US 9,844,378 B2Grant
Surgical stapling apparatus and methods of adhering a surgical buttress thereto
Issue Date:2017-12-19
•22 Claims
•7 Drawing Sheets
Abstract
A surgical stapling apparatus includes a tool assembly, at least one surgical buttress, and a resilient, porous material. The tool assembly includes a cartridge assembly and an anvil assembly pivotably coupled to the cartridge assembly. The cartridge assembly includes a first tissue facing surface defining staple retaining slots. The anvil assembly includes a second tissue facing surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly. The at least one surgical buttress is releasably disposed on at least one of the first and second tissue facing surfaces. The resilient, porous material is releasably disposable between the first and second tissue facing surfaces and in contact with the at least one surgical buttress. The resilient, porous material is configured to expel a liquid therefrom upon compression thereof by an approximation of the cartridge assembly and the anvil assembly.
Metadata
Assignee
- Covidien LP
Inventors
- Thomas Casasanta
- Kenneth Whitfield
- Richard Simpson
Application Information
Application Number:US 14/264,269
Filing Date:2014-04-29
Priority Date:2014-04-29
Art Unit:3721
Classifications
IPC:
A61B17/068A61B17/10A61B17/072A61B17/00
Field of Search:
A61B 17/07292A61B 17/07207A61B 2017/07271
Patent Drawings (7 sheets)
Description
Background
[0001] Technical Field
[0002] The present disclosure relates to a surgical apparatus having a buttress material incorporated therewith. More particularly, the present disclosure relates to a surgical stapling apparatus including a detachable surgical buttress and a resilient, porous material releasably disposable with the surgical buttress that acts to facilitate adherence of the surgical buttress to tissue facing surfaces of the surgical stapling apparatus.
[0003] Background of Related Art
[0004] Surgical devices for grasping or clamping tissue between opposing jaw structure and then joining tissue by surgical fasteners are well known in the art. In some instruments, a knife is provided to cut the tissue which has been joined by the fasteners. The fasteners are typically in the form of surgical staples but two-part polymeric fasteners can also be utilized.
[0005] Instruments for this purpose can include two elongated jaw members which are respectively used to capture or clamp tissue. In certain surgical staplers, one of the jaw members carries a staple cartridge which houses a plurality of staples arranged in at least two lateral rows while the other jaw member has an anvil that defines a surface for forming the staple legs as the staples are driven from the staple cartridge. The stapling operation is effected by cam members that travel longitudinally through the staple cartridge, with the cam members acting upon staple pushers to sequentially eject the staples from the staple cartridge.
[0006] Each of the instruments described above are designed for use in surgical procedures in which surgeons have direct manual access to the operative site. However, in minimally invasive procedures, such as, for example, endoscopic or laparoscopic procedures, surgery is performed through a small incision or through a narrow cannula inserted through small entrance wounds in the skin. In order to address the specific needs of minimally invasive surgical procedures, surgical stapling devices have been developed and are disclosed in, for example, U.S. Pat. No. 5,332,142 (Robinson, et al.); and U.S. Pat. No. 6,241,139 (Milliman et al.), the entire contents of each of which are incorporated by reference herein. These instruments include a surgical stapling apparatus and a loading unit. Typically, the loading unit is attached to the apparatus immediately prior to surgery. After use, the loading unit can be removed from the apparatus and a new loading unit can be fastened to the apparatus to perform additional stapling and/or cutting operations. These instruments have provided significant clinical benefits. Nonetheless, improvements to these instruments are still desirable.
[0007] When stapling relatively thin or fragile tissues, it is important to effectively seal the staple line against air or fluid leakage. Additionally, it is often necessary to reinforce the staple line against the tissue to prevent tears in the tissue or pulling of the staples through the tissue. One method of preventing tears or pull through involves the placement of a biocompatible fabric reinforcing material, or “buttress” material, between the staple and the underlying tissue. In this method, a layer of buttress material is placed against the tissue and the tissue is stapled in conventional manner. In another method, the buttress material is positioned on the stapling instrument itself prior to stapling the tissue. An example of this is disclosed in U.S. Pat. No. 5,542,594 to McKean et al., the entire contents of which is incorporated by reference herein. In McKean et al., a tube of buttress material is slipped over the jaw of the stapler. The stapler is then actuated to staple the subject tissue and secure the buttress material between the tissue and staple line to reinforce the tissue and staple line.
