Surgical Stapler with Terminal Staple Orientation Crossing Center Line

(19) TZZ¥__T

(11) EP 3 155 985 A1

(12) EUROPEAN PATENT APPLICATION

(43) Date of publication: (51) Int Cl.: 19.04.2017 Bulletin 2017/16 A61B 17/072 (2006.01)

(21) Application number: 16193975.6

(22) Date of filing: 14.10.2016

(84) Designated Contracting States: (71) Applicant: Ethicon Endo-Surgery, LLC AL AT BE BG CH CY CZ DE DK EE ES FI FR GB 00969 Guaynabo (PR) GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR (72) Inventors: Designated Extension States: • SCHEIB, Charles J. BA ME Cincinnati, OH 45242 (US) Designated Validation States: • SHELTON, IV, Frederick E. MA MD Cincinnati, OH 45242 (US)

(30) Priority: 15.10.2015 US 201514884096 (74) Representative: Carpmaels & Ransford LLP One Southampton Row London WC1B 5HA (GB)

(54) SURGICAL STAPLER WITH TERMINAL STAPLE ORIENTATION CROSSING CENTER LINE

(57) A surgical instrument includes a shaft assembly, tridge is received within the second jaw. The staple car- an end effector, and a staple cartridge. The end effector tridge includes a deck and a plurality of staples. The deck includes a first jaw and a second jaw. The first jaw in- has a plurality of staple openings. The staples are posi- cludes an anvil that is configured to form a plurality of tioned within respective staple openings. At least one of staples pressed against the anvil. The first and second the staple openings obliquely crosses a centerline of the jaws are configured to transition between an open con- end effector. figuration and a closed configuration. The staple car- EP 3 155 985 A1

Printed by Jouve, 75001 PARIS (FR) 1 EP 3 155 985 A1 2

Description Instrument Incorporating a Multistroke Firing Mechanism Having a Rotary Transmission," issued May 6, 2008; U.S. BACKGROUND Pat.No. 7,380,695, entitled "Surgical Stapling Instrument Having a Single Lockout Mechanism for Prevention of [0001] In some settings, endoscopic surgical instru- 5 Firing," issued June 3, 2008; U.S. Pat. No. 7,380,696, ments may be preferred over traditional open surgical entitled "Articulating Surgical Stapling Instrument Incor- devices since a smaller incision may reduce the post- porating a Two-Piece E-Beam Firing Mechanism," is- operative recovery time and complications. Consequent- sued June 3, 2008; U.S. Pat. No. 7,404,508, entitled "Sur- ly, some endoscopic surgical instruments may be suita- gical Stapling and Cutting Device," issued July 29, 2008; ble for placement of a distal end effector at a desired10 U.S. Pat. No. 7,434,715, entitled "Surgical Stapling In- surgical site through the cannula of a trocar. These distal strument Having Multistroke Firing with Opening Lock- end effectors may engage tissue in a number of ways to out," issued October 14, 2008; U.S. Pat. No. 7,721,930, achieve a diagnostic or therapeutic effect (e.g., endoc- entitled "Disposable Cartridge with Adhesive for Use with utter, grasper, cutter, stapler, clip applier, access device, a Stapling Device," issued May 25, 2010; U.S. Pat. No. drug/gene therapy delivery device, and energy delivery 15 8,408,439, entitled "Surgical Stapling Instrument with An device using ultrasonic vibration, RF, laser, etc.). Endo- Articulatable End Effector," issued April 2, 2013; and U.S. scopic surgical instruments may include a shaft between Pat. No. 8,453,914, entitled "Motor-Driven Surgical Cut- the end effector and a handle portion, which is manipu- ting Instrument with Electric Actuator Directional Control lated by the clinician. Such a shaft may enable insertion Assembly," issued June 4, 2013. to a desired depth and rotation about the longitudinal axis 20 [0003] While the surgical staplers referred to above are of the shaft, thereby facilitating positioning of the end described as being used in endoscopic procedures, it effector within the patient. Positioning of an end effector should be understood that such surgical staplers may may be further facilitated through inclusion of one or more also be used in open procedures and/or other non-en- articulation joints or features, enabling the end effector doscopic procedures. By way of example only, a surgical to be selectively articulated or otherwise deflected rela- 25 stapler may be inserted through a thoracotomy, and tive to the longitudinal axis of the shaft. thereby between a patient’s ribs, to reach one or more [0002] Examples of endoscopic surgical instruments organs in a thoracic surgical procedure that does not use include surgical staplers. Some such staplers are oper- a trocar as a conduit for the stapler. Such procedures able to clamp down on layers of tissue, cut through the may include the use of the stapler to sever and close a clamped layers of tissue, and drive staples through the 30 vessel leading to a lung. For instance, the vessels leading layers of tissue to substantially seal the severed layers to an organ may be severed and closed by a stapler be- of tissue together near the severed ends of the tissue fore removal of the organ from the thoracic cavity. Of layers. Merely exemplary surgical staplers are disclosed course, surgical staplers may be used in various other in U.S. Pat. No. 4,805,823, entitled "Pocket Configuration settings and procedures. for Internal Organ Staplers," issued February 21, 1989; 35 [0004] Examples of surgical staplers that may be par- U.S. Pat. No. 5,415,334, entitled "Surgical Stapler and ticularly suited or use through a thoracotomy are dis- Staple Cartridge," issued May 16, 1995; U.S. Pat. No. closed in U.S. Patent App. No. 14/810,786, entitled "Sur- 5,465,895, entitled "Surgical Stapler Instrument," issued gical Staple Cartridge with Compression Feature at Knife November 14, 1995; U.S. Pat. No. 5,597,107, entitled Slot," filed July 29, 2015; U.S. Patent Pub. No. "Surgical Stapler Instrument," issued January 28, 1997; 40 2014/0243801, entitled "Surgical Instrument End Effec- U.S. Pat. No. 5,632,432, entitled "Surgical Instrument," tor Articulation Drive with Pinion and Opposing Racks," issued May 27, 1997; U.S. Pat. No. 5,673,840, entitled published August 28, 2014; U.S. Patent Pub. No. "Surgical Instrument," issued October 7, 1997; U.S. Pat. 2014/0239041, entitled "Lockout Feature for Movable No. 5,704,534, entitled "Articulation Assembly for Surgi- Cutting Member of Surgical Instrument," published Au- cal Instruments," issued January 6, 1998; U.S. Pat. No. 45 gust 28, 2014; U.S. Patent Pub. No. 2014/0239042, en- 5,814,055, entitled "Surgical Clamping Mechanism," is- titled "Integrated Tissue Positioning and Jaw Alignment sued September 29,1998; U.S. Pat. No. 6,978,921, en- Features for Surgical Stapler," published August 28, titled "Surgical Stapling Instrument Incorporating an E- 2014; U.S. Patent Pub. No. 2014/0239036, entitled "Jaw Beam Firing Mechanism," issued December 27, 2005; Closure Feature for End Effector of Surgical Instrument," U.S. Pat. No. 7,000,818, entitled "Surgical Stapling In- 50 published August 28, 2014; U.S. Patent Pub. No. strument Having Separate Distinct Closing and Firing 2014/0239040, entitled "Surgical Instrument with Articu- Systems," issued February 21,2006; U.S. Pat. No. lation Lock having a Detenting Binary Spring," published 7,143,923, entitled "Surgical Stapling Instrument Having August 28, 2014; U.S. Patent Pub. No. 2014/0239043, aFiring Lockout for an UnclosedAnvil," issued December entitled "Distal Tip Features for End Effector of Surgical 5, 2006; U.S. Pat. No. 7,303,108, entitled "Surgical Sta- 55 Instrument," published August 28, 2014; U.S. Patent pling Instrument Incorporating a Multi-Stroke Firing Pub. No. 2014/0239037, entitled "Staple Forming Fea- Mechanism with a Flexible Rack," issued December 4, tures for Surgical Stapling Instrument," published August 2007; U.S. Pat. No. 7,367,485, entitled "Surgical Stapling 28, 2014; U.S. Patent Pub. No. 2014/0239038, entitled

