US 9,010,608 B2Grant
Releasable buttress retention on a surgical stapler
Issue Date:2015-04-21
•14 Claims
•8 Drawing Sheets
Abstract
A surgical stapling apparatus including a releasable buttress material includes a cartridge assembly, an anvil assembly, and a buttress material. The cartridge assembly includes a plurality of staples, a tissue contacting surface defining staple retaining slots, and a swaged outer edge. The anvil assembly includes a tissue contacting surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly. The buttress material has an outer portion that is retaining within the swaged outer edge of the cartridge assembly.
Metadata
Assignee
- Covidien LP
Inventors
- Thomas Casasanta, Jr.
- Andrew Miesse
- Jennifer Whiffen
- Elizabeth M. Contini
- Sally Carter
Application Information
Application Number:US 13/325,404
Filing Date:2011-12-14
Priority Date:2011-12-14
Art Unit:3721
Classifications
IPC:
A61B17/068A61B17/072A61B17/115
Field of Search:
A61B 17/068A61B 17/115
Patent Drawings (8 sheets)
Description
Background
[0001] 1. Technical Field
[0002] The present disclosure relates to surgical stapling apparatus including surgical buttresses which can be releasably attached to the surgical stapling apparatus, and in particular, to surgical stapling apparatus having a surgical buttress temporarily secured to an anvil and/or staple cartridge assembly of the surgical stapling apparatus.
[0003] 2. Background of Related Art
[0004] Surgical stapling apparatus are employed by surgeons to sequentially or simultaneously apply one or more rows of fasteners, e.g., staples or two-part fasteners, to body tissue for the purpose of joining segments of body tissue together. Such apparatus generally include a pair of jaws or finger-like structures between which the body tissue to be joined is placed. When the stapling apparatus is actuated, or “fired”, longitudinally moving firing bars contact staple drive members in one of the jaws. The staple drive members push the surgical staples through the body tissue and into an anvil in the opposite jaw which forms the staples. If tissue is to be removed or separated, a knife blade can be provided in the jaws of the apparatus to cut the tissue between the lines of staples.
[0005] A number of surgical stapling apparatus rely on knife blade cutting of some portion of the buttress material to effect buttress release. These methods may employ a secondary material or mounting structure in addition to the buttress material to provide attachment to the surgical stapling apparatus. Typically, firing forces are increased with each material that must be transected by the knife blade in order to release the buttress. For example, WO 08/109125 discloses a surgical stapling apparatus that includes a surgical buttress releasably secured by an anchor.
[0006] It would be desirable to provide a buttress that may be releasably secured to a surgical stapling apparatus without the need for a secondary material or mounting structure, and without the need for a knife blade to cut the buttress and/or secondary material or mounting structure to release the buttress from the surgical stapling apparatus, thereby resulting in the use of few materials and lower firing forces.
Summary
[0007] According to an aspect of the present disclosure, a surgical stapling apparatus including a releasable buttress material includes a cartridge assembly, an anvil assembly, and a buttress material. The cartridge assembly includes a plurality of staples, a tissue contacting surface defining staple retaining slots, and a swaged outer edge. The anvil assembly includes a tissue contacting surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly. The buttress material has an outer portion retained within the swaged outer edge of the cartridge assembly. In some embodiments, the buttress material may include slits. In some embodiments, the outer portion of the buttress material may be frayed.
[0008] The swaged outer edge of the cartridge assembly may include a rim overlapping the tissue contacting surface of the cartridge assembly in spaced relation therewith and defining an inner pocket between the tissue contacting surface and the rim. In embodiments, the rim continuously extends around the entire perimeter of the buttress material. In other embodiments, the rim includes a plurality of discontinuous tabs extending around the buttress material. In some embodiments, the rim may include sharp edges extending radially inward of the outer edge.
[0009] The anvil assembly may include a swaged outer edge and a buttress material retained within the swaged outer edge of the anvil assembly. The swaged outer edge of the anvil assembly may include a rim overlapping the tissue contacting surface of the anvil assembly in spaced relation therewith and defining an inner pocket between the tissue contacting surface and the rim. In some embodiments, the buttress material retained within the swaged outer edge of the anvil assembly may include slits. In some embodiments, the outer portion of the buttress material retained within the swaged outer edge of the anvil assembly may be frayed. The buttress material of the anvil assembly may be different from the buttress material of the cartridge assembly.
[0010] In embodiments, the cartridge assembly is associated with a body portion of the surgical stapling apparatus and the anvil assembly includes a shaft removably mountable to the body portion, the anvil assembly being movable toward and away from the body portion. In such embodiments, the cartridge assembly and the anvil assembly may be circular, and the buttress material may include a central opening dimensioned to receive the shaft of the anvil assembly.
[0011] In embodiments, the cartridge assembly is associated with a first jaw and the anvil assembly is associated with a second jaw, the first and second jaws being selectively movable relative to one another from a first spaced apart position to a second position wherein the first and second jaws cooperate to grasp tissue therebetween.
[0012] Accordingly to another aspect of the present disclosure, a surgical stapling apparatus including a releasable buttress material includes a cartridge assembly, an anvil assembly, and a buttress material. The cartridge assembly includes a plurality of staples and a tissue contacting surface defining staple retaining slots. The anvil assembly includes a tissue contacting surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly, and a swaged outer edge. The swaged outer edge of the anvil assembly may include a rim overlapping the tissue contacting surface of the anvil assembly in spaced relation therewith and defining an inner pocket between the tissue contacting surface and the rim. The buttress material has an outer portion retained within the swaged outer edge of the anvil assembly. In some embodiments, the buttress material may include slits. In some embodiments, the outer portion of the buttress material may be frayed.
