CA2133182A1

CA2133182A1 - Articulable socket joint assembly for an endoscopic instrument and surgical fastener track therefor

Info

Publication number: CA2133182A1
Application number: CA002133182A
Authority: CA
Inventors: Warren P. Williamson; Mark Fogelberg; Steven Burnett; Jack E. Smith; E. David Allen
Original assignee: Ethicon Inc
Current assignee: Ethicon Inc
Priority date: 1993-09-30
Filing date: 1994-09-28
Publication date: 1995-03-31
Also published as: AU682710B2; AU7431694A; JPH07163574A; EP0646356A3; US5405344A; EP0646356A2

Abstract

ABSTRACT
An articulable assembly is provided for an endoscopic instrument along with a surgical fastener track therefor. The assembly includes a distal end portion for supporting an end effector to effect tissue manipulation while carrying out a surgical procedure within a body cavity. The assembly includes an articulable joint connecting an elongate support housing with the distal end portion. The joint includes a hollow socket and a convex member that is received in the socket. The convex member defines a passageway for accommodating an actuator extending from the housing through the joint to actuate the end effector. An operator is provided on the housing and extends to the socket or convex member for moving the distal end portion into and out of alignment with the housing. A
flexible track is provided for guiding fasteners through the joint.

Description

~```: ^ ` ` :

3~ ~2 ~RTICULABLE SOCKET JOINT ASSEMBLY FOR ~N ENDOSCOPIC
INSTRUMENT AND SURGICAL FASTENER TRACK THEREFOR
P052593\LLR1 T~CENICA~ FI~D
This inventio~ r~lates generally to ~urgical instruments used in e~doscopic procedu:res.
BACRG~OUND OF ~ I~V~N~'ION
~ND
T~ ~NICA~ PROB~M8 PO~D BY T~ ~IOR ~RT
Endoscopic surgical techniyues have become widely accepted. As used herein, the term S'endoscopic"
pertains generally to the use of a surgical instrument which is inserted i~to a body cavity in conjunction with an endoscope which is inserted into the same body cavity. The endoscope permits visual inspection, with or without magnification, o~ the interior of the bocly cavity and permits observation of the operation of the surgical instrument for therapeutic or diagnostic purposes.
In a typical endoscopic surgical proc~dure, the abdomin~l cavity of a human or ani~al subje~t is insufflated with a sterile gas, such as carbon dioxide, in order to provide increased man~uvering room within the body cavity for endoscopic instruments. Then, conventional trocars are inserted into the sub~ect's ~5 body cavity through th~. surrounding skin~ tissue, and musculaturP. A conventional trocar typically consists of a trocar cannula which houses an elongated trocar obturator. Trocar obturators typically have a pierc.ing point, although other types of obturators are ~lso available.
A~ter eac~ trocar ha~ been posi~ione~ within the body cavity adjacent th~ target ~urgical site, th2 trocar obturator is rsmoved leaving the trocar rannula as a pathway to the body ca~ityO A plurality of trocar cannulas are typically placed in this manner, T~P

.:: ` ~ ' `

. 8 2 surgeon can then insert an endoscope through one of the trocar cannulas and can insert various types of endoscopic, surgical instruments ~hrough one or more of the other trocar cannulas at the target suryical site where the diagnostic or therapeuti~ surgical procedure is performed.
The endoscope is typically connected to a video camera, and the output from the video camera is ~ed ~o a video moni~or which displays the suryical site and the end of the endoscopic instrument at the surgical sit~. Examples of endoscopic instruments include ligating clip appliers, tissue cutters, electrosurgical instruments, tissue graspers, needle graspers, cannulas, tissue manipulators, and the like.
Although-endoscopic surgical procedures offer many advantages, there are some problems associated with these procedures as conventionally practiced. For example, because the surgeon typically views the di~play on the vldeo monitor as he manipulates instruments within the body cavity, the video display provide~ the surgeon with only a two-dimensional view of the surgical site, and there is a consPquent loss of depth perception.
Another problem relates to engaging tissue Prom the instrument insertion direction. ~any conventional, endoscopic i~struments~ such as gra~pers and ~cissors includ~ a distal end m~chani m for engaging the tissue in a way that eP~ects the desired result (eOgO, sgueezing or cutting the tissue). Such di~al end mechanisms can be generally described as "end e~ectors." In many conventional, endoscvpic instruments, the end effector is mounted tOg and extends generally linearly with, a rigid, straight sha~t o~ th in~trument.

, ` ~ . `

Depending upon the nature of the operation to be performed on the tissue within the body cavity, it may be desirable to provide an end effector which can be angled or articulated relative to the longitudinal axis of the instrum n~ shaft. This can permit the surgeon to more easily engage the tissue in some situations.
A further problem relates to the potential ~or blocking part of the field of view with the endoscopic instrument~ Thus, the usP of an endoscopic instrument with an articulating distal end would permit the surgeon to engage the tissue with the distal end of the end effector laterally offset relative to the instrument'~
main sha~t. This would permit the engaged tissue and distal end of the end effector to be better viewed through an adjacent endoscope with little or not interfere~ce from the main shaft.
Although a number of designs have been propos~d for articulating endoscopic instruments, and although articulating endoscopes and other instruments are commercially availabl~, it would be desirable to provide an improved design ~or accommodatiny articulation of an end effector.
In particular, it would be advantageous to provide an articulating in~trument with the capability Por orienting tha end effector at a substantial oblique angle relative to the longitudinal axis of the instrum~nt. Further, it would be benefici 1 if such an improved design pe~mitted articulation in any radial direction around the longi~udinal axis of ~he instrument.
In endoscopic surgery it may be desirable in some situations to sen~e en~ironmental characteristics at the surgical site (e.g., temperature, chemical, etc.). Further, it may be desirable to sense the actual presence or position of a component of the instrument.

