WO1999005974A1 - Surgical instrument with multiple rotatably mounted spreadable end effectors - Google Patents

Surgical instrument with multiple rotatably mounted spreadable end effectors Download PDF

Info

Publication number
WO1999005974A1
WO1999005974A1 PCT/US1998/015306 US9815306W WO9905974A1 WO 1999005974 A1 WO1999005974 A1 WO 1999005974A1 US 9815306 W US9815306 W US 9815306W WO 9905974 A1 WO9905974 A1 WO 9905974A1
Authority
WO
WIPO (PCT)
Prior art keywords
end effector
elongate shaft
effector assembly
surgical instrument
recited
Prior art date
Application number
PCT/US1998/015306
Other languages
French (fr)
Other versions
WO1999005974A9 (en
Inventor
Inbae Yoon
Original Assignee
Inbae Yoon
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Inbae Yoon filed Critical Inbae Yoon
Priority to AU87579/98A priority Critical patent/AU8757998A/en
Publication of WO1999005974A1 publication Critical patent/WO1999005974A1/en
Publication of WO1999005974A9 publication Critical patent/WO1999005974A9/en

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/06Needles ; Sutures; Needle-suture combinations; Holders or packages for needles or suture materials
    • A61B17/062Needle manipulators
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0469Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0491Sewing machines for surgery
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/28Surgical forceps
    • A61B17/29Forceps for use in minimally invasive surgery
    • A61B2017/2926Details of heads or jaws
    • A61B2017/2927Details of heads or jaws the angular position of the head being adjustable with respect to the shaft
    • A61B2017/2929Details of heads or jaws the angular position of the head being adjustable with respect to the shaft with a head rotatable about the longitudinal axis of the shaft
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00General characteristics of surgical instruments
    • A61B2217/002Auxiliary appliance
    • A61B2217/005Auxiliary appliance with suction drainage system
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B2217/00General characteristics of surgical instruments
    • A61B2217/002Auxiliary appliance
    • A61B2217/007Auxiliary appliance with irrigation system