2 3 EP 3 155 985 A1 4

"Surgical Instrument with Multi-Diameter Shaft," pub- FIG. 11 depicts a top view of a lower jaw of the end lished August 28, 2014; and U.S. Patent Pub. No. effector of FIG. 10; 2014/0239044, entitled "Installation Features for Surgi- cal Instrument End Effector Cartridge," published August FIG. 12 depicts a bottom view of an upper jaw of the 28, 2014. 5 end effector of FIG. 10; [0005] While various kinds of surgical stapling instruments and associated components have been made and FIG. 13 depicts an exploded perspective view of the used, it is believed that no one prior to the inventor(s) lower jaw of FIG. 11; has made or used the invention described in the append- ed claims. 10 FIG. 14 depicts a perspective view of a cross driver assembly of the lower jaw of FIG. 11; BRIEF DESCRIPTION OF THE DRAWINGS FIG. 15 depicts a top view of the cross driver assem- [0006] The accompanying drawings, which are incor- bly of FIG. 14; porated in and constitute a part of this specification, il- 15 lustrate embodiments of the invention, and, together with FIG. 16A depicts a schematic representation of a the general description of the invention given above, and liver having a vessel extending through the liver tis- the detailed description of the embodiments given below, sue; serve to explain the principles of the present invention. 20 FIG. 16B depicts the schematic representation of the FIG. 1 depicts a perspective view of an exemplary end effector of FIG. 10 severing the liver tissue of articulating surgical stapling instrument; FIG. 16A;

FIG. 2 depicts a side elevational view of the instru- FIG. 16C depicts the schematic representation of ment of FIG. 1; 25 the vessel of FIG. 16B exposed from the severed liver tissue of FIG. 16A; FIG. 3 depicts a perspective view of an end effector of the instrument of FIG. 1, with the end effector in FIG. 16D depicts the schematic representation of a closed configuration; the end effector of FIG. 10 stapling the exposed ves- 30 sel of FIG. 16C; FIG. 4 depicts a perspective view of the end effector of FIG. 3, with the end effector in an open configu- FIG. 16E depicts the schematic representation of the ration; vessel of FIG. 16D exposed and stapled; and

FIG. 5 depicts an exploded perspective view of the 35 FIG. 16F depicts the schematic representation of the end effector of FIG. 3; liver of FIG. 16A having a portion of the liver tissue and the vessel resected therefrom. FIG. 6 depicts a cross-sectional end view of the end effector of FIG. 3, taken along line 6-6 of FIG. 4; [0007] The drawings are not intended to be limiting in 40 any way, and it is contemplated that various embodi- FIG. 7A depicts a cross-sectional side view of the ments of the invention may be carried out in a variety of end effector of FIG. 3, taken along line 7-7 of FIG. other ways, including those not necessarily depicted in 4, with a firing beam in a proximal position; the drawings. The accompanying drawings incorporated in and forming a part of the specification illustrate several FIG. 7B depicts a cross-sectional side view of the 45 aspects of the present invention, and together with the end effector of FIG. 3, taken along line 7-7 of FIG. description serve to explain the principles of the inven- 4, with the firing beam in a distal position; tion; it being understood, however, that this invention is not limited to the precise arrangements shown. FIG. 8 depicts a perspective view of the end effector of FIG. 3, positioned at tissue and having been ac- 50 DETAILED DESCRIPTION tuated once in the tissue; [0008] The following description of certain examples FIG. 9 depicts a side elevational view of another ex- of the invention should not be used to limit the scope of emplary articulating surgical stapling instrument; the present invention. Other examples, features, as- 55 pects, embodiments, and advantages of the invention FIG. 10 depicts a perspective view of an end effector will become apparent to those skilled in the art from the of the instrument of FIG. 9, with the end effector in following description, which is by way of illustration, one an open configuration; of the best modes contemplated for carrying out the in-

3 5 EP 3 155 985 A1 6 vention. As will be realized, the invention is capable of tion (34). Exemplary features that may be used to provide other different and obvious aspects, all without departing longitudinal translation of closure tube (32) and closure from the invention. Accordingly, the drawings and de- ring (36) will be described in greater detail below. scriptions should be regarded as illustrative in nature and [0012] Articulation section (34) is operable to laterally not restrictive. 5 deflect closure ring (36) and end effector (40) laterally away from the longitudinal axis (LA) of shaft assembly I. Exemplary Surgical Stapler (30) at a desired angle ( α). End effector (40) may thereby reach behind an organ or approach tissue from a desired [0009] FIG. 1 depicts an exemplary surgical stapling angle or for other reasons. In some versions, articulation and severing instrument (10) that includes a handle as- 10 section (34) enables deflection of end effector (40) along sembly (20), a shaft assembly (30), and an end effector a single plane. In some other versions, articulation sec- (40). End effector (40) and the distal portion of shaft as- tion (34) enables deflection of end effector along more sembly (30) are sized for insertion, in a nonarticulated than one plane. In the present example, articulation is state as depicted in FIG. 1, through a trocar cannula to controlled through an articulation control knob (35) which a surgical site in a patient for performing a surgical pro- 15 is located at the proximal end of shaft assembly (30). cedure. By way of example only, such a trocar may be Knob (35) is rotatable about an axis that is perpendicular inserted in a patient’s abdomen, between two of the pa- to the longitudinal axis (LA) of shaft assembly (30). Clo- tient’s ribs, or elsewhere. In some settings, instrument sure ring (36) and end effector (40) pivot about an axis (10) is used without a trocar. For instance, end effector that is perpendicular to the longitudinal axis (LA) of shaft (40) and the distal portion of shaft assembly (30) may be 20 assembly (30) in response to rotation of knob (35). By inserted directly through a thoracotomy or other type of way of example only, rotation of knob (35) clockwise may incision. It should be understood that terms such as cause corresponding clockwise pivoting of closure ring "proximal" and "distal" are used herein with reference to (36) and end effector (40) at articulation section (34). a clinician gripping handle assembly (20) of instrument Articulation section (34) is configured to communicate (10). Thus, end effector (40) is distal with respect to the 25 longitudinal translation of closure tube (32) to closure ring more proximal handle assembly (20). It will be further (36), regardless of whether articulation section (34) is in appreciated that for convenience and clarity, spatial a straight configuration or an articulated configuration. terms such as "vertical" and "horizontal" are used herein [0013] In some versions, articulation section (34) with respect to the drawings. However, surgical instru- and/or articulation control knob (35) are/is constructed ments are used in many orientations and positions, and 30 and operable in accordance with at least some of the these terms are not intended to be limiting and absolute. teachings of U.S. Pub. No. 2014/0243801, entitled "Sur- gical Instrument End Effector Articulation Drive with Pin- A. Exemplary Handle Assembly and Shaft Assembly ion and Opposing Racks," published August 28, 2014. Articulation section (34) may also be constructed and [0010] As shown in FIGS. 1-2, handle assembly (20) 35 operable in accordance with at least some of the teach- of the present example comprises pistol grip (22), a clo- ings of U.S. Pat. App. No. 14/314,125, entitled "Articula- sure trigger (24), and a firing trigger (26). Each trigger tion Drive Features for Surgical Stapler," filed June 25, (24, 26) is selectively pivotable toward and away from 2014; and/or in accordance with the various teachings pistol grip (22) as will be described in greater detail below. below. Other suitable forms that articulation section (34) Handle assembly (20) further includes an anvil release 40 and articulation knob (35) may take will be apparent to button (25), a firing beam reverse switch (27), and a re- those of ordinary skill in the art in view of the teachings movable battery pack (28). These components will also herein. be described in greater detail below. Of course, handle [0014] As shown in FIGS. 1-2, shaft assembly (30) of assembly (20) may have a variety of other components, the present example further includes a rotation knob (31). features, and operabilities, in addition to or in lieu of any 45 Rotation knob (31) is operable to rotate the entire shaft of those noted above. Other suitable configurations for assembly (30) and end effector (40) relative to handle handle assembly(20) will be apparent to those ofordinary assembly (20) about the longitudinal axis (LA) of shaft skill in the art in view of the teachings herein. assembly (30). In some versions, rotation knob (31) is [0011] As shown in FIGS. 1-3, shaft assembly (30) of operable to selectively lock the angular position of shaft the present example comprises an outer closure tube 50 assembly (30) and end effector (40) relative to handle (32), an articulation section (34), and a closure ring (36), assembly (20) about the longitudinal axis (LA) of shaft which is further coupled with end effector (40). Closure assembly (30). For instance, rotation knob (31) may be tube (32) extends along the length of shaft assembly (30). translatable between a first longitudinal position, in which Closure ring (36) is positioned distal to articulation sec- shaft assembly (30) and end effector (40) are rotatable tion (34). Closure tube (32) and closure ring (36) are con- 55 relative to handle assembly (20) about the longitudinal figured to translate longitudinally relative to handle as- axis (LA) of shaft assembly (30); and a second longitu- sembly (20). Longitudinal translation of closure tube (32) dinal position, in which shaft assembly (30) and end ef- is communicated to closure ring (36) via articulation sec- fector (40) are not rotatable relative to handle assembly

