MXPA06001878A - Surgical instrument incorporating a fluid transfer controlled articulation bladder and method of manufacture - Google Patents

Abstract

A surgical instrument particularly suited to endoscopic use articulates an end effector by including a fluid transfer articulation mechanism that is proximally controlled. A fluid control, which is attached to a proximal portion, transfers fluid through the elongate shaft through a first fluid passage to a first fluid actuator that responds by articulating an articulation joint. Two opposing fluid actuators may respond to differential fluid transfer to effect articulation. Thereby, design flexibility is achieved by avoiding the design constraints of transferring a mechanical motion through the tight confines of the elongate shaft sufficient to effect articulation.

Description

SURGICAL INSTRUMENT THAT INCORPORATES AN ARTICULATION MECHANISM CONTROLLED BY TRANSFER OF FLUID FIELD OF THE INVENTION In general, the present invention relates to surgical instruments that are suitable for endoscopically inserting an end effector (e.g., endocortator, fastener, cutter, stapler, clip applier, access device, drug therapy delivery device / gene , and energy device using ultrasound, RF, laser, etc.) in a surgical site, and more particularly to such surgical instruments with an articulating arrow.

BACKGROUND OF THE INVENTION Endoscopic surgical instruments are often preferred over traditional open surgical devices, since a smaller incision tends to reduce postoperative recovery time and complications. Consequently, there has been a significant development in many endoscopic surgical instruments that are suitable for the precise placement of a distant end effector at a desired surgical site, by means of a trocar cannula. These distal end effectors couple the tissue in various ways to achieve a diagnostic or therapeutic effect (e.g., endocortator, fastener, cutter, stapler, clip applier, access device, drug / gene therapy delivery device, and device). of energy using ultrasound, RF, laser, etc.). The placement of the end effector is restricted by the trocar.

Generally these endoscopic surgical instruments include a long arrow between the end effector and a handle portion manipulated by the clinician. This long arrow allows insertion at a desired depth and rotation about the longitudinal axis of the arrow, thus placing the end effector to a certain degree. With the judicious placement of the trocar and the use of grippers, for example, by means of another trocar, this amount of placement is often sufficient. The stapling and separation surgical instruments such as those described in the US patent. No. 5,465,895, are an example of an endoscopic surgical instrument that successfully places an end effector by insertion and rotation. More recently, the US patent. Serial No. 10 / 443,617, "Surgical Stapling Instrument Incorporating An E-Beam Firing Mechanism," by Shelton IV et al., Filed May 20, 2003, which is incorporated herein by reference in its entirety, discloses a bar trigger as "E-bar" to separate tissue and drive staples. Some of the additional advantages include affirmatively spacing the end effector jaws, or more specifically a staple applicator assembly, even if much or little tissue is clamped for optimal staple formation. In addition, the firing bar in E couples the end effector and the staple cartridge in a way that allows incorporating several beneficial closures. Depending on the nature of the operation, it may be convenient to further adjust the placement of the end effector of an endoscopic surgical instrument. In particular, it is often desirable to orient the end effector on an axis transverse to the longitudinal axis of the arrow of the instrument. The transverse movement of the end effector with respect to the arrow of the instrument is conventionally referred to as "articulation". This is normally performed by a pivot joint (or joint) that is placed on the extended shaft just next to the staple applicator assembly. This allows the surgeon to articulate the staple applicator assembly remotely on either side for better surgical placement of the staple line, and easier manipulation and orientation of tissue. This articulated positioning allows the clinician to attach tissue more easily in some cases, such as behind an organ. Furthermore, the articulated positioning advantageously allows placing an endoscope behind the end effector without being blocked by the arrow of the instrument. Proposals for articulating a surgical stapling and detaching instrument tend to be complicated by the integrating control of the joint along with the end effector closing control to clamp the tissue and trigger the end effector (this is, staple and separate) within the small diameter restrictions of an endoscopic instrument.

Generally, the three control movements are transferred through the arrow as longitudinal translations. For example, the US patent. No. 5,673,840, discloses an articulation mechanism of the accordion type ("flexible neck") that is articulated by selectively retracting one of two connecting bars through the arrow of the instrument, each bar offset respectively on opposite sides of the center line of the instrument. arrow. The connector bars graduating a series of discontinuous positions. Another example of longitudinal control of an articulation mechanism is the US patent. No. 5,865,361, which includes an off-center articulation link of a levator pivot, in such a way that by pushing or pulling the longitudinal translation of the articulation link, the articulation to a respective side is effected. Similarly, the US patent. No. 5,797,537, discloses a similar rod passing through the arrow to effect articulation. In the co-pending patent application of E.U. serial number / 615,973, entitled "Surgical Instrument Incorporating An Articulation Mechanism Having Rotation About The Longitudinal Axis", by Frederick E. Shelton IV and others, of the same attorney, whose description is hereby incorporated by reference in its entirety, a movement is used rotational to transfer the articulation movement as an alternative to a longitudinal movement. Although these mechanically communicated articulation movements have successfully articulated an endoscopic surgical stapling and separation instrument, the development trends pose numerous challenges and barriers to enter the market. The conflicting design objects include an arrow of diameter as small as possible to reduce the size of the surgical opening, but with sufficient force to perform the various movements (for example closing, firing, articulation, rotation, etc.). In addition, transferring sufficient strength without locking or other frictional problems imposes design restrictions that limit desirable characteristics and reliability. Consequently, there is a significant need for an articulating surgical instrument that incorporates an articulation mechanism that employs a joint force that can be incorporated within the narrow limits thereof, without affecting the firing and closing movements.

BRIEF DESCRIPTION OF THE INVENTION The invention overcomes the aforementioned deficiencies and other deficiencies of the prior art, by providing a surgical instrument having an articulating shaft joined between a handle and an end effector, which uses fluid pressure to effect articulation. In one aspect of the invention, a surgical instrument includes a proximal portion that is manipulated externally to a patient to place an elongated arrow attached and an end effector at a desired surgical site within the patient. An articulation joint joins the end effector to the elongated shaft to give more clinical flexibility to reach tissue at a desired angle. A fluid control, which is attached to the proximal portion, transfers fluid through the elongated shaft through a first fluid passage to a first fluid actuator, which responds by articulating the joint joint. With this design flexibility is obtained avoiding the design restrictions of the transfer of a mechanical movement through the narrow limits of the elongated arrow, sufficient to effect the articulation. In another aspect of the invention, a surgical instrument includes a fluid control that differentially transfers fluid through two fluid passages in an elongated shaft, which communicate with opposing fluid actuators cooperating to articulate the joint joint. Thus, actuators operating efficiently and accurately in response to an increase in fluid pressure can be used to articulate the joint joint in one direction, whereby the other fluid actuator is compressed. These and other objects and advantages of the present invention will become apparent from the accompanying drawings and the description thereof.

BRIEF DESCRIPTION OF THE FIGURES The accompanying drawings that are incorporated and constitute a part of this specification illustrate embodiments of the invention and, together with the general description of the invention given above and the detailed description of the modalities given below, serve to explain the principles of the present invention. Figure 1 is a top front perspective view of a stapling and separation surgical instrument shown with an open end effector, or staple applicator assembly, and without the staple cartridge. Figure 2 is a top front perspective view of the surgical stapling and separating instrument of Figure 1, with an articulation mechanism actuated by a fluid actuation control. Figure 3 is a perspective view of disassembled portions of an elongated arrow and the articulation mechanism of the stapling and separation surgical instrument of Figure 1. Figure 4 is a perspective view of disarmed portions of the distal portions of a portion. of the stapling and separation surgical instrument of figure 1, which includes the staple applicator assembly and the articulation mechanism. Figure 5 is a top perspective view of the staple applicator assembly of Figures 1 and 4, without a side half of a staple cartridge for exposing the components driven by a firing movement. Figure 6 is a front perspective view of a portion of the surgical instrument of Figure 1 with a double pivot closure sleeve assembly, and without the end effector to expose a single pivot frame floor hinged by a mechanism of fluid articulation. Figure 7 is a detailed perspective view of an alternative articulation joint of the surgical instrument of Figure 1, showing a double pivot closure sleeve assembly in a proximal position with a single pivot frame floor. Fig. 8 is a bottom right perspective view of spaced apart portions of the alternative hinge joint of Fig. 7, including a double-pivot fixed wall dog bone link and a frame floor incorporating rail guides for a laterally movable member (bar T). Figure 9 is a perspective top left view of separate portions of an alternative articulation joint of the surgical instrument of Figure 1, including an alternative solid wall support plate mechanism, incorporated in a lower double pivot link to hold a firing bar, and includes a laterally movable member guided by rail (bar T). Fig. 10 is a schematic top view of an alternate articulation lock mechanism for the surgical instrument of Fig. 1, without a closure sleeve assembly for exposing a decoupled T-bar for back-loading, for automatic coupling and decoupling of joint locking . Figure 11 is a schematic top view of a further alternative articulation mechanism for the surgical instrument of Figure 1, a spring-loaded zipper on a T-bar with locking functionalities that engage due to the backloading of an end effector. Figure 12 is an alternative T-bar and floor frame incorporating lateral guidance for the surgical instrument of Figure 1. Figure 13 is an additional alternative T-bar and floor frame incorporating lateral guidance for the surgical instrument of Figure 1 Figure 14 is a top left perspective view of disassembled parts of an alternative articulation mechanism, including a double pivot frame assembly and a single pivot closure sleeve assembly for the surgical instrument of Figure 1. Figure 15 is a left lower perspective view of the reciprocating articulation mechanism of Figure 14. Figure 16 is a diagram of a laterally movable fluid articulation mechanism, with the rack and gear segment moving pivotally represented in a state not articulated. Figure 17 is a cross-sectional front elevational view of the fluid articulation mechanism of Figure 16, taken along lines 17-17.