[0013] According to yet another aspect of the present disclosure, a surgical stapling apparatus including a releasable buttress material includes a cartridge assembly including a plurality of staples and a tissue contacting surface defining staple retaining slots, an anvil assembly including a tissue contacting surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly, a knife disposed within a knife slot formed in the tissue contacting surface of the cartridge assembly, and a buttress material having an outer portion swaged to an outer edge of one of the cartridge assembly and the anvil assembly.
Brief Description of the Drawings
[0014] Embodiments of the presently disclosed surgical stapling apparatus and surgical buttress are described herein with reference to the accompanying drawings, wherein:
[0015] FIG. 1A is a perspective view of an illustrative embodiment of a surgical stapling apparatus and surgical buttress (shown separated from a staple cartridge assembly of the surgical stapling apparatus) in accordance with an embodiment of the present disclosure;
[0016] FIG. 1B is a partial, longitudinal cross-sectional view of the surgical stapling apparatus of FIG. 1A including a surgical buttress positioned thereon and shown disposed within an intestinal area;
[0017] FIG. 1C is an enlarged cross-sectional view of the area of detail indicated in FIG. 1B ;
[0018] FIG. 2 is a top plan view of a surgical buttress in accordance with another embodiment of the present disclosure illustrating its attachment to a surgical stapling apparatus;
[0019] FIG. 3 is a perspective view of a surgical buttress in accordance with an embodiment of the present disclosure attached to an anvil assembly;
[0020] FIGS. 4A and 4B are cross-sectional views of a staple cartridge of the surgical stapling apparatus and a surgical buttress of the present disclosure, illustrating an exemplary process of forming a swaged outer edge in accordance with an embodiment of the present disclosure;
[0021] FIG. 5 is a top plan view of a surgical buttress in accordance with another embodiment of the present disclosure;
[0022] FIG. 6A is a top plan view of a surgical buttress in accordance with yet another embodiment of the present disclosure;
[0023] FIG. 6B is a schematic side view of the surgical buttress of FIG. 6A positioned on a staple cartridge assembly in accordance with an embodiment of the present disclosure;
[0024] FIG. 7 is a top plan view of a surgical buttress in accordance with an embodiment of the present disclosure illustrating its attachment to a surgical stapling apparatus;
[0025] FIGS. 8A and 8B are perspective views of a surgical buttress secured to a staple cartridge assembly in accordance with embodiments of the present disclosure;
[0026] FIG. 9 is a schematic side view of a surgical buttress secured to a staple cartridge assembly in accordance with another embodiment of the present disclosure;
[0027] FIG. 10A is a perspective view of an illustrative embodiment of a surgical stapling apparatus in accordance with an embodiment of the present disclosure;
[0028] FIG. 10B is a perspective view of the surgical buttress secured to the staple cartridge assembly of the surgical stapling apparatus of FIG. 10A ;
[0029] FIG. 11 is a perspective view of another illustrative embodiment of a surgical stapling apparatus for use with a surgical buttress of the present disclosure; and
[0030] FIG. 12 is a perspective view of yet another illustrative embodiment of a surgical stapling apparatus for use with a surgical buttress of the present disclosure.
Detailed Description of the Embodiments
[0031] Various exemplary embodiments of the present disclosure are discussed herein below in terms of surgical buttresses for use with surgical stapling apparatus. The surgical buttresses described herein may be used in closing a wound by approximating the edges of wound tissue between a staple cartridge and an anvil of a surgical stapling apparatus which contains at least one buttress. The at least one buttress is joined to the surgical stapling apparatus by a swaged outer edge of an anvil and/or staple cartridge assembly which captures an outer portion of the surgical buttress to retain the surgical buttress therein. Staples fired from the surgical stapling apparatus attach the surgical buttress to tissue and maintain a force on the surgical buttress to allow the surgical buttress to slip out from under the outer edge of the anvil and/or staple cartridge assembly as the surgical stapling apparatus is pulled away from the anastomosed site, releasing the surgical buttress from the surgical stapling apparatus. Thus, the present disclosure describes surgical buttresses, surgical stapling apparatus supporting said surgical buttresses, and methods and mechanisms for using the same.
[0032] It should be understood that a variety of surgical stapling apparatus may be utilized with a surgical buttress of the present disclosure. For example, linear stapler configurations may be utilized, such as, for example those including Duet TRS™ reloads and staplers with Tri-Staple™ technology, available through Covidien, which maintain a principal place of business at 555 Long Wharf Drive, North Haven, Conn. 06511, and transverse anastomosis staplers, such as, for example, EEA™, CEEA™, GIA™, EndoGIA™, and TA™ staplers, available through Covidien. It should also be appreciated that the principles of the present disclosure are equally applicable to surgical staplers having alternate configurations, such as, for example, end-to-end anastomosis staplers having a circular cartridge and anvil (see, e.g., commonly owned U.S. Pat. No. 5,915,616, entitled “Surgical Fastener Applying Apparatus,” the entire content of which is incorporated herein by this reference); laparoscopic staplers (see, e.g., commonly owned U.S. Pat. Nos. 6,330,965 and 6,241,139, each entitled “Surgical Stapling Apparatus,” the entire contents of each of which being incorporated herein by this reference); and transverse anastomosis staplers (see, e.g., commonly owned U.S. Pat. Nos. 5,964,394 and 7,334,717, each entitled “Surgical Fastener Applying Apparatus”, the entire contents of each of which being incorporated herein by this reference).
[0033] Embodiments of the presently disclosed surgical buttress and surgical stapling apparatus will now be described in detail with reference to the drawing figures wherein like reference numerals identify similar or identical elements. In the following discussion, the terms “proximal” and “trailing” may be employed interchangeably, and should be understood as referring to the portion of a structure that is closer to a clinician during proper use. The terms “distal” and “leading” may also be employed interchangeably, and should be understood as referring to the portion of a structure that is further from the clinician during proper use. As used herein, the term “patient” should be understood as referring to a human subject or other animal, and the term “clinician” should be understood as referring to a doctor, nurse, or other care provider and may include support personnel.
