CN104321021B - Expansible tissue thickness compensation part - Google Patents

Expansible tissue thickness compensation part Download PDF

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Publication number
CN104321021B
CN104321021B CN201380027745.0A CN201380027745A CN104321021B CN 104321021 B CN104321021 B CN 104321021B CN 201380027745 A CN201380027745 A CN 201380027745A CN 104321021 B CN104321021 B CN 104321021B
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CN
China
Prior art keywords
nail
tissue thickness
thickness compensation
view
compensation part
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
CN201380027745.0A
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Chinese (zh)
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CN104321021A (en
Inventor
J·L·奥尔德里奇
C·杨
C·J·沙伊布
C·W·威登豪斯
W·B·威森伯格二世
J·L·斯塔门
M·H·兰西克
S·A·马奇勒
G·W·奈特
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Ethicon Endo Surgery Inc
Original Assignee
Ethicon Endo Surgery Inc
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US13/433,098 external-priority patent/US9301753B2/en
Application filed by Ethicon Endo Surgery Inc filed Critical Ethicon Endo Surgery Inc
Publication of CN104321021A publication Critical patent/CN104321021A/en
Application granted granted Critical
Publication of CN104321021B publication Critical patent/CN104321021B/en
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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
    • A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
    • A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00491—Surgical glue applicators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0643—Surgical staples, i.e. penetrating the tissue with separate closing member, e.g. for interlocking with staple
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/064—Surgical staples, i.e. penetrating the tissue
    • A61B17/0644—Surgical staples, i.e. penetrating the tissue penetrating the tissue, deformable to closed position

Abstract

The invention discloses a kind of tissue thickness compensation part (70010,70130,70150,70182), the tissue thickness compensation part can generally include biocompatible materials, the first component (70010A) and the second component (70010B), wherein first component and the second component form reaction product so that the tissue thickness compensation part extends.First component may include the first hydrogel precursor, and second component may include the second hydrogel precursor, and the reaction product may include hydrogel.In vivo and/or the reaction product can be formed in situ and contacting first component and second component.First component and/or the second component can be packaged, and can discharge the component in broken dissipate.The reaction product may include the swollen composition of fluid-soluble.The method for also describing the product including the tissue thickness compensation part and making and using the tissue thickness compensation part.

Description

Expansible tissue thickness compensation part
Cross reference to related applications
The patent application of this non-transitory is entitled according to submitting 29 days April in 2011 of 35 U.S.C. § 120 “Tissue Thickness Compensator For A Surgical Stapler Comprising An Adjustable The part continuation application of the U.S. Patent Application Serial Number 13/097,891 of Anvil ", the U.S. Patent application are according to 35 U.S.C. entitled " the Selectively Orientable Implantable that Septembers in 2010 30th of § 120 are submitted The part continuation application of the U.S. Patent application 12/894,377 of Fastener Cartridge ", the whole of above-mentioned patent application Disclosure is hereby incorporated by reference.
Background technique
The present invention relates to surgical instruments, and are related to the surgery cuts and suture that are designed to cut and suture tissue Instrument and its nail bin.
Summary of the invention
Be below be claimed or may claimed invention embodiment incomplete column Table.
1. a kind of tissue thickness compensation part, includes:
Biocompatible materials；
First component；With
Second component；
Wherein first component and the second component suitably form reaction product so that the tissue thickness compensation part extends.
2. also including encapsulating component according to tissue thickness compensation part described in embodiment 1, the encapsulating component includes described One of first component and the second component, wherein the other of first component and second component are embedded in the biology In compatibility material.
3. according to tissue thickness compensation part described in embodiment 1, wherein first component includes to be embedded in the biology Hydrophilic material in compatibility material, and described second group is divided into body fluid.
4. the tissue thickness compensation part includes to contain described first according to tissue thickness compensation part described in embodiment 1 First encapsulating component of component and the second encapsulating component containing second component.
5. according to tissue thickness compensation part as described in example 4, wherein the biocompatible materials include at least one Packaging part, at least one described packaging part include first encapsulating component and second encapsulating component.
6. according to tissue thickness compensation part as described in example 4, wherein when first encapsulating component is broken dissipate when, described the One encapsulating component can discharge first component, and when second encapsulating component is broken scattered, second encapsulating component Second component can be discharged.
7. the tissue thickness compensation part according to any one of previous embodiment, wherein the biocompatible materials packet It is poly- containing albumin, alginates, carbohydrate, casein, cellulose, chitin, chitosan, collagen, blood, Portugal Sugar, elastin laminin, fibrin, fibrinogen, gelatin, heparin, hyaluronic acid, keratin, protein, serum, starch, Poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyester, polyethylene glycol, polyalkylene oxides, poly- third Acrylamide, polycarbonate, poly hydroxy ethyl acrylate, polyvinylpyrrolidone), polyvinyl alcohol, poly- (caprolactone), poly- (two Oxa- cyclohexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, glycerol, poly- (amino acid), copolymerization (ether-ester), polyalkylene oxalic acid The combination of ester, polyamide, poly- (iminocarbonic ester), polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance.
8. according to tissue thickness compensation part described in embodiment 1, wherein the reaction product is by making first component It contacts and is formed in situ with second component.
9. the tissue thickness compensation part according to any one of previous embodiment, wherein the reaction product is that fluid can The composition of swelling.
10. the tissue thickness compensation part according to any one of embodiment 1 and 4-9, wherein first component includes First hydrogel precursor, second component includes the second hydrogel precursor, and the reaction product includes hydrogel.
11. the tissue thickness compensation part according to any one of previous embodiment, wherein first component and second Component is independently selected from albumin, alginates, carbohydrate, casein, cellulose, chitin, chitosan, glue Original, blood, glucan, elastin laminin, fibrin, fibrinogen, gelatin, heparin, hyaluronic acid, keratin, albumen Matter, serum, starch, poly- (lactic acid), poly- (glycolic), polycarbonate, poly- (butyric ester), poly- (phosphine piperazine), polyester, poly- second two Alcohol, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone), polyvinyl alcohol, gathers polyalkylene oxides (caprolactone), poly- (dioxanone), polyacrylic acid, poly- acetic acid esters, polypropylene, glycerol, poly- (amino acid), copolymerization (ether- Ester), polyalkylenes oxalates, polyamide, poly- (iminocarbonic ester), polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance Combination.
12. the tissue thickness compensation part according to any one of previous embodiment, including include water impermeable material Outer layer and internal layer comprising at least one of the biocompatible materials and first component and the second component.
13. according to tissue thickness compensation part described in embodiment 12, wherein the water impermeable material includes poly- (cream Acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyester, polyethylene glycol, polyalkylene oxides, polyacrylamide Amine, polycarbonate, poly hydroxy ethyl acrylate, polyvinylpyrrolidone), polyvinyl alcohol, poly- (caprolactone), poly- (dioxa Cyclohexanone), polyacrylic acid, poly- acetic acid esters, polypropylene, glycerol, poly- (amino acid), copolymerization (ether-ester), polyalkylenes oxalates, The combination of polyamide, poly- (iminocarbonic ester), polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance.
14. the tissue thickness compensation part according to any one of previous embodiment, wherein the biocompatible materials Comprising the reinforcing material being embedded, and wherein, the reinforcing material includes mesh sheet, fiber, particle, powder or above-mentioned substance Combination.
15. according to tissue thickness compensation part described in embodiment 14, wherein the reinforcing material includes collagen, gelatin, blood Fibrin, fibrinogen, elastin laminin, keratin, albumin, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxyl Propyl cellulose, carboxymethyl cellulose, chitin, chitosan, alginates, poly- (lactic acid), gathers carboxyethyl cellulose (glycolic), poly- (butyric ester), poly- (phosphine piperazine), polyester, polyethylene glycol, polyalkylene oxides, polyacrylamide, poly- first Base hydroxy-ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, poly- (caprolactone), poly- (dioxanone), polyacrylic acid, Poly- acetic acid esters, polycaprolactone, polypropylene, aliphatic polyester, glycerol, poly- (amino acid), copolymerization (ether-ester), polyalkylenes oxalates, Polyamide, poly- (iminocarbonic ester), polyalkylenes oxalates, polyoxaesters, polyorthoester, the group of polyphosphazene or above-mentioned substance It closes.
16. the tissue thickness compensation part according to any one of previous embodiment includes hemostat, anti-inflammatory agent, antibiosis Plain agent, the combination of antimicrobial, antiblocking agent, anticoagulant, drug, pharmaceutically active agents or above-mentioned substance.
17. a kind of product, the anvil block selected from robotic suturing device and the nail bin for robotic suturing device, the product include:
According to tissue thickness compensation part described in embodiment 1, the tissue thickness compensation part includes:
Outer layer, it includes pore-free materials；
Internal layer it includes: porous material, the first encapsulating component containing first component and contains second component The second encapsulating component.
18. according to product described in embodiment 17, in which:
The outer layer includes polyglycolic acid, polylactic acid, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone, gathers Caprolactone or their combination；
The porous material includes oxidized regenerated cellulose, and first component includes the first hydrogel precursor, and institute Stating the second component includes the second hydrogel precursor；And
Wherein the reaction product is hydrogel, and first hydrogel precursor and the second hydrogel precursor are suitable for shape At the hydrogel, expand the tissue thickness compensation part when first encapsulating component and the second encapsulating component are broken scattered Exhibition.
19. according to product described in embodiment 17 or embodiment 18, wherein the product according to circumstances limits nail from institute At least part for the nail forming path that storehouse to be followed to anvil block or from storehouse to the anvil block is stated, and wherein first encapsulation Component and the second encapsulating component are aligned with the nail forming path so that the sting for following the path wear the packaging part or with Other modes keep it broken scattered.
20. a kind of side for the tissue thickness compensation part that extension is formed in situ using the tissue thickness compensation part of embodiment 4 Method, which comprises
Keep first encapsulating component and the second encapsulating component broken scattered, to allow first encapsulating component and second to encapsulate The reaction in-situ of component, to form the reaction product；
Wherein the reaction product makes the tissue thickness compensation part extension to compensate different tissue thickness.
21. according to method described in embodiment 20, in which:
The tissue thickness compensation part includes:
Outer layer it includes polyglycolic acid, polylactic acid, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone, gathers The combination of caprolactone or above-mentioned substance；With
Internal layer, it includes oxidized regenerated celluloses；
First encapsulating component includes the first hydrogel precursor；
Second encapsulating component includes the second hydrogel precursor；And
Reaction product includes hydrogel.