Figure 18 is a diagram of the laterally movable fluid articulation mechanism, with the rack and gear segment moving pivotally shown in an articulated state. Figure 19 is a cross-sectional front elevational view of the fluid articulation mechanism of Figure 18, taken along lines 19-19. Figure 20 is a schematic top view of a surgical instrument articulated by at least one longitudinally movable member that cam laterally with a slide bar, which in turn articulates an end effector. Figure 21 is a schematic top view of the surgical instrument of Figure 20 in an articulated condition. Fig. 22 is a cross-sectional front elevational view of an alternative rotary link mechanical control system for a surgical instrument of Figs. 16 or 20, for laterally moving a T-bar or a sliding bar, respectively, shown in a non-articulated state . Figure 23 is a cross-sectional front elevation view of the alternative rotary link mechanical control system of Figure 22 in an articulated state. Figure 24 is a schematic top view of a surgical instrument having a sliding bar positioned laterally by a pair of bending members, each with a longitudinally adjustable proximal end point, for articulating an end effector. Figure 25 is a schematic top view of the surgical instrument of Figure 24 shown in an articulated state. Figure 26 is a schematic top view of a surgical instrument having an electromagnetic lateral joint control mechanism. Figure 27 is a schematic top view of the surgical instrument of Figure 26 in an articulated condition. Figure 28 is a schematic top view of the surgical instrument, incorporating a source of pressurized fluid and an articulation conirol mechanism. Fig. 29 is a schematic top view of the surgical instrument of Fig. 28 in an articulated condition. Figure 30 is a schematic view of a bag having a side compression spring. . Figure 31 is a transverse front elevation view of a tubular arrow of the surgical instrument, incorporating a pair of collapsible bellows for bags, showing the T-bar in an articulated position and an expanded bellows and a collapsed bellows. Figure 32 is a schematic top view of a surgical instrument incorporating fluid transfer articulation of opposed piston-driven bags in a T-bar that pivotally moves an articulation mechanism.

Figure 33 is a schematic top view of the surgical instrument of Figure 32 in an articulated condition. Figure 34 is a schematic top view of a surgical instrument incorporating fluid transfer articulation of opposed bags, which are driven by laterally movable compressing rollers, on a T-bar that pivotally moves an articulation mechanism. Figure 35 is a schematic top view of the surgical instrument of Figure 35 in an articulated condition. Figure 36 is a schematic top view of a surgical instrument, incorporating a fluid transfer joint of opposite distant portions of a single bag, differentially actuated by a mid-portion compressing roller. Figure 37 is a cross section of the medial portion compressive roller along lines 37-37 of the surgical instrument of Figure 36. Figure 38 is a top schematic view of the surgical instrument of Figure 36 in an articulated condition. Figure 39 is a cross section of the median portion compressive roller along lines 39-39 of the surgical instrument of Figure 38. Figure 40 is a top schematic view of the surgical instrument., which incorporates a fluid transfer joint of opposite distant portions of differentially operating, single-ply bellows compression members. Figure 41 is a schematic top view of the surgical instrument of Figure 40 hinged to the right. Figure 42 is a schematic top view of a surgical instrument, incorporating a fluid transfer joint of a T-bar coupled proximally to a side spool valve, translated by movement of fluid displaced by a piston. Figure 43 is a schematic top view of the surgical instrument of Figure 42 in an articulated condition. Figure 44 is a schematic top view of the surgical instrument, incorporating fluid bores, left and right, projecting distally distant pistons moved by fluid to differentially articulate an end effector around its pivotal joint with an elongated shaft. Figure 45 is a schematic top view of the surgical instrument of Figure 44 in a state hinged to the left, in response to the rotation of an articulation control that differentially and proximally moves proximal pistons in respective fluid perforations. Figure 46 is a schematic top view of a surgical instrument incorporating a diapason-shaped pouch, the distal end of which laterally translates an articulation mechanism in response to fluid displacement with a mid-portion rotary pump.

Fig. 47 is a schematic top view of the surgical instrument of Fig. 46, with the rotary pump driven counterclockwise when viewed from the top, to cause articulation to the right of an end effector. Figure 48 is a schematic top view of a surgical instrument incorporating a fluid transfer articulation mechanism, comprised of a turbine remote from two blades differentially coupled and fluidly with close control of two blades. Figure 49 is a top schematic view of the surgical instrument of Figure 49, with the proximal control of two blades rotated counterclockwise as viewed from above, to cause rotation to the left of an end effector. Fig. 50 is a schematic rear view of a surgical instrument with a fluid transfer hinge mechanism using opposed pistons, to create a rotational movement about a circular fluid passage in an elongated shaft. Fig. 51 is a schematic rear view of the surgical instrument of Fig. 50 with a rotary member moved clockwise due to a lateral control input to the right. Figure 52 is a schematic top view of a surgical instrument of a tiller articulation mechanism positioned with a fluid transfer. Figure 53 is a schematic top view of the surgical instrument of Figure 52 hinged to the right.

DETAILED DESCRIPTION OF THE INVENTION General Examination of the Articulator Arrow Returning to the drawings, where similar numbers denote similar components in all views, Figure 1 depicts a surgical instrument that, more particularly, in the illustrative versions is a surgical stapling and separation instrument, 10, which is capable of implementing the unique benefits of the present invention. In particular, the stapling and separation surgical instrument 10 is sized for insertion, in a non-articulated state as depicted in Figure 1, through a trocar cannula passage, in a surgical site in a patient (not shown). ), to perform a surgical procedure. Once a portion 12 of the instrument is inserted through a cannula passage, an articulation mechanism 14 incorporated in a distal portion of an elongated shaft 16 of the instrument portion 12 can be remotely articulated, as depicted in FIG. Figure 2, by an articulation control 18. An end effector, represented in the illustrative version as a staple applicator assembly, 20, is attached distally to the articulation mechanism 14. In this way, the remote articulation of the articulation mechanism 14 articulates the staple applicator assembly 20 from a longitudinal axis of the elongated shaft 16. Such an angular position may have the advantage of bringing the tissue closer from a desired angle to separate and staple, bringing the tissue clogged in some way by other organs and tissue, or allowing the placement of an endoscope behind the staple applicator assembly 20 and in alignment therewith to confirm placement.

Handle The stapling and separation surgical instrument 10 includes a handle portion, 22, attached proximally to the implement portion 12 to provide placement, articulation, closure and firing movements. The handle portion 22 includes a gun grip, 24, towards which a lock trigger, 26, is pivotally and proximally pulled by the clinician to hold or close the staple applicator assembly 20. A trigger trigger 28 is further removed from the closing trigger 26 and is pulled pivotally by the clinician to cause stapling and separation of the tissue fastened in the staple applicator assembly 20. Subsequently, a closure release button is depressed., 30, to release the clamped fastener 26, and thus the separated and stapled ends of the fastened tissue. The handle portion 22 also includes a rotation knob, 32, engaged for movement with the elongated shaft 16, to rotate the shaft 16 and the staple applicator assembly 20 about the longitudinal axis of the shaft 16. The handle portion 22 also includes a trigger retraction handle, 34, to assist in retracting a mechanism (not shown in FIGS. 1-2) if engagement occurs, such that the opening of the staple applicator assembly 20 may occur later. It will be appreciated that the terms "near" and "distant" are used herein with respect to a clinician holding the handle of an instrument. In this way, the staple applicator assembly 20 is distant with respect to the next handle portion 22. It will also be appreciated that for convenience and clarity, spatial terms such as "vertical" and "horizontal" are used here with respect to the drawings. However, surgical instruments are used in many orientations and positions, and these terms are not considered limiting or absolute. An illustrative multi-ply handle portion, 22, for the stapling and separation surgical instrument 10 of Figures 1-2, is described in greater detail in the co-pending U.S. patent application. Serial No. 10 / 374,026, entitled "Surgical Stapling Instrument Incorporating A Miltistroke Firing Position Indicator And Retraction Mechanism" by Swayze and Shelton IV, from the same attorney, whose description is incorporated herein by reference in its entirety, with additional features and variations as is described in the present. Although a multi-blow handle portion 22 advantageously supports applications with high firing forces over a large distance, applications consistent with the present invention may incorporate a single firing strike, as described in the copending U.S. patent application. Serial No. 10/441, 632, entitled "Surgical Stapling Instrument Having Separate Distinct Closing and Firing Systems" by Frederick E. Shelton IV, Michael E. Setser and Brain J.

Hemmelgarn, of the same attorney, whose description is embodied in the present as a reference in its entirety.

