(19)
(11)EP 2 644 128 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
13.05.2020 Bulletin 2020/20

(21)Application number: 13173986.4

(22)Date of filing:  13.12.2012
(51)Int. Cl.: 
A61B 17/072  (2006.01)
A61B 17/00  (2006.01)
A61B 17/115  (2006.01)

(54)

Surgical stapling apparatus including buttress attachment

Chirurgische Klammervorrichtung mit Versteifungsbefestigung

Appareil d'agrafage chirurgical comprenant une fixation de renfort


(84)Designated Contracting States:
AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

(30)Priority: 14.12.2011 US 201113325501

(43)Date of publication of application:
02.10.2013 Bulletin 2013/40

(62)Application number of the earlier application in accordance with Art. 76 EPC:
12196911.7 / 2604195

(73)Proprietor: Covidien LP
Mansfield, MA 02048 (US)

(72)Inventors:
  • Carter, Sally
    Wallingford, CT Connecticut 06492 (US)
  • Stevenson, Richard P.
    Colchester, CT Connecticut 06415 (US)

(74)Representative: Maschio, Antonio et al
Maschio & Soames IP Limited 30 Carlton Crescent
Southampton SO15 2EW
Southampton SO15 2EW (GB)


(56)References cited: : 
WO-A2-2006/044490
US-A1- 2005 059 996
US-A- 5 443 198
  
      
    Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


    Description

    BACKGROUND


    Technical Field



    [0001] The present disclosure relates to a surgical instrument for applying surgical fasteners or staples to body tissue, and more particularly, to a surgical buttress for use with an end-to-end anastomosis stapling apparatus.

    Background of Related Art



    [0002] Anastomosis is a surgical joining of separate hollow organ sections. Typically, an anastomosis procedure follows surgery in which a diseased or defective section of hollow tissue is removed and the remaining end sections are joined. Depending on the desired anastomosis procedure, the end sections may be joined by either circular, end-to-end or side-to-side organ reconstruction methods.

    [0003] In a circular anastomosis procedure, the two ends of the organ sections are joined by means of a stapling instrument, which drives a circular array of staples through the end section of each organ section and simultaneously cores any tissue interior of the driven circular array of staples to free the tubular passage. Typically, these instruments include an elongated shaft having a handle portion at a proximal end to actuate the instrument and a staple holding component disposed at a distal end. An anvil assembly including an anvil shaft with attached anvil head is mounted to the distal end adjacent the staple holding component. Opposed end sections of the organ to be stapled are clamped between the anvil head and the staple holding component. The clamped tissue is stapled by driving a plurality of staples from the staple holding component so that the ends of the staples pass through the tissue and are deformed by the anvil head.

    [0004] In use, one end section of the organ is secured about the anvil assembly and the other end section of the organ is held in place adjacent the staple holding component. The shaft of the anvil assembly is removably connected to the instrument. Once the anvil shaft is secured to the instrument, the anvil is drawn into close approximation to the staple holding component. The instrument is then fired to cause the staples to pass through tissue of both sections of the organ and deform against the anvil. During the firing step, a circular knife is advanced to cut tissue inside the staple line, thereby establishing a passage between the two sections of the organ. After firing, the instrument is typically removed by withdrawing the anvil through the staple line, after which the surgeon will carefully inspect the surgical site to ensure a proper anastomosis has been achieved.

    [0005] While circular staplers are helpful in a number of surgical procedures, problems such as anastomotic leak, tear of tissue during stapler extraction, bleeding, and other complications may arise. In order to remedy such problems, buttress or reinforcing materials have been utilized. However, due to the inherent difficulty in positioning and securing such materials with the instrument, there is a continuing need for buttress material and buttress material and instrument combinations that can be safely and effectively positioned within staple cartridge and/or anvil.

    [0006] WO 2006/044490 A2 discloses an assembly for disposing a support structure between intestinal sections of tissue.

    [0007] US 2005/0059996 A1 discloses a reinforcement device for use with a circular stapler, the stapler having an anvil portion with a compression surface, and the reinforcement device comprising a buttress having a contact surface adapted to attach to the stapler anvil without use of an adhesive on the compression surface and the contact surface. US 2005/0059996 A1 also discloses a reinforcement device for use with a circular stapler, the reinforcement device comprising a buttress adapted for mounting on the circular stapler, the buttress including at least one adaptive opening created by the circular stapler which corresponds to the surgical opening in the patient, the adaptive opening when circular having a diameter smaller than the diameter of the anvil, and wherein the adaptive opening allows the anvil to be removed therethrough without causing permanent alteration to the buttress.

    SUMMARY



    [0008] The present invention is defined in independent claim 1 and certain optional features thereof are defined in the dependent claims.

    [0009] In accordance with the present disclosure, there is provided an apparatus for joining two hollow organ sections with an annular array of surgical staples. The apparatus includes a staple cartridge component, an anvil component, a knife member and a first buttress component. The staple cartridge component includes a plurality of surgical staples in an annular array. The anvil component includes an anvil member defining a plurality of staple pockets for forming the surgical staples and a shaft extending distally from the anvil member. The anvil component is movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp the organ sections between the staple cartridge and anvil components. The knife member is concentrically arranged in the staple cartridge component. The knife member is movable relative to the staple cartridge component. The first buttress component includes a buttress member concentrically aligned with the anvil component and a rim extending distally from the buttress member. The rim is an outer rim that engages an outer surface of the anvil member. The first buttress component encloses the plurality of staple pockets defined in the anvil member. The apparatus further includes a separate fastening member securing the first buttress component to the shaft of the anvil component.

    [0010] In particular, the fastening member may include a plurality of barbs. In addition, the first buttress component may further include an inner rim extending proximally from the buttress member. The inner rim may be configured and dimensioned to engage the shaft of the anvil component.

