<NUM>) and such that end effector (<NUM>) is aligned with sleeve (<NUM>) with sleeve (<NUM>) retracted proximally from jaws (<NUM>, <NUM>) as shown in <FIG>. The operator would then advance sleeve (<NUM>) distally relative to end effector (<NUM>) to mechanically engage closure surface (<NUM>) with the outer external surface of anvil (<NUM>) as indicated by second arrow (A2) in <FIG>. End effector jaws (<NUM>, <NUM>) may be back-driven closed on platform (<NUM>) by such mechanical engagement (e.g., while closure trigger (<NUM>) of instrument (<NUM>) remains unactuated), thereby adhesively attaching buttress assembly (<NUM>, <NUM>) to anvil (<NUM>) (e.g., to the stapling surface thereof). Buttress assembly (<NUM>, <NUM>) may be released from platform (<NUM>), such that end effector jaws (<NUM>, <NUM>) may be disengaged from platform (<NUM>) while buttress assembly (<NUM>, <NUM>) remains adhered to anvil (<NUM>). In one example, sleeve (<NUM>) may be sequentially advanced and retracted in a back-and-forth or "pumping" manner to incrementally transition end effector (<NUM>) toward the closed state.

While buttress applicator (<NUM>) is shown applying buttress assembly (<NUM>, <NUM>) to anvil (<NUM>), buttress applicator (<NUM>) may additionally or alternatively apply buttress assembly (<NUM>, <NUM>) to lower jaw (<NUM>), such as to stapler cartridge (<NUM>) (e.g., to the stapling surface thereof).

<FIG> show another exemplary buttress applicator (<NUM>) configured to force the jaws of an end effector to close onto a portion of buttress applicator (<NUM>) supporting one or more buttress assemblies (<NUM>, <NUM>), or otherwise "back-drive" the jaws of the end effector for applying buttress assemblies (<NUM>, <NUM>) thereon. Buttress applicator (<NUM>) is similar to buttress applicators (<NUM>, <NUM>) described above except as otherwise described below.

Buttress applicator (<NUM>) of this example comprises a housing (<NUM>) extending between an open proximal end (<NUM>) and a closed distal end (<NUM>). Housing (<NUM>) includes a generally frustoconical proximal portion (<NUM>) and a generally cylindrical distal portion (<NUM>) such that housing (<NUM>) is generally funnel-shaped. A compression pad or platform (<NUM>) extends proximally from closed distal end (<NUM>) within proximal and distal portions (<NUM>, <NUM>) of housing (<NUM>) and is fixed against movement relative thereto. Housing (<NUM>) is configured to selectively receive end effector (<NUM>) as will be described in greater detail below.

Proximal and distal portions (<NUM>, <NUM>) of housing (<NUM>) include tapered and untapered inner closure surfaces (<NUM>, <NUM>), respectively, configured to selectively mechanically engage an outer external surface of at least one of end effector jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from an open state toward a closed state when platform (<NUM>) is positioned between jaws (<NUM>, <NUM>). In this regard, proximal and distal portions (<NUM>, <NUM>) may be sized and configured relative to end effector (<NUM>) such that closure surfaces (<NUM>, <NUM>) are capable of at least partially circumferentially surrounding or encircling end effector (<NUM>) and to be in contact or near-contact with an outer external surface of at least one of jaws (<NUM>, <NUM>) for constricting end effector (<NUM>) in the closed state. For example, untapered closure surface (<NUM>) may define a minor cross dimension (e.g., diameter) substantially equal to or slightly greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state; while tapered closure surface (<NUM>) may define a major cross dimension (e.g., diameter) substantially equal to or greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state, and may taper radially inwardly in a distal direction toward untapered closure surface (<NUM>). It will be appreciated that tapered closure surface (<NUM>) may alternatively be curved radially inwardly in a distal direction toward untapered closure surface (<NUM>). Proximal and/or distal portions (<NUM>, <NUM>) may also be sized and configured to assist in providing proper alignment of end effector (<NUM>) with buttress applicator (<NUM>), such as by abutting one or more lateral sides of end effector (<NUM>) when buttress applicator (<NUM>) is positioned over end effector (<NUM>) with platform (<NUM>) properly positioned between jaws (<NUM>, <NUM>).