[0034] Referring now to FIGS. 1A and 1B , there is disclosed an exemplary surgical stapling apparatus or surgical stapler 10 for use in stapling tissue and applying a buttress material or surgical buttress to the tissue. Surgical stapling apparatus 10 generally includes a handle assembly 12 having at least one pivotable actuating handle member 33, and an advancing member 35. Extending from handle member 12, there is provided a tubular body portion 14 which may be constructed so as to have a curved shape along its length. Body portion 14 terminates in a staple cartridge assembly 32 which includes an annular array of staple retaining slots 52 having a staple 50 disposed in each one of staple retaining slots 52. Positioned distally of staple cartridge assembly 32 there is provided an anvil assembly 20 including an anvil member 21 and a shaft 23 operatively associated therewith for removably connecting anvil assembly 20 to a distal end portion of stapling apparatus 10.
[0035] Staple cartridge assembly 32 may be fixedly connected to the distal end of tubular body portion 14 or may be configured to concentrically fit within the distal end of tubular body portion 14. Typically, staple cartridge assembly 32 includes a staple pusher 64 including a proximal portion having a generally frusto-conical shape and a distal portion defining concentric rings of peripherally spaced fingers (not shown), each one of which is received within a respective staple retaining slot 52. For example, the staple pusher of the staple cartridge assembly can have two concentric rings of fingers.
[0036] A knife 30, substantially in the form of an open cup with the rim thereof defining a knife blade 31, is disposed within staple cartridge assembly 32 and mounted to a distal surface of a staple pusher 64. The knife 30 is disposed radially inward of the annular arrays of staples 50. Accordingly, in use, as the staple pusher 64 is advanced, the knife 30 is also advanced axially outward.
[0037] Reference may be made to commonly owned U.S. Pat. No. 5,915,616 to Viola et al., referenced above, for a detailed discussion of the construction and operation of an annular stapling device.
[0038] A surgical buttress 24 is releasably attached to the staple cartridge assembly 32 by an overlapping outer edge 36 of the staple cartridge assembly 32 that is swaged, molded or otherwise formed to entrap an outer portion 26 of the surgical buttress 24 between a rim 40 and a tissue contacting/facing surface 38 of staple cartridge assembly 32. It should be understood that while the surgical buttress 24 is described herein as being associated with the staple cartridge assembly 32, the surgical buttress 24 may, alternatively or additionally, be associated with the anvil assembly 20, as illustrated in FIG. 3 . Surgical buttress 24 is provided to reinforce and/or seal staple lines applied to tissue by surgical stapling apparatus 10. Surgical buttress 24 may be configured into any shape, size, or dimension suitable to fit any surgical stapling, fastening, or firing apparatus.
[0039] Surgical buttress 24 is fabricated from a biocompatible material which is a bioabsorbable or non-absorbable, natural or synthetic material. It should of course be understood that any combination of natural, synthetic, bioabsorbable, and non-bioabsorbable materials may be used to form the surgical buttress. In embodiments, the entire surgical buttress 24, or portions thereof, may be fabricated from the same material, or combination of materials that is homogeneous throughout the surgical buttress 24. In other embodiments, the surgical buttress 24 may be formed of different materials.
[0040] The surgical buttress 24 may be porous, non-porous, or combinations thereof. It is also envisioned that surgical buttress 24 described herein may contain a plurality of layers in which any combination of non-porous and porous layers may be configured as discussed further below. For example, surgical buttress may be formed to include multiple non-porous layers and porous layers that are stacked in an alternating manner. In another example, surgical buttress may be formed in a “sandwich-like” manner wherein the outer layers of the surgical buttress include porous layers and the inner layers are non-porous layers. It is further envisioned that non-porous and porous layers may be positioned in any order relative to the tissue contacting surfaces of the staple cartridge/anvil assembly. Examples of multilayered surgical buttresses are disclosed in U.S. Patent Application Publication No. 2009/0001122 filed Jun. 27, 2007, entitled “Buttress and Surgical Stapling Apparatus,” the entire disclosure of which is incorporated by reference herein.
[0041] Some non-limiting examples of materials from which non-porous and/or porous layers of surgical buttress 24 may be made include, but are not limited to, poly(lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyesters, polyethylene glycols, polyethylene oxides, polyacrylamides, polyhydroxyethylmethylacrylate, polyvinylpyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyesters, glycerols, poly(amino acids), copoly (ether-esters), polyalkylene oxalates, polyamides, poly (iminocarbonates), polyalkylene oxalates, polyoxaesters, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, blends, and combinations thereof.
[0042] In embodiments, natural biological polymers are used in forming a non-porous layer of the surgical buttress. Suitable natural biological polymers include, but are not limited to, collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitan, chitosan, and combinations thereof. In addition, the natural biological polymers may be combined with any of the other polymeric materials described herein to produce a non-porous layer of the surgical buttress.
[0043] In embodiments, collagen of human and/or animal origin, e.g., type I porcine or bovine collagen, type I human collagen or type III human collagen, may be used to form a non-porous layer of the surgical buttress. In embodiments, a non-porous layer of the surgical buttress according to the present disclosure is made of collagen which is oxidized or a mixture in any proportions of non-oxidized and oxidized collagens.
[0044] The use of non-porous layer(s) in the surgical buttress may enhance the ability of the surgical buttress to resist tears and perforations during the manufacturing, shipping, handling, and stapling processes. Also, the use of a non-porous layer in the surgical buttress may also retard or prevent tissue ingrowth from surrounding tissues thereby acting as an adhesion barrier and preventing the formation of unwanted scar tissue. Thus, in embodiments, the non-porous layer(s) of the surgical buttress may possess anti-adhesion properties.
[0045] A non-porous layer of the surgical buttress may be formed using techniques within the purview of those skilled in the art, such as casting, molding, and the like.
