Rotable articulating endoscopic fastening instrument

Claim 2

An instrument according to claim 1, which includes a handle portion attached to the proximal end of said elongate portion, and wherein said articulation mechanism is disposed in said handle portion.

Claim 3

An instrument according to claim 2, wherein said means for advancing a fastener comprises feed means extending from said handle to said fastener applying head through said elongate portion for feeding a fastener to said fastener applying head, said means being flexible at least in the area where said fastener applying head is hingedly attached to said elongate portion.

Claim 4

An instrument according to claim 2 or 3, wherein said actuating means comprises means extending from said handle to said fastener applying head to actuate said head to apply a fastener, said means being flexible at least in the area where said fastener applying head is hingedly attached to said elongate portion.

Claim 5

An instrument according to any preceding claim, wherein the elongate portion is hollow.

Claim 6

An instrument according to any preceding claim, wherein the elongate portion is rigid.

Claim 7

An instrument according to any preceding claim, wherein the actuating means comprises a trigger.

Claim 8

An articulating endoscopic fastening instrument for applying a surgical fastener to body tissue, comprising: (a) an actuation mechanism; (b) an elongate endoscopic portion extending distally from the said actuation mechanism; (c) a fastener applying head or end portion hingedly attached to the distal end of said elongate portion; (d) means for rotating the elongate portion and the fastener applying head about the longitudinal axis of the same; and (e) articulating means for moving said fastener applying head in and out of longitudinal alignment with said elongate portion.

Claim 9

An instrument according to claim 8, further comprising means allowing for articulation of the fastener applying head at any rotational position of the elongate portion.

Claim 10

An instrument according to claim 8 or 9, further comprising fastener applying means disposed at the distal end of said fastener applying head, feed means disposed in said tubular elongate portion and extending into the fastener applying head for feeding a fastener to said fastener applying means, drive means disposed in said tubular elongate portion and extending to the fastener applying means to actuate said fastener applying means to place a fastener in body tissue, and means disposed in said fastener applying head distally of said hinged attachment to maintain the relative position of the feed means and the drive means with respect to each other and with respect to said fastener applying means throughout all movement of said fastener applying head with respect to said elongate tubular portion.

Claim 11

An instrument according to claim 10, wherein the means for maintaining the relative positions of the feed means and the drive means comprises a pair of tracks disposed on the inside surface of the hollow fastener applying head, one of said pair of tracks engaging at least a portion of said feed means and the other of said pair of tracks engaging at least a portion of said drive means.

Claim 12

An instrument according to claim 8 or 9, further comprising a pair of jaws for holding and closing a fastener placed therebetween disposed at the distal end of said fastener applying head, an elongated fastener storage track for housing an array of surgical fasteners in an end-to-end relationship, the proximal end of said track being disposed in the hollow elongate portion and the distal end of the track extending into said hollow fastener applying head, the portion of said fastener track on both sides of said hinged attachment of the hollow fastener applying head to the elongate tubular portion being flexible, said fastener storage track including means for biasing the array of fasteners towards the distal end of said fastener storage track, the instrument further comprising a feed bar member mounted for reciprocation and disposed adjacent to and substantially parallel to said fastener storage track throughout all movement of said fastener applying head, spring means for placing the distal most fastener from the fastener track to in front of said feed bar member whereby said feed bar member can place said fastener between said pair of jaws, and a jaw closure mechanism mounted for reciprocation and disposed adjacent and substantially parallel to said feed bar member throughout all movement of said fastener applying head.

Claim 13

An instrument according to claim 8 or 9, further comprising a jaw member having a pair of spaced apart jaws for receiving a surgical fastener therebetween, a fastener storage and placement mechanism for storing an array of fasteners and placing the distal most fastener of said array in a position to be fed between said jaws, a fastener feed member for feeding said distal most fastener to said jaws, a jaw closure mechanism for controlling said jaws and closing a fastener positioned between said jaws, a handle assembly rotatably connected to said elongate portion and containing means for actuating said jaws and for actuating said fastener feed member, and a rotating assembly attached to said elongate portion to rotate said portion about its longitudinal axis, and an articulating knob for actuating the articulating mechanism to move said hingedly attached end portion in and out of longitudinal alignment with said elongate portion.

