Surgical stapling instrument

Abstract

A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient in order to effect a joining of the skin or fascia. The instrument is adapted to associate with a staple-carrying cartridge having a plurality of staples therein. The instrument is manually powered and includes a nose portion rotatably mounted in a hand-held main body portion and adapted to mount the staple-carrying cartridge so that the stapling angle can be varied without rotating the hand-held portion of the stapler. A clutch means is provided for ensuring that the staple-advancing drive means of the instrument is only activated once per stapling operation. The instrument is further provided with means for preventing the insertion of a fresh staple-carrying cartridge until the instrument is in the readiness position for a driving stroke, and means for maintaining the unloaded instrument in its readiness position until equipped with a cartridge.

What is claimed is: 
     
       1. A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the skin or fascia, the instrument adapted to associate with a staple-carrying cartridge having anvil means at one end thereof and adapted to house a plurality of staples therein, a pusher element slidably mounted therein for ejecting staples from said cartridge and for forming said staples around said anvil means, and means for advancing said staples in said cartridge, said surgical stapling instrument comprising: a main body portion; means for mounting said staple-carrying cartridge on said main body portion; drive means to activate said staple-advancing means for driving the staples toward said anvil means.[.;.]. and .[.pusher-activating means.]. for driving the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means; said instrument being manually powered, and further comprising trigger means for transmitting a manually applied force to said drive means .[.and said pusher-activating means.]. to power said drive means .[.and said pusher-activating means.].. 
     
     
       2. The instrument defined in claim 1, wherein said .[.pusher-activating.]. .Iadd.drive .Iaddend.means comprises a thrust bar slidably mounted in said main body portion and said trigger means comprises a handle pivotally mounted to said main body portion and having a lower hand-engaging portion and an upper force-transmitting portion associated with said thrust bar. 
     
     
       3. The instrument defined in claim 2, wherein means are associated with said thrust bar for initiating the advancement of staples, said initiating means comprising an index pawl pivotally mounted to said thrust bar and adapted for sliding movement therewith. 
     
     
       4. The instrument defined in claim 3, wherein said thrust bar has a notch formed therein and wherein said index pawl has an upstanding leg formed thereon and cooperating with said notch to permit the pivotal movement of said index pawl, and wherein said index pawl is pivotally mounted to said thrust bar by means of a resilient member. 
     
     
       5. The instrument defined in claim 1, wherein said drive means comprises a ratchet and main gear mounted in said main body portion for rotation in unison, at least one pinion gear rotatably driven by said main gear, and a pinion shaft rotatably driven by each said pinion gear. 
     
     
       6. The instrument defined in claim 5, wherein said drive means is adapted to be over-driven and thereby advance each staple but the first in said staple-carrying cartridge more than one staple unit for each thrust of said thrust bar; and further including means to reverse the direction of rotation of said drive means so that said drive means ultimately advances each staple one staple unit, said reversing means comprising a spring pawl biasing said drive means in said reverse directon when said drive means is in the over-driven state. 
     
     
       7. The instrument defined in claim 1, and further comprising means for alerting the surgeon that a staple has reached a readiness position for ejection and formation. 
     
     
       8. The instrument defined in claim 7, wherein said alerting means comprises a notch associated with said pusher-activating means and a spring-biased wedge housed in said main body portion and adapted to cooperate with said notch to provide said alerting function. 
     
     
       9. A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the skin or fascia, the instrument adapted to associate with a staple-carrying cartridge having anvil means at one end thereof and adapted to house a plurality of staples therein, a pusher element slidably mounted therein for ejecting staples from said cartridge and for forming said staples around said anvil means, and means for advancing said staples in said cartridge, said surgical stapling instrument comprising: a main body portion; a nose portion; means for mounting said staple-carrying cartridge on said nose portion so that said cartridge is rotatable therewith; drive means housed in said nose portion and rotatable therewith for activating said staple-advancing means for driving the staples toward said anvil means .[.;.]. and .[.pusher-activating means housed in said nose portion and rotatable therewith.]. for driving the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means, wherein said instrument is manually powered, and further comprising trigger means for transmitting a manually applied force to said drive means .[.and said pusher-activating means.]. to power said drive means .[.and said pusher-activating means.].. 
     
     
       10. The instrument defined in claim 9, wherein said .[.pusher-activating.]. .Iadd.drive .Iaddend.means comprises a thrust bar slidably mount in said nose portion and said trigger means comprises a handle pivotally mounted to said main body portion and having a lower hand-engaging portion and an upper force-transmitting portion, and wherein said instrument further comprises collar means housed in said main body portion and slidably mounted on and rotatable with said nose portion for transmitting force from said trigger means to said .[.pusher-activated.]. .Iadd.drive .Iaddend.means. 
     
     
       11. The instrument defined in claim 10, wherein said collar means comprises a cylindrically-shaped body member having outwardly and radially extending flange portions at each end thereof, and wherein said upper force-transmitting portion of said trigger means is formed in the shape of a yoke and is positioned around said cylindrically-shaped body member and between said flange portions of said collar means so that said collar means can rotate relative to said trigger means. 
     