Instrument portion (elongated articulating arrow and staple applicator assembly) In FIGS. 3-5, the instrument portion 12 advantageously incorporates the multiple movements of longitudinal rotation, articulation, closing and firing drive, within a small diameter suitable for endoscopic and laparoscopic procedures. The staple applicator assembly 20 ("end effector") has a pair of pivotally opposed jaws, shown as an elongate channel 40 with a pivotally attached anvil 42 (Figures 1, 2, 4, 5). The closing and securing of the anvil 42 towards the elongate channel 40 are achieved by longitudinally supporting the elongate channel 40 with a frame assembly 44 (Figure 3), rotatably attached to the handle portion 22, on which a sleeve assembly moves longitudinally. of double pivot closure, 46, for imparting closure and opening respectively to a distant and proximal movement of the anvil 42, even with the staple applicator assembly 20 articulated as in Figure 2. With particular reference to Figure 3, the assembly of frame 44 includes a frame floor 48 of a single pivot whose proximal end is engaged with rotary knob 32, with a right half cover 50 thereon shown in figure 3. It should be noted that a proximal end of the sleeve assembly closure 46, specifically a straight closure tube 52, encompasses the proximal end of the frame floor 48, which passes internally further towards the handle portion 22 to engage the closure components (not shown) that longitudinally translate the closure sleeve assembly, 46. A circular lip 54 at the proximal end of the straight closure tube 52 provides a rotational engagement with said components. The coupling components of the rotation knob pass through a longitudinal slot 56 on a proximal portion of the straight closure tube 52, to engage an opening 58 positioned proximally on the frame floor 48. The longitudinal slot 56 is of sufficient length to allow longitudinal closing translation of the closure sleeve assembly 46 at various rotational angles, determined by the rotation knob 32 for the closure sleeve assembly 46 and the frame floor 48. The elongated shaft 16 supports the firing movement receiving a firing rod 60 that rotatably couples firing components of the handle portion 22 (not shown). The firing rod 60 enters the proximal opening 62 along the longitudinal centerline of the frame floor 48. The distal portion of the frame floor 48 includes a firing bar slot 64 along its bottom portion, communicating with the proximal opening 62. A firing bar 66 is longitudinally translated in the firing bar groove 64 and includes an upwardly projecting proximal bolt, 68, which engages a distal end 70 of the firing rod. shot 60. The elongated shaft 16 supports the hinge incorporating a rectangular reservoir cavity, 72, a lateral portion shown in a distal portion of the rotation knob 32. A lower compartment 74 that resides within the rectangular reservoir cavity 72 has diverters left and right laterally separated, 76, 78. An articulating actuator, 80, slides laterally on the lower compartment 74, its tabs left and right sideways down, 82, 84, which are outside the diverters 76, 78, each communicating laterally with left and right push buttons, 86, 88, extending outwardly from the respective cover halves of the knob rotation 32. The lateral movement of the articulation actuator 80 pulls the left and right flanges 82 and 84, closer and further away respectively from the left and right deviators, 76 and 78, operating against left and right reservoir bags, 90 and 92, of a fluid articulation system 94, each bag, 90, 92, communicating distally with the left and right fluid passages or passages, 96, 98 , respectively, which in turn communicate with left and right drive bags, 100, 102, respectively. The latter being opposite and pivoting laterally with a bar T 104 of the articulation mechanism 14. The frame assembly 44 restricts these fluid drives including a top and distal hollow board, 106, of the frame floor 48, on which the rests reside. fluid passages 96, 98, and drive bags 100, 102. The bar T 104 also resides slidably on the recessed board 106 between the drive pockets 100, 102. Next to the bar 104 and aligned therewith, is a raised barrier rib 108, which serves to prevent inward expansion of the fluid passages, 96, 98. The frame assembly 44 has a round upper frame cover 110 (spacer) that slides over the frame floor 48. , preventing vertical expansion of fluid passages 96, 98 and drive pockets 100, 102, as well as restricting any vertical movement of bar 104. In particular, the sea cover co 110 includes functionalities that also allow it to provide a hinge lock member 111, described in more detail below as part of a hinge lock mechanism, 113. A distal end ("zipper") 112 of the T-bar 104 is engages to pivotally move a proximally directed gear segment, 115, of an articulated remote frame member 114 of the articulation mechanism 14. An articulated closure tube 116 encompasses the articulated frame member 14 and includes a horseshoe opening 118 that engages with the anvil 42. A double pivot connection is formed between the straight closing tube 52 and the articulating closing ring 116 on the articulation mechanism 14, allowing the longitudinal closing movement even when the articulation mechanism 14 is articulated. particular, the distally projecting upper and lower pivot appendages, 118, 120, on the straight closing tube 52 having the miniscule holes. the 122, 124, respectively, are longitudinally spaced from the corresponding proximally projected upper and lower pivot appendages, 126, 128, on the hinge closure ring 116 having the tiny holes 130, 132, respectively. A double pivoted upper link, 134, has longitudinally spaced-apart and aft-directed rear and aft bolts, 136, 138, which engage with tiny holes 122, 130, respectively, and a double-pivoted lower link 140 has distant and aft bolts which project downwards and longitudinally spaced, 142, 144, which engage with tiny holes 124, 132, respectively. With particular reference to Figure 4, it is shown that for ease of manufacture, the hinge closure ring 116 includes a short tube 146 attached to a hinge joint collar 148 that includes the pivot appendages that 126, 128 are projected proximally. Similarly, the straight closure tube 52 is assembled from a large closure tube 150 that is attached to an aft attachment collar 152 that includes the distally projecting pivot appendages, 118, 120. The horseshoe opening, 118, in the short closure tube 146 engages an upwardly projecting anvil functionality 154, slightly proximal to the side pivot bolts 156 which engage pivot holes, 158, within of the elongated channel 40. The illustrative version of Figure 4 includes a dog bone link 160, whose proximal pin 157 is pivotally joined to the frame floor 48 in a frame hole 161, and whose proximal pin 159 is attached rigidly to a proximal lower surface 162 of the articulation frame member 114, thus providing pivotal support between them. A lower longitudinal blade groove, 163, in the dog bone link 160 guides an articulating portion of the firing bar 66. The articulation frame member 114 also includes a lower longitudinal groove 164 for guiding a distal portion of the frame. firing bar 66.

Staple applicator apparatus (end effector) Referring to FIGS. 4-5, the firing bar 66 ends distally in an E 165 bar that includes upper guide pins 166 that enter an anvil groove, 168, in the anvil 42 to verify and assist in holding the anvil 42 in a closed state during staple formation and separation. The spacing between the elongate channel 40 and the anvil 42 is further maintained by the E 164 bar by having half bolts 170 slides along the upper surface of the elongate channel 40, while a lower foot 172 slides oppositely along the lower surface of the elongated channel 40, guided by a longitudinal opening 174 in the elongated channel 40. A surface of cut presented distally, 176, of the bar E 164, which is between the upper guide pins 166 and the middle pin 170, separates the fastened tissue while the bar E drives a replaceable staple cartridge, 178, by moving distally a wedge sled 180 which causes the staple drivers 182 to lift the staples 184 out of the open staple holes 186, of a staple cartridge body, 188, forming against a staple forming bottom surface, 190, of the anvil 42. A staple cartridge tray, 192, spans from the bottom of the other components of the staple cartridge 178 to retain them. in position. The staple cartridge tray, 192, includes a rearwardly open slot 194 that is over the longitudinal opening 174 in the elongated channel 40, in this way the middle pins 170 pass within the staple cartridge tray, 192. The assembly Staple applicator 20 is described in greater detail in the co-pending US patent application Serial No. 10 / 955,042, entitled "Articulating Surgical Stapling Instrument Incorporating A Two Piece E-Beam Firing Mechanism" by Frederick E. Shelton IV and others, from the same attorney, filed on September 30, 2004, the description of which is incorporated herein as a reference in its entirety.

Joint Lock Mechanism In Figures 3-4 and 6-8 an articulation lock mechanism 200 is advantageously used to maintain the staple applicator assembly 20 at a desired articulation angle. The articulation lock mechanism 200 reduces the loads on the left and right drive bags, 100, 102. In particular, a compression spring 202 (Fig. 3) is positioned proximally between a proximal end 204 of the articulation lock member 111. and the handle portion 22, urging the hinge lock member 111 distally. Referring particularly to Figure 4, two parallel slots 206, 208, at a distal end 210 of the hinge lock member 111, receive respective upwardly projecting guide ribs, 212, 214, on the frame floor, 48. The guide ribs 212, 214 are longitudinally shorter than the parallel grooves 206, 208, allowing a relative longitudinal travel. With this, with particular reference to FIG. 8, the selective abutment of a distant frictional surface shown as a serrated recess 216 projecting distally from the articulation lock member 111, is coupled with a corresponding engaging gear segment 217 in a brake plate, 218, received in an upper proximal recess 220 of articulation frame member 114. Distant and proximal holes 221, 222 of brake plate 218 receive distant and proximal bolts 223, 224, projecting upwards from the upper proximal recess 220. With particular reference to Figure 6, the elongated arrow 16 is shown in an articulated position, with the closure sleeve assembly 46 removed from around the frame assembly 44 and without the elongated channel 40. neither the anvil 42. The hinge actuator 80 is shown moved laterally to the left to compress the right next tank bag 90 and ex pandir bag right remote 100, which moves the bar T 104 to the position shown. In this manner, lateral movement of the hinge actuator 80 articulates the remote frame 114 clockwise around the frame floor 48 of a single pivot, as shown. Advantageously, the hinge actuator 80 also automatically engages and decouples the hinge lock mechanism 200. In particular, a toothed detent surface, 225, along a proximal upper surface of the hinge driver 80, receives a locking bolt. projecting upward, 226, from the proximal end 204 of the hinge lock member 111. The engagement of the locking bolt 226 within the root of the detent toothed surface 225 provides sufficient distal movement of the hinge link member 111 for locking engagement of the engagement gear segment 217 in the brake plate 218. Lateral movement by an operator of the compression member 272 propels the locking bolt 226 proximally and thereby decouples the articulation locking member 111 from the brake plate 218. When the operator releases the hinge actuator 80, the lock bolt 226 is driven by the resort compression 202 towards the adjacent detent on retainer surface 225, to lock the locking mechanism 111, and thus the staple applicator assembly 20, and to constrain the articulation mechanism 14 in a desired articulation position by restricting and expanding the inflated shape of the next left and right reservoir bags, 90, 92. Portions of the articulation lock mechanism 200 are described in greater detail in the US patent. No. 5,673,841, entitled "A Surgical Instrument" by Dale R. Schulze and Keneth S. Wales, et al., Filed March 10, 1996, by the same attorney, whose description is incorporated herein by reference. Alternatively or additionally, a hole may be provided within parallel fluid bags, 236, 238, to control the flow rate between the proximal drive bags 100, 102, and the distant reservoir bags 90, 92. In FIGS. and 18, the fluid passages 258, 264, can be dimensioned to provide resistance to changing the articulation angle, serving as the orifices, or to include a limiting structure of the fluid flow velocity. In Figure 10, an alternate locking mechanism 2000 of a hinge mechanism 2002 of a surgical instrument 2004 is normally unlocked and activated by mounting a laterally movable T-bar 2006 due to backloading. A slot 2008 is located in a frame floor 2010 to receive and guide a 2012 rib that extends below the 2006 T-bar. A thinned longitudinal section 2014, which is orthogonally attached to the 2012 rib, is deflected if an end effector 2016 is overloaded. For example, as the end effector 2016 is forced to the right as represented by the arrow 2018, for example, its next gear segment 2020 acts on a rack 2022 of the 2006 T-bar, imparting a non-orthogonal feedback force, as represented by the arrow 2024. In this way, the thinned longitudinal section 2014 is bent, mounting the 2012 rib in the groove 2008. This assembly produces opposite joining forces, represented by the arrows 2026, 2028, which lock the bar T 2006 and prevent further articulation. It occurs unlocked when the action of the articulation bags disassembles the laterally movable T-bar 2006. Subsequently the rib 2016 can help guide the T bar 2006. In figure 11 an additional articulation locking mechanism 2100 is represented for a surgical instrument 2102 which is normally unlocked and is activated by the force vector proximate to the pressure angle of 20 degrees from the gear teeth 2104 of an end effector 2106 and the rack teeth 2108 of a T-bar 2110. When the end effector 2106 it is retrocharged, as represented by the non-orthogonal arrow 2112, the longitudinal vector of the pressure angle, represented as arrow 2114, moves the bar T 2110 proximally. This longitudinal force vector is applied to a rigid spring 2118 behind a rack 2120 of the bar T 2110. When the spring 2118 deviates as the bar T 2110 moves proximally, the locking teeth 2126 projecting proximally from the rack 2120 are in engagement with the locking elements 2122, which project distally and are laterally aligned on a floor frame 2124.k 2120. The locking teeth 2126 and the locking elements 2122 are decoupled when the near force vector is reduced or removed by removing the backfeed of the end effector 2106 and allowing the T-bar 2110 to move distally under the impulse of the spring 2118.