[0046] Any of the porous layers of the surgical buttress may have openings or pores over at least a portion of a surface thereof. As described in more detail below, suitable materials for forming a porous layer include, but are not limited to, fibrous structures (e.g., knitted structures, woven structures, non-woven structures, etc.) and/or foams (e.g., open or closed cell foams). In embodiments, the pores may be in sufficient number and size so as to interconnect across the entire thickness of the porous layer. Woven fabrics, knitted fabrics, and open cell foam are illustrative examples of structures in which the pores can be in sufficient number and size so as to interconnect across the entire thickness of the porous layer. In embodiments, the pores may not interconnect across the entire thickness of the porous layer, but rather may be present at a portion thereof. Thus, in some embodiments, pores may be located on a portion of the porous layer, with other portions of the porous layer having a non-porous texture. Those skilled in the art reading the present disclosure will envision a variety of pore distribution patterns and configurations for the porous layer. Closed cell foam or fused non-woven materials are illustrative examples of structures in which the pores may not interconnect across the entire thickness of the porous layer.
[0047] Where a porous layer of the surgical buttress is fibrous, the fibers may be filaments or threads suitable for knitting or weaving or may be staple fibers, such as those frequently used for preparing non-woven materials. Woven, non-woven, drawing, knitting, and other known techniques can be used to make the surgical buttress. Suitable techniques for making fibrous structures are within the purview of those skilled in the art.
[0048] Where a porous layer of the surgical buttress is a foam, the porous layer may be formed using any method suitable to forming a foam or sponge including, but not limited to, the lyophilization or freeze-drying of a composition. Suitable techniques for making foams are within the purview of those skilled in the art.
[0049] The origin and types of collagens that may be used to form the porous layer are the same as those indicated above for the non-porous layer. However, the oxidized or non-oxidized collagen may be lyophilized, freeze-dried, or emulsified in the presence of a volume of air to create a foam and then freeze-dried, to form a porous compress.
[0050] In embodiments, a porous layer of the surgical buttress may be made from denatured collagen or collagen which has at least partially lost its helical structure through heating or any other method. The term “denatured collagen” means collagen which has lost its helical structure. The collagen used for the porous layer as described herein may be native collagen or atellocollagen. The collagen may have been previously chemically modified by oxidation, methylation, succinylation, ethylation, or any other known process.
[0051] The porous layer(s) may enhance the ability of the surgical buttress to absorb fluid, reduce bleeding, and seal the wound. Also, the porous layer(s) may allow for tissue ingrowth to fix the surgical buttress in place.
[0052] Referring again to FIGS. 1B and 1C , staple cartridge 32 includes an outer edge 36 extending in a “c” or “u” shape to form a rim 40 which overlaps the tissue contacting surface 38 of the staple cartridge assembly 32 in spaced relation to define an inner pocket 42 that is dimensioned to releasably retain an outer portion 26 of the surgical buttress 24 against the tissue contacting surface 38 of the staple cartridge 32. While the rim 40 is shown as continuously extending around the entire perimeter of the surgical buttress, it should be understood that the rim 40 may be discontinuous and include a plurality of tabs 41 extending around the surgical buttress 24, such as in the configuration illustrated in FIG. 2 , for example. It is envisioned that the outer edge 36 may be swaged by pinching, crimping, or otherwise deforming at least a portion of the outer edge 36 to capture at least a portion of the surgical buttress 24. The outer edge may be swaged, molded or otherwise formed.
[0053] As illustrated in FIG. 2 , surgical buttress 24 includes an inner portion 28 defining an aperture 29 to receive shaft 23 of anvil assembly 20 and an outer portion 26 extending under the rim 40 of the outer edge 36 (FIGS. 1A-1C ) of the staple cartridge assembly 32.
[0054] With reference now to FIGS. 4A and 4B , a method of swaging the outer edge 36 of the staple cartridge assembly 32 (or anvil assembly 20) for retaining a surgical buttress 24 is illustrated. The staple cartridge assembly 32 and surgical buttress 24 are placed within a retaining channel 1022 of base 1020 of swaging assembly apparatus 1000. Swaging assembly 1000, or the like, includes a horn 1010 operably connected to a generator (not shown) for mechanically capturing and re-forming the outer edge 36 of cartridge assembly 32. Horn 1010 includes a swage 1012 that may include a curved surface 1014 for forming a rim 40 to retain buttress 24.
[0055] In one embodiment, swaging assembly 1000 is operatively mounted on a press assembly (not shown) for approximating horn 1010 towards and away from base 1020. Alternatively, swaging assembly 1000 may be securely mounted relative to base 1020 and base 1020 may be raised and lowered to approximate base 1020 towards and away from horn 1010. The downward pressure exerted on the cartridge assembly 32 by the horn 1010, indicated by the arrow in FIG. 4A , and the shape of swage 1012 displaces the material forming the outer edge 36 of the cartridge assembly 32 over a portion of the tissue contacting surface 38 of the cartridge assembly 32 to entrap the surgical buttress 24 between the formed rim 40 and the tissue contacting surface 38. In embodiments, the addition of heat may cause the outer edge 36 to melt thereby re-shaping the outer edge 36 into a rim 40 over the surgical buttress 24 to retain the surgical buttress 24 on the cartridge assembly 32. It should be understood that the swage 1012 may be configured in a variety of shapes to roll, pinch, wedge, or otherwise re-shape the outer edge 36 of the staple cartridge 32 to capture the outer portion 26 of the surgical buttress 24 to the cartridge assembly 32.
[0056] Alternatively, during manufacture, the swaged outer edge 36 of cartridge assembly 32 may be formed without a surgical buttress 24 present. Instead, a spacing material (not shown) may be placed over the tissue contacting surface 38 of the cartridge assembly 32 to form an inner pocket 42 (FIG. 1C ) within which the surgical buttress 24 may be later loaded. After swaging the outer edge 36, the buttress 24 may be wedged between the rim 40 and the tissue contacting surface 38 of the cartridge assembly 32. In embodiments, as illustrated in FIG. 5 , the surgical buttress 24 may include slits 19 to facilitate flexible loading and positioning of the surgical buttress 24 under the rim 40 of the cartridge assembly 32.