    [0011] In an embodiment, the apparatus may further include a second buttress component concentrically aligned with the staple cartridge component. The second buttress component may include a buttress member and a plurality of circumferentially arranged tabs extending proximally from the buttress member. The plurality of tabs may engage an outer wall of the staple cartridge component. In particular, the plurality of tabs and the outer wall of the staple cartridge component may include corresponding hook and loop fasteners to secure the second buttress component to the staple cartridge component.

    [0012] Each tab may include a line of weakening adjacent the buttress member for detachment of the buttress member from the plurality of tabs. The buttress component may be configured such that the plurality of tabs engage an inner wall of the staple cartridge component. The plurality of tabs and the inner wall of the staple cartridge component may include corresponding hook and loop fasteners to secure the second buttress component to the staple cartridge component.

    [0013] The apparatus may further include a fastening member configured and dimensioned to engage the plurality of circumferentially arranged tabs to securely position the second buttress component on the staple cartridge component. The fastening member may be an annular ring configured and dimensioned to apply inward force to the plurality of circumferentially arranged tabs against an outer wall of the staple cartridge component. Alternatively, the fastening member may be a suture tied around the plurality of circumferentially arranged tabs against an outer wall of the staple cartridge component.

    BRIEF DESCRIPTION OF THE DRAWINGS



    [0014] Various embodiments of the present disclosure are described hereinbelow with reference to the drawings, wherein:

    FIG. 1 is a perspective view of an annular surgical stapling apparatus configured for use with a surgical buttress assembly in accordance with an embodiment of the present disclosure;

    FIG. 2 is a perspective view of a head portion of the surgical stapling apparatus of FIG. 1 illustrating a surgical buttress assembly mounted on a distal portion of a staple cartridge assembly;

    FIG. 3 is an exploded, perspective view, with parts separated, of the head portion of FIG. 2;

    FIG. 4 is an enlarged, cross-sectional view of the area of detail indicated in FIG. 2;

    FIG. 5 is a perspective view of a head portion of a surgical stapling apparatus including a surgical buttress assembly in accordance with another embodiment of the present disclosure;

    FIG. 6 is an exploded, perspective view, with parts separated, of the head portion of FIG. 5;

    FIG. 7 is an enlarged, cross-sectional view of the area of detail indicated in FIG. 5;

    FIG. 8 is a perspective view of the annular surgical apparatus of FIG. 1 illustrating insertion of the apparatus through two hollow organ sections;

    FIG. 9 is an enlarged, partial longitudinal, cross-sectional view of the head portion of the apparatus of FIG. 8;

    FIG. 10 is an enlarged, partial longitudinal, cross-sectional view of the head portion of the apparatus of FIG. 8, illustrating stapling and cutting of the two hollow organ sections;

    FIG. 11 is a perspective view of a head portion of a surgical stapling apparatus including a surgical buttress assembly in accordance with still another embodiment of the present disclosure;

    FIG. 12 is an exploded, perspective view, with parts separated, of the head portion of FIG. 11;

    FIG. 13 is an enlarged, cross-sectional view of the area of detail indicated in FIG. 11;

    FIG. 14 is a perspective view of a head portion of a surgical stapling apparatus including a surgical buttress assembly in accordance with still another embodiment of the present disclosure;

    FIG. 15 is an exploded, perspective view, with parts separated, of the head portion of FIG. 14;

    FIG. 16 is an enlarged, cross-sectional view of the area of detail indicated in FIG. 14;

    FIG. 17 is a perspective view of a head portion of a surgical stapling apparatus including a surgical buttress assembly in accordance with still yet another embodiment of the present disclosure;

    FIG. 18 is an exploded, perspective view, with parts separated, of the head portion of FIG. 17;

    FIG. 19 is an enlarged, cross-sectional view of the area of detail indicated in FIG. 17;

    FIG. 20 is a perspective view of a head portion of a surgical stapling apparatus including a surgical buttress assembly in accordance with still yet another embodiment of the present disclosure;

    FIG. 21 is an exploded, perspective view, with parts separated, of the head portion of FIG. 20;

    FIG. 22 is an enlarged, cross-sectional view of the area of detail indicated in FIG. 20;

    FIG. 23 is a perspective view of a head portion of a surgical stapling apparatus including a surgical buttress assembly in accordance with still another embodiment of the present disclosure, illustrating an anvil assembly and the surgical buttress assembly detached from the surgical stapling apparatus;

    FIG. 24 is a perspective view of the anvil assembly and the surgical buttress assembly of FIG. 23 securely positioned on the anvil assembly;

    FIG. 25 is an exploded, perspective view, with parts separated, of a head assembly of a surgical stapling apparatus including a surgical buttress assembly in accordance with still yet another embodiment of the present disclosure; and

    FIG. 26 is a perspective view of an anvil assembly and the surgical buttress assembly of FIG. 25 securely positioned on the anvil assembly.


    DETAILED DESCRIPTION OF EMBODIMENTS



    [0015] Embodiments of the present disclosure 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. As used herein, the term "distal," as is conventional, will refer to that portion of the instrument, apparatus, device or component thereof which is farther from the user while, the term "proximal," will refer to that portion of the instrument, apparatus, device or component thereof which is closer to the user. In the following description, well-known functions or constructions are not described in detail to avoid obscuring the present disclosure in unnecessary detail.

