CN103635150B

CN103635150B - There is implanted compressible portion and insert the nail bin of cap

Info

Publication number: CN103635150B
Application number: CN201280032329.5A
Authority: CN
Inventors: F·E·谢尔顿四世; C·O·巴克斯特三世; T·W·阿伦霍尔特; V·M·瓦苏德万; I·纳; J·V·亨特; G·C·休伊尔; G·J·法努尔
Original assignee: Ethicon Endo Surgery Inc
Current assignee: Ethicon Endo Surgery Inc
Priority date: 2011-04-29
Filing date: 2012-04-13
Publication date: 2016-08-03
Anticipated expiration: 2032-04-13
Also published as: JP2014518682A; RU2606316C2; AU2012250138B2; RU2013152969A; AU2012250138A1; CA2834419C; BR112013027757B1; CA2834419A1; CN103635150A; JP6033848B2

Abstract

Fastener cartridge can include support section, the tissue thickness's compensating part positioned relative to described support section and be positioned at the multiple securing members that can be used for fastening tissue in described support section and/or described tissue thickness compensating part.In use, fastener cartridge can be positioned in the first jaw of surgical fastening device, and wherein the second jaw or anvil block can be positioned in the opposite of described first jaw.For disposing securing member, nail is disposed component and is advanced through described fastener cartridge so that securing member moves towards anvil block.When securing member is deployed, described securing member can capture at least some of of tissue thickness therein compensating part, at least some of together with the tissue just fastened.

Description

There is implanted compressible portion and insert the nail bin of cap

Cross-Reference to Related Applications

The patent application of this non-transitory is the U.S. Patent Application Serial Number 12/894 of entitled " SurgicalStapleCartridgesWithDetachableSupportStructuresa ndSurgicalStaplingInstrumentsWithSystemsForPreventingAct uationMotionsWhenaCartridgeisNotPresent " that the JIUYUE in 2010 according to 35U.S.C. § 120 are submitted on the 30th, the part continuation application of 350, the entire disclosure is hereby incorporated herein by accordingly.

Background technology

The present invention relates to a kind of surgical instruments, and relate in various embodiments being designed to cutting and sewing up the surgical cutting and suture instruments and nail bin thereof organized.

Accompanying drawing explanation

By combining the accompanying drawing following description with reference to the embodiment of the present invention, inventive feature and advantage and acquisition methods thereof will become more apparent, and be better understood invention itself, wherein:

Fig. 1 is the sectional view of surgical instrument embodiment；

Figure 1A is the perspective view of an embodiment of implanted nail bin；

Figure 1B-1E shows the some with the clamping of implanted nail bin and the end effector sewing up tissue；

Fig. 2 is the partial cross-sectional side view of another end effector of the part being connected to surgical instruments, and its end effector supports surgery nail bin and its anvil block is in an open position；

Fig. 3 is another partial cross-sectional side view that the end effector shown in Fig. 2 is in the close position；

Fig. 4 is that the end effector shown in Fig. 2 and Fig. 3 begins to pass another partial cross-sectional side view when end effector advances at knife bar；

Fig. 5 is another partial cross-sectional side view when knife bar is partly advanced through wherein of the end effector shown in Fig. 2 to Fig. 4；

The perspective view of alternative nail bin embodiment that Fig. 6 is mounted in surgical cutting and stitching devices；

Fig. 7 is surgery nail bin and the top view of elongated passageway of Fig. 6 shown device；

The top view of another surgery nail bin embodiment that Fig. 8 is mounted in the elongated passageway of end effector；

Fig. 9 is the bottom view of anvil block；

Figure 10 is the fragmentary, perspective view of the multiple nails of the part forming nail row；

Figure 11 is another fragmentary, perspective view of the nail row of Figure 10, and its nail is for after being contacted shaping by surgical cutting with the anvil block of stitching devices；

Figure 12 is the fragmentary, perspective view of the alternative nail of the part forming another nail row；

Figure 13 is the fragmentary, perspective view of the alternative nail of the part forming another nail row；

Figure 14 is the fragmentary, perspective view of the alternative nail of the part forming another nail row embodiment；

Figure 15 is the sectional view of the end effector supporting nail bin；

Figure 16 is the elongated passageway portion of end effector shown in Figure 15 sectional view after removing implanted cartridge body part and nail from it；

Figure 17 is the sectional view of the end effector supporting another nail bin；

Figure 18 A-18D describes to be positioned at the deformation of the surgical staples can collapsed in staple cartridge body according at least one embodiment；

Figure 19 A is to illustrate that be positioned at can the schematic diagram of nail in conquassation staple cartridge body；

Figure 19 B be illustrate shown in Figure 19 A can conquassation staple cartridge body by the schematic diagram of anvil block conquassation；

Figure 19 C be illustrate shown in Figure 19 A can conquassation staple cartridge body by the schematic diagram of the further conquassation of anvil block；

Figure 19 D is to illustrate that the nail shown in Figure 19 A is in be fully formed to be in the schematic diagram of complete conquassation state by conquassation nail bin shown in configuration and Figure 19 A；

Figure 20 is to illustrate the nail positioned against nail bin stayed surface and illustrate the schematic diagram of the potential relative motion followed closely between nail bin stayed surface；

Figure 21 is the sectional view of nail bin stayed surface, and described nail bin stayed surface includes slit or groove, with the base portion of the nail shown in stable Figure 20；

Figure 22 is the sectional view of the nail according at least one alternative embodiment, and described nail includes the bizet of overmolding and can accommodate the slit of a part or the groove of described bizet；

Figure 23 is the top view of the nail bin according at least one embodiment, and described nail bin includes embedding the nail in staple cartridge body of can collapsing；

Figure 24 is the front view of nail bin shown in Figure 23；

Figure 25 is the front view of the nail bin according at least one embodiment, and described nail bin includes around the protective layer being positioned at the nail can collapsed in staple cartridge body；

Figure 26 is the sectional view of nail bin shown in Figure 25 that the line 26-26 along Figure 25 intercepts；

Figure 27 is the front view of the nail bin according at least one embodiment, and described nail bin includes extending the nail can collapsed outside staple cartridge body and the protective layer around described staple cartridge body at least in part；

Figure 28 is the sectional view of nail bin shown in Figure 27 that the line 28-28 along Figure 27 intercepts；

Figure 29 is the partial cutaway view of the nail bin according at least one embodiment, and described nail bin includes being at least partially embedded the nail can collapsed in staple cartridge body, and described nail is at least partially situated in the nail lacuna in described staple cartridge body；

Figure 30 is the sectional view of nail bin shown in Figure 29 that the line 30-30 along Figure 29 intercepts；

Figure 31 is the partial cutaway view of the nail bin according at least one embodiment；

Figure 32 is the partial cutaway view of the nail bin according at least one embodiment, and described nail bin includes being at least partially embedded the nail can collapsed in staple cartridge body and connecting described nail the alignment matrix making described nail relative to each other align；

Figure 33 is the sectional view of nail bin shown in Figure 32 that the line 33-33 along Figure 32 intercepts；

Figure 34 is the partial cutaway view of the internal layer of compressible staple cartridge body；

Figure 35 shows the schematic diagram of the internal layer shown in the Figure 34 compressed between transfer plate and gripper shoe；

Figure 36 is to illustrate that nail is inserted into the schematic diagram in the compressed internal layer shown in Figure 35；

Figure 37 is to illustrate the schematic diagram that gripper shoe shown in Figure 35 is removed from internal layer；

Figure 38 is the schematic diagram illustrating the sub-component including internal layer shown in Figure 34 and the shown nail of the Figure 36 being inserted in outer layer；

Figure 39 is to illustrate that outer layer shown in Figure 38 is sealed to form the schematic diagram sealing nail bin；

Figure 40 is the sectional view sealing nail bin shown in Figure 39；

Figure 41 is the sectional view of the nail bin according at least one embodiment and staple cartridge channel；

Figure 42 is to illustrate the schematic diagram that a part for nail bin shown in Figure 41 is in deformation state；

Figure 43 is the front view of the end effector of surgical stapling device, and described end effector includes anvil block in an open position and the nail bin being positioned in staple cartridge channel；

Figure 44 is the front view of end effector shown in Figure 43, and it illustrates anvil block in the close position and the nail bin being compressed between anvil block and staple cartridge channel；

Figure 45 is the front view of end effector shown in Figure 43, and it illustrates that the nail bin shown in Figure 43 is positioned at staple cartridge channel with alternative；

Figure 46 is the sectional view of the end effector of surgical stapling device, and described end effector includes being positioned at the compressible nail bin of staple cartridge channel and being attached to one piece of backing material of anvil block；

Figure 47 is the sectional view of end effector shown in Figure 46, and it illustrates anvil block in the close position；

Figure 48 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the nail bin with impermeable stratum；

Figure 49 is the sectional view of another alternative embodiment of the end effector of surgical stapling device；

Figure 50 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes staged anvil block and has the nail bin of staged warehouse；

Figure 51 is the sectional view of another alternative embodiment of the end effector of surgical stapling device；

Figure 52 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the tissue contacting surface tilted；

Figure 53 is the sectional view of another alternative embodiment of the end effector of surgical stapling device, and described end effector includes the tissue contacting surface tilted；

Figure 54 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the support insert that can support nail bin；

Figure 55 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the nail bin with multiple compressible stratum；

Figure 56 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the nail bin with the compressible warehouse of staged；

Figure 57 is the sectional view of another alternative embodiment of the end effector of surgical stapling device, and described end effector includes the nail bin with the compressible warehouse of staged；

Figure 58 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the nail bin with the tissue contacting surface of bending；

Figure 59 is the sectional view of alternative embodiment of the end effector of surgical stapling device, and described end effector includes the nail bin with the tissue contacting surface of inclination；

Figure 60 is the sectional view of compressible nail bin, and described compressible nail bin includes following closely and wherein storing have at least one medicament；

Figure 61 be illustrate the compressible nail bin shown in Figure 60 compressed and accommodated in it nail deformation after schematic diagram；

Figure 62 is the partial cutaway view of the nail bin according at least one embodiment；

Figure 63 is the sectional view of nail bin shown in Figure 62；

Figure 64 is the perspective view of the implanted nail bin according at least one alternative embodiment；

Figure 65 is the sectional view of implanted nail bin shown in Figure 64；

Figure 66 is the perspective view of alternative embodiment of nail bin, and described nail bin includes the deformable member extended from the outer layer of nail bin；

Figure 67 is the perspective view of alternative embodiment of nail bin, and described nail bin includes the nail bin outer layer being assembled to internal layer；

Figure 68 is the sectional view of alternative embodiment of nail bin, and described nail bin includes multiple nail, compressible stratum and degreasing cotton layer；

Figure 69 is the perspective view of degreasing cotton layer shown in Figure 68；

Figure 70 is the absorbent cotton being partitioned into from the degreasing cotton layer shown in Figure 68 and the perspective view of nail alignd with the groove absorbent cotton；

Figure 71 is the perspective view of two connected absorbent cottons from degreasing cotton layer shown in Figure 68；

Figure 72 is the perspective view that the absorbent cotton support frame of degreasing cotton layer shown in Figure 68 is removed from the absorbent cotton being partitioned into；

Figure 73 is the decomposition diagram of alternative embodiment of compressible nail bin, and described compressible nail bin includes nail and for driving the system of nail against anvil block；

Figure 73 A is the partial cutaway view of alternative embodiment of nail bin shown in Figure 73；

Figure 74 is the sectional view of nail bin shown in Figure 73；

Figure 75 is the front view that can traverse the nail bin shown in Figure 73 the sliding part that makes nail advance towards anvil block；

Figure 76 is the schematic diagram illustrating staple drivers, and described staple drivers can be promoted towards anvil block by the sliding part shown in Figure 75；

Figure 77 is the excision view of the nail bin according at least one alternative embodiment, and described nail bin includes the nail being positioned at staple drivers；

Figure 78 is sectional view when being positioned at staple cartridge channel of the nail bin shown in Figure 77；

Figure 79 is the sectional view of nail bin shown in Figure 77, and it illustrates the anvil block moving to make position and the nail being contained in nail bin deformed by anvil block；

Figure 80 is the sectional view of nail bin shown in Figure 77, and it illustrates the nail moved upward towards anvil block；

Figure 81 is the perspective view of alternative embodiment of nail bin, and described nail bin includes the band connecting each flexible sides of nail bin；

Figure 82 is sliding part and the perspective view of cutting element assembly；

Figure 83 is to be shown with the sliding part shown in Figure 82 and cutting element assembly to promote the schematic diagram of the nail of nail bin shown in Figure 77；

Figure 84 is to illustrate the ability to jointing nail and promote the sliding part of nail and the schematic diagram of the locking system that can optionally make sliding part distal motion towards anvil block；

Figure 85 A-85C illustrates and nail is inserted the process in crown portion；

Figure 86 is the sectional view of the nail bin including a support plate or keeper；

Figure 87 is the partial sectional view of the compressible nail bin according at least one alternative embodiment；

Figure 88 is to illustrate the schematic diagram when nail bin shown in Figure 87 is in implanting state；

Figure 89 is the partial cutaway view of the compressible nail bin according at least one alternative embodiment；

Figure 90 is the partial sectional view of nail bin shown in Figure 89；

Figure 91 is to illustrate the schematic diagram when nail bin shown in Figure 89 is in implanting state；

Figure 92 be according at least one alternative embodiment can the partial sectional view of conquassation nail bin；

Figure 93 is the partial cutaway view of the collapsed nail bin including multiple crushable member according at least one embodiment；

Figure 94 is perspective view when being in non-collapsed state of the crushable member shown in Figure 93；

Figure 95 is perspective view when being in collapsed state of the crushable member shown in Figure 94；

Figure 96 A is the partial sectional view of the end effector of surgery suturing appliance, described end effector includes the staple cartridge channel that jaw and described jaw relatively position and the nail bin being positioned at described staple cartridge channel, and wherein said jaw includes the holding matrix being attached to jaw；

Figure 96 B is the partial sectional view of end effector shown in Figure 96 A, and it illustrates jaw, the nail bin by anvil block and keeping matrix compression and the nail advanced towards staple cartridge channel, and described nail extends through at least in part and is positioned at the tissue kept in the middle of matrix and nail bin；

Figure 96 C is the partial sectional view of end effector shown in Figure 96 A, and it illustrates the jaw being in final position and the holding matrix closed with the nail joint shown in Figure 96 B；

Figure 96 D is the partial sectional view of end effector shown in Figure 96 A, and it illustrates that jaw and staple cartridge channel away from the nail bin implanted and keep matrix motion；

Figure 97 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes multiple holding component, for engaging the fastener leg extending through described retaining hole；

Figure 98 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes that six keep component；

Figure 99 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes that eight keep component；

Figure 100 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes multiple holding component, for engaging the fastener leg extending through described retaining hole；

Figure 101 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes that six keep component；

Figure 102 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes that eight keep component；

Figure 103 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes the multiple holding components being stamped to form by sheet metal；

Figure 104 is the perspective view of the retaining hole keeping matrix according at least one alternative embodiment, and described holding matrix includes the multiple holes extended along the periphery of described retaining hole；

Figure 105 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 106 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 107 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 108 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 109 is the top view of the retaining hole keeping matrix according at least one alternative embodiment；

Figure 110 is the top view of the retaining hole keeping matrix according at least one embodiment, and described retaining hole includes the holding inserted sheet extending in described retaining hole；

Figure 111 is the top view of the retaining hole keeping matrix according at least one alternative embodiment, and described retaining hole includes the holding inserted sheet extending in described retaining hole；

Figure 112 is the perspective view of fastening system, and described fastening system includes that what multiple nail closed with described nail joint keeps matrix and the alignment matrix of the described nail that can align；

Figure 113 is the perspective view keeping matrix shown in Figure 112；

Figure 114 is the perspective view of alignment matrix shown in Figure 112；

Figure 115 is partial top view when keeping matrix to close with the nail joint shown in Figure 112 shown in Figure 112；

Figure 116 is partial bottom view when keeping matrix to close with the nail joint shown in Figure 112 shown in Figure 112；

Figure 117 is the partial elevation view of fastening system shown in Figure 112；

Figure 118 is the fragmentary, perspective view of fastening system shown in Figure 112；

Figure 119 is partial sectional view when keeping matrix to close with the nail joint shown in Figure 112 shown in Figure 112；

Figure 120 is the partial sectional view of fastening system shown in Figure 112；

Figure 121 is the perspective view of fastening system shown in Figure 112, and described fastening system also includes the protective cap being assembled to follow closely lower limb；

Figure 122 is the bottom perspective view of fastening system structure shown in Figure 121；

Figure 123 is the fragmentary, perspective view of fastening system structure shown in Figure 121；

Figure 124 is the partial sectional view of fastening system structure shown in Figure 121；

Figure 125 is the front view of the end effector according at least one embodiment, and described end effector includes jaw in an open position, the holding matrix being positioned in jaw and multiple protective cap and the nail bin being positioned in staple cartridge channel；

Figure 126 be the end effector shown in Figure 125 in the close position time front view；

Figure 127 is front view when being in firing position of the end effector shown in Figure 125；

Figure 128 is front view when keeping matrix and protective cap to be assembled to the nail bin shown in Figure 125 shown in Figure 125；

Figure 129 is the detail drawing of structure shown in Figure 128；

Figure 130 is the front view of end effector shown in Figure 125, and it illustrates jaw in an open position and is keeping the relatively thin tissue between matrix and nail bin；

Figure 131 is the front view of end effector shown in Figure 125, and it illustrates the jaw in the close position against the relatively thin tissue shown in Figure 130；

Figure 132 is the front view of end effector shown in Figure 125, and it illustrates and is in firing position to keep the jaw of relatively thin tissue shown in capture Figure 130 between matrix and nail bin；

Front view when Figure 133 is to keep matrix and protective cap are assembled to the nail bin shown in Figure 125 and make the thin tissue shown in Figure 130 therebetween shown in Figure 125；

Figure 134 is the detail drawing of structure shown in Figure 133；

Figure 135 is the sectional view of the protective cap being positioned on nail lower limb end according at least one alternative embodiment；

Figure 136 is the perspective view of the multiple protective caps being embedded in material piece；

Figure 137 is the perspective view of jaw, and described jaw includes that multiple depressed part is accommodated therein for by multiple protective caps；

Figure 138 is the detail drawing of a part for jaw, and a described part includes the thin slice for covering the protective cap being positioned at jaw shown in Figure 137；

Figure 139 is the sectional view of the protective cap being positioned on nail lower limb end according at least one alternative embodiment, and wherein said protective cap includes internal profiled surface；

Figure 140 is another sectional view of protective cap shown in Figure 139, and it illustrates the nail lower limb deformed against profiled surface；

Figure 141 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected matrix element；

Figure 142 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected matrix element；

Figure 143 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected matrix element；

Figure 144 is to maintain the top view of alternative embodiment of matrix array, and described holding matrix array includes multiple connected matrix element；

Figure 145 is to maintain the top view of alternative embodiment of matrix, and described holding matrix includes multiple connected matrix element；

Figure 146 is the part exploded partial view including keeping the jaw of matrix, and described holding matrix includes compressible lid；

Figure 147 is the detail drawing keeping matrix shown in Figure 146；

Figure 148 is the partial sectional view including keeping the fastening system of matrix, and described holding matrix includes compressible stratum and encapsulates multiple unit of one or more medicines；

Figure 149 is to illustrate the schematic diagram that nail lower limb pierces through unit shown in Figure 148 with holding matrix when engaging；

Figure 150 is the partial sectional view including keeping the fastening system of matrix, and described holding matrix includes compressible stratum；

Figure 151 is the front view of fastener cartridge plug-in package, and described fastener cartridge plug-in package includes clamper, the first fastener cartridge and the second fastener cartridge；

Figure 152 is the front view of the end effector of surgical stapling device, and described surgical stapling device includes that the first jaw and the second jaw, described second jaw are shown in open configuration；

Figure 153 is the front view of end effector shown in Figure 152, and it illustrates and is in the second jaw of closed configuration and for loading the first storehouse for the first jaw and being that the second jaw loads the fastener cartridge plug-in package shown in the Figure 151 in the second storehouse；

Figure 154 is the front view of end effector shown in the Figure 153 loaded, its illustrate from the storehouse plug-in package that end effector removes, be again at open configuration the second jaw and be positioned at the tissue in the middle of the first jaw and the second jaw；

Figure 155 is the front view that the end effector loaded shown in Figure 154 is in percussion configuration；

Figure 156 is in the first storehouse and the front view in the second storehouse of implanting state；

Figure 157 is the front view of end effector shown in Figure 152, and it illustrates the part in the first storehouse still engaged with the first jaw according at least one embodiment；

Figure 158 is the front view of alternative embodiment of fastener cartridge plug-in package, and described fastener cartridge plug-in package includes clamper, the first fastener cartridge and the second fastener cartridge；

Figure 159 is used to the first jaw of end effector and loads the first storehouse and be that the second jaw loads the front view of fastener cartridge plug-in package shown in the Figure 158 in the second storehouse；

Figure 160 is the sectional view having loaded end effector shown in Figure 159；

Figure 161 is the perspective view of the surgical stapling device including bottom jaw and top jaw according at least one embodiment, and wherein some part of surgical stapling device is removed；

Figure 162 is the perspective view of surgical stapling device shown in the Figure 161 having removed top jaw；

Figure 163 is the perspective view of the slidably anvil block system of the top jaw of surgical stapling device shown in Figure 161, and described slidably anvil block system includes the first slidably anvil block and second slidably anvil block；

Figure 164 is the end-view of slidably anvil block system shown in Figure 163；

Figure 165 is the top view of slidably anvil block system shown in Figure 163；

Figure 166 is to illustrate the schematic diagram that the slidably anvil block system shown in Figure 163 is in non-cock；

Figure 167 be illustrate shown in Figure 163 slidably the first of anvil block system slidably anvil block be in non-firing position and be positioned at the nail of bottom jaw and be in the schematic diagram of non-deployed position；

Figure 168 be the nail being shown in the jaw of bottom be in dispose shown in configuration and Figure 167 first slidably anvil block be pulled to nearside so that the schematic diagram of nail lower limb deformation of first group of nail；

Figure 169 is to illustrate to follow closely the schematic diagram being deformed into the state of being badly deformed for first group shown in Figure 168；

Figure 170 be illustrate shown in Figure 163 slidably the second of anvil block system slidably anvil block be pushed to distally so that the schematic diagram of second group of nail lower limb deformation；

Figure 171 is the fragmentary, perspective view of the anvil block including multiple shaping pit according at least one embodiment；

Figure 172 is the cross sectional end view of anvil block shown in Figure 171；

Figure 173 is the schematic diagram illustrating and manufacturing the first step shaping pit shown in Figure 171；

Figure 174 is the schematic diagram illustrating and manufacturing the second step shaping pit shown in Figure 171；

Figure 175 is the top view shaping bowl configurations of anvil block shown in Figure 171；

Figure 176 is the schematic diagram of the first step illustrating the manufacturing process for manufacturing anvil block；

Figure 177 is the schematic diagram of the second step illustrating manufacturing process shown in Figure 176；

Figure 178 is the schematic diagram of the third step illustrating manufacturing process shown in Figure 176；

Figure 179 is surgical stapling and the front, left perspective view cutting off apparatus, and wherein handle portions includes automatic retracted mechanism that connecting rod triggers and ratchet manual retrieving mechanism；

Figure 180 is surgical stapling and the right rear view of cut-out apparatus of Figure 179, and wherein cut and shank shell the right half-shell of a part for slender axles is removed show automatic firing end traveling cam mechanism and manually fire cam mechanism；

Figure 181 is the surgical stapling of Figure 179 and cuts off perspective disassembled view behind the handle portions of apparatus and the right side of slender axles；

Figure 182 is surgical stapling and the right rear view of cut-out apparatus of Figure 31, and the outside of the rightest half-shell and tool portion is removed Guan Bi and the firing lock being in original state with display；

Figure 183 is surgical stapling and the right side elevational view of cut-out apparatus of the decomposed of Figure 182；

Figure 184 is surgical stapling and the right rear view of cut-out apparatus of the decomposed of Figure 182, wherein close mechanism Guan Bi and clamping, and gemmule pawl firing lock completes the first stroke, and wherein manual retrieving mechanism is removed to show the distal link of link-type tooth bar, this distal link triggers the automatic retracted of firing lock；

Figure 185 is surgical stapling and the right rear view of cut-out apparatus of the decomposed of Figure 183, and wherein gemmule pawl firing lock departs from and distal link is close to automatic retracted；

Figure 186 is in the surgical stapling of the decomposed of Figure 183 of original state and cuts off the left side elevational view of apparatus, and when this original state, end effector is opened and Anti-backup mechanism is engaged；

Figure 187 is right half-shell and the left side detail drawing of anti-retrogression trip lever of the handle portions of Figure 186；

Figure 188 is surgical stapling and thin portion, the left side elevational view of cut-out apparatus of the decomposition of Figure 179, and wherein closure trigger is clamped, percussion trigger performs last stroke and distal link is oriented to trigger automatic retracted；

Figure 189 is that distal link activates towards anti-retrogression trip lever and locks, so that the surgical stapling of the decomposition of the Figure 188 after link-type tooth bar retraction and thin portion, the left side elevational view of cut-out apparatus；

Figure 190 is the surgical stapling of Figure 179 and the idler gear of the manual retrieving mechanism of cut-out apparatus and the right resolution perspective view of backgear and manual retrieving lever and ratchet pawl；

Figure 191 is the right perspective view of the manual retrieving mechanism of Figure 190, and wherein manual retrieving lever is partly cut away to expose the ratchet gear of small diameter on the backgear engaging ratchet pawl；

Figure 192 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of Figure 179, wherein Anti-backup mechanism is joined to the link-type tooth bar fired completely, before the manual retrieving lever of Figure 190 is braked, this link-type tooth bar departs from the tension force/compression spring of combination；

Figure 193 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of Figure 192, and wherein the hidden parts of anti-retrogression trip lever, backgear and manual percussion trip lever is shown in phantom；

Figure 194 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of the Figure 193 after the actuating manually firing trip lever has made link-type tooth bar manual retrieving；

Figure 195 is the surgical stapling left side elevational view with the decomposed cutting off apparatus of Figure 194, and wherein link-type tooth bar is omitted, it is shown that manually percussion trip lever and Anti-backup mechanism disengaging；

Figure 196 is the surgical stapling for Figure 179 and alternative anti-retrogression trip lever and the left side detail drawing of shank shell cutting off apparatus；

Figure 197 is alternative anti-retrogression release thick stick, backgear axle and the left perspective disassembled view of automatic retracted cam of Figure 196；

Figure 198 is the right side elevational view of alternative anti-retrogression relieving mechanism of Figure 196, and wherein link-type tooth bar is in advanced position, and anti-retrogression trip lever is proximally positioned in the anti-backup plate being joined to fire connecting rod；

Figure 198 A is thin portion, the right side elevational view of the backgear of Figure 198, automatic retracted cam and farthest side connecting rod；

Figure 199 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 198 after the first firing stroke；

Figure 199 A is thin portion, the right side elevational view of the backgear of Figure 199, automatic retracted cam and second connecting rod；

Figure 200 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 199 after the second firing stroke；

Figure 200 A is thin portion, the right side elevational view of the backgear of Figure 200, automatic retracted cam and third connecting rod；

Figure 20 1 is the right side elevational view of the anti-retrogression relieving mechanism of the Figure 200 after the 3rd percussion and last stroke；

Figure 20 1A is thin portion, the right side elevational view of the backgear of Figure 20 1, automatic retracted cam and recent side fourth link；

Figure 20 2 is to make automatic retracted cam slide towards distally at another firing stroke and lock anti-retrogression trip lever, thus the right side elevational view of the automatic releasing mechanism shown in Figure 20 1 after separating with anti-retrogression relieving mechanism；

Figure 20 3 is the front, left perspective view that assembly used by the nail opened, and the right half part of the most replaceable nail bin is included in nail groove；

Figure 20 4 is the decomposition diagram that assembly used by the nail of the axle configuration with complete replaceable nail bin and non-joint motions shown in Figure 20 3；

Figure 20 5 is split type cutter and the perspective view of trigger shaft (E type crossbeam) that assembly used by the nail shown in Figure 20 3；

Figure 20 6 is the perspective view that the wedge-shaped slides of the nail bin of assembly used by nail；

Figure 20 7 is to use, along the nail shown in Figure 20 3, the left side elevational view that the centrage 207-207 of assembly intercepts in longitudinal cross-section；

Figure 20 8 is the perspective view that assembly used by the nail opened shown in Figure 20 3, without the part following closely groove of the intermediate pin of replaceable nail bin, neighbouring split type cutter and trigger shaft, and does not follow closely the distal part of groove；

Figure 20 9 is to use, along the nail shown in Figure 20 3, the front elevational view that the centrage 209-209 of assembly intercepts in cross-section, it is shown that the inside staple drivers of nail bin and split type cutter and each several part of trigger shaft；

Figure 21 0 is the left side elevational view that the nail approximately along the Guan Bi shown in Figure 20 3 uses that the longitudinal axis 207-207 of assembly intercepts, to include the center contact point between split type cutter and wedge-shaped slides, but also Strategic Lateral Offset is to illustrate the nail in nail bin and staple drivers；

Figure 21 1 is thin portion, the left side elevational view that assembly used by the nail shown in Figure 21 0, and wherein split type cutter retraction is the most, and this is typical situation for nail bin is replaced；

Figure 21 2 is thin portion, the left side elevational view that assembly used by the nail shown in Figure 21 1, and wherein split type cutter starts percussion, corresponding to the configuration shown in Figure 21 0；

Figure 21 3 is the left cross sectional elevational view having used assembly at split type cutter and trigger shaft towards the nail of the Guan Bi shown in the Figure 21 0 after the percussion of distally；

Figure 21 4 is the left cross sectional elevational view that assembly used by the nail of the Guan Bi shown in the Figure 21 3 after the percussion of nail bin and the retraction of split type cutter；

Figure 21 5 is the left cross sectional elevational view that assembly used by the nail shown in Figure 21 4, and wherein split type cutter is allowed to fall in latched position；

Figure 21 6 is the perspective view of the nail bin of at least one embodiment according to the present invention, and nail bin includes rigid support part and the compressible tissue thickness compensating part being used together with surgery suturing appliance；

Figure 21 7 is the decomposed figure of the nail bin shown in Figure 21 6；

Figure 21 8 is the complete exploded view of the nail bin shown in Figure 21 6；

Figure 21 9 is another exploded view of the nail bin shown in Figure 21 6, and this nail bin is not covered with the wrappage of tissue thickness's compensating part；

Figure 22 0 is warehouse or the perspective view of support section of the nail bin shown in Figure 21 6；

Figure 22 1 is the top perspective of sliding part, and this sliding part can move in the nail bin shown in Figure 21 6, to dispose nail from nail bin；

Figure 22 2 is the bottom perspective view of the sliding part shown in Figure 22 1；

Figure 22 3 is the front view of the sliding part shown in Figure 22 1；

Figure 22 4 is the top perspective of driver, and this driver can support one or more nail and is lifted up penetrating nail from nail bin by the sliding part shown in Figure 22 1；

Figure 22 5 is the bottom perspective view of the driver shown in Figure 22 4；

Figure 22 6 is the wrappage of the compressible tissue thickness compensating part that can at least partly surround nail bin；

Figure 22 7 is the partial sectional view of nail bin, and nail bin includes rigid support part and compressible tissue thickness compensating part, it is shown that nail never firing position during First ray moves to firing position；

Figure 22 8 is the front view of the nail bin shown in Figure 22 7；

Figure 22 9 is the thin portion front view of the nail bin shown in Figure 22 7；

Figure 23 0 is the cross sectional end view of the nail bin shown in Figure 22 7；

Figure 23 1 is the bottom view of the nail bin shown in Figure 22 7；

Figure 23 2 is the thin portion bottom view of the nail bin shown in Figure 22 7；

Figure 23 3 is nail bin and the longitudinal sectional view of anvil block in the close position, and nail bin includes rigid support part and compressible tissue thickness compensating part, it is shown that nail never firing position during First ray moves to firing position；

Figure 23 4 is another sectional view of the anvil block shown in Figure 23 3 and nail bin, it is shown that anvil block in an open position after percussion sequence completes；

Figure 23 5 is the local detail drawing of the nail bin shown in Figure 23 3, it is shown that be in the nail of non-firing position；

Figure 23 6 is the cross-sectional elevational view of nail bin, and this nail bin includes rigid support part and compressible tissue thickness compensating part, it is shown that be in the nail of non-firing position；

Figure 23 7 is the detail drawing of the nail bin shown in Figure 23 6；

Figure 23 8 is nail bin and the front view of anvil block in an open position, and nail bin includes rigid support part and compressible tissue thickness compensating part, it is shown that be in the nail of non-firing position；

Figure 23 9 is nail bin and the front view of anvil block in the close position, and nail bin includes rigid support part and compressible tissue thickness compensating part, it is shown that is in the nail of non-firing position and is trapped in the tissue between anvil block and tissue thickness's compensating part；

Figure 24 0 is the detail drawing of the anvil block shown in Figure 23 9 and nail bin；

Figure 24 1 is nail bin and the front view of anvil block in the close position, and nail bin includes rigid support part and compressible tissue thickness compensating part, it is shown that be in the nail of non-firing position, it is shown that the thicker tissue being positioned between anvil block and nail bin；

Figure 24 2 is the detail drawing of the anvil block shown in Figure 24 1 and nail bin；

Figure 24 3 is the front view of the anvil block shown in Figure 24 1 and nail bin, it is shown that the tissue with different-thickness being positioned between anvil block and nail bin；

Figure 24 4 is the detail drawing of the anvil block shown in Figure 24 1 and nail bin, as shown in Figure 24 3；

Figure 24 5 shows the schematic diagram to tissue thickness's compensating part that the different tissues thickness captured in difference is followed closely compensates；

Figure 24 6 shows tissue thickness's compensating part and applies the schematic diagram of compression pressure to one or more blood vessel crosscutting by nail row；

Figure 24 7 shows the schematic diagram of the imappropriate situation about shaping of wherein one or more nails；

Figure 24 8 shows the schematic diagram of the tissue thickness's compensating part that can compensate for the most appropriately becoming staple；

Figure 24 9 shows the schematic diagram of the tissue thickness's compensating part being positioned in the tissue regions that multiple nail row intersects；

Figure 25 0 shows the schematic diagram of the tissue captured in nail；

Figure 25 1 shows the tissue and the schematic diagram of tissue thickness's compensating part capturing in nail；

Figure 25 2 shows the schematic diagram of the tissue captured in nail；

Figure 25 3 shows the thick tissue and the schematic diagram of tissue thickness's compensating part capturing in nail；

Figure 25 4 shows the thin tissue and the schematic diagram of tissue thickness's compensating part captured in nail；

Figure 25 5 shows the tissue thickness's compensating part captured in nail and has the schematic diagram of tissue of interior thickness；

Figure 25 6 shows the tissue thickness's compensating part captured in nail and has the schematic diagram of tissue of another interior thickness；

Figure 25 7 shows the thick tissue and the schematic diagram of tissue thickness's compensating part capturing in nail；

Figure 25 8 is the partial sectional view of the end effector of surgery suturing appliance, it is shown that be in retraction, the trigger shaft of non-firing position and nail percussion sliding part；

Figure 25 9 is another partial sectional view of the end effector shown in Figure 25 8, it is shown that is in local and advances trigger shaft and the nail percussion sliding part of position；

Figure 26 0 is the cross-sectional schematic of the end effector shown in Figure 25 8, it is shown that is in and is fully advanced or the trigger shaft of firing position；

Figure 26 1 is the sectional view of the end effector shown in Figure 25 8, it is shown that is in the trigger shaft of advanced position after being fired and stays the nail percussion sliding part of its complete firing position；

Figure 26 2 is the detail drawing of the trigger shaft being in advanced position shown in Figure 26 1；

Figure 26 3 is the partial sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes tissue thickness's compensating part and is at least partially positioned at nail therein；

Figure 26 4 is another partial sectional view of the end effector shown in Figure 26 3, it is shown that the nail at least partly moving relative to the anvil block being positioned in nail bin opposite and/or rotating；

Figure 26 5 is the partial sectional view of the end effector of the surgery suturing appliance according at least one embodiment；

Figure 26 6 is the partial sectional view of the end effector according at least one alternative embodiment；

Figure 26 7 is the partial sectional view of the end effector according to another alternative embodiment；

Figure 26 8 is the perspective view of the end effector of the surgery suturing appliance according at least one embodiment；

Figure 26 9 is the partial sectional view of the end effector shown in Figure 26 8 being illustrated at deflected；

Figure 27 0 is in the partial sectional view of the end effector shown in Figure 26 9 of release conditions；

Figure 27 1 is the perspective view of the end effector including tissue thickness's compensating part set；

Figure 27 2 is the rear view of the tissue thickness's compensating part set in Figure 27 1；

Figure 27 3 is the perspective view of the end effector including multiple guide rail, and tissue thickness's compensating part that the plurality of guide rail is limited to longitudinal cavity therein from support section and having extends；

Figure 27 4 is the perspective view of the tissue thickness's compensating part shown in Figure 27 3；

Figure 27 5 is the perspective view of end effector, and this end effector includes the multiple tusks extended from supporting part and the tissue thickness compensating part that engages；

Figure 27 6 is the perspective view of the anvil block including pit array according at least one embodiment；

Figure 27 7 is the local detail drawing of the anvil block shown in Figure 27 6；

Figure 27 8 is the partial lengthwise sectional view of the anvil block shown in Figure 27 6；

Figure 27 9 is the transverse sectional view of the anvil block shown in Figure 27 6；

Figure 28 0 is the front view of the percussion nail including substantially B shape configuration；

Figure 28 1 is the front view of the percussion nail of the lower limb including a lower limb and the outwards deformation being deformed inward；

Figure 28 2 is to include the front view that the percussion of two lower limbs outwards shaped is followed closely；

Figure 28 3 is the fragmentary, perspective view of the support section of nail bin, and this nail bin includes detachable and/or interchangeable nail lower limb guider；

Figure 28 4 is the partial sectional view of the nail bin shown in Figure 28 3, it is shown that the nail disposed from nail bin；

Figure 28 5 is by the detail drawing of the sectional view shown in Figure 28 4 after firing at nail bin；

Figure 28 6 is the exploded view of the nail bin including tissue thickness's compensating part, and this tissue thickness's compensating part includes being limited to space therein；

Figure 28 7 shows against the schematic diagram organizing the tissue thickness's compensating part shown in implanted Figure 28 6；

Figure 28 8 shows against another schematic diagram organizing the tissue thickness's compensating part shown in implanted Figure 28 6；

Figure 28 9 is the perspective cross-sectional view including laterally keeping the nail bin of component, and this laterally keeps component to extend from its support section, it is possible to be held in place by tissue thickness's compensating part；

Figure 29 0 is the sectional view for sewing up the nail bin shown in Figure 28 9 of tissue；

Figure 29 1 is another sectional view of the nail bin shown in Figure 28 9, it is shown that positive motion is away from the support section of the tissue thickness's compensating part implanted；

Figure 29 2 is the perspective cross-sectional view of nail bin, and what this nail bin included being remained to by tissue thickness's compensating part support section laterally keeps component；

Figure 29 3 is the sectional view for sewing up the nail bin shown in Figure 29 2 of tissue；

Figure 29 4 is another sectional view of the nail bin shown in Figure 29 2, it is shown that positive motion is away from the support section of the tissue thickness's compensating part implanted；

Figure 29 5 is the cross section detail drawing of the keeper of the support section that tissue thickness's compensating part remains to nail bin according at least one embodiment；

Figure 29 6 is the partial sectional view of the nail bin of the staple drivers including having differing heights according at least one embodiment；

Figure 29 6A shows the staple drivers shown in Figure 29 6 and is supported on the schematic diagram with the different nail not firing height thereon；

Figure 29 7 shows and includes tissue thickness's compensating part of variable thickness, have the staple drivers of differing heights and have the schematic diagram of nail of different unshaped height；

Figure 29 8 shows the nail shown in Figure 29 7 of implanted tissue and the schematic diagram of tissue thickness's compensating part；

Figure 29 9 is the partial sectional view of the nail bin of the tissue thickness's compensating part including having variable thickness according at least one embodiment；

Figure 30 0 is in opening the sectional view of the end effector of the surgery suturing appliance of configuration；

Figure 30 1 is the sectional view of the end effector shown in Figure 30 0 being illustrated at part percussion configuration；

Figure 30 2 is the sectional view of the end effector shown in Figure 30 0 being illustrated at being again turned on configuration；

Figure 30 3 is the sectional view of the end effector of the surgery suturing appliance according at least one embodiment, and this surgery suturing appliance includes having differing heights and the staple drivers of wavy platform surface；

Figure 30 4 is the sectional view of the end effector of the surgery suturing appliance according at least one embodiment, and this surgery suturing appliance includes having differing heights and the staple drivers of staged platform surface；

Figure 30 5 is the perspective view of the nail bin using nail bin application device to be loaded in the executor of surgery suturing appliance；

Figure 30 6 is the bottom perspective view of the nail bin application device shown in Figure 30 5；

Figure 30 7 is the side view of the nail bin application device shown in Figure 30 5 being assembled into nail bin；

Figure 30 8 is the sectional view of the assembly shown in Figure 30 7；

Figure 30 9 is the perspective view of the nail bin application device assembly according at least one embodiment, and this nail bin application device assembly also includes the top tissue thickness compensation part being positioned on the top surface of nail bin application device；

Figure 31 0 is the top tissue thickness compensation part shown in Figure 30 9 and the exploded view of nail bin application device；

Figure 31 0A is the exploded view of the nail bin application device assembly including tractive component, and this tractive component can make the top tissue thickness compensation part being attached to nail bin application device separate；

Figure 31 1 is the decomposed figure of the nail bin application device assembly according at least one alternative embodiment；

Figure 31 2 is the perspective view of nail bin application device assembly, and multiple holding structures and nail bin that this nail bin application device assembly includes top tissue thickness compensation part and nail bin, top tissue thickness compensation part to include from it and extends include bottom tissue thickness compensating part；

Figure 31 3 is the front view of the nail bin application device assembly shown in Figure 31 2, and this nail bin application device assembly is positioned in staple cartridge channel and in the anvil block of Guan Bi on nail bin application device assembly；

Figure 31 4 is in being again turned on the anvil block shown in Figure 31 3 of position and the front view of the nail bin application device shown in Figure 31 2 being just removed from end effector；

Figure 31 4A is to be positioned in the top tissue thickness compensation part shown in Figure 31 2 and the sectional view of the tissue in the middle of bottom tissue thickness compensating part；

Figure 31 4B shows and is seamed to tissue cut-off top tissue thickness compensation part and the sectional view of bottom tissue thickness compensating part by cutting element；

Figure 31 5 is, according to showing of at least one embodiment, tissue thickness's compensating part is inserted the schematic diagram in anvil block；

Figure 31 6 is the sectional view of the tissue thickness's compensating part shown in Figure 31 5；

Figure 31 7 is the tissue thickness's compensating part according at least one alternative embodiment and the exploded view of anvil block；

Figure 31 8 is the perspective view of the nail bin application device assembly according at least one embodiment, and this nail bin application device assembly includes the top tissue thickness compensation part that can be attached to anvil block；

Figure 31 9 is the front view of the nail bin application device assembly shown in Figure 31 8, this nail bin application device assembly be positioned in staple cartridge channel and just towards top tissue thickness compensation part motion anvil block in；

Figure 32 0 shows after top tissue thickness compensation part engages with anvil block, the nail bin application device shown in Figure 31 8 just removed from end effector；

Figure 32 1 is directed towards the cross sectional end view of the anvil block of the top tissue thickness compensation part motion shown in Figure 31 8；

Figure 32 2 is the cross sectional end view of the anvil block engaged with top tissue thickness compensation part；

Figure 32 3 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes the tissue thickness's compensating part being attached to the sectional of the support section of nail bin by multiple securing members；

Figure 32 4 is the sectional view of the end effector shown in Figure 32 3, it is shown that be in the firing member of part firing position；

Figure 32 5 is the sectional view of the end effector shown in Figure 32 3, it is shown that the support section of tissue thickness's compensating part that positive motion is implanted away from part；

Figure 32 6 is the fragmentary, perspective view of the support section shown in Figure 32 3；

Figure 32 7 is the perspective view that sliding part disposed by the nail according at least one embodiment；

Figure 32 8 is the front view of the sliding part shown in Figure 32 7；

Figure 32 9 is the perspective view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes tissue thickness's compensating part and the multiple nail guiders being positioned on tissue thickness's compensating part；

Figure 33 0 is in not firing the tissue thickness's compensating part shown in Figure 32 9 of configuration and the partial sectional view of nail guider；

Figure 33 1 is in firing the tissue thickness's compensating part shown in Figure 32 9 of configuration and the partial sectional view of nail guider；

Figure 33 2 is the sectional view of the nail bin including tissue thickness's compensating part and support section according at least one embodiment；

Figure 33 3 is the partial sectional view of tissue thickness's compensating part, nail guide layer and the nail being in non-firing position；

Figure 33 4 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 33 5 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 33 6 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 33 7 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 33 8 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 33 9 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 34 0 is around the detail drawing in the region of the end of the nail shown in Figure 33 9；

Figure 34 1 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 34 2 is around the detail drawing in the region of the end of the nail shown in Figure 34 1；

Figure 34 3 is the partial sectional view of the tissue thickness's compensating part according at least one alternative embodiment, nail guide layer and the nail being in non-firing position；

Figure 34 4 is the perspective view of the nail guide layer according at least one alternative embodiment and the multiple nails being in non-firing position；

Figure 34 5 is the end-view of the tissue thickness's compensating part can being used together with circular surgical staplers；

Figure 34 6 is the tissue thickness's compensating part shown in Figure 34 5 and the perspective view of circular surgical staplers；

Figure 34 7 is the end-view of the tissue thickness's compensating part can being used together with circular surgical staplers according at least one alternative embodiment；

Figure 34 8 is the tissue thickness's compensating part shown in Figure 34 7 and the perspective view of circular surgical staplers；

Figure 34 9 is the end-view of the tissue thickness's compensating part can being used together with circular surgical staplers；

Figure 35 0 is in the end-view of the tissue thickness's compensating part shown in Figure 34 9 of local extended configuration；

Figure 35 1 is the front view of the surgery suturing appliance including nail bin according at least one embodiment；

Figure 35 2 is the end-view relative to the surgery suturing appliance shown in Figure 35 1 of tissue positioned；

Figure 35 3 is the end-view of the surgery suturing appliance shown in Figure 35 1, and this surgery suturing appliance also includes the tissue thickness's compensating part being positioned between nail bin and tissue；

Figure 35 4 is the fragmentary, perspective view never with the nail that the surgery suturing appliance shown in Figure 35 1 of tissue thickness's compensating part is deployed in tissue；

Figure 35 5 is the fragmentary, perspective view of the nail being deployed to tissue from the surgery suturing appliance shown in the Figure 35 1 with tissue thickness's compensating part；

Figure 35 6 is the partial sectional view of the end effector of the surgery suturing appliance shown in Figure 35 1, including the anvil plate being in primary importance；

Figure 35 7 is the partial sectional view of the end effector of the surgery suturing appliance shown in Figure 35 1, it is shown that be in the anvil plate shown in Figure 35 6 of the second position；

Figure 35 8 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes that gap sets element；

Figure 35 9 shows the perspective view of firing member, and this firing member gap shown in cutting drawing 358 at the end of the firing stroke of firing member sets element；

Figure 36 0 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes flexible nose；

Figure 36 1 is the sectional view of the end effector shown in Figure 36 0, it is shown that be in the nose of flexure configuration；

Figure 36 2 is the sectional view of the end effector of the surgery suturing appliance including nail bin, and this nail bin includes slidably part；

Figure 36 3 is the sectional view of the end effector shown in Figure 36 2, it is shown that the slidably part slided towards distally；

Figure 36 4 is the sectional view of the end effector of the surgery suturing appliance including support section and tissue thickness's compensating part, and this support section includes that the platform surface tilted and this tissue thickness's compensating part include the thickness of change；

Figure 36 5 is the sectional view of the end effector of the surgery suturing appliance including support section and tissue thickness's compensating part, and this support section includes that the platform surface tilted and this tissue thickness's compensating part include consistent thickness；

Figure 36 6 is the perspective view of the nail bin of the tissue thickness's compensating part including having variable thickness；

Figure 36 7 is the end-view of the nail bin shown in Figure 36 6；

Figure 36 8 is the perspective cross-sectional view of the tissue thickness's compensating part including longitudinal layer；

Figure 36 9 is the perspective cross-sectional view of the tissue thickness's compensating part including multiple layers according at least one alternative embodiment；

Figure 37 0 is the perspective view of disposable loading unit, and this disposable loading unit includes the holding component that tissue thickness's compensating part can releasably hold it；

Figure 37 1 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part includes the holding component that tissue thickness's compensating part can releasably hold disposable loading unit；

Figure 37 2 is attached to the perspective view of the tissue thickness's compensating part shown in Figure 37 1 of disposable loading unit；

Figure 37 3 is the end-view of the disposable loading unit shown in Figure 37 2；

Figure 37 4 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part includes the holding component that tissue thickness's compensating part can releasably hold disposable loading unit；

Figure 37 5 is attached to the perspective view of the tissue thickness's compensating part shown in Figure 37 4 of disposable loading unit；

Figure 37 6 is the end-view of the disposable loading unit shown in Figure 37 5；

Figure 37 7 is the perspective view of tissue thickness's compensating part, and this tissue thickness's compensating part includes the holding component that tissue thickness's compensating part can releasably hold disposable loading unit；

Figure 37 8 is attached to the perspective view of the tissue thickness's compensating part shown in Figure 37 7 of disposable loading unit；

The perspective view of tissue thickness's compensating part application device that Figure 37 9 is located in the executor of disposable loading unit；

Figure 38 0 is the top perspective of the tissue thickness's compensating part application device shown in Figure 37 9；

Figure 38 1 is the bottom perspective view of the tissue thickness's compensating part application device shown in Figure 37 9；

Figure 38 2 is the perspective view of the tissue thickness's compensating part application device being positioned in the executor of disposable loading unit according at least one alternative embodiment；

Figure 38 3 is the top perspective of the tissue thickness's compensating part application device shown in Figure 38 2；

Figure 38 4 is the bottom perspective view of the tissue thickness's compensating part application device shown in Figure 38 2；

Figure 38 5 is the front view of disposable loading unit, and this disposable loading unit includes the pivotable jaw that can support nail bin；

Figure 38 6 is the sectional view of the nail bin according at least one embodiment, and this nail bin includes the tissue thickness's compensating part being attached to the support section of nail bin；

Figure 38 7 is the sectional view of the nail bin according at least one embodiment, and this nail bin includes the tissue thickness's compensating part being attached to the support section of nail bin；

Figure 38 8 is the sectional view of the nail bin according at least one embodiment, and this nail bin includes the tissue thickness's compensating part being attached to the support section of nail bin；And

Figure 38 9 is the perspective view of the tissue thickness's compensating part shown in Figure 38 7.

Run through multiple view, the parts that corresponding reference marks instruction is corresponding.Example shown herein as shows certain embodiments of the present invention, and the scope should not being construed as in any way limiting the present invention by this type of example in one form.

Detailed description of the invention

Present applicant also has following U.S. Patent application, and these patent applications are submitted in JIUYUE in 2010 on the 30th, and are the most each entirely incorporated into herein:

The U.S. Patent Application Serial Number 12/894,360 of entitled " SurgicalStaplingInstrumentWithaVariableStapleFormingSyst em "；

The U.S. Patent Application Serial Number 12/894,322 of entitled " SurgicalStaplingInstrumentWithInterchangeableStapleCartr idgeArrangements "；

The U.S. Patent Application Serial Number 12/894,351 of entitled " SurgicalCuttingandFasteningInstrumentsWithSeparateandDis tinctFastenerDeploymentandTissueCuttingSystems "；

The U.S. Patent Application Serial Number 12/894,339 of entitled " SurgicalStaplingInstrumentWithCompactArticulationControl Arrangement "；

The U.S. Patent Application Serial Number 12/894,327 of entitled " JawClosureArrangementsForSurgicalInstruments "；

The U.S. Patent Application Serial Number 12/894,311 of entitled " SurgicalInstrumentsWithReconfigurableShaftSegments "；

The U.S. Patent Application Serial Number 12/894,340 of entitled " SurgicalStapleCartridgesSupportingNon-LinearlyArrangedSt aplesandSurgicalStaplingInstrumentsWithCommonStaple-Form ingPockets "；

The U.S. Patent Application Serial Number 12/894,350 of entitled " SurgicalStapleCartridgesWithDetachableSupportStructuresa ndSurgicalStaplingInstrumentsWithSystemsForPreventingAct uationMotionsWhenaCartridgeisNotPresent "；

The U.S. Patent Application Serial Number 12/894,338 of entitled " ImplantableFastenerCartridgeHavingaNon-UniformArrangemen t "；

The U.S. Patent Application Serial Number 12/894,312 of entitled " ImplantableFastenerCartridgeComprisingMultipleLayers "；

The U.S. Patent Application Serial Number 12/894,377 of entitled " SelectivelyOrientableImplantableFastenerCartridge "；

The U.S. Patent Application Serial Number 12/894,383 of entitled " ImplantableFastenerCartridgeComprisingBioabsorbableLayer s "；

The U.S. Patent Application Serial Number 12/894,389 of entitled " CompressibleFastenerCartridge "；

The U.S. Patent Application Serial Number 12/894,345 of entitled " FastenersSupportedByaFastenerCartridgeSupport "；

The U.S. Patent Application Serial Number 12/894,306 of entitled " CollapsibleFastenerCartridge "；

The U.S. Patent Application Serial Number 12/894,318 of entitled " FastenerSystemComprisingaPluralityofConnectedRetentionMa trixElements "；

The U.S. Patent Application Serial Number 12/894,330 of entitled " FastenerSystemComprisingaRetentionMatrixandanAlignmentMa trix "；

The U.S. Patent Application Serial Number 12/894,361 of entitled " FastenerSystemComprisingaRetentionMatrix "；

The U.S. Patent Application Serial Number 12/894,367 of entitled " FasteningInstrumentForDeployingaFastenerSystemComprising aRetentionMatrix "；

The U.S. Patent Application Serial Number 12/894,388 of entitled " FastenerSystemComprisingaRetentionMatrixandaCover "；

The U.S. Patent Application Serial Number 12/894,376 of entitled " FastenerSystemComprisingaPluralityofFastenerCartridges "；And

The U.S. Patent Application Serial Number 12/894,369 of entitled " ImplantableFastenerCartridgeComprisingaSupportRetainer ".

Present applicant also has following U.S. Patent application, and these patent applications are submitted on the same day with the application, and is each each entirely incorporated into herein with way of reference:

The U.S. Patent Application Serial Number of entitled " CompressibleStapleCartridgeAssembly " _ _ _ _ _, attorney is END6848USCIP1/100533CIP1；

The U.S. Patent Application Serial Number of entitled " TissueThicknessCompensatorComprisingPortionsHavingDiffer entProperties " _ _ _ _ _, attorney is END6849USCIP1/100534CIP1；

The U.S. Patent Application Serial Number of entitled " StapleCartridgeComprisinganAdjustableDistalPortion " _ _ _ _ _, attorney is END6847USCIP1/100532CIP1；

The U.S. Patent Application Serial Number of entitled " TissueThicknessCompensatorForaSurgicalStapler " _ _ _ _ _, attorney is END6736USCIP1/100060CIP1；

The U.S. Patent Application Serial Number of entitled " SurgicalStaplerAnvilComprisingaPluralityofFormingPockets " _ _, attorney is END6735USCIP1/100059CIP1；

The U.S. Patent Application Serial Number of entitled " StapleCartridgeComprisingaVariableThicknessCompressibleP ortion " _ _ _ _ _, attorney is END6840USCIP1/100525CIP1；

The U.S. Patent Application Serial Number of entitled " TissueThicknessCompensatorComprisingDetachablePortions " _ _, attorney is END6842USCIP1/100527CIP1；

The U.S. Patent Application Serial Number of entitled " TissueThicknessCompensatorForaSurgicalStaplerComprisinga nAdjustableAnvil " _ _ _ _ _, attorney is END6843USCIP1/100528CIP1；

The U.S. Patent Application Serial Number of entitled " CompressibleStapleCartridgeComprisingAlignmentMembers " _, attorney is END6856USCIP1/100541CIP1；

The U.S. Patent Application Serial Number of entitled " StapleCartridgeComprisingaReleasablePortion " _ _ _ _ _, attorney is END6857USCIP1/100542CIP1；

The U.S. Patent Application Serial Number of entitled " StapleCartridgeComprisingCompressibleDistortionResistant Components " _ _ _ _ _, attorney is END6858USCIP1/100543CIP1；

The U.S. Patent Application Serial Number of entitled " StapleCartridgeComprisingaTissueThicknessCompensator " _ _ _, attorney is END6859USCIP1/100544CIP1；

The U.S. Patent Application Serial Number of entitled " StapleCartridgeComprisingStaplesPositionedWithinaCompres siblePortionThereof " _ _ _ _ _, attorney is END6841USCIP1/100526CIP1.

Some exemplary embodiment be will now be described, to understand the structure of apparatus as disclosed herein and method, function, manufacture and purposes on the whole.One or more examples of these embodiments are shown in the drawings.It will be understood by those skilled in the art that apparatus and method specifically described herein and illustrated in the accompanying drawings are nonrestrictive exemplary embodiment, and the scope of various embodiments of the invention is limited only by the appended claims.One exemplary embodiment is carried out to the feature of graphic extension or description, can be combined with the feature of other embodiments.Within this modification and version are intended to be included in the scope of the present invention.

" the various embodiments ", " some embodiments ", " embodiment " or " embodiment " that this specification is quoted in the whole text etc., refer to that the specific features, structure or the characteristic that combine the description of described embodiment include at least one embodiment.Therefore, the phrase " in many embodiment ", " in certain embodiments ", " in one embodiment " or " in an embodiment " etc. that this specification occurs in the whole text is not necessarily all referring to identical embodiment.Additionally, in one or more embodiments, specific features, structure or characteristic can combine in any suitable way.Therefore, without limitation, the specific features, structure or the characteristic that illustrate in conjunction with an embodiment or describe can be combined with feature, structure or the characteristic of other embodiments one or more whole or in part.Within this modification and version are intended to be included in the scope of the present invention.

Terms used herein " nearside " and " distally " are for the clinician of manipulation of surgical apparatus handle portions.Term " nearside " refers to that the part near clinician, term " distally " refer to the part of clinician.It is also understood that for succinct and clear for the sake of, can use such as " vertically " in conjunction with accompanying drawing herein, " level ", the spatial terminology of "up" and "down" etc.But, surgical instruments uses in many directions and position, and these terms nonrestrictive and/or absolute.

Provide various exemplary means and method to perform abdominal cavity mirror and micro-wound surgical operation operation.But, those skilled in the art will readily appreciate that, various method and devices disclosed herein can be used in many surgical procedures and application (including such as operating, with open surgery, the application combined).With continued reference to this detailed description of the invention, those skilled in the art it will be appreciated that various apparatus disclosed herein can insert internal by any way, such as, pass through nature tract, by the otch being formed in tissue or puncturing hole etc..The working portion of apparatus or end effector portion can be plugged directly into and the most maybe can insert by having the entrance device of service aisle, and the end effector of surgical instruments and slender axles can be advanced by described service aisle.

Seeing accompanying drawing, wherein in multiple views, the element that similar digitized representation is similar, Fig. 1 shows the surgical instruments 10 that can put into practice multiple beneficial effect specific to the present invention.Surgery suturing appliance 10 is designed to handle and/or activate be operably attached to the various forms of surgery suturing appliance 10 and the end effector 12 of size.In the embodiment shown in Fig. 1-1E, such as end effector 12 includes elongated passageway 14, and this elongated passageway forms the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implanted " nail bin 30 and also support the anvil block 20 of the upper jaw 15 being used as end effector 12 actively.

In various embodiments, elongated passageway 14 can be made by such as 300 and 400 series, 17-4 and 17-7 rustless steel, titanium etc., and be formed together with spaced-apart sidewalls 16.Anvil block 20 can be made by such as 300 and 400 series, 17-4 and 17-7 rustless steel, titanium etc., and be had nail shaped lower face, is generally designated as 22, described nail shaped lower face have multiple be formed at therein nail shape pit 23.See Figure 1B-1E.It addition, anvil block 20 has and is divided into two-part slide assemblies 24 from its proximad projection.Anvil block pin 26 is from each cross side projection of slide assemblies 24, to be contained in the respective slots in the sidewall 16 of elongated passageway 14 or opening 18, thus is conducive to movable for anvil block pin or be pivotably attached to described respective slots or opening.

Various forms of implanted nail bins can be used together with the various embodiments of surgical instruments disclosed herein.Specific nail bin configuration and structure below be will be discussed in more detail.But, in the embodiment shown in Figure 1A, it is shown that implanted nail bin 30.In at least one embodiment, nail bin 30 has main part 31, and supporting in this main part has multiple rows of unfashioned peg 32, and main part is made up of compressible hemostatic material (such as oxidized regenerated cellulose (ORC) or bioabsorbable foam).In at least certain embodiments, impacted for anti-non-magnetic shim and prevent hemostatic material introduce and position fixing process during be activated, whole storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markSell six cyclic ketones films or with polyglycerol sebacate (PGS) film or with by PGA(polyglycolic acid, with trade mark Vicryl sell), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or other biodegradable films of being formed by the complex of PGA, PCL, PLA, PDS, described film only when rupturing ability the most permeable.The main body 31 of nail bin 30 be sized to be supported on removedly in elongated passageway 14 as depicted so that when anvil block 20 is driven to nail bin 30 shaping contact, all corresponding with the anvil block nail of each nail 32 therein shapes pit 23 and aligns.

In use, once end effector 12 positions adjacent to target tissue, and end effector 12 is just manipulated to target tissue capture or is clamped between the top surface 36 of nail bin 30 and the nail profiled surface 22 of anvil block 20.Nail 32 shapes in the following way: motion anvil block 20 in the path being arranged essentially parallel to elongated passageway 14, so that nail profiled surface 22 nail the most therein shapes pit 23 and substantially simultaneously contacts the top surface 36 of nail bin 30.When anvil block 20 continues to move in nail bin 30, the lower limb 34 of nail 32 contacts the nail of correspondence in anvil block 20 and shapes pit 23, and this nail shapes pit and is used for making nail lower limb 34 bend so that following closely 32 to be configured to " B shape ".Anvil block 20 will compress nail 32 further towards the motion further of elongated passageway 14, and makes nail 32 be configured to desired final forming height " FF ".

Above-mentioned nail forming process is substantially illustrated in Figure 1B-1E.Such as, Figure 1B illustrates end effector 12, and its target tissue " T " is between the top surface 36 of anvil block 20 and implanted nail bin 30.Fig. 1 C illustrates the initial clamped position of anvil block 20, and wherein anvil block 20 has been closed up to target tissue " T ", to be clamped in by target tissue " T " between the top surface 36 of anvil block 20 and nail bin 30.Fig. 1 D illustrates and initially follows closely shaping, and wherein anvil block 20 has started to compress nail bin 30 so that the lower limb 34 of nail 32 begins through the nail in anvil block 20 and shapes pit 23 and shape.Fig. 1 E illustrates and is in the nail 32 of final shaped state through target tissue " T ", has the most removed anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", and surgeon just makes anvil block motion 20 to open position, to make warehouse 31 and nail 32 can remain attached to target tissue when withdrawing from end effector 12 from patient.When two jaws 13,15 clamp jointly, end effector 12 makes all of nail shape simultaneously.Remaining " by conquassation " material of main part 31 is used as hemorrhage (ORC) and nail row strengthening agent (other film compositions 38 of PGA, PDS or any of above).Additionally, due to nail 32 need not leave warehouse 31 during shaping, therefore follow closely 32 probabilities becoming deformity during shaping and be minimized.As used herein, term " implanted " refers to that the warehouse material for support nail also would be held in the patient and can finally be absorbed by patient body in addition to nail.This type of implanted nail bin is different from previous nail bin structure, and this previous nail bin structure is the most intactly positioned in end effector after it is by percussion.

In various being embodied as, end effector 12 can be connected to from the prominent slender axles assembly 40 of shank assembly 100.End effector 12(is when Guan Bi) and slender axles assembly 40 can have a similar shape of cross section, and it is sized to operationally through trocar tube or the service aisle in another access instruments form.As used herein, term " operationally passes " and refers to can being inserted by passage or tube opening or be may pass through passage or tube opening at least partially of end effector and slender axles assembly, and if necessary in passage or tube opening, it can have been handled surgery stitching operation.In certain embodiments, when in the closed position, the jaw 13 and 15 of end effector 12 can be that end effector provides the shape of cross section of circular to be beneficial to it through circular passage/opening.It is contemplated, however, that the end effector of various embodiments of the present invention and slender axles Assemblies Example have other shape of cross sections, thus may pass through entrance passage and the opening with non-circular transverse cross-section.Therefore, the overall dimension of the cross section of the end effector of Guan Bi by end effector by relevant for the size of the passage passed or opening.Therefore, an end effector is such as referred to alternatively as " 5mm " end effector, and this refers to that it operationally can be at least the opening of about 5mm through diameter.

In many embodiment, slender axles assembly 40 can have the external diameter of substantially equal with the external diameter of end effector in the closed position 12.Such as, 5mm end effector can be connected to the slender axles assembly 40 with 5mm cross-sectional diameter.But, with continued reference to this detailed description of the invention, it will be apparent that, various embodiments of the present invention can be effectively combined various sizes of end effector and use.Such as, 10mm end effector could attach to the slender axles with 5mm cross-sectional diameter.For wherein providing the application entering opening or passage of 10mm or bigger, slender axles assembly 40 can have 10mm(or bigger) cross-sectional diameter, but also be able to activate 5mm or 10mm end effector.Therefore, the external diameter of outer shaft 40 can be identical or different with the external diameter of the end effector 12 of the Guan Bi being attached to it.