Combination of double pivot lock sleeve and single pivot frame floor Referring to Figures 3-4 and 7, instrument portion 12 advantageously incorporates the double pivot lock sleeve assembly 46, which moves longitudinally on, and covers, a single pivot frame floor, 48. These mechanisms and their operation will now be described in greater detail. With particular reference to Figure 7, the articulation mechanism 14 is shown in an articulated condition with the closure sleeve assembly 46 retracted proximally to an open anvil condition. With the anvil 42 open, the actuation of the articulation control 18 causes the articulated locking ring 116 to move pivotally around the upwardly directed distal bolt, 136, and the distally directed downward bolt, 142, respectively, of the linkages of upper and lower double pivot closure, 134, 140. The frame floor 48 is pivotally moved around a single bolt, represented as the proximal bolt 157 joining the frame floor 48 to the distant frame member 114. With the anvil 42 open, the proximal pin 147 of the frame floor 48 is aligned with the most distal position of the upper and lower double pivot links, 134, 140, of the lock sleeve assembly 46. This placement allows for easy pivotal movement and rotation of the staple applicator assembly 20 while the anvil 42 is open. When the closure sleeve assembly 46 is moved distally to pivotally move the closed anvil 42, the straight closure tube 52 moves distally around the frame floor 48, and the articulated closure ring 116 moves distally along the axis of the articulated distant frame member, 114, driven by pivot links 134, 140. The double pivoting bolts 136, 138, and 142, 144 on the links 134, 140, facilitate coupling with the straight closing pipe 52 and the ring of articulated closure 116, since they are urged towards the distant closing position when the device is articulated (not shown). In the remote closing position, the frame floor pivot pin ("proximal bolt"), 147, is vertically aligned with the proximal pivot bolts 138, 144, in full hinge, or may fall at any point between the bolts. 136, 142, and the next pins 138, 144, while working efficiently.

Solid firing bar support In figure 8, the articulation mechanism 14 of figure 7 is partially parted and viewed from the bottom, showing a solid wall firing bar support design (dog bone link) 160) that offers advantages over conventional flexible support plates. The support plates are used to bridge the clear space and guide and hold the firing bar 66 through an articulation joint of a single frame floor pivot, 1801. Flexible firearms are known but the incorporation of Solid wall firing bars like the ones shown in figures 4, 8 and 9 offer unique advantages. Referring now to Figure 8, the frame floor 48 includes a frame knife slot, 1802, which runs along the bottom of the frame floor 48, and a distant knife slot 164 runs along the bottom of the bottom of the frame floor 48. a distal link frame member 114 for sliding reception of the firing bar 66 (not shown). The frame floor 48 described above includes a single pivot direct connection 157 with the remote frame member 114. The fixed wall dog bone link 160 which is rotatably connected to the proximal pin end 157, and movably connected in the distant bolt end 159 includes left and right lateral guides, 1818, 1820, defining between them a guide groove 1822 for the sliding passage of a firing bar 66 (Figure 4). In this way, for bridging the clear space between the frame floor 48 and the distant frame member 114, the fixed wall dog bone pivoting link 160 is pivotally attached to the frame floor 48 and slidably attached to the frame member 48. frame 114. The proximal pin 157 of the dog bone pivoting link 160 is pivotally received in a bore 1824 in the frame floor 48, allowing the dog bone pivoting link 160 to move pivotally around the cavity 1824. A pin Distant 159 extends upwardly of the dog bone pivoting link 160 and is slidably received in a slot 1826 in the distant frame 114. The articulation of the staple applicator assembly 20 at an angle of 45 degrees from the longitudinal axis moves pivotally the dog bone pivoting link 116 in the bore 1824 in its proximal pin 157, and the distant pin 157 slides in the slot 1826 at its distal end 1814 to bend the firing bar 66 at two separate angles, which are half the angle of the staple applicator assembly 20. Unlike the aforementioned flexible support plates that bend the firing bar 66 at a 45 degree angle, the pivoting link of Fixed wall dog bone 160 doubles firing bar 66 at two separate angles as of 22.5 degrees each. The flexing of the flexible firing bar or bars, 66, at half the angle, cuts the bending stress on the firing rods 66 to one half that found in conventional articulation supports. Reducing the bending stress on the firing rods 66 reduces the possibility of permanently bending or distorting the firing rods, reduces the possibility of firing jams, ensures lower firing bar retraction forces, and provides Smoother operation of the firing system. In Figure 9, a surgical instrument 1900 includes a double-closed pivot. The single frame pivot joint 1902 shows an alternating mechanism of solid wall support plate, 1904, which replaces the lower double pivot link 140 and the dog bone link 1812. Left firing rod supports and right, 1906, 1908, extend upwards from a lower double pivot link, 1910, of a lock sleeve assembly 1912. The clearance 1914 is provided in a frame floor 1916 for the firing bar holders 1906, 1908, to run as the lock sleeve assembly 1912 moves distally to close the anvil 42 (not shown in Figure 9) and proximally to open the anvil 42. Like the dog bone pivoting link 1812 described above, the alternate lower double pivot link, 1910, also bends and holds the firing bar 66 (not shown in Figure 9) to have two separate bending angles that are up to one-half the flex angle n applicator assembly 20 staples.

Lateral member guide mechanisms Referring further to Figure 9, upward, left and right flanges, 1918, 1929, on frame floor 1916 include distant and proximal side bolt guides, 1922, 1924, which pass laterally through the holes in a T bar 1926, helping to minimize the locking in a hinge mechanism 1928. As another example, in Fig. 7, the bar T 104 advantageously includes a lateral duck tail guide 1930 that slides laterally within a duck tail channel 1932 formed in it. As a further example, in Figure 12 a raised rib 1934 on a frame floor 1936, is received within a rectangular groove 1938 formed in a T-bar 1940. To further facilitate lateral translation without locking, distant side bearing rails and next include a plurality of respective ball bearings 1946, 1948. As a further example, in Figure 13, a plurality of side frame notches 1950-1954 are formed in a 1956 frame floor with corresponding T-bar side notches 1958- 1962 on a 1964 T bar. Sliding rollers 1966-1970 reside trapped within pairs of respective lateral notches 1950/1958, 1952/1960, 1954/1962. These are not an exhaustive list of side guide members that prevent unwanted assembly or rotation of the T 1940 bar.

Combination of double pivot frame floor and single pivot closure In Figures 14-15, an alternate frame and closure floor mechanism 2200 includes a surgical instrument 2202 including double pivoting frame assembly 2204. In particular, a floor of frame 2206 is connected to a remote frame member 2208 by a dog bone link 2210 of double pivot frame, which has a proximal pivot pin 2212 pivotally coupling a proximal bore 2214 in the frame floor 2206, and a pin of remote pivot 2216 engaging a distal piercing 2218 of distant frame member 2208. A guide groove 2220 is located on the underside of the dog bone link 2210 to guide a firearm (not shown in Figures 14-15). The knife slot 2222 is located in the distant frame member 2208. As shown, the articulation of the locking ring 2230 at a 45 degree angle articulates the distant frame member 2208 at a 45 degree angle, and articulates the link of frame dog bone, 2210, at half that angle. Consequently, the firing bar 66 is subjected to the two shallow half-bends that are separated, and obtains all the benefits described above. The outermost sleeve sleeve assembly 2224 is different in that only a pivotal axis of the double pivoting design of the frame assembly 2204 accommodates its longitudinal closing movement. As shown, a closing tube arrow 2226 has a clamp 2228 at a distal end. The clamp 2228 is pivotally coupled with a lock ring 2230. The lock ring 2230 has a proximal gear 2232 formed at a distal end and the pin 2234 is pivotally coupled with an upper tail 2236 of the clamp 2228, and a lower arm 2234. 2238 is engaged with a lower tail 2240 of the clamp 2228. The holes 2242 in the clamp 2228 receive side guide bolts 2243 and there slidably join a T-bar 2244 to engage the proximal gear 2232 of the closure ring 2230. In this way, this alternate mechanism 2200 uses an alternate single / double inverted pivot concept of the mechanism described above. That is, the alternating closing mechanism has a single pivot and the alternate frame floor has a double pivot, unlike the double pivot locking mechanism described above with a single pivot frame floor.

