Double fire stapling

This application is a continuation of U.S. patent application Ser. No. 14/927,675, filed Oct. 30, 2015, which claims the benefit of and priority to U.S. Provisional Patent Application Ser. No. 62/119,354, filed Feb. 23, 2015, the entire disclosure of which is incorporated by reference herein.

The present disclosure relates to surgical stapling apparatus, devices and/or systems for performing endoscopic surgical procedures and methods of use thereof.

Surgical stapling apparatus that clamp, cut and/or staple tissue between opposing jaw structure are well known in the art. Such surgical stapling apparatus can include loading units with a tool assembly having two elongated jaw members used to capture or clamp tissue. One of the two jaw members usually carries a staple cartridge that houses a plurality of staples while the other of the two jaw members has an anvil for forming the staples as the staples are driven from the staple cartridge. Generally, a stapling operation is effectuated by a cam bar, a drive sled or other similar mechanism having a cam member that travels longitudinally through channels defined in the staple cartridge and acts upon staple pushers in the channels to sequentially eject the staples from the staple cartridge.

During endoscopic or laparoscopic procedures in which surgery is performed through small incisions or through narrow cannulas inserted through the small incisions in the skin, replacement of the staple cartridge or the loading unit, for example, after firing, requires removal of the surgical stapling device from the incision or cannula, replacement of the staple cartridge and/or loading unit and reinsertion of the surgical stapling device into the incision or cannula.

It would be advantageous to provide a staple cartridge or loading unit that is capable of being fired a plurality of times before replacement of the staple cartridge or loading unit is required.

Accordingly, the present disclosure is directed to a surgical stapling apparatus for use during laparoscopic and/or endoscopic surgical procedures that can be employed to provide multiple firings of the surgical stapling apparatus without requiring removal of the surgical stapling apparatus from the incision/cannula. In particular, the present disclosure is directed to a tool assembly, loading unit, and/or a surgical stapling apparatus that includes a firing cam assembly with one or more firing cams. The firing cam assembly is positioned to repeatedly move longitudinally through a staple cartridge to effectuate multiple firings with each firing cam during longitudinal translations of the firing cam assembly from a proximal end to a distal end of the staple cartridge. The firing cam assembly may include a knife bar configured to cut tissue as the firing cam assembly longitudinally translates through the staple cartridge. Advantageously, the firing cam assembly can be fired multiple times without removing the surgical stapling apparatus from an in vivo work space before the staple cartridge and/or the loading unit would require changing/reload, greatly reducing time to complete the in vivo surgical procedure.

In one aspect, the surgical stapling device of the present disclosure includes a housing, a shaft that extends distally from the housing, and a tool assembly supported on the shaft. The tool assembly may include a cartridge assembly, an anvil assembly, and a first firing cam.

The cartridge assembly has a cartridge body that may define a tissue contact surface and a plurality of rows of retention slots. Each retention slot of the plurality of rows of retention slots supports a staple therein and defines an opening on the tissue contact surface. The cartridge body defines a first firing channel and a second firing channel. The first firing channel is associated with a first row of staples and the second firing channel associated with a second row of staples.

The anvil assembly is supported adjacent the cartridge assembly. The anvil assembly and the cartridge assembly are movable between open and closed positions in relation to each other.

The first firing cam is positioned within the first firing channel of the cartridge body. The first firing cam is configured to translate through the first firing channel during a first axial translation of the first firing cam to fire the first row of staples. The first firing cam is biased to move into the second firing channel of the cartridge body upon retraction of the first firing cam after the first axial translation such that the first firing cam moves to a position to translate through the second firing channel upon a second axial translation of the first firing cam to fire the second row of staples.

The first firing cam may be engaged with a first T-bar. The first T-bar may be positioned to maintain the first firing cam in registration with the first firing channel when the first firing cam and the first T-bar are in fully retracted positions.

In some embodiments, the tool assembly includes a second firing cam and the cartridge body defines third and fourth firing channels. The second firing cam is configured to translate through the third firing channel during the first axial translation to fire a third row of staples. The second firing cam is biased to move into the fourth firing channel upon retraction of the second firing cam after the first axial translation such that the second firing cam is positioned to translate through the fourth firing channel upon the second axial translation to fire a fourth row of staples.