4 7 EP 3 155 985 A1 8

(20) about the longitudinal axis (LA) of shaft assembly (71). The upper side of cartridge body (71) presents a (30). Of course, shaft assembly (30) may have a variety deck (73), against which tissue may be compressed of other components, features, and operabilities, in ad- when anvil (60) is in a closed position. Cartridge body dition to or in lieu of any of those noted above. By way (71) further defines a longitudinally extending channel of example only, at least part of shaft assembly (30) is 5 (72) and a plurality of staple pockets (74). A staple (77) constructed in accordance with at least some of the is positioned in each staple pocket (74). A staple driver teachings of U.S. Pub. No. 2014/0239038, entitled "Sur- (75) is also positioned in each staple pocket (74), under- gical Instrument with Multi-Diameter Shaft," published neath a corresponding staple (77), and above tray (76). August 28, 2014. Other suitable configurations for shaft As will be described in greater detail below, staple drivers assembly (30) will be apparent to those of ordinary skill 10 (75) are operable to translate upwardly in staple pockets in the art in view of the teachings herein. (74) to thereby drive staples (77) upwardly through staple pockets (74) and into engagement with anvil (60). Staple B. Exemplary End Effector drivers (75) are driven upwardly by a wedge sled (78), which is captured between cartridge body (71) and tray [0015] As also shown in FIGS. 3-5, end effector (40) 15 (76), and which translates longitudinally through car- of the present example includes a lower jaw (50) and a tridge body (71). Wedge sled (78) includes a pair of ob- pivotable anvil (60). Anvil (60) includes a pair of integral, liquely angled cam surfaces (79), which are configured outwardly extending pins (66) that are disposed in cor- to engage staple drivers (75) and thereby drive staple responding curved slots (54) of lower jaw (50). Anvil (60) drivers (75) upwardly as wedge sled (78) translates lon- ispivotable towardand away fromlower jaw(50) between 20 gitudinally through cartridge (70). For instance, when an open position (shown in FIGS. 2 and 4) and a closed wedge sled (78) is in a proximal position as shown in position (shown in FIGS. 1,3, and 7A-7B). Use of the term FIG. 7A, staple drivers (75) are in downward positions "pivotable" (and similar terms with "pivot" as a base) and staples (77) are located in staple pockets (74). As should not be read as necessarily requiring pivotal move- wedge sled (78) is driven to the distal position shown in ment about a fixed axis. For instance, in the present ex- 25 FIG. 7B by a translating knife member (80), wedge sled ample, anvil (60) pivots about an axis that is defined by (78) drives staple drivers (75) upwardly, thereby driving pins (66), which slide along curved slots (54) of lower jaw staples (77) out of staple pockets (74) and into staple (50) as anvil (60) moves toward lower jaw (50). In such forming pockets (64). Thus, staple drivers (75) translate versions, the pivot axis translates along the path defined along a vertical dimension as wedge sled (78) translates by slots (54) while anvil (60) simultaneously pivots about 30 along a horizontal dimension. that axis. In addition or in the alternative, the pivot axis [0018] It should be understood that the configuration may slide along slots (54) first, with anvil (60) then piv- of staple cartridge (70) may be varied in numerous ways. oting about the pivot axis after the pivot axis has slid a For instance, staple cartridge (70) of the present example certain distance along the slots (54). It should be under- includestwo longitudinally extending rows of staplepock- stood that such sliding/translating pivotal movement is 35 ets (74) on one side of channel (72); and another set of encompassed within terms such as "pivot," "pivots," "piv- two longitudinally extending rows of staple pockets (74) otal," "pivotable," "pivoting," and the like. Of course, some on the other side of channel (72). However, in some other versions may provide pivotal movement of anvil (60) versions, staple cartridge (70) includes three, one, or about an axis that remains fixed and does not translate some other number of staple pockets (74) on each side within a slot or channel, etc. 40 of channel (72). In some versions, staple cartridge (70) [0016] As best seen in FIG. 5, lower jaw (50) of the is constructed and operable in accordance with at least present example defines a channel (52) that is configured some of the teachings of U.S. Pub. No. 2014/0239042, to receive a staple cartridge (70). Staple cartridge (70) entitled "Integrated Tissue Positioning and Jaw Align- may be inserted into channel (52), end effector (40) may ment Features for Surgical Stapler," published August be actuated, and then staple cartridge (70) may be re- 45 28, 2014. In addition or in the alternative, staple cartridge moved and replaced with another staple cartridge (70). (70) may be constructed and operable in accordance with Lower jaw (50) thus releasably retains staple cartridge at least some of the teachings of U.S. Pub. No. (70) in alignment with anvil (60) for actuation of end ef- 2014/0239044, entitled "Installation Features for Surgi- fector (40). In some versions, lower jaw (50) is construct- cal Instrument End Effector Cartridge," published August ed in accordance with at least some of the teachings of 50 28, 2014. Other suitable forms that staple cartridge (70) U.S. Pub. No. 2014/0239044, entitled "Installation Fea- may take will be apparent to those of ordinary skill in the tures for Surgical Instrument End Effector Cartridge," art in view of the teachings herein. published August 28, 2014. Other suitable forms that low- [0019] As best seen in FIG. 4, anvil (60) of the present er jaw (50) may take will be apparent to those of ordinary example comprises a longitudinally extending channel skill in the art in view of the teachings herein. 55 (62) and a plurality of staple forming pockets (64). Chan- [0017] As best seen in FIGS. 4-6, staple cartridge (70) nel (62) is configured to align with channel (72) of staple of the present example comprises a cartridge body (71) cartridge (70) when anvil (60) is in a closed position. Each and a tray (76) secured to the underside of cartridge body staple forming pocket (64) is positioned to lie over a cor-