i ' ' ~ ~ ' ' . . .
ii.~;: ;' `'' ' , In addition, it may be beneficial to provide conduits for irrigation or aspiration at the surgical site. It may also be necessary to provide clip~ or staples at th~
sitP and to proYide means, as part of the end effactor, for applying the clips or skaples. Accordinyly, it would be especially advantageous to provide an improved articulable assemb~y which can accommodate internal sensor lines, aspiration conduits, irrigation conduits~
flexible actuator m~mbers, as well as the fe~ding and application of fasteners (e.g., of clips and staples~.
Such an improved articulable assembly should preferably have su~ficient interior space to accommodate internal passages and components and to permit the movement of such components through the ar~iculable assembly.
It would also be advantageous if such an improved articulable assembly for an endoscopic instrument could be provided with a relatively smooth exterior configuration having a minim~m of indentations and projections thak might serve as sites for contaminants and be hard t3 clean or thak might be more likely to catch on, or tear, ad3acent tissue.
It would also be beneficial if such an improved articulable assembly could be provided with sufficient strength ko accommodate relatiYely high moments and force~ during operation o~ tha instrum2nt end e~feGtor in an articulated orientation as well as in a straight orientation.
An improved articulable ~ssembly ~hould desirably al~o permik relatively precise conkrol o~ th~
ori2ntation of the end effector r~lative to the longitudinal axis o~ th~ instrument~ F~rther, it would be beneficial i~ such control could be exercised wigh a minimal amount ~f re~uired inpu~ ~orce or ~orque.
~dditionally, such an impro~ed axticulable assembly should easily accommodate operation and control ~rom the proximal end of the instrument exterior of the body cavity.
Also, it would be desirable to provide a :
system for transporting fasteners, such ~s ligating clips or staples, ~hrough th~ articulable assembly.
Such a system should accommodate movement o~ the fasteners when the end effector is articulated, as well as when the end e~fector is aligned with the instru~ent main shaft. Further, such a fastener tra~sport system should desirably isolate the fasteners within the assembly from adjacent mechanisms so as to avoid interference with the fas~en~rs and/or contamination thereof.
The present invention provides an improved articulable assembly for an instrument used in an endoscopic procedure which can accommodate designs having the above discussed benefits and features.
~ ~MNARY OF ~ IN~BNTION
;~ According to the principles of the present invention, a u~ique, articulable assembly is provided ~ ~ for an endoscopic ins~ument and permits articulation of ~ the instrument end effector in a controlled manner. The assembly includes a joint which is relatively strong and : can withstand the mom nts and forces ~o which it is subjected during articulation as well as during op~ration of the end e~fector.
The assembly is readily operated from the proximal end o~ the instrum~nt without requiring the applica~ion of an excessively high input forces or torques.
The assembly provides a signi~icant a~ount of internal cl~arance to accommodate components extending from the proximal end of the instrument to the ~nd effect~r. The interna} region of the assembly can also accommodate the passage of fasteners, such as ligating clips or staples.
The assembly can be provided with a relatively smooth exterior configuration to minimize potential contamination sites or ~issue snagging sites.
The assembly includes a distal end portion for supporting an end effector to effect tissue manipulation while carrying out a surgical procedure within a body cavity.
An articulable joint connects the distal end portion to an elongate support housing. The joint includes a hsllow socket and a con~ex member that is received in the socketO The convex member defines a passageway for accommodating an actuator extending fro~
the housing through the joint to actuate the encl effec~or.
An operator is provided on the housing and extends to ei~her ~hP socket or ~he convex member for moving the distal end portion into and out of alignm~nt with the housing.
Accordin~ to a~othQr aspect of the invention, a track is provided for guiding at least one surgical fastener through an articulable joint in an instrument ~or use in an endoscopic procedure.
The track includes a tube of material which i5 suf~iciently flexible ko accommodate bending through the joint. The tube defines a longitudinal passage ~ith a transverse cross-sectional configuration for a¢co~odating and maintaining the fastener genarally in a predetermined orienta~ion while the ~as~ener moves alo~g the passage.
The tube passage is at least in part de~ined by two generally opposed wall portions. The wall portions each define a lonyitudinal groove that i5 open toward the other wall portion. The size o~ the groove ,;. ,. ~

2~ 33182 opening can vary in response to compressive and tensile bending loads.
Numerous other advantages and features of the present invention will become readily apparent from the following detailed description of the invention, from the claims, and from the accompanying drawings.
BRIBF DE8CR~P~ION OF T~ DR~WIN~8 In the accompanying drawings that form part of the specification, and in which like numerals are employed to designate like parts thrvughout the sam~, FIG. 1 is a schematic representation of an instrument i~corporating a general form of an articulable assembly of the present invention;
FIG. 2 is a view similar to FIG. 1, but showing an modified form of the articulable assembly;
FIG. 3 is a simplified, perspective view of an instrument that incorporates a first embodiment of the articulable assembly of the present invention;
FIG. 4 is an exploded, fragmentary, perspective view of ths instrument shown in FI&. 3;
FI~. 5 is an enlarged, fragmen~ary, cross-sectional view taken generally along the plane 5-5 in FIG. 3;
FIG. 6 is a cross-sectional view taken generally along the plane 6-6 in FIG. 5;
: FIG. 7 is a fragmentary, cross-sectional view i :~
of a second embodiment of an articulable assembly ~ -i~corporated in an endoscopic instrument;
FIG. 8 i~ an exploded, fragmentary, perspective view of the ins~rument shown in FIG. 7;
FIG. 9 is a fragmentary, exploded, perspective view of a proximal portion of ~he instrumen~ shown in FIG. 8:

FIGS. 10-13 are simplified, schematic diagram~
showing the articulation of the end effector in the instrument illustrated in FIGS. 7-9:
FIG. 14 is a fragmentary, perspective view of a third embodiment of an articulable assembly ~or an endoscopic instrument;
FIG. 15 is an ~nlarged, fra~mentary, cros~-sectional vi~w of the instrument shown in FIG~ 14:
FI5~ 16 is a cross-sectional view taken generally along the plane 16-16 in FIG. 15;
FIG. 17 is an exploded, fragmentary, perspective view of the instrument shown in FIGS~ 14-16:
FIG. 18 is a rear, perspe~tive view of the instrument shown in FIGS. 14-17;
FI~. 19 is an enlarged, fragmentary, cross-sectional view taken generally along the plane 19-19 in FIG. 18;
FIG. 20 is a view similar to FIG. 18~ but showing portions of the in~trument in phantom wi~h dashed lines to reveal int~rior detail;
FIG. 21 is a fra~mentary, per.~pective ~iew of a modified form o the instrument illustrat2d in FIGS.
14-20, FIG. 22 is an enlarged, fra~mentary, sro~s-sectional vi~w taken ~enerally along the plane 22-22 in FIG. 21;
FIGo 23 is a fra~mentary~ cross-sectional view of a fourth embodiment of an articulable assembly o~ tha present invention incorporated in an in~trumPnt with a track for guiding a ligating clip in azcordance with another aspect of the present invQntivn;
FIG. 24 is a cross-sec~ional view taken genexally along the plane 24-24 in FIG~ 23;
FIG. 25 is a ~ra~mentary, cros~ectional view taken generally along the plane 25-25 in FIG. 23;

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:
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2 ~ 3 ~