    [0016] With reference to FIG. 1, a surgical stapling apparatus 10 for performing circular anastomosis of hollow organs is shown. Surgical stapling apparatus 10 drives a circular array of staples 7 (FIG. 9) through the end sections of each organ and simultaneously fires a cylindrical knife 76 (FIG. 9) to cores any tissue radially inward of the driven circular array of staples 7 to free the tubular passage, and thereby joining two ends of the organ. Surgical stapling apparatus 10 includes a handle assembly 20 having a pair of pivotable actuating handle members 22 and an advancing means 24 including a rotatable grip member 26, an elongate body portion 30 extending distally from handle assembly 20, and a head portion 50 including an anvil assembly 60, a staple cartridge assembly 70, and a surgical buttress assembly 100 in accordance with an embodiment of the present disclosure.

    [0017] The components of surgical apparatus 10 are generally formed from thermoplastics including polycarbonates, and metals including stainless steel and aluminum. The particular material selected to form a particular component will depend upon the strength requirements of the particular component. Staples 7 are of a conventional type and include a backspan having a pair of legs extending from the backspan. The legs terminate in tissue penetrating tips.

    [0018] Handle assembly 20 can be actuated to approximate anvil assembly 60 relative to staple cartridge assembly 70 and to apply a pair of annular arrays of staples 7 through tissue. In order to properly position tissue in head portion 50, rotatable grip member 26 may be rotated to move anvil assembly 60 axially relative to staple cartridge assembly 70 between a spaced apart position and an approximated position in which anvil assembly 60 is positioned adjacent staple cartridge assembly 70 to clamp tissue therebetween. Handle members 22 may be squeezed to fire staples 7 through tissue to join two segments "T1," "T2" (FIG. 9) of tubular tissues together, as will be discussed in detail below.

    [0019] Elongate body portion 30 is constructed to have a slightly curved/bent shape along its length. However, elongate body portion 30 may also be straight, as well as flexible to bend to any configuration. The length, shape and/or the diameter of elongate body portion 30 may be varied to suit a particular surgical procedure.

    [0020] With reference to FIGS. 2-4, head portion 50 includes anvil assembly 60, staple cartridge assembly 70 and surgical buttress assembly 100 detachably secured with staple cartridge assembly 70. Staple cartridge assembly 70 may be fixedly connected to a distal end portion of elongate body portion 30 or may be configured to concentrically fit within the distal end portion of elongate body portion 30. In particular, staple cartridge assembly 70 defines a pair of annular arrays of staple receiving slots 72 having a staple 7 disposed in each one of staple receiving slots 72 and a circumferentially arranged groove 71 (FIG. 4) such as, e.g., a countersink, in an outer wall 79 thereof.

    [0021] In addition, staple cartridge assembly 70 includes cylindrical knife 76 concentrically arranged with the pair of annular arrays of staples 7 and a plurality of staple pushers 9 (FIG. 9) each disposed in respective staple receiving slot 72 to eject the respective staple 7 through slot 72. In use, staples 7 travel through slots 72 and tissue toward anvil assembly 60 for formation thereof.

    [0022] With brief reference to FIG. 9, cylindrical knife 76 includes a distal rim 79 defining a knife blade adapted to cut tissue. Upon actuation of handle members 22, cylindrical knife 76 is moved distally to cut tissue, and the plurality of pushers 9 are moved distally to eject staples 7 disposed in staple receiving slots 72 therethrough, toward anvil assembly 60.

    [0023] With particular reference back to FIG. 3, positioned distally of staple cartridge assembly 70 is anvil assembly 60 including an anvil member 62 and a shaft 64 extending proximally from anvil member 62. Anvil member 62 includes a plurality of pockets (not shown) for receiving and forming staples 7. Shaft 64 is configured to be detachably received in approximation shaft 75 disposed in elongate body portion 30. Approximation shaft 75 is operatively coupled with rotatable grip member 26 of handle assembly 20, whereby rotation of rotatable grip member 26 moves approximation shaft 75 axially. Such axial movement of approximation shaft 75 is imparted to anvil assembly 60 detachably coupled with approximation shaft 75. In this manner, anvil assembly 60 is movable axially relative to staple cartridge assembly 70 between a spaced apart position and an approximated position in which anvil assembly 60 is positioned adjacent staple cartridge assembly 70 to adjustably clamp tissue between anvil assembly 60 and staple cartridge assembly 70.

    [0024] Examples of instruments for performing circular anastomosis of hollow organs are described in U.S. Patent Nos. 6,053,390, 5,588,579, 5,119,983, 5,005,749, 4,646,745, 4,576,167, and 4,473,077.

    [0025] With continued reference to FIGS. 3 and 4, surgical buttress assembly 100 includes a buttress component 110 and a fastening member in the form of an annular ring 130 configured and dimensioned to secure buttress component 110 on staple cartridge assembly 70. Buttress component 110 is provided to reinforce and seal staple lines applied to tissue by surgical stapling apparatus 10.

    [0026] Buttress component 110 includes a buttress member 112 having an annular profile configured to be concentrically aligned with staple cartridge assembly 70 and a plurality of circumferentially arranged tabs 120 extending proximally from buttress member 112. In use, buttress member 112 is mounted on a distal surface 74 of staple cartridge assembly 70. The annular profile of buttress member 112 is configured and dimensioned to be flush with an outer peripheral edge of staple cartridge assembly 70 when mounted on staple cartridge assembly 70. Moreover, buttress member 112 is superposed with the pair of annular arrays of staple receiving slots 72. In this manner, when staples 7 are ejected through the pair of annular arrays of staple receiving slots 72, the legs of each staple 7 penetrate through buttress member 112 and the backspan of staple 7 is secured or abuts against a proximal surface of buttress member 112.

    [0027] In addition, cylindrical knife 76 is disposed radially inward of annular array of staple receiving slots 72 and of buttress member 112 that is in a superposed relation with the annular array of staple receiving slots 72 so as to not extend across a knife path of cylindrical knife 76. In this manner, upon actuation of handle members 22, the entire buttress member 112 is stapled to tissue to reinforce said tissue, and severing of buttress member 112 by cylindrical knife 76 is eliminated.