[0008] Buttress materials which are either pre-loaded or are an after-market add-on, for minimally invasive or open mechanical surgical stapling apparatus, may shift in position relative to a stapler reload cartridge assembly and anvil assembly to which they are attached during grasping and manipulation of tissue by the surgical stapling apparatus. If the shifting of the buttress material is pronounced and is not corrected by the surgeon before firing the surgical stapling apparatus, then staples may form outside the perimeter or width of the buttress material thereby reducing the benefits of having the entire staple line reinforced by the buttress material.
Summary
[0009] In accordance with the present disclosure, a surgical stapling apparatus is provided. The surgical stapling apparatus includes a tool assembly, a surgical buttress and a resilient, porous material. The tool assembly includes a cartridge assembly and an anvil assembly pivotably coupled to the cartridge assembly. The cartridge assembly includes a first tissue facing surface defining staple retaining slots. The anvil assembly includes a second tissue facing surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly. The surgical buttress is releasably disposed on at least one of the first and second tissue facing surfaces. The resilient, porous material is releasably disposable between the first and second tissue facing surfaces and in contact with the surgical buttress. The resilient, porous material is configured to expel a liquid therefrom upon compression thereof by an approximation of the cartridge assembly and the anvil assembly.
[0010] In embodiments, the resilient, porous material may include a sponge. The sponge may have an oblong shape and may have a first end and a second end. The sponge may taper from the first end to the second end.
[0011] In embodiments, the resilient, porous material may have a length equal to a length of the surgical buttress and a width equal to a width of the surgical buttress. The resilient, porous material may be sized and dimensioned to occupy a space defined between the first and second tissue facing surfaces. The resilient, porous material may have a top surface and bottom surface. The top surface may be in abutting engagement with the second tissue facing surface and the bottom surface may be in abutting engagement with the surgical buttress. It is contemplated that the resilient, porous material may include a water soluble adhesive.
[0012] In embodiments, the cartridge assembly and the anvil assembly may be selectively movable relative to one another from a first, spaced apart position to a second, approximated position. In the second, approximated position, the cartridge assembly and the anvil assembly may cooperate to grasp tissue therebetween.
[0013] In embodiments, the surgical buttress may be secured to at least one of the anvil assembly and the cartridge assembly by at least one anchor.
[0014] In accordance with the present disclosure, a surgical stapling system is provided. The system includes a tool assembly, a surgical buttress, and a resilient, porous material. The tool assembly includes a cartridge assembly and an anvil assembly pivotably coupled to the cartridge assembly. The cartridge assembly includes a first tissue facing surface defining staple retaining slots. The anvil assembly includes a second tissue facing surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly. The surgical buttress is releasably disposed on at least one of the first and second tissue facing surfaces. The resilient, porous material is configured to be releasably disposed between the first and second tissue facing surfaces and in contact with the surgical buttress. The resilient, porous material is configured to expel a liquid therefrom upon compression thereof by an approximation of the cartridge assembly and the anvil assembly.
[0015] In embodiments, the resilient, porous material may have a length equal to a length of the surgical buttress and a width equal to a width of the surgical buttress.
[0016] In accordance with the present disclosure, a method of preparing a surgical stapling apparatus is provided. The method includes providing a tool assembly including a cartridge assembly and an anvil assembly pivotably couple to the cartridge assembly. The cartridge assembly and the anvil assembly each have a tissue facing surface. The method further includes providing at least one surgical buttress releasably secured to the tissue facing surface of at least one of the anvil assembly and the cartridge assembly; disposing a resilient, porous material between the tissue facing surfaces of the cartridge assembly and the anvil assembly such that the resilient, porous material is in abutting engagement with the at least one surgical buttress; wetting the resilient, porous material with a liquid; and approximating the cartridge assembly and the anvil assembly to compress the resilient, porous material therebetween such that the liquid exits the resilient, porous material and contacts the surgical buttress.
[0017] In embodiments, the resilient, porous material may have a length equal to a length of the surgical buttress and a width equal to a width of the surgical buttress. The resilient, porous material may be sized and dimensioned to occupy a space defined between the tissue facing surfaces of the cartridge assembly and the anvil assembly. The resilient, porous material may have a top surface and a bottom surface. The top surface may be in abutting engagement with the tissue facing surface of the anvil assembly and the bottom surface may be in abutting engagement with the surgical buttress.
