JP2009189838A - Motorized cutting and fastening instrument having control circuit for optimizing battery usage - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical cutting and fastening instrument. <P>SOLUTION: The instrument 10 comprises an end effector 12 and a shaft 8 connected to the end effector. The shaft comprises a drive train 16 for powering the end effector. The instrument also comprises a handle 6 connected to the shaft. The handle comprises an electric DC motor connected to the drive train for powering the drive train and a DC power source comprising one or more batteries. The handle also comprises a power regulator having an input device connected to the DC power source and an output device connected to the input device of the motor. The power regulator comprises a power converter and a control circuit for controlling the power converter. The control circuit controls a voltage set point for the power converter so that a voltage delivered from the power source is less than the voltage at which the power source delivers maximum power. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

Disclosure details

[Cross-reference to related applications]
This application is related to the following simultaneously filed applications and also incorporates those applications by reference:
-"Motorized Surgical Cutting and Fastening Instrument Having a Magnetic Drive Train Torque Limiting Device", agent reference number END6267USNP / 070389
-"Motorized Surgical Cutting and Fastening Instrument", agent reference number END6268USNP / 070390;
-"Motorized Surgical Cutting and Fastening Instrument Having Handle Based Power Source", agent reference number END6269USNP / 070391; and
-"Surgical Cutting and Fastening Instrument Having RF Electrodes", agent reference number END6270USNP / 070392.

〔background〕
Surgical staplers have been used in the prior art to make a longitudinal incision in tissue while attaching staple lines on both sides of the incision. Such instruments typically include a pair of cooperating jaw members that can pass through the cannula passageway when the instrument is intended for use in endoscopic or laparoscopic applications. . One of the jaw members receives a staple cartridge having at least two rows of staples laterally spaced. The other jaw member defines an anvil having staple forming pockets aligned with the staple rows of the cartridge. Such instruments typically include a plurality of reciprocating wedges that, when driven distally, pass through the opening of the staple cartridge and support the staples. Engage with the body and fire staples toward the anvil.

  An example of a surgical stapler suitable for endoscopic application is described in US Patent Application Publication No. 2004 / 0232196A1, entitled “Surgical stapling instrument having separate distinct closing and firing systems”, the disclosure of which is , Incorporated herein by reference. In use, the clinician can close the stapler jaw member over the tissue to position the tissue prior to firing. Once the clinician determines that the jaw members are properly grasping tissue, the clinician can fire the surgical stapler, thereby cutting and stapling the tissue. Simultaneous cutting and stapling steps avoid complications. Complications can occur when such operations are performed sequentially with different surgical tools each performing only cutting or stapling.

  In addition, it is also known in the prior art to include an electrode in the end effector, which can be used to emit / receive RF energy to form a tourniquet along the cutting line. U.S. Pat. No. 5,403,312 (hereinafter "the '312 patent"), named "Electrosurgical hemostatic device", incorporated herein by reference, is bipolar energy on one interface. An electrosurgical instrument is disclosed that includes an end effector that compresses tissue between one pole (or electrode) of a source and a second pole (or electrode) on a second interface. The RF energy applied through the compressed tissue in the end effector cauterizes the tissue. The end effector described in the '312 patent also includes staples for stapling tissue compressed within the end effector.

  Powered by a motor, such as that described in US Patent Application Publication No. 2007 / 0175962A1, entitled “Motor-driven surgical cutting and fastening instrument with tactile position feedback”, incorporated herein by reference. Surgical cutting / fixing instruments are also known in the prior art, wherein the motor powers the cutting instrument.

〔Overview〕
In one general aspect, embodiments of the present invention are directed to a surgical cutting and securing instrument. The instrument may be an endoscopic instrument such as a linear end cutter or a circular stapler, or a laparoscopic instrument. The instrument can be configured with staples and / or RF electrodes to secure the clamped tissue at the end effector.

  Some embodiments disclosed herein relate to instruments powered by a cordless motor. The appliance can be powered by a power pack that includes a DC power source, such as one or more batteries connected in series. A cell selection switch can control how many batteries are used to power the motor at a given time to control the power available to the motor. This allows the instrument operator to have more control over both motor speed and power. In another embodiment, the instrument can include a power conditioner that regulates the voltage supplied to the motor, including, for example, a DC-DC converter. Further, the voltage set point of the power regulator can be set such that the voltage delivered from the power source is less than the voltage at which the power source delivers maximum power. As such, a power source (eg, some batteries connected in series) can function on the “left” or increasing side of the power curve, resulting in increased power. Will be done.

  In addition, according to various embodiments, the power source can include secondary accumulator devices such as rechargeable batteries or supercapacitors. Such a secondary storage battery device can be repeatedly charged by a replaceable battery. A charge management circuit can control charging of the secondary storage battery device and can provide various status signals such as an alarm when the charging of the secondary storage battery device is complete.

  In other embodiments, a power pack including a secondary battery device may be removable from the appliance and connectable to a remote charger base. The charger base can charge secondary storage battery devices, for example from AC electrical mains or batteries. The charger base can also include a processor and a memory device. Data stored in the memory of the removable power pack can be downloaded to the charger base, from which the data is for example by a user (eg a doctor), a device manufacturer or distributor, etc. Can be uploaded for later use and analysis. This data can include operating parameters such as charge cycle information, as well as ID values of various replaceable components of the instrument such as staple cartridges.

  In addition, the instrument can include a torque limiting device to limit the torque provided by the motor, thereby limiting the actuation forces that can damage the instrument components. According to various embodiments, the torque limiting device may be an electromagnetic or permanent magnet connected to the output pole of the motor (directly or indirectly), or a mechanical clutch device.

  In another general aspect, the present invention provides an RF instrument with a new type of electrode configuration (ie, surgical cutting with an electrode on the end effector for applying RF energy to tissue held by the end effector) -It is pointed at the fixing device. In general, the new electrode configuration includes a combination of smaller active electrodes and larger return electrodes. The smaller active electrode is used to concentrate the treatment energy into the tissue, and the larger return electrode is preferentially used to complete the circuit with minimal impact on the tissue interface. The return electrode typically has a larger mass so that it can remain cold during electrosurgical application.

  In addition, the end effector can include several active electrodes that are collinear and segmented, according to various embodiments. The segmented electrodes can be pressurized synchronously or more preferably one after the other. By activating the segmented electrodes one after the other, (1) due to the smaller area of tissue coagulation, the requirement for instantaneous power is reduced, and (2) launching another segment when one is shorted The advantage is that

  In addition, several mechanisms are disclosed herein for activating the RF electrode and for articulating the end effector.

  Various embodiments of the present invention are described herein by way of example in connection with the following drawings.

〔Explanation〕
1 and 2 depict a surgical cutting and securing instrument 10 according to various embodiments of the present invention. The illustrated embodiment is an endoscopic instrument, and in general, the embodiment of the instrument 10 described herein is an endoscopic surgical cutting and securing instrument. However, it should be noted that according to other embodiments of the present invention, the instrument may be a non-endoscopic surgical cutting and fixation instrument, such as a laparoscopic instrument.

  The surgical instrument 10 depicted in FIGS. 1 and 2 includes an articulating end effector 12 that is pivotally connected to the shaft 8 at a handle 6, a shaft 8, and an articulation pivot 14. An articulation control device 16 may be provided adjacent to the handle 6 to effect rotation of the end effector 12 about the articulation pivot 14. In the illustrated embodiment, the end effector 12 is configured to act as an end cutter for clamping, cutting, and stapling tissue, but in other embodiments, different types of end effectors, For example, end effectors for other types of surgical devices such as graspers, cutters, staplers, clip appliers, access devices, drug / gene therapy devices, ultrasound, RF or laser devices, etc. may be used. Further details regarding the RF device can be found in the '312 patent.

  The handle 6 of the instrument 10 can include a closure trigger 18 and a firing trigger 20 for actuating the end effector 12. It will be appreciated that instruments having end effectors directed to different surgical tasks may have different numbers or types of triggers, or other suitable control devices for operating the end effector 12. . The end effector 12 is shown being pulled away from the handle 6, preferably by an elongate shaft 8. In one embodiment, the clinician or operator of the instrument 10 is a US patent application published by Geoffrey C. Hueil et al., Entitled “Surgical Instrument Having An Articulating End Effector”, which is incorporated herein by reference. As described in greater detail in 2007 / 0158385A1, the end effector 12 can be articulated relative to the shaft 8 by utilizing the articulation control device 16.

  The end effector 12 in this example includes, among other things, a staple channel 22 and a pivotally translatable clamping member, such as an anvil 24, which effectively staples tissue clamped within the end effector 12. And held at intervals to ensure cutting. The handle 6 includes a pistol grip 26, toward which the closure trigger 18 is pivotally pulled by a clinician to cause clamping or closure of the anvil 24 toward the staple channel 22 of the end effector 12. Thereby clamping the tissue located between the anvil 24 and the channel 22. The firing trigger 20 is further outside the closure trigger 18. As described further below, once the closure trigger 18 is locked in the closed position, the firing trigger 20 can rotate slightly toward the pistol grip 26 so that the operator can use one hand to fire the firing trigger. Can reach to 20. Next, the operator can pivot the firing trigger 20 toward the pistol grip 12 to cause stapling and cutting of the clamped tissue in the end effector 12. In other embodiments, different types of clamping members may be used in addition to the anvil 24, such as opposing jaws.