Definitions

  • the present invention pertains to surgical instruments and procedures and, more particularly, to an instrument and method for performing various procedures during endoscopic and open surgery.
  • Endoscopic and minimally invasive medical procedures have become widely accepted for surgery and diagnosis due to the associated advantages relating to reduced trauma and hospital ization time.
  • the performance of an endoscopic procedure typically involves the creation of puncture sites through a wall of an anatomical cavity using penetrating instruments including an obturator, such as a trocar, disposed within a portal sleeve.
  • the obturator is withdrawn leaving the sleeve in place to form a portal in the cavity wall through which endoscopes are introduced to view the surgical site and through which instruments having end effectors, such as forceps, cutters, needle holders, staplers, clip applicators and the like, are introduced at the surgical site.
  • the end effectors are typically disposed at the distal end of the instrument and are manipulated by the surgeon using controls disposed at the proximal end of the instrument.
  • the aforementioned patent applications disclose instruments having multiple needle holders movable with respect to one another to suture anatomical tissue; however, it would be desirable to incorporate other types of end effectors into a single endoscopic instrument so that the end effectors can be moved with respect to one another in a similar manner. Also, it would be desirable to move various types of end effectors through predetermined paths, such as an arc, to manipulate tissue without repositioning the entire endoscopic instrument.
  • the needle holders described in the aforementioned patent applications can include distal portions that extend laterally outward at an angle from the instrument to provide a wide range of relative movement for suturing a wide range of tissue sizes. It would also be desirable to provide a wide range of relative movement between various types of end effectors to permit other operative acts or functions to be performed on a wide range of tissue sizes.
  • Another object of the present invention is to permit multiple end effectors to be used in combination in surgical procedures without the need of having to utilize multiple instruments.
  • Still another object of the present invention is to increase the working span or range of movement of multiple end effectors carried by a single instrument while minimizing the insertion diameter of the instrument.
  • An additional object of the present invention is to minimize the number of puncture sites required for performing operative steps on anatomical tissue in an endoscopic procedure by inserting more than one end effector through a single puncture site or incision with an instrument that is operable to move the end effectors relative to one another in a cooperative manner to operate on anatomical tissue.
  • the present invention is generally characterized in a surgical instrument including a housing, an elongate shaft having a proximal end mounted by the housing and a distal end with a peripheral edge, and first and second end effector assemblies protruding from the distal end of the elongate shaft.
  • Each end effector assembly includes an end effector at a distal end.
  • a distal portion of the first end effector assembly extends laterally outward at an angle from a first longitudinal axis of the elongate shaft to a position where at least a portion of the corresponding end effector is spaced laterally outward of the peripheral edge of the elongate shaft.
  • first end effector assembly is rotatable about the first longitudinal axis of the elongate shaft to cause the corresponding end effector to move along a first arcuate path having a center of curvature coaxial with the first longitudinal axis.
  • second end effector assembly is rotatable about the second longitudinal axis to cause the corresponding end effector to move along a second arcuate path having a center of curvature coaxial with the second longitudinal axis.
  • the first and second end effector assemblies are also preferably movable from undeployed positions where the end effectors are spaced laterally inward of the peripheral edge of the shaft to deployed positions spaced laterally outward of the shaft, for example by rotation or axial movement relative to the shaft.
  • the end effector assemblies are also preferably movable relative to one another in the axial or longitudinal direction.
  • a surgical instrument for use in open and endoscopic procedures including a housing, an elongate shaft having a proximal end mounted by the housing and a distal end with a peripheral edge, and first and second end effector assemblies mounted by the shaft.
  • the first end effector assembly includes a proximal portion extending at least part way through the elongate shaft along a first longitudinal axis, a distal portion extending laterally outward from the proximal portion at an angle, and an end effector mounted on the distal portion.
  • the proximal portion of the first end effector assembly is rotatably mounted within the elongate shaft to move the end effector of the first end effector assembly along a first arcuate path having a center of curvature coaxial with the first longitudinal axis.
  • the second end effector assembly also includes a proximal portion extending at least part way through the elongate shaft along a second longitudinal axis laterally spaced from the first longitudinal axis, a distal portion extending laterally outward from the proximal portion at an angle, and an end effector mounted on the distal portion.
  • the proximal portion of the second end effector assembly is rotatably mounted within the elongate shaft to move the end effector of the second end effector assembly along a second arcuate path having a center of curvature coaxial with the second longitudinal axis.
  • the first and second arcuate paths each preferably have a radius of curvature causing at least a portion of the end effector to extend outwardly of the peripheral edge of the elongate shaft.
  • Still another aspect of the present invention is generally characterized in a method of performing a surgical procedure in an anatomical cavity including the steps of introducing a surgical instrument having an elongate shaft into the anatomical cavity, the surgical instrument including first and second end effector assemblies protruding distally from the distal end of the elongate shaft, the first end effector assembly including a distal portion extending laterally outward at an angle from a first longitudinal axis of the elongate shaft to an end effector disposed at least partly outside a peripheral edge of the elongate shaft and the second end effector assembly including a distal portion extending laterally outward at an angle from a second longitudinal axis of the elongate shaft to an end effector disposed at least partly outside a peripheral edge of the elongate shaft, and operating on tissue within the anatomical cavity by rotating the first end effector assembly about the first longitudinal axis.
  • Other operative steps or functions can be performed by moving the end effector assemblies axially relative to one another and by rotating
  • Fig. 1 is a perspective view, broken longitudinally, of a surgical instrument according to the present invention.
  • Fig. 2 is a side view, broken longitudinally, of the surgical instrument shown in Fig. 1.
  • Fig. 3A is a fragmentary top view of the distal end of the surgical instrument shown in Fig. 2 with a pair of end effectors in axially retracted, open positions.
  • Fig. 3B is a fragmentary top view of the distal end of the surgical instrument shown in Fig. 2 with the end effectors in axially retracted, closed positions.
  • Fig. 4 is an enlarged front view of the distal end of the surgical instrument taken along line 4-4 in Fig. 3B.
  • Fig. 5 is a fragmentary top view, partly in section, taken through line 5-5 in Fig. 2.
  • Fig. 6 is a fragmentary cross-sectional view of an end effector rotating mechanism for use with the surgical instrument according to the present invention taken through line 6-6 in Fig. 5.
  • Fig. 7 is a top view, broken longitudinally, of the surgical instrument according to the present invention with the end effectors in axially extended, deployed positions.
  • Figs. 7A, 7B and 7C are fragmentary side views of the distal end of the surgical instrument illustrating use of the surgical instrument according to the present invention.
  • Fig. 8 is a fragmentary perspective view of the distal end of the surgical instrument shown in Fig. 7.
  • Fig. 9 is a fragmentary side view of a modified end effector for use with the surgical instrument according to the present invention.
  • Fig. 10 is a cross-sectional view of the modified end effector of Fig. 9 taken through line 10 -10.
  • Fig. 11 is a fragmentary side view of another modification of an end effector for use with the surgical instrument according to the present invention.
  • Figs. 12 and 13 are a fragmentary side view and a front view, respectively, of yet another modified end effector for use with the surgical instrument according to the present invention.
  • Fig. 14 is a fragmentary perspective view of still another modification of an end effector for use with a surgical instrument according to the present invention.
  • Fig. 15 is a fragmentary side view, partly in section, of yet another modification of an end effector for use with a surgical instrument according to the present invention.
  • Fig. 16 is a cross-sectional view of the modified end effector of Fig. 15 taken through line 16-16.
  • the surgical instrument of the present invention can be utilized to manipulate or otherwise operate on any type of anatomical tissue in any type of anatomical cavity; and, accordingly, while the instrument is described hereinafter for use with a portal sleeve in endoscopic procedures, such as laparoscopy, the instrument can be used in open surgery and with catheters and other small and large diameter tubular or hollow, cylindrical members providing access to small cavities, such as veins and arteries, as well as large cavities, such as the abdomen.
  • a surgical instrument 10 in accordance with the present invention includes a hub or housing 12, a handle 14 coupled with the housing, an elongate shaft or barrel 16 extending distally from the housing, a pair of end effector assemblies 18a and 18b movably disposed within longitudinal channels formed through the shaft, and a pair of collars 20a and 20b disposed distally of the housing at axially spaced locations along the length of the shaft to control operation of the end effectors in conjunction with the handle.
  • elongate shaft 16 is of generally cylindrical configuration with a plurality of longitudinally extending passages or channels 22a, 22b, 22c, 22d and 22e defined therethrough in spaced, parallel relation, the channels each being of generally circular configuration in transverse cross- section.
  • Channel 22c is disposed coaxial with a central longitudinal axis 24 of the shaft.
  • Channels 22a and 22b are laterally offset from central channel 22c and are disposed on opposite sides of the central channel in diametrically opposed relation.
  • Channels 22d and 22e are laterally offset from central channel 22c and are defined in the spaces between channels 22a and 22b.
  • End effector assemblies 18a and 18b are shown extending through channels 22a and 22b, respectively, and an endoscope 26 of conventional design is shown extending through channel 22e.
  • Channels 22c and 22d are shown in an open condition to provide access to an anatomical body cavity from outside the body via the surgical instrument without the need of having to create additional incisions or punctures through the wall of the anatomical cavity.
  • Optical fibers 28 are shown extending through shaft 16 to transmit light from a proximal light source to the body cavity of the patient.
  • the optical fibers are shown extending through a tubular member or sleeve 30 forming the outer surface of the shaft, however, the shaft can be formed without a separate sleeve, for example by embedding or molding the optical fibers within a medically acceptable polymer matrix or by adhesively connecting the fibers together.
  • Channels 22a, 22b, 22c, 22d and 22e can optionally be formed by thin wall, tubular sleeves extending longitudinally through shaft 16 or by voids or spaces defined between the optical fibers as shown.
  • housing 12 includes a hollow, cylindrical portion or side wall 32 with longitudinally spaced front and rear walls 34 and 36 oriented perpendicular to longitudinal axis 24 of the shaft.
  • Tubular member 30 of the shaft extends distally from an outwardly extending flange 38 fixedly mounted within a recess 40 formed in the front wall of housing 12 to a distal end of generally blunt configuration which cooperates with respective distal ends of the optical fibers to define a generally flat surface or face 42 at a distal end of the shaft, the distal face being shown oriented substantially perpendicular to the longitudinal axis of the shaft for purposes of illustration.
  • Handle 14 includes a central portion 44 of generally cylindrical configuration oriented pe ⁇ endicular to the longitudinal axis of shaft 16 and a pair of end caps or end portions 46 and 48 of generally cylindrical configuration disposed at opposite axial ends of the cylindrical central handle portion.
  • Central handle portion 44 is of larger diameter than housing 12 and is provided with axially aligned openings or holes 50 and 52 on opposite sides thereof to permit the cylindrical housing to be inserted cross-wise through the cylindrical central handle portion as shown in Fig. 5.
  • Round flanges 54 and 56 extend outwardly from opposite axial ends of the central handle portion and are received within annular grooves 58 and 60 formed along inner surfaces of the cylindrical end caps 46 and 48 adjacent respective open ends of the end caps to permit rotation of the end caps about a central longitudinal axis 62 of handle portion 44.
  • End caps 46 and 48 are of cup-like configuration and extend outwardly from respective open inner ends to outer ends closed by walls 64 and 66, respectively, of generally circular configuration oriented perpendicular to the longitudinal axis 62 of the central handle portion.
  • a fixed handle member 68 in the form of a finger loop 70 extends downwardly, looking at Figs. 1 and 2, from the cylindrical side wall of end cap 46 at an acute angle relative to the proximal direction to accommodate one or more fingers of a user's hand.
  • a movable handle member 72 includes a finger loop 74 disposed distally of fixed finger loop 70 and an arm 76 extending upwardly from the finger loop to a terminal end in the form of an internally splined sleeve or collar 78 of generally cylindrical configuration disposed within end cap 46 via an elongate slot 80 formed part way about the circumference of the cylindrical side wall of the end cap adjacent the point of attachment for finger loop 70.
  • a transverse shaft 82 extends through splined sleeve 78 from a push button 84 disposed within a cylindrical recess formed in end cap wall 64 to a tubular sleeve or collar 86 with a smooth bore disposed within housing 12 perpendicular to the shaft.
  • Transverse shaft 82 carries a bevel gear 88 of decreasing diameter in the direction of sleeve 86, the bevel gear being disposed between the smooth bore sleeve and the side wall of the housing.
  • a spur gear 90 is carried on transverse shaft 82 within end cap 46.
  • Spur gear 90 engages straight teeth or splines formed on an inner surface of sleeve 78 parallel to longitudinal axis 62 of the handle so that, among other things, pivotal movement of movable handle member 72 is translated into rotary movement of shaft 82.
  • the movable handle member is preferably biased to move in a counterclockwise direction, looking at Fig. 2, toward fixed handle member 68, for example using a bias member 92 connected between the movable handle member and end cap 46. While a bias member in the form of a torsion spring is shown coiled around sleeve 78 in Fig. 5, it will be appreciated that other types of bias members can be used including, but not limited to, compression or expansion springs, leaf springs, rubber or magnets. Alternatively, the movable handle can be biased away from the fixed handle or configured for ratcheting or frictional movement.
  • Push button 84 is of a conventional type which, when pressed, alternatingly moves shaft 82 in the axial direction, along longitudinal axis 62 of the handle, between an engaged or depressed position where the first bevel gear 88 engages a second bevel gear 94 as shown by solid lines in Fig. 5 and a disengaged or elevated position, outwardly spaced from the extended position, where the first bevel gear is disengaged from the second bevel gear as shown by broken lines in Fig. 5.
  • Spur gear 90 is disposed within end cap 46 and is of sufficient axial length to permit movement of the shaft in the axial direction while remaining at least partly engaged with splined sleeve 78 at the end of handle member 72.
  • a tubular extension 96 extends radially outward from the smooth bored sleeve in the direction of bevel gear 88 to receive the inner terminal end of shaft 82 telescopically, the tubular extension being sufficiently long to accommodate axial movement of the shaft associated with operation of button 84.
  • Shaft 82 extends through an elongate slot 98 formed part way about the circumference of housing sidewall 32 to permit rotation of handle 14 about the longitudinal axis of housing 12 as described in greater detail below.
  • second bevel gear 94 is mounted on an elongate drive shaft 100 extending longitudinally through the surgical instrument and is of decreasing diameter in the proximal direction to mesh with first bevel gear 88 when push button 84 is depressed or operated to move the first bevel gear to the engaged position.
  • Drive shaft 100 is of hollow, tubular configuration and is oriented coaxial with longitudinal axis 24 of the surgical instrument to define central channel 22c.
  • the drive shaft extends through smooth bored sleeve 86 to define an axis of rotation for the handle and terminates proximally at a rotational coupling 102 within housing 12 where the drive shaft connects telescopically with a tubular shaft extension 104, the tubular shaft extension preferably being fixed relative to a wall or walls of the housing so that it does not rotate or otherwise move with the drive shaft.
  • Shaft extension 104 extends proximally from coupling 102 through housing rear wall 36 to a coupling 106, for example a Luer-type lock, for connection with sources of fluid or suction, operating units, or medical instruments and devices, with a valve 108 being disposed between the couplings to control passage of fluids and instruments through the central channel.
  • the drive shaft is preferably formed of a medically acceptable plastic or metal material having a wall thickness sufficient to carry or form external threads at axially spaced locations within shaft 16 as shown at 110a and 110b in Fig. 5.
  • end effector assemblies 18a and 18b are coupled with threaded portions 110a and 110b of the drive shaft such that handle members 68 and 72 can be used to control operation of end effectors at respective distal ends of the end effector assemblies.
  • End effector assembly 18a and end effector assembly 18b each include an end effector in the form of a forceps mounted by the housing for rotation. While the end effectors are shown herein as forceps, it will be appreciated that any type of end effector can be used including, but not limited to, cauterizing electrodes, needle holders, dissectors, clip applicators, staplers, scissors, cutting members such as blades, needles, and biopsy devices.
  • the end effector 111a of assembly 18a is shown in Figs. 3A and 3B as a forceps having a pair of pivotally opposed jaws 112a and 114a.
  • Jaws 112a and 114a are preferably formed at the distal end of an elongate tubular rod or body 116a as an integral one-piece unit; however, it will be appreciated that the jaws can be formed separately from the tubular rod and attached thereto and that the tubular rod can be of solid configuration in cross section, if desired.
  • the tubular end effector rod 116a defines an elongate passage 118a through the end effector assembly which can be used as an additional or auxiliary operating channel providing access to the operative site from outside the body.
  • the tubular end effector rod 116a will terminate proximally at a coupling (not shown) similar to coupling 106 and will be provided with a valve (not shown) disposed distally of the coupling to control access through the operating channel 118a of the end effector assembly.
  • the jaws of the end effector assembly are preferably biased apart toward an open position, shown in Fig. 3A, where inner needle holding or grasping surfaces 120a and 122a are angularly spaced from one another.
  • the lower jaw 114a in Fig. 3A is of fixed configuration and extends in parallel with a longitudinal axis 124a at the distal portion of the end effector assembly while the upper jaw 112a is pivotally movable between an
  • Fig. 3A where it extends outwardly from the longitudinal axis 124a of the end effector assembly distal portion at an angle and a closed position, shown in Fig. 3B, where it is in substantially parallel, abutting relation with the lower jaw.
  • Opposed inner surfaces 120a and 122a of the jaws are shown with a plurality of longitudinally spaced teeth or ribs oriented perpendicular to the longitudinal axis 124a of the end effector assembly distal portion to securely hold a suture needle, tissue or other objects therebetween during a surgical procedure; however, the inner surfaces can have any other suitable configuration for holding a suture needle and/or performing other functions including, but not limited to, configurations made up of spaced diamond-shaped protrusions, irregularly spaced teeth or ribs, opposed arcuate portions which define a hole or opening when closed, and transverse or longitudinal grooves. As will be described in greater detail below, either jaw can carry a cutting member or biopsy box.
  • fixed jaw 114a of the end effector assembly 18a is disposed between movable jaw 112a and central channel 22c so that, when the jaws of the end effector assemblies are in their respective open positions, the movable jaws will not contact one another or otherwise interfere with the movement of the other end effector. Under certain circumstances, however, it may be desirable to orient one or both of the end effector assemblies in a manner causing the movable jaw to be disposed inwardly of the fixed jaw, for example, by rotating the jaws 180° from the positions shown in Fig. 4.
  • the tubular body or rod 116a of end effector assembly 18a is disposed telescopically within a flexible elongate outer member or sleeve 126a of tubular configuration which is axially movable relative to the rod between a retracted position, shown in Fig. 3A, where a distal end 128a of the flexible sleeve is proximally spaced from the jaws to allow them to open under the force of their own resilience and an extended position, shown in Fig. 3B, where the distal end of the flexible outer member slides over the jaws to cause them to close.
  • the rod 116a and sleeve 126a of the end effector assembly cooperate to define an elongate proximal portion 130a of generally straight configuration extending through channel 22a in shaft 16 and a distal portion 132a with a predetermined deployed or working shape or condition where the distal portion bends outwardly at an angle relative to the longitudinal axis 125a of the proximal portion of the end effector assembly, the distal portion assuming the deployed shape or condition when the end effector assembly is in an axially extended position with the distal portion protruding distally beyond the distal end or face 42 of the shaft as shown, for example, in Figs. 7 and 8.
  • the length and angular deflection of the distal portion of the end effector assembly are such that at least portions of jaws 112a and 114a are spaced laterally outward of a peripheral edge or diameter of the shaft 16 when the distal portion of the rod is in the deployed condition.
  • the tubular rod is preferably stiffer than the sleeve but formed of an elastic material or with an elastic portion having elastic properties allowing the distal portion to bend inwardly, in a lateral direction relative to the longitudinal axis of the proximal portion of the rod so that, when the rod is axially retracted or moved proximally relative to the shaft, the distal portion will move laterally inward from the deployed working position shown in Figs.
  • a sufficient amount of the distal portion of the end effector assembly is disposed within the shaft to cause the distal portion to straighten out or assume an undeployed shape or condition where the jaws do not protrude beyond the outer periphery or diameter of the shaft.
  • the instrument can be modified to permit complete retraction of the end effector assembly (and/or the end effector assembly) to a position where the jaws are proximally spaced from the distal end or face of the shaft as shown, for example, by broken lines in Figs. 3A and 3B.
  • a rigid outer sleeve (not shown) can be telescopically fitted around the end effector sleeve and moved axially or longitudinally along the end effector assembly to cause the distal portion to alternately straighten and spread laterally outward without the need of having to retract the entire end effector assembly into the instrument.
  • Tubular rod 116a of end effector assembly 18a carries a spur gear 134a adjacent a proximal end of collar 20a, the spur gear having straight teeth oriented parallel to longitudinal axis 125a of the proximal portion of the end effector assembly.
  • An idler gear 136a is disposed between spur gear 134a and a sun gear 138a of epicyclic configuration formed along an inner surface of collar 20a adjacent the proximal end of the collar.
  • Idler gear 136a includes a pair of face plates 140a and 142a of circular configuration which extend radially beyond the gear teeth to define a pair of lips or rims between which the spur gear and the epicyclic collar gear are disposed in order to maintain alignment of the gear system.
  • Idler gear 136a is mounted on a pin 144a secured to a plate 146a extending upwardly, looking at Fig. 5, from the distal end of a tubular spacer 148a disposed telescopically around rod 116a adjacent spur gear 134a.
  • a push button 150a is disposed within a cylindrical recess 152a formed in an outer surface of collar 20a and includes a plunger or post 154a extending from the button through an elongate slot 156a formed part way about the circumference of the collar to a linear coupling block 158a disposed within shaft 16.
  • Plunger 154a extends through a longitudinal slot 160a formed in block 158a to a cross member 162a wider than the slot so as to allow the block to slide transversely relative to the plunger while remaining attached to the plunger.
  • Block 158a carries one or more external teeth 164a on a side facing threaded portion 110a of drive shaft 100 and defines a longitudinal opening or passage 166a therethrough with internal teeth 168a formed on an upper surface thereof looking at Fig. 5.
  • the block is movable by operation of the button between an engaged position where teeth 164a meshingly engage threaded portion 110a of the drive shaft to cause the block to move linearly in response to rotation of the shaft and a disengaged position where the teeth 164a are radially or laterally spaced from the threaded portion such that the block is not moved in response to rotation of the shaft.
  • the tubular sleeve 126a of end effector assembly 18a extends through opening 166a in block 158a with lateral clearance and includes a round flange 170a extending radially outward therefrom between the block and spacer 148a and a rack made up of axially spaced rings or teeth 172a that extend around the portion of the sleeve disposed within the longitudinal block opening. Teeth 172a of the rack meshingly engage teeth 168a on the inner surface of the block opening when block 158a is in the engaged position shown in Fig. 5 such that axial movement of the block caused by rotation of shaft 100 is imparted to end effector assembly sleeve 126a thereby controlling the operation of jaws 112a and 114a as will be described in greater detail below.
  • a bias member 174a is disposed between spacer 148a and flange 170a to bias sleeve 126a distally relative to rod 116a so that jaws 112a and 114a are normally in a closed position.
  • the bias member is shown as a helical spring coiled around rod 116a and held in compression between flange 170a and spacer 148a, however, any suitable bias member can be used including, but not limited to, tension springs, compression springs, helical springs, leaf springs, rubber and magnets.
  • End effector assembly 18b is shown as being identical to end effector assembly 18a, with an end effector 111b in the form of opposed jaws 112b and 114b mounted at the distal end of a tubular rod 116b slidably disposed within a sleeve 126b to define straight and angled portions 130b and 132b of the end effector assembly. It will be appreciated, however, that end effector 111b can have any useful configuration for performing surgical procedures.
  • Tubular rod 116b of end effector assembly 18b carries a spur gear 134b engaging an idler gear 136b disposed between the spur gear and a sun gear 138b formed about the inner circumference of collar 20b.
  • the gears are substantially the same as those described for end effector assembly 18a, with the idler gear being mounted on a pin 144b secured to a plate 146b extending radially or laterally outward from a tubular spacer 148b fitted telescopically around tubular rod 116b.
  • Push button 150b which controls engagement of a linear coupling block 158b with threaded portion 110b of drive shaft 100, is similar to push button 150a with a plunger or post 154b extending therefrom through a slot 156b extending part way about the circumference of collar 160b and a longitudinal slot 160b formed in coupling block 158b to a cross member 162b slidably disposed within the block.
  • coupling block 158b carries external teeth 164b on a side facing a threaded portion of the drive shaft and defines a longitudinal passage or opening 166b therethrough through which sleeve 126b of the end effector assembly extends. Opening 166b includes teeth 166b on an inner surface thereof for engaging ring-like teeth 172b on the end effector assembly sleeve. Like the jaws of end effector assembly 18a, the jaws of end effector assembly 18b are biased to a closed position by providing a bias member 174b between a flange 170b carried by the sleeve and spacer 148b. As best seen in Fig.
  • idler gears 136a and 136b as well as plungers 154a and 154b extend through longitudinal slots 176a and 176b formed through tubular member 30 of the shaft on diametrically opposed sides of the shaft to permit axial movement of the collar assemblies when push buttons 150a and 150b are operated to move blocks 158a and 158b to disengaged positions such as the position of block 158b shown in Fig. 5.
  • collars 20a and 20b will slide frictionally against or be coupled in ratching relation to shaft 16 so that, once the collars are moved to a desired axial location relative to the shaft, the collars will not move unless deliberately forced.