Detailed description of the invention
Refer to following explanation of the invention, the features and advantages of the present invention and the side for obtaining them in conjunction with the accompanying drawings Formula will become apparent, and invention itself is also easier to understand, in which:
Fig. 1 is the sectional view of surgical instrument embodiment；
Figure 1A is the perspective view of one embodiment of implanted nail bin；
Figure 1B-Fig. 1 E shows the part that the end effector of tissue is clamped and sutured with implanted nail bin；
Fig. 2 is the partial cross-sectional side view for being connected to another end effector of part of surgical instruments, middle-end Portion's actuator supports surgery nail bin and its anvil block is in an open position；
Fig. 3 is the end effector of Fig. 2 another partial cross-sectional side view in the close position；
Fig. 4 is that another part of the end effector of Fig. 2 and Fig. 3 when knife bar starts to be advanced through end effector is horizontal Side cross-sectional view；
Fig. 5 is another partial cross sectional of the end effector of Fig. 2-Fig. 4 when knife bar is partly advanced through wherein Surface side view；
Fig. 6 is mounted in the perspective view of the alternative nail bin embodiment in surgery cuts and stitching devices；
Fig. 7 is the surgery nail bin of Fig. 6 shown device and the top view of elongated passageway；
Fig. 8 is mounted in the top view of another surgery nail bin embodiment in the elongated passageway of end effector；
Fig. 9 is the bottom view of anvil block；
Figure 10 is the local perspective view to form multiple nails of part of staple line；
Figure 11 is another local perspective view of the staple line of Figure 10, wherein the nail of the staple line with surgery cuts and suture It is formed after the anvil block contact of device；
Figure 12 is the local perspective view to form the alternative nail of part of another staple line；
Figure 13 is the local perspective view to form the alternative nail of part of another staple line；
Figure 14 is the local perspective view to form the alternative nail of part of another staple line embodiment；
Figure 15 is the sectional view of the end effector of support nail cartridge；
Figure 16 is that the elongate channel portion of the end effector of Figure 15 is removing implanted nail bin main part and nail from it Sectional view later；
Figure 17 is the sectional view for supporting the end effector of another nail bin；
The deformation for the surgical staples that Figure 18 A- Figure 18 D diagram is located in staple cartridge body according at least one embodiment；
Figure 19 A is to show the schematic diagram for being located in the nail that can be crushed in staple cartridge body；
Figure 19 B is the schematic diagram for being crushed staple cartridge body and being crushed by anvil block for showing Figure 19 A；
Figure 19 C is the schematic diagram for being crushed staple cartridge body and being further crushed by anvil block for showing Figure 19 A；
Figure 19 D is to show following closely for Figure 19 A to be in complete conquassation in the nail bin that is crushed for forming configuration and Figure 19 A completely The schematic diagram of condition；
Figure 20 is to describe following closely and showing latent between nail and nail bin support surface against what nail bin support surface positioned In the schematic diagram of relative motion；
Figure 21 is the sectional view of nail bin support surface, which includes slit or slot, can stablize Figure 20 Nail base portion；
Figure 22 is according to the sectional view of the nail of at least one alternative embodiment, which includes the bizet and energy of overmolding Enough receive the slit or slot of the part of the bizet；
Figure 23 is the top view of nail bin according at least one embodiment, which includes being embedded in staple cartridge body Nail；
Figure 24 is the front view of the nail bin of Figure 23；
Figure 25 is the front view of nail bin according at least one embodiment, which includes surrounding to be located in collapsible nail bin The protective layer of intracorporal nail；
Figure 26 is the nail bin of Figure 25 along the sectional view of the line 26-26 interception in Figure 25；
Figure 27 is the front view of nail bin according at least one embodiment, which includes at least partly extending and can collapsing Nail except contracting staple cartridge body and the protective layer around staple cartridge body；
Figure 28 is the nail bin of Figure 27 along the sectional view of the line 28-28 interception in Figure 27；
Figure 29 is the partial cutaway view of nail bin according at least one embodiment, which includes being at least partially embedded Nail in staple cartridge body, the nail are located at least partially in the nail cavity gap in staple cartridge body；
Figure 30 is the sectional view along the nail bin of Figure 29 of the line 30-30 interception in Figure 29；
Figure 31 is the partial cutaway view of nail bin according at least one embodiment；
Figure 32 is the partial cutaway view of nail bin according at least one embodiment, which includes being at least partially embedded Nail and connected nail in staple cartridge body and the alignment matrix for being aligned nail relative to each other；
Figure 33 is the sectional view along the line 33-33 interception in Figure 32 of the nail bin of Figure 32；
Figure 34 is the local sectility view of the internal layer of compressible nail bin body；
Figure 35 is to show the schematic diagram of the internal layer of compressed Figure 34 between transfer plate and support plate；
Figure 36 is the schematic diagram for showing nail and being inserted into the compression internal layer of Figure 35；
Figure 37 is the schematic diagram for showing the support plate of Figure 35 and being removed from internal layer；
Figure 38 be include the internal layer of Figure 34 and the nail of Figure 36 being inserted into outer layer sub-component schematic diagram；
Figure 39 is to show the outer layer of Figure 38 to be sealed to form the schematic diagram of sealing nail bin；
Figure 40 is the sectional view of the sealing nail bin of Figure 39；
Figure 41 is the sectional view of nail bin and staple cartridge channel according at least one embodiment；
Figure 42 is the schematic diagram for being partially in deformation state for showing the nail bin of Figure 41；
Figure 43 is the front view of the end effector of surgical stapling device, which includes anvil in an open position Seat and the nail bin being located in staple cartridge channel；
Figure 44 is the front view of the end effector of Figure 43, it illustrates anvil block in the close position and is compressed in anvil Nail bin between seat and staple cartridge channel；
Figure 45 is the front view of the end effector of Figure 43, and it illustrates be located in staple cartridge channel in alternative mode The nail bin of Figure 43；
Figure 46 is the sectional view of the end effector of surgical stapling device, which includes being located in staple cartridge channel Compressible nail bin and be attached to one piece of buttress material of anvil block；
Figure 47 is the sectional view of the end effector of Figure 46, and it illustrates anvil blocks in the close position；
Figure 48 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes tool There is the nail bin of water impermeable barrier；
Figure 49 is the sectional view of the another alternative embodiment of the end effector of surgical stapling device；
Figure 50 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes rank Ladder type anvil block and nail bin with staged warehouse；
Figure 51 is the sectional view of the another alternative embodiment of the end effector of surgical stapling device；
Figure 52 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes inclining Oblique tissue contacting surface；
Figure 53 is the sectional view of the another alternative embodiment of the end effector of surgical stapling device, the end effector Including inclined tissue contacting surface；
Figure 54 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes energy The support insert of enough support nail cartridges；
Figure 55 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes tool There is the nail bin of multiple compressible stratums；
Figure 56 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes tool There is the nail bin of staged compressible warehouse；
Figure 57 is the sectional view of the another alternative embodiment of the end effector of surgical stapling device, the end effector Including the nail bin with staged compressible warehouse；
Figure 58 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes tool There is the nail bin of bending tissue contacting surface；
Figure 59 is the sectional view of the alternative embodiment of the end effector of surgical stapling device, which includes tool There is the nail bin of inclination tissue contacting surface；
Figure 60 is the sectional view of compressible nail bin, which includes following closely and being stored at least one medicine therein Object；
Figure 61 is to show the compressible nail bin of Figure 60 to be compressed at it and after the nail accommodated in it deformed Schematic diagram；
Figure 62 is the partial sectional view of nail bin according at least one embodiment；
Figure 63 is the sectional view of the nail bin of Figure 62；
Figure 64 is the perspective view according to the implantation nail bin of at least one alternative embodiment；
Figure 65 is the sectional view of the implantation nail bin of Figure 64；
Figure 66 is the perspective view of the alternative embodiment of nail bin, which includes the deformable structure extended from the outer layer of nail bin Part；
Figure 67 is the perspective view of the alternative embodiment of nail bin, which includes the outer layer for being mounted to the nail bin of internal layer；
Figure 68 is the sectional view of the alternative embodiment of nail bin, which includes multiple nails, compressible stratum and degreasing cotton layer；
Figure 69 is the perspective view of the degreasing cotton layer of Figure 68；
Figure 70 is from the saturating of the absorbent cotton that the degreasing cotton layer of Figure 68 is partitioned into and the nail being aligned with the groove in absorbent cotton View；
Figure 71 is the perspective view of two connected absorbent cotton of the degreasing cotton layer from Figure 68；
Figure 72 is the perspective view that the absorbent cotton support frame of the degreasing cotton layer of Figure 68 is removed from the absorbent cotton being partitioned into；
Figure 73 is the dismantling perspective view of the alternative embodiment of compressible nail bin, the compressible nail bin include nail therein and System for driving nail against anvil block；
Figure 73 A is the partial sectional view of the alternative embodiment of the nail bin of Figure 73；
Figure 74 is the sectional view of the nail bin of Figure 73；
Figure 75 is the front view that can be traversed the nail bin of Figure 73 and make to follow closely the sliding part moved towards anvil block；
Figure 76 is the schematic diagram of staple drivers, which can be promoted by the sliding part of Figure 75 towards anvil block；
Figure 77 is the excision view according to the nail bin of at least one alternative embodiment, which includes being located in nail driving Nail in device；
Figure 78 is the sectional view when nail bin of Figure 77 is located in staple cartridge channel；
Figure 79 is the sectional view of the nail bin of Figure 77, is become it illustrates the anvil block moved in closed position and by anvil block The nail of shape being contained in nail bin；
Figure 80 is the sectional view of the nail bin of Figure 77, and it illustrates the nails moved upwards towards anvil block；
Figure 81 is the perspective view of the alternative embodiment of nail bin, which includes the band for connecting the flexible sides of nail bin；
Figure 82 is the perspective view of sliding part and cutting element component；
Figure 83 is the schematic diagram that the nail of nail bin of Figure 77 is promoted using the sliding part of Figure 82 and cutting element component；
Figure 84 be show can jointing nail and towards anvil block promoted nail sliding part and can selectively allow for sliding part to The schematic diagram of the locking system of distal movement；
Figure 85 A- Figure 85 C is shown the process in nail insertion crown portion；
Figure 86 be include support plate or retainer nail bin sectional view；
Figure 87 is the partial cutaway view according to the compressible nail bin of at least one alternative embodiment；