5 9 EP 3 155 985 A1 10 responding staple pocket (74) of staple cartridge (70) ly, end effector (40) may simply omit such lockout fea- when anvil (60) is in a closed position. Staple forming tures. pockets (64) are configured to deform the legs of staples (77) when staples (77) are driven through tissue and into C. Exemplary Actuation of Anvil anvil (60). In particular, staple forming pockets (64) are 5 configured to bend the legs of staples (77) to secure the [0022] In the present example, anvil (60) is driven to- formed staples (77) in the tissue. Anvil (60) may be con- wardlower jaw(50) by advancing closure ring (36)distally structed inaccordance with atleast some of the teachings relative to end effector (40). Closure ring (36) cooperates of U.S. Pub. No. 2014/0239042, entitled "Integrated Tis- with anvil (60) through a camming action to drive anvil sue Positioning and Jaw Alignment Features for Surgical 10 (60) toward lower jaw (50) in response to distal translation Stapler," published August 28, 2014; at least some of the of closure ring (36) relative to end effector (40). Similarly, teachings of U.S. Pub. No. 2014/0239036, entitled "Jaw closure ring (36) may cooperate with anvil (60) to open Closure Feature for End Effector of Surgical Instrument," anvil (60) away from lower jaw (50) in response to prox- published August 28, 2014; and/or at least some of the imal translation of closure ring (36) relative to end effector teachings of U.S. Pub. No. 2014/0239037, entitled "Sta- 15 (40). By way of example only, closure ring (36) and anvil ple Forming Features for Surgical Stapling Instrument," (60) may interact in accordance with at least some of the published August 28, 2014. Other suitable forms that an- teachings of U.S. Pub. No. 2014/0239036, entitled "Jaw vil (60) may take will be apparent to those of ordinary skill Closure Feature for End Effector of Surgical Instrument," in the art in view of the teachings herein. published August 28, 2014; and/or in accordance with at [0020] In the present example, knife member (80) is 20 least some of the teachings of U.S. Patent App. No. configured to translate through end effector (40). As best 14/314,108, entitled "Jaw Opening Feature for Surgical seen in FIGS. 5 and 7A-7B, knife member (80) is secured Stapler," filed on June 25, 2014. Exemplary features that to the distal end of a firing beam (82), which extends may be used to provide longitudinal translation of closure through a portion of shaft assembly (30). As best seen ring (36) relative to end effector (40) will be described in in FIGS. 4 and 6, knife member (80) is positioned in chan- 25 greater detail below. nels (62, 72) of anvil (60) and staple cartridge (70). Knife [0023] As noted above, handle assembly (20) includes member (80) includes a distally presented cutting edge pistol grip (22) and closure trigger (24). As also noted (84) that is configured to sever tissue that is compressed above, anvil (60) is closed toward lower jaw (50) in re- between anvil (60) and deck (73) of staple cartridge (70) sponse to distal advancement of closure ring (36). In the as knife member (80) translates distally through end ef- 30 present example, closure trigger (24) is pivotable toward fector (40). As noted above and as shown in FIGS. 7A- pistol grip (22) to drive closure tube (32) and closure ring 7B, knifemember (80)also drives wedgesled (78) distally (36) distally. Various suitable components that may be as knife member (80) translates distally through end ef- used to convert pivotal movement of closure trigger (24) fector (40), thereby driving staples (77) through tissue toward pistol grip (22) into distal translation of closure and against anvil (60) into formation. Various features 35 tube (32) and closure ring (36) relative to handle assem- that may be used to drive knife member (80) distally bly (20) will be apparent to those of ordinary skill in the through end effector (40) will be described in greater de- art in view of the teachings herein. When closure trigger tail below. (24) reaches a fully pivoted state, such that anvil (60) is [0021] In some versions, end effector (40) includes in a fully closed position relative to lower jaw (50), locking lockout features that are configured to prevent knife40 features in handle assembly (20) lock the position of clo- member (80) from advancing distally through end effector sure trigger (24) and closure tube (32), thereby locking (40) when a staple cartridge (70) is not inserted in lower anvil (60) in a fully closed position relative to lower jaw jaw (50). In addition or in the alternative, end effector (40) (50). These locking features are released by actuation may include lockout features that are configured to pre- of anvil release button (25). Anvil release button (25) is vent knife member (80) from advancing distally through 45 configured and positioned to be actuated by the thumb end effector (40) when a staple cartridge (70) that has of the operator hand that grasps pistol grip (22). In other already been actuated once (e.g., with all staples (77) words, the operator may grasp pistol grip (22) with one deployed therefrom) is inserted in lower jaw (50). By way hand, actuate closure trigger (24) with one or more fin- of example only, such lockout features may be configured gers of the same hand, and then actuate anvil release in accordance with at least some of the teachings of U.S. 50 button (25) with the thumb of the same hand, without Pub. No. 2014/0239041, entitled "Lockout Feature for ever needing to release the grasp of pistol grip (22) with Movable Cutting Member of Surgical Instrument," pub- the same hand. Other suitable features that may be used lished August 28, 2014; and/or at least some of the teach- to actuate anvil (60) will be apparent to those of ordinary ings of U.S. Pat. App. No. 14/314,108, entitled "Method skill in the art in view of the teachings herein. of Using Lockout Features for Surgical Staple cartridge," 55 filed on June 25, 2014. Other suitable forms that lockout D. Exemplary Actuation of Firing Beam features may take will be apparent to those of ordinary skill in the art in view of the teachings herein. Alternative- [0024] In the present example, instrument (10) pro-

6 11 EP 3 155 985 A1 12 vides motorized control of firing beam (82). In particular, two alternating rows of staples (77) through the tissue instrument (10) includes motorized components that are (90) on each side of the cut line produced by cutting edge configured to drive firing beam (82) distally in response (84). Staples (77) are all oriented substantially parallel to pivoting of firing trigger (26) toward pistol grip (22). In to the cut line in this example, though it should be under- some versions, a motor (not shown) is contained in pistol 5 stood that staples (77) may be positioned at any suitable grip (22) and receives power from battery pack (28). This orientations. In the present example, end effector (40) is motor is coupled with a transmission assembly (not withdrawn from the trocar after the first stroke is com- shown) that converts rotary motion of a drive shaft of the plete, the spent staple cartridge (70) is replaced with a motor into linear translation of firing beam (82). In some new staple cartridge (70), and end effector (40) is then such versions, firing beam (82) may only be advanced 10 again inserted through the trocar to reach the stapling distally when anvil (60) is in a fully closed position relative site for further cutting and stapling. This process may be to lower jaw (50). After firing beam (82) is advanced dis- repeated until the desired amount of cuts and staples tally to sever tissue and drive staples (77) as described (77) have been provided. Anvil (60) may need to be above with reference to FIGS. 7A-7B, the drive assembly closed to facilitate insertion and withdrawal through the for firing beam (82) may be automatically reversed to 15 trocar; and anvil (60) may need to be opened to facilitate drive firing beam (82) proximally back to the retracted replacement of staple cartridge (70). position (e.g., back from the position shown in FIG. 7B [0028] It should be understood that cutting edge (84) to the position shown in FIG. 7A). Alternatively, the op- may cut tissue substantially contemporaneously with sta- erator may actuate firing beam reverse switch (27), which ples (77) being driven through tissue during each actu- may reverse the drive assembly for firing beam (82) in 20 ation stroke. In the present example, cutting edge (84) order to retract firing beam (82) to a proximal position. just slightly lags behind driving of staples (77), such that Handle assembly (20) of the present example further in- staple (77) is driven through the tissue just before cutting cludes a bailout feature (21), which is operable to provide edge (84) passes through the same region of tissue, a mechanical bailout allowing the operator to manually though it should be understood that this order may be retract firing beam (82) proximally (e.g., in the event of 25 reversed or that cutting edge (84) may be directly syn- power loss while firing beam (82) is in a distal position, chronized with adjacent staples. While FIG. 8 shows end etc.). effector (40) being actuated in two layers (92, 94) of tissue [0025] By way of example only, the features that are (90), it should be understood that end effector (40) may operable to provide motorized actuation of firing beam be actuated through a single layer of tissue (90) or more (82) may be configured and operable in accordance with 30 than two layers (92, 94) of tissue. It should also be un- at least some of the teachings of U.S. Pat. No. 8,210,411, derstood that the formation and positioning of staples entitled "Motor-Driven Surgical Instrument," issued July (77) adjacent to the cut line produced by cutting edge 3, 2012. As another merely illustrative example, the fea- (84)may substantiallyseal the tissue atthe cutline, there- tures that are operable to provide motorized actuation of by reducing or preventing bleeding and/or leaking of oth- firing beam (82) may be configured and operable in ac- 35 er bodily fluids at the cut line. Furthermore, while FIG. 8 cordance with at least some of the teachings of U.S. Pat. shows end effector (40) being actuated in two substan- No. 8,453,914, entitled "Motor-Driven Surgical Cutting tially flat, apposed planar layers (92, 94) of tissue, it Instrument with Electric Actuator Directional Control As- should be understood that end effector (40) may also be sembly," issued June 4, 2013. As yet another merely il- actuated across a tubular structure such as a blood ves- lustrative example, the features that are operable to pro- 40 sel, a section of the gastrointestinal tract, etc. FIG. 8 vide motorized actuation of firing beam (82) may be con- should therefore not be viewed as demonstrating any figured and operable in accordance with at least some limitation on the contemplated uses for end effector (40). of the teachings of U.S. Patent App. No. 14/226,142, en- Various suitable settings and procedures in which instru- titled "Surgical Instrument Comprising a Sensor System," ment (10) may be used will be apparent to those of ordi- filed March 26, 2014. 45 nary skill in the art in view of the teachings herein. [0026] Other suitable components, features, and con- [0029] It should also be understood that any other com- figurations that may be used to provide motorization of ponents or features of instrument (10) may be configured firing beam (82) will be apparent to those of ordinary skill and operable in accordance with any of the various ref- in the art in view of the teachings herein. It should also erences cited herein. Additional exemplary modifications be understood that some other versions may provide 50 that may be provided for instrument (10) will be described manual driving of firing beam (82), such that a motor may in greater detail below. Various suitable ways in which be omitted. By way of example only, firing beam (82) may the below teachings may be incorporated into instrument be manually actuated in accordance with at least some (10) will be apparent to those of ordinary skill in the art. of the teachings of any other reference cited herein. Similarly, various suitable ways in which the below teach- [0027] FIG. 8 shows end effector (40) having been ac- 55 ings may be combined with various teachings of the ref- tuated through a single stroke through tissue (90). As erences cited herein will be apparent to those of ordinary shown, cutting edge (84) (obscured in FIG. 8) has cut skill in the art. It should also be understood that the below through tissue (90), while staple drivers (75) have driven teachings are not limited to instrument (10) or devices