The second firing cam may be engaged with a second T-bar. The second T-bar may be positioned to maintain the second firing cam in registration with the third firing channel when the second firing cam and the second T-bar are in fully retracted positions.

The first and second T-bars are configured to move along the cartridge body in response to movement of the first and second firing cams from a proximal position to a distal position during the first axial translation. The first and second T-bars are retained in the distal position as the first and firing cams are retracted to the proximal position after the first axial translation. In the distal position, the first and second T-bars are positioned to enable movement of the first and second firing cams. The first and second firing cams may be pivotally coupled together and positioned to pivot relative to one another.

In certain embodiments, the cartridge body defines a T-bar recess. The first and second T-bars are positioned within the T-bar recess while the first and second T-bars are disposed in the distal position.

In some embodiments, the cartridge body includes a first ramp and a second ramp. The first ramp is positioned to align the first firing cam with one of the first and second firing channels. The second ramp is positioned to align the second firing cam with one of the third and fourth firing channels.

The tool assembly may further include a knife bar that supports a blade at a distal end of the knife bar. The cartridge body defines a knife channel. The knife bar is distally movable through the knife channel as the first firing cam translates through the first and second firing channels.

In some embodiments, the first firing cam includes a cam surface positioned to engage a plurality of pusher members. Each of the plurality of pusher members is disposed within one or more of the retention slots and is configured to support one or more of the staples. The cam surface of the first firing cam may extend distally beyond the blade of the knife bar.

In certain embodiments, the cartridge body defines a knife channel therethrough. Two of the first, second, third, and fourth firing channels may be disposed on one side of the knife channel and a remaining two of the first, second, third and fourth firing channels are disposed on another side of the knife channel.

Other aspects, features, and advantages will be apparent from the description, the drawings, and the claims that follow.

The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate embodiments of the disclosure and, together with a general description of the disclosure given above, and the detailed description of the embodiment(s) given below, serve to explain the principles of the disclosure, wherein:

FIG. 1A is a perspective view of a surgical stapling apparatus in accordance with the principles of the present disclosure;

FIG. 1B is a perspective view, with parts separated, of the surgical stapling apparatus of FIG. 1A ;

FIGS. 2 and 3 are side, perspective views of a loading unit of the surgical stapling apparatus of FIG. 1A ;

FIG. 4 is a perspective view, with parts separated, of the loading unit of FIGS. 2 and 3 ;

FIG. 5 is a perspective view, with parts separated, of a cartridge assembly of the loading unit of FIGS. 2-4 ;

FIG. 6 is a perspective view of a firing cam assembly of the loading unit of FIGS. 2-4 ;

FIG. 7 is an enlarged perspective view of an indicated area of detail shown in FIG. 6 ,

FIG. 8 is a top view of the firing cam assembly of FIG. 6 ;

FIG. 9 is an enlarged view of an indicated area of detail shown in FIG. 8 ;

FIG. 10 is a perspective view, with parts separated, of the firing cam assembly of FIG. 6 ;

FIG. 11 is a top, perspective view of a staple pusher of the cartridge assembly of FIG. 5 ;

FIG. 12 is bottom, perspective view of the staple pusher of FIG. 11 ;

FIG. 13 is a top, perspective view of a pair of staple pushers of the cartridge assembly of FIG. 5 positioned together, each of the pair of staple pushers supporting a pair of staples;

FIG. 14 is an enlarged, cross-sectional view of the cartridge assembly taken along section line 14 - 14 illustrated in FIG. 2 ;

FIG. 15 is a bottom view of the cartridge assembly with T-bars of the cartridge assembly shown in a first position;

FIG. 16 is a bottom, perspective view of the cartridge assembly shown in FIG. 15 ;

FIG. 17 is an enlarged, bottom, perspective view of portions of the cartridge assembly of FIGS. 15 and 16 ;

FIG. 18 is an enlarged, bottom view of a proximal portion of the cartridge assembly with portions of the cartridge assembly removed and/or shown in phantom for clarity, the firing assembly shown in a first proximal position;