  It will be appreciated that the terms “proximal” and “distal” are used herein with respect to a clinician gripping the handle 6 of the instrument 10. Thus, the end effector 12 is distal to the more proximal handle 6. It will be further appreciated that for convenience and clarity, spatial terms such as “vertical” and “horizontal” are used herein with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not intended to be limiting and absolute.

  The closure trigger 18 can be activated first. Once the clinician is satisfied with the positioning of the end effector 12, the clinician can pull the closure trigger 18 back to its fully closed locked position proximate the pistol grip 26. The firing trigger 20 can then be activated. The firing trigger 20 returns to the open position (shown in FIGS. 1 and 2) when the clinician relieves pressure, as will be more fully described below. When the release button on the handle 6 is depressed, the release button can release the locked closure trigger 18. The release button may take various forms, for example, as either the slide release button 160 shown in FIG. 7 or the mechanism described in US Patent Application Publication No. 2007 / 0175555A1, which is incorporated herein by reference. Can be executed in

  FIG. 3 is an exploded view of the end effector 12 according to various embodiments. As shown in the illustrated embodiment, the end effector 12 includes a cutting instrument 32, a sled 33, a staple cartridge 34 removably mounted in the channel 22, in addition to the channel 22 and anvil 24 referred to above. And a helical screw shaft 36 can be included. The cutting instrument 32 may be a knife, for example. The anvil 24 can be pivotally opened and closed at a pivot point 25 connected to the proximal end of the channel 22. The anvil 24 may also include a tab 27 at its proximal end, which is inserted into a mechanical closure system component (described further below) to open and close the anvil 24. When the closure trigger 18 is actuated, i.e. retracted by the user of the instrument 10, the anvil 24 can pivot about the pivot point 25 into the clamped or closed position. If the end effector 12 is not clamped satisfactorily, the operator can actuate the firing trigger 20 which moves the knife 32 and sled 33 along the channel 22 as described in more detail below. Move longitudinally, thereby cutting tissue clamped within the end effector 12. As the sled 33 moves along the channel 22, the staples of the staple cartridge 34 are driven through the cut tissue and against the closed anvil 24, which causes the staples to be folded and cut. Fix the tissue. In various embodiments, the sled portion 33 may be an integral component of the cartridge 34. US Pat. No. 6,978,921, entitled “Surgical stapling instrument incorporating an E-beam firing mechanism,” incorporated herein by reference, provides more details on such a two-stroke cutting and fastening instrument. Is provided. The sled portion 33 may be a part of the cartridge 34, and the sled portion 33 does not retract when the knife 32 retracts after the cutting operation.

  While embodiments of the instrument 10 described herein use an end effector 12 that staples the cut tissue, in other embodiments, different techniques for securing or sealing the cut tissue. Note that can be used. For example, an end effector that uses RF energy or an adhesive to secure the cut tissue may also be used. U.S. Pat. No. 5,709,680 entitled "Electrosurgical Hemostatic Device" granted to Yates et al., Which is incorporated herein by reference, and "Electrosurgical Hemostatic Device with Recessed" granted to Yates et al. US Pat. No. 5,688,270, entitled “and / or Offset Electrodes”, discloses an endoscopic cutting instrument that seals cut tissue using RF energy. US Patent Application Publication No. 2007 / 0104453A1 by Jerome R. Morgan et al. And US Patent Application Publication No. 2007 / 0102452A1 by Frederick E. Shelton, IV et al., Which are also incorporated herein by reference. Discloses an endoscopic cutting instrument for fixing a cut tissue using an adhesive. Accordingly, although the description herein refers to cutting / stapling operations and the like below, it is recognized that this is an exemplary embodiment and is not meant to be limiting. Should. Other tissue fixation techniques can also be used.

  4 and 5 are exploded views and FIG. 6 is a side view of end effector 12 and shaft 8 according to various embodiments. As shown in the illustrated embodiment, the shaft 8 can include a proximal closure tube 40 and a distal closure tube 42 that are pivotally coupled by a pivot link 44. The distal closure tube 42 includes an opening 45, and a tab 27 on the anvil 24 is inserted into the opening 45 to open and close the anvil 24, as further described below. A proximal spine tube 46 may be disposed inside the closure tubes 40, 42. Inside the proximal spine tube 46, a main rotational (or proximal) drive shaft 48 may be disposed, which is driven by a bevel gear assembly 52 to a secondary (or distal) drive shaft 50. Is in contact. The secondary drive shaft 50 is connected to a drive gear 54 that engages the proximal drive gear 56 of the helical screw shaft 36. The vertical bevel gear 52 b is located at the opening 57 at the distal end of the proximal spine tube 46 and can pivot at the opening 57. A distal spine tube 58 may be used to surround the secondary drive shaft 50 and drive gears 54, 56. Collectively, the primary drive shaft 48, the secondary drive shaft 50, and the articulation assembly (eg, bevel gear assemblies 52a-52c) may be referred to herein as "primary drive shaft assemblies". .

  A bearing 38 positioned at the distal end of the staple channel 22 receives a helical drive screw 36 and freely rotates the helical drive screw 36 relative to the channel 22. The helical threaded shaft 36 can be associated with a threaded opening (not shown) in the knife 32 and rotation of the shaft 36 causes the knife 32 to move distally through the staple channel 22 (depending on the direction of rotation). Or translate proximally. Thus, when the main drive shaft 48 is rotated by actuation of the firing trigger 20 (as will be described in more detail below), the bevel gear assemblies 52a-52c rotate the secondary drive shaft 50 to produce a secondary The mechanical drive shaft 50 in turn rotates the helical screw shaft 36 for engagement of the drive gears 54, 56, which causes the knife drive member 32 to move longitudinally along the channel 22. Cut any tissue clamped inside the end effector. The sled portion 33 may be made of plastic, for example, and may have an inclined distal surface. As the sled 33 crosses the channel 22, the angled front surface can push up or drive the staples in the staple cartridge through the clamped tissue and against the anvil 24. Anvil 24 bends the staples, thereby stapling the cut tissue. When the knife 32 is retracted, the knife 32 and the sled portion 33 can be disengaged, thereby leaving the sled portion 33 at the distal end of the channel 22.

  7-10 illustrate an exemplary embodiment of a motor driven end cutter. The illustrated embodiment provides feedback to the user regarding the deployment and loading force of the cutting instrument within the end effector. In addition, this embodiment can use the power provided by the user when retracting the firing trigger 20 to power the device (so-called “power assist” mode). As shown in the illustrated embodiment, the handle 6 includes outer lower parts 59, 60 and outer upper parts 61, 62 that generally fit together to form the exterior of the handle 6. A battery 64 such as a lithium ion battery may be provided on the pistol grip portion 26 of the handle 6. The battery 64 supplies electric power to a motor 65 disposed in an upper portion of the pistol grip portion 26 of the handle 6. According to various embodiments, a number of batteries connected in series may be used to power the motor 65.

  The motor 65 may be a DC brushed drive motor having a maximum rotation of about 25,000 RPM with no load. The motor 64 can drive a 90 ° bevel gear assembly 66 that includes a first bevel gear 68 and a second bevel gear 70. The bevel gear assembly 66 can drive the planetary gear assembly 72. The planetary gear assembly 72 can include a pinion gear 74 connected to the drive shaft 76. The pinion gear 74 can drive the coupling ring gear 78, and the coupling ring gear 78 drives the helical gear drum 80 by the drive shaft 82. A ring 84 may be threaded over the helical gear drum 80. Thus, as the motor 65 rotates, the ring 84 is moved along the helical gear drum 80 by the bevel gear assembly 66, planetary gear assembly 72, and ring gear 78 placed therebetween.

  The handle 6 also includes a run motor sensor 110 in communication with the firing trigger 20 so that when the firing trigger 20 is retracted (or “closed”) by the operator toward the pistol grip portion 26 of the handle 6. The cutting / stapling operation by the end effector 12 can be started. The sensor 110 may be a proportional sensor, such as an adjustable resistor or a variable resistor. When the firing trigger 20 is retracted, the sensor 110 detects motion and transmits an electrical signal indicating the voltage (or power) to be supplied to the motor 65. If the sensor 110 is a variable resistor or the like, the rotation of the motor 65 can generally be proportional to the amount of movement of the firing trigger 20. That is, if the operator pulls the firing trigger 20 slightly or closes it, the rotation of the motor 65 is relatively low. When the firing trigger 20 is fully retracted (or is in a fully closed position), the rotation of the motor 65 is maximized. In other words, the more the user pulls the firing trigger 20 harder, the more voltage is applied to the motor 65, causing a greater rotational speed.

  The handle 6 can include a central handle piece 104 adjacent the upper portion of the firing trigger 20. The handle 6 can also include a biasing spring 112 connected between the post on the central handle component 104 and the firing trigger 20. The biasing spring 112 can bias the firing trigger 20 to its fully open position. As such, when the operator releases the firing trigger 20, the biasing spring 112 pulls the firing trigger 20 to its open position, thereby removing the actuation of the sensor 110 and thereby stopping the rotation of the motor 65. Further, thanks to the biasing spring 112, whenever the user closes the firing trigger 20, the user receives resistance to the closing operation, thereby providing feedback to the user regarding the amount of rotation exerted by the motor 65. give. Further, the operator can stop retracting the firing trigger 20, thereby removing the force from the sensor 100 and thereby stopping the motor 65. Thus, the user can stop the deployment of the end effector 12, thereby providing the operator with a means to control the cutting / fixing operation.