    [0028] A fastening member is configured and dimensioned to engage the plurality of circumferentially arranged tabs to securely position the buttress component on the staple cartridge component of the stapling apparatus. For example, the plurality of circumferentially arranged tabs 120 that extend proximally from buttress member 112 are positionable on distal surface 74 of cartridge assembly 70. See FIG. 3. More particularly, a proximal end of each tab 120 extends proximal of a groove 71 circumferentially defined in outer wall 79 of cartridge assembly 70. See FIG. 4.

    [0029] The fastening member may be provided in the form of an annular ring 130, which is secured around circumferentially arranged tabs 120, such that annular ring 130 applies a radially inward force against tabs 120 disposed across groove 71. In this manner, annular ring 130 overlies groove 71 and is substantially flush with portions of buttress member 112 and/or tabs 120 that are disposed on or against outer wall 79 of staple cartridge assembly 70. Such configuration enables buttress member 112 to be securely positioned in place with respect to staple cartridge assembly 70.

    [0030] Annular ring 130 may include and is not limited to a resilient band. For example, a piece of spring metal, which may be circular in shape, or a length of suture material, or similar straps, bands, cables, or other members may be used.

    [0031] Buttress component 110 is monolithically formed as a single construct. However, each tab 120 may include a break, perforations, or a line of weakening adjacent buttress member 112, whereby buttress member 112 that is stapled to tissue may be severed or detached from the plurality of tabs 120. In this manner, tabs 120 may at least partially be retained in groove 71 by annular ring 130 and later removed from the surgical site along with surgical stapling apparatus 10.

    [0032] Buttress member 112 is fabricated from a biocompatible material which is bio-absorbable or non-absorbable, as well as natural or synthetic materials. It should be understood that any combination of natural, synthetic, bio-absorbable, and non-bioabsorbable materials may be used to form buttress member 112.

    [0033] In addition, buttress member 112 may be porous, non-porous, or combinations thereof. It is also envisioned that buttress member 112 described herein may contain a plurality of layers in which any combination of non-porous and porous layers may be configured. For example, buttress member 112 may be formed to include multiple non-porous layers and porous layers that are stacked in an alternating manner. In another example, buttress member 112 may be formed in a "sandwich-like" manner wherein the outer layers of buttress member 112 include porous layers and the inner layers are non-porous layers. Examples of multi-layered buttress members are disclosed in U.S. Patent Application Publication No. 2009/0001122, filed on June 27, 2007, entitled "Buttress and Surgical Stapling Apparatus,".

    [0034] In particular, the use of non-porous layers in buttress member 112 may enhance the ability of buttress member 112 to resist tears and perforations during the manufacturing, shipping, handling, and stapling processes. In addition, the use of a non-porous layer in the surgical buttress may also retard or inhibit tissue ingrowth from surrounding tissues, and thereby acting as an adhesion barrier and inhibiting the formation of unwanted scar tissue.

    [0035] In addition, at least one bioactive agent may be combined with buttress member 112. The agent may be disposed on a surface of the surgical buttress and/or impregnated therein. In these embodiments, buttress member 112 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.

    [0036] With reference now to FIGS. 5-7, it is further contemplated that a surgical buttress assembly 200 may include buttress component 110 and a fastening member in the form of a suture 230. In contrast to surgical buttress assembly 100, suture 230 may be utilized to securely position buttress component 110 on a distal surface 274 of a staple cartridge assembly 270. As described hereinabove, a proximal end of each tab 120 extends across a groove 271 (FIG. 7) defined in an outer wall 279 of cartridge assembly 270 when buttress member 112 is positioned on distal surface 274 of staple cartridge assembly 270.

    [0037] In use, suture 230 is wrapped around circumferentially arranged tabs 120, such that suture 230 applies radially inward force against portions of tabs 120 disposed at least partially across groove 271. In particular, staple cartridge assembly 270 defines groove 271 having an arcuate, transverse, cross-sectional profile to better accommodate suture 230 that overlies groove 271, as shown in FIG. 7. Such configuration enables buttress component 110 to be securely positioned in place with respect to staple cartridge assembly 270.

    [0038] With reference to FIGS. 8-10, surgical stapling apparatus 10 is shown in use in an anastomosis procedure to effect joining of, for example, two opposing intestinal sections. The anastomosis procedure is typically performed using minimally invasive surgical techniques including laparoscopic means and instrumentation. Initially, a diseased intestinal section is removed. Thereafter, anvil assembly 60 is inserted to the operative site either through a surgical incision or transanally and is positioned within the intestinal section "T1." Elongate body portion 30 of surgical stapling apparatus 10, including staple cartridge assembly 70, is inserted transanally into the other intestinal section "T2." The intestinal sections "T1," "T2" are then temporarily secured about their respective components (e.g., shaft 64 of anvil assembly 60 and the distal end of elongate body portion 30) by conventional means such as a purse string suture "P" (see FIG. 9).

    [0039] Thereafter, the clinician maneuvers anvil assembly 60 until the proximal end of shaft 64 is inserted into and attached/connected to the distal end of approximation shaft 75 disposed in elongate body portion 30 of surgical stapling apparatus 10. Shaft 64 engages approximation shaft 75 to be operable as a unitary construct. Anvil assembly 60 and elongate body portion 30 are then approximated to approximate the intestinal sections "T1," T2." Surgical stapling apparatus 10 is then fired causing the plurality of staple pushers 9 each disposed in respective staple receiving slot 72 to eject the respective staple 7 through slot 72. Staples 7 travel through intestinal sections "T1," T2," as well as buttress member 112, toward anvil assembly 60, thereby effecting stapling of intestinal sections "T1," T2" to one another, while cylindrical knife 76 cuts a portion of tissue disposed radially inward of cylindrical knife 76 to complete the anastomosis. At this time, tabs 120 remain attached to buttress member 112 stapled to the intestinal sections "T1," T2" and are secured with staple cartridge assembly 70 by annular ring 130. Upon removal of surgical stapling apparatus 10 from the surgical site, the break or the line of weakening adjacent buttress member 112 facilitates detachment of tabs 120 from buttress member 112 stapled to intestinal sections "T1," T2."