FIG. 19 is a side, cross-sectional view of the cartridge assembly with the firing assembly shown in the first proximal position and the T-bars shown in the first position;

FIG. 20 is an enlarged, cross-sectional view of a distal portion of the cartridge assembly with the firing assembly shown in a first distal position and with the T-bars shown in a second position;

FIG. 21 is a bottom, perspective view of portions of the cartridge assembly with the T-bars shown in the second position; and

FIGS. 22 and 23 are bottom views of the proximal portion of the cartridge assembly showing the firing assembly progressing to a second proximal position.

Embodiments of the presently disclosed surgical stapling apparatus are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “distal” refers to that portion of the surgical stapling apparatus, or component(s) thereof, that is farther from the clinician, while the term “proximal” refers to that portion of the surgical stapling apparatus, or component(s) thereof, that is closer to the clinician.

FIG. 1A illustrates one embodiment of the presently disclosed surgical stapling apparatus 10 . Briefly, surgical stapling apparatus 10 includes a handle assembly 12 , an elongated body 14 and a loading unit 100 , which may be disposable and/or include one or more disposable components. Elongated body 14 and loading unit 100 define a longitudinal axis “X 1 -X 1 ” that extends longitudinally along elongated body 14 . With reference also to FIGS. 1B, 2 , and 3 , loading unit 100 is releasably secured to a distal end of elongated body 14 and includes a tool assembly 110 . Tool assembly 110 includes a cartridge assembly 130 that houses a plurality of staples and an anvil assembly 120 that is pivotally secured to loading unit 100 by a pair of pivot pins 128 a , 128 b ( FIG. 4 ) that define a pivot axis “X 2 -X 2 .” Anvil assembly 120 is configured to pivot about pivot axis “X 2 -X 2 ” in relation to cartridge assembly 130 , as indicated by arrow “A,” between spaced and approximated positions.

Handle assembly 12 includes a stationary handle 16 , a movable handle 18 and a barrel portion 20 . A rotatable member 22 is rotatably supported on a distal end of barrel position 20 . Rotatable member 22 supports a proximal end of elongated body 14 and is rotatable in relation to barrel portion 20 of handle assembly 12 , as indicated by arrow “B,” to effectuate rotation of elongated body 14 and tool assembly 110 about longitudinal axis “X 1 -X 1 ” in relation to handle assembly 12 . Rotatable member 22 supports an articulation lever 24 , and barrel portion 20 supports a retraction member 26 and a firing release button 28 . Handle assembly 12 is described in detail in, for example, U.S. Pat. No. 8,070,033 to Milliman et al. (“the '033 patent”), the entire contents of which are incorporated herein by reference.

Elongated body 14 supports a control rod 15 ( FIG. 1B ) that is coupled to a proximal end of a firing cam assembly 140 ( FIG. 4 ) of loading unit 100 as described in further detail below. A release switch 15 a ( FIG. 1B ) is provided on rotatable member 22 of handle assembly 12 to facilitate disengagement of loading unit 100 from elongated body 14 .

Referring to FIG. 4 , loading unit 100 includes a proximal body portion 101 having an upper housing half 102 that is adapted to releasably engage a distal end of elongated body 14 ( FIGS. 1A and 1B ) of surgical stapling apparatus 10 and a lower housing half 104 that couples to upper housing half 102 of proximal body portion 101 . A distal end of upper housing half 102 defines a recess 102 a that receives a first end of a first coupling member 103 a and distal end of lower housing half 104 defines a recess 104 a that receives a first end of a second coupling member 103 b . Each coupling member 103 a , 103 b defines an opening 1032 therethrough. Upper housing half 102 defines a channel 102 c and lower housing half 104 defines a channel 104 b . Together, channels 102 c , 104 b slidably receive firing cam assembly 140 , as will be described in further detail below.