[0057] Referring again to FIGS. 1A-1C , surgical stapling apparatus 10 and detachable anvil assembly 20 are used in an anastomosis procedure to effect joining of intestinal sections 1 and 2, or other body tissue, vessels, or lumens. The anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. At the point in the procedure shown in FIG. 1B , a diseased intestinal section has been previously removed, anvil assembly 20 has been applied to the operative site either through a surgical incision or transanally and positioned within intestinal section 2, and tubular body portion 14 of surgical stapling apparatus 10 has been inserted transanally into intestinal section 1. Intestinal sections 1 and 2 are also shown temporarily secured about their respective components (e.g., shaft 23 of anvil assembly 20, and the distal end of tubular body portion 14) by conventional means such as a purse string suture “P”.
[0058] Thereafter, the clinician maneuvers anvil assembly 20 until the proximal end of shaft 23 is inserted into the distal end of tubular body portion 14 of surgical stapling apparatus 10, wherein a mounting structure within the distal end of tubular body portion 14 engages shaft 23 to effect the mounting. Anvil assembly 20 and tubular body portion 14 are then approximated to approximate intestinal sections 1, 2. Surgical stapling apparatus 10 is then fired. The staples 50 are fired, effecting stapling of intestinal sections 1, 2 to one another. The staples 50 provide enough force to allow the outer portion 26 of the surgical buttress 24 to slip out from within the inner pocket 42 formed between the rim 40 and the tissue contacting surface 38 of the cartridge assembly 32, thereby releasing the surgical buttress 24 from the staple cartridge assembly 32. Alternatively, the buttress slips out from the inner pocket 42 as the surgical stapling apparatus is removed from the tissue. Thereafter, or therewith, knife 30 cuts the portion of tissue and surgical buttress 24 disposed radially inward of the knife 30, to complete the anastomosis.
[0059] FIGS. 6A and 6B illustrate an embodiment of a surgical buttress 24 including an outer portion 26 having an edge 27 that is frayed, cut, distressed, or otherwise weakened. Frayed edge 27, for example, creates fewer tension points between the surgical buttress 24 and the rim 40 of the cartridge assembly 32 thereby requiring less force to remove the surgical buttress 24 from the cartridge assembly 32 compared to surgical buttresses including an intact outer edge 36, such as those shown in FIGS. 1A and 2 , for example. A buttress disclosed in connection with FIGS. 6A and 6B can be used in any of the embodiments disclosed herein.
[0060] In embodiments, as shown in FIG. 7 , release of the surgical buttress 24 may be accomplished by shaping the rim 40 of the cartridge assembly 32 with sharp edges, such as a jagged tooth pattern 40a extending radially inward from the outer edge 36, which will cut the surgical buttress 24, held under tension by staples, as the surgical stapling apparatus is being pulled away after firing. The outer edge 36 of the cartridge assembly 32 maintains a curved or rounded shape to prevent injury during handling and placement within tissue. It is envisioned that other patterns may be formed in the rim 40 of the cartridge assembly 32, as is within the purview of those skilled in the art. A stapling apparatus having a cartridge assembly with sharp edges, as disclosed in connection with FIG. 7 may be used with any of the embodiments disclosed herein.
[0061] In other embodiments, a surgical buttress may be retained on the cartridge assembly, or anvil assembly, by encasing at least the outer portion of the surgical buttress with a quick dissolving or rapidly bioerodible polymeric material. Examples of quick dissolving or rapidly bioerodible polymer materials include water soluble polymers such as polyvinyl alcohol, and hydroxylpropyl methylcellulose; biopolymers such as sugars, starches, salts, and gelatin; and derivatives and combinations thereof.
[0062] FIG. 8A illustrates a quick dissolving or rapidly bioerodible polymeric material in the form of a film or cap 160 surrounding an outer portion 26 of a surgical buttress 24 and an outer edge 36 of a cartridge assembly 32. Film or cap 160 may be applied to the surgical buttress 24 and cartridge assembly 32 by pressing, snap fitting, dipping, spraying, molding, or other forming processes within the purview of those skilled in the art. In embodiments, the film or cap 160 may dissolve in a sufficient amount of time to allow for placement of the surgical stapling apparatus at the anastomosis site. In other embodiments, the film or cap 160 may split, deform, or have a manual release strip for releasing the surgical buttress 124. In some embodiments, the film or cap 160 may be flexible to allow the surgical buttress 26 to be pulled out from under the film or cap 160. In other embodiments, the film or cap 160 may be rigid and include perforations 162 that will break as the surgical stapling apparatus is being pulled away from the stapled surgical buttress 24 after firing as illustrated in FIG. 8B . It should be understood that a variety of surgical buttress configurations may be utilized with the film or cap 160 of the present disclosure, such as a surgical buttress including slits and/or frayed edges as illustrated in FIGS. 5 and 6A above.
[0063] In embodiments, a quick dissolving or rapidly bioerodible polymeric material may encase an entire surgical buttress over a staple cartridge and/or anvil assembly. As illustrated in FIG. 9 , for example, a film or cap 260 may be suction fitted, self-molded, or shrink-wrapped around the surgical buttress 24 and a portion of the cartridge assembly 32. Perforations 262 may be provided in film or cap 260, which fracture or split, as the mounting structure within the surgical stapling apparatus is advanced during use. A buttress and/or buttress and stapling apparatus with a quick dissolving or rapidly bioerodible material, as disclosed in connection with FIGS. 8A , 8B, and 9, can be included in any of the embodiments disclosed herein.