  The distal end of the helical gear drum 80 includes a distal drive shaft 120 that drives a ring gear 122 that meshes with a pinion gear 124. The pinion gear 124 is connected to the main drive shaft 48 of the main drive shaft assembly. As such, rotation of the motor 65 rotates the main drive shaft assembly, thereby actuating the end effector 12 as described above.

  The ring 84 passed over the helical gear drum 80 may include a post 86 disposed within the slot 88 of the slotted arm 90. The slotted arm 90 has an opening 92 at its opposite end 94 that receives a pivot pin 96 connected between the handle outer parts 59, 60. The pivot pin 96 is also disposed through the opening 100 of the firing trigger 20 and the opening 102 of the central handle piece 104.

  In addition, the handle 6 can include a reverse motor (or end-of-stroke sensor) 130 and a stop motor (or beginning-of-stroke) sensor 142. In various embodiments, the reversing motor sensor 130 may be a limiting switch located at the distal end of the helical gear drum 80, and the ring 84 threaded over the helical gear drum 80 may cause the ring 84 to be far from the helical gear drum 80. When it reaches the extreme end, it contacts the reverse motor sensor 130 and trips the reverse motor sensor 130. When activated, the reverse motor sensor 130 sends a signal to the motor 65 to reverse the direction of rotation of the motor, thereby retracting the knife 32 of the end effector 12 after the cutting operation. The stop motor sensor 142 may be, for example, a normally closed limit switch. In various embodiments, the stop motor sensor can be located at the proximal end of the helical gear drum 80, and when the ring 84 reaches the proximal end of the helical gear drum 80, the ring 84 triggers the switch 142. .

  During operation, when the operator of the instrument 10 pulls back the firing trigger 20, the sensor 110 detects the deployment of the firing trigger 20 and sends a signal to the motor 65, for example proportional to how hard the operator has pulled the firing trigger 20 back. The motor 65 is rotated forward at the speed. The forward rotation of the motor 65 then rotates the ring gear 78 at the distal end of the planetary gear assembly 72, thereby rotating the helical gear drum 80 and spiraling the ring 84 passed over the helical gear drum 80. Move distally along the gear drum 80. The rotation of the helical gear drum 80 also drives the main drive shaft assembly, as described above, which in turn deploys the knife 32 of the end effector 12. That is, the knife 32 and the sled 33 are traversed longitudinally through the channel 22, thereby cutting tissue clamped within the end effector 12. Also, the stapling operation of the end effector 12 occurs in an embodiment where a stapling type end effector is used.

  By the time the end effector 12 cutting / stapling operation is complete, the ring 84 on the helical gear drum 80 has reached the distal end of the helical gear drum 80, thereby triggering the reverse motor sensor 130. The reverse motor sensor sends a signal to the motor 65, which reverses its rotation. This in turn causes the knife 32 to be retracted and the ring 84 on the helical gear drum 80 to return to the proximal end of the helical gear drum 80.

  The central handle piece 104 includes a rear shoulder 106 that engages a slotted arm 90 as best shown in FIGS. The central handle component 104 also has a forward motion stop 107 that engages the firing trigger 20. The movement of the slotted arm 90 is controlled as described above by the rotation of the motor 65. As the slotted arm 90 rotates counterclockwise as the ring 84 moves from the proximal end to the distal end of the helical gear drum 80, the central handle piece 104 is free to rotate counterclockwise. I will. Thus, when the user retracts the firing trigger 20, the firing trigger 20 engages the forward motion stop 107 of the central handle component 104, causing the central handle component 104 to rotate counterclockwise. However, due to the rear shoulder 106 engaging the slotted arm 90, the central handle piece 104 can only rotate counterclockwise as allowed by the slotted arm 90. As such, if the motor 65 has to stop rotating for any reason, the slotted arm 90 stops rotating and the user is free to rotate the central handle piece 104 counterclockwise due to the slotted arm 90. Since it cannot rotate, the firing trigger 20 cannot be further retracted.

  Components of an exemplary closure system for closing (or clamping) the anvil 24 of the end effector 12 by retracting the closure trigger 18 are also shown in FIGS. In the illustrated embodiment, the closure system includes a yoke 250 connected to the closure trigger 18 by a pin 251 that is inserted through aligned openings in both the closure trigger 18 and the yoke 250. A pivot pin 252 about which the closure trigger 18 pivots is inserted through another opening in the closure trigger 18, which is offset from where the pin 251 is inserted through the closure trigger 18. Thus, retraction of the closure trigger 18 causes the upper portion of the closure trigger 18 to which the yoke 250 is attached by the pin 251 to rotate counterclockwise. The distal end of the yoke 250 is connected to the first closure bracket 256 by a pin 254. The first closure bracket 256 is connected to the second closure bracket 258. Collectively, the closure brackets 256, 258 define an opening in which the proximal end of the proximal closure tube 40 (see FIG. 4) is installed and held, and the closure brackets 256, 258 The longitudinal movement causes a longitudinal movement by the proximal closure tube 40. The instrument 10 also includes a closure rod 260 disposed inside the proximal closure tube 40. The closure rod 260 may include a window 261 with a post 263 disposed on one of the handle outer parts, such as the outer lower part 59 in the illustrated embodiment. The closure rod 260 is securely connected to the handle 6. As such, the proximal closure tube 40 can move longitudinally relative to the closure rod 260. The closure rod 260 can also include a distal collar 267 that fits within the cavity 269 of the proximal spine tube 46 and is retained therein by a cap 271 (see FIG. (See FIG. 4).

  During operation, when the yoke 250 rotates due to the retraction of the closure trigger 18, the closure brackets 256, 258 move the proximal closure tube 40 distally (ie, away from the handle end of the instrument 10), thereby The distal closure tube 42 is moved distally, which causes the anvil 24 to rotate about the pivot point 25 into the clamped or closed position. When the closure trigger 18 is unlocked from the locked position, the proximal closure tube 40 is slid proximally, thereby causing the distal closure tube 42 to slide proximally, thereby causing the distal closure tube 42 to slide. Thanks to the tabs 27 inserted in the window 45, the anvil 24 is pivoted about the pivot point 25 into the open or unclamped position. As such, by retracting and locking the closure trigger 18, the operator can clamp tissue between the anvil 24 and the channel 22 and also unlock the closure trigger 20 from the locked position. Allows the tissue clamp to be released after the cutting / stapling operation.

  FIG. 11 is a circuit diagram of an electrical circuit of the instrument 10 according to various embodiments of the present invention. When the operator first retracts the firing trigger 20 after the closure trigger 18 is locked, the sensor 110 is activated, causing current to flow through the sensor. When the normally open reverse motor sensor switch 130 is open (ie, the end effector stroke end has not been reached), current flows through the single pole double relay 132. Since the reverse motor sensor switch 130 is not closed, the inductor 134 of the relay 132 is not pressurized and therefore the relay 132 should be in its unpressurized state. The circuit also includes a cartridge lockout sensor 136. When the end effector 12 includes a staple cartridge 34, the sensor 136 is in a closed state and conducts current. Otherwise, if the end effector 12 does not include the staple cartridge 34, the sensor 136 will open, thereby preventing the battery 64 from powering the motor 65.

  When the staple cartridge 34 is present, the sensor 136 is closed, and the single pole single relay 138 is pressurized. When the relay 138 is pressurized, current flows through the relay 136, through the variable resistor sensor 110, and through the bipolar and double relay 140 to the motor 65, thereby powering the motor 65 and the motor. Rotate forward. When the end effector 12 reaches the end of its stroke, the reverse motor sensor 130 is activated, thereby closing the switch 130 and pressurizing the relay 134. This causes the relay 134 to assume its pressurized state (not shown in FIG. 13), so that the current bypasses the cartridge lockout sensor 136 and the variable resistor 110, and instead the current is Both normally closed bipolar double relay 142 and motor 65 are flowed by relay 140 so that motor 65 reverses its direction of rotation. Since the stop motor sensor switch 142 is normally closed, the current returns to the relay 134 to keep the switch 142 closed until the switch 142 is opened. When the knife 32 is fully retracted, the stop motor sensor switch 142 is activated, opening the switch 142 and thereby removing power from the motor 65.

  In other embodiments, an on-off sensor may be used instead of the proportional sensor 110. In such an embodiment, the rotational speed of the motor 65 will not be proportional to the force applied by the operator. Rather, the motor 65 will typically rotate at a constant speed. However, since the firing trigger 20 is engaged with the gear power transmission path, the operator will still receive force feedback.

  A further configuration for a motorized surgical instrument is disclosed in US Patent Application Publication No. 2007 / 0175962A1, entitled “Motor-driven surgical cutting and fastening instrument with tactile position feedback”, which is incorporated herein by reference. Is disclosed.

  In a motorized surgical instrument, such as one of the motorized endoscopic instruments described above, or in a motorized circular cutter instrument, the motor can be powered by several batteries connected in series. Furthermore, in some situations it may be desirable to power the motor with a fraction of the total number of batteries. For example, as shown in FIG. 12, the motor 65 can be powered by a power pack 299 that includes six (6) batteries 310 connected in series. The battery 310 may be a 3 volt lithium battery, such as a CR 123A battery, for example, but in other embodiments, different types of batteries (including batteries with different voltage levels and / or different chemistries) are used. May be. If six 3 volt batteries 310 are connected in series to power the motor 65, the total voltage available to power the motor 65 will be 18 volts. The battery 310 can include a rechargeable battery or a non-rechargeable battery.