Laterally movable articulation mechanism In Figures 16-19, a laterally movable articulation mechanism 230 is shown schematically to show the lateral movement used to effect the articulation of an end effector 232. Lateral movement is the movement of at least one element towards or from the longitudinal axis of a surgical device 234. This movement is generally at right angles to the longitudinal axis, which is a horizontal line that bisects mechanism 230 and does not include rotational movement or longitudinal movement. Laterally movable articulation mechanisms can be fluid driven as shown in Figures 16-19, or they can be mechanically actuated as shown in Figures 20-23.

Laterally Movable Fluid Joint Mechanism The laterally movable articulation mechanism 230 is shown schematically in Figures 16-19, and includes a fluid control system 235 having fluid filled left and right fluid bags, 236, 238, which extend longitudinally therein, which move a side member or bar T 240 laterally with the movement of the fluids 242. All directions are with respect to the longitudinal axis. Referring to the non-articulated view of Figures 16 and 17, the distally located end effector 232 moves pivotally on the pin 244 and has a gear segment 246 at a proximal end. The pivot pin 244 is attached to a frame (not shown). A rack 248 at a distal end of the bar T is operatively coupled to the gear segment 246. The bar T 240 and the rack 248 are laterally movable along the axis A-A. A distal portion of the left and right large fluid bags 236, 238, laterally rests on the laterally movable T-bar 240, and is laterally constrained within a closure sleeve 250 and vertically constrained by a frame 252 below, and a spacer 254 above. The left operating fluid bag, 236, is filled with fluid 242 and has the left operating remote bag, 256, left fluid passage, 258, and a left next reservoir bag, 260. The right fluid bag 238 contains fluid 242 and has a right operating remote bag, 262, left fluid passage, 264, and right next tank bag, 268. A fixed splitter 270 extends from frame 252 and separates bags 260, 268, and passages fluid 258, 264. Fixed divider 270 and closure sleeve 250 restrict fluid passages 258, 264, and prevent expansion of fluid passage sections 258, 264, of bags 236, 238. A fluid is included. laterally movable "C" shaped compression member, 272, in the articulation control mechanism 230, for compressing one of the proximal reservoir bags 260, 268, and the articulation of the end effector 232. Furthermore, they can be incorporated other components, ta They are like a firing bar 274 that passes through a firing bar slot 276 in the frame 252 (Figs. 17, 19). As shown in Figures 2 and 18-19, the lateral movement of the C-shaped compression member, 272, toward the left, compresses the next right reservoir bag, 260, forcing the fluid into the right fluid passage 258. and the right remote operating bag, 256.

According to the right remote operating bag 256, moves the bar T 240 laterally to the left, the left remote operating bag 262 is compressed and the end effector 232 is hinged to the right (in the clockwise direction of the hands). watch observed from the top, as shown). Compression of the far left driving bag 262 causes the fluid to flow proximally through the left fixed fluid passage 264 and into the next left reservoir bag 266. In particular, an adjacent right wall 280 of the compression member in the form of C, 272, moves to the left causing compression of the next right reservoir bag, 260. A corresponding movement to the left of an annexed left wall 278 of the C-shaped compression member 272, provides space for the fluid from the left reservoir bag 262 compressed, as the fluid flows into the next left bag of reservoir 266 in expansion. This fluid control system 235 for the articulation mechanism 230 offers at least several advantages. First, the orientation of the drive bags, 256, 262, close to the link or link mechanism 20, allows the use of larger bags 236, 238, and larger T 240 bars within the instrument 234. As a system fluid driven, the increase of the output force of the fluid control system 235 can be achieved in two ways. First, for a fixed fluid area on the T 240 bar, the fluid pressure over the fixed area can be increased. Second, for a fixed fluid pressure, the fluid contact area on the T-bar can be increased. The first method results in a more compact design and higher system pressures. The second method results in a larger design and lower system pressures. To reduce the cost, simplify the design, reduce the effort of the system and reduce the risk of rupture of the bag, the illustrative version represents large remote operating pockets 256, 262, in an advantageous position close to the articulation mechanism 230, within an elongated arrow of the instrument. It is this positioning of the bags 256, 262, which allows the bags 256, 262 to be large and the output force of the joint to be high for a low inlet pressure. In this way, the exit force of! articulation mechanism 230 can be increased (for the same inlet pressure) simply by increasing the pressure contact area of the distant balloons 256, 262 on the T-bar 240. The pressure contact area increases are restricted in height and length . Since the diameter of conventional endoscopic surgical instruments is fixed at certain diameters to pass through the insufflation orifices, this limits the change in height. The change of the length of the contact area of pressure has the greatest effect and allows to advantageously adjust the lateral output force of the device (changing the length), to cover any output force required by the system. The fluids used in a laterally movable device may be compressible or incompressible. As used herein, the term "fluid" comprises liquids, gases, gels, microparticles and any other material that can be made to flow between a pressure gradient. Although any fluid can be used, sterile solutions such as saline, mineral oil or silicone are especially preferred.

Laterally movable mechanical articulation mechanism Although previously described fluid mechanisms to cause lateral movement and articulation, mechanical mechanisms can perform a lateral movement similar to that produced by fluid bags 206, 208. In figures 20-21, a mechanism laterally movable alternating articulation 300 employs a mechanical control system, in particular a longitudinally movable member, to effect lateral movement and articulation of a surgical instrument 301. In the illustrative version, with particular reference to FIG. 20, a laterally movable sliding bar 302 has at least one pair of left and right angled cam surfaces, 304, 306, extending laterally therefrom on opposite sides of an elongated longitudinal arrow 308. In the illustrative version, another pair of surfaces is also included. Angular cam next, left and right, 310 and 312. A longitudinally movable right link 314 includes corresponding inwardly directed distant and adjacent ramp surfaces 316, 318, which coincide and engage slidably with the right and proximal right cam surfaces, 306, 312, such that distant longitudinal movement. of the movable link 312 causes lateral movement to the left of the slide bar 302. It should be appreciated that this ramp contact can be reversed, such that the distant movement causes a respective movement to the right. It should be appreciated that a spring pulse (not shown) may be included in the slide bar 302 to drive the slide bar 302 to the right in engagement with the right longitudinally movable link 314, so that the opposite proximal movement of the right link longitudinally movable 314 causes movement to the left of the sliding bar 302. Alternatively, in the illustrative version, a longitudinally movable left link 320 includes corresponding inward facing distant and ramp counter-surfaces, 322, 324, which coincide and slidably engage the right and proximal right cam surfaces 304, 310, such that the longitudinal movement distant from the longitudinally movable left link 320 causes lateral movement of the slide bar 302 to the right. It should be appreciated that this ramp contact can be reversed so that the next movement causes movement to the left. It should be noted that the right and left longitudinally movable links, 314, 320, and the sliding bar 302, are held within an elongated arrow 326 that allows this longitudinal movement of the first and the lateral movement of the latter. A distal end of the slide bar 302, shown as a receptacle ball, 328, is received within a V-shaped cam groove, 330, aligned proximally and proximal to a pivot pin 332 of an end effector 334. Thus, in Figure 21, the proximal movement of the right longitudinally movable link 314 and the distal movement of the left longitudinally movable link 320, cause movement of the sliding rod 302 to the right with a corresponding rightward movement of the ball of rotation. receptacle 328. In this manner, the V-shaped cam notch 330 is propelled to the right, pivoting its most distant end 336 to the left. Alternatively, the lateral movement of the slide bar 302 can be converted into articulation of the end effector 334 by the rack and gear coupling described above with respect to FIGS. 16-19. In this way, mechanical systems using longitudinal movement can be used to provide lateral articulation for the surgical instrument 301.

Rotating link In figures 22 and 23, an additional alternating articulation mechanism, 400, uses a rotary link 402 to move a lateral member, represented as laterally movable sliding bar 404, to cause articulation for a surgical instrument 406. The laterally movable sliding bar 404 can be operatively coupled with a rotary gear or a cam notch as described above for Figures 16 and 20, at a proximal end of an end effector (not shown). The rotary link 402 can be located below the slide bar 404 with at least one arm 408, which extends rotatably transverse to the longitudinal axis thereof to engage within a receptacle 410 within the slide bar. The sliding bar 404 is vertically constrained between an upper spacer 412 and a lower frame 414, the latter having a longitudinal depression 416 which receives the rotary link 402 and accommodates the rotation of the arm 408. The spacer 412 and the frame 414 are encompassed by a tubular sleeve 418. The rotation of the rotating link 402 moves the arm 408 in an arc and thus moves the slide bar 404 laterally in the direction of rotation.

Joint Mechanism Having Opposite Flexible Flexing Members In Figure 24, a surgical instrument 500 has a sliding member 502 aligned along a longitudinal axis of an elongated shaft 504, and allows lateral movement between a left bend member 506 and a right bending member 508, and is restricted vertically by a frame and spacer (not shown). Each bending member 506, 508, has a respective fixed remote attachment, 510, 512, and a longitudinally translatable proximal link, 514, 516. The respective left and right flexible members, 518, 520, bow inwardly as opposed to sliding bar 502, with the amount of lateral intrusion with respect to the longitudinal movement distant from its respective proximal link 514, 516. In a disarticulated state shown in Figure 24, the next links 514, 516 are not placed differentially, and thus a distally projecting tip, 522, of the sliding member 502 is centered within a V-shaped cam groove, 524, which opens proximally with respect to a pivot bolt 526 of an end effector 528. In Figure 25 , the left-hand link 514 has advanced distally and the right-hand link has retracted proximally, causing the slide bar 502 to move laterally to the right. has, thus causing a cam action of the distally projecting tip 522, against a right portion of the V-shaped cam groove, 524, with resultant articulation to the left of the end effector 528 about the pivot pin 526 .