7 13 EP 3 155 985 A1 14 taught in the references cited herein. The below teach- case of the portal vein and extrahepatic vessels, etc.), ings may be readily applied to various other kinds of in- the vessel or duct that is sealed by the staples is separate struments, including instruments that would not be clas- from the liver tissue that the operator has crushed with sified as surgical staplers. Various other suitable devices surfaces (214, 216). While the following description of and settings in which the below teachings may be applied 5 surgical instruments (210) and method of treatment is will be apparent to those of ordinary skill in the art in view provided in the context of liver resection, it will be appre- of the teachings herein. ciated that surgical instruments (210) may be alternatively configured to treat any tissue in the human body with II. Exemplary Alternative Stapling End Effector similar features. It should also be understood that that 10 the features discussed below may be readily incorporat- [0030] While the above surgical instrument (10) pro- ed into surgical instrument (10) discussed above. To this vides one example of an end effector (40) that may be end, like numbers indicate like features described above used to staple and sever tissue within a patient, it will be in greater detail. appreciated that the human body is comprised a wide [0033] In the following examples, end effectors (212) variety of tissues located in distinct, sometimes difficult 15 apply at least two laterally spaced apart rows of staples to access regions throughout the patient. For example, where the staples in one row have the same height as a liver includes tissue including vessels or ducts passing the staples in another row. In some variations, end ef- throughout. In settings where the liver includes a tumor, fectors (212) are modified to apply at least two laterally it may be desirable to resect the portion of the liver con- spaced apart rows of staples where the staples in one taining the tumor. The resection may be anatomic (e.g., 20 row have a height that is different from the height of the resection of the right or left side of the liver, inclusive of staples in another row. the lobes on that side) or non-anatomic (e.g., resection of just a single lobe or wedge of liver tissue). This resec- A. Exemplary Stapling Instrument with Curved End Ef- tion process may entail at least three kinds of steps - a fector first step to dissect the tissue (e.g., liver parenchyma) 25 around the vessels or ducts, to thereby isolate or reveal [0034] FIGS. 9-12 show surgical instrument (210) with the vesselsor ducts;a secondstep toligate those vessels end effector (212) having upper crush surface (214), low- or ducts; and a third step to sever the ligated vessels or er crush surface (216) and staple cartridge (218). Surgi- ducts. cal instrument (210) also includes handle assembly (20) [0031] One such method of liver resection includes the 30 and shaft assembly (30) discussed above in greater de- well known Kelly clamp method, where a Kelly style tail. Except as otherwise described below, end effector clamp is used to compress the liver tissue and thereby (212), in conjunction with handle assembly (20) and shaft dissect the tissue through a crushing action. However, assembly (30), is configured and operable similar to end treatments may require many instruments to accommo- effector (40) (see FIG. 1). date such a wide variety of tissues and vessels or ducts 35 [0035] End effector (212) of the present example fur- within the human body, thereby adding to the time and ther includes a lower jaw (220) and an upper jaw (222). complexity associated with assessing the state of the tis- Upper jaw (222) forms an anvil (224) and is pivotally sue, selecting and/or changing instruments, and per- mounted relative to lower jaw (220) for receiving the tis- forming the resection. It may therefore be desirable to sue therebetween. More particularly, anvil (224) is pivot- provide a surgical instrument (210) with an end effector 40 able toward and away from lower jaw (220) between an (212) having a pair of crush surfaces (214, 216) that are open position and a closed position (e.g., in response to configured to sever tissue by crushing the tissue; while pivotal movement of trigger (24) toward and away from also providing an adjacent staple cartridge (218) to se- pistol grip (22)). For instance, in the present example, lectively ligate one or more vessels or ducts passing anvil (224) pivots about an axis that is defined by pins through the tissue. Thereby, a single surgical instrument 45 (not shown), which slide along curved slots (not shown) (210) will allow the operator to more quickly assess the of lower jaw (220) as anvil (224) moves toward lower jaw tissue and proceed with further tissue dissection and/or (220). In such versions, the pivot axis translates along ligation of vessels and ducts. the path defined by slots (not shown) while anvil (224) [0032] Surgical instruments (210) are described below simultaneously pivots about that axis. In addition or in in the context of dissecting liver tissue (e.g., liver paren- 50 the alternative, the pivot axis may slide along slots (not chyma) with crush surfaces (214, 216) and using staples shown) first, with anvil (224) then pivoting about the pivot to ligate associated vessels or ducts (e.g., portal vein, axis after the pivot axis slides a certain distance along hepatic vein branches, hepatic artery branches, extrahe- the slots (not shown). Alternatively, some versions may patic vessels, etc.). In some instances (e.g., in the case provide pivotal movement of anvil (224) about an axis of hepatic vein branches and hepatic artery branches, 55 that remains fixed and does not translate within a slot or etc.), the vessel or duct that is sealed by the staples is channel, etc. exposed when the operator crushes the liver tissue with [0036] As best seen in FIG. 10 and FIG. 11, lower jaw surfaces (214, 216). In some other instances (e.g., in the (220) of the present example defines a channel (226)

8 15 EP 3 155 985 A1 16 that is configured to receive staple cartridge (218). Staple verse to the centerline (233) in order to install the plurality cartridge (218) may be inserted into channel (226), end of staples (244a, 244b, 244c) within the tissue and inhibit effector (212) may be actuated, and then staple cartridge openings therebetween, for improved ligation. In other (218) may be removed and replaced with another staple words, a consistent gap (G1) ( see FIG. 13) is maintained cartridge (218). Lower jaw (220) thus releasably retains 5 between adjacent staple pockets (242a, 242b, 242c) for staple cartridge (218) in alignment with anvil (224) for consistent overlap in the present example. As used here- actuation of end effector (212). In some alternative ver- in, the term "overlap" is intended to include one feature sions, the components of staple cartridge (218) are fully overlapping with another in at least one direction. Thus, integrated into lower jaw (220) such that end effector a feature may be offset from another feature and still (212) may only be used once. Other suitable forms that 10 overlap as described herein in the event that these fea- lower jaw (220) may take will be apparent to those of tures overlap in at least one plane, such as a transverse ordinary skill in the art in view of the teachings herein. plane including the transverse direction. While exempla- [0037] End effector (212) is generally shaped for im- ry cartridge body (234) includes a variety of staple pock- proved access to the tissue during the surgical proce- ets (242a, 242b, 242c) with staples (244a, 244b, 244c) dure. More particularly, end effector (212) has a linear 15 in order to accommodate the arcuate portion (230) as portion (228) that projects from closure ring (36) and ex- discussed below in additional detail, it should be under- tends to an arcuate portion (230). Arcuate portion (230) stood that the configuration of staple cartridge (218) may in one example curves transversely to the right (when be varied in numerous ways. Other suitable forms that viewed from above) relative to the linear portion (228). staple cartridge (218) may take will be apparent to those However, it will be appreciated that the arcuate portion 20 of ordinary skill in the art in view of the teachings herein. (230) may alternatively curve transversely to the left [0041] As best seen in FIG. 12, anvil (224) of the (when viewed from above) relative to the linear portion present example has a plurality of staple forming pockets (228). In any case, lower and upper jaws (220, 222) de- (246a, 246b, 246c). Each staple forming pocket (246a, fine the linear and arcuate portions (228, 230) as shown 246b, 246c) is positioned to lie over a corresponding sta- in FIGS. 11-13. In addition, lower and upper jaws (220, 25 ple pocket (242a, 242b, 242c) of staple cartridge (218) 222) are tapered such that the end effector narrows in when anvil (224) is in a closed position. Staple forming the transverse dimension toward a distal tip (232) of the pockets (246a, 246b, 246c) are configured to deform end effector (212) for further access within the tissue. As each leg (248) of staples (244a, 244b, 244c) when sta- such, a centerline (233) along a transverse width of end ples (244a, 244b, 244c) are driven through tissue and effector (212) extends longitudinally along end effector 30 into anvil (224). In particular, staple forming pockets (212) following linear and arcuate portions (228, 230) (246a, 246b, 246c) are configured to bend legs (248) of thereof. staples (244a, 244b, 244c) to secure the formed staples [0038] Staple cartridge (218) accommodates the (244a, 244b, 244c) in the tissue. Other suitable forms shape of lower and upper jaws (220, 222) by further de- that anvil (224) may take will be apparent to those of fining the linear and arcuate portions (228, 230) and ta- 35 ordinary skill in the art in view of the teachings herein. pering of end effector (212). To this end, staple cartridge [0042] As shown in FIG. 13, staple cartridge (218) in- (218) of the present example comprises a cartridge body cludes staple row drivers (252) and a cross staple driver (234) and a tray (not shown) secured to an underside of (254) positioned in staple pockets (242a, 242b, 242c), cartridge body (234). An upper side of cartridge body underneath corresponding sets of staples (244a, 244b, (234) presents a deck (238), against which tissue may 40 244c), and above tray (not shown). As will be described be compressed when anvil (224) is in a closed position. in greater detail below, staple drivers (252, 254) are op- In some versions, lower crush surface (216) is positioned erable to translate upwardly in staple pockets (242a, along staple cartridge (218). However, it will be appreci- 242b, 242c) to thereby drive staples (244a, 244b, 244c) ated that lower crush surface (216), as well as cooper- upwardly through staple pockets (242a, 242b, 242c) and ating upper crush surface (214), may be alternatively po- 45 into engagement with anvil (224). Staple drivers (252, sitioned along end effector (212) for severing tissue via 254) are driven upwardly by a distally translating wedge compression. sled (256), which is captured between cartridge body [0039] Cartridge body (234) further defines a plurality (234) and tray (236) (not shown), and which translates of staple pockets (242a, 242b, 242c) following a prede- longitudinally through cartridge body (234) along a cam termined pattern along the centerline (233) of deck (238). 50 slot (257). Wedge sled (256) includes a cam ramp (258) More particularly, staple cartridge (218) includes two lon- having a leading cam surface (260), an intermediate cam gitudinally extending rows of staple pockets (242a, 242b, surface (262), and a trailing cam surface (264). By way 242c), with a left row on a left side of the centerline (233) of example only, leading cam surface (260) may be an- and a right row and a right side of the centerline (233). gled at approximately 45° relative to a horizontal plane; [0040] One of a plurality of staples (244a, 244b, 244c) 55 and intermediate cam surface (262) may be angled at is positioned in respective staple pockets (242a, 242b, approximately 22° relative to a horizontal plane. Alterna- 242c). The left and right rows of staple pockets (242a, tively, any other suitable angles may be used. Cam ramp 242b, 242c) are configured to overlap in a direction trans- (258) is generally configured to engage staple drivers