[0064] Referring now to FIGS. 10A and 10B , an exemplary surgical stapling apparatus or surgical stapler 100 for use in stapling tissue and applying a buttress material or surgical buttress to the tissue. Surgical stapling apparatus 100 generally includes a handle 112 having an elongate tubular member 114 extending distally from handle 112. A jaw assembly 116 is mounted on a distal end 118 of elongate tubular member 114. Jaw assembly 116 includes a staple clinching anvil jaw member 120 and a receiving jaw member 122 configured to receive a staple cartridge assembly 132. Jaw assembly 116 may be permanently affixed to elongate tubular member 114 or may be detachable and thus replaceable with a new jaw assembly 116. Additionally or alternatively, a staple cartridge may be removable and replaceable in the jaw assembly. Staple clinching anvil jaw member 120 is movably mounted on distal end 118 of jaw assembly 116 and is movable between an open position spaced apart from staple cartridge jaw member 122 to a closed position substantially adjacent staple cartridge jaw member 122.
[0065] Surgical stapling apparatus 100 further includes a trigger 133 movably mounted on handle 112. Actuation of trigger 133 initially operates to move anvil jaw member 120 from the open to the closed position relative to staple cartridge jaw member 122 and subsequently actuates surgical stapling apparatus 100 to apply lines of staples to tissue. In order to properly orient jaw assembly 116 relative to the tissue to be stapled, surgical stapling apparatus 100 is additionally provided with a rotation knob 134 mounted on handle 112. Rotation of rotation knob 134 relative to handle 112 rotates elongate tubular member 114 and jaw assembly 116 relative to handle 112 so as to properly orient jaw assembly 116 relative to the tissue to be stapled.
[0066] A driver 166 is provided to move anvil jaw member 120 between the open and closed positions relative to staple cartridge jaw member 122. Driver 166 moves between a longitudinal slot 168 formed in anvil jaw member 120. A knife (not shown) is associated with driver 166 to cut tissue captured between anvil jaw member 120 and staple cartridge jaw member 122 as driver 166 passes through slot 168.
[0067] As illustrated in the current embodiment and shown in FIG. 10B , a surgical buttress 124 is releasably attached to the staple cartridge assembly 132 and/or the anvil jaw member 120 by an outer edge 136 of the cartridge assembly 132. The outer edge 136 may be swaged, molded or otherwise formed. Swaged outer edge 136, for example, forms a rim 140 overlying tissue contacting surface 138 of cartridge assembly 132 for capturing an outer portion 126 of surgical buttress 124, in a manner similar to that of swaged outer edge 36, as described above, and may be formed as discussed above. While the rim 140 is illustrated in the present embodiment as being discontinuous and extending along two sides of the surgical buttress 124, it is envisioned that the rim 140 may continuously extend around the surgical buttress or include a plurality of tabs surrounding the surgical buttress similar to the embodiment of FIG. 2 .
[0068] The surgical buttress of the present disclosure, in particular surgical buttress 124, may also be adapted for use with a surgical stapling apparatus, such as that shown and described in U.S. Pat. No. 7,334,717, entitled “Surgical Fastener Applying Apparatus,” the entire content of which is incorporated herein by reference. As illustrated in FIG. 11 , surgical stapling apparatus 210 includes an anvil receiving section 220 and a cartridge receiving section 222. A surgical buttress (not shown) may be attached to at least one of an anvil 221 coupled to the anvil receiving section 220, a staple cartridge assembly 232 coupled to the cartridge receiving section 222, or both, as discussed above, by a swaged outer edge. The anvil receiving section 220 and the cartridge receiving section 222 are pivotally connected via handles 212, 213 for approximation during use. Following approximation of the anvil receiving section 220 and the cartridge receiving section 222, the surgical stapling apparatus 210 is fired by driving a firing slide 236 distally through the advancement of a firing lever 233. Distal movement of the firing slide 236 causes a plurality of cam bars to engage camming surfaces that interact with a plurality of pushers to expel a plurality of surgical staples (not shown) from the cartridge receiving section 222. The staples are positioned on either side of a track which guides a knife (not shown) during longitudinal movement. The knife severs tissue along a cut-line. Fastening of the staples through the surgical buttress retains the surgical buttress within tissue and provides a force that allows the surgical buttress to slip out of the swaged outer edge of the cartridge assembly as the surgical stapling apparatus is pulled away from the tissue, thereby releasing the surgical buttress from the staple cartridge.
[0069] The surgical buttress of the present disclosure, in particular surgical buttress 124, may also be adapted for use with a transverse surgical stapling apparatus 310, as illustrated in FIG. 12 . An exemplary transverse surgical stapling apparatus is shown and described in U.S. Pat. No. 5,964,394, entitled “Surgical Fastener Applying Device,” the entire content of which is incorporated herein by reference. The surgical stapling apparatus 310 includes an approximation lever 333, a movable handle 312, an elongated portion 314 that extends distally from the handle 312, and an arm 322 that extends from a distal end 315 of the elongated portion 314. The surgical stapling apparatus 310 further includes an anvil 321 that is orthogonally affixed to the arm 322, and a cartridge receiver 320 that is operatively coupled to the distal end 315 of the elongated portion 314 for retention of a staple cartridge assembly 332. One or more pushers are moved through the cartridge assembly to drive staples against the anvil simultaneously or sequentially. A surgical buttress (not shown) may be joined to at least one of the anvil 321, staple cartridge assembly 332, or both as discussed above, via a swaged outer edge.
[0070] In embodiments, at least one bioactive agent may be combined with any of the surgical buttresses of the present disclosure. The at least one bioactive agent may be disposed on a surface of the surgical buttress and/or impregnated therein. In these embodiments, the surgical buttress can also serve as a vehicle for delivery of the bioactive agent. The term “bioactive agent”, as used herein, is used in its broadest sense and includes any substance or mixture of substances that have clinical use. Consequently, bioactive agents may or may not have pharmacological activity per se, e.g., a dye, or fragrance. Alternatively a bioactive agent could be any agent which provides a therapeutic or prophylactic effect, a compound that affects or participates in tissue growth, cell growth, cell differentiation, an anti-adhesive compound, a compound that may be able to invoke a biological action such as an immune response, or could play any other role in one or more biological processes. It is envisioned that the bioactive agent may be applied to the surgical buttress in any suitable form of matter, e.g., films, powders, liquids, gels and the like.