Upper housing half 102 has a proximal end that includes engagement nubs 102 b . Engagement nubs 102 b are positioned and configured to releasably engage a distal end of elongated body 14 of handle assembly 12 ( FIG. 1 ) in a bayonet-type coupling arrangement to secure loading unit 100 to elongated body 14 . This structure is similar to that described in U.S. Pat. No. 7,780,055 to Scirica et al. (“the'055 patent”) and U.S. Pat. No. 7,143,924 to Scirica et al. (“the'924 patent”), the entire contents of each of which are incorporated by reference herein.

A pair of blow out plate assemblies 105 a , 105 b is positioned adjacent distal ends of upper and lower housing halves 102 , 104 to prevent outward buckling and/or bulging of firing cam assembly 140 during articulation and firing of tool assembly 110 . The configuration of the blow out plate assemblies is described in detail, for example, in International Publication No. WO/2003/030743, the entire contents of which are incorporated by reference herein.

A locking member 106 is rotatably supported about proximal body portion 101 . Locking member 106 is movable from a first position engaged with firing cam assembly 140 to axially lock firing cam assembly 140 to a second position, unlocking firing cam assembly 140 to enable axial movement of firing cam assembly 140 . Locking member 106 is movable from the first position to the second position in response to attachment of loading unit 100 to surgical stapling apparatus 10 . For a more detailed description of the construction and operation of locking member 106 , reference can be made to the '924 patent, which has been incorporated by reference herein as noted above.

A mounting assembly 107 includes upper and lower mounting portions 107 a , 107 b pivotally secured to a distal end of proximal body portion 101 and configured to engage and support a proximal end of anvil and cartridge assemblies 120 , 130 such that pivotal movement of mounting assembly 107 in relation to proximal body portion 101 effectuates articulation of tool assembly 110 in relation to proximal body portion 101 . Upper mounting portion 107 a includes a central pin 1074 a that extends upwardly therefrom and lower mounting portion 107 b includes a central pin 1074 b ( FIG. 4 ) that extends downwardly therefrom. Central pins 1074 a , 1074 b of upper and lower mounting portions 107 a , 107 b are received within respective openings 1032 of first and second coupling members 103 a , 103 b to pivotably couple mounting assembly 107 to proximal body portion 101 . Upper mounting portion 107 a further includes a pin 1076 that is offset from the longitudinal axis “X 1 -X 1 ” of loading unit 100 and lower mounting portion 107 b defines pin channels 1078 . Both will be described in further detail below.

An articulation link 108 is slidably positioned between upper and lower housing halves 102 , 104 and defines an opening 108 a . Opening 108 a of articulation link 108 receives pin 1076 of upper mounting portion 107 a to facilitate articulation of tool assembly 110 about pins 1074 a and 1074 b in relation to proximal body portion 101 of loading unit 100 . Pivoting movement of articulation lever 24 , as indicated by arrow “CC,” causes axial movement of articulation link 108 along axis “X 1 -X 1 ” to pivot/articulate mounting assembly 107 , as indicated by arrow “C,” about an axis “X 3 -X 3 ” ( FIG. 1A ) of proximal body portion 101 that is transverse to axes “X 1 -X 1 ” and “X 2 -X 2 ” ( FIG. 1A ). For a more detailed description of the construction and operation of articulation link 108 and mounting assembly 107 reference can be made to the '033 patent, which has been incorporated by reference herein as noted above.

Pins 109 a , 109 b are received through openings 1072 defined in upper and lower mounting portions 107 a , 107 b , to couple upper and lower mounting portions 107 a , 107 b together.

With continued reference to FIG. 4 , as discussed above, tool assembly 110 includes anvil assembly 120 and cartridge assembly 130 that are positioned to move in relation to each other between unapproximated and approximated positions. Anvil assembly 120 is pivotably secured to mounting assembly 107 by pivot pins 128 a , 128 b to enable pivotal movement of anvil assembly 120 relative to mounting assembly 107 and cartridge assembly 130 . Lower mounting portion 107 b includes a distal portion that is secured within support plate 132 of cartridge assembly 130 by pivot pins 128 a , 128 b to fixedly secure cartridge assembly 130 to mounting assembly 107 .