  • a separate locking mechanism can be provided for each collar to maintain the axial and/or angular location of the collar relative to the shaft.
  • An electrical connector can optionally be mounted on the housing 12, as shown at 178 in Fig. 1, or at any other suitable location on the instrument including, but not limited to, the instrument handle or the proximal end of one of the channel-defining tubular shafts extending proximally from the housing, to connect electrically conductive elements of the instrument with a source of electricity for performing unipolar or bipolar procedures such as electric coagulation, for example using one or both of the jaws of an end effector assembly as conductive elements.
  • an interior surface of any of the channels 22a - 22e can be coated with an electrical and/or thermal insulating layer to permit safe insertion of electrical, thermal and/or other types of energy transmitting devices through the operating channels.
  • instrument 10 is preferably grasped using finger loops 70 and 74 and, in the case of an endoscopic procedure, the instrument is guided to the operative site by a portal sleeve positioned in the wall of an anatomical cavity.
  • the portal sleeve can be positioned in the anatomical cavity wall using any suitable penetrating technique, including those creating puncture sites by means of removable obturators, such as trocars, and can include a valve housing, if desired, to prevent loss of pneumoperitoneum during insertion and withdrawal of the instrument.
  • the visualization of the endoscopic procedure can be accomplished using a conventional endoscope incorporated into the instrument, for example within the longitudinal operating channel 22e defined through shaft 16, or separately positioned within the anatomical cavity through a second portal sleeve located at another puncture site.
  • instrument 10 Prior to insertion, instrument 10 is preferably in the condition, state or position shown in Figs. 3B and 4. More specifically, end effector assembly 18a and end effector assembly 18b are preferably initially in axially retracted positions where respective distal portions of the end effector assemblies are drawn at least part way into elongate shaft 16 and thus forced to move laterally inward in an elastic manner to undeployed positions where the end effector jaws are spaced laterally inward of the peripheral edge of the shaft so as not to snag or catch on structure within the portal sleeve or valve housing during insertion. To this end, collars 20a and 20b are preferably initially disposed in the retracted positions shown in Fig.
  • a sheath (not shown) can be telescopically fitted around the shaft in a manner to be movable axially or longitudinally between a retracted position spaced proximally of the end effectors and an extended position protruding distally from the shaft to cover and protect the end effectors.
  • Push buttons 150a and 150b on collars 20a and 20b, respectively, are preferably initially disposed in elevated positions so that the jaws of both end effector assemblies will be in closed or grasping positions with inner grasping surfaces of the jaws close together or abutting one another.
  • end effector assembly 18a and end effector assembly 18b can be moved distally relative to shaft 16 from the axially retracted, undeployed positions shown in Fig. 3B to the axially extended, deployed positions shown by solid lines in Figs. 7 and 7A by sliding collars 20a and 20b distally along longitudinal slots 176a and 176b.
  • distal portions of the end effector assemblies will no longer be restrained within the channels of the elongate shaft and will thus tend to recover elastically or move toward the undeformed shape or condition shown by solid lines in Fig. 7.
  • distal portions of the end effector assemblies will spread apart or bend outwardly, away from the longitudinal axes of the channels from which they extend, toward deployed positions where the jaws of each of the end effector assemblies are spaced laterally outward of the peripheral edge or outer diameter of the shaft.
  • end effector assemblies 18a and 18b can be individually or simultaneously rotated about their respective longitudinal axes to produce movement of their respective end effectors along arcuate paths shown by arrows at IA and IB.
  • Rotation of an end effector assembly in a first direction is accomplished by turning the corresponding collar in a second direction opposite the first direction, thereby causing the sun gear on the inner surface of the collar to rotate in the second direction.
  • Rotation of the sun gear in the second direction causes the idler gear to rotate in the first direction, thereby causing the spur gear and, thus, the entire end effector assembly to rotate within the channel in the first direction.
  • the end effector assemblies can also be individually or simultaneously moved proximally and distally along longitudinal paths indicated by arrows at IIA and IIB to cause the end effectors to move axially relative to one another and/or the shaft.
  • proximal and distal movement of an end effector assembly is accomplished by sliding the corresponding collar along the slots formed in the shaft, it being understood that proximal movement of the end effector assembly from the axially extended position to the axially retracted position can be accompanied by lateral movement of the distal portion of the end effector assembly toward the longitudinal axis of the assembly as the distal portion is drawn into a channel of the shaft. Such lateral movement can also be used to perform certain surgical procedures.
  • shaft 16 can be rotated about longitudinal axis 24 as indicated by the curved arrow at III, moved axially and distally along the directions shown by the arrow IV, and/or moved laterally in the directions shown by the arrow at V. It will be appreciated that any of the above movements can be combined where necessary or desirable to achieve a specific result. It is also possible for one of the end effector assemblies to remain stationary while the other end effector assembly is moved.
  • one of the end effector assemblies may be desirable for one of the end effector assemblies to bend outwardly in the extended position while the other end effector assembly remains within the periphery of the outer tubular member in the axially extended position, for example as shown in Fig. 7B.
  • the spreadable end effector assembly 18a can be moved in any of the ways described above (i.e., in the directions indicted by arrows IA and IIA).
  • the other end effector assembly 18b is either straight or only slightly bent or curved so that the end effector at the distal end of the non-spreadable end effector is not movable along an arcuate path.
  • the end effector assembly 18b may, however, be rotated about its longitudinal axis in the direction indicated by the arrow at VIB and may be moved axially in the directions indicated by the arrow IIB. Shaft 16 can also be moved in any of the directions indicated by arrows III, IV or V.
  • Fig. 7C shows one of the end effector assemblies bending outwardly in the extended position and the other end effector assembly in an axially retracted position where the end effector is disposed within the periphery of the elongate shaft.
  • the end effector assembly 18a shown in the axially extended position can be moved in any of the ways described above (i.e., in the directions indicated by arrows IA and IIA).
  • the other end effector assembly 18b can be relatively straight or bent like end effector assembly 18a in the axially extended position; however, when the end effector assembly 18b is in the axially retracted position shown in Fig.
  • shaft 16 can also be moved in any of the directions indicated by arrows III, IV orV.
  • the jaws of each end effector assembly can be moved between the open position shown by broken lines and the closed position shown by solid lines by operation of handle members 68 and 72 of the instrument.
  • push button 84 of the handle is in the elevated or disengaged position shown by broken lines in Fig. 5
  • the push button is depressed to cause bevel gear 88 to move inwardly, in the direction of longitudinal axis 24, and into meshing engagement with bevel gear 94 mounted on drive shaft 100, as shown by solid lines in Fig. 5.
  • movable handle member 72 is moved in a counterclockwise direction, looking at Fig.
  • buttons 158a and 158b Depression of the buttons causes blocks 158a and 158b to move inwardly, toward the drive shaft, such that teeth 164a and 164b mesh with or engage the threaded portions 110a and 110b, respectively, of the drive shaft. Coupling blocks 158a and 158b move linearly in the distal direction along the drive shaft as the drive shaft rotates in the clockwise direction, with the plungers 154a and 154b sliding axially within the slots 160a and 160b formed through the blocks. In the depressed or engaged condition shown at the top of Fig.
  • the teeth or rings 172a of the end effector assembly sleeve 126a engage teeth 168a inside the block opening 166a such that the end effector assembly sleeve 126a moves linearly with the block in the distal direction relative to rod 116a.
  • the distal end 128a of sleeve 126a is thus moved distally relative to the jaws, causing the jaws to come together or move toward the closed position shown in Fig. 3B against the force biasing the upper jaw away from the lower jaw.
  • the jaws can be locked in a closed position by use of ratchet members 186 and 188 on opposed sides of finger loops 70 and 74; however, if it is not necessary or desirable for the finger loops to be locked together, one of the ratchet members may be pivoted to prevent engagement with the other ratchet member.
  • movable handle member 72 is released or otherwise caused to move in a clockwise direction, looking at Fig. 2, in response to finger pressure and/or the spring bias provided by bias member 92.
  • transverse shaft 82 is also caused to move clockwise thereby carrying bevel gear 88 in the clockwise direction.
  • Bevel gear 94 is thus caused to move in a counterclockwise direction, looking proximally along longitudinal axis 24, so that drive shaft 100 is driven counterclockwise, causing block 158a to move in the proximal direction relative to rod 116a such that distal end 128a of the sleeve moves proximally relative to the rod to allow jaws 112a and 114a to move resiliently apart.
  • closing of the jaws may be used to grasp or hold an object positioned between the jaws. If the jaws are provided with a cutting member, objects positioned between the jaws can be cut when the jaws are closed. Similarly, if a biopsy box is mounted on the jaws, tissue samples may be taken from tissue positioned between the jaws when the jaws are closed. One or both of the jaws may also function as a cautery electrode, if desired. Conversely, opening of the jaws can be used to spread objects apart or to permit a suture needle, tissue or some other object to be placed between the jaws.
  • the foregoing functions are merely exemplary of the types of functions that may be performed using an end effector assembly with an end effector in the form of jaws.
  • operating channels 22a - 22e can be used for irrigation or aspiration of the surgical site and can serve as a space for holding objects or devices such as needles and suture material or as a portal for the introduction of other medical instruments and devices such as, for example, forceps, cutting members, staplers and endoscopes.
  • Knotting elements can also be introduced at the operative site via the operating channels for use in leu of or in addition to traditional knotting techniques during suturing procedures.
  • Fig. 8 illustrates a further use of one of the operating channels 22a - 22e wherein a conventional clip applier 190 is advanced distally through one of the channels, for example central channel 22c, to apply a clip as part of a surgical procedure.
  • End effector assemblies 18a and 18b are shown by solid lines in their axially extended, outwardly spread positions with jaws closed and by broken lines with their jaws open.
  • the end effector assemblies can be used in any suitable manner to manipulate or position tissue so that it can be clipped or to move tissue so that the clip applier can access other areas of the body.
  • auxiliary operating channels can be defined through one or both of the end effector assemblies 18a and 18b as shown at 118a and 118b in Figs. 3A and 3B to provide access to the operative site from outside the anatomical cavity.
  • the auxiliary operating channels are shown terminating distally at openings adjacent the jaws of the end effector assemblies but can terminate at openings defined at the bend connecting straight and angled portions of the end effector assemblies as shown by broken lines in Fig. 8.
  • push button 84 by moving push button 84 to the elevated, undepressed position and rotating the entire handle portion 14 about the housing 12, for example by grasping the housing with one hand while moving the handle with the other hand.
  • push button 84 may be depressed so that the bevel gear 88 is made to engage bevel gear 94, thereby locking the handle in place relative to the housing.
  • Figs. 9 and 10 show a modification of an end effector assembly for use with the surgical instrument according to the present invention wherein the modified end effector assembly 1018 includes a pair of jaws 1112 and 1114 pivotably mounted on a pair of pins 1216a and 1216b secured to diametrically opposed sides of a hollow tubular rod or sleeve 1116 telescopically fitted within an outer tubular sleeve 1126, the tubular rod defining an auxiliary operating channel 1118 providing access to the operative site from outside the anatomical cavity. Jaws 1112 and 1114 are biased apart toward the open position shown in Fig.
  • jaws 1112 and 1114 can be mounted on a single pin or pivot extending diametrically across the width of sleeve 1116; however, use of separate pivots provides a substantially unobstructed passage through the operating channel.
  • any of the end effector jaws described herein can carry a biopsy box or a cutting member such as the blade shown by broken lines at 1220 in Fig. 9.
  • Blade 1220 is oriented perpendicular to the inner grasping surface of upper jaw 1112 and extends downwardly, looking at Fig. 9, from an edge of the inner grasping surface to fit within a cooperatively configured pocket or recess 1222 formed along an edge of lower jaw 1114 when the jaws are closed together.
  • An elongate groove or recess with an open proximal end can be formed along an inner surface of one or both of the jaws, for example as shown by broken lines at 1223 in Fig. 10, to permit a cutting member, such as a blade, to slide between the jaws when closed.
  • the modified end effector assembly 2018 shown in Fig. 11 is similar to the end effector assemblies shown in Figs. 1 - 8 but with both jaws 2112 and 2114 being pivotably movable between normally open positions extending laterally outward from the tubular rod 2116 at acute angles and closed positions wherein the jaws abut one another.
  • a pair of cams 2224a and 2224b are also shown extending outwardly from the jaws adjacent the distal end 2128 of outer sleeve 2126 to provide additional force when closing the jaws together.
  • An optional cutting member in the form of a blade 2220 and a cooperatively configured pocket or recess 2222 are also shown.
  • FIG. 12 and 13 Yet another modified end effector assembly is shown in Figs. 12 and 13 at 3018 and includes a first jaw member 3112 in the form of an outer tubular sleeve 3126 with a lateral cut-out or window 3226 having a grasping surface 3120 formed on a proximal-facing surface or face of the window and a second jaw member 3114 in the form of an inner tubular sleeve 3116 fitted telescopically within the outer tubular sleeve and having a grasping surface 3122 formed along a peripheral edge of the inner member to operate cooperatively with the grasping surface at the distal end of the outer member to hold a suture needle or other objects within the window.
  • An auxiliary operating channel shown by broken lines in Fig.
  • the second jaw member 3114 can be solid instead of tubular, thus presenting a wider grasping surface if desired.
  • Fig. 14 shows still another modification of an end effector assembly for use with the surgical instrument according to the present invention wherein the modified end effector assembly 4018 includes a first needle holding member 4112 in the form of a hook and a second needle holding member 4114 in the form of a keeper movable relative to the hook to capture and release a suture needle placed within the hook.
  • the needle holding members are preferably formed of flat strips of a medically acceptable material, such as stainless steel, configured to lay flat against one and other to permit relative sliding movement of the needle holding members.
  • the first needle holding member 4112 includes an elongate portion or leg 4228 extending distally from within the instrument housing to a bend 4230 where the first needle holding member folds inwardly upon itself to form a short leg 4232 parallel to the elongate portion or leg of the needle holding member thereby defining a hook with a proximal-facing mouth 4233 having a gap width suitable for receiving the shaft or body of a suture needle.
  • the second needle holding member 4114 is slidingly disposed along the first needle holding member 4112 and includes a distal end 4234 configured to fit within the mouth of the hook as a keeper, the distal end of the second needle holding member being shown with an optional scalloped edge having one or more curved recesses.
  • the first or second needle holding member may also be formed with a cutting member such as a blade or a notch of generally V-shaped configuration defined along an edge of the needle holding member and having one or more sharp edges to cut lengths of suture material received therein under pressure as shown, for example, by broken lines at 4236 in Fig. 14.
  • the first needle holding member is also shown with optional slots or openings 4238a and 4238b formed on opposite sides of the hook to permit straight or slightly curved suture needles to be placed perpendicularly through short and long legs of the hook so as to be oriented radially relative to the longitudinal axis of the shaft.
  • the slotted openings extend transversely, relative to a longitudinal axis of the end effector assembly, from respective open ends disposed along a lateral or longitudinal edge of the first needle holding member to generally centrally located terminal tends of rounded or semi-circular configuration with a size to receive the body or shank of a suture needle extending transversely through legs of the hook.
  • the scalloped edge at the distal end of the second needle holding member or keeper 4114 is configured with laterally spaced recesses, one of which is preferably aligned with a terminal portion or end of the slotted openings to cradle a needle positioned within the openings.
  • Still another modification of an end effector assembly for use with the surgical instrument according to the present invention includes a pair of jaws 5112 and 5114 extending distally from a pair of crossed arms 5240a and 5240b connected by a pivot 5242 located medially along the lengths of the arms.
  • a pair of elongate linkages 5244a and 5244b extend inwardly from pivots 5246a and 5246b at respective proximal ends of the arms to a pivot 5248 connecting the linkages with an elongate rod 5250.
  • Linkages 5244a and 5244b are disposed on opposite sides of the rod, with pivot 5248 extending through the linkages and the rod and with tabs or ears 5252 extending laterally outward from the rod in opposite directions to overhang the linkages as stops preventing the linkages from spreading outwardly beyond a predetermined position.
  • Jaws 5112 and 5114 are moved relative to one another by moving the outer tubular member and rod relative to one another.
  • the jaws are normally biased apart, for example by a torsion spring coiled around a pivot and connected between the jaws, and are closed by moving the outer tubular member distally relative to the jaws, for example by advancing the outer tubular member distally and/or pulling the rod in the proximal direction.
  • the outer tubular member is biased distally relative to the jaws so that the jaws are normally in a closed position.
  • the surgical instrument permits manipulation of anatomical tissue during endoscopic procedures without the need of having to use multiple instruments inserted through multiple puncture sites by inserting an elongate shaft carrying at least two end effector assemblies through a single puncture site.
  • the end effector assemblies each include a distal portion movable between an undeployed, contracted or parked position spaced laterally inward of a peripheral edge of the elongate shaft to facilitate insertion through a portal sleeve and a deployed, expanded or working position where at least part of the distal portion is spaced laterally outward of the peripheral edge of the elongate shaft to provide maximum working span.
  • the elongate shaft is mounted by a handle with controls for moving one or both of the end effector assemblies axially and in a rotary manner.
  • the end effector assemblies each include an end effector at a distal end. While the end effectors are described above as being forceps jaws, it will be appreciated that the end effectors can have any suitable configuration for individually or cooperatively manipulating or otherwise affecting tissue and other objects including, but not limited to, forceps, cutters, needle holders, cauteries, clip appliers, staplers, ligators and the like.
  • the end effector assemblies of the surgical instrument can be of the same or different design.
  • one end effector assembly can include an end effector in the form of a forceps while another end effector assembly includes an end effector in the form of a cutter.
  • the end effector assemblies are shown disposed within cylindrical channels formed through the elongate shaft, it will be appreciated that one or more of the end effector assemblies can be disposed within arcuate channels so that, for example, one of the end effector assemblies can be moved arcuately within the shaft about the center of curvature of the curved channel while the other end effector assembly is rotated about its longitudinal axis or vice versa.
  • Distal portions of the end effector assemblies preferably extend laterally outward at an angle from respective longitudinal axes of the elongate shaft so that, when the end effector assemblies are rotated about their respective longitudinal axes, the end effectors at the distal ends of the assemblies are made to move arcuately along non-concentric arcuate paths which may or may not intersect dependent upon the respective lengths of the distal portions and their respective bend angles.
  • Any type of end effector assembly can be modified for use with the surgical instrument according to the present invention by configuring a distal portion of the end effector assembly to be normally bent outwardly at an angle relative to the proximal portion, including, but not limited to, any of the end effector assemblies or drivers described in U.S. patent application Serial No.
  • the end effector assemblies can include a transverse connecting member extending outwardly from a proximal portion of the end effector assembly at an angle to connect with longitudinally oriented end effectors laterally offset from the proximal portion.
  • the end effectors can be straight, curved or angled in configuration and, when an end effector is a pair of jaws, the jaws can be provided with ribs, a diamond tread pattern or any other type of grasping surface to assure a positive grip as well as grooves, slots or holes to permit access through the jaws when the jaws are closed.
  • the jaws can also carry cutting members, such as slots with sharp edges or protruding blades, and can have opposed arcuate or concave portions for clamping tubular objects, such as organs, without compressing the objects, as well as portions configured to take a tissue sample for biopsy.
  • either component can include a distal portion of predetermined shape which, in an unrestrained condition, bends laterally outward at an angle relative to the longitudinal axis of the proximal portion of the end effector component.
  • components of an end effector assembly can be keyed or coupled to move together so that, for example, if one of the components is rotated the other component will be rotated as well.
  • the end effectors can be used alone or in combination to perform lysis of adhesion, dissection, pickup and cutting, pickup and clipping, pickup and suturing with a suture needle, unipolar and bipolar electrosurgery, and numerous other procedures.
  • the end effectors can be used in combination to perform dual electrode cauterization, to clamp tissue between adjacent end effectors, or to separate tissue by placing adjacent end effectors between tissue sections and moving the end effectors away from one another.
  • Adjacent end effectors, acting as electrodes can also be pressed against opposite sides of tissue to cauterize the tissue.
  • a button or switch can be provided to selectively switch the electric power between end effectors for unipolar cauterization.
  • the surgical instrument is shown and described herein as having two end effectors, it will be appreciated that the instrument can have one end effector or more than two end effectors (e.g., three or four) dependent upon the procedure to be performed and the preference of the user. Also, the end effectors can be positioned at diametrically opposed locations relative to the central longitudinal axis of the elongate shaft as shown or at any other laterally spaced positions.
  • the elongate shaft is shown as being composed of optical fibers disposed within a tubular sleeve, it will be appreciated that the elongate shaft can be formed without a separate sleeve, for example by embedding or molding the optical fibers within a medically acceptable polymer matrix or by adhesively connecting the fibers together.
  • the elongate shaft can also be formed without optical fibers extending therethrough, in which case a light source may be inserted through one of the channels defined through the shaft or through a separate puncture to illuminate the operative site.
  • the shaft can be rigid or flexible and can be made of any suitable medically acceptable material, such as plastic or stainless steel.
  • the cross-sectional configuration of the outer surface of the shaft is preferably circular as shown but can be elliptical, polygonal or have any other configuration suitable for a particular purpose.
  • the distal end or face of the shaft can be flat as shown, convex or concave; and, when flat, the distal face can be oriented at any angle relative to the longitudinal axis of the shaft.
  • three channels are shown in addition to the end effector channels, any number of channels can be formed through the elongate shaft, for example by thin wall, tubular sleeves extending longitudinally through the shaft or by voids or spaces defined between the optical fibers as shown.
  • the channels can be parallel to one another or oriented at angles, can be straight or curved, and can be of constant or varying lateral dimension along their length.
  • the channels can be located anywhere within the elongate shaft and can be of the same or different design dependent upon procedural use and space constraints.
  • the operating channels can have any configuration in transverse cross- section including, but not limited to, elliptical, polygonal and irregular or asymmetrical cross-sectional configurations. Also, all or part of the inner surface of a channel can be electrically insulated to permit passage of electrosurgical instruments therethrough.
  • the valves and couplings shown at the proximal end of each channel are merely exemplary of the types of conventional valves and conventional couplings that can be used.
  • Operating channels may also be defined along the length of the end effector assemblies of the instrument, if desired. It will also be appreciated that storage spaces or recesses can be defined in the elongate shaft to hold suture needles, lengths of suture material, and other devices.
  • handle assembly for holding the instrument and controlling operation of the end effectors
  • handle configurations can be used including, but not limited to, configurations wherein the handle includes pivoted legs with finger loops, one fixed and one pivoted leg with finger loops, a pistol grip with one or more movable triggers, and/or resilient U-shaped handle members.
  • handle members can be mounted on both sides of the handle housing so that operation of the end effector assemblies is controlled by separate pairs of handle members as described, for example, in application Serial No. 08/847,254, the disclosure of which is incorporated herein by reference.
  • the handle can have adjustable handle members of variable orientation as shown or handle members which are fixed in a specific orientation relative to the housing. If desired, the housing and at least a portion of the handle can be formed as an integral one-piece unit.
  • end effector assemblies have been described above as being independently controlled by operating mechanisms such as push buttons and collars which, for the most part, must be operated with both hands, it will be appreciated that a single operating mechanism can be used to synchronize movement of the end effector assemblies relative to one another as well as operation of their respective end effectors when appropriate to further simplify the surgical process by allowing one-hand operation of the instrument.
  • Moving the end effectors of the present invention relative to one another can be accomplished in any suitable manner, for example by connecting a knob at the proximal end of each end effector assembly and sliding the knobs along slots formed in the handle housing or by mounting the end effector assemblies on geared components and moving the gears with a trigger or some other handle member or device.
  • end effector assemblies have been described herein as having a normally bent configuration which can be straightened by retracting the end effector assemblies in a proximal direction relative to a tubular member so as to elastically deform the end effector assemblies
  • the end effector assemblies of the present invention can be moved between contracted and expanded positions using any suitable method including, but not limited to, methods utilizing linkages, gears, cables, movable stiffeners or inserts, shape memory materials, actuators or motors.
  • the distal portions may be movable between deployed and parked positions merely by rotation about their respective axes.
  • distal portions of the end effector assemblies need not be straight as shown but can be curved or multiply angled, if desired.
  • the components of the surgical instrument of the present invention can be made of any suitable, medical grade materials to permit sterilization for reuse or disposal for single patient use.
  • the components can be made of multiple parts of various configurations and materials to reduce cost.
  • the housing and/or handle can have various valves, stop cocks and seals therein to control the flow of fluid and medical devices through the surgical instrument.