[0018] In embodiments, the wetting of the resilient, porous material with a liquid may include inserting the resilient, porous material in a saline solution prior to approximating the cartridge assembly and the anvil assembly.
[0019] Additional advantages will become apparent from the description which follows, taken in conjunction with the accompanying drawings.
Brief Description of the Drawings
[0020] The present disclosure will be further described with reference to the accompanying drawings, wherein like reference numerals refer to like parts in the several views, and wherein:
[0021] FIG. 1 is a perspective view of a surgical stapling apparatus according to an embodiment of the present disclosure;
[0022] FIG. 2 is a top, perspective view, with parts separated, of a distal end of a loading unit of the surgical stapling apparatus shown in FIG. 1 ;
[0023] FIG. 3A is an enlarged perspective view of a distal end of an anvil assembly of the loading unit shown in FIG. 2 illustrating a surgical anvil buttress operatively secured to a tissue facing surface thereof;
[0024] FIG. 3B is an enlarged perspective view of a cartridge assembly of the loading unit shown in FIG. 2 illustrating a surgical cartridge buttress secured to a tissue facing surface thereof;
[0025] FIG. 4 is a perspective view of a loading unit disposed in a package and including a cartridge assembly and a resilient, porous material according to an embodiment of the present disclosure;
[0026] FIG. 5A illustrates the resilient, porous material shown in FIG. 4 in a first, expanded state prior to a closing of the loading unit shown in FIG. 2 ; and
[0027] FIG. 5B illustrates the resilient, porous material shown in FIG. 4 in a second, compressed state after a closing of the loading unit shown in FIG. 4 .
Detailed Description of Embodiments
[0028] Embodiments of the presently disclosed surgical stapling apparatus will now be described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views.
[0029] In the drawings and in the description that follows, the term “proximal”, as is traditional, will refer to the end of the surgical stapling apparatus which is closest to the operator, while the term “distal” will refer to the end of the surgical stapling apparatus which is farthest from the operator.
[0030] 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 Endo GIA™ Reinforced Reloads and staplers with Tri-Staple™ technology, available through Covidien, and transverse anastomosis staplers, also 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 by reference herein); 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 are incorporated herein by this reference); and transverse anastomosis staplers (see, e.g., commonly owned U.S. Pat. No. 5,964,394 entitled “Surgical Fastener Applying Apparatus”, the entire contents of which are incorporated herein by this reference).
[0031] FIG. 1 shows a surgical apparatus, e.g., a surgical stapling apparatus, generally referred to as 10 including a loading unit 16, surgical buttresses “B1,” “B2” attached thereto, and a resilient, porous material, such as, for example, a sponge, which is generally referred to as 200, disposable therewith. Sponge 200 is used to wet surgical buttresses “B1,” “B2” to facilitate an adherence of surgical buttresses “B1,” “B2” to surgical fastening apparatus 10. In the interest of brevity, this disclosure will focus primarily on loading unit 16, surgical buttresses “B1,” “B2”, and sponge 200 of the surgical stapling apparatus 10. A detailed discussion of the remaining components and method of use of surgical stapling apparatus 10 is disclosed in U.S. Pat. No. 6,241,139, the disclosure of which has already been incorporated by reference herein.
[0032] Surgical stapling apparatus 10 can be an endoscopic apparatus and includes a handle assembly 12 and an elongated body 14 extending from handle assembly 12. A loading unit 16, which includes a tool assembly 17, is releasably secured to the distal end of elongated body 14. Furthermore, the present disclosure contemplates surgical stapling apparatus that have a replaceable cartridge that is received in the end effector of the apparatus (the end effector may be removable and replaceable or form an integral part of the handle and elongated body).
[0033] Handle assembly 12 includes a stationary handle member 22, a movable handle member 24, and a barrel portion 26. A rotatable member 28 is mounted on the forward end of barrel portion 26 to facilitate rotation of elongated body 14 and attached loading unit 16 with respect to handle assembly 12. An articulation lever 30 is also mounted on the forward end of barrel portion 26 adjacent rotatable member 28 to facilitate articulation of tool assembly 17. Preferably, a pair of knobs 32 is movably positioned along barrel portion 26. Knobs 32 are advanced distally to approximate or close tool assembly 17, and retracted proximally to unapproximate or open tool assembly 17.
