Apparatus and method for applying surgical staples to attach an object to body tissue

Abstract

An apparatus is disclosed for endoscopic application of surgical staples adapted to attach surgical mesh to body tissue in laparoscopic hernia surgery. The apparatus includes a frame, and a generally elongated endoscopic section connected to the frame and extending distally therefrom. A staple storage cartridge is removably supported on a pivotal support system at the distal end portion of the endoscopic section with each staple being configured and adapted to attach the mesh to the body tissue. An elongated pusher system formed of several assembled components and extending from the frame to the endoscopic section is provided for individually advancing at least one staple at a time distally for positioning adjacent the surgical mesh and the body tissue. The pusher system also includes a trigger system to actuate the pusher. The trigger system is provided with perceptible tactile sensing means to indicate when the legs of the staple being advanced are exposed so as to be visible to the user for positioning and orientation purposes. Anvil means provides for individually closing each staple to encompass at least a portion of the surgical mesh and to penetrate the body tissue in a manner to attach the portion of the mesh to the body tissue. Projecting distally of the cartridge support system is a pair of legs which are dimensioned and configured to engage the staple during closure to prevent unwanted roll or deformation outside of the plane of the staple.

What is claimed is:  
     
         1 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) a frame;    b) an elongated member connected to said frame and extending distally therefrom;    c) a cartridge cooperating with said elongated member for storing at least one surgical staple, said staple configured and adapted to attach an object to body tissue;    d) a pusher for advancing said at least one staple distally for positioning adjacent the body tissue; and    e) an anvil for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         2 . Apparatus for endoscopic application of surgical staples adapted to attach an object to body tissue, which comprises: 
 a) frame means;    b) generally elongated endoscopic means connected to said frame means and extending distally therefrom;    c) cartridge means for storing a plurality of surgical staples, said staples configured and adapted to attach an object to body tissue;    d) means for individually advancing said staples distally for positioning adjacent the body tissue; and    e) means for closing each staple in a manner at least sufficient to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         3 . Apparatus according to  claim 2  wherein said surgical staples are stored in stacked relation in said cartridge means.  
     
     
         4 . Apparatus according to  claim 3  wherein said cartridge means for storing said surgical staples is removably positioned at the distal end portion of said endoscopic means.  
     
     
         5 . Apparatus according to  claim 4  wherein said endoscopic means defines a longitudinal axis and said surgical staples are stacked to form an angle with respect to said longitudinal axis.  
     
     
         6 . Apparatus according to  claim 5  wherein said cartridge means for storing surgical staples is supported by support means pivotally attached at the distal end portion of said endoscopic means.  
     
     
         7 . Apparatus according to  claim 6  wherein said surgical staple storing cartridge support means is selectively pivotal by the user such that said cartridge means is pivotal therewith.  
     
     
         8 . Apparatus according to  claim 7  further comprising control means to pivot said surgical staple cartridge support means from a proximal location.  
     
     
         9 . Apparatus according to  claim 8  wherein said pivotal control means is located at the proximal end portion of said endoscopic means.  
     
     
         10 . Apparatus according to  claim 9  wherein said pivotal control means of said surgical staple cartridge support means comprises a member movable with respect to said endoscopic means in proximal and distal directions and adapted to position said surgical staple storing means at substantially zero degrees with respect to said longitudinal axis when said pivotal control means is in a first position and said surgical staple storing means forms an angle of up to about 45 degrees when said pivotal control means is in a second position.  
     
     
         11 . Apparatus according to  claim 10  wherein said cartridge means is adapted to contain a predetermined plurality of staples in stacked relation.  
     
     
         12 . Apparatus according to  claim 11  wherein said cartridge means comprises resilient means to bias said staples toward a position for individually advancing each staple distally toward a position for closing the staple.  
     
     
         13 . Apparatus according to clam  12  wherein said cartridge comprises staple follower means positioned and adapted to engage the uppermost staple under said bias of said resilient means.  
     
     
         14 . Apparatus according to  claim 13  wherein said staple follower means comprises means to provide visual indication to the user when the last staple has been distally advanced and fired.  
     
     
         15 . Apparatus according to  claim 14  wherein said cartridge comprises a housing having an opening adapted to receive said visual indication means of said staple follower means.  
     