Abstract

An instrument for performing a surgical procedure includes a housing (12), an elongate shaft (16) having a proximal end mounted by the housing (12), a distal end with a peripheral edge, a first end effector assembly (18a) protruding from the distal of the elongate shaft (16) having an end effector (111a) at a distal end, a second end effector assembly (18b) protruding from the distal end of the elongate shaft, and having an end effector (111b) at a distal end. Distal portions of the first and second end effector assemblies extend laterally outward at an angle from first and second longitudinal axes of the elongate shaft to positions where at least a portion of the corresponding end effectors are spaced laterally outward of the peripheral edge of the elongate shaft. The end effector assemblies (18a, 18b) are rotatable about the first and second longitudinal axes of the elongate shaft to cause the corresponding end effectors to move along first and second arcuate paths.

Description

Surgical Instrument With Multiple Rotatably Mounted Spreadable End Effectors
CROSS-REFERENCE TO RELATED APPLICATIONS This application is related to U.S. patent applications Serial No. 08/758,648, filed November 27, 1996, Serial No. 08/847,182, filed May 1 , 1997, and Serial No. 08/877,764 filed June 17, 1997, the disclosures of which are incorporated herein by reference.
BACKGROUND OF THE INVENTION Field of the Invention:
The present invention pertains to surgical instruments and procedures and, more particularly, to an instrument and method for performing various procedures during endoscopic and open surgery.
Discussion of the Related Art:
Endoscopic and minimally invasive medical procedures, such as laparoscopy, have become widely accepted for surgery and diagnosis due to the associated advantages relating to reduced trauma and hospital ization time. The performance of an endoscopic procedure typically involves the creation of puncture sites through a wall of an anatomical cavity using penetrating instruments including an obturator, such as a trocar, disposed within a portal sleeve. After the penetrating instrument has penetrated into the anatomical cavity, the obturator is withdrawn leaving the sleeve in place to form a portal in the cavity wall through which endoscopes are introduced to view the surgical site and through which instruments having end effectors, such as forceps, cutters, needle holders, staplers, clip applicators and the like, are introduced at the surgical site. The end effectors are typically disposed at the distal end of the instrument and are manipulated by the surgeon using controls disposed at the proximal end of the instrument.
It is common in endoscopic procedures to use multiple end effectors in combination. However, typical endoscopic instruments include only one end effector, requiring several incisions for placement of multiple portal sleeves to accommodate a suitable number of endoscopic instruments for performing the required functions. Recently, however, in U.S. patent application Serial No. 08/758,648, Serial No. 08/847,182 and Serial No. 08/877,764 it has been proposed to provide a plurality of end effectors on a single endoscopic instrument to minimize the number of puncture sites and thus reduce the risk and healing time associated with endoscopic surgery. The aforementioned patent applications disclose instruments having multiple needle holders movable with respect to one another to suture anatomical tissue; however, it would be desirable to incorporate other types of end effectors into a single endoscopic instrument so that the end effectors can be moved with respect to one another in a similar manner. Also, it would be desirable to move various types of end effectors through predetermined paths, such as an arc, to manipulate tissue without repositioning the entire endoscopic instrument. The needle holders described in the aforementioned patent applications can include distal portions that extend laterally outward at an angle from the instrument to provide a wide range of relative movement for suturing a wide range of tissue sizes. It would also be desirable to provide a wide range of relative movement between various types of end effectors to permit other operative acts or functions to be performed on a wide range of tissue sizes. SUMMARY OF THE INVENTION
Accordingly, it is a primary object of the present invention to overcome the above-mentioned disadvantages of the prior art and to improve surgical instruments and methods of surgery including open and endoscopic surgery.
Another object of the present invention is to permit multiple end effectors to be used in combination in surgical procedures without the need of having to utilize multiple instruments.
Still another object of the present invention is to increase the working span or range of movement of multiple end effectors carried by a single instrument while minimizing the insertion diameter of the instrument.
An additional object of the present invention is to minimize the number of puncture sites required for performing operative steps on anatomical tissue in an endoscopic procedure by inserting more than one end effector through a single puncture site or incision with an instrument that is operable to move the end effectors relative to one another in a cooperative manner to operate on anatomical tissue.
The present invention is generally characterized in a surgical instrument including a housing, an elongate shaft having a proximal end mounted by the housing and a distal end with a peripheral edge, and first and second end effector assemblies protruding from the distal end of the elongate shaft. Each end effector assembly includes an end effector at a distal end. A distal portion of the first end effector assembly extends laterally outward at an angle from a first longitudinal axis of the elongate shaft to a position where at least a portion of the corresponding end effector is spaced laterally outward of the peripheral edge of the elongate shaft. In addition, the first end effector assembly is rotatable about the first longitudinal axis of the elongate shaft to cause the corresponding end effector to move along a first arcuate path having a center of curvature coaxial with the first longitudinal axis. In a preferred embodiment, the second end effector assembly is rotatable about the second longitudinal axis to cause the corresponding end effector to move along a second arcuate path having a center of curvature coaxial with the second longitudinal axis. The first and second end effector assemblies are also preferably movable from undeployed positions where the end effectors are spaced laterally inward of the peripheral edge of the shaft to deployed positions spaced laterally outward of the shaft, for example by rotation or axial movement relative to the shaft. The end effector assemblies are also preferably movable relative to one another in the axial or longitudinal direction.
Another aspect of the present invention is generally characterized in a surgical instrument for use in open and endoscopic procedures including a housing, an elongate shaft having a proximal end mounted by the housing and a distal end with a peripheral edge, and first and second end effector assemblies mounted by the shaft. The first end effector assembly includes a proximal portion extending at least part way through the elongate shaft along a first longitudinal axis, a distal portion extending laterally outward from the proximal portion at an angle, and an end effector mounted on the distal portion. The proximal portion of the first end effector assembly is rotatably mounted within the elongate shaft to move the end effector of the first end effector assembly along a first arcuate path having a center of curvature coaxial with the first longitudinal axis. The second end effector assembly also includes a proximal portion extending at least part way through the elongate shaft along a second longitudinal axis laterally spaced from the first longitudinal axis, a distal portion extending laterally outward from the proximal portion at an angle, and an end effector mounted on the distal portion. The proximal portion of the second end effector assembly is rotatably mounted within the elongate shaft to move the end effector of the second end effector assembly along a second arcuate path having a center of curvature coaxial with the second longitudinal axis. The first and second arcuate paths each preferably have a radius of curvature causing at least a portion of the end effector to extend outwardly of the peripheral edge of the elongate shaft.
Still another aspect of the present invention is generally characterized in a method of performing a surgical procedure in an anatomical cavity including the steps of introducing a surgical instrument having an elongate shaft into the anatomical cavity, the surgical instrument including first and second end effector assemblies protruding distally from the distal end of the elongate shaft, the first end effector assembly including a distal portion extending laterally outward at an angle from a first longitudinal axis of the elongate shaft to an end effector disposed at least partly outside a peripheral edge of the elongate shaft and the second end effector assembly including a distal portion extending laterally outward at an angle from a second longitudinal axis of the elongate shaft to an end effector disposed at least partly outside a peripheral edge of the elongate shaft, and operating on tissue within the anatomical cavity by rotating the first end effector assembly about the first longitudinal axis. Other operative steps or functions can be performed by moving the end effector assemblies axially relative to one another and by rotating the second end effector assembly about the first longitudinal axis.
Other objects and advantages of the present invention will become apparent from the following description of the preferred embodiments taken in conjunction with the accompanying drawings, wherein like parts in each of the several figures are identified by the same reference numerals or by reference numerals having the same last three digits.
BRIEF DESCRIPTION OF THE DRAWINGS
Fig. 1 is a perspective view, broken longitudinally, of a surgical instrument according to the present invention.
Fig. 2 is a side view, broken longitudinally, of the surgical instrument shown in Fig. 1.
Fig. 3A is a fragmentary top view of the distal end of the surgical instrument shown in Fig. 2 with a pair of end effectors in axially retracted, open positions.
Fig. 3B is a fragmentary top view of the distal end of the surgical instrument shown in Fig. 2 with the end effectors in axially retracted, closed positions.
Fig. 4 is an enlarged front view of the distal end of the surgical instrument taken along line 4-4 in Fig. 3B. Fig. 5 is a fragmentary top view, partly in section, taken through line 5-5 in Fig. 2.
Fig. 6 is a fragmentary cross-sectional view of an end effector rotating mechanism for use with the surgical instrument according to the present invention taken through line 6-6 in Fig. 5.
Fig. 7 is a top view, broken longitudinally, of the surgical instrument according to the present invention with the end effectors in axially extended, deployed positions.
Figs. 7A, 7B and 7C are fragmentary side views of the distal end of the surgical instrument illustrating use of the surgical instrument according to the present invention.
Fig. 8 is a fragmentary perspective view of the distal end of the surgical instrument shown in Fig. 7.
Fig. 9 is a fragmentary side view of a modified end effector for use with the surgical instrument according to the present invention.
Fig. 10 is a cross-sectional view of the modified end effector of Fig. 9 taken through line 10 -10.
Fig. 11 is a fragmentary side view of another modification of an end effector for use with the surgical instrument according to the present invention.
Figs. 12 and 13 are a fragmentary side view and a front view, respectively, of yet another modified end effector for use with the surgical instrument according to the present invention.
Fig. 14 is a fragmentary perspective view of still another modification of an end effector for use with a surgical instrument according to the present invention.
Fig. 15 is a fragmentary side view, partly in section, of yet another modification of an end effector for use with a surgical instrument according to the present invention.
Fig. 16 is a cross-sectional view of the modified end effector of Fig. 15 taken through line 16-16. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The surgical instrument of the present invention can be utilized to manipulate or otherwise operate on any type of anatomical tissue in any type of anatomical cavity; and, accordingly, while the instrument is described hereinafter for use with a portal sleeve in endoscopic procedures, such as laparoscopy, the instrument can be used in open surgery and with catheters and other small and large diameter tubular or hollow, cylindrical members providing access to small cavities, such as veins and arteries, as well as large cavities, such as the abdomen.
A surgical instrument 10 in accordance with the present invention, as illustrated in Figs. 1 - 6, includes a hub or housing 12, a handle 14 coupled with the housing, an elongate shaft or barrel 16 extending distally from the housing, a pair of end effector assemblies 18a and 18b movably disposed within longitudinal channels formed through the shaft, and a pair of collars 20a and 20b disposed distally of the housing at axially spaced locations along the length of the shaft to control operation of the end effectors in conjunction with the handle.
As best seen in Fig. 4, elongate shaft 16 is of generally cylindrical configuration with a plurality of longitudinally extending passages or channels 22a, 22b, 22c, 22d and 22e defined therethrough in spaced, parallel relation, the channels each being of generally circular configuration in transverse cross- section. Channel 22c is disposed coaxial with a central longitudinal axis 24 of the shaft. Channels 22a and 22b are laterally offset from central channel 22c and are disposed on opposite sides of the central channel in diametrically opposed relation. Channels 22d and 22e are laterally offset from central channel 22c and are defined in the spaces between channels 22a and 22b. End effector assemblies 18a and 18b are shown extending through channels 22a and 22b, respectively, and an endoscope 26 of conventional design is shown extending through channel 22e. Channels 22c and 22d are shown in an open condition to provide access to an anatomical body cavity from outside the body via the surgical instrument without the need of having to create additional incisions or punctures through the wall of the anatomical cavity. Optical fibers 28 are shown extending through shaft 16 to transmit light from a proximal light source to the body cavity of the patient. The optical fibers are shown extending through a tubular member or sleeve 30 forming the outer surface of the shaft, however, the shaft can be formed without a separate sleeve, for example by embedding or molding the optical fibers within a medically acceptable polymer matrix or by adhesively connecting the fibers together. Channels 22a, 22b, 22c, 22d and 22e can optionally be formed by thin wall, tubular sleeves extending longitudinally through shaft 16 or by voids or spaces defined between the optical fibers as shown.
As best seen in Figs. 2 and 5, housing 12 includes a hollow, cylindrical portion or side wall 32 with longitudinally spaced front and rear walls 34 and 36 oriented perpendicular to longitudinal axis 24 of the shaft. Tubular member 30 of the shaft extends distally from an outwardly extending flange 38 fixedly mounted within a recess 40 formed in the front wall of housing 12 to a distal end of generally blunt configuration which cooperates with respective distal ends of the optical fibers to define a generally flat surface or face 42 at a distal end of the shaft, the distal face being shown oriented substantially perpendicular to the longitudinal axis of the shaft for purposes of illustration.
Handle 14 includes a central portion 44 of generally cylindrical configuration oriented peφendicular to the longitudinal axis of shaft 16 and a pair of end caps or end portions 46 and 48 of generally cylindrical configuration disposed at opposite axial ends of the cylindrical central handle portion. Central handle portion 44 is of larger diameter than housing 12 and is provided with axially aligned openings or holes 50 and 52 on opposite sides thereof to permit the cylindrical housing to be inserted cross-wise through the cylindrical central handle portion as shown in Fig. 5. Round flanges 54 and 56 extend outwardly from opposite axial ends of the central handle portion and are received within annular grooves 58 and 60 formed along inner surfaces of the cylindrical end caps 46 and 48 adjacent respective open ends of the end caps to permit rotation of the end caps about a central longitudinal axis 62 of handle portion 44. End caps 46 and 48 are of cup-like configuration and extend outwardly from respective open inner ends to outer ends closed by walls 64 and 66, respectively, of generally circular configuration oriented perpendicular to the longitudinal axis 62 of the central handle portion.
A fixed handle member 68 in the form of a finger loop 70 extends downwardly, looking at Figs. 1 and 2, from the cylindrical side wall of end cap 46 at an acute angle relative to the proximal direction to accommodate one or more fingers of a user's hand. A movable handle member 72 includes a finger loop 74 disposed distally of fixed finger loop 70 and an arm 76 extending upwardly from the finger loop to a terminal end in the form of an internally splined sleeve or collar 78 of generally cylindrical configuration disposed within end cap 46 via an elongate slot 80 formed part way about the circumference of the cylindrical side wall of the end cap adjacent the point of attachment for finger loop 70. A transverse shaft 82 extends through splined sleeve 78 from a push button 84 disposed within a cylindrical recess formed in end cap wall 64 to a tubular sleeve or collar 86 with a smooth bore disposed within housing 12 perpendicular to the shaft. Transverse shaft 82 carries a bevel gear 88 of decreasing diameter in the direction of sleeve 86, the bevel gear being disposed between the smooth bore sleeve and the side wall of the housing. A spur gear 90 is carried on transverse shaft 82 within end cap 46. Spur gear 90 engages straight teeth or splines formed on an inner surface of sleeve 78 parallel to longitudinal axis 62 of the handle so that, among other things, pivotal movement of movable handle member 72 is translated into rotary movement of shaft 82. The movable handle member is preferably biased to move in a counterclockwise direction, looking at Fig. 2, toward fixed handle member 68, for example using a bias member 92 connected between the movable handle member and end cap 46. While a bias member in the form of a torsion spring is shown coiled around sleeve 78 in Fig. 5, it will be appreciated that other types of bias members can be used including, but not limited to, compression or expansion springs, leaf springs, rubber or magnets. Alternatively, the movable handle can be biased away from the fixed handle or configured for ratcheting or frictional movement.
Push button 84 is of a conventional type which, when pressed, alternatingly moves shaft 82 in the axial direction, along longitudinal axis 62 of the handle, between an engaged or depressed position where the first bevel gear 88 engages a second bevel gear 94 as shown by solid lines in Fig. 5 and a disengaged or elevated position, outwardly spaced from the extended position, where the first bevel gear is disengaged from the second bevel gear as shown by broken lines in Fig. 5. Spur gear 90 is disposed within end cap 46 and is of sufficient axial length to permit movement of the shaft in the axial direction while remaining at least partly engaged with splined sleeve 78 at the end of handle member 72. A tubular extension 96 extends radially outward from the smooth bored sleeve in the direction of bevel gear 88 to receive the inner terminal end of shaft 82 telescopically, the tubular extension being sufficiently long to accommodate axial movement of the shaft associated with operation of button 84. Shaft 82 extends through an elongate slot 98 formed part way about the circumference of housing sidewall 32 to permit rotation of handle 14 about the longitudinal axis of housing 12 as described in greater detail below.
Referring still to Fig. 5, second bevel gear 94 is mounted on an elongate drive shaft 100 extending longitudinally through the surgical instrument and is of decreasing diameter in the proximal direction to mesh with first bevel gear 88 when push button 84 is depressed or operated to move the first bevel gear to the engaged position. Drive shaft 100 is of hollow, tubular configuration and is oriented coaxial with longitudinal axis 24 of the surgical instrument to define central channel 22c. The drive shaft extends through smooth bored sleeve 86 to define an axis of rotation for the handle and terminates proximally at a rotational coupling 102 within housing 12 where the drive shaft connects telescopically with a tubular shaft extension 104, the tubular shaft extension preferably being fixed relative to a wall or walls of the housing so that it does not rotate or otherwise move with the drive shaft. Shaft extension 104 extends proximally from coupling 102 through housing rear wall 36 to a coupling 106, for example a Luer-type lock, for connection with sources of fluid or suction, operating units, or medical instruments and devices, with a valve 108 being disposed between the couplings to control passage of fluids and instruments through the central channel. The drive shaft is preferably formed of a medically acceptable plastic or metal material having a wall thickness sufficient to carry or form external threads at axially spaced locations within shaft 16 as shown at 110a and 110b in Fig. 5. As will be described in greater detail below, end effector assemblies 18a and 18b are coupled with threaded portions 110a and 110b of the drive shaft such that handle members 68 and 72 can be used to control operation of end effectors at respective distal ends of the end effector assemblies.
End effector assembly 18a and end effector assembly 18b each include an end effector in the form of a forceps mounted by the housing for rotation. While the end effectors are shown herein as forceps, it will be appreciated that any type of end effector can be used including, but not limited to, cauterizing electrodes, needle holders, dissectors, clip applicators, staplers, scissors, cutting members such as blades, needles, and biopsy devices.
The end effector 111a of assembly 18a is shown in Figs. 3A and 3B as a forceps having a pair of pivotally opposed jaws 112a and 114a. Jaws 112a and 114a are preferably formed at the distal end of an elongate tubular rod or body 116a as an integral one-piece unit; however, it will be appreciated that the jaws can be formed separately from the tubular rod and attached thereto and that the tubular rod can be of solid configuration in cross section, if desired. As shown, however, the tubular end effector rod 116a defines an elongate passage 118a through the end effector assembly which can be used as an additional or auxiliary operating channel providing access to the operative site from outside the body. Preferably, the tubular end effector rod 116a will terminate proximally at a coupling (not shown) similar to coupling 106 and will be provided with a valve (not shown) disposed distally of the coupling to control access through the operating channel 118a of the end effector assembly. The jaws of the end effector assembly are preferably biased apart toward an open position, shown in Fig. 3A, where inner needle holding or grasping surfaces 120a and 122a are angularly spaced from one another. The lower jaw 114a in Fig. 3A is of fixed configuration and extends in parallel with a longitudinal axis 124a at the distal portion of the end effector assembly while the upper jaw 112a is pivotally movable between an
l l open position, shown in Fig. 3A, where it extends outwardly from the longitudinal axis 124a of the end effector assembly distal portion at an angle and a closed position, shown in Fig. 3B, where it is in substantially parallel, abutting relation with the lower jaw. Opposed inner surfaces 120a and 122a of the jaws are shown with a plurality of longitudinally spaced teeth or ribs oriented perpendicular to the longitudinal axis 124a of the end effector assembly distal portion to securely hold a suture needle, tissue or other objects therebetween during a surgical procedure; however, the inner surfaces can have any other suitable configuration for holding a suture needle and/or performing other functions including, but not limited to, configurations made up of spaced diamond-shaped protrusions, irregularly spaced teeth or ribs, opposed arcuate portions which define a hole or opening when closed, and transverse or longitudinal grooves. As will be described in greater detail below, either jaw can carry a cutting member or biopsy box.
Referring to Figs. 3A, 3B and 4, it can be seen that fixed jaw 114a of the end effector assembly 18a is disposed between movable jaw 112a and central channel 22c so that, when the jaws of the end effector assemblies are in their respective open positions, the movable jaws will not contact one another or otherwise interfere with the movement of the other end effector. Under certain circumstances, however, it may be desirable to orient one or both of the end effector assemblies in a manner causing the movable jaw to be disposed inwardly of the fixed jaw, for example, by rotating the jaws 180° from the positions shown in Fig. 4. The tubular body or rod 116a of end effector assembly 18a is disposed telescopically within a flexible elongate outer member or sleeve 126a of tubular configuration which is axially movable relative to the rod between a retracted position, shown in Fig. 3A, where a distal end 128a of the flexible sleeve is proximally spaced from the jaws to allow them to open under the force of their own resilience and an extended position, shown in Fig. 3B, where the distal end of the flexible outer member slides over the jaws to cause them to close. The rod 116a and sleeve 126a of the end effector assembly cooperate to define an elongate proximal portion 130a of generally straight configuration extending through channel 22a in shaft 16 and a distal portion 132a with a predetermined deployed or working shape or condition where the distal portion bends outwardly at an angle relative to the longitudinal axis 125a of the proximal portion of the end effector assembly, the distal portion assuming the deployed shape or condition when the end effector assembly is in an axially extended position with the distal portion protruding distally beyond the distal end or face 42 of the shaft as shown, for example, in Figs. 7 and 8. The length and angular deflection of the distal portion of the end effector assembly are such that at least portions of jaws 112a and 114a are spaced laterally outward of a peripheral edge or diameter of the shaft 16 when the distal portion of the rod is in the deployed condition. The tubular rod is preferably stiffer than the sleeve but formed of an elastic material or with an elastic portion having elastic properties allowing the distal portion to bend inwardly, in a lateral direction relative to the longitudinal axis of the proximal portion of the rod so that, when the rod is axially retracted or moved proximally relative to the shaft, the distal portion will move laterally inward from the deployed working position shown in Figs. 7 and 8 to the undeployed insertion position shown in Figs. 1 and 2. In the axially retracted position, a sufficient amount of the distal portion of the end effector assembly is disposed within the shaft to cause the distal portion to straighten out or assume an undeployed shape or condition where the jaws do not protrude beyond the outer periphery or diameter of the shaft. If desired, however, the instrument can be modified to permit complete retraction of the end effector assembly (and/or the end effector assembly) to a position where the jaws are proximally spaced from the distal end or face of the shaft as shown, for example, by broken lines in Figs. 3A and 3B. Alternatively, a rigid outer sleeve (not shown) can be telescopically fitted around the end effector sleeve and moved axially or longitudinally along the end effector assembly to cause the distal portion to alternately straighten and spread laterally outward without the need of having to retract the entire end effector assembly into the instrument.
Tubular rod 116a of end effector assembly 18a carries a spur gear 134a adjacent a proximal end of collar 20a, the spur gear having straight teeth oriented parallel to longitudinal axis 125a of the proximal portion of the end effector assembly. An idler gear 136a is disposed between spur gear 134a and a sun gear 138a of epicyclic configuration formed along an inner surface of collar 20a adjacent the proximal end of the collar. Idler gear 136a includes a pair of face plates 140a and 142a of circular configuration which extend radially beyond the gear teeth to define a pair of lips or rims between which the spur gear and the epicyclic collar gear are disposed in order to maintain alignment of the gear system. Idler gear 136a is mounted on a pin 144a secured to a plate 146a extending upwardly, looking at Fig. 5, from the distal end of a tubular spacer 148a disposed telescopically around rod 116a adjacent spur gear 134a.
A push button 150a is disposed within a cylindrical recess 152a formed in an outer surface of collar 20a and includes a plunger or post 154a extending from the button through an elongate slot 156a formed part way about the circumference of the collar to a linear coupling block 158a disposed within shaft 16. Plunger 154a extends through a longitudinal slot 160a formed in block 158a to a cross member 162a wider than the slot so as to allow the block to slide transversely relative to the plunger while remaining attached to the plunger. Block 158a carries one or more external teeth 164a on a side facing threaded portion 110a of drive shaft 100 and defines a longitudinal opening or passage 166a therethrough with internal teeth 168a formed on an upper surface thereof looking at Fig. 5. The block is movable by operation of the button between an engaged position where teeth 164a meshingly engage threaded portion 110a of the drive shaft to cause the block to move linearly in response to rotation of the shaft and a disengaged position where the teeth 164a are radially or laterally spaced from the threaded portion such that the block is not moved in response to rotation of the shaft.
The tubular sleeve 126a of end effector assembly 18a extends through opening 166a in block 158a with lateral clearance and includes a round flange 170a extending radially outward therefrom between the block and spacer 148a and a rack made up of axially spaced rings or teeth 172a that extend around the portion of the sleeve disposed within the longitudinal block opening. Teeth 172a of the rack meshingly engage teeth 168a on the inner surface of the block opening when block 158a is in the engaged position shown in Fig. 5 such that axial movement of the block caused by rotation of shaft 100 is imparted to end effector assembly sleeve 126a thereby controlling the operation of jaws 112a and 114a as will be described in greater detail below.
A bias member 174a is disposed between spacer 148a and flange 170a to bias sleeve 126a distally relative to rod 116a so that jaws 112a and 114a are normally in a closed position. The bias member is shown as a helical spring coiled around rod 116a and held in compression between flange 170a and spacer 148a, however, any suitable bias member can be used including, but not limited to, tension springs, compression springs, helical springs, leaf springs, rubber and magnets.
End effector assembly 18b is shown as being identical to end effector assembly 18a, with an end effector 111b in the form of opposed jaws 112b and 114b mounted at the distal end of a tubular rod 116b slidably disposed within a sleeve 126b to define straight and angled portions 130b and 132b of the end effector assembly. It will be appreciated, however, that end effector 111b can have any useful configuration for performing surgical procedures. Tubular rod 116b of end effector assembly 18b carries a spur gear 134b engaging an idler gear 136b disposed between the spur gear and a sun gear 138b formed about the inner circumference of collar 20b. The gears are substantially the same as those described for end effector assembly 18a, with the idler gear being mounted on a pin 144b secured to a plate 146b extending radially or laterally outward from a tubular spacer 148b fitted telescopically around tubular rod 116b. Push button 150b, which controls engagement of a linear coupling block 158b with threaded portion 110b of drive shaft 100, is similar to push button 150a with a plunger or post 154b extending therefrom through a slot 156b extending part way about the circumference of collar 160b and a longitudinal slot 160b formed in coupling block 158b to a cross member 162b slidably disposed within the block. Like coupling block 158a for end effector assembly 18a, coupling block 158b carries external teeth 164b on a side facing a threaded portion of the drive shaft and defines a longitudinal passage or opening 166b therethrough through which sleeve 126b of the end effector assembly extends. Opening 166b includes teeth 166b on an inner surface thereof for engaging ring-like teeth 172b on the end effector assembly sleeve. Like the jaws of end effector assembly 18a, the jaws of end effector assembly 18b are biased to a closed position by providing a bias member 174b between a flange 170b carried by the sleeve and spacer 148b. As best seen in Fig. 5, idler gears 136a and 136b as well as plungers 154a and 154b extend through longitudinal slots 176a and 176b formed through tubular member 30 of the shaft on diametrically opposed sides of the shaft to permit axial movement of the collar assemblies when push buttons 150a and 150b are operated to move blocks 158a and 158b to disengaged positions such as the position of block 158b shown in Fig. 5. Preferably, collars 20a and 20b will slide frictionally against or be coupled in ratching relation to shaft 16 so that, once the collars are moved to a desired axial location relative to the shaft, the collars will not move unless deliberately forced. If desired, a separate locking mechanism can be provided for each collar to maintain the axial and/or angular location of the collar relative to the shaft.
An electrical connector can optionally be mounted on the housing 12, as shown at 178 in Fig. 1, or at any other suitable location on the instrument including, but not limited to, the instrument handle or the proximal end of one of the channel-defining tubular shafts extending proximally from the housing, to connect electrically conductive elements of the instrument with a source of electricity for performing unipolar or bipolar procedures such as electric coagulation, for example using one or both of the jaws of an end effector assembly as conductive elements. In addition, an interior surface of any of the channels 22a - 22e can be coated with an electrical and/or thermal insulating layer to permit safe insertion of electrical, thermal and/or other types of energy transmitting devices through the operating channels.