[0034] As shown herein, loading unit 16 (FIG. 2 ) is configured to apply six (6) linear rows of staples, in loading units measuring from about 30 mm to about 60 mm in length. Loading units for applying any number of rows of staples, having staple pockets arranged in various patterns and/or loading units and end effectors having any other lengths, e.g., 45 mm, are also envisioned.
[0035] Loading unit 16 is desirably selectively removably coupleable to elongated body 14. Loading unit 16 includes a housing portion 36 having a proximal end adapted to releasably engage the distal end of elongated body 14. A mounting assembly 38 is pivotally secured at “P” to the distal end of housing portion 36, and is configured to receive the proximal end of tool assembly 17 such that pivotal movement of tool assembly 17 about an axis at “P”, perpendicular to the longitudinal axis of housing portion 36, effects articulation of tool assembly 17.
[0036] As mentioned above, loading unit 16 includes a tool assembly 17. Tool assembly 17 includes a cartridge assembly 18 housing a plurality of surgical fasteners or staples 84 (see FIG. 2 ) and an anvil assembly 20 secured in juxtaposed relation relative to cartridge assembly 18. Anvil assembly 20 and cartridge assembly 18 are selectively moveable, e.g., pivotable, relative to one another from a first, spaced apart position, to a second, approximated position to close tool assembly 17.
[0037] Reference may be made to U.S. Pat. No. 7,819,896, filed on Aug. 31, 2009, entitled “TOOL ASSEMBLY FOR A SURGICAL STAPLING DEVICE”, the disclosure of which is hereby incorporated by reference herein, for an exemplary discussion of the construction and operation of tool assembly 17, as illustrated in FIG. 2 .
[0038] With continued reference to FIG. 2 , anvil assembly 20 includes an anvil plate 70 having a tissue facing surface 72. A plurality of staple deforming pockets/cavities (not shown) is defined in tissue facing surface 72. Anvil assembly 20 further includes a cover plate 74 secured to a top surface of anvil plate 70, opposite tissue facing surface 72. Anvil plate 70 defines a proximal pair of recesses 70d formed near a proximal end 73 of anvil plate 70 and disposed, one each, on opposed sides of a longitudinal slot 70b. Anvil plate 70 defines a distal pair of recesses 70e formed near a distal end 75 of anvil plate 70 and disposed, one each, on opposed sides of longitudinal slot 70b.
[0039] As seen in FIGS. 2 and 3A , anvil assembly 20 further includes a surgical anvil buttress “B1”, pledget or the like operatively secured to a lower surface or tissue facing surface 72 of anvil plate 70, by anchors “S1,” “S2” to overlie at least some of the anvil pockets and/or at least a portion of a length of longitudinal slot 70b. In particular, an anchor “S2” is cinched around a proximal portion of surgical anvil buttress “B1” and each of the proximal pair of recesses 70d and an anchor “S1” is cinched around a distal portion of the surgical anvil buttress “B1” and each of the distal pair of recesses 70e. The present application contemplates that the buttress can be attached by other means, such as for example, by use of an adhesive.
[0040] Surgical anvil buttress “B1” further includes a tongue or tab extending from a distal edge thereof to facilitate with the attachment of surgical anvil buttress “B1” to anvil assembly 20 during the assembly process. It is contemplated that the tongue is removed from surgical anvil buttress “B1” following securement of surgical anvil buttress “B1” to anvil assembly 20 and prior to packaging or shipment. In some embodiments, surgical anvil buttress “B1” may be removably secured to tissue facing surface 72 of anvil plate 70 via various fastening engagements, such as, for example, adhesives, sutures, and/or frictional engagement.
[0041] In operation, with surgical anvil buttress “B1” secured against tissue facing surface 72 of anvil plate 70. During firing of surgical stapling apparatus 10, a knife blade 66 (FIG. 2 ) may slice through a central section of the proximal suture “S2”, thereby freeing the proximal end of the surgical anvil buttress “B1” from anvil assembly 20. During use, as the firing stroke of surgical stapling apparatus 10 is nearing completion, a release mechanism (not shown) releases distal suture “S1” and the surgical anvil buttress “B1” is free to separate from tissue facing surface 72 of anvil plate 70. The release mechanism may include a separate knife for slicing the anchor or anchors, or may include a bar or other member for simply pushing the anchor from a constricting slot. In embodiments, after surgical buttress “B1” is stapled and secured with tissue, the opening of tool assembly 17 provides a sufficient amount of force to separate surgical buttress “B1” from tissue facing surface 72 of anvil plate 70.