As it can be seen, slender axles assembly 40 is distally extending substantially along straight line from shank assembly 100, to limit longitudinal axis A-A.In various embodiments, such as slender axles assembly 40 may be about 9-16 inch (229-406mm) length.But, slender axles assembly 40 may be configured as other length, and in other embodiments, slender axles assembly can have joint or end effector 12 in other words can be conducive to carry out hinged relative to other parts of axle or shank assembly, below will be discussed in more detail.In various embodiments, slender axles assembly 40 includes ridge component 50, and this ridge component extends to end effector 12 from shank assembly 100.The near-end of the elongated passageway 14 of end effector 12 has a pair holding lug 17 from its projection, holding lug is sized to be contained in the corresponding lug opening provided in the far-end of ridge component 50 or support 52 by this, so that end effector 12 can couple slender axles assembly 40 removedly.Ridge component 50 can be made up of such as 6061 or 7075 aluminum, rustless steel, titanium etc..

In various embodiments, shank assembly 100 includes that pistol grasps shell body, and described pistol grasps shell body can be processed to two or more parts for assembling.Such as, shank assembly 100 as depicted include by polymer or molded of plastic material or be in other words processed into and be designed to right hand housing member 102 and the left hand housing member (not shown) being combined together.This type of housing member can be attached together by the snap arrangement moulding wherein or in other words being formed, bolt and pod and/or by binding agent, screw etc..Ridge component 50 has near-end 54, is formed with flange 56 on this near-end.Flange 56 can be rotationally supported in groove 106, and this groove is by from housing member 102, and each in 104 is formed to the fit ribs 108 of inner process.This structure beneficially ridge component 50 is attached to shank assembly 100, makes ridge component 50 can rotate around longitudinal axis A-A along 360 ° of paths relative to shank assembly 100 simultaneously.

As in FIG it can further be shown that ridge component 50 is through installing axle bush 60 and being supported by installing axle bush 60, this installation axle bush is pivotally attached to shank assembly 100.Installing axle bush 60 and have proximal flange 62 and distal lip 64, this proximal flange and distal lip restriction rotated trench 65, the leading edge portion 101 of shank assembly 100 can be rotatably received within therebetween by this rotated trench.This structure makes installation axle bush 60 can rotate around longitudinal axis A-A relative to shank assembly 100.Axle bush 60 extremely installed by ridge component 50 by ridge pin 66 non-rotatably pin joint.It addition, rotary knob 70 is attached to install axle bush 60.In one embodiment, rotary knob 70 has hollow mounting flange portion 72, this hollow mounting flange portion be sized to by install axle bush 60 a part contained therein.In various embodiments, rotary knob 70 can by such as glass or carbon filled nylon, Merlon,Etc. processing, and it is attached to axle bush 60 is installed also by ridge pin 66.It addition, be formed in mounting flange portion 72 and can extend to be formed in the radial groove 68 installed in axle bush 60 to the flange 74 that keeps of inner process.Therefore, surgeon can by promptly rotary knob 70 and make it rotate relative to shank assembly 100 and make ridge component 50(and be attached to the end effector 12 of ridge component 50) rotate around longitudinal axis A-A along 360 ° of paths.

In various embodiments, anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.Anvil block 20 can optionally move to various Guan Bi or clamped position and firing position by trigger system from open position, and described trigger system is generally indicated at 109.Trigger system 109 includes " firing member " 110, in various embodiments, " firing member " should include hollow firing tube 110.Hollow firing tube 110 can axially-movable on ridge component 50, the therefore outside of formation slender axles assembly 40.Firing tube 110 can be formed by polymer or other suitable materials processing, and has the near-end of the percussion yoke 114 being attached to trigger system 109.The most in various embodiments, the percussion moldable near-end to firing tube 110 of yoke 114.But, it is possible to use other fastener constructions.

As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, and this support lining ring can axially-movable in shank assembly 100.In various embodiments, supporting lining ring 120 and have the fin extended laterally a pair, fin is sized to be slidably received within the fin slit being formed in left hand housing member and right hand housing member by this.Therefore, supporting lining ring 120 can slide axially in shank housing 100, makes percussion yoke 114 and firing tube 110 can rotate around longitudinal axis A-A relative to supporting lining ring 120 simultaneously.In various embodiments, firing tube 110 being provided with longitudinal slit, so that ridge pin 66 can extend in ridge component 50 through longitudinal slit, the most beneficially firing tube 110 is axially advanced on ridge component 50.

Trigger system 109 also includes firing trigger 130, and this percussion trigger is for controlling the firing tube 110 axial traveling on ridge component 50.See Fig. 1.The axially-movable generation in a distal direction of this type of firing tube 110 is referred to herein as " percussion motion " with the percussion interaction of anvil block 20.As can be seen in Figure 1, percussion trigger 130 is movable by pivot pin 132 or is pivotally coupled to shank assembly 100.Use torsionspring 135 to bias percussion trigger 130 to make it away from the pistol grip portion 107 of shank assembly 100 and arrive " the opening " or the original position that do not activate.As can be seen in Figure 1, percussion trigger 130 has top 134, and this top is attached (pin joint) movingly and arrives percussion chain link 136, and this percussion chain link is attached (pin joint) movingly to supporting lining ring 120.Therefore, percussion trigger 130 will make percussion yoke 114 and firing tube 110 move along distal direction " DD " from original position (Fig. 1) to the motion of the end position of the pistol grip portion 107 of adjacent hub parts 100.Percussion trigger 130 will make percussion yoke 114 and firing tube 110 move along proximal direction " PD " on ridge component 50 away from the motion (under the bias of torsionspring 135) of the pistol grip portion 107 of shank assembly 100.

Various embodiments of the present invention can be used together with the implanted nail bin of different size and configuration.Such as, when being used in combination with the first percussion adapter 140, surgical instruments 10 can be used together with the 5mm end effector 12 of the about 20mm length (or having other length) for supporting implanted nail bin 30.This end effector size can be particularly well-suited in such as realizing dissection and the management of blood vessels of opposite fine.But, as hereafter institute is described in more detail, the most also by the first percussion adapter 140 is replaced by the second percussion adapter, surgical instruments 10 can be used in combination with end effector and the nail bin of other sizes.In further embodiments, slender axles assembly 40 can be attached to the end effector of a kind of form or size.

To explain a kind of method for end effector 12 is removably coupled to ridge component 50 now.Connection process is started by being inserted in the lug support 52 in ridge component 50 by the holding lug 17 on elongated passageway 14.Subsequently, percussion trigger 130 is advanced by surgeon towards the pistol grip 107 of casing assembly 100, so that firing tube 110 and the first percussion adapter 140 are advanced on the proximal part 47 of elongated passageway 14 towards distally, thus lug 17 is maintained in its respective support 52.First percussion adapter 140 this type of position on lug 17 is referred to herein as " coupled position ".Various embodiments of the present invention also can have end effector locked component, locks in place for after being attached to ridge component 50 at end effector 12 by percussion trigger 130.

More specifically, end effector locked component 160 embodiment includes retaining pin 162, this retaining pin is movably supported in the top 134 of percussion trigger 130.As it has been described above, first firing tube 110 must be advanced coupled position towards distally, wherein, the lug 17 that keeps of end effector 12 is maintained in the lug support 52 in ridge component 50 by the first percussion adapter 140.Surgeon is by distally advancing percussion adapter 140 to coupled position towards pistol grip 107 tractive percussion trigger 130 from original position.When firing trigger 130 and first activating, retaining pin 162 is towards distal movement, until the first percussion adapter 140 is advanced to coupled position, during now retaining pin 162 is biased to the latch well 164 being formed in housing member by firing tube 110.In various embodiments, when retaining pin 162 enters in latch well 164, pin 162 can send audible " clicker " sound or other sound, and can provide, for surgeon, the haptic indication that end effector 12 has been " locked " on ridge component 50.As long as it addition, the most wittingly retaining pin 162 is biased out latch well 164, surgeon just will not activate unintentionally percussion trigger 130 to start to make the nail 32 in end effector 12 shape.Similarly, if surgeon's release is in the percussion trigger 130 of coupled position, then retaining pin 162 can make percussion trigger 130 be maintained at this position, to prevent percussion trigger 130 be back to original position and therefore discharge end effector 12 from ridge component 50.

Various embodiments of the present invention may also include trigger system locking press button 137, and this trigger system locking press button is can pivotably be attached to shank assembly 100.In one form, trigger system locking press button 137 has the breech lock 138 formed on its distal end, and this breech lock is oriented to the breech lock 138 when percussion release button is in the first position latching and engages percussion yoke 114.As can be seen in Figure 1, late spring 139 is for being biased to the first position latching by trigger system locking press button 137.In all cases, breech lock 138 is for engaging percussion yoke 114 at following point: at this point, and the position of the percussion yoke 114 on ridge component 50 will be towards the point on the clamping slideway 28 being distally advanced on anvil block 20 corresponding to the wherein first percussion adapter 140.Should be appreciated that anvil block 20 will move along path so that nail forming surface portion 22 is arranged essentially parallel to the top surface 36 of nail bin 30 along with the first percussion adapter 140 axially advances on clamping slideway 28.

After end effector 12 is connected to ridge component 50, start to follow closely forming process by first depressing trigger system locking press button 137 so that percussion yoke 114 can on ridge component 50 further distal motion during anvil block 20 is compressed to nail bin 30 the most at last.After pressure trigger system locking press button 137, surgeon continues to activate percussion trigger 130 towards pistol grip 107, thus the nail that the first nail lining ring 140 is driven into correspondence shapes on slideway 29, to force anvil block 20 and nail 32 shaping contact in nail bin 30.Trigger system locking press button 137 prevents from being ready to start to make the unexpected shaping of nail 32 before following closely forming process surgeon.In this type of embodiment, surgeon must can depress trigger system locking press button 137 to start to follow closely forming process at percussion trigger 130 before being further actuated.

Surgical instruments 10 optionally can be used only as tissue apposition device.But, various embodiments of the present invention may also comprise tissue diced system, and this tissue diced system is generally indicated at 170.In at least one form, tissue diced system 170 includes cutter component 172, by activating cutter traveling trigger 200, optionally from the unactuated position of the near-end of adjacent end executor 12, this cutter component can be advanced to actuated position.Cutter component 172 is movably supported in ridge component 50 and is attached to knife bar 180 or in other words from knife bar 180 projection.Cutter component 172 can be by such as having more than 38HRC(RHC) 420 or 440 rustless steels of hardness process, and can have the tissue cutting edge 176 being formed on its far-end 174, and the slit in anvil block 20 and the slit 33 being centrally located in nail bin 30 can be slidably extended through, to cut through the tissue being clamped in end effector 12.In various embodiments, knife bar 180 extends through ridge component 50 and has and the proximal part of cutter transporter transmission handing-over, and this cutter transporter is operably attached to cutter traveling trigger 200.In various embodiments, cutter traveling trigger 200 is attached to pivot pin 132 so that cutter traveling trigger 200 can be without being pivoted or in other words activated in the case of activating percussion trigger 130.In various embodiments, the first cutter tooth wheel 192 is also attached to pivot pin 132 so that the actuating of cutter traveling trigger 200 also makes the first cutter tooth wheel 192 pivot.It is attached with percussion return spring 202 between first cutter tooth wheel 192 and shank housing 100, is biased to original position or unactuated position with trigger 200 of being advanced by cutter.

The various embodiments of cutter transporter also include the second cutter tooth wheel 194, and this second cutter tooth wheel is pivotally supported on the second gear shaft and engages with the first cutter tooth wheel 192.Second cutter tooth wheel 194 engages with the 3rd cutter tooth wheel 196 being supported on the 3rd gear shaft.4th cutter tooth wheel 198 is also supported on the 3rd gear shaft 195.4th cutter tooth wheel 198 transmission can engage a series of gear teeth or ring being positioned on the near-end of knife bar 180.Therefore, this structure makes the 4th cutter tooth wheel 198 can axially drive knife bar 180 along distal direction " DD " or proximal direction " PD ", makes trigger shaft 180 rotate around longitudinal axis A-A relative to the 4th cutter tooth wheel 198 simultaneously.Therefore, surgeon can make trigger shaft 180 axially advance by the pistol grip 107 tractive cutter traveling trigger 200 towards shank assembly 100 and all morning distally promotes cutter component 172.

Various embodiments of the present invention also include cutter locking system 210, and this cutter locking system prevents the propelling of cutter component 172, unless percussion trigger 130 has been pulled to complete firing position.Therefore, this structure will prevent the activation of cutter propulsion system 170, unless first nail is fired or form in tissue.As can be seen in Figure 1, various being embodied as of cutter locking system 210 includes cutter securing rod 211, and this cutter securing rod is by can pivotably be supported in the pistol grip portion 107 of shank assembly 100.Cutter securing rod 211 has activated end 212, and when firing trigger 130 and being in complete firing position, activated end 212 can be engaged by percussion trigger 130.It addition, cutter securing rod 211 has holding suspension hook 214 on the other end thereof, this holding suspension hook can engage the latch bar 216 on the first cutting gear 192 in suspension hook mode.Use cutter locking spring 218 that cutter securing rod 211 is biased to " locking " position.In this " locks " position, keep suspension hook 214 to keep engaging with latch bar 216, thus prevent the actuating of cutter traveling trigger 200, unless percussion trigger 130 is in complete firing position.

It is " fired " (shaping) to after in target tissue at nail, surgeon can depress percussion trigger release button 167, so that percussion trigger 130 can be back to original position, so that anvil block 20 can bias downwards into open position at the bias of spring 21 under the bias of torsionspring 135.When in open position, surgeon can withdraw from end effector 12 and leave implanted nail bin 30 and nail 32.During end effector passes the application that passage, service aisle etc. insert wherein, surgeon will make anvil block 20 be back to make position, so that end effector 12 can be withdrawn by by described passage or service aisle by activating percussion trigger 130.But, if surgeon wants to cut target tissue after percussion nail, then surgeon activates cutter traveling trigger 200 in the above described manner, to drive knife bar 172 to arrive the end of end effector through target tissue.Subsequently, surgeon's releasable cutter traveling trigger 200, so that percussion return spring 202 can make percussion transporter be back to knife bar 172 initiate (actuating) position.Once knife bar 172 is back to original position, and surgeon just can open end effector jaw 13,15, to be released in the patient in implanted storehouse 30 and subsequently from withdrawing from end effector 12 in the patient.Therefore, this type of surgical instruments beneficially uses the little implanted nail bin that can be inserted by relatively small service aisle and path, provides following selection for surgeon: percussion is followed closely or also cuts tissue if necessary in after percussion nail in the case of not cutting tissue simultaneously.

The various uniquenesses of the present invention and new embodiment use compressible nail bin, and described compressible nail bin supports and is in substantially fixed position for the nail by anvil block shaping contact.In various embodiments, during anvil block is driven to unshaped nail.Wherein, at least one this type of embodiment, the degree that the nail reached shapes depends on how far anvil block is driven in nail.This class formation allows a surgeon to regulation and applies shaping or the size of percussion pressure to nail, thus changes the final forming height of nail.In other various embodiments of the present invention, surgical stapling structure can use nail to drive element, and this nail drives element to be lifted towards anvil block by nail.Hereafter this type of embodiment is described in more detail.

In various embodiments, with reference to the embodiment of foregoing detailed description, the size of the percussion motion being applied to movable anvil block depends on firing the degree of the actuating of trigger.Such as, if surgeon goes for the nail that only part shapes, the most only need partially inwardly to depress percussion trigger towards pistol grip 107.Wanting to obtain and more follow closely shaping, surgeon only needs to compress percussion trigger further so that anvil block is driven to contact to form with nail further.As used herein, term " shaping contact " refers to follow closely profiled surface or nail shapes the end of pit contact stud lower limb and has started to be shaped by lower limb or bend to shaping position.The degree that nail shapes refers to follow closely the degree that lower limb is folded and the forming height finally referring to nail referred to above.Those skilled in the art are it will be appreciated that because when anvil block 20 applies percussion motion, anvil block 20 is to move with the relation substantially parallel with nail bin, substantially simultaneously shapes so following closely and have substantially the same forming height.

Fig. 2 and Fig. 3 shows alternative end effector 12 ", outside the lower difference that can accommodate knife bar 172 ', end effector 12 " it is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or from knife bar 180 projection, and in addition operates in the way of above in connection with described in knife bar 172.But, in this embodiment, knife bar 172 ' long enough is to traverse end effector 12 " whole length, therefore end effector 12 " in be provided without single distal blade component.Be formed on knife bar 172 ' crosscutting component 173 ' and under crosscutting component 175 '.Upper crosscutting component 173 ' is oriented to the most crosscutting anvil block 20 " in corresponding elongated slot 250, and under crosscutting component 175 ' be oriented to crosscut end executor 12 " elongated passageway 14 " in elongated slot 252.Also at anvil block 20 " in provide depart from slit (not shown); make when knife bar 172 ' is driven to end effector 12 " in end position time, upper crosscutting component 173 ' is fallen by corresponding slit, makes anvil block 20 " open position can be moved to, depart from the tissue being sewn and cutting.Anvil block 20 " can be in addition identical with above-mentioned anvil block 20, and elongated passageway 14 " can be in addition identical with above-mentioned elongated passageway 14.

In these embodiments, anvil block 20 " it is biased to fully open position (Fig. 2) by spring or other Unclosing structure (not shown).Anvil block 20 " moved between open position and fully clamped position in the above described manner by axially advancing of percussion adapter 150.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), and surgeon the most just can make knife bar 172 in the above described manner towards distally " advance.If surgeon wants that end effector is used as grasp device carrys out manipulating tissue, then percussion adapter proximally can be moved, to allow anvil block 20 " away from elongated passageway 14 " motion, as shown in phantom in figure 4.In this embodiment, when knife bar 172 " towards distal movement time, upper crosscutting component 173 ' and under crosscutting component 175 ' tractive anvil block 20 simultaneously " and elongated passageway 14 ", with at knife bar 172 " through end effector 12 " obtain desired nail shaping when advancing towards distally.See Fig. 5.Therefore, in this embodiment, nail shapes to cut with tissue and occurs simultaneously, but nail itself can be at knife bar 172 " sequentially shape when being driven towards distally.

The various surgery nail bins of the present invention and the uniqueness of surgical instruments and novel structure enable the nail in described nail bin to be arranged in one or more row linearly or nonlinearly.Can be provided with this type of staple line multiple on each side of elongated slot, described elongated slot is centrally positioned in nail bin, accommodates tissue cutting element for through described elongated slot.In a kind of arrangement mode, such as the nail in one row can be substantially parallel to be positioned at the adjacent nail followed closely in row but offset from it.In further embodiments, one or more nail row can be essentially nonlinear.In other words, the base portion of at least one nail in nail row can extend along substantially crosscutting with the base portion of other nails in same nail row axis.Such as, as hereafter will be discussed in more detail, in alternative embodiment, the nail row on each side of elongated slot can have sawtooth appearance.Compared with various linear nail arrangement mode employed in nail bin with prior art, this type of nonlinear nail arrangement mode can use less nail to obtain and preferably organize tightening results.

Fig. 6 shows the use of end effector embodiment 612 ' Chinese and foreign department nail bin embodiment 900.As can be seen that in figure 6 and figure 7, the embodiment of surgery nail bin 900 has warehouse 902, and this warehouse has the elongated slot 904 being centrally located, and this elongated slot extends to the region adjacent with far-end 905 through near-end 903.Elongated slot 904 can allow during carrying out tissue cutting actions in the above described manner that cutter main body is through elongated slot 904 axially-movable.In at least one embodiment, warehouse 902 is by such as oxidized regenerated cellulose (ORC) or such as by PGA(polyglycolic acid, sell with trade mark Vicryl), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PDS(PPDO), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or PGA, PCL, the compressible hemostatic material compositions such as the bioabsorbable foam that the complex of PLA and PDS processes, the row 920 having unshaped nail 922 formation is supported in described compressible hemostatic material, 930.But, warehouse 902 also can be processed by other materials, and this material is for being supported on unshaped nail 922 in expectation orientation so that when anvil block 910 ' contacts with unshaped nail 922, unshaped nail 922 can be compressed.As above-mentioned other embodiments various, nail bin 900 is implanted, and completes the tissue remaining attached to afterwards be sewn at suture operation.In at least certain embodiments, and hemostatic material impacted for anti-non-magnetic shim 922 is introducing and is being activated during position fixing process, and whole storehouse 900 can be coated with or be wrapped in biodegradable film 906, such as with trade markThe six cyclic ketones films sold or polyglycerol sebacate (PGS) film or such as by PGA(polyglycolic acid, with trade mark Vicryl sell), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the film that formed of the complex of PGA, PCL, PLA, PDS, described film is only just the most permeable when rupturing.Being sized to of the warehouse 902 of nail bin 900 is supported in the elongated passageway of end effector 612 ' removedly.

In the embodiment shown in Fig. 6, Figure 10 and Figure 11, surgery nail bin 900 the first row 920 that operationally support nail 922 is formed on a cross side 907 of elongated slot 904, and the second row 930 that support nail 922 is formed on another cross side 909 of elongated slot 904.In various embodiments, nail 922 can be processed and have nail base portion 924 and two upright nail lower limbs 926 from nail base portion 924 projection by such as titanium, titanium alloy (such as 6Al-4V titanium, 3al-2.5V titanium), stainless steel and other metal materials.Tissue-piercing tips 928 can be formed with on each nail lower limb 926.In the first row 920 of nail 922 formation, the nail base portion 924 of at least one nail 922 is overlapping with the nail base portion of another nail 922.In a preferred embodiment, in addition to the base portion 924 of the last nail 922 being positioned on the first each end of nail row 920, the nail base portion 924 of each nail 922 is all overlapping with the nail base portion 924 of two adjacent nails 922.See Figure 10.Therefore, the first nail row 920 has the most nonlinear shape.More specifically, when viewed from above, the first nail row 920 has the most zigzag outward appearance.

As can be seen that in fig .9, anvil block 90 has the longitudinal direction nail of two orders and shapes pit 912, nail shaping pit 912 has the most zigzag shape corresponding with the shape of the first rows 920 of nail 922 formation longitudinally in each, make when anvil block 910 with nail 922 form contact time, the lower limb 926 of nail shapes as shown in figure 11.Therefore, the far leg of a nail shares same pit with the near leg of next nail in the vertical.This structure can form more dense pit pattern, even up to follows closely the degree of self carry out interacting (such as stride across and fold each other).In the nail bowl configurations of prior art, in general, must have the metal/space between 0.005 inch to 0.015 inch between one group of pit and next group pit.But, this type of embodiment of the such as present invention has the interference/section gap structure (substantially, a-0.020 ") of 0 to 0.02 inch, this is because a nail coordinates with next nail.This structure makes it possible to include having more the nail of 15% to 30% in identical space.Additionally, when each nail interlocking, the demand of multiple lateral staples is reduced.Existing structure generally uses three nails on each side of tissue cut line, to prevent from there is the open approach that blood can flow through.The probability in the path that pinning row formation blood can flow through is less mutually.Another clear advantage that the various interlocking pin structures of the present invention are provided relate to tear nail row opening needed for " rupture strength " of the relevant improvement of the size of power.

Another nail shapes the nail shaping pit that pocket configuration can include sharing.As used herein, term " shared nail shape pit " refers to, different from the anvil design that wherein each lower limb for each preformation staple arranges the prior art being individually formed pit, one shapes pit and all nails in single nail row can be made to shape.

Figure 12 illustrates that another follows closely embodiment 922 ', and wherein base portion 924 ' has offset part 929, is beneficial to each base portion 924 ' and carries out overlapping more closely.As it has been described above, nail bin 900 has the second row 930 of the nail 922 on the second cross side 909 being supported on elongated slot 904.Second row 930 of nail 922 is substantially the same with the first row 920 of nail 922.Therefore, anvil block 910 has the corresponding to the second nail row 930 second shared nail shaping pit 912, to follow closely row 930 shaping contact with second.But, in alternative embodiment, the second row 930 of nail 922 can in shape and may be different from the first nail row 920 following closely on number.

Fig. 8 illustrates surgery nail bin 900 ', and in addition to being supported on the row 920 ', 930 ' that nail 922 therein is formed, surgery nail bin 900 ' is substantially the same with above-mentioned nail bin 900.Such as, in this embodiment, the row 920 ' of nail 922 is relative to each other set such that at least one follows closely the base portion axis S-S of the nail base portion 924 of base portion axis S-S at least one another adjacent nail 922 substantially transverse of base portion 924.When viewed from above, this type of predetermined nail pattern includes the most zigzag arrangement.In the embodiment shown in fig. 13, each base portion 924 of nail 922 additionally can there is base support member 927, as shown in the figure by overmolding.In various embodiments, base support member 927 can be by the plastics (such as polyether-ether-ketone " PEEK ") of such as nonabsorable or absorbable plastics (such as polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with trade mark Monocryl sell) or the various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.Base support member 927 is conducive to making to interlock between each nail in the case of not making nail self overlap.Therefore, this class formation can make nail be configured to " B " shape or " W " shape of falling in the case of not making the lower limb overlap of nail self.But, owing to bizet is connected by base support member, therefore bizet works as overlapping nail.This class formation makes combination pit have two discreet paths for each lower limb.

Embodiment shown in Figure 14 uses nail row 920 ", at nail row 920 " in, the lower limb 926 of neighbouring nail 922 is linked together by the coupling part 929 being attached to lower limb 926 with molding or other modes.Each coupling part 929 can be by such as polyether-ether-ketone " PEEK " or absorbable plastics (such as polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", PPDO " PDS ", PCL(polycaprolactone), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, with trade mark Monocryl sell) or the various compound mixtures of PGS, PDS, PLA, PGA and PCL) process.When viewed from above, this type of nail row 920 " there is the most zigzag outward appearance.Although combined end effector 612 ' makes for explaining various surgery nail bin embodiment 900,900 ', it being understood, however, that nail bin 900,900 ' can be used together with other end effectors various mentioned above and surgical instruments effectively.The anvil block of these apparatuses is wherein provided with suitably nail and shapes bowl configurations, in order to reach desired nail shaping amount when anvil block moves to and follows closely shaping contact.

Figure 15 and Figure 16 shows another surgery nail bin 940 embodiment in the elongated passageway 14 being supported on surgical instruments 10.In at least one embodiment, surgery nail bin 940 includes warehouse 942, and this warehouse has the elongated slot 944 being centrally located, and this elongated slot extends at least partially through warehouse 942.Elongated slot 944 can allow during carrying out tissue cutting actions in the above described manner that the cutter main body of surgical instruments 10 is axially movable through elongated slot 944.In various embodiments, warehouse 942 is made up of compressible hemostatic materials such as the bioabsorbable foams of the above-mentioned or following type of such as oxidized regenerated cellulose (ORC), supports the row 946,948 having unshaped nail 922 formation in described hemostatic material, 950, and 952.In at least certain embodiments, and hemostatic material impacted for anti-non-magnetic shim 922 is introducing and is being activated during position fixing process, and whole storehouse 940 can be coated with or be wrapped in biodegradable film 954, such as with trade markThe six cyclic ketones films sold or polyglycerol sebacate (PGS) film or such as by PGA(polyglycolic acid, with trade mark Vicryl sell), PCL(polycaprolactone), PLA or PLLA(polylactic acid), PHA(polyhydroxyalkanoatefrom), PGCL(poliglecaprone 25, sell with trade mark Monocryl) or the film that formed of the complex of PGA, PCL, PLA, PDS, described film is only just the most permeable when rupturing.

In the embodiment shown in fig. 15, storehouse 940 also includes the storehouse supporting member 960 being connected to warehouse 942.In various embodiments, storehouse supporting member 960 can be processed by rigid metals such as any alloys that such as titanium, rustless steel, aluminum, above-mentioned material are formed, and can be partially embedded in warehouse 942.In various embodiments, storehouse supporting member 960 can be held in place by such as film 954.In other embodiments needing restricted combination, can sporadically use cyanoacrylate adhesive by two elements " glued " together.In further embodiments, warehouse 942 can be heated also " welding " or " melting " to storehouse supporting member 960.In various embodiments, storehouse supporting member 960 forms lower surface at least some of to coordinate of warehouse 942 with elongated passageway 14.In at least one embodiment, storehouse supporting member 960 has the one or more snap arrangement 962 from its projection, for storehouse supporting member 960 is releasably attached to elongated passageway 14.Storehouse supporting member 960 is releasably attached to elongated passageway 14 by the snap arrangement/fastener constructions that can use other forms.

In various embodiments, storehouse supporting member 960 is formed with a series of support ridge 964,966,968,970,972,974,976, with to nail row 946, the base portion 924 of the nail 922 in 948,950,952 provides some lateral support, as shown in figure 15.Therefore, at least certain embodiments, support ridge is the most coextensive with nail row.Figure 17 illustrates alternative nail bin embodiment 940 ' substantially the same with storehouse 940, and difference is, nail bin embodiment 940 ' includes respectively from support ridge 964,966,968,970,972,976 projections are with the upstanding fins part 978 to the nail 922 extra lateral support of offer, 979,980,981,982,983.In various embodiments, finless parts can form as one with storehouse supporting member 960, and it highly may be about 1/2 or less than storehouse height.Therefore, in various embodiments, any rising structure being such as used for supporting foam all cannot extend to more than the solid height of foam.Therefore, if storehouse is designed to such as be compressed to the 1/3 of its original height when firing, then 66% on the way down between the 10% of uncompressed height by uncompressed height of fin.

In use, once nail 922 is shaped by contact anvil block 20 in the above described manner, then anvil block 20 is opened and end effector 12 is pulled away from sutured tissue, when end effector 12 is pulled away from sutured tissue, warehouse 942 keeps being fastened to sutured tissue and separating with the storehouse supporting member 960 remaining coupled to elongated passageway 14 subsequently.In various embodiments, the color of storehouse supporting member 960 is different from color and the color of elongated passageway 14 of the material including warehouse 942.This type of is arranged as surgeon and provides the instruction that can easily identify that there is not nail bin in end effector.Therefore, surgeon will not by mistake attempt in the case of not installing new nail bin in end effector again insertable into/use end effector.To this end, surgeon only needs the snap arrangement making storehouse supporting member 960 to depart from elongated passageway 14, so that the storehouse supporting member 960 of new nail bin 940 can be placed in elongated passageway 14.Although explaining nail bin 940 in conjunction with surgical instruments 10,940 ', it being understood, however, that under conditions of without departing substantially from the spirit and scope of the invention, these storehouses can be used together with other surgical instrument embodiment of many disclosed herein effectively.

In various embodiments, nail bin can include warehouse and the multiple nails being stored in warehouse.In use, nail bin can be introduced in operative site and be located on the side of handled tissue.It is positioned on the opposite side of tissue it addition, nail can be shaped anvil block.In various embodiments, anvil block can be carried by the second jaw by the first jaw carrying and nail bin, and wherein the first jaw and/or the second jaw can move towards another jaw.Once nail bin and anvil block are relative to tissue positioned, then can penetrate nail from staple cartridge body so that the pierceable tissue of nail contact stud shape anvil block.From staple cartridge body, once dispose nail, then can remove staple cartridge body from operative site.In various embodiments disclosed herein, nail bin or nail bin at least some of in implantable have nail.In at least one this type of embodiment, as being hereafter more fully described, nail bin can include warehouse, and when anvil block moves to make position from open position, described warehouse can be compressed by described anvil block, conquassation and/or collapse.When warehouse compressed, conquassation and/or when collapsing, the nail being positioned in warehouse can be deformed by anvil block.Alternatively, the jaw being used for supporting nail bin can move to make position towards anvil block.In any one of two kinds of situations, in various embodiments, when nail is at least partially situated in warehouse, follow closely deformable.In certain embodiments, nail can not be shot up from nail bin, and in certain embodiments, nail can be shot up together with a part for warehouse from nail bin.

Referring now to Figure 18 A-18D, compressible nail bin (such as nail bin 1000) such as can include compressible, implanted warehouse 1010, and be positioned at the multiple nails 1020 in compressible warehouse 1010 in addition, but Figure 18 A-18D only illustrates a nail 1020.Figure 18 A illustrates the nail bin 1000 supported by nail bin support member or staple cartridge channel 1030, and wherein nail bin 1000 is shown at uncompressed state.In this type of uncompressed state, anvil block 1040 can contact or not contact tissue T.In use, anvil block 1040 can move to contact tissue T from open position, as shown in figure 18b, and tissue T is positioned against warehouse 1010.Even if tissue T can be located against the tissue contacting surface 1019 of staple cartridge body 1010 by anvil block 1040, but refer again to Figure 18 B, staple cartridge body 1010 now by few (if any) compression stress or pressure, and can be followed closely 1020 and be positively retained at unshaped or non-cock.As shown in Figure 18 A and Figure 18 B, staple cartridge body 1010 can include one or more layer, and follow closely the nail lower limb 1021 of 1020 and may pass through these layers and upwardly extend.In various embodiments, warehouse 1010 can include ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, wherein the second layer 1012 can be positioned between ground floor 1011 and third layer 1013, and wherein third layer 1013 can be positioned between the second layer 1012 and the 4th layer 1014.In at least one embodiment, the such as base portion 1022 of nail 1020 can be positioned in the chamber 1015 in the 4th layer 1014, and follow closely lower limb 1021 and can upwardly extend and pass the 4th layer 1014, third layer 1013 and the second layer 1012 from base portion 1022.In various embodiments, each deformable lower limb 1021 can include end, the sharpest end 1023, such as, when nail bin 1000 is in uncompressed state, sharp end 1023 such as can be positioned in the second layer 1012.In at least one this type of embodiment, end 1023 can be not extend to and/or through ground floor 1011, the most at least one embodiment, when nail bin 1000 is in uncompressed state, end 1023 can be not projecting through tissue contacting surface 1019.In certain embodiments, when nail bin is in uncompressed state, sharp end 1023 can be positioned in third layer 1013 and/or any other suitable layer.In various alternative embodiments, the warehouse of nail bin can have any suitable number of layer, such as less than four layers or more than four layers.

In various embodiments, as being hereafter more fully described, ground floor 1011 can be made up of backing material and/or plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)), and the second layer 1012 can be made up of bioabsorbable foamed materials and/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)).In various embodiments, nail can 1020 be maintained in staple cartridge body 1010 by one or more in ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, and nail 1020 additionally can be made to keep being mutually aligned.In various embodiments, third layer 1013 can comprise backing material or the most incompressible or non-elastic material, and the nail lower limb 1021 of nail 1020 can be relative to each other held in place by described material.Additionally, the second layer 1012 being positioned in the opposite sides of third layer 1013 and the 4th layer 1014 can stablize or reduce the motion of nail 1020, even if the second layer 1012 and the 4th layer 1014 can comprise compressible foam or elastomeric material.In certain embodiments, the nail end 1023 of nail lower limb 1021 can be at least partially embedded in ground floor 1011.In at least one this type of embodiment, ground floor 1011 and third layer 1013 can be held in place collaboratively and firmly by nail lower limb 1021.In at least one embodiment, ground floor 1011 and third layer 1013 can comprise the bioabsorbable material (polyglycolic acid (PGA) such as sold with trade name Vicryl respectively, polylactic acid (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL sold with trade name Monocryl), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or the complex of PCL) thin slice that formed, and the second layer 1012 and the 4th layer 1014 can comprise at least one hemostatic material or hemorrhage respectively.

Although ground floor 1011 can be compressible, but the second layer 1012 can be substantially more compressible than ground floor 1011.Such as, the compressibility of the second layer 1012 can be ground floor 1011 approximately twice as, about three times, about four times, about five times and/or about ten times.In other words, for given power, the compression degree of the second layer 1012 can be ground floor 1011 approximately twice as, about three times, about four times, about five times and/or about ten times.In certain embodiments, the compressibility of the second layer 1012 can ground floor 1011 approximately twice as about ten times between.In at least one embodiment, can define multiple air gap in the second layer 1012, wherein amount and/or the size of the air gap in the second layer 1012 can be controlled to provide the expectation compression of the second layer 1012.With similar to the above, although third layer 1013 can be compressible, but the 4th layer 1014 can be than third layer 1013 the most more compressibility.Such as, the compressibility of the 4th layer 1014 can be third layer 1013 approximately twice as, about three times, about four times, about five times and/or about ten times.In other words, for given power, the compression degree of the 4th layer 1014 can be third layer 1013 approximately twice as, about three times, about four times, about five times and/or about ten times.In certain embodiments, the compressibility of the 4th layer 1014 can third layer 1013 approximately twice as about ten times between.In at least one embodiment, can define multiple air gap in the 4th layer 1014, wherein amount and/or the size of the air gap in the 4th layer 1014 can be controlled to provide the expectation of the 4th layer 1014 to compress.In all cases, compression ratio (that is, layer is for the distance compressed to the power of sizing) can be passed through and express warehouse or the compressibility of warehouse layer.Such as, compared with the layer with relatively little compressible, the layer with high compression rate will compress bigger distance for apply to this layer to the compression stress of sizing.For Ru Ci, the second layer 1012 has higher compression ratio than ground floor 1011；Similarly, the 4th layer 1014 has higher compression ratio than third layer 1013.In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise identical material and can have identical compression ratio.In various embodiments, the second layer 1012 and the 4th layer 1014 can comprise the material with different compression ratio.Similarly, ground floor 1011 and third layer 1013 can comprise identical material and can have identical compression ratio.In certain embodiments, ground floor 1011 and third layer 1013 can comprise the material with different compression ratio.

When anvil block 1040 is advanced towards its make position, anvil block 1040 can contact tissue T tissue T and nail bin 1000 are applied compression stress, as shown in figure 18 c.In this case, anvil block 1040 can push down on top surface or the tissue contacting surface 1019 of warehouse 1010 towards nail bin support member 1030.In various embodiments, nail bin support member 1030 can include storehouse stayed surface 1031, and when nail bin 1000 is compressed between the tissue contacting surface 1041 of storehouse stayed surface 1031 and anvil block 1040, described storehouse stayed surface 1031 can support nail bin 1000.Due to anvil block 1040 pressure applied, warehouse 1010 can be compressed and anvil block 1040 can contact stud 1020.More specifically, in various embodiments, ground floor 1011 that the compression of warehouse 1010 and the downward motion of tissue contacting surface 1019 can make the end 1023 of nail lower limb 1021 pierce through warehouse 1010, pierce through tissue T and enter in anvil block 1040 shaping pit 1042 in.When warehouse 1010 is compressed further by anvil block 1040, end 1023 can contact and limit the wall shaping pit 1042, and the most such as lower limb 1021 can be deformed inward or crimp, as shown in figure 18 c.When following closely lower limb 1021 and deforming, the most as shown in figure 18 c, the base portion 1022 of nail 1020 can contact nail bin support member 1030 or be supported by nail bin support member 1030.In various embodiments, as described in more detail below, nail bin support member 1030 can include multiple supporting construction, such as, follow closely support trenches, slit or groove 1032, the plurality of supporting construction can work as nail 1020 deformation time support nail 1020 or at least nail 1020 base portion 1022.The most as shown in figure 18 c, apply to the compression stress of staple cartridge body 1010 to make the chamber 1015 in the 4th layer 1014 collapse.In addition to chamber 1015, staple cartridge body 1010 may also include one or more space (such as space 1016), such as can position in the one or more space or no-fix has the part of nail, and the one or more space can allow for warehouse 1010 and collapses.In various embodiments, can collapse in chamber 1015 and/or space 1016 so that the wall limiting chamber and/or space bend downwards and contact storehouse stayed surface 1031 and/or contact warehouse 1010 be positioned at the layer below chamber and/or space.

When comparison diagram 18B and Figure 18 C, it is clear that the second layer 1012 and the 4th layer of 1014 compression pressure applied by anvil block 1040 substantially compress.It may also be noted that ground floor 1011 and third layer 1013 are also compressed.When anvil block 1040 moves to its make position, anvil block 1040 can continue compression warehouse 1010 further by pushing down on tissue contacting surface 1019 towards nail bin support member 1030.When warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed into it and be fully formed shape, as shown in Figure 18 D.See Figure 18 D, the lower limb 1021 of each nail 1020 can deform downwards towards the base portion 1022 of each nail 1020, in order to capturing tissue T, ground floor 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 between deformable lower limb 1021 and base portion 1022 at least partially.When comparison diagram 18C and Figure 18 D, more obviously, the second layer 1012 and the 4th layer of 1014 compression pressure applied by anvil block 1040 further are significantly compression.When comparison diagram 18C and Figure 18 D it may also be noted that ground floor 1011 and third layer 1013 are also further compressed.After nail 1020 is shaped completely or the most fully, anvil block 1040 can be lifted away from tissue T, and nail bin support member 1030 can away from and/or depart from nail bin 1000 and move.As shown in Figure 18 D and due to mentioned above, warehouse 1010 is implantable nail 1020.In various embodiments, implanted warehouse 1010 can be along nail row supporting tissue.In some cases, the hemorrhage and/or any other the suitable medicine that accommodate in implanted warehouse 1010 can process tissue in time.It is hemorrhage that hemorrhage as above can reduce the tissue sewed up and/or cut, and As time goes on can provide intensity for tissue in combination with agent or tissue adhesive.The warehouse 1010 implanted can comprise such as ORC(oxidized regenerated cellulose), albumen substrate, the polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), the material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.In some cases, warehouse 1010 can include anti-biotic material and/or the antimicrobial material that can reduce the probability of surgical site infection, such as collargol and/or triclosan.

In various embodiments, each layer of warehouse 1010 can be connected with each other.In at least one embodiment, can utilize at least one binding agent (such as fibrin and/or protein hydrogel) that the second layer 1012 is adhered to ground floor 1011, third layer 1013 be adhered to the second layer 1012, and adheres to third layer 1013 by the 4th layer 1014.In certain embodiments, although not shown, but each layer of warehouse 1010 can be linked together by interlocked mechanical structure.In at least one this type of embodiment, ground floor 1011 and the second layer 1012 can each include the interlocking structure of correspondence, such as tenon groove structure and/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can each include the interlocking structure of correspondence, and third layer 1013 and the 4th layer 1014 can each include the interlocking structure of correspondence simultaneously.In certain embodiments, although not shown, but nail bin 1000 can such as include one or more rivet, the one or more rivet can extend across one or more layers of warehouse 1010.In at least one this type of embodiment, each rivet can include first end that adjacent first layer 1011 positions or head and neighbouring 4th layer 1014 and the second head of positioning, and described 4th layer can be assembled into the second end of rivet or be formed by the second end of rivet.Due to the compressible character of warehouse 1010, at least one embodiment, the compressible warehouse of such as rivet 1010, so that the head of rivet can cave in relative to the tissue contacting surface 1019 of warehouse 1010 and/or lower surface 1018.In at least one this type of embodiment, each rivet can comprise such as sell with trade name Vicryl polyglycolic acid (PGA), polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), the bioabsorbable material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.In certain embodiments, in addition to by the nail 1020 accommodated in warehouse 1010, each layer of warehouse 1010 can not be connected to each other.In at least one this type of embodiment, each layer of warehouse 1010 such as can be kept together by the frictional engagement between nail lower limb 1021 and warehouse 1010, and once follows closely shaping, and the most each layer can be trapped in nail 1020.In certain embodiments, roughened surface or the rough coatings that can include at least partially increasing the frictional force between nail 1020 and warehouse 1010 of nail lower limb 1021.

As it has been described above, surgical instruments can include the first jaw and the second jaw, the first jaw includes that nail bin support member 1030, the second jaw include anvil block 1040.In various embodiments, described in greater detail below, nail bin 1000 can include one or more holding structure, and the one or more keeps structure can engage nail bin support member 1030 and therefore nail bin 1000 be releasably held nail bin support member 1030.In certain embodiments, at least one binding agent (such as, fibrin and/or protein hydrogel) can be passed through and nail bin 1000 is adhered to nail bin support member 1030.In use, at least one situation, especially in abdominal cavity mirror and/or endoscopic procedure, the such as second jaw is moveable to the make position relative with the first jaw so that the first jaw and the second jaw can be inserted in operative site by the trocar.In at least one this type of embodiment, the trocar can limit the hole of about 5mm or intubate, and the first jaw and the second jaw can be by described holes or intubate and be inserted into.In certain embodiments, second jaw is moveable to the partial closed position between in an open position and make position, described partial closed position tolerable the first jaw and the second jaw are inserted into through the trocar, and without making the nail 1020 accommodated in staple cartridge body 1010 deform.In at least one this type of embodiment, when the second jaw is in the centre position of its part Guan Bi, anvil block 1040 can not apply compression stress to staple cartridge body 1010, and in some other embodiment, when the second jaw is in the centre position of its part Guan Bi, the compressible staple cartridge body of anvil block 1,040 1010.Although the compressible staple cartridge body 1010 when anvil block 1040 is in this type of centre position, but anvil block 1040 can compress staple cartridge body 1010 by halves, so that anvil block 1040 contact stud 1020 and/or make to follow closely 1020 and deformed by anvil block 1040.Once the first jaw and the second jaw are inserted into by the trocar in operative site, then the second jaw can be opened again, and anvil block 1040 and nail bin 1000 can position relative to target tissue as mentioned above.

Referring now to Figure 19 A-19D, in various embodiments, the end effector of surgical stapling device can include the implanted nail bin 1100 between anvil block 1140 and nail bin support member 1130.With similar to the above, anvil block 1140 can include that tissue contacting surface 1141, nail bin 1100 can include tissue contacting surface 1119, and nail bin support member 1130 can include the stayed surface 1131 that can support nail bin 1100.See Figure 19 A, tissue T is positioned to not make nail bin 1100 deform against the tissue contacting surface 1119 of nail bin 1100 by available anvil block 1140, and when anvil block 1140 is in this type of position, tissue contacting surface 1141 can be positioned so that and nail bin stayed surface 1131 distance 1101a, and tissue contacting surface 1119 can be positioned so that and nail bin stayed surface 1131 distance 1102a.Subsequently, when anvil block 1140 moves towards nail bin support member 1130, referring now to Figure 19 B, anvil block 1140 can push down on the top surface of nail bin 1100 or tissue contacting surface 1119 and compress ground floor 1111 and the second layer 1112 of warehouse 1110.When layer 1111 and layer 1112 are compressed, referring again to Figure 19 B, the second layer 1112 by conquassation, and can be followed closely the lower limb 1121 of 1120 and can be pierced ground floor 1111 and enter tissue T.In at least one this type of embodiment, follow closely in the 1120 nail chambeies can being positioned at least partially in the second layer 1112 or space 1115, and when the second layer 1112 is compressed, can collapse and therefore allow that the second layer 1112 is collapsed around nail 1120 in nail chamber 1115.In various embodiments, the second layer 1112 can include covering part 1116, this covering part extensible in nail chamber 1115 on and around or at least partly surround nail chamber 1115.Figure 19 B shows and is pressed downward the covering part 1116 burst to nail chamber 1115.In certain embodiments, the second layer 1112 can include one or more weakening part, and the one or more weakening part can be conducive to collapsing of the second layer 1112.In various embodiments, this type of weakening part can include such as being conducive to warehouse 1110 to carry out controlled cut, perforation and/or the thin cross section collapsed.In at least one embodiment, ground floor 1111 can include that can beneficially follow closely lower limb 1121 penetrates one or more weakening parts of ground floor 1111.In various embodiments, this type of weakening part can include cut, perforation and/or the thin cross section that such as can align with nail lower limb 1121 or at least substantially align.

Referring again to Figure 19 A, when anvil block 1140 is in the non-firing position of part Guan Bi, anvil block 1140 can be positioned so that and storehouse stayed surface 1131 distance 1101a so that defines gap therebetween.This gap can be filled by the nail bin 1100 and tissue T with nail bin height 1102a.When anvil block 1140 moves downward to compress nail bin 1100, referring again to Figure 19 B, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be limited by distance 1101b being shorter than distance 1101a.In all cases, the gap limited by distance 1101b between tissue contacting surface 1141 and the storehouse stayed surface 1131 of anvil block 1140 can be more than original undeformed nail bin height 1102a.Referring now to Figure 19 C, when anvil block 1140 moves to closer to storehouse stayed surface 1131, the second layer 1112 can continue to collapse and follow closely lower limb 1121 and the distance shaped between pit 1142 can reduce.Similarly, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be decreased to distance 1101c, in various embodiments, distance 1101c can greater than, equal to or less than original not deformed storehouse height 1102a.Referring now to Figure 19 D, anvil block 1140 is moveable to final firing position, and in final firing position, nail 1120 is fully formed or is at least shaped to Desired Height.In this type of position, the tissue contacting surface 1141 of anvil block 1140 can be with storehouse stayed surface 1131 distance 1101d, and wherein distance 1101d can be shorter than original not deformed storehouse height 1102a.Same as shown in Figure 19 D, can collapse completely or at least substantially in nail chamber 1115, and follow closely 1120 second layers 1112 that can be collapsed completely or at least substantially around.In all cases, anvil block 1140 can move away from nail bin 1100 subsequently.Once anvil block 1140 departs from nail bin 1100, then during warehouse 1110 can be stretched in various position (that is, the adjacent position between nail 1120) the most again.In at least one embodiment, the warehouse 1110 of conquassation may not stretch again with elastic type.In various embodiments, the nail 1120 of shaping and be additionally disposed in the warehouse 1110 between adjacent nail 1120 and tissue T can be applied pressure or compression stress, this can provide various useful therapeutic effect.

As it has been described above, refer again to the embodiment shown in Figure 19 A, each nail 1120 can include the nail lower limb 1121 extended from it.Although nail 1120 is shown as including two nail lower limbs 1121, but it is possible with to include a nail lower limb or alternately including the various nails more than two nail lower limbs (such as three nail lower limbs or four nail lower limbs).As shown in Figure 19 A, during each nail lower limb 1121 all can embed the second layer 1112 of warehouse 1110 so that nail 1120 is fixed in the second layer 1112.In various embodiments, nail 1120 can be inserted in the nail chamber 1115 of warehouse 1110 so that end 1123 the advancing in chamber 1115 at base portion 1122 of nail lower limb 1121.In various embodiments, after end 1123 is inserted into chamber 1115, end 1123 can be pressed in covering part 1116 and cut the second layer 1112.In various embodiments, enough depths that nail 1120 can be sealed in the second layer 1112 so that follow closely 1120 and do not move relative to the second layer 1112 or do not move.In certain embodiments, enough depths that nail 1120 can be sealed in the second layer 1112 so that base portion 1122 is positioned or embeds in nail chamber 1115.In other embodiments various, base portion 1122 can not be positioned or embed in the second layer 1112.Referring again to Figure 19 A, in certain embodiments, base portion 1122 can extend below the lower surface 1118 of warehouse 1110.In certain embodiments, base portion 1122 can be bearing on storehouse stayed surface 1130 or directly abut storehouse stayed surface 1130 and positions.In various embodiments, storehouse stayed surface 1130 can include extending from it and/or being limited to supporting construction therein, wherein at least one this type of embodiment, the base portion 1122 of nail 1120 can be positioned in the one or more support trenches in such as nail bin support member 1130, slit or groove 1132 or be supported, as described in more detail below by the one or more support trenches, slit or groove 1132.

To being described further above, referring now to Figure 20, the base portion 1122 of nail 1120 can directly abut the stayed surface 1131 of nail bin support member 1130 and position.In various embodiments, including below embodiment: wherein nail base portion 1122 includes can moving along nail bin stayed surface 1131 or slide in circle or arcuate shaped bottom surface 1124, such as nail base portion 1122.This type of can be occurred to slide when anvil block 1140 is compressed against the end 1123 following closely lower limb 1121 during following closely forming process.In certain embodiments, as mentioned above and referring now to Figure 21, can include one or more support slit 1132 in nail bin support member 1130, the one or more supports slit and can eliminate or at least reduce the relative motion between nail base portion 1122 and storehouse stayed surface 1131.In at least one this type of embodiment, each support slit 1132 all can be limited by surface profile, and described surface profile and the profile being positioned at the nail lower surface supported in slit 1132 match or at least substantially match.Such as, the lower surface 1124 of the base portion 1122 shown in Figure 21 can include circular or at least substantially circular surface, and support slit 1132 and may also comprise circular or at least substantially circular surface.In at least one this type of embodiment, can be limited by more than or equal to the radius of curvature of the radius of curvature limiting lower surface 1124 for limiting the surface of slit 1132.Although slit 1132 can help to prevent or reduce the sliding relative movement between nail 1120 and nail bin support member 1130, but slit 1132 also is able to prevent or reduce the relative rotary motion between nail 1120 and nail bin support member 1130.More specifically, at least one embodiment, slit 1132 can be closely received base portion 1122, in order to prevents or reduce the nail 1120 rotation around axis 1129, such as so that nail 1120 will not rotate or distort when deformation.

In various embodiments, to being described further above, each nail 1120 all can be formed by wire rod that is round or that at least substantially justify.In certain embodiments, lower limb and the base portion of each nail all can be formed by the wire rod with non-circular cross sections (such as rectangular cross section).In at least one this type of embodiment, nail bin support member 1130 can include the non-circular slit (such as rectangular slot) of correspondence, and described non-circular slit can accommodate the base portion of this type of nail.Referring now to Figure 22, in various embodiments, each nail 1120 may each comprise overmolding bizet such as bizet 1125 to base portion 1122, and the most each bizet 1125 all can be positioned in the support slit in nail bin support member 1130.In at least one this type of embodiment, each bizet 1125 may each comprise such as square and/or the cross section of rectangle, and described cross section can be contained in the slit 1134 of the square in such as nail bin support member 1130 and/or rectangle.In various embodiments, bizet 1125 can comprise bioabsorbable plastics (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), polycaprolactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL), and can be formed around the base portion 1122 of nail 1120 by such as injection moulding process.Various bizets and the method for forming various bizet are disclosed in JIUYUE in 2006 and within 29th, submit in the U.S. Patent Application Serial Number 11/541,123 of entitled " SURGICALSTAPLESHAVINGCOMPRESSIBLEORCRUSHABLEMEMBERSFORSE CURINGTISSUETHEREINANDSTAPLINGINSTRUMENTSFORDEPLOYINGTHE SAME ".Referring again to Figure 22, slit 1134 may also include introduction part or oblique angle 1135, this introduction part or oblique angle and can be conducive to inserting in slit 1134 bizet 1125.In various embodiments, when nail bin 1100 is assembled to nail bin support member 1130, base portion and/or the bizet of nail 1120 can be positioned in slit 1134.In certain embodiments, when nail bin 1100 is assembled to nail bin support member 1130, the bizet 1125 of nail 1120 can align with slit 1134.In at least one this type of embodiment, bizet 1125 can not enter in slit 1134, until to nail lower limb 1121 apply compression stress and nail 1120 base portion and/or bizet be pushed down in slit 1134.

Referring now to Figure 23 and Figure 24, in various embodiments, nail bin such as nail bin 1200 such as can include compressible implanted warehouse 1210, and this warehouse includes outer layer 1211 and internal layer 1212.With similar to the above, nail bin 1200 can include the multiple nails 1220 being positioned at warehouse 1210.In various embodiments, each nail 1220 may each comprise base portion 1222 and the one or more nail lower limbs 1221 extended from base portion.In at least one this type of embodiment, nail lower limb 1221 can be inserted in internal layer 1212 and be sealed to such as to make the lower surface 1218 of the adjacent and/or neighbouring internal layer 1212 of base portion 1222 of nail 1220 position.In the embodiment shown in Figure 23 and Figure 24, internal layer 1212 does not include the nail chamber that can accommodate a part for nail 1220, and in other embodiments, internal layer 1212 can include that this type of follows closely chamber.In various embodiments, to being described further above, internal layer 1212 can comprise the compressible material (the most bioabsorbable foam and/or oxidized regenerated cellulose (ORC)) that can allow that warehouse 1210 is collapsed when it is applied compressive load.In various embodiments, internal layer 1212 can comprise and such as comprise polylactic acid (PLA) and/or the freeze dried foam of polyglycolic acid (PGA).ORC can be commercially available with trade name Surgicel and can include loose weaven goods (similar surgery with sponge), staple in bulk (similar cotton balls) and/or foam.In at least one embodiment, internal layer 1212 can be by wherein comprising and/or applied atop has the material of medicine (the most cryodesiccated thrombin and/or fibrin) to constitute, and described medicine such as can be activated by fluid water in the patient and/or activation.In at least one this type of embodiment, cryodesiccated thrombin and/or fibrin are positively retained at such as Vicryl(PGA) in substrate.But, in some cases, such as, when in the operative site that nail bin 1200 is inserted into the patient, activable medicine can by mistake be activated.Refer again to Figure 23 and Figure 24, in various embodiments, outer layer 1211 can be made up of water impervious or the most water impervious material, so that liquid does not contacts or does not the most contact internal layer 1212, until warehouse 1210 is compressed and follows closely after lower limb penetrates outer layer 1211 and/or after outer layer 1211 is cut open in some way.In various embodiments, outer layer 1211 can comprise backing material and/or plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, outer layer 1211 can include around internal layer 1212 and the wrappage of nail 1220.More specifically, at least one embodiment, nail 1220 can be inserted in internal layer 1212 and outer layer 1211 and around including that internal layer 1212 and the sub-component of nail 1220 are wrapped and are subsequently sealed.

Referring now to Figure 25 and Figure 26, in various embodiments, nail bin such as nail bin 1300 such as can include compressible implanted warehouse 1310, and this warehouse includes outer layer 1311 and internal layer 1312.With similar to the above, nail bin 1300 may also include the nail 1320 being positioned at warehouse 1310, and the most each nail 1320 may each comprise base portion 1322 and the one or more lower limbs 1321 extended from base portion 1322.Being similar to nail bin 1200, the base portion 1322 of nail 1320 can extend below the lower surface 1318 of internal layer 1312, and outer layer 1311 can be around base portion 1322.In at least one this type of embodiment, outer layer 1311 can have enough flexibilities to surround each nail base portion 1322 so that outer layer 1311 conforms to the profile of base portion 1322.Referring again to Figure 24, at least one alternative embodiment, outer layer 1211 can have enough rigidity so that it extends around base portion 1222 and does not conform to each base portion 1222.In any case, in various embodiments, outer layer 1311 can be positioned in the base portion 1322 of nail 1320 and between the nail bin stayed surface (such as stayed surface 1031 or 1131) supporting nail bin 1300.In at least one this type of embodiment, outer layer 1311 can be positioned between base portion 1322 and the support slit (such as slit 1032 or 1132) being limited in nail bin stayed surface.In at least one this type of embodiment, to being described further above, outer layer 1311 can limit the motion of base portion 1322 and/or increase base portion 1322 and nail bin stayed surface and/or support the coefficient of friction between slit to reduce relative motion therebetween.Referring now to Figure 27 and Figure 28, in various alternative embodiments, the outer layer of nail bin such as nail bin 1400 can be by halves around the nail being located therein.In at least one this type of embodiment, before the nail lower limb 1421 of nail 1420 inserts in warehouse 1410, the outer layer 1411 of compressible implanted warehouse 1410 can be assembled to internal layer 1412.Due to mentioned above, the base portion 1422 of nail 1420 is extensible in the outside of outer layer 1411, and at least one this type of embodiment, such as in the support slit 1032 or 1132 in base portion 1422 can be positioned directly in nail bin stayed surface 1031 or 1131.In various embodiments, when following closely lower limb 1421 and being inserted through outer layer 1411, nail lower limb 1421 can cut outer layer 1411.In all cases, the hole formed by nail lower limb 1421 can be closely around nail lower limb 1421, making to follow closely the fluid of leakage few (if present) between lower limb 1421 and outer layer 1411, this can reduce or prevent the medicine accommodated in staple cartridge body 1410 from being activated and/or leaking out the probability of warehouse 1410 prematurely.

As it has been described above, refer again to Figure 23 and Figure 24, the lower limb 1221 of nail 1220 can embed in warehouse 1210, and follow closely the base portion 1222 of 1220 and can stretch out from the lower surface 1218 of internal layer 1212.In various embodiments, to being described further above, internal layer 1212 may not include the nail chamber that can accommodate nail 1220.Referring now to Figure 29 and Figure 30, in other embodiments various, nail bin such as nail bin 1500 such as can include compressible implanted warehouse 1510, and this warehouse includes at least one of nail chamber 1515 that can accommodate nail 1520 wherein.In at least one this type of embodiment, the top of the nail lower limb 1521 of nail 1520 can embed in internal layer 1512, and follows closely the bottom of lower limb 1521 and base portion 1522 can be positioned in nail chamber 1515.In certain embodiments, base portion 1522 can be fully located in nail chamber 1515, and in certain embodiments, base portion 1522 can extend at least in part below the lower surface 1518 of internal layer 1512.With similar to the above, outer layer 1511 can be around internal layer 1512 and the nail 1520 being positioned in internal layer 1512.Referring now to Figure 31, in some other embodiment, nail bin 1600 can include the nail 1620 in the nail chamber 1615 being positioned in compressible implanted warehouse 1610, and wherein at least some of of nail 1620 is not surrounded by outer layer 1611.In at least one this type of embodiment, each nail 1620 may each comprise the nail lower limb 1621 being at least partially embedded in internal layer 1612 and around the outward extending base portion of outer layer 1,611 1622.

Referring now to Figure 32 and Figure 33, in various embodiments, nail bin such as nail bin 1700 such as can include compressible implanted warehouse 1710 and the multiple nails 1720 being at least partially situated in warehouse 1710.Warehouse 1710 can include outer layer 1711, internal layer 1712 and alignment matrix 1740, and this alignment matrix by nail 1720 alignment and/or can be held in place in warehouse 1710.In at least one embodiment, internal layer 1712 can include the depressed part 1741 that can accommodate alignment matrix 1740 wherein.In various embodiments, in alignment matrix 1140 can be press-fitted in depressed part 1741 and/or in other words utilize at least one binding agent (such as, fibrin and/or protein hydrogel) to be fixed to internal layer 1712 rightly.In at least one embodiment, the lower surface 1718 of lower surface 1742 and internal layer 1712 that depressed part 1741 enables to alignment matrix 1740 is alignd or is at least substantially alignd.In certain embodiments, the lower surface 1742 of alignment matrix can cave in relative to the lower surface 1718 of the second layer 1712 and/or extend from lower surface 1718.In various embodiments, each nail 1720 may each comprise base portion 1722 and the one or more lower limbs 1721 extended from base portion 1722, and that wherein follows closely lower limb 1721 can extend across alignment matrix 1740 at least partially.Alignment matrix 1740 may also include such as extend through multiple hole therein and/or slit, the plurality of hole and/or slit can accommodate wherein nail lower limb 1721.In at least one this type of embodiment, each hole all can be closely received nail lower limb 1721 so that between nail lower limb 1721 and the sidewall in hole, the least (if any) relative motion occurs.In certain embodiments, alignment matrix hole can not extend completely through alignment matrix 1740, and when following closely lower limb 1721 and being pushed through alignment matrix 1740, nail lower limb 1721 can need to cut alignment matrix 1740.

In certain embodiments, alignment matrix 1740 can be made up of the plastic body moulded, and at least one embodiment, the plastic body of described molding is than internal layer 1712 and/or outer layer 1711 is harder or compressibility is lower.In at least one this type of embodiment, alignment matrix 1740 can comprise plastic material and/or any other suitable material (such as PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, alignment matrix 1740 can be assembled to internal layer 1712, and nail lower limb 1721 is insertable through alignment matrix 1740 and embeds in internal layer 1712 subsequently.In various embodiments, the lower surface 1742 of alignment matrix 1740 can include one or more grooves, slit or the groove that can accommodate the base portion 1722 of nail 1720 at least in part.With similar to the above, outer layer 1711 can be placed in around the sub-component including internal layer 1712, alignment matrix 1740 and nail 1720.Alternatively, outer layer 1711 can be placed in around the sub-component including internal layer 1712 and alignment matrix 1740, and wherein nail 1720 can be then inserted through outer layer 1711, alignment matrix 1740 and internal layer 1712.In any case, due to mentioned above, nail 1720 can be held in place by internal layer 1712, alignment matrix 1740 and/or outer layer 1711, until anvil block makes nail 1720 deform as mentioned above, and/or after anvil block makes nail 1720 deformation as mentioned above, nail 1720 can be held in place by internal layer 1712, alignment matrix 1740 and/or outer layer 1711.In at least one this type of embodiment, alignment matrix 1740 can be used for being held in place by nail 1720 before nail bin 1700 is implanted in the patient, and follows closely row fixing organization at the tailing edge that nail bin 1700 is implanted.In at least one embodiment, such as it is not embedded in internal layer 1712 and/or outer layer 1711 in nail 1720 can be fixed on alignment matrix 1740.

Referring now to Figure 34-40, in various embodiments, can be by compressing internal layer 1812, nail is such as followed closely in 1820 insertion internal layers 1812 and assembling nail bin such as nail bin 1800 by outer layer 1811 wrapping inner layer 1812.Referring first to Figure 34, compressible internal layer 1812 is shown as including and is limited to multiple nail chamber 1815 therein, but it can also be envisaged that goes out wherein internal layer 1812 do not include following closely other embodiments in chamber.Referring now to Figure 35, compressible internal layer 1812 can be positioned between transfer plate 1850 and gripper shoe 1860 and is compressed in respectively between the compressive surfaces 1852 of transfer plate 1850 and the compressive surfaces 1862 of gripper shoe 1860.As shown in figure 35, the top surface of internal layer 1812 and lower surface can be compressed toward each other, and in response to this, internal layer 1812 can expand laterally outward.In certain embodiments, internal layer 1812 can be compressed at the height of about 1/3rd of such as its original height, and can have the height between the most about 0.06 " to about 0.08 " or thickness in its compressive state.The most as shown in figure 35, transfer plate 1850 may also include and is such as positioned at multiple nails of multiple nail well 1853 and such as follows closely 1820.It addition, transfer plate 1850 may also include multiple driver 1851, the plurality of driver can be by outside nail 1820 upwards push nail well 1853.Referring now to Figure 36, the nail lower limb 1821 of nail 1820 is pushed in the internal layer 1812 of compression and passes through the internal layer 1812 of compression by available driver 1851.In various embodiments, driver 1851 enables to when following closely 1820 and being fully deployed from the nail well 1853 of transfer plate 1850, and the compressive surfaces 1852 that the top surface of driver 1851 is oriented to transfer plate 1850 flushes or the most almost flushes.In certain embodiments, the most as shown in figure 36, gripper shoe 1860 can include multiple receiving hole 1861, and the plurality of receiving hole 1861 can accommodate nail lower limb 1821 after nail lower limb 1821 is pushed through internal layer 1812 or at least follow closely the end of lower limb 1821.Internal layer 1812 has been compressed in the embodiment at the height being shorter than nail 1820 height wherein, receiving hole 1861 or similar structures can be required, therefore, when following closely 1820 and being penetrated completely from nail well 1853, nail lower limb 1821 can be from the top surface projection of the internal layer 1812 of compression.In some other embodiment, internal layer 1812 can be compressed at the height higher than nail 1820 height, therefore need not the receiving hole 1861 in gripper shoe 1860.