In use, instrument 10 is preferably grasped using finger loops 70 and 74 and, in the case of an endoscopic procedure, the instrument is guided to the operative site by a portal sleeve positioned in the wall of an anatomical cavity. The portal sleeve can be positioned in the anatomical cavity wall using any suitable penetrating technique, including those creating puncture sites by means of removable obturators, such as trocars, and can include a valve housing, if desired, to prevent loss of pneumoperitoneum during insertion and withdrawal of the instrument. The visualization of the endoscopic procedure can be accomplished using a conventional endoscope incorporated into the instrument, for example within the longitudinal operating channel 22e defined through shaft 16, or separately positioned within the anatomical cavity through a second portal sleeve located at another puncture site.
Prior to insertion, instrument 10 is preferably in the condition, state or position shown in Figs. 3B and 4. More specifically, end effector assembly 18a and end effector assembly 18b are preferably initially in axially retracted positions where respective distal portions of the end effector assemblies are drawn at least part way into elongate shaft 16 and thus forced to move laterally inward in an elastic manner to undeployed positions where the end effector jaws are spaced laterally inward of the peripheral edge of the shaft so as not to snag or catch on structure within the portal sleeve or valve housing during insertion. To this end, collars 20a and 20b are preferably initially disposed in the retracted positions shown in Fig. 2 with plungers 154a and 154b being disposed at the proximal ends of slots 176a and 176b in the shaft. Alternatively, a sheath (not shown) can be telescopically fitted around the shaft in a manner to be movable axially or longitudinally between a retracted position spaced proximally of the end effectors and an extended position protruding distally from the shaft to cover and protect the end effectors. Push buttons 150a and 150b on collars 20a and 20b, respectively, are preferably initially disposed in elevated positions so that the jaws of both end effector assemblies will be in closed or grasping positions with inner grasping surfaces of the jaws close together or abutting one another.
After insertion, end effector assembly 18a and end effector assembly 18b can be moved distally relative to shaft 16 from the axially retracted, undeployed positions shown in Fig. 3B to the axially extended, deployed positions shown by solid lines in Figs. 7 and 7A by sliding collars 20a and 20b distally along longitudinal slots 176a and 176b. As the end effector assemblies are advanced longitudinally, distal portions of the end effector assemblies will no longer be restrained within the channels of the elongate shaft and will thus tend to recover elastically or move toward the undeformed shape or condition shown by solid lines in Fig. 7. More particularly, distal portions of the end effector assemblies will spread apart or bend outwardly, away from the longitudinal axes of the channels from which they extend, toward deployed positions where the jaws of each of the end effector assemblies are spaced laterally outward of the peripheral edge or outer diameter of the shaft.
Referring now to Fig. 7A, end effector assemblies 18a and 18b can be individually or simultaneously rotated about their respective longitudinal axes to produce movement of their respective end effectors along arcuate paths shown by arrows at IA and IB. Rotation of an end effector assembly in a first direction is accomplished by turning the corresponding collar in a second direction opposite the first direction, thereby causing the sun gear on the inner surface of the collar to rotate in the second direction. Rotation of the sun gear in the second direction causes the idler gear to rotate in the first direction, thereby causing the spur gear and, thus, the entire end effector assembly to rotate within the channel in the first direction. The end effector assemblies can also be individually or simultaneously moved proximally and distally along longitudinal paths indicated by arrows at IIA and IIB to cause the end effectors to move axially relative to one another and/or the shaft. As mentioned above, proximal and distal movement of an end effector assembly is accomplished by sliding the corresponding collar along the slots formed in the shaft, it being understood that proximal movement of the end effector assembly from the axially extended position to the axially retracted position can be accompanied by lateral movement of the distal portion of the end effector assembly toward the longitudinal axis of the assembly as the distal portion is drawn into a channel of the shaft. Such lateral movement can also be used to perform certain surgical procedures. In addition to the above, shaft 16 can be rotated about longitudinal axis 24 as indicated by the curved arrow at III, moved axially and distally along the directions shown by the arrow IV, and/or moved laterally in the directions shown by the arrow at V. It will be appreciated that any of the above movements can be combined where necessary or desirable to achieve a specific result. It is also possible for one of the end effector assemblies to remain stationary while the other end effector assembly is moved.
Under certain circumstances, it may be desirable for one of the end effector assemblies to bend outwardly in the extended position while the other end effector assembly remains within the periphery of the outer tubular member in the axially extended position, for example as shown in Fig. 7B. The spreadable end effector assembly 18a can be moved in any of the ways described above (i.e., in the directions indicted by arrows IA and IIA). The other end effector assembly 18b is either straight or only slightly bent or curved so that the end effector at the distal end of the non-spreadable end effector is not movable along an arcuate path. The end effector assembly 18b may, however, be rotated about its longitudinal axis in the direction indicated by the arrow at VIB and may be moved axially in the directions indicated by the arrow IIB. Shaft 16 can also be moved in any of the directions indicated by arrows III, IV or V.
Fig. 7C shows one of the end effector assemblies bending outwardly in the extended position and the other end effector assembly in an axially retracted position where the end effector is disposed within the periphery of the elongate shaft. The end effector assembly 18a shown in the axially extended position can be moved in any of the ways described above (i.e., in the directions indicated by arrows IA and IIA). The other end effector assembly 18b can be relatively straight or bent like end effector assembly 18a in the axially extended position; however, when the end effector assembly 18b is in the axially retracted position shown in Fig. 7C, it may be rotated about its longitudinal axis in the direction indicated by the arrow at VIB or moved axially in the directions indicated by the arrow IIB. As mentioned above, shaft 16 can also be moved in any of the directions indicated by arrows III, IV orV.
Referring to Figs. 7 and 8, the jaws of each end effector assembly can be moved between the open position shown by broken lines and the closed position shown by solid lines by operation of handle members 68 and 72 of the instrument. If push button 84 of the handle is in the elevated or disengaged position shown by broken lines in Fig. 5, the push button is depressed to cause bevel gear 88 to move inwardly, in the direction of longitudinal axis 24, and into meshing engagement with bevel gear 94 mounted on drive shaft 100, as shown by solid lines in Fig. 5. To move the jaws from the open position to the closed position, movable handle member 72 is moved in a counterclockwise direction, looking at Fig. 2, toward fixed handle member 68 to cause internally threaded sleeve 78 to rotate in a counterclockwise direction. Spur gear 90 rotates with sleeve 78, causing shaft 82 to rotate in the counterclockwise direction with bevel gear 88. Bevel gear 94 meshingly engages bevel gear 88 and is thus rotated in a clockwise direction, looking proximally, in response to counterclockwise rotation of bevel gear 88 thereby causing drive shaft 100, including threaded portions 110a and 110b, to rotate in a clockwise direction. Rotation of the drive shaft 100 can be converted into linear movement of the end effector assembly components by selectively depressing one or both of the buttons 150a and 150b mounted on collars 20a and 20b. Depression of the buttons causes blocks 158a and 158b to move inwardly, toward the drive shaft, such that teeth 164a and 164b mesh with or engage the threaded portions 110a and 110b, respectively, of the drive shaft. Coupling blocks 158a and 158b move linearly in the distal direction along the drive shaft as the drive shaft rotates in the clockwise direction, with the plungers 154a and 154b sliding axially within the slots 160a and 160b formed through the blocks. In the depressed or engaged condition shown at the top of Fig. 5, the teeth or rings 172a of the end effector assembly sleeve 126a engage teeth 168a inside the block opening 166a such that the end effector assembly sleeve 126a moves linearly with the block in the distal direction relative to rod 116a. The distal end 128a of sleeve 126a is thus moved distally relative to the jaws, causing the jaws to come together or move toward the closed position shown in Fig. 3B against the force biasing the upper jaw away from the lower jaw. The jaws can be locked in a closed position by use of ratchet members 186 and 188 on opposed sides of finger loops 70 and 74; however, if it is not necessary or desirable for the finger loops to be locked together, one of the ratchet members may be pivoted to prevent engagement with the other ratchet member.
To open the jaws, movable handle member 72 is released or otherwise caused to move in a clockwise direction, looking at Fig. 2, in response to finger pressure and/or the spring bias provided by bias member 92. As the movable handle member 72 moves clockwise, transverse shaft 82 is also caused to move clockwise thereby carrying bevel gear 88 in the clockwise direction. Bevel gear 94 is thus caused to move in a counterclockwise direction, looking proximally along longitudinal axis 24, so that drive shaft 100 is driven counterclockwise, causing block 158a to move in the proximal direction relative to rod 116a such that distal end 128a of the sleeve moves proximally relative to the rod to allow jaws 112a and 114a to move resiliently apart.
Dependent upon the procedure to be performed, closing of the jaws may be used to grasp or hold an object positioned between the jaws. If the jaws are provided with a cutting member, objects positioned between the jaws can be cut when the jaws are closed. Similarly, if a biopsy box is mounted on the jaws, tissue samples may be taken from tissue positioned between the jaws when the jaws are closed. One or both of the jaws may also function as a cautery electrode, if desired. Conversely, opening of the jaws can be used to spread objects apart or to permit a suture needle, tissue or some other object to be placed between the jaws. The foregoing functions are merely exemplary of the types of functions that may be performed using an end effector assembly with an end effector in the form of jaws.
At any point during the surgical procedure, operating channels 22a - 22e can be used for irrigation or aspiration of the surgical site and can serve as a space for holding objects or devices such as needles and suture material or as a portal for the introduction of other medical instruments and devices such as, for example, forceps, cutting members, staplers and endoscopes. Knotting elements can also be introduced at the operative site via the operating channels for use in leu of or in addition to traditional knotting techniques during suturing procedures. Some examples of suitable knotting elements for this purpose are described in pending applications Serial Nos. 08/366,285, filed December 29, 1994; 08/377,723, filed January 25, 1995; 08/401 ,002, filed March 9, 1995; and 08/585,875, filed January 16, 1996; the disclosures of which are incorporated herein by reference.
Fig. 8 illustrates a further use of one of the operating channels 22a - 22e wherein a conventional clip applier 190 is advanced distally through one of the channels, for example central channel 22c, to apply a clip as part of a surgical procedure. End effector assemblies 18a and 18b are shown by solid lines in their axially extended, outwardly spread positions with jaws closed and by broken lines with their jaws open. The end effector assemblies can be used in any suitable manner to manipulate or position tissue so that it can be clipped or to move tissue so that the clip applier can access other areas of the body. In addition to operating channels 22a - 22e, auxiliary operating channels can be defined through one or both of the end effector assemblies 18a and 18b as shown at 118a and 118b in Figs. 3A and 3B to provide access to the operative site from outside the anatomical cavity. The auxiliary operating channels are shown terminating distally at openings adjacent the jaws of the end effector assemblies but can terminate at openings defined at the bend connecting straight and angled portions of the end effector assemblies as shown by broken lines in Fig. 8.
It will also be appreciated that when push button 84 is in the elevated, undepressed position shown by broken lines in Fig. 5, shaft 82 slides outwardly within tubular extension 96, moving bevel gear 88 away from bevel gear 94 so that end cap 46 may be rotated about an axis transverse to the longitudinal axis of shaft 16 to move handle members 68 and 72 between the transverse position shown by solid lines in Fig. 2 and the rearward facing position shown by broken lines in Fig. 2. Push button 84 may then be depressed to maintain the handle members in the desired angular orientation. The handle members 68 and 72 can also be rotated about the longitudinal axis of the shaft 16 (e.g., as shown by broken lines in Fig. 7) by moving push button 84 to the elevated, undepressed position and rotating the entire handle portion 14 about the housing 12, for example by grasping the housing with one hand while moving the handle with the other hand. When a desired angular orientation is achieved, push button 84 may be depressed so that the bevel gear 88 is made to engage bevel gear 94, thereby locking the handle in place relative to the housing.
Figs. 9 and 10 show a modification of an end effector assembly for use with the surgical instrument according to the present invention wherein the modified end effector assembly 1018 includes a pair of jaws 1112 and 1114 pivotably mounted on a pair of pins 1216a and 1216b secured to diametrically opposed sides of a hollow tubular rod or sleeve 1116 telescopically fitted within an outer tubular sleeve 1126, the tubular rod defining an auxiliary operating channel 1118 providing access to the operative site from outside the anatomical cavity. Jaws 1112 and 1114 are biased apart toward the open position shown in Fig. 9, for example using a torsion spring (not shown) coiled around one of the pins and connected between the jaws or a pair of spring members (not shown) held in compression between each jaw and the hollow tubular rod, and the jaws are movable inwardly toward one another against the spring bias in response to distal movement of tubular sleeve 1126 against the rear or back edges of the jaws. If desired, jaws 1112 and 1114 can be mounted on a single pin or pivot extending diametrically across the width of sleeve 1116; however, use of separate pivots provides a substantially unobstructed passage through the operating channel.
Any of the end effector jaws described herein can carry a biopsy box or a cutting member such as the blade shown by broken lines at 1220 in Fig. 9. Blade 1220 is oriented perpendicular to the inner grasping surface of upper jaw 1112 and extends downwardly, looking at Fig. 9, from an edge of the inner grasping surface to fit within a cooperatively configured pocket or recess 1222 formed along an edge of lower jaw 1114 when the jaws are closed together. An elongate groove or recess with an open proximal end can be formed along an inner surface of one or both of the jaws, for example as shown by broken lines at 1223 in Fig. 10, to permit a cutting member, such as a blade, to slide between the jaws when closed. Other examples of cutting members which can be used are shown and described in U.S. patent application Serial No. 08/612,634, filed March 4, 1996, and U.S. patent application Serial No. 08/376,186, filed January 20, 1995, the disclosures of which are incorporated herein by reference. The modified end effector assembly 2018 shown in Fig. 11 is similar to the end effector assemblies shown in Figs. 1 - 8 but with both jaws 2112 and 2114 being pivotably movable between normally open positions extending laterally outward from the tubular rod 2116 at acute angles and closed positions wherein the jaws abut one another. A pair of cams 2224a and 2224b are also shown extending outwardly from the jaws adjacent the distal end 2128 of outer sleeve 2126 to provide additional force when closing the jaws together. An optional cutting member in the form of a blade 2220 and a cooperatively configured pocket or recess 2222 are also shown.
Yet another modified end effector assembly is shown in Figs. 12 and 13 at 3018 and includes a first jaw member 3112 in the form of an outer tubular sleeve 3126 with a lateral cut-out or window 3226 having a grasping surface 3120 formed on a proximal-facing surface or face of the window and a second jaw member 3114 in the form of an inner tubular sleeve 3116 fitted telescopically within the outer tubular sleeve and having a grasping surface 3122 formed along a peripheral edge of the inner member to operate cooperatively with the grasping surface at the distal end of the outer member to hold a suture needle or other objects within the window. An auxiliary operating channel, shown by broken lines in Fig. 23 at 3118, may optionally be formed through the inner and outer members of the end effector assembly to permit access to the operative site via the channel from outside the body. If an auxiliary operating channel is not needed or desired, the second jaw member 3114 can be solid instead of tubular, thus presenting a wider grasping surface if desired.
Fig. 14 shows still another modification of an end effector assembly for use with the surgical instrument according to the present invention wherein the modified end effector assembly 4018 includes a first needle holding member 4112 in the form of a hook and a second needle holding member 4114 in the form of a keeper movable relative to the hook to capture and release a suture needle placed within the hook. The needle holding members are preferably formed of flat strips of a medically acceptable material, such as stainless steel, configured to lay flat against one and other to permit relative sliding movement of the needle holding members. The first needle holding member 4112 includes an elongate portion or leg 4228 extending distally from within the instrument housing to a bend 4230 where the first needle holding member folds inwardly upon itself to form a short leg 4232 parallel to the elongate portion or leg of the needle holding member thereby defining a hook with a proximal-facing mouth 4233 having a gap width suitable for receiving the shaft or body of a suture needle. The second needle holding member 4114 is slidingly disposed along the first needle holding member 4112 and includes a distal end 4234 configured to fit within the mouth of the hook as a keeper, the distal end of the second needle holding member being shown with an optional scalloped edge having one or more curved recesses. The first or second needle holding member may also be formed with a cutting member such as a blade or a notch of generally V-shaped configuration defined along an edge of the needle holding member and having one or more sharp edges to cut lengths of suture material received therein under pressure as shown, for example, by broken lines at 4236 in Fig. 14. The first needle holding member is also shown with optional slots or openings 4238a and 4238b formed on opposite sides of the hook to permit straight or slightly curved suture needles to be placed perpendicularly through short and long legs of the hook so as to be oriented radially relative to the longitudinal axis of the shaft. The slotted openings extend transversely, relative to a longitudinal axis of the end effector assembly, from respective open ends disposed along a lateral or longitudinal edge of the first needle holding member to generally centrally located terminal tends of rounded or semi-circular configuration with a size to receive the body or shank of a suture needle extending transversely through legs of the hook. As mentioned above, the scalloped edge at the distal end of the second needle holding member or keeper 4114 is configured with laterally spaced recesses, one of which is preferably aligned with a terminal portion or end of the slotted openings to cradle a needle positioned within the openings.
Still another modification of an end effector assembly for use with the surgical instrument according to the present invention, as shown in Figs. 15 and 16, includes a pair of jaws 5112 and 5114 extending distally from a pair of crossed arms 5240a and 5240b connected by a pivot 5242 located medially along the lengths of the arms. A pair of elongate linkages 5244a and 5244b extend inwardly from pivots 5246a and 5246b at respective proximal ends of the arms to a pivot 5248 connecting the linkages with an elongate rod 5250. Linkages 5244a and 5244b are disposed on opposite sides of the rod, with pivot 5248 extending through the linkages and the rod and with tabs or ears 5252 extending laterally outward from the rod in opposite directions to overhang the linkages as stops preventing the linkages from spreading outwardly beyond a predetermined position. Jaws 5112 and 5114 are moved relative to one another by moving the outer tubular member and rod relative to one another. The jaws are normally biased apart, for example by a torsion spring coiled around a pivot and connected between the jaws, and are closed by moving the outer tubular member distally relative to the jaws, for example by advancing the outer tubular member distally and/or pulling the rod in the proximal direction. In a preferred embodiment, the outer tubular member is biased distally relative to the jaws so that the jaws are normally in a closed position.
From the above, it will be appreciated that the surgical instrument according to the present invention permits manipulation of anatomical tissue during endoscopic procedures without the need of having to use multiple instruments inserted through multiple puncture sites by inserting an elongate shaft carrying at least two end effector assemblies through a single puncture site. Preferably, the end effector assemblies each include a distal portion movable between an undeployed, contracted or parked position spaced laterally inward of a peripheral edge of the elongate shaft to facilitate insertion through a portal sleeve and a deployed, expanded or working position where at least part of the distal portion is spaced laterally outward of the peripheral edge of the elongate shaft to provide maximum working span. The elongate shaft is mounted by a handle with controls for moving one or both of the end effector assemblies axially and in a rotary manner. The end effector assemblies each include an end effector at a distal end. While the end effectors are described above as being forceps jaws, it will be appreciated that the end effectors can have any suitable configuration for individually or cooperatively manipulating or otherwise affecting tissue and other objects including, but not limited to, forceps, cutters, needle holders, cauteries, clip appliers, staplers, ligators and the like.
The end effector assemblies of the surgical instrument can be of the same or different design. For example, one end effector assembly can include an end effector in the form of a forceps while another end effector assembly includes an end effector in the form of a cutter. While the end effector assemblies are shown disposed within cylindrical channels formed through the elongate shaft, it will be appreciated that one or more of the end effector assemblies can be disposed within arcuate channels so that, for example, one of the end effector assemblies can be moved arcuately within the shaft about the center of curvature of the curved channel while the other end effector assembly is rotated about its longitudinal axis or vice versa. Distal portions of the end effector assemblies preferably extend laterally outward at an angle from respective longitudinal axes of the elongate shaft so that, when the end effector assemblies are rotated about their respective longitudinal axes, the end effectors at the distal ends of the assemblies are made to move arcuately along non-concentric arcuate paths which may or may not intersect dependent upon the respective lengths of the distal portions and their respective bend angles. Any type of end effector assembly can be modified for use with the surgical instrument according to the present invention by configuring a distal portion of the end effector assembly to be normally bent outwardly at an angle relative to the proximal portion, including, but not limited to, any of the end effector assemblies or drivers described in U.S. patent application Serial No. 08/758,648, filed November 27, 1996, and Serial Nos. 08/847,182, 08/847,254, 08/847,253, 08/847,189, and 08/847,252, filed May 1 , 1997, the disclosures of which are incorporated herein by reference. For example, the end effector assemblies can include a transverse connecting member extending outwardly from a proximal portion of the end effector assembly at an angle to connect with longitudinally oriented end effectors laterally offset from the proximal portion.
The end effectors can be straight, curved or angled in configuration and, when an end effector is a pair of jaws, the jaws can be provided with ribs, a diamond tread pattern or any other type of grasping surface to assure a positive grip as well as grooves, slots or holes to permit access through the jaws when the jaws are closed. The jaws can also carry cutting members, such as slots with sharp edges or protruding blades, and can have opposed arcuate or concave portions for clamping tubular objects, such as organs, without compressing the objects, as well as portions configured to take a tissue sample for biopsy.
When the end effectors are carried at the distal end of one or more elongate components, for example a rod telescopically fitted within a tube, either component can include a distal portion of predetermined shape which, in an unrestrained condition, bends laterally outward at an angle relative to the longitudinal axis of the proximal portion of the end effector component. Furthermore, components of an end effector assembly can be keyed or coupled to move together so that, for example, if one of the components is rotated the other component will be rotated as well.
The end effectors can be used alone or in combination to perform lysis of adhesion, dissection, pickup and cutting, pickup and clipping, pickup and suturing with a suture needle, unipolar and bipolar electrosurgery, and numerous other procedures. For example, the end effectors can be used in combination to perform dual electrode cauterization, to clamp tissue between adjacent end effectors, or to separate tissue by placing adjacent end effectors between tissue sections and moving the end effectors away from one another. Adjacent end effectors, acting as electrodes, can also be pressed against opposite sides of tissue to cauterize the tissue. Also, a button or switch can be provided to selectively switch the electric power between end effectors for unipolar cauterization.
Although the surgical instrument is shown and described herein as having two end effectors, it will be appreciated that the instrument can have one end effector or more than two end effectors (e.g., three or four) dependent upon the procedure to be performed and the preference of the user. Also, the end effectors can be positioned at diametrically opposed locations relative to the central longitudinal axis of the elongate shaft as shown or at any other laterally spaced positions.
Although the elongate shaft is shown as being composed of optical fibers disposed within a tubular sleeve, it will be appreciated that the elongate shaft can be formed without a separate sleeve, for example by embedding or molding the optical fibers within a medically acceptable polymer matrix or by adhesively connecting the fibers together. The elongate shaft can also be formed without optical fibers extending therethrough, in which case a light source may be inserted through one of the channels defined through the shaft or through a separate puncture to illuminate the operative site. The shaft can be rigid or flexible and can be made of any suitable medically acceptable material, such as plastic or stainless steel. The cross-sectional configuration of the outer surface of the shaft is preferably circular as shown but can be elliptical, polygonal or have any other configuration suitable for a particular purpose. The distal end or face of the shaft can be flat as shown, convex or concave; and, when flat, the distal face can be oriented at any angle relative to the longitudinal axis of the shaft. While three channels are shown in addition to the end effector channels, any number of channels can be formed through the elongate shaft, for example by thin wall, tubular sleeves extending longitudinally through the shaft or by voids or spaces defined between the optical fibers as shown. The channels can be parallel to one another or oriented at angles, can be straight or curved, and can be of constant or varying lateral dimension along their length. Furthermore, the channels can be located anywhere within the elongate shaft and can be of the same or different design dependent upon procedural use and space constraints.
The operating channels can have any configuration in transverse cross- section including, but not limited to, elliptical, polygonal and irregular or asymmetrical cross-sectional configurations. Also, all or part of the inner surface of a channel can be electrically insulated to permit passage of electrosurgical instruments therethrough. The valves and couplings shown at the proximal end of each channel are merely exemplary of the types of conventional valves and conventional couplings that can be used. Operating channels may also be defined along the length of the end effector assemblies of the instrument, if desired. It will also be appreciated that storage spaces or recesses can be defined in the elongate shaft to hold suture needles, lengths of suture material, and other devices.
While a particular handle assembly is shown and described herein for holding the instrument and controlling operation of the end effectors, it will be appreciated that other handle configurations can be used including, but not limited to, configurations wherein the handle includes pivoted legs with finger loops, one fixed and one pivoted leg with finger loops, a pistol grip with one or more movable triggers, and/or resilient U-shaped handle members. It is also possible to mount handle members on both sides of the handle housing so that operation of the end effector assemblies is controlled by separate pairs of handle members as described, for example, in application Serial No. 08/847,254, the disclosure of which is incorporated herein by reference. Moreover, the handle can have adjustable handle members of variable orientation as shown or handle members which are fixed in a specific orientation relative to the housing. If desired, the housing and at least a portion of the handle can be formed as an integral one-piece unit.
While the end effector assemblies have been described above as being independently controlled by operating mechanisms such as push buttons and collars which, for the most part, must be operated with both hands, it will be appreciated that a single operating mechanism can be used to synchronize movement of the end effector assemblies relative to one another as well as operation of their respective end effectors when appropriate to further simplify the surgical process by allowing one-hand operation of the instrument.
Moving the end effectors of the present invention relative to one another can be accomplished in any suitable manner, for example by connecting a knob at the proximal end of each end effector assembly and sliding the knobs along slots formed in the handle housing or by mounting the end effector assemblies on geared components and moving the gears with a trigger or some other handle member or device. While the end effector assemblies have been described herein as having a normally bent configuration which can be straightened by retracting the end effector assemblies in a proximal direction relative to a tubular member so as to elastically deform the end effector assemblies, it will be appreciated that the end effector assemblies of the present invention can be moved between contracted and expanded positions using any suitable method including, but not limited to, methods utilizing linkages, gears, cables, movable stiffeners or inserts, shape memory materials, actuators or motors. Dependent upon the angular deflection and length of the bent or angled distal portions of the end effector assemblies, the distal portions may be movable between deployed and parked positions merely by rotation about their respective axes. Also, distal portions of the end effector assemblies need not be straight as shown but can be curved or multiply angled, if desired.
The components of the surgical instrument of the present invention can be made of any suitable, medical grade materials to permit sterilization for reuse or disposal for single patient use. The components can be made of multiple parts of various configurations and materials to reduce cost. The housing and/or handle can have various valves, stop cocks and seals therein to control the flow of fluid and medical devices through the surgical instrument.
The features of the various embodiments described above can be combined in any manner desired dependent upon the operational requirements of the procedure to be performed and the complexity of the surgical instrument.
Inasmuch as the present invention is subject to many variations, modifications and changes in detail, it is intended that all subject matter discussed above or shown in the accompanying drawings be interpreted as illustrative only and not be taken in a limiting sense.