FIG. 26 is a fraymentary, perspective view o~
the ligating clip track employed in the instrument illustrat~d in FIGS. 23-25;
FIG. 27 is a front, end view of the track shown in FIG. 26;
FIG. 28 i~ a fragmentary, perspective view of the track bending in one plane; and FIG. 29 is a ~ragmentary, perspectiYe view of the track bending in another plane.
DE8~ ION OF T~E P~EFBRRED EMBODIN~NTB
one aspect of the present invention relates tD
a uniqu~, articulable assembly which can be employ~cl in an endoscopic instrumen~ to accommodate articulatiorl of an end effector with relatively littl~ required ~orc:e or torque applied at the proximal end of the instrument.
The articulable assembly has a substantial amount of internal clearance to accommodate end effector actuating members, sensor lines, clips or staples, irrigati~n conduits, aspirator conduitsl and the likPo The articulable asse~bly is relatively ~trsng and can be provided with an exterior configuration ~hat minimizes structural pro~ections that miqht snag on tissue or accumulate contaminants.
In addition, the articulable assembly can b~
employed with instrument~ for effect1ng a variety of function~ with r~pect to the ~urgical si~e 9 and th2se ~unctions can include, but are not limited to, dissectiny, cutting~ grasping, clamping, applying ~aples or ligating clips, applying ultrasoni energy, conducting electrocautery procedures, irrigating the surgical site, or removing matarial ~rom th~ site by aspiration or suction.
Components for various sensor systems can he routed thr~ugh the novel articulable joint a~sembly~
Such sensor syst~ms can include, but are not limited to, , : .,;, ;.
. .: . . .
, .. - ~ , 2133~2 systems for measuring tissue thickness or compre~sion, tumor sensing, pulse oximitry, and dopplar effect sensing of fluid in vessels. Also, light guides and other fiber optic system componen~s may be routed through the assembly.
Further, the articula~le assembly of the present in~ention accommodates various dssigns for venting or sealing the instrument and accommodates the use o~ ~ilt~rs ~or fil~ering gas and smoke.
While this invention is susceptible of embodiment in many different forms, this specification and the accompanying drawings disclos~ only some specific forms as ~xamples of the invention. The invention is not intended to be limited to the embodiments so described, however. The scope of the invention is pointed out in the appended claims.
For ease of description, the instrument~
incorporating this inven~ion are described in various operating positions, and terms such as upper, lower, horiæontal, etc., are usPd with reference to these positions. It will be understood, however, that instrum~nts incorporating this invention may be ma~u~actured, stored, transported, used, and sold in an orientation other than the position described.
Figures illustrating the instruments show ;om~
m~chanical el~ments that are known and that will be recognized by one skilled in the art. The detailed de~criptions of such elPments are not necessary to an understanding of the invention, and accordingly, are herein presented only to the de~ree n~cessary tc facilitate an understanding o~ the novel featur~ of th present inve~tion.
The instruments incorp~rating the present invention can be used with certain conventiDnal components the details of which, although not fully .. . .
,;; , . . .

21331 ~2 illustrated or described, will be apparent to those having skill in the art and an unders~anding of the necessary ~unctions of such componen~s.
FIGS. 1 and 2 schematically illustrate some basic features of the articulable assembly o~ the present invention. The instruments il:Lustrated in FIGS.
1 and 2 each include a proximal porti~n in th~ form of a support hou~ing 34 (FIGn 1~ or 34A (FIG. 2). This part of the instxument is grasped by the surgeon and remains outside of the patient while the rest of the instrument is inserted through the trocar cannula and into ~the body cavity. The instrument includes a distal end portion 31 (FIG. 1) or 3lA (FI~. 2) that includes an end ef.~ector 36 (FIG. 1) or 36A (FIG. 2) which is positioned at the surgical site and actuated to manipulate the tissue in a desired manner.
Various types of end effectors for endoscopic instruments are disclosed in the catalog entitled "HOSPITAL PRICE LIST ~- ETHICON AND YOU. THE ULTIMATE
SURGICAL TEAM ~ ~THICON ENDO-SUR~ERY - a Johnson &
Johnson comp2ny EFFECTIVE FEBRU~RY 24, 1992'l and distributed by Ethicon, Inc. 4545 Creek Road, Cincinnati, Ohio 45242 U.S.A. For sxample, see the end e~fectors on the following instruments shown in the catalog- the micro soissors D~Sll as shown on page 5, the straight grasper DSG20 as shown on page 5, the straight dissector DSD31 a~ shown on page 13l the extractor DEX40 as shown on page 13, the clamp BC10 as shown on page 13, the clip applier ER320 a~ shown on page 21, the linear cutter ELC60 shown on pa~e 2BI and the stapler ES100 shown on page 29. The design and operation of such end Pffectors are well known. Some type~ of ~nd effectorg are disclosed in detail in U.S.
and ~oreign patents. See, for example, the clip appli~r shown in the Ethicon, Inc. U. 6. Patent No. S,lS3,945~

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-- 2~33~

- ~2 In general, end effectors for performing the functions of the above-listed types of end effector~
can, with appropriate designs, be incorporated in the articulable assemhlies schematically illustrated in FIGS. 1 and 2. ~he design and operation of particular end effectors form no part of the present invention.
In FIG. 1, the distal end portion 31 is connected to the support housing 34 through an articulable joint. The joint includes a hollow socket 40 and a convex member 44 which is received in the socket 40. In particular, the socket 40 is rigidly incorporated in the distal end portion 31 while the convex member 44 is rigidly incorpora~ed in the support housing 34~
The socket 40 can be rotated on the convex member 44 by means of an articulation operator 48 on the ~upport housing 340 This effects articulation of the di~tal end effector 36. The detailed structure and operation of particular articulation operators are d~scribed in detail hereinafter.
The convex member ~ defines a passageway 50 for accommodating an actuator m~mber 52 which extends from an end e~fector actuator 54 on the support h~using 34 through the joint to actuate the distal end ePfector 36. The actuator me~ber 52 may be characterized as part of~ and an ext~nsion o~, th~ end effector artuator 54.
Such an actuator member 52 may be a flexible band for pushing a distal ~nd ef~ector mechanism S~-.g., a link to pi~ot a scissors-type blade~O The actuator member 5,2 may also be an electric cable in an electric circuit for operating an electrically powered end e~fector. The actuator member could also include t~insion cords or cables for pulling distal end e~ector mechanism~ to e~fect actuation thereofO The actuator member 52 may also be a pneumatic or hydraulic line for pressurizing a ~: :`