<FIG> shows buttress applicator (<NUM>) positioned relative to end effector (<NUM>) such that tapered closure surface (<NUM>) mechanically engages the outer external surface of upper jaw (<NUM>) to thereby transition end effector (<NUM>) from the open state toward the closed state; while <FIG> shows buttress applicator (<NUM>) positioned relative to end effector (<NUM>) such that untapered closure surface (<NUM>) mechanically engages the outer external surfaces of both jaws (<NUM>, <NUM>) to thereby maintain end effector (<NUM>) in the closed state. To use buttress applicator (<NUM>) to load end effector (<NUM>), the operator would first position buttress applicator (<NUM>) and end effector (<NUM>) such that platform (<NUM>) and buttress assembly (<NUM>, <NUM>) are positioned between anvil (<NUM>) and staple cartridge (<NUM>) and such that end effector (<NUM>) is received by proximal portion (<NUM>) of housing (<NUM>) as shown in <FIG>. The operator would then advance housing (<NUM>) proximally relative to end effector (<NUM>) to mechanically engage tapered closure surface (<NUM>) with the outer external surface of anvil (<NUM>) as indicated by third arrows (A3) in <FIG> such that anvil (<NUM>) is cammed radially inwardly as indicated by fourth arrow (A4) in <FIG> until untapered closure surface (<NUM>) mechanically engages the outer external surfaces of both jaws (<NUM>, <NUM>) as shown in <FIG>. End effector jaws (<NUM>, <NUM>) may be back-driven closed on platform (<NUM>) by such mechanical engagement (e.g., while closure trigger (<NUM>) of instrument (<NUM>) remains unactuated), thereby adhesively attaching buttress assembly (<NUM>, <NUM>) to anvil (<NUM>) (e.g., to the stapling surface thereof). Buttress assembly (<NUM>, <NUM>) may be released from platform (<NUM>), such that end effector jaws (<NUM>, <NUM>) may be disengaged from platform (<NUM>) while buttress assembly (<NUM>, <NUM>) remains adhered to anvil (<NUM>), such as by retracting housing (<NUM>) distally relative to end effector (<NUM>).

In one example, platform (<NUM>) may be omitted and housing (<NUM>) may be configured to selectively receive another buttress applicator or applier cartridge, such as cartridge (<NUM>), in place of platform (<NUM>). In this manner, buttress applicator (<NUM>) may be reusable by selectively inserting loaded cartridges (<NUM>) into housing (<NUM>) and removing spent cartridges (<NUM>) from housing (<NUM>).

<FIG> show another exemplary buttress applicator (<NUM>) configured to force the jaws of an end effector to close onto a portion of buttress applicator (<NUM>) supporting one or more buttress assemblies (<NUM>, <NUM>), or otherwise "back-drive" the jaws of the end effector for applying buttress assemblies (<NUM>, <NUM>) thereon. Buttress applicator (<NUM>) is similar to buttress applicators (<NUM>, <NUM>, <NUM>) described above except as otherwise described below.

Buttress applicator (<NUM>) of this example comprises a frame (<NUM>) including a compression pad or platform (<NUM>). Buttress applicator (<NUM>) further comprises a movable member in the form of a rotatable sleeve (<NUM>) coupled to frame (<NUM>) and configured to rotate relative to platform (<NUM>) about a rotational axis (RA) parallel to a longitudinal axis of platform (<NUM>), and to selectively receive end effector (<NUM>) as will be described in greater detail below.

Rotatable sleeve (<NUM>) includes a bore (<NUM>) having a generally oval or elliptical cross section defining a generally oval or elliptical inner closure surface (<NUM>) configured to selectively mechanically engage an outer external surface of at least one of end effector jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from an open state toward a closed state when platform (<NUM>) is positioned between jaws (<NUM>, <NUM>). In this regard, sleeve (<NUM>) may be sized and configured relative to end effector (<NUM>) such that closure surface (<NUM>) is capable of at least partially circumferentially surrounding or encircling end effector (<NUM>) and to be in contact or near-contact with an outer external surface of at least one of jaws (<NUM>, <NUM>) for constricting end effector (<NUM>) in the closed state. For example, closure surface (<NUM>) may define a minor cross dimension (e.g., diameter) substantially equal to or slightly greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state, and may further define a major cross dimension (e.g., diameter) substantially equal to or greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state. Sleeve (<NUM>) may also be sized and configured to assist in providing proper alignment of end effector (<NUM>) with buttress applicator (<NUM>), such as by abutting one or more lateral sides of end effector (<NUM>) when buttress applicator (<NUM>) is positioned over end effector (<NUM>) with platform (<NUM>) properly positioned between jaws (<NUM>, <NUM>).