Claims

WHAT IS CLAIMED IS:
1. A surgical instrument for use in open and endoscopic surgery comprising a housing; an elongate shaft having a proximal end mounted by said housing and a distal end with a peripheral edge; a first end effector assembly protruding from said distal end of said elongate shaft and having an end effector at a distal end; and a second end effector assembly protruding from said distal end of said elongate shaft and having an end effector at a distal end; wherein a distal portion of said first end effector assembly extends laterally outward at an angle from a first longitudinal axis of said elongate shaft to a position where at least a portion of said corresponding end effector is spaced laterally outward of said peripheral edge of said elongate shaft; and wherein said first end effector assembly is rotatable about said first longitudinal axis of said elongate shaft to cause said corresponding end effector to move along a first arcuate path having a center of curvature coaxial with said first longitudinal axis.
2. A surgical instrument as recited in claim 1 wherein said end effector of said first end effector assembly is movable between an undeployed position where said end effector is spaced laterally inward of said peripheral edge of said elongate shaft and a deployed position where at least a portion of said end effector is disposed laterally outward of said peripheral edge.
3. A surgical instrument as recited in claim 2 wherein said first end effector assembly includes an elongate proximal portion extending at least partly through said shaft in coaxial alignment with said first longitudinal axis.
4. A surgical instrument as recited in claim 3 wherein said first end effector assembly is longitudinally movable relative to said elongate shaft between an axially extended position where said distal portion of said first end effector assembly bends outwardly in a lateral direction relative to said first longitudinal axis and an axially retracted position where said distal portion of said first end effector assembly is drawn laterally inward toward said first longitudinal axis.
5. A surgical instrument as recited in claim 4 wherein said end effector of said first end effector assembly is proximally spaced from said distal end of said shaft in said retracted position.
6. A surgical instrument as recited in claim 1 wherein said second end effector assembly extends laterally outward at an angle from a second longitudinal axis of said elongate shaft to a position where at least a portion of said corresponding end effector is spaced laterally outward of said peripheral edge of said elongate shaft.
7. A surgical instrument as recited in claim 6 wherein said second end effector assembly is rotatable about said second longitudinal axis of said elongate shaft to cause said corresponding end effector to move along a second arcuate path having a center of curvature coaxial with said second longitudinal axis.
8. A surgical instrument as recited in claim 6 wherein said end effector of said second end effector assembly is movable between an undeployed position where said end effector is spaced laterally inward of said peripheral edge of said elongate shaft and a deployed position where at least a portion of said end effector is disposed laterally outward of said peripheral edge.
9. A surgical instrument as recited in claim 8 wherein said second end effector assembly includes an elongate proximal portion extending at least partly through said shaft in coaxial alignment with said second longitudinal axis.
10. A surgical instrument as recited in claim 9 wherein said second end effector assembly is longitudinally movable relative to said elongate shaft between an axially extended position where said distal portion of said second end effector assembly bends outwardly in a lateral direction relative to said second axis of rotation and an axially retracted position where said distal portion of said second end effector assembly is drawn inwardly toward said second axis of rotation.
11. A surgical instrument as recited in claim 10 wherein said end effector of said second end effector assembly is proximally spaced from said distal end of said shaft in said retracted position.
12. A surgical instrument as recited in claim 1 and further comprising an operating channel defined through said elongate shaft to provide access to the operative site from outside the body.
13. A surgical instrument as recited in claim 1 and further comprising a plurality of operating channels defined through said elongate shaft in laterally spaced relation to provide access to the operative site from outside the body.
14. A surgical instrument as recited in claim 12 wherein said operating channel extends through said housing to define a longitudinal channel along the length of said instrument, and further comprising a coupling at a proximal end of said channel.
15. A surgical instrument as recited in claim 12 wherein said operating channel extends through said housing to define a longitudinal channel along the length of said instrument, and further comprising a valve disposed along said longitudinal channel to control passage of fluids and instruments therethrough.
16. A surgical instrument as recited in claim 1 wherein an operating channel is defined through one of said end effector assemblies to provide access to the operative site from outside the body.
17. A surgical instrument as recited in claim 16 wherein said end effector assembly having an operating channel defined therethrough includes an elongate proximal portion extending through said elongate shaft and wherein said operating channel terminates distally at an opening adjacent the junction between said proximal and distal portions of said end effector assembly.
18. A surgical instrument for use in open and endoscopic procedures comprising a housing; an elongate shaft having a proximal end mounted by said housing and a distal end with a peripheral edge; a first end effector assembly having a proximal portion extending at least part way through said elongate shaft along a first longitudinal axis, a distal portion extending laterally outward from said proximal portion at an angle, and a end effector mounted on said distal portion, said proximal portion of said first end effector assembly being rotatably mounted within said elongate shaft to move said end effector of said first end effector assembly along a first arcuate path having a center of curvature coaxial with said first longitudinal axis; and a second end effector assembly having a proximal portion extending at least part way through said elongate shaft along a second longitudinal axis laterally spaced from said first longitudinal axis, a distal portion extending laterally outward from said proximal portion at an angle, and a end effector mounted on said distal portion, said proximal portion of said second end effector assembly being rotatably mounted within said elongate shaft to move said end effector of said second end effector assembly along a second arcuate path having a center of curvature coaxial with said second longitudinal axis; wherein said first arcuate path has a radius of curvature causing at least a portion of said end effector of said first end effector assembly to extend outwardly of said peripheral edge of said elongate shaft.
19. A surgical instrument as recited in claim 18 wherein said second arcuate path has a radius of curvature causing at least a portion of said end effector of said second end effector assembly to extend outwardly of said peripheral edge of said elongate shaft.
20. A surgical instrument as recited in claim 18 wherein said respective end effectors of said first and second end effector assemblies are movable between undeployed positions where said end effectors are spaced laterally inward of said peripheral edge of said elongate shaft and deployed positions where at least a portion of each of said end effectors is disposed laterally outward of said peripheral edge.
21. A surgical instrument as recited in claim 18 wherein said first and second end effector assemblies are longitudinally movable relative to said elongate shaft between respective axially extended positions where respective distal portions of said first and second end effector assemblies bend outwardly in a lateral direction relative to said first and second longitudinal axes, respectively, and respective axially retracted positions where said distal portions are drawn inwardly toward said first and second longitudinal axes, respectively.
22. A surgical instrument as recited in claim 21 wherein said end effectors of said first and second end effector assemblies are proximally spaced from said distal end of said elongate shaft in said respective retracted positions.
23. A method of performing a surgical procedure in an anatomical cavity comprising the steps of introducing a surgical instrument having an elongate shaft into the anatomical cavity, the surgical instrument including first and second end effector assemblies protruding distally from the distal end of the elongate shaft, the first end effector assembly including a distal portion extending laterally outward at an angle from a first longitudinal axis of the elongate shaft to an end effector disposed at least partly outside a peripheral edge of the elongate shaft ; and operating on tissue within the anatomical cavity by rotating the first end effector assembly about the first longitudinal axis.
24. A method of performing a surgical procedure as recited in claim 23 and further comprising, prior to said operating step, the step of moving the first end effector assembly laterally outward from an undeployed position spaced laterally inward of the peripheral edge of the elongate shaft to a deployed position spaced laterally outward of the peripheral edge of the elongate shaft.
25. A method of performing a surgical procedure as recited in claim 23 and further comprising, prior to said operating step, the step of moving the first end effector assembly distally relative to the elongate shaft from an axially retracted position within the elongate shaft to an axially extended position protruding from the distal end of the elongate shaft.
26. A method of performing a surgical procedure as recited in claim 23 wherein the second end effector assembly includes a distal portion extending laterally outward at an angle from a second longitudinal axis of the elongate shaft to an end effector disposed at least partly outside a peripheral edge of the elongate shaft and further comprising the step of operating on the tissue by rotating the second end effector assembly about the second longitudinal axis of the elongate shaft.
27. A method of performing a surgical procedure as recited in claim 23 and further comprising the step of operating on the tissue by moving the second end effector assembly axially relative to the first end effector assembly.
28. A method of performing a surgical procedure as recited in claim 23 and further comprising the step of operating on the tissue by moving the first end effector assembly axially relative to the second end effector assembly.
29. A method of performing a surgical procedure as recited in claim 23 and further comprising the step of operating on the tissue by rotating the shaft.
PCT/US1998/015306 1997-07-29 1998-07-28 Surgical instrument with multiple rotatably mounted spreadable end effectors WO1999005974A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU87579/98A AU8757998A (en) 1997-07-29 1998-07-28 Surgical instrument with multiple rotatably mounted spreadable end effectors