Figure 88 is to show the nail bin of Figure 87 to be in schematic diagram under implantation condition；
Figure 89 is the partial sectional view according to the compressible nail bin of at least one alternative embodiment；
Figure 90 is the partial cutaway view of the nail bin of Figure 89；
Figure 91 is to show the nail bin of Figure 89 to be in schematic diagram under implantation condition；
Figure 92 is the partial cutaway view for being crushed nail bin according at least one alternative embodiment；
Figure 93 is the partial sectional view of the collapsible nail bin including multiple crushable members according at least one embodiment；
Figure 94 is that the crushable member of Figure 93 is in the perspective view under non-collapsed state；
Figure 95 is that the crushable member of Figure 94 is in the perspective view under collapsed state；
Figure 96 A is the partial cutaway view of the end effector of surgery suturing appliance, which includes jaw and pincers The mouth staple cartridge channel relatively positioned and the nail bin being located in staple cartridge channel, wherein jaw includes the guarantor being attached to thereon Hold matrix；
Figure 96 B is the partial cutaway view of the end effector of Figure 96 A, and it illustrates the jaws moved towards staple cartridge channel, quilt The nail bin and nail of anvil block and holding matrix compression, the nail at least partly extend through be positioned within matrix and nail bin it Between tissue；
Figure 96 C is the partial cutaway view of the end effector of Figure 96 A, it illustrates in final position jaw and with The holding matrix that the nail joint of Figure 96 B is closed；
Figure 96 D is the partial cutaway view of the end effector of Figure 96 A, and it illustrates jaws and staple cartridge channel far from implantation Nail bin and holding matrix movement；
Figure 97 is according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment, which includes Multiple holding members, which, which can engage, extends through fastener leg therein；
Figure 98 is according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment, which includes Six holding members；
Figure 99 is according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment, which includes Eight holding members；
Figure 100 is the retaining hole packet according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment Multiple holding members are included, which, which can engage, extends through fastener leg therein；
Figure 101 is the retaining hole packet according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment Include six holding members；
Figure 102 is the retaining hole packet according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment Include eight holding members；
Figure 103 is the retaining hole packet according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment Include the multiple holding members being stamped to form by sheet metal；
Figure 104 is the retaining hole packet according to the perspective view of the retaining hole of the holding matrix of at least one alternative embodiment Include the multiple holes extended around the periphery of retaining hole；
Figure 105 is the top view according to the retaining hole of the holding matrix of at least one alternative embodiment；
Figure 106 is the top view according to the retaining hole of the holding matrix of at least one alternative embodiment；
Figure 107 is the top view according to the retaining hole of the holding matrix of at least one alternative embodiment；
Figure 108 is the top view according to the retaining hole of the holding matrix of at least one alternative embodiment；
Figure 109 is the top view according to the retaining hole of the holding matrix of at least one alternative embodiment；
Figure 110 is the top view of the retaining hole of holding matrix according at least one embodiment, which includes extending Holding inserted sheet into retaining hole；
Figure 111 is the retaining hole packet according to the top view of the retaining hole of the holding matrix of at least one alternative embodiment Include the holding inserted sheet extended in retaining hole；
Figure 112 is the perspective view of fastening system, the holding matrix and energy which includes multiple nails, closes with nail joint The alignment matrix of enough alignment nails；
Figure 113 is the perspective view of the holding matrix of Figure 112；
Figure 114 is the perspective view of the alignment matrix of Figure 112；
Figure 115 is the partial top view that the nail joint of the holding matrix and Figure 112 of Figure 112 is closed；
Figure 116 is the partial bottom view that the nail joint of the holding matrix and Figure 112 of Figure 112 is closed；
Figure 117 is the partial elevation view of the fastening system of Figure 112；
Figure 118 is the local perspective view of the fastening system of Figure 112；
Figure 119 is the partial cutaway view that the nail joint of the holding matrix and Figure 112 of Figure 112 is closed；
Figure 120 is the partial cutaway view of the fastening system of Figure 112；
Figure 121 is the perspective view of the fastening system of Figure 112, which further includes the protectiveness top for being assembled to nail leg Lid；
Figure 122 is the bottom perspective view of the fastening system construction of Figure 121；
Figure 123 is the local perspective view of the fastening system construction of Figure 121；
Figure 124 is the partial cutaway view of the fastening system construction of Figure 121；
Figure 125 is the front view of end effector according at least one embodiment, which includes being in beat The jaw of open position, the holding matrix being located in jaw and multiple protectiveness top covers and the nail being located in staple cartridge channel Storehouse；
Figure 126 is the front view when end effector of Figure 125 is in the close position；
Figure 127 is the front view when end effector of Figure 125 is in firing position；
The front view when holding matrix and protectiveness top cover that Figure 128 is Figure 125 are assembled to the nail bin of Figure 125；
Figure 129 is the detail drawing of the construction of Figure 128；
Figure 130 is the front view of the end effector of Figure 125, it illustrates jaw in an open position and is positioned at Relatively thin tissue between holding matrix and nail bin；
Figure 131 is the front view of the end effector of Figure 125, and it illustrates jaws in the close position against Figure 130 Relatively thin tissue；
Figure 132 is the front view of the end effector of Figure 125, and it illustrates jaws to be in firing position in holding matrix The relatively thin tissue of Figure 130 is captured between nail bin；
Figure 133 is that the holding matrix of Figure 125 and protectiveness top cover are assembled to the nail bin of Figure 125 and make the thin tissue of Figure 130 The front view of positioning therebetween；
Figure 134 is the detail drawing of the construction of Figure 133；
Figure 135 is the section according to the protectiveness top cover of at least one alternative embodiment being located on nail leg top Figure；
Figure 136 is the perspective view of multiple protectiveness top covers in insert material piece；
Figure 137 is the perspective view of jaw, which includes multiple grooves, which can receive multiple protectiveness top covers In wherein；
Figure 138 is the detail drawing of a part of jaw, which includes the protection that covering is located in the jaw of Figure 137 The thin slice of property top cover；
Figure 139 is the section according to the protectiveness top cover of at least one alternative embodiment being located on nail leg top Figure, wherein protectiveness top cover includes internal formation surface；
Figure 140 is another sectional view of the protectiveness top cover of Figure 139, and it illustrates deform against the formation surface Nail leg；
Figure 141 is to maintain the top view of the alternative embodiment of matrix, which includes multiple connected matrix elements Part；
Figure 142 is to maintain the top view of the alternative embodiment of matrix, which includes multiple connected matrix elements Part；
Figure 143 is to maintain the top view of the alternative embodiment of matrix, which includes multiple connected matrix elements Part；
Figure 144 is a series of top view of the alternative embodiment of holding matrixes, which includes multiple phases Matrix element even；
Figure 145 is to maintain the top view of the alternative embodiment of matrix, which includes multiple connected matrix elements Part；
Figure 146 be include holding matrix jaw partial exploded view, which includes compressible lid；
Figure 147 is the detail drawing of the holding matrix of Figure 146；
Figure 148 be include holding matrix fastening system partial cutaway view, which includes compressible stratum and envelope Fill multiple units of one or more drugs；
Figure 149 is the schematic diagram for showing the unit that nail leg pierces through Figure 148 when engaging with holding matrix；
Figure 150 be include holding matrix fastening system partial cutaway view, which includes compressible stratum；
Figure 151 is the front view of fastener cartridge plug-in package, which includes clamper, the first fastening Part storehouse and the second fastener cartridge；
Figure 152 is the front view of the end effector of surgical stapling device, which includes the first jaw and second Jaw, second jaw are shown in open configuration；
Figure 153 is the front view of the end effector of Figure 152, and it illustrates the second jaws and use that are in closed configuration In the fastener cartridge plug-in package for loading the first jaw and Figure 151 with the second jaw of the second storehouse load with the first storehouse；
Figure 154 is the front view of the end effector of the Figure 153 loaded, and it illustrates the storehouses removed from end effector Plug-in package, the second jaw for being again at open configuration and the tissue being located between the first jaw and the second jaw；
Figure 155 is the front view for having loaded end effector and being in percussion configuration of Figure 154；
Figure 156 is the first storehouse and the second storehouse is in the front view under implantation condition；
Figure 157 is the front view of the end effector of Figure 152 according at least one embodiment, and it illustrates still with first The a part in the first storehouse of jaw engagement；
Figure 158 is the front view of the alternative embodiment of fastener cartridge plug-in package, which includes Clamper, the first fastener cartridge and the second fastener cartridge；
Figure 159 is the front view of the fastener cartridge plug-in package of Figure 158, which is used for the first storehouse It loads the first jaw of end effector and loads the second jaw with the second storehouse；
Figure 160 is the sectional view for having loaded end effector of Figure 159；
Figure 161 is the perspective of the surgical stapling device according at least one embodiment including bottom jaw and top jaw Figure, the part for showing surgical stapling device has been removed；
Figure 162 is the perspective view for having removed the surgical stapling device of Figure 161 of top jaw；
Figure 163 is the perspective view of the slidably anvil block system of the top jaw of the surgical stapling device of Figure 161, the slidably anvil Base system includes the first slidably anvil block and the second slidably anvil block；
Figure 164 is the end-view of the slidably anvil block system of Figure 163；
Figure 165 is the top view of the slidably anvil block system of Figure 163；
Figure 166 be show Figure 163 slidably anvil block system be in do not fire under the conditions of schematic diagram；
Figure 167 be show Figure 163 slidably anvil block system first slidably anvil block be in non-firing position and fixed Nail of the position in bottom jaw is in the schematic diagram of non-deployed position；
Figure 168 be show nail in bottom jaw in guidewire lumen and Figure 167 first slidably anvil block drawn To nearside so that the schematic diagram of the nail leg deformation of first group of nail；
Figure 169 is to show first group of nail of Figure 168 to be deformed into the schematic diagram of the state of being badly deformed；
Figure 170 be show Figure 163 slidably anvil block system second slidably anvil block be pushed to distal side so that second group The schematic diagram of nail leg deformation；
Figure 171 is the local perspective view of the anvil block including multiple forming pits at least one embodiment；
Figure 172 is the section end view of the anvil block of Figure 171；
Figure 173 is the schematic diagram for showing the first step of forming pit of manufacture Figure 171；