Anvil assembly 120 includes an anvil body 122 and an anvil plate 124 that is secured to an underside of anvil body 122 . Anvil plate 124 includes a tissue contact surface 124 a that defines a plurality of staple forming depressions 124 b ( FIG. 20 ). A proximal end of anvil body 122 includes a bracket 126 that defines apertures 126 a therethrough.

Turning now to FIG. 5 and FIG. 14 , cartridge assembly 130 includes a support plate 132 , a cartridge body 134 , a plurality of staple pushers 136 including staple pushers 136 a , 136 b , 136 c , 136 d , a pair of T-bars 138 a , 138 b , and a plurality of staples “S.”

Support plate 132 includes sidewalls 132 a that define a plurality of windows 132 b and pin channels 132 c therethrough. An inner surface 132 d of support plate 132 defines a channel 132 e that extends longitudinally along support plate 132 and is adapted to receive cartridge body 134 .

Cartridge body 134 includes a tissue contact surface 134 a that defines a plurality of staple retention pockets 134 b arranged in a plurality of rows “R 1 ”-“R 8 ” extending longitudinally along tissue contact surface 134 a . Cartridge body 134 further defines a knife slot 134 d that extends longitudinally along tissue contact surface 134 a . A plurality of clips 134 e extends from a side surface of cartridge body 134 . Clips 134 e of cartridge body 134 are received in the plurality of windows 132 b of support plate 132 to secure cartridge body 134 within channel 132 e of support plate 132 by, for example, snap-fit connection. Other forms of connection can be used alternatively and/or additionally to clips 134 e and windows 132 b . A proximal end of cartridge body 134 defines elongated T-bar channels 134 f , 134 g that extend through tissue contact surface 134 a and a pair of spring channels 134 h , 134 i . Elongated T-bar channels 134 f , 134 g slidably receive T-bars 138 a , 138 b therein to enable and limit axial movement of T-bars 138 a , 138 b in relation to cartridge body 134 . Spring channels 134 h , 134 i receive a pair of leaf springs 135 a , 135 b therein that are adapted to bias anvil assembly 120 to an unapproximated/open position relative to cartridge assembly 130 when firing cam assembly 140 is in a proximal position as described in greater detail below.

Referring also to FIG. 4 , pins 128 a , 128 b are received within apertures 126 a of anvil body 122 , pin channels 132 c of support plate 132 , and pin channels 1078 of lower mounting portion 107 b to couple mounting assembly 107 , anvil assembly 120 , and cartridge assembly 130 together. As described above, pins 128 a , 128 b enable anvil assembly 120 to pivot about pivot axis “X 2 -X 2 ” ( FIG. 1A ) relative to cartridge assembly 130 to position anvil and cartridge assemblies 120 , 130 between unapproximated and approximated positions.

Each of the T-bars 138 a , 138 b includes an elongated shaft 1384 and a post 1382 that extends upwardly from elongated shaft 1384 . Elongated shaft 1384 defines proximal and distal elongated channels 1384 a , 1384 b and supports a distally located cross member 1386 . Cross member 1386 extends outwardly beyond sidewalls of elongated shaft 1384 in a direction transverse to longitudinal axis “X 1 -X 1 ” of elongated body 14 ( FIG. 1A ) to define a pair of abutments 1386 a , 1386 b.

Referring now to FIGS. 6-10 , firing cam assembly 140 includes a first or right hand firing cam 142 , a second or left hand firing cam 144 , and a knife bar 146 supporting a drive beam 148 . Proximal ends of right and left hand firing cams 142 , 144 and knife bar 146 are coupled together using any suitable fastening technique such as tack welding ( FIG. 9 ), for example. Right and left hand firing cams 142 , 144 are elongated, resilient, and can flex outwardly from knife bar 146 as indicated by arrows “D” and “E” in FIG. 8 .

Right and left hand firing cams 142 , 144 are substantially identical and therefore, in the interest of brevity, only right hand firing cam 142 is described in detail. A proximal end of right hand firing cam 142 includes first and second spaced arms 142 a , 142 b that define an opening 142 c . First and second arms 142 a , 142 b extend distally from the proximal end and are joined to an elongated shaft portion 142 d . Elongated shaft 142 d extends distally from first and second arms 142 a , 142 b to a driver head 142 e . Right and left hand firing cams 142 , 144 are configured to have a narrow profile, for example, to enable smooth translation through firing channels 137 a - 137 d defined in cartridge body 134 .