  In such an embodiment, under the heaviest load, the input voltage to the motor 65 can drop to about 9-10 volts. Under this operating condition, the power pack 299 carries the maximum power to the motor 65. Thus, as shown in FIG. 12, the circuit may include a switch 312 that is powered by the motor 65 by either (1) all of the battery 310 or (2) a portion of the battery 310. Allows selectively to be supplied. As shown in FIG. 12, with appropriate selection, the switch 312 can allow the motor 65 to be powered by all six batteries or four of the batteries. As such, the switch 312 is either 18 volts (when all six batteries 310 are used) or 12 volts (such as using four of the second battery cells), and the motor Can be used to power 65. In various embodiments, the design choice of the number of parts of the battery used to power the motor 65 is based on the voltage required by the motor 65 when operating at the heaviest load and maximum power. It may be.

  The switch 312 may be an electromechanical switch such as a micro switch, for example. In other embodiments, the switch 312 can be implemented with a solid state switch, such as a transistor. A second switch 314, such as a push button switch, can be used to control whether any power is applied to the motor 65. Also, a forward / reverse switch 316 can be used to control whether the motor 65 is rotating in the forward or reverse direction. The forward / reverse switch 316 can be implemented with a double pole-double throw switch, such as the relay 140 shown in FIG.

  During operation, the user of the instrument 10 may use any switch control device, such as a toggle switch, mechanical lever switch, or position dependent switch (not shown) such as a cam to control the position of the switch 312. The power level can be selected. The user can then activate the second switch 314 to connect the selected battery 310 to the motor 65. In addition, the circuit shown in FIG. 12 can be used to power the motors of other types of motorized surgical instruments such as circular cutters and / or laparoscopic instruments. Further details regarding circular cutters can be found in US Patent Application Publication Nos. 2006 / 0047307A1 and 2007 / 0262116A1, which are incorporated herein by reference.

  In other embodiments, as shown in FIG. 13, a primary power source 340, for example, a battery such as a CR2 or CR123A battery, can be used to charge several secondary battery devices 342. The primary power source 340 may include one or several batteries connected in series, which are preferably replaceable in the illustrated embodiment. Secondary storage battery device 342 can include, for example, a rechargeable battery and / or a supercapacitor (also known as an “ultracapacitor” or “electrochemical double layer capacitor” (EDLC)). A supercapacitor is an electrochemical capacitor that has an unusually high energy density compared to a typical electrolytic capacitor, typically approximately thousands of times greater than a large electrolytic capacitor.

  The primary power source 340 can charge the secondary storage battery device 342. Once fully charged, the primary power source 340 may be removed and the secondary battery device 342 can be used to power the motor 65 during the procedure or surgery. The storage device 342 will take approximately 15-30 minutes to charge in various situations. Supercapacitors have the property of being able to charge and discharge extremely rapidly compared to conventional batteries. In addition, while batteries are convenient for only a limited number of charge / discharge cycles, supercapacitors can often be charged / discharged repeatedly and sometimes for tens of millions of cycles. For embodiments that use a supercapacitor as the secondary battery device 342, the supercapacitor may include carbon nanotubes, conductive polymers (eg, polyacene), or carbon aerogels.

  As shown in FIG. 14, the charge management circuit 344 can be used to determine when the secondary storage battery device 342 is fully charged. The charge management circuit 344 may include an indicator, such as one or more LEDs, an LCD display, etc., that is activated to alert the user of the instrument 10 when the secondary storage device 342 is fully charged. .

  The primary power source 340, the secondary battery device 342, and the charge management circuit 344 are part of the power pack in the pistol grip portion 26 of the handle 6 of the instrument 10 or are in another part of the instrument 10. Can do. The power pack may be removable from the pistol grip portion 26, in which case when the instrument 10 is used in surgery, the power pack may be removed from the pistol grip portion 26 (or other, for example, by an indirect assistant nurse assisting in the surgery). Can be inserted aseptically into other locations of the instrument according to this embodiment. After insertion of the power pack, the nurse can place a replaceable primary power source 340 into the power pack to charge the secondary storage battery device 342 for some time, eg, 30 minutes, before using the instrument 10. . When secondary storage battery device 342 is charged, charge management circuit 344 can indicate that the power pack is ready for use. At this point, the replaceable primary power source 340 may be removed. During surgery, the user of instrument 10 can then activate motor 65, such as by actuating switch 314, whereby secondary storage battery device 342 powers motor 65. Thus, instead of having several disposable batteries to power the motor 65, a single disposable battery (as the primary power source 340) may be used in such an embodiment and the secondary storage battery device 342 is May be reusable. However, it should be noted that in alternative embodiments, secondary storage device 342 may be non-rechargeable and / or non-reusable. The secondary storage battery 342 can be used with the battery selection switch 312 described above in connection with FIG.

  The charge management circuit 344 can also include an indicator (eg, an LED or LCD display) that indicates how much charge remains in the secondary battery device 342. As such, the surgeon (or other user of the instrument 10) can know how much charge remains during the course of the procedure involving the instrument 10.

  The charge management circuit 344 may include a charge meter 345 for measuring the charge of the entire secondary storage battery 342 as shown in FIG. The charge management circuit 344 may also include non-volatile memory 346, such as flash memory or ROM memory, and one or more processors 348. The processor 348 can be connected to the memory 346 to control the memory. In addition, the processor 348 can be connected to the charge meter 345 to read the reading of the charge meter 345 and otherwise control the charge meter 345. Further, the processor 348 can control the LEDs of the charge management circuit 344 or other output device. The processor 348 can store the parameters of the instrument 10 in the memory 346. This parameter can be attached to the instrument 10 or sensed by various sensors that can be used with the instrument 10, such as instrument operating parameters, such as the number of firings, the level of force involved, the opposing jaws of the end effector 12. The distance between compression gaps between them, the amount of articulation, etc. can be included. Further, the parameters stored in the memory 346 can include ID values of various components of the instrument 10 that can be read and stored by the charge management circuit 344. The component having such an ID may be a replaceable component, such as a staple cartridge 34. The ID may be an RFID read by the charge management circuit 344 by the RFID transponder 350, for example. The RFID transponder 350 can read RFID including RFID tags from instrument components such as the staple cartridge 34. The ID value is read and stored in memory 346 and compared by processor 348 to a list of acceptable ID values stored in memory 346 or another storage device associated with the charge management circuit, for example, It can be determined whether the removable / replaceable component associated with the read ID value is reliable and / or appropriate. According to various embodiments, if the processor 348 determines that the removable / replaceable component associated with the read ID value is not reliable, the charge management circuit 344 may receive power from the power pack. Use of the power pack by the instrument 10 can be prevented, such as by opening a switch (not shown) that would prevent it from being carried to the motor 65. According to various embodiments, the various parameters that processor 348 can evaluate to determine whether a component is reliable and / or appropriate are: date code; component model / type; manufacturer ; Region information; and previous error codes.

  The charge management circuit 344 can also include an input / output interface 352 for communicating with another device, such as those described below. As such, the parameters stored in memory 346 can be downloaded to another device. The input / output interface 352 may be, for example, a wired or wireless interface.

  As described above, the power pack can include a secondary storage battery 342, a charge management circuit 344, and / or a forward / reverse switch 316. According to various embodiments, as shown in FIG. 16, the power pack 299 can be connected to a charger base 362 that, among other things, charges the secondary battery 342 of the power pack. can do. The charger base 362 can be connected to the power pack 299 by aseptically connecting the charger base 362 to the power pack 299 while the power pack is attached to the instrument 10. In other embodiments in which the power pack is removable, the charger base 362 can be connected to the power pack 299 by removing the power pack 299 from the appliance 10 and connecting the power pack to the charger base 362. For such embodiments, after the charger base 362 has fully charged the secondary battery 342, the power pack 299 can be aseptically attached to the instrument 10.

  As shown in FIG. 16, the charger base 362 can include a power source 364 for charging the secondary storage battery 342. The power source 364 of the charger base 362 can be, for example, a battery (or several batteries connected in series), an AC / DC converter that converts AC power from electrical power mains, etc. to DC, or two Any other suitable power source for charging secondary storage battery 342 may be used. The charger base 362 may also include a display device, such as an LED, LCD display, etc., to indicate the state of charge of the secondary battery 342.

  In addition, as shown in FIG. 16, the charger base 362 can include one or more processors 366, one or more memory devices 368, and input / output interfaces 370, 372. Through the first input / output interface 370, the charger base 362 can communicate with the power pack 299 (via the power pack input / output interface 352). As such, for example, data stored in the memory 346 of the power pack 299 can be downloaded to the memory 368 of the charger base 362. As such, the processor 366 can evaluate the ID value of the removable / replaceable component downloaded from the charge management circuit 344 to determine the reliability and suitability of the component. The operating parameters downloaded from the charge management circuit 344 may also be stored in the memory 368, after which, for example, by the hospital system where the surgery involving the instrument 10 is performed, by the surgeon's office, by the instrument distributor, by the instrument distributor. It may be downloaded to another computer device via the second input / output interface 372 for evaluation and analysis, such as by a manufacturer.