9 17 EP 3 155 985 A1 18

(252, 254) and thereby drive staple drivers (252, 254) centerline (233). To this end, each staple driver (252, upwardly as wedge sled (256) translates longitudinally 254) further includes a longitudinal groove (304) that is through staple cartridge (218) from a proximal sled po- configured to cradle a corresponding crown (282a) of sta- sition to a distal sled position. For instance, when wedge ples (244b, 244c). It will be appreciated that the term sled (256) is in the proximal sled position, staple drivers 5 "assembly" as used herein is not intended to be limited (252, 254) are in downward positions and staples (244a, to discrete assembled components. Rather the term "as- 244b, 244c) are located in staple pockets (442) below sembly" includes components that may be formed sep- deck (238). arately and assembled and components that may be [0043] Wedge sled (256) is driven distally by a trans- formed integrally as a single part. Thus, the term "assem- lating member (266). By way of example only, translating 10 bly" is not intended to limit the invention described herein. member (266) may be translated distally by actuating It will be further appreciated that cross staple driver (254) trigger (26)). Translating member (266) may thus operate is tilted relative to centerline (233) to accommodate the in a manner similar to firing beam (82) described above, curvature of arcuate portion (230) and that alternative though translating member (266) lacks a cutting edge curvature of any directions may be similarly accommo- (84) and is unable to otherwise sever tissue. As wedge 15 dated. Thus, the invention described herein is not intend- sled (256) is driven to the distal sled position by translated to be limited to the tilted direction of cross staple driver ing member (266), wedge sled (256) drives staple drivers (254). (252, 254) upwardly, thereby driving staples (244a, 244b, 244c) out of staple pockets (242a, 242b, 242c) and into 2. Exemplary Method of Tissue Resection staple forming pockets (246a, 246b, 246c). Thus, staple 20 drivers (252, 254) translate along corresponding vertical [0046] FIGS. 16A-16F show one example of using end planes as wedge sled (256) translates along a horizontal effector (212)to resect tissue, suchas a liver parenchyma plane. tissue (310), and to ligate a vessel or duct (316) therein. As noted above, vessel or duct (316) may comprise a 1. Exemplary Staple Straddling Centerline in Staple Car- 25 hepatic vein or a hepatic artery. It should also be under- tridge stood that the method may further include the use of end effector (212) to ligate other vessels such as the portal [0044] As shown in FIG. 13 and FIGS. 14-15, as wedge vein and extrahepatic vessels, etc. sled (256) approaches the distal position, wedge sled [0047] As shown in FIG. 16B, the operator positions (256) engages a cross driver assembly (300) having a 30 end effector (212) such that tissue (310), including vessel pair of staple row drivers (252) as well as one distally or duct (316), is located between lower and upper jaws positioned cross staple driver (254). In the present ex- (220, 222). The operator then compresses tissue (310) ample, staple row drivers (252) may also be referred to between upper and lower crush surfaces (214, 216) of as proximal and intermediate staple row drivers (252), upper and lower jaws (220, 222), respectively, to deliver and cross staple driver (254) may also be referred to as 35 the predetermined crush pressure to tissue (310). By way distal cross staple driver (254) given the relative positions of example only, jaws (220, 222) may be actuated in this between staple drivers (252, 254), which form cross driv- manner by pivoting trigger (24) toward pistol grip (22). It er assembly (300). The pair of staple row drivers (252) should be understood that jaws (220, 222) need not nec- and cross staple driver (254) are connected by a driver essarily be actuated to a fully closed configuration. In cam (302) extending therebetween. The pair of staple 40 some instances, the operator may rely on tactile feed- row drivers (252) generally includes a distally positioned back through trigger (24) and pistol grip (22) to determine staple driver (252) and a proximally positioned staple whether the operator has achieved a desired gap be- driver (252) on each lateral side of driver cam (302). Sta- tween jaws (220,222) to suitably crush tissue (310) with- ple row drivers (252) for cross driver assembly (300) are out undesirably damaging vessel or duct (316). In addi- generally positioned such that one staple driver (252) 45 tion or in the alternative, the operator may rely on visual overlaps in the transverse direction with the other staple feedback. driver (252). As such, cross driver assembly (300) is con- [0048] In any case, the crush pressure applied by jaws figured to similarly overlap a proximally positioned staple (220, 222) effectively severs tissue (310), and the oper- row drivers (252). ator then removes end effector (212) from tissue (310) [0045] Cross staple driver (254) extends distally be- 50 to view whether or not any vessels or ducts (316) are yond staple row drivers (252) on cross driver assembly present. As shown in FIG. 16C, vessel or duct (316) re- (300) and is obliquely angled relative to centerline (233) mains intact and is left exposed, extending between sev- such that cross staple driver (254) itself straddles cen- ered portions of tissue (310). terline (233) proximate to distal tip (232) of end effector [0049] In some instances, the operator may leave ves- (212). More particularly, cross staple driver (254) has 55 sel or duct (316) intact. However, in the present example, ends that are positioned near staple row drivers (252) to the operator ligates vessel or duct (316) to complete the maintain consistent gaps (G1) for effective ligation such resection of a severed portion of tissue (310), as shown that staple (244c) is configured to staple tissue across in FIG. 16D and FIG. 16E. Ligation includes placement