<FIG> shows end effector (<NUM>) in the open state and buttress applicator (<NUM>) in a configuration where sleeve (<NUM>) is in a first angular (e.g., "unclocked") position relative to end effector (<NUM>) such that closure surface (<NUM>) is mechanically disengaged from the outer external surfaces of jaws (<NUM>, <NUM>); while <FIG> shows buttress applicator (<NUM>) in a configuration where sleeve (<NUM>) is in a second angular (e.g., "clocked") position relative to end effector (<NUM>) such that closure surface (<NUM>) mechanically engages the outer external surfaces of jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from the open state toward the closed state. To use buttress applicator (<NUM>) to load end effector (<NUM>), the operator would first position buttress applicator (<NUM>) and end effector (<NUM>) such that platform (<NUM>) and buttress assembly (<NUM>, <NUM>) are positioned between anvil (<NUM>) and staple cartridge (<NUM>) and such that end effector (<NUM>) is received by sleeve (<NUM>) with sleeve (<NUM>) oriented about the rotational axis (RA) relative to end effector (<NUM>) in the first angular position as shown in <FIG>. The operator would then rotate sleeve (<NUM>) relative to end effector (<NUM>) about the rotational axis (RA) toward the second angular position to mechanically engage closure surface (<NUM>) with the outer external surfaces of both jaws (<NUM>, <NUM>) as indicated by fifth arrow (AS) in <FIG> until the narrow or minor cross-dimension portion of closure surface (<NUM>) mechanically engages the outer external surfaces of both jaws (<NUM>, <NUM>). End effector jaws (<NUM>, <NUM>) may be back-driven closed on platform (<NUM>) by such mechanical engagement (e.g., while closure trigger (<NUM>) of instrument (<NUM>) remains unactuated), thereby adhesively attaching buttress assembly (<NUM>, <NUM>) to anvil (<NUM>) (e.g., to the stapling surface thereof). Buttress assembly (<NUM>, <NUM>) may be released from platform (<NUM>), such that end effector jaws (<NUM>, <NUM>) may be disengaged from platform (<NUM>) while buttress assembly (<NUM>, <NUM>) remains adhered to anvil (<NUM>), such as by rotating sleeve (<NUM>) relative to end effector (<NUM>) about the rotational axis (RA) to the first angular position.

<FIG> show another exemplary buttress applicator (<NUM>) configured to force the jaws of an end effector to close onto a portion of buttress applicator (<NUM>) supporting one or more buttress assemblies (<NUM>, <NUM>), or otherwise "back-drive" the jaws of the end effector for applying buttress assemblies (<NUM>, <NUM>) thereon. Buttress applicator (<NUM>) is similar to buttress applicators (<NUM>, <NUM>, <NUM>, <NUM>) described above except as otherwise described below.

Buttress applicator (<NUM>) of this example comprises a frame (<NUM>) extending between a proximal end (<NUM>) and a distal end (<NUM>). Frame (<NUM>) includes a dual hinge knuckle (<NUM>) positioned at or near distal end (<NUM>) of frame (<NUM>) and a compression pad or platform (<NUM>) extending proximally from knuckle (<NUM>) to proximal end (<NUM>). Buttress applicator (<NUM>) further comprises a pair of movable members in the form of opposing pivotable lever arms (<NUM>) coupled to knuckle (<NUM>) via respective hinge pins (<NUM>) and configured to pivot relative to platform (<NUM>) about respective lateral pivot axes (PA) extending in a direction perpendicular to a longitudinal axis of platform (<NUM>), and to selectively receive end effector (<NUM>) as will be described in greater detail below.

Lever arms (<NUM>) are each generally flat and include respective generally flat inner closure surfaces (<NUM>) configured to selectively mechanically engage respective outer external surfaces of end effector jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from an open state toward a closed state when platform (<NUM>) is positioned between jaws (<NUM>, <NUM>). In this regard, lever arms (<NUM>) may be sized and configured relative to end effector (<NUM>) such that closure surfaces (<NUM>) are collectively capable of at least partially circumferentially surrounding or encircling end effector (<NUM>) and to be in contact or near-contact with respective outer external surfaces of jaws (<NUM>, <NUM>) for constricting end effector (<NUM>) in the closed state. For example, closure surfaces (<NUM>) may collectively define a variable cross dimension capable of being substantially equal to or slightly greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state. In one example, hinge pins (<NUM>) may be spaced apart from each other by a distance substantially equal to or slightly greater than the distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state.