  The charger base 362 may also include a charge meter 374 for measuring the charge of the entire secondary storage battery 342. The charge meter 374 may be in communication with the processor 366, which can determine in real time the suitability of the power pack 299 for use to ensure high performance.

  In another embodiment, as shown in FIG. 17, the battery circuit can include a power regulator 320 to control the power supplied to the motor 65 by the power saver 310. The power conditioner 320 may also be part of the power pack 299 or may be another component. As described above, the motor 65 may be a brushed DC motor. The speed of a brushed DC motor is generally proportional to the applied input voltage. The power regulator 320 can provide a highly regulated output voltage to the motor 65, which will operate at a constant (or substantially constant) speed. According to various embodiments, the power conditioner 320 can include a switch-mode power converter, such as a buck-boost converter, as shown in the example of FIG. Such a buck-boost converter 320 may include a power switch 322 such as a FET, a rectifier 32, an inductor 326, and a capacitor 328. When the power switch 322 is on, the input voltage source (eg, power supply 310) is directly connected to the inductor 326, which stores energy in this state. In this state, capacitor 328 supplies energy to an output load (eg, motor 65). When power switch 320 is turned off, inductor 326 is connected to an output load device (eg, motor 65) and capacitor 328 so that energy is transferred from inductor 326 to capacitor 328 and load device 65. The control circuit 330 can control the power switch 322. The control circuit 330 can utilize digital and / or analog control loops. In addition, in other embodiments, the control circuit 330 can receive control information from a master controller (not shown) via a communication link such as a serial or parallel digital data bus. The voltage set point for the output of the power regulator 320 may be set, for example, at half the open circuit voltage, at which point the maximum power available from the source is obtained.

  In other embodiments, different power converter topologies may be utilized, including linear or switch-mode power converters. Other switch-mode topologies that can be utilized include flyback, forward, buck, boost, and SEPIC. The set point voltage of the power regulator 320 may vary depending on how many batteries are used to power the motor 65. Furthermore, the power regulator 320 may be used with the secondary storage battery device 342 shown in FIG. Further, the forward-reverse switch 316 can be incorporated into the power regulator 320, but is shown separately in FIG.

  A battery can typically be shaped as an ideal voltage source and source resistance. For the ideal model, once the source resistance and load resistance are met, maximum power is delivered to the load device. FIG. 18 shows a typical power curve for a battery. When the battery circuit is open, the voltage across the battery is high (at its open circuit value) and the current drawn from the battery is zero. The power delivered from the battery is also zero. As more current is drawn from the battery, the voltage across the battery decreases. The power delivered by the battery is the product of current and voltage. The power reaches its peak around a voltage level below the open circuit voltage. As shown in FIG. 18, in most battery chemistries, voltage / power plummets at higher currents due to chemistry or positive temperature coefficient (PTC) or due to battery protection devices.

  Particularly for embodiments that use a single battery (or batteries) to power the motor 65 during the procedure, the control circuit 330 can monitor the output voltage and control the set point of the regulator 320. The battery functions on the “left” side of the power curve, ie, the side where power is increasing. When the battery reaches a peak power level, the control circuit 330 can change (eg, lower) the set point of the regulator, thereby requiring less total power from the battery. The motor 65 will then decelerate. In this way, the demand from the power pack rarely exceeds the peak available power, so a power-starving situation during the procedure can be avoided.

  In addition, according to other embodiments, the power drawn from the battery may be optimized to have time for the chemical reaction in the cell to recover, thereby optimizing the current and power available from the battery. To do. In pulse loading, the battery typically provides more power at the beginning of the pulse towards the end of the pulse. This is because (1) the PTC may have changed its resistance during the pulse; (2) the battery temperature may have changed; and (3) the electrochemical reaction rate may be depleted. This is due to several factors, including the fact that the electrolyte at the cathode is changing and that the diffusion rate of the fresh electrolyte limits the reaction rate. According to various embodiments, the control circuit 330 can control the converter 320 so that the control circuit draws lower current from the battery and recovers the battery before the battery is pulsed again. Let

  According to other embodiments, the instrument 10 may include a clutch-type torque limiting device. The clutch-type torque limiting device can be located, for example, between the motor 65 and the bevel gear 68, between the bevel gear 70 and the planetary gear assembly 72, or on the output shaft of the planetary gear assembly 72. According to various embodiments, the torque limiting device may use an electromagnetic clutch or a permanent magnet clutch.

  19-22 illustrate a sample electromagnetic clutch 400 that may be used with the instrument 10 according to various embodiments. The clutch 400 may include a horseshoe stator 402 having magnetic disks 404, 406 at each end. The first disk 404 can be connected to an axially movable rotatable pole piece 408, such as the output pole of the motor 65. The second magnetic disk 406 can be connected to an axially stationary, rotatable pole piece 410, eg, an input pole to the gear box of the instrument 10. 19 and 20, the first pole piece 408 is axially separated from the second pole piece 410 by a distance 412 and the magnetic disks 404 and 406 are not engaged. A wire coil (not shown) that can be wound around the stator 402 may be used to create the electromagnetic flux required to operate the clutch 400. When the coil conducts current, the resulting magnetic flux can attract the two magnetic disks 404, 406 and the first pole piece 408 is moved axially toward the second pole piece 410, which Causes the two magnetic disks 404, 406 to engage as shown in FIGS. 21 and 22, so that the two torques are increased until the torque exceeds the friction torque generated between the surfaces of the magnetic disks 404 and 406. The pole pieces 408, 410 will rotate together.

  The attractive force between the two disks 404, 406, and the corresponding torque capacity of the clutch 400, is also known by controlling the diameter of the disks 404, 406 and the friction coefficient between the contact surfaces of the magnetic disks 404 and 406. Control can be achieved by using magnetic material in the disks 404, 406 that saturates at a controllable bundle density. Thus, even with operating conditions in which more current passes through the coil, the magnetic material of the disks 404, 406 does not generate greater attraction and subsequent limiting torque.

  Using such a clutch has many additional potential benefits. Electrically controlled, the clutch 400 can be quickly deactivated by removing current from the wires to limit the amount of heat generated in the clutch 400 and in the motor 65. By separating the motor from the rest of the power transmission path via the clutch 400, most of the stored inertial energy in the power transmission path is separated, and the shock is applied when the output is suddenly cut off. Limit. In addition, by being electrically controlled, some limited slipping is designed to help alleviate the impact when restarting the driveline under load Can be designed-in. Further, since one or more of the magnetic saturation characteristics of the clutch internal components (eg, magnetic disks 404, 406) can be used to control torque limits rather than coil current, the clutch 400 It will not be very sensitive to changes. The torque limit in such embodiments is primarily a function of the physical dimensions of the clutch components (e.g., magnetic disks 404, 406), and a voltage regulator or other external configuration for proper operation. You will not need the element.

  In another embodiment, rather than using an electromagnetic clutch, the torque limiting device can include a permanent magnet (not shown). The permanent magnet is connected to the first pole piece 408 that is movable in the axial direction, for example, and can attract the second pole piece 410 that is fixed in the axial direction, or is connected to the second pole piece. The first pole part can be pulled. In such an embodiment, one of the disks 404, 406 may be made from a permanent magnet and the other may be made from a magnetic material such as iron. In minor variations, the stator 402 may be made in the form of a permanent magnet that pulls the magnetic disks 404 and 406 toward each other. With permanent magnets, the two disks 404, 406 will always engage. Using a permanent magnet will not provide as accurate torque control as the electromagnetic clutch configuration described above, but (1) does not require a controller or control logic to control the current through the coil; (2) It would have the advantage of being more compact than the electromagnetic clutch configuration; and (3) simplifying the design of the instrument 10.

  As previously mentioned, the end effector 12 can release RF energy to coagulate tissue clamped within the end effector. RF energy can be transferred between the electrodes of the end effector 12. An RF source (not shown), including for example an oscillator and amplification, among other components, is one that can supply RF energy to the electrode, but an instrument such as handle 6 for cordless instrument 10 It may be located within itself or the RF source may be external to the instrument 10. The RF source can be operated as described further below.

According to various embodiments, the end effector 12 can include multiple sections (or segments) of electrodes. For example, as shown in the example of FIG. 23, the lower surface of the anvil 24 (ie, the surface facing the staple cartridge 34) can include three collinear RF segments. In this example, each segment has the same length (eg, 20 mm), but in other embodiments there may be more or fewer segments, and the segments have different lengths. It's okay. In the example of FIG. 23, there are three pairs of active or “anode” terminals or electrodes 500 aligned longitudinally along each side of the channel length on the underside of the anvil 24. In particular, in the illustrated embodiment, there are a pair of distal electrodes 500 ₁ , a pair of intermediate electrodes 500 ₂ , and a pair of proximal electrodes 500 ₃ on each side of the knife channel 516. The metal outer portion or channel 22 of the end effector 12 or the metal anvil 24 can serve as a counter electrode (or cathode) for each of the three upper active electrodes (or anodes) 500. The upper electrode 500 can be coupled to an RF source. When pressurized, RF energy can propagate between the upper electrode 500 and the counter electrode, causing the tissue clamped between the electrodes to coagulate.