[0042] As seen in FIGS. 1, 2, and 3B , cartridge assembly 18 includes a tissue facing surface 82 defining retention slots 82a formed therein for receiving a plurality of fasteners 84 and pushers 86. Cartridge assembly 18 defines a proximal pair of recesses 82e formed near a proximal end 83 thereof and disposed, one each, on opposed sides of a longitudinal slot 82c. Staple cartridge assembly 18 further defines a distal pair of recesses 82f formed near a distal end 85 thereof and disposed, one each, on opposed sides of longitudinal slot 82c. In one embodiment, at least one of the recesses of each of the proximal pair of recesses 82e and the distal pair of recesses 82f is preferably non-circular and constricting or otherwise arranged so as to frictionally engage and/or pinch anchors “S3,” “S4.”
[0043] As seen in FIGS. 2 and 3B , cartridge assembly 18 further includes a surgical cartridge buttress “B2”, pledget or the like operatively secured to an upper surface or tissue facing surface 82 of staple cartridge assembly 18, by anchors “S3” and “S4”, to overlie at least some of staple pockets 82a and/or at least a portion of a length of longitudinal slot 82c. In particular, an anchor “S4” is cinched around a proximal portion of surgical cartridge buttress “B2” and each of the proximal pair of recesses 82e, and an anchor “S3” is cinched around a distal portion of the surgical cartridge buttress “B2” and each of the distal pair of recesses 82f. In some embodiments, surgical cartridge buttress “B2” may be removably secured to tissue facing surface 82 of cartridge assembly 18 via various fastening engagements, such as, for example, adhesives, sutures, and/or frictional engagement. In some embodiments, only one of tissue facing surfaces 72, 82 has a surgical buttress attached thereto.
[0044] Exemplary surgical buttresses for use with the surgical stapling devices disclosed herein are shown and described in commonly assigned U.S. Pat. Nos. 5,542,594; 5,908,427; 5,964,774; and 6,045,560, and commonly assigned U.S. application Ser. No. 12/579,605, filed on Oct. 15, 2009 (now U.S. Patent Publication No. 2010/0092710, now U.S. Pat. No. 8,157,151), commonly assigned U.S. application Ser. No. 11/241,267, filed on Sep. 30, 2005 (U.S. Patent Publication No. 2006/0085034, now U.S. Pat. No. 7,938,307), and U.S. application Ser. No. 11/248,846, filed on Oct. 12, 2005 (U.S. Patent Publication No. 2006/0135992, now U.S. Pat. No. 7,823,592), the entire contents of each of which is incorporated herein by reference. The buttress may also be made according to methods and materials disclosed in U.S. Publication Nos. 2013/0123816 and/or 2013/0112731, the disclosure of which are hereby incorporated by reference herein in their entirety.
[0045] In accordance with the present disclosure, and either in place of or in addition to the methods and systems disclosed above for attaching surgical buttresses “B1, B2” to the tissue facing/contacting surface 72 of anvil assembly 20 and/or tissue facing/contacting surface 82 of cartridge assembly 18 of surgical stapling apparatus 10, surgical buttresses “B1, B2” may be further attached to the tissue facing surfaces 72, 82 of surgical stapling apparatus 10 in a number of different ways.
[0046] With reference to FIGS. 4, 5A, and 5B , a sponge 200, which is disposable with tool assembly 17, is shown. Sponge 200 and tool assembly 17 may be provided as a surgical fastener system 100, as shown in FIG. 4 . Sponge 200 and tool assembly 17 can be disposed in a bubble packaging sized and dimensioned to accommodate both sponge 200 and tool assembly 17 and maintain sponge 200 and tool assembly 17 in a sterile and compact condition. Sponge 200 is made of a resilient or compressible material that has a porosity configured to readily absorb and retain liquids therein and to expel a liquid therefrom upon compression thereof, as described in detail below.