<FIG> shows buttress applicator (<NUM>) in a configuration where lever arms (<NUM>) are pivoted about the respective pivot axes (PA) from an open position toward a closed position such that closure surfaces (<NUM>) mechanically engage the outer external surfaces of the respective jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from the open state toward the closed state; while <FIG> shows buttress applicator (<NUM>) in a configuration where lever arms (<NUM>) are in the closed position such that closure surfaces (<NUM>) mechanically engage the outer external surfaces of the respective jaws (<NUM>, <NUM>) to thereby maintain end effector (<NUM>) in the closed state. To use buttress applicator (<NUM>) to load end effector (<NUM>), the operator would first position buttress applicator (<NUM>) and end effector (<NUM>) such that platform (<NUM>) and buttress assembly (<NUM>, <NUM>) are positioned between anvil (<NUM>) and staple cartridge (<NUM>) and such that end effector (<NUM>) is received between lever arms (<NUM>) with lever arms (<NUM>) at or near the open position as shown in <FIG>. The operator would then advance buttress applicator (<NUM>) proximally relative to end effector (<NUM>) as indicated by sixth arrow (A6) in <FIG> and/or pivot lever arms (<NUM>) toward the closed position (e.g., by pinching lever arms (<NUM>) toward each other) as indicated by seventh arrows (A7) in <FIG> to mechanically engage closure surfaces (<NUM>) with the outer external surfaces of the respective jaws (<NUM>, <NUM>) until closure surfaces (<NUM>) are generally parallel to the respective outer external surfaces as shown in <FIG>. End effector jaws (<NUM>, <NUM>) may be back-driven closed on platform (<NUM>) by such mechanical engagement (e.g., while closure trigger (<NUM>) of instrument (<NUM>) remains unactuated) as indicated by eighth arrow (A8) in <FIG>, thereby adhesively attaching buttress assembly (<NUM>, <NUM>) to anvil (<NUM>) (e.g., to the stapling surface thereof). Buttress assembly (<NUM>, <NUM>) may be released from platform (<NUM>), such that end effector jaws (<NUM>, <NUM>) may be disengaged from platform (<NUM>) while buttress assembly (<NUM>, <NUM>) remains adhered to anvil (<NUM>), such as by pivoting lever arms (<NUM>) toward the open position. In one example, buttress applicator (<NUM>) may be simultaneously advanced proximally relative to end effector (<NUM>) while lever arms (<NUM>) are pivoted toward the closed position.

In one example, buttress applicator (<NUM>) may include a threshold force-application or pressure-application feature configured to prevent the end effector jaws (<NUM>, <NUM>) from pivoting toward the open state until lever arms (<NUM>) have applied a threshold force and/or pressure to the respective jaws (<NUM>, <NUM>) sufficient to ensure proper seating of buttress assembly (<NUM>, <NUM>) on anvil (<NUM>) (or lower jaw (<NUM>)). For example, each lever arm (<NUM>) may include one or more notches configured to frictionally engage the respective jaws (<NUM>, <NUM>) for inhibiting opening of jaws (<NUM>, <NUM>) until lever arms (<NUM>) are pivoted toward the open position. In addition or alternatively, buttress applicator (<NUM>) may include a threshold force-notification or pressure-notification feature configured to provide a visual, haptic, and/or audible indication to a user that lever arms (<NUM>) have applied a threshold force and/or pressure to the respective jaws (<NUM>, <NUM>) sufficient to ensure proper seating of buttress assembly (<NUM>, <NUM>) on anvil (<NUM>) (or lower jaw (<NUM>)).

<FIG> shows another exemplary buttress applicator (<NUM>) configured to force the jaws of an end effector to close onto a portion of buttress applicator (<NUM>) supporting one or more buttress assemblies (<NUM>, <NUM>), or otherwise "back-drive" the jaws of the end effector for applying buttress assemblies (<NUM>, <NUM>) thereon. Buttress applicator (<NUM>) is similar to buttress applicators (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>) described above except as otherwise described below.

Buttress applicator (<NUM>) of this example comprises a frame (<NUM>) extending between a proximal end (not shown) and a distal end (<NUM>). Frame (<NUM>) includes a hinge knuckle (<NUM>) positioned at or near distal end (<NUM>) of frame (<NUM>), a compression pad or platform (<NUM>) extending proximally from knuckle (<NUM>) to the proximal end of frame (<NUM>), and a fixed arm (<NUM>) extending proximally from knuckle (<NUM>). Buttress applicator (<NUM>) further comprises a movable member in the form of a pivotable lever arm (<NUM>) coupled to knuckle (<NUM>) via a hinge pin (<NUM>) and configured to pivot relative to platform (<NUM>) about a lateral pivot axis (PA) extending in a direction perpendicular to a longitudinal axis of platform (<NUM>), and to selectively receive end effector (<NUM>) against fixed arm (<NUM>) as will be described in greater detail below.