The electrodes 500 can be pressurized simultaneously or in various orders, eg, continuously. For embodiments in which the electrode 500 is pressurized according to the array, the array is automatic (eg, controlled by a controller (not shown) in communication with the RF source) or selected by the user It may be due to. For example, proximal electrode 500 ₃ is first pressed it is possible to pressure; may distal electrodes ₅₀₀₁ to the next is pressed; then the intermediate electrode 500 _2. As such, an operator (eg, a surgeon operating) can selectively coagulate the area of the staple line. The electrodes in such embodiments can be controlled by a multiplexer and / or multiple output generator, as further described below. As such, the tissue under each electrode 500 can be individually treated according to the need for coagulation. Each electrode in the pair may be connected to an RF source so that the pair is pressurized simultaneously. That is, for the active electrode 500 ₁ of the distal pair, respectively on both sides of the knife channel, may be energized by the RF source at the same time. Although the same for the electrodes 500 _third electrode ₅₀₀₂ and the proximal pair of intermediate pairs, in the embodiment where the electrode pairs are energized in sequence, the distal pair as the middle and proximate pairs at the same time as the pressure Not.

  In addition, various electrical parameters, such as impedance, delivered power or energy, etc. may be monitored, and the output to a particular electrode 500 can be altered to produce the most desirable tissue action. In addition, there is another advantage in the case of metal staples or other conductive objects left over from previous instrument firings or surgical procedures that can cause electrode shorts. Such a short circuit condition can be detected by a generator and / or a multiplexer, and the energy can be modulated in a manner suitable for the short circuit.

  In addition, pressurizing the electrodes 500 one after the other from the RF source, as compared to the design shown in FIG. 23, which has a set of electrodes that is as long as the combined length of the three segmented electrodes 500. Reduce the instantaneous power required. For example, it has been demonstrated that for an electrode configuration such as that shown in the '312 patent, it would require 50-100 watts to successfully solidify a 45 mm line on each side of the cutting line. By using a smaller active electrode (eg, upper electrode 500) that has a smaller surface area than a larger return electrode (eg, metal anvil 24), the smaller active electrode 500 can concentrate treatment energy into the tissue. The larger return electrode is used to complete the circuit with minimal impact on the tissue interface. In addition, the return electrode preferably has a larger mass so that it can remain cold during electrosurgical application.

  The electrode 500 may be surrounded by an electrically insulating material 504, which may include a ceramic material.

FIG. 24 illustrates another embodiment having segmented RF electrodes. In the embodiment shown in FIG. 24, there are _four electrodes 500 ₁ -500 ₄ that are of equal length (15 mm in this example) and are collinear and segmented. Similar to the embodiment of FIG. 23, the electrodes 500 of FIG. 24 can be pressurized simultaneously or sequentially.

FIG. 25 shows yet another embodiment in which segmented electrodes have different lengths. In the illustrated embodiment, there are four collinear, segmented electrodes, but the most distal electrodes 500 ₁ , 500 ₂ are 10 mm long and have two proximal electrodes 500 ₃ , 500 _4, it is 20mm long. Having a short distal electrode can provide the advantage of concentrating therapeutic energy as described above.

  FIG. 59 has 15 pairs of segmented RF electrodes 500 on circuit board 570, or other type of suitable circuit substrate, on the underside of anvil 24 (ie, the side facing channel 22). An embodiment is shown. Various electrode pairs are pressurized by an RF source (or generator) 574. Multiplexer 576 can distribute RF energy to various electrode pairs as desired under the control of controller 578. According to various embodiments, the RF source 574, the multiplexer 576, and the controller 578 may be located on the handle 6 of the instrument.

In such an embodiment, circuit board 570 may include multiple layers, which provide electrical connections between multiplexer 576 and various electrode pairs. For example, as shown in FIGS. 60-63, the circuit board can include _three layers 580 ₁ -580 ₃ , each layer 580 providing connections to five of the electrode pairs. For example, the uppermost layer 580 _3, as shown in FIGS. 60 and 61, it is possible to provide a connection to the fifth electrode pair most proximal; middle layer 580 ₂ is shown in FIGS. 60 and 62 as such, it is possible to provide a connection to the 5 electrode pairs of the intermediate; layer 580 of _the most downward, as shown in FIGS. 60 and 63, provide a connection to the 5 electrode pairs distalmost it can.

FIG. 64 shows a cross-sectional end view of an anvil 24 according to such an embodiment. Circuit board adjacent to the staple pockets 584 570, an insulating layer ₅₈₂ 1-582 ₄ during comprises three conductive layers ₅₈₀ 1-580 _3. Figures 65 and 66, the various layers ₅₈₀ 1-580 ₃ shows how may be stacked to connect back to the multiplexer 576 in the handle.

  As shown in FIG. 67, the advantage of having such many RF electrodes on the end effector 12 is that metal staples left in tissue 592 due to previous instrument firing or surgical procedures that can cause shorting of the electrodes. In the case of line 590 or other conductive object, such a short circuit condition can be detected by the generator and multiplexer, and that the energy can be modulated in a manner appropriate to the short circuit.

FIG. 27 shows another end effector 12 with RF electrodes. In this embodiment, the end effector 12 only comprises distal electrodes 500 _1, the metallic anvil 24 serving as the return electrode. The distal electrodes ₅₀₀₁ is not over the entire length of the anvil 24, spans only a portion of its length. In the illustrated embodiment, the distal electrodes ₅₀₀₁ along a 60mm anvil is slightly about 20mm in length, the distal electrode _5001, the approximate distal-most anvil length 1/3 Only In other embodiments, the distal electrodes 500 ₁ could cover the 1 / 10-1 / 2 of the most distal anvil length. Such an embodiment can be used for spot coagulation, as described in US Pat. No. 5,599,350, which is incorporated herein by reference.

  FIG. 28 shows yet another embodiment of the end effector 12 with RF electrodes. In this embodiment, the active electrode 500 is positioned at the distal tip of the anvil 24 and is insulated from the anvil 24 by a non-conductive insulator 504 that can be made from a ceramic material. Such an embodiment can be used for spot coagulation.

FIGS. 29-32 illustrate another embodiment of the end effector 12 that may be useful for spot coagulation. In these embodiments, the anvil 24 includes a pair of electrodes 500 ₁ , 500 ₂ at the distal end of the anvil 24 and along the sides of the anvil 24. 29 is a front end view of an anvil 24 according to such an embodiment, FIG. 30 is a side view, FIG. 31 is an enlarged fragmentary front end view, and FIG. 32 is a top view. It is. In such an embodiment, the metal anvil 24 can act as a return electrode. The active electrodes 500 ₁ , 500 ₂ can be insulated from the anvil 24 by a non-conductive insulator 504 that can include a ceramic material.

FIGS. 33-36 show an embodiment in which the anvil 24 includes two distal electrodes 500 ₁ , 500 ₂ located in the center of the top of the anvil 24. Again, the metal anvil 24 can act as a return electrode, and the active electrodes 500 ₁ , 500 ₂ can be insulated from the anvil 24 by the non-conductive insulator 504.

Figures 37-40 show an embodiment where one active electrode 500 ₁ (e.g., the active electrode) is positioned on the anvil 24, and another active electrode 500 ₂ is lower jaw 22, preferably positioned on the cartridge 34 An embodiment is shown. The metal anvil 24 can act as a return electrode. Anvil electrode 500 ₁ is insulated from the anvil 24 by an insulator 504. Preferably made of non-conductive material such as plastic, the electrode 500 ₂ is positioned at the cartridge 34 is insulated from the metallic channel 22 by the cartridge 34.

41-44 show an embodiment in which the anvil 24 has _two active electrodes 500 ₁ , 500 ₂ at the very distal end of the anvil 24, which are active from the top surface to the bottom surface of the anvil 24. It is fully extended. Again, the metallic anvil 24 can act as a return electrode, and the active electrodes 500 ₁ , 500 ₂ can be insulated from the anvil 24 by the non-conductive insulator 504.

45-48 show an embodiment in which the cartridge 34 has two active electrodes 500 ₁ , 500 ₂ at the very distal end of the staple cartridge 34. In such an embodiment, the metal anvil 24 or the metal channel 22 can act as a return electrode. In this illustrated embodiment, the electrodes 500 ₁ , 500 ₂ are connected to the insulator insert 503, but in other embodiments the insulator insert 503 may be omitted and the plastic cartridge 34 may be It can serve as an insulator for the electrodes 500 ₁ , 500 ₂ .

FIGS. 49 52, one active electrode 500 ₁ at the distal-most end exactly the anvil 24, another active electrode 500 ₂ at the most distal end just of the cartridge 34, with the embodiment Show. Again, in such an embodiment, the metal anvil 24 or metal channel 22 can act as a return electrode. In the illustrated embodiment, the electrode 500 ₂ is connected to insulator inserts 503, 505, in other embodiments, may insulator inserts 503, 505 can be omitted and the plastic cartridge 34, it can serve as the insulator for the electrode 500 _2.

  FIG. 57 is a side view of a handle 6 according to another embodiment of the present invention, and FIG. 58 is a cross-sectional side view. The illustrated embodiment includes only one trigger, the closure trigger 18. Activation of the knife, staple driver, and / or RF electrode in this embodiment can be accomplished by means other than a separate firing trigger. For example, as shown in FIG. 57, the activation of the knife, staple driver, and / or RF electrode may be activated by a push button switch 540 or other type of switch in a position convenient for the operator. it can. In FIG. 57, the switch 540 is shown in the proximal portion of the handle 6. In another embodiment, the switch may be positioned near the distal end of the handle 6 and pulling the nozzle 539 activates the switch, causing activation of the instrument. In such an embodiment, a switch (not shown) may be placed under or near the nozzle 539 and the movement of the nozzle toggles the switch.