3 ~ 8 2 suitable operator for ac~uating the distal end effector.
The det2iled design and operation of the particular end effector and actuator therefor ~orm no part of the present invention.
S The passageway 50 defined in~ and through, th~
convex member 44 i5 preferably sufficiently large to accommodate one or more end effector actuator members 52 as well ~s additional component~ such as irrigation conduits, aspiration conduits, and sensor lines (electrical, pneumatic, etc.).
In the other form of ~hP instrument illustrated in FIG. 2, a conYex member 44A is rigidly incorporated in the distal end portion 3lA. The convex member 44A defines a passageway 5OA and is received in a socket 4OA which is rigidly incorporated in the end of the support housing 34A.
An articulation op~rator 48A on the housing 34A is operably connected to the convex member 44A for rotating the member 44A within tha socket 40A so a~ to articulat~ the distal end portion 31A (and distal end effectox 36A carried thereon) to a desired orientation at an oblique angle relative to the longitudinal axis of the instrum2nt.
An end effeotor actuator 54A on the housing 34A has an end effector member 52A ~xtendin~ hrough the convex mem~er passage 50A to actuat2 the di~tal end effector 36A.
Th~ embodiments discussed above wikh r~ferlence to FIGS. 1 and 2 incorporate basic forms o~ ~he articulabl~ joint assembly of the present invention.
Particular, d~tailed ~signs of such ~oint assemblias are describ~d in detail hereinafter a~ employed in particular instruments.
FIGS. 3-6 illustEate an instrument incorporating an articulabl2 a~sembly which employs : -: - - - ,: ~ .

~'331~2 basic design feature~ illus~ra~ed in FIG. 1 described above. In particular, the instrument includes an elongate, distal end portion 60 extending from a proximal housing 62.
At the distal end of the portion 60 are a pair o jaws 64 and 66. The jaw. 64 is ~ixed to thP end portion 60, but the jaw 66 is pivotally mounted to the end portion 60 with a screw 68 for mov~ement toward and away from the fixed jaw 64. A l~a~ spring 70 mounted to the end portion 60 normally biases the jaw 66 to an open position. The jaw 66 has a downwardly projecting 1~9g 72 to which is attached a cable 74 extendiny through the instrument to the proximal end wh~r~ the cable 74 i~s attached to a lever 76. As illustrated in FIG. 5, khe lever 7~ is pivotally mounted on a pin 7~ to a clev.is 80 projecting from a rear plate 82. The lev~r 76 can b~
pivoted ~orwardly or rearwardly, as illustrated by the double headed arrow 84 in FIG. 3, so as to close the jaw 66 or permit it to be held open by the spring 70.
The ~longate, distal end portion 60 d~Pin~s an interior passage 88, as illustrated in FIGS. 3 and 5, fo~ accommoda~ing the cord or ~abl~ 74~ ~s illus~ra~d in FIG. 5, the pxoximal end of thP end portion 60 has an open end defining a conc~ve urface or 50CX2t 90. The socket 90 receives a con~ex member or ball 92 whirh defines the dî~tal end of an elongate shaft 94. Th~
convex member 92 and shaft 94 define an internal passageway 96 for the ca~le 74.
As illustrated in FIG. 6, the elongate sha~t 9~ has two outwardly projecting ~.ys or guide member 101 and 103. A ~irst drive member 10~ defines an ~longate slot 107 ~or r~ceiving the gulde member 101.
second drive member 109 is ~iametrically disposed relatiYe to the first drlv~ m~mber 105 and define~ a slot 11~ ~or receiving the guide mP~ber 103, ~ach dri~e :
"~ .

2~.g~3~2 mem~er 105 and 109 i5 ~hus carried on ~he lelongat~ shaft 94 for longitudirlal movemQnt along the shafk 94 toward and away from the convex member 92.
As best illustrat~d in FIGS. 3-5, th~ drive member lOS has a distal end defining a tooth llSo The tooth 115 is received in a notch 117 dl~fined in the proacimal end of the distal end portion 60.
Similarly, the second drive member 109 ha~ a dist~l ~nd de~ining a too~h 119 which is received in a notch 122 defined in the proximal end of the distal end psrtion 60. In ~he pre~erred fonn illustrated, the distal end portion 60 has a cylindri ::al exterior configuration, and the no~ches 117 and 122 are diametric:ally opposed.
The drive ~ember 105 defines an outwardly oriented left-hand thread segment 124, and the second drive member 109 defines an s~utwardly orierlted right-hand thread segment 126. The thread seg~ents 124 and 126 are threadingly ~nyaged with an articulation c~pera~or nut or sleeve l3a. The nut or sleeve 130 has a ~orward cylindrical interi~r .surface which de~ines a left-hand thread portiorl 132 and has a rearward cylindric:al interior surface which deIin~s a riglht-hand thread portiorl 1349 The left-hand thread portion 132 is separat d from th~ right-hand thread portion 134 by a cyl irldrical ~pace 13 6 .
The le~t-hand thread segment :L24 o~ th2 :~irst drive member lOS threadingly engages the le~t-hand ~.hread portiorl 132 of the sleeve 130, and the right~hand thread ~egm2nt :L26 of the ~econd driv~ me~nb r 1Og threadingly engages th~ right-hand thr~ad po;rtiorl 13~ o~
th~ ~leeve 131)o Wh~n- the ~leeve 130 is rotated~ the ~r~gaged left hand threads 124 and 132 ms)ve the ~irst drive :: . :. .
.~ .. . . . . . .