As seen in FIG. 7 , a bottom surface of driver head 142 e of each of right and left hand firing cams 142 , 144 , respectively, includes a rib 142 f and a top surface of driver head 142 e defines a cam surface 142 g . A distal end of rib 142 f defines a shoulder 142 h that is positioned beneath a tip portion 142 i of cam surface 142 g.

With reference to FIGS. 9 and 10 , knife bar 146 includes resilient bars 146 a , 146 b , 146 c , 146 d that are substantially identical. A proximal end of each bar of the plurality of bars 146 a , 146 b , 146 c , 146 d includes first and second spaced arms 1462 , 1464 that define an opening 1466 open at its proximal end. Opening 1466 is positioned to receive control rod 15 of surgical stapling apparatus 10 when loading unit 100 is coupled to elongated body 14 of surgical stapling apparatus 10 . First and second arms 1462 , 1464 are secured together by one or more posts 1468 a , 1468 b.

With reference again to FIG. 7 , drive beam 148 is secured to a distal end of knife bar 146 and has an I-shaped cross-sectional profile. Drive beam 148 includes a lower retention foot 148 a , an upper retention foot 148 b , and a vertically-oriented support strut 148 c that couples lower and upper retention feet 148 a , 148 b together. Vertically-oriented support strut 148 c supports a blade 148 d with a sharpened edge adapted to sever tissue. Drive beam 148 is positioned between right and left hand firing cams 142 , 144 and disposed proximal of driver heads 142 e of right and left hand firing cams 142 , 144 .

With reference to FIGS. 11-14 , staple pushers 136 are substantially similar in that each staple pusher of the plurality of staple pushers 136 includes a first pusher plate 1362 , a second pusher plate 1364 , and a cam member 1366 that connects first and second pusher plates 1362 , 1364 together. First and second pusher plates 1362 , 1364 are longitudinally offset and each defines a staple support channel 1363 that is configured to support a backspan of one of the staples “S.” Cam member 1366 includes a pusher ramp 1368 that is adapted to engage cam surface 142 g of one of right and left hand firing cam members 142 , 144 .

Staple pushers 136 are arranged in cartridge body 134 on each side of knife slot 134 d such that staple pushers 136 are disposed in registration with corresponding rows of staple retaining pockets 134 b of cartridge body 134 (e.g., rows “R 1 ”-“R 8 ” seen in FIG. 5 ) (four rows on either side of knife slot 134 d ). Each staple pusher 136 is associated with two of the four rows on one of the two sides of knife slot 134 d of cartridge body 134 .

Staple pushers from adjacent rows of staple pushers within cartridge body 134 are disposed in a nested relationship to support staples “S” in four adjacent rows (e.g., rows “R 1 ”-“R 4 ”) on each side of knife slot 134 d . In the nested relationship, staple pushers 136 a , 136 b ( FIG. 13 ) include cam members 1366 a , 1366 b disposed in mirrored relationship such that first pusher plate 1362 of staple pusher 136 a is longitudinally aligned with second pusher plate 1364 of staple pusher 136 b , and second pusher plate 1364 of staple pusher 136 a is longitudinally aligned with first pusher plate 1362 of staple pusher 136 b.

Referring to FIGS. 15-18 , cartridge body 134 further defines a plurality of firing channels 137 a - 137 d . Firing channels 137 a and 137 c are adapted to receive right hand firing cam 142 and firing channels 137 b , 137 d are adapted to receive left hand firing cam 144 . Firing assembly 140 is preloaded within cartridge body 134 in a first proximal position. In the first proximal position, resilient right hand firing cam 142 is disposed in an outwardly deformed orientation against its natural bias with drive head 142 e of right hand firing cam 142 positioned within firing channel 137 a . Also in the first proximal position, left hand firing cam 144 is disposed in an inwardly deformed orientation against its natural bias with drive head 142 e of left hand firing cam 144 positioned within firing channel 137 d.