[0047] In embodiments, sponge 200 may be made of various materials, such as, for example, natural, man-made, and/or synthetic materials, or may include synthetic materials manufactured from natural materials, such as synthetic fibers manufactured from natural cellulose. Sponge 200 may be formed from cellulose, cellulose esters such as cellulose acetate and cellulose triacetate, and materials of a cellulosic nature such as cotton or rayon. Sponge 200 may also be formed from polyamides such as nylon, polyolefins such as polyethylene and polypropylene, acrylics, modacrylics, rubber, plastic, thermoplastics, polyvinyl alcohol, polyester, polyurethane, polyether urethane, polyvinyl chloride, vinyl nitrile, silicone, latex, combinations and derivatives thereof, and other absorbent materials within the purview of those skilled in the art. Sponge 200 may also include reticulated, open, and/or closed cell foams.
[0048] Sponge 200 is sized and dimensioned to be releasably disposed between tissue facing surfaces 72, 82 of anvil assembly 20 and cartridge assembly 18. Sponge 200 is sized and dimensioned to occupy a substantially V-shaped space “SP” defined between tissue facing surfaces 72, 82 of anvil assembly 20 and cartridge assembly 18 when tool assembly 17 is in the open position, as shown in FIGS. 4 and 5A . When sponge 200 is disposed between tissue facing surfaces 72, 82, sponge 200 abuts surgical buttresses “B1”, “B2” to resiliently bias tool assembly 17 toward the open position. It is contemplated that sponge 200 includes straps, belts, hooks, elastic bands or the like (not shown) that can be slipped over cartridge assembly 18 and/or anvil assembly 20 to assist in securing sponge 200 therewith.
[0049] Sponge 200 has a first end or proximal end 202 and a second end or distal end 204 and defines a tapered profile therebetween. Sponge 200 has an oblong shape that conforms or corresponds to the shape of space “SP” of tool assembly 17. First end 202 of sponge 200 has a thickness “T1” that is less than a thickness “T2” of second end 204 of sponge 200 such that sponge 200 tapers between first end 202 to second end 204. Thickness “T1” of first end 202 is substantially equal to a height “H1” (FIG. 4 ) defined between proximal ends 83, 73 of cartridge assembly 18 and anvil assembly 20 when tool assembly 17 is in the open position, as shown in FIGS. 4 and 5A . Second end 204 of sponge 200 has a thickness “T2” substantially equal to a height “H2” (FIG. 4 ) defined between distal ends 85, 75 of cartridge assembly 18 and anvil assembly 20 when tool assembly 17 is in the open position, as shown in FIGS. 4 and 5A . Sponge 200 has a length substantially equal to a length of surgical buttresses “B1”, “B2” and a width substantially equal to a width of surgical buttresses “B1”, “B2” such that surface area contact between sponge 200 and surgical buttresses “B1”, “B2” is maximized. In this way, sponge 200 has an overall shape corresponding to a shape of space “SP.”
[0050] Sponge 200 has a top surface 206 and a bottom surface 208 each extending between first and second ends 202, 204. Surfaces 206, 208 may be planar to maximize surface area contact between sponge 200 and surgical buttresses “B1”, “B2”. In embodiments, longitudinal grooves or channels (not shown) are defined in top and bottom surfaces 206, 208 that are configured to accommodate tissue facing surfaces 72, 82 of anvil assembly 20 and cartridge assembly 18, respectively, such that lateral movement of sponge 200 within space “SP” of tool assembly 17 is resisted and/or prevented. When sponge 200 is disposed within space “SP” of tool assembly 17, top surface 206 is in abutting engagement with surgical buttress “B1” or tissue facing surface 72 of anvil assembly 20 and bottom surface 208 is in abutting engagement with surgical buttress “B2” or tissue facing surface 82 of cartridge assembly 18.
[0051] In some embodiments, sponge 200 may be variously shaped and configured, such as, for example, uniform, non-uniform, planar, undulating, arcuate, rectangular, circular, triangular, V-shaped, U-shaped, polygonal and/or variable. In some embodiments, ledges or lips (not shown) extend from distal ends 204 of top and bottom surfaces 206, 208 that are configured to overlap with distal ends 75, 85 of anvil assembly 20 and cartridge assembly 18 to resist and/or prevent sponge 200 from moving distally out from between cartridge assembly 18 and anvil assembly 20.