'213~2 member 105 longitudinally (proximally or distally depending upon the direction of rotation of the sleeve 130). At the same ~ime, the drive member lO9 is moved in the opposite longitudinal direction owing to the engagement of th~ right-hand thr~ad segments 126 and 134. As one drive member moves distally, the other drive member moves an equal distance proximallyO ~he distal end of the dis~ally moving drive m~mber forces the inctrument distal end portion 60 to pivot about th~
convex member 92. The pivoting is accommodated by the other driYe member moving proximally.
The drive me~bers 105 and lO9 are retained within an outer tube 140. The outer tube 14G has a flange 142 at the proximal end which is ~astened, as with screws 144, to a retaining ring 146. The retaining ring ~46 defines a pair of access apertures 148 which accommodate placement of one or more fingers on the exteri~r of the slae~e 130 to e~fect rotation th~reof, The proximal end of the retainer ring 146 has an inwardly projecting, annular ~lange 152 which is fastened, as with screws 154, to the end plate 82~ The end plate 82 defines an aperture 162 for accommodating the cord or ca~le 74 which is a~tached ~o the lever 76.
The plate 82 also serves as a base to which he lever c?evis 80 is attached.
In operation, the surgeon can hold the exterior of the instrument's outer casing 140 in one handO With a finger o~ the other hand, the surgPon can rotate the ~leeve 130 as necessary to articulate th distal end portion to the desired orienta~ion~ Th~
lever 76 can ~hen ~e operated to actuate the end e~fector.
It will be appreciated that the embodiment o~
the articulable assembly incorporated in th~ instrument illustrat2d in FIGS. 3~6 p~ovides a number of ,"'' ~ '-' . .
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~133~2 advantayes. First, the articulation i6 posi~ively driven through a threaded drive system. Thus, the artirulable assembly has no stored energy mechanisms (e.g., springs or members under ~ensi~n or compression, e~c.) for ~aintaining the articulated position.
Ther~for, in the event of a component 1Eailure, there will not be an uncontrolled movement of the distal end portion o~ the instrument.
Further, the articulable assembly can be preloaded (without backlash) so as to maintain preload throughout the stroke.
The novel design also accommodates variou:
types of end effector actuator systems. For example, a particular end effector could be provided with a flexible compression member actuator system in place of the tension cable 74. Other types of actuating systems could al~o be employed and extend through the central passage 96. These could include hydraulir lines~
electric lines, and the like. Further, the c~ntral passage 96 can accommodate systems other than actuator systems. For exampls, ~lectrical sensor lines or optical fibers can be routed through the c ntral pa~sage 9S. In addition, cunduits for supplying fluid to the surgical site, or for withdrawing gas or liquid from th~
surgical site, could be employed in the central passag~
96.
A~other embodiment of the articulable assembly of the present invention is illustrated as incorporated i~ an instrument in FIGSo 7~13. As shown in FIG~ 10, ~he instrumPnt includes a proximal handle portisn 160, an elongate housing or support tube 162 which d~fi~es ~
longitudinal axis 1~1, and a distal end portion 16~ for supporting an end effector lS6. The end e~eckor 166 may b~ one of the types discuss~d above with reference to khe instruments illustrated in FIGS9 1 6. The 2~331~2 detailed de ign and operation o~ the end effector 166 form no part of the present invention.
The device illustrated in FIGS. 7-13 incorporates the basic invention principl~s which are schematically illustrated in FI~. 2 described ahove. In particular, and as illustra~ed in FIGS. 7 and 8, thQ
housing or support tube 162 has a generally hollow, cylindrical configuration defining a socket 168 at the distal end. A tab 170 projects inwardly from the open end of the ~ube 162 a~ the socket region. In th preferred embodiment illustrated, the tab 170 has a rectangular prism shape.
The distal end portion 164 includes a conv~x ~emb r 174 which is received in the socket 168. The convex member 174 defines a passageway 178 oriented with it5 longitudinal axis 180 (FIG. 8) at an obligue angle relative to the longi~udinal axis 161. The convex member 174 also defines an arcuate groove 184 ~or receiviny the tab 170.
An articulation operator is provided on the elongate support tube 162 for moving the dis~al end por~ion 164 into and out of alignmen~ wi~h the elongat~
support tube 162. The articulation operator includes a sha~t 188 disposed inside of the suppsrt tube 162. The shaft 188 has a proximal portion 190 generally aliyned with the longi~udinal axis 161. In the embodim2nt illustrated in FIG~ 7, th~ shaft proximal portion 190 is supported for rotation about the longitudinal axis 161 by ~wo b~arings 19~ which are mounted wikhin ~he ~ube 162.
~he shaft 188 also includes an intexmediate portion 196 which extsnds from the proximal portion 190 at an oblique angle relativP. to ths longi~udinal axis 161. A distal portion 198 extends ~rom the intermediate .. -.- ~ , .:
;

' ' , '' - 2~331~2 - 19 - ~:

portion 196 and is disposed for rotation within the :
convex member passageway 178.
The distal end of the shaft distal portion 198 de~ines a groove 202 (FIG. 8] for receiving a snap ring or clip 204. A bottom portion of the convex member 174 defines a clearance or slot.208 (FIG. 7) generally transverse to both the slot 184 and axis 180 for receiving the clip 204. Further, the shaft 188 is provided with a flange 210 (FIG. 7 and FIG. 8) on the distal portion 198. Thus, the distal portion 198 can be inserted into the convex member passageway 178 until the flange 210 abuts a generally planar, annular, bearing surface 212 a~ one end of the convex member ~74. The clip 204 can then be inserted through the convex me~ber slot 208 to engage the shaft distal portion 198 in the groove 202. This holds the convex member 174 on the shaft distal portion 198. However, the shaft distal portion 198 is free to rotate about the axis 180 (FIG.
8) within the convex member passageway 178.
The shaft 188 is hollow and accommodates one :: or more end effector actuator components, such as cables 216, and can also accommodate sensor components ~not illustrated), fluid transfer tubing (not illustrated~, and the like. Such ccmponents are generally flexible to accommodate rotation o~ the shaft 188 and concomitant articulation of the end effector 166 as explained in detail hereinafter.
In a preferred embodiment, the shaft proxi~al portion 190 can be rotated abou~ the longitudinal axis 161 by a gear drive system as illustrated in FIG. 9. I~
particular, a central gear 2Z0 is mounted to the sha~t proximal portion 190 so that rotation o~ the gear 220 would effect rotation of th~ proximal portion 190 about the axis 161. A gear 224 is mounted for rotation on a mounting pin 226 projecting from a flange 228 at the 213~ 82 proximal end of the support tube 162. The gear 224 meshes with the gear 220.
The housing 160 includes a rotatable, frustoconical, drive sleeve 230 with an exterior bezel surface 232 which can be grasped betwe~n the surgeon's thumb and forefinger to rotate the sleeve 230. The distal end of the sleeve 230 includes an interior, cylindrical surface for engaging a portion of the exterior surface of the support tube 162. Fur~her, recessed inwardly in the sleeve 230 is a ring gear 236 for enga~ing the gear 224. Rotation o:E the sleeve 230 thus effects rotation of the gears 236, 224, and 220 to rotate the shaft 188~ . .
When the shaft 188 rotates, the orientation of the end effector 1~6 is change~ as illustrated in FIGS.
10-13. It will be appreciated that the tab 170 (FIG. 7) engages the side walls o~ the slot 184 in the convex member 174. This functions as a fixed pivot point while the convex member 174, and hence slot 184, are moved together within the socket 168 by the offset distal end portion 178 of the shaft 188.
In FIGS. 10-13, an operating handle or lever 234 is ~chematically represented as being con~ected ~o the proximal end of the shaft 188. Such an operating handle 234 can be used in lieu of a drive sleeve 230 and gear drive system illustrated in FIG. 9.
The handle 234 is illustrated in FIGS. 10-13 primarily for the purpose of conveniently showing thle rotational position of the sha~t 188 relative to the articulated orientation of ~he end effec~or 166. The handle 234 is fixed at a right angle to the proxi~al portion 190 of the shaft 188, and there~ore the relationship between the rotation of the shaft 188 and the movement of the end e~ector 166 an be more readily observed in FIGS. 10-13.