     
         16 . Apparatus according to  claim 15  wherein said staple cartridge includes markers on the outer surface of the housing thereof to enable the user to grip the cartridge at preselected locations for removal thereof and positioning of said cartridge with respect to said cartridge support member.  
     
     
         17 . Apparatus according to  claim 2  wherein said elongated endoscopic means comprises means for contacting at least portions of each staple as said staple is deformed, said contacting means configured and adapted to prevent deformation of each staple in a direction other than the intended direction of deformation.  
     
     
         18 . Apparatus according to  claim 3  wherein said elongated endoscopic means includes a pair of spaced members extending distally and dimensioned and configured to overlie portions of the leg members of each staple as said staple is deformed to thereby prevent said staple legs from being deformed out of the plane of said staple.  
     
     
         19 . Apparatus according to  claim 18  wherein said spaced members extend inwardly toward each other at the distal end.  
     
     
         20 . Apparatus according to  claim 19  wherein said inwardly extending tip portions are pointed.  
     
     
         21 . Apparatus according to  claim 20  wherein said means for individually advancing said staples distally comprises a plate member positioned adjacent and proximal of the lowermost staple and adapted to be movable distally whereby said plate member engages said lowermost staple and advances said staple in the distal direction.  
     
     
         22 . Apparatus according to  claim 2  wherein said means to individually advance said staples comprises staple pusher means and manually operable means is provided to advance said pusher means from the pre-fired position to the staple forming position.  
     
     
         23 . Apparatus according to  claim 22  wherein said manually operable pusher advancing means is a trigger mechanism.  
     
     
         24 . Apparatus according to  claim 2  further comprising anvil means positioned distally of said cartridge means and configured, dimensioned and adapted to be engaged by each said staple when said staple is advanced distally by said plate member.  
     
     
         25 . Apparatus according to  claim 24  wherein said staples are each formed of a first length of wire having at least two leg portions at each end extending generally perpendicular to said first length of wire.  
     
     
         26 . Apparatus according to  claim 25  wherein said leg members of said anvil means are dimensioned, positioned and arranged such that engagement by said first length of wire of each said staples causes said leg members of said staple to fold inwardly toward said first wire due to the configuration of said staple and the corresponding configuration of the distalmost staple engaging edge of said plate member.  
     
     
         27 . Apparatus according to  claim 2  wherein said endoscopic means is rotatable about said longitudinal axis.  
     
     
         28 . Apparatus according to  claim 2  further comprising means for providing a perceptible tactile indicator to the user when each staple has been advanced to a predetermined position at the distal end of said cartridge.  
     
     
         29 . Apparatus according to  claim 28  wherein said predetermined staple position is such that said leg portions of said staple extend outwardly of said cartridge and are thereby visible to the user.  
     
     
         30 . Apparatus according to  claim 29  wherein said cartridge is removable and replaceable by a cartridge having a predetermined plurality of staples.  
     
     
         31 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) frame means;    b) generally elongated endoscopic means connected to said frame means and extending distally therefrom;    c) a cartridge adapted for storing a plurality of surgical staples at the distal end portion, said staples configured and adapted to attach an object to body tissue;    d) means on said generally elongated endoscopic means for engagably receiving and supporting said cartridge in a manner to advance said staples individually for endoscopic application;    e) means for individually advancing said staples distally for positioning adjacent the object and the body tissue; and    f) anvil means for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         32 . A cartridge for containing a plurality of surgical fasteners for fastening body tissue which comprises: 
 a) housing means adapted to support said plurality of fasteners in stacked relation at a generally acute angle with respect to the direction of dispensing movement of said fasteners;    b) indicator means disposed within said housing means and movable from a first position when said housing means supports a predetermined plurality of said fasteners, to a second position whereby said indicator means provides indication to the user when the last of said fasteners has been dispensed from said housing means; and    c) resilient means to bias said indicator means toward an opening in said housing means to provide visual indication after the last fastener has been fired.    
     
     
         33 . Apparatus according to  claim 32  wherein said indicator means is formed as part of a fastener follower and said fastener follower changes position as said fasteners are dispensed from said housing means while said indicator means moves in a direction generally opposite the direction of said follower.  
     