Referring now to Figure 37, after nail 1820 is inserted in internal layer 1812, gripper shoe 1860 can be moved away from transfer plate 1850, in order to allows that internal layer 1812 reduces pressure.In this case, internal layer 1812 can again extend to its original uncompressed height or at least close to original uncompressed height with elastic type.When internal layer 1812 stretches again, the height of internal layer 1812 can increase to exceed the nail lower limb 1821 of the height of nail 1820 and nail 1820 no longer from the top surface projection of internal layer 1812.In all cases, nail lower limb 1821 can be held in place by receiving hole 1861, has moved to enough remote at least up to gripper shoe 1860 and makes lower limb 1821 be no longer in receiving hole 1861.In this case, the nail 1820 that receiving hole 1861 can contribute in internal layer 1812 when internal layer 1812 stretches again keeps alignment relative.In all cases, internal layer 1812 and the nail 1820 being located therein can include sub-component 1801, and referring now to Figure 38, sub-component 1801 can such as be inserted in outer layer 1811.In at least one this type of embodiment, outer layer 1811 can include being limited to cavity 1802 therein, and described cavity can accommodate sub-component 1801 wherein.In all cases, available instrument such as tweezers 1855 are by outer layer 1811 tractive to sub-component 1801.Referring now to Figure 39, in once sub-component 1801 is fully located at outer layer 1811, then outer layer 1811 can be sealed.In various embodiments, the part applying heat energy of available outer layers 1811 carrys out sealable outer 1811.More specifically, at least one embodiment, outer layer 1811 can comprise plastic material, and the opening of its ectomesoderm 1811 can be by one or more heated elements or ferrum 1856 hot melt, in order to is combined by the periphery of the opening of outer layer 1811 and/or is sealed.Referring now to Figure 40, at least one this type of embodiment, the redundance 1857 of outer layer 1811 can be removed, and as described herein can use nail bin 1800 subsequently.

As it has been described above, nail bin can be located in nail bin attachment and/or is fixed to nail bin attachment.Referring now to Figure 41 and Figure 42, in various embodiments, nail bin attachment can include staple cartridge channel such as staple cartridge channel 1930, and this staple cartridge channel such as can accommodate at least some of of nail bin such as nail bin 1900 wherein.In at least one embodiment, staple cartridge channel 1930 can include bottom support surface the 1931, first lateral support wall 1940 and the second lateral support wall 1941.In use, in nail bin 1900 can be positioned in staple cartridge channel 1930 so that nail bin 1900 against and/or adjacent bottom stayed surface 1931 position, and between the first lateral support wall 1940 and the second lateral support wall 1941.In certain embodiments, sideshake can be defined between the first lateral support wall 1940 and the second lateral support wall 1941.In at least one this type of embodiment, nail bin 1900 can include lateral width 1903, the width of the sideshake limited between this lateral width and supporting walls 1940 and 1941 is identical and/or is wider than between supporting walls 1940 and 1941 sideshake limited so that the compressible implanted warehouse 1910 of nail bin 1900 can be securely fitted between wall 1940 and 1941.In some other embodiment, the lateral width 1903 of nail bin 1900 can be shorter than between the first side wall 1940 and the second sidewall 1941 gap limited.In various embodiments, wall 1940 and 1941 and can being limited by the metal passage of punching press at least partially of bottom support surface 1931, and at least one embodiment, lateral support wall 1940 and/or lateral support wall 1941 can comprise flexible material (such as elastomeric material) at least partially.Referring first to Figure 41, the first side wall 1940 of staple cartridge channel 1930 and the second sidewall 1941 all can be by constituting from the upwardly extending rigid element of bottom support surface 1,931 1933 and from the upwardly extending flexible portion of rigid element 1,933 1934.

In various embodiments, to being described further above, the warehouse 1910 of nail bin 1900 can be made up of one or more compressible layers such as ground floor 191 and the second layer 1912.When warehouse 1910 is compressed against bottom support surface 1931 in the above described manner by anvil block, the sidepiece of warehouse 1910 can laterally stretch.In the embodiment that nail bin 1930 is made up of rigid sidewalls wherein, rigid sidewalls can prevent or at least limit the lateral extension of warehouse 1910, therefore can produce internal pressure or the stress of significant quantity in warehouse 1910.In at least some of embodiment being made up of flexible sidewall of nail bin 1930, flexible sidewall can laterally bend and allow the sidepiece lateral extension of warehouse 1910, thus produced internal pressure or stress in reducing warehouse 1910.Not including that sidewall or included sidewall are relatively shorter than in the embodiment of nail bin at storehouse passage, the sidepiece of nail bin can be not inhibited ground or laterally stretch with being at least substantially not inhibited.Referring now to Figure 42, in any case, staple cartridge channel 2030 can include sidewall 2040 and 2041, and this sidewall can completely include flexible material, such as elastomeric material.Staple cartridge channel 2030 may also include the lateral slit 2033 that the limit of the bottom support surface 2031 along staple cartridge channel 2030 extends, and this lateral slit can accommodate and fixed sidewall 2040 and 2041 at least some of wherein.In certain embodiments, sidewall 2040 and 2041 can be fixed in slit 2033 via snap-fitted and/or press-fit structure, and at least some embodiments, sidewall 2040 and 2041 can be fixed in slit 2033 by one or more binding agents.In at least one embodiment, sidewall 2040 and 2041 can separate with bottom support surface 2031 during use.In any case, when being implanted with following closely 2020 in warehouse 2010, compressible implanted warehouse 2010 can separate with sidewall 2040 and 2041 and/or depart from.

Referring now to Figure 43, in various embodiments, surgical instruments can include axle 2150 and the end effector of the remote extension from axle 2150.With similar to the above, end effector can include staple cartridge channel 2130, the anvil block 2140 that can move between the open position and the closed position and the nail bin 2100 between staple cartridge channel 2130 and anvil block 2140.Being also similarly to above, nail bin 2100 can include compressible implanted warehouse 2110 and the multiple nails 2120 being positioned in warehouse 2110.In various embodiments, staple cartridge channel 2130 can include bottom support surface 2131, far-end 2135 and near-end 2136, and nail bin 2100 can position against bottom support surface 2131.In at least one embodiment, as shown in figure 43, nail bin 2100 can include that first end 2105 and the second end 2106, described first end 2105 can be positioned in the far-end 2135 of staple cartridge channel 2130, and described the second end 2106 can be positioned in the near-end 2136 of staple cartridge channel 2130.In various embodiments, the far-end 2135 of staple cartridge channel 2130 can include that at least one distally keeps structure (such as keeping wall 2137)；Similarly, near-end 2136 can include that at least one nearside keeps structure (such as keeping wall 2138).In at least one this type of embodiment, distally keeps wall 2137 and nearside to keep between wall 2138 can define gap, described gap can be equal to or less than the length of nail bin 2100 so that when nail bin 2100 is inserted in staple cartridge channel 2130, nail bin 2100 can be securely fitted in staple cartridge channel 2130.

Referring again to Figure 23 and Figure 24, in various embodiments, nail bin such as nail bin 1200 such as can include flat or the most flat tissue contacting surface 1219.In at least one this type of embodiment, the staple cartridge body 1210 of nail bin 1200 can include first end 1205 and the second end 1206, described first end can be limited by the first height or thickness 1207, described the second end 1206 can be limited by the second height or thickness, and wherein the first height 1207 can be equal to or the substantially equal at least second height 1208.In certain embodiments, warehouse 1210 can include constant or the most constant height or thickness between first end 1205 and the second end 1206.In at least one this type of embodiment, tissue contacting surface 1219 can parallel or lower surface 1218 at least substantially parallel to warehouse 1210.Referring again to Figure 43, in various embodiments, the first end 2105 of the warehouse 2110 of nail bin 2,100 2107 can be limited by the first height, and this first is highly different from the second highly 2108 of the second end 2106.In the embodiment shown, the first height 2107 is more than the second height 2108, but in alternative embodiment, the second height 2108 can be more than the first height 2107.In various embodiments, the height of warehouse 2110 can reduce between first end 2105 and the second end 2106 linearly and/or geometrically.In at least one this type of embodiment, the tissue contacting surface 2119 extended between first end 2105 and the second end 2106 can be orientated along the angle limited between first end 2105 and the second end 2106.In at least one this type of embodiment, tissue contacting surface 2119 can be not parallel to the lower surface 2118 of warehouse 2110 and/or be not parallel to the stayed surface 2131 of staple cartridge channel 2130.

Refer again to Figure 43 and Figure 44, in various embodiments, anvil block 2140 can include tissue contacting surface 2141, when anvil block 2140 is in the close position, tissue contacting surface 2141 can be parallel to or at least substantially parallel to the stayed surface 2131 of staple cartridge channel 2130, as shown in figure 44.When anvil block 2140 is in the close position, anvil block 2140 can be more than the second end 2106 to the compression degree of the first end 2105 of nail bin 2100, this is because the height of first end 2105 is higher, and the height of the second end 2106 is relatively low.In some cases, there is the situation of constant or the most constant thickness including wherein tissue T between tissue contacting surface 2119 and 2141, can be more than at pressure produced by the proximal end of end effector at pressure produced by the far-end of end effector in tissue T and storehouse 2100.More specifically, when tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant, the degree that the tissue T between the far-end 2145 and the first end 2105 of nail bin 2100 of anvil block 2140 is compressed can be more than the tissue T between the near-end 2146 and the second end 2106 of nail bin 2100 of anvil block 2140.In various embodiments, the tissue T between near-end and the far-end of end effector can produce barometric gradient.More specifically, in at least one embodiment, tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant and the height of nail bin 2100 when end effector distal-to-proximal reduces linearly, and the pressure in tissue T can reduce linearly from the near-end of the far-end of end effector to end effector.Similarly, in at least one embodiment, tissue T between anvil block 2140 and nail bin 2100 has the thickness of substantial constant and the height of nail bin 2100 when end effector distal-to-proximal geometrically reduces, and the pressure in tissue T geometrically can reduce from the near-end of the far-end of end effector to end effector.

Referring again to Figure 43, in various embodiments, the tissue T between nail bin 2100 and anvil block 2140 can not have the most constant thickness.In at least one this situation, the tissue T between the near-end 2146 and the second end 2106 of nail bin 2100 of anvil block 2140 can be thicker than the tissue T between the far-end 2145 and the first end 2105 of nail bin 2100 of anvil block 2140.Therefore, in this case, thicker tissue T can be usually located at above the relatively low near-end 2106 of nail bin 2100, and relatively thin tissue T can be usually located at above higher far-end 2105.In use, the percussion lining ring 2152 of axle 2150 can advance along axle ridge 2151 towards distally so that percussion lining ring 2152 engages the cam portion 2143 of anvil block 2140, and makes anvil block 2140 rotate towards nail bin 2100, as shown in figure 44.Once anvil block 2140 rotates to of completely closed position, then tissue T can be compressed between tissue contacting surface 2119 and 2141, although and the height of nail bin 2100 can be non-constant between the near-end of end effector and far-end, but applying to the pressure of tissue T or compression stress can be constant or the most constant in tissue T.More specifically, when relatively thin tissue T can be with the higher height correlation of nail bin 2100, and thicker tissue T can with the relatively low height correlation of nail bin 2100 time, tissue T and the cumulative height of nail bin 2100 or height sum can be constant or the most constant between the near-end of end effector and far-end, and therefore this height that adds up is compressed in cumulative height by anvil block 2140 can be constant or the most constant.

Referring again to Figure 43 and Figure 44, in various embodiments, nail bin 2100 can include asymmetric configuration.In at least one this type of embodiment, the such as nail bin 2100 height at its first end 2105 can be higher than the nail bin 2100 height at its second end 2106.In certain embodiments, nail bin 2100 and/or staple cartridge channel 2130 can include one or more alignment and/or keep structure, the one or more alignment and/or holding structure are able to ensure that nail bin 2100 (direction during i.e., wherein first end 2105 is positioned at the far-end 2135 of staple cartridge channel 2130 and in the second end 2106 proximally-located 2136) the most in one direction is positioned at staple cartridge channel 2130.In various alternative embodiments, nail bin 2100 and/or staple cartridge channel 2130 can include one or more alignment and/or keep structure, and the one or more alignment and/or holding structure can allow that nail bin 2100 is positioned in staple cartridge channel 2130 along more than one direction.Referring now to Figure 45, such as in nail bin 2100 can be positioned in staple cartridge channel 2130, so that the first end 2105 of nail bin 2100 can be positioned in the near-end 2136 of staple cartridge channel 2130 and the second end 2106 can be positioned in far-end 2135.Therefore, in various embodiments, the nail bin 2100 of lower height can keep wall 2137 to position in neighbouring distally, and the nail bin 2100 of high height can keep wall 2138 to position by neighbouring nearside.In at least one this type of embodiment, nail bin 2100 can be set appropriately to have the tissue T of thinner part in the near-end of end effector and apply constant or the most constant clamping pressure to having thicker portion in the far-end of end effector.In various embodiments, nail bin 2100 such as optionally can be orientated in staple cartridge channel 2130.In at least one this type of embodiment, alignment and/or the holding structure of nail bin 2100 can be symmetrical, and surgeon can carry out selectivity orientation to nail bin 2100 along the such as direction shown in Figure 43 and Figure 45 in staple cartridge channel 2130.

To being described further above, implanted warehouse 2110 can include longitudinal axis 2109, and when nail bin 2100 is positioned in staple cartridge channel 2130, longitudinal axis 2109 can extend between the near-end of end effector and far-end.In various embodiments, the thickness of warehouse 2110 can substantially reduce along longitudinal axis 2109 between first end 2105 and the second end 2106 and/or substantially increase.In at least one this type of embodiment, distance or height between lower surface 2118 and tissue contacting surface 2119 can substantially reduce between first end 2105 and the second end 2106 and/or substantially increase.In certain embodiments, the thickness of warehouse 2110 both can increase along longitudinal axis 2109 and also can reduce.In at least one this type of embodiment, the thickness of warehouse 2110 may be included in the one or more parts increased on thickness and the one or more parts that can reduce on thickness.In various embodiments, nail bin 2100 can include the multiple nails 2120 being positioned in.In use, as it has been described above, when anvil block 2140 moves to make position, follow closely 2120 deformables.In certain embodiments, each nail 2120 can have identical or the most identical height.In at least one this type of embodiment, such as can measure the height of nail to the top or end following closely the highest lower limb from the bottom of nail base portion.

In various embodiments, the nail in nail bin can have different staple heights.In at least one this type of embodiment, nail bin can include first group of nail with the first staple height and have second group of nail of the second staple height, described first group of nail is positioned in the Part I of compressible warehouse, and second group of nail is positioned in the Part II of compressible warehouse.In at least one embodiment, the first staple height can be higher than the second staple height, and first group of nail can be positioned in the first end 2105 of nail bin 2100, and second group of nail can be positioned in the second end 2106.Alternatively, first group of higher nail can be positioned in the second end 2106 of nail bin 2100, and relatively low second group of nail can be positioned in first end 2105.In certain embodiments, available multiple nail groups, the most each group each has different staple heights.In at least one this type of embodiment, having the 3rd group of middle staple height can be positioned in warehouse 2110 between first group of nail with second group of nail.In various embodiments, each nail in the staple in nail bin can each include different staple heights.In at least one embodiment, the Gao Ding in staple can be positioned on the first end of staple, and minimum nail can be positioned on the opposite end of this staple.In at least one this type of embodiment, the nail between the highest nail and minimum nail may be arranged such that staple height such as declines between the highest nail and minimum nail.

Referring now to Figure 46, in various embodiments, the end effector of surgical stapling device can include anvil block 2240, staple cartridge channel 2230 and the nail bin 2200 supported by staple cartridge channel 2230.Nail bin 2200 can include compressible implanted warehouse 2210 and the multiple nails being positioned in warehouse 2210, such as nail 2220a and nail 2220b.In various embodiments, staple cartridge channel 2230 can include that storehouse stayed surface 2231 and the multiple nails being limited in storehouse stayed surface 2231 support slit, such as supports slit 2232a and 2232b.In at least one this type of embodiment, nail bin 2200 can include two outside nail 2220a row and two inner side nail 2220b row, wherein support slit 2232a can support nail 2220a, and support slit 2232b can support nail 2220b.Seeing Figure 46 and Figure 47, anvil block 2240 can include that being limited to multiple nail therein shapes pit 2242, and when anvil block 2240 moves towards nail bin 2200, the plurality of nail shapes pit 2242 and can accommodate nail 2220a and 2220b and make it deform.In at least one this type of embodiment, support slit 2232a lower surface can with nail shape pit 2242 top surface first distance 2201a, and support slit 2232b lower surface can with nail shape pit 2242 top surface second distance 2201b.In at least one this type of embodiment, owing to wherein defining the step in the stayed surface 2231 supporting slit 2232b with rising, therefore support slit 2232b and position closer to anvil block 2240.Owing to having different distances 2201a and 2201b, the most in various embodiments, outside nail 2220a row and inner side nail 2220b row can be deformed to different forming heights.In all cases, the nail being deformed into differing formed height can apply different clamping pressures or clamping force to the tissue T sewed up.Over and above what is described above, nail can have different unshaped staple heights originally.Referring again to Figure 46, at least one this type of embodiment, the initial unshaped height of outer layer nail 2220a can be more than the initial unshaped height of inner side nail 2220b.As shown in Figure 46 and Figure 47, the unshaped height inner side nail 2220b less than outside nail 2220a also can have the forming height less than outside nail 2220b.In various alternative embodiments, inner side nail 2220b can have the unshaped height higher than outside nail 2220a and have the deformation staple height lower than outside nail 2220a.

In various embodiments, to being described further above, anvil block 2240 is moveable in make position, as shown in figure 47, in order to compression warehouse 2210 also makes nail 2220a and 2220b deform.In certain embodiments, the surgical stapling device including end effector shown in Figure 46 and Figure 47 such as may also include cutting element, and described cutting element can crosscutting tissue T between anvil block 2240 and nail bin 2200.In at least one this type of embodiment, anvil block 2240, staple cartridge channel 2230 and/or nail bin 2200 can limit slit, and described slit can accommodate cutting element slidably therein.More more specifically, anvil block 2240 can include slotted portion 2249, staple cartridge channel 2230 can include slotted portion 2239, and nail bin 2200 can include slotted portion 2203, when the position that anvil block 2240 is in the close position or at least substantially closes, slotted portion 2249, slotted portion 2239 and slotted portion 2203 can be mutually aligned or at least substantially align.In various embodiments, after anvil block 2240 is closed and follows closely 2220a, 2220b deformation, cutting element can be from the near-end of end effector towards the distal movement of end effector.In at least one embodiment, cutting element can be to move with the nail incoherent mode of deformation process.In certain embodiments, cutting element can be pushed into while nail deformation.In any case, at least one embodiment, cutting element can be along the path incised tissue between the nail 2220b row of inner side.

In various embodiments, as shown in figure 47, inner side nail 2220b can be shaped to the height less than outside nail 2220a, and wherein nail 2220b in inner side can apply bigger clamping pressure or clamping force to the tissue adjacent with the line of cut that cutting element is formed.In at least one this type of embodiment, bigger clamping pressure or clamping force that inner side nail 2220b is formed can provide various useful therapeutic effect, such as make to be cut open tissue T and reduce hemorrhage, and the less clamping pressure that outside nail 2220a is formed can provide motility in the tissue sewed up.Referring again to Figure 46 and Figure 47, in various embodiments, anvil block 2240 may also include at least one piece of backing material being attached to anvil block 2240, such as backing material 2260.In at least one this type of embodiment, nail 2220a, the lower limb of 2220b can be worked as nail bin 2200 and be compressed by anvil block 2240 and time the nail in contact anvil block 2240 shapes pit 2242 subsequently, and the lower limb of nail 2220a, 2220b cuts backing material 2260 and/or through the hole in backing material 2260.When following closely the lower limb deformation of 2220a, 2220b, described lower limb can contact and/or cut backing material 2260 again.In various embodiments, backing material 2260 can improve sewed up tissue hemostatic capability and/or by sewed up tissue provide intensity.

Referring again to Figure 46 and Figure 47, in various embodiments, the lower surface of warehouse 2210 can include that stepped profile, described stepped profile are mated with the stepped profile of storehouse stayed surface 2231 or at least substantially mated.In certain embodiments, the lower surface deformable of warehouse 2210 is to mate or at least substantially to mate the profile of storehouse stayed surface 2231.Referring now to Figure 48, in various embodiments, it is similar to the nail bin 2300 that the end effector of end effector shown in Figure 46 such as can include being positioned in.Nail bin 2300 can include the compressible implanted main body 2310 with internal layer 2312 and outer layer 2311.Wherein to being described further above, at least one embodiment, outer layer 2311 can comprise water impervious material.In various embodiments, outer layer 2311 can extend around nail 2220a, 2220b and can lay respectively at nail 2220a, 2220b and support slit 2232a, between 2232b.Referring now to Figure 49, in various embodiments, it is similar to the nail bin 2400 that the end effector of end effector shown in Figure 46 such as can include being positioned in.Being similar to nail bin 2300, the compressible implanted warehouse 2410 of nail bin 2400 can include internal layer 2412 and outer layer 2411；But, at least one embodiment, warehouse 2410 can not include cutting element slit therein.In at least one this type of embodiment, cutting element can need such as to cut when it is pushed into internal layer 2412 and/or outer layer 2411 through nail bin.

Referring now to Figure 50, in various embodiments, the end effector of surgical stapling device can include anvil block 2540, staple cartridge channel 2530 and the nail bin 2500 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2500 can include compressible implanted warehouse 2510, outside nail 2220a row and inner side nail 2220b row.Staple cartridge channel 2530 can include that flat or the most flat storehouse stayed surface 2531 and the nail being limited in storehouse stayed surface 2531 support slit 2532.Anvil block 2540 can include that stepped surface 2541 and the multiple nails being limited in stepped surface 2541 shape pit, such as, shape pit 2542a and 2542b.With similar to the above, shaping and can define distance between pit 2542a and support slit 2532, described distance is more than shaping pit 2452b and the distance supported between slit 2532.In various embodiments, anvil block 2540 may also include one piece of backing material 2560 of the stepped surface 2541 being attached to anvil block 2540.In at least one this type of embodiment, backing material 2560 can conform to or at least substantially conform to stepped surface 2541.In various embodiments, backing material 2560 can pass through at least one binding agent (such as, fibrin and/or protein hydrogel) and is removably attached to surface 2541.In certain embodiments, warehouse 2510 may also include staged profile, and at least one embodiment, described staged profile is parallel to or at least substantially parallel to the stepped surface 2541 of anvil block 2540.More specifically, in at least one embodiment, anvil block 2540 can include the step 2548 extended towards nail bin 2500, and wherein step 2548 can include shoulder height, and described shoulder height is equal to or substantially equal at least from the shoulder height of the step 2508 of warehouse 2510 extension.In at least one this type of embodiment, due to mentioned above, the amount that the most compressible warehouse 2510 can be trapped in the first nail 2220a may differ from the amount that compressible warehouse 2510 can be trapped in the second nail 2220b.

Referring now to Figure 51, in various embodiments, end effector can include anvil block 2640, staple cartridge channel 2530 and the nail bin between anvil block 2640 and staple cartridge channel 2,530 2600.Nail bin 2600 can include compressible implanted warehouse 2610, and warehouse 2610 includes internal layer 2612, outer layer 2611 and the multiple nails (such as nail 2220a and 2200b) being positioned in warehouse 2610.In various embodiments, anvil block 2640 can include on surface 2641 that multiple nail shapes pit 2642, and staple cartridge channel 2530 can include multiple nail formed slots 2532 of being limited in stayed surface 2531.As shown in figure 51, anvil faces 2641 can be parallel to or at least substantially parallel to storehouse stayed surface 2531, and the most each shaping pit 2642 can be positioned so that and supports slit 2532 at a distance of equal or the most equal distance with relative and corresponding nail.In various embodiments, the nail included by nail bin 2600 can have identical or the most identical initial unshaped staple height and identical or the most identical shaping staple height.In some other embodiment, outside staple can include following closely 2220a and inner side staple can include following closely 2220b, wherein as it has been described above, nail 2220a and 2220b can have different unshaped staple heights.When anvil block 2640 moves to make position towards nail bin 2600, nail 2220a and 2220b can be shaped as and make nail 2220a and 2220b have identical or the most identical shaping staple height.In at least one this type of embodiment, due to mentioned above, follow closely 2220a and inner side nail 2220b outside shaping and can have identical, or the compressible warehouse 2610 being contained therein of at least substantially equal number；But, such as follow closely 2220b higher unshaped staple height owing to outside nail 2220a has than inner side, but can have identical shaping staple height, outside nail 2220a can generate the clamping pressure bigger than inner side nail 2220b.

Referring now to Figure 52, in various embodiments, the end effector of surgical stapling device can include anvil block 2740, staple cartridge channel 2530 and the nail bin 2700 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2700 can include compressible implanted warehouse 2710, and this warehouse includes internal layer 2712, outer layer 2711 and the multiple nails (such as nail 2220a and 2220b) being positioned in warehouse 2710.In at least one embodiment, the thickness of warehouse 2710 can change on its whole width.In at least one this type of embodiment, warehouse 2710 can include central part 2708 and sidepiece 2709, and wherein the thickness of central part 2708 can be more than the thickness of sidepiece 2709.In various embodiments, the thickest part of warehouse 2710 can be located at central part 2708, and the thinnest part of warehouse 2710 can be located at sidepiece 2709.In at least one this type of embodiment, the thickness of warehouse 2710 can be gradually reduced between central part 2708 and sidepiece 2709.In certain embodiments, the thickness of warehouse 2710 can reduce between central part 2708 and sidepiece 2709 linearly and/or geometrically.In at least one this type of embodiment, the tissue contacting surface 2719 of warehouse 2710 can include from central part 2708 towards sidepiece 2709 downward-sloping two inclination or angled surfaces.In various embodiments, anvil block 2740 can include two that tilt or angled surfaces, and that said two tilts or angled surface is parallel to or at least substantially parallel to the tissue contacting surface 2719 tilted.In at least one embodiment, anvil block 2740 may also include at least one piece of backing material 2760 of the inclined surface being attached to anvil block 2740.

In various embodiments, to being described further above, the inner side staple in nail bin 2700 can include higher nail 2220a, and outside staple can include relatively low nail 2220b.In at least one embodiment, higher nail 2220a can be positioned in thicker central part 2708 and/or adjacent with central part 2708, and follow closely 2220b and can be positioned in sidepiece 2709 and/or adjacent with sidepiece 2709.In at least one this type of embodiment, due to mentioned above, higher nail 2220a captures the material of more implanted warehouse 2710 than relatively low nail 2220b.This situation can make nail 2220a, than nail 2220b, tissue T be applied bigger clamping pressure.In certain embodiments, although higher nail 2220a captures the material of more warehouse 2710 than relatively low nail 2220b, shaping pit 2742a and 2742b yet with nail and have the structure of inclination, the highest nail 2220a has higher shaping staple height than relatively low nail 2220b.This type of Consideration can be utilized to obtain the clamping pressure that the clamping pressure in desired clamping pressure, the most such as nail 2220a can be more than, be less than or apply tissue equal to nail 2220b in the tissue that nail 2220a and 2220b is captured.In various alternative embodiment of end effector shown in Figure 52, relatively low nail 2220b can be positioned in the thicker central part 2708 of warehouse 2710 and/or neighbouring central part 2708, and higher nail 2220a can be positioned in relatively thin sidepiece 2709 and/or adjacent side portion 2709.Although additionally, nail bin 2700 is depicted as including inner side and outside staple, but nail bin 2700 can include the staple added, the such as staple between inner side staple and outside staple.In at least one this type of embodiment, in the middle of such as, the unshaped staple height of staple can be between the unshaped staple height of the unshaped staple height of nail 2220a and nail 2220b, and the staple height that shapes of middle staple can be between the shaping staple height shaping staple height and nail 2220b of nail 2220a.

Referring now to Figure 53, in various embodiments, the end effector of surgical stapling device can include anvil block 2840, staple cartridge channel 2530 and the nail bin 2800 being positioned in staple cartridge channel 2530.With similar to the above, nail bin 2800 can include compressible implanted warehouse 2810, and this warehouse includes internal layer 2812, outer layer 2811 and the multiple nails (such as nail 2220a and 2220b) being positioned in warehouse 2810.In at least one embodiment, the thickness of warehouse 2810 can change on its whole width.In at least one this type of embodiment, warehouse 2810 can include central part 2808 and sidepiece 2809, and wherein the thickness of central part 2808 is smaller than the thickness of sidepiece 2809.In various embodiments, the thinnest part of warehouse 2810 can be located at central part 2808, and the thickest part of warehouse 2810 can be located at sidepiece 2809.In at least one this type of embodiment, the thickness of warehouse 2810 can be gradually increased between central part 2808 and sidepiece 2809.In certain embodiments, the thickness of warehouse 2810 can increase between central part 2808 and sidepiece 2809 linearly and/or geometrically.In at least one this type of embodiment, the tissue contacting surface 2819 of warehouse 2810 can include from central part 2808 towards acclivitous two that tilt or the angled surfaces of sidepiece 2809.In various embodiments, anvil block 2840 can include two that tilt or angled surfaces, and that said two tilts or angled surface is parallel to or at least substantially parallel to the tissue contacting surface 2819 tilted.In at least one embodiment, anvil block 2840 may also include at least one piece of backing material 2860 of the inclined surface being attached to anvil block 2840.In various embodiments, to being described further above, the outside staple in nail bin 2800 can include higher nail 2220a, and inner side staple can include relatively low nail 2220b.In at least one embodiment, higher nail 2220a can be positioned in thicker sidepiece 2809 and/or adjacent with sidepiece 2809, and follow closely 2220b and can be positioned in central part 2808 and/or adjacent with central part 2808.In at least one this type of embodiment, due to mentioned above, higher nail 2220a captures the material of more implanted warehouse 2810 than relatively low nail 2220b.

As discussed above concerning described in the embodiment of Figure 46, such as, staple cartridge channel 2230 can include stepped support surface 2231, and nail 2220a and 2220b can be supported at differing heights by this stepped support surface relative to anvil block 2240.In various embodiments, staple cartridge channel 2230 can be made up of metal, and the step in stayed surface 2231 can be formed in stayed surface 2231 by such as grinding operation.Referring now to Figure 54, in various embodiments, the end effector of surgical instruments can include staple cartridge channel 2930, and this staple cartridge channel includes the support insert 2935 being positioned in.More specifically, in at least one embodiment, staple cartridge channel 2930 can be formed to make it have the most flat or the most flat stayed surface 2931, this stayed surface can support insert 2935, and this support insert includes for nail 2220a and 2220b of nail bin 2200 is supported on the stepped surface at differing heights.In at least one this type of embodiment, insert 2935 can include flat or the most flat lower surface, and described lower surface can position against stayed surface 2931.Insert 2935 may also include support slit, groove or groove 2932a and 2932b, and supporting slit, groove or groove 2932a and 2932b can be respectively supported at nail 2220a and 2220b at differing heights.With similar to the above, insert 2935 can include being limited to cutter slit 2939 therein, and this cutter slit can allow that cutting element passes through.In various embodiments, staple cartridge channel 2930 can be constituted by being same or different from the material supporting insert 2935.In at least one this type of embodiment, staple cartridge channel 2930 and support insert 2935 both of which and can be such as made up of metal, and in other embodiments, staple cartridge channel 2930 can be such as made up of metal, and support insert 2935 and can be such as made up of plastics.In various embodiments, support insert 2935 to be fastened and/or be welded in staple cartridge channel 2930.In certain embodiments, supporting insert 2935 can be snap-fitted and/or be press-fitted in staple cartridge channel 2930.In at least one embodiment, binding agent can be used to be fixed in staple cartridge channel 2930 by support insert 2935.

Referring now to Figure 55, in various embodiments, the end effector of surgical stapling device can include anvil block 3040, staple cartridge channel 3030 and the compressible implanted nail bin 3000 being positioned in staple cartridge channel 3030.With similar to the above, anvil block 3040 can include that being limited to multiple nail therein shapes pit 3042 and cutting element can be slidably received within cutter slit 3049 therein.Being also similarly to above, staple cartridge channel 3030 can include that being limited to multiple nail therein supports slit 3032 and also be able to cutting element is slidably received within cutter slit 3039 therein.In various embodiments, nail bin 3000 can include ground floor 3011, the second layer 3012 and the multiple nails (such as nail 3020a and 3020b) being positioned in nail bin 3000.In at least one embodiment, the unshaped staple height of nail 3020a can be higher than the unshaped staple height of nail 3020b.In various embodiments, ground floor 3011 can comprise the first compressible material, and the second layer 3012 can comprise the second compressible material.In certain embodiments, the compression ratio of the first compressible material can be higher than the second compressible material, and in some other embodiment, the compression ratio of the first compressible material can be less than the second compressible material.In at least one embodiment, the first compressible material can be made up of the elastomeric material that can comprise the first flexible ratio, and the second compressible material can be by can the elastomeric material of staple constitute, and described second flexible ratio is different from described first flexible ratio.In various embodiments, the flexible ratio of the first compressible material can be more than the flexible ratio of the second compressible material.In some other embodiment, the flexible ratio of the first compressible material is smaller than the flexible ratio of the second compressible material.In various embodiments, the first compressible stratum can comprise the first rigidity, and the second compressible stratum can comprise the second rigidity, and wherein the first rigidity is different from the second rigidity.In various embodiments, the rigidity of the first compressible stratum can be more than the rigidity of the second compressible stratum.In some other embodiment, the rigidity of the first compressible stratum is smaller than the rigidity of the second compressible stratum.

Referring again to Figure 55, in various embodiments, the second layer 3012 of nail bin 3000 can include constant or the most constant thickness on its whole width.In at least one embodiment, the thickness of ground floor 3011 can change on its whole width.In at least one this type of embodiment, ground floor 3011 can include one or more step 3008, and this step can increase the thickness of warehouse 3010 in some part (such as central part) of warehouse 3010.Refer again to Figure 55, relatively low nail 3020b and can be positioned in the step 3008(i.e. thicker portion of warehouse 3010) in or align with step 3008, and higher nail 3020a can be positioned in the thinner part of warehouse 3010 or align with described thinner part.In various embodiments, due to thicker portion and the thinner part of warehouse 3010, warehouse 3010 can be more than the rigidity along outside nail 3020a row along the rigidity of inner side nail 3020b row.In various embodiments, ground floor 3011 may be connected to the second layer 3012.In at least one this type of embodiment, ground floor 3011 and the second layer 3012 can include interlocking structure, and layer 3011 and 3012 can be kept together by described interlocking structure.In certain embodiments, ground floor 3011 can include that ground floor compound and the second layer 3012 can include second layer compound, and wherein ground floor compound can adhere to second layer compound by one or more binding agents.In various embodiments, nail bin 3000 can include cutter slit 3003, and this cutter slit can accommodate cutting element slidably therein.

Referring now to Figure 56, in various embodiments, nail bin 3100 can include compressible implanted warehouse 3110, and this warehouse includes monolayer compressible material and the multiple nails (such as, nail 3020b) being positioned in warehouse 3110.In at least one embodiment, the thickness of warehouse 3110 can change on its whole width.In at least one this type of embodiment, warehouse 3110 can include the step 3108 extended along its sidepiece.Referring now to Figure 57, in various embodiments, nail bin 3200 can include compressible implanted warehouse 3210, and this warehouse includes monolayer compressible material and the multiple nails (such as, nail 3020b) being positioned in warehouse 3210.In at least one embodiment, the thickness of warehouse 3210 can change on its whole width.In at least one this type of embodiment, warehouse 3210 can include the step 3208 extended along the center portion thereof.Referring now to Figure 58, in various embodiments, nail bin 3300 can include compressible implanted warehouse 3310, and wherein with similar to the above, the thickness of warehouse 3310 can change on its whole width.In at least one embodiment, the thickness of warehouse 3310 geometrically can increase between the sidepiece of warehouse 3310 and central part.In at least one this type of embodiment, the thickness of warehouse 3310 can be limited and can include the tissue contacting surface 3319 of arch or bending by the profile of arch or bending.In certain embodiments, the thickness of warehouse 3310 and the profile of tissue contacting surface 3319 by such as radius of curvature or alternately can be limited by multiple radius of curvature.Referring now to Figure 59, in various embodiments, nail bin 3400 can include compressible implanted warehouse 3410, and wherein the thickness of warehouse 3410 can increase between the sidepiece of warehouse 3410 and central part linearly or at least substantially linearly.

Referring now to Figure 60, in various embodiments, nail bin 3500 can include compressible implanted warehouse 3510 and the multiple nails 3520 being positioned in.Implanted warehouse 3510 can include the first internal layer the 3512, second internal layer 3513 and outer layer 3511.In at least one embodiment, the first internal layer 3512 can comprise the first thickness and the second internal layer 3513 can comprise the second thickness, and wherein the second internal layer 3513 can be thicker than the first internal layer 3512.In at least one alternative embodiment, the first internal layer 3512 can be thicker than the second internal layer 3513.In another alternative embodiment, the first internal layer 3512 and the second internal layer 3513 can have identical or the most identical thickness.In certain embodiments, each nail 3520 can include base portion 3522 and the one or more deformable lower limbs 3521 extended from base portion 3522.In various embodiments, each lower limb 3521 can include embedding the end 3523 in the first internal layer 3511, it addition, each base portion 3522 of nail 3520 can embed in the second internal layer 3512.In at least one embodiment, first internal layer 3512 and/or the second internal layer 3513 can include at least one medicine being stored therein, and in various embodiments, outer layer 3511 can encapsulate and seal the first internal layer 3512 and the second internal layer 3513 so that only after outer layer 3511 is pierced through by nail 3520, medicine just can flow out staple cartridge body 3510.More specifically, to being described further above, the tissue positioned against the tissue contacting surface 3519 of nail bin 3500 can be abutted against and push down on anvil block, warehouse 3510 is compressed and surface 3519 moves downward towards nail end 3523 and following closely end 3523 moved beneath at least in part so that end 3523 makes outer layer 3511 rupture or pierces through outer layer 3511.After nail lower limb 3521 makes outer layer 3511 rupture, at least one medicine M can flow out from the warehouse 3510 around nail lower limb 3521.In all cases, additional medicine M can be extruded warehouse 3510, as shown in Figure 61 by the additional compression of warehouse 3510.

Referring again to Figure 60, in various embodiments, outer layer 3511 can include water impervious or the most impermeable wrappage, and described wrappage can 1) prevent medicine from flowing out nail bin 3500 prematurely；And 2) prevent the fluid in such as operative site from entering prematurely in nail bin 3500.In certain embodiments, the first internal layer 3512 can include storage or be absorbed in the first medicine therein, and the second internal layer 3513 can include storage or be absorbed in the second medicine therein, and wherein the second medicine may differ from the first medicine.In at least one embodiment, the initial compression making outer layer 3511 rupture of warehouse 3510 generally can make the first internal layer 3512 discharge the first medicine, and the subsequent compression of warehouse 3510 generally can make the second internal layer 3513 discharge the second medicine.But, in this type of embodiment, some part of the first medicine and the second medicine can be released simultaneously, but the major part of the medicine being initially released can be made up of the first medicine, and the major part of the medicine being subsequently released can be made up of the second medicine.In certain embodiments, to being described further above, first internal layer 3512 can be constituted by having the biggest compressible material than the second internal layer 3513 so that can be less than subsequent compression power or the initial compression force of pressure or pressure can produce the initial deflection amount bigger than in the second internal layer 3513 in the first internal layer 3512.This type of bigger initial deflection amount in first internal layer 3512 can make second medicine partially larger than discharged from the second internal layer 3513 of the first medicine discharged from the first internal layer 3512.In at least one embodiment, the first internal layer 3512 is than the second internal layer 3513 more porous and/or more flexible.In at least one this type of embodiment, first internal layer 3512 can include being limited to multiple hole therein or space 3508, and the second internal layer 3513 can include being limited to multiple hole therein or space 3509, the most in various embodiments, hole 3508 can be by the first medicament storage in the first internal layer 3512, and hole 3509 can be by the second medicament storage in the second internal layer 3513.In certain embodiments, the hole 3508 in the first internal layer 3512 and the size in the hole 3509 in the second internal layer 3513 and density can be selected to provide results needed as herein described.

Referring again to Figure 60 and Figure 61, in various embodiments, outer layer the 3511, first internal layer 3512 and/or the second internal layer 3513 can be made up of bioabsorbable material.In at least one embodiment, first internal layer 3512 can comprise the first bioabsorbable material, second internal layer 3513 can comprise the second bioabsorbable material, and outer layer 3511 can be made up of the 3rd bioabsorbable material, wherein the first bioabsorbable material, the second bioabsorbable material and/or the 3rd bioabsorbable material can be made up of different materials.In certain embodiments, first bioabsorbable material can be with first rate by bio-absorbable, second bioabsorbable material can the second speed by bio-absorbable, and the 3rd bioabsorbable material can be with third speed by bio-absorbable, and wherein first rate, the second speed and/or third speed can be different.In at least one this type of embodiment, when material with specific speed by bio-absorbable time, this type of speed can be defined as the amount of the quality of materials absorbed by patient body within the unit interval.It is known that the health of different patients can be different speed absorb different materials, therefore this type of speed can be expressed as Mean Speed to explain this type of transmutability.In any case, compared with slower speed, speed can be the more absorbed speed of quality within the unit interval faster.Refer again to Figure 60 and Figure 61, in various embodiments, the constituent material of the first internal layer 3512 and/or the second internal layer 3513 than the constituent material of outer layer 3511 quickly by bio-absorbable.In at least one this type of embodiment, first internal layer 3512 and/or the second internal layer 3513 can be by bioabsorbable foams, tissue seal, and/or hemostatic material (such as oxidized regenerated cellulose (ORC)) is constituted, and outer layer 3511 can be by backing material and/or the plastic material (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA, PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL sold with trade name Monocryl), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or the complex of PCL) constitute.In this type of embodiment, the first internal layer 3512 and/or the second internal layer 3513 such as can directly process tissue and can to reduce tissue hemorrhage, its ectomesoderm 3514 long-term structure can be provided to support and can be slower speed by bio-absorbable.

To being described further above, owing to the bioabsorbable speed of outer layer 3511 is relatively slow, therefore outer layer 3511 can when the organization healing in nail row supporting tissue or structurally strengthen tissue.In certain embodiments, one of them constituent material of the first internal layer 3512 and the second internal layer 3513 than the constituent material of another one quickly by bio-absorbable.In at least one embodiment, one layer therein can provide the initial release treating material, and another layer can provide identical treatment material and/or the slow release of different treatment material.In at least one this type of embodiment, treatment material can be depending on the absorbability of the bottom wherein absorbing or being dispersed with medicine from the speed that layer 3512,3513 is released.Such as, at least one embodiment, including the substrate of the first internal layer 3512 than including that the substrate of the second internal layer 3513 can be faster than the speed of release from the second internal layer 3513 quickly by bio-absorbable, the most such as medicine from the speed that the first internal layer 3512 discharges.In various embodiments, as described herein, one or more at least one binding agent (such as, fibrin and/or protein hydrogel) that pass through in the layer 3511,3512 and 3513 of warehouse 3510 adhere to each other.In certain embodiments, binding agent can be water soluble and can work as nail bin 3500 implanted time and/or implanted certain period after discharge the connection between each layer.In at least one this type of embodiment, binding agent can be than outer layer the 3511, first internal layer 3512 and/or the second internal layer 3513 quickly by bio-absorbable.

Referring now to Figure 62 and Figure 63, in various embodiments, nail bin (such as, nail bin 3600) such as can include warehouse 3610, and this warehouse includes compressible ground floor 3611, the second layer 3612 being attached to ground floor 3611 and is attached to the removable compressible stratum 3613 of the second layer 3612.In at least one this type of embodiment, such as ground floor 3611 can be made up of compressible foamed materials, the second layer 3612 can include the laminate utilizing one or more binding agents to adhere to ground floor 3611, and third layer 3613 can include the compressible foam material that utilizes one or more binding agents to be removably adhered to the second layer 3612.In various embodiments, nail bin 3600 may also include the multiple nails (such as following closely 3620) being positioned in warehouse 3610.In at least one this type of embodiment, the most each nail 3620 can include the base portion 3622 being positioned in third layer 3613 and the one or more deformable lower limbs 3621 extending upwardly to ground floor 3611 through the second layer 3612 from base portion 3622.In use, to being described further above, the top surface 3619 of staple cartridge body 3610 can be pushed down on by anvil block, until nail lower limb 3621 penetrates top surface 3619 and target tissue and contacts anvil block.After nail lower limb 3621 is badly deformed, anvil block can move away from nail bin 3600 so that the compressible stratum of nail bin 3600 can stretch the most again.In all cases, nail can make tissue hemorrhage when inserting through tissue.In at least one embodiment, third layer 3613 can be made up of absorbing material (such as protein hydrogel), and described absorbing material can absorb blood from the tissue being sewn.In addition to above or as replacement above, third layer 3613 can be made up of hemostatic material and/or tissue seal (the most freeze-dried thrombin and/or fibrin), and it is hemorrhage that described hemostatic material and/or tissue seal can reduce tissue.In certain embodiments, ground floor 3611 and the second layer 3612 can be provided structure to support by third layer 3613, and wherein third layer 3613 can be made up of bioabsorbable material and/or the most bioabsorbable material.In any case, in various embodiments, after nail bin 3610 is implanted, third layer 3613 can separate with the second layer 3612.Third layer 3613 includes having in the embodiment of the material of implanted characteristic wherein, and surgeon may choose whether to remove the third layer 3613 of warehouse 3610.In at least one embodiment, third layer 3613 can remove from the second layer 3612 with integral form.

In various embodiments, ground floor 3611 can be made up of the first foamed materials, and third layer 3613 can be made up of the second foamed materials, and the second foamed materials may differ from the first foamed materials.In at least one embodiment, the first foamed materials can have the first density and the second foamed materials can have the second density, and wherein the first density may differ from the second density.In at least one this type of embodiment, the second density can be higher than the first density, and therefore third layer 3613 is less than the compressibility of ground floor 3611 or has lower compression ratio.In at least one alternative embodiment, the first density can be higher than the second density, and therefore ground floor 3611 is less than the compressibility of third layer 3613 or has lower compression ratio.Referring now to Figure 64 and Figure 65, in various embodiments, it is similar to nail bin 3600, nail bin 3700 can include warehouse 3710, and this warehouse includes the first compressible froth bed 3711, the second layer 3712 being attached to ground floor 3711 and is removably attached to dismountable 3rd compressible foam foam layer 3713 of the second layer 3712.In at least one this type of embodiment, third layer 3713 can include that multiple nail accommodates slit or otch 3709, and the plurality of nail accommodates slit or otch can be able to accommodate at least some of (the such as nail base portion 3622) following closely 3620 wherein.In certain embodiments, nail 3620 can slide in nail accommodates slit 3709, or in other words, such as, when nail bin 3700 positions against target tissue and compressed by anvil block, third layer 3713 can be relative to nail 3620 slip.In at least one embodiment, accommodate slit 3709 can make to there is space between nail 3620 and the sidewall accommodating slit 3709.In at least one this type of embodiment, due to mentioned above, when following closely 3620 deformation, nail 3620 can not by the part capture of third layer 3713 wherein, as shown in Figure 64 and Figure 65.In some other embodiment, nail accommodates the end of the neighbouring second layer 3712 of slit 3709 can be by the part Guan Bi of third layer 3713, therefore when following closely 3620 deformation, can being trapped at least partially in nail 3620 of third layer 3713.In any case, third layer 3713 such as can include one or more perforation and/or cut 3708, and the one or more perforation and/or cut can allow that third layer 3713 is removed from the second layer 3712, as shown in Figure 64 with two parts or more parts.In Figure 64, a portion of third layer 3713 is shown to pass through instrument 3755 and removes.In various embodiments, perforation 3708 can be arranged along the line being positioned at the first nail middle with the second nail.

Referring again to Figure 64 and Figure 65, in various embodiments, the base portion 3622 of nail 3620 can be located in receiving slit 3709, and the most at least one embodiment, the sidewall accommodating slit 3709 can contact stud lower limb 3621 nail lower limb 3621 is releasably held in place.In certain embodiments, although not shown, but third layer 3713 can include the elongated slot of all nails in nail row.In at least one this type of embodiment, such as can include the elongated slot alignd with each staple in nail bin bottom including the nail bin of four staples.To being described further above, nail bin 3600 and/or nail bin 3700 at least partially can implanted in the patient, and nail bin at least partially can be from removing in the patient.Referring again to Figure 64 and Figure 65, at least one embodiment, ground floor 3711 and the second layer 3712 can be trapped in following closely 3620 and can be implanted together with nail 3620, and third layer 3713 is optionally removed from nail bin 3700 or separates.In all cases, removing and implant the part of nail bin and can reduce the amount of the material that patient body must absorb, this can provide various useful therapeutic effect.In the situation such as by abdominal cavity mirror instrument 3755, a part for nail bin being separated and being removed, the nail bin part separated can be passed through the trocar (such as having the trocar in 5mm hole) and be removed from operative site.In certain embodiments, warehouse can include the more than one layer being removed.Such as, warehouse 3710 can include the 4th layer, and wherein the third layer 3713 of warehouse 3710 can be made up of hemostatic material, and the 4th layer can be made up of supporting layer.In at least one this type of embodiment, the most removable supporting layer of surgeon also chooses whether to remove hemostatic layer subsequently.

Referring now to Figure 66, in various embodiments, nail bin (such as, nail bin 3800) such as can include warehouse 3810, and this warehouse includes outer layer 3811 and internal layer 3812.Internal layer 3812 can be made up of compressible foamed materials, and outer layer 3811 can at least partly surround internal layer 3812 and wrap up.In at least one embodiment, outer layer 3811 can include Part I 3811a and Part II 3811b, this Part I can be positioned on the first side of internal layer 3812, this Part II can be positioned on the second side of internal layer 3812, and wherein Part I 3811a and Part II 3811b can pass through flexible hinge (such as hinge 3809) connection.In at least one this type of embodiment, the first side of internal layer 3812 and/or the second side can be coated at least one binding agent (such as, fibrin and/or protein hydrogel) so that some part of outer layer 3811 is fixed to the first side and/or the second side.In various embodiments, outer layer 3811 can include the one or more fastening members extended from it.In at least one this type of embodiment, outer layer 3811 can include the multiple deformable lower limbs 3821 extending from the side of outer layer 3811 and can being placed in compressible internal layer 3812.In at least one this type of embodiment, lower limb 3821 can not be from the second lateral process of internal layer 3812, and at least one alternative embodiment, lower limb 3821 can be at least in part from internal layer 3812 projection.When compressible warehouse 3810 is compressed, in use, lower limb 3821 can pierce through the Part II 3811b of internal layer 3812 and outer layer 3811.In certain embodiments, the Part II 3811b of outer layer 3811 can include being limited to hole therein (such as hole 3808), and described hole can accommodate nail lower limb 3821.In certain embodiments, at least some included cutter slit 3803 of nail bin 3800, this cutter slit can accommodate cutting element slidably therein.In at least one this type of embodiment, cutter slit 3803 can extend not entirely through the thickness of warehouse 3810, and therefore when cutting element moves relative to warehouse 3810, cutting element can cut warehouse 3810.

Referring now to Figure 67, in various embodiments, similar to nail bin 3800, nail bin 3900 can include warehouse 3910, this warehouse includes internal layer 3812 and outer layer 3811, Part I 3811a and the second side of neighbouring internal layer 3812 that its ectomesoderm 3811 can include the first side of neighbouring internal layer 3812 and position and the Part II 3811b that positions.In at least one embodiment, with similar to the above, outer layer 3811 can include the one or more fastening members extended from it.In at least one this type of embodiment, outer layer 3811 can include the multiple deformable lower limbs 3921 extending from the side of outer layer 3811 and can being placed in compressible internal layer 3812.In certain embodiments, each deformable lower limb 3921 can include that at least one suspension hook from its projection or barb 3923, at least one suspension hook described or barb can engage the Part II 3811b of outer layer 3811 and therefore outer layer 3811 be remained to internal layer 3812.In at least one this type of embodiment, barb 3923 can hole 3808 from the second lateral process of internal layer 3812 the Part II 3811b extending through outer layer 3811 so that outer layer 3811 is also locked onto internal layer 3812 by the outer surface of the engageable outer layer of barb 3,923 3811.For structure nail bin 3900, internal layer 3812 can be at least partially compressed, so that barb is from internal layer 3812 projection access aperture 3808.In at least one this type of embodiment, such as when nail bin 3900 is inserted in nail bin, nail bin 3900 can be by precommpression at least in part.In certain embodiments, to being described further above, in the Part I 3811a that can embed outer layer 3811 at least partially of lower limb 3921, the most at least one embodiment, outer layer 3811 can be made up of plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)), and described plastic material can be around at least some of overmolding of lower limb 3921.

Referring now to Figure 68-72, in various embodiments, nail bin (such as, nail bin 4000) can include warehouse 4010, and this warehouse includes compressible ground floor 4011, the second layer 4012 and the multiple nails 4020 being positioned in warehouse 4010.Seeing Figure 70, in certain embodiments, each nail 4020 can include base portion 4022 and at least one the deformable lower limb 4023 extended from base portion 4022.See Figure 68, in at least one embodiment, nail bin 4000 can be positioned between the anvil block 4040 of the end effector of staple cartridge channel 4030 and surgical stapling device, and wherein the second layer 4012 of warehouse 4010 and/or the base portion 4022 of nail 4020 can position against staple cartridge channel 4030.Referring now to Figure 69, in various embodiments, the second layer 4012 can include one layer of absorbent cotton 4060, and described one layer of absorbent cotton is interconnected amongst one another by absorbent cotton support frame 4061.In at least one this type of embodiment, absorbent cotton 4060 and absorbent cotton support frame 4061 can be made up of the plastic material (such as polyglycolic acid (PGA)) moulded.Each absorbent cotton 4060 can include that one or more hole or slit 4062, the one or more hole or slit can accommodate and extend through nail lower limb 4021 therein, as shown in Figure 70 and Figure 71.Each absorbent cotton 4060 may also include and is limited to receiving slit 4063 therein, and this receiving slit can accommodate the base portion 4022 of nail 4020.Refer again to Figure 69, in various embodiments, absorbent cotton 4060 and/or absorbent cotton support frame 4061 can include that multiple cut, perforation or similar structures, the plurality of cut, perforation or similar structures can allow that absorbent cotton 4060 separates with absorbent cotton support frame 4061 at desired location.Similarly, seeing Figure 71, one or more absorbent cottons 4060 such as can be connected to each other along the line including perforation and/or cut 4064.In use, compressible froth bed 4011 can position against target tissue T, and warehouse 4010 can be compressed by anvil block 4040 so that anvil block 4040 can make nail 4020 deform.When following closely 4020 deformation, tissue T, a part for ground floor 4011 and absorbent cotton 4060 can be captured in the nail of deformation by the nail lower limb 4021 of each nail 4020.When staple cartridge channel 4030 moves away from the nail bin 4060 implanted, such as absorbent cotton support frame 4061 can separate with absorbent cotton 4060 and/or each absorbent cotton 4060 can be separated from one another.In some cases, when following closely 4020 and being deformed in the above described manner by anvil block 4040, absorbent cotton 4060 can be with framework 4061 and/or separated from one another.

In various embodiments described herein, when anvil block moves to make position, the nail of nail bin can be fully formed by anvil block.Referring now to Figure 73-76, in other embodiments various, the nail of nail bin (such as nail bin 4100) such as by moving to the anvil block of make position and can make nail deform towards the staple drivers system of the anvil block motion of Guan Bi.Nail bin 4100 can include compressible warehouse 4110, and this compressible warehouse can be such as made up of foamed materials and multiple nails 4120 of being at least partially situated in compressible warehouse 4110.In various embodiments, staple drivers system can include driver clamper 4160, the multiple staple drivers 4162 being positioned at driver clamper 4160 and cartridge tray 4180, and staple drivers 4162 can be maintained in driver clamper 4160 by this cartridge tray.In at least one this type of embodiment, staple drivers 4162 can be positioned in the one or more slits 4163 in driver clamper 4160, and wherein the sidewall of slit 4163 can help to boot up staple drivers 4162 towards anvil block.In various embodiments, nail 4120 can be supported in slit 4163 by staple drivers 4162, and the most at least one embodiment, when following closely 4120 and staple drivers 4162 is in its non-firing position, nail 4120 can be fully located in slit 4163.In some other embodiment, when following closely 4120 and staple drivers 4162 is in its non-firing position, the opening 4161 that may pass through slit 4163 at least partially of nail 4120 upwardly extends.Now referring first to Figure 74, at least one this type of embodiment, the base portion of nail 4120 can be positioned in driver clamper 4160, and follow closely the end of 4120 and can embed in compressible warehouse 4110.In certain embodiments, nail 4120 about 1/3rd height can be positioned in driver clamper 4160, and follow closely 4120 about 2/3rds height can be positioned in warehouse 4110.Seeing Figure 73 A, at least one embodiment, such as nail bin 4100 also can include water impervious wrappage or film 4111 around warehouse 4110 and driver clamper 4160.

In use, such as, nail bin 4100 can be located in staple cartridge channel, and anvil block can move to make position towards nail bin 4100.In various embodiments, when anvil block moves to its make position, anvil block can contact and compress compressible warehouse 4110.In certain embodiments, when anvil block is in its make position, anvil block can not contact stud 4120.In some other embodiment, when anvil block moves to its make position, anvil block can the lower limb of contact stud 4120 make nail 4120 deform at least in part.In any case, nail bin 4100 may also include one or more sliding part 4170, the one or more sliding part can be along being longitudinally propelling in nail bin 4100 so that sliding part 4170 can jointing nail driver 4162 make staple drivers 4162 and nail 4120 move towards anvil block subsequently.In various embodiments, sliding part 4170 can slide between cartridge tray 4180 and staple drivers 4162.During the Guan Bi of anvil block has made the embodiment that the forming process of nail 4120 starts wherein, nail 4120 moves upward towards anvil block and can complete forming process and to make nail 4120 be deformed into its height being fully formed or the most desired height.During the Guan Bi of anvil block does not makes the embodiment that nail 4120 deforms wherein, nail 4120 moves upward towards anvil block and can start and complete forming process and to make nail 4120 be deformed into its height being fully formed or the most desired height.In various embodiments, sliding part 4170 can be advanced to the far-end of nail bin 4100 from the near-end of nail bin 4100 so that before the nail 4120 in the far-end being positioned at nail bin 4100 is fully formed, and the nail 4120 being positioned in the near-end of nail bin 4100 is fully formed.Seeing Figure 75, at least one embodiment, sliding part 4170 can each include at least one angularly or surface 4711 of tilting, and it can be in staple drivers 4162 slid underneath and promote staple drivers 4162 as shown in Figure 76.

In various embodiments, to being described further above, nail 4120 can be formed, in order to by least some of capture of the compressible warehouse 4110 of at least some of of tissue T and nail bin 4100 wherein.After nail 4120 shaping, the anvil block of surgical stapling device and staple cartridge channel 4130 can move away from the nail bin 4100 implanted.In all cases, storehouse dish 4180 can jointing nail storehouse passage 4130 in a position-stable manner, therefore when staple cartridge channel 4130 is pulled away from the warehouse 4110 implanted, storehouse dish 4180 can separate with compressible warehouse 4110.Referring again to Figure 73, in various embodiments, storehouse dish 4180 can include relative sidewall 4181, and this warehouse 4110 can be removably positioned between relative sidewall 4181.In at least one this type of embodiment, compressible warehouse 4110 can be compressed between sidewall 4181, warehouse 4110 during use can be removably retained between sidewall 4181, and when storehouse dish 4180 is pulled away from, warehouse 4110 departs from releasedly from storehouse dish 4180.In at least one this type of embodiment, driver clamper 4160 may be connected to storehouse dish 4180 so that when storehouse dish 4180 is removed from operative site, and driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.In some other embodiment, driver 4162 can be shot up from driver clamper 4160 and stay in operative site.In at least one this type of embodiment, each driver 4162 can be by the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), the bioabsorbable material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL constituted.In various embodiments, driver 4162 could attach to follow closely 4120 so that driver 4162 is deployed with nail 4120.In at least one this type of embodiment, each driver 4162 can include the groove that such as can accommodate the base portion of nail 4120, and the most at least one embodiment, described groove can accommodate nail base portion with press-fit and/or snap fit.

In certain embodiments, to being described further above, driver clamper 4160 and/or sliding part 4170 can be shot up from storehouse dish 4180.In at least one this type of embodiment, sliding part 4170 can slide between storehouse dish 4180 and driver clamper 4160, making when sliding part 4170 advances to drive up staple drivers 4162 and nail 4120, sliding part 4170 also can make driver clamper 4160 move upward to outside storehouse dish 4180.In at least one this type of embodiment, driver clamper 4160 and/or sliding part 4170 can be by the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sell with trade name Monocryl), the bioabsorbable material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL constituted.In various embodiments, sliding part 4170 can be integrally formed and/or be attached to driving rod or cutting element, described driving rod or cutting element and promote sliding part 4170 through nail bin 4100.In this type of embodiment, sliding part 4170 can not be shot up from storehouse dish 4180 and can keep together with surgical stapling device, and in sliding part 4170 is not attached to other embodiments of driving rod, sliding part 4170 can be stayed in operative site.In any case, to being described further above, the compressibility tolerable of warehouse 4110 uses thicker nail bin in the end effector of surgical stapling device, this is because when the anvil block of stiching instrument closes, warehouse 4110 is compressible or collapses.In certain embodiments, deformed at least in part owing to following closely when anvil block closes, therefore can use higher nail (such as have about 0.18 " nail of staple height); the most about 0.12 " staple height can be positioned in compressible stratum 4110, and wherein compressible stratum 4110 may have about 0.14 " uncompressed height.

Referring now to Figure 77-80, in various embodiments, nail bin (such as, nail bin 4200) such as can include compressible warehouse 4210, the multiple nails 4220 being positioned in compressible warehouse 4210 and the lateral supports 4234 of multiple flexibility.Referring now to Figure 78, in various embodiments, it is middle with staple cartridge channel 4230 that nail bin 4200 can be positioned in anvil block 4240, and the most at least one embodiment, lateral support component 4234 could attach to staple cartridge channel 4230.When anvil block 4240 moves downward compress warehouse 4210 and make nail 4220 deform at least in part, as shown in Figure 79, the sidepiece of warehouse 4210 can laterally expand and push out lateral support component 4234.In at least one this type of embodiment, lateral support component 4234 could attach to warehouse 4210, and when warehouse 4210 laterally expands as mentioned above, lateral support component 4234 can separate with warehouse 4210, as shown in Figure 79.In at least one embodiment, lateral support component 4234 can utilize at least one binding agent (such as, fibrin and/or protein hydrogel) to adhere to warehouse 4210.With similar to the above, nail 4220 when anvil block 4240 closes, can be only partially made to deform, wherein can be by advancing one or more sliding part 4270 to complete to follow closely the shaping of 4220 through nail bin 4200 as shown in Figure 80.Referring now to Figure 82 and Figure 83, in various embodiments, sliding part 4270 can be cut component 4280 and be advanced to the far-end of nail bin 4200 from the near-end of nail bin 4200.In at least one this type of embodiment, cutting element 4280 can include that cutting element or cutter 4283, described cutting element or cutter 4283 may pass through tissue T and/or compressible warehouse 4210 and advance.In certain embodiments, cutting element 4280 can include cam member 4282, and this cam member can advance along the outer surface of jaw 4230 and 4240 and moved by described jaw or be held in place.In various embodiments, due to mentioned above, nail 4220 can be shaped to its net shape while tissue T is cut open or the most simultaneously.In at least one this type of embodiment, sliding part 4270 can be positioned in distally relative to cutter 4283 so that when only the propulsive units at tissue is sewed up completely, tissue T is just cut open.

Referring again to Figure 82 and Figure 83, in various embodiments, sliding part 4270 can include that single slidable member, described slidable member are advanced by cutting element 4280 together.In at least one this type of embodiment, sliding part 4270 can be accommodated in nail bin 4200, and cutting element 4280 can be advanced in nail bin 4200 by trigger shaft 4281 so that cutting element 4280 engaging slide part 4270 also advances sliding part 4270 towards distally.In certain embodiments, each sliding part 4270 can be connected to each other.In any one situation, each sliding part 4270 can include angled surface or cam 4271, and this angled surface or cam can be lifted in staple the nail 4220 of alignment.In certain embodiments, angled surface 4271 can be formed as overall with cutting element 4280.Refer again to Figure 82 and Figure 83, in at least one embodiment, each nail 4200 can include base portion and bizet 4229, at least one deformable member extends from base portion, and bizet 4229 overmolding is to the base portion of nail 4200 and/or the most above and/or positioning at least partially around described of deformable member.In various embodiments, such as this type of bizet 4229 directly can be driven by sliding part 4270.More specifically, in at least one embodiment, the bizet 4229 of nail 4220 enables in the case of between the angled surface 4271 and bizet 4229 of sliding part 4270, no-fix has staple drivers, and angled surface 4271 can be in bizet 4229 slid underneath and directly contact bizet 4229.In this type of embodiment, each bizet 4229 all includes at least one angled or surface of inclination cooperated, the surface that is angled or that tilt of at least one cooperation described can be engaged by the angled surface 4271 of sliding part 4270, make when sliding part 4270 is when following closely 4220 slid underneath, and the angled surface of cooperation can drive up nail 4220.