Figure 174 is the schematic diagram for showing the second step of forming pit of manufacture Figure 171；
Figure 175 is the top view of the forming pit construction of the anvil block of Figure 171；
Figure 176 is the schematic diagram for showing the first step of the manufacturing process for manufacturing anvil block；
Figure 177 is the schematic diagram for showing the second step of manufacturing process of Figure 176；
Figure 178 is the schematic diagram for showing the third step of manufacturing process of Figure 176；
Figure 179 is the front, left perspective view of surgical stapling and cutting off apparatus, and wherein handle portions include the automatic of connecting rod triggering Cam mechanism and ratchet manual retract mechanism；
Figure 180 is the surgical stapling of Figure 179 and the right rear perspective view of cutting off apparatus, and wherein a part of elongated shaft is removed And the right half-shell of shank shell is removed to show automatic firing end traveling cam mechanism and fire cam mechanism manually；
Figure 181 be the surgical stapling of Figure 179 and the handle portions of cutting off apparatus and elongated shaft the right side after perspective dismantling view；
Figure 182 is the outer of the surgical stapling of Figure 31 and the right rear perspective view of cutting off apparatus, wherein right half-shell and execution part Portion is removed to show close mechanism and firing lock under original state；
Figure 183 is the surgical stapling of the part dismantling of Figure 182 and the right side elevation view of cutting off apparatus；
Figure 184 is the surgical stapling of the part dismantling of Figure 182 and the right rear perspective view of cutting off apparatus, and wherein close mechanism closes It closes and clamps, and gemmule pawl firing lock completes first stroke, and wherein manual retract mechanism is removed to show link The distal link of rack gear, the distal link trigger the automatic retracted of firing lock；
Figure 185 is the surgical stapling of the part dismantling of Figure 183 and the right rear perspective view of cutting off apparatus, and wherein gemmule pawl fires Mechanism is detached from and distal link is close to automatic retracted；
Figure 186 is the left side elevation view of the part surgical stapling disassembled and cutting off apparatus of Figure 183 in original state, In the original state, end effector is opened and anti-inversion organization is engaged；
Figure 187 is the right half-shell of the handle portions of Figure 186 and the left side detail drawing of anti-reversing trip lever；
Figure 188 is the surgical stapling of the dismantling of Figure 179 and the left side thin portion front view of cutting off apparatus, wherein closure trigger It is clamped, firing trigger executes final stroke and distal link is oriented triggering automatic retracted；
Figure 189 is that distal link is activated and is locked towards anti-reversing trip lever after so that link tooth bar is bounced back The surgical stapling of the dismantling of Figure 188 and the left side thin portion front view of cutting off apparatus；
Figure 190 be the surgical stapling of Figure 179 and the manual retract mechanism of cutting off apparatus idler gear and backgear and The right dismantling perspective view of manual retrieving lever and ratchet pawl of cut-out apparatus；
Figure 191 is the right perspective view of the manual retract mechanism of Figure 190, and wherein manual retrieving lever is partly cut away to connect Close the ratchet gear that small diameter is shown on the backgear of ratchet pawl of cut-out apparatus；
Figure 192 is the left side elevation view of the surgical stapling of Figure 179 and the part dismantling of cutting off apparatus, wherein anti-inversion organization It is joined to the link tooth bar fired completely, before the manual retrieving lever actuating of Figure 190, the link tooth bar and combination tension/ Compressed spring disconnects；
Figure 193 is the left side elevation view of the surgical stapling of Figure 192 and the part dismantling of cutting off apparatus, and wherein anti-turn discharges The hidden parts of lever, backgear and manual percussion trip lever are shown in phantom；
Figure 194 is the surgery seam for Figure 193 that the actuating of manual percussion trip lever has made after link tooth bar manual retrieving Close the left side elevation view disassembled with the part of cutting off apparatus；
Figure 195 is the left side elevation view of the surgical stapling of Figure 194 and the part dismantling of cutting off apparatus, wherein link tooth bar quilt It omits, shows percussion trip lever manually and anti-inversion organization is detached from；
Figure 196 is the alternative anti-reversing trip lever and shank shell of the surgical stapling and cutting off apparatus for Figure 179 Left side detail drawing；
Figure 197 is the left perspective dismantling of the alternative anti-turn release thick stick, backgear axle and automatic retracted cam of Figure 196 View；
Figure 198 is the right side elevation view of the alternative anti-turn relieving mechanism of Figure 196, and wherein link tooth bar is in retraction position It sets, and anti-reversing trip lever is proximally positioned, wherein anti-down flap is joined to excitation connecting rod；
Figure 198 A is the right side thin portion front view of the backgear of Figure 198, automatic retracted cam and farthest side connecting rod；
Figure 199 is the right side elevation view of the anti-turn relieving mechanism of Figure 198 after the first firing schedule；
Figure 199 A is the right side thin portion front view of the backgear of Figure 199, automatic retracted cam and second connecting rod；
Figure 200 is the right side elevation view of the anti-turn relieving mechanism of Figure 199 after the second firing schedule；
Figure 200 A is the right side thin portion front view of the backgear of Figure 200, automatic retracted cam and third connecting rod；
Figure 20 1 be the right side thin portion of the anti-turn relieving mechanism of Figure 200 after third percussion and last stroke just View；
Figure 20 1A is the right side thin portion front view of the backgear of Figure 20 1, automatic retracted cam and recent side fourth link；
Figure 20 2 is to slide automatic retracted cam distad in another firing schedule and lock anti-reversing trip lever, To the right side elevation view of the automatic releasing mechanism with Figure 20 1 after the disengaging of anti-turn relieving mechanism；
Figure 20 3 is open the front, left perspective view of nail administration assembly, wherein the right half part of replaceable nail bin is included in nail In channel；
Figure 20 4 is the nail administration assembly of the axis configuration with complete replaceable nail bin and non-joint motions of Figure 20 3 Disassemble perspective view；
Figure 20 5 is the two cuttves of the nail administration assembly of Figure 20 3 and the perspective view of trigger shaft (" E type crossbeam ")；
Figure 20 6 is the perspective view of the wedge-shaped slides of the nail bin of nail administration assembly；
Figure 20 7 is that the left side intercepted in longitudinal cross-section along the center line 207-207 of the nail administration assembly of Figure 20 3 is faced Figure；
Figure 20 8 is the perspective view of the nail administration assembly of the opening of Figure 20 3, without replaceable nail bin, neighbouring two cuttves With the part of the nail channel of the intermediate pin of trigger shaft, and the not distal part of nail channel；
Figure 20 9 is the anterior elevational view intercepted in cross-section along the center line 209-209 of the nail administration assembly of Figure 20 3, Show the inside staple drivers of nail bin and each section of two cuttves and trigger shaft；
Figure 21 0 is that the left side intercepted substantially along the longitudinal axis 207-207 of the nail administration assembly of the closure of Figure 20 3 is faced Figure, to include the center contact point between two cuttves and wedge-shaped slides, but also laterally offset to show the nail in nail bin And staple drivers；
Figure 21 1 is the left side thin portion front view of the nail administration assembly of Figure 21 0, and wherein two cuttves retraction is slightly more, this is for nail It is typical situation for the replacement of storehouse；
Figure 21 2 is the left side thin portion front view of the nail administration assembly of Figure 21 1, and wherein two cuttves start to fire, and corresponds to figure Configuration shown in 210；
Figure 21 3 be the left side section of the closure nail administration assembly of Figure 21 0 after two cuttves and trigger shaft distad fire just View；
Figure 21 4 is the left side of the closure nail administration assembly of Figure 21 3 after the percussion of nail bin and the retraction of two cuttves Cross-section front view；
Figure 21 5 is the left side cross-sectional details front view of the nail administration assembly of Figure 21 4, and wherein two cuttves are allowed to fall into locking In position；
Figure 21 6 is the perspective view of the nail bin of at least one embodiment according to the present invention, which includes and surgical stapling The rigid support portion and compressible tissue thickness compensation part that instrument is used together；
Figure 21 7 is the partial exploded view of the nail bin of Figure 21 6；
Figure 21 8 is the complete exploded view of the nail bin of Figure 21 6；
Figure 21 9 is another exploded view of the nail bin of Figure 21 6, which is not covered with the package of tissue thickness compensation part Object；
Figure 22 0 is the warehouse of the nail bin of Figure 21 6 or the perspective view of support section；
Figure 22 1 is the top perspective of sliding part, which can move in the nail bin of Figure 21 6 with from cartridge deployment Nail；
Figure 22 2 is the bottom perspective view of the sliding part of Figure 22 1；
Figure 22 3 is the front view of the sliding part of Figure 22 1；
Figure 22 4 is the top perspective of driver, which can support one or more follow closely and by the sliding of Figure 22 1 Part is lifted up will follow closely from nail bin and project；
Figure 22 5 is the bottom perspective view of the driver of Figure 22 4；
Figure 22 6 is can be at least partly around the wrappage of the compressible tissue thickness compensation part of nail bin；
Figure 22 7 is the partial sectional view of nail bin, which includes rigid support portion and the compensation of compressible tissue thickness Part, showing nail, never firing position moves to firing position during First ray；
Figure 22 8 is the front view of the nail bin of Figure 22 7；
Figure 22 9 is the thin portion front view of the nail bin of Figure 22 7；
Figure 23 0 is the section end view of the nail bin of Figure 22 7；
Figure 23 1 is the bottom view of the nail bin of Figure 22 7；
Figure 23 2 is the thin portion bottom view of the nail bin of Figure 22 7；
Figure 23 3 is the longitudinal sectional drawing of nail bin and anvil block in the close position, the nail bin include rigid support portion and Compressible tissue thickness compensation part, showing nail, never firing position moves to firing position during First ray；
Figure 23 4 is the anvil block of Figure 23 3 and another sectional view of nail bin, is in and beats after completing it illustrates percussion sequence The anvil block of open position；
Figure 23 5 is the local detail drawing of the nail bin of Figure 23 3, and it illustrates the nails for being in non-firing position；
Figure 23 6 is the cross-section front view of nail bin, which includes rigid support portion and the compensation of compressible tissue thickness Part shows the nail in non-firing position；
Figure 23 7 is the detail drawing of the nail bin of Figure 23 6；
Figure 23 8 is the front view of nail bin and anvil block in an open position, which includes rigid support portion and can press The tissue thickness compensation part of contracting shows the nail in non-firing position；
Figure 23 9 is the front view of nail bin and anvil block in the close position, which includes rigid support portion and can press The tissue thickness compensation part of contracting, show the nail in non-firing position and be trapped in anvil block and tissue thickness compensation part it Between tissue；
Figure 24 0 is the anvil block of Figure 23 9 and the detail drawing of nail bin；
Figure 24 1 is the front view of nail bin and anvil block in the close position, which includes rigid support portion and can press The tissue thickness compensation part of contracting shows the nail in non-firing position, show be positioned between anvil block and nail bin compared with Thick tissue；