T-bars 138 a , 138 b are movable from a proximal or retracted position within cartridge body 134 to a distal or advanced position. In the proximal position, the proximal end of T-bars 138 a and 138 b are positioned to retain right and left hand firing cams 142 and 144 , respectively, within firing channels 137 a and 137 d , respectively. More specifically, side surfaces of T-bars 138 a , 138 b engage side surfaces of right and left hand firing cams 142 , 144 to prevent right and left hand firing cams 142 , 144 from moving toward their non-deformed orientation when right and left hand firing cams 142 , 144 and T-bars 138 a , 138 b are fully retracted (see FIGS. 22-23 ).

Cartridge body 134 also includes ramps 139 that are positioned to engage right and left hand firing cams 142 , 144 during first and/or second axial translations of firing cam assembly 140 within cartridge body 134 , as described in greater detail below. The plurality of ramps 139 includes a first ramp 139 a that is configured to direct drive head 142 e of right hand firing cam 142 into firing channel 137 c so that drive head 142 e of right hand firing cam 142 is positioned to axially translate along firing channel 137 c . A second ramp 139 b of the plurality of ramps 139 directs drive head 142 e of left hand firing cam 144 within firing channel 137 b so that drive head 142 e of left hand firing cam 144 is positioned to axially translate along firing channel 137 b . First ramp 139 a is shown with a rounded bump and second ramp 139 b is shown with a flat, shallow slope, but one or both of these ramps 139 a , 139 b may include any suitable shape and/or dimension to facilitate movement of right and left hand firing cams 142 , 144 into the appropriate firing channels.

Cartridge body 134 includes proximal and distal T-bar engagement posts 131 a , 131 b and defines a T-bar recess 133 dimensioned to receive a distal portion of T-bars 138 a , 139 b . Proximal and distal T-bar engagement posts 131 a , 131 b are received within proximal and distal elongated channels 1384 a , 1384 b of T-bars 138 a , 138 b , respectively, to maintain alignment of T-bars 138 a , 138 b as T-bars 138 a , 138 b translate relative to cartridge body 134 , as described in greater detail below. Engagement surfaces 133 a ( FIG. 15 ) extend from cartridge body 134 into T-bar recess 133 . Engagement surfaces 133 a are adapted to frictionally engage cross members 1386 of T-bars 138 a , 138 b to maintain T-bars 138 a , 138 b in an advanced position relative to cartridge body 134 when T-bars 138 a , 138 b are received within T-bar recess 133 . The pair of engagement surfaces 133 a can have any suitable shape/dimension (e.g., rounded, tapered, etc.) and/or may include surface texturing (e.g., bumps knurling, ribs, etc.).

In use, as illustrated in FIGS. 1A and 18-23 , firing cam assembly 140 is actuated (e.g., via pivotal retraction of movable handle 18 of handle assembly 12 , as indicated by arrow “AA”) to advance drive beam 148 and right and left hand firing cams 142 , 144 distally through cartridge body 134 as indicated by arrow “F.” As drive beam 148 advances distally through cartridge body 134 , upper and lower retention feet 148 a , 148 b are received within channels (not shown) defined within anvil and cartridge assemblies 120 , 130 to approximate anvil and cartridge assemblies 120 , 130 while blade 148 d ( FIG. 7 ) advances through knife slot 134 d to severe tissue grasped between anvil and cartridge assemblies 120 , 130 . With drive beam 148 advancing through cartridge body 134 , right and left hand firing cams 142 , 144 simultaneously distally translate through firing channels 137 a , 137 d , respectively, so that cam surfaces 142 g of right and left hand firing cams 142 , 144 engage pusher ramps 1368 of the plurality of staple pushers 136 during a first axial translation of firing cam assembly 140 to fire staples “S” of rows “R 2 ,” “R 4 ,” “R 6 ,” and “R 8 ” and to form the fired staples within corresponding staple forming depressions 124 b of anvil assembly 120 .