Referring now to Figure 81, in various embodiments, nail bin (such as, nail bin 4300) such as can include compressible main body 4310 and be positioned at the multiple nails 4320 in compressible main body 4310.With similar to the above, nail bin 4300 can include the lateral supports 4334 of flexibility, and the lateral supports of this flexibility could attach to staple cartridge channel and/or adheres to compressible main body 4310.In addition to person mentioned above, flexible lateral supports 4334 can be connected together by one or more pillars or connecting elements 4335, and lateral supports 4334 can be kept together by the one or more pillar or connecting elements 4335.In use, connecting elements 4335 is prevented from or at least suppression lateral supports 4334 separates with warehouse 4310 prematurely.In certain embodiments, connecting elements 4335 can be after nail bin 4300 be compressed by anvil block, and lateral supports 4334 is kept together by this connecting elements.In this type of embodiment, lateral supports 4334 can resist lateral expansion or the displacement of the sidepiece of warehouse 4310.In certain embodiments, cutting element (such as cutting element 4280) can work as cutting element 4280 in warehouse 4310 towards distal movement time, cutting element can crosscutting connecting elements 4335.In at least one this type of embodiment, cutting element 4280 can promote one or more sliding parts (such as sliding part 4270) towards distally, in order to makes nail 4320 shape against anvil block.The bootable cutting blade of sliding part 4,270 4283 so that cutting element 4280 will not crosscutting connecting elements 4335, until the nail 4320 of neighbouring connecting elements 4335 is fully formed or is at least shaped to Desired Height.In all cases, connecting elements 4335 cooperates with lateral supports 4334 and can prevent or at least reduce the lateral movement of compressible warehouse 4310, and prevents simultaneously or at least reduce the lateral movement of the nail 4320 being positioned at warehouse 4310.In this case, nail 4320 can be held in place by connecting elements 4335, until nail 4320 deforms, and connecting elements 4335 can be then cut out discharging the sidepiece of warehouse 4310.As it has been described above, lateral supports 4334 may be connected to staple cartridge channel, therefore after nail bin 4300 is implanted, lateral supports 4334 can be removed from operative site together with staple cartridge channel.In certain embodiments, lateral supports 4334 can be made up of implanted material and can be left in operative site.In at least one embodiment, connecting elements 4335 can be positioned in the middle of warehouse 4310 and tissue T, and after connecting elements 4335 separates with lateral supports 4334, connecting elements 4335 can keep implantation within a patient.In at least one this type of embodiment, connecting elements 4335 can be made up of implanted material, and in certain embodiments, connecting elements 4335 can be such as made up of the material identical with lateral support component 4334.In various embodiments, connecting elements 4335 and/or lateral supports 4334 can be by the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sell with trade name Monocryl), the flexible bioabsorbable material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL constituted.In various embodiments, connecting elements can include the material piece for connecting each lateral supports 4334.In certain embodiments, nail bin can include the connecting elements extending through the top surface of warehouse 4310 and the connecting elements extended around the lower surface of warehouse 4310.

Referring now to Figure 84, in various embodiments, nail bin can include nail (such as, follow closely 4420), and described nail such as can include the wire rod portion being inserted in bizet.In at least one embodiment, wire rod portion can be made up of metal (such as titanium and/or rustless steel) and/or plastics (such as PPDO (PDS) and/or polyglycolic acid (PGA)).In at least one embodiment, bizet can be made up of metal (such as titanium and/or rustless steel) and/or plastics (such as PPDO (PDS) and/or polyglycolic acid (PGA)).In certain embodiments, the wire rod portion of each nail 4420 can include base portion 4422 and the deformable lower limb 4421 extended from base portion 4422, and the bizet of the most each nail 4420 can include bizet 4429, and this bizet can accommodate at least some of of base portion 4422 wherein.Referring now to Figure 85 A-85C, for assembling each several part of each nail 4420, can be inserted by the leg 4421 in wire rod portion in the opening 4426 in bizet 4429, lower limb 4421 can be guided to base portion chamber 4427 by its split shed 4426.Wire rod portion also can be inserted in bizet 4429 so that lower limb 4421 leaves the base portion 4422 in base portion chamber 4427 and wire rod portion and enters in base portion chamber 4427.In at least one this type of embodiment, base portion chamber 4427 enables to when base portion 4422 enters base portion chamber 4427, and wire rod portion rotates in bizet 4429 so that nail lower limb 4421 point to upwards or at least substantially upwardly direction.Referring again to Figure 84, in various embodiments, bizet 4429 can include outlet opening 4425, and this outlet opening can accommodate nail lower limb 4421 wherein.

In various embodiments, to being described further above, surgical stapling device can include sliding part 4470, and the nail 4420 that this sliding part is accommodated in can traversing nail bin 4400 and staple cartridge channel 4430 and making warehouse 4410 moves towards anvil block.In all cases, sliding part 4470 can be from the proximal movement of staple cartridge channel 4430 to the far-end of storehouse passage 4430, to implant warehouse 4410 and nail 4420.In some cases, sliding part 4470 regracting or return to the near-end of storehouse passage 4430, and another nail bin 4400 can be inserted in storehouse passage 4430.The newest nail bin 4400 is positioned in storehouse passage 4430, then sliding part 4470 can advance towards distally again.In various embodiments, surgical stapling device can include one or more latch-up structure, and the one or more latch-up structure no-fix can prevent sliding part 4470 from again advancing towards distally in storehouse passage 4430 in the case of having new nail bin 4400.Referring again to Figure 84, at least one this type of embodiment, staple cartridge channel 4430 can include locking shoulder 4439, and this locking shoulder is prevented from or at least limit slippage part 4470 is towards distal movement.More specifically, unless sliding part 4470 is lifted up exceeding shoulder 4439 at least in part by lift structure 4428, otherwise sliding part 4470 can adjoin shoulder 4439, extend between the lift structure 4428 such as recent side in nail bin 4400 nail 4420.In other words, when there is not recent side in new nail bin 4400 and following closely 4420, sliding part 4470 cannot advance.Therefore, when there is used nail bin 4400 in storehouse passage 4430 or when there is not any nail bin 4400 in storehouse passage 4430, sliding part 4470 cannot advance in storehouse passage 4430.

Referring now to Figure 86, to being described further above, nail bin (such as, nail bin 4500) such as can be positioned in staple cartridge channel 4530 and can include compressible warehouse 4510, the multiple nails 4520 being positioned in warehouse 4510 and storehouse dish or keeper 4580.In various embodiments, compressible warehouse 4510 can include outer layer 4511 and internal layer 4512, and the most at least one embodiment, outer layer 4511 can surround internal layer 4512 in a sealing fashion.In at least one this type of embodiment, outer layer 4511 can extend between internal layer 4512 and storehouse dish 4580.In some other embodiment, outer layer 4511 can be only partially about internal layer 4512, and at least one this type of embodiment, outer layer 4511 and storehouse dish 4580 can cooperate with surrounding or at least substantially surround internal layer 4512.In various embodiments, to being described further above, nail 4520 can be supported by storehouse dish 4580, and wherein storehouse dish 4580 can include the one or more of support nail 4520 can following closely support passages.In certain embodiments, storehouse dish 4580 could attach to warehouse 4510, and wherein at least one this type of embodiment, warehouse 4510 laterally can be compressed between the relative sidewall of storehouse dish 4580.In various embodiments, the sidewall of storehouse dish 4580 can laterally support warehouse 4510, and at least one this type of embodiment, storehouse dish 4580 can include one or more walls or the fin 4582 extending upwardly to warehouse 4510 from bottom support 4583.In at least one this type of embodiment, warehouse 4510 can including, one or more slit or passage, the one or more slit or passage can accommodate wall 4582 and/or interlock with wall 4582.In various embodiments, wall 4582 can partly or almost all extend through warehouse 4510.In at least one this type of embodiment, wall 4582 can extend longitudinally through nail bin 4500 between the first nail 4520 and the second nail 4520.

In various embodiments, warehouse 4510 and/or storehouse dish 4580 can include that cooperation keeps structure, and described cooperation keeps structure can provide snap-fitted between storehouse dish 4580 and warehouse 4510.In certain embodiments, during nail bin 4500 can be positioned in storehouse passage 4530 so that storehouse dish 4580 positions against storehouse passage 4530 and/or is attached to storehouse passage 4530.In at least one embodiment, storehouse dish 4580 can be detachably coupled to storehouse passage 4530 so that after nail bin 4500 is compressed by anvil block 4540 and follows closely 4520 deformation, storehouse dish 4580 can separate with storehouse passage 4530 and can be implanted together with warehouse 4510.In at least one this type of embodiment, storehouse dish 4580 can be by the polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), the bioabsorbable material such as the complex of polycaprolactone (PCL) and/or PGA, PLA, PDS, PHA, PGCL and/or PCL constituted.In certain embodiments, surgical stapling device may also include firing lock and/or driver, described firing lock and/or driver can be at staple cartridge channel 4530 and driving surface, bottom middle slip on storehouse dish 4580, and driving surface, described bottom can promote from storehouse passage 4530 or penetrate storehouse dish 4580.In certain embodiments, warehouse 4510 can be detachably coupled to storehouse dish 4580 so that after nail bin 4500 is compressed by anvil block 4540 and follows closely 4520 deformation, warehouse 4510 can separate from storehouse dish 4580.In at least one this type of embodiment, storehouse dish 4580 can keep engaging storehouse passage 4530 in a position-stable manner so that storehouse dish 4580 is removed from operative site together with storehouse passage 4530.In certain embodiments, surgical stapling device may also include firing lock and/or driver, described firing lock and/or driver can be at cartridge tray 4580 and driving surface, bottom middle slip on warehouse 4510, and driving surface, described bottom can promote from storehouse dish 4580 or penetrate warehouse 4510.In at least one this type of embodiment, nail bin 4500 may also include and is positioned at storehouse dish 4580 and the middle staple drivers of nail 4520 so that when firing lock slides towards distally, staple drivers and nail 4520 can be driven upwardly towards anvil block.In at least one this type of embodiment, staple drivers can be at least partially embedded in compressible warehouse 4510.

In various embodiments, with similar to the above, nail bin 4500 can include that latch-up structure, described latch-up structure are prevented from or at least restriction cutting element is towards distal movement, unless positioned the nail bin 4500 not fired in staple cartridge channel 4530.In certain embodiments, cartridge tray 4580 can include such as being lifted up cutting element in staple cartridge channel 4530 and making it exceed the surface of locking surface.Not existing in storehouse passage 4530 wherein in the situation of the nail bin 4500 including storehouse dish 4580, cutting element cannot advance.In at least one embodiment, recent side nail and/or any other suitably nail in nail bin 4500 can include promoting surface, and cutting element can be lifted beyond locking surface by described lifting surface completely.Over and above what is described above or substitute mentioned above, each several part of nail bin 4500 can be made up of the material with different colours.In this type of embodiment, surgeon can visually identify when there is the nail bin not firing and/or firing in staple cartridge channel 4530.In at least one this type of embodiment, the outer layer 4511 of warehouse 4510 can have the first color, and storehouse dish 4580 can have the second color, and staple cartridge channel 4530 can have the 3rd color.In surgeon sees the situation of the first color, surgeon may know that the storehouse 4500 not fired is present in staple cartridge channel 4530；In surgeon sees the situation of the second color, surgeon may know that the storehouse 4500 of percussion is present in staple cartridge channel 4530, and remaining storehouse dish 4580 needs to remove；And in surgeon sees the situation of the 3rd color, surgeon may know that any part of nail bin 4500 is all not kept in staple cartridge channel 4530.

Referring now to Figure 87, in various embodiments, nail bin (such as, nail bin 4600) such as can include compressible implanted warehouse 4610 and the multiple nails 4620 being positioned in warehouse 4610.Warehouse 4610 can include outer layer 4611 and internal layer 4612.In certain embodiments, internal layer 4612 can include being limited to multiple pit therein (such as pit or chamber 4615), and the plurality of pit can be conducive to collapsing of warehouse 4610.In at least one this type of embodiment, internal layer 4612 can include the corrugated or dot matrix of honeycomb configuration, and described dot matrix can bear compression stress or pressure, as long as this compression stress or pressure are less than specific threshold value.When not less than threshold value, internal layer 4612 can be relative to the compression stress applied or pressure with linear or the most linear rate deformation.After compression stress or pressure exceed threshold value, internal layer 4612 can be yielded to suddenly due to compressive load bend greatly and collapse or bend.In various embodiments, the dot matrix of internal layer 4612 can be made up of multiple sublayers 4612a being connectable to together.In at least one embodiment, each sublayer 4612a can include that multiple ditch alternately and ridge or ripple, the plurality of ditch alternately can align with ridge with the ditch alternately of adjacent sublayers 4612a with ridge or ripple.In at least one this type of embodiment, the ditch of the first sublayer 4612a can be positioned so that adjacent with the ridge of the second sublayer 4612a；Similarly, the ridge of the first sublayer 4612a can be positioned so that adjacent with the ditch of the second sublayer 4612a.In various embodiments, adjacent sublayer 4612a can be passed through at least one binding agent (such as, fibrin and/or protein hydrogel) and adhere to each other and/or adhere to outer layer 4611.Figure 88 shows to have collapsed at warehouse 4610 and followed closely 4620 and has deformed capture against warehouse 4610 and keep the nail bin 4600 after tissue T.

Referring now to Figure 89-91, in various embodiments, nail bin (such as, nail bin 4700) such as can include compressible implanted warehouse 4710 and the multiple nails 4720 being positioned in warehouse 4710.With similar to the above, warehouse 4710 can include outer layer 4711 and internal layer 4712, and wherein internal layer 4712 can include multiple sublayer 4712a.Same with similar to the above, each sublayer 4712a can include that ditch 4717 alternately and ridge 4718, described zastrugi alternately can be mutually aligned to limit pit or chamber 4715 betwixt.In at least one this type of embodiment, ditch 4717 and/or ridge 4718 can be along that be parallel to each other and/or be parallel to the axis of longitudinal axis 4709 and extend.In various embodiments, nail 4720 can align in multiple staples, and the plurality of staple can be along that be parallel to each other and/or be parallel to the axis extension of longitudinal axis 4709.Referring again to Figure 87 and Figure 88, in various alternative embodiments, the nail 4620 accommodated in warehouse 4600 can extend along axis, described axis across or be perpendicular to the axis limited by the zastrugi of sublayer 4612a.Referring again to Figure 89-91, nail 4720 can extend across ditch 4717 and ridge 4718, and wherein nail 4720 can be maintained in warehouse 4710 by the frictional force between nail 4720 and sublayer 4712a.In certain embodiments, the plurality of sublayer 4712a can be made up of backing material and/or plastic material (such as PPDO (PDS) and/or polyglycolic acid (PGA)), nail 4720 such as can be maintained at upright orientation and/or be kept into by nail 4720 and relative to each other align, as shown in Figure 89 and Figure 90 by described backing material and/or plastic material.Figure 91 is shown in warehouse 4710 and has collapsed and followed closely 4720 and deformed capture against warehouse 4710 and keep the nail bin 4700 after tissue T.

Refer again to Figure 89-91, in various embodiments, when warehouse 4710 is compressed, warehouse 4710 can with resilience ground or collapse with elastic type.In at least one this type of embodiment, when warehouse 4710 is compressed, ditch 4717 and ridge 4718 ripple formed in each sublayer 4712a can be by graduation or at least substantially by graduation, this can make the cavity 4715 limited between ditch 4717 and ridge 4718 collapse or at least substantially collapse.In all cases, after removing compression stress or pressure from warehouse 4710, at least some of warehouse 4710 or warehouse 4710 can with resilience ground or again stretch with elastic type.In at least one this type of embodiment, when warehouse 4710 is compressed, connection between ditch 4717 and the ridge 4718 of adjacent sublayers 4712a can keep intact or the most intact, make after removing compression stress on warehouse 4710, sublayer 4712a can bias ditch 4717 and itself make it away from each other with ridge 4718, and therefore makes warehouse 4710 the most again stretch.In certain embodiments, when warehouse 4710 is compressed, it can deform or in plastic manner by conquassation, and therefore after removing compression stress or pressure on warehouse 4710, warehouse 4710 can not stretch again.Referring now to Figure 92, in certain embodiments, nail bin (such as nail bin 4800) such as can include can the warehouse 4810 of conquassation, this warehouse of conquassation can include outer layer 4811 and internal layer 4812, wherein internal layer 4812 can include corrugated, the dot matrix of honeycomb configuration, and described dot matrix has the multiple pits or chamber 4815 limited wherein.In various embodiments, the wall of dot matrix limiting internal layer 4812 can include one or more reduction or thin cross section 4819, and that the one or more weakens or thin cross section 4819 can the wall of tolerance bound fixed point battle array be ruptured when warehouse 4810 compresses.In this case, when nail bin 4800 is implanted, warehouse 4810 can be by conquassation.

Referring now to Figure 93-95, in various embodiments, nail bin (such as, nail bin 4900) such as can include warehouse 4910, this warehouse include outer layer 4911 and be positioned at outer layer 4911 top and bottom between multiple crushable members 4912.Referring first to Figure 93 and Figure 94, nail bin 4900 may also include multiple nail 4920, and the most each nail 4920 can be positioned in crushable member 4912.More specifically, each crushable member 4912 can include Part I 4912a, Part II 4012b and Part III 4012c, described Part I 4912a, Part II 4012b and Part III 4012c can limit cavity 4915 the most wherein, and described cavity can accommodate nail 4920.In use, to being described further above, nail bin 4900 can be positioned in staple cartridge channel and tissue contacting surface 4919 can apply compression stress to compress warehouse 4910.When tissue contacting surface 4919 moves downward, crushable member 4912 can be collapsed.In this case, during the Part II 4912b of each crushable member 4912 can be collapsed to the Part I 4912a of correspondence；Similarly, during the Part III 4912c of each crushable member 4912 can be collapsed to the Part II 4912b of correspondence.When warehouse 4910 is compressed and crushable member 4912 is collapsed, nail 4920 deformable being positioned in crushable member 4912, as shown in Figure 95.In various embodiments, the Part II 4912b of each crushable member 4912 can be frictionally engaged correspondence Part I 4912a and/or be press-fitted in correspondence Part I 4912a in, make the compression stress once applied crushable member 4912 exceed the retentivity for being maintained in its extended position (Figure 94) by Part I 4912a and Part II 4912b, then Part I 4912a and Part II 4912b can start relative to each other to slide.Similarly, the Part III 4912c of each crushable member 4912 can be frictionally engaged correspondence Part II 4912b and/or be press-fitted in correspondence Part II 4912b in, make the compression stress once applied crushable member 4912 exceed the retentivity for being maintained in its extended position (Figure 94) by Part II 4912b and Part III 4912c, then Part II 4912b and Part III 4912c can start relative to each other to slide.

In many embodiments as herein described, nail bin can include multiple nail.In various embodiments, this type of nail can by be deformed into substantially U-shaped configuration and have two nail lower limbs metal wire rods constitute.It is contemplated that wherein nail can include other embodiments of various configuration (being such as joined together and have two or more wire rods of three or more nail lower limbs).In various embodiments, for forming cross section that is that one or more wire rods of nail can include circle or that at least substantially justify.In at least one embodiment, staple line material can include any other suitable cross section, such as square and/or the cross section of rectangle.In certain embodiments, nail can be made up of plastic wire.In at least one embodiment, nail can be made up of the metal wire rod being coated with plastics.In various embodiments, except nail in addition to or as follow closely replacement, storehouse can include the securing member of any suitable type.In at least one this type of embodiment, this type of securing member can include that pivotable arm, described arm can be folded when being engaged by anvil block.In certain embodiments, available it is divided into two-part securing member.In at least one this type of embodiment, nail bin can include multiple first fastener portion, and anvil block can include multiple second fastener portion；When anvil block is compressed against nail bin, the second fastener portion is connected to the first fastener portion.In certain embodiments, as it has been described above, sliding part or driver can be advanced in nail bin to complete the forming process of nail.In certain embodiments, sliding part or driver can be advanced in anvil block, in order to make one or more formed parts move downwardly to and engage with relative nail bin and nail or the securing member that is positioned in nail bin.

In various embodiments described herein, nail bin can include being stored in four staples therein.In at least one embodiment, described four staples can be configured to two inner side staples and two outside staples.In at least one this type of embodiment, inner side staple and outside staple can be positioned on the first side of the cutting element in nail bin or cutter slit；Similarly, inner side staple and outside staple can be positioned on the second side of cutting element or cutter slit.In certain embodiments, nail bin can not include cutting element slit；But, this type of nail bin can include that the specific part that can be cut component incision is to substitute nail bin slit.In various embodiments, each inner side staple can be arranged in nail bin so that it equidistantly or is at least substantially equally spaced with cutting element slit.Similarly, each outside staple can be arranged in nail bin so that it equidistantly or is at least substantially equally spaced with cutting element slit.In various embodiments, nail bin can include being stored in nail bin more or less than four staples.In at least one embodiment, nail bin can include six staples.In at least one this type of embodiment, nail bin can include three staples on the first side of cutting element slit, and includes three staples on the second side of cutting element slit.In certain embodiments, nail bin can include odd number staple.Such as, nail bin can include two staples on the first side of cutting element slit, and includes three staples on the second side of cutting element slit.In various embodiments, staple can include the nail with identical or the most identical unshaped staple height.In some other embodiment, one or more staples can include the nail from other nails with different unshaped staple heights.In at least one this type of embodiment, such as nail on the first side of cutting element slit can have the first unshaped height, and the nail on the second side of cutting element slit can have the second unshaped height, described second unshaped height is different from described first height.

Referring now to Figure 96 A-96D, in various embodiments, the end effector of surgical stapling device comprises the steps that storehouse attachment (such as, staple cartridge channel 5030)；The fastener cartridge (such as, nail bin 5000) being removeably positioned in staple cartridge channel 5030；And the jaw 5040 relatively positioned with nail bin 5000 and staple cartridge channel 5030.Nail bin 5000 can include compressible body 5010 and multiple nail 5020 and/or any other the suitable securing member being at least partially situated in compressible body 5010.In at least one this type of embodiment, each nail 5020 can include base portion 5022 and from the upwardly extending lower limb of base portion 5,022 5021, wherein can being embedded at least partially in warehouse 5010 of lower limb 5021.In various embodiments, compressible body 5010 can include top surface or tissue contacting surface 5019 and lower surface 5018, and wherein lower surface 5018 can position against the stayed surface 5031 of staple cartridge channel 5030 and be supported by stayed surface 5031.With similar to the above, stayed surface 5031 such as can include being limited to multiple support slit 5032(Figure 96 D therein), the plurality of support slit 5032 can accommodate and the base portion 5022 of support nail 5020.In various embodiments, the end effector of surgical stapling device may also include holding matrix (such as keep matrix 5050), described holding matrix can jointing nail 5020, and tissue capture is being kept matrix and is following closely between 5020.In at least one this type of embodiment, keep matrix 5050 can be removably attached to jaw 5040.In use, during once nail bin 5000 is positioned in staple cartridge channel 5030, then jaw 5040 and be attached to the holding matrix 5050 of jaw 5040 and can move towards nail bin 5000 and staple cartridge channel 5030.In at least one embodiment, jaw 5040 can move downward along axis 5099 so that when jaw 5040 closes, and jaw 5040 and staple cartridge channel 5030 remain parallel to each other or the most parallel.More specifically, in at least one this type of embodiment, jaw 5040 can be closed, so that when jaw 5040 moves towards nail bin 5000, keeps the tissue contacting surface 5051 of matrix 5050 to be parallel to or at least substantially parallel to the tissue contacting surface 5019 of nail bin 5000.

Referring now to Figure 96 A, in various embodiments, keep matrix 5050 can be detachably secured to jaw 5040 so that when keeping matrix 5050 to be attached to jaw 5040, keep there is the least (if any) relative motion between matrix 5050 and jaw 5040.In at least one embodiment, jaw 5040 can include one or more holding structure, and the one or more keeps structure can be held in place keeping matrix 5050.In at least one this type of embodiment, keep the matrix 5050 can be snap-fitted and/or be press-fitted in jaw 5040.In certain embodiments, can utilize at least one binding agent that holding matrix 5050 is adhered to jaw 5040.In any case, jaw 5040 is moveable in following location: wherein keep matrix 5050 contact tissue T and tissue T to position against the tissue contacting surface 5019 of nail bin 5000.When tissue T is located against nail bin 5000 by jaw 5040, the compressible body 5010 of described nail bin 5000 can be compressed by jaw 5040 or can not be compressed by it.In any one situation, in various embodiments, the lower limb 5021 of nail 5200 can be not passed through tissue contacting surface 5019 projection of nail bin 5000, as shown in Figure 96 A.Additionally, same as shown in Figure 96 A, in the case of retaining matrix 5050 not jointing nail 5020, jaw 5040 can keep tissue T against compressible body 5010.This type of embodiment tolerable surgeon repeatedly open and close jaw 5040, in order to such as obtains end effector expected location in operative site in the case of not damaging tissue T.It is contemplated, however, that other embodiments, wherein nail end 5023 can from tissue contacting surface 5019 projection before warehouse 5010 is compressed by anvil block 5040.Referring now to Figure 96 B, once end effector is properly positioned, then jaw 5040 can move downward towards staple cartridge channel 5030 so that compressible body 5010 is compressed by anvil block 5040, and tissue contacting surface 5019 is pushed down relative to nail 5020.When tissue contacting surface 5019 is pushed down, the end 5023 of nail lower limb 5021 can be pierced tissue contacting surface 5019 and pierces through at least some of of tissue T.In this case, matrix 5050 is kept can be positioned in above nail 5020 to keep the retaining hole 5052 of matrix 5050 to align with the end 5023 of nail lower limb 5021 or at least substantially align.

Referring now to Figure 96 C, when pushing down on holding matrix 5050 along axis 5099, the nail lower limb 5021 of nail 5020 can enter in retaining hole 5052.In various embodiments, the sidewall of the engageable retaining hole of lower limb 5,021 5052 is followed closely.In certain embodiments, described in greater detail below, keeping matrix 5050 can include extending in retaining hole 5052 and/or around one or more holding components of retaining hole 5052, the one or more keeps component can jointing nail lower limb 5021.In any one situation, nail lower limb 5021 can be maintained in retaining hole 5052.In all cases, the end 5023 of nail lower limb 5021 can enter in retaining hole 5052 and can be frictionally engaged holding component and/or the sidewall in hole 5052.When keeping the matrix 5050 base portion 5022 towards nail 5020 to be promoted, nail lower limb 5021 can be relative to sidewall and/or holding member slide.Due to mentioned above, can produce force of sliding friction between nail lower limb 5021 and holding matrix 5050, wherein this type of force of sliding friction can be resisted and keep matrix 5050 to be inserted on nail 5020.In various embodiments, when keeping matrix 5050 along nail lower limb 5021 slide downward of nail 5020, it can be constant or the most constant for keeping the force of sliding friction between matrix 5050 and nail 5020.In certain embodiments, owing to such as following closely lower limb 5021, retaining hole 5052 and/or extend in retaining hole 5052 and/or keep component change in size and geometry around retaining hole 5052, when keeping matrix 5050 along nail lower limb 5021 slide downward, force of sliding friction can increase and/or reduce.In various embodiments, during the compressible body 5010 of nail bin 5000 also can resist holding matrix 5050 insertion nail 5020.More specifically, compressible body 5010 can be such as made up of elastomeric material, described elastomeric material can apply drag to keeping matrix 5050；When the distance that compressible body 5010 is compressed increases, described drag increases.In at least one this type of embodiment, warehouse 5010 increase of the drag produced can be the most proportional to the distance that warehouse 5010 is compressed or the most proportional.In certain embodiments, warehouse 5010 increase of the drag produced can be proportional to the geometric distance ground that warehouse 5010 is compressed.

In various embodiments, to being described further above, jaw 5040 and holding matrix 5050 can be applied enough percussion forces, to overcome above-mentioned drag and frictional force.In use, matrix 5050 is kept can be seated to any suitable depth relative to nail 5020.In at least one embodiment, matrix 5050 is kept can be seated to a depth relative to the base portion 5022 of nail 5020, in order to two-layer or more layers tissue be secured together and produce compression stress or pressure in tissue.In all cases, including the compression stress keeping the system tolerable surgeon of matrix 5050 and nail 5020 by selecting the degree of depth keeping matrix 5050 to be placed to select, tissue to be applied or the size of pressure.Such as, keep matrix 5050 can be pushed down towards the nail base portion 5022 of nail 5020, until keeping matrix 5050 to be seated to and supporting the bottom of slit 5032 at a distance of certain depth 5011, the most shallow degree of depth 5011 can produce the highest compression stress or pressure applied to tissue T, and the deepest degree of depth 5011 can produce the lowest compression stress or pressure applied to tissue T.In various embodiments, the compression stress or the pressure that are applied to tissue T can be the most proportional or the most proportional to the degree of depth 5011 keeping matrix 5050 to be placed.In all cases, the compression stress or the pressure that are applied to tissue T can be depending on the thickness in the tissue T kept between matrix 5050 and nail bin 5020.More specifically, for given distance 5011, the existence of thicker tissue T may compare the existence of thin tissue T and produces higher compression stress or pressure.

In all cases, to being described further above, the degree of depth that surgeon's adjustable holding matrix 5050 is placed is to cause being positioned at the thicker and/or relatively thin tissue of end effector, and in the way of unrelated with tissue thickness, tissue T is applied specific or predetermined pressure.Such as, when fastening relatively thin tissue T, surgeon can be seated to the shallower degree of depth 5011 by keeping matrix 5050, or be seated to the deeper degree of depth 5011 when the tissue T of fastening thicker, in order to reaches identical or the most identical compression stress in tissue.In certain embodiments, to being described further above, surgeon optionally determines the size being pointed to keep the compression stress of the tissue T applying between matrix 5050 and nail bin 5010.In all cases, surgeon can engage keeping matrix 5050 with nail 5020, and matrix 5050 will be kept to be positioned to and base portion 5022 first distance of nail 5020, in order to tissue is applied the first compression pressure.Alternatively, surgeon can be positioned to keeping matrix 5050 and base portion 5022 second distance, and described second distance is shorter than described first distance, in order to tissue is applied more than the second compression pressure of the first pressure.Alternatively, surgeon can be positioned to keeping matrix 5050 with base portion 5022 at a distance of the 3rd distance, and described 3rd distance is shorter than described second distance, in order to tissue is applied more than the 3rd compression pressure of the second pressure.In various embodiments, can allow that target tissue is executed the compression pressure of widening range by surgeon including the fastening system keeping matrix 5050 and nail 5020.

Referring now to Figure 96 D, in various embodiments, nail lower limb 5021 may pass through holding matrix 5050 and is inserted into so that nail lower limb end 5023 extends to keep above the top surface of matrix 5050.Referring again to Figure 96 C, at least one embodiment, jaw 5040 may also include and is limited to mesopore 5042 therein, and when following closely lower limb end 5023 through the retaining hole 5052 kept in matrix 5050, this mesopore can accommodate nail lower limb end 5023.In at least one this type of embodiment, mesopore 5042 can align with retaining hole 5052 so that lower limb 5021 not contact jaw 5040.In various embodiments, mesopore 5042 can have enough degree of depth so that no matter the distance that holding matrix 5050 is placed why, follows closely lower limb 5021 the most not contact jaw 5040.Referring now to Figure 96 D, after keeping matrix 5050 to engage with nail 5020 and be placed to desired location, staple cartridge channel 5030 and jaw 5040 can move away from tissue T.More specifically, staple cartridge channel 5030 can separate with the nail bin 5000 implanted, and anvil block 5040 can separate with the holding matrix 5050 implanted.When away from holding matrix 5050, traveling and nail support member 5032 move jaw 5040 away from nail base portion 5022, although jaw 5040 and staple cartridge channel 5030 are no longer to keeping matrix 5050 and base portion 5022 to provide support, but still can keep the distance 5011 between the bottom of matrix 5050 and base portion 5022.In various embodiments, although the warehouse compressed 5010 and/or the tissue T compressed are to keeping matrix 5050 to apply bias force, but nail lower limb 5021 and keep the stiction between matrix 5050 can be enough to be held in place holding matrix 5050.In at least one this type of embodiment, warehouse 5010 can be made up of elastomeric material, described elastomeric material when compressed can be to keeping matrix 5050 and nail 5020 applying elastic bias force, described elastic bias force is propulsive and keeps matrix 5050 and nail 5020 so that it separates, but this type games resisting by the frictional engagement between nail lower limb 5021 and holding matrix 5050.

In various embodiments, as it has been described above, keep matrix can include multiple retaining hole, the most each retaining hole can accommodate the lower limb of securing member wherein.In at least one embodiment, referring now to Figure 97, there is shown the part keeping matrix 5150, this part can include the retaining hole 5152 limited by periphery 5156.In various embodiments, the periphery 5156 in hole 5152 can include circular or at least substantially circular profile and/or any other suitable profile.In certain embodiments, keep matrix 5150 can include one or more holding component (such as keeping component 5153), when the one or more keeps component to extend in hole 5152 and can work as in fastener leg insertion hole 5152, described hole 5152 engages this fastener leg.In at least one this type of embodiment, each holding component 5153 can include towards central axis 5159(i.e., towards the center in hole 5152) cantilever that extends internally.In various embodiments, each cantilever can include that first end and the second end, described first end are attached to keep matrix main body 5158, and described the second end forms the periphery 5156 of retaining hole 5152.In certain embodiments, the periphery 5156 of retaining hole 5152 can be limited by the first diameter or width, and fastener leg can be limited by Second bobbin diameter or width, and wherein said Second bobbin diameter can be more than described first diameter.In at least one this type of embodiment, fastener leg can contact and keeps one or more in component 5153 and make it bend, in order to make the diameter of retaining hole 5152 increase when fastener leg is inserted in retaining hole 5152.In certain embodiments, to being described further above, the periphery that fastener leg is limited can be more than the periphery 5156 of retaining hole 5152 so that when fastener leg is inserted in periphery 5156, fastener leg can make periphery 5156 extend.

Referring again to Figure 97, in various embodiments, hole 5152 can be limited by deformable member 5153, the most each deformable member 5153 can relative to or bend independent of other deformable members 5153.In at least one this type of embodiment, adjacent deformable member 5153 can be separated by slit 5154, and this slit can allow that each deformable member 5153 bends relative to other deformable members 5153.In certain embodiments, each slit 5154 can include the first end 5155 in keeping matrix main body 5158, the second end leading to retaining hole 5152 and the constant or the most constant width extended between first end 5155 and the second end.In other embodiments various, the width of each slit 5154 can be inconsistent, and the width that each slit 5154 is between its first end and the second end can increase and/or reduce.In certain embodiments, the first end 5155 of slit 5154 can include amplifier section (such as circular portion), described amplifier section both can be to be attached to keep the base portion of the deformable member 5153 of matrix main body 5158 to provide release of tension, it is possible to increases the flexibility of deformable member 5153.In various embodiments, the geometry of deformable member 5153 and/or slit 5154 can be selected to deformable member 5153 and provide desired flexibility.In certain embodiments, such as slit 5154 can be lengthened out, and to form longer deformable member 5153, this longer deformable member is the most flexible than the deformable member 5153 with short length.In at least one embodiment, the width of each deformable member 5153 can be selected to it and provide desired flexibility.More specifically, the deformable member with relatively thin width is the most flexible than the deformable member with thicker width.Refer again to Figure 97, in certain embodiments, the second end being attached to keep the first end of matrix main body 5158 can be wider than cantilever of the cantilever of deformable member 5153.In at least one this type of embodiment, cantilever can between its first end and the second end by linearly or the most linear in the way of be tapered.

Refer again to Figure 97, in various embodiments, keep matrix main body 5158 can include the flat or the most flat material piece with tissue contacting surface 5151 and top surface 5157.In at least one this type of embodiment, tissue contacting surface 5151 can be parallel to each other or be at least substantially parallel to each other with top surface 5157.In various embodiments, each deformable member 5153 can include Part I 5153a and Part II 5153b, and wherein Part I 5153a can extend in a first direction, and Part II 5153b can extend along different directions or second direction.In at least one this type of embodiment, keep matrix main body 5158 can limit plane, and the Part I 5153a of deformable member 5153 can be located in this plane.In various embodiments, the Part II 5153b of deformable member 5153 angularly can extend relative to Part I 5153a.In at least one this type of embodiment, Part II 5153b can extend along the direction away from the top surface 5157 keeping matrix main body 5158, and in certain embodiments, Part II 5153b can assemble towards the central axis 5159 of retaining hole 5152.In any case, in various embodiments, when fastener leg is inserted into through Part II 5153b, Part II 5153b can bend away from central axis 5159.The nail lower limb 5021 of nail 5020 inserts in the embodiment in retaining hole 5152 wherein, and deformable member 5153 can be along the Direction distortion of the base portion 5122 generally away from nail 5120.Therefore, in certain embodiments, deformable member 5153 can be along the general direction flexure identical or the most identical with the direction that nail lower limb 5021 is inserted into.

Referring again to figure BD, in various embodiments, the Part II 5153b of deformable member 5153 such as can each include sharp end, and described sharp end can work as nail lower limb 5021 when being inserted, and described end slides against nail lower limb 5021.If nail lower limb 5021 (that is, the direction removed from retaining hole 5052 by nail lower limb 5021) in opposite direction is pulled, then the sharp tips of Part II 5153b also is able to occlusion to following closely in lower limb 5021.In some cases, Part II 5153b can be tilted more than the angle of 90 degree relative to the limit of nail lower limb 5021, and therefore when following closely lower limb 5021 by tending to the power withdrawing from nail lower limb 5021 from retaining hole 5052, Part II 5153b can dig or be dug in the limit of nail lower limb 5021.In certain embodiments, nail lower limb 5021 can include that impression and/or concavity (such as micro-indentations), described impression and/or concavity can accommodate the end of deformable member 5053 the most wherein in its surface.In at least one this type of embodiment, when nail lower limb 5021 is applied withdraw from power, the end of deformable member 5053 can be confined in or be dug in the impression of nail lower limb 5021.In various embodiments, owing to Part II 5153b is dug in nail lower limb 5021, Part II 5153b can only be seated to the power acted on for removing nail lower limb 5021 from retaining hole 5022 follow closely the deeper inside in lower limb 5021 and increase removes the nail desired power of lower limb 5021.Additionally, due to Part II 5153b is inclined upwardly, the most at least one embodiment, Part II 5153b can more allow that nail lower limb 5021 inserts withdrawing from retaining hole 5152 and more resistant to nail lower limb 5021.Therefore, at least one embodiment, desired power in retaining hole 5022 of being inserted by nail lower limb 5021 is smaller than removing the nail desired power of lower limb 5021 from retaining hole 5022.In various embodiments, from retaining hole 5022, the nail desired power of lower limb 5021 is such as removed than nail lower limb 5021 being inserted desired power about 50% in retaining hole 5022.In other embodiments various, such as, remove the nail desired power of lower limb 5021 than inserting between the nail desired power of lower limb 5021 about 10% to about 100%.In certain embodiments, such as removing the nail desired power of lower limb 5021 can be to insert nail about the 100% of the desired power of lower limb 5021, about 150%, about 200% and/or ratio to insert the nail desired power of lower limb 5021 about 200%.

Referring again to Figure 97, in certain embodiments, Part II 5153b can circumferentially arrange around hole 5152 and can limit pit between Part II 5153b and hole 5152.More specifically, Part II 5153b can limit pit 5160, this pit can work as fastener leg when being inserted in retaining hole 5152, and pit 5160 accommodates the end of fastener leg.In various embodiments, the Part II 5153b of deformable member 5153 can include annular or at least substantially annular profile, and described profile such as can limit the annular of pit 1560 or at least substantially annular profile collaboratively.In at least one this type of embodiment, Part II 5153b can limit taper or truncated cone shape pit.In various embodiments, pit can be limited by suitable number of deformable member, such as four deformable member 5153(Figure 97), six deformable member 5153(Figure 98) or eight deformable member 5153(Figure 99).Referring now to Figure 100, the deformable member, in certain embodiments, keeping matrix (such as keeping matrix 5250) such as can form cone shape or at least substantially for the shape of cone.In various embodiments, keeping matrix 5250 such as can include multiple retaining hole (such as retaining hole 5252), the plurality of retaining hole can be limited by periphery 5256.In various embodiments, periphery 5256 can include polygonal or be at least substantially polygonal profile and/or other suitable profiles.In certain embodiments, keep matrix 5250 can include one or more holding component (such as keeping component 5253), when the one or more keeps component to extend in hole 5252 and can work as in fastener leg insertion hole 5252, described hole 5252 engages this fastener leg.In at least one this type of embodiment, each holding component 5253 can include towards central axis 5259(i.e., towards the center in hole 5252) cantilever that extends internally.In various embodiments, each cantilever can include that first end and the second end, described first end are attached to keep matrix main body 5258, and described the second end forms the periphery 5256 of retaining hole 5252.In certain embodiments, the periphery 5256 of retaining hole 5252 can be limited by the first diameter or width, and fastener leg can be limited by Second bobbin diameter or width, and wherein said Second bobbin diameter can be more than described first diameter.In at least one this type of embodiment, fastener leg can contact and keeps one or more in component 5253 and make it bend, in order to make the diameter of retaining hole 5252 increase when fastener leg is inserted in retaining hole 5252.In certain embodiments, to being described further above, the periphery that fastener leg is limited can be more than the periphery 5256 of retaining hole 5252 so that when fastener leg is inserted in periphery 5256, fastener leg can make periphery 5256 extend.

Referring again to Figure 100, in various embodiments, hole 5252 can be limited by deformable member 5253, the most each deformable member 5253 can relative to or bend independent of other deformable members 5253.In at least one this type of embodiment, adjacent deformable member 5253 can be separated by slit 5254, and slit 5254 can allow that each deformable member 5253 bends relative to other deformable members 5253.In various embodiments, matrix main body 5258 is kept can to include the flat or the most flat material piece with tissue contacting surface 5251 and top surface 5257.In at least one this type of embodiment, tissue contacting surface 5251 can be parallel to each other or be at least substantially parallel to each other with top surface 5257.In various embodiments, each deformable member 5253 can include Part I 5253a and Part II 5253b, and wherein Part I 5253a can extend in a first direction, and Part II 5253b can extend along different directions or second direction.In at least one this type of embodiment, keep matrix main body 5258 can limit plane, and the Part I 5253a of deformable member 5253 can be located in this plane.In various embodiments, the Part II 5253b of deformable member 5253 angularly can extend relative to Part I 5253a.In at least one this type of embodiment, Part II 5253b can extend along the direction away from the top surface 5257 keeping matrix main body 5258, and in certain embodiments, Part II 5253b can assemble towards the central axis 5259 of retaining hole 5252.In any case, in various embodiments, Part II 5253b can work as fastener leg through Part II 5253b when being inserted into, and Part II 5253b can bend away from central axis 5259.Referring again to Figure 100, in certain embodiments, Part II 5253b can circumferentially arrange around hole 5252 and can limit pit between Part II and hole.More specifically, Part II 5253b can limit pit, when fastener leg is inserted in retaining hole 5252, described pit accommodates the end of fastener leg.In various embodiments, the Part II 5253b of deformable member 5253 such as can limit polygon or at least substantially for polygonal pit.In various embodiments, pit can be limited by suitable number of deformable member, such as, can limit foursquare four deformable member 5253(Figure 100), hexagonal six deformable member 5253(Figure 101 can be limited), maybe can limit octagonal eight deformable member 5253(Figure 102).

Referring now to Figure 103, in various embodiments, keep matrix (such as, keeping matrix 5350) such as can be formed by flat or the most flat material (such as, titanium and/or rustless steel) thin slice.In at least one this type of embodiment, multiple hole 5352 can be formed by one or more punching courses in the main body 5358 keeping matrix 5350.Material piece can be positioned in diel, and some part of material can be stamped out by described mould when activating, in order to forms the hole 5355 of such as slit 5354, slit 5354 and/or the periphery 5356 of retaining hole 5352.Diel also is able to deformable member 5353 is bent to suitable configuration.In at least one this type of embodiment, diel can make Part II 5353b upwardly-deformed relative to Part I 5353a along broken line 5353c.Referring now to Figure 104, in various embodiments, keep matrix (such as, keeping matrix 5450) such as can include multiple retaining hole 5452.With similar to the above, the periphery 5456 of each retaining hole 5452 can be limited by multiple deformable members 5453 spaced apart by slit or slit 5454.In at least one this type of embodiment, the entirety of each deformable member 5453 all can be bent upwards, and the free end including the cantilever of deformable member 5453 can limit periphery 5456.In various embodiments, keep matrix 5450 can include around or at least substantially about multiple holes 5455 of retaining hole 5452.In at least one this type of embodiment, hole 5455 can around or surround the periphery that limited by the fixing end of the cantilever of deformable member 5453 and be arranged to circular array.In certain embodiments, each hole 5455 can include circular or at least substantially circular periphery and/or any other suitable periphery.In use, hole 5455 both can be to be attached to keep the base portion of the deformable member 5453 of matrix main body 5458 to provide release of tension, can increase again the flexibility of deformable member 5453.In various embodiments, bigger hole 5455 can make deformable member 5453 the most flexible compared with less hole 5455.Additionally, bigger flexibility can be provided compared with farther hole 5455 closer to the hole 5455 of deformable member 5453.

Referring now to Figure 105, in various embodiments, keep matrix (such as, keeping matrix 5550) such as can include multiple retaining hole 5552.Each retaining hole 5552 may each comprise elongated slot 5554, and this elongated slot has the circular of amplification or at least substantially circular end 5555.In at least one this type of embodiment, end 5555 can be limited by the diameter being wider than slit 5554.In certain embodiments, elongated slot 5554 and end 5555 can position along longitudinal axis 5559 and/or between two parties.In various embodiments, slit 5554 and end 5555 can limit two relative inserted sheets 5553, the relative inserted sheet 5553 of said two can the lower limb of jointing fastener, and when fastener leg is inserted into through inserted sheet 5553, the relative inserted sheet 5553 of said two can bend.In at least one embodiment, the end 5555 with the biggest girth or diameter can limit the longest inserted sheet 5553, and described inserted sheet 5553 is the most flexible than the inserted sheet 5553 that the end 5555 with less girth or diameter is limited.In various embodiments, end 5555 can have identical girth and diameter, and at least one this type of embodiment, each inserted sheet 5553 can be about the axisymmetrical vertical or the most vertical with longitudinal axis 5559.Alternatively, end 5555 can have different girths and/or diameter, and the most at least one embodiment, each inserted sheet 5553 can be not in relation to its axisymmetrical.At at least one in this type of alternative embodiment, when fastener leg is inserted into through retaining hole 5552, inserted sheet 5553 can distort around its axis.Referring now to Figure 106, in various embodiments, keep matrix (such as, keeping matrix 5650) such as can include multiple retaining hole 5652.Each retaining hole 5652 may each comprise elongated slot 5654, and this elongated slot includes circular or at least substantially circular end 5655.In at least one this type of embodiment, elongated slot 5654 and end 5655 can position along longitudinal axis 5659 and/or between two parties.In various embodiments, each end 5655 all can be limited by the diameter identical or the most identical with the width of slit 5654.

Referring now to Figure 107, in various embodiments, keep matrix (such as, keeping matrix 5750) such as can include multiple retaining hole 5752.Each retaining hole 5752 can include multiple slits (such as slit 5754) with enlarged distal end 5755.In at least one this type of embodiment, slit 5754 and end 5755 can position along longitudinal axis 5759 and/or between two parties.In various embodiments, axis 5759 can extend along perpendicular or transverse to direction each other.In certain embodiments, slit 5754 and end 5755 can such as limit four inserted sheets 5753, described four inserted sheets 5753 can jointing fastener supporting leg, and when fastener leg is through retaining hole 5752 when being inserted into, and described four inserted sheets 5753 bend.In at least one embodiment, each inserted sheet 5753 can include triangle or at least substantially for the configuration (such as equilateral triangle) of triangle.Referring now to Figure 108, in other embodiments various, keep matrix (such as keeping matrix 5850) such as can include multiple retaining hole 5852.Each retaining hole 5852 can include multiple slits (such as slit 5854) with end 5855, and wherein slit 5854 and end 5855 can position along longitudinal axis 5859 and/or between two parties.In various embodiments, axis 5859 can extend along perpendicular or transverse to direction each other.In certain embodiments, slit 5854 and end 5855 can limit inserted sheet 5853, inserted sheet 5853 can jointing fastener supporting leg, and when fastener leg is through retaining hole 5852 when being inserted into, and inserted sheet 5853 bends.In at least one embodiment, each inserted sheet 5853 can include the profile of arch.More specifically, different from the end of the point shown in Figure 105, each inserted sheet 5853 can include the end of bending, and described end can contact fastener leg.

Referring now to Figure 109, in various embodiments, keep matrix (such as, keeping matrix 5950) such as can include multiple retaining hole 5952.Each retaining hole 5952 can include multiple slit (such as slit 5954), and the most each slit 5954 can extend along axis 5959 and/or between two parties.In various embodiments, axis 5959 can transversely to one another, and at least one this type of embodiment, axis 5959 can be disposed so that all axis 5959 extend through the center of retaining hole 5952 and ground equally spaced from each other or are at least substantially equally spaced.In at least one embodiment, each slit 5954 can include the center towards retaining hole 5952 opening and be positioned at slit 5954 opposed ends second or Guan Bi end 5955.With similar to the above, slit 5954 and end 5955 can such as limit three inserted sheets 5953, described three inserted sheets 5953 can jointing fastener supporting leg, and when fastener leg is through retaining hole 5952 when being inserted into, and described three inserted sheets 5953 bend.In various embodiments, each inserted sheet 5953 may be included in the arcuate configuration extended between the adjacent end 5955 of slit 5954.Referring now to Figure 110, in various embodiments, keep matrix (such as, keeping matrix 6050) such as can include multiple retaining hole 6052.Each retaining hole 6052 can include inserted sheet 6053, described inserted sheet can jointing fastener supporting leg, and when fastener leg is inserted in retaining hole 6052, inserted sheet 6053 bends.In at least one this type of embodiment, inserted sheet 6053 can include the base portion being fixed to keep matrix main body 6058 and include arch or the free end of curved profile 6056, and described free end can contact fastener leg.In certain embodiments, fastener leg can be the nail lower limb being made up of circular wire rod, and the profile 6056 wherein bent can be mated with the crooked outer surface of circular wire rod or at least substantially mate.

Refer again to Figure 110, in various embodiments, keep matrix main body 6058 can include that multiple slit 6054 and hole 6055, the plurality of slit 6054 and hole 6055 can limit inserted sheet 6053 and the various piece of retaining hole 6052.In at least one embodiment, inserted sheet 6053 can include that rectangular configuration, described rectangular configuration include parallel or the most parallel limit.Referring now to Figure 111, in certain embodiments, keep matrix (such as keeping matrix 6150) such as can include multiple retaining hole 6152.Each retaining hole 6152 can include inserted sheet 6153, this inserted sheet can jointing fastener supporting leg, and when fastener leg is inserted in retaining hole 6152, this inserted sheet bends.In at least one this type of embodiment, inserted sheet 6153 can include the base portion being fixed to keep matrix main body 6158 and include arch or the free end of curved profile 6156, and described free end can contact fastener leg.In various embodiments, matrix main body 6158 is kept can to include that multiple slit 6154 and hole 6155, the plurality of slit 6154 and hole 6155 can limit inserted sheet 6153 and the various piece of retaining hole 6152.In at least one embodiment, inserted sheet 6153 can include that tapered configuration, described tapered configuration include the limit of arch.In at least one this type of embodiment, inserted sheet 6153 can geometrically be tapered, such as, make base portion be wider than free end.

In various embodiments, as it has been described above, fastening system can include that multiple nail, the plurality of nail include the nail lower limb being inserted into through the multiple retaining holes kept in matrix.In certain embodiments, as being hereafter more fully described, nail can be maintained in the first jaw, and keeps matrix can be maintained in the second jaw, and wherein at least one in the first jaw and the second jaw can be moved towards another one.In all cases, being positioned at the nail in the first jaw can be fixed on wherein so that when keeping matrix to engage with nail lower limb, nail lower limb aligns with retaining hole.Seeing Figure 112 and Figure 113, in certain embodiments, closure system can include the holding matrix 6250 in the nail bin 6200 being such as positioned in the first jaw of surgical stapling device and the second jaw being such as positioned at surgical stapling device.Referring now to Figure 119 and Figure 120, to being described further above, keep matrix 6250 can include that multiple retaining hole 6252, the most each retaining hole 6252 can include the periphery 6256 limited by one or more deflection components 6253.In at least one this type of embodiment, to being described further above, pit 6201 can be limited for limiting the deflection component 6253 in each hole 6252.In various embodiments, each pit 6201 can include such as bending and/or concave surface, and described bending and/or concave surface such as can be unjustified with retaining hole 6252 at nail lower limb and first contact in the situation of deflection component 6253 and/or tissue contacting surface 6251 and will follow closely the end guiding of lower limb in hole 6252.

In various embodiments, to being described further above, fastening system may also include multiple nail 6220, and the plurality of nail 6220 includes may pass through the nail lower limb 6221 keeping retaining hole 6252 in matrix 6250 and be inserted into.In at least one this type of embodiment, each nail 6220 can include that the most substantially U-shaped cross section configuration, described configuration include that base portion 6222, described nail lower limb 6221 can upwardly extend from base portion 6222.Referring now to Figure 115 and Figure 116, in various embodiments, keeping the retaining hole 6252 in matrix 6250 can be arranged to such as two parallel or the most parallel stringers, described stringer along keeping the longitudinal axis of matrix or can be parallel to the extension of described longitudinal axis.In certain embodiments, the retaining hole 6252 in first row can bias or stagger arrangement relative to the retaining hole 6252 in second row.In at least one this type of embodiment, the first nail lower limb 6221 that each nail 6220 can include being positioned in the retaining hole 6252 of first row and be positioned at second row retaining hole 6252 in the second nail lower limb 6221, therefore base portion 6222 can extend along the direction across the longitudinal axis keeping matrix 6250.In at least one this type of embodiment, nail 6220 can be parallel to each other or be at least substantially parallel to each other.More specifically, the base portion 6222a such as following closely 6220a can be parallel to or can be parallel at least substantially parallel to the base portion 6222b, the base portion 6222b of described nail 6220b following closely 6220b or at least substantially parallel to the base portion 6222c following closely 6220c.In at least one embodiment, the plane that the such as plane that limited of nail lower limb 6221a of nail 6220a can be parallel to or be limited at least substantially parallel to the nail lower limb 6221b of nail 6220b, and the plane that limited of the nail lower limb 6221b following closely 6220b can be parallel to or follows closely, at least substantially parallel to follow closely 6220c, the plane that lower limb 6221 is limited.

Referring now to Figure 112 and Figure 114, in various embodiments, nail bin 6200 can include multiple nail 6220 and include the alignment matrix 6260 of multiple alignment guide (such as, slit, groove and/or hole), and the plurality of alignment guide can be alignd nail 6220.In all cases, alignment matrix 6260 enables to before keeping matrix 6250 jointing nail lower limb 6221, and the nail lower limb 6221 of nail 6220 aligns with keeping the retaining hole 6252 in matrix 6250.Referring now to Figure 117 and Figure 118, in various embodiments, alignment matrix 6260 can include that multiple alignment hole 6262, the plurality of alignment hole can be closely received the nail lower limb 6221 of nail 6220.In at least one this type of embodiment, each nail 6220 can include base portion 6222 and two the nail lower limbs 6221 extended from base portion 6222, wherein nail 6220 base portion 6222 can around keep matrix 6260 lower surface 6264 extend, and follow closely lower limb 6221 may pass through alignment hole 6262 and upwardly extend.In certain embodiments, each alignment hole 6262 can be circle or at least substantially circular, and the diameter following closely lower limb 6221 that the diameter limiting alignment hole 6262 can extend equal to or slightly greater than passing through.In various embodiments, alignment matrix 6260 may also include the component 6263 of multiple projection, the component of the plurality of projection can upwardly extend from the top surface 6261 of alignment matrix 6260 and around or at least partly surround alignment hole 6262.In certain embodiments, protruding component 6263 can provide longer alignment hole 6262, and the most in all cases, longer hole 6262 may compare short hole 6262 and better controls over the alignment of nail lower limb 6221.

In use, in various embodiments, the first jaw supporting nail bin 6200 can be located on the side of the tissue being sewn, and support and keep the second jaw of matrix 6250 can be positioned on the opposite side of tissue.In certain embodiments, once jaw is properly positioned relative to tissue, then the second jaw and holding matrix 6250 can move towards nail bin 6200.In various embodiments, when following closely lower limb 6221 and being inserted into through the retaining hole 6252 keeping matrix 6250, keep the tissue contacting surface of matrix 6250 or the lower surface 6251 can contact tissue being pressed against by tissue on tissue contacting surface or the top surface 6261 of alignment matrix 6260.In other embodiments various, as described in more detail below, nail bin 6200 also can such as include being positioned at above the top surface 6261 of alignment matrix 6260 and can the compressible warehouse of contact tissue.Referring again to Figure 114 and Figure 118, in certain embodiments, alignment matrix 6260 may also include and is limited to one or more hole 6203；When alignment matrix 6260 positions against tissue, the one or more hole can accommodate a part for tissue wherein.The most compressible warehouse is positioned at above alignment matrix 6260 and/or against in the embodiment of alignment matrix 6260, and when warehouse is compressed, a part for compressible warehouse can be in access aperture 6203.Similarly, keeping matrix 6250 can include multiple hole 6202, when keeping matrix 6250 to position against tissue, the plurality of hole 6202 can accommodate at least some of of tissue wherein.

To being described further above, when the nail lower limb 6221 following closely 6220 is inserted into through the retaining hole 6252 keeping matrix 6250, the end of nail lower limb 6221 can be from keeping the top surface 6257 of matrix 6250 upwardly.In all cases, as it has been described above, the end of nail lower limb 6221 can be inserted into keep afterwards not bending through retaining hole 6252.Referring now to Figure 121-124; in certain embodiments; fastening system including nail bin 6200 and holding matrix 6250 can include multiple protective cap or lid (such as cap 6270), and the plurality of protective cap or lid can mount to be projected on the nail lower limb 6221 kept above matrix 6250.In various embodiments, each cap 6270 can the sharp tips of completely or at least partially covering nail lower limb 6221 so that described sharp tips will not contact the tissue being adjacent.Referring now to Figure 124, at least one embodiment, each cap 6270 can include being limited to hole 6271 therein, and this hole can be closely received the end of nail lower limb 6221 wherein.In various embodiments, cap 6270 can be made up of elastomeric material (such as siloxanes, polyisoprene, Sanoprene and/or natural rubber).In at least one embodiment, the girth in hole 6271 or diameter are smaller than the girth of nail lower limb 6221 or the diameter being inserted.In at least one this type of embodiment, the hole 6271 in protective cap 6270 is expansible to accommodate nail lower limb 6221 wherein.In various alternative embodiments, cap 6270 may not include hole, and when lower limb 6221 inserts cap 6270, the end of nail lower limb 6221 can cut cap 6270.In any case, in various embodiments, each cap 6270 all can be seated to follow closely on lower limb 6221, until the base portion 6272 of cap 6270 is adjacent or positions adjacent to the top surface 6257 keeping matrix 6250.In all cases, cap 6270 enable to its by be closely seated to follow closely lower limb 6221 end on, so as not to be removed from described end easily.In certain embodiments, each cap 6270 can such as include taper or the outer surface of at least substantially taper.In various embodiments, cap 6270 can include any suitable shape, such as, include the shape of parabola shaped or the most parabola shaped outer surface.

In various embodiments, the surgical stapling device shown in Figure 125-127 such as can be used to dispose the most above-mentioned closure system.In various embodiments; end effector can include the first jaw or staple cartridge channel 6230 and the second jaw 6240; nail bin 6200 can be supported on wherein by the first jaw or staple cartridge channel 6230, and the second jaw 6240 can support holding matrix 6250 and the plurality of protective cap 6270.Referring first to Figure 125, it illustrates and is in the second jaw 6240 opening configuration, relative to tissue T, jaw 6230 and 6240 can be positioned such that tissue T is keeping between matrix 6250 and nail bin 6200.In various embodiments, as it has been described above, nail bin 6200 may also include compressible warehouse (such as warehouse 6210), described compressible warehouse can position nail 6220 and alignment matrix 6260.In at least one this type of embodiment, tissue T can position against the top surface of warehouse 6210.In certain embodiments; second jaw 6240 can include multiple depressed part or hole 6245 and one or more holding structure or keeper; the plurality of depressed part or hole 6245 can accommodate multiple protective cap 6270, and the one or more keeps structure or keeper can be held in place by holding matrix 6250 relative to cap 6270.In at least one this type of embodiment, matrix 6250 is kept to be maintained in hole 6245 by cap 6270.Referring now to Figure 137, in various embodiments, each hole 6245 all can be by contained therein for part or all of cap 6270.In certain embodiments, be sufficiently set to and can be for instance such that can be by being press-fitted and/or cap 6270 is fixed in hole 6245 by least one in snap fit features for the size in hole 6245.In certain embodiments, at least one binding agent can be utilized to be fixed in hole 6245 by cap 6270.In at least one this type of embodiment, this type of binding agent may be chosen such that cap 6270 can separate with the second jaw 6240 after cap 6270 jointing nail lower limb 6221 and the second jaw 6240 move away from the fastener assembly implanted.Referring now to Figure 138, in certain embodiments, the second jaw 6240 may also include at least one emulsion sheet 6246, and at least one emulsion sheet described can be assembled to the second jaw 6240 and may extend into above cap 6270 and be maintained in hole 6245 by cap 6270.In at least one this type of embodiment, such as, can utilize at least one binding agent that emulsion sheet 6246 is fixed to jaw 6240 at least partially.In use, at least one embodiment, before end effector is inserted into operative site, emulsion sheet 6246 can separate with jaw 6240 at least in part.In certain embodiments, emulsion sheet 6246 can be made up of implanted material (such as PDS and/or PGA), and when following closely lower limb 6221 and showing from holding matrix 6250, described implanted material can be cut by nail lower limb 6221.In at least one this type of embodiment, emulsion sheet 6246 can be fixed in fastening system between lid 6270 and holding matrix 6250.

Referring now to Figure 126, to being described further above, jaw 6240 can move to make position from open position, and in make position, tissue T positions against holding matrix 6250 and warehouse 6210.In this type of position, holding matrix 6250 can not jointing nail 6220.In various embodiments, jaw 6240 can be moved between its open position and its make position by actuator 6235.In at least one this type of embodiment, jaw 6240 can include distal pin 6243 and the proximal pin 6244 extended from it, wherein distal pin 6243 vertically or at least substantially vertically can be slided in the distally slit 6233 in being limited to storehouse passage 6230, and wherein proximal pin 6244 vertically or at least substantially vertically can be slided in the proximal slot 6234 in being limited to staple cartridge channel 6230 equally.In use, actuator 6235 can proximally be retracted, to be driven to the upper end of its corresponding slit 6233 and 6234 by pin 6243 and 6244, as shown in Figure 126.In at least one this type of embodiment, actuator 6235 can include that distally drives slit 6236 and nearside to drive slit 6237, wherein drive slit 6236 with 6237 sidewall can contact distal pin 6243 and proximal pin 6244 respectively, and drive up pin 6243 and 6244 when actuator 6235 proximally moves.More specifically, when actuator 6235 proximally moves, distal pin 6243 can make distally drive the Part I 6236a upward sliding of inclination of slit 6236 in mid portion or Part II 6236b；Similarly, proximal pin 6244 can make distally drive the Part I 6237a upward sliding of inclination of slit 6237 in mid portion or Part II 6237b.When pin 6243 and 6244 both of which moves upward, jaw 6240 can rotate down to make position towards tissue T.

Referring now to Figure 127; to being described further above; actuator 6235 can the most proximally be pulled, to push down on the second jaw 6240, compression warehouse 6210 towards the first jaw 6230 and to make holding matrix 6250 and multiple protective cap 6270 engage with the nail lower limb of nail 6220.In at least one this type of embodiment, the additional proximal movement of actuator 6235 can make the sidewall of driving slit 6236 and 6237 contact plug 6243 respectively and 6244 and respectively towards the downward drive pin in bottom 6243 and 6244 of slit 6233 and 6234.In this case, actuator 6235 can proximally be pulled, distal pin 6243 is made to leave the Part II 6236b driving slit 6236 the Part III 6236c entering inclination, and similarly, proximal pin 6244 leaves the Part II 6237b driving slit 6237 the Part III 6237c entering inclination.When pin 6243 and 6244 both of which moves downward, the second jaw 6240 can move downwardly to firing position towards the first jaw 6230.In at least one this type of embodiment, the second jaw 6240 can move downward so that keeps matrix 6250 to remain parallel to or at least substantially parallel to the top surface of warehouse 6210 and/or be parallel to or at least substantially parallel to alignment matrix 6260.In any case, once keep matrix 6250 and the nail lower limb 6221 of protective cap 6270 jointing nail 6220, as shown in Figure 129, then the second jaw 6240 may return to open or at least substantially open position.In at least one this type of embodiment, actuator 6235 can be promoted towards distally, with the end that pin 6243 and 6244 is driven respectively to slit 6233 and 6234, and the most once sell through corresponding mid portion 6236b and 6237b driving slit 6236 and 6237, then actuator 6235 is driven downwards towards the bottom of slit 6233 and 6234.Once the second jaw 6240 is opened, then the first jaw 6230 can separate with the nail bin 6200 implanted, and the first jaw 6230 and the second jaw 6240 can remove from the fastener assembly implanted, as shown in Figure 128.