[0052] Sponge 200 can include a water soluble adhesive, for example, a polysaccharide, that when wet will facilitate a releasable retention of surgical buttresses “B1”, “B2” with tissue facing surfaces 82, 72 of cartridge assembly 18 and anvil assembly 20. In some embodiments, surgical buttresses “B1,” “B2” include a first composition and sponge 200 includes a second composition. Upon wetting and combining the first and second compositions, an adhesive is formed. It is contemplated that sponge 200 may be pre-wetted and encapsulated such that upon approximation of cartridge assembly 18 and anvil assembly 20, the capsule is broken to expose pre-wetted sponge 200.
[0053] In operation, loading unit 16 is coupled to elongate body 14 of surgical fastening apparatus 10. With tool assembly 17 in the open or unapproximated position, as shown in FIGS. 4 and 5A , sponge 200 is disposed between tissue facing surfaces 72, 82 such that sponge 200 is in abutting engagement with surgical buttresses “B1”, “B2”. Sponge 200 is wetted by, for example, inserting tool assembly 17 into a bath of liquid, such as, for example, a saline solution. It is contemplated that tool assembly 17 can be closed and then opened while immersed in the saline solution to facilitate absorption of the saline solution into sponge 200. It is further contemplated that sponge 200 is wetted prior to being positioned between tissue facing surfaces 72, 82. Therefore, the step of wetting sponge 200 may include sponge 200 being pre-wetted. For example, as described above, sponge 200 may be pre-wetted and disposed within a capsule that is configured to break upon a closing of tool assembly 17. In some embodiments, the bath of liquid may include an adhesive.
[0054] Handle assembly 12 is actuated to approximate cartridge assembly 18 and anvil assembly 20. The approximation of cartridge assembly 18 and anvil assembly 20 compresses sponge 200 therebetween, as shown in FIG. 5B . Compression of sponge 200 causes the saline solution to exit sponge 200 and contact surgical buttresses “B1”, “B2.” The clamping pressure or force provided by the closing of tool assembly 17, which is transferred to surgical buttresses “B1”, “B2” via sponge 200, causes the saline solution to penetrate and/or impregnate surgical buttresses “B1”, “B2.” It is envisioned that sponge 200 is sufficiently resiliently biased to its uncompressed or natural state, as shown in FIG. 5A , such that liquid contained therein is forcefully expelled from sponge 200 upon compression thereof.
[0055] Tool assembly 17 may be held in the fully approximated position, as shown in FIG. 5B , so that sponge 200 can continue to transfer the saline solution therefrom to surgical buttresses “B1”, “B2.” Sponge 200 is removed from between tissue facing surfaces 82, 72 of cartridge assembly 18 and anvil assembly 20 such that surgical fastening apparatus 10 can be used in its ordinary manner for stapling tissue.
[0056] In accordance with the principles of the present disclosure, sponge 200 effectively drives liquid into and/or onto surgical buttresses “B1”, “B2” to at least partially saturate surgical buttresses “B1”, “B2” with the liquid. It has been found that surgical buttresses in a wetted condition better adhere to tissue facing surfaces of a cartridge assembly and an anvil assembly compared to dry surgical buttresses. Accordingly, with surgical buttresses “B1”, “B2” at least partially saturated with liquid via use of sponge 200, surgical buttresses “B1”, “B2” are resisted and/or prevented from shifting or sliding laterally along tissue facing surfaces 72, 82 during use of surgical fastening apparatus 10.
[0057] It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended thereto.
Claims
The invention claimed is:
1. A surgical stapling apparatus, comprising:
a cartridge assembly including a first tissue facing surface defining staple retaining slots;
an anvil assembly pivotably coupled to the cartridge assembly and including a second tissue facing surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly;
at least one surgical buttress releasably disposed on one of the first and second tissue facing surfaces; and
a resilient, porous material releasably disposed between the first and second tissue facing surfaces and in contact with the at least one surgical buttress, the resilient, porous material resiliently biasing the cartridge and anvil assemblies toward a spaced apart position, wherein the resilient, porous material is configured to expel a liquid therefrom upon compression thereof by an approximation of the cartridge assembly and the anvil assembly, the resilient, porous material including a top surface and a bottom surface, a distal portion of each of the top and bottom surfaces being in abutting engagement with a respective distal portion of each of the cartridge and anvil assemblies when the cartridge and anvil assemblies are in the spaced apart position.
2. The surgical stapling apparatus of claim 1, wherein the resilient, porous material is a sponge.
3. The surgical stapling apparatus of claim 2, wherein the sponge has an oblong shape and has a first end and a second end, wherein the sponge tapers from the first end to the second end.