10 19 EP 3 155 985 A1 20 of at least some of overlapping staples (244a, 244b, fector extending from the shaft assembly along a jaw 244c) within vessel or duct (316) as discussed above in centerline, the end effector comprising: (i) a first jaw hav- greater detail. It should therefore be understood that the ing an anvil configured to form a plurality of staples same end effector (212) may be used to crush (and there- pressed against the anvil, and (ii) a second jaw, wherein by sever) tissue (310) of the liver and also ligate a vessel 5 the first and second jaws are configured to transition be- or duct (316) in the tissue (310). In the present example, tween an open configuration and a closed configuration; afterligation of vesselor duct (316),the operator removes and (c) a staple cartridge received within the second jaw, end effector (212) from liver tissue (310) and severs ves- the staple cartridge comprising: (i) a deck facing the anvil, sel or duct (316) with another surgical instrument (not (ii) a plurality of staple openings formed through the deck, shown) known in the art for cutting tissue, such as a con- 10 wherein at least one of the staple openings obliquely ventional blade or shears, etc. Thereby, the operator crosses the centerline, and (iii) a plurality of staples po- completes resection of a right portion of tissue (310) and sitioned respectively within the plurality of staple open- the corresponding portion of the vessel or duct (316), as ings. shown in FIG. 16F. The applied staples (244a) seal the severed end (318) of the vessel or duct (316). 15 Example 2 [0050] As described above, the operator removes end effector (212) for viewing vessel (316) as shown in FIG. [0053] The surgical instrument of Example 1, wherein 16C. Alternatively, the operator may apply the predeter- the plurality of staple openings comprises a first row of mined crush pressure (or as determined based on tactile staple openings and a second row of staple openings, and/or visual feedback as noted above), as shown in FIG. 20 wherein the first and second rows of staple openings are 16B, and immediately thereafter ligate any tissue remain- on respective sides of the centerline. ing therein, such as vessel or duct (316). As such, it is not necessary to view such tissue, but the operator may Example 3 find such viewing desirable in one or more liver resection procedures. It will be appreciated that the above de-25 [0054] The surgical instrument of Example 2, wherein scribed resection is merely illustrative and not limited to the at least one staple opening obliquely crossing the liver tissue. Alternatively, tissue resection with end effec- centerline extends from the first row of staple openings tor (212) may be performed on other tissues within the to the second row of staple openings. patient as desired by the user. 30 Example 4 III. Exemplary Combinations [0055] The surgical instrument of Example 3, wherein [0051] The following examples relate to various non- the at least one staple opening that obliquely crosses the exhaustive ways in which the teachings herein may be centerline is a distal-most staple opening in the deck. combined or applied. It should be understood that the 35 following examples are not intended to restrict the cov- Example 5 erage of any claims that may be presented at any time in this application or in subsequent filings of this applica- [0056] The surgical instrument of Example 4, wherein tion. No disclaimer is intended. The following examples the end effector extends to a distal tip, wherein the distal- are being provided for nothing more than merely illustra- 40 most staple opening in the deck is adjacent to the distal tive purposes. It is contemplated that the various teach- tip. ings herein may be arranged and applied in numerous other ways. It is also contemplated that some variations Example 6 may omit certain features referred to in the below examples. Therefore, none of the aspects or features referred 45 [0057] The surgical instrument of any one or more of to below should be deemed critical unless otherwise ex- Examples 3 through 5, wherein the end effector, the sta- plicitly indicated as such at a later date by the inventors ple cartridge, and the centerline having a straight portion or by a successor in interest to the inventors. If any claims extending to an arcuate portion, and the at least one sta- are presented in this application or in subsequent filings ple opening that obliquely crosses the centerline is related to this application that include additional features 50 formed in the arcuate portion of the staple cartridge. beyond those referred to below, those additional features shall not be presumed to have been added for any reason Example 7 relating to patentability. [0058] The surgical instrument of any one or more of Example 1 55 Examples 1 through 6, wherein the end effector, the staple cartridge, and the centerline have the arcuate portion [0052] A surgical instrument for treating a tissue of a and a straight portion, wherein straight portion extends patient, comprising: (a) a shaft assembly; (b) an end ef- to the arcuate portion.

11 21 EP 3 155 985 A1 22

Example 8 below the driver assembly.

[0059] The surgical instrument of Example 7, wherein Example 14 the plurality of staple openings comprises a first row of staple openings and a second row of staple openings, 5 [0065] The surgical instrument of any one or more of wherein the first and second rows of staple openings are Examples 1 through 13, wherein the first jaw comprises located on respective sides of the centerline and are a first crush surface extending generally parallel with the formed on the deck in the straight portion. centerline, wherein the first crush surface is configured to receive tissue thereagainst, wherein the second jaw Example 9 10 comprises a second crush surface extending generally parallel with the centerline, wherein the second crush [0060] The surgical instrument of any one or more of surface is configured to receive tissue thereagainst, Examples 2 through 8, wherein the first row of staple wherein the first and second crush surfaces are config- openings comprises an outer row of staple openings, ured to compress tissue therebetween with a crush pres- wherein the second row of staple openings comprises 15 sure configured to sever the tissue along the first and an inner row of staple openings, wherein the outer row second crush surfaces. of staple openings is positioned radially outwardly from the centerline in the arcuate portion, wherein the inner Example 15 row of staple openings is positioned radially inwardly from the centerline in the arcuate portion. 20 [0066] The surgical instrument of Example 14, wherein the end effector, the staple cartridge, and the centerline Example 10 have a straight portion extending to an arcuate portion, wherein the first and second crush surfaces extend along [0061] The surgical instrument of Example 9, wherein the straight and arcuate portions. the outer row of staple openings defines a plurality of25 outer gaps between the adjacent staple openings of the IV. Miscellaneous plurality of staple openings, wherein the inner row of staple openings defines a plurality of inner gaps between [0067] It should be understood that any one or more adjacent staple openings of the plurality of staple open- of the teachings, expressions, embodiments, examples, ings, wherein the inner gaps and outer gaps have an30 etc. described herein may be combined with any one or equivalent length. more of the other teachings, expressions, embodiments, examples, etc. that are described herein. The above-de- Example 11 scribed teachings, expressions, embodiments, examples, etc. should therefore not be viewed in isolation rel- [0062] The surgical instrument of any one or more of 35 ative to each other. Various suitable ways in which the Examples 1 through 10, wherein the staple cartridge fur- teachings herein may be combined will be readily appar- ther comprises a wedge sled configured to slide proxi- ent to those of ordinary skill in the art in view of the teach- mate to the deck from a proximal sled position to a distal ings herein.Such modifications and variationsare intend- sled position, wherein the distal sled position is below ed to be included within the scope of the claims. the at least one of the staple opening obliquely crossing 40 [0068] Versions of the devices described above may the centerline. have application in conventional medical treatments and procedures conducted by a medical professional, as well Example 12 as application in robotic-assisted medical treatments and procedures. By way of example only, various teachings [0063] The surgical instrument of Example 11, further 45 herein may be readily incorporated into a robotic surgical comprising a wedge sled having a distal nose, wherein system such as the DA VINCI™ system by Intuitive Sur- the second jaw has a blocker wall distally positioned gical, Inc., of Sunnyvale, California. Similarly, those of therein along the centerline, wherein the blocker wall is ordinary skill in the art will recognize that various teach- configured to receive the wedge sled thereagainst and ings herein may be readily combined with various teach- inhibit movement of the wedge sled distally beyond the 50 ings of any of the following: U.S. Pat. No. 5,792,135, en- distal sled position, wherein the blocker wall defines a titled "Articulated Surgical Instrument For Performing clearance hole configured to receive the distal nose of Minimally Invasive Surgery With Enhanced Dexterity and the wedge sled in the distal sled position. Sensitivity," issued August 11, 1998; U.S. Pat. No. 5,817,084, entitled "Remote Center Positioning Device Example 13 55 with Flexible Drive," issued October 6, 1998; U.S. Pat. No. 5,878,193, entitled "Automated Endoscope System [0064] The surgical instrument of Example 12, wherein for Optimal Positioning," issued March 2, 1999; U.S. Pat. a majority of the wedge sled in the distal sled position is No. 6,231,565, entitled "Robotic Arm DLUS for Perform-