[0071] Examples of classes of bioactive agents which may be utilized in accordance with the present disclosure include anti-adhesives, antimicrobials, analgesics, antipyretics, anesthetics, antiepileptics, antihistamines, anti-inflammatories, cardiovascular drugs, diagnostic agents, sympathomimetics, cholinomimetics, antimuscarinics, antispasmodics, hormones, growth factors, muscle relaxants, adrenergic neuron blockers, antineoplastics, immunogenic agents, immunosuppressants, gastrointestinal drugs, diuretics, steroids, lipids, lipopolysaccharides, polysaccharides, and enzymes. It is also intended that combinations of bioactive agents may be used.
[0072] Other bioactive agents which may be included as a bioactive agent in the surgical buttress of the present disclosure include: local anesthetics; non-steroidal antifertility agents; parasympathomimetic agents; psychotherapeutic agents; tranquilizers; decongestants; sedative hypnotics; steroids; sulfonamides; sympathomimetic agents; vaccines; vitamins; antimalarials; anti-migraine agents; anti-parkinson agents such as L-dopa; anti-spasmodics; anticholinergic agents (e.g. oxybutynin); antitussives; bronchodilators; cardiovascular agents such as coronary vasodilators and nitroglycerin; alkaloids; analgesics; narcotics such as codeine, dihydrocodeinone, meperidine, morphine and the like; non-narcotics such as salicylates, aspirin, acetaminophen, d-propoxyphene and the like; opioid receptor antagonists, such as naltrexone and naloxone; anti-cancer agents; anti-convulsants; anti-emetics; antihistamines; anti-inflammatory agents such as hormonal agents, hydrocortisone, prednisolone, prednisone, non-hormonal agents, allopurinol, indomethacin, phenylbutazone and the like; prostaglandins and cytotoxic drugs; estrogens; antibacterials; antibiotics; anti-fungals; anti-virals; anticoagulants; anticonvulsants; antidepressants; antihistamines; and immunological agents.
[0073] Other examples of suitable bioactive agents which may be included include viruses and cells, peptides, polypeptides and proteins, analogs, muteins, and active fragments thereof, such as immunoglobulins, antibodies, cytokines (e.g. lymphokines, monokines, chemokines), blood clotting factors, hemopoietic factors, interleukins (IL-2, IL-3, IL-4, IL-6), interferons (β-IFN, (α-IFN and γ-IFN), erythropoietin, nucleases, tumor necrosis factor, colony stimulating factors (e.g., GCSF, GM-CSF, MCSF), insulin, anti-tumor agents and tumor suppressors, blood proteins, gonadotropins (e.g., FSH, LH, CG, etc.), hormones and hormone analogs (e.g., growth hormone), vaccines (e.g., tumoral, bacterial and viral antigens); somatostatin; antigens; blood coagulation factors; growth factors (e.g., nerve growth factor, insulin-like growth factor); protein inhibitors, protein antagonists, and protein agonists; nucleic acids, such as antisense molecules, DNA and RNA; oligonucleotides; polynucleotides; and ribozymes.
[0074] In embodiments, a reinforcement member may be positioned within or over any of the surgical buttresses disclosed herein. In embodiments utilizing a multilayered surgical buttress, one or more reinforcement members may be positioned between, within, or at an external surface of a layer of the surgical buttress as are disclosed, for example, in U.S. Patent Application Publication No. 2009/0001122, reference above, the disclosure of which is hereby incorporated by reference herein.
[0075] Further aspects of the present disclosure are described in the following numbered paragraphs.
[0076] 1. A surgical stapling apparatus including a releasable buttress material, the surgical stapling apparatus comprising: a cartridge assembly including a plurality of staples and a tissue contacting surface defining staple retaining slots; an anvil assembly including a tissue contacting surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly; a knife disposed within a knife slot formed in the tissue contacting surface of the cartridge assembly; wherein one of the cartridge assembly and the anvil assembly includes a rim defining an inner pocket; and a buttress material including an outer portion disposed in the inner pocket of the one of the cartridge assembly and the anvil assembly.
[0077] 2. The surgical stapling apparatus of paragraph 1, wherein the outer edge of the one of the cartridge assembly and the anvil assembly is swaged to form the rim.
[0078] 3. The surgical stapling apparatus of any preceding paragraph, wherein the rim continuously extends around an entire perimeter of the buttress material.
[0079] 4. The surgical stapling apparatus of any preceding paragraph, wherein the rim includes a plurality of discontinuous tabs extending around the buttress material.
[0080] 5. The surgical stapling apparatus of any preceding paragraph, wherein the rim includes sharp edges extending radially inward of the outer edge.
[0081] 6. The surgical stapling apparatus of any preceding paragraph, wherein the buttress material includes slits.
[0082] 7. The surgical stapling apparatus of any preceding paragraph, wherein the outer portion of the buttress material is frayed.
[0083] 8. The surgical stapling apparatus of any preceding paragraph, wherein the rim includes a first rim on the anvil assembly and a second rim on the cartridge assembly.
[0084] 9. The surgical stapling apparatus of paragraph 8, wherein the buttress material of the anvil assembly is different from the buttress material of the cartridge assembly.
[0085] 10. The surgical stapling apparatus of any preceding paragraph, wherein the cartridge assembly is associated with a body portion of the surgical stapling apparatus and the anvil assembly includes a shaft removably mountable to the body portion, the anvil assembly being movable toward and away from the body portion.
[0086] 11. The surgical stapling apparatus of paragraph 10, wherein the cartridge assembly and the anvil assembly are circular, and wherein the buttress material includes a central opening dimensioned to receive the shaft of the anvil assembly.