Referring again to Figure 127, reader will note that, although keeping matrix 6250 and cap 6270 jointing nail lower limb 6221, but pin 6243 and 6244 not being shown as being placed in the bottommost of its respective slots 6233 and 6234 by figure.When thick tissue T can occur this situation when keeping between matrix 6250 and warehouse 6210.Referring now to Figure 130, the most relatively thin tissue T is in keeping the situation between matrix 6250 and warehouse 6210, and pin 6243 and 6244 can be driven downwards further to its corresponding slit 6233 and 6234, as shown in Figure 132.In general; in at least one this type of embodiment; actuator 6235 can proximally be pulled; come upwardly or downwardly drive pin 6243 and 6244 will pass through the process shown in above-mentioned and Figure 130-132; and owing to tissue T is relatively thin; keep matrix 6250 and protective cap 6270 can be driven to further follow closely on the nail lower limb 6221 of 6220, as shown in Figure 133 and Figure 134.In various embodiments, due to the adjustable keeping matrix 6250 to be provided, it is thick or thin for no matter capturing the tissue in end effector, all can obtain identical or the most identical compression pressure in the tissue fastened.In certain embodiments, the adjustable tolerable surgeon keeping matrix 6250 to be provided applies, by selecting the degree of depth keeping matrix 6250 to be placed to select tissue, the compression pressure that bigger compression pressure is the least.In at least one this type of embodiment, the scope keeping matrix 6250 can be seated to follow closely on lower limb 6221 such as can be determined by the length of slit 6233 and 6234 or scope.

In various embodiments, as it has been described above, protective cap 6270 can be made up of soft or flexibility the material of the end that such as can promptly follow closely lower limb 6221.In certain embodiments, protective cap 6270 can be by bioabsorbable plastics (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), polycaprolactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL) and/or biocompatibility metal (such as titanium and/or rustless steel) constituted.As shown in Figure 124, at least one embodiment, each cap 6270 can be not attached to other caps 6270.In some other embodiment, one or more caps 6270 can be mounted to keep matrix 6250.In at least one this type of embodiment, cap 6270 such as can be connected to keep matrix 6250 by least one binding agent, and wherein can align with keeping the retaining hole 6252 in matrix 6270 or at least substantially align in the hole 6271 in cap 6270.Referring now to Figure 135, in various embodiments, protective cap (such as cap 6370) such as can limit inner chamber or fornix 6374, inner chamber or fornix 6374 such as can by nail lower limb 6221 end contained therein.In at least one this type of embodiment, cap 6370 can include bottom 6372 and extend through the hole 6371 of bottom 6372.In various embodiments, hole 6371 can be limited by the component 6373 of one or more deflections, and when following closely lower limb 6221 and pass through and being inserted into, the component 6373 of the one or more deflection can bend.In certain embodiments, such as two or more caps 6370 can be connected together to be formed the array of cap 6370.Referring now to Figure 136, at least one this type of embodiment, multiple caps 6370 can be linked together by material piece 6375.In certain embodiments, sheet 6375 can have enough rigidity to keep desired arrangement and/or the alignment thereof of cap 6370.In at least one embodiment, cap 6370 can be made up of biocompatibility metal (such as titanium and/or rustless steel), and sheet 6375 can be by bioabsorbable plastics (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL that sells with trade name Monocryl), polycaprolactone (PCL) and/or the complex of PGA, PLA, PDS, PHA, PGCL and/or PCL) constituted.In various embodiments, sheet 6375 can be made up of the bioabsorbable material wherein storing and/or being dispersed with antibacterial (such as collargol and/or triclosan), such as, when sheet 6375 is by bio-absorbable, described antibacterial can be released.

In various embodiments, to being described further above, such as, may utilize injection moulding process and sheet 6375 is molded around cap 6370 so that cap 6370 is embedded in sheet 6375.In some other embodiment, such as, may utilize injection moulding process and carry out molded tablet 6375, the most such as, during injection moulding process and/or after injection moulding process, available process for stamping forms hole 6376 in sheet 6375.In any one situation, cap 6370 can be inserted in hole 6376 and utilize and be press-fitted and/or snap-fitted interconnecting method and/or at least one binding agent are fixed in hole 6376.In certain embodiments, each cap 6370 can include around or at least partly surround the ring-shaped groove of cap 6370 periphery, and described ring-shaped groove can be by contained therein for the periphery in hole 6376.In certain embodiments, sheet 6375 can be by allowing that the flexibility carrying out relative motion between cap 6370 and/or pliable material are constituted.In at least one this type of embodiment, flexible sheets 6375 can be made up of such as rubber, plastics and/or silicone compositions, and cap 6370 can be made up of rigid material (such as metal).In at least one this type of embodiment, with similar to the above, flexible material can be overmolded to around cap 6370.In certain embodiments, such as cap 6370 can be pressed in the sheet 6375 moulded in advance.In various embodiments, can be chosen to the hardness of flexible material provide the desired rigidity of sheet 6375.In certain embodiments, sheet 6375 is configurable to include the band of flexibility.In any case, sheet 6375 can be conducive to being assembled in end effector cap 6370, this is because multiple caps 6370 can be positioned and/or are aligned in end effector simultaneously.Additionally, the sheet 6375 for attachment cap 6370 is the most implanted, then such as can strengthen along nail row or support nail.In addition to the thin slice for attachment cap 6370 or as the replacement of described thin slice, cap 6370 can be linked together by multiple chain links.In at least one this type of embodiment, this type of chain link can be flexible and carry out relative motion between tolerable cap 6370.

Referring now to Figure 139 and Figure 140, in various embodiments, protective cap (such as, cap 6470) can include that profiled surface, described profiled surface can make the end of nail lower limb deform.In at least one this type of embodiment, cap 6470 can include base portion 6472, and this base portion can include extending through hole 6471 therein.In various embodiments, nail lower limb (such as nail lower limb 6221) can be closely received wherein by hole 6471.In at least one this type of embodiment, the diameter or the girth that limit hole 6471 can be equal to or more than the diameter of nail lower limb 6221 or girths.In various embodiments, cap 6470 may also include chamber or fornix 6474, this chamber or fornix and can work as nail lower limb 6221 and accommodate the end of nail lower limb 6221 when being inserted in cap 6470.Referring first to Figure 140, cap 6470 may also include anvil block or profiled surface 6473, this anvil block or profiled surface can make nail lower limb 6221 bend and deform.In some cases, profiled surface 6473 can be such as bending and/or spill, and nail lower limb 6221 can be worked as make nail lower limb 6221 crimp when being inserted into cap 6470.In certain embodiments, nail lower limb 6221 can be deformed sufficiently so that it cannot be withdrawn by through hole 6471, and therefore cap 6470 can be locked to follow closely lower limb 6221.In at least one this type of embodiment, the base portion 6472 of cap 6470 can limit the antelabium extended around hole 6471, and described antelabium can prevent strained nail lower limb 6221 to be removed from chamber 6474.In all cases, due to mentioned above, one or more caps 6470 can prevent from or suppress keeping matrix (such as keeping matrix 6250) fall back from nail 6220 or depart from.In various embodiments, although not shown, but cap 6470 can be asymmetrically formed symmetrically or at least substantially, and hole 6471 can position along the central axis 6479 extended through cap 6470.Referring again to Figure 139, in various alternative embodiments, hole 6471 can bias relative to central axis 6479.In at least one this type of embodiment, the hole 6471 tolerable nail lower limb 6221 of biasing contacts the side of profiled surface 6473 and is crimped onto the opposite side of profiled surface 6473, rather than the center of contact profiled surface 6473, as contingent in the embodiment in the above-mentioned hole 6471 including and being centrally located.

In various embodiments, as it has been described above, keep matrix (such as, keeping matrix 6250) can be made up of material piece and the multiple retaining holes 6252 extended through described material piece.In at least certain embodiments, constitute keep the material piece of matrix 6250 can be rigidity or the most not deflection.In some other embodiment, keep matrix can be made up of the array keeping matrix element and multiple flexible connecting members or chain link for connecting described holding matrix element.Referring now to Figure 141, in various embodiments, keeping matrix or keep a part for matrix 6550 can include multiple element body 6505, the plurality of element body can be linked together by one or more connection chain links 6507.In at least one embodiment, each element body 6505 may each comprise multiple deformable member 6553, and the plurality of deformable member can limit retaining hole 6552 wherein.In certain embodiments, the element body 6505 and the connection chain link 6507 that keep matrix 6550 are formed as one and can include integral type material block.In various embodiments, matrix 6550 is kept such as to be formed by metal material (such as titanium and/or rustless steel) punching press or casting.In at least one embodiment, keep matrix 6550 can be made up of plastics, such as polyether-ether-ketone (PEEK), polypropylene, polyester, polyethylene terephthalate, polyvinylidene fluoride, polyvinylidene fluoride-co-hexafluoropropene, the polyhexafluoropropylene-VDF sold with trade name Pronova and/or the long-chain fat race polymer nylon 6 sold with trade name Ethilon and Nurolon sold with trade name Ethibond and Mersilene and the nylon 6 sold with trade name Pu Liling (Prolene), 6, and can be formed by such as injection moulding process.In certain embodiments, element body 6505 can not form one with being connected chain link 6507.In various embodiments, can produce multiple single element body 6505, the plurality of single element body 6505 is then connected to together and is embedded in holding matrix.In at least one this type of embodiment, element body 6505 can be stamped to form and be placed on by metal material (such as titanium and/or rustless steel) in plastic injection mould, wherein can be injected by plastic material in mould with the edge 6506 forming around or at least partly surrounding element body 6505 and the connection chain link 6507 extended from edge 6506.In some other embodiment, one or more connector dot matrix can be formed the hole including being limited in multiple edge 6506, and this pores the most each all can be by contained therein for element body 6505.In at least one embodiment, each element body 6505 can include neighboring that is circular or that be at least substantially circle；Similarly, hole that is that can define circle in each edge 6506 or that be at least substantially circle, the diameter in wherein said hole can be equal to or less than the diameter of element body 6505.In at least one this type of embodiment, element body 6505 can be press-fitted or in hole in built-in edge 6505.In certain embodiments, at least one binding agent can be utilized to be fixed in hole by element body 6505.

In certain embodiments, to being described further above, keeping matrix can include multiple element body 6505 and multiple connection chain link 6507, the plurality of connection chain link 6507 can carry out connecting element main body 6505 with any suitable array (such as, those shown in Figure 142-145).No matter the pattern of array why, in various embodiments, connect chain link 6507 and can allow that element body 6505 relative to each other moves with retaining hole 6552.In at least one this type of embodiment, constitute and keep the element body 6505 of matrix 6550 and connect the dot matrix of chain link 6507 once engaging with tissue just can stretching, distort, collapse and/or in other words bend, in order to allow the motion of in-house at least some and while resisted organize carry out bigger motion.In various embodiments, each connection chain link 6507 can include that flexible member, described flexible member can stretch, distort and/or collapse, in order to such as allows that holding matrix 6550 is keeping flexure between matrix element 6505.Referring again to Figure 141, the width limiting each chain link 6507 extended from edge 6506 can be narrower than element body 6505 and/or the width at edge 6506.Seeing Figure 142-145, in certain embodiments, one or more chain links 6507 can include straight part, and described straight part such as extends along the line between adjacent element body 6506.In at least one this type of embodiment, each chain link 6507 can include being attached to the first end at the first edge 6506 and being attached to the second end at the second edge 6506.Referring again to Figure 141, in certain embodiments, two or more chain links 6507 can be connected to each other.In at least one this type of embodiment, such as two or more chain links 6507 can be connected at middle hinge 6509.In various embodiments, the such as tranverse sectional thickness of hinge 6509 can reduce along one or more directions compared with the tranverse sectional thickness of chain link 6507, and the chain link 6507 that this tolerable is connected is movable with respect to.In certain embodiments, keeping matrix 6550 to may also include hinge 6508, chain link 6507 can be connected to edge 6506 and allow relative motion between chain link 6507 and edge 6506 by hinge 6508.Similar to hinge 6509, the such as tranverse sectional thickness of hinge 6508 can reduce along one or more directions compared with the tranverse sectional thickness of chain link 6507.

In various embodiments, to being described further above, the chain link 6507 being connected can extend in different directions.In at least one this type of embodiment, the first chain link 6507 can extend in a first direction, and the second chain link 6507 can extend in a second direction, and wherein said first direction may differ from described second direction.In certain embodiments, first chain link 6507 can extend along the first row, and the second chain link 6507 can extend along the second row, and wherein said the first row can be at an angle of (the most about 30 degree, about 45 degree, about 60 degree and/or about 90 degree) with described second row intersects.In various embodiments, hinge 6508 and/or hinge 6509 can include that hinges, described hinges tolerable chain link 6507 the most repeatedly move without rupturing.In certain embodiments, hinge 6508 and/or hinge 6509 can include the frangible or part of easy fracture, fracture when described frangible or easy fracture part in excessive deflection and/or too much can bend number of times.In at least one this type of embodiment, this type of frangible portion tolerable keeps one or more parts of matrix 6550 to disconnect with the another part keeping matrix 6550.In various embodiments, hinge 6508 and/or hinge 6509 such as can include keeping the ratio of matrix 6550 to keep other parts of matrix 6550 to be easier to the section of cutting.More specifically, that has implanted keeps matrix and can be cut component incision the most for various reasons by the tissue keeping matrix fastening implanted, and it is crosscutting in order to be conducive to carrying out this type of, hinge 6508 and/or hinge 6509 such as can provide approach or thin layer, and cutting element may pass through described approach or thin layer more readily passes through holding matrix 6550.In various embodiments, to being described further above, connect chain link 6507 and can include that being such as limited to one or more cast structure or material upsetting, the one or more cast structure or material upsetting can beneficially connect the bending of chain link 6507, fracture and/or cutting.

In various embodiments, keeping matrix can include multiple holding matrix element (such as, matrix element main body 6505), the plurality of holding matrix element can embed in piece of flexible material or material band.In at least one embodiment, piece of flexible material can be formed by bioabsorbable elastomeric material (such as siloxanes), and wherein said flexible flake can produce and be limited to multiple hole therein.In at least one this type of embodiment, moldable go out solid flexible flake form multiple hole in described flexible flake middle punch.In various alternative embodiments, moldable flexible flake and in molding process formed be limited to hole therein.In any one situation, keep matrix element 6505 such as can be inserted into and be maintained in flexible flake.In some other embodiment, with similar to the above, flexible flake can be formed at around matrix element 6505.In at least one embodiment, flexible flake can be such as made up of woven net and/or any other suitable material.To being described further above, this type of woven net can be easy to crosscutting.

Referring now to Figure 146 and Figure 147, in various embodiments, including keeping matrix (such as, keep matrix 6250) closure system may also include lid (such as, lid 6670), when the end following closely lower limb 6221 extends to keep above the top surface 6257 of matrix 6250, described lid can cover described end.In various embodiments, lid 6670 could attach to keep matrix 6250.In certain embodiments, lid 6670 and/or holding matrix 6250 can include keeping structure, and lid 6670 can be remained to keep matrix 6250 by described holding structure.In at least one embodiment, at least one binding agent can be utilized to adhere to lid 6670 keep matrix 6250.In at least one embodiment, lid 6670 can be made up of single layer, but lid 6670 is shown as including two layers, as being hereafter more fully described.In various embodiments, referring first to Figure 147, the end of nail lower limb 6221 can extend across the lower surface 6673 of lid 6670；But, lid 6670 can include enough thickness so that nail end does not extends across the top surface 6675 of lid 6670.Therefore, at least one this type of embodiment, the end of nail lower limb 6221 can not be from covering 6670 projections.In various embodiments, lid 6670 can include multiple layer.In at least one this type of embodiment, lid 6670 can include ground floor 6671 and the second layer 6672.In at least one embodiment, ground floor 6671 and the second layer 6672 can be attached to each other, and the most at least one embodiment, the second layer 6672 can include the lower surface 6676 being attached to ground floor 6671.In various embodiments, ground floor 6671 and the second layer 6672 can include different thickness, and in certain embodiments, it can include identical thickness.In at least one embodiment, ground floor 6671 and the second layer 6672 can include substantially the same width and/or length.In alternative embodiment, layer 6671 and 6672 can include different width and/or length.

In various embodiments, to being described further above, ground floor 6671 can be made up of compressible foam, Web materials and/or the hydrogel that can be cut by nail lower limb 6211.In at least one embodiment, the second layer 6672 can be made up of more tough and tensile material or skin (such as PGA and/or PDS) and/or any suitable backing material.In at least one this type of embodiment, nail lower limb 6221 can penetrate ground floor 6671；But, in various embodiments, nail lower limb 6221 possibly cannot penetrate the second layer 6672.In certain embodiments, the second layer 6672 can be made up of the material with sufficiently resilient and/or toughness, and the described material tolerable second layer 6672 is contacted by nail lower limb 6221 and shifts, but do not cut by the nail end of nail lower limb 6221 or only marginally cut.Although not shown in, but lid can include many more than two layer, and wherein one or more in these layers are puncture-proof.In at least one this type of embodiment, in use, holding matrix 6250 can be against tissue positioned to be fastened and to be promoted towards distally so that the nail lower limb 6221 of nail 6220 is promoted through the retaining hole 6252 in tissue T and holding matrix 6250, and enters in the ground floor 6271 covering 6270.In various embodiments, during the end of nail lower limb 6221 can not enter or the most not enter the second layer 6272 of lid 6270.After keeping matrix 6250 to be properly positioned, jaw 6240 can be opened, and cover 6670 and keep matrix 6250 to separate with jaw 6240, as shown in Figure 146.As shown in Figure 146, jaw 6640 can keep more than one to keep matrix 6250 and lid 6670.In at least one this type of embodiment, jaw 6640 can include two passages 6679, said two passage 6679 can be able to accommodate lid 6670 and the holding matrix 6250 relative to lid 6670 location wherein so that the tissue contacting surface 6251 of each holding matrix 6250 is downwardly depending from the bottom of jaw 6240.In at least one this type of embodiment, keep matrix 6250 and lid 6270 can be contained in jaw 6640 on each side of cutter slit 6678.In use, both matrix 6250 and lid 6670 is kept can be deployed simultaneously and/or be deployed in identical depth relative to the relative nail bin (such as storehouse 6200) positioned through it.Subsequently, in various embodiments, can be cut, by the cutting element traversing cutter slit 6678, the tissue fastened along line of cut, wherein jaw 6640 can be opened again subsequently.In certain embodiments, lid 6670 can be not attached to keep matrix 6250.In at least one this type of embodiment, lid 6670 can be positioned in passage 6679 and can be maintained in passage 6679 by being fixed to the holding matrix 6250 of jaw 6640.In various embodiments, each holding matrix 6250 can be wider than and/or be longer than its lid 6670 accordingly so that the entirety keeping matrix 6250 can be covered 6670 is held in place.In certain embodiments, each holding matrix 6250 can include identical width and/or length by the most its corresponding lid 6670.

In various embodiments, as it has been described above, closure system can include the material layer that can be attached to keep matrix (such as, keeping matrix 6250).Referring now to Figure 150, at least one embodiment, material layer 6870 could attach to keep the lower surface 6251 of matrix 6250.In certain embodiments, layer 6870 and/or holding matrix 6250 can include keeping structure, and layer 6870 can be remained to keep matrix 6250 by described holding structure.In at least one embodiment, at least one binding agent can be utilized to adhere to layer 6870 keep matrix 6250.In any case, layer 6870 can include lower surface or tissue contacting surface 6873, lower surface or tissue contacting surface 6873 can work as holding matrix 6250 towards nail 6220 move downward so that retaining hole 6252 with follow closely lower limb 6221 engage time, lower surface or tissue contacting surface 6873 contact tissue T.In at least one this type of embodiment, layer 6870 can be made up of compressible material (the most bioabsorbable foam), and described compressible material can be compressed between lower surface 6251 and the tissue T keeping matrix 6250.In various embodiments, layer 6870 may also include storage and/or is absorbed at least one medicine therein, and at least one medicine described can be discharged from layer 6870 when layer 6870 compresses.In at least one embodiment, described medicine can include at least one tissue seal, hemorrhage and/or anti-biotic material (such as ionic silver and/or triclosan).In various embodiments, the compression of layer 6870 can extrude medicine from layer 6870 so that the whole or at least a big chunk on the surface of tissue T is coated with medicine.Additionally, when layer 6870 compressed and follow closely lower limb 6221 penetrate tissue T and layer 6870 time, medicine such as can flow down and treat along nail lower limb 6221 by the nail tissue that cuts of lower limb 6221.In various embodiments, the main body keeping matrix 6250 can include the ground floor that is made up of biocompatible materials (such as titanium and/or rustless steel), and bottom 6870 can include the second layer that is made up of bioabsorbable material (such as oxidized regenerated cellulose (ORC), such as (liquid or be frozen dry) bioactivator such as fibrin and/or thrombin, glycerol, be in the fluffy or absorbable pig gelatin of foam configuration and/or the such as antibacterial such as electron ion silver and/or triclosan).Other bioabsorbable material can include such as SurgicelNu-Knit, SurgicelFibrillar, with trade name Promogran sell collagen/ORC(its for the mixture with collagen matrix form construction), the polyglycolic acid (PGA) sold with trade name Vicryl, polylactic acid (PLA or PLLA), PPDO (PDS), polyhydroxyalkanoatefrom (PHA), the poliglecaprone 25(PGCL sold with trade name Monocryl), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL, and/or the complex of PCL.Although Figure 150 only illustrates a layer 6870, but any suitable number of layer can be used.In at least one embodiment, the ground floor including the first medicine could attach to keep matrix 6250, and includes that the second layer of the second medicine or different pharmaceutical could attach to ground floor.In at least one this type of embodiment, multiple layer, the most each layer can be used can to include different pharmaceutical contained therein and/or different drug regimens.

Referring now to Figure 148, in various embodiments, closure system can include the material layer 6770 being attached to keep the lower surface 6251 of matrix 6250.In certain embodiments, layer 6770 and/or holding matrix 6250 can include keeping structure, and layer 6770 can be remained to keep matrix 6250 by described holding structure.In at least one embodiment, at least one binding agent can be utilized to adhere to layer 6770 keep matrix 6250.In any case, layer 6770 can include lower surface or tissue contacting surface 6773, lower surface or tissue contacting surface 6773 can work as holding matrix 6250 towards nail 6220 move downward so that retaining hole 6252 with follow closely lower limb 6221 engage time, lower surface or tissue contacting surface 6773 contact tissue T.In at least one this type of embodiment, layer 6770 can be made up of compressible material (the most bioabsorbable foam), and described compressible material can be compressed between surface 6251 and the tissue T keeping matrix 6250.In various embodiments, layer 6770 may also include one or more capsule or born of the same parents 6774, the one or more capsule or born of the same parents 6774 can store at least one medicine wherein.Seeing Figure 149, in certain embodiments, capsule 6774 can align with retaining hole 6252 or at least substantially align so that when following closely lower limb 6221 and being promoted through tissue T and layer 6770, and nail lower limb 6221 can be pierced capsule 6774 and/or in other words makes capsule 6774 rupture.After capsule 6774 ruptures, at least one medicine M being stored in capsule 6774 can flow out in tissue T.In at least one this type of embodiment, medicine M can include fluid, the tissue T that described fluid can be flowed down along nail lower limb 6221 or just cut by nail lower limb by nail lower limb drain treatment.Due to mentioned above, it be stored in the medicine in capsule 6774 and tissue can be provided local treatment.In certain embodiments, the capsule 6774 in thin slice 6770 can store different medicines.Such as, first group of capsule 6774 can store in the first medicine or the first drug regimen, and second group of capsule and can store different medicines or different drug regimens.In various embodiments, layer 6770 can be made up of flexible siloxanes thin slice, and capsule 6774 can represent the space in siloxanes thin slice.In at least one this type of embodiment, siloxanes thin slice can include two layers that can be attached to each other, and wherein capsule 6774 can be limited between said two layer.In various embodiments, layer 6770 can include one or more thin layer or weakening part (such as local perforations), and the one or more thin layer or weakening part can be conducive to lower limb 6221 cut layer 6770 and make capsule 6774 rupture.In certain embodiments, can being positioned at least partially in fornix 6777 of capsule 6774, wherein fornix 6777 can upwardly extend from thin slice 6770.In at least one this type of embodiment, in can being positioned at least partially of fornix 6777 and/or capsule 6774 keeps the pit 6201 formed in matrix 6250.In certain embodiments, capsule 6774 can include the independent born of the same parents not being connected to each other.In some other embodiment, one or more in capsule 6774 can be in fluid communication with each other via one or more paths, conduit and/or the passage extending through layer 6770.The disclosure of the United States Patent (USP) 7,780,685 being published on August 24th, 2010 and entitled " ADHESIVEANDMECHANICALFASTENER " is incorporated by reference in its entirety herein accordingly.

In various embodiments, to being described further above, nail bin including warehouse, nail and/or alignment matrix can be loaded in the first jaw of end effector, and similarly, keeps matrix and/or one or more lid can be loaded in the second jaw of end effector.Referring now to Figure 151, apparatus (such as storehouse loader 6990), in certain embodiments, can be used two or more fastener cartridge to be inserted simultaneously in end effector.In at least one embodiment; such as storehouse loader 6990 can include shank 6991 and storehouse carrier 6992; wherein storehouse carrier 6992 can include the first maintaining part and the second maintaining part; the warehouse 6210 of nail bin 6200 can be remained to storehouse carrier 6992 by described first maintaining part; and described second maintaining part can keep warehouse 6980, this warehouse 6980 supports multiple protective cap 6270 wherein and the lower surface along warehouse 6980 supports and keeps matrix 6250.In various embodiments, the first maintaining part and the second maintaining part can each include one or more holding component, and the one or more keeps component can be releasably engaged warehouse 6210 and 6980.Referring now to Figure 152 and Figure 153, in use, end effector can include the first jaw or bottom jaw 6230 and the second jaw or top jaw 6940, and during wherein nail bin 6200 can be loaded on the first jaw 6230, and warehouse 6980 can be loaded in the second jaw 6940.In all cases, top jaw 6940 can rotate to make position (Figure 153) by actuator 6235 from open position (Figure 152), and wherein the operation of actuator 6235 is as it has been described above, here is omitted for simplicity's sake.Referring now to Figure 153, once top jaw 6940 is in its make position, then the far-end 6993 of storehouse carrier 6992 can be inserted in end effector so that nail bin 6200 slides in the first attachment in the first jaw 6230 or passage 6939 through the far-end 6938 of the first jaw 6930.Similarly, the far-end 6993 of storehouse carrier 6992 can be inserted in end effector so that warehouse 6980 slides in the second attachment in the second jaw 6940 or passage 6949 through the far-end 6948 of the second jaw 6940.The surgeon of the shank 6991 of hand-held storehouse loader 6990 or other clinicians can be each passed through passage 6939 and 6949 and promote nail bin 6200 and warehouse 6980, until nail bin 6200 and warehouse 6980 are placed in passage 6939 and 6949 completely.

When nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can engage the one or more maintaining parts in its corresponding jaw 6230 and 6940 respectively, as being hereafter more fully described.Referring now to Figure 154, in any case, once nail bin 6200 and warehouse 6980 are placed, then storehouse loader 6990 can separate with nail bin 6200 and warehouse 6980 and remove from end effector.In at least one this type of embodiment, retentivity for being maintained at by nail bin 6200 in first jaw 6230 can be more than the retentivity being used for remaining to nail bin 6200 storehouse carrier 6992, making when storehouse carrier 6992 is pushed out end effector towards distally, nail bin 6200 is positively retained at the first jaw 6230 rear.Similarly, retentivity for being maintained at by warehouse 6980 in second jaw 6940 can be more than the retentivity being used for remaining to warehouse 6940 storehouse carrier 6992, making when storehouse carrier 6992 is pushed out end effector towards distally, warehouse 6940 is positively retained at the second jaw 6940 rear.Once storehouse loader 6990 is removed from end effector, then the first jaw 6230 loaded and the second jaw 6940 loaded can position relative to by the tissue T being sewn.Referring now to Figure 155, the second jaw 6940 can move to firing position (Figure 155) from open position (Figure 154), in order to keep matrix 6250 and the plurality of protective cap 6270 that make warehouse 6980 be carried engage with the nail 6220 being positioned in nail bin 6200.

Referring now to Figure 156 and Figure 157, the second jaw 6940 can be opened again, and the plurality of protective cap 6270 and holding matrix 6250 can separate with warehouse 6980 so that cap 6270 and holding matrix 6250 can keep engaging with tissue T and nail bin 6200.In at least one embodiment, warehouse 6980 can include multiple pit and one or more holding slit, the plurality of cap 6270 can be removably positioned in the plurality of pit, and the one or more keeps slit can remain to warehouse 6980 removedly by keeping matrix 6250.In various embodiments, after the second jaw 6940 is opened, warehouse 6980 can be maintained in the second jaw 6940 by the holding component engaged with warehouse 6980 of the second jaw 6940.In certain embodiments, warehouse 6980 can work as tear when the second jaw 6940 is opened so that a part for warehouse 6980 is implanted together with cap 6270 and holding matrix 6250, and a part for warehouse 6980 is retained in the second jaw 6940.Similarly, referring again to Figure 156 and Figure 157, after the second jaw 6940 is opened, warehouse 6210 can be maintained in the first jaw 6230 by the holding component engaged with warehouse 6210 of the first jaw 6230.In certain embodiments, warehouse 6210 can work as tear when the first jaw 6230 is pulled away from the storehouse 6200 implanted, the part making warehouse 6210 is implanted together with nail 6220 and alignment matrix 6260, and a part for warehouse 6210 remaines in the first jaw 6230.Referring now to Figure 158-160, in various embodiments, nail bin (such as nail bin 6900) such as can include the one or more longitudinally holding slits 6913 extended along the length of warehouse 6910, such as when nail bin 6900 is inserted in jaw 6930, the one or more longitudinally keeps slit 6913 can accommodate the one or more longitudinally holding guide rails 6916 extended from jaw 6930 wherein.In use, at least one embodiment, such as before nail bin 6900 slides through the far-end 6938 of holding passage 6939, the end of slit 6913 is kept can to align with the far-end keeping guide rail 6916.

Referring again to Figure 160, in various embodiments, jaw 6940 can include that two keep passage 6949, and the most each holding passage 6949 can accommodate wherein and includes multiple cap 6270 and keep the warehouse 6980 of matrix 6250.In certain embodiments, each warehouse 6980 can include one or more longitudinally holding shoulder 6917, when the one or more longitudinally keeps shoulder can work as in its corresponding holding passage 6949 that warehouse 6980 is inserted in jaw 6940, the one or more longitudinally keeps shoulder 6917 to slide along one or more longitudinally holding guide rails 6918 of the second jaw 6940.In various embodiments, when warehouse 6980 is with when separating on the cap 6270 being stored therein and holding matrix 6250, keeps guide rail 6918 and keep shoulder 6917 to be maintained in the second jaw 6940 by warehouse 6980 collaboratively.Referring now to Figure 159, in various embodiments, second jaw 6940 may also include the one or more distally projection extended from it or keeps component 6915, and warehouse 6980 can be locked in it and keep accordingly in passage by the one or more distally projection or holding component removedly.In at least one this type of embodiment, second jaw 6940 can include distally projection 6915, distally projection 6915 is configured relative to each holding passage 6949 and is located so that when warehouse 6980 is inserted in passage 6949, each warehouse 6980 can bend around projection 6915, wherein, just when warehouse 6915 is placed in passage 6949 completely, the far-end of warehouse 6980 can cross projection 6915 and by being buckled in above projection 6915.Remove it afterwards for being previously used at warehouse 6980, as it has been described above, warehouse 6980 can be withdrawn into above projection 6915 and it is removed from holding passage 6949.With similar to the above, first jaw 6930 can include keeping projection 6914 from its one or more distally extended, when nail bin 6900 is laid completely, the one or more distally keeps the one or more holding grooves that can be contained in warehouse 6910 of projection or slit 6912(Figure 158) in.

In various embodiments, to being described further above, wherein location has the first fastener cartridge of multiple first securing member can be positioned in the first jaw of surgical fastening device, and wherein location has the second fastener cartridge of multiple second securing member can be positioned in the second jaw of surgical fastening device.In use, the one in the first jaw and/or the second jaw can be moved towards another one, in order to makes the first securing member and the second securing member engage and be fixed on therebetween by tissue.In certain embodiments, when the first securing member and the second securing member engage, the first fastener cartridge can engage with the second fastener cartridge.In at least one embodiment, the main body of the first fastener cartridge can be made up of the first compressible material, and the main body of the second fastener cartridge can be made up of the second compressible material, and wherein the first main body and/or the second main body can be compressed against the tissue fastened.After tissue is by fastening, the first jaw can move away from the first fastener cartridge implanted, and the second jaw can be away from the second fastener cartridge motion implanted.Subsequently, the first jaw can be again loaded with another the first fastener cartridge or like, and the second jaw can load another the second fastener cartridge or like again, and can reuse surgical fasteners tool.Although nail can be used in certain embodiments, but it can also be envisaged that go out to include other embodiments of other kinds of securing member (such as lock together is divided into two-part securing member) when being bonded with each other.In at least one this type of embodiment, the first fastener cartridge can include the first storage part for storing the first fastener portion, and the second fastener cartridge can include the second storage part for storing the second fastener portion.In various embodiments, fastening system as herein described may utilize the securing member of material and/or the form including any suitable type.In certain embodiments, securing member can include penetrating component.This type of penetrates component and can be such as made up of polymer, complex and/or multiple field substrate.The example of multiple field substrate can be to have elastomer or the wire rod of polymer coating or sheet substrate.It can be thin thin slice, and is formed so that penetrating component is oriented to be perpendicular to or be at least substantially orthogonal to connecting elements.Penetrate component and can include the profile of rectangle, semicircular profile and/or any crossbeam profile.In various embodiments, available any suitable method (such as wire rod extrusion method) manufactures securing member as herein described.Further possibility is to use precision machining method to penetrate component to form hollow.These penetrate component and by being different from wire rod extrusion method and the method for combination of materials can be used to process.

As it has been described above, the end through holding matrix projection of nail lower limb can be by one or more caps and/or blanketing lid.In certain embodiments, the end of nail lower limb deformable after being inserted through holding matrix.In at least one embodiment, being positioned at, for keeping the jaw of matrix may also include, the anvil block pit alignd above retaining hole and/or with retaining hole, described anvil block pit can make nail lower limb deform when following closely lower limb and being projected on above holding matrix.In various embodiments, the nail lower limb of each nail can such as towards each other and/or the center inward curl towards nail.In some other embodiment, nail nail lower limb in one or more can away from other nail lower limbs and/or away from nail center and outwards crimp.In various embodiments, no matter nail lower limb crimps along which direction, the end of nail lower limb all can contact and keeps the main body of matrix and can not be again introduced into being clenched in solid tissue.In at least one embodiment, nail lower limb can be locked in keeping matrix in location in the deformation after holding matrix.

Referring now to Figure 161 and Figure 162, in various embodiments, surgery suturing appliance (such as, surgical stapling device 7000) can include the first jaw 7030 and the second jaw 7040, and wherein the second jaw 7040 can be moved toward and away from the first jaw 7030 by the motion of actuator 6235.The operation of actuator 6235 is as it has been described above, here is omitted for simplicity's sake.In various embodiments, the first jaw 7030 can include far-end 7031 and near-end 7032, and wherein the first jaw 7030 can be limited between far-end 7031 and near-end 7032 passage extended, and described passage can accommodate nail bin.For ease of diagram, Figure 161 does not shows the warehouse of this type of nail bin, but this type of nail bin can include warehouse, the nail 6220 being positioned at warehouse and be positioned at the staple drivers 7012 below nail 6220.In certain embodiments, although the most not shown in Figure 161, but the second jaw 7040 can will keep matrix to move to engage with the lower limb following closely 6220 by keeping matrix (such as keeping matrix 6250) to be maintained on nail 6220 and/or move as mentioned above.In at least one embodiment, surgical stapling device 7000 may also include the sliding part 7010 being such as positioned in the first jaw 7030, and sliding part 7010 can slide towards near-end 7032 from the far-end 7031 of the first jaw 7030 and promote staple drivers 7012 and the nail 6220 being supported on staple drivers 7012 towards the matrix that keeps of the second jaw 7040.In other embodiments various, such as sliding part 7010 can proximally 7032 move towards far-end 7031, in order to disposes nail 6020.In at least one embodiment, sliding part 7010 can include slope or the cam 7011 of one or more inclination, and the one or more slope tilted or cam can be in staple drivers 7012 slid underneath and be lifted up staple drivers 7012.In various embodiments, surgical stapling device 7000 may also include pull bar or the push rod being such as operably linked to sliding part 7010, described pull bar or push rod can be by being positioned at the actuator on the shank of surgical stapling device 7000 and/or axle and proximally and/or towards distal movement.

Referring again to Figure 161, in various embodiments, the second jaw 7040 of surgical stapling device 7000 can include framework 7041, far-end 7048 and the near-end 7049 with far-end 7048 relative localization.In certain embodiments, second jaw 7040 may also include guidance system, described guidance system includes the one or more guide rails (such as guide rail 7045 and 7046) extended along the longitudinal axis of framework 7041, as being hereafter more fully described, the one or more guide rail can guide can be at the nail lower limb 6221 of nail 6220 through keeping the nail lower limb of jointing nail 6220 after matrix the one or more anvil blocks making it deform or cam.In at least one this type of embodiment, guide rail 7045 and 7046 can include leading line or cable, and described leading line or cable are such as along the top of framework 7041 or surface, extend around distally post 7047 returning along top or the surface of framework 7041.As mentioned above, and now referring first to Figure 163 and Figure 165, in various embodiments, second jaw 7040 may also include one or more anvil block or cam (such as first anvil block 7050 and the second anvil block 7060), the one or more anvil block or cam longitudinally can move along the second jaw 7040, in order to the lower limb at nail 6220 makes described lower limb deform after keeping matrix.In at least one embodiment, surgical stapling device 7000 may also include the first anvil block driver or the actuator 7051 being connected to and/or being operably linked to the first anvil block 7050, this first anvil block driver or actuator can proximally tractive the first anvil block 7050 and/or promote the first anvil block 7050 towards distally.Similarly, in at least one embodiment, surgical stapling device 7000 may also include the second anvil block driver or the actuator being connected to and/or being operably linked to the second anvil block 7060, described second anvil block driver or actuator can promote the second anvil block 7060 and/or proximally tractive the second anvil block 7060 towards distally.In various embodiments, the first anvil block 7050 can include guide groove 7052, and the second anvil block 7060 can include guide groove 7062, and this guide groove 7052 and guide groove 7062 can be able to be slidably received within wherein guide rail 7045 or guide rail 7046.In at least one this type of embodiment, guide rail 7045 and 7046 can be closely received in guide groove 7052 and 7062 so that can prevent from or at least limit guide rail 7045 and 7046, between guide groove 7052 and 7062, relative lateral movement or side-to-side movement occur.

In certain embodiments, to being described further above, can proximally pull the first anvil block 7050 and the second anvil block 7060 can be pulled towards distally.Seeing Figure 161, at least one embodiment, guide rail 7045 and 7046 and distally post 7047 can include pulley system, and described pulley system can be towards distally tractive the second anvil block 7060 and/or proximally tractive the second anvil block 7060.In at least one this type of embodiment, guide rail 7045 and guide rail 7046 can include continuous wire or the cable extended around distally post 7047, a part for wherein said continuous wire can be pulled so that wire rod around distally post 7047 round.In various embodiments, guide rail 7046 such as can be mounted to the second anvil block 7060, make when continuous cable round in the first direction, second anvil block 7060 can be pulled to distally towards the far-end 7048 of jaw 7040, and in a second direction or during rightabout round, the second anvil block 7060 can be pulled to nearside towards near-end 7049 when continuous cable.Referring now to Figure 163, during, at least one embodiment, guide rail 7046 can be fixed on guide groove 7062 so that pulling force can be transmitted betwixt.In at least one this type of embodiment, guide rail 7045 can slide in another guide groove 7062.In various embodiments, first anvil block 7050 can work in the way of unrelated with the second anvil block 7060, and pulley system and the guide groove 7052 being limited in the first anvil block 7050 can slidably receive guide rail 7045 and 7046 so that allow and carry out relative motion between pulley system and guide groove 7052 and guide rail 7045 and 7046.In various embodiments, the continuous cable constituting guide rail 7045 and 7046 can have enough flexibilities, in order to adapts to opening and closing of top jaw 7040.Cable also can have enough flexibilities so that adaptation the second jaw 7060 is toward and away from the vertical movement of bottom jaw 7030 continuously, is described in more detail.

Refer again to Figure 163 and Figure 165, in various embodiments, first anvil block 7050 can include the cam follower 7055 extended from it, and described cam follower 7055 can ride the one or more cam slot in the framework 7041 being limited to the second jaw 7040 or guide groove such as cam slot 7070(Figure 166) in.More specifically, in at least one embodiment, framework 7041 can include the first cam slot 7070 of the first side longitudinal extension along framework 7041 and along the second side of framework 7041 or the second cam 7070 of opposite side longitudinal extension, the cam follower 7055 wherein extended from the first side of the first anvil block 7050 can ride in the first cam slot 7070, and the cam follower 7055 extended from the second side of the first anvil block 7050 can ride in the second cam slot 7070.In at least one this type of embodiment, the profile of each cam slot 7070 can be identical or the most identical, and can be mutually aligned or at least substantially align.Similarly, in various embodiments, the second anvil block 7060 can include the cam follower 7065 extended from it, and described cam follower 7065 can ride the cam slot 7070(Figure 166 in the framework 7041 being limited to the second jaw 7040) in.More specifically, in at least one embodiment, the cam follower 7065 extended from the first side of the second anvil block 7060 can ride in the first cam slot 7070, and the cam follower 7065 extended from the second side of the second anvil block 7060 can ride in the second cam slot 7070.In use, the cam follower 7055 of the first anvil block 7050 and the cam follower 7065 of the second anvil block 7060 can slide in cam slot 7070, making when the first anvil block 7050 and the second anvil block 7060 are pulled to nearside and/or are pushed to distally, the first anvil block 7050 and the second anvil block 7060 advance along the profile of cam slot 7070.In various embodiments, each cam slot 7070 can include multiple portion or top 7071 and multiple driver portion or bottom 7072 of resting, the plurality of portion or top 7071 and the plurality of driver portion or the bottom 7072 of resting can be at anvil block 7050 and 7060 along (the most i.e., between the far-end 7048 and near-end 7049 of framework 7041) motion while vertically (i.e., toward and away from bottom jaw 7030) motion anvil block 7050 and 7060, as being hereafter more fully described.

When surgical stapling device 7000 is in non-cock, seeing Figure 166, the first anvil block 7050 can be positioned on the far-end 7048 of framework 7041, and the second anvil block 7060 can be positioned on the near-end 7049 of framework 7041；Additionally, referring now to Figure 167, when surgical stapling device 7000 is in non-cock, the nail 6220 being positioned at the first jaw 7030 may be not inserted into being positioned at holding matrix thereon.Referring now to Figure 168, in use, staple drivers 7012 can drive up nail 6220 in the nail chamber 7033 of nail bin；It addition, the first anvil block 7050 can be from the far-end 7048 of framework 7041 towards far-end 7049 proximal motion, in order to the nail lower limb 6221 of jointing nail 6220.In at least one embodiment, the nail lower limb 6221 at the first anvil block 7050 with nail 6220 can drive up nail 6220 before engaging.In various embodiments, before the first anvil block 7050 is advanced into contact stud lower limb 6221, sliding part 7010 can upwards dispose all of nail 6220, or alternatively, sliding part 7010 proximally can move while the first anvil block 7050 proximally moves, but sliding part 7010 can guide the first anvil block 7050 so that nail 6220 to be deployed in the first anvil block 7050 front fully.In various embodiments, as shown in Figure 168, cam slot 7070 can or be arranged such that such as when the first cam 7050 through rest portion or top time, the profiled surface (such as profiled surface or cam face 7053 and 7054) of the first cam 7050 can at least some in contact stud lower limb 6221.In all cases, the cam follower 7055 of the first anvil block 7050 can be respectively positioned in the portion of resting 7071 of cam slot 7070, making profiled surface 7053 and 7054 be in the position raised, and make when during anvil block 7050 is there through rest position, nail lower limb 6221 only partially deforms.When the first cam 7050 moves further along cam slot 7070, as shown in Figure 169, the cam follower 7055 of the first anvil block 7050 can be driven in drive division or the bottom 7072 of cam slot 7070, profiled surface 7053 and 7054 is moved downward vertically, in order to driven to its configuration finally shaped by nail lower limb 6021 towards nail lower limb 6021.Subsequently, when the first anvil block 7050 advances along cam slot 7070 further, the first anvil block 7050 can be rested in portion 7071 by another group of upwards vertical drive to cam slot 7070.As shown in Figure 168 and Figure 169, reader will note that, the first anvil block 7050 can only engage some nail lower limb and not engage other nail lower limbs.In at least one this type of embodiment, the first anvil block 7050 can the most only make to include following closely one group of nail lower limb deformation of the distally nail lower limb 6221 of 6220.In at least one this type of embodiment, the first anvil block 7050 can make distally nail lower limb 6221 towards the center deformation of nail 6220.In various embodiments, each nearside nail lower limb 6221 all can twice by the first anvil block 7050(i.e., by the first profiled surface 7053 and the second profiled surface 7054 of aliging with the first profiled surface 7053) contact.In at least one this type of embodiment, when the first anvil block 7050 is in the portion of resting or top, first profiled surface 7053 can make distally nail lower limb 6221 be deformed into part deformed configuration, and when the first anvil block 7050 moves in drive division or bottom, the second profiled surface 7054 can make distally nail lower limb 6221 be deformed into and be fully formed configuration.Referring now to Figure 163 and Figure 164, in various embodiments, first anvil block 7050 can include multiple first profiled surface 7053 and multiple second profiled surface 7054, in order to make the distally nail lower limb 6221 of nail 6220 deform when following closely lower limb 6221 and being arranged to a more than row or a line.In various embodiments, as being hereafter more fully described, the such as second anvil block 7060 can make the nearside nail lower limb 6221 of nail 6020 deform.

In various embodiments, to being described further above, the first anvil block 7050 can move to near-end 7049 from the far-end 7048 of framework 7041, in order to makes all distally nail lower limb 6221 of nail 6220 deform.Reader will note that, first anvil block 7050 upwardly or downwardly can move relative to undeformed nearside nail lower limb 6221, and for adapting to this type of relative motion, in various embodiments, first anvil block 7050 can include one or more clearance slot 7057(Figure 165), the one or more clearance slot 7057 can work as the first anvil block 7050 makes distally nail lower limb 6221 accommodate unbent nearside nail lower limb 6221 when bending.Similarly, referring again to Figure 163, the second anvil block 7060 can include clearance slot 7067, and this clearance slot can be worked as the first anvil block 7050 and adapt to the vertical movement of the first cam actuator 7051 moved up and down as mentioned above when it rests motion between portion and drive division.After all distally nail lower limb 6221 is bent, at least one embodiment, anvil block actuator 7061 can make the second anvil block 7060 move to far-end 7048 from the near-end 7049 of framework 7041.With similar to the above, referring now to Figure 170, the cam follower 7065 of the such as second anvil block 7060 can slide in cam slot 7070 so that the second anvil block 7060 moves between the portion of resting or top and drive division or bottom, in order to makes nearside nail lower limb 6221 be deformed inward towards the center of nail 6220.With similar to the above, second anvil block 7060 can include that multiple first shapes or cam face 7063 and multiple second shapes or cam face 7064, and the plurality of first shapes or cam face 7063 and the plurality of second shapes or cam face 7064 can be able to make in nearside nail lower limb 6021 one or more deform at least in part and/or be badly deformed.Refer again to Figure 164, second anvil block 7060 can include multiple first profiled surface 7063 and multiple second profiled surface 7064, the plurality of first profiled surface 7063 and the plurality of second profiled surface 7064 can make to be arranged in the nail 6220 of multiple row or multiple row nearside nail lower limb 6221 deform.Same as shown in Figure 164, first profiled surface 7063 of the second anvil block 7060 and the second profiled surface 7064 can not align with the first profiled surface 7053 of the first anvil block 7050 and the second profiled surface 7054, and therefore the near leg 6221 of nail 6220 can be positioned in different rows or row from the far leg 6221 of nail 6220.Reader it shall yet further be noted that, when the second anvil block 7060 is towards distal movement, the second anvil block 7060 can promote the first anvil block 7050.In at least one this type of embodiment, the first anvil block 7050 can be pushed back in the far-end 7048 of framework 7041 by the second anvil block 7060 so that the first anvil block 7050 may return to its initial position or non-firing position.After all nearsides nail lower limb 6221 of nail 6220 all deforms, the second anvil block 7060 can proximally retract and be back to its initial position or non-firing position.Consequently, it is possible to surgical stapling device 7000 can reset to so that positioning new nail bin in the first jaw 7030, and new holding matrix can be positioned in the second jaw 7040, in order to reuse surgical stapling device 7000.

In various embodiments, as it has been described above, surgical stapling device can include that two or more anvil blocks, said two or more anvil block can longitudinally be advanced transversely to engage the lower limb of multiple nail.In certain embodiments, surgical stapling device can include the anvil block proximally moved, such as so that first group of nail lower limb deforms and such as make second group of nail lower limb deformation.In at least one this type of embodiment, this type of anvil block can include the such as profiled surface towards nearside and the profiled surface towards distally.

Referring now to Figure 171, in various embodiments, anvil block such as anvil block 7140 can include lower surface or tissue contacting surface 7141 and the multiple shaping pits 7142 being limited in lower surface or tissue contacting surface 7141.In at least one embodiment, anvil block 7140 can include the more than one plate can being welded in framework 7144, such as crater plate 7143.In at least one this type of embodiment, each crater plate 7143 all can be positioned in the plate passage 7145 in framework 7144 and be soldered to framework 7144 by extend through the welding slit 7146 of framework 7144 to form longitudinal measure part 7147.In various embodiments, longitudinal measure part 7147 such as can include a series of the most spaced apart pad that the sequential welding fitting extended along the whole length of welding slit 7146 or the length along welding slit 7146 extend.In various embodiments, each crater plate 7143 may each comprise two or more plate parts being soldered together.In at least one this type of embodiment, each crater plate 7143 may each comprise can be along seam 7,148 first plate part 7143a welded together and the second plate part 7143b.In various embodiments, in the plate passage 7145 in plate 7143 is soldered to framework 7144 before, the first plate part 7143a and second plate part 7143b of each plate 7143 can be soldered together.In at least one this type of embodiment, the first plate part 7143a and the second plate part 7143b can include the cooperation profile that can fit together to be formed impervious seam 7148, the such as tooth profile shown in Figure 171.In at least one embodiment, each plate 7143 can include the most about .02 " height, described height can be higher than the degree of depth of plate passage 7145 so that the tissue contacting surface 7141 of plate 7143 extends from the framework 7044 of anvil block 7040.Referring now to Figure 172, in certain embodiments, plate 7143 can such as connect together by being positioned at least one weldment 7149 of the far-end of plate 7143.

As shown in Figure 171 and Figure 172, each crater plate 7143 may each comprise and is limited at multiple shaping pit 7142 therein.In various embodiments, shaping pit 7142 can be formed in plate 7143 by any suitable manufacture method (such as Ginding process and/or electrode combustion method).Referring now to Figure 173 and Figure 174, in at least one this type of embodiment, such as can manufacture each shaping pit 7142 by the following method: be initially formed deep-well 7150, that form arch then around deep-well 7150 or curved surface 7151, then forms nail lower limb guiding groove 7152 in curved surface 7151.In other embodiments various, these steps can be performed in any suitable order.Referring now to Figure 175, in various embodiments, nail shapes pit 7142 can be formed the inner edge 7153 making shaping pit spaced apart by consistent or the most consistent gap 7154.In at least one this type of embodiment, gap 7154 can the most about .008 ".Additionally, at least one this type of embodiment, shaping pit 7142 can position along two or more row or line, and the centrage shaping pit 7142 can be spaced apart by consistent or the most consistent spacing 7155.In at least one this type of embodiment, the spacing 7155 between centrage can the most about .035 ".Referring again to Figure 175, in various embodiments, each shaping pit 7142 can be tapered between narrow width 7156 and wide width 7157.In at least one this type of embodiment, the narrowest width 7156 may be about .045 ", and wide width 7157 may be about .075 ".In various embodiments, plate 7143 can be made up of the material identical with framework 7144.In at least one this type of embodiment, plate 7143 and framework 7144 both of which can be such as made up of rustless steel (such as 300 series or the rustless steel of 400 series) and/or titanium.In other embodiments various, plate 7143 and framework 7144 can be made up of different materials.In at least one this type of embodiment, plate 7143 can be such as made up of ceramic material, and framework 7144 can be such as made up of rustless steel and/or titanium.In all cases, according to the material used, such as, in addition to above-mentioned welding method or as the replacement of above-mentioned welding method, it be also possible to use at least one solder brazing method and plate 7143 is fixed in framework 7144.

Referring now to Figure 176-178, in various embodiments, anvil block 7240 can include framework 7244 and the multiple crater plate 7243 can being inserted in framework 7244.With similar to the above, each crater plate 7243 can include being limited to multiple shaping pit 7242 therein.In at least one embodiment, anvil block framework 7244 can include being limited to holding slit 7246 therein, and this holding slit can accommodate the holding guide rail 7247 extended from crater plate 7243.For crater plate 7243 is assembled into anvil block framework 7244, the sidewall 7245 of this anvil block framework 7244 can flex outward or launch (as shown in Figure 177), so that keeping slit 7246 to broaden, so that each holding slit 7246 can accommodate the holding guide rail 7247 of crater plate 7243 wherein.Once keeping guide rail 7247 to be positioned in holding slit 7246, sidewall 7245 can be released (as shown in Figure 178), thus allows that framework 7244 is retracted with elastic type and/or is back to its non-deflected.In this case, keep slit 7246 regracting and therefore holding guide rail 7247 captured wherein.In certain embodiments, keep guide rail 7247 and/or keep slit 7246 can include the conical surface of one or more cooperation；After the holding slit 7246 of flexure is released, the one or more conical surface coordinated can be formed and the taper lock in slit 7246 can be kept to engage by keeping guide rail 7247 to be maintained at.With similar to the above, crater plate 7243 can be made up of the material identical or different with framework 7244.In at least one this type of embodiment, plate 7243 can be such as made up of ceramic material, and framework 7244 can be such as made up of rustless steel and/or titanium.In all cases, according to the material used, such as, at least one solder brazing method and/or at least one welding method can be used to be fixed in framework 7244 by plate 7243.

In Figure 179 and 180, surgical stapling and cut-out apparatus 8010 can include anvil block 8014, and this anvil block can be repeatedly opened around it to the pivotal attachment of elongated nail groove 8016 and close.Assembly 8012 used by nail can include anvil block 8014 and groove 8016, and wherein assembly 8012 can proximally be attached to be formed the slender axles 8018 of tool portion 8022.When nail use assembly 8012 close time, or when at least substantially closing, tool portion 8022 can present sufficiently small cross section, and this cross section is suitable to make nail use assembly 8012 and is inserted by the trocar.In various embodiments, assembly 8012 can be handled by the shank 8020 being connected to axle 8018.Shank 8020 can include user control such as rotary knob 8030, and this rotary knob makes slender axles 8018 and nail use the assembly 8012 longitudinal axis rotation around axle 8018.Closure trigger 8026 can be depressed to close nail and use assembly 8012, and this closure trigger can be in pistol grip 8036 front wall around the closure trigger pin 8152(Figure 181 laterally engaged across shank shell 8154) pivot.In various embodiments, when closure trigger 8026 is clamped, Guan Bi release button 8038 can outwards be present on shank 8020 so that release button 8038 can be depressed to unclamp closure trigger 8026 and open nail to use assembly 8012, as described in more detail below.The percussion trigger 8034 that can pivot before closure trigger 8026 can make nail use assembly 8012 to cut off and stitching is clamped in tissue therein simultaneously.In all cases, as described in more detail below, percussion trigger 8034 can be used to use multiple firing stroke to need the size of the power applied by surgical hands to reduce every stroke.In certain embodiments, shank 8020 can include may indicate that percussion progress rotatable right indicator wheel 8040 and/or left indicator wheel 8041(Figure 181).Such as, percussion stroke completely may need to fire three complete firing stroke of trigger 8034, thus indicate that device wheel 8040,8041 each can rotate at most 1/3rd turns at every stroke of percussion trigger 8034.As described in more detail below, the need to, manually percussion trip lever 8042 can allow trigger system firing retraction before stroke completes completely, and in addition, if trigger system is blocked and/or lost efficacy, percussion trip lever 8042 can allow surgeon or other clinicians to make trigger system bounce back.

In conjunction with Figure 179 and Figure 181, slender axles 8018 can include external structure, this external structure includes the most reciprocating Guan Bi pipe 8024, and this Guan Bi pipe makes anvil block 8014 pivot towards its make position in response to pressing under the nearside of the closure trigger 8026 of shank 8020.Elongated slot 8018 can be by the framework 8028(Figure 181 within Guan Bi pipe 8024) it is connected to shank 8020.Framework 8028 is rotatably engaged to shank 8020 so that rotary knob 8030(Figure 179) the rotation part 8022 that can make tool rotate.Referring specifically to Figure 181, rotary knob 8030 can be made up of two half-shell, and these two half-shell can include one or more inward projection 8031, and this protuberance can extend across the one or more elongated side opening 8070 in Guan Bi pipe 8024 and engages framework 8028.Therefore, rotary knob 8030 and framework 8028 can together with or rotated simultaneously so that the position of rotation of knob 8030 determines the position of rotation of tool portion 8022.In various embodiments, the longitudinal length long enough of longer opening 8070, to allow longitudinal closing motion of Guan Bi pipe 8024 and to open motion.About producing the closing motion closing pipe 8024, referring first to Figure 181 and Figure 183, the top 8160 of closure trigger 8026 can promote forward closed yoke 8162 by Guan Bi connecting rod 8164.Guan Bi connecting rod 8164 its far-end by Guan Bi yoke pin 8166 can pivotably be attached to closed yoke 8162, and in its proximal end by Guan Bi link pin 8168 can pivotably be attached.In various embodiments, closure trigger 8026 can be closed trigger stretching spring 8246 and be advanced into open position, top 8160 that this stretching spring is proximally connected to closure trigger 8026 and the shank shell 8154 formed by right half-shell 8156 and left shell half 8158.The tension force applied by stretching spring 8246 can be applied to the closing force of closure trigger 8026 and overcome, in order to advance yoke 8162, Guan Bi connecting rod 8164 and Guan Bi pipe 8024 towards distally.

As mentioned above, when closure trigger 8026 activated or depresses, the need to, Guan Bi release button 8038 can be oriented so that surgeon or other clinicians can press Guan Bi release button 8038, and makes the remainder of closure trigger 8026 and surgical instruments be back to non-actuating state.In various embodiments, close release button 8038 and can be connected to pivoting latch arm 8172 by the lateral pivot 8173 of central authorities so that transmitting movement between button 8038 and lock arm 8172 can discharged.Refer again to Figure 181, Guan Bi release button 8038 can proximally be biased by compression spring 8174, i.e. as observed from the right side, bias clockwise around the lateral pivot of central authorities 8173, and the top 8160 of closure trigger 8026 can include the nearside tooth top 8170 with rear recess 8171.When closure trigger 8026 is depressed, pivoting latch arm 8172 can straddle on nearside tooth top 8170, and when closure trigger 8026 arrives its fully depressed position, it is to be understood that, rear recess 8171 is present in below pivoting latch arm 8172, this pivoting latch arm compression spring 8174 force fall into and lock after recess 8171.Now, the manual depression of Guan Bi release button 8038 makes pivoting latch arm 8172 upwards and rotates from rear recess 8171, thus unlocks and make closure trigger 8026 to be back to its unclamped position closure trigger 8026.

Once closure trigger 8026 is proximally clamped, as it has been described above, then percussion trigger 8034 can be pulled to pistol grip 8036, in order to from shank 8020 towards distally propelling percussion connecting rod 8032.In various embodiments, percussion trigger 8034 can pivot around percussion trigger pin 8202, and this percussion trigger pin is horizontally through the right half-shell 8156 of shank 8020 and left shell half 8158 and engages.When activated, percussion trigger 8034 can advance link-type transmission firing lock 8150.Link-type transmission firing lock 8150 can be forced to retraction, non-firing position by spring 8184.This spring: 1) it is attached to the pistol grip 8036 of shank 8020；And 2) it is attached to one of them connecting rod of such as link-type transmission firing lock 8150, as described in more detail below.Spring 8184 can include the motion end 8188 of non-athletic the end 8186 and near-end 8190 being connected to steel band 8192 being connected to shell 8154.The end 8194 being arranged at distally of steel band 8192 can be attached to the attachment structure 8195 on the front rod 8196a in multiple connecting rod 8196a-8196d, and the plurality of connecting rod forms link-type tooth bar 8200.Link-type tooth bar 8200 can be flexible, it is made can be easily retracted into pistol grip 8036 and minimize the length of shank 8020, but forming the tooth bar assembly of straight rigidity, significant percussion force can be transferred to and/or through percussion connecting rod 8032 by this tooth bar assembly.As described in more detail below, percussion trigger 8034 can engage with first connecting rod 8196a during the first actuating of percussion trigger 8034, engage with second connecting rod 8196b during the second actuating of percussion trigger 8034, engage with third connecting rod 8196c during the 3rd actuating of percussion trigger 8034, and engaging with fourth link 8196d during the 4th actuating of percussion trigger 8034, wherein link-type tooth bar 8200 can be advanced the amount being incremented by by activating of percussion trigger 8034 towards distally every time.In various embodiments, to being described further above, multiple strokes of percussion trigger 1034 can make right indicator wheel 1040 and left indicator wheel 1041 rotate, with the distance indicating link-type tooth bar 8200 to advance.

Referring now to Figure 181 and Figure 183, Anti-backup mechanism 8250 can prevent combining stretching/compressing spring 8184 makes link-type tooth bar 8200 bounce back between firing stroke.In various embodiments, couple sliding tube 8131 adjoin first connecting rod 8196a and be connected to fire connecting rod 8032 with transmission percussion motion.Percussion connecting rod 8032 proximally extends the near-end of framework 8028 and extends through the through hole 8408 of anti-backup plate 8266.Being sized to when firing connecting rod 8032 with slidingly receiving when firing connecting rod 8032 vertical alignment of through hole 8408, and it is the most motionless to make percussion connecting rod roll in through-holes when inclined.Bottom inserted sheet attachment 8271 proximally extends from the lower lip of the near-end of framework 8028, extends through the hole 8269 on the lower limb of anti-backup plate 8266.The bottom of anti-backup plate 8266 is drawn to neighbouring framework 8028 by this bottom inserted sheet attachment 8271, it is vertical for making the anti-backup plate 8266 when firing connecting rod 8032 and being pushed into towards distally, and anti-backup plate 8266 can make top tilt backwards to bound state when firing connecting rod 8032 and attempting retraction.Anti-retrogression compression spring 8264 is retrained towards distally by the near-end of framework 8028, and proximally adjoins the top of anti-backup plate 8266, thus anti-backup plate 8266 is biased to lock-out state.Anti-retrogression cam tube 8268 resists spring biasing and cincture slidably couples sliding tube 8131 and adjacent anti-backup plate 8266.The proximally prominent anti-retrogression yoke 8256 being attached to anti-retrogression cam tube 8268 extends beyond closed yoke 8162.

Seeing Figure 181, the automatic retracted mechanism 8289 that connecting rod triggers is attached to surgical stapling and cuts off in apparatus 8010, so that cutter bounces back at the end of firing stroke completely.To this end, distal link 8196d includes tang 8290, when distal link 8196d is advanced the rach slot 8291(Figure 181 being formed in closed yoke 8162) in time tang upwardly.Align this tang 8290 to start anti-retrogression trip lever 8248(Figure 186) on bottom proximal cam 8292.Referring specifically to Figure 186 and Figure 187, the motion of the structural constraint anti-retrogression trip lever 8248 being formed in right half-shell 8156 and left shell half 8158.The pin socket 8296 and the circular pegs 8293 that are respectively formed between right half-shell 8156 and left shell half 8158 are received through longitudinally elongated hole 8294, this hole is formed in the anti-retrogression trip lever 8248 in proximal cam 8292 distally, bottom, thus allows longitudinal translation and rotate around circular pegs 8293.In right half-shell 8156, the groove 8295 proximally opened includes with up and angled part 8295b connects towards distally nearside horizontal component 8295a, this is up and angled part 8295b accommodates rear pin 8297(Figure 187 to the right of the near proximal ends of anti-retrogression trip lever 8248 towards distally), thus when anti-retrogression trip lever 8248 arrives the farthest side part of its translation, this is up and angled part 8295b gives rotation upwards towards distally.Once anti-retrogression trip lever 8248 is assembled, and the barrier structure being formed in the right half-shell 8156 of neighbouring anti-retrogression trip lever 8248 prevents anti-retrogression trip lever 8248 from proximally moving, so that rear pin 8297 to the right is maintained in the groove 8295 proximally opened.

To being described further above, as shown in Figure 187 and Figure 188, the far-end 8254 of anti-retrogression trip lever 8248 thus towards distally and be forced to downwards, making front pin 8298 to the right fall in the hierarchic structure 8299 opened towards distally being formed in right half-shell 8156, this is engaged through compression spring 8300(Figure 188) hook 8301 to the left that is fixed on the anti-retrogression trip lever 8248 between the front pin 8298 to the right and longitudinally elongated hole 8294 and realize.The other end of compression spring 8300 be attached to be formed in right half-shell 8156 closed yoke 8266 immediately above closer to and hook 8302(Figure 186, Figure 188, Figure 189 of lower position).Compression spring 8300 thus by the far-end 8254 downwardly and rearwardly tractive of anti-retrogression trip lever 8248, make front pin 8298 to the right lock onto when being pushed into towards distally in the hierarchic structure 8299 opened towards distally.Therefore, the most released, see Figure 189, anti-retrogression trip lever 8248 keeps forward, is held vertically throughout anti-backup plate 8266, so that link-type tooth bar 8200 bounces back.When in the case of free end executor 8012, closed yoke 8266 bounces back subsequently, reset tang 8303 upwardly on closed yoke 8266 contacts the bottom distal cam 8305 of anti-retrogression trip lever 8248, front pin 8298 to the right is lifted from the hierarchic structure 8299 opened towards distally so that anti-retrogression cam tube 8268 and anti-retrogression trip lever 8248 can be proximally pushed to its advanced position (Figure 186) by anti-retrogression compression spring 8264.