Electromagnetic Mechanism of Lateral Joint Control In Figure 26, a surgical instrument 600 has an end effector 602 connected distally, which is selectively articulated in an arc about its pivot pin 604 with respect to an elongated shaft 606, by lateral movement of a slide bar 608. In particular, a remote receptacle 610 of the slide bar 608 engages a V-shaped cam groove, 612, which opens proximally to the pivot pin 604. The slide bar 608 is vertically constrained within elongated arrow 606 by a frame and spacer (not shown). Left and right compression springs, 614, 616, which are directed inwardly on opposite side sides of the slide bar 608, are proximate to a distal end 618 of the elongated shaft 606. These springs, 614, 616, provide an impulse of centered on the slide bar 608 and thus on the end effector 602. Left and right electromagnets 620, 622, on opposite sides on the slide bar 608, are selectively activated to attract a ferrous target 624 integral or added to the slide bar 608, thus selectively displacing the sliding bar 608 laterally and effected articulation of the end effector 602, as shown in FIG. 27. For simplicity, a longitudinally aligned coil is shown, although it should be appreciated that one or more electromagnets can be aligned to produce a magnetic field perpendicular to the slide bar 608, such as a plurality of coils (not shown) aligned along the length of the longitudinal axis of the sliding bar 608, with each coil having its longitudinal axis aligned with the axis of lateral movement of the sliding bar 608.

Articulation Control Mechanism with Pressure Source In Figure 28, a surgical instrument 700 incorporates an articulation control mechanism 702 utilizing elongated, left and right piston supports, 704, 706, which are joined laterally on each side in a pivot pin 708 of end effector 710. A spool valve 712 is slidably located in bore 713 of valve frame 715 in a proximal portion (e.g., handle) 714 of surgical instrument 700, and selectively communicates with a source of pressure (for example, accumulator, pump, orifice to the line or portable pressure source) 716. The lateral movement of the spool valve 712 allows fluids to flow from the pressurized material, 718, to one of the piston supports 704 or 706. The pressurized material 718 of the pressure source 716 may be fluid or pneumatic. For example, spool valve 712 can selectively communicate a hospital vacuum source with one of the elongated piston supports 704, 706, retracting on the selected side as the other side expands when exposed to atmospheric pressure or is let it expand in another way. It should be appreciated that an incompressible or compressible fluid can be used. In addition, the translation material in each elongated piston holder 704, 706 may further include a proximal dynamic spool seal, which is actuated by the pressure source 716. As shown in FIG. 29, the sliding of a piston in a The elongate tube, or alternatively the elongation of a circumferentially flexible material, can respectively produce reduction and increase in the length of the elongated piston supports 704, 706.

Fluid Bags Figure 30 depicts a bag 800 that includes an actuator bag 802 in fluid communication through a passageway or fluid conduit 804 to a reservoir bag 806. In this illustrative embodiment, a compression spring 808 drives laterally the actuator bag 802 to an expanded state. Advantageous features of incorporating compression spring 808, include providing a restoring force to expand bag 802 or to center an end effector (not shown), as well as other advantages. If desired, the springs may be placed in either of the two bags 802, 806, or in both bags 802, 806. Said bag 800 may be constructed in various ways, from various combinations of materials. Although shown above as a unified part, these bags 800 can be assembled from multiple parts or can be constructed as a single unit fluid bag 800. For the construction of multiple parts, at least one of the bags can be attached to either of the other elements. Many leak-proof joining methods are available, such as welding, glue, press fit, heat stacking, folding accessories, clamp fittings, connections, and the like. Two basic types of 800 fluid bags can be constructed. One is a rigid, non-elastic, high-pressure pouch of rigid or elastomeric materials, and the other is a lower-pressure elastomeric balloon. Rigid balloon materials are known in the medical sciences and are used for dilatation or angioplasia or the expansion of stents within the walls of blood vessels. Rigid balloons are made of non-elastic or low-elastic materials that retain their size and shape under high-pressure loading. Normally these balloons are thin-walled and are formed of high tensile strength materials with low elongation. Typical materials for these balloons are polyvinyl chloride (PVC), interlaced polyethylene, and polyester (PET) polyethylene terephthalate, nylon and others. For angioplasty balloons, thin-walled sections of PET tubing can be blow molded in the form of a balloon. Each of the fluid bags, left and right, can be formed from a continuous piece of thin-walled tubing, the proximal and distal pockets being formed by expanding local sections of the thin-walled tubing. The expansion of the proximal and distant areas of the bag can be effected by locally heating the tubing and blow molding the shapes of the bag. One of the open ends of the formed fluid bags can then be sealed, and the other open end of the bags can act as a filling hole for the fluids. After filling, the filling hole is sealed. Alternatively, the fluid bags can be assembled from multiple pieces instead of one piece. The non-bag portions of the fluid bags 800, such as the fluid passages 804, may be formed of rigid or semi-rigid tubing or other materials. Alternatively, elastomeric balloons can also be used to construct the fluid bags 800. These elastomeric materials are formed in a first shape and, upon application of pressure, can be expanded to a larger shape. Elastomeric materials can expand and return to the original form several times, without degrading their elastomeric properties. Although they are not capable of handling pressures as high as rigid materials, elastomeric bags can be used to articulate. By confining or restricting the elastomeric fluid bags 800 between walls or constrictions, buckling of the bag material towards undesired areas is prevented and the forces that can be applied are increased. In Figures 16-19, the remote actuator pockets 256 are well constrained between the closure sleeve 32, the spacer 203, the T-bar 230 and the frame 34. The elastomeric bags 210, 220, can be constructed by various methods including dip molding or, like IV bags, can be formed of two sheets that are welded or glued together. The elastomeric bags 210, 220 may be formed of latex, rubber, silicone, polyurethane, polyethylene, polypropylene, Teflon, or any of several elastic or semi-elastic materials used in engineering. Additionally, conventional blow molding techniques can be used to form the 800 bags. Unlike thin-walled PET shrink tubing used in angioplasty balloons, conventional blow molding techniques use a hollow tube or a hollow preform molded, heated and moved in an injection station where low pressure air is normally used to initially inflate the rod or preform. A discharge of high pressure gas is then applied to force the hot tube or expanded preform into contact with the walls of the mold, to cool the blown material in the net form. Although thin walls are produced, the blow molding process of the preform produces thin walls that are much thicker than angioplasty balloons of 1 x 10"4 mm.This process forms many current products such as soda bottles, disposable pipettes. with a rigid tube and expanded bag, and containers For the formation of bags 800, a preform with the appropriate material thickness is first injection molded into the expandable bag areas, to provide the desired wall thickness when the bags are expanded In the blow molding process, once the bags are blow molded in the net shape, they can be filled with fluid and sealed.The appropriate materials for blow molding include nylon, polyester (PET), polyethylene, polypropylene, polyethylene high density (HDPE) and any of several known blow molding materials In addition to the rigid and eiastomeric bags, the construction of the bag a can be spring or flaccid. That is, at least one of the close pockets or at least one of the distant pockets can be constructed of an elastic material that requires resuming its original shape after compression and releasing it. Alternatively, at least one of the close pockets or at least one of the distant pockets can be constructed of a generally flaccid material with a weak elasticity ratio, or loose non-rigid materials that will not expand back to the previous original shape. to deformation. Flaccid bags or spring bags, such as the bag 800, may include the internal compression spring 808 that forces the walls of the bag 800 outwardly. The internal compression spring 808 can be formed from a variety of materials including metal springs, plastic springs, foams, squeezable elastomers, and the like. A sealed assembly of a full flaccid bag, with a partially filled spring bag (in a passage), results in the spring bag expanding to extract fluid from the flaccid bag. The assembly of a pair of partially compressed spring bags (of walls and size of equal elasticity ratio) results in both spring bags being in the partial compressed position. The compression of one of the partially filled spring bags results in the complete expansion of the uncompressed spring bag and the reduction of the compressed spring bag. The release of the compressed spring bag allows the compressed spring bag to expand and withdraw fluid back into the compressed spring bag. This process is controlled by the elasticity ratio, and if the two bags have the same elasticity ratio, the fluid will be withdrawn back into the compressed spring bag released until the two spring bags are equally full. If desired, unequal elasticity ratios can be used in the spring bags to extract and store fluids ad libitum in one of the bags. Although the next deposit bags, 806, and the distant actuation bags, 802, are shown in a rounded rectangular shape, the actual transverse shape of the bag can be modified to any shape. For example, it could be advantageous to construct the distant or nearby bags 802, 806 as a folded bellows. For example, a tubular shaft 810 of a surgical instrument 812, shown in FIG. 31, has a spacer 814 spaced apart from a frame 816. A trigger rod 818 is longitudinally translated in a trigger bar slot, 829, provided in a lower surface of the frame 816. The left operating bag 802 and a right operating bag 824 are both of a rectangular folded design. The right operating bag 824 is shown in a compressed state and the left operating bag 802 is shown in an expanded state in the respective left or right lateral cavity, 826, 828, defined between the tubular arrow 810 and the slide bar 830. The folded right bellows 824 is easily collapsed in the confined area of the right side cavity 826 as shown. Similarly, the folded left bellows 802 expands easily to fill the area of the left side cavity 828. Although not shown, the folded bellows can also be used for the nearby reservoir bags 260, 266 of Figures 16-19 . It should be appreciated that the drive bags and the distant bags can easily be formed into other transverse shapes, such as round, square, triangle, hexagon, octagon or any other form that covers the needs of the mechanism.