    [0040] With reference now to FIGS. 11-13, a buttress assembly 300 in accordance with another embodiment of the present disclosure is shown. A fastening member is in the form of a suture 330. In particular, buttress component 310 includes a buttress member 312 configured and dimensioned to be positioned on a distal surface 374 of staple cartridge assembly 370 and a rim 320 extending proximally from an outer radial edge of buttress member 312. Rim 320 engages an outer wall 379 of staple cartridge assembly 370, whereby buttress component 310 encloses distal surface 374 of staple cartridge assembly 370. A cylindrical knife 376 is disposed radially inward of buttress member 312, whereby under such a configuration severing of buttress member 312 by cylindrical knife 376 is eliminated.

    [0041] Rim 320 includes a plurality of circumferentially arranged loops 315. Each loop 315 is configured and dimensioned to accommodate a suture 330 therethrough. Suture 330 is wrapped and tied around rim 320 through the plurality of loops 315 against outer wall 379 of staple cartridge assembly 370 to secure buttress component 310 on staple cartridge assembly 370. In addition, rim 320 includes a circumferentially defined break, plurality of perforations or line of weakening 316 adjacent buttress member 312, whereby buttress member 312 that is stapled to tissue may be detached from rim 320. In this manner, rim 320 that is detached from buttress member 312 remains secured to outer wall 379 of staple cartridge assembly 370 by suture 330 and is removed from the surgical site along with staple cartridge assembly 370. Alternatively, each loop 315 may be created by defining a pair of substantially adjacent slits in rim 320.

    [0042] With reference to FIGS. 14-16, a buttress assembly 400 in accordance with another embodiment of the present disclosure is shown. Buttress assembly 400 includes a buttress component 410 and a fastening member in the form of a suture 430. In particular, buttress component 410 includes a buttress member 412 configured and dimensioned to be positioned on a distal surface 474 of staple cartridge assembly 470 and a rim 420 extending proximally from an outer radial edge of buttress member 412. Rim 420 engages an outer wall 479 of staple cartridge assembly 470, whereby buttress component 410 encloses distal surface 474 of staple cartridge assembly 470.

    [0043] In contrast to rim 320, rim 420 includes a plurality of circumferentially arranged apertures, holes or bores 415. Each bore 315 is configured and dimensioned to receive suture 430 therethrough. Suture 430 is looped and tied around rim 420 through the plurality of bores 415 to secure buttress component 410 on staple cartridge assembly 470. In addition, rim 420 includes a break 416 circumferentially defined adjacent buttress member 412, whereby buttress member 412 that is stapled to tissue may be detached from rim 420. In this manner, rim 420 that is detached from buttress member 412 is secured to outer wall 479 of staple cartridge assembly 470 and is removed from the surgical site along with staple cartridge assembly 470.

    [0044] It is further contemplated that each bore 415 may include an adhesive or a gel such as, e.g., hydrogel, to improve securement of suture 430 in bore 415. In addition, it is also envisioned that suture 430 may include a plurality of, e.g., unidirectional, barbs, to improve securement of suture 430 in bores 415. Examples of barbed sutures are disclosed in U.S. Patent Application No. 12/361,962, filed January 29, 2009. A compound barbed suture is available commercially as V-LOC™ from Tyco Healthcare Group, LLP (dba Covidien AG, Mansfield, Massachusetts).

    [0045] With reference to FIGS. 17-19, a buttress assembly 600 in accordance with another embodiment of the present disclosure is shown. Buttress assembly 600 includes a buttress member 610 and a plurality of circumferentially arranged tabs 620 extending proximally from an outer radial edge of buttress member 610. Each tab 620 includes an attaching member 630a on an inner wall or surface 625 thereof.

    [0046] Furthermore, outer wall 679 of staple cartridge assembly 670 includes a plurality of circumferentially arranged attaching members 630b corresponding to attaching members 630a on tabs 620. Attaching members 630a, 630b may include, for example, a refastenable tape or a hook and loop fastener. Alternatively, tabs 620 may include a double-sided adhesive tape to detachably position buttress assembly 600 to staple cartridge assembly 670.

    [0047] In addition, it is also envisioned that each tabs 620 may include a break, perforations or a line of weakening 616, whereby buttress member 610 that is stapled to tissue may be severed or detached from tabs 620. In this manner, tabs 620 may be secured with staple cartridge assembly 670 by attaching members 630a, 630b and removed from the surgical site along with staple cartridge assembly 670.

    [0048] With reference now to FIGS. 20-22, it is also contemplated that a buttress assembly 700 may include a buttress member 710 and a plurality of circumferentially arranged tabs 720 extending proximally from an inner radial edge of buttress member 710 that engage an inner wall 777 of staple cartridge assembly 770. In particular, each tab 720 includes an attaching member 730a on an outer wall thereof. Furthermore, inner wall 777 of staple cartridge assembly 770 includes a plurality of circumferentially arranged attaching members 730b corresponding to attaching members 730a on tabs 720. Attaching members 730a, 730b may include, for example, a refastenable tape or a hook and loop fastener.