  Alternatively, the activation of the knife, staple driver, and / or RF electrode may be activated by a voice or other audible command sensed by the microphone 542. In other embodiments, the handle 6 may include an RF or acoustic transceiver 541 that can receive and / or transmit RF or acoustic signals to actuate the instrument. Also, as shown in FIG. 58, a foot pedal or switch 544 can be used to activate the instrument 10. The foot pedal 544 can be connected to the handle 6 by a cord 545. The handle 6 can also include a dial controller 546 for controlling the operation of the segmented RF electrode, or some other suitable controller (see, eg, FIGS. 23 and 24). Using such a control device 546, the operator can continuously operate various pairs of RF electrodes 500 in the end effector 12.

  The instrument 10 shown in FIGS. 57 and 58 also includes a number of feedback systems for the user. As described above, the instrument 10 can include a speaker 543 for audibleizing instructions or instructions to the operator. In addition, the handle 6 can include a visual indicator 548, such as an LED or other light source, that provides visual feedback regarding the operation of various segmented RF electrodes. For example, each visual indicator 548 can correspond to one of the segmented RF electrode pairs. A corresponding visual indicator 548 can be activated when a segmented RF electrode pair is activated. In addition, the handle 6 may include an alphanumeric display 550, which may be, for example, an LED or LCD display. The display 550 may be connected to the circuit board 552 inside the handle 6. The handle 6 may include a vibrator 554 in the pistol grip portion 26, which can provide vibration feedback to the operator. For example, the vibrator 554 can vibrate each time one of the segmented pair of RF electrodes in the end effector 12 is actuated.

  FIG. 26 is a cross-sectional view of the end effector 12 according to various embodiments, with the electrodes in the upper jaw (ie, anvil) 24. In the illustrated embodiment, the active electrode 500 is positioned adjacent to the knife slot 516. The metal anvil 24 serves as a return electrode. An insulator 504, which can be made of ceramic, insulates the electrode 500 from the metal anvil 24. The embodiment of FIG. 68 is similar to the embodiment of FIG. 26 except that the electrode 500 is made smaller, and a portion of the insulator 504 includes the edges of each electrode 500 and the knife channel 516. It extends between.

FIG. 53 is a cross-sectional end view of the end effector 12 according to another embodiment. In this embodiment, similar to the embodiment of FIG. 26, the active electrodes 500 ₁ , 500 ₂ are on the anvil 24 on either side of the knife channel. The electrodes 500 ₁ , 500 ₂ are insulated from the metal anvil by an insulator 504, which again preferably comprises a ceramic material. However, in this embodiment, the insulator 504 is made very thin (compare FIG. 26). Making the insulator 504 very thin provides the potential advantage that the anvil 24 can include a relatively large metal section 520 over the electrode 500, thereby providing a thinner anvil profile for a given anvil stiffness. Or potentially supporting a more rigid profile for a given anvil cross-sectional dimension. Insulator 504 may be cast in anvil 24 or sputter coated onto anvil 24.

FIG. 54 shows another embodiment. In this embodiment, the active electrodes 500 ₁ , 500 ₂ are sputter coated or bonded to the insulator 504, and the insulator 504 can also be sputter coated or bonded to the anvil 24. . Similar to the embodiment of FIG. 53, this design allows for more anvil material on the electrode. In such an embodiment, the electrodes 500 ₁ , 500 ₂ may include silver, which is a good electrical conductor and has antibacterial properties.

  FIG. 55 shows a side view of an end effector according to another embodiment. In this embodiment, a thin film of electrically insulating material 530 is deposited on the surface of cartridge 34. Insulating film 530 preferably includes a heat and arc resistant material such as ceramic. This tends to increase the resistance of the cartridge 34 to arc tracking and shorts, allowing more firing between cartridge 34 replacements. In addition, if the cartridge 34 is a poor electrical conductor, the cartridge will support faster tissue heating and reduce overall energy requirements. The active electrode (not shown in FIG. 55) may be in the anvil 24 as described in the previous embodiment.

  56 shows an embodiment similar to the embodiment shown in FIG. 55, except that a thin layer 532 of slightly conductive material is deposited on the top surface of the insulating film 530 in FIG. The conductivity of the slightly conductive thin layer 532 may be lower than the conductivity of the tissue clamped in the end effector 12 for treatment. Thus, the slightly conductive thin layer 532 will provide a path with reduced conductivity so as to further heat the clamped tissue. This will help reduce the time required to heat the tissue and achieve coagulation.

  As previously described, the instrument 10 may include an articulation pivot 14 for articulating the end effector 12. The clinician or operator of the instrument 10 is described in more detail in US Patent Application Publication No. 2007 / 0158385A1, entitled “Surgical Instrument Having An Articulating End Effector” by Geoffrey C. Hueil et al., Which is incorporated herein by reference. The end effector 12 can be articulated with respect to the shaft 8 by using the articulation control device 16. In other embodiments, rather than a controller integrated with the instrument 10, the end effector 12 may be articulated by a separate instrument, such as a gripper inserted into the patient, and the operating part of the separate instrument is Near the end effector 12, the separate instrument can articulate the end effector 12 as desired. This separate instrument can be inserted through a different opening than the end effector 12 or through the same opening. Moreover, in order to articulate the end effector 12, different operators may operate different instruments, or a single person may operate both instruments. In another passive articulation scenario, the end effector 12 can be articulated by carefully pressing the end effector against other parts of the patient to achieve the desired articulation.

  In another embodiment, the end effector 12 can be connected to the handle by a flexible cable. In such embodiments, the end effector 12 can be positioned as desired and held in place by using another instrument, such as a separate gripper instrument. In addition, in other embodiments, the end effector 12 can be positioned by a separate instrument and clamped by a second separate instrument. In addition, the end effector 12 may be sufficiently small, such as a width of 8-9 mm and a height of 10-11 mm, and a pull-to-close mechanism is used to extend the end effector from the handle 6. Can be clamped. This pull-close mechanism can be adapted from that described in US Pat. No. 5,562,701, entitled “Cable-Actuated Jaw Assembly For Surgical Instruments”, which is incorporated herein by reference. The cable 600 can be placed in or along the flexible endoscope, eg, for use in upper or lower gastrointestinal tract procedures.

  In yet another embodiment, as shown in FIGS. 69 and 70, the instrument 10 can include a flexible neck assembly 732 that allows articulation of the end effector 12. When the articulation transmission assembly 731 coupled to the shaft 8 is rotated, the articulation transmission assembly can cause remote articulation of the flexible neck assembly 732. The flexible neck assembly 732 can include a first flexible neck portion 733 and a second flexible neck portion 734, which neck portion includes a first flexible band assembly 735. And a second flexible band assembly 736 is received. As the articulation transmission assembly 731 rotates, one of the first flexible transmission band assembly 735 and the second flexible transmission band assembly 736 is moved forward, while the other band assembly is , Moved backwards. In response to the reciprocation of the band assembly within the first flexible neck portion 733 and the second flexible neck portion 734 of the flexible neck assembly 732, the flexible neck assembly 732 bends. Bring about joint movement. A further description of the flexible neck is described in US Pat. No. 5,704,534, which is incorporated herein by reference.

  The devices disclosed herein may be designed to be discarded after a single use, or may be designed to be used multiple times. In either case, however, the device can be reconditioned for reuse after at least one use. Reconditioning can include any combination of device disassembly steps, followed by cleaning or replacement of specific parts, and subsequent reassembly steps. In particular, the device may be disassembled and any number of particular parts or parts of the device may be selectively replaced or removed in any combination. Once a particular part has been cleaned and / or replaced, the device can be reassembled for subsequent use at a reconditioning facility or by a surgical team immediately prior to a surgical procedure. One skilled in the art will recognize that reconditioning of the device may utilize various techniques for disassembly, cleaning / replacement, and reassembly. The use of such techniques and the resulting reconditioned device are all within the scope of this application.

  Preferably, the various embodiments of the invention described herein are processed before surgery. First, a new or used instrument is obtained and cleaned if necessary. The instrument can then be sterilized. In one sterilization technique, the instrument is placed in a closed and sealed container, such as a thermoformed plastic shell covered with a sheet of TYVEK. The container and instrument are then placed in a field of radiation that can penetrate the container, such as gamma radiation, x-rays, or high energy electrons. Radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. The sealed container keeps the instrument sterile until it is opened in the medical facility.

  The device is preferably sterilized. This can be done by many methods known to those skilled in the art including beta or gamma radiation, ethylene oxide, steam, and other methods.

  While the invention has been illustrated by the description of several embodiments and exemplary embodiments have been described in considerable detail, the scope of the claims should be limited to such details or limited in any way. This is not what the applicant intends to do. Additional advantages and modifications will be readily apparent to those skilled in the art. Various embodiments of the present invention provide a significant improvement over prior stapling methods that require the use of different sized staples in a single cartridge to obtain staples having differently shaped (final) heights. Represents a point.