4. The surgical stapling apparatus of claim 1, wherein the resilient, porous material has a length equal to a length of the at least one surgical buttress and a width equal to a width of the at least one surgical buttress.
5. The surgical stapling apparatus of claim 1, wherein the resilient, porous material is sized and dimensioned to occupy a space defined between the first and second tissue facing surfaces when the cartridge and anvil assemblies are in the spaced apart position.
6. The surgical stapling apparatus of claim 1, wherein the bottom surface is in abutting engagement with the at least one surgical buttress when the cartridge and anvil assemblies are in the spaced apart position.
7. The surgical stapling apparatus of claim 1, wherein the cartridge assembly and the anvil assembly are selectively movable relative to one another from the spaced apart position, to an approximated position, wherein the cartridge assembly and the anvil assembly cooperate to grasp tissue therebetween.
8. The surgical stapling apparatus of claim 1, wherein the resilient, porous material includes a water soluble adhesive.
9. The surgical stapling apparatus of claim 1, wherein the at least one surgical buttress is secured to at least one of the anvil assembly and the cartridge assembly by at least one anchor.
10. A surgical stapling system, comprising:
a tool assembly including:
a cartridge assembly including a first tissue facing surface defining staple retaining slots;
an anvil assembly pivotably coupled to the cartridge assembly and including a second tissue facing surface defining staple pockets for forming staples expelled from the staple retaining slots of the cartridge assembly; and
a surgical buttress releasably disposed on the first tissue facing surface of the cartridge assembly; and
a resilient, porous material configured to be releasably disposed between the first and second tissue facing surfaces and on top of and in contact with the surgical buttress, the resilient, porous material resiliently biasing the cartridge and anvil assemblies toward a spaced apart position, wherein the resilient, porous material is configured to expel a liquid therefrom upon compression thereof by an approximation of the cartridge assembly and the anvil assembly.
11. The surgical stapling system of claim 10, wherein the resilient, porous material is a sponge.
12. The surgical stapling system of claim 11, wherein the sponge has an oblong shape and has a first end and a second end, wherein the sponge tapers from the first end to the second end.
13. The surgical stapling system of claim 10, wherein the resilient, porous material has a length equal to a length of the surgical buttress and a width equal to a width of the surgical buttress.
14. The surgical stapling system of claim 10, wherein the resilient, porous material includes a water soluble adhesive.
15. A method of preparing a surgical stapling apparatus, the method comprising:
providing a tool assembly including:
a cartridge assembly having a first tissue facing surface; and
an anvil assembly having a second tissue facing surface;
providing at least one surgical buttress releasably secured to the first or second tissue facing surfaces;
disposing a resilient, porous material between the first and second tissue facing surfaces such that the resilient, porous material is in abutting engagement with the at least one surgical buttress and resiliently biases the cartridge and anvil assemblies toward a spaced apart position, the resilient, porous material including a top surface and a bottom surface, a distal portion of each of the top and bottom surfaces being in abutting engagement with a respective distal portion of each of the cartridge and anvil assemblies when the cartridge and anvil assemblies are in the spaced apart position;
wetting the resilient, porous material with a liquid; and
approximating the cartridge assembly and the anvil assembly from the spaced apart position to an approximated position to compress the resilient, porous material therebetween such that the liquid exits the resilient, porous material and contacts the at least one surgical buttress.
16. The method of claim 15, wherein the resilient, porous material is a sponge.
17. The method of claim 16, wherein the sponge has an oblong shape and has a first end and a second end, wherein the sponge tapers from the first end to the second end.
18. The method of claim 15, wherein the resilient, porous material has a length equal to a length of the at least one surgical buttress and a width equal to a width of the at least one surgical buttress.
19. The method of claim 15, wherein the resilient, porous material is sized and dimensioned to occupy a space defined between the first and second tissue facing surfaces when the cartridge and anvil assemblies are in the spaced apart position.
20. The method of claim 15, wherein the bottom surface is in abutting engagement with the at least one surgical buttress.
21. The method of claim 15, wherein the wetting of the resilient, porous material includes inserting the resilient, porous material in a saline solution prior to approximating the cartridge assembly and the anvil assembly.
22. The method of claim 15, wherein the resilient porous material includes a water soluble adhesive.
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