Lever arm (<NUM>) is generally flat and includes a protruding tapered closure surface (<NUM>) configured to selectively mechanically engage an outer external surface of one of end effector jaws (<NUM>, <NUM>), while fixed arm (<NUM>) is generally flat and includes a generally flat untapered closure surface (<NUM>) configured to selectively mechanically engage an outer surface of the other of end effector jaws (<NUM>, <NUM>) to thereby transition end effector (<NUM>) from an open state toward a closed state when platform (<NUM>) is positioned between jaws (<NUM>, <NUM>). In this regard, arms (<NUM>, <NUM>) may be sized and configured relative to end effector (<NUM>) such that closure surfaces (<NUM>, <NUM>) are collectively capable of at least partially circumferentially surrounding or encircling end effector (<NUM>) and to be in contact or near-contact with respective outer external surfaces of jaws (<NUM>, <NUM>) for constricting end effector (<NUM>) in the closed state. For example, closure surfaces (<NUM>, <NUM>) may collectively define a variable cross dimension capable of being substantially equal to or slightly greater than a distance between outer external surfaces of jaws (<NUM>, <NUM>) when end effector (<NUM>) is in the closed state. It will be appreciated that tapered closure surface (<NUM>) may alternatively be curved.

<FIG> shows buttress applicator (<NUM>) in a configuration where lever arm (<NUM>) is pivoted about the pivot axis (PA) from an open position toward a closed position such that tapered closure surface (<NUM>) mechanically engages the outer external surface of anvil (<NUM>) while untapered closure surface (<NUM>) mechanically engages the outer external surface of lower jaw (<NUM>) to thereby transition end effector (<NUM>) from the open state toward the closed state; while <FIG> shows buttress applicator (<NUM>) in a configuration where lever arm (<NUM>) is in the closed position such that closure surfaces (<NUM>, <NUM>) mechanically engage the respective outer external surfaces of jaws (<NUM>, <NUM>) to thereby maintain end effector (<NUM>) in the closed state. To use buttress applicator (<NUM>) to load end effector (<NUM>), the operator would first position buttress applicator (<NUM>) and end effector (<NUM>) such that platform (<NUM>) and buttress assembly (<NUM>, <NUM>) are positioned between anvil (<NUM>) and staple cartridge (<NUM>) and such that end effector (<NUM>) is received between arms (<NUM>, <NUM>) with lever arm (<NUM>) at or near the open position as shown in <FIG>. The operator would then pivot lever arm (<NUM>) toward the closed position as indicated by ninth arrow (A9) in <FIG> to mechanically engage closure surface (<NUM>) with the outer external surface of anvil (<NUM>) such that anvil (<NUM>) is cammed radially inwardly as indicated by tenth arrow (A10) in <FIG>. End effector jaws (<NUM>, <NUM>) may be back-driven closed on platform (<NUM>) by such mechanical engagement (e.g., while closure trigger (<NUM>) of instrument (<NUM>) remains unactuated) as shown in <FIG>, thereby adhesively attaching buttress assembly (<NUM>, <NUM>) to anvil (<NUM>) (e.g., to the stapling surface thereof). Buttress assembly (<NUM>, <NUM>) may be released from platform (<NUM>), such that end effector jaws (<NUM>, <NUM>) may be disengaged from platform (<NUM>) while buttress assembly (<NUM>, <NUM>) remains adhered to anvil (<NUM>). In one example, buttress applicator (<NUM>) may be simultaneously advanced proximally relative to end effector (<NUM>) while lever arm (<NUM>) is pivoted toward the closed position.

Claim 1:
An apparatus (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>) for applying at least one adjunct element to at least one of opposing first and second jaws (<NUM>, <NUM>) of an end effector (<NUM>) of a surgical stapler, wherein each of the first and second jaws (<NUM>, <NUM>) includes a stapling surface and an external surface opposed from the respective stapling surface, the apparatus comprising:
(a) a platform (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>) configured to be positioned between the first and second jaws (<NUM>, <NUM>) of the end effector (<NUM>);
(b) at least one adjunct element (<NUM>, <NUM>) positioned on the platform (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>); and characterized by:
(c) at least one closure surface (<NUM>; <NUM>, <NUM>; <NUM>; <NUM>; <NUM>, <NUM>) opposed from the platform (<NUM>; <NUM>; <NUM>; <NUM>; <NUM>), wherein the at least one closure surface (<NUM>; <NUM>, <NUM>; <NUM>; <NUM>; <NUM>, <NUM>) is configured to mechanically engage the external surface of at least one of the first or second jaws (<NUM>, <NUM>) to thereby transition the end effector (<NUM>) from an open state toward a closed state for placing the respective stapling surface of the at least one of the first or second jaws (<NUM>, <NUM>) in contact with the at least one adjunct element (<NUM>).