  Accordingly, the present invention has been discussed with respect to endoscopic procedures and endoscopic devices. However, the use of terms such as “endoscopic” herein limits the present invention to surgical stapling and cutting instruments that are only used with an endoscopic tube (ie, trocar). It should not be interpreted as a thing. On the contrary, it is contemplated that the present invention may find use in any procedure with limited access, including but not limited to laparoscopic procedures as well as open procedures. In addition, the unique and novel aspects of the various staple cartridge embodiments of the present invention may also be useful when used in connection with other forms of stapling devices without departing from the spirit and scope of the present invention. Can be found.

FIG. 1 is a perspective view of a surgical cutting and securing instrument according to various embodiments of the present invention. FIG. 2 is a perspective view of a surgical cutting and securing instrument according to various embodiments of the present invention. FIG. 3 is an exploded view of an end effector and shaft of an instrument according to various embodiments of the present invention. FIG. 4 is an exploded view of an end effector and shaft of an instrument according to various embodiments of the present invention. FIG. 5 is an exploded view of an end effector and shaft of an instrument according to various embodiments of the present invention. FIG. 6 is a side view of an end effector according to various embodiments of the invention. FIG. 7 is an exploded view of a handle of an instrument according to various embodiments of the present invention. FIG. 8 is a partial perspective view of a handle according to various embodiments of the present invention. FIG. 9 is a partial perspective view of a handle according to various embodiments of the present invention. FIG. 10 is a side view of a handle according to various embodiments of the present invention. FIG. 11 is a circuit diagram of a circuit used in an instrument according to various embodiments of the present invention. FIG. 12 is a circuit diagram of a circuit used to power an appliance motor according to various embodiments of the invention. FIG. 13 is a circuit diagram of a circuit used to power an appliance motor according to various embodiments of the invention. FIG. 14 is a circuit diagram of a circuit used to power an appliance motor according to various embodiments of the invention. FIG. 15 is a block diagram illustrating a charge management circuit according to various embodiments of the invention. FIG. 16 is a block diagram illustrating a charger base according to various embodiments of the present invention. FIG. 17 is a circuit diagram of a circuit used to power an appliance motor according to various embodiments of the invention. FIG. 18 is a diagram illustrating a typical power curve of a battery. FIG. 19 is a diagram illustrating an embodiment of an electromagnetic clutch type torque limiting device according to various embodiments of the present invention. FIG. 20 is a diagram illustrating an embodiment of an electromagnetic clutch type torque limiting device according to various embodiments of the present invention. FIG. 21 is a diagram illustrating an embodiment of an electromagnetic clutch type torque limiting device according to various embodiments of the present invention. FIG. 22 is a diagram illustrating an embodiment of an electromagnetic clutch type torque limiting device according to various embodiments of the present invention. FIG. 23 is a view of the underside of an anvil of an instrument according to various embodiments of the present invention. FIG. 24 is a view of the underside of an anvil of an instrument according to various embodiments of the present invention. FIG. 25 is a view of the underside of an anvil of an instrument according to various embodiments of the present invention. FIG. 26 is a cross-sectional front view of an end effector according to various embodiments of the invention. FIG. 27 is a view of the underside of an anvil of an instrument according to various embodiments of the present invention. FIG. 28 is a view of the underside of an anvil of an instrument according to various embodiments of the present invention. FIG. 29 is a diagram illustrating an embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 30 is a diagram illustrating an embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 31 is a diagram illustrating an embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 32 is a diagram illustrating an embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 33 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 34 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 35 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 36 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 37 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 38 illustrates another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 39 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 40 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 41 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 42 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 43 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 44 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 45 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 46 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 47 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 48 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 49 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 50 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 51 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 52 is a diagram illustrating another embodiment of an end effector having RF electrodes according to various embodiments of the present invention. FIG. 53 is a cross-sectional front view of an end effector according to various embodiments of the invention. FIG. 54 is a cross-sectional front view of an end effector according to various embodiments of the invention. FIG. 55 is a side view of an end effector according to various embodiments of the invention. FIG. 56 is a side view of an end effector according to various embodiments of the invention. FIG. 57 is a diagram of a handle of an instrument according to another embodiment of the present invention. FIG. 58 is a cutaway view of the handle of the embodiment of FIG. 57 according to various embodiments of the invention. FIG. 59 is a view of the underside of an anvil of an instrument according to various embodiments of the present invention. FIG. 60 is a diagram illustrating a multilayer circuit board according to various embodiments of the present invention. FIG. 61 illustrates a multi-layer circuit board according to various embodiments of the present invention. FIG. 62 is a diagram illustrating a multi-layer circuit board according to various embodiments of the present invention. FIG. 63 illustrates a multilayer circuit board according to various embodiments of the present invention. FIG. 64 is a diagram illustrating a multi-layer circuit board according to various embodiments of the present invention. FIG. 65 is a diagram illustrating a multi-layer circuit board according to various embodiments of the present invention. FIG. 66 is a diagram illustrating a multilayer circuit board according to various embodiments of the present invention. FIG. 67 is a diagram illustrating an end effector according to various embodiments of the invention. FIG. 68 is a cross-sectional front view of an end effector according to various embodiments of the invention. FIG. 69 is a diagram of an instrument including a flexible neck assembly according to various embodiments of the present invention. FIG. 70 is a diagram of an instrument including a flexible neck assembly according to various embodiments of the present invention.

Claims (20)

In surgical cutting and fixing instruments,
An end effector;
A shaft connected to the end effector, the shaft including a power transmission path for powering the end effector;
A handle connected to the shaft, wherein the handle is
An electric DC motor connected to the power transmission path to supply power to the power transmission path;
A DC power source including one or more batteries, and
A power regulator having an input device connected to the DC power source and an output device connected to the input device of the motor, the power regulator comprising:
Power converter, and
A control circuit for controlling the power converter, wherein the control circuit is configured to control the power converter such that a voltage delivered by the power source is lower than a voltage at which the power source delivers maximum power. A control circuit for controlling the voltage set point,
Including, power regulator,
Including a handle,
Surgical cutting and fastening instruments, including The surgical cutting and fixing instrument according to claim 1,
The power converter includes a DC-DC power converter. The surgical cutting / fixing instrument according to claim 2,
The DC-DC power converter is a surgical cutting and securing instrument including a switch-mode power converter. The surgical cutting / fixing instrument according to claim 3,
The DC-DC power converter is a surgical cutting and fastening instrument including a buck-boost converter. The surgical cutting and fixing instrument according to claim 1,
The surgical cutting and securing instrument, wherein the end effector includes at least one RF electrode. The surgical cutting and fixing instrument according to claim 1,
A torque limiting device connected to the output pole of the motor;
A surgical cutting and fastening instrument further comprising: The surgical cutting and fixing instrument according to claim 1,
A power selection switch connected to the power source;
A surgical cutting and fastening instrument further comprising: The surgical cutting and fixing instrument according to claim 1,
The end effector is
With the upper jaw,
A lower jaw facing the upper jaw;
A cutting instrument disposed in a longitudinal channel defined by the lower jaw;
Surgical cutting and fastening instruments, including The surgical cutting / fixing instrument according to claim 8,
The lower jaw includes a surgical cutting and securing instrument including a staple cartridge. The surgical cutting and fixing instrument according to claim 9,
The surgical cutting and securing instrument, wherein the upper jaw includes at least one RF electrode. In surgical cutting and fixing instruments,
An end effector;
A shaft connected to the end effector, the shaft including a power transmission path for powering the end effector;
A handle connected to the shaft, wherein the handle is
An electric DC motor connected to the power transmission path to supply power to the power transmission path;
A DC power source including one or more batteries, and
A power regulator having an input device connected to the DC power source and an output device connected to the input device of the motor, the power regulator comprising:
A power converter; and a control circuit for controlling the power converter, the control circuit for controlling a voltage set point of the power converter to control a current drawn from the DC power source. Control circuit,
Including, power regulator,
Including a handle,
Surgical cutting and fastening instruments, including The surgical cutting and fixing instrument according to claim 11,
The control circuit is for controlling the voltage set point of the power converter to control the current drawn from the DC power source, the DC power source being charged before the next pulse; Surgical cutting and fixing device. The surgical cutting and fixing instrument according to claim 11,
The power converter includes a DC-DC power converter. The surgical cutting / fixing instrument according to claim 13,
The DC-DC power converter is a surgical cutting and securing instrument including a switch-mode power converter. The surgical cutting and fixing instrument according to claim 14,
The DC-DC power converter is a surgical cutting and fastening instrument including a buck-boost converter. The surgical cutting and fixing instrument according to claim 11,
A torque limiting device connected to the output pole of the motor;
A surgical cutting and fastening instrument further comprising: The surgical cutting and fixing instrument according to claim 11,
A power selection switch connected to the power source;
A surgical cutting and fastening instrument further comprising: The surgical cutting and fixing instrument according to claim 11,
The end effector is
With the upper jaw,
A lower jaw facing the upper jaw;
A cutting instrument disposed in a longitudinal channel defined by the lower jaw;
Surgical cutting and fastening instruments, including The surgical cutting and fixing instrument according to claim 18,
The lower jaw includes a surgical cutting and securing instrument including a staple cartridge. The surgical cutting and fixing instrument according to claim 19,
The surgical cutting and securing instrument, wherein the upper jaw includes at least one RF electrode.

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