     
       12. A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the skin or fascia, the instrument adapted to associate with a staple-carrying cartridge having anvil means at one end thereof and adapted to house a plurality of staples therein, a pusher element slidably mounted therein for ejecting staples from said cartridge and for forming said staples around said anvil means, and means for advancing said staples in said cartridge, said surgical staple instrument comprising: a main body portion; means for mounting said staple-carrying cartridge on said main body portion; drive means to activate said staple-advancing means for driving the staples toward said anvil means .[.; pusher-activating means.]. .Iadd.and .Iaddend.for driving the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means; and clutch means for preventing said drive means from activating said staple-advancing means more than once in each stapling operation, said clutch means comprising two surfaces movable relative to one another with one of said two surfaces being sloped relative to the other, a roller positioned between said two surfaces, and a wedge member in one of said two surfaces, said wedge member adapted to permit said roller means to move therepast only at the respective ends of the drive means stroke.  13. The instrument defined in claim 12, wherein said .[.pusher-activating.]. .Iadd.drive .Iaddend.means comprises a thrust bar slidingly mounted for reciprocative movement in said main body portion and wherein said clutch means prevents said thrust bar from returning to its initial rest position until said thrust bar has completed its forward 
     
     
        thrust movement. 14. The instrument defined in claim 13, wherein the sloped surface is inclined relative to said thrust bar and defines an opening therewith which increases in size in the direction of the forward thrust movement of said thrust bar, and wherein said roller is positioned 
     
     
        between and cooperating with said sloped surface and said thrust bar. 15. The instrument defined in claim 14, wherein said wedge member 
     
     
        cooperating with said roller is spring-biased. 16. A surgical stapling instrument for applying sterilized staples to the disunited skin or fascia of a patient for effecting a joining of the skin or fascia, the instrument adapted to associate with a staple-carrying cartridge having anvil means at one end thereof and adapted to house a plurality of staples therein, a pusher element slidably mounted therein for ejecting staples from said cartridge and for forming said staples around said anvil means, and means for advancing said staples in said cartridge, said surgical stapling instrument comprising: a main body portion; means for mounting said staple-carrying cartridge on said main body portion: drive means to activate said staple-advancing means for driving the staples toward said anvil means .[.; pusher-activating means.]. .Iadd.and .Iaddend.for driving the pusher element forward to eject a staple from the staple-carrying cartridge and to form said staple around said anvil means; and locking means associated with said .[.pusher-activating.]. .Iadd.drive .Iaddend.means and adapted to cooperate with said staple-carrying cartridge for ensuring that said .[.pusher-activating.]. .Iadd.drive .Iaddend.means is in its initial rest position when said staple-carrying 
     
     
        cartridge is mounted on said main body portion. 17. The instrument defined in claim 16, wherein said locking means is adapted to lock said .[.pusher-activating.]. .Iadd.drive .Iaddend.means in its initial rest position until said staple-carrying cartridge is mounted on said main body 
     
     
        portion. 18. The instrument defined in claim 17, wherein said .[.pusher-activating.]. .Iadd.drive .Iaddend.means comprises a thrust bar mounted for reciprocative movement in said main body portion, and wherein said locking means comprises a movable cartridge interlock member adapted to lie in blocking and abutting relationship with the forwardmost end of said thrust bar when said thrust bar is in its initial rest position and adapted to move out of said blocking relationship with said thrust bar when said staple-carrying cartridge is mounted on said main body portion. 
     
     
         9. The instrument defined in claim 18, wherein said cartridge interlock member comprises a body portion spring-biased toward a blocking relationship with said thrust bar and having an opening therein through which said thrust bar can pass when moved out of said blocking relationship, said cartridge inter-lock member further having a leg porton adapted to contact said staple-carrying cartridge when said staple-carrying cartridge is mounted on said main body portion such that said cartridge inter-lock member is moved out of said blocking 
     
     
        relationship. 20. The instrument defined in claim 16, wherein said locking means comprises a movable cartridge stop lock member adapted to prevent the mounting of said staple-carrying cartridge in said main body portion unless said .[.pusher-activating.]. .Iadd.drive .Iaddend.means is in said 
     
     
        initial rest position. 21. The instrument defined in claim 20, wherein said .[.pusher-activating.]. .Iadd.drive .Iaddend.means comprises a thrust bar mounted for reciprocative movement in said main body portion and wherein said cartrige stop lock member is adapted to block the mounting of said staple-carrying cartridge when said thrust bar is not in said initial rest position, and is adapted to be moved into a non-blocking position by said thrust bar when said thrust bar is in said initial rest position. 
     
     
            The instrument defined in claim 20, wherein said cartridge stop lock member comprises a body portion and a leg portion, said leg portion being spring-biased into a position adapted to block the mounting of said staple-carrying cartridge when said thrust bar is not in said initial rest position, and wherein each of said cartridge stop lock member and said thrust bar have correspondingly inclined surfaces such that said cartridge stop lock member is moved into a non-blocking position by said thrust bar when said thrust bar is in said initial rest position.