Figure 24 2 is the anvil block of Figure 24 1 and the detail drawing of nail bin；
Figure 24 3 is the anvil block of Figure 24 1 and the front view of nail bin, and it illustrates be positioned in having between anvil block and nail bin The tissue of different-thickness；
Figure 24 4 is the anvil block of Figure 24 1 and the detail drawing of nail bin, as shown in Figure 24 3；
Figure 24 5 is to show the tissue thickness compensation part compensated to the different tissues thickness being trapped in different nails Schematic diagram；
Figure 24 6 is to show tissue thickness compensation part to apply compression pressure to by one or more crosscutting blood vessel of staple line Schematic diagram；
Figure 24 7 is the schematic diagram for being shown in which the case where one or more nails are not appropriately formed；
Figure 24 8 is to show the schematic diagram for the tissue thickness compensation part that can compensate for imappropriate forming nail；
Figure 24 9 is to show showing for the tissue thickness compensation part being positioned in the tissue regions of plurality of staple line intersection It is intended to；
Figure 25 0 is to show the schematic diagram for the tissue being trapped in nail；
Figure 25 1 is to show the schematic diagram of the tissue and tissue thickness compensation part that are trapped in nail；
Figure 25 2 is to show the schematic diagram for the tissue being trapped in nail；
Figure 25 3 is to show the schematic diagram of the thick tissue and tissue thickness compensation part that are trapped in nail；
Figure 25 4 is to show the schematic diagram of the thin tissue and tissue thickness compensation part that are trapped in nail；
Figure 25 5 is to show the signal of the tissue with interior thickness and tissue thickness compensation part that are trapped in nail Figure；
Figure 25 6 is to show the tissue and tissue thickness compensation part with another interior thickness being trapped in nail Schematic diagram；
Figure 25 7 is to show the schematic diagram of the thick tissue and tissue thickness compensation part that are trapped in nail；
Figure 25 8 is the partial cutaway view of the end effector of surgery suturing appliance, and it illustrates be in retraction, do not fire position The trigger shaft and nail percussion sliding part set；
Figure 25 9 is another partial cutaway view of the end effector of Figure 25 8, and it illustrates promote position in part Trigger shaft and nail percussion sliding part；
Figure 26 0 is the sectional view of the end effector of Figure 25 8, and it illustrates in being fully advanced or the percussion of firing position Bar；
Figure 26 1 is the sectional view of the end effector of Figure 25 8, and it illustrates the percussions that retraction position is in after being fired Bar and the nail percussion sliding part for staying in its complete firing position；
Figure 26 2 is the detail drawing of the trigger shaft in retraction position of Figure 26 1；
Figure 26 3 be include nail bin surgery suturing appliance end effector partial cutaway view, which includes tissue Thickness compensation part and it is at least partially positioned at nail therein；
Figure 26 4 is another partial cutaway view of the end effector of Figure 26 3, and it illustrates relative to being positioned in nail bin The nail that the anvil block on opposite is at least partly moved and/or rotated；
Figure 26 5 is the partial cutaway view of the end effector of surgery suturing appliance according at least one embodiment；
Figure 26 6 is the partial cutaway view according to the end effector of at least one alternative embodiment；
Figure 26 7 is the partial cutaway view according to the end effector of another alternative embodiment；
Figure 26 8 is the perspective view of the end effector of surgery suturing appliance according at least one embodiment；
Figure 26 9 is the partial cutaway view for being shown as the end effector of Figure 26 8 in flexing conditions；
Figure 27 0 is the partial cutaway view of the end effector of Figure 26 9 in release conditions；
Figure 27 1 is the perspective view for including the end effector that tissue thickness compensation part covers；
Figure 27 2 is the rear perspective view of the tissue thickness compensation part set in Figure 27 1；
Figure 27 3 be include multiple guide rails end effector perspective view, the multiple guide rail is from support section and tool There is the tissue thickness compensation part for being defined in longitudinal cavity therein to extend；
Figure 27 4 is the perspective view of the tissue thickness compensation part of Figure 27 3；
Figure 27 5 be include multiple teeth end effector perspective view, the multiple tooth from support portion and The tissue thickness compensation part being engaged with it extends；
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 of Figure 27 6；
Figure 27 8 is the partial longitudinal sectional view of the anvil block of Figure 27 6；
Figure 27 9 is the transverse cross-sectional view of the anvil block of Figure 27 6；
Figure 28 0 is the front view for including the substantially percussion nail of B shape configuration；
Figure 28 1 be include the one leg being deformed inward and the one leg deformed outward percussion nail front view；
Figure 28 2 be include the two legs being outwardly formed percussion nail front view；
Figure 28 3 is the local perspective view of the support section of nail bin, which includes that detachable and/or interchangeable nail leg is led To device；
Figure 28 4 is the partial cutaway view of the nail bin of Figure 28 3, and it illustrates the nails from cartridge deployment；
Figure 28 5 is the detail drawing of the sectional view of Figure 28 4 after nail bin is fired；
Figure 28 6 be include tissue thickness compensation part nail bin exploded view, the tissue thickness compensation part include be defined in it In gap；
Figure 28 7 is to show the schematic diagram of the tissue thickness compensation part for the Figure 28 6 being implanted against tissue；
Figure 28 8 is to show another schematic diagram of the tissue thickness compensation part for the Figure 28 6 being implanted against tissue；
Figure 28 9 be include lateral holding member nail bin sectional perspective view, the lateral holding member is from its support section Extend, tissue thickness compensation part can be held in place；
Figure 29 0 is the sectional view of the nail bin for suturing tissue of Figure 28 9；
Figure 29 1 is another sectional view of the nail bin of Figure 28 9, tissue thickness's compensation it illustrates positive motion far from implantation The support section of part；
Figure 29 2 is the sectional perspective view of nail bin, which includes that tissue thickness compensation part can be remained to support section Lateral holding member；
Figure 29 3 is the sectional view of the nail bin for suturing tissue of Figure 29 2；
Figure 29 4 is another sectional view of the nail bin of Figure 29 2, tissue thickness's compensation it illustrates positive motion far from implantation The support section of part；
Figure 29 5 is the holding that tissue thickness compensation part is remained to the support section of nail bin according at least one embodiment The cross-sectional details figure of device；
Figure 29 6 be according at least one embodiment include the part section with the nail bin of staple drivers of different height Figure；
Figure 29 6A is the nail with different non-firing heights for showing the staple drivers of Figure 29 6 and being supported on Schematic diagram；
Figure 29 7 be show the tissue thickness compensation part including variable thickness, the staple drivers with different height and The schematic diagram of nail with different unshaped height；
Figure 29 8 is the nail for showing the Figure 29 7 for being implanted to tissue and the schematic diagram of tissue thickness compensation part；
Figure 29 9 is the office of the nail bin including tissue thickness compensation part with different thickness according at least one embodiment Portion's sectional view；
Figure 30 0 is the sectional view of the end effector of the surgery suturing appliance in open configuration；
Figure 30 1 is the sectional view for showing the end effector of Figure 30 0 in part percussion configuration；
Figure 30 2 is the sectional view for showing the end effector in the Figure 30 0 for being again turned on configuration；
Figure 30 3 is the sectional view of the end effector of surgery suturing appliance according at least one embodiment, surgery seam Clutch tool includes the staple drivers with different height and wavy platform surface；
Figure 30 4 is the sectional view of the end effector of surgery suturing appliance according at least one embodiment, surgery seam Clutch tool includes the staple drivers with different height and staged platform surface；
Figure 30 5 is the perspective view for the nail bin being loaded into the actuator of surgery suturing appliance using nail bin application device；
Figure 30 6 is the bottom perspective view of the nail bin application device of Figure 30 5；
Figure 30 7 is to fit into the side view of the nail bin application device of Figure 30 5 of nail bin；
Figure 30 8 is the sectional view of the component of Figure 30 7；
Figure 30 9 is the perspective view of nail bin application device component according at least one embodiment, the nail bin application device group Part further includes the Top tissue thickness compensation part being located on the top surface of nail bin application device；
Figure 31 0 is the Top tissue thickness compensation part of Figure 30 9 and the exploded view of nail bin application device；
Figure 31 0A be include the exploded view for pulling the nail bin application device component of component, which can make to be attached to The Top tissue thickness compensation part of nail bin application device separates；
Figure 31 1 is the partial exploded view according to the nail bin application device component of at least one alternative embodiment；
Figure 31 2 is the perspective view of nail bin application device component, which includes that top tissue thickness is mended Part and nail bin are repaid, under which includes multiple holding feature structures extending therefrom and the nail bin includes Portion's tissue thickness compensation part；
The nail bin application device component for Figure 31 2 that Figure 31 3 is located in staple cartridge channel is filled with nail bin application is closed to Set the front view of the anvil block on component；
Figure 31 4 is the nail of anvil block and the Figure 31 2 just removed from end effector in the Figure 31 3 for being again turned on position The front view of storehouse application device；
The Top tissue thickness compensation part and the tissue among Lower tissue thickness compensation part that Figure 31 4A is located at Figure 31 2 Sectional view；
Figure 31 4B is to show the Top tissue thickness compensation part and lower part group for being sewn onto tissue and being cut off by cutting element Knit the sectional view of thickness compensation part；
Figure 31 5 is to show according at least one embodiment the schematic diagram being inserted into tissue thickness compensation part in anvil block；
Figure 31 6 is the sectional view of the tissue thickness compensation part of Figure 31 5；
Figure 31 7 is the exploded view of the tissue thickness compensation part and anvil block according at least one alternative embodiment；
Figure 31 8 is the perspective view of nail bin application device component according at least one embodiment, the nail bin application device group Part 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 component of Figure 31 8, which is positioned in nail bin In the anvil block of channel and just tissue thickness compensation part movement toward upper；
Figure 32 0 is shown after Top tissue thickness compensation part is engaged with anvil block, is removed from end effector The nail bin application device of Figure 31 8；
Figure 32 1 is the section end view of the anvil block moved towards the Top tissue thickness compensation part of Figure 31 8；
Figure 32 2 is the section end view of the anvil block engaged with Top tissue thickness compensation part；
Figure 32 3 be include nail bin surgery suturing appliance end effector sectional view, which includes by multiple Fastener is attached to the tissue thickness compensation part of the sectional of the support section of nail bin；
Figure 32 4 is the sectional view of the end effector of Figure 32 3, and it illustrates the firing members for being in part firing position；