     
         34 . Apparatus according to  claim 33  wherein said housing means defines an opening adapted to receive said indicator means after the last staple is dispensed to thereby provide visual indication thereof.  
     
     
         35 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) frame means;    b) generally elongated endoscopic means connected to said frame means and extending distally therefrom;    c) cartridge means for storing at least one surgical staple at the distal end portion, said staple configured and adapted to attach an object to body tissue;    d) means for individually advancing said at least one staple distally for positioning adjacent the body tissue;    e) anvil means for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue; and    f) means dimensioned, positioned and adapted to engage said staple as said staple is advanced from said housing in a manner to prevent said staple from deforming out of the plane of the staple when the staple is deformed to attach said staple to body tissue.    
     
     
         36 . The cartridge according to  claim 35  wherein said staple engaging means comprises a pair of spaced members extending distally and dimensioned and configured to overly portions of each staple as said staple is deformed to prevent said staple from being deformed out of the plane of said staple.  
     
     
         37 . The cartridge according to  claim 36  wherein said spaced members extend inwardly toward each other at the distal end.  
     
     
         38 . The cartridge according to  claim 37  wherein said inwardly extending portions comprise pointed tips.  
     
     
         39 . Apparatus according to  claim 38  wherein said means for individually advancing said staples distally comprises a plate member positioned adjacent and proximal of the lowermost staple and adapted to be movable distally whereby said plate member engages said lowermost staple and advances said staple in the distal direction.  
     
     
         40 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) frame means;    b) generally elongated endoscopic means connected to said frame means and extending distally therefrom;    c) cartridge means for storing at least one surgical staple at a distal portion, said staple configured and adapted to attach an object to body tissue;    d) means for individually advancing said at least one staple distally for positioning adjacent the body tissue;    e) anvil means for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue; and    f) gaseous seal means.    
     
     
         41 . Apparatus according to  claim 40  wherein said cartridge is removable and replaceable.  
     
     
         42 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) frame means;    b) generally elongated endoscopic means connected to said frame means and extending distally therefrom;    c) means for storing at least one surgical staple at the distal end portion, said staple configured and adapted to attach an object to body tissue;    d) manual means for individually advancing said at least one staple distally for positioning adjacent the body tissue and for providing perceptible indication when the staple being advanced is at a predetermined location visible to the user to thereby facilitate positioning and orientation of said staple with respect to the body tissue; and    e) anvil means for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         43 . Apparatus according to  claim 42  wherein said perceptible indicator means comprises tactile sensing means.  
     
     
         44 . Apparatus according to  claim 43  wherein said tactile sensing means comprises means to alter the manual feel to the user when said manual means individually advances said at least one staple and is at a predetermined location along its path prior to closure thereof.  
     
     
         45 . Apparatus according to  claim 44  wherein said staples comprises a length of wire having a wire leg member extending generally perpendicular thereto at each end portion and said predetermined location corresponds to the position of the next staple being advanced whereby said leg members of said staple extend outwardly of said cartridge means so as to be visible to the user to facilitate positioning and orientation of the staple with respect to the body tissue.  
     
     
         46 . Apparatus according to  claim 45  wherein said means for storing said at least one staple comprises a cartridge removably attached to said endoscopic means and adapted for storing a plurality of staples in stacked relation.  
     
     
         47 . Apparatus according to  claim 46  wherein each said staple includes a first length of wire having a pair of wire leg members extending distally from said backing member.  
     
     
         48 . Apparatus according to  claim 47  further comprising a staple cartridge support member and said elongated endoscopic means is rotatable up to about 360° to thereby facilitate corresponding rotation of said staple cartridge support member and said staple cartridge.  
     
     
         49 . Apparatus according to  claim 48  wherein said staple cartridge support member and said staple cartridge are pivotal up to about 45° with respect to the central axis of said elongated endoscopic means whereby said staple cartridge may be pivoted up to said 45° angle and rotated up to 360°.  
     
     
         50 . Apparatus according to  claim 49  wherein said means to pivot said staple cartridge support member and said staple cartridge is controllable manually from a location relatively proximal of said stable cartridge.  
     