2~ ~31~2 The end e~fector 166 is schematically represent~d as a rectangular parallelpiped having four, side surfaces A, B, C, and D. This pe~mits the orientation of the end effectox ~9 be more easily understood in the two-dimensional illustrations which constitute FIGSo 10-13~
In particular, FI&. 10 illustrates the end ef~ctor 166 oriented substantially in alignment along the longitudinal axis 1~1 of the instrument. The end e~fector 166 is viewed at an anyle from the front alld from above. Sur~ace A ~aces upwardly, and surface C
faces downwardly. In this posi~ion the handle 234 projects vertically upwardly at a 90 angle relative to the proximal portion 190 of the shaft 188.
When the handle is rotatad 90 countar-clockwis~ as viewed in FIG. 11 so as to rotate the shaft proximal portion 1~0 countPrclockwise 90 , the ~nd ef~ector 166 swings toward the viewer and upwardly.
Surace C is now visibl~ to the viewer along with surface D.
When the handle 23~ is pivoted 90 clockwise as viewed in FIG. 12, the end effector 166 swings away ~rom the viawer and upwardly in a generally opposite, mirror-imag~ relationship to that shown in ~IG. llo Surace A is now visi~le to the view~r along with sur~ace D.
When the handle ~34 .is pivo~ed 180 Prom the position illustrated in FIG. 10 to the position illustrated in FI~. 13, the dis~al end o~ the end effector 166 bec4mes off~et above the lonyitudinal axis lb~ by a m~ximum amount, and the end ef~ector 166 lie~
midway betw~en ths two lateral positions of th~ end e~fe~tor in FIGS. 11 and 12. Sur~aces C and D are now visible.

2~33~ 8~

The instrument handle portion 1~0 can include suitable triggsrs 241 and 243 (FIG. 10~ for actuating the end effector flexible actuating components (e.g., flexible cables, hydraulic systems, etc.) or other devices, systems, or components.
Although not illustrated, the elongate support tube 162 may also include appropriate gas seals, filters, or venting systems. Further, in some applications, it may be desirable to line the socket 168 wi~h a low-friction, bearing ma~erial t such as a suitable thermoplastic polymer.
Another embodiment of the articulable assembly of the present invention is incorporated in an instrument as illustrated in FI~S. 1~-20. The embodimPnk illustrated in FIGS. 14-20 employs the principles of the invention in the form as schematically illl?strate~ in FIG~ 2. In particular, as illustrated in FIG. 18, the instrument includes a proximal portion 250 from which extends a hollow support tube or housing 252 de~ining a longitudinal axis 254 (FIG. 14). The support tube or housing 252 includes an internal tube 253 a5 best illustrated in FIGS. 15 and 19~ ~s illustrated in FIG. 17, the support tub~ 252 has an enlarged e~d defining an open socket 254 for receiving a co~vex memb~r 256 which de~ines ~he proximal part of a distal end portion 260 of the instrument. The distal end portion 2~0 supports an end ~f~ector 2620 The end effector 262 may ~e one o~ the various end e~ectors discussed above with r~ference to FI~S. 1~6.
Preferably, a~ illustrated in FI~S. ~5 and 17, the convex m~mber 256 d~ines an annular groovQ 257 f9E
r~ceiving an o-ring 259 ~or eP~cting a 5~al of the joint assembly within the instrument.
The convex member 256 also de~in~s a pas~age 26~ for accQmmodating in~ rnal components such a~ an -, .. ~ , . . . . .

. .

~3~2 - ~3 -actuator member, hydraulic line, sensor line, QtC. Two flexible lin~s 268 are illustrated in FIGS. 15 and 16 as extending through the instrument.
As illustrated in FIGS. 15, 17, and 20, th2 convex member 256 includ~s four, equal:ly spac~d-apart, radially extending projections 270. A cable or cord 274 is looped around or otherwise fastened to each projection 270. Each projection 270 and the fastened end of the associated cord 274 are received in a circum~erencial channel or recess 278 in the enlarged end of the support tube 252.
As illustrated in FIGS. 15 and 16, the int~rnal portion of the tube 252 adjac~nt the sock~t 254 d~fines four apertures 282 for each receiving one o~ the cords 274. The cords 274 extend along the inside of the support tube 252 and, as illustrated in FIG. 20, cross and diverge to opposite positions relative to the longitudinal axis of the support tube 252.
As illustrated in FIGo 20~ the proximal end of each cord 274 is fastened to a wobble plat~ 286. As shown in FI~. 19, the plate 286 i5 held against a flange 288 on a post 290 projecting from a bracket 292 caxried on the inside of the in~trument proximal portion 250.
Extending between the plate 286 and the brack t 292 are ~our tension springs 296 (only two o~ which are shown in FIG. 19). These hold the plate 2æ6 against the flange 28~.
When the instrum~nt proximal portion 250 i.
held in one hand, a selected peripher~l region of th~
plate 286 can b~ pushed inwardly with a thumb. This causes one or more o~ th~ springs 296 to contract while one or more o~ the other springs 296 are extended. The tilting of the plate 286 from the normal, rest posi~ion illustrated in FIG, 19 results in onP or more of the cords 274 bQing pulled rearwardly (proximally) while one 2 ~
- 24 ~

or more of the other cords 274 are relaxed. This causes a rotation or swiveling of the convex member 256 in the socket 254. This results in articulation of the end ef~`ector 262. Because the cords 274 cross in opposite directions as illustrated in FIG. 20, pushing on one guadrant region of the plate 286 will cause the end effector 262 to articulate generally in the direction toward which that ~uadrant region of the plate 286 is pushed.
The support tube 252 may include additional seals, ~ents, ~ilters, etc. (not illustrated). Further, various actuating mechanisms, end effector devices, sensor lines, el ctric power lines, and the like, may be provided within the tube 253 and may extend through the joint assembly passage 266~
A modification of the instrument illustrated in FIGS~ 14-20 is shown in FIGS. 21 and 22. The instrument includes an elongatP support tube or hou~ing 252A for supporting a distal end portion 260A extending from a convex member 256A. Cords or cab~es 27~A extend from projections 270A on the convex member through the tube 252~ ~o a proximal portion 250A of the instrument.
The components so far d scribed are substantially identical to those components having the same n~mbers withouk the "A" ide~tified above with reference to the e~bDdiment illus~rated in FI~S~ 14 20. ~owever, in this modified ~orm illustra~ed in F~S. 21 and 22, the instrument does not hav~ an actuator plate 286 mounted at the proximal end as ~hown i~ FIG. 18. Rather, an ~0 actuator plate 286A is moun~ed within a proximal portisn 250A o~ the instrument, and a T-shaped operating lever 2~7A extends upwardly through the top of the instrument.
Th0 handle 287A includes a spherical ba~e 291A received in an arcuate socket 293A. The cables 274A are attach~d at four, equally spaced locations around the fronk o~

:," ~
.,-, , :, .
,;:; - ,.: .:

2~'~3~2 the plate 236A. The rear side of the plate ~86A is connected at corresponding location~ to tension springs 296A. The proximal ends of the springs 296A are attached to a bracket 2g2A mounted on the inside of the instrument proximal portion 250A.
The four springs 296A normally maintain the plate 236A in a neutral position as illustrated in FIG.
22 with equal tension on each of the cords 274A. When the handle 287A is moved ~rom th~ position illustrated in FIGS. 21 and 22, some of the cords 274A are pulled while others are relaxed so as to effect swiveling of the convex member 256A and articulation of the distal end portion 260A.
FIGS. 23~29 illustrate another aspect of this i~vention which provides a track for guiding surgical fasteners, such as staples or clip~, through an articulable joint. In particular, an articulable joint ass2mbly similar to the one described above with refPrence to FIGS. 14-20 can he employed in an instrument for feeding and applying ligating clips to tissue, such as a blood v~ssel.
FIGS. 23-25 illustrate a portion of an in~trument having an elongate support tube or hou~ing 302 defi~ing a socket 304 in which is m~unted a convex me~ber 308. The convex member 308 i~ de~ined on a distal end pcrtion 310 which carrie~ ~n end ~ector in the form of a jaw assembly 314.
The convQx member 30B and distal end portion 3~0 ~efin~ a passagPway at 318 (~IG. 2~3 in ~hich thQ
~aw as~embly 314 is mounted. The jaw assembly 314 ha~ a generally U-shaped ~onfiguration with th~ legs of the l'UII each defining a jaw 320. ~ach jaw 320 ha~ a r~arwardly facing cam sur~ace 322 for engaging a sla~ted surface 324 at the distal end of th~ end portion 310 ~FIGo 23)~ The jaw assembly 314 i~ connect~d at it~

.. ~ , ~ ,~: .

~1~3~2 proximal end with a pin 32~ to a flexible member or cable 332. The cable 332 can be pulled rearwardly by suitable means (not illustratPd~. This causes the jaw assembly 314 to be moved further into the instrument which causQs the jaws to be cammed toglether to close about tissue, such as a blood vessel 336 (FIG. 23).
Each jaw 320 also define a channel 337 (FIG.
23) for receiving a generally U-~haped ligating clip 340 which can be positioned in khe distal portion of thle jaws 320 (as dascribed in detail hereinafter~. When the jaws 320 are closed, the clip 31.4 is sgueezed and crimped about the tissue 336.
The elongate support tube 302 has an inne:r tube 344 extending from the socket 304 around the jaw actuating cable 332. The space between the elongate support tube 302 a~d the inner ~ube 344 defines a region fsr accommodating articulation operator cables 348 whi~h are fa~tenPd to projections 350 extending radially outwardly from th~ surface of the conY~x member 308. In a preferred embodiment, there are four such projections 350 and four attached cabl s 348 in substantially the same configuration as described above with respPct to the embodiment illustrated in FIGS. 14 2D wherein the convex m~mber 2S6 has four projection~ 270 which are each attached to one of the cables 274.
Pulling on one or more of the cables 348 while xelaxing one or ~ore o~ the other cable~ 348 results in the convex member 308 being swiveled within th~ socke~
304, and this articulates the distal end portion 310.
The cables 3~8 may be tensioned and r~laxed by a suitable operating mechanism, such as khe wobble platP
286 described above with ref~rence to thP embodiment illustrated in FIGS. 1~-20.
In accordance with the teachings of one a~pect of th~ present invention, the ligating clips 340 are : .. ; .
.,..~., 21331~2 guided through the articulable joint assembly in a unique track. The track includes a tube 400. The tube 400 is made from material which is sufficiently ~lexible to accommodate bending through khe joint. It i~
pre~ently contemplated that the tube 400 would be extruded from a suitable elastomeric or thermoplastic material.
The tu~e 400 defines a longitudinal passage fox the ligating clips 340. The passage has a transverse cross sec~ional configuration for accommodating and maintaining each clip 340 generally in a predetermined orientation while moving along the passage. The clips 3~0 can be pushed in a line through the tu~e 400 by a suitable flexible pusher bar (not illustrated) in the proximal portion of the instrument.
The design and operation of mechanisms for advancing the clips 340 through the tube ~00 form no part of the pr~sent invention.
As illustrated in FIG. 27, tha passage i5 at least in part defined by two, generally opposed wall portions 408 and 410. The opposed wall portions 408 and 410 are joined by thin, connecting portions 411. The wall porkion 408 defines a longitudinal gro~ve 412/ and the wall portion 410 de~ines a longitudinal groove 416.
The grooves 412 and ~16 open toward each other, and each ~roovP has a generally V-~hape.
As illustrated in FIG. 29, when the track tub~
400 is de~o~med or bent to th~ right, the opening o~ the groo~e 412 decreases while the opening o~ khe grooY~ 416 can increase somewhat. On the oth2r hand~ when the track tube 400 is bent or flexed in the opposite direction (not illustrated~, the groove 412 would ope~
whil the groove 416 would tend to close.
I~ the track tube ~00 is flex~d or bPnt as illu~trated in FIG. 2B t 90 t~ the orientation o~ the ,.. :, ~ : ; . : :.- .
:. . :. :; ,.............. ..
i:, :
.. :.~ . . ;: .: , ~:

4~1 3 bending illustrated in FIG. 29, then both grooves 412 and 416 tend to close or flatten~
The track tube 400 is disposed within the instrument so that the distal end of the tube 400 terminates within the convex member 30~ so as to discharge the ligating clips 340 into the passage 318 (FIG. 25). As illustrated in FIG. 25, a portion of the passage 318 is defined by an upwardly ~lanting ramp sur~ace 422. This surface 422 ~uides the clips 340 from the end of the track tube 400 into the receiving channels 337 within the jaws 320. When the instrume.nt end portion 310 is articulated, the distal end o~ track tube 400 will move wi~h the convex member 30B, and the tube 400 will bend at a point proximally (rearwardly) o~
the convex member 308 to accommodate the movement of the member 308.
Although FIGS. ~3-25 illustrate only ~he jaw assembly 314 and track tube 400 in the passage 318, it will be appreciated that modifications can be made tD
accomm~date additional components if desired. Such additional component san include sensor linas, aspirator or su~tion lines, op~ical fibers, etc.
It will also be appreciatPd that the track tube 400 may be ~mployed for guiding fasteners, ~uch as ligating clips or staples, through other types of articulable joints in endoscopic instruments. ThR t:rack tub~ 400 is e~pecially suitable for us~ in guiding fasteners where the tube is subjected to compressive or tensile bending loads ~ha~ effect the bending of the tube.
It will be readil~ ~pparent from the foregoing detailed description of the invenkion ~nd from the illustrakions thereof that numerous other variations and modi~ications may be effec-ted without departing from khe ... . :
. `, . . .
,: . :
.;: . ~........... . . .