12 23 EP 3 155 985 A1 24 ing Surgical Tasks," issued May 15,2001; U.S. Pat. No. device may utilize a variety of techniques for disassem- 6,783,524, entitled "Robotic Surgical Tool with Ultra- bly, cleaning/replacement, and reassembly. Use of such sound Cauterizing and Cutting Instrument," issued Au- techniques, and the resulting reconditioned device, are gust 31, 2004; U.S. Pat. No. 6,364,888, entitled "Align- all within the scope of the present application. ment of Master and Slave in a Minimally Invasive Surgical 5 [0070] By way of example only, versions described Apparatus," issued April 2, 2002; U.S. Pat. No.herein may be sterilized before and/or after a procedure. 7,524,320, entitled "Mechanical Actuator Interface Sys- In one sterilization technique, the device is placed in a tem for Robotic Surgical Tools," issued April 28,2009; closed and sealed container, such as a plastic or TYVEK U.S. Pat. No. 7,691,098, entitled "Platform Link Wrist bag. The container and device may then be placed in a Mechanism," issued April 6, 2010; U.S. Pat. 10 No.field of radiation that can penetrate the container, such 7,806,891, entitled "Repositioning and Reorientation of as gamma radiation, x-rays, or high-energy electrons. Master/Slave Relationship in Minimally Invasive Telesur- The radiation may kill bacteria on the device and in the gery," issued October 5, 2010; U.S. Pub. No.container. The sterilized device may then be stored in 2013/0012957, entitled "Automated End Effector Com- the sterile container for later use. A device may also be ponent Reloading System for Use with a Robotic System, 15 sterilized using any other technique known in the art, in- published January 10, 2013; U.S. Pub. cluding No. but not limited to beta or gamma radiation, eth- 2012/0199630, entitled "Robotically-Controlled Surgical ylene oxide, or steam. Instrument with Force-Feedback [0071] Having shown and described various embodi- Capabilities," published August 9, 2012; U.S. Pub. No. ments of the present invention, further adaptations of the 2012/0132450, entitled "Shiftable Drive Interface for Ro- 20 methods and systems described herein may be accom- botically-Controlled Surgical Tool," published May 31, plished by appropriate modifications by one of ordinary 2012; U.S. Pub. No. 2012/0199633, entitled "Surgical skill in the art without departing from the scope of the Stapling Instruments with Cam-Driven Staple Deploy- present invention. Several of such potential modifications ment Arrangements," published August 9, 2012; U.S. have been mentioned, and others will be apparent to Pub. No. 2012/0199631, entitled "Robotically-Controlled 25 those skilled in the art. For instance, the examples, em- Motorized Surgical End Effector System with Rotary Ac- bodiments, geometrics, materials, dimensions, ratios, tuated Closure Systems Having Variable Actuation steps, and the like discussed above are illustrative and Speeds," published August 9, 2012; U.S. Pub. No. are not required. Accordingly, the scope of the present 2012/0199632, entitled "Robotically-Controlled Surgical invention should be considered in terms of the following Instrument with Selectively Articulatable 30 Endclaims and is understood not to be limited to the details Effector," published August 9, 2012; U.S. Pub. No. of structure and operation shown and described in the 2012/0203247, entitled "Robotically-Controlled Surgical specification and drawings. End Effector System," published August 9, 2012; U.S. Pub. No. 2012/0211546, entitled "Drive Interface for Op- erably Coupling a Manipulatable Surgical Tool to 35 a Claims Robot," published August 23, 2012; U.S. Pub. No. 2012/0138660, entitled "Robotically-Controlled Cable- 1. A surgical instrument for treating a tissue of a patient, Based Surgical End Effectors," published June 7, 2012; comprising: and/or U.S. Pub. No. 2012/0205421, entitled "Robotically-Controlled Surgical End Effector40 (a) a shaft assembly; System with Rotary Actuated Closure(b) an end effector extending from the shaft as- Systems," published August 16, 2012. sembly along a jaw centerline, the end effector [0069] Versions of the devices described above may comprising: be designed to be disposed of after a single use, or they can be designed to be used multiple times. Versions may, 45 (i) a first jaw having an anvil configured to in either or both cases, be reconditioned for reuse after form a plurality of staples pressed against at least one use. Reconditioning may include any com- the anvil, and bination of the steps of disassembly of the device, fol- (ii) a second jaw, wherein the first and sec- lowed by cleaning or replacement of particular pieces, ond jaws are configured to transition be- and subsequent reassembly. In particular, some ver-50 tween an open configuration and a closed sions of the device may be disassembled, and any configuration; and number of the particular pieces or parts of the device may be selectively replaced or removed in any combination. (c) a staple cartridge received within the second Upon cleaning and/or replacement of particular parts, jaw, the staple cartridge comprising: some versions of the device may be reassembled for 55 subsequent use either at a reconditioning facility, or by (i) a deck facing the anvil, a operator immediately prior to a procedure. Those (ii) a plurality of staple openings formed skilled in the art will appreciate that reconditioning of a through the deck, wherein at least one of

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the staple openings obliquely crosses the plurality of staple openings, wherein the inner row of centerline, and staple openings defines a plurality of inner gaps be- (iii) a plurality of staples positioned respec- tween adjacent staple openings of the plurality of tively within the plurality of staple openings. staple openings, wherein the inner gaps and outer 5 gaps have an equivalent length. 2. The surgical instrument of claim 1, wherein the plurality of staple openings comprises a first row of sta- 11. The surgical instrument of any one of claims 1 to 10, ple openings and a second row of staple openings, wherein the staple cartridge further comprises a wherein the first and second rows of staple openings wedge sled configured to slide proximate to the deck are on respective sides of the centerline. 10 from a proximal sled position to a distal sled position, wherein the distal sled position is below the at least 3. The surgical instrument of claim 2, wherein the at one of the staple opening obliquely crossing the cen- least one staple opening obliquely crossing the centerline. terline extends from the first row of staple openings to the second row of staple openings. 15 12. The surgical instrument of claim 11, wherein the wedge sled having a distal nose, wherein the second 4. The surgical instrument of claim 3, wherein the at jaw has a blocker wall distally positioned therein least one staple opening that obliquely crosses the along the centerline, wherein the blocker wall is con- centerline is a distal-most staple opening in the deck. figured to receive the wedge sled thereagainst and 20 inhibit movement of the wedge sled distally beyond 5. The surgical instrument of claim 4, wherein the end the distal sled position, wherein the blocker wall de- effector extends to a distal tip, wherein the distal- fines a clearance hole configured to receive the distal most staple opening in the deck is adjacent to the nose of the wedge sled in the distal sled position. distal tip. 25 13. The surgical instrument of claim 12, wherein a ma- 6. The surgical instrument of any one of claims 3 to 5, jority of the wedge sled in the distal sled position is wherein the end effector, the staple cartridge, and below the driver assembly. the centerline having a straight portion extending to an arcuate portion, and the at least one staple open- 14. The surgical instrument of any one of claims 1 to 13, ing that obliquely crosses the centerline is formed in 30 wherein the first jaw comprises a first crush surface the arcuate portion of the staple cartridge. extending generally parallel with the centerline, wherein the first crush surface is configured to re- 7. The surgical instrument of any one of claims 1 to 6, ceive tissue thereagainst, wherein the second jaw wherein the end effector, the staple cartridge, and comprises a second crush surface extending gener- the centerline have the arcuate portion and a straight 35 ally parallel with the centerline, wherein the second portion, wherein straight portion extends to the ar- crush surface is configured to receive tissue therea- cuate portion. gainst, wherein the first and second crush surfaces are configured to compress tissue therebetween 8. The surgical instrument of claim 7, wherein the plu- with a crush pressure configured to sever the tissue rality of staple openings comprises a first row of sta- 40 along the first and second crush surfaces. ple openings and a second row of staple openings, wherein the first and second rows of staple openings 15. The surgical instrument of claim 14, wherein the end are located on respective sides of the centerline and effector, the staple cartridge, and the centerline have are formed on the deck in the straight portion. a straight portion extending to an arcuate portion, 45 wherein the first and second crush surfaces extend 9. The surgical instrument of any one of claims 2 to 8, along the straight and arcuate portions. wherein the first row of staple openings comprises an outer row of staple openings, wherein the second row of staple openings comprises an inner row of staple openings, wherein the outer row of staple50 openings is positioned radially outwardly from the centerline in the arcuate portion, wherein the inner row of staple openings is positioned radially inwardly from the centerline in the arcuate portion. 55 10. The surgical instrument of claim 9, wherein the outer row of staple openings defines a plurality of outer gaps between the adjacent staple openings of the

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REFERENCES CITED IN THE DESCRIPTION

This list of references cited by the applicant is for the reader’s convenience only. It does not form part of the European patent document. Even though great care has been taken in compiling the references, errors or omissions cannot be excluded and the EPO disclaims all liability in this regard.

Patent documents cited in the description

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