In various embodiments, seeing Figure 179 and Figure 189, percussion trigger 8034 can be operatively engaged to link-type tooth bar 8200 in any suitable manner.Referring specifically to Figure 180 and Figure 185, percussion trigger 8034 pivots around the percussion trigger pin 8202 being connected to shell 8154.When firing trigger 8034 and depressing towards pistol grip 8036, the top 8204 of percussion trigger 8034 is around percussion trigger pin 8202 towards distal movement, thus the percussion trigger stretching spring 8206(Figure 181 that will proximally place) stretching, this stretching spring is proximally connected between top 8204 and the shell 8154 of percussion trigger 8034.Under percussion trigger every time during pressure, the side pawl mechanism 8210 engagement link formula tooth bar 8200 that the top 8204 of percussion trigger 8034 biases via spring.When firing trigger and being released, side pawl mechanism separates with link-type tooth bar 8200, and fires trigger and may return to non-depressed or non-firing position.In use, by connecting rod 8196a-8196d each in the right rail of inclination that formed towards nearside and inclined-plane to the right 8284 engaged by side pawl assembly 8285.Specifically, pawl slide block 8270(Figure 181 and Figure 183) there is lower left quarter guide rail and right lower quadrant guide rail 8272, this lower left quarter guide rail and right lower quadrant guide rail left track 8274(Figure 181 in the closed yoke 8266 being formed at below rach slot 8291 respectively) in and right track 8275 in closed yoke guide rail 8276 in slide.Closed yoke guide rail 8276 is parallel to rach slot 8291 and is attached to rach slot lid 8277, and what this rach slot lid closed the rach slot 8291 in closed yoke 8266 opens to the right part, described opens to the right the distally that part is positioned at the traveling of pawl slide block 8270.In Figure 181, Figure 182 and Figure 185, compression spring 8278 is attached between the hook 8280 on the Distal Right of the hook 8279 in the top proximal position on closed yoke guide rail 8276 and pawl slide block 8270, and this makes pawl slide block 8270 proximally contact with the top 8204 firing trigger 8034 downwards.

Referring specifically to Figure 181, pawl block 8318 is positioned on pawl slide block 8270, pivots around vertical rear pin 8320, and this rear pin is through the left proximal turning of pawl block 8318 and pawl slide block 8270.Kick out of in the distal part of the top surface that block groove 8322 is formed at block 8318, therein being kicked out of block 8324 by normal pin 8326 can pivotably be fixed on to accommodate, the bottom end of this normal pin extends in the pawl spring groove 8328 on the top surface of pawl slide block 8270.Pawl spring 8330 in pawl spring groove 8328 extends to the right side of vertical front pin 8326, forces pawl block 8318 to rotate counterclockwise to time viewed from above with the right rail 8282 tilted and engages.Kick out of the little wind spring 8332 in block groove 8322 to force and kick out of block 8324 and turn clockwise time viewed from above so that it is near-end is forced to contact with the wavy antelabium 8334 in the closed yoke 8266 being formed at above rach slot 8291.As shown in Figure 184, pawl spring 8330 means pawl block 8318 to be prone to the block 8324 of kicking out of turned clockwise compared to the higher mechanical dominance being had for little wind spring 8332 to engage.In Figure 185, when firing trigger 8034 and being fully depressed and start to be released, kick out of block 8324 and run into the ridge 8336 of wavy antelabium 8334 when pawl slide block 8270 bounces back, force and kick out of block 8324 and turn clockwise time viewed from above, thus pawl block 8318 is kicked out of and the joint of link-type tooth bar 8200.The shape kicking out of block groove 8322 makes to kick out of the stopping that turning clockwise of block 8324 so that it is be in the direction being perpendicular to wavy antelabium 8334, eliminates ratcheting noise being fully retracted period this disengaging of holding.

In Figure 181, Figure 183, Figure 190 and Figure 195, surgical stapling and cut-out apparatus 8010 can include manual retrieving mechanism 8500, this manual retrieving mechanism provides the manual release of firing lock, manual retrieving, and also performs automatic retracted at the end of firing stroke completely in a kind of pattern (Figure 196-202).Referring now to Figure 181, Figure 190 and Figure 191, specifically, front idler gear 8220 engages with the surface, dentation upper left 8222 of link-type tooth bar 8200, and the most front idler gear 8220 also engages the rear idler gear 8230 with less right-side ratchet gear 8231.Front idler gear 8220 and rear idler gear 8230 are rotationally attached to lay respectively at the shank shell 8154 on front idler axle 8232 and rear idler wheel axle 8234.The often end of rear idler wheel axle 8232 extends through corresponding right half-shell 8156 and left shell half 8158, and it is attached to left indicator wheel 8040 and right indicator wheel 8041, and owing to hind axle 8234 rotates freely in shank shell 8154 and is bonded to backgear 8230 with bonding pattern, thereby indicate that device wheel 8040,8041 rotates together with backgear 8230.The gear relation between link-type tooth bar 8200, idler gear 8220 and backgear 8230 can be advantageously selected, dentation upper surface 8222 is made to have the teeth size that intensity is suitable, and making during the stroke of percussion completely of link-type transmission firing lock 8150, the rotation of backgear 8230 is less than a circle.Gear mechanism 8502 is in addition to indicating percussion stroke or progress intuitively, and gear mechanism 8502 can be additionally used in and makes cutter manual retrieving.In various embodiments, the less right-side ratchet gear 8231 of rear idler gear 8230 extends in the wheel hub 8506 of manual retrieving lever 8042, specifically with by wheel hub 8506 to point vertical longitudinally-aligned slit 8508(Figure 190) align.The lateral through hole 8510 of wheel hub 8506 connects with upper grooves 8512.Anterior 8514 are shaped as the locking pawl 8516 that receiving proximally guides, and this locking pawl pivots around the lateral pin 8518 to the right in the far-end being formed at upper grooves 8512.Rear portion 8520 is shaped as receiving L-type spring tab 8522, and this spring tab forces locking pawl 8516 ratchet gear 8231 the least with right side to engage.Barrier structure 8524(Figure 186 and Figure 193) project into upper grooves 8512 from right half-shell 8156；When manual retrieving lever 8042 is downward (Figure 193), this barrier structure stops locking pawl 8516 to engage less right-side ratchet gear 8231.Wind spring 8525(Figure 181) force manual retrieving lever 8042 downward.

In use, as shown in Figure 192 and Figure 193, combination stretching/compressing spring 8184 can depart from the link-type tooth bar being positioned at distally.In Figure 194 and Figure 195, when manual retrieving lever 8042 lifts, locking pawl 8516 turns clockwise and is no longer blocked structure 8524 and stops, and engages less right-side ratchet gear 8231, so that rear idler gear 8230 turns clockwise when from left sides.Therefore, front idler gear 8220 responds counterclockwise, makes link-type tooth bar 8200 bounce back.Additionally, curved ridges 8510 to the right highlights from wheel hub 8506, and it is sized to contact and towards distal movement anti-retrogression trip lever 8248, and with when manual retrieving lever 8042 rotates, this anti-retrogression trip lever discharges Anti-backup mechanism 8250.

In Figure 196-202, automatic retracted can be attached at the end of firing stroke completely by the automatic retracted mechanism 8600 of surgical stapling and cut-out apparatus 8010a to be had in the front idler gear 8220a of tooth 8602；Move in this front idler gear circular groove 8604 in cam 8606, until rotating, corresponding to the nearly omnidistance of three firing stroke, the thing 8608 that meets with obstruction.In such cases, ridge 8610 to the right is rotated upwardly to contact bottom cam groove 8612, with towards distal movement anti-retrogression trip lever 8248a.The far-end 8254 operated as described in the preceding is included referring specifically to Figure 197, anti-retrogression trip lever 8248a.It is respectively formed in the circular pegs 8293 between right half-shell 8156 and left shell half 8158 and substantially rectangular hole 8294a that pin socket 8296 is formed through in the anti-retrogression trip lever 8248a after bottom cam 8192 is received, thus allow the downward lock motion of the far-end 8254 of longitudinal translation and anti-retrogression trip lever 8248a.In right half-shell 8156, the groove 8295a proximally opened of level accommodates the rear pin 8297 to the right of the near proximal ends of anti-retrogression trip lever 8248a.

In operation, before the percussion in Figure 198,198A, link-type tooth bar 8200 and anti-retrogression cam tube 8268 are in advanced position, thus when anti-retrogression compression spring 8264 makes anti-backup plate 8266 proximally tilt, Anti-backup mechanism 8250 is locked.Automatic retracted mechanism 8600 is in original state, wherein anti-retrogression trip lever 8248a retraction, and connecting rod 8196a contacts with front idler gear 8220a.Tooth 8602 is in the position of six o'clock sharps, and wherein the total travel of circular groove 8604 is carried out counterclockwise, ridge 8610 just adjacent teeth 8602 to the right.In Figure 199, Figure 199 A, there is a firing stroke, moved upward to a distal link 8196b contact with front idler gear 8220a.Tooth 8602 has advanced 1/3rd turns by the circular groove 8604 of fixing cam 8606.In Figure 200, Figure 200 A, there is second firing stroke, moved upward to another connecting rod 8196c contact with front idler gear 8220a.Tooth 8602 has advanced 2/3rds turns by the circular groove 8604 of fixing cam 8606.In Figure 20 1, Figure 20 1A, there is the 3rd firing stroke, moved upward to a distal link 8196d contact with front idler gear 8220a.Tooth 8602 proceeds to contact with hindering thing 8608 around circular groove 8604 whole process, thus the rotation (when observing from right side) counterclockwise of starting cam 8606, so that ridge 8608 to the right contacts with anti-retrogression trip lever 8248a.In Figure 20 2, anti-retrogression trip lever 8248a is as responding towards distal movement, thus is locked onto in the hierarchic structure 8299 opened towards distally by front pin 8298 to the right and discharge Anti-backup mechanism 8250.Similar surgery suturing appliance is disclosed in the United States Patent (USP) 7 announced on August 1st, 2006, and in 083,075, the complete disclosure of this patent is incorporated by reference herein.

Seeing Figure 20 3, the nail of surgery suturing appliance 9010 is used assembly 9012 and is implemented function such as: clamp organizationally, by driving nail along axle 9016 relative to two kinds of different motion of the longitudinal going down of pedestal 9070 and cut off tissue.Pedestal 9070 is proximally attached to the shank of surgery suturing appliance and is coupled to it, to be rotated about longitudinal axes.For surgical stapling with cut off illustrative many strokes shank of apparatus in CO-PENDING and the U.S. Patent Application Serial Number 10/374 of entitled " SURGICALSTAPLINGINSTRUMENTINCORPORATINGAMULTISTROKEFIRIN GPOSITIONINDICATORANDRETRACTIONMECHANISM " owned together, being described in more detail in 026, the disclosure of this patent application is incorporated by reference in its entirety.Other application meeting the present invention can be in conjunction with single firing stroke, such as in CO-PENDING and entitled " SURGICALSTAPLINGINSTRUMENTHAVINGSEPARATEDISTINCTCLOSINGA NDFIRINGSYSTEMS " U.S. Patent Application Serial Number 10/441 of owning together, as described in 632, the disclosure of this patent application is incorporated by reference in its entirety.

Referring specifically to Figure 20 4, the distal attachment of pedestal 9070 is to nail groove 9018.Anvil block 9022 has nearside hub switch side 9072, and this nearside hub switch side, can pivotably be contained in the near-end 9074 of nail groove 9018, is placed exactly in the distally at itself and pedestal 9070 attachment.When anvil block 9022 pivots downwards, anvil block 9022 makes tissue contacting surface 9028 and shapes pit 9026 towards relative nail bin motion, as the most described in more detail.The hub switch side 9072 of anvil block 9022 includes closing structure 9076, this closing structure distally at itself and the attachment of nail groove 9018 but at itself and nail groove attachment.Therefore, Guan Bi its far-end of pipe 9078(includes the shape of a hoof hole 9080 engaging this closing structure 9076) optionally will open motion imparting anvil block 9022 during nearside lengthwise movement, and during the distally lengthwise movement of Guan Bi pipe 9078, closing motion is given anvil block 9022, this Guan Bi pipe 9078 slides on pedestal 9070 in response to closure trigger, similarly as described above.Pedestal 9070 promotes and guides percussion motion from shank through the split type cutter of longitudinally reciprocating motion and trigger shaft 9090.Specifically, pedestal 9070 includes the trigger shaft 9094 that longitudinal trigger shaft slit 9092, this longitudinal direction trigger shaft slit receiving split type cutter and the portions of proximal of trigger shaft 9090, in particular lamination are tapered.Should be appreciated that the tapered trigger shaft 9094 of lamination can be replaced by solid trigger shaft and/or any other suitable material.

E type crossbeam 9102 is the distal part of split type cutter and trigger shaft 9090, and it is conducive to individually Guan Bi and percussion, and by spaced apart to anvil block 9022 and elongated nail groove 9018 during firing.Referring specifically to Figure 20 4 and Figure 20 5, in addition to any attachment processes such as solder brazing and binding agent, the vertical attachment hole of spill 9104 that cutter is also formed from E type crossbeam 9102 with trigger shaft 9090 is formed, this hole accommodates the correspondingly convex attachment members 9106 presented by the trigger shaft 9094 that lamination is tapered in distally, so that each part is formed by the selected material and method being suitable to its difference in functionality (such as intensity, pliability, frictional force).E type crossbeam 9102 can advantageously be formed by the material with desired material properties, to form a pair top pin 9110, a pair intermediate pin 9112 and base pins or leg 9114, and is obtained in that sharp knife edges 9116.Additionally, hold the one-body molded of each vertical end of blade 9116 and proximally prominent top guide device 9118 and intermediate guide 9120 also defines set of organizations tie region 9122, contribute to guiding to sharp knife edges 9116 before cutting off tissue.Intermediate guide 9120 is additionally operable to by adjacent wedge-shaped slides 9126(Figure 20 6) staged central member 9124 engage and fire nail application equipment 9012, thus by nail use assembly 9012 realize follow closely formation, as described in more detail below.For being assembled by multiple parts, it is integrally formed these structures (such as with E type crossbeam 9102, top pin 9110, intermediate pin 9112 and bottom supports 9114) be conducive to manufacture under the tolerance limit of the most more compactness, ensure that percussion and/or with nail use assembly 9012 various latch-up structures effective interaction during carry out desired operation.

In Figure 20 7 and Figure 20 8, nail uses what assembly 9012 was illustrated as opening, and wherein E type crossbeam 9102 is fully retracted.During assembly, the lower leg 9114 of E type crossbeam 9102 falls in nail groove 9018 through expanded hole 9130, and E type crossbeam 9102 is pushed into subsequently so that E type crossbeam 9102 slides along the lower railway 9132 being formed in nail groove 9018 towards distally.Specifically, lower railway 9132 includes slit 9133, and it is opened as expanding slit 9134 on the lower surface of nail groove 9018, to form the T-shaped of reversion in lateral cross section, as specifically shown in Figure 20 8 and Figure 20 9；This slit 9133 connects with expanded hole 9130.The most assembled, the parts being attached to the tapered trigger shaft of lamination 9094 at nearside do not allow lower leg 9114 the most proximally to march to expanded hole 9130 to allow to depart from.Seeing Figure 21 0, the tapered trigger shaft of lamination 9094 is conducive to that nail is used assembly 9012 and inserts through the trocar.Specifically, when E type crossbeam 9102 is fully retracted, the downward protuberance 9136 of farther side lifts E type crossbeam 9102.This is subjected to displacement in certain point by downward protuberance 9136 and realizes；At this point, upwards cam in the proximal of this protuberance expanded hole 9130 in nail groove 9018.Referring now to Figure 21 1, the tapered trigger shaft 9094 of lamination also strengthens the operation of some latch-up structure, and described latch-up structure can be attached to closer to the protuberance 9138 upwards of side follow closely in groove 9018 by including；Described protuberance is ordered about downwards by pedestal 9070 during the initial part of percussion stroke.Specifically, lateral rod 9140 is limited at pedestal 9070(Figure 20 4) in a square holes 9142 between.Surrounding downwards the clip springs 9144 of lateral rod 9140 forces the part of the tapered trigger shaft 9094 of lamination prominent towards distally from longitudinal trigger shaft slit 9092, it is ensured that the when of suitably, some favourable latch-up structure is engaged.When protuberance 9138 contacts clip spring 9144 upwards, this motive force becomes apparent from or is limited only to firing the part of stroke.

In Figure 20 7 and Figure 20 8, E type crossbeam 9102 bounces back, and its top pin 9110 is positioned at the anvil block pit 9150 pivoting near proximal ends of anvil block 9022.The vertical anvil slot 9152(Figure 20 3 opened downwards) anvil block 9022 is laterally expanded into anvil block inner tracks 9154, when the top pin 9110 of E type crossbeam 9102 advances towards distally during firing, the top pin 9110 of anvil block inner tracks capture E type crossbeam 9102, as shown in Figure 21 0 and Figure 21 1, anvil block 9022 is the most spaced apart with nail groove 9018.Therefore, after E type crossbeam 9102 bounces back, surgeon can be repeatedly opened and close nail and use assembly 9012, until to being trapped in the placement of tissue that is the most to be stapled and that cut off and orientation pleases oneself, and E type crossbeam 9102 is even for having the diameter of minimizing and correspondingly reducing for assembly 9012 used by the nail of rigidity and also contribute to appropriately positioning of tissue.In Figure 20 3, Figure 20 4, Figure 20 6, Figure 20 7, Figure 20 9 and Figure 21 5, nail is used assembly 9012 and is shown as having the replaceable nail bin 9020 including wedge-shaped slides 9126.Longitudinally-aligned and parallel multiple wedge slot 9202(Figure 20 9 opened downwards) accommodate the corresponding wedge 9204 that wedge-shaped slides 9126 is required.In Figure 20 9-211, the multiple staple drivers of wedge-shaped slides 9126 the most upwards cam 9206, the plurality of staple drivers can vertical sliding motion in staple drivers groove 9208.In this illustrative pattern, each staple drivers 9206 includes two vertical contact pins, each vertical contact pin translates up in corresponding nail 9210 or cavity 9024, will rest against nail profiled surface 9214(Figure 21 1 of anvil block 9022) on nail 9023 upwards extrude and make it deform.The central authorities percussion groove 9216(Figure 20 4 being limited in the nail bin 9020 of neighbouring nail groove 9018) allow bottom horizontal portion 9218(Figure 20 6 of wedge-shaped slides 9126) and the intermediate pin 9112 of E type crossbeam 9102 pass through.Specifically, nail bin pallet 9220(Figure 20 4, Figure 20 9) it is attached to polymer staple cartridge body 9222 and is positioned under；This polymer staple cartridge body have be formed at staple drivers groove 9208 therein, nail 9210 and central authorities percussion groove 9216.When following closely 9023 and therefore shaping at either side, sharp knife edges 9116 enters vertical through slot 9230, and in addition to the only distalmost end of this vertical through slot, this vertical through slot is through the longitudinal axis of nail bin 9020.

As shown in Figure 21 1, when by split type cutter and trigger shaft 9090 proximally tractive until downward protuberance 9136 is by intermediate guide 9120 upwardly and rearwardly cam on E type crossbeam 9102, start to fire nail and use assembly 9012, thus when anvil block 9022 such as Figure 20 3 and 207 is opened, make new nail bin 9020 insert in nail groove 9018.In Figure 21 2, split type cutter and trigger shaft 9090 are pushed into a small distance towards distally, so that when clip springs 9144 acts on the protuberance 9138 upwards of the tapered trigger shaft of lamination 9094, downward protuberance 9136 falls in the expanded hole 9130 of lower railway 9132.Intermediate guide 9120 prevents owing to being resisted against further being rotated down of producing in the staged central member 9124 of wedge-shaped slides 9126, thus is maintained at by the intermediate pin 9112 of E type crossbeam in central authorities' percussion groove 9216.In Figure 21 3, split type cutter and trigger shaft 9090 are fired towards distally, thus advance wedge-shaped slides 9126, to make nail 9023 shape when being cut off by the tissue being clamped between anvil block 9022 and the nail bin 9020 with sharp knife edges 9,116 9242.Subsequently, in Figure 21 4, split type cutter and trigger shaft 9090 bounce back, and make wedge-shaped slides 9126 position in distally.In Figure 21 5, intermediate pin 9112 be allowed to pan-down to be formed at nail groove 9018(referring also to Figure 20 8, Figure 21 1) in latch recess 9240 in.Therefore, when wedge-shaped slides 9126(is not shown in Figure 21 5) not when proximally-oriented (such as, nail bin 9020 lacks or nail bin 9020 exhausts), if intermediate pin 9112 runs into the distal side edge of latch recess 9240, then operator will receive haptic indication.The United States Patent (USP) 7 that similar surgery suturing appliance was announced on June 3rd, 2008, has disclosed in 380,696, the complete disclosure of this patent is incorporated by reference herein.

In various embodiments, as it has been described above, nail bin can include warehouse, this warehouse includes multiple nail chamber limited wherein.Warehouse can include that platform and top platform surface, the most each nail chamber can limit the opening in platform surface.As also described above, nail can be positioned in each nail intracavity so that until it is shot up from warehouse in nail is stored in warehouse.In various embodiments, before being shot up from warehouse, nail can be accommodated in warehouse so that nail does not protrudes into above platform surface.In this type of embodiment, when nail is positioned in below platform surface, the damaged and/or probability of premature contact target tissue of nail can be reduced.In all cases, nail can move between non-firing position and firing position.When non-firing position, it does not highlights from warehouse, and when firing position, it has exposed from warehouse and can contact the anvil block being positioned in nail bin opposite.In various embodiments, anvil block and/or the nail that is limited in anvil block shape pit and can be positioned so that anomaly platform surface one preset distance so that when nail is deployed from warehouse, nail is deformed into a predetermined forming height.In some cases, the thickness variable of the tissue being trapped between anvil block and nail bin, therefore, in thicker tissue can be trapped in some nail, relatively thin tissue can be trapped in some other nail.In either case, nail it is applied to the clamping pressure of tissue or compaction forces such as can be different because of nail, or change between the nail on the other end of nail on one end of staple and staple.In some cases, the gap between anvil block and nail bin platform can be controlled so that nail applies the clamping pressure of a certain minimum in each nail.But in some such cases, the notable change of the clamping pressure in different nails may possibly still be present.

In various embodiments described herein, nail bin can include following device: this device is for compensating the thickness of the tissue of the nail capture disposed from nail bin.In various embodiments, seeing Figure 21 6, nail bin such as nail bin 10000 such as can include Part I such as support section 10010 of rigidity, and compressible Part II such as thickness compensation part 10020.In at least one embodiment, referring first to Figure 21 8, support section 10010 can include warehouse, top platform surface 10011 and multiple nail chamber 10012.Wherein, similarly as described above, each nail chamber 10012 can limit the opening in platform surface 10011.Nail 10030 such as can be removably positioned in each nail chamber 10012.In at least one this type of embodiment, referring first to Figure 24 5 and as described in more detail below, each nail 10030 can include base portion 10031 and the one or more lower limbs 10032 extended from base portion 10031.Before nail 10030 is deployed, the most as described in more detail below, the base portion 10031 of nail 10030 can be supported by the staple drivers being positioned in support section 10010, and simultaneously, the lower limb 10032 of nail 10030 can at least be partly accommodated in nail chamber 10012.In various embodiments, nail 10030 can be deployed between non-firing position and firing position so that lower limb 10032 moves across tissue thickness's compensating part 10020, penetrates the top surface of tissue thickness's compensating part 10020, penetrate tissue T, and contact the anvil block being positioned in nail bin 10000 opposite.When lower limb 10032 is against deflection, the lower limb 10032 of each nail 10030 can the part of tissue T in the part of capture tissue thickness compensation part 10020 and each nail 10030, and apply compressive force to tissue.To being described further above, the lower limb 10032 of each nail 10030 can be made to deform downwardly toward the base portion 10031 of nail, retain region 10039 forming nail, retaining region, tissue T and tissue thickness's compensating part 10020 at this nail can be captured.In all cases, nail retains between inner surface and the inner surface of base portion 10031 that region 10039 can be limited at strained lower limb 10032.Nail retains the size in region and can be depending on some questions, the length of such as lower limb, the diameter of lower limb, the width of base portion and/or the degree of such as lower limb deformation.

In embodiment previously, the organizational choice that surgeon is usually required for just being sewn has the suitable nail of suitable staple height.Such as, surgeon may select high nail and is used together and selects low nail to be used together with thin tissue with thick organizing.But in some cases, the tissue being just sewn does not has consistent thickness, and therefore, some nails cannot realize desired percussion configuration.Such as, Figure 25 0 shows the higher nail in relatively thin tissue.Referring now to Figure 25 1, when such as tissue thickness's compensating part 10020 is such as used together tissue thickness's compensating part with thin tissue, the biggest nail can be configured to desired percussion configuration.

Due to the compression ratio of tissue thickness's compensating part, the thickness of capture tissue in each nail can be compensated by tissue thickness's compensating part.More specifically, referring now to Figure 24 5 and Figure 24 6, tissue thickness's compensating part such as tissue thickness's compensating part 10020, the thickness of the tissue that such as can accommodate in retaining region 10039 according to nail and/or type occupy the nail of each nail 10030 and retain the bigger and/or less part in region 10039.Such as, being trapped in the situation in nail 10030 compared to thicker tissue T, if relatively thin tissue T is trapped in nail 10030, then tissue thickness's compensating part 10020 can occupy nail and retain the major part in region 10039.Correspondingly, being trapped in the situation in nail 10030 compared to relatively thin tissue T, if thicker tissue T is trapped in nail 10030, then tissue thickness's compensating part 10020 can occupy nail and retain the smaller portions in region 10039.So, tissue thickness's compensating part can compensate for relatively thin tissue and/or thicker tissue, and guarantees that compression stress is applied to tissue, no matter regardless of whether or being at least substantially trapped in the tissue thickness in nail.In addition to the above, the tissue of the dissimilar or different compression ratio being trapped in different nail 10030 can be compensated by tissue thickness's compensating part 10020.Referring now to Figure 24 6, tissue thickness's compensating part 10020 can apply compressive force to include the vascular tissue T of blood vessel V, and therefore limit blood flows through the most compressible blood vessel V, but desired compression stress is still applied to the tissue T of surrounding.In all cases, to being described further above, tissue thickness's compensating part 10020 can also compensate for strained nail.Seeing Figure 24 7, the deformation of various nails 10030 may result in the bigger nail being limited in this type of nail and retains region 10039.Resilience force due to tissue thickness's compensating part 10020, referring now to Figure 24 8, even if be limited at deform nail 10030 in nail retain region 10039 can be extended, be positioned at this deformed nail 10030 in tissue thickness's compensating part 10020 still enough compression stresses can be applied to tissue T.In all cases, be positioned at the tissue thickness's compensating part 10020 in the middle of adjacent nail 10030 to be biased against tissue T by the nail 10030 suitably shaped that be deformed around nail 10030, and therefore apply compressive force to such as around and/or be trapped in the tissue deformed in nail 10030.In all cases, tissue thickness's compensating part can compensate for different tissue densities, and described different tissue density can such as produce due to classification, zone of fiber and/or the tissue previously sewed up or processed.

In various embodiments, that fix or unmodifiable interstice can be limited between support section and anvil block.No matter the thickness of the tissue being therefore trapped in nail the most all can make nail be deformed into predetermined height.When tissue thickness's compensating part is used together with these embodiments, tissue thickness's compensating part is suitable for the tissue being trapped between anvil block and support section nail bin, and due to the resilience force of tissue thickness's compensating part, additional compression stress can be applied to tissue by tissue thickness's compensating part.Referring now to Figure 25 2-257, nail 10030 is formed for predetermined height H.With reference to Figure 25 2, tissue thickness's compensating part is not used, and tissue T occupies whole nail and retains region 10039.With reference to Figure 25 9, a part for tissue thickness's compensating part 10020 has been trapped in nail 10030, tissue T is compressed, and has occupied nail and retain at least some of of region 10039.Referring now to Figure 25 4, thin tissue T, it has been trapped in nail 10030.In this embodiment, the tissue T compressed has the height of about 2/9H, and the tissue thickness's compensating part 10020 compressed has the height of the most about 7/9H.Referring now to Figure 25 5, the tissue T with interior thickness has been trapped in nail 10030.In this embodiment, the tissue T compressed has the height of about 4/9H, and the tissue thickness's compensating part 10020 compressed has the height of the most about 5/9H.Referring now to Figure 25 6, the tissue T with interior thickness has been trapped in nail 10030.In this embodiment, the tissue T compressed has the height of about 2/3H, and the tissue thickness's compensating part 10020 compressed has the height of the most about 1/3H.Referring now to Figure 25 5, thick tissue T has been trapped in nail 10030.In this embodiment, the tissue T compressed has the height of about 8/9H, and the tissue thickness's compensating part 10020 compressed has the height of the most about 1/9H.In all cases, tissue thickness's compensating part can include compression height, and this compression height includes: the nail of the most about 10% retains height, the nail of about 20% retains height, the nail of about 30% retains height, the nail of about 40% retains height, the nail of about 50% retains height, the nail of about 60% retains height, the nail of about 70% retains height, the nail of about 80% retains height and/or the nail of about 90% retains height.

In various embodiments, nail 10030 can include any suitable unshaped height.In certain embodiments, nail 10030 can include such as unshaped height between about 2mm and about 4.8mm.Nail 10030 can include the unshaped height of the most about 2.0mm, about 2.5mm, about 3.0mm, about 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm and/or about 4.8mm.In various embodiments, follow closely deformable height H to be determined by the distance between platform surface 10011 and the relative anvil block of support section 10010.In at least one embodiment, the distance between platform surface 10011 and the tissue contacting surface of anvil block can the most about 0.097 ".Highly H also can be determined by the degree of depth shaping pit being limited in anvil block.In at least one embodiment, shape pit and such as can have the degree of depth measured from tissue contacting surface.In various embodiments, as described in more detail below, nail bin 10000 may also include staple drivers.Nail can 10030 be lifted by this staple drivers towards anvil block, and is lifted by nail at least one embodiment or " excessively driving " is to above platform surface 10011.In this type of embodiment, the distance that the forming height H of nail 10030 also can be overdriven by nail 10030 determines.The height that at least one this type of embodiment, nail 10030 can be overdriven the most about .028 ", and may result in nail 10030 be shaped as the most about 0.189 ".In various embodiments, nail 10030 can be shaped as the height of the most about 0.8mm, about 1.0mm, about 1.5mm, about 1.8mm, about 2.0mm and/or about 2.25mm.In certain embodiments, nail can be shaped as the most about 2.25mm and the height of about 3.0mm.To being described further above, the nail of nail retains the height in region and can be determined by the forming height followed closely and the width of the wire rod including nail and diameter.In various embodiments, the nail of nail 10030 retains the height in region 10039 and can include that the forming height H of nail deducts two diameter widths of wire rod.In certain embodiments, staple line material can include the most about 0.0089 " diameter.In various embodiments, nail row can include such as between the diameter of about 0.0069 " and about 0.0119 ".In at least one exemplary embodiment, the forming height H of nail 10030 may be about 0.189 ", and follow closely gauge or diameter of wire may be about 0.0089 ", thus such as produces about 0.171 " nail retain height.

In various embodiments, to being described further above, tissue thickness's compensating part can include the height of unpressed or pre-deployment, and can be deformed in multiple compression height.In certain embodiments, tissue thickness's compensating part can include the most about 0.125 " uncompressed height.In various embodiments, the compensating part of tissue thickness can include being greater than equal to about 0.080 " uncompressed height.In at least one embodiment, tissue thickness's compensating part can include the height of unpressed or pre-deployment, this height not firing highly more than nail.In at least one embodiment, the height of the unpressed or pre-deployment of tissue thickness's compensating part does not fires the highest by about 10%, height about 20%, height about 30%, height about 40%, height about 50%, height about 60%, height about 70%, height about 80%, height about 90% and/or height about 100% than follow closely.In at least one embodiment, the height of the unpressed or pre-deployment of tissue thickness's compensating part is the highest by the most up to about 100% than not firing of nail.In certain embodiments, the height of the unpressed or pre-deployment of tissue thickness's compensating part is the highest such as more than 100% than not firing of nail.In at least one embodiment, tissue thickness's compensating part can include the uncompressed height not firing height equal to nail.In at least one embodiment, tissue thickness's compensating part can include the uncompressed height not firing height less than nail.In at least one embodiment, the height of the unpressed or pre-deployment of tissue thickness's compensating part the lowest by about 10%, low by about 20%, low by about 30%, low by about 40%, low by about 50%, low by about 60% than not firing of nail, low by about 70%, low about 80% and/or low by about 90%.In various embodiments, compressible Part II can include uncompressed height, and this uncompressed height is higher than the uncompressed height of the tissue T being just sewn.In certain embodiments, tissue thickness's compensating part can include uncompressed height, and this uncompressed height is equal to the uncompressed height of the tissue T being just sewn.In various embodiments, tissue thickness's compensating part can include uncompressed height, and this uncompressed height is less than the uncompressed height of the tissue T being just sewn.

As it has been described above, whether thickness is organized or thin tissue is trapped in nail, tissue thickness's compensating part all can be compressed in multiple one-tenth staples.In at least one exemplary embodiment, the nail in nail row or staple can be made to deform so that the nail of each nail retains the height that region includes the most about 2.0mm, within wherein tissue T and tissue thickness's compensating part can be compressed to this height.In some cases, tissue T may be included in nail and retains the compression height of the about 1.75mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 0.25mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 1.50mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 0.50mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 1.25mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 0.75mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 1.0mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 1.0mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 0.75mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 1.25mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 1.50mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 0.50mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.In some cases, tissue T may be included in nail and retains the compression height of the about 0.25mm in region, and tissue thickness's compensating part may be included in nail and retains the compression height of the about 1.75mm in region, thus the nail obtaining adding up to the most about 2.0mm retains region height.

In various embodiments, to being described further above, tissue thickness's compensating part can include the uncompressed height of the percussion height less than nail.In certain embodiments, tissue thickness's compensating part can include the uncompressed height of the percussion height equal to nail.In some other embodiment, tissue thickness's compensating part can include the uncompressed height of the percussion height higher than nail.In at least one this type of embodiment, the uncompressed height of tissue thickness's compensating part can include thickness such as follows: this thickness is about the 110% of shaping staple height, about the 120% of shaping staple height, about the 130% of shaping staple height, about the 140% of shaping staple height, about the 150% of shaping staple height, about the 160% of shaping staple height, about the 170% of shaping staple height, about the 180% of shaping staple height, about the 190% of shaping staple height and/or about the 200% of shaping staple height.In certain embodiments, tissue thickness's compensating part can include uncompressed height, more than the twice of the percussion height that this height is nail.In various embodiments, tissue thickness can include compression height, and this height is such as to shape about the 85% to about 150% of staple height.In various embodiments, as it has been described above, tissue thickness's compensating part can be compressed between uncompressed thickness and compressed thickness.In certain embodiments, the compressed thickness of tissue thickness's compensating part can for example, about the 10% of its uncompressed thickness, about the 20% of its uncompressed thickness, about the 30% of its uncompressed thickness, about the 40% of its uncompressed thickness, about the 50% of its uncompressed thickness, about the 60% of its uncompressed thickness, about the 70% of its uncompressed thickness, about the 80% of its uncompressed thickness and/or about the 90% of its uncompressed thickness.In various embodiments, the uncompressed thickness of tissue thickness's compensating part can such as thick than its compressed thickness approximately twice as, about ten times, about 50 times and/or about 100 times.In at least one embodiment, the compressed thickness of tissue thickness's compensating part can be between about the 60% of its uncompressed thickness to about 99%.In at least one embodiment, the uncompressed thickness of tissue thickness's compensating part is than its compressed thickness thickness at least 50%.In at least one embodiment, the uncompressed thickness of tissue thickness's compensating part is than its compressed thickness thickness at most 100 times.In various embodiments, compressible Part II can be elastic, or the most elastic, and tissue T can be biased against the deformation lower limb of nail.In at least one this type of embodiment, compressible Part II can between tissue T and the base portion of nail elastic stretch, in order to against nail lower limb promote tissue T.In certain embodiments, discussing in detail as discussed further below, tissue thickness's compensating part can be positioned in the middle of the nail lower limb of tissue T and deformation.In all cases, due to mentioned above, tissue thickness's compensating part can eliminate any gap that nail retains in region.

In various embodiments, tissue thickness's compensating part can include polymer composition.Polymer composition can include one or more synthetic polymers and/or one or more non-synthetic polymer.Synthetic polymer can include absorbable polymer and/or the non-absorbable polymer of synthesis of synthesis.In various embodiments, polymer composition can include such as biocompatible foam.Biocompatible foam can include the open celled foam of such as porous and/or the closed-cell foam of porous.Biocompatible foam can have uniform pore morphology maybe can have gradient pore form (that is, on the whole depth of foam in a direction, orifice size is gradually increased and becomes macropore).In various embodiments, one or more during polymer composition can include porous support, porous matrix, gel-type vehicle, hydrogel matrix, solution substrate, thread substrate, tubulose substrate, composite interstitial substance, membrane matrix, Biostatic polymer and biodegradable polymer and combinations thereof.Such as, tissue thickness's compensating part can include the foam by thread matrix enhancement, maybe can include the foam with additional hydrogel layer, and this additional hydrogel layer extends in the presence of body fluid, to further provide for compression organizationally.In various embodiments, tissue thickness's compensating part also can be made up of the coating in material and/or the second layer or third layer, and this coating extends in the presence of body fluid, to further provide for compression organizationally.This type of layer can be hydrogel, this hydrogel can be synthesis and/or natural source material, and can be such as that biology is durable and/or biodegradable.In certain embodiments, can use and be provided that the fibrous nonwoven material of additional flexibility, rigidity and/or intensity or fiber mesh type element are to strengthen tissue thickness's compensating part.In various embodiments, tissue thickness's compensating part has porous form, and this porous form shows gradient-structure, aperture the most on a surface and bigger hole on the other surface.This type of form is even more ideal for tissue growth or hemostasis behavior.Additionally, gradient also can be combined with the bio-absorbable section of change.Short-term absorption profile can be that preferably to solve hemostasis problem, and Long-term absorption section makes the problem that tissue more preferably heals in the case of can solving ne-leakage.

The example of non-synthetic polymer includes but not limited to lyophilizing polysaccharide, glycoprotein, elastin laminin, Dan Baiduotang proteoglycan PG, gelatin, collagen and oxidized regenerated cellulose (ORC).nullThe example of the absorbable polymer of synthesis includes but not limited to poly-(lactic acid) (PLA)、PLLA (PLLA)、Polycaprolactone (PCL)、Polyglycolic acid (PGA)、PTMC (TMC)、Polyethylene terephthalate (PET)、Polyhydroxy-alkanoates (PHA)、Acetic acid, hydroxy-, bimol. cyclic ester and the copolymer of 6-caprolactone (PGCL)、Acetic acid, hydroxy-, bimol. cyclic ester and the copolymer of trimethylene carbonate、Poly-(decanedioic acid glyceride) (PGS)、PPDO、Poly-(ortho esters)、Condensing model、Polysaccharide、Poly-(ester-acid amide)、Tyrosine-based polyarylate、The poly-imido-carbonic ester of tyrosine-based、Tyrosine-based polycarbonate、Poly-(D,L-lactide-carbamate)、Poly-(B-hydroxybutyric acid)、Poly-(E-caprolactone)、Polyethylene Glycol (PEG)、Poly-[two (carboxyphenoxy) phosphonitrile]、Poly-(aminoacid)、Intend poly-(aminoacid)、Absorbable polyurethane and combinations thereof.In various embodiments, polymer composition can include the polymer composition of the PLLA of the most about 50% to about 90%, and the polymer composition of the PCL of the most about 50% to about 10%.In at least one embodiment, polymer composition can include the PLLA of the most about 70%, and the PCL of the most about 30%.In various embodiments, polymer composition can include the polymer composition of the PGA of the most about 55% to about 85%, and the polymer composition of the PCL of by weight 15% to 45%.In at least one embodiment, polymer composition can include the PGA of the most about 65%, and the PCL of the most about 35%.In various embodiments, polymer composition can include the polymer composition of the PGA of the most about 90% to about 95%, and the polymer composition of the PLA of the most about 5% to about 10%.

In various embodiments, the absorbable polymer of synthesis can include bioabsorbable, biocompatible elastomers copolymer.nullThe most bioabsorbable、Biocompatible elastomers copolymer includes but not limited to that (the preferably mol ratio of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester is about 30:70 to about 70:30 for the copolymer of 6-caprolactone and Acetic acid, hydroxy-, bimol. cyclic ester，Preferably 35:65 to about 65:35，Still more preferably 45:55 to 35:65)、6-caprolactone and lactide (include its L-lactide、D-lactide blend or lactic acid copolymer) elastomer copolymer (the preferably mol ratio of 6-caprolactone and lactide is about 35:65 to about 65:35，Still more preferably 45:55 to 30:70)、To dioxanone (1,4-dioxane-2-ketone) and lactide (include L-lactide、D-lactide and lactic acid) elastomer copolymer (the preferably mol ratio to dioxanone Yu lactide is about 40:60 to about 60:40)、6-caprolactone and to the elastomer copolymer of dioxanone (preferably 6-caprolactone is about 30:70 to about 70:30 with to the mol ratio of dioxanone)、Elastomer copolymer (the preferably mol ratio to dioxanone Yu trimethylene carbonate is about 30:70 to about 70:30) to dioxanone and trimethylene carbonate、The elastomer copolymer (preferably trimethylene carbonate is about 30:70 to about 70:30 with the mol ratio of Acetic acid, hydroxy-, bimol. cyclic ester) of trimethylene carbonate and Acetic acid, hydroxy-, bimol. cyclic ester、Trimethylene carbonate and lactide (include its L-lactide、D-lactide blend or lactic acid copolymer) elastomer copolymer (the preferably mol ratio of trimethylene carbonate and lactide is about 30:70 to about 70:30) and blend.In one embodiment, elastomer copolymer is the copolymer of Acetic acid, hydroxy-, bimol. cyclic ester and 6-caprolactone.In another embodiment, elastomer copolymer is the copolymer of lactide and 6-caprolactone.

It is published in the United States Patent (USP) 5 of entitled " ELASTOMERICMEDICALDEVICE " on November nineteen ninety-five 21,468,253 and be published in the United States Patent (USP) 6 that calendar year 2001 December entitled " FOAMBUTTRESSFORSTAPLINGAPPARATUS " of 4 days is used for, the disclosure of 325,810 is each hereby incorporated herein by full.

nullIn various embodiments，The absorbable polymer of synthesis can include such as can be with brand name VICRYL (polyglactic910) from Ethicon,The most commercially available 90/10 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-L-lactide) copolymer、Can be with brand name DEXON from PGA commercially available for AmericanCyanamidCo.、Can be with brand name PDS from Ethicon,The most commercially available PPDO、Can be with brand name MAXON from poly-(glycolide-trimethylene carbonate) statistic copolymer commercially available for AmericanCyanamidCo.、Can be with brand name MONOCRYL from one or more treasured 75/25 poly-(Acetic acid, hydroxy-, bimol. cyclic ester-E-caprolactone-poliglecaprolactone25) copolymer that Kanggong department is commercially available.

The non-absorbable polymer of synthesis includes but not limited to polyurethane foam plastics, polypropylene (PP), polyethylene (PE), Merlon, polyamide, such as nylon, polrvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyether-ether-ketone (PEEK), polytetrafluoroethylene (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), PEP (FEP), polyacetals, polysulfones and combinations thereof.The non-absorbable polymer of synthesis may include but be not limited to elastomeric foams and porous elastomers, such as siloxanes, polyisoprene and rubber.In various embodiments, synthetic polymer can include expanded PTFE (ePTFE) (can be commercially available from Ge Er company (W.L.Gore&Associates, Inc.) with brand name GORE-TEXSoftTissuePatch) and copolyether ester polyurethane foam (can be commercially available from Polyganics with brand name NASOPORE).

The polymer composition of tissue thickness's compensating part is characterised by such as percent porosity, hole dimension and/or hardness.In various embodiments, polymer composition can have the percent porosity of the most about 30% to about 99%.In certain embodiments, polymer composition can have the percent porosity of the most about 60% to about 98%.In various embodiments, polymer composition can have the percent porosity of the most about 85% to about 97%.In at least one embodiment, polymer composition can include the PLLA and the PCL of the most about 30% of the most about 70%, and can include the porosity of the most about 90%.In at least one this type of embodiment, therefore, polymer composition will include the copolymer of the most about 10%.In at least one embodiment, polymer composition can include the PGA and the PCL of the most about 35% of the most about 65%, and can have the percent porosity of the most about 93% to the most about 95%.In various embodiments, polymer composition can include the porosity being more than 85% by volume.Polymer composition can have the hole dimension of the most about 5 microns to about 2000 microns.In various embodiments, polymer composition can have such as hole dimension between about 10 microns to about 100 microns.In at least one this type of embodiment, polymer composition can such as include the copolymer of PGA and PCL.In certain embodiments, polymer composition can have such as hole dimension between about 100 microns to about 1000 microns.In at least one this type of embodiment, polymer composition can include the copolymer of such as PLLA and PCL.According to some aspect, the hardness of polymer composition can represent with Shore hardness.This Shore hardness can be defined as the toleration of the permanent indenture to material such as measured by sclerometer.In order to assess the durometer value of given material, ASTM program D2240-00 according to entitled " StandardTestMethodforRubberProperty-DurometerHardness " (standard method of test of rubber property-durometer hardness), applying pressure to material with penetrator foot, it is hereby incorporated herein by full.Penetrator foot can be administered to material and continue enough a period of times, such as 15 seconds, such as, wherein reading read from suitable scale.According to scale type used, when pressure head foot completely penetrates through material, reading 0 can be obtained, and when material is not pierced, reading 100 can be obtained.This reading dimensionless.In various embodiments, such as durometer can be determined according to ASTMD2240-00 according to any suitable scale such as A class and/or OO class scale.In various embodiments, the polymer composition of tissue thickness's compensating part may have about the 4A Shore A Hardness value to about 16A, and this Shore A Hardness value is such as in the Shore OO scope of about 45OO to about 65OO.In at least one this type of embodiment, polymer composition can include such as PLLA/PCL copolymer or PGA/PCL copolymer.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value less than 15A.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value less than 10A.In various embodiments, the polymer composition of tissue thickness's compensating part can have the Shore A Hardness value less than 5A.In certain embodiments, polymeric material can have the Shore OO compositions value of the most about 35OO to about 75OO.

In various embodiments, at least two during polymer composition can have the above-mentioned characteristic identified.In various embodiments, at least three kinds during polymer composition can have the above-mentioned characteristic identified.Polymer composition can have the porosity of the most by volume 85% to 97%, the hole dimension of 5 microns to 2000 microns and the Shore OO hardness value of the Shore A Hardness value of 4A to 16A and 45OO to 65OO.In at least one embodiment, polymer composition can include the polymer composition of PLLA of 70 weight % and the polymer composition of the PCL of 30 weight %；Described polymer composition has the porosity of the most by volume 90%, the hole dimension of 100 microns to 1000 microns and the Shore OO hardness value of the Shore A Hardness value of 4A to 16A and 45OO to 65OO.In at least one embodiment, polymer composition can include the polymer composition of PGA of 65 weight % and the polymer composition of the PCL of 35 weight %；Described polymer composition has the porosity of the most by volume 93% to 95%, the hole dimension of 10 microns to 100 microns and the Shore OO hardness value of the Shore A Hardness value of 4A to 16A and 45OO to 65OO.

In various embodiments, polymer composition can include pharmaceutically active agents.The pharmaceutically active agents of the releasable therapeutically effective amount of polymer composition.In various embodiments, when polymer composition is desorbed or absorbs, pharmaceutically active agents can be released.In various embodiments, pharmaceutically active agents can be released to fluid and such as flows through on polymer composition or through in the blood of polymer composition.The example of pharmaceutically active agents may include but be not limited to hemorrhage and medicine, such as fibrin, thrombin and oxidized regenerated cellulose (ORC)；Anti-inflammatory agent, such as diclofenac, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial agents or reagent, such as triclosan, ionic silver, ampicillin, gentamycin, polymyxin B, chloromycetin；And anticarcinogen, such as cisplatin, mitomycin, amycin.

In various embodiments, referring now to Figure 21 6, nail bin such as nail bin 10000 such as can include support section 10010 and compressible tissue thickness compensating part 10020.Referring now to Figure 21 8-220, support section 10010 can include platform surface 10011 and the multiple nail chambeies 10012 being limited in support section 10010.The size in each nail chamber 10012 such as can be set to and can store nail the most removedly such as follows closely 10030.Nail bin 10000 may also include multiple staple drivers 10040.When following closely 10030 and staple drivers 10040 is in its non-firing position, each staple drivers can one or more nails 10030 in support nail chamber 10012.In at least one this type of embodiment, referring first to Figure 22 4 and Figure 22 5, each staple drivers 10040 can include the most one or more support or groove 10041, this support or groove can support nail and limit nail 10030 and staple drivers 10040 between relative motion.In various embodiments, referring again to Figure 21 8, nail bin 10000 may also include nail percussion sliding part 10050；This nail percussion sliding part can move to the far-end 10002 of nail bin from the near-end 10001 of nail bin, in order to staple drivers 10040 and nail 10030 is lifted towards the anvil block being positioned in nail bin 10000 opposite from its non-firing position successively.In certain embodiments, referring first to Figure 21 8 and Figure 22 0, each nail 10030 can include base portion 10031 and the one or more lower limbs 10032 extended from base portion 10031, and the most each nail can be such as at least one in substantially U-shaped and basic V-arrangement.In at least one embodiment, nail 10030 may be configured such that, when following closely 10030 and being in its non-firing position, the end of nail lower limb 10032 caves in relative to the platform surface 10011 of support section 10010.In at least one embodiment, nail 10030 may be configured such that, when following closely 10030 and being in its non-firing position, the end of nail lower limb 10032 flushes relative to the platform surface 10011 of support section 10010.In at least one embodiment, nail 10030 may be configured such that when following closely 10030 and being in its non-firing position, and the end of nail lower limb 10032 or at least certain part of nail lower limb 10032 extend to above the platform surface 10011 of support section 10010.In this type of embodiment, when following closely 10030 and being in its non-firing position, nail lower limb 10032 may extend into and is embedded in tissue thickness's compensating part 10020.In at least one this type of embodiment, nail lower limb 10032 can such as extend to above platform surface 10011 about 0.075 ".In various embodiments, nail lower limb 10032 can such as extend to the distance above platform surface 10011 between about 0.025 " and about 0.125 ".In certain embodiments, to being described further above, tissue thickness's compensating part 10020 can include the uncompressed thickness between the most about 0.08 " and about 0.125 ".

In use, to being described further above and referring first to Figure 23 3, anvil block such as anvil block 10060 is such as moveable to the make position relative with nail bin 10000.As described in more detail below, tissue can be positioned by anvil block 10060 against tissue thickness's compensating part 10020, and in various embodiments, such as, tissue thickness's compensating part 10020 presses to the platform surface 10011 of support section 10010.Once anvil block 10060 is appropriately positioned, then can dispose nail 10030, equally as shown in Figure 23 3.In various embodiments, as it has been described above, nail percussion sliding part 10050 can move towards far-end 10002 from the near-end 10001 of nail bin 10000, as shown in Figure 23 4.When sliding part 10050 is pushed into, sliding part 10050 can contact stud driver 10040 and nail chamber 10012 in staple drivers 10040 is lifted up.In at least one embodiment, sliding part 10050 and staple drivers 10040 can each include one or more slope or inclined-plane, and these one or more slopes or inclined-plane can cooperate so that staple drivers 10040 moves upward from its non-firing position.In at least one this type of embodiment, see Figure 22 1-225, each staple drivers 10040 can include at least one inclined-plane 10042, and sliding part 10050 can include one or more inclined-plane 10052, it may be configured such that, when sliding part 10050 is pushed into towards distally in nail bin, inclined-plane 10052 is in inclined-plane 10042 lower slider.When staple drivers 10040 is lifted up in its respective nail chamber 10012, nail 10030 can be lifted up by staple drivers 10040 so that nail 10030 can be exposed from its nail chamber 10012 by the opening in nail platform 10011.During exemplary percussion sequence, referring first to Figure 22 7-229, sliding part 10050 can first contact stud 10030a and start to be lifted up nail 10030a.When sliding part 10050 is further promoted towards distally, sliding part 10050 can start by follow closely 10030b, 10030c, 10030d, 10030e and 10030f and any other follow-up nail order lift.As shown in Figure 22 9, nail 10030 can be driven up by sliding part 10050 so that the lower limb 10032 of the nail contacted with relative anvil block is deformed into desired shape, and is shot up from support section 10010.In all cases, as a part for percussion sequence, multiple nails can be moved upward by sliding part 10030 simultaneously.With reference to the percussion sequence shown in Figure 22 9, nail 10030a and 10030b has moved to its complete firing position and is shot up from support section 10010, nail 10030c and 10030d is in by during percussion and be at least partly accommodated in support section 10010, and follows closely 10030e and 10030f and be still within its non-firing position.

As mentioned above and see Figure 23 5, when following closely 10030 and being in its non-firing position, the nail lower limb 10032 of nail 10030 may extend into above the platform surface 10011 of support section 10010.With further reference to the percussion sequence shown in Figure 22 9, nail 10030e and 10030f is illustrated at its non-firing position, and its nail lower limb 10032 extends to above platform surface 10011 and extends in tissue thickness's compensating part 10020.In various embodiments, when following closely 10030 and being in its non-firing position, the end of nail lower limb 10032 or the top tissue contacting surface 10021 of any other part possible Bu Tuchuan tissue thickness compensating part 10020 of nail lower limb 10032.As shown in Figure 22 9, when following closely 10030 and moving to its firing position from its non-firing position, the end of nail lower limb convex can wear tissue contacting surface 10032.In various embodiments, the end of nail lower limb 10032 can include the sharp distal end that can cut and penetrate tissue thickness's compensating part 10020.In certain embodiments, tissue thickness's compensating part 10020 can include that multiple hole, the plurality of hole can accommodate nail lower limb 10032 and make nail lower limb 10032 slide relative to tissue thickness's compensating part 10020.In certain embodiments, support section 10010 may also include the multiple guiders 10013 extended from platform surface 10011.Guider 10013 can be positioned so that the nail chamber opening of neighbouring platform surface 10011 so that nail lower limb 10032 can be supported by guider 10013 at least in part.In certain embodiments, guider 10013 can be positioned in near-end and/or the far-end of nail chamber opening.In various embodiments, first guider 10013 can be positioned in the first end of each nail chamber opening, and the second guider 10013 can be positioned in the second end of each nail chamber opening, make the first nail lower limb 10032 of each first sustainable nail 10030 of guider 10013, and the second nail lower limb 10032 of each second sustainable nail of guider 10013.In at least one embodiment, seeing Figure 23 5, each guider 10013 can include groove or slit, such as groove 10016；Nail lower limb 10032 such as can be slidingly received in this groove.In various embodiments, each guider 10013 can include can extending from platform surface 10011 and may extend into the clamping plate tissue thickness's compensating part 10020, projection and/or spike.In at least one embodiment, as described in more detail below, clamping plate, projection and/or spike can reduce the relative motion between tissue thickness's compensating part 10020 and support section 10010.In certain embodiments, the end of nail lower limb 10032 can be positioned in guider 10013, and can not extend to above the top surface of guider 10013 when following closely 10030 and being in its non-firing position.In at least this type of embodiment, guider 10013 can limit guiding height, and can not extend to this guiding elevation-over when following closely 10030 and being not at its non-firing position.

In various embodiments, tissue thickness's compensating part such as tissue thickness's compensating part 10020, such as can be made up of single material piece.In at least one embodiment, tissue thickness's compensating part can include continuous sheet, and this continuous sheet can cover the whole top platform surface 10011 of support section 10010, or covers less than whole platform surface 10011.In certain embodiments, material piece can cover the nail chamber opening in support section 10010, and in other embodiments, material piece can include can be with opening that is that follow closely chamber register or that at least partly align.In various embodiments, tissue thickness's compensating part can be made up of multilayer material.In certain embodiments, referring now to Figure 21 7, tissue thickness's compensating part can include compressible core and the wrappage around compressible core.In certain embodiments, compressible core can be releasably held support section 10010 by wrappage 10022.In at least one this type of embodiment, support section 10010 can include the one or more protuberances such as extended from it, such as protuberance 10014(Figure 22 0), this protuberance may be housed in one or more hole and/or slit, such as, be limited in the hole 10024 in wrappage 10022.Protuberance 10014 and hole 10024 may be configured such that wrappage 10022 can be remained to support section 10010 by protuberance 10014.In at least one embodiment, the end of protuberance 10014 such as can be processed by hot melt and deform, in order to expands the end of protuberance 10014, and therefore limits the relative motion between wrappage 10022 and support section 10010.In at least one embodiment, wrappage 10022 can include one or more perforation 10025, and it can be conducive to being discharged from support section 10010 by wrappage 10022, as shown in Figure 21 7.Referring now to Figure 22 6, tissue thickness's compensating part can include wrappage 10222, and this wrappage includes multiple hole 10223, and its mesopore 10223 can be with the nail chamber register in support section 10010 or at least partly align.In certain embodiments, the core of tissue thickness's compensating part may also include the hole alignd with the hole 10223 in wrappage 10222 or at least partly align.In other embodiments, the core of tissue thickness's compensating part can include continuous main body and may extend into below hole 10223 so that the nail chamber opening during main body covers platform surface 10011 continuously.

In various embodiments, as it has been described above, tissue thickness's compensating part can include the wrappage for compressible core releasably holds support section 10010.In at least one this type of embodiment, seeing Figure 21 8, nail bin may also include keeper fixture 10026, and this keeper fixture can suppress wrappage and compressible core to separate with support section 10010 prematurely.In various embodiments, each keeper fixture 10026 can include the hole 10028 that can accommodate the protuberance 10014 extended from support section 10010 so that keeper fixture 10026 can be held support section 10010.In certain embodiments, keeper fixture 10026 can each include at least one disc portion 10027, and this disc portion may extend into below support section 10010 and staple drivers 10040 can be supported and is maintained in support section 10010.In certain embodiments, as it has been described above, tissue thickness's compensating part can be removably attachable to support section 10010 by nail 10030.More specifically, as also described above, when following closely 10030 and being in its non-firing position, the lower limb of nail 10030 may extend in tissue thickness's compensating part 10020, and therefore tissue thickness's compensating part 10020 releasably held support section 10010.In at least one embodiment, the lower limb of nail 10030 can the sidewall contact in its corresponding nail chamber 10012, wherein, due to the friction between nail lower limb 10032 and sidewall, nail 10030 and tissue thickness's compensating part 10020 can be held in place, until nail 10030 is deployed from nail bin 10000.After nail 10030 is deployed, it is kept in tissue thickness's compensating part 10020 can be trapped in nail 10030 and against the tissue T sewed up.When anvil block is subsequently moved into open position with release tissue T, support section 10010 is movable away from the tissue thickness's compensating part 10020 having been secured to tissue.In certain embodiments, binding agent can be used so that tissue thickness's compensating part 10020 is remained to support section 10010 removedly.In at least one embodiment, two-part adhesive can be used, the most at least one embodiment, the Part I of binding agent can be placed on platform surface 10011, and the Part II of binding agent can be placed on tissue thickness's compensating part 10020, make when tissue thickness's compensating part 10020 be close to platform surface 10011 place time, Part I can contact Part II to enable binding agent and tissue thickness's compensating part 10020 is bonded to support section 10010 separably.In various embodiments, can use any other suitable method that tissue thickness's compensating part remains to the support section of nail bin separably.

In various embodiments, to being described further above, sliding part 10050 proximally 10001 can be advanced to far-end 10002 to dispose all nails 10030 being accommodated in nail bin 10000 completely.In at least one embodiment, referring now to Figure 25 8-262, sliding part 10050 can be advanced towards distally by the knife bar 10052 of firing member or surgical stapling device in support section 10010 in longitudinal cavity 10016.In use, nail bin 10000 can be inserted in the staple cartridge channel in the jaw of surgical stapling device, such as in staple cartridge channel 10070, and firing member 10052 can be advanced to contact with sliding part 10050, as shown in Figure 25 8.When sliding part 10050 is advanced towards distally by firing member 10052, sliding part 10050 can contact staple drivers or the driver 10040 of recent side, and nail 10030 is fired from warehouse 10010 or penetrated, as mentioned above.As shown in Figure 25 8, firing member 10052 may also include cutting blade 10053, and when following closely 10030 and being fired, this cutting blade can be pushed into towards distally by the cutter slit in support section 10010.In various embodiments, corresponding cutter slit can extend across the anvil block being positioned in nail bin 10000 opposite, making at least one embodiment, cutting blade 10053 can extend and cut the tissue being positioned in therebetween and tissue thickness's compensating part between anvil block and support section 10010.In all cases, sliding part 10050 can be advanced towards distally by firing member 10052, until sliding part 10050 arrives the far-end 10002 of nail bin 10000, as shown in Figure 26 0.Now, firing member 10052 can proximally bounce back.In certain embodiments, sliding part 10050 proximally can bounce back with firing member 10052, but in various embodiments, referring now to Figure 26 1, when firing member 10052 bounces back, sliding part 10050 can be left in the far-end 10002 of nail bin 10000.Once firing member 10052 the most fully bounces back, anvil block can be opened again, and tissue thickness's compensating part 10020 can separate with support section 10010, and has exhausted the remaining non-implanted portion of nail bin 10000, including support section 10010, can be removed from staple cartridge channel 10070.

When exhausting after nail bin 10000 is removed from staple cartridge channel, to being described further above, new nail bin 10000 or any other suitable nail bin can be inserted in staple cartridge channel 10070.In various embodiments, to being described further above, staple cartridge channel 10070, firing member 10052 and/or nail bin 10000 can include cooperative structures, and this cooperative structures can prevent firing member 10052 again in new not firing or be pushed into towards distally for follow-up time when nail bin 10000 is not located in staple cartridge channel 10070.More specifically, refer again to Figure 25 8, when firing member 10052 is advanced to contact with sliding part 10050, and when sliding part 10050 is in the non-firing position of its nearside, firing member 10052 support nose 10055 can be positioned on the support lugn 10056 on sliding part 10050 and/or on, firing member 10052 is made to be maintained at position the most upwards, to prevent the lock or the crossbeam 10054 that extend from firing member 10052 from falling into the lock groove being limited in staple cartridge channel.When will not fall into lock groove due to lock 10054, in such cases, when firing member 10052 is pushed into, lock 10054 can not adjoin the distally sidewall 10057 of lock groove.When sliding part 10050 is promoted by firing member 10052 towards distally, firing member 10052 can be supported on its upwards firing position due to the support nose 10055 that leans against on support lugn 10056.When firing member 10052 bounces back relative to sliding part 10050, as mentioned above and as shown in Figure 26 1, when supporting nose 10055 and not relying on the support lugn 10056 of sliding part 10050, firing member 10052 upwards can fall position from it.In at least one this type of embodiment, surgical staples can include spring 10058 and/or any other the suitable biasing element that firing member 10052 can be biased to its down position.Once firing member 10052 is fully retracted, and as shown in Figure 26 2, firing member 10052 can not again pass through the nail bin 10000 used up and be pushed into towards distally.More specifically, when the sliding part 10050 being now in operation order has been left at the far-end 10002 of nail bin 10000, firing member 10052 can not be maintained at its upper position by sliding part 10050.Therefore, if as it has been described above, firing member 10052 is re-advanced in the case of not replacing nail bin, then lock crossbeam 10054 is by the sidewall 10057 of contact lock groove, and this will prevent firing member 10052 to be again advanced in nail bin 10000 towards distally.In other words, the nail bin 10000 once used up is replaced by new nail bin, new nail bin will have proximally-oriented sliding part 10050, and firing member 10052 can be maintained at its upwards position by this proximally-oriented sliding part, and makes firing member 10052 again be pushed into towards distally.

As it has been described above, staple drivers 10040 can be moved between the first non-firing position and the second firing position by sliding part 10050, in order to nail 10030 is penetrated from support section 10010.In various embodiments, when nail 10030 is shot up from support section 10010, staple drivers 10040 can be accommodated in nail chamber 10012.In certain embodiments, support section 10010 can include one or more holding structures that staple drivers 10040 can be stoped to penetrate or drop out from nail chamber 10012.In other embodiments various, staple drivers 10040 can be penetrated from the support section 10010 with nail 10030 by sliding part 10050.In at least one this type of embodiment, staple drivers 10040 can be made up of the most bioabsorbable and/or biocompatible materials, such as Polyetherimide.In certain embodiments, staple drivers could attach to follow closely 10030.In at least one this type of embodiment, staple drivers can be molded on the base portion of each nail 10030 and/or surrounding so that driver is one-body molded with nail.Entitled " SURGICALSTAPLESHAVINGCOMPRESSIBLEORCRUSHABLEMEMBERSFORSE CURINGTISSUETHEREINANDSTAPLINGINSTRUMENTSFORDEPLOYINGTHE SAME " U.S. Patent Application Serial Number 11/541,123 of JIUYUE in 2006 submission on the 29th is incorporated by reference in its entirety herein.