29 ~1~3182 true spirit and scope of the novel concepts or principles of this invention.

`' ~

Claims

1. An articulable assembly for an instrument used in an endoscopic procedure, said assembly comprising:
a distal end portion for supporting an end effector to effect tissue manipulation while carrying out a surgical procedure within a body cavity, said distal end portion having an open end defining a socket;
an elongate shaft defining a longitudinal passage and terminating in a convex member received in said socket, said convex member having a partially spherical configuration and defining a passageway communicating with said shaft passage for accommodating an actuator extending from said housing to actuate said end effector; and an operator on said shaft for moving said distal end portion into and out of alignment with said elongate shaft, said operator including pair of first and second drive members disposed on said shaft for longitudinal movement along aid shaft toward and away from said convex member, each said drive member having a distal end engaged with said distal end portion, said first and second drive members defining outwardly oriented left-hand thread segments and right-hand thread segments, respectively, said operator including a sleeve mounted on said drive members for rotation about said shaft, said sleeve having an interior surface defining a left-hand thread portion and a right-hand thread portion for operatively engaging said drive member left-hand thread segments and right-hand thread segments, respectively.

2. An articulable assembly for an instrument used in an endoscopic procedure, said assembly comprising:

a hollow support tube defining a longitudinal axis and having an open end defining a socket;
a distal end portion connected to said tube for supporting an end effector to effect tissue manipulation while carrying out a surgical procedure within a body cavity, said distal end portion having a convex member that is received in said socket and that defines a passage for accommodating an actuator extending from said support tube through said convex member passage to actuate said end effector; and a plurality of tension cables extending through said support tube and attached to said convex member at spaced-apart locations for moving said distal end portion into and out of alignment with said support tube.

3. An articulable assembly for an instrument used in an endoscopic procedure, said assembly comprising:
an elongate support tube defining a longitudinal axis and having an open end defining a socket with an inwardly projecting tab;
a distal end portion connected to said tube for supporting an end effector to effect tissue manipulation while carrying out a surgical procedure within a body cavity, said distal end portion having a convex member received in said socket, said convex member defining a passageway oriented with its axis at an oblique angle relative to said tube longitudinal axis and defining an arcuate groove receiving said tab; and an operator on said elongate support tube for moving said distal end portion into and out of alignment with said elongate support tube, said operator including a shaft having (1) a proximal portion in said tube generally aligned with said longitudinal axis, (2) an intermediate portion in said tube extending from said proximal portion at an oblique angle relative to said longitudinal axis, and (3) a distal portion extending from said intermediate portion into said convex member passageway and disposed for rotation in said passageway, said shaft portions being hollow for accommodating an actuator extending from said support tube through said shaft to actuate said end effector.

4. The assembly in accordance with claim 3 in which said convex member passageway is a cylindrical bore and in which said shaft distal portion is cylindrical.

5. An articulable assembly for an instrument used in an endoscopic procedure, said assembly comprising:
a distal-end portion for supporting an end effector to effect tissue manipulation while carrying out a surgical procedure within a body cavity;
an elongate support housing and an articulable joint connecting said housing with said distal end portion, said joint including a hollow socket and a convex member that is received in said socket and that defines a passageway for accommodating an actuator extending from said housing through said joint to actuate said end effector; and an operator on said housing and extending to one of said socket and convex member for moving said distal end portion into and out of alignment with said housing.

6. The assembly in accordance with claim 5 in which said socket is rigidly incorporated in said distal end portion for movement therewith.

7. The assembly in accordance with claim 5 in which said socket is rigidly incorporated in said support housing.

8. The assembly in accordance with claim 5 in which said convex member is rigidly incorporated in said distal end portion for movement therewith.

9. The assembly in accordance with claim 5 in which said convex member is rigidly incorporated in said support housing.

10. The assembly in accordance with claim 5 in which said housing has a proximal end including a handle portion.

11. The assembly in accordance with claim 5 in which said convex member has a convex surface portion; and said socket is defined by the open end of a tube in which said convex surface portion is disposed.

12. The assembly in accordance with claim 5 in which said distal end portion includes a tube having an open end defining said socket;
said housing includes a shaft to which said convex member is attached and which defines a longitudinal passage;
said convex member has a partially spherical configuration in which said passageway is defined as a central aperture communicating with said shaft passage;
said operator includes a pair of first and second drive members diametrically disposed on said shaft for longitudinal movement along said shaft toward and away from said convex member, each said drive member having a distal end engaged with said open end of said head tube, said first and second drive members defining outwardly oriented left-hand thread segments and right-hand thread segments, respectively; and said operator includes a sleeve mounted on said drive members for rotation about said shaft, said sleeve having an interior surface defining a left-hand thread portion and a right-hand thread portion for engaging said drive member left-hand thread segments and right-hand thread segments, respectively.

13. The assembly in accordance with claim 5 in which said housing includes a tube defining a longitudinal axis and having an open end defining said socket with an inwardly projecting tab;
said distal end portion defines said convex member;
said convex member defines a passageway oriented with its axis at an oblique angle relative to said tube longitudinal axis and defines an arcuate groove receiving said tab; and said operator includes a shaft having (1) a proximal portion aligned along said housing tube longitudinal axis, (2) an intermediate portion extending from said proximal portion at an oblique angle relative to said housing tube longitudinal axis, and (3) a distal portion extending from said intermediate portion into said convex member passageway and disposed for rotation in said passageway.

14. The assembly in accordance with claim 5 in which said housing includes a hollow support tube defining a longitudinal axis and having an open end defining said socket with an inwardly projecting tab;
said distal end portion defines said convex member; and said operator includes a plurality of tension cables in said tube which are attached to said convex member at spaced-apart locations.

15. A track in which at least one surgical fastener can be guided through an articulable joint in an instrument for use in an endoscopic procedure, said track comprising:
a tube of material sufficiently flexible to accommodate bending through said joint, said tube defining a longitudinal passage with a transverse cross sectional configuration for accommodating and maintaining said fastener generally in a predetermined orientation while moving along said passage, said tube passage being at least in part defined by two, generally opposed wall portions, each said wall portion defining a longitudinal groove that is open toward the other of said wall portions whereby the groove opening can vary in response to compressive and tensile bending loads.

16. The track in accordance with claim 15 in which each said groove has a generally V-shaped configuration when said tube is unstressed.

17. The track in accordance with claim 15 in which said passage has a width dimension and a height dimension which is less than the width dimension.

18. The track in accordance with claim 15 in which said tube includes two, opposed, connecting portions connecting said two, opposed wall portions.