Figure 32 5 is the sectional view of the end effector of Figure 32 3, the tissue thickness it illustrates positive motion far from part implantation The support section of compensating part；
Figure 32 6 is the local perspective view of the support section of Figure 32 3；
Figure 32 7 is the perspective view of nail deployment sliding part according at least one embodiment；
Figure 32 8 is the front view of the sliding part of Figure 32 7；
Figure 32 9 be include nail bin surgery suturing appliance end effector perspective view, which includes tissue thickness Compensating part and the multiple nail guiders being located in tissue thickness compensation part；
Figure 33 0 is the tissue thickness compensation part of Figure 32 9 in non-percussion configuration and the partial cutaway view of nail guider；
Figure 33 1 is the tissue thickness compensation part of Figure 32 9 in percussion configuration and the partial cutaway view of nail guider；
Figure 33 2 is the section of the nail bin according at least one embodiment including tissue thickness compensation part and support section Figure；
Figure 33 3 is the partial cutaway view of tissue thickness compensation part, nail guide layer and the nail in non-firing position；
Figure 33 4 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 33 5 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 33 6 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 33 7 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 33 8 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 33 9 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 34 0 is the detail drawing in the region on the top of the nail around Figure 33 9；
Figure 34 1 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 34 2 is the detail drawing in the region on the top of the nail around Figure 34 1；
Figure 34 3 is according to the tissue thickness compensation part of at least one alternative embodiment, nail guide layer and in not hitting Send out the partial cutaway view of the nail of position；
Figure 34 4 is the saturating of the nail guide layer according at least one alternative embodiment and multiple nails in non-firing position View；
Figure 34 5 is the end-view for the tissue thickness compensation part that can be used together with circular surgical staplers；
Figure 34 6 is the tissue thickness compensation part of Figure 34 5 and the perspective view of circular surgical staplers；
Figure 34 7 is thick according to the tissue that can be used together with circular surgical staplers of at least one alternative embodiment Spend the end-view of compensating part；
Figure 34 8 is the tissue thickness compensation part of Figure 34 7 and the perspective view of circular surgical staplers；
Figure 34 9 is the end-view for the tissue thickness compensation part that can be used together with circular surgical staplers；
Figure 35 0 is the end-view of the tissue thickness compensation part of Figure 34 9 in part expanded 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 of Figure 35 1 of tissue positioning；
Figure 35 3 is the end-view of the surgery suturing appliance of Figure 35 1, which further includes being located in nail bin and group Tissue thickness compensation part between knitting；
Figure 35 4 is the nail being deployed in tissue from the surgery suturing appliance for the Figure 35 1 for not having tissue thickness compensation part Local perspective view；
Figure 35 5 is the office that the nail in tissue is deployed to from the surgery suturing appliance of Figure 35 1 with tissue thickness compensation part Portion's perspective view；
Figure 35 6 is the partial cutaway view of the end effector of the surgery suturing appliance of Figure 35 1, including being in first position Anvil plate；
Figure 35 7 is the partial cutaway view of the end effector of the surgery suturing appliance of Figure 35 1, and it illustrates be in second The anvil plate of the Figure 35 6 set；
Figure 35 8 be include nail bin surgery suturing appliance end effector sectional view, the nail bin include gap setting Element；
Figure 35 9 is the perspective view for showing firing member, which cuts at the end of the firing schedule of firing member The gap sets element of Figure 35 8；
Figure 36 0 be include nail bin surgery suturing appliance end effector sectional view, which includes flexible nose；
Figure 36 1 is the sectional view of the end effector of Figure 36 0, and it illustrates the noses for being in flexure configuration；
Figure 36 2 be include nail bin surgery suturing appliance end effector sectional view, which includes slidably portion Point；
Figure 36 3 is the sectional view of the end effector of Figure 36 2, and it illustrates the slidably parts distad slided；
Figure 36 4 be include support section and tissue thickness compensation part surgery suturing appliance end effector section Figure, which includes inclined platform surface and the tissue thickness compensation part includes different-thickness；
Figure 36 5 be include support section and tissue thickness compensation part surgery suturing appliance end effector section Figure, which includes inclined platform surface and the tissue thickness compensation part includes uniform thickness；
Figure 36 6 be include tissue thickness compensation part with different thickness nail bin perspective view；
Figure 36 7 is the end-view of the nail bin of Figure 36 6；
Figure 36 8 be include longitudinal layer tissue thickness compensation part sectional perspective view；
Figure 36 9 is the exploded perspective according at least one alternative embodiment including multiple layers of tissue thickness compensation part Figure；
Figure 37 0 is the perspective view of disposable loading unit, which includes that can compensate tissue thickness Part releasably holds holding member thereon；
Figure 37 1 is the perspective view of tissue thickness compensation part, which includes that can mend the tissue thickness Repay the holding member that part releasably holds disposable loading unit；
Figure 37 2 is attached to the perspective view of the tissue thickness compensation part of Figure 37 1 of disposable loading unit；
Figure 37 3 is the end-view of the disposable loading unit of Figure 37 2；
Figure 37 4 is the perspective view of tissue thickness compensation part, which includes that can compensate tissue thickness Part releasably holds the holding member of disposable loading unit；
Figure 37 5 is attached to the perspective view of the tissue thickness compensation part of Figure 37 4 of disposable loading unit；
Figure 37 6 is the end-view of the disposable loading unit of Figure 37 5；
Figure 37 7 is the perspective view of tissue thickness compensation part, which includes that can compensate tissue thickness Part releasably holds the holding member of disposable loading unit；
Figure 37 8 is attached to the perspective view of the tissue thickness compensation part of Figure 37 7 of disposable loading unit；
Figure 37 9 is located at the perspective of the tissue thickness compensation part application device in the actuator of disposable loading unit Figure；
Figure 38 0 is the top perspective of the tissue thickness compensation part application device of Figure 37 9；
Figure 38 1 is the bottom perspective view of the tissue thickness compensation part application device of Figure 37 9；
Figure 38 2 is the tissue being positioned in the actuator of disposable loading unit according at least one alternative embodiment The perspective view of thickness compensation part application device；
Figure 38 3 is the top perspective of the tissue thickness compensation part application device of Figure 38 2；
Figure 38 4 is the bottom perspective view of the tissue thickness compensation part application device of Figure 38 2；
Figure 38 5 is the front view of disposable loading unit, the disposable loading unit include be capable of support nail cartridge can pivot Turn jaw；
Figure 38 6 is the sectional view of nail bin according at least one embodiment, which includes the support portion for being attached to nail bin The tissue thickness compensation part divided；
Figure 38 7 is the sectional view of nail bin according at least one embodiment, which includes the support portion for being attached to nail bin The tissue thickness compensation part divided；
Figure 38 8 is the sectional view of nail bin according at least one embodiment, which includes the support portion for being attached to nail bin The tissue thickness compensation part divided；
Figure 38 9 is the perspective view of the tissue thickness compensation part of Figure 38 7；
Figure 39 0 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 39 1 is the detail drawing of the non-woven material of the tissue thickness compensation part of Figure 39 0；
Figure 39 2 is the tissue thickness compensation part for showing the Figure 39 0 being implanted against tissue and from end effector release Front view；
Figure 39 3 is the detail drawing of the non-woven material of tissue thickness compensation part according at least one embodiment；
Figure 39 4 is the schematic diagram that the cluster of randomly-oriented crimped fibre is illustrated according at least one implementation；
Figure 39 5 is the schematic diagram that the cluster of randomly-oriented crimped fibre is illustrated according at least one implementation；
Figure 39 6 is the schematic diagram that the construction of crimped fibre is illustrated according at least one implementation；
Figure 39 7 is the schematic diagram that the construction of crimped fibre is illustrated according at least one implementation；
Figure 39 8 is the schematic diagram that the construction of crimped fibre is illustrated according at least one implementation；
Figure 39 9 is the section plan of the coiled fiber in tissue thickness compensation part according at least one embodiment；
Figure 39 9A is the section plan of the coiled fiber of Figure 39 9；
Figure 39 9B is the cross-sectional details figure of the tissue thickness compensation part of Figure 39 9；
Figure 40 0 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 40 1 is the schematic diagram for showing the deformation of tissue thickness compensation part of Figure 40 0；
Figure 40 2 is the schematic diagram for being used for the weaving suture loading of tissue thickness compensation part according at least one embodiment, Show the weaving suture loading in loading configuration；
Figure 40 3 is the schematic diagram of the weaving suture loading of Figure 40 2, and it illustrates the weaving suture loadings in release configuration；
Figure 40 4 is the tissue thickness compensation part of the weaving suture loading in the end effector of surgical instruments with Figure 40 2 Plan view；
The perspective of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment of Figure 40 5 Figure；
Figure 40 6 is the partial plan layout of the tissue thickness compensation part of Figure 40 5；
Figure 40 7 is the exploded view of the end effector of Figure 39 0 and the fastener cartridge assembly of tissue thickness compensation part；
Figure 40 8 is the partial cutaway view of the fastener cartridge assembly of Figure 40 7, and it illustrates do not fire, partially fire and hit The fastener of hair；
Figure 40 9 is the front view of the fastener cartridge assembly of Figure 40 7, and it illustrates drivers to fire fastener from fastener cartridge The nail cavity of component enters tissue thickness compensation part；
Figure 41 0 is the detail drawing of the fastener cartridge assembly of Figure 40 9；
Figure 41 1 is the front view of the tissue of the tissue thickness compensation part and capture of Figure 39 0 in percussion fastener；
Figure 41 2 is the front view of the tissue of the tissue thickness compensation part and capture of Figure 39 0 in percussion fastener；
Figure 41 3 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 41 4 is the schematic diagram for showing the deformation of the deformable tube of tissue thickness compensation part of Figure 41 3；
Figure 41 5 is the detail drawing of the deformable tube of the tissue thickness compensation part of Figure 41 3；
Figure 41 6 is that the schematic diagram of the deformation of deformable tube of tissue thickness compensation part is exemplified according at least one implementation；
Figure 41 7 is the front view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part packet Include a tubular element against tissue implantation；
Figure 41 8 is the front view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part packet Include multiple tubular elements against tissue implantation；
Figure 41 9 is the local perspective view of the deformable tube including tubulose dot matrix according at least one embodiment；
Figure 42 0 is the front view of the tubulose strand of the deformable tube of Figure 41 9.