Fluid Transfer Articulation Although the lateral fluid mechanism described above utilizes bags and lateral movement to cause articulation, other fluid transfer mechanisms will now be described. These fluid transfer mechanisms illustrate various aligning mechanisms of the present invention to transfer fluids from one location to another to effect articulation. In FIG. 32, a surgical instrument 900 includes an articulation mechanism 902 which contains fluid 242, facing a proximally directed meshing segment, 904, on an end effector 906 which engages a rack 908 on a T 910 bar that is roughly rotated. with an elongated arrow 912, in response to the expansion and differential compression of Disiani bags, left and right, 914, 916. Said compression and expansion is confounded remofamenie by pistons of left and right conirol 918, 920, which in the illusive version are oriented for movement laferal deníro of left and right cylinders respecíivos, 922, 924. Dynamic seals left and right respecíivos, 926, 928, make a hermetic seal to fluid fluid, enire the pistons conírol 918, 920, and its cylinders respecíivos 922, 924. A fluid transfer hinge system 930 thus formed moves the articulation mechanism 902 selectively to the right or the left. In Fig. 33 the right control piston 920 has been operated to expand the right-hand distance bag 916, causing the left-hand bag 914 to be compressed and the left-away bag 918 to extend. With the corresponding leftward movement of the T-bar 910, the rack 908 rotates the meshing segment 904 in the clockwise direction, moving pivoi-ally the end effector 906 to the right. Similarly it should be appreciated that the left conirol foot 918 can be pulled, extracting fluid from the left distal bag 914, or that the two conirol pistons, 918, 920, are mechanically coupled to move differentially in concert. In FIG. 34, a surgical instrument 1000 includes an articulation mechanism 1002 of a proximally directed gear segment, 1004, of an end effector 1006 that is coupled to a rack 1008 of a T-bar 1010 that is laminated at least one elongated arrow 1012, in response to a fluid transfer articulation system 1014. In particular, the respective left and right laterally operative portions, 1016, 1018, of the left and right continuous bags 1020, 1022, are positioned on sides of the bar T 1010 within a closing sleeve 1024 of the elongated shaft 1012. The left and right proximal bag portions 1026, 1028 are part of a rolling mechanism 1030. A conirol rod that moves larally is 1032. it moves left and right compressor rollers 1034, 1036, which compress particularly the left and right bag portions 1026, 1028 it confers the left and right compression surfaces 1038, 1040, which may be a hard surface or an elastic surface that deviates from the gap with the roller. On the left, the lateral movement of the laterally moving conirol rod 1032, represented in FIG. 35, compresses fluid from the right-hand bag portion 1028 to the operatively right-hand portion 1018. The expansion of the latter is effecive motion. to the left of bar T 1010 and thus articulation to the right of end effector 1006. Cooperating with this movement, the movement to the left of the left compressor roller 1034 coniras the left-hand bag portion 1026, provides space for the fluids flow from the left side disinfection portion of laterally operative compression, 1016, of the left conical bag 1020. One or more springs 1042 propel the conveying rod that moves larally 1032., and therefore the compressor rollers 1034, 1036, towards their respective compression surfaces 1038, 1040. In FIGS. 26-27, a surgical instrument 1100 includes an articulation mechanism 1102 of a proximally directed gear segment 1104 of an end effector. end 1106, which is coupled with a rack 1108 of a T-bar 1110 that translates laterally within an elongated shaft 1112, in response to a fluid-transfer hinge system 1114. In particular, respective laterally operative distal portions, left and right. right, 1116, 1118, of a U-shaped pouch 1120, are defined between a mid-point compressor roll 1122 that acts against a compression surface 1124 (e.g., flat surface, opposing compressor roll), thus effectively separating the pouch U-shaped 1120 in two parts. The forced fluid differentially from one of the selected portions of the left and right operationally disinfecting portions, 1116, 1118, allows the compressive force to flow fluid to the shaft. In Figures 38-39, the compressor roll 1122 has been crossed to the right by expanding the operatively right hand side portion 1118, causing movement to the left of the T-bar 1110, and at the same time to the right of the end effector 1106. It should be noted that the U-shaped bag 1120 is represented with a middle bag section, 1126, which is crossed by the mid-point compressor roll 1122, which is communicated respeci vely by means of communicating bag portions left and right 1128 , 1130, with the left and right operative functional portions 1116, 1118, which may comprise rigid conduits or a passage of fluid formed in other spherical portions of the elongated shaft 1112. In FIG. 40, a surgical instrument 1200 includes a mechanical mechanism. articulation 1202 of a segment of gear directed proximally to 1204, of an effector of eximeum 1206 that is coupled with a cr rack 1208 of a T-bar 1210, which is laterally indented from an elongated shaft 1212 in response to a fluid transfer articulation system 1214. In particular, the respective laterally operative dysenide portions, left and right, 1216, 1218, the left and right conical bags 1220, 1222 are placed on respective sides of the T-bar 1210 within a locking sleeve 1224 of the elongated shaft 1212. The left and right handbag portions 1226, 1228 are part of a mechanism of lateral conirol 1230. In particular, left and right bellows compression members 1232, 1234, compress the left and right proximal bag portions 1226, 1228, and force fluid into the respective laterally operative dishyte portions, left and right, 1218. In Figure 41, the right bellows compression member 1234 is driven towards the underside, compressing the nearby right-hand bag portion. 1228, thus expanding the laterally operative right hand portion 1218. With this, the T 1210 rod moves laterally to the left, articulating the efferent force 1206 to the right. In addition, the operatively left left hand portion 1216 is compressed, expanding the left proximal bag portion 1226 and moving the left bellows compression member 1232 outwardly. The joint to the left would encompass the inverse operation. In FIG. 42, a surgical instrument 1300 includes an articulation mechanism 1302 of a proximally directed gear segment 1304 of an end effector 1306, which is coupled with a rack 1308 of a T-bar 1310, which is rotated lamellarly in one piece. elongated arrow 1312 in response to a fluid transfer hinge system 1314. In particular, a proximal portion of the bar 1310 is a spool valve ("disianie piston") 1316 formed in a side spool bore 1318 communicating in the opposite direction to the left and right fluid passages 1320, 1322, formed on the elongated arrow 1312, which in turn communicate with proximal left and right perforations 1324, 1326. The left and right next pistons 1328, 1330, slide into respective right and left perforations 1324, 1326. For to prevent the loss of fluid, next seals 1332, 1334 are located in each of the respective respec- tive pistons 1328, 1330, and left and right disiani seals 1336, 1338 are located in left and right exirres respeci- vely of the spool valve 1316. As is shown in figure 43, the laminar movement (left) of the right next step 1330, causes laminar movement (to the left) fan of the piston disianie 1316 as of the left next step 1328, articulating the effect of eximere 1306 to the right . In Figure 44, a surgical instrument 1400 includes an articulation mechanism 1402 that includes a pivoial connection 1404 between an end effector 1406 and an elongate shaft 1408 that is conirmed by a fluid transfer hinge system 1410. In particular, perforations Fluid, left and right, 1412, 1414, provide fluid communication between the proximal and distal ends 1416, 1418 of the elongated shaft 1108. The left fluid perforation 1412 ends respectively in a left-hand cylinder 1420 and in a left cylinder 1422. The right fluid perforation 1414 terminates in a right-hand cylinder 1424 and a right-hand cylinder 1426. It should be noted that the fluid perforations 1412, 1414 may comprise a cylindrical unilamellar tube or other component of assembled fluid. A left disengage piston 1428, sealed by a left disinfector piston seal 1430, is dislodged longitudinally, distally outside the left diaphragm cylinder 1422 in abutment with the end effector 1406, to the left of the pivoial connection 1404. A footwell disianie right 1432 , sealed by a piston seal 1434 disfaníe right, is damaged long, differently outside the cylinder disiaie right 1424 in abutment with effector eximerous 1406, to the right of pivoial connection 1404. A piston left next 1436, sealed by a seal of proximal left piston 1438, is drawn longiludinaimenie, proximally outside the left proximal cylinder 1420, and is coupled with a left lateral junction 1440 to a rotational joint control actuator 1442. A right proximal piston 1444, sealed by a piston seal proximal right 1446 moves longitudinally, proximally outside the right proximal cylinder 1422, and coupled with a right lateral joint 1448 to the radial articulation conirol actuator 1442. Left fluid 1450 fluidized in the left fluid perforation 1412, communicates by fluid motion to the left proximal piston 1436 towards the piston The left fluid 1422. The fluid on the right side 1452 in the right fluid perforation 1414 fluidly communicates the movement of the right next foot 1444 to the right foot 1472. In this way, as in Figure 45, the rotation in the right direction clockwise of the rheoidal articulation conirol actuator 1442, observed from the top, dissimilarly advances the right-hand piston 1444, the fluid on the right-hand side 1452, and in this manner the piston will disengage right 1432, as long as it is recirculated proximally. the left next step 1436, the left side fluid 1450 and therefore the left piston 1442. The differential abutment of the distal pistons 1422, 1432, with the effector of eximelus 1406 causes articulation to the left. By reversing the rotation of the rotational joint screw actuator, 1442, articulation to the right would be obtained. In Figure 46, a surgical instrument 1500 including an articulation mechanism 1502 of a proximally driven gear segmentation.1504, of an end effector 1506, is coupled with a rack 1508 of a T-bar 1510, which is rotated laminarly in an elongated shaft 1512 in response to a fluid-relief joint system 1514. In particular, portions of the shaft 1514 are used. operative left and right, 1516, 1518, are part of a pocket in the form of a tuning fork 1520. A roving pump 1522 acts on a circular middle portion 1522 of the tuning fork bag 1520, effectively separating the bag 1520 into two differentially adjustable portions. , which differentially force the fluid into one of the selected portions of the left and right laterally operative lateral portions, 1516, 1518, while allowing the compressive force to be transferred to the other to force fluid from the other. In Fig. 47, the rotational pump 1522 has rotated in the clockwise direction, observed from the top, expanding the operatively right hand portion 1518, causing movement to the left of the T-bar 1510 and so fancy. articulation to the right of the end effector 1506. In FIG. 48, a surgical insert 1600 includes a fluid distractor articulation system 1602 that includes a proximal cylindrical cavity 1604, which is bisected lamerally by a ripple 1606 bisected confroll actuator. longiudinally by a siallial sealing barrier 1608, to form nearby left and right deposits 1610, 1612, which are the two discrete compartments of cuafro thus defined. A smaller cylindrical cavity 1614 is also bisected similarly by a linear follower actuator 1616, and bisected longitudinally by a stationary 1618 sealing barrier in four quadrants, with the next two being the left and right remote compartments, 1620, 1622. A duct of left fluid 1624 communicates between the left-hand reservoir 1610 and the left-hand compartment 1620, and a right-hand fluid conduit 1626 communicates between the right-hand reservoir 1612 and the right-hand compartment 1622. In this manner, as depicted in figure 49 , the rotation in the conirrary sense of the clock hands of the rotary actuator 1606, reduces the size of the right-hand reservoir 1612, while expanding the left-hand reservoir 1610 with a corresponding reaction in the right and left remote compartments 1622, 1620 Therefore, in response to this would be articulated by an end effector (not shown) which is pivoially coupled with the manual follower actuator, 1616. In FIG. 50, a surgical inslroument 1700 incorporates a movable lever mechanism, 1702, of left and right pistons layerally opposite. , 1704, 1706, which move in concert in such a way that a flow of fluid fluid is produced in a passage of circular fluid 1708 which communicates between both. In particular, each foot 1704, 1706, which includes respective left and right piston seals 1710, 1712, is received respectively in a left and right cylinder bore 1714, 1716, the last in fluid communication through the circulating fluid passage 1708. , a portion of which may include a passage of longiíudinai fluid (not mosírado). A curved roving member 1708 is rotated by this differential fluid flow around a longitudinal axis of an elongated shaft 1720 of the surgical superstructure 1700. In FIG. 51, lateral movement to the right of the pistons 1704, 1706 causes the 1718 rotational member moves clockwise, from the 6 o'clock position to the 8 o'clock position. It should be appreciated that the rotational member 1718 is operably coupled with a mechanism of rooting drive (not shown), such as the gear drive that is described in the application of a covenient map of E.U. No. 10/615, 973"Surgical Insírument Incorporating An Articulation Mechanism Having Abouf The Longitudinal Axis Rogation" by Wales and others, presented on July 9, 2003, by the same attorney, which is incorporated herein as a reference in its tofality.