[0087] Persons skilled in the art will understand that the devices and methods specifically described herein and illustrated in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, it is envisioned that the elements and features illustrated or described in connection with one exemplary embodiment may be combined with the elements and features of another exemplary embodiment without departing from the scope of the present disclosure, and that such modifications and variations are also intended to be included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not to be limited by what has been particularly shown and described, except as indicated by the appended claims.
Claims
What is claimed is:
1. A surgical stapling apparatus including a releasable buttress material, the surgical stapling apparatus comprising:
a cartridge assembly including a plurality of staples and a tissue contacting surface defining staple retaining slots, the cartridge assembly including a swaged outer edge having a rim overlapping the tissue contacting surface of the cartridge assembly in spaced relation therewith and defining an inner pocket between the tissue contacting surface and the rim, the rim including an annular array of teeth extending radially inward of the swaged outer edge;
an anvil assembly including a tissue contacting surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly; and
a buttress material including an outer portion retained within the swaged outer edge of the cartridge assembly.
2. The surgical stapling apparatus of claim 1, wherein the rim continuously extends around an entire perimeter of the buttress material.
3. The surgical stapling apparatus of claim 1, wherein the rim includes a plurality of discontinuous tabs extending around the buttress material.
4. The surgical stapling apparatus of claim 1, wherein the annular array of teeth define sharp edges.
5. The surgical stapling apparatus of claim 1, wherein the buttress material includes slits.
6. The surgical stapling apparatus of claim 1, wherein the outer portion of the buttress material is frayed.
7. The surgical stapling apparatus of claim 1, wherein the anvil assembly includes a swaged outer edge and a buttress material retained within the swaged outer edge of the anvil assembly.
8. The surgical stapling apparatus of claim 7, wherein the swaged outer edge of the anvil assembly includes a rim overlapping the tissue contacting surface of the anvil assembly in spaced relation therewith and defines an inner pocket between the tissue contacting surface and the rim.
9. The surgical stapling apparatus of claim 7, wherein the buttress material retained within the swaged outer edge of the anvil assembly includes slits.
10. The surgical stapling apparatus of claim 7, wherein the outer portion of the buttress material retained within the swaged outer edge of the anvil assembly is frayed.
11. The surgical stapling apparatus of claim 7, wherein the buttress material of the anvil assembly is different from the buttress material of the cartridge assembly.
12. The surgical stapling apparatus of claim 1, wherein the cartridge assembly is associated with a body portion of the surgical stapling apparatus and the anvil assembly includes a shaft removably mountable to the body portion, the anvil assembly being movable toward and away from the body portion.
13. The surgical stapling apparatus of claim 12, wherein the cartridge assembly and the anvil assembly are circular, and wherein the buttress material includes a central opening dimensioned to receive the shaft of the anvil assembly.
14. The surgical stapling apparatus of claim 1, wherein the cartridge assembly is associated with a first jaw and the anvil assembly is associated with a second jaw, the first and second jaws being selectively movable relative to one another from a first spaced apart position to a second position wherein the first and second jaws cooperate to grasp tissue therebetween.
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- Extended European Search Report corresponding to EP 13 17 7437.4, completed Sep. 11, 2013 and mailed Sep. 19, 2013; (6 pp).Applicant
- Extended European Search Report corresponding to EP 13 17 7441.6, completed Sep. 11, 2013 and mailed Sep. 19, 2013; (6 pp).Applicant
- Extended European Search Report corresponding to EP 07 86 1534.1, completed Sep. 20, 2013 and mailed Sep. 30, 2013; (5 pp).Applicant
- Extended European Search Report corresponding to EP 13 17 1856.1, completed Oct. 29, 2013 and mailed Nov. 7, 2013; (8 pp).Applicant
- Extended European Search Report corresponding to EP 13 18 0373.6, completed Oct. 31, 2013 and mailed Nov. 13, 2013; (7 pp).Applicant
- Extended European Search Report corresponding to EP 13 18 0881.8, completed Nov. 5, 2013 and mailed Nov. 14, 2013; (6 pp).Applicant
- Extended European Search Report corresponding to EP 13 17 6895.4, completed Nov. 29, 2013 and mailed Dec. 12, 2013; (5 pp).Applicant
- Extended European Search Report corresponding to EP 13 18 2911.1, completed Dec. 2, 2013 and mailed Dec. 16, 2013; (8 pp).Applicant
- Extended European Search Report corresponding to EP 10 25 1795.0, completed Dec. 11, 2013 and mailed Dec. 20, 2013; (6 pp).Applicant
- Extended European Search Report corresponding to EP 13 18 7911.6, completed Jan. 22, 2014 and mailed Jan. 31, 2014; (8 pp).Applicant
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- Extended European Search Report corresponding to EP 13 19 6816.6, completed Mar. 28, 2014 and mailed Apr. 9, 2014; (9 pp).Applicant
- Extended European Search Report corresponding to EP 13 19 4995.0, completed Jun. 5, 2014 and mailed Jun. 16, 2014; (5 pp).Applicant
- Extended European Search Report corresponding to EP 13 19 5019.8, completed Mar. 14, 2014 and mailed Mar. 24, 2014; (7 pp).Applicant
- Extended European Search Report corresponding to EP 13 19 2111.6, completed Feb. 13, 2014 and mailed Feb. 27, 2014; (10 pp).Applicant
- Extended European Search Report corresponding to EP 13 19 7958.5, completed Apr. 4, 2014 and mailed Apr. 15, 2014; (8 pp).Applicant
- Extended European Search Report corresponding to EP 14 15 6342.9, completed Jul. 22, 2014 and mailed Jul. 29, 2014; (8 pp).Applicant
- Extended European Search Report corresponding to EP 14 15 7195.0, completed Jun. 5, 2014 and mailed Jun. 18, 2014; (9 pp).Applicant