Figure 42 1 is the front view of the deformable tube of Figure 41 9；
Figure 42 2 is the front view of more tubulose strands of the deformable tube for Figure 41 9 according to various embodiments；
Figure 42 3 is the front view against the tubulose dot matrix of Figure 41 9 of tissue implantation；
Figure 42 4 is the local perspective view of deformable tube according at least one embodiment；
Figure 42 5 is the local perspective view of deformable tube according at least one embodiment；
Figure 42 6 is the local perspective view of deformable tube according at least one embodiment；
Figure 42 7 is the front view of the deformable tube of Figure 42 6；
Figure 42 8 is the local perspective view of deformable tube according at least one embodiment；
Figure 42 9 is the local perspective view of deformable tube according at least one embodiment；
Figure 43 0 is the local perspective view of deformable tube according at least one embodiment；
Figure 43 1 is the perspective view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the end effector of surgical instruments；
Figure 43 2 is the front view of the tubular element of the tissue thickness compensation part of Figure 43 1；
Figure 43 3 is the tissue thickness compensation part of Figure 43 1 and the orthogonal view of end effector, and it illustrates be in not clamp The end effector of configuration；
Figure 43 4 is the tissue thickness compensation part of Figure 43 1 and the orthogonal view of end effector, it illustrates in clamping and The end effector of percussion configuration；
Figure 43 5 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；
Figure 43 6 is the tissue thickness compensation part of Figure 43 5 and the orthogonal view of end effector, it illustrates in clamping and The end effector of percussion configuration；
Figure 43 7 is that the tissue thickness compensation part in the end effector of surgical instruments is being just according at least one embodiment Sectional view；
Figure 43 8 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；
Figure 43 9 is the tissue thickness compensation part of Figure 43 8 and the orthogonal view of end effector, it illustrates in clamping and The end effector of percussion configuration；
Figure 44 0 is the perspective view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the end effector of surgical instruments；
Figure 44 1 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；
Figure 44 2 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；
Figure 44 3 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；
Figure 44 4 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part It is located in the end effector of surgical instruments；
Figure 44 5 is the partial plan layout of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is located in the end effector of surgical instruments；
Figure 44 6 is the partial plan layout of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is located in the end effector of surgical instruments；
Figure 44 7 is the tissue thickness compensation part of Figure 44 5 and the local orthogonal view of end effector, and it illustrates in not The end effector of clamping configuration；
Figure 44 8 is the tissue thickness compensation part of Figure 44 5 and the local orthogonal view of end effector, and it illustrates in folder The end effector of tight configuration；
Figure 44 9 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 45 0 is the tissue thickness compensation part of Figure 44 9 and the front view of end effector；
Figure 45 1 is the tissue thickness compensation part of Figure 44 9 and the perspective view of end effector, and it illustrates transport towards clamping configuration The anvil block of dynamic end effector；
Figure 45 2 is the tissue thickness compensation part of Figure 44 9 and the front view of end effector, and it illustrates be in clamping configuration End effector；
Figure 45 3 is the orthogonal view of the tubular element of the tissue thickness compensation part of Figure 44 9 in undeformed configuration；
Figure 45 4 is the orthogonal view of the tubular element of the tissue thickness compensation part of Figure 44 9 in deformed configuration；
Figure 45 5 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 45 6 is the tissue thickness compensation part of Figure 45 5 and the orthogonal view of end effector, and it illustrates in clamping structure The end effector of type；
Figure 45 7 is the tissue thickness compensation part of Figure 45 5 and the orthogonal view of end effector, it illustrates in percussion and The end effector of the non-clamping configuration in part；
Figure 45 8 is the perspective view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the end effector of surgical instruments；
Figure 45 9 is the orthogonal view of tissue thickness compensation part according at least one embodiment, the tissue thickness compensation part The anvil block of end effector fixed to surgical instruments；
Figure 46 0 is the tissue thickness compensation part of Figure 45 9 and the orthogonal view of end effector, and it illustrates in clamping structure The end effector of type；
Figure 46 1 is the tissue thickness compensation part of Figure 45 9 and the orthogonal view of end effector, it illustrates in percussion and The end effector of the non-clamping configuration in part；
Figure 46 2 is the tissue thickness compensation part of Figure 46 1 and the detail drawing of end effector；
Figure 46 3 is the tissue thickness's compensation being clamped in the end effector of surgical instruments according at least one embodiment The orthogonal view of part, it illustrates nail is disposed by nail percussion sliding part；
Figure 46 4 is the tissue thickness compensation part of Figure 46 3 and the orthogonal view of end effector, and it illustrates in clamping structure The end effector of type；
Figure 46 5 is the tissue thickness compensation part of Figure 46 3 and the orthogonal view of end effector, and it illustrates in percussion structure The end effector of type；
Figure 46 6 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 46 7 is the perspective view of the tubular element of the tissue thickness compensation part of Figure 46 6；
Figure 46 8 is the perspective view of the tubular element for the Figure 46 7 being cut off between first end and second end；
Figure 46 9 is the perspective view of the tissue thickness compensation part of Figure 46 6, and it illustrates the cuttings of cutting tissue thickness compensation part Element and the nail for engaging tissue thickness compensation part；
Figure 47 0 is the perspective that the frame of tissue thickness compensation part of Figure 46 6 can be made according at least one embodiment Figure；
Figure 47 1 is the orthogonal view of the frame of Figure 47 0, and it illustrates the tissue thickness of cured Figure 46 6 in the frame benefits Repay part；
Figure 47 2 is the group for removing from the frame of Figure 47 1 and being prepared for being trimmed by least one cutting device Knit the orthogonal view of thickness compensation part；
Figure 47 3 is that the tissue of Figure 47 2 after at least one cutting device trims tissue thickness compensation part is thick Spend the orthogonal view of compensating part；
Figure 47 4 is the orthogonal view of the tissue thickness compensation part formed in the frame of Figure 47 1, and it illustrates with various The cut-off tube of cross-sectional geometry；
Figure 47 5 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment View；
Figure 47 6 is the detail drawing of the tissue thickness compensation part of Figure 47 5 according at least one embodiment；
Figure 47 7 is the local perspective view of tissue thickness compensation part according at least one embodiment；
Figure 47 8 is the local perspective view of tissue thickness compensation part according at least one embodiment；
Figure 47 9A is the tissue thickness compensation part of Figure 47 5 and the orthogonal view of end effector, and it illustrates be in not press from both sides The end effector of tight configuration；
Figure 47 9B is the tissue thickness compensation part of Figure 47 5 and the orthogonal view of end effector, and it illustrates in clamping The end effector of configuration；
Figure 47 9C is the tissue thickness compensation part of Figure 47 5 and the orthogonal view of end effector, and it illustrates in clamping With the end effector of percussion configuration；
Figure 47 9D is the orthogonal view for capturing the tissue thickness compensation part of Figure 47 5 in percussion nail；
Figure 47 9E is the orthogonal view for capturing the tissue thickness compensation part of Figure 47 5 in percussion nail, and it illustrates tissues Thickness compensation part further expands；
Figure 48 0 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Pseudosection；
Figure 48 1 is the partial elevation view for capturing the tissue thickness compensation part of Figure 48 0 in percussion nail；
Figure 48 2 is the front view of the deformable tube of the tissue thickness compensation part of Figure 48 0；
Figure 48 3 is the front view of deformable tube according at least one embodiment；
Figure 48 4 is the perspective section view of the tissue thickness compensation part of Figure 48 0；
Figure 48 5 is the saturating of the tissue thickness compensation part in the end effector of surgical instruments according at least one embodiment Pseudosection；
Figure 48 6 is the perspective view of tissue thickness compensation part according at least one embodiment；
Figure 48 7 is the local orthogonal view of the tissue thickness compensation part of Figure 48 6, and it illustrates thick with tissue and with tissue Spend the fastener of compensating part engagement；
Figure 48 8 is the perspective section view of tissue thickness compensation part according at least one embodiment；
Figure 48 9 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 0 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 1 is the front view of tissue thickness compensation part according at least one embodiment, and the tissue thickness compensation part is fixed Position is in the rounded ends actuator of surgical instruments；
Figure 49 2 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 3 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 4 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 5 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 6 is the front view of tissue thickness compensation part according at least one embodiment；
Figure 49 7 is the local perspective view of tissue thickness compensation part according at least one embodiment；
Figure 49 8 is the local perspective view of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is located in the end effector of surgical instruments；
Figure 49 9 is the local perspective view of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part has the fastener being located in its hole；
Figure 50 0 is the local perspective view of the tissue thickness compensation part of Figure 49 8, and it illustrates the tissues for being in undeformed configuration Thickness compensation part；
Figure 50 1 is the local perspective view of the tissue thickness compensation part of Figure 49 8, and it illustrates the groups for being in part deformed configuration Knit thickness compensation part；
Figure 50 2 is the local perspective view of the tissue thickness compensation part of Figure 49 8, and it is thick that it illustrates the tissues in deformed configuration Spend compensating part；
Figure 50 3 is the perspective view of tissue thickness compensation part according at least one embodiment；
Figure 50 4 is the perspective of the end effector of the suture instruments according at least one embodiment including anvil block and nail bin Figure；
Figure 50 5 is the sectional view of the end effector of Figure 50 4, and it illustrates be located in nail bin to be in non-cock Nail and include the tissue thickness compensation part in the sealing container for not piercing through state, wherein for illustrative purposes, container It is illustrated as its part to be removed；
Figure 50 6 is the sectional view of the end effector of Figure 50 4, and it illustrates Figure 50 5 at least partly cock Nail and at least partly pierce through state container；
Figure 50 7 is the perspective view of the end effector of suture instruments according at least one embodiment, the suture instruments packet Include anvil block and nail bin；
Figure 50 8 is the sectional view of the end effector of Figure 50 7, and it illustrates be located in nail bin to be in non-cock Nail and be located in the tissue thickness compensation part of nail bin in not piercing through the sealing container of state, wherein in order to illustrate Purpose, container are illustrated as its part and are removed；
Figure 50 9 is the sectional view of the end effector of Figure 50 7, and it illustrates Figure 50 8 at least partly cock Nail and nail bin at least partly pierce through state container；
Figure 51 0 is the suture according to the perspective view of the end effector of the suture instruments of at least one alternative embodiment Instrument includes anvil block and the sealing container for being attached to anvil block, wherein for illustrative purposes, container is illustrated as its part and is removed；