    [0049] Under such a configuration, cylindrical knife 776 is positioned radially inward of attaching members 730b circumferentially arranged on inner wall 777 of staple cartridge assembly 770 and positioned radially outward of attaching members 730a on respective outer wall of each tab 720. Under such a configuration, cylindrical knife 776 travels between attaching members 730a, 730b and severs tabs 720 from buttress member 710. In addition, tabs 720 may include a break, perforations, or a line of weakening 716 to facilitate severing of tabs 720 from buttress member 710. In this manner, buttress member 710 that is stapled to tissue may be detached from tabs 720.

    [0050] With reference to FIGS. 23 and 24, a buttress assembly 800 in accordance with another embodiment of the present disclosure is shown. In contrast to buttress assemblies 100, 200, 300, 400, 600, 700, described hereinabove, buttress assembly 800 is configured and adapted to be securely positioned with anvil assembly 60. Buttress assembly 800 includes a buttress component 810. A suture 830 is used to attach the buttress component to the stapling apparatus. Buttress component 810 includes a buttress member 812 having an annular profile configured and dimensioned to be flush with an outer peripheral edge of anvil member 62 when mounted on anvil member 62 and a rim 820 extending distally from buttress member 812. In addition, rim 820 engages an outer wall 61 of anvil member 62, whereby buttress component 810 encloses a proximal surface of anvil member 62 defining the plurality of pockets for receiving and forming staples 7. Additionally, buttress member 812 defines an aperture, hole or bore 816 configured and dimensioned to receive shaft 64 of anvil assembly 60 therethrough. Bore 816 is dimensioned to provide a friction and tight fit around shaft 64. Additionally or alternatively, a suture 830 may be further utilized to securely fasten buttress member 812 to shaft 64.

    [0051] With reference to FIGS. 25 and 26, in an alternate embodiment a buttress assembly 900 includes a buttress member 912 radially extending between an outer rim 920 and an inner rim 940. In particular, outer rim 920 is configured and dimensioned to engage outer wall 61 of anvil member 62 and inner rim 940 is configured and dimensioned to provide a tight or friction fit against shaft 64 of anvil assembly 60. In this manner, radial and longitudinal movement of buttress assembly 900 with respect to anvil assembly 60 is minimized. In addition, a fastening member in the form of a suture 930 is wrapped or tied around inner rim 940 of buttress member 912 against shaft 64 of anvil assembly 60 to further secure buttress assembly 900 on anvil assembly 60.

    [0052] With continued reference to FIG. 25, buttress assembly 900 may be used in conjunction with buttress assembly 100 that is positionable on distal surface 74 of staple cartridge assembly 70, as well as any one of buttress assemblies 200, 300, 400, 600, 700, described hereinabove. Buttress assembly 100 is positioned radially outward of cylindrical knife 76. As such, upon actuation of handle members 22, the entire buttress member 112 is stapled to tissue to reinforce the tissue, and severing of buttress member 112 by cylindrical knife 76 is eliminated. However, cylindrical knife 76 cores a portion of buttress member 912 along with inner rim 940 and suture 930 wrapped and tied around inner rim 940, to free such portions from a portion of buttress member 912 that is also stapled to tissue. The use and operation of assemblies 200, 300, 400, 600, 700, 800, 900 are substantially similar to the use and operation of buttress assembly 100 described hereinabove, and thus will not be described further herein.

    [0053] Although the illustrative embodiments of the present disclosure have been described herein with reference to the accompanying drawings, the above description, disclosure, and figures should not be construed as limiting, but merely as exemplifications of particular embodiments. For example, buttress assembly 900 including buttress member 912 radially extending between inner rim 940 and outer rim 920 may be tailored for use on distal surface 74 of staple cartridge assembly 70. In addition, buttress assembly 900 may further utilize an annular ring 130 or suture 330 to secure outer rim 920 of buttress assembly 900 against outer wall 61 of anvil assembly 60. It is to be understood, therefore, that the disclosure is not limited to those precise embodiments, and that various other changes and modifications may be effected therein by one skilled in the art without departing from the scope of the disclosure.


    Claims

    1. An apparatus (10) for joining two hollow organ sections with an annular array of surgical staples, the apparatus comprising:

    a staple cartridge component (70; 270; 370; 470; 670; 770) including a plurality of surgical staples (7) in an annular array;

    an anvil component (60) including an anvil member (62) defining a plurality of staple pockets for forming the surgical staples and a shaft (64) extending proximally from the anvil member, the anvil component movable relative to the staple cartridge component between spaced apart and approximated positions to adjustably clamp the organ sections between the staple cartridge and anvil components;

    a knife member (76) concentrically arranged in the staple cartridge component, the knife member movable relative to the staple cartridge component; and

    a first buttress component including a buttress member (812; 912) concentrically aligned with the anvil component and a rim (820; 920) extending distally from the buttress member, the first buttress component enclosing the plurality of staple pockets defined in the anvil member, and the rim being an outer rim that engages an outer surface (61) of the anvil member;

    characterized in that the apparatus further comprises a separate fastening member (830; 930) securing the first buttress component to the shaft of the anvil component.


     
    2. The apparatus (10) according to claim 1, wherein the fastening member includes a plurality of barbs.
     
    3. The apparatus (10) according to claim 1 or claim 2, wherein the first buttress component includes an inner rim (940) extending proximally from the buttress member.
     
    4. The apparatus (10) according to claim 3, wherein the inner rim is configured and dimensioned to engage the shaft of the anvil component.
     
    5. The apparatus (10) according to any of the preceding claims, further including a second buttress component (110; 310; 410; 600; 700) concentrically aligned with the staple cartridge component.
     