In various embodiments, to being described further above, compressible tissue thickness compensating part can be relative to the rigid support componental movement below nail bin, distortion and/or deflection.In various embodiments, any other suitably part of support section and/or nail bin can include limiting one or more structures of relative motion between tissue thickness's compensating part and support section.As mentioned above, above the platform surface 10011 that may extend into support section 10010 at least partially of nail 10030, wherein, in some cases, referring now to Figure 26 3 and Figure 26 4, it is applied to nail 10030 and/or clamping plate 10013 that the side force of tissue thickness's compensating part 10120 such as can be extended from support section 10010 and keeps out.In all cases, nail 10030 when keeping out the lateral movement of tissue thickness's compensating part 10120 can nail chamber 10012 tilted and/or bending, the most in various embodiments, the size of nail chamber 10012 and nail 10030 can be set to and can keep following closely 10030 lower limb 10032 and relative anvil block 10060 in the alignment relative shaped between pit 10062 so that nail 10000 correctly shapes during nail forming process.In various embodiments, follow closely 10030 and/or clamping plate 10013 are prevented from or at least limit laterally distorting, as shown in Figure 26 4 in tissue thickness's compensating part 10020.In at least one this type of embodiment, nail 10030 and/or clamping plate 10013 such as can strengthen or limit first or the tissue contacting surface 10021 of tissue thickness's compensating part relative to second or lower surface 10029 laterally and/or lengthwise movement.In various embodiments, nail bin and/or wherein location have the staple cartridge channel of nail bin can include at least one minimizing twisting component, and this minimizing twisting component can upwardly extend to limit the lateral of tissue thickness's compensating part and/or lengthwise movement or distortion.As it has been described above, at least partly surround the wrappage of tissue thickness's compensating part prevented also from or at least limit the lateral of tissue thickness's compensating part and/or lengthwise movement or distortion.

In various embodiments, referring again to Figure 26 3 and 264, tissue thickness's compensating part such as tissue thickness's compensating part 10120 such as can include core 10128 and crust 10122.Crust 10122 can be made up of different materials or identical material with compressible core 10128.In either case, crust 10122 can have density more higher than core 10128.In the case of crust 10122 includes the top of tissue thickness's compensating part 10120, the end of nail lower limb 10032 can embed in crust 10122.During skin includes the embodiment of bottom of tissue thickness's compensating part 10120 outside, nail lower limb 10032 can extend across crust and enters in core.In either case, the crust of tissue thickness's compensating part can help to keep nail lower limb 10032 to align with the shaping pit 10062 of anvil block 10060.In various embodiments, crust 10122 can include such as lower density: this density such as than the density of core 10128 larger about 10%, than the density of core 10128 larger about 20%, than the density of core 10128 larger about 30%, than the density of core 10128 larger about 40%, than the density of core 10128 larger about 50%, than the density of core 10128 larger about 60%, than the density of core 10128 larger about 70%, than the density of core 10128 larger about 80%, than the density of core 10128 larger about 90%, than the density of core 10128 larger about 100%.In various embodiments, crust 10122 can include such as lower density, and this density is greater than the density of core 10128 and the twice of the density less than core 10128.In various embodiments, crust 10122 can include such as lower density, and this density is greater than the twice of the density of core 10128.In various embodiments, to being described further above, crust 10122 and core 10128 can be formed simultaneously or manufacture.In at least one this type of embodiment, the fluid comprising any suitable material disclosed herein can be introduced in dish or be molded, and when fluid sets, fluid can be formed has crust more highdensity than surplus material or layer.In various embodiments, the multiple layers in material can be by making to be formed with the following method: in the method, one or more succeeding layers of material are poured on the layer of prior cured.In certain embodiments, two or more layers can be such as bonded to each other by binding agent.In certain embodiments, two or more layers can be such as attached to each other by one or more securing member and/or one or more mechanical interlock.In at least one this type of embodiment, adjacent layer can such as be linked together by one or more dovetail joint.In certain embodiments, outer micromicro includes that can prevent or at least limit fluid passes through the sealing surfaces of flowing.In some other embodiment, outer micromicro includes the loose structure of such as perforate.

In various embodiments, to being described further above, crust can be cut from tissue thickness's compensating part.In at least one embodiment, tissue thickness's compensating part can be from bigger material block excision so that tissue thickness's compensating part does not include crust.In at least one this type of embodiment, tissue thickness's compensating part can be made up of the material of the homogeneity such as including macropore or at least substantially homogeneity.

In various embodiments, nail bin can include multiple nail chamber, and each nail chamber accommodates the nail being positioned in, and wherein nail chamber can be arranged to multirow, and the anvil block being wherein positioned in nail bin opposite can include the multiple shaping pits corresponding with the nail chamber in nail bin.In other words, anvil block can include the opposite following closely chamber that multiple shaping pit row, the most each shaping pit can be positioned in nail bin.In various embodiments, each shaping pit can include two the shaping cups that can accommodate the nail lower limb 10032 of nail 10030, and the most each shaping cup can accommodate nail lower limb 10032, and makes nail lower limb 10032 such as shape towards other nail lower limbs 10032 or crimp.In all cases, lower limb 10032 may lack shaping cup or not properly enter shaping cup, and therefore nail lower limb 10032 may deform during percussion sequence.In various embodiments described herein, anvil block can include shaping pit array or grid, and it each can accommodate and be formed nail lower limb.In at least one this type of embodiment, shape pit array and can include that some shape pit, the quantity of the nail that the quantity of this shaping pit accommodates in exceeding nail bin.In at least one embodiment, nail bin can include the nail chamber of such as six lengthwise rows, and wherein anvil block can include that six row alignd with six row nail chambeies shape pit, and shaping pit is positioned in the centre shaping pit row in addition.Such as, on the side of anvil block, anvil block can include being positioned in the first row on the first nail chamber and shape pit, can be positioned adjacent to the second row on the second nail chamber in the first nail chamber and shape pit and be positioned in first row in addition and shape pit and second row shapes in the middle of pit one lines up shape pit.In various embodiments, referring now to Figure 27 6-279, anvil block 10260 can include that six line up shape pit 10261, on its corresponding six nail chambeies can being placed in nail bin 10200.In at least one this type of embodiment, multiple rows of middle pit 10262 that shapes can be positioned in the middle of multiple rows of shaping pit 10261 and/or neighbouring multiple rows of shaping pit 10261.In certain embodiments, referring now to Figure 27 7, Figure 27 8 and Figure 28 0, each shaping pit 10261 and 10262 can include that two shape cups, and the most each shaping cup includes making nail lower limb 10032 proximally shape or the distal part 10263 that crimp and the portions of proximal 10264 that nail lower limb 10032 can be made to shape towards distally or crimp.Various in the case of other, nail 10030 can be shaped by other modes multiple.Such as, nail 10030 may be shaped so that a lower limb 10032 outwards shapes and another lower limb 10032 is to internal shaping (Figure 28 1), or two lower limbs 10032 the most outwards shape (Figure 28 2), this depends on such as 1) nail lower limb 10032 enters that and shapes cup, and/or 2) whether lower limb 10032 enter portions of proximal 10263 or the distal part 10064 of each shaping cup.

In various embodiments, to being described further above, each shaping pit 10261 and/or shaping pit 10262 can include such as triangle or diamond shape.In at least one embodiment, the each distal part 10263 and/or each portions of proximal 10264 that shape pit can include triangular shaped, wherein at least one this type of embodiment, distal part 10263 and the triangular shaped of portions of proximal 10264 may be arranged so that it has the summit pointing to relative direction.In certain embodiments, anvil block can include the most foursquare the most a series of shaping pit.In at least one this type of embodiment, the profiled surface of each foursquare shaping pit may be included in the arcuate surfaces extended between foursquare side.In certain embodiments, anvil block can include the most a series of circle or spherical pit.In various embodiments, to being described further above, shaping pit 10261 can be positioned along one or more row, and similarly, shapes pit 10262 and also can be positioned along one or more row.In other embodiments various, shape pit 10261 and/or shaping pit 10262 can be arranged to one or more circular row.In at least one this type of embodiment, shaping pit 10261 can be arranged along main circumference, and the parallel pit 10262 that shapes can be arranged along different circumference.In various embodiments, main circumference and different circumference can be concentric or substantially concentric.In certain embodiments, shape pit 10262 can such as be arranged along inner periphery and/or excircle；Described inner periphery radially-inwardly positions relative to main circumference, and described excircle is located radially outward relative to main circumference.In various embodiments, main circumference can be limited by full diameter, and inner periphery can be limited by interior diameter, and excircle can be limited by overall diameter.In at least one this type of embodiment, interior diameter can be shorter than full diameter, and overall diameter can be longer than full diameter.

In various embodiments, as it has been described above, anvil block such as can move to make position from open position, in order to against tissue thickness's compensating part such as tissue thickness's compensating part 10020 compressed tissue of nail bin.In all cases, before tissue thickness's compensating part is relative to tissue positioned, tissue thickness's compensating part can be adjacent to the support section location of nail bin.In certain embodiments, tissue thickness's compensating part 10020 can be at following location: in this position, before anvil block moves to its make position, tissue thickness's compensating part adjoins support section 10018.In some other embodiment, tissue thickness's compensating part 10020 can be at following location: in this position, and gap is present between tissue thickness's compensating part 10020 and support section 10018.In at least one this type of embodiment, anvil block can make tissue and tissue thickness's compensating part 10020 to bottom offset, until tissue thickness's compensating part 10020 adjoins support section 10018, wherein, anvil block is now moveable to its make position and produces compression in tissue.If the location of the tissue between anvil block and nail bin is felt dissatisfied, then surgeon can open anvil block, adjusts anvil block and the position of nail bin, and again closes anvil block.Owing to nail bin relative to this type of location of tissue and is reorientated, in all cases, the far-end of tissue thickness's compensating part 10020 can such as separate with support section 10010.In some such cases, the far-end of tissue thickness's compensating part 10020 can contact tissue, and peel off from support section 10010 or roll relative to support section 10010.In various embodiments, as further discussed below, nail bin can include one or more structures that tissue thickness's compensating part can releasably hold the support section below nail bin.

In various embodiments, referring now to Figure 26 5, nail bin 10300 can include support section 10310, supported by support section 10310 tissue thickness's compensating part 10320 and the far-end 10302 including nose 10303, the far-end 10325 of tissue thickness's compensating part 10320 can be releasably held in place by this nose.In at least one embodiment, nose 10303 can include the slit 10305 that can accommodate the far-end 10325 of tissue thickness's compensating part 10320.In various embodiments, far-end 10325 can be compressed or be wedged in slit 10305 so that when nail bin 10300 is relative to tissue positioned, far-end 10325 can be held in place.In at least one this type of embodiment, slit 10305 can be orientated along the direction of the platform surface 10311 being parallel to or being at least substantially parallel to support section 10310.In various embodiments, slit 10305 can be level relative to platform surface 10311.In other embodiments various, referring now to Figure 26 6, nail bin 10400 can include support section, supported by support section tissue thickness's compensating part 10420 and the far-end 10402 including nose 10403, the far-end 10425 of tissue thickness's compensating part 10420 can be releasably held in place by this nose.In at least one embodiment, far-end 10425 can include the protuberance extended from it, and nose 10403 can include the vertical slit 10405 that can accommodate the protuberance of far-end 10425.In various embodiments, far-end 10425 and/or can be compressed or be wedged in slit 10405 from its protuberance extended so that when nail bin 10400 is relative to tissue positioned, far-end 10425 can be held in place.In certain embodiments, tissue thickness's compensating part 10420 such as can include slit such as slit 10429, and this slit can accommodate at least some of of nose 10403 wherein.In at least one embodiment, slit 10405 can be along the direction orientation of the platform surface 10411 being perpendicular to or being at least substantially perpendicular to support section.In various embodiments, referring now to Figure 26 7, nail bin 10500 can include support section, supported by support section tissue thickness's compensating part 10520 and the far-end 10502 including nose, the far-end 10525 of tissue thickness's compensating part 10520 can be releasably held in place by this nose.In at least one embodiment, nose can include the vertical slit 10505 that can accommodate the far-end 10525 of tissue thickness's compensating part 10520.In various embodiments, far-end 10525 can be compressed or be wedged in slit 10505 so that when nail bin 10500 is relative to tissue positioned, far-end 10525 can be held in place.

In various embodiments, referring again to Figure 26 5, tissue thickness's compensating part 10320 can include top surface 10324, and this top surface can be positioned in above the top surface 10304 of nose 10303.Figure 23 8 shows another exemplary embodiment, in this exemplary embodiment, the top surface of tissue thickness's compensating part is positioned in above the nose of nail bin, and wherein the top surface 10721 of tissue thickness's compensating part 10720 is such as positioned in above the top surface 10004 of nose 10003.In use, refer again to Figure 26 5, tissue can slide on the top surface 10304 of nose 10303, and in some cases, tissue can the far-end 10325 of contact tissue thickness compensation part 10320, and can exert a force to tissue thickness's compensating part 10320, so that tissue thickness's compensating part 10320 is peeled off from support section 10310.In the embodiments described herein, this peeling force can be resisted by the part of the far-end 10325 of wedging in nose 10303.Under any circumstance, once organizing and appropriately position relative to nail bin 13000, anvil block can be rotated to make position with against support section 10310 compression tissue and tissue thickness's compensating part 10320.In at least one this type of embodiment, anvil block can be rotated to following location: in this position, the top surface 10304 of anvil block contact nose 10303, therefore can prevent anvil block from further rotating.In all cases, owing to the top surface 10324 of tissue thickness's compensating part 10320 is positioned in above the top surface 10304 of nose 10303, when anvil block is just closed, top surface 10324 can be pushed down towards support section 10310, and in some cases, top surface 10324 such as can be pushed to below the top surface 10304 of nose 10303.As described herein, nail in being contained in nail bin 10300 be deployed and tissue thickness's compensating part 10320 cut after, support section 10310 and nose 10303 are movable away from tissue thickness's compensating part 10320 so that the far-end 10325 of tissue thickness's compensating part 10320 can skid off slit 10305.

As it has been described above, anvil block such as anvil block 10060 such as can be rotated to make position, in this make position, anvil block 10060 contacts the top nose surface 10004 of nail bin such as nail bin 10000.Once anvil block has arrived its make position, then tissue thickness's compensating part amount that such as tissue thickness's compensating part 10020 is compressed will depend upon which the uncompressed thickness of tissue thickness's compensating part or height and the thickness of tissue inter alia.Referring now to Figure 23 6 and Figure 23 7, tissue thickness's compensating part 10920 can include the top surface that the top surface 10004 with nose 10003 flushes or is at least substantially flush.In this type of embodiment, the top surface of tissue thickness's compensating part 10920 can be pushed to below the top surface 10004 of nose 10003.Referring now to Figure 24 1 and Figure 24 2, tissue thickness's compensating part such as tissue thickness's compensating part 10820 such as can include top surface 10821.Before tissue thickness's compensating part 10820 is compressed by tissue T and anvil block 10060, this top surface is positioned in below top nose surface 10004.As shown in Figure 23 9 and Figure 24 0, in the case of tissue T is relatively thin, tissue thickness's compensating part 10920 can suffer from relatively small compression.Referring now to Figure 24 1 and Figure 24 2, when tissue T is relatively thick, tissue thickness's compensating part 10820 can suffer from bigger compression.As shown in Figure 24 3 and Figure 24 4, in the case of tissue T has thin layer and relatively thick-layer simultaneously, tissue thickness's compensating part 10820 can be worked as and compressed relatively large when it is positioned in below thicker tissue T, and is compressed less amount when it is positioned in compared with time below thin tissue.As it has been described above, by this way, tissue thickness's compensating part can compensate for different tissue thicknesses.

In various embodiments, referring now to Figure 26 8-270, surgery suturing appliance can include 1) the storehouse passage 16670 of nail bin 16600, and 2 can be accommodated) can pivotably be attached to the anvil block 16660 of storehouse passage 16670.Nail bin 16600 can include support section 16610 and tissue thickness's compensating part 16620, and wherein the far-end 16625 of tissue thickness's compensating part 16620 can be releasably held support section 16610 by the nose 16603 of the far-end 16602 of nail bin 16600.In at least one embodiment, nose 16603 can include slit 16605 and can be made up of flexible material.In use, referring first to Figure 26 9, nose 16603 can bend downwards, in order to expands the opening of slit 16605.In certain embodiments, nose 16603 can include notch or cut out 16606, and this notch or cut out can make nose 16603 bend downwards.Under any circumstance, in all cases, the opening of the expansion of slit 16605 can be conducive to inserting in slit 16605 far-end 16625 of tissue thickness's compensating part 16620.Once tissue thickness's compensating part 16620 the most appropriately positions, nose 16603 can be released, and the resilience force of the material due to composition nose 16603, nose 16603 can return to or be the most substantially back to its non-deflected, and on platform surface 16611 far-end 16625 of capture tissue thickness compensation part 16620, as shown in graph 270.In use, similarly as described above, when support section 16610 moves away from the tissue sewed up, far-end 16625 can be pulled out slit 16605.In all cases, when tissue thickness's compensating part 16620 separates with support section 16610, flexible nose 16603 can deflect.In various embodiments, referring again to Figure 27 0, tissue thickness's compensating part 16620 can include that the top surface 16604 with nose 16603 aligns or the most substantially aligned top surface 16621.

In various embodiments, seeing Figure 27 1, surgery suturing appliance can include 1) passage 10770 of nail bin 10700, and 2 can be accommodated) it is rotatably coupled to the anvil block 10760 of passage 10770.Nail bin 10700 can include support section 10710 and tissue thickness's compensating part 10720.In various embodiments, tissue thickness's compensating part 10720 can be held in place by nose set 10703, and this nose set can slide on support section 10710.In at least one embodiment, referring first to Figure 27 2, nose set 10703 can include one or more sides slit 10707, and this one or more sides slit can accommodate the one or more attachments such as extended along support section 10710 removedly.In various embodiments, tissue thickness's compensating part 10720 can be positioned in the middle of side slit 10707.In certain embodiments, nose set 10703 may also include far-end 10702 and the cavity 10706 being limited in far-end 10702, and wherein cavity 10706 can also accommodate at least some of of such as support section 10710 wherein.In use, nose set 10703 can be distally to the direction slip of nearside on support section 10710.In various embodiments, tissue thickness's compensating part 10720 can be removably mountable to nose set 10703, make to have fired after tissue thickness's compensating part 10720 at nail, when support section 10710 and nose set 10703 move away from tissue thickness's compensating part 10720, tissue thickness's compensating part 10720 can separate with nose set 10703.In various embodiments, the top surface 10721 of tissue thickness's compensating part 10720 can be positioned in below the top surface 10704 of nose 10703.

In various embodiments, referring now to Figure 27 3 and Figure 27 4, surgery suturing appliance can include 1) staple cartridge channel 11070 of nail bin 11000, and 2 can be accommodated) it is rotatably coupled to the anvil block 11060 of passage 11070.Nail bin 11000 can include support section 11010 and tissue thickness's compensating part 11020.In various embodiments, tissue thickness's compensating part 11020 can be held in place by the one or more longitudinal rails 11019 extended from the platform 11011 of support section 11010.In at least one embodiment, during longitudinal rail 11019 can be embedded in tissue thickness's compensating part 11020.In certain embodiments, referring first to Figure 27 4, tissue thickness's compensating part 11020 can include the longitudinal fluting 11029 that can accommodate longitudinal rail 11019.In at least one this type of embodiment, the size of groove 11029 can be set to and can accommodate the guide rail 11019 of such as press-fit structure.To being described further above, this class formation be prevented from or at least limit between tissue thickness compensating part 11020 and support section 11010 relative to lateral movement, and such as discharged from support section 11010 prematurely additionally, limit tissue thickness's compensating part 11020.In various embodiments, referring now to Figure 27 5, surgery suturing appliance can include 1) staple cartridge channel 11170 of nail bin 11100, and 2 can be accommodated) it is rotatably coupled to the anvil block 11160 of passage 11170.Nail bin 11100 can include support section 11110 and tissue thickness's compensating part 11120.In various embodiments, tissue thickness's compensating part 11120 can be held in place by one or more lengthwise rows of the spike extended from the platform 11111 of support section 11110 or tusk 11119.In at least one embodiment, the lengthwise rows 11119 of spike can be embedded in tissue thickness's compensating part 11120.

With reference to the embodiment shown in Figure 27 3.To being described further above, when nail from be limited to nail chamber 10012 therein be shot up time, tissue thickness's compensating part 11020 of nail bin 11000 gradually can be discharged from support section 11010.More specifically, to being described further above, the nail being positioned in nail chamber 10012 can be penetrated between the near-end 11001 of nail bin 11000 and the far-end 11002 of nail bin 11000 successively, make when nail is shot up, bias force upwards is applied to tissue thickness's compensating part 11020 by nail, and this bias force effect is to push away guide rail 11019 by tissue thickness's compensating part 11020.In such cases, when nail is shot up from recent side nail chamber 10012, the near-end 11006 of tissue thickness's compensating part 11020 can be released from support section 11010.When nail is gradually penetrated from the support section 11010 between the near-end 11001 and far-end 11002 of nail bin 11000, tissue thickness's compensating part 11020 gradually can be discharged from support section 11010 subsequently.When the nail being positioned in farthest side nail chamber 10012 is shot up from support section 11010, the far-end 11007 of tissue thickness's compensating part 11020 can be released from support section 11010.With reference to the embodiment shown in Figure 27 5, when nail is gradually penetrated from the nail bin between most advanced and sophisticated 11101 and far-end 11102, tissue thickness's compensating part 11120 gradually can be discharged from the spike 1119 that self-supporting part 11110 extends.

As it has been described above, when nail is gradually penetrated also contact tissue thickness compensation part from support section, tissue thickness's compensating part gradually can be discharged from the support section of nail bin.In various embodiments, such as not by tissue thickness's compensating part from support section discharge in the case of, the lower limb of nail such as follows closely lower limb 10032 can pass tissue thickness's compensating part.In this type of embodiment, tissue thickness's compensating part can keep engaging with support section, until the base portion such as base portion 10031 contact tissue thickness compensation part by it upwardly of nail.But in various embodiments, clamping plate and/or other holding structures extended from support section such as can hinder the release from support section of tissue thickness's compensating part.In certain embodiments, as described in more detail below, support section can include keeping structure, and when nail is gradually fired from nail bin, tissue thickness's compensating part can gradually be discharged by this holding structure from support section.Referring now to Figure 28 3, nail bin such as nail bin 11200 such as can include support section 11210, and this support section includes can be by tissue thickness compensating part 11220(Figure 28 4) releasably hold the holding structure 11213 of support section 11210.In various embodiments, keep structure 11213 can be positioned in the end in the most each nail chamber 11212, the most each holding structure 11213 can include being limited to guide groove 11216 therein, and this guide groove can slidably receive the nail lower limb 10032 of nail 10030.In this type of embodiment, tissue thickness's compensating part 11220 can be releasably held support section 11210 by nail lower limb 10032 and holding structure 11213.In use, referring now to Figure 28 4, the staple drivers 10040 being contained in support section 11210 can be driven up by sliding part 10050, as mentioned above, wherein staple drivers 10040 can contact holding structure 11213, make holding structure 11213 be at least partially separated with support section 11210, and make holding structure 11213 be outwardly and away from nail 10030 and nail chamber 11212 displacement.When keeping structure 11213 to separate with support section 11210 and/or during outward displacement, as shown in Figure 28 4, keeping structure 11213 can be no longer able to remain to tissue thickness's compensating part 11220 support section 11210, therefore, tissue thickness's compensating part 11220 can be released from support section 11210.Similarly as described above, when follow closely 10030 such as from nail bin towards anvil block such as anvil block 11260 is gradually penetrated time, tissue thickness's compensating part 11220 gradually can be discharged from support section 11210.In various embodiments, when the top surface of staple drivers 10040 is such as with platform surface 11211 copline of support section 11210 or at least substantially copline, staple drivers 10040 can contact holding structure 11213.In this type of embodiment, nail 10030 be formed its be fully formed or completely percussion configuration while and/or nail 10030 be formed its be fully formed or completely percussion configuration before, tissue thickness's compensating part 11220 can discharge from support section 11210.In at least one this type of embodiment, referring first to Figure 28 5, driver 10040 can be overdriven so that it is pushed to above platform surface 11211 so that nail 10030 is fully formed, and during the process being overdriven, make holding structure 11213 depart from support section 11210.In various embodiments, refer again to Figure 28 4, keep structure 11213 to may extend into before separation or outward displacement or dangle to following closely on chamber 11212 and enter in nail chamber so that just when driver 10040 arrives platform surface 11211, driver 10040 can contact holding structure 11213.Under any circumstance, once tissue thickness's compensating part 11220 is released from support section 11210, and referring now to Figure 28 5, then support section 11210 is movable away from the tissue thickness's compensating part 11220 implanted.

As it has been described above, when nail is fired from nail bin or disposes, the compressible tissue thickness compensating part of nail bin gradually can be discharged from the support section of nail bin or warehouse.In all cases, this type of release can include making tissue thickness's compensating part gradually unclamp from support section, the most in some cases, until anvil block be opened and support section move away from implant tissue thickness's compensating part, tissue thickness's compensating part is only possible to be kept completely separate with support section.In various embodiments, referring now to Figure 28 9, nail bin such as nail bin 11300 such as can include the tissue thickness's compensating part 11320 releasably holding support section 11310.In at least one embodiment, support section 11310 can include the multiple holding components 11313 extended from it, and tissue thickness's compensating part 11320 can be compressed and remain to support section 11310 by the plurality of holding component releasedly.In at least one this type of embodiment, each holding component 11313 can include accommodating wherein longitudinal side of tissue thickness's compensating part 11320 towards interior passage or slit 11316.In all cases, multiple holding components 11313 can extend along the longitudinal side of the first of support section 11310, and multiple holding component 11313 can extend along the longitudinal side of the second of support section 11310.Wherein, in some cases, keep component 11313 to be prevented from or at least limit between tissue thickness compensating part 11320 and support section 11310 relative to lateral movement, and prevent from addition or at least limit tissue thickness's compensating part 11320 discharging from support section 11310 prematurely.In various embodiments, holding component 11313 can be one-body molded with support section 11310, and at least one embodiment, see Figure 29 0, keep component 11313 can separate with support section 11310 or be at least partially separate, to make tissue thickness's compensating part 11320 separate with support section 11310, such as shown in Figure 29 1.In certain embodiments, anvil block such as anvil block 11360 such as can compress tissue thickness's compensating part 11320, and in response to the pressure produced in tissue thickness's compensating part 11320, tissue thickness's compensating part 11320 can lateral extension to making holding component 11313 be at least partially separated with tissue thickness compensating part 11320 or depart from.In various embodiments, as mentioned above, advance cutter component can dispose be accommodated in nail therein through anvil block 11360 and nail bin 11300, and extruding anvil block 11360 and nail bin 11300 make it closer to each other simultaneously, the compression stress of increase can be applied to tissue thickness's compensating part 11320 by this, thus makes holding component 11313 separate successively when cutter component is through nail bin 11300.

In various embodiments, referring now to Figure 29 2-294, nail bin such as nail bin 11400 such as can include the tissue thickness's compensating part 11420 being removably attached to support section 11410.In at least one embodiment, nail bin 11400 can include one or more keeper bars 11413 that longitudinal side of tissue thickness's compensating part 11420 can remain to platform surface 11411.In at least one this type of embodiment, each keeper bar 11413 can include opposing arms 11418, and this opposing arms limits passage 11416 therebetween.In this type of embodiment, one in arm 11418 can extend on tissue thickness's compensating part 11420, and another arm 11418 can extend to below the antelabium 11419 that support section 11410 extends.Referring first to Figure 29 2, the size of the passage 11416 of each keeper bar 11413 can be set to and can apply compressive force to longitudinal side of tissue thickness's compensating part 11420 before using nail bin 11400.During use, referring first to Figure 29 3, nail bin 11400 can be positioned in staple cartridge channel, and once nail bin 11400 the most appropriately positions, and anvil block such as anvil block 11460 is such as moveable in the position of its compressible tissue thickness compensating part 11420.Similarly as described above, when pressurised, therefore tissue thickness's compensating part 11420 laterally or flex outward, and can make keeper bar 11413 separate with nail bin 11400.In some other embodiment, the Guan Bi of anvil block 11460 can make keeper bar 11413 not separate with nail bin or not be kept completely separate with nail bin.In at least one this type of embodiment, as mentioned above, advance trigger shaft can dispose nail 10030 from support section 11410 through nail bin 11400, and extruding anvil block 11460 and nail bin 11400 make it closer to each other simultaneously, to apply compressive force to tissue thickness's compensating part 11420, this compression stress be enough to make tissue thickness's compensating part 11420 lateral extension, and makes keeper bar 11413 separate with nail bin 11400.Once keeper bar 11413 separates with nail bin 11400, sees Figure 29 4, and support section 11410 is movable away from the tissue thickness's compensating part 11420 implanted and to be removed from operative site.In some alternative embodiment, referring now to Figure 29 5, nail bin 11400 ' can include keeper bar 11413 ', this keeper bar arm 11418 ' including extending from it similarly as described above.In at least one this type of embodiment, each in arm 11418 ' can include wedge-lock inclined-plane 11417 ' that keeper bar 11413 ' can be latchable to nail bin 11400 ' releasedly.More specifically, in at least one embodiment, the support section 11410 ' of nail bin 11400 ' can include undercuting 11419 ', this undercutting cooperates with wedge-lock inclined-plane 11417 ', keeper bar 11413 ' can be releasably held nail bin 11400, and suppress tissue thickness's compensating part 11420 to separate with support section 11410 ' prematurely.Using therebetween, similarly as described above, when enough compression stresses are applied to tissue thickness's compensating part 11420, keeper bar 11413 ' can separate with nail bin 11400 '.

In all cases, as mentioned above and refer again to Figure 25 9 and Figure 26 0, the sliding part 10050 of nail bin 10000 and the firing member 10052 of surgery suturing appliance can move to far-end 10002(Figure 21 9 of nail bin 10000 from the near-end 10001 of nail bin 10000), in order to dispose nail 10030 from support section 10010.At at least one in the case of this type of, each nail 10030 never can move to firing position by firing position, and penetrates to capture whole tissue thickness compensating part 10020 at the tissue being positioned between anvil block 10060 and nail bin 10000 from support section 10010.In some cases, surgeon is perhaps without firing all nails 10030 from nail bin 10000, and surgeon may make the advance of sliding part 10050 and trigger shaft 10052 be barred from the point of near-end 10001 and far-end 10002 centre being positioned at nail bin 10000.In such cases, tissue thickness's compensating part 10020 can be only by part implanting tissue T, in order to make the non-implant part of tissue thickness's compensating part 10020 separate with support section 10010.Tissue thickness's compensating part 10020 tractive that support section 10010 can be implanted by surgeon away from part so that non-implant part is peeled off from support section 10010 or comes off.Although this type of embodiment is suitable to various situation, Figure 30 0-302 shows improvement, wherein tissue thickness's compensating part 11520 of tissue thickness's compensating part such as nail bin 11500 such as can include can be separated from one another multiple junction fragments.In at least one this type of embodiment, tissue thickness's compensating part 11520 can include first or recent side fragment 11520a, be removably connected to the second fragment 11520b of the first fragment 11520a, is removably connected to the 3rd fragment 11520c of the second fragment 11520b, is removably connected to the 4th fragment 11520d of the 3rd fragment 11520c and is removably connected to the 5th fragment 11520e of the 4th fragment 11520d.In various embodiments, tissue thickness's compensating part 11520 can include being positioned at least one thin layer 11529 that can limit predetermined breakdown point or burble point in the middle of any two adjacent segment 11520a-11520e, and tissue thickness's compensating part fragment can be separated from one another at this breakdown point or burble point.In certain embodiments, tissue thickness's compensating part can include any suitable perforation, thin layer and/or for producing any other device of burble point in tissue thickness's compensating part.Referring first to Figure 30 1, anvil block 11560 is shown in make position, and firing member 10052 is shown as and is partly advanced through nail bin 11500 so that the nail 10030 below the first fragment 11520a, the second fragment 11520b and the 3rd fragment 11520c is fired to capture tissue thickness compensation part 11520 in tissue T.In this position, firing member 10052 is not also pushed into dispose the nail 10030 below the such as the 4th fragment 11520d and the 5th fragment 11520e.Referring now to Figure 30 2, anvil block 11560 has been moved to open position, and the support section 11510 of nail bin 11500 has moved away from the implant part of tissue thickness's compensating part 11520.As shown in Figure 30 2, it being positioned at the thin layer 11529(Figure 30 0 in the middle of the 3rd fragment 11520c and the 4th fragment 11520d) the non-implant part of Yi Shi tissue thickness compensating part 11520 separates with implant part.

In various embodiments, to being described further above, nail bin can include multiple securing member, and tissue thickness's compensating part can be releasably held the support section of nail bin by the plurality of securing member.In certain embodiments, support section can include the multiple holes being such as limited in platform surface, and wherein securing member can extend across tissue thickness's compensating part and can be releasably retained in support section hole.In use, when nail is gradually penetrated from support section, securing member gradually can be discharged from support section.In at least one this type of embodiment, securing member can be implanted with tissue thickness's compensating part, and at least one embodiment, securing member can be such as made up of at least one bioabsorbable material.In certain embodiments, after tissue thickness's compensating part is at least partly implanted, and when support section moves away from the tissue thickness's compensating part implanted, securing member can separate with support section.In various embodiments, referring now to Figure 32 3-325, nail bin such as nail bin 11600 such as can include the tissue thickness's compensating part 11620 being releasably attached to support section 11610 by multiple securing members 11613.The second end 11618 that the first end 11618 engaged in each securing member 11613 can include embedding tissue thickness compensating part 11620 and/or with tissue thickness compensating part 11620 engages with support section 11610 and the adapter 11616 that first end 11618 is connected to the second end 11618.In each middle embodiment, securing member 11613 can extend across the cutter slit 11615 being limited in support section 11610.In use, as it has been described above, firing member 10052 can make cutter slit 11615 that blade moves across in support section 11610 and cut securing member 11613, in order to discharge tissue thickness's compensating part 11620 from support section 11610.In at least one this type of embodiment, trigger shaft 10052 can be advanced to the far-end 11602 of nail bin 11600 from the near-end 11601 of nail bin 11600,1) sliding part 10050 to advance towards distally and gradually fires nail 10030 as mentioned above, and 2) gradually cut securing member 11613 and/or make securing member 11613 rupture gradually to discharge tissue thickness's compensating part 11620 from support section 11610.In certain embodiments, similarly as described above, tissue thickness's compensating part 11620 can include multiple separable fragment 11620a-11620e, and the plurality of separable fragment such as can remain to support section 11610 each via one or more securing members 11613.As shown in Figure 32 4, if firing member 10052 is barred from the middle of near-end 11601 and the far-end 11602 of nail bin 11600, after anvil block 11660 is opened and support section 11610 moves away from tissue T, as shown in Figure 32 5, securing member 11613 can help to the non-implant part of tissue thickness's compensating part 11620 is remained to support section 11610.In various embodiments, to being described further above, the cutting blade 10053 of firing member 10052 can cut securing member 11613 and/or make securing member 11613 rupture.In some alternative embodiment, referring now to Figure 32 7 and Figure 32 8, sliding part such as sliding part 11650 disposed by nail such as can include blade 11653, and when sliding part 11650 traverses nail bin 11600, this blade can cut the adapter 11616 of securing member 11613.In at least one this type of embodiment, each adapter 11616 may be included in the cylindrical member extended between the T-shaped end 11618 of securing member 11613, wherein blade 11653 can include concave profile 11653, and this concave profile such as can accommodate cylinder shape connector 11616.

As it has been described above, nail bin can be loaded onto in the staple cartridge channel of surgery suturing appliance.In all cases, surgeon or other clinicians can be in place to be locked by nail bin by being applied to downward power on nail bin insert nail bin in staple cartridge channel.At some in the case of this type of, its thumb such as can be placed on the top surface of nail bin and apply this type of downward power by clinician.In various embodiments, the top surface of nail bin can include the top surface of tissue thickness's compensating part, wherein, as mentioned above, tissue thickness's compensating part can be compressible, and the downward power in certain embodiments, being applied to tissue thickness's compensating part can make tissue thickness's compensating part be compressed to following point: at this point, the thumb of clinician contacts with the end of the nail being stored in support section.In various embodiments, nail bin is inserted in staple cartridge channel by available nail bin application device, and this nail bin application device is prevented from or at least limits clinician touching the probability of the nail in nail bin.After nail bin is correctly positioned in staple cartridge channel, as described in more detail below, application device can separate with nail bin.

In certain embodiments, referring now to Figure 30 5 and Figure 30 6, nail bin application device can such as include that the rigid cap that could attach to nail bin 10000 such as covers 10080.To being described further above, when nail bin 10000 is inserted in staple cartridge channel, cover the end of 10080 nails 10030 that can such as prevent or at least suppress the thumb contact of clinician to be positioned in nail bin 10000.Referring now to Figure 30 7 and Figure 30 8, lid 10080 may extend on the top surface 10021 of tissue thickness's compensating part 10020 or at least some of of top surface 10021, and 1 can be included) may extend on tissue thickness's compensating part 10020 and/or the lower surface 10081 of subjacent tissue's thickness compensation part 10020, and 2) can be that clinician provides pressing surface to apply the top surface 10082 of downward power to it.In use, clinician can grasp the handle portions 10084 of lid 10080, is alignd with staple cartridge channel by the support section 10010 of nail bin 10000, and is inserted in staple cartridge channel by nail bin 10000 at least in part.Then, clinician can make nail bin 10000 rest upon completely in staple cartridge channel by applying downward power to the top surface 10082 of lid 10880.In various embodiments, this downward power can be directly transferred to support section 10010.In at least one this type of embodiment, lid 10080 can include proximal supports 10087, and this support member can downwardly extend and contact the platform surface 10011 of support section.In certain embodiments, lid 10080 may also include the distally support section 10083 that can adjoin nose 10003.When the power downward to lid 10080 applying, this downward power can be passed by proximal supports 10087 and/or distally support section 10083, without or at least substantially this downward power will not be delivered to support section 10010 by tissue thickness's compensating part 10020.In all cases, due to mentioned above, clinician can be not directly contacted with tissue thickness's compensating part 10020.Due also to mentioned above, when nail bin 10000 is inserted in staple cartridge channel, lid 10080 can not compress or the most not compress tissue thickness's compensating part 10020.In various embodiments, lid can include any appropriate number of support member, and downward power can be delivered to support section by this support member, without or at least substantially will not transmit this downward power by tissue thickness's compensating part.In certain embodiments, support member may extend into around the near-end of tissue thickness's compensating part, far-end and/or longitudinal side.In certain embodiments, support member can extend across tissue thickness's compensating part.In at least one this type of embodiment, support member can extend across the hole in tissue thickness's compensating part the platform of adjacent support section.In certain embodiments, at least some support member can not contact platform before downward power is applied to lid；But, in various embodiments, lid can bend, or moves downward until support member contacts the platform of support section.Now, can stop or at least substantially stop the downward flexure of lid or motion to bend further.

As it has been described above, lid 10080 could attach to nail bin 10000 and can be used for regulating and controlling the position of nail bin 10000.In various embodiments, lid 10080 can include any appropriate number of clamping components, and lid 10080 such as can be releasably held the support section 10010 of nail bin 10000 by this clamping components.In at least one this type of embodiment, lid 10080 such as may also include one or more holding component, such as hammerlock 10088 and/or 10089.In various embodiments, hammerlock 10089 can extend to the side periphery of nose 10003 and engages lower surface 10009(Figure 30 6 of nose 10003).Similarly, hammerlock 10088 may extend into the side periphery of lock protuberance 10008, and this lock protuberance extends from support section 10010 and engages the lower surface of lock protuberance 10008.In various embodiments, lid 10080 can be positioned on following district or region by these hammerlocks: in this district or region, and nail is stored in support section 10010.Under any circumstance, once nail bin 10000 is properly oriented, and lid 10080 can separate with nail bin 10000.In at least one embodiment, clinician can apply lifting force upwards to shank 10084, in order to is separated with the far-end 10002 of nail bin 10000 by the far-end of lid 10080.In at least one this type of embodiment, when shank 10084 is lifted up, hammerlock 10088 and 10089 can flex outward so that hammerlock 10088 and 10089 can bend around lock protuberance 10008 and nose 10003 respectively.Then, the near-end of lid 10080 can be subsequently lifted the near-end 10001 of nail bin, and it is movable away from nail bin 10000 to cover 10080.

In certain embodiments, referring now to Figure 30 9 and Figure 31 0, in addition to by nail bin, such as nail bin 10600 is such as positioned in staple cartridge channel, top such as can also be organized thickness compensation part such as tissue thickness's compensating part 10690 such as to position relative to anvil block by nail bin application device such as nail bin application device 10680.Similarly as described above, application device 10680 can include the hammerlock 10688 can being releasably engaged with lock protuberance 10608, this lock protuberance extends from the support section 10610 of nail bin 10600 so that application device can be maintained at the position on tissue thickness's compensating part 10620 of nail bin 10600.In various embodiments, top tissue thickness compensation part 10690 can be removably attached to nail bin application device 10680, the anvil block such as anvil block 10060 making surgical instruments such as can close on application device 10680, engage tissue thickness's compensating part 10690, and make tissue thickness's compensating part 10690 separate with application device 10680.In various embodiments, tissue thickness's compensating part 10690 and/or anvil block 10060 can include one or more holding structure, and tissue thickness's compensating part 10690 can be releasably held anvil block 10060 by this holding structure.In at least one this type of embodiment, tissue thickness's compensating part 10690 can include the longitudinal rail 10695 such as extended from the top surface 10691 of tissue thickness's compensating part 10690, and this longitudinal rail can be housed inside in the longitudinal knife slit 10065 being limited in anvil block 10060.In various embodiments, tissue thickness's compensating part 10690 and longitudinal rail 10695 can be such as made up of any suitable compressible material, such as being described in those in this patent application, wherein longitudinal rail 10695 such as can be compressed and/or be wedged in cutter slit 10065.Once anvil block 10060 engages with tissue thickness compensating part 10690, then anvil block 10060 can return to open position, and in such cases, tissue thickness's compensating part 10690 can separate with application device 10680.Then, application device 10680 can separate with nail bin 10600 so that anvil block 10060 and nail bin 10600 can be relative to the tissue positioned that will be sewn and/or cut.In use, sliding part such as sliding part 10050(Figure 23 6 disposed by nail) such as can be by firing member 10052(Figure 23 6) it is advanced through nail bin 10600 towards distally, such as to be penetrated from nail bin 10060 by nail, as mentioned above.Due to nail deformation, the most each nail can be in the part of top surface capture tissue thickness compensation part 10690 for tissue, an and part for the lower surface capture tissue thickness compensation part 10620 at tissue.Meanwhile, firing member 10052 can advance blade 10053(Figure 23 6) through tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690.The most at least one embodiment, blade 10053 can be pushed into by longitudinal rail 10695, in order to cuts guide rail 10695 and makes tissue thickness's compensating part 10690 be gradually disengaged with anvil block 10060.After nail is deployed, anvil block 10060 can be opened again and move away from the tissue thickness's compensating part 10690 implanted, and similarly, the support section 10610 of nail bin 10600 is movable away from the tissue thickness's compensating part 10620 implanted.In various embodiments, to being described further above, tissue thickness's compensating part 10620 and/or tissue thickness's compensating part 10690 can include multiple separable fragment.If only the part of tissue thickness's compensating part 10620 and 10690 is implanted by nail, separable fragment can be separated from one another.

In various embodiments, to being described further above, application device 10680 can include one or more holding structures that tissue thickness's compensating part 10690 can releasably hold application device 10680.In at least one this type of embodiment, referring first to Figure 31 0, application device 10680 can include being accommodated in the longitudinal direction holding guide rail 10685 longitudinally kept in slit 10694, and this longitudinal direction keeps slit to be limited in the lower surface 10692 of tissue thickness's compensating part 10690 with press-fit.In all cases, keep guide rail 10685 and keep slit 10694 tissue thickness's compensating part 10690 can be remained to application device 10680, until applying enough lifting forces upwards by anvil block 10060 to tissue thickness's compensating part 10690, as mentioned above.In at least one this type of embodiment, may also include the end stop 10686 proximally and distally being positioned within guide rail 10685 from the holding guide rail 10685 of application device 10680 extension, this end stop is prevented from or at least limits the relative longitudinal motion between tissue thickness's compensating part 10690 and application device 10680.In certain embodiments, refer again to Figure 31 0, one or more binding agents such as longitudinal adhesive tape 10693 such as can be placed in the contact surface 10691 of tissue thickness's compensating part 10690, make when anvil block 10060 contact tissue thickness compensation part 10690, as it has been described above, tissue thickness's compensating part 10690 can be releasably attached to anvil block 10060 by binding agent.In various embodiments, in addition to above-mentioned compressible holding structure or replace above-mentioned compressible holding structure, such as, can use one or more binding agents.In certain embodiments, can use one or more binding agents that tissue thickness's compensating part is releasably held nail bin application device.In at least one embodiment, referring now to Figure 31 0A, lid 10080 such as can include one or more adhesive pad 12185, and top can be organized thickness compensation part such as tissue thickness's compensating part 12190 such as to releasably hold the top surface 10082 of lid 10080 by these one or more adhesive pads.In at least one this type of embodiment, being similar to above-described embodiment, anvil block can be closed to engage the longitudinal direction of tissue thickness's compensating part 12190 on tissue thickness's compensating part 12190 and keep guide rail 12195.In certain embodiments, relieving mechanism can be positioned in the middle of tissue thickness's compensating part 12190 and lid 10080.This relieving mechanism can be used for breaking the bonding that tissue thickness's compensating part 12190 remains to cover 10080, and makes tissue thickness's compensating part 12190 separate with lid 10080.In at least one embodiment, relieving mechanism can include pull tab 12196 and the collar 12197, and wherein the collar 12197 can include first end and the second end being attached to pull tab 12196.The collar 12197 can such as include stitching thread, and this stitching thread can limit the periphery defining adhesive pad 12185 so that when pull tab 12196 is pulled towards distally, and stitching thread can slide and contact tissue pad 12185 between tissue thickness's compensating part 12190 and lid 10080.In such cases, stitching thread such as can complete at least one in following functions: makes adhesive pad 12185 separate with tissue thickness compensating part 12190；Adhesive pad 12185 is made to separate with lid 10080；And/or cut off adhesive pad 12185.

In various embodiments, referring now to Figure 31 1, nail bin can such as include support section 10710.Similarly as described above, this support section can include the longitudinal knife slit 10715 running through extension.In at least one this type of embodiment, nail bin application device such as application device 10780 such as can include longitudinally keeping and alignment member 10786, and this longitudinal direction keeps and alignment member extends in the cutter slit 10715 in support section 10710.In certain embodiments, component 10786 is kept such as can to engage the sidewall of cutter slit 10715 with press-fit so that application device 10780 can be releasably retained support section 10710.In various embodiments, although not shown, the Part I of tissue thickness's compensating part can be positioned on the first side keeping component 10786, and the Part II of tissue thickness's compensating part can be positioned in and keep the relative of component 10786 or on the second side.Similarly as described above, the Part I of tissue thickness's compensating part and Part II such as can be installed to the support section 10710 of nail bin by keeping component 10013.Being also similar to mentioned above, top tissue thickness compensation part 10790 can be by keeping component 10785 to be removably attachable to application device 10780 from the longitudinal direction loading surface 10782 extension of application device 10780.In wherein keeping longitudinal slit 10794 that component 10785 such as can be press-fitted in the lower surface 10792 being limited to tissue thickness's compensating part 10790 releasedly.In various embodiments, it is also similar to mentioned above, tissue thickness's compensating part 10790 may also include the longitudinal direction extended from the top surface 10791 of tissue thickness's compensating part 10790 and keeps component 10795, and this longitudinal direction keeps component can be releasably retained in the longitudinal knife slit 10065 in being limited to anvil block 10060.In at least one this type of embodiment, longitudinally keeping component 10795 can include wedge-shaped cross-section, this wedge-shaped cross-section includes the top more than bottom, and wherein bottom such as can be attached to tissue thickness's compensating part 10790 by keeping component 10795.

In various embodiments, referring now to Figure 31 2 and Figure 31 3, the nail bin 10800 including support section 10810 and tissue thickness's compensating part 10820 such as can be loaded onto in staple cartridge channel with nail bin application device 10880.Similarly as described above, top such as can also be organized thickness compensation part 10890 to position relative to anvil block such as anvil block 10060 by nail bin application device 10880 so that when anvil block 10060 closes, anvil block 10060 can contact and engage tissue thickness's compensating part 10890.In at least one embodiment, tissue thickness's compensating part 10890 can include the multiple holding lower limbs 10895 extended from the top surface 10891 of tissue thickness's compensating part 10890, and this holding lower limb can engage anvil block 10060 and tissue thickness's compensating part 10890 is releasably held anvil block 10060.In at least one this type of embodiment, lower limb 10895 can be arranged to longitudinal row, and the most each lower limb 10895 can include at least one foot, and this foot can enter and engage the cutter slit 10065 being limited in anvil block 10060.In certain embodiments, some feet of lower limb 10895 can extend in one direction, and other feet can extend along another direction.In at least one embodiment, some feet can extend along relative direction.Under any circumstance, once anvil block 10060 engages with tissue thickness compensating part 10890, referring now to Figure 31 3 and Figure 31 4, anvil block 10060 can be opened again, and nail bin application device 10880 can be moved apart tissue thickness's compensating part 10820 and 10890 by clinician.Then, seeing Figure 31 4A, top tissue thickness compensation part 10890 can be positioned in the first side of target tissue, and can include that tissue thickness's compensating part 10820 of bottom tissue thickness compensating part can be positioned on the second side of tissue.After tissue thickness's compensating part 10820 and 10890 is properly oriented, referring now to Figure 31 4B, the blade of firing member such as blade 10053 such as can be advanced through tissue and tissue thickness's compensating part.In various embodiments, referring now to Figure 31 8, nail bin application device such as application device 12280 such as can include the tissue thickness's compensating part 12290 being detachably mounted to it.As shown in Figure 31 9, when anvil block 10060 moves to make position, this tissue thickness's compensating part can be similar to mentioned above be inserted in staple cartridge channel and engaged by anvil block 10060.In at least one this type of embodiment, tissue thickness's compensating part 12290 can include from the upwardly extending multiple holding components 12295 of the top surface 12291 of tissue thickness's compensating part 12290.The most each holding component 12295 can include multiple flexible leg 12296, and the plurality of flexible leg is inserted in the cutter slit 10065 in anvil block 10060.Referring first to Figure 32 1 and Figure 32 2, the flexible leg 12296 of each holding component 12295 can be separated by gap 12298, make when lower limb 12296 inserts in cutter slit 10065, lower limb 12296 can inward deflection, and once the foot of the expansion of flexible leg 12296 is through cutter slit 10065, then lower limb 12296 springs back outward into subsequently.In various embodiments, the foot of the expansion of flexible leg 12296 can be in relative holding antelabium 12297 flexure below in being limited at anvil block 10060, and due to lower limb 12296 and the interaction of antelabium 12297, tissue thickness's compensating part 12290 can be held anvil block 10060.Then, nail bin application device 12280 is movable away from tissue thickness's compensating part 12290, as shown in Figure 32 0.In use, once tissue thickness's compensating part 12290 is implanted to tissue by the nail disposed from nail bin 10000 the most, then anvil block 10060 can be opened again, and when anvil block 10060 moves away from tissue thickness's compensating part 12290 of implantation, the lower limb 12296 keeping component 12995 can inward deflection so that it can be pulled out from cutter slit 10065.

In various embodiments, referring now to Figure 31 5 and Figure 31 6, tissue thickness's compensating part such as tissue thickness's compensating part 11990 such as can be by longitudinal load to anvil block such as anvil block 11960.More specifically, in at least one embodiment, tissue thickness's compensating part 11990 can include one or more longitudinal rail 11995, these one or more longitudinal rails can be inserted in the distal openings in the cutter slit 11965 of anvil block 11960, and promote towards distally subsequently, until tissue thickness's compensating part 11990 rests upon the most rightly in anvil block 11960.In at least one this type of embodiment, each guide rail 11995 can include being positioned in the longitudinal direction holding foot 11996 longitudinally keeping antelabium 11997 below, and this longitudinally keeps antelabium the most partially defined cutter slit 11965.As shown in Figure 31 6, foot 11996 can extend along relative direction, in order to being positioned in after holding antelabium 11997, this holding antelabium is positioned on the opposite side of cutter slit 11965.In various embodiments, axial clearance 11998 can be limited between guide rail 11995, and when tissue thickness's compensating part 11990 separates with anvil block 11960, this axial clearance can make guide rail 11995 inward deflection toward each other.In certain embodiments, referring now to Figure 31 7, tissue thickness's compensating part such as tissue thickness's compensating part 12090 such as can include the one or more hammerlocks 12098 extending to the side periphery of anvil block such as anvil block 12060.In use, the engageable anvil block of hammerlock 12,098 12060 tissue thickness's compensating part 12090 is releasably held anvil block 12060.In at least one this type of embodiment, anvil block 12060 such as can include that one or more recess or lock shoulder 12097, these one or more recesses or lock shoulder each can accommodate the foot extended from hammerlock 12098.In use, after tissue thickness's compensating part 12090 is at least partly implanted, arm 12098 can flex outward, and separate with anvil block 12060 when anvil block 12060 moves away from tissue thickness's compensating part 12090.

As it has been described above, surgery suturing appliance can include can accommodating the staple cartridge channel of nail bin, being rotationally coupled to the anvil block of staple cartridge channel and include the firing member of blade, this firing member can move relative to anvil block and staple cartridge channel.In use, nail bin can be positioned in staple cartridge channel, and after nail bin is consumed at least in part, nail bin can remove from staple cartridge channel and replaced by new nail bin.In some these type of embodiments, the staple cartridge channel of surgery suturing appliance, anvil block and/or firing member can be reused together with replacing nail bin.In some other embodiment, nail bin can include the disposable loading unit assembly of part, this disposable loading unit assembly such as can include staple cartridge channel, anvil block and/or firing member, and these can be replaced with nail bin, as the part replacing disposable loading unit assembly.Some disposable loading unit assembly is disclosed in the U.S. Patent Application Serial Number 12/031 of entitled " ENDEFECTORCOUPLINGARRANGMENTSFORASURGICALCUTTINGANDSTAPL INGINSTRUMENT " that on February 15th, 2008 submits to, in 817, the complete disclosure of this patent application is incorporated by reference herein.Referring now to Figure 37 0, disposable loading unit such as disposable loading unit 12500 such as can include support section 12510, the anvil block 12560 being rotationally coupled to support section 12510 and the slender axles 12570 extended from support section 12510.Being similar to nail bin as herein described, support section 12510 can include multiple nail chamber 10012 and nail, such as, be positioned at the nail 10030 in each nail chamber 10012.Disposable loading unit 12500 may also include firing member 12552, and this firing member can be advanced to towards distally from open position, anvil block 12560 be moved to make position, as shown in Figure 37 0.In various embodiments, disposable loading unit 12500 may also include the tissue thickness's compensating part 12520 being positioned on support section 12510 and/or being attached to support section 12510.Wherein, when anvil block 12560 is in its make position, anvil block 12560 can be positioned in the opposite of tissue thickness's compensating part 12520, and in certain embodiments, when anvil block 12560 is in its make position, anvil block 12560 can compress tissue thickness's compensating part 12520 at least in part.In either case, firing member 12552 can be further promoted, in order to is penetrated from support section 12510 by nail.After nail is shot up, nail can be deformed by anvil block 12560, and captures at least some of of tissue thickness therein compensating part 12520.Then, firing member 12552 can proximally bounce back, and anvil block 12560 can be opened again, and support section 12510 is movable away from the tissue thickness's compensating part 12520 implanted.

In various embodiments, support section 12510 can be detachably mounted to being described further tissue thickness's compensating part 12520 above.In at least one this type of embodiment, support section 12510 can include that the longitudinal direction being installed to each of which side keeps guide rail 12526, the most each guide rail 12526 can include one or more hole 12528, and these one or more holes can accommodate at least some of of tissue thickness's compensating part 12520 wherein.Once tissue thickness's compensating part 12520 is partly implanted, then can be drawn out from hole 12528 by tissue thickness's compensating part 12520 when support section 12510 is displaced from.In various embodiments, referring now to Figure 37 1-373, disposable loading unit 12600 can include support section 12610, the tissue thickness's compensating part 12620 being detachably mounted to support section 12610 and one or more holding guide rail 12626, these one or more holding guide rails can extend to below tissue thickness's compensating part 12620, and tissue thickness's compensating part 12620 is installed to support section 12610.Each holding guide rail 12626 such as can include multiple retaining hook 12628, and the plurality of retaining hook can be joined to support section 12610 by the holding slit 12614 being such as limited in support section 12610.In use, at least one this type of embodiment, after tissue thickness's compensating part 12620 is at least partly implanted and support section 12610 moves away from tissue thickness's compensating part 12620, tissue thickness's compensating part 12620 can separate with keeping guide rail 12626.In various embodiments, referring now to Figure 37 4-376, disposable loading unit 12700 can include one or more holding guide rail 12726, and these one or more holding guide rails can each include the bottom bar 12725 that may extend into below tissue thickness's compensating part 12720 and extend to the push rod 12727 on the top surface 12621 of tissue thickness's compensating part 12620.In certain embodiments, tissue thickness's compensating part 12620 at least can be partially compressed between push rod 12727 and bottom bar 12725 so that keeps guide rail 12726 can keep tissue thickness's compensating part 12620 relative to support section 12610.In at least one this type of embodiment, each holding guide rail 12726 can include one or more retaining hook 12728, and these one or more retaining hooks can engage holding guide rail 12726 is remained to support section 12610 with support section 12610.

In various embodiments, referring now to Figure 37 7 and Figure 37 8, disposable loading unit 12800 can include keeping component 12822, and tissue thickness's compensating part 12620 can be installed to support section 12610 by this holding component.In at least one this type of embodiment, keeping component 12822 can include the material piece being positioned on the platform surface 12611 of support section, wherein tissue thickness's compensating part 12620 such as can be attached to material piece by least one binding agent.Keeping component 12822 to may also include longitudinally and keep guide rail 12825, this longitudinal direction keeps guide rail can extend downwardly in the cutter slit 12615 being limited in support section 12610.In at least one this type of embodiment, keep the size of guide rail 12825 can be set to and be configured so that it is compressed between the sidewall of cutter slit 12615.In use, firing member 12552 can include blade, and when firing member 12552 is pushed into also longitudinal cutting tissue thickness compensating part 12620 and holding guide rail 12825 towards distally, this blade may pass through cutter slit 12615.It addition, in use, holding component 12822, tissue thickness's compensating part 12820 can be penetrated from the nail of support section 12610 injection and be positioned at the tissue between tissue thickness's compensating part 12820 and anvil block 12560.In various embodiments, component 12822 is kept can be made up of biocompatibility and/or bioabsorbable material.In certain embodiments, holding component 12822 can be by constituting by compressed sufficiently material, to include tissue thickness's compensating part 12620 tissue below thickness compensation part.In various embodiments, referring now to Figure 37 9-381, disposable loading unit 12900 can include charging assembly, this charging assembly include being removably attached to support section 12610 bottom 12922, the top 12990 of anvil block 12560 can be removably attached to and connect bottom 12922 and the flexible joint 12991 at top 12990.Similarly as described above, longitudinally keep guide rail 12825 can extend downwardly in the cutter slit 12615 being limited to support section 12610 from bottom 12922 so that bottom 12922 can be releasably retained support section 12610.Similarly, guide rail 12995 is longitudinally kept can to extend up in the cutter slit being limited to anvil block 12560 from top 12990 so that top 12990 can be releasably retained anvil block 12560.As shown in Figure 38 0 and Figure 38 1, tissue thickness's compensating part 12620 can be installed to the bottom 12922 of charging assembly, wherein, in order to relative to support section 12610 position tissue thickness compensation part 12620, clinician can make top 12990 and the flexure of bottom 12922 towards each other, charging assembly is positioned between anvil block 12560 and support section 12610, and discharge the charging assembly of flexure, make charging assembly can against anvil block 12560 come elastic stretch and biasing top 12990, and against support section 12610 come elastic stretch and biasing bottom 12922.In at least one embodiment, referring now to Figure 38 2-384, charging assembly may also include one or more latch hooks such as latch hook 12994 such as extended from it, top 12990 can be releasably connected to anvil block 12560 by this latch hook, and/or bottom 12922 is releasably connected to support section 12610.

In various embodiments, referring now to Figure 38 5, disposable loading unit 15900 such as can include anvil block 15960 and staple cartridge channel 15970, and wherein staple cartridge channel 15970 can rotate relative to anvil block 15960.In at least one this type of embodiment, anvil block 15960 may not rotate.In certain embodiments, tissue can be positioned between anvil block 15960 and staple cartridge channel 15970, and staple cartridge channel 15970 can rotate towards tissue with against anvil block clamping tissue subsequently.In at least one this type of embodiment, disposable loading unit 15900 may also include can tissue thickness's compensating part 15920 of contact tissue.

As mentioned above and see Figure 33 2, nail bin such as nail bin 10000 such as can include support section 10010 and tissue thickness's compensating part 10020, plurality of nail 10030 can at least by section store in support section 10010, and when follow closely 10030 be in its non-firing position time may extend in tissue thickness's compensating part 10020.In various embodiments, when following closely 10030 and being in its non-firing position, the end of nail 10030 is not from tissue thickness's compensating part 10020 projection.When following closely 10030 and being moved to its firing position by staple drivers 10040 from its non-firing position, as it has been described above, the end of nail 10030 may pass through tissue thickness's compensating part 10020 and/or through upper strata or crust 10022.In some alternative embodiment, when following closely 10030 and being in its non-firing position, the end of nail 10030 can the top surface of Tu Chuan tissue thickness compensating part 10020 and/or crust 10022.In either case, when following closely 10030 and extending upward support section 10010 before being deployed, nail 10030 can tilt relative to support section and/or deflection, similarly, as described above.In various embodiments, referring now to Figure 32 9, nail bin such as nail bin 13000 such as can include the relative motion between support section 13010 that multiple ways or keeper, the plurality of ways or keeper can limit nail bin 13000 and the end of nail being positioned in.Referring first to Figure 33 0, nail bin 13000 can include the tissue thickness's compensating part 13020 being installed to support section 13010, and is attached to multiple absorbent cottons 13022 of the top surface 13021 of tissue thickness's compensating part 13020 in addition.In various embodiments, each absorbent cotton 13022 can include being limited to multiple hole 13029 therein, and the plurality of hole can accommodate and/or guide the lower limb 13022 of nail 13030 slidably therein.In addition to hole or replace hole, absorbent cotton such as can include any suitable opening, such as slit, guider and/or groove, and it can slidably receive and/or lead leg 13022.In certain embodiments, as shown in Figure 33 0, when following closely 13030 and being in its non-firing position, the end of nail lower limb 13032 can be positioned in hole 13029.In at least one this type of embodiment, when nail is in its non-firing position, the end of nail lower limb 13032 can project into above absorbent cotton 13022.In some other embodiment, when following closely 13030 and being in its non-firing position, the end of nail lower limb 13032 can be positioned in the immediately below of absorbent cotton 13022, making when following closely 13030 and being moved upwardly through tissue thickness's compensating part 13020, nail lower limb 13032 can enter in the hole 13029 of absorbent cotton 13022 and slide through this hole.Under any circumstance, when the lower limb 13032 following closely 13030 is positioned in absorbent cotton, the lateral of nail lower limb 13032 and/or lengthwise movement can be limited, and do not stop moving upward of nail lower limb 13032 when following closely 13030 and being deployed.When following closely 13030 and being deployed, referring now to Figure 33 1, nail lower limb 13032 can pass absorbent cotton 13022 by upward sliding, and to penetrate tissue T, contact is positioned at the anvil block on nail bin 13030 opposite, and deforms downwards to capture tissue T therein and tissue thickness's compensating part 13030.

In various embodiments, to being described further above, absorbent cotton 13022 such as can use at least one biocompatibility and/or bioabsorbable binding agent to be attached to tissue thickness's compensating part 13020.In certain embodiments, absorbent cotton 13022 and/or the holding component that extends from each absorbent cotton can be at least partially embedded tissue thickness compensating parts 13020.In at least one this type of embodiment, tissue thickness's compensating part 13020 can include being limited to the pit that can at least partly accommodate absorbent cotton 13022 therein.In certain embodiments, in molding manufacture process, tissue thickness's compensating part 13020 can be integrally molded or be formed around absorbent cotton 13022.In various embodiments, absorbent cotton 13022 can include the discrete keeper that can move independently of one another.In at least one embodiment, referring first to Figure 33 0, each absorbent cotton 13022 can include interlocking and/or bonding structure, this interlocking and/or bonding structure can allow for and limit to a certain extent between absorbent cotton 13022 relative to laterally and longitudinally motion.In at least one this type of embodiment, each absorbent cotton 13022 such as can include protuberance 13026 and one or more groove 13027, in wherein the protuberance 13026 of the first absorbent cotton 13022 can be positioned in the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022, and/or align relative to the groove 13027 of the second adjacent absorbent cotton and the 3rd absorbent cotton 13022.In various embodiments, gap may be present between adjacent absorbent cotton 13022, and this gap can make absorbent cotton 13022 be movable with respect to or slide, until the absorbent cotton 13022 that its contact is adjacent.In certain embodiments, absorbent cotton 13022 can loosely interconnect.In various embodiments, absorbent cotton 13022 can be detachably connected to each other.In at least one this type of embodiment, absorbent cotton 13022 can be manufactured such that the absorbent cotton of a piece of interconnection.Wherein, when applying enough power to this sheet, one or more in absorbent cotton 13022 can depart from other absorbent cottons.In certain embodiments, referring again to Figure 32 9, first 13024 absorbent cotton 13022 can be positioned on the first side of longitudinal slit 13025, and second 13024 absorbent cotton 13022 can be positioned on the second side of slit 13025.In at least one embodiment, to being described further above, the longitudinal slit 13025 extending through tissue thickness's compensating part 13020 can be conducive to the blade of firing member through tissue thickness's compensating part 13020, and when firing member is through out-of-date, firing member can apply compression stress to described 13024, and make at least some in absorbent cotton 13022 separately or separate.