     
         51 . In combination: 
 a) a cannula adapted for insertion into a body cavity, said cannula including valve means for sealing said cannula;    b) an endoscopic surgical staple applier having: 
 i) a frame; and  
 ii) an endoscopic portion defining a longitudinal axis, and extending distally from said frame, said endoscopic portion being configured and adapted for insertion into said cannula through said valve means in sealing engagement therewith, said endoscopic portion further including a cartridge having a plurality of surgical staples in stacked relation, and means for individually pushing said staples through the distal end thereof whereby staple closing means causes said staples to be closed while attaching an object such as surgical mesh to the body tissue; and  
   c) seal means positioned and adapted to obstruct passage of gaseous media from the body cavity.    
     
     
         52 . A kit for endoscopic application of a surgical staple adapted to attach surgical mesh to body tissue in hernia repair, which comprises: 
 a) surgical mesh;    b) cannula means; and    c) apparatus for endoscopic application of a surgical staple adapted to attach said surgical mesh to body tissue, including: 
 i) frame means; and  
 ii) generally elongated endoscopic means connected to said frame means and extending distally therefrom and dimensioned and configured for insertion into said cannula means, including: 
 1) a removable and replaceable cartridge for storing a plurality of surgical staples at the distal end portion, said staple configured and adapted to attach objects to body tissue;  
 2) means for individually advancing said at least one staple distally for positioning adjacent said surgical mesh and the body tissue; and  
 3) anvil means for closing said staple at least sufficient to encompass at least a portion of said surgical mesh and to penetrate said surgical mesh and the body tissue in a manner to attach the portion of the surgical mesh to the body tissue.  
 
   
     
     
         53 . The kit according to  claim 52  wherein said staples are each comprised of a length of wire having at least one leg member extending perpendicular thereto at either end thereof and adapted to penetrate said mesh and adjacent body tissue therebeneath.  
     
     
         54 . The kit according to  claim 53  wherein said staples are fabricated of titanium.  
     
     
         55 . The kit according to  claim 54  wherein said cannula means is a cannula assembly including a cannula and a valve assembly attached to the proximal end of said cannula, said valve assembly providing selective communication between said cannula.  
     
     
         56 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) a frame;    b) an elongated member connected to said frame and extending distally therefrom;    c) a cartridge mounted for pivotal movement with respect to said elongated member and cooperating with said elongated member for storing at least one surgical staple, said staple configured and adapted to attach an object to body tissue;    d) a pusher for advancing said at least one staple distally from said cartridge for positioning adjacent the body tissue, said pusher cooperating with said cartridge independent of the pivotal position thereof; and    e) an anvil for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         57 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) a frame;    b) an elongated member connected to said frame and extending distally therefrom;    c) a cartridge cooperating with said elongated member for storing at least one surgical staple, said staple configured and adapted to attach an object to body tissue;    d) a pusher communicating with said cartridge at for advancing said at least one staple distally for positioning adjacent the body tissue; and    e) an anvil for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         58 . Apparatus for endoscopic application of a surgical staple adapted to attach an object to body tissue, which comprises: 
 a) a frame;    b) an elongated member connected to said frame and extending distally therefrom;    c) a cartridge mounted with respect to said elongated member for storing at least one surgical staple, said staple configured and adapted to attach an object to body tissue;    d) a pusher which extends through said elongated member and into said cartridge for advancing said at least one staple distally from said cartridge for positioning adjacent the body tissue; and    e) an anvil for closing said staple in a manner to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue.    
     
     
         59 . Apparatus according to  claim 2  further comprising gaseous seal means positioned and adapted to obstruct passage of gaseous media from the body.  
     
     
         60 . Apparatus for endoscopic application of surgical staples adapted to attach an object to body tissue, which comprises: 
 a) frame means; and    b) generally elongated endoscopic means connected to said frame means and extending distally therefrom;    c) cartridge means for storing a plurality of surgical staples, said staples configured and adapted to attach an object to body tissue;    d) means for individually advancing said staples distally for positioning adjacent the body tissue;    e) means for individually advancing said staples distally for positioning adjacent the body tissue;    f) means for closing each staple in a manner at least sufficient to encompass at least a portion of the object and to penetrate the body tissue to attach the portion of the object to the body tissue; and    g) means for pivotally supporting said cartridge and said staple closing means for pivotal movement with respect to said elongated endoscopic means.