Rudder Tongue Articulation In Figure 52, a surgical instrument 2400 includes a fimon cane hinge mechanism 2402 of a proximally directed downstream shank 2404 of an effector 2406, which is pivotally coupled with an elongated arrow 2412 in a vertical pivot bolt 2408, which had an arm 2410 of imitra cane, which moves pivoially within the elongated shaft 2412 in response to a fluid transfer articulation system 2414. In particular, respective laterally operative dishyte portions, left and right. right, 2416, 2418, of the left and right conical bags, 2420, 2422, are placed on respective sides of the lemon shank arm 2410 of a closing sleeve 2424 of the elongated arrow 2412. The portions of pouch next left and right 2426, 2428, are part of a lateral control mechanism 2430. In particular, left and right compression members 2 432, 2434, compress the next left and right bag portions 2426, 2428, and force fluids respectively toward the left and right side laterally remote portions 2418. In Figure 53, the right compression member 2434 is driven inward, compressing the right-hand bag portion 2428, thereby expanding the operatively operative right-hand distancing portion 2418. In this way, the shank arm 2410 is pivotally moved laterally and moved to the left, articulating the effector of extruder 2406 to the right. In addition, the left laterally operative distal portion 2416 is compressed, expanding the left proximal bag portion 2426 and moving the left compression member 2432 outwardly. The articulation to the left would encompass the inverse operation. Although the present invention has been illustrated by various modalities, and although the illustrative modalities have been described in considerable detail, it is not the intention of the applicant to restrict or limit in any way the scope of the appended claims to said details. Malaria experts can easily consider additional rods and modifications. For example, a single fluid transfer proposal can be incorporated wherein a single fluid actuator expands and compresses to effect articulation, perhaps aided by an elastically opposed member that is not in fluid or pneumatic communication with the handle. An application consistent with such a design, for example, could include a bag attached to a T-bar so that when the bag is compressed by extracting the fluid, pull the T-bar with it.

Claims (1)

NOVELTY OF THE INVENTION CLAIMS

1- A surgical instrument comprising: a proximal portion configured for external manipulation of a patient; an elongated arrow attached to the proximal portion; an end effector; an articulation joint joining the end effector to the elongated shaft; a fluid control attached to the proximal portion, operatively configured to transfer fluid through the elongated shaft through a first fluid passage; and a first fluid actuator in fluid communication with the first fluid passage, and responsive to the fluid transferred by the fluid control to drive the joint joint. 2. The surgical device according to claim 1, further characterized in that the fluid conirol is also configured to transfer a fluid in an opposite direction through a second fluid passage, the surgical instrument further comprising a second fluid actuator. in fluid communication with the second fluid passage, and responsive to the fluid transferred by the fluid control, to assist the first fluid actuator in driving the joint joint. 3. The surgical device according to claim 2, further characterized in that it comprises: a resilted sliding bar for lateral movement of the elongated shaft; a distant end of the sliding bar placed in a joint of articulation; and a proximal surface of the end effector coupled with the end effector distal to the articulation movement, to convert a lateral movement of the sliding bar into a pivotal movement of the end effector; wherein the first fluid actuator comprises a first bag positioned on a first side of the actuator member on the elongated shaft, and the second fluid actuator comprises a second bag positioned on a second side oppositely of the fluid; actuator member of the elongated arrow. 4. The articulation member according to claim 3, further characterized in that the articulation member includes a proximal portion comprising first and second piston disenies projecting oppositely, moving laterally from a first and second cylinder disianíes respecíivos which are respectively communicated with the first and second fluid passage. 5.- The surgical inslrumenio in accordance with the claim 3, further characterized in that the fluid conirol comprises: a first fluid reservoir in communication with the first fluid passage; a second fluid reservoir in communication with the second fluid passage; and a lateral actuator operatively configured to compress a fluid reservoir selected from the first and second fluid reservoirs, while allowing the fluid actuator not selected from the first and second fluid accumulator to expand in response to the compressive forces on the fluid. second bag. 6. - The surgical instrument in accordance with the claim 5, further characterized in that the first and second fluid reservoirs comprise respective piston cylinders, the articulation conirol comprising respective first and second pistons received for movement in the first and second piston cylinder. 7. The surgical device according to claim 5, further characterized in that the joint control comprises means for differentially compressing the first and second fluid reservoirs. 8.- The surgical instrument in accordance with the claim 3, further characterized in that the fluid confrol comprises: a fluid reservoir in communication with the first fluid passage and the second fluid passage; a movable sealing surface separating the fluid reservoir in first and second reservoir portions; and a spring actuator operatively configured to move the movable seal surface to differentially adjust a volume of fluid for the first and second tank portions. 9. The surgical instrument according to claim 8, further characterized in that the laminar actuator comprises means for differentially adjusting the fluid volume of the first and second reservoir portions. 10. The surgical instrument according to claim 3, further characterized in that the proximal surface of the end effector comprises a gear segment and the distal end of the slide bar comprises a rack. 11. The surgical insert according to claim 10, further characterized in that it comprises an idle member on the elongated shaft, which moves selectively, distally and longitudinally to engage the end effector gear segment, locking the joint joint . 12. The surgical instrument according to claim 11, further characterized in that the leg member is disially driven and includes a proximal pin, the articulation conirol including a toothed surface that raises the pin proximally during actuation, and allows the The proximal bolt moves distally toward a corresponding tooth root of the serrated surface when the articulation control is relaxed. 13. The surgical device according to claim 2, further characterized in that the first and second fluid actuator comprise respective first and second pistons, each coupled with opposite sides of the end effector spaced around a pivotal axis thereof. 14. The surgical instrument according to claim 13, further characterized in that the drive control comprises a selector valve operatively configured to couple a fluid passage selected from the first and second fluid passage, with a fluid source under pressure, and to discharge the pressure to the fluid passage not selected from the first and second fluid passage. 15. The surgical instrument according to claim 13, further characterized in that the first and second fluid reservoirs comprise respec- tive proximal piston cylinders, the joint confrol comprising respective first and second pistons received for movement in the first and second cylinders. of piston, and a rotary control actuator positioned to differentially move the first and second pistons close together. 16. The surgical instrument according to claim 2, further characterized in that the articulation joint comprises an imiton rod projecting proximally from the end effector, received pivotally on the elongated shaft, and extending therein to present a Ion arm, the first fluid actuator comprising a first bag positioned on a first side of the tiller arm on the elongated shaft, and the second fluid actuator comprising a second bag positioned on a second side of the arm of the arm. Rudder on the elongated arrow. 17. A surgical instrument comprising: a proximal portion configured for external manipulation of a patient; an elongated arrow attached to the proximal portion and including first and second fluid passage through a proximal portion thereof; an end effector; an articulation joint that joins the end effector with the elongated arrow; a fluid control attached to the proximal control, operatively configured to transfer fluid differentially through the elongated shaft by means of the first and second fluid passage; a first fluid actuator in fluid communication with the first fluid passage; and a second fluid actuator in fluid communication with the second fluid passage; wherein the first and second fluid actuator cooperatively respond to the differential fluid transfer to drive the joint joint. 18. The surgical insírumenío according to claim 17, further characterized in that the fluid is not compressible. 19. The surgical instrument according to claim 17, characterized in that the fluid is compressible. 20. A surgical instrument comprising: a proximal portion configured for external manipulation of a patient; an elongated arrow attached to the proximal portion; an end effector; an articulation joint joining the end effector with the elongated arrow; fluid control means for bi-directionally transferring fluid through the elongated shaft; and fluid actuating means responsive to the fluid transferred from the elongated shaft to articulate the joint joint.