    6. The apparatus (10) according to claim 5, wherein the second buttress component includes a buttress member (112; 610) and a plurality of circumferentially arranged tabs (120; 620) extending proximally from the buttress member.
     
    7. The apparatus (10) according to claim 6, further including a fastening member configured and dimensioned to engage the plurality of circumferentially arranged tabs to securely position the second buttress component on the staple cartridge component.
     
    8. The apparatus (10) according to claim 6 or claim 7, wherein the plurality of tabs engage an outer wall (79; 679) of the staple cartridge component.
     
    9. The apparatus (10) according to claim 8, wherein the plurality of tabs and the outer wall of the staple cartridge component include corresponding hook and loop fasteners (630a, 630b) to secure the second buttress component to the staple cartridge component.
     
    10. The apparatus (10) according to claim 8, wherein the fastening member is an annular ring (130) configured and dimensioned to apply inward force to the plurality of circumferentially arranged tabs against the outer wall of the staple cartridge component.
     
    11. The apparatus (10) according to claim 8, wherein the fastening member is a suture (230) tied around the plurality of circumferentially arranged tabs against the outer wall of the staple cartridge component.
     
    12. The apparatus (10) according to claim 6 or claim 7, wherein the second buttress component is configured such that the plurality of tabs engage an inner wall (777) of the staple cartridge component.
     
    13. The apparatus (10) according to claim 12, wherein the plurality of tabs and the inner wall of the staple cartridge component include corresponding hook and loop fasteners (730a, 730b) to secure the second buttress component to the staple cartridge component.
     
    14. The apparatus (10) according to any of claims 6 to 13, wherein each tab includes a line of weakening adjacent the buttress member for detachment of the buttress member from the plurality of tabs.
     


    Ansprüche

    1. Einrichtung (10) zum Verbinden von zwei Hohlorganabschnitten mit einer ringförmigen Anordnung von chirurgischen Klammern, wobei die Einrichtung Folgendes umfasst:

    eine Klammermagazinkomponente (70; 270; 370; 470; 670; 770), die mehrere chirurgische Klammern (7) in einer ringförmigen Anordnung beinhaltet;

    eine Ambosskomponente (60), die ein Ambosselement (62) beinhaltet, das mehrere Klammertaschen zum Ausbilden der chirurgischen Klammern und einen Schaft (64) definiert, der sich proximal aus dem Ambosselement erstreckt, wobei die Ambosskomponente relativ zu der Klammermagazinkomponente zwischen voneinander beabstandeten und geschätzten Positionen beweglich ist, um die Organabschnitte zwischen dem Klammermagazin und den Ambosskomponenten einstellbar einzuklemmen;

    ein Messerelement (76), das konzentrisch in der Klammermagazinkomponente angeordnet ist, wobei das Messerelement relativ zu der Klammermagazinkomponente beweglich ist; und

    eine erste Stützkomponente, die ein Stützelement (812; 912), das konzentrisch an der Ambosskomponente ausgerichtet ist, und eine Fassung (820; 920) beinhaltet, die sich distal aus dem Stützelement erstreckt, wobei die erste Stützkomponente mehrere in dem Ambosselement definierte Klammertaschen einschließt und die Fassung eine Außenfassung ist, die eine Außenoberfläche (61) des Ambosselements in Eingriff nimmt;

    dadurch gekennzeichnet, dass die Einrichtung ferner ein separates Befestigungselement (830; 930) umfasst, das die erste Stützkomponente an dem Schaft der Ambosskomponente sichert.


     
    2. Einrichtung (10) nach Anspruch 1, wobei das Befestigungselement mehrere Widerhaken beinhaltet.
     
    3. Einrichtung (10) nach Anspruch 1 oder 2, wobei die erste Stützkomponente eine Innenfassung (940) beinhaltet, die sich proximal aus dem Stützelement erstreckt.
     
    4. Einrichtung (10) nach Anspruch 3, wobei die Innenfassung konfiguriert und bemessen ist, um den Schaft der Ambosskomponente in Eingriff zu nehmen.
     
    5. Einrichtung (10) nach einem der vorhergehenden Ansprüche, ferner beinhaltend eine zweite Stützkomponente (110; 310; 410; 600; 700), die konzentrisch an der Klammermagazinkomponente ausgerichtet ist.
     
    6. Einrichtung (10) nach Anspruch 5, wobei die zweite Stützkomponente ein Stützelement (112; 610) und mehrere in Umfangsrichtung angeordnete Laschen (120; 620) beinhaltet, die sich proximal aus dem Stützelement erstrecken.
     
    7. Einrichtung (10) nach Anspruch 6, ferner beinhaltend ein Befestigungselement, das konfiguriert und bemessen ist, um in Umfangsrichtung angeordnete Laschen in Eingriff zu nehmen, um die zweite Stützkomponente auf der Klammermagazinkomponente sicher zu positionieren.
     
    8. Einrichtung (10) nach Anspruch 6 oder 7, wobei die mehreren Laschen eine Außenwand (79; 679) der Klammermagazinkomponente in Eingriff nehmen.
     
    9. Einrichtung (10) nach Anspruch 8, wobei die mehreren Laschen und die Außenwand der Klammermagazinkomponente entsprechende Haken- und Schlaufenbefestigungen (630a, 630b) beinhalten, um die zweite Stützkomponente an der Klammermagazinkomponente zu sichern.
     
    10. Einrichtung (10) nach Anspruch 8, wobei das Befestigungselement ein ringförmiger Ring (130) ist, der konfiguriert und bemessen ist, um eine nach innen gerichtete Kraft auf mehrere in Umfangsrichtung angeordnete Laschen gegen die Außenwand der Klammermagazinkomponente auszuüben.
     