In various embodiments, absorbent cotton 13022 such as can be made up of biocompatibility and/or bioabsorbable plastics.In certain embodiments, absorbent cotton 13022 such as can be made up of solid material, semi-solid material and/or flexible material.In certain embodiments, in absorbent cotton 13022 can embed tissue thickness's compensating part so that absorbent cotton 13022 is with tissue thickness's compensating part motion.In at least one this type of embodiment, absorbent cotton 13022 can be sufficiently flexible so that it can bend with the top surface of tissue thickness's compensating part.In certain embodiments, absorbent cotton 13022 can keep being embedded in tissue thickness's compensating part, and in some other embodiment, and absorbent cotton 13022 can eject from tissue thickness's compensating part or separate with tissue thickness compensating part.In various embodiments, absorbent cotton 13022 can include the top surface that the top surface with tissue thickness compensating part flushes.In certain embodiments, the top surface of absorbent cotton 13022 can be positioned in the top surface above and or below of tissue thickness's compensating part.In various embodiments, the top surface of absorbent cotton 13022 can be oriented so that it is for visible when observing from the top surface of tissue thickness's compensating part, and in other embodiments, the top surface of absorbent cotton 13022 such as can be positioned in the lower section of the layer of tissue thickness's compensating part.In certain embodiments, guide frame such as can be molded in the top surface of tissue thickness's compensating part.In at least one this type of embodiment, tissue thickness's compensating part may not include composite, and such as can include one block of overall material.

In various embodiments, referring now to Figure 33 8, nail bin such as can include tissue thickness's compensating part 13620 and crust or top layer 13621.In at least one this type of embodiment, one or more absorbent cottons or keeper 13622 such as can embed crust 13621.In certain embodiments, each keeper 13622 can include the one or more holes 13629 wherein limited, and when following closely 13030 and being in its non-firing position, these one or more holes can accommodate the nail lower limb 13032 of nail 13030 wherein, as shown in Figure 33 8.In use, to being described further above, when following closely 13030 and moving to its firing position from its non-firing position, nail lower limb 10032 can be slid through hole 13629, until the base portion 13031 contact tissue thickness compensation part 13620 of nail 13030, and such as lower surface against absorbent cotton 13622 compresses at least some of of tissue thickness's compensating part 13620.In various embodiments, referring now to Figure 33 3, nail bin such as can include tissue thickness's compensating part 13120 and crust or top layer 13122.In at least one this type of embodiment, tissue thickness's compensating part 13120 such as can include can be from top surface 13121 upwardly extending taper lug, protuberance and/or the jut 13128 of tissue thickness's compensating part 13120.When following closely 13030 and being in its non-firing position, protuberance 13128 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, as shown in Figure 33 3.Top layer 13122 may also include taper lug, protuberance and/or the jut 13129 aliging with protuberance 13128 or at least substantially aliging.In use, nail lower limb 10032 can penetrate protuberance 13128 and 13129, and exposes from tissue thickness's compensating part 13120.In various embodiments, referring now to Figure 33 7, nail bin such as can include tissue thickness's compensating part 13520 and crust or top layer 13522.In at least one this type of embodiment, crust 13522 such as can include can be from top surface 13521 upwardly extending taper lug, protuberance and/or the jut 13529 of tissue thickness's compensating part 13520.Similarly as described above, when following closely 13030 and being in its non-firing position, protuberance 13529 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, as shown in Figure 33 7.In use, nail lower limb 10032 can penetrate protuberance 13529 and expose from crust 13522.

In various embodiments, referring now to Figure 33 4, nail bin such as can include tissue thickness's compensating part 13220 and crust or top layer 13222.In at least one this type of embodiment, tissue thickness's compensating part 13220 such as can include pyramidal pits and/or the groove 13128 that can extend downwardly in the top surface 13221 of tissue thickness's compensating part 13220.In various embodiments, when following closely 13030 and being in its non-firing position, the end of nail lower limb 13032 can extend across groove 13128, as shown in Figure 33 4.In at least one embodiment, top layer 13222 may also include the pyramidal pits and/or groove 13229 can alignd with groove 13228 or at least substantially align.In various embodiments, referring now to Figure 33 5, nail bin such as can include tissue thickness's compensating part 13320 and crust or top layer 13322.In at least one this type of embodiment, crust 13320 can include the thick part 13329 that can extend downwardly in the top surface 13321 of tissue thickness's compensating part 13320.In various embodiments, when following closely 13030 and being in its non-firing position, thick part 13329 can accommodate at least some of, as shown in Figure 33 5 of the nail lower limb 13032 of nail 13030 wherein.In this type of embodiment, nail lower limb 13032 can be held in place by thick part 13329 so that lower limb 13032 shapes pit with the nail of the anvil block being positioned at tissue thickness's compensating part 13320 opposite and aligns or at least substantially align.In various embodiments, referring now to Figure 33 6, nail bin such as can include tissue thickness's compensating part 13420 and crust or top layer 13422.In at least one this type of embodiment, crust 13422 can include can be from the part 13429 of the upwardly extending thickness of top surface 13421 of tissue thickness's compensating part 13420.In various embodiments, when following closely 13030 and being in its non-firing position, thick part 13429 can accommodate at least some of, as shown in Figure 33 6 of the nail lower limb 13032 of nail 13030 wherein.In this type of embodiment, nail lower limb 13032 can be held in place by thick part 13429 so that lower limb 13032 shapes pit with the nail of the anvil block being positioned at tissue thickness's compensating part 13420 opposite and aligns or at least substantially align.

In various embodiments, referring now to Figure 33 9 and Figure 34 0, nail bin such as can include tissue thickness's compensating part 13720 and crust or top layer 13721.In at least one this type of embodiment, tissue thickness's compensating part 13720 such as can include can be from the upwardly extending taper of top surface 13721 of tissue thickness's compensating part 13720 and/or staged lug, protuberance and/or jut 13728.When following closely 13030 and being in its non-firing position, protuberance 13728 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, as shown in Figure 34 0.Similarly, top layer 13721 can include taper and/or staged lug, protuberance and/or the jut 13729 that can align with protuberance 13728 or at least substantially align.In various embodiments, crust 13721 may also include from the upwardly extending one or more tusks 13727 of protuberance 13729, this tusk can be engaged against the tissue of top layer 13721 location, and prevent or at least limit between the end of tissue, top layer 13721 and/or nail lower limb 13032 relative to laterally and/or lengthwise movement.In use, when following closely 13030 and moving to its firing position from its non-firing position, nail lower limb 13032 can penetrate protuberance 13728 and 13729 and expose from tissue thickness's compensating part 13720.In various embodiments, referring now to Figure 34 1 and Figure 34 2, nail bin such as can include tissue thickness's compensating part 13820 and crust or top layer 13821.In at least one this type of embodiment, tissue thickness's compensating part 13820 such as can include can be from the upwardly extending taper of top surface 13821 of tissue thickness's compensating part 13820 and/or staged lug, protuberance and/or jut 13828.When following closely 13030 and being in its non-firing position, protuberance 13828 can accommodate and encapsulate the end of the nail lower limb 13032 of nail 13030, as shown in Figure 34 2.Similarly, top layer 13821 can include taper and/or staged lug, protuberance and/or the jut 13829 that can align with protuberance 13828 or at least substantially align.In various embodiments, top layer 13821 may also include the one or more tusks 13827 extending downwardly in tissue thickness's compensating part 13820, this tusk be such as prevented from or at least limit between top layer 13821 and tissue thickness's compensating part 13820 relative to lateral and/or lengthwise movement.In use, when following closely 13030 and moving to its firing position from its non-firing position, nail lower limb 10032 can penetrate protuberance 13828 and 13829 and expose from tissue thickness's compensating part 13820.

In various embodiments, referring now to Figure 34 3, nail bin can include tissue thickness's compensating part such as tissue thickness's compensating part 13920, and this tissue thickness's compensating part such as can include being limited to ridge 13923 therein and paddy 13924.In at least one embodiment, paddy 13924 can be limited between ridge 13923.In various embodiments, each ridge 13923 can include identical height, substantially the same height or different height.Similarly, each paddy 13924 can include the identical degree of depth, the substantially the same degree of depth or the different degree of depth.In various embodiments, multiple nails 13030 can at least partly be stored in tissue thickness's compensating part 13920 so that the end of nail 13030 can be positioned in ridge 13923.In at least one this type of embodiment, when following closely 13030 and being stored in its non-firing position, the nail lower limb 13032 of nail 13030 such as can not be from tissue thickness's compensating part 13920 and/or the crust being attached to tissue thickness's compensating part 13920 or top layer 13921 projection.In various embodiments, ridge 13923 and/or paddy 13924 can extend laterally across nail bin.In at least one this type of embodiment, nail bin can include longitudinal knife slit, its median ridge 13923 and paddy 13924 can transverse to and/or be perpendicular to the direction of cutter slit and extend.In all cases, the end of nail lower limb 13032 can be held in place by ridge 13923, until nail 13030 moves to its firing position from its non-firing position.In various embodiments, referring now to Figure 34 4, the outer micromicro of tissue thickness's compensating part and/or covering tissue thickness compensating part includes longitudinal ridge and/or paddy.In at least one this type of embodiment, tissue thickness's compensating part can include the top surface limited by ridge 14023 and paddy 14024, and its two-story valley 14024 such as can be limited between ridge 14023.In various embodiments, tissue thickness's compensating part can include crust 14021, and this outer micromicro includes being limited to multiple hole 14029 therein, and each hole each can accommodate nail lower limb 13032.In certain embodiments, hole 14029 can be limited in ridge 14023, above wherein the end of nail lower limb 13032 can be positioned in below the summit 14028 of ridge 14029, is oriented to flush and/or be positioned in summit 14028 with summit 14028.In certain embodiments, in addition to the above or replace mentioned above, hole 14029 such as can be limited in paddy 14024.In certain embodiments, each hole such as can embossed around or at least partially surrounding, this embossing can strengthen the crust around hole and/or tissue thickness's compensating part.Under any circumstance, to being described further above, crust 14021 can be attached to tissue thickness's compensating part in any suitable manner, such as, include using at least one binding agent.

As mentioned above and refer again to Figure 23 3, surgery suturing appliance such as can include anvil block such as anvil block 10060, and this anvil block can move between the open and the closed positions, in order to the such as tissue thickness's compensating part 10020 against nail bin 10000 compresses tissue T.In all cases, anvil block 10060 can rotate towards nail bin 10000, is had certain part of passage of nail bin 10000 to stop until it moves downward by certain part of nail bin 10000 and/or location.In at least one this type of embodiment, anvil block 10060 can be rotated down, until it moves downward by the nose 10003 of nail bin 10000 and/or is positioned at the tissue T in the middle of nose 10003 and nail bin 10000 and resists.In some cases, anvil block 10060 can fully compress tissue thickness's compensating part 10020, so that the end of tissue T contact stud 10030.In some cases, according to the thickness of tissue T, anvil block 10060 can fully compress tissue thickness's compensating part 10020 so that until anvil block 10060 has arrived its fully closed position, and anvil block 10060 contacts with nail 10030.In other words, in such cases, in firing member 10052 is advanced to nail bin 10000 before percussion nail 10030, anvil block 10060 can make nail 10030 deform.This type of situation is acceptable in certain embodiments；But referring now to Figure 35 8 and Figure 35 9, it is contemplated to other embodiments.In other embodiments described, such as, distant gap can be used to set element such as element 10059 to limit following distance: before trigger shaft 10052 is advanced in nail bin 10000, anvil block 10060 can be closed in this distance.In various embodiments, element 10059 can upwardly extend from the top surface 10021 of tissue thickness's compensating part 10020 so that when tissue T rest element 10059 is compressed and produces drag therebetween, moving downward of anvil block 10060 can be prevented from.In use, as it has been described above, firing member 10052 can be advanced in nail bin 10000 towards distally towards the far-end 10002 of nail bin 10000, in order to nail 10030 is penetrated from support section 10010.Meanwhile, the engageable anvil block of firing member 10,052 10060, and anvil block 10060 is positioned at the platform surface 10011(Figure 21 8 on the nail 10030 being just formed, away from support section 10010) desired distance.So, firing member 10052 can control the tissue contacting surface of anvil block 10060 and the distance between the platform surface 10011 of particular locations or gap.Wherein, when firing member 10052 is pushed into towards distally, this particular location can be pushed into towards distally.In all cases, this clearance distance can be shorter than the gap between anvil block 10060 and platform surface 10011, and this gap is set element 10059 by the distant gap of the far-end of tissue thickness's compensating part 10020 and controlled or determine.In various embodiments, referring now to Figure 35 9, when firing member 10052 arrives the far-end of tissue thickness's compensating part 10020, the blade 10053 of firing member 10052 can set element 10059 by crosscutting distant gap, make after element 10059 is crosscut, firing member 10052 can be by anvil block 10060 towards the downward tractive of support section 10010, and when firing nail 10030 at the far-end of nail bin 10000, by gap-closing to desired clearance height.In some alternative embodiment, when firing member is close to the far-end of nail bin, distant gap sets element and can close up.In at least one this type of embodiment, distant gap sets element can include pillars, this pillars can the resistance for anvil block provided as described above, and once reach when firing member is close to the far-end of nail bin gap set element fastening intensity, then this pillars buckles the most suddenly.In at least one embodiment, this tightening force such as may be about 10lbf.In certain embodiments, when setting element to gap and applying the power such as exceeding scheduled volume, gap sets in the platform that element can drop downward into support section.In some other embodiment, distant gap can be controlled by the nose of nail bin.In at least one this type of embodiment, moving downward of anvil block 10060 can be limited by nose, until firing member has arrived the far-end in storehouse.Wherein, the compression stress being applied to nose now can make nose collapse.In certain embodiments, nose can include the cavity limited by cavity wall.The compression stress being once applied to cavity exceedes predetermined power, then cavity can be made to collapse.In at least one this type of embodiment, cavity can be limited by wall of can collapsing.

In various embodiments, as it has been described above, anvil block such as anvil block 10060 such as can passive movement between the open and the closed positions, in order to compress tissue thickness's compensating part between anvil block and the support section of nail bin.In some cases, referring now to Figure 36 0 and Figure 36 1, when tissue thickness's compensating part 14120 is compressed against the support section 14110 of nail bin 14100, tissue thickness's compensating part 14120 of tissue thickness's compensating part of nail bin such as nail bin 14100 such as can laterally and/or extending longitudinally.In certain embodiments, the end of tissue thickness's compensating part 14120 and/or side can not supported portion divide 14110 and/or anvil block 10060 retrain.Therefore, in the case of not producing compression pressure or the most unexpected compression pressure in tissue thickness's compensating part 14120, tissue thickness's compensating part 14120 can stretch along those directions.In this type of embodiment, firing member is such as through firing member 10052(Figure 23 6 of tissue thickness's compensating part 14120) such as can be by the improper prevention of compression stress unexpected in tissue thickness's compensating part 14120.In some other embodiment, referring again to Figure 36 0, the far-end 14125 of tissue thickness's compensating part 14120 such as can be retrained by the nose 14103 of nail bin 14100.In this specific embodiment, similarly as described above, the far-end 14125 of tissue thickness's compensating part 14120 can be retrained by nose 14103, in order to reduces the probability of tissue thickness's compensating part 14120 and support section 14110 premature disengagement.Under any circumstance, due to mentioned above, big internal pressure can result from far-end 14125, and this internal pressure can stop the propelling of firing member 10052, especially when firing member 10052 arrives far-end 14125.More specifically, in some cases, when firing member 10052 transecting patient tissue thickness compensation part 14120, firing member can promote towards distally, plough and remove and/or shift tissue thickness's compensating part 14120.Therefore, the biggest internal pressure can result from the far-end 14125 of tissue thickness's compensating part 14120.In order at least partly eliminate this pressure in tissue thickness's compensating part 14120, nose 14103 can be made up of flexible material.This flexible material can make nose 14103 such as towards distal flex, and is that tissue thickness's compensating part 14120 produces additional space.In certain embodiments, referring now to Figure 36 2 and Figure 36 3, the nose of nail bin can include the part can slided towards distally.More specifically, the nose 14203 of nail bin 14200 can include slidably part 14204, this slidably partly can be slidably attached to nose 14203, make when anvil block 10060 is closed and/or firing member 10052 is advanced in the far-end of nail bin 14200, slidably part 14204 can be slided towards distally and is that tissue thickness's compensating part 14200 produces additional space, and at least partly alleviates internal pressure therein.In at least one embodiment, one in nose 14203 and slidably part 14204 can include one or more guide rail, and nose 14203 and slidably the another one in part 14204 can include the one or more passages that can slidingly receive guide rail wherein.In at least one this type of embodiment, passage and guide rail such as can cooperate the motion limiting slidably part 14204 to longitudinally distal passage.

In all cases, to being described further above, the part that such as farthest side in nail bin nail such as can be bigger for the following closely compared to the nearside in nail bin of capture tissue thickness compensation part.In such cases, therefore, for following closely compared to nearside, the tissue that can be captured in distad following closely applies big clamping pressure.As mentioned above, although tissue thickness's compensating part can be made up of the material of the substantially homogeneity with substantial constant thickness, but when when being transferred at least partially and/or gather the far-end of nail bin during use of tissue thickness's compensating part, may occur in which these situations.In all cases, it is desirable to some nail applies bigger clamping pressure to tissue compared with other nails.Wherein, in various embodiments, support section and/or tissue thickness's compensating part are configurable to and are arranged to control which nail can to apply less clamping force to tissue to the tissue bigger clamping force of applying and which nail.Referring now to Figure 36 4, nail bin 14300 can include support section 14310, and the tissue thickness's compensating part 14320 being in addition positioned on the platform surface 14311 of support section 14310.Compared with disclosed with present patent application other embodiments including having the support section 14310 of smooth or the most smooth platform surface, platform surface 14311 can tilt between the far-end 14305 of support section 14310 and near-end 14306 and/or decline.In at least one embodiment, the platform surface 14311 of support section 14310 can include the podium level at its far-end 14305, and this podium level is less than the podium level at its near-end 14306.In at least one this type of embodiment, the nail 10030 of the far-end of nail bin 14300 may extend into distance bigger above platform surface 14311 compared to the nail 10030 of proximal end.In various alternative embodiments, the platform surface of support section can include the height of its far-end, and this height is higher than the height of its proximal end.Referring again to Figure 36 4, tissue thickness's compensating part 14320 can include along the thickness that its longitudinal length is different.In various embodiments, tissue thickness's compensating part 14320 such as can include the thickness at its far-end 14325, and this thickness is thicker than its near-end 14326.In at least one this type of embodiment, tissue thickness's compensating part 14322 can include lower surface 14322, this lower surface tiltable or decline, the inclination with coupling or at least substantially mating support section 14310 or the platform surface 14311 declined.Therefore, top or the tissue contacting surface 14321 of tissue thickness's compensating part 14320 can include the above smooth or the most smooth surface that can position T in a organized way.Under any circumstance, due to tissue thickness's compensating part 14320 at its far-end 14325 thicker, major parts that therefore distally nail 10030 can capture tissue thickness therein compensating part 14320 compared to nearside nail 10030.Therefore, distally nail 10030 can to tissue T apply bigger compression stress, the especially clearance distance between anvil block 10060 and platform surface 14311 nail bin be proximally and distally constant or substantial constant time.But in some cases, anvil block 10060 can arrive fully closed position, and therefore the clearance distance between anvil block 10060 and platform surface 14311 is bigger than proximal end at the far-end of nail bin 14300.In all cases, distally nail 10030 is likely not to have and is fully formed, and should may not apply desired clamping pressure to tissue T by this distally nail 10030.At tissue thickness's compensating part in the thicker embodiment of the far-end of nail bin, tissue thickness's compensating part can compensate for unshaped nail and applies enough pressure to tissue T.

In various embodiments, referring now to Figure 36 5, nail bin such as nail bin 14400 such as can include support section 14410 and the tissue thickness's compensating part 14420 being in addition positioned on the platform surface 14411 of support section 14410.Similarly as described above, platform surface 14411 tiltable and/or decline so that at least one embodiment, the far-end 14405 of support section 14410 such as can have the podium level of the podium level at less than near-end 14406.In certain embodiments, tissue thickness's compensating part 14420 can include constant or the most constant thickness along its length.Therefore, tissue thickness's compensating part 14420 top or tissue contacting surface 14421 can be parallel to or at least substantially parallel to the profile of platform surface 14411.In various embodiments, when following closely 10030 and being in its non-firing position, the nail 10030 of nail bin 14400 can be completely embedded in tissue thickness's compensating part 14420 and support section 14410.In certain embodiments, when following closely 10030 and being in its non-firing position, the nail 10030 of the proximal end being positioned in nail bin 14400 can be completely embedded in tissue thickness's compensating part 14420 and support section 14410；And due to the decline slope of platform 14411 and top surface 14421, when following closely 10030 and being in its non-firing position, some nail 10030, including the nail 10030 of the far-end being positioned in nail bin 14400, can the top surface 14421 of Tu Chuan tissue thickness compensating part 14420.

In various embodiments, as mentioned above, tissue thickness's compensating part can be made up of single material, and the most whole tissue thickness compensating part can have identical or the most identical material behavior, such as density, rigidity, flexible ratio, hardness and/or elasticity from start to finish.In other embodiments various, referring now to Figure 36 8, tissue thickness's compensating part such as tissue thickness's compensating part 14520 such as can include multiple material or material layer.In at least one embodiment, tissue thickness's compensating part 14520 can include first or central stratum 14520a, be attached to ground floor 14520a on opposite sides thereof second or intermediate layer 14520b and be attached in second layer 14520b the 3rd or outer layer 14520c of each.In certain embodiments, can utilize at least one binding agent that intermediate layer 14520b is attached to central stratum 14520a, and similarly, can use at least one binding agent that outer layer 14520c is attached to the second layer 14520.Than adhesives or replace binding agent, such as by one or more interlocking structures and/or securing member, layer 14520a-14520c can be kept together.Under any circumstance, internal layer 14520a such as can be made up of first material with first group of material behavior；Intermediate layer 14520b can be made up of second material with second group of material behavior；And outer layer 14520c can be made up of the 3rd material with the 3rd group of material behavior.These several groups of material behaviors such as can include density, rigidity, flexible ratio, hardness and/or elasticity.In certain embodiments, nail bin such as can include six nails 10030, wherein a nail 10030 such as can at least be partially positioned in each in each in outer layer 14520c and in internal layer 14520b, and wherein two nails 10030 can at least be partially positioned in internal layer 14520a.In use, similarly as described above, nail 10030 can penetrate from nail bin, the nail lower limb 10032 following closely 10030 is made to penetrate the top surface 14521 of tissue thickness's compensating part 14520, penetrate the tissue positioned against top surface 14521 by anvil block and contact anvil block subsequently so that lower limb 10032 deforms with the tissue thickness's compensating part 14520 in capture nail 10030 and tissue.Being also similar to mentioned above, when firing member is advanced through nail bin, tissue thickness's compensating part 14520 can be crosscutting by firing member.In at least one this type of embodiment, firing member such as can be along the passage limited by axis 14529 crosscutting internal layer 14520a and tissue.

In various embodiments, to being described further above, the many nails 10030 being positioned in internal layer 14520a can include the staple at the edge closest to the tissue being crosscut.Correspondingly, the many nails 10030 being positioned in outer layer 14520c can include the staple that the edge of the tissue that distance is crosscut is farthest.In certain embodiments, the first material including internal layer 14520a such as can include such as lower density: this density is higher than the density of the second material including intermediate layer 14520b；And similarly, the density of the second material can be higher than the density of the 3rd material including outer layer 14520c.In all cases, therefore, for the compression stress produced in the nail 10030 being positioned in intermediate layer 14520b and outer layer 14520c, bigger compression stress can produce in the nail 10030 in being positioned in internal layer 14520a.Similarly, for the compression stress produced in the nail 10030 being positioned in outer layer 14520c, bigger compression stress can produce in the nail 10030 in being positioned in intermediate layer 14520b.In various alternative embodiments, the first material including internal layer 14520a such as can include such as lower density: this density is less than the density of the second material including intermediate layer 14520b；And similarly, the density of the second material can be less than the density of the 3rd material including outer layer 14520c.In all cases, therefore, for the compression stress produced in the nail 10030 being positioned in intermediate layer 14520b and internal layer 14520a, bigger compression stress can produce in the nail 10030 in being positioned in outer layer 14520c.Similarly, for the compression stress produced in the nail 10030 being positioned in internal layer 14520a, bigger compression stress can produce in the nail 10030 in being positioned in intermediate layer 14520b.In other embodiments various, the layer of any other suitable constructions, material and/or material behavior can be used.Under any circumstance, in various embodiments, the layer 14520a-14520c of tissue thickness's compensating part 14520 can keep being attached to one another after it is implanted.In some other embodiment, the layer 14520a-14520c of tissue thickness's compensating part 14520 can maintain separately from each other after it is implanted.In at least one this type of embodiment, layer 14520a-14520c can utilize one or more bioabsorbable binding agents to combine, first layer can be remained to together by these one or more bioabsorbable binding agents, and passage the most in time makes layer from discharging each other.

As it has been described above, tissue thickness's compensating part of nail bin such as tissue thickness's compensating part 14520 such as can include multiple longitudinal layer.In other embodiments various, referring now to Figure 36 9, nail bin can include tissue thickness's compensating part such as tissue thickness's compensating part 14620, and this tissue thickness's compensating part such as can include multiple level course.In at least one this type of embodiment, tissue thickness's compensating part 14620 can include first or bottom 14620a, is attached to the second or intermediate layer 14620b of bottom 14620a and is attached to the 3rd or top layer 14620c of intermediate layer 14620b.In various embodiments, ground floor 14620a such as can include smooth or substantially flat lower surface 14626a and the top surface 14625a of triangle or taper.In at least one this type of embodiment, second layer 14620b can include lower surface 14626b of triangle or taper, and this lower surface can be parallel to and adjoin the top surface 14625a of ground floor 14620a.Similarly as described above, second layer 14620b can include the top surface 14625b of triangle or taper, and this top surface such as can be parallel to and adjoin the bottom triangle of third layer 14620c or lower surface 14626c of taper.In various embodiments, the top surface of third layer 14626c can include smooth or the most smooth tissue contacting surface 14621.It is also similar to mentioned above, tissue thickness's compensating part 14620 such as can store six nails the most at least in part and such as follow closely 10030, and wherein firing member such as can be along the tissue thickness's compensating part 14620 between the staple of crosscutting two inner sides of the passage extending through axis 14629.Similarly as described above, each layer of 14620a, 14620b, and 14620c can be made up of the different materials including dissimilar material properties, and due to triangle or the conical configuration of layer 14620a-14620c, tissue thickness's compensating part 14620 within it can have different overall characteristic in each position.Such as, outermost many nails 10030 can capture more more third layer 14620c than ground floor 14620a wherein, and many nails 10030 of inner side can capture third layer 14620c more less than ground floor 14620a.Therefore, although tissue thickness's compensating part 14620 can have the identical or the most identical general thickness across it, but tissue thickness's compensating part 14620 such as can be trapped in be different from compression in the way of the tissue in 10030 is followed closely in inner side and compress the tissue being trapped in outermost nail 10030.

In various embodiments, referring now to Figure 28 6, tissue thickness's compensating part of nail bin, tissue thickness's compensating part 14720 of such as nail bin 14700, such as can include being limited to space, pit, passage and/or the groove that the thickness making tissue thickness's compensating part 14720 therein changes.In at least one this type of embodiment, tissue thickness's compensating part 14720 can position against the platform surface 14711 of the support section 14710 of nail bin 14700 so that the space 14723 being limited in the lower surface 14722 of tissue thickness's compensating part 14720 can overlay on some nail chamber 10012, and above rather than other are followed closely on chambeies.In various embodiments, space 14723 can transverse to support section 14710 cutter slit 14715, be perpendicular to cutter slit 14715 and/or be parallel to cutter slit 14715 and extend.In certain embodiments, space 14723 can limit bearing-surface pattern in the lower surface 14722 of tissue thickness's compensating part 14720.Under any circumstance, when such as nail 10030 is such as deployed nail from support section 14710, referring now to Figure 28 7 and 288, some nail 10030 can comprise the region IT tissue thickness compensating part 14720 in space 14723；And other nails 10030 can be positioned in the region IT tissue thickness compensating part 14720 in the middle of space 14723.In addition to the above or replace mentioned above, tissue thickness's compensating part 14720 such as can include space, pit, passage and/or the groove being limited in top or tissue contacting surface 14721.In certain embodiments, referring now to Figure 36 6 and Figure 36 7, nail bin 14800 can include tissue thickness's compensating part 14820, this tissue thickness's compensating part can include multiple bearing-surface 14823, at least one in the plurality of bearing-surface for example, situations below: upwardly extends from the top surface 14821 of tissue thickness's compensating part 14820, extend internally and/or towards the far-end of nail bin 14800 towards distal extension towards central authorities' groove 14825.In at least one this type of embodiment, bearing-surface 14823 such as can by passage, slit and/or groove such as passage 14824 separately.In all cases, due to mentioned above, the general thickness of tissue thickness's compensating part can change between staple and/or change between nail in staple.In some cases, the part of bearing-surface or thickness may be structured to and be arranged so that, when tissue thickness's compensating part is compressed, the part of bearing-surface or thickness the most inwardly can flow along desired direction.

In various embodiments, referring now to Figure 30 3, nail bin such as nail bin 14900 such as can include support section 14910 and in addition against tissue thickness's compensating part 14920 that support section 14910 is positioned.Similarly as described above, support section 14910 can include can being disposed, by nail, the staple drivers that sliding part is lifted up, to lift nail such as follow closely 10030, this nail such as towards anvil block, is such as positioned in the anvil block 10060 on nail bin 14900 opposite and is at least partially positioned in support section 14910.In certain embodiments, support section 14910 can include six nail chambeies, the such as two nail chambeies in outside, two nail chambeies of inner side and be positioned at the nail chamber, centre two in the middle of inboard row and outboard row.Wherein anvil block 10060 can include that align with nail chamber or at least substantially align six line up shape pit 10062.In various embodiments, inner side nail chamber row can include the staple drivers 14940a being positioned in；Middle nail chamber row can include the staple drivers 14940b being positioned in；And nail chamber, outside row can include the staple drivers 14940c being positioned in.Wherein can include can the support 14949a of support nail 10030 for each in staple drivers 14940a；Wherein can include can the support 14949b of support nail 10030 for each in staple drivers 14940b；And wherein can include can the support 14949c of support nail 10030 for each in staple drivers 14940c.At its non-firing position, i.e., when staple drivers 14940a-14940c is placed on the driver support member 14926 extended to below support section 14910, support 14949b and the support 14949a of the support 14949c of staple drivers 14940c, staple drivers 14940a compared to staple drivers 14940b can position closer to anvil block 10060.In this type of position, the first forming distance can be limited at support 14949a and be positioned between the shaping pit 10062 on support 14949a；Second forming distance can be limited at support 14949b and be positioned between the shaping pit 10062 on support 14949b；And the 3rd forming distance can be limited at support 14949c and be positioned between the shaping pit 10062 on support 14949c.Wherein, in various embodiments, the such as first forming distance can be shorter than the second forming distance, and the second forming distance can be shorter than the 3rd molding distance.When staple drivers 14940a-14940c moves to its firing position from its non-firing position (Figure 30 3), each staple drivers 14940a-14940c can be disposed sliding part by nail and move upward equal or the most equal distance towards anvil block 10060 so that its respective nail 10030 is driven the first forming height by the first driver 14940a；Its respective nail 10030 is driven the second forming height by the second driver 14940b；And its respective nail 10030 is driven the 3rd forming height by the 3rd driver 14940c.Wherein, the such as first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Contemplating other embodiments various, wherein the first staple drivers 14940a is by upward displacement the first distance；Second staple drivers 14940b is by upward displacement second distance, and the 3rd staple drivers 14940c is by upward displacement the 3rd distance.Wherein, one or more in the first distance, second distance, the 3rd distance can be different.

In various embodiments, referring again to Figure 30 3, relative to the tissue contacting surface 10061 of anvil block 10060, the platform surface 14911 of support section 14910 can in height be varied from.In certain embodiments, this height change can produce on the side, and at least one embodiment, such as the height around the platform surface 14911 of nail chamber, inner side row can be higher than the height of the platform surface 14911 around nail chamber, outside row.In various embodiments, the lower surface 14922 of tissue thickness's compensating part 14920 can be parallel to or at least substantially parallel to the platform surface 14911 of support section 14910.To being described further above, tissue thickness's compensating part 14920 also can be varied from thickness.Wherein, at least one embodiment, top or the tissue contacting surface 14921 of tissue thickness's compensating part 14920 can slope inwardly from its outward flange or lateral edge.In at least one this type of embodiment, due to mentioned above, tissue thickness's compensating part 14920 can be relatively thin in being positioned in inner side and following closely the region on the row of chamber, and thicker being positioned in the region on the row of nail chamber, outside.In various embodiments, referring now to Figure 30 4, the platform surface of support section 15010 such as can include staged platform surface, and wherein the highest step of stepped surface can be arranged around nail chamber, inner side, and the minimum step of stepped surface can be arranged around nail chamber, outside.In at least one this type of embodiment, the step with intermediate altitude can be arranged around nail chamber, centre.In certain embodiments, tissue thickness's compensating part such as tissue thickness's compensating part 15020 such as can include lower surface, and this lower surface is parallel to and adjoins the platform surface of support section 15010.In at least one embodiment, the top of tissue thickness's compensating part or tissue contacting surface 15021 such as can include arch, parabolical and/or curved surface, in at least one this type of embodiment, this surface can extend to the second cross side of tissue thickness's compensating part 15020 from the first cross side of tissue thickness's compensating part 15020, wherein the center alignment of summit and nail bin 15000 or at least substantially align.In various embodiments, referring now to Figure 29 9, nail bin 15300 such as can include support section 15310, the multiple staple drivers 15340 being movably positioned in the nail intracavity being limited in support section 15310 and be positioned at the tissue thickness's compensating part 15320 above the platform surface 15311 of support section 15310.Nail bin 15300 may also include one or more bottom plate part 15326, and this bottom plate part could attach to support section 15310 and extends to the bottom periphery of support section 15310, and supporting driver 15340 and be in the nail 15330 of its non-firing position.When nail deployment sliding part is advanced through nail bin, along with staple drivers 15340 and nail 15330 are lifted up through tissue thickness's compensating part 15320 by sliding part, sliding part also can be supported by bottom plate part 15326.In at least one embodiment, tissue thickness's compensating part 15320 can include that being positioned at inner side follows closely first on the row of chamber or internal 15322a, be centrally positioned second or mid portion 15322b on the row of nail chamber and be positioned at the 3rd on a nail chamber or outside 15322c.Wherein, such as internal 15322a can be thicker than mid portion 15322b, and mid portion 15322b can be thicker than outside 15322c.In at least one embodiment, tissue thickness's compensating part 15320 such as can include being limited to vertical passage therein, and this vertical passage can produce thinner part 15322b and 15322c of tissue thickness's compensating part 15320.In various alternative embodiments, vertical passage can be limited in top surface and/or the lower surface of tissue thickness's compensating part.In at least one embodiment, the top surface 15321 of tissue thickness's compensating part 15320 such as can include smooth or the most smooth surface.

In various embodiments, referring now to Figure 29 6, nail bin such as can include tissue thickness's compensating part such as tissue thickness's compensating part 15120, and this tissue thickness's compensating part can include the some with different-thickness.In at least one embodiment, tissue thickness's compensating part 15120 can include the first with the first thickness or internal 15122a, has the second or mid portion 15122b of the second thickness from what Part I 15122a extended and have the 3rd or outside 15122c of the 3rd thickness from what Part II 15122b extended.In at least one this type of embodiment, the such as the 3rd thickness can be thicker than the second thickness, and the second thickness can be thicker than the first thickness, but can use any suitable thickness in other embodiments various.In various embodiments, part 15122a-15122c of tissue thickness's compensating part 15120 can include the step with different-thickness.In at least one embodiment, similarly as described above, nail bin can include many nails 10030 and have multiple staple drivers of differing heights, and this staple drivers can make nail 10030 be deformed into different forming heights.It is also similar to mentioned above, nail bin can include the first staple drivers 15140a, it can drive nail 10030 to the first forming height, the second staple drivers 15140b being supported on, it can drive nail 10030 to the second forming height and the 3rd staple drivers being supported on, and it can drive the nail 10030 being supported on to the 3rd forming height.Wherein, the such as first forming height can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.In various embodiments, as shown in Figure 29 6, each nail 10030 can include identical or substantially the same unshaped or not fire height.In some other embodiment, referring now to Figure 29 6A, the first driver 15140a, the second driver 15140b and/or the 3rd driver 15140c can support the nail with different unshaped height.In at least one this type of embodiment, first staple drivers 15140a can support the nail 15130a with the first unshaped height, second staple drivers 15140b can support the nail 15130b with the second unshaped height, and the 3rd staple drivers 15140c can support the nail 15130c with the 3rd unshaped height.Wherein, the such as first unshaped height can be shorter than the second unshaped height, and the second unshaped height can be shorter than the 3rd unshaped height.In various embodiments, refer again to Figure 29 6A, follow closely 15130a, the end of 15130b and/or 15130c can be located at or be at least substantially positioned in identical plane, and in other embodiments, the end of nail 15130a, 15130b and/or 15130c can not be positioned in identical plane.In certain embodiments, referring now to Figure 29 7, nail bin can include tissue thickness's compensating part 15220 with some, the plurality of part has different thickness, this tissue thickness's compensating part can be located against tissue T by nail 15130a, 15130b and 15130c and implant, as mentioned above.In at least one embodiment, referring now to Figure 29 8, nail 15130a, 15130b and/or 15130c can be deformed to different forming heights.Wherein the first nail 15130a can be deformed to the first forming height, second nail 15130b can be deformed to the second forming height, and the 3rd nail 15130c can be deformed to the 3rd forming height, and wherein the first forming height such as can be shorter than the second forming height, and the second forming height can be shorter than the 3rd forming height.Contemplate other embodiments, wherein follow closely 15130a, 15130b and 15130c and can be configured to any suitable forming height and/or any relative forming height.

In various embodiments, as it has been described above, the anvil block of surgery suturing appliance can move between the open and the closed positions.In such cases, when anvil block moves to its make position, the tissue contacting surface of anvil block is moveable to its final or shaping position.Once anvil block is in its make position, and in certain embodiments, tissue contacting surface can be no longer adjustable.In some other embodiment, referring now to Figure 35 1, surgical stapling device such as surgical stapling device 15500 such as can include anvil channel 15560 and the adjustable tissue contact anvil block adjustable plate 15561 being positioned in anvil channel 15560.In this type of embodiment, anvil plate 15561 can in anvil channel 15560 elevated and/or reduce, in order to relative to being positioned at the nail bin on anvil plate 15561 opposite to regulate the position of the tissue contacting surface of anvil plate 15561.In various embodiments, surgical stapling device 15500 can include adjusting slider 15564.Seeing Figure 35 6 and Figure 35 7, this adjusting slider can be at anvil channel 15560 and anvil plate 15561 middle slip, in order to control the distance between anvil plate 15561 and nail bin.In certain embodiments, refer again to Figure 35 1 and Figure 35 2, surgical stapling device 15500 may also include the actuator 15562 being attached to adjusting slider 15564, and this actuator can proximally slide to make adjusting slider 15564 proximally slide and/or sliding towards distally to make adjusting slider 15564 slide towards distally.In various embodiments, referring again to Figure 35 6 and Figure 35 7, actuator 15562 can slide between two or more precalculated positions, in order to regulates anvil plate 15561 respectively between two or more positions.In at least one embodiment, this type of precalculated position such as can be divided into demarcation line 15563(Figure 35 1 on surgical stapling device 15500).In certain embodiments, see Figure 35 7, adjusting slider 15564 such as can include multiple stayed surface, such as the first stayed surface 15565a, the second stayed surface 15565b and the 3rd stayed surface 15565c, the plurality of stayed surface can align with the multiple plate locating surfaces on the back side of anvil plate 15561 respectively, such as the first locating surface 15569a, the second locating surface 15569b and the 3rd locating surface 15569c, in order to anvil plate 15561 is positioned at primary importance.In order to position in the second position by anvil plate 15561, actuator 15562 and slide block 15564 such as can proximally slide, in order to realigned relative to the locating surface 15569a-15569c of anvil plate 15561 by the stayed surface 15565a-15565c of slide block 15564.More specifically, see Figure 35 6, slide block 15564 can slide towards distally, the the first stayed surface 15565a making slide block 15564 can be positioned in after the second locating surface 15569b of anvil plate 15561, and the second stayed surface 15565b making slide block 15564 can be positioned in after the 3rd locating surface 15569c of anvil plate 15561, in order to moves to anvil plate 15561 closer to nail bin.When anvil plate 15561 moves to its second position from its primary importance, in such cases, adjustable anvil plate 15561 can compression set tissue T between anvil plate 15561 and nail bin further.In addition to the above, when the shaping pit during anvil plate 15561 is conditioned and is limited to anvil plate 15561 will be moved to closer to and/or during further from nail bin, the forming height of nail can be controlled relative to the position of nail bin by anvil plate 15561.Although foregoing describes only two positions, but slide block 15564 being slid in appropriate number of position, with anvil plate 15561 is moved to closer to and/or further from nail bin.Under any circumstance, once anvil plate 15561 is properly oriented, and nail is disposed sliding part 15550 and can be slided towards distally in nail bin, in order to is lifted towards anvil plate 15561 with following closely 15530 and sews up tissue T, as shown in Figure 35 4 by staple drivers 15540.Similar surgical stapling device is disclosed in the U.S. Patent Application Serial Number 13/036,647 of entitled " SURGICALSTAPLINGINSTRUMENT " that on February 28th, 2011 submits to, and the entire disclosure is incorporated by reference herein.

In various embodiments, referring now to Figure 35 3, nail bin can be positioned in the staple cartridge channel 15570 of surgical stapling device 15500, and this staple cartridge channel such as can include tissue thickness's compensating part, such as tissue thickness's compensating part 15520.When anvil plate 15561 moves towards nail bin, as it has been described above, anvil plate 15561 compressible tissue thickness compensating part 15520 and/or be positioned at the tissue T in the middle of anvil plate 15561 and tissue thickness's compensating part 15520.When following closely 15530 and being deployed from nail bin, seeing Figure 35 5, nail 15530 can be against tissue T compression implanting tissue thickness compensation part 15520.In various embodiments, when anvil plate 15561 positions against slide block 15564 and organizes and is not also placed between anvil plate 15561 and tissue thickness's compensating part 15520, can work as when anvil plate 15561 is in its primary importance between the top surface 15521 of anvil plate 15561 and tissue thickness's compensating part 15520, limit gap.When anvil plate 15561 moves to the second position, anvil plate 15561 can contact tissue thickness compensation part 15520.In various alternative embodiments, when anvil plate 15561 positions against slide block 15564 and organizes and is not also placed between anvil plate 15561 and tissue thickness's compensating part 15520, can work as when anvil plate 15561 is in its primary importance and/or the second position between the top surface 15521 of anvil plate 15561 and tissue thickness's compensating part 15520, limit gap.In at least one this type of embodiment, anvil plate 15561 can not contact with tissue thickness compensating part 15520.In other alternative embodiment, when anvil plate 15561 positions against slide block 15564 and organizes and is not also placed between anvil plate 15561 and tissue thickness's compensating part 15520, anvil plate 15561 such as can contact, regardless of whether whether anvil plate 15561 is in primary importance and/or the second position with the top surface 15521 of tissue thickness compensating part 15520.Although only describing two positions of anvil plate 15611 herein, anvil plate 15611 can be positioned or index in any appropriate number of position.

In various embodiments, due to mentioned above, surgery suturing appliance can include the device of the forming height for regulating nail, and this device can compensate different tissue thicknesses in all cases.Additionally, surgery suturing appliance such as can include for compensating different tissue thicknesses and/or the device of in-house thickness change.In at least one this type of embodiment, anvil plate 15561 can be adjusted up or be adjusted to away from relative nail bin, to increase shaping or the percussion height of nail.Correspondingly, anvil plate 15561 can downwards or be regulated towards relative nail bin, to reduce shaping or the percussion height of nail.In various embodiments, the gap between the shaping pit that the regulation such as scalable to anvil plate 15561 is limited in anvil plate 15561 and the percussion height of the percussion height of staple drivers or the most such as staple drivers support.Even if having this type of ability of the forming height of regulating nail to be such as responsible for processing thicker and/or relatively thin tissue, tissue thickness's compensating part can also compensate for thicker and/or relatively thin tissue, and/or compensates the change of in-house thickness, as mentioned above.In this type of embodiment, in same surgery suturing appliance, multiple compensation device can be provided for surgeon.

As mentioned above and as shown in multiple embodiments, surgery suturing appliance can use nail bin, and this nail bin has nail chamber and the nail of linear arrangement, and wherein firing member can be advanced through nail bin to dispose nail from nail chamber towards distally.In certain embodiments, nail bin can include nail chamber and the staple of bending.In at least one embodiment, referring now to Figure 34 5 and Figure 34 6, surgery suturing appliance such as stiching instrument 15600 such as can include one or more circles or the ring-shaped staple chamber row being limited in circle or annular support portion 15610.This type of circular staple such as can include nail chamber 15612, the inner side row of circle and circular nail chamber 15613, outside row.In at least one this type of embodiment, circular nail chamber row can be around the circle being limited in stiching instrument 15600 or looping pit 15615, and this hole can accommodate and is removably positioned in circle therein or endless knife.In use, tissue can position against the platform surface 15611 of support section 15610, and anvil block (not shown) can by extend through and/or the actuator group that is positioned in hole 15615 install to surgical stapling device 15600, make when actuator activated, anvil block can be clamped towards support section 15610, and against platform surface 15611 compression tissue.Once organizing and be sufficiently compressed, the nail being positioned in nail chamber 15612 and 15613 can penetrate from support section 15610 and pass tissue so that nail can contact anvil block and fully deform to capture tissue therein.When nail just fired and/or when nail by fired after, circular knife can be pushed into transecting patient tissue.Then, anvil block is movable separates away from support section 15610 and/or with surgical stapling device 15600 so that anvil block and surgical stapling device 15600 can be removed from operative site.This type of surgical stapling device 15600 and this type of surgical technic can be utilized, in various embodiments such as to connect two parts of large intestine.In all cases, the some of large intestine can be kept together in the case of organization healing by circular staple row, and meanwhile makes some elastic stretch of large intestine.Similar surgery suturing appliance and surgical technic are disclosed in the United States Patent (USP) 5 of entitled " SURGICALANASTOMOSISSTAPLINGINSTRUMENT " that on February 15th, 1994 submits to, and in 285,945, the entire disclosure is incorporated by reference herein.

In various embodiments, to being described further above, tissue thickness's compensating part such as can position against the support section 15610 of surgical stapling device 15600 and/or be attached to the support section 15610 of surgical stapling device 15600.In at least one embodiment, tissue thickness's compensating part can be made up of circular or annular material ring, and this rings of material such as includes inside radius and outer radius.In some cases, tissue can position against this rings of material, and when anvil block is for moving tissue towards support section 15610, tissue thickness's compensating part can be compressed between tissue and platform surface 15611.During use, nail can be by percussion through tissue thickness's compensating part and tissue so that nail joint is touched anvil block and is deformed into its firing position, the part of tissue and tissue thickness's compensating part to be captured in nail.In all cases, to being described further above, the rings of material including tissue thickness's compensating part must be the most with resilience, so that the some around the large intestine of nail row stretches.In various embodiments, referring again to Figure 34 5 and Figure 34 6, flexible tissue thickness's compensating part 15620 such as can include the flexible internal ring 15624 of circle or annular, and this internal ring can limit circle or looping pit 15625 at least one embodiment.In certain embodiments, internal ring 15624 may be structured to make it not be trapped in the nail that surgical stapling device 15600 is disposed；On the contrary, in at least one embodiment, internal ring 15624 radially-inwardly can be positioned at least one this type of embodiment relative to nail chamber 15612, inner side row, tissue thickness's compensating part 15620 can include the multiple attachments such as extended from it, interior attachment 15622 and outer attachment 15623 so that when nail deformation, attachment can at least partly be captured in nail.More specifically, referring first to Figure 34 5, each interior attachment 15622 can include such as head portion: this head is positioned on the nail chamber 15612 being limited in surgical stapling device 15600, wherein head such as can be attached to internal ring 15624 by cervical region 15626；And the most each outer attachment 15623 can include such as head portion: this head is positioned on the nail chamber 15613 being limited in surgical stapling device 15600, wherein head such as can be attached to internal ring 15624 by cervical region 15627.In various embodiments, the head of interior attachment 15622 and outer attachment 15623 such as can include any suitable shape, the most circular, avette and/or oval.Cervical region 15626 and/or 15627 may also include any suitable shape, the most at least one embodiment, the cervical region 15627 that the head of outer attachment 15623 is connected to internal ring 15624 can extend between the adjacent nail chamber, inner side 15612 in support section 15610 so that cervical region 15627 is not trapped in the nail disposed from nail chamber 15612, inner side.

In various embodiments, referring now to Figure 34 7 and Figure 34 8, flexible tissue thickness's compensating part 15720 such as can include circle or the flexible outer shroud 15724 of annular.In certain embodiments, outer shroud 15724 may be structured to make it not be trapped in the nail that surgical stapling device 15600 is disposed；But, at least one embodiment, outer shroud 15724 can be located radially outward relative to nail chamber 15613, outside row.In at least one this type of embodiment, tissue thickness's compensating part 15720 can include the multiple attachments such as extended, such as interior attachment 15622 and outer attachment 15623 from it so that when nail deformation, attachment can at least partly be captured in nail.More specifically, referring first to Figure 34 7, each interior attachment 15622 can include such as head portion: this head is positioned on the nail chamber 15612 being limited in surgical stapling device 15600, wherein head such as can be attached to outer shroud 15724 by cervical region 15726；And the most each outer attachment 15623 can include such as head portion: this head is positioned on the nail chamber 15613 being limited in surgical stapling device 15600, wherein head such as can be attached to outer shroud 15724 by cervical region 15727.In various embodiments, the head of interior attachment 15622 and outer attachment 15623 such as can include any suitable shape, the most circular, avette and/or oval.Cervical region 15726 and/or 15727 may also include any suitable shape, the most at least one embodiment, the cervical region 15727 that the head of interior attachment 15622 is connected to outer shroud 15724 can extend between adjacent nail chamber, outside 15613 so that cervical region 15726 is not trapped in the nail disposed from nail chamber 15613, outside.In some alternative embodiment, tissue thickness's compensating part can include circle or the flexible internal ring of annular, circular or annular flexible outer shroud and in addition be connectable to multiple attachments of internal ring and/or outer shroud.In at least one embodiment, some attachment is connectable to internal ring, and some other attachment is connectable to outer shroud.In certain embodiments, at least some in attachment is connectable to internal ring and outer shroud.Under any circumstance, to being described further above, the internal ring 15624 of tissue thickness's compensating part 15620, the outer shroud 15724 of tissue thickness's compensating part 15720 and/or any other suitable tissue thickness compensating part can elastic stretch and/or contractions, to adapt to stretching, extension and/or the contraction of tissue, this tissue thickness's compensating part is implanted against this tissue.Although additionally, various embodiment is being described herein as including circle or annular brace ring, but tissue thickness's compensating part can include the supporting construction of any suitable shape for attachment is connected to it.In various embodiments, to being described further above, surgical stapling device advance the circular knife so that the tissue being trapped between anvil block and support section to be cut also can cut backing material.In at least one this type of embodiment, inside support ring can such as can be separated with attachment by cutter by the cervical region of cutting attachment.

In various embodiments, to being described further above, tissue thickness's compensating part can include separable and/or the most movable position, and this position can make tissue thickness's compensating part stretch and/or shrink, to adapt to the motion of tissue, this tissue thickness's compensating part is implanted against this tissue.Referring now to Figure 34 9 and Figure 35 0, when tissue thickness's compensating part 15820 is just against when organizing implanted, circular or annular tissue thickness's compensating part 15820 can position against the platform surface 15611 of the surgical stapling device 15600 that can be maintained at un-extended position (Figure 34 9), and/or is supported by the platform surface 15611 of the surgical stapling device 15600 that can be maintained at un-extended position；After tissue thickness's compensating part 15820 is the most implanted, tissue thickness's compensating part 15820 can flex outward, as shown in Figure 35 0.In various embodiments, tissue thickness's compensating part 15820 can include multiple arcuate section 15822, and the plurality of arcuate section such as can be joined together by internal ring 15824.In at least one embodiment, arcuate section 15822 can be separated from each other by seam 15828.In at least one other embodiment, arcuate section 15822 can be connected to each other, and wherein at least one this type of embodiment, the structure in hole can make arcuate section 15822 be separated from each other.In either case, in various embodiments, arcuate section 15822 such as can include interlocking structure, such as protuberance 15826 and recess 15823, and this interlocking structure can cooperate with limiting the relative motion between arcuate section 15822 before tissue thickness's compensating part 15820 is implanted.To being described further above, each arcuate section 15822 such as can be connected to internal ring 15824 by one or more adapters 15827, and arcuate section 15822 can be releasably held in place by these one or more adapters.When using the nail 10030 that is such as stored in support section 15610 of nail against after tissue implanting tissue thickness compensation part 15620, referring first to Figure 35 0, adapter 15827 can separate with internal ring 15824, and makes tissue thickness's compensating part 15820 at least partly stretch the motion adapting in tissue below.In all cases, all arcuate sections 15822 can separate with internal ring 15824, and in other cases, more only can separate with internal ring 15824 in arcuate section 15822.In some alternative embodiment, arcuate section 15822 can be connected by flexible portion, and this flexible portion can make arcuate section 15822 be movable with respect to but the most separated from one another.In at least one this type of embodiment, flexible portion can not accommodate nail wherein, and can stretch and/or shrink to adapt to the relative motion of arcuate section 15822.In the embodiment shown in Figure 34 9 and Figure 35 0, tissue thickness's compensating part 15820 such as can include eight arcuate sections 15822.In some other embodiment, tissue thickness's compensating part such as can include any appropriate number of arcuate section, such as two or more arcuate sections.

To being described further above, tissue thickness's compensating part 15620,15720 and/or 15820 such as can compensate for the thicker and/or relatively thin tissue being trapped between the support section 15610 of anvil block and surgical instruments 15600.In various embodiments, similarly as described above, can by towards and/or away from support section 15610 motion anvil block come regulating nail shaping or percussion height.More specifically, anvil block is moveable to closer to support section 15610 to reduce the forming height of nail, and correspondingly, anvil block can be moved further into away from support section 15610 to increase the forming height of nail.In this type of embodiment, therefore, anvil block can be adjusted to process thickness tissue away from support section 15610 with responsible by surgeon, and is adjusted to towards support section 15610 with responsible process thin tissue.In other embodiments various, surgeon can determine not regulate anvil block, and relies on tissue thickness's compensating part to be responsible for processing relatively thin and/or thicker tissue.In various embodiments, therefore, surgical instruments 15600 can include that at least two device is for compensating different tissue thicknesses and/or tissue thickness's change.

In various embodiments, as it has been described above, tissue thickness's compensating part could attach to the support section of nail bin.In certain embodiments, the lower surface of tissue thickness's compensating part can include the one in hook layer or set circular layer, and the platform surface of support section can include the another one in hook layer and set circular layer.In at least one this type of embodiment, hook and the collar can be engaged with each other and tissue thickness's compensating part is releasably held support section.In various embodiments, each hook such as can include the head of the expansion from neck extension.In certain embodiments, such as can be adhered to the lower surface of tissue thickness's compensating part including multiple pads of the collar, and include that multiple pads of hook can be adhered to the platform surface of support section.In at least one embodiment, support section such as can include one or more hole and/or groove, and these one or more holes and/or groove can accommodate the insert including hook and/or the collar wherein.In addition to the above or replace mentioned above, tissue thickness's compensating part such as can use this type of hook and the collar to be removably attachable to anvil block.In various embodiments, hook and the collar such as can include fiber surface.

In various embodiments, as it has been described above, nail bin can include support section and be attached to tissue thickness's compensating part of support section.In certain embodiments, as also described above, support section can include the longitudinal slit that can accommodate cutting element wherein, and tissue thickness's compensating part can include the holding component that can be maintained in longitudinal slit.In at least one embodiment, referring now to Figure 38 6, nail bin 16000 can include support section 16010, and this support section includes platform surface 16011 and longitudinal slit 16015.Nail bin 16000 may also include the tissue thickness's compensating part 16020 being positioned at above platform surface 16011.In various embodiments, tissue thickness's compensating part 16020 can include that the longitudinal direction extended downwardly in longitudinal slit 16015 keeps component 16025.In at least one this type of embodiment, keep component 16025 can be pressed down in slit 16015 to keep the interaction between component 16025 and slit 16015 can resist the relative motion between support section 16010 and tissue thickness's compensating part 16020.In various embodiments, the main body of tissue thickness's compensating part 16020 can be made up of the first material, and keeps component 16025 can be made up of second or different materials.In certain embodiments, the main body of tissue thickness's compensating part 16020 can be made up of the material with the first hardness, and keeps component 16025 can be made up of the material with the second hardness, and wherein the second hardness such as can be higher than the first hardness.In use, in at least one embodiment, nail 10030 can by staple drivers 10040 upwardly, the end following closely 10030 is made to may pass through the main body of tissue thickness's compensating part 16020 and expose from tissue contacting surface 16021, and at least some of against target tissue capture tissue thickness compensation part 16020.In various embodiments, when following closely 10030 and being just deployed, the cutting element through slit 16015 can crosscutting holding component 16025.Once tissue thickness's compensating part 16020 is the most implanted, in various embodiments, keeps component 16025 to be pulled out slit 16015.In some other embodiment, the main body of tissue thickness's compensating part 16020 can separate with keeping component 16025.

Referring now to Figure 38 7 and Figure 38 9, nail bin 17000 can include support section 17010, and this support section includes platform surface 17011 and longitudinal slit 17015.Nail bin 17000 may also include the tissue thickness's compensating part 17020 being positioned at above platform surface 17011.In various embodiments, tissue thickness's compensating part 17020 can include that the longitudinal direction extended downwardly in longitudinal slit 17015 keeps component 17025.In at least one this type of embodiment, keep component 17025 can be pressed down in slit 17015 to keep the interaction between component 17025 and slit 17015 can resist the relative motion between support section 17010 and tissue thickness's compensating part 17020.In various embodiments, keeping component 17025 to can extend across whole tissue thickness compensating part 17020 to its top surface 17021, wherein the main part 17024 of tissue thickness's compensating part 17020 could attach to keep the opposite side of component 17025.In at least one this type of embodiment, component 17025 is kept can also such as to resist the lateral deflection of tissue thickness's compensating part 17020.In various embodiments, main part 17024 can be made up of the first material, and keeps component 17025 can be made up of second or different materials.In certain embodiments, main part 17024 can be made up of the material with the first hardness, and keeps component 17025 can be made up of the material with the second hardness, and wherein the second hardness such as can be higher than the first hardness.In various embodiments, to being described further above, when following closely 10030 and being just deployed, the cutting element through slit 17015 can crosscutting holding component 17025.Once tissue thickness's compensating part 17020 is the most implanted, in various embodiments, keeps component 17025 to be pulled out slit 17015.In some other embodiment, main part 17024 can separate with keeping component 17025.

Referring now to Figure 38 8, nail bin 18000 can include support section 18010, and this support section includes platform surface 18011 and longitudinal slit 18015.Nail bin 18000 may also include the tissue thickness's compensating part 18020 being positioned at above platform surface 18011.In various embodiments, tissue thickness's compensating part 18020 can include that the longitudinal direction extended downwardly in longitudinal slit 18015 keeps component 18025.In at least one this type of embodiment, keep component 18025 can be pressed down in slit 18015 to keep the interaction between component 18025 and slit 18015 can resist the relative motion between support section 18010 and tissue thickness's compensating part 18020.In various embodiments, keeping component 18025 to can extend across whole tissue thickness compensating part 18020 to its top surface 18021, wherein the main part 18024 of tissue thickness's compensating part 18020 could attach to keep the opposite side of component 18025.In at least one embodiment, keeping component 18025 can include amplifier section 18026, this amplifier section may be housed in the cavity 18016 being limited in slit 18015.In at least one this type of embodiment, amplifier section 18026 can resist holding component 18025 and withdraw from from slit 18015.

Can i.e. process after being designed as being intended for single use by device disclosed in this invention, or can be designed as them being used for multiple times.But, in either case, described device all can be repaired, to reuse after using at least one times.Again the combination in any that can comprise the steps is repaired: dismantle this device, then clean or replace some part and be subsequently assembled.Specifically, described device can be dismantled, and can the most optionally replace or remove any number of specific component of this device or part.Clean and/or after displacement specific part, this device can re-assembly to use subsequently at restoration facilities, or will be re-assemblied by surgical team before carrying out surgical operation.Those skilled in the art is it will be appreciated that repairing of device may utilize the multiple technology for dismantling, clean/replace and re-assemblying.The use of these technology and the prosthetic device of gained are within the scope of the present invention.

Preferably, device as herein described is processed before surgery.First, obtain new or used device, and when necessary device is cleaned.Then device is carried out disinfection.In a kind of disinfection technology, this device is placed in the container closing and sealing, such as in plastics or TYVEK bag.Then container and device are placed in the radiation area that can penetrate this container, such as gamma-radiation, x-ray or high energy electron.Radiate and the antibacterial on device and in container is killed.Then the device after sterilizing is saved in disinfecting container.Apparatus is kept aseptic by this sealing container, until opening this container in armarium.

The most only it is not expressly incorporated herein with in existing definition of the present invention, statement or other open afoul scopes of material at the material being incorporated to any patent, announcement or other the open materials that way of reference in full or is partly expressly incorporated herein.Thus, under necessary degree, replacement is incorporated by reference any afoul material herein by the disclosure herein explicitly illustrated.If according to state be incorporated by reference herein but with existing definition as herein described, statement or other open afoul any material of material or its part, be expressly incorporated herein under the degree only not producing conflict between the material being incorporated to and existing open material.

Although the present invention being described as exemplary design, it is also possible to the present invention is modified in the spirit and scope of the disclosure.Therefore present patent application is intended to use any modification pattern, purposes or the remodeling of its general principles.Additionally, present patent application is intended in art of the present invention to come from the pattern of the known or used disengaging disclosure having in practical framework.

Claims

1., with the nail bin including that the surgical stapling device of anvil block is used together, described nail bin includes:

Warehouse, described warehouse includes:

Platform, wherein said platform includes following closely memory block；And

The multiple nail chambeies being limited in described warehouse, the most each described nail chamber includes the opening being positioned in described platform, and wherein said opening is positioned in described nail memory block；

Being positioned at the implanted compressible portion above described platform, wherein said implanted compressible portion extends above in described nail memory block, and wherein said compressible portion includes:

Top surface；And

Lower surface towards described platform；

Multiple nails, the at least some of of the most each described nail is stored in described nail intracavity removedly, the most each described nail can move between non-firing position and firing position, the most each described nail the most just extends, and each described nail is positioned at least partially in described compressible portion when non-firing position described in each described nail is positioned at, wherein when each described nail moves between described non-firing position and described firing position, each described nail can deform between configuration and percussion configuration not firing, and wherein said compressible portion can capture in described nail, and when described nail described do not fire between configuration and described percussion configuration deformation time, described compressible portion takes different compression heights in different nails；And

Removable insertion cap, described insertion cap includes:

Covering at least one of lid of the described top surface of described compressible portion, the wherein said described nail chamber overthe openings covered in described nail memory block extends；

The attachment part being releasably engaged with described warehouse；And

The multiple support members extended from described lid, described support member can engage described warehouse, and limit the relative motion between described insertion cap and described warehouse.

Nail bin the most according to claim 1, wherein said warehouse includes proximally and distally, and wherein said multiple support member includes to engage at least one distally support member of described far-end and can engaging at least one proximal supports of described near-end.

Nail bin the most according to claim 1, wherein said lid extends on whole described nail memory block.

Nail bin the most according to claim 1, wherein said removable insertion cap also includes loaded surfaces, wherein said nail bin also includes the second compressible portion being removably attached to described loaded surfaces, and the described anvil block of wherein said surgical stapling device can contact described second compressible portion, and makes described second compressible portion separate with described removable insertion cap.

Nail bin the most according to claim 4, wherein said second compressible portion includes that contact surface, wherein said contact surface include binding agent, and wherein said anvil block can contact described contact surface.

Nail bin the most according to claim 5, also include being positioned at the pull tab in the middle of described second compressible portion and described insertion cap, wherein said pull tab can be slided between described second compressible portion and described insertion cap, so that described second compressible portion separates with described insertion cap.

Nail bin the most according to claim 6, wherein said pull tab includes shank and the stitching thread collar extended from described shank, wherein said shank stretches out from described second compressible portion and described insertion cap, and the wherein said stitching thread collar is around the periphery extension of described warehouse.

8., with the nail bin including that the surgical stapling device of anvil block is used together, described nail bin includes:

Warehouse, described warehouse includes:

Platform, described platform includes following closely memory block；And

The multiple nail chambeies being limited in described warehouse, the most each described nail chamber includes the opening being positioned in described platform, and wherein said limited opening is in described nail memory block；

Top surface；And

Lower surface towards described platform；

Removable load distribution lid, described load distribution lid includes:

The push pedal of neighbouring described top surface location, wherein said push pedal covers the described nail chamber opening in described nail memory block；

The attachment part being releasably engaged with described warehouse；And

The multiple support members extended from described push pedal, described support member can engage described warehouse, and limit the relative motion between described push pedal and described warehouse.

Nail bin the most according to claim 8, wherein said warehouse includes proximally and distally, and wherein said multiple support member includes to engage at least one distally support member of described far-end and can engaging at least one proximal supports of described near-end.

Nail bin the most according to claim 8, wherein said removable load distribution lid also includes loaded surfaces, wherein said nail bin also includes the second compressible portion being removably attached to described loaded surfaces, and the described anvil block of wherein said surgical stapling device can contact described second compressible portion and make described second compressible portion separate with described load distribution lid.

11. nail bins according to claim 10, wherein said second compressible portion includes that contact surface, wherein said contact surface include binding agent, and wherein said anvil block can contact described contact surface.

12. nail bins according to claim 11, also include being positioned at the pull tab in the middle of described second compressible portion and described load distribution lid, wherein said pull tab can be slided between described second compressible portion and described load distribution lid, so that described second compressible portion separates with described load distribution lid.

13. nail bins according to claim 12, wherein said pull tab includes shank and the stitching thread collar extended from described shank, wherein said shank stretches out from described second compressible portion and described load distribution lid, and the wherein said stitching thread collar is around the periphery extension of described warehouse.