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US08/902,311 1997-07-29
US08/902,311 US5954731A (en) 1997-07-29 1997-07-29 Surgical instrument with multiple rotatably mounted spreadable end effectors

Publications (2)

Publication Number Publication Date
WO1999005974A1 true WO1999005974A1 (en) 1999-02-11
WO1999005974A9 WO1999005974A9 (en) 1999-04-29

Family

ID=25415666

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US1998/015306 WO1999005974A1 (en) 1997-07-29 1998-07-28 Surgical instrument with multiple rotatably mounted spreadable end effectors

Country Status (3)

Country Link
US (1) US5954731A (en)
AU (1) AU8757998A (en)
WO (1) WO1999005974A1 (en)

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19926555A1 (en) * 1999-06-11 2000-12-28 Storz Karl Gmbh & Co Kg Medical gripping instrument and method for using this gripping instrument
WO2012068004A1 (en) * 2010-11-15 2012-05-24 Ethicon Endo-Surgery, Inc. Laparoscopic suturing instrument with perpendicular eccentric needle motion
CN112312842A (en) * 2018-06-22 2021-02-02 波士顿科学医学有限公司 Tissue removal device

Families Citing this family (350)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6436107B1 (en) 1996-02-20 2002-08-20 Computer Motion, Inc. Method and apparatus for performing minimally invasive surgical procedures
US6132441A (en) * 1996-11-22 2000-10-17 Computer Motion, Inc. Rigidly-linked articulating wrist with decoupled motion transmission
US6726686B2 (en) 1997-11-12 2004-04-27 Sherwood Services Ag Bipolar electrosurgical instrument for sealing vessels
US7435249B2 (en) 1997-11-12 2008-10-14 Covidien Ag Electrosurgical instruments which reduces collateral damage to adjacent tissue
US6228083B1 (en) 1997-11-14 2001-05-08 Sherwood Services Ag Laparoscopic bipolar electrosurgical instrument
US7758569B2 (en) * 1998-02-24 2010-07-20 Hansen Medical, Inc. Interchangeable surgical instrument
US6860878B2 (en) * 1998-02-24 2005-03-01 Endovia Medical Inc. Interchangeable instrument
US7297142B2 (en) * 1998-02-24 2007-11-20 Hansen Medical, Inc. Interchangeable surgical instrument
US8303576B2 (en) 1998-02-24 2012-11-06 Hansen Medical, Inc. Interchangeable surgical instrument
US7901399B2 (en) 1998-02-24 2011-03-08 Hansen Medical, Inc. Interchangeable surgical instrument
US7569062B1 (en) 1998-07-15 2009-08-04 St. Jude Medical, Inc. Mitral and tricuspid valve repair
US6165183A (en) * 1998-07-15 2000-12-26 St. Jude Medical, Inc. Mitral and tricuspid valve repair
EP0979635A2 (en) 1998-08-12 2000-02-16 Origin Medsystems, Inc. Tissue dissector apparatus
US7118570B2 (en) 2001-04-06 2006-10-10 Sherwood Services Ag Vessel sealing forceps with disposable electrodes
US7364577B2 (en) 2002-02-11 2008-04-29 Sherwood Services Ag Vessel sealing system
US7267677B2 (en) 1998-10-23 2007-09-11 Sherwood Services Ag Vessel sealing instrument
US7582087B2 (en) 1998-10-23 2009-09-01 Covidien Ag Vessel sealing instrument
US6659939B2 (en) 1998-11-20 2003-12-09 Intuitive Surgical, Inc. Cooperative minimally invasive telesurgical system
US8527094B2 (en) 1998-11-20 2013-09-03 Intuitive Surgical Operations, Inc. Multi-user medical robotic system for collaboration or training in minimally invasive surgical procedures
US6398726B1 (en) 1998-11-20 2002-06-04 Intuitive Surgical, Inc. Stabilizer for robotic beating-heart surgery
US6852107B2 (en) 2002-01-16 2005-02-08 Computer Motion, Inc. Minimally invasive surgical training using robotics and tele-collaboration
US6951535B2 (en) 2002-01-16 2005-10-04 Intuitive Surgical, Inc. Tele-medicine system that transmits an entire state of a subsystem
US6248124B1 (en) * 1999-02-22 2001-06-19 Tyco Healthcare Group Arterial hole closure apparatus
US6179776B1 (en) 1999-03-12 2001-01-30 Scimed Life Systems, Inc. Controllable endoscopic sheath apparatus and related method of use
US6071289A (en) * 1999-03-15 2000-06-06 Ethicon Endo-Surgery, Inc. Surgical device for suturing tissue
US6821285B2 (en) 1999-06-22 2004-11-23 Ndo Surgical, Inc. Tissue reconfiguration
US7846180B2 (en) 1999-06-22 2010-12-07 Ethicon Endo-Surgery, Inc. Tissue fixation devices and methods of fixing tissue
US8287554B2 (en) 1999-06-22 2012-10-16 Ethicon Endo-Surgery, Inc. Method and devices for tissue reconfiguration
US6663639B1 (en) 1999-06-22 2003-12-16 Ndo Surgical, Inc. Methods and devices for tissue reconfiguration
US6835200B2 (en) 1999-06-22 2004-12-28 Ndo Surgical. Inc. Method and devices for tissue reconfiguration
US7637905B2 (en) * 2003-01-15 2009-12-29 Usgi Medical, Inc. Endoluminal tool deployment system
US7416554B2 (en) 2002-12-11 2008-08-26 Usgi Medical Inc Apparatus and methods for forming and securing gastrointestinal tissue folds
US7618426B2 (en) 2002-12-11 2009-11-17 Usgi Medical, Inc. Apparatus and methods for forming gastrointestinal tissue approximations
US7744613B2 (en) 1999-06-25 2010-06-29 Usgi Medical, Inc. Apparatus and methods for forming and securing gastrointestinal tissue folds
US20030109875A1 (en) 1999-10-22 2003-06-12 Tetzlaff Philip M. Open vessel sealing forceps with disposable electrodes
EP1095622A1 (en) * 1999-10-29 2001-05-02 Biomedix S.A. Endoscopic suturing instrument
US7252666B2 (en) * 2000-02-14 2007-08-07 Sherwood Services Ag Arterial hole closure apparatus
US6726699B1 (en) 2000-08-15 2004-04-27 Computer Motion, Inc. Instrument guide
US6558313B1 (en) 2000-11-17 2003-05-06 Embro Corporation Vein harvesting system and method
EP2441395A3 (en) 2000-11-28 2014-06-18 Intuitive Surgical Operations, Inc. Endoscope beating-heart stabilizer and vessel occlusion fastener
US6997931B2 (en) * 2001-02-02 2006-02-14 Lsi Solutions, Inc. System for endoscopic suturing
US8313496B2 (en) * 2001-02-02 2012-11-20 Lsi Solutions, Inc. System for endoscopic suturing
US7699835B2 (en) 2001-02-15 2010-04-20 Hansen Medical, Inc. Robotically controlled surgical instruments
JP4499992B2 (en) 2001-04-06 2010-07-14 コヴィディエン アクチェンゲゼルシャフト Vascular sealing machine and splitting machine having non-conductive stop member
AU2001249932B8 (en) 2001-04-06 2006-05-04 Covidien Ag Electrosurgical instrument which reduces collateral damage to adjacent tissue
US20020165524A1 (en) 2001-05-01 2002-11-07 Dan Sanchez Pivot point arm for a robotic system used to perform a surgical procedure
JP3987312B2 (en) * 2001-08-31 2007-10-10 株式会社東芝 Semiconductor device manufacturing apparatus and manufacturing method, and semiconductor manufacturing apparatus cleaning method
US7867243B2 (en) * 2001-09-06 2011-01-11 Design Standards Corporation Tissue grasping and clipping/stapling device
US6728599B2 (en) 2001-09-07 2004-04-27 Computer Motion, Inc. Modularity system for computer assisted surgery
DE10147145C2 (en) * 2001-09-25 2003-12-18 Kunz Reiner Multi-function instrument for micro-invasive surgery
ES2388729T3 (en) 2001-12-04 2012-10-18 Tyco Healthcare Group Lp System and method to calibrate a surgical instrument
US6793653B2 (en) 2001-12-08 2004-09-21 Computer Motion, Inc. Multifunctional handle for a medical robotic system
US7261728B2 (en) * 2002-03-15 2007-08-28 Ethicon Endo-Surgery, Inc. Biopsy forceps device and method
US7041113B2 (en) * 2002-05-07 2006-05-09 Terumo Corporation Minimal invasive endoscopic methods and apparatus for harvesting blood vessels
EP1515651B1 (en) 2002-06-14 2006-12-06 Power Medical Interventions, Inc. Device for clamping, cutting, and stapling tissue
US7270664B2 (en) 2002-10-04 2007-09-18 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7931649B2 (en) 2002-10-04 2011-04-26 Tyco Healthcare Group Lp Vessel sealing instrument with electrical cutting mechanism
US7276068B2 (en) 2002-10-04 2007-10-02 Sherwood Services Ag Vessel sealing instrument with electrical cutting mechanism
US7087064B1 (en) 2002-10-15 2006-08-08 Advanced Cardiovascular Systems, Inc. Apparatuses and methods for heart valve repair
US7799026B2 (en) 2002-11-14 2010-09-21 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US8187324B2 (en) * 2002-11-15 2012-05-29 Advanced Cardiovascular Systems, Inc. Telescoping apparatus for delivering and adjusting a medical device in a vessel
US7404824B1 (en) 2002-11-15 2008-07-29 Advanced Cardiovascular Systems, Inc. Valve aptation assist device
US9149602B2 (en) 2005-04-22 2015-10-06 Advanced Cardiovascular Systems, Inc. Dual needle delivery system
US7981152B1 (en) 2004-12-10 2011-07-19 Advanced Cardiovascular Systems, Inc. Vascular delivery system for accessing and delivering devices into coronary sinus and other vascular sites
US7942898B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Delivery systems and methods for gastric reduction
US7942884B2 (en) 2002-12-11 2011-05-17 Usgi Medical, Inc. Methods for reduction of a gastric lumen
AU2003294347A1 (en) * 2002-12-30 2004-07-29 Fannie Mae System and method for processing data pertaining to financial assets
US20040249367A1 (en) * 2003-01-15 2004-12-09 Usgi Medical Corp. Endoluminal tool deployment system
US7481817B2 (en) 2003-02-13 2009-01-27 Lsi Soultions, Inc. Instrument for surgically cutting tissue and method of use
AU2003223284C1 (en) 2003-03-13 2010-09-16 Covidien Ag Bipolar concentric electrode assembly for soft tissue fusion
DE10324844A1 (en) * 2003-04-01 2004-12-23 Tuebingen Scientific Surgical Products Gmbh Surgical instrument with instrument handle and zero point adjustment
US7753909B2 (en) 2003-05-01 2010-07-13 Covidien Ag Electrosurgical instrument which reduces thermal damage to adjacent tissue
US7160299B2 (en) 2003-05-01 2007-01-09 Sherwood Services Ag Method of fusing biomaterials with radiofrequency energy
ES2368488T3 (en) 2003-05-15 2011-11-17 Covidien Ag FABRIC SEALER WITH VARIABLE BUMPER MEMBERS SELECTIVELY AND NON-DRIVING.
US7857812B2 (en) 2003-06-13 2010-12-28 Covidien Ag Vessel sealer and divider having elongated knife stroke and safety for cutting mechanism
US7156846B2 (en) 2003-06-13 2007-01-02 Sherwood Services Ag Vessel sealer and divider for use with small trocars and cannulas
USD956973S1 (en) 2003-06-13 2022-07-05 Covidien Ag Movable handle for endoscopic vessel sealer and divider
US7150749B2 (en) 2003-06-13 2006-12-19 Sherwood Services Ag Vessel sealer and divider having elongated knife stroke and safety cutting mechanism
US8216252B2 (en) 2004-05-07 2012-07-10 Usgi Medical, Inc. Tissue manipulation and securement system
US8764765B2 (en) * 2003-09-23 2014-07-01 Covidien Lp Laparoscopic instrument and related surgical method
US20050070935A1 (en) * 2003-09-30 2005-03-31 Ortiz Mark S. Single lumen access deployable ring for intralumenal anastomosis
US8211142B2 (en) 2003-09-30 2012-07-03 Ortiz Mark S Method for hybrid gastro-jejunostomy
US7998112B2 (en) 2003-09-30 2011-08-16 Abbott Cardiovascular Systems Inc. Deflectable catheter assembly and method of making same
US7452363B2 (en) * 2003-09-30 2008-11-18 Ethicon Endo-Surgery, Inc. Applier for fastener for single lumen access anastomosis
US9848938B2 (en) 2003-11-13 2017-12-26 Covidien Ag Compressible jaw configuration with bipolar RF output electrodes for soft tissue fusion
US7736372B2 (en) * 2003-11-13 2010-06-15 Usgi Medical, Inc. Apparatus and methods for endoscopic suturing
US7367976B2 (en) 2003-11-17 2008-05-06 Sherwood Services Ag Bipolar forceps having monopolar extension
US7131970B2 (en) 2003-11-19 2006-11-07 Sherwood Services Ag Open vessel sealing instrument with cutting mechanism
US7500975B2 (en) 2003-11-19 2009-03-10 Covidien Ag Spring loaded reciprocating tissue cutting mechanism in a forceps-style electrosurgical instrument
US7811283B2 (en) 2003-11-19 2010-10-12 Covidien Ag Open vessel sealing instrument with hourglass cutting mechanism and over-ratchet safety
JP4540328B2 (en) * 2003-11-19 2010-09-08 カール事務器株式会社 Multi-function drilling device
US7442193B2 (en) 2003-11-20 2008-10-28 Covidien Ag Electrically conductive/insulative over-shoe for tissue fusion
US7347863B2 (en) 2004-05-07 2008-03-25 Usgi Medical, Inc. Apparatus and methods for manipulating and securing tissue
US7361180B2 (en) 2004-05-07 2008-04-22 Usgi Medical, Inc. Apparatus for manipulating and securing tissue
US20050251189A1 (en) * 2004-05-07 2005-11-10 Usgi Medical Inc. Multi-position tissue manipulation assembly
US7780662B2 (en) 2004-03-02 2010-08-24 Covidien Ag Vessel sealing system using capacitive RF dielectric heating
US8100822B2 (en) 2004-03-16 2012-01-24 Macroplata Systems, Llc Anoscope for treating hemorrhoids without the trauma of cutting or the use of an endoscope
US20050272977A1 (en) * 2004-04-14 2005-12-08 Usgi Medical Inc. Methods and apparatus for performing endoluminal procedures
US8512229B2 (en) * 2004-04-14 2013-08-20 Usgi Medical Inc. Method and apparatus for obtaining endoluminal access
US8277373B2 (en) 2004-04-14 2012-10-02 Usgi Medical, Inc. Methods and apparaus for off-axis visualization
US8562516B2 (en) * 2004-04-14 2013-10-22 Usgi Medical Inc. Methods and apparatus for obtaining endoluminal access
US8444657B2 (en) 2004-05-07 2013-05-21 Usgi Medical, Inc. Apparatus and methods for rapid deployment of tissue anchors
US8257394B2 (en) 2004-05-07 2012-09-04 Usgi Medical, Inc. Apparatus and methods for positioning and securing anchors
US7736374B2 (en) 2004-05-07 2010-06-15 Usgi Medical, Inc. Tissue manipulation and securement system
US20050251091A1 (en) * 2004-05-10 2005-11-10 Usgi Medical Inc. Apparatus and methods for transgastric tissue manipulation
DE102004030030A1 (en) * 2004-05-18 2005-12-15 Erbe Elektromedizin Gmbh Handle for a surgical instrument
US20060020274A1 (en) * 2004-07-23 2006-01-26 Usgi Medical Inc. Manipulatable grasping needle
US7195631B2 (en) 2004-09-09 2007-03-27 Sherwood Services Ag Forceps with spring loaded end effector assembly
US7540872B2 (en) 2004-09-21 2009-06-02 Covidien Ag Articulating bipolar electrosurgical instrument
US7955332B2 (en) 2004-10-08 2011-06-07 Covidien Ag Mechanism for dividing tissue in a hemostat-style instrument
US7909823B2 (en) 2005-01-14 2011-03-22 Covidien Ag Open vessel sealing instrument
US7686804B2 (en) 2005-01-14 2010-03-30 Covidien Ag Vessel sealer and divider with rotating sealer and cutter
US7491202B2 (en) 2005-03-31 2009-02-17 Covidien Ag Electrosurgical forceps with slow closure sealing plates and method of sealing tissue
US9504461B2 (en) * 2005-05-20 2016-11-29 Neotract, Inc. Anchor delivery system
US9585651B2 (en) 2005-05-26 2017-03-07 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US8298291B2 (en) 2005-05-26 2012-10-30 Usgi Medical, Inc. Methods and apparatus for securing and deploying tissue anchors
US8500756B2 (en) * 2005-06-13 2013-08-06 Ethicon Endo. Surgery, Inc. Quick load mechanism for a surgical suturing apparatus
US20060287641A1 (en) * 2005-06-16 2006-12-21 Alfred Perlin Laparoscopic surgical instrument for in situ tool exchange
JP4436793B2 (en) * 2005-08-01 2010-03-24 オリンパスメディカルシステムズ株式会社 Endoscopic treatment tool
US7879035B2 (en) 2005-09-30 2011-02-01 Covidien Ag Insulating boot for electrosurgical forceps
US7922953B2 (en) 2005-09-30 2011-04-12 Covidien Ag Method for manufacturing an end effector assembly
US7722607B2 (en) 2005-09-30 2010-05-25 Covidien Ag In-line vessel sealer and divider
CA2561034C (en) 2005-09-30 2014-12-09 Sherwood Services Ag Flexible endoscopic catheter with an end effector for coagulating and transfecting tissue
US7789878B2 (en) 2005-09-30 2010-09-07 Covidien Ag In-line vessel sealer and divider
EP2308406B1 (en) 2005-09-30 2012-12-12 Covidien AG Insulating boot for electrosurgical forceps
US8241282B2 (en) 2006-01-24 2012-08-14 Tyco Healthcare Group Lp Vessel sealing cutting assemblies
US8882766B2 (en) 2006-01-24 2014-11-11 Covidien Ag Method and system for controlling delivery of energy to divide tissue
US8298232B2 (en) 2006-01-24 2012-10-30 Tyco Healthcare Group Lp Endoscopic vessel sealer and divider for large tissue structures
US8734443B2 (en) 2006-01-24 2014-05-27 Covidien Lp Vessel sealer and divider for large tissue structures
US8726909B2 (en) 2006-01-27 2014-05-20 Usgi Medical, Inc. Methods and apparatus for revision of obesity procedures
US7918783B2 (en) * 2006-03-22 2011-04-05 Boston Scientific Scimed, Inc. Endoscope working channel with multiple functionality
US7670351B2 (en) * 2006-05-20 2010-03-02 Darrell Hartwick Medical device using beam construction and methods
US9770230B2 (en) 2006-06-01 2017-09-26 Maquet Cardiovascular Llc Endoscopic vessel harvesting system components
US7776037B2 (en) 2006-07-07 2010-08-17 Covidien Ag System and method for controlling electrode gap during tissue sealing
US20100063437A1 (en) * 2006-07-12 2010-03-11 Nelson Drew V Multifunctional surgical instrument
US8597297B2 (en) 2006-08-29 2013-12-03 Covidien Ag Vessel sealing instrument with multiple electrode configurations
US8070746B2 (en) 2006-10-03 2011-12-06 Tyco Healthcare Group Lp Radiofrequency fusion of cardiac tissue
AU2007307024B2 (en) 2006-10-05 2013-06-06 Covidien Lp Flexible endoscopic stitching devices
US8226667B2 (en) 2006-10-05 2012-07-24 Tyco Healthcare Group Lp Axial stitching device
WO2008045374A2 (en) * 2006-10-05 2008-04-17 Tyco Healthcare Group Lp Handle assembly for articulated endoscopic instruments
JP5143840B2 (en) 2006-10-06 2013-02-13 タイコ ヘルスケア グループ リミテッド パートナーシップ Endoscopic vessel sealer and divider with flexible articulation shaft
US8475453B2 (en) 2006-10-06 2013-07-02 Covidien Lp Endoscopic vessel sealer and divider having a flexible articulating shaft
US8715270B2 (en) * 2006-12-01 2014-05-06 Boston Scientific Scimed, Inc. Multi-part instrument systems and methods
US8292801B2 (en) * 2006-12-22 2012-10-23 Olympus Medical Systems Corp. Surgical treatment apparatus
US7918785B2 (en) * 2007-01-17 2011-04-05 Olympus Medical Systems Corp. Medical apparatus, treatment instrument for endoscope and endoscope apparatus
US7655004B2 (en) * 2007-02-15 2010-02-02 Ethicon Endo-Surgery, Inc. Electroporation ablation apparatus, system, and method
USD649249S1 (en) 2007-02-15 2011-11-22 Tyco Healthcare Group Lp End effectors of an elongated dissecting and dividing instrument
US7815662B2 (en) 2007-03-08 2010-10-19 Ethicon Endo-Surgery, Inc. Surgical suture anchors and deployment device
EP2120728B1 (en) 2007-03-15 2020-04-15 Boss Instruments, Ltd., Inc. Replaceable tip suturing device and system for use with differing needles
US8852216B2 (en) 2007-03-23 2014-10-07 Ethicon Endo-Surgery, Inc. Tissue approximation methods
US8267935B2 (en) 2007-04-04 2012-09-18 Tyco Healthcare Group Lp Electrosurgical instrument reducing current densities at an insulator conductor junction
US8075572B2 (en) 2007-04-26 2011-12-13 Ethicon Endo-Surgery, Inc. Surgical suturing apparatus
US8100922B2 (en) 2007-04-27 2012-01-24 Ethicon Endo-Surgery, Inc. Curved needle suturing tool
US8262655B2 (en) 2007-11-21 2012-09-11 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8579897B2 (en) 2007-11-21 2013-11-12 Ethicon Endo-Surgery, Inc. Bipolar forceps
US8568410B2 (en) 2007-08-31 2013-10-29 Ethicon Endo-Surgery, Inc. Electrical ablation surgical instruments
EP2197363B1 (en) 2007-09-21 2016-11-02 Covidien LP Surgical device
EP3097869B1 (en) 2007-09-21 2020-03-11 Covidien LP Surgical device
AU2008221509B2 (en) 2007-09-28 2013-10-10 Covidien Lp Dual durometer insulating boot for electrosurgical forceps
US8267936B2 (en) 2007-09-28 2012-09-18 Tyco Healthcare Group Lp Insulating mechanically-interfaced adhesive for electrosurgical forceps
US8235993B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with exohinged structure
US8235992B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Insulating boot with mechanical reinforcement for electrosurgical forceps
US9023043B2 (en) 2007-09-28 2015-05-05 Covidien Lp Insulating mechanically-interfaced boot and jaws for electrosurgical forceps
US8251996B2 (en) 2007-09-28 2012-08-28 Tyco Healthcare Group Lp Insulating sheath for electrosurgical forceps
US8236025B2 (en) 2007-09-28 2012-08-07 Tyco Healthcare Group Lp Silicone insulated electrosurgical forceps
US8221416B2 (en) 2007-09-28 2012-07-17 Tyco Healthcare Group Lp Insulating boot for electrosurgical forceps with thermoplastic clevis
US20090112059A1 (en) 2007-10-31 2009-04-30 Nobis Rudolph H Apparatus and methods for closing a gastrotomy
US8480657B2 (en) 2007-10-31 2013-07-09 Ethicon Endo-Surgery, Inc. Detachable distal overtube section and methods for forming a sealable opening in the wall of an organ
US9192376B2 (en) * 2008-01-04 2015-11-24 Luis Jose Almodovar Rotational driver
US8764748B2 (en) 2008-02-06 2014-07-01 Covidien Lp End effector assembly for electrosurgical device and method for making the same
US8623276B2 (en) 2008-02-15 2014-01-07 Covidien Lp Method and system for sterilizing an electrosurgical instrument
US8388646B2 (en) * 2008-02-22 2013-03-05 Covidien Lp Monocoque jaw design
US8262680B2 (en) 2008-03-10 2012-09-11 Ethicon Endo-Surgery, Inc. Anastomotic device
US8864776B2 (en) 2008-04-11 2014-10-21 Covidien Lp Deployment system for surgical suture
US8114072B2 (en) 2008-05-30 2012-02-14 Ethicon Endo-Surgery, Inc. Electrical ablation device
US8317806B2 (en) 2008-05-30 2012-11-27 Ethicon Endo-Surgery, Inc. Endoscopic suturing tension controlling and indication devices
US8679003B2 (en) 2008-05-30 2014-03-25 Ethicon Endo-Surgery, Inc. Surgical device and endoscope including same
US8771260B2 (en) 2008-05-30 2014-07-08 Ethicon Endo-Surgery, Inc. Actuating and articulating surgical device
US8652150B2 (en) 2008-05-30 2014-02-18 Ethicon Endo-Surgery, Inc. Multifunction surgical device
US8070759B2 (en) 2008-05-30 2011-12-06 Ethicon Endo-Surgery, Inc. Surgical fastening device
US8906035B2 (en) 2008-06-04 2014-12-09 Ethicon Endo-Surgery, Inc. Endoscopic drop off bag
US8403926B2 (en) 2008-06-05 2013-03-26 Ethicon Endo-Surgery, Inc. Manually articulating devices
DE202008007775U1 (en) * 2008-06-11 2008-08-07 Ovesco Endoscopy Gmbh Medical gripping device
US20110040308A1 (en) 2008-06-13 2011-02-17 Ramiro Cabrera Endoscopic Stitching Devices
US8628545B2 (en) 2008-06-13 2014-01-14 Covidien Lp Endoscopic stitching devices
US11812951B2 (en) 2008-06-17 2023-11-14 Apollo Endosurgery Us, Inc. Endoscopic needle assembly
JP5763531B2 (en) 2008-06-17 2015-08-12 アポロ エンドサージェリー,インコーポレイティド Endoscopic suture system
US9486126B2 (en) 2008-06-17 2016-11-08 Apollo Endosurgery, Inc. Endoscopic helix tissue grasping device
US8679136B2 (en) 2008-06-17 2014-03-25 Apollo Endosurgery, Inc. Needle capture device
US8361112B2 (en) 2008-06-27 2013-01-29 Ethicon Endo-Surgery, Inc. Surgical suture arrangement
US8262563B2 (en) 2008-07-14 2012-09-11 Ethicon Endo-Surgery, Inc. Endoscopic translumenal articulatable steerable overtube
US8888792B2 (en) 2008-07-14 2014-11-18 Ethicon Endo-Surgery, Inc. Tissue apposition clip application devices and methods
EP2337488B1 (en) 2008-07-18 2016-05-25 Boston Scientific Scimed, Inc. Endoscope with guide
US8469956B2 (en) 2008-07-21 2013-06-25 Covidien Lp Variable resistor jaw
US8529437B2 (en) 2008-08-06 2013-09-10 Encision, Inc. Multifunctional surgical instrument with flexible end effector tools
US8211125B2 (en) 2008-08-15 2012-07-03 Ethicon Endo-Surgery, Inc. Sterile appliance delivery device for endoscopic procedures
US8162973B2 (en) 2008-08-15 2012-04-24 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US8257387B2 (en) 2008-08-15 2012-09-04 Tyco Healthcare Group Lp Method of transferring pressure in an articulating surgical instrument
US9603652B2 (en) 2008-08-21 2017-03-28 Covidien Lp Electrosurgical instrument including a sensor
US8529563B2 (en) 2008-08-25 2013-09-10 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8784417B2 (en) 2008-08-28 2014-07-22 Covidien Lp Tissue fusion jaw angle improvement
US8317787B2 (en) 2008-08-28 2012-11-27 Covidien Lp Tissue fusion jaw angle improvement
US8795274B2 (en) 2008-08-28 2014-08-05 Covidien Lp Tissue fusion jaw angle improvement
US8241204B2 (en) 2008-08-29 2012-08-14 Ethicon Endo-Surgery, Inc. Articulating end cap
US8480689B2 (en) 2008-09-02 2013-07-09 Ethicon Endo-Surgery, Inc. Suturing device
US8409200B2 (en) 2008-09-03 2013-04-02 Ethicon Endo-Surgery, Inc. Surgical grasping device
US8114119B2 (en) 2008-09-09 2012-02-14 Ethicon Endo-Surgery, Inc. Surgical grasping device
US8303582B2 (en) 2008-09-15 2012-11-06 Tyco Healthcare Group Lp Electrosurgical instrument having a coated electrode utilizing an atomic layer deposition technique
WO2010035953A2 (en) * 2008-09-23 2010-04-01 (주)트리플씨메디칼 Anastomotic device for a tubular organ
US8535312B2 (en) 2008-09-25 2013-09-17 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US9375254B2 (en) 2008-09-25 2016-06-28 Covidien Lp Seal and separate algorithm
US8968314B2 (en) 2008-09-25 2015-03-03 Covidien Lp Apparatus, system and method for performing an electrosurgical procedure
US8337394B2 (en) 2008-10-01 2012-12-25 Ethicon Endo-Surgery, Inc. Overtube with expandable tip
US8142473B2 (en) 2008-10-03 2012-03-27 Tyco Healthcare Group Lp Method of transferring rotational motion in an articulating surgical instrument
US8469957B2 (en) 2008-10-07 2013-06-25 Covidien Lp Apparatus, system, and method for performing an electrosurgical procedure
US8636761B2 (en) 2008-10-09 2014-01-28 Covidien Lp Apparatus, system, and method for performing an endoscopic electrosurgical procedure
US8016827B2 (en) 2008-10-09 2011-09-13 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US8486107B2 (en) 2008-10-20 2013-07-16 Covidien Lp Method of sealing tissue using radiofrequency energy
US8157834B2 (en) 2008-11-25 2012-04-17 Ethicon Endo-Surgery, Inc. Rotational coupling device for surgical instrument with flexible actuators
US8197479B2 (en) 2008-12-10 2012-06-12 Tyco Healthcare Group Lp Vessel sealer and divider
US8172772B2 (en) 2008-12-11 2012-05-08 Ethicon Endo-Surgery, Inc. Specimen retrieval device
US8828031B2 (en) 2009-01-12 2014-09-09 Ethicon Endo-Surgery, Inc. Apparatus for forming an anastomosis
US8361066B2 (en) 2009-01-12 2013-01-29 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8114122B2 (en) 2009-01-13 2012-02-14 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
US9226772B2 (en) 2009-01-30 2016-01-05 Ethicon Endo-Surgery, Inc. Surgical device
US8252057B2 (en) 2009-01-30 2012-08-28 Ethicon Endo-Surgery, Inc. Surgical access device
US8037591B2 (en) 2009-02-02 2011-10-18 Ethicon Endo-Surgery, Inc. Surgical scissors
JP5431749B2 (en) 2009-03-04 2014-03-05 テルモ株式会社 Medical manipulator
AU2010228986B2 (en) 2009-03-23 2015-03-26 Linvatec Corporation Suture passing apparatus and method
US8187273B2 (en) 2009-05-07 2012-05-29 Tyco Healthcare Group Lp Apparatus, system, and method for performing an electrosurgical procedure
USD708746S1 (en) 2009-06-10 2014-07-08 Covidien Lp Handle for surgical device
US8246618B2 (en) 2009-07-08 2012-08-21 Tyco Healthcare Group Lp Electrosurgical jaws with offset knife
US8696690B2 (en) * 2009-09-01 2014-04-15 Luis Jose Almodovar Continuous driver with changeable parameters
US8133254B2 (en) 2009-09-18 2012-03-13 Tyco Healthcare Group Lp In vivo attachable and detachable end effector assembly and laparoscopic surgical instrument and methods therefor
US8112871B2 (en) 2009-09-28 2012-02-14 Tyco Healthcare Group Lp Method for manufacturing electrosurgical seal plates
US8490713B2 (en) 2009-10-06 2013-07-23 Covidien Lp Handle assembly for endoscopic suturing device
US20110098704A1 (en) 2009-10-28 2011-04-28 Ethicon Endo-Surgery, Inc. Electrical ablation devices
US8608652B2 (en) 2009-11-05 2013-12-17 Ethicon Endo-Surgery, Inc. Vaginal entry surgical devices, kit, system, and method
US8979884B2 (en) 2009-12-15 2015-03-17 Cornell University Method and apparatus for stabilizing, straightening, expanding and/or flattening the side wall of a body lumen and/or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same
US10149601B2 (en) 2009-12-15 2018-12-11 Lumendi Ltd. Method and apparatus for manipulating the side wall of a body lumen or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same
US11877722B2 (en) 2009-12-15 2024-01-23 Cornell University Method and apparatus for manipulating the side wall of a body lumen or body cavity
US10485401B2 (en) 2009-12-15 2019-11-26 Lumendi Ltd. Method and apparatus for manipulating the side wall of a body lumen or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same
US9986893B2 (en) 2009-12-15 2018-06-05 Cornell University Method and apparatus for manipulating the side wall of a body lumen or body cavity so as to provide increased visualization of the same and/or increased access to the same, and/or for stabilizing instruments relative to the same
US9565998B2 (en) * 2009-12-16 2017-02-14 Boston Scientific Scimed, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US10758116B2 (en) 2009-12-16 2020-09-01 Boston Scientific Scimed, Inc. System for a minimally-invasive, operative gastrointestinal treatment
US11344285B2 (en) * 2009-12-16 2022-05-31 Boston Scientific Scimed, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US10966701B2 (en) 2009-12-16 2021-04-06 Boston Scientific Scimed, Inc. Tissue retractor for minimally invasive surgery
USRE48850E1 (en) * 2009-12-16 2021-12-14 Boston Scientific Scimed, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US9186131B2 (en) 2009-12-16 2015-11-17 Macroplata, Inc. Multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
WO2011084616A2 (en) 2009-12-16 2011-07-14 Macroplata, Inc. Arrangements and methods for effecting an endoluminal anatomical structure
US10595711B2 (en) 2009-12-16 2020-03-24 Boston Scientific Scimed, Inc. System for a minimally-invasive, operative gastrointestinal treatment
US8932211B2 (en) 2012-06-22 2015-01-13 Macroplata, Inc. Floating, multi-lumen-catheter retractor system for a minimally-invasive, operative gastrointestinal treatment
US10531869B2 (en) 2009-12-16 2020-01-14 Boston Scientific Scimed, Inc. Tissue retractor for minimally invasive surgery
US8496574B2 (en) 2009-12-17 2013-07-30 Ethicon Endo-Surgery, Inc. Selectively positionable camera for surgical guide tube assembly
US8353487B2 (en) 2009-12-17 2013-01-15 Ethicon Endo-Surgery, Inc. User interface support devices for endoscopic surgical instruments
US9028483B2 (en) 2009-12-18 2015-05-12 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US8506564B2 (en) 2009-12-18 2013-08-13 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US9005198B2 (en) 2010-01-29 2015-04-14 Ethicon Endo-Surgery, Inc. Surgical instrument comprising an electrode
US20110230711A1 (en) * 2010-03-16 2011-09-22 Kano Akihito Endoscopic Surgical Instrument
US8540749B2 (en) 2010-06-02 2013-09-24 Covidien Lp Apparatus for performing an electrosurgical procedure
US8491626B2 (en) 2010-06-02 2013-07-23 Covidien Lp Apparatus for performing an electrosurgical procedure
WO2011163634A1 (en) * 2010-06-25 2011-12-29 Suturenetics, Inc. Endoscopic suturing device, system and method
WO2012074564A1 (en) 2010-12-02 2012-06-07 Freehand Endoscopic Devices, Inc. Surgical tool
US9113940B2 (en) 2011-01-14 2015-08-25 Covidien Lp Trigger lockout and kickback mechanism for surgical instruments
US10092291B2 (en) 2011-01-25 2018-10-09 Ethicon Endo-Surgery, Inc. Surgical instrument with selectively rigidizable features
US8986287B2 (en) 2011-02-14 2015-03-24 Adrian E. Park Adjustable laparoscopic instrument handle
US8968340B2 (en) 2011-02-23 2015-03-03 Covidien Lp Single actuating jaw flexible endolumenal stitching device
US9254169B2 (en) 2011-02-28 2016-02-09 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9233241B2 (en) 2011-02-28 2016-01-12 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
US9314620B2 (en) 2011-02-28 2016-04-19 Ethicon Endo-Surgery, Inc. Electrical ablation devices and methods
WO2012125785A1 (en) 2011-03-17 2012-09-20 Ethicon Endo-Surgery, Inc. Hand held surgical device for manipulating an internal magnet assembly within a patient
US8852185B2 (en) 2011-05-19 2014-10-07 Covidien Lp Apparatus for performing an electrosurgical procedure
CA2838722C (en) 2011-06-08 2019-04-02 Suturenetics, Inc. Offset jaw suturing device, system, and methods
KR101427330B1 (en) * 2011-11-23 2014-08-06 주식회사 리브스메드 Differential component
JP6475987B2 (en) 2011-11-23 2019-02-27 リブスメド インコーポレーテッド Surgical instrument
USD680220S1 (en) 2012-01-12 2013-04-16 Coviden IP Slider handle for laparoscopic device
US8986199B2 (en) 2012-02-17 2015-03-24 Ethicon Endo-Surgery, Inc. Apparatus and methods for cleaning the lens of an endoscope
US9265514B2 (en) 2012-04-17 2016-02-23 Miteas Ltd. Manipulator for grasping tissue
US9451946B2 (en) * 2012-04-18 2016-09-27 Ethicon Endo-Surgery, Llc Laparoscopic suturing instrument with parallel concentric shaft pairs
US9585655B2 (en) * 2012-04-18 2017-03-07 Ethicon Endo-Surgery, Llc Laparoscopic suturing instrument with multi-drive sequenced transmission
US9408610B2 (en) 2012-05-04 2016-08-09 Covidien Lp Surgical clip applier with dissector
US9427255B2 (en) 2012-05-14 2016-08-30 Ethicon Endo-Surgery, Inc. Apparatus for introducing a steerable camera assembly into a patient
WO2013176167A1 (en) * 2012-05-25 2013-11-28 富士フイルム株式会社 Endoscopic surgery device and outer sleeve tube
US8679140B2 (en) 2012-05-30 2014-03-25 Covidien Lp Surgical clamping device with ratcheting grip lock
US9078662B2 (en) 2012-07-03 2015-07-14 Ethicon Endo-Surgery, Inc. Endoscopic cap electrode and method for using the same
US9545290B2 (en) 2012-07-30 2017-01-17 Ethicon Endo-Surgery, Inc. Needle probe guide
US9572623B2 (en) 2012-08-02 2017-02-21 Ethicon Endo-Surgery, Inc. Reusable electrode and disposable sheath
US10314649B2 (en) 2012-08-02 2019-06-11 Ethicon Endo-Surgery, Inc. Flexible expandable electrode and method of intraluminal delivery of pulsed power
US9277957B2 (en) 2012-08-15 2016-03-08 Ethicon Endo-Surgery, Inc. Electrosurgical devices and methods
US9173655B2 (en) 2012-12-13 2015-11-03 Ethicon Endo-Surgery, Inc. Needle driver and pawl mechanism for circular needle applier
US10098527B2 (en) 2013-02-27 2018-10-16 Ethidcon Endo-Surgery, Inc. System for performing a minimally invasive surgical procedure
US9579090B1 (en) * 2013-02-27 2017-02-28 The Administrators Of The Tulane Educational Fund Surgical instrument with multiple instrument interchangeability
US9125645B1 (en) 2013-03-11 2015-09-08 Ethicon Endo-Surgery, Inc. Reciprocating needle drive without cables
US9375212B2 (en) 2014-06-06 2016-06-28 Ethicon Endo-Surgery, Llc Circular needle applier with cleats
USD771811S1 (en) 2013-03-15 2016-11-15 Ethicon Endo-Surgery, Llc Suture tray
US9788830B2 (en) 2014-06-06 2017-10-17 Ethicon Llc Needle cartridge with cage
JP6023872B2 (en) * 2013-03-29 2016-11-09 富士フイルム株式会社 Endoscopic surgery device
CN109938787A (en) * 2013-06-09 2019-06-28 波士顿科学希梅德公司 Multicarity catheter type retractor systems for Minimally Invasive Surgery gastro-intestinal therapeutic
WO2015017992A1 (en) 2013-08-07 2015-02-12 Covidien Lp Surgical forceps
US9254129B2 (en) * 2013-09-12 2016-02-09 Kuan-Ju Chen Surgery automatic suturing and knot tying apparatus
KR101584766B1 (en) 2014-04-24 2016-01-12 주식회사 리브스메드 Surgical instrument
US9468434B2 (en) 2014-06-03 2016-10-18 Covidien Lp Stitching end effector
US9526495B2 (en) 2014-06-06 2016-12-27 Ethicon Endo-Surgery, Llc Articulation control for surgical instruments
USD745146S1 (en) 2014-06-06 2015-12-08 Ethicon Endo-Surgery, Inc. Surgical suturing device
US9636103B2 (en) 2014-08-28 2017-05-02 Covidien Lp Surgical suturing instrument
US10709467B2 (en) 2014-10-02 2020-07-14 Livsmed Inc. Surgical instrument
KR102153407B1 (en) 2015-02-17 2020-09-08 주식회사 리브스메드 Surgical instrument
US11344381B2 (en) 2015-02-17 2022-05-31 Livsmed Inc. Instrument for surgery
US11896336B2 (en) 2015-02-17 2024-02-13 Livsmed Inc. Instrument for surgery
DE102015103913A1 (en) * 2015-03-17 2016-09-22 Richard Wolf Gmbh Hollow shaft instrument and in particular medical endoscopic hollow shaft instrument
WO2016152626A1 (en) * 2015-03-23 2016-09-29 富士フイルム株式会社 Endoscopic surgical device, and mantle tube
US10398459B2 (en) 2015-04-02 2019-09-03 Aod Holdings Llc Combination device for endoscopic and arthroscopic surgical procedures
US10022120B2 (en) 2015-05-26 2018-07-17 Ethicon Llc Surgical needle with recessed features
US10092286B2 (en) 2015-05-27 2018-10-09 Covidien Lp Suturing loading unit
NL2015110B1 (en) * 2015-07-07 2017-02-01 Mellon Medical B V Surgical suture apparatus, coupling unit, and method to provide a surgical suture apparatus.
WO2017031712A1 (en) 2015-08-26 2017-03-02 Covidien Lp Electrosurgical end effector assemblies and electrosurgical forceps configured to reduce thermal spread
US10213250B2 (en) 2015-11-05 2019-02-26 Covidien Lp Deployment and safety mechanisms for surgical instruments
USD800306S1 (en) 2015-12-10 2017-10-17 Ethicon Llc Surgical suturing device
CN109561846B (en) 2016-03-11 2022-01-28 锐凌公司 Arthroscopic devices and methods
US10595889B2 (en) 2016-04-11 2020-03-24 RELIGN Corporation Arthroscopic devices and methods
US11172953B2 (en) 2016-04-11 2021-11-16 RELIGN Corporation Arthroscopic devices and methods
US10542970B2 (en) 2016-05-31 2020-01-28 Covidien Lp Endoscopic stitching device
US11141147B2 (en) 2016-08-10 2021-10-12 Apollo Endosurgery Us, Inc. Endoscopic suturing system having external instrument channel
US11051800B2 (en) 2016-08-10 2021-07-06 Apollo Endosurgery Us, Inc. Endoscopic suturing system having external instrument channel
US9820736B1 (en) * 2016-12-27 2017-11-21 Peter Fan Laparoscopic suture loop maker
CN110087526B (en) 2016-12-30 2022-01-14 波士顿科学国际有限公司 System for minimally invasive treatment inside body cavity
USD865964S1 (en) 2017-01-05 2019-11-05 Ethicon Llc Handle for electrosurgical instrument
US10709439B2 (en) 2017-02-06 2020-07-14 Covidien Lp Endoscopic stitching device
JP7048861B2 (en) 2017-03-18 2022-04-06 ボストン サイエンティフィック サイムド,インコーポレイテッド Intraluminal minimally invasive treatment system
US11607227B2 (en) 2017-03-21 2023-03-21 Teleflex Medical Incorporated Surgical clip and clip applier
JP7159189B2 (en) 2017-03-21 2022-10-24 テレフレックス メディカル インコーポレイテッド Flexible stabilizing member for clip applier
JP7026127B2 (en) 2017-03-21 2022-02-25 テレフレックス メディカル インコーポレイテッド Clip applier with stabilizer
US10492811B2 (en) * 2017-04-27 2019-12-03 Slatr Surgical Holdings Llc Rotatable endoscopic instrument
US11166759B2 (en) 2017-05-16 2021-11-09 Covidien Lp Surgical forceps
BR102017016192B8 (en) * 2017-07-28 2021-08-24 Hospital Das Clinicas Da Faculdade De Medicina Da Univ De Sao Paulo Hcfmusp mechanical suture device for automated closure of the linea alba of the abdominal wall after incision by midline laparotomy
JP2020534931A (en) * 2017-09-26 2020-12-03 リライン コーポレーション Arthroscopic device and method
US10905411B2 (en) 2017-11-03 2021-02-02 Covidien Lp Surgical suturing and grasping device
KR102191482B1 (en) 2017-11-14 2020-12-15 주식회사 리브스메드 Roll Joint Member for Surgical instrument
US20190283075A1 (en) * 2018-03-14 2019-09-19 Solisto Auto Glass LLC Rotary Applicator Devices for Applying a Material to a Surface
US11547466B2 (en) * 2018-06-20 2023-01-10 Covidien Lp Visualization devices and methods for use in surgical procedures
US11197665B2 (en) 2018-08-06 2021-12-14 Covidien Lp Needle reload device for use with endostitch device
WO2020055797A1 (en) * 2018-09-10 2020-03-19 Activ Surgical, Inc. Laparoscopic device with suture cutter
US11219457B2 (en) 2018-10-11 2022-01-11 Covidien Lp Laparoscopic purse string suture device
USD895112S1 (en) 2018-11-15 2020-09-01 Ethicon Llc Laparoscopic bipolar electrosurgical device
WO2021062170A1 (en) * 2019-09-26 2021-04-01 Teleflex Medical Incorporated Clip applier
GB2588410A (en) * 2019-10-22 2021-04-28 Cmr Surgical Ltd Controlling a surgical instrument
US11832789B2 (en) 2019-12-13 2023-12-05 Boston Scientific Scimed, Inc. Devices, systems, and methods for minimally invasive surgery in a body lumen
DK3989844T3 (en) 2020-08-03 2023-10-30 Teleflex Life Sciences Ltd Handle and cartridge system for medical inventions
US11413034B2 (en) * 2020-10-13 2022-08-16 Olympus Corporation Method for closing wound
US20230100698A1 (en) * 2021-09-29 2023-03-30 Cilag Gmbh International Methods for Controlling Cooperative Surgical Instruments

Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5364408A (en) * 1992-09-04 1994-11-15 Laurus Medical Corporation Endoscopic suture system

Family Cites Families (102)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US919138A (en) * 1909-03-16 1909-04-20 Clarence A Drake Surgical needle.
US1037864A (en) * 1911-04-20 1912-09-10 John C Carlson Surgical-needle holder.
US1131163A (en) * 1913-06-30 1915-03-09 Edward W Saunders Surgical needle-holder.
US1155378A (en) * 1915-02-06 1915-10-05 Edwin H Steedman Needle-holder.
US1449087A (en) * 1921-12-05 1923-03-20 Edwin P Bugbee Suturing instrument
US1822330A (en) * 1930-01-13 1931-09-08 Ainslie George Suturing instrument
US1916722A (en) * 1931-06-15 1933-07-04 Frank M Ende Diathermy
US2213830A (en) * 1938-12-10 1940-09-03 Anastasi John Joseph Suturing and ligating instrument
US2580964A (en) * 1948-01-23 1952-01-01 Maja L Skaller Surgical suturing device
US2601564A (en) * 1950-07-08 1952-06-24 David P Smith Suturing device
US2646045A (en) * 1951-05-01 1953-07-21 Bruno S Priestley Mechanical suturing device
US2959172A (en) * 1957-08-27 1960-11-08 American Cystoscope Makers Inc Self-threading suturing instrument
US3090386A (en) * 1961-07-20 1963-05-21 Curtis Scott Company Surgical suturing instrument
US3139089A (en) * 1961-11-16 1964-06-30 George S Schwerin Needle manipulating device
US3349772A (en) * 1963-07-24 1967-10-31 C V Heljestrand Ab Needle holding instrument for applying continuous sutures
US3470875A (en) * 1966-10-06 1969-10-07 Alfred A Johnson Surgical clamping and suturing instrument
US3842840A (en) * 1973-05-07 1974-10-22 E Schweizer Suture applicator
US3946740A (en) * 1974-10-15 1976-03-30 Bassett John W Suturing device
US4109658A (en) * 1977-02-04 1978-08-29 Hughes Joe L Needle holding device with pick-up means
US4164225A (en) * 1977-12-28 1979-08-14 Johnson & Lorenz, Inc. Surgical suturing instrument
US4257420A (en) * 1979-05-22 1981-03-24 Olympus Optical Co., Ltd. Ring applicator with an endoscope
JPS57170239A (en) * 1981-04-13 1982-10-20 Janome Sewing Machine Co Ltd Holding of shuttle of suturing device for operation
SE441643B (en) * 1983-02-08 1985-10-28 Innova Ab suturing instrument
US4621640A (en) * 1984-01-09 1986-11-11 Mulhollan James S Mechanical needle carrier and method for its use
US4635638A (en) * 1984-02-07 1987-01-13 Galil Advanced Technologies Ltd. Power-driven gripping tool particularly useful as a suturing device
US5244948A (en) * 1988-06-30 1993-09-14 Ciba-Geigy Corporation Process for the stabilization of polyolefins
US4935027A (en) * 1989-08-21 1990-06-19 Inbae Yoon Surgical suture instrument with remotely controllable suture material advancement
US5037433A (en) * 1990-05-17 1991-08-06 Wilk Peter J Endoscopic suturing device and related method and suture
JP2545558Y2 (en) * 1990-10-23 1997-08-25 ジョンソン・エンド・ジョンソンメディカル株式会社 Deep suture instrument
US5211650A (en) * 1991-01-07 1993-05-18 Laparomed Corporation Dual function suturing device and method
US5100421A (en) * 1991-02-05 1992-03-31 Cyprus Endosurgical Tools, Inc. Christoudias curved needle suture assembly
US5181919A (en) * 1991-04-23 1993-01-26 Arieh Bergman Suture ligating device for use with an endoscope
US5147373A (en) * 1991-04-29 1992-09-15 Ferzli George S Laparoscopic instrument
US5171257A (en) * 1991-04-29 1992-12-15 Ferzli George S Laparoscopic instrument
US5209741A (en) * 1991-07-08 1993-05-11 Endomedix Corporation Surgical access device having variable post-insertion cross-sectional geometry
EP0595892B1 (en) * 1991-07-23 1995-12-20 Forschungszentrum Karlsruhe GmbH Surgical stitching instrument
US5234443A (en) * 1991-07-26 1993-08-10 The Regents Of The University Of California Endoscopic knot tying apparatus and methods
GB2260704B (en) * 1991-09-30 1995-08-23 Philip Richardson Suturing apparatus
AU656628B2 (en) * 1991-10-18 1995-02-09 United States Surgical Corporation Endoscopic surgical instrument for aspiration and irrigation
US5562703A (en) * 1994-06-14 1996-10-08 Desai; Ashvin H. Endoscopic surgical instrument
US5152769A (en) * 1991-11-04 1992-10-06 Will Baber Apparatus for laparoscopic suturing with improved suture needle
DE4137218C1 (en) * 1991-11-13 1993-02-11 Heidmueller, Harald, 5000 Koeln, De
US5281238A (en) * 1991-11-22 1994-01-25 Chin Albert K Endoscopic ligation instrument
US5300082A (en) * 1992-01-08 1994-04-05 Sharpe Endosurgical Corporation Endoneedle holder surgical instrument
US5261917A (en) * 1992-02-19 1993-11-16 Hasson Harrith M Suture tying forceps with a plurality of suture holders and method of tying a suture
US5403328A (en) * 1992-04-22 1995-04-04 United States Surgical Corporation Surgical apparatus and method for suturing body tissue
US5368601A (en) * 1992-04-30 1994-11-29 Lasersurge, Inc. Trocar wound closure device
US5336231A (en) * 1992-05-01 1994-08-09 Adair Edwin Lloyd Parallel channel fixation, repair and ligation suture device
US5364409A (en) * 1992-05-08 1994-11-15 Ethicon, Inc. Endoscopic needle holder
US5389098A (en) * 1992-05-19 1995-02-14 Olympus Optical Co., Ltd. Surgical device for stapling and/or fastening body tissues
US5305121A (en) * 1992-06-08 1994-04-19 Origin Medsystems, Inc. Stereoscopic endoscope system
US5395367A (en) * 1992-07-29 1995-03-07 Wilk; Peter J. Laparoscopic instrument with bendable shaft and removable actuator
US5308353A (en) * 1992-08-31 1994-05-03 Merrimac Industries, Inc. Surgical suturing device
US5540704A (en) * 1992-09-04 1996-07-30 Laurus Medical Corporation Endoscopic suture system
CA2106127A1 (en) * 1992-09-23 1994-03-24 Peter W.J. Hinchliffe Instrument for closing trocar puncture wounds
US5222508A (en) * 1992-10-09 1993-06-29 Osvaldo Contarini Method for suturing punctures of the human body
DE4304353A1 (en) * 1992-10-24 1994-04-28 Helmut Dipl Ing Wurster Suturing device used in endoscopic surgical operations - has helical needle with fixed non-traumatic thread held and rotated by rollers attached to instrument head extended into patients body.
US5336230A (en) * 1992-11-04 1994-08-09 Charles S. Taylor Endoscopic suture tying method
US5304185A (en) * 1992-11-04 1994-04-19 Unisurge, Inc. Needle holder
US5356424A (en) * 1993-02-05 1994-10-18 American Cyanamid Co. Laparoscopic suturing device
KR960700656A (en) * 1993-02-22 1996-02-24 알렌 제이. 스피겔 Laparoscopic dissection tension retractor device and method (A LAPAROSCOPIC DISSECTION TENSION RETRACTOR DEVICE AND METHOD)
US5374275A (en) * 1993-03-25 1994-12-20 Synvasive Technology, Inc. Surgical suturing device and method of use
DE4310582C1 (en) * 1993-03-31 1993-12-09 Strobel & Soehne Gmbh & Co J Surgical stitching machine with oscillating needle and grip - has tilting pivoting and sliding grip bar passing through opening forming bearing in front housing wall
DE4310555C1 (en) * 1993-03-31 1993-12-09 Strobel & Soehne Gmbh & Co J Surgical machine stitching tissue edges together - has forceps opening and shutting in synchronism with needle to hold edges together before puncturing
US5503634A (en) * 1993-04-28 1996-04-02 Christy; William J. Surgical stab wound closure device and method
US5462562A (en) * 1993-05-17 1995-10-31 Henry Ford Hospital Suture passer and method of using
US5520703A (en) * 1993-06-07 1996-05-28 Essig; Mitchell N. Laparoscopic deschamp and associated suturing technique
US5582617A (en) * 1993-07-21 1996-12-10 Charles H. Klieman Surgical instrument for endoscopic and general surgery
US5569269A (en) * 1993-07-26 1996-10-29 Innovasive Devices, Inc. Surgical grasping and suturing device and method
US5462561A (en) * 1993-08-05 1995-10-31 Voda; Jan K. Suture device
US5578048A (en) * 1993-09-15 1996-11-26 United States Surgical Corporation Manipulator apparatus
US5674230A (en) * 1993-10-08 1997-10-07 United States Surgical Corporation Surgical suturing apparatus with locking mechanisms
US5478344A (en) * 1993-10-08 1995-12-26 United States Surgical Corporation Surgical suturing apparatus with loading mechanism
US5470338A (en) * 1993-10-08 1995-11-28 United States Surgical Corporation Instrument for closing trocar puncture wounds
US5474568A (en) * 1993-10-08 1995-12-12 United States Surgical Corporation Instrument for closing trocar puncture wounds
US5468251A (en) * 1993-10-12 1995-11-21 Advanced Surgical, Inc. Surgical suturing device
US5632752A (en) * 1993-10-12 1997-05-27 Urohealth Systems, Inc. Surgical suturing device
US5397325A (en) * 1993-11-09 1995-03-14 Badiaco, Inc. Laparoscopic suturing device
DE4340056A1 (en) * 1993-11-24 1995-06-01 Delma Elektro Med App Laparoscopic surgical device
US5376096A (en) * 1993-12-17 1994-12-27 Vance Products Inc. Medical instrument for driving a suture needle
US5437681A (en) * 1994-01-13 1995-08-01 Suturtek Inc. Suturing instrument with thread management
JP3526609B2 (en) * 1994-03-31 2004-05-17 テルモ株式会社 Suture instrument
US5607435A (en) * 1994-05-23 1997-03-04 Memory Medical Systems, Inc. Instrument for endoscopic-type procedures
US5573542A (en) * 1994-08-17 1996-11-12 Tahoe Surgical Instruments-Puerto Rico Endoscopic suture placement tool
US5478345A (en) * 1994-08-19 1995-12-26 United States Surgical Corporation Mechanism for endoscopic suturing device
US5601575A (en) * 1994-09-02 1997-02-11 Ethicon Endo-Surgery, Inc. Needle driving device
US5562685A (en) * 1994-09-16 1996-10-08 General Surgical Innovations, Inc. Surgical instrument for placing suture or fasteners
US5609601A (en) * 1994-09-23 1997-03-11 United States Surgical Corporation Endoscopic surgical apparatus with rotation lock
US5496310A (en) * 1994-09-30 1996-03-05 Exconde; Primo D. Endoscopic cholangiogram guide instrument and method of use
US5480406A (en) * 1994-10-07 1996-01-02 United States Surgical Corporation Method of employing surgical suturing apparatus to tie knots
US5702407A (en) * 1994-11-29 1997-12-30 Olympus Optical Co., Ltd. Ligating apparatus
US5569270A (en) * 1994-12-13 1996-10-29 Weng; Edward E. Laparoscopic surgical instrument
US5713908A (en) 1995-01-09 1998-02-03 Jameel; Irfan Mufty Laparascopic suturing instrument
US5643292A (en) * 1995-01-10 1997-07-01 Applied Medical Resources Corporation Percutaneous suturing device
US5709694A (en) 1995-03-22 1998-01-20 Human Factors Industrial Design, Inc. Endoscopic intracorporeal suture tying aid
US5562686A (en) * 1995-04-19 1996-10-08 United States Surgical Corporation Apparaus and method for suturing body tissue
US5540705A (en) * 1995-05-19 1996-07-30 Suturtek, Inc. Suturing instrument with thread management
US5632751A (en) * 1995-07-28 1997-05-27 Piraka; Hadi A. Surgical suturing device
US5707379A (en) * 1995-10-20 1998-01-13 Coral Medical Method and apparatus for intracorporeal suturing
US5722990A (en) 1995-11-08 1998-03-03 Sugar Surgical Technologies, Inc. Tissue grasping device
US5810805A (en) 1996-02-09 1998-09-22 Conmed Corporation Bipolar surgical devices and surgical methods
US5709693A (en) 1996-02-20 1998-01-20 Cardiothoracic System, Inc. Stitcher

Patent Citations (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5364408A (en) * 1992-09-04 1994-11-15 Laurus Medical Corporation Endoscopic suture system

Cited By (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE19926555A1 (en) * 1999-06-11 2000-12-28 Storz Karl Gmbh & Co Kg Medical gripping instrument and method for using this gripping instrument
US6730109B2 (en) 1999-06-11 2004-05-04 Karl Storz Gmbh & Co. Kg Medical gripping instrument and method for using this medical gripping instrument
WO2012068004A1 (en) * 2010-11-15 2012-05-24 Ethicon Endo-Surgery, Inc. Laparoscopic suturing instrument with perpendicular eccentric needle motion
JP2014500756A (en) * 2010-11-15 2014-01-16 エシコン・エンド−サージェリィ・インコーポレイテッド Laparoscopic suturing instrument with vertical eccentric needle movement
US8702732B2 (en) 2010-11-15 2014-04-22 Ethicon Endo-Surgery, Inc. Laparoscopic suturing instrument with dual-action needle graspers
US8906043B2 (en) 2010-11-15 2014-12-09 Ethicon Endo-Surgery, Inc. Laparoscopic suturing instrument with perpendicular eccentric needle motion
US9833232B2 (en) 2010-11-15 2017-12-05 Ethicon Llc Laparoscopic suturing instrument with perpendicular eccentric needle motion
CN112312842A (en) * 2018-06-22 2021-02-02 波士顿科学医学有限公司 Tissue removal device

Also Published As

Publication number Publication date
AU8757998A (en) 1999-02-22
WO1999005974A9 (en) 1999-04-29
US5954731A (en) 1999-09-21

Similar Documents

Publication Publication Date Title
US5954731A (en) Surgical instrument with multiple rotatably mounted spreadable end effectors
US5993466A (en) Suturing instrument with multiple rotatably mounted spreadable needle holders
US5993467A (en) Suturing instrument with rotatably mounted spreadable needle holder
US5957937A (en) Suturing instrument with spreadable needle holder mounted for arcuate movement
US5984932A (en) Suturing instrument with one or more spreadable needle holders mounted for arcuate movement
US6080180A (en) Surgical instrument with rotatably mounted offset end effector and method of using the same
US6214028B1 (en) Surgical instrument with multiple rotatably mounted offset end effectors and method of using the same
US6099550A (en) Surgical instrument having jaws and an operating channel and method for use thereof
US5893863A (en) Surgical instrument with jaws and movable internal hook member for use thereof
US5922001A (en) Surgical instrument with jaws and a movable internal blade member and method for use thereof
US5984939A (en) Multifunctional grasping instrument with cutting member and operating channel for use in endoscopic and non-endoscopic procedures
US6126665A (en) Surgical instrument with arcuately movable offset end effectors and method of using the same
US5984938A (en) Surgical instrument with jaws and movable internal scissors and method for use thereof
US5797939A (en) Endoscopic scissors with longitudinal operating channel
AU742708B2 (en) Systems, methods, and instruments for minimally invasive surgery
US5797958A (en) Endoscopic grasping instrument with scissors
US5922002A (en) Surgical instrument with jaws and movable internal biopsy device and method for use thereof
AU710892B2 (en) Multi functional instrument with interchangeable operating units for performing endoscopic procedures
US6004332A (en) Suturing instrument with multiple rotatably mounted offset needle holders and method of using the same
KR101855568B1 (en) Minimally invasive surgical assembly and methods
US20220087665A1 (en) Articulating mechanism for the laparoscopic ablation device for blunt dissection
WO1999005976A1 (en) Surgical instrument with multiple spreadable end effectors mounted for arcuate movement
WO2000030524A2 (en) Surgical instrument with rotatably mounted offset end effector and method of using the same

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): AU CA JP US

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE

AK Designated states

Kind code of ref document: C2

Designated state(s): AU CA JP US

AL Designated countries for regional patents

Kind code of ref document: C2

Designated state(s): AT BE CH CY DE DK ES FI FR GB GR IE IT LU MC NL PT SE

COP Corrected version of pamphlet

Free format text: PAGES 1/7-7/7, DRAWINGS, REPLACED BY NEW PAGES 1/10-10/10; DUE TO LATE TRANSMITTAL BY THE RECEIVINGOFFICE

121 Ep: the epo has been informed by wipo that ep was designated in this application
NENP Non-entry into the national phase

Ref country code: JP

Ref document number: 1999511021

Format of ref document f/p: F

NENP Non-entry into the national phase

Ref country code: CA

122 Ep: pct application non-entry in european phase