    11. Einrichtung (10) nach Anspruch 8, wobei das Befestigungselement eine Naht (230) ist, die um die mehreren in Umfangsrichtung angeordneten Laschen gegen die Außenwand der Klammermagazinkomponente gebunden ist.
     
    12. Einrichtung (10) nach Anspruch 6 oder 7, wobei die zweite Stützkomponente derart konfiguriert ist, dass die mehreren Laschen eine Innenwand (777) der Klammermagazinkomponente Eingriff nehmen.
     
    13. Einrichtung (10) nach Anspruch 12, wobei die mehreren Laschen und die Innenwand der Klammermagazinkomponente entsprechende Haken- und Schlaufenbefestigungen (730a, 730b) beinhalten, um die zweite Stützkomponente an der Klammermagazinkomponente zu sichern.
     
    14. Einrichtung (10) nach einem der Ansprüche 6 bis 13, wobei jede Lasche eine Schwächungslinie angrenzend an das Stützelement zum Ablösen des Stützelements von den mehreren Laschen beinhaltet.
     


    Revendications

    1. Appareil (10) pour joindre deux sections d'organes creux avec un réseau annulaire d'agrafes chirurgicales, l'appareil comprenant :

    un composant de cartouche d'agrafes (70 ; 270 ; 370 ; 470 ; 670 ; 770) comprenant une pluralité d'agrafes chirurgicales (7) dans un réseau annulaire ;

    un composant d'enclume (60) comprenant un élément d'enclume (62) définissant une pluralité de poches d'agrafes pour former les agrafes chirurgicales et un arbre (64) s'étendant de manière proximale à partir de l'élément d'enclume, le composant d'enclume étant mobile par rapport au composant de cartouche d'agrafes entre des positions espacées et approximatives pour serrer de manière réglable les sections d'organes entre la cartouche d'agrafes et les composants d'enclume ;

    un élément de couteau (76) disposé concentriquement dans le composant de cartouche d'agrafes, l'élément de couteau étant mobile par rapport au composant de cartouche d'agrafes ; et

    un premier composant de renfort comprenant un élément de renfort (812 ; 912) aligné concentriquement sur le composant d'enclume et un bord (820 ; 920) s'étendant distalement à partir de l'élément de renfort, le premier composant de renfort enfermant la pluralité de poches d'agrafes définies dans l'élément d'enclume, et le bord étant un bord extérieur qui entre en prise avec une surface extérieure (61) de l'élément d'enclume ;

    caractérisé en ce que l'appareil comprend en outre un élément de fermeture séparé (830 ; 930) fixant le premier composant de renfort à l'arbre du composant d'enclume.


     
    2. Appareil (10) selon la revendication 1, dans lequel l'élément de fermeture comprend une pluralité de barbes.
     
    3. Appareil (10) selon la revendication 1 ou la revendication 2, dans lequel le premier composant de renfort comprend un bord intérieur (940) s'étendant de manière proximale à partir de l'élément de renfort.
     
    4. Appareil (10) selon la revendication 3, dans lequel le bord intérieur est conçu et dimensionné pour entrer en prise avec l'arbre du composant d'enclume.
     
    5. Appareil (10) selon l'une quelconque des revendications précédentes, comprenant en outre un second composant de renfort (110 ; 310 ; 410 ; 600 ; 700) aligné concentriquement sur le composant de cartouche d'agrafes.
     
    6. Appareil (10) selon la revendication 5, dans lequel le second composant de renfort comprend un élément de renfort (112 ; 610) et une pluralité de languettes disposées circonférentiellement (120 ; 620) s'étendant de manière proximale à partir de l'élément de renfort.
     
    7. Appareil (10) selon la revendication 6, comprenant en outre un élément de fermeture conçu et dimensionné pour entrer en prise avec la pluralité de languettes disposées circonférentiellement pour positionner de manière fixe le second composant de renfort sur le composant de cartouche d'agrafes.
     
    8. Appareil (10) selon la revendication 6 ou la revendication 7, dans lequel la pluralité de languettes entrent en prise avec une paroi extérieure (79 ; 679) du composant de cartouche d'agrafes.
     
    9. Appareil (10) selon la revendication 8, dans lequel la pluralité de languettes et la paroi extérieure du composant de cartouche d'agrafes comprennent des fermetures auto-agrippantes correspondantes (630a, 630b) pour fixer le second composant de renfort au composant de cartouche d'agrafes.
     
    10. Appareil (10) selon la revendication 8, dans lequel l'élément de fermeture est une bague annulaire (130) conçue et dimensionnée pour appliquer une force à l'intérieur de la pluralité de languettes disposées circonférentiellement contre la paroi extérieure du composant de cartouche d'agrafes.
     
    11. Appareil (10) selon la revendication 8, dans lequel l'élément de fermeture est une suture (230) nouée autour de la pluralité de languettes disposées circonférentiellement contre la paroi extérieure du composant de cartouche d'agrafes.
     
    12. Appareil (10) selon la revendication 6 ou la revendication 7, dans lequel le second composant de renfort est conçu de telle sorte que la pluralité de languettes entrent en prise avec une paroi intérieure (777) du composant de cartouche d'agrafes.
     
    13. Appareil (10) selon la revendication 12, dans lequel la pluralité de languettes et la paroi intérieure du composant de cartouche d'agrafes comprennent des fermetures auto-agrippantes correspondantes (730a, 730b) pour fixer le second composant de renfort au composant de cartouche d'agrafes.
     
    14. Appareil (10) selon l'une quelconque des revendications 6 à 13, dans lequel chaque languette comprend une ligne d'affaiblissement adjacente à l'élément de renfort pour le détachement de l'élément de renfort à partir de la pluralité de languettes.
     




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    REFERENCES CITED IN THE DESCRIPTION



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

    Patent documents cited in the description