Claim 14

An instrument according to claim 13, wherein the fastener storage and placement mechanism, the fastener feed member and the jaw closure mechanism are all flexible in the area where the distal end portion is hingedly attached to the elongate portion.

Claim 15

An instrument according to claim 13 or 14, wherein the hingedly attached end portion includes means for maintaining the relative positions of the fastener storage and placement mechanism, the fastener feed member and the jaw closure mechanism throughout articulation of the distal end portion.

Claim 16

An instrument according to claim 12, 13, 14 or 15, wherein the elongated fastener storage track or fastener storage and placement member is a member having a rectangular cross-section defining a floor, lateral side walls, and a top overlying the legs of the fasteners, said lateral side walls having spaced apart openings disposed therein in that portion of the fastener track on both sides of the hinged attachment of the fastener applying head to the elongate tubular portion.

Claim 17

An instrument according to claim 16 wherein the openings in the lateral side walls extend into the top of said fastener track.

Claim 18

An instrument according to claim 17, wherein the portion of the openings in the top of the fastener track are narrower than the portion of the openings in the lateral side walls.

Claim 19

An instrument according to claim 16, 17 or 18 wherein the floor of the fastener track has an opening therein on that portion of the fastener track on both sides of the hinged attachment of the hollow fastener applying head to the elongate tubular portion.

Claim 20

An instrument according to claim 16, 17 or 18 wherein the floor of the fastener track has an opening therein, said opening extending for at least that portion of the fastener track wherein there are openings in said lateral side walls.

Claim 21

An instrument according to any preceding claim, wherein the articulating mechanism or articulating means comprises a strap member extending from the hingedly attached end portion to an articulating knob, and wherein said articulating knob includes means to allow said strap member to rotate with the rotatable elongate portion.

Claim 22

An instrument according to claim 9, wherein the elongate portion id rigid, and the means for rotating the elongate portion comprises a rotatable knob mounted on said elongate portion at the proximal end thereof and hinged to said elongate portion so that on rotation of said knob said elongate portion rotates therewith, the articulating means includes a member having an end thereof attached to said fastener applying head with the other end of said member extending to the proximal portion of said elongate portion and an articulating knob mounted for rotation on said elongate portion, said knob comprising a first circular portion having its inside surface threaded and a second circular portion fitting inside said first circular portion and having its outside surface threaded to mesh with the threads on the inside surface of said first circular portion whereby when said first circular portion is rotated, said second circular portion moves longitudinally and the means for allowing articulation of the fastener applying head at any rotational position of the elongate portion comprises a connecting member having its distal end attached to said member and its proximal end attached to said second circular portion to allow rotation of said member with respect to said second circular portion and movement of said member longitudinally with the longitudinal movement of said second circular portion.

Claim 23

An instrument according to any preceding claim, wherein the fastener applying head is pivotally attached to the distal end of said elongate portion.

Claim 24

An instrument according to any preceding claim, wherein said articulating means is attached to said fastener applying head distally of said hinged or pivoted attachment.

Claim 25

An instrument according to any preceding claim wherein the instrument is a fastener applier for applying surgical fasteners to vessels to ligate a vessel.

Claim 26

An instrument according to any of claims 1 to 8, wherein the means for applying a surgical fastener is a pair of jaws for holding the fastener therebetween.

Claim 27

An instrument according to any of claims 1 to 7, further comprising means for storing a plurality of fasteners in said instrument.

Claim 28

An instrument according to any preceding claim, wherein a plurality of surgical fasteners are stored in said elongate portion.

Claim 29

An instrument according to any preceding claim, wherein the actuator means comprises a single trigger for actuating the applying means in the form of a jaw closure mechanism to close a fastener positioned in said applying means and for actuating the advancing means to advance a fastener to the applying means.