Just before right and left hand firing cams 142 , 144 reach a distal-most position, shoulders 142 h of drive heads 142 e of right and left hand firing cams 142 , 144 engage one of the pair of abutments 1386 a , 1386 b of cross members 1386 of T-bars 138 a , 138 b , respectively. With proximal and distal T-bar engagement posts 131 a , 131 b of cartridge body 134 maintaining lateral alignment of T-bars 138 a , 138 b within cartridge body 134 , posts 1382 of T-bars 138 a , 138 b distally translate through T-bar channels 134 f , 134 g of cartridge body 134 as right and left hand firing cams 138 a , 138 b engage and drive first and second T-bars 138 a , 138 b distally to a distal-most position relative to cartridge body 134 . In the distal-most position, the distal portions of T-bars 138 a , 138 b are received within T-bar recess 133 of cartridge body 134 and maintained therein via frictional engagement with the pair of engagement surfaces 133 a of cartridge body 134 (see FIG. 21 ).

Referring to FIGS. 22-23 , with T-bars 138 a , 138 b fixed in the distal-most position, firing cam assembly 140 can then be retracted proximally to a second proximal position, as indicated by arrows “G,” (e.g., via retraction of retraction member 26 of handle assembly 12 in the proximal direction, as indicated by arrow “AAA” in FIG. 1A ). Retraction of firing cam assembly 140 moves drive beam 138 proximally and unapproximates anvil and cartridge assemblies 120 , 130 . When firing cam assembly 140 is retracted to its second proximal position, drive heads 142 e of right and left hand firing cams 142 , 144 are disposed proximal to proximal ends of T-bars 138 a , 138 b . Since drive heads 142 e no longer engage the proximal end of T-bars 138 a , 138 b , drive heads 142 e of right and left hand firing cams 142 , 144 move/pivot toward their natural, unflexed orientation, as indicated by arrows “H” and springs 135 a , 135 b ( FIG. 5 ) spring bias anvil assembly 120 open. In the natural, unflexed orientations of right and left hand firing cams 142 , 144 , drive heads 142 e of right and left hand firing cams 142 , 144 are aligned with firing channels 137 b , 137 c of cartridge body 134 , respectively. First ramp 139 a of cartridge body 134 directs right hand firing cam 142 into firing channel 137 c of cartridge body 134 and second ramp 139 b directs left hand firing cam 144 into firing channel 137 b . Firing cam assembly 140 can then again be distally advanced, as indicated by arrow “F,” to fire loading unit 100 a second time. Surgical stapling apparatus 10 can be released from tissue after the first firing and re-positioned to clamp tissue at a different location before the second firing.

During a second axial translation of firing cam assembly 140 , drive beam 148 again advances distally through cartridge body 134 so that upper and lower retention feet 148 a , 148 b of drive beam 148 approximate anvil and cartridge assemblies 120 , 130 . With drive beam 148 advancing distally through cartridge body 134 , right and left hand firing cams 142 , 144 simultaneously distally translate through firing channels 137 c , 137 b , respectively, so that cam surfaces 142 g of right and left hand firing cams 142 , 144 engage pusher ramps 1368 of the plurality of staple pushers 136 during a first axial translation of firing cam assembly 140 to fire staples “S” of rows “R 1 ,” “R 3 ,” “R 5 ,” and “R 7 ” and to form the fired staples within corresponding staple forming depressions 124 b of anvil assembly 120 .

Loading unit 100 and/or cartridge assembly 130 can be removed and/or replaced with a new loading unit 100 and/or a new cartridge assembly 130 as desired.

Persons skilled in the art will understand that the structures and methods specifically described herein and shown in the accompanying figures are non-limiting exemplary embodiments, and that the description, disclosure, and figures should be construed merely as exemplary of particular embodiments. It is to be understood, therefore, that the present disclosure is not limited to the precise embodiments described, and that various other changes and modifications may be effected by one skilled in the art without departing from the scope or spirit of the disclosure. Additionally, the elements and features shown or described in connection with certain embodiments may be combined with the elements and features of certain other embodiments without departing from the scope of the present disclosure, and that such modifications and variations are also included within the scope of the present disclosure. Accordingly, the subject matter of the present disclosure is not limited by what has been particularly shown and described.