Figure 51 1 is the sectional view of the end effector of Figure 51 0, it illustrates at least partly from nail bin fire nail and It is attached to the container at least partly puncture state of anvil block；
Figure 51 2 is attached to the sectional view of the container of the anvil block of Figure 51 0, which is shown with extended mode；
Figure 51 3 is attached to the detail drawing of the container of the anvil block of Figure 51 2, which is shown with extended mode；
Figure 51 4 shows the container upwardly extended in the side transverse to staple line；
Figure 51 5 shows the multiple containers upwardly extended in the side transverse to staple line；
Figure 51 6 is the sectional view of nail bin according to various embodiments；
Figure 51 7 is the partial cutaway view of Figure 51 6 under implantation condition；
Figure 51 8A is local perspective view of the tissue thickness compensation part before extension；
Figure 51 8B is local perspective view of the tissue thickness compensation part of Figure 51 8 during extension；
Figure 51 9 is that the part of the tissue thickness compensation part of the composition swollen comprising fluid-soluble according to various embodiments is saturating View；
Figure 52 0 is the sectional view for being oriented the tissue adjacent with tissue thickness compensation part according to various embodiments；
Figure 52 1 is the partial cutaway view of Figure 52 0 after nail bin is fired；
Figure 52 2 is the schematic diagram of the tissue thickness compensation part for the Figure 52 0 for showing with organizing adjacent implantation；
Figure 52 3 is the local perspective view of tissue thickness compensation part according to various embodiments；
Figure 52 4 is the perspective view that can receive the jaw of tissue thickness compensation part of Figure 52 3；
Figure 52 5 is the partial cutaway view of nail bin, and it illustrates the nails from cartridge deployment；
Figure 52 6 is located at Top tissue thickness compensation part and lower part tissue thickness in the actuator of disposable loading unit Spend the perspective view of compensating part；
Figure 52 7A is the section of the Lower tissue thickness compensation part of Figure 52 6 manufactured in a mold according to various embodiments Figure；
Figure 52 7B is the sectional view of the three-layer weave thickness compensation part manufactured in a mold according to various embodiments；
Figure 52 8 is the sectional view of anvil block according to various embodiments, which includes the tissue thickness comprising reinforcing material Compensating part；
Figure 52 9 is the sectional view of tissue according to various embodiments, the tissue be located in Top tissue thickness compensation part with Among Lower tissue thickness compensation part；
Figure 53 0 is the sectional view of Figure 52 9, and it illustrates the nails from cartridge deployment；
Figure 53 1 is the sectional view of Figure 52 9 after nail bin is fired；
Figure 53 2A shows needle according to various embodiments, which can deliver a fluid to the tissue thickness for being attached to nail bin Spend compensating part；
Figure 53 2B be include tissue thickness compensation part nail bin sectional view, which can receive figure The needle of 532A；
Figure 53 3 shows the method for manufacturing tissue thickness compensation part according to various embodiments；
Figure 53 4 is the schematic diagram and method for the thickness compensation part for forming extension according to various embodiments；
Figure 53 5 shows the micella comprising hydrogel precursor；And
Figure 53 6 is the schematic diagram of surgical instruments according to various embodiments, which includes tissue thickness compensation part And the fluid of tissue thickness compensation part can be delivered to；
Figure 53 7 is the local perspective view of tissue thickness compensation part according at least one embodiment, tissue thickness compensation Part is fixed to the anvil block of the end effector of surgical instruments.
Figure 53 8 is the perspective view of the tubular element of the tissue thickness compensation part of Figure 53 7.
Figure 53 9 is the perspective view of the tubular element of Figure 53 8, it illustrates the tubular element for being cut into two halves and each The fluid of contact hydroaropic substance in half.
Figure 54 0 is the perspective view of the half for the tubular element of Figure 53 9 cut off, and it illustrates the expansions of cutting tubular element Exhibition.
Through several views, corresponding reference symbol indicates corresponding component.Example shown in this article is in one form Show certain embodiments of the present invention, and the range that such example should not be construed as in any way limiting the present invention.
Specific embodiment
Present applicant also possesses U.S. Patent application below, these patent applications are respectively complete by reference Text is incorporated herein:
The U.S. of entitled " SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS " Patent application 12/894,311 (attorney number END6734USNP/100058)；
Entitled " SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS” U.S. Patent application 12/894,340 (attorney number END6735USNP/100059)；
The United States Patent (USP) Shen of entitled " JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS " It please 12/894,327 (attorney number END6736USNP/100060)；
Entitled " SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND The U.S. Patent application 12/894 of DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS ", 351 (attorney number END6839USNP/100524)；
Entitled " IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM The U.S. Patent application 12/894,338 (attorney number END6840USNP/100525) of ARRANGEMENT "；
Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER " U.S. Patent application 12/894,369 (attorney number END6841USNP/100526)；
The beauty of entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS " State's patent application 12/894,312 (attorney number END6842USNP/100527)；
The U.S. of entitled " SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE " is special 12/894,377 (attorney number END6843USNP/100528) of benefit application；
Entitled " SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL The U.S. Patent application 12/894,339 (attorney number END6847USNP/100532) of ARRANGEMENT "；
Entitled " SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING The U.S. Patent application 12/894,360 (attorney number END6848USNP/100533) of SYSTEM "；
Entitled " SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE (the attorney number END6849USNP/ of U.S. Patent application 12/894,322 of CARTRIDGE ARRANGEMENTS " 100534)；
Entitled " SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES AND SURGICAL STAPLING INSTRUMENTS WITH SYSTEMS FOR PREVENTING ACTUATION 12/894,350 (the attorney number of U.S. Patent application of MOTIONS WHEN A CARTRIDGE IS NOT PRESENT " END6855USNP/100540)；
Entitled " IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE The U.S. Patent application 12/894,383 (attorney number END6856USNP/100541) of LAYERS "；
(the agency of U.S. Patent application 12/894,389 of entitled " COMPRESSIBLE FASTENER CARTRIDGE " People file number END6857USNP/100542)；
The United States Patent (USP) of entitled " FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT " Apply for 12/894,345 (attorney number END6858USNP/100543)；
12/894,306 (the agent of U.S. Patent application of entitled " COLLAPSIBLE FASTENER CARTRIDGE " File number END6859USNP/100544)；
Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION The U.S. Patent application 12/894,318 (attorney number END6860USNP/100546) of MATRIX ELEMENTS "；
Entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT The U.S. Patent application 12/894,330 (attorney number END6861USNP/100547) of MATRIX "；
The U.S. Patent application of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX " 12/894,361 (attorney number END6862USNP/100548)；
Entitled " FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM 12/894,367 (the attorney number of U.S. Patent application of COMPRISING A RETENTION MATRIX " END6863USNP/100549)；
The beauty of entitled " FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER " State's patent application 12/894,388 (attorney number END6864USNP/100550)；
Entitled " FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES " U.S. Patent application 12/894,376 (attorney number END6865USNP/100551)；
Entitled " SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING The U.S. Patent application 13/097,865 (attorney number END6735USCIP1/100059CIP1) of POCKETS "；
The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER " Apply for 13/097,936 (attorney number END6736USCIP1/100060CIP1)；
Entitled " STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE The U.S. Patent application 13/097,954 (attorney number END6840USCIP1/100525CIP1) of PORTION "；
Entitled " STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A 13/097,856 (the attorney number of U.S. Patent application of COMPRESSIBLE PORTION THEREOF " END6841USCIP1/100526CIP1)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS's " U.S. Patent application 13/097,928 (attorney number END6842USCIP1/100527CIP1)；
Entitled " TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING (the attorney number END6843USCIP1/ of U.S. Patent application 13/097,891 of AN ADJUSTABLE ANVIL " 100528CIP1)；
The beauty of entitled " STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION " State's patent application 13/097,948 (attorney number END6847USCIP1/100532CIP1)；
The U.S. Patent application 13/097 of entitled " COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY ", 907 (attorney number END6848USCIP1/100533CIP1)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING (the attorney number END6849USCIP1/ of U.S. Patent application 13/097,861 of DIFFERENT PROPERTIES " 100534CIP1)；
13/097,869 (the generation of U.S. Patent application of entitled " STAPLE CARTRIDGE LOADING ASSEMBLY " Manage people file number END6855USCIP1/100540CIP1)；
Entitled " COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS's " U.S. Patent application 13/097,917 (attorney number END6856USCIP1/100541CIP1)；
The United States Patent (USP) Shen of entitled " STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION " It please 13/097,873 (attorney number END6857USCIP1/100542CIP1)；
Entitled " STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT The U.S. Patent application 13/097,938 (attorney number END6858USCIP1/100543CIP1) of COMPONENTS "；
Entitled " STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent application 13/097,924 (attorney number END6859USCIP1/100544CIP1)；
The U.S. Patent application 13/242,029 of entitled " SURGICAL STAPLER WITH FLOATING ANVIL " (attorney number END6841USCIP2/100526CIP2)；
The U.S. Patent application of entitled " CURVED END EFFECTOR FOR A STAPLING INSTRUMENT " 13/242,066 (attorney number END6841USCIP3/100526CIP3)；
The U.S. Patent application 13/ of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK " 242,086 (attorney number END7020USNP/110374)；
The U.S. of entitled " STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT " Patent application 13/241,912 (attorney number END7019USNP/110375)；
The U.S. Patent application of entitled " SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS " 13/241,922 (attorney number END7013USNP/110377)；
Entitled " SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING (the attorney number END6888USNP3/ of U.S. Patent application 13/241,637 of MULTIPLE ACTUATION MOTIONS " 110378)；And
Entitled " SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END The U.S. Patent application 13/241,629 (attorney number END6888USNP2/110379) of EFFECTOR ".
Present applicant also possesses U.S. Patent application below, these patent applications mention on the same day with the application It hands over, and each is respectively integrally incorporated herein by reference:
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF The U.S. Patent application of CAPSULES " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6864USCIP1/100550CIP1)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS " U.S. Patent application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6864USCIP2/100550CIP2)；
The United States Patent (USP) of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR " Application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP3/100528CIP3)；
Entitled " RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR's " U.S. Patent application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP4/100528CIP4)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE The U.S. Patent application of MEDICAMENT " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP5/ 100528CIP5)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND The U.S. Patent application of EXPANSION " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP6/ 100528CIP6)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A The U.S. Patent application of RESILIENT LOAD " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP7/ 100528CIP7)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A The U.S. Patent application of RESILIENT LOAD " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP8/ 100528CIP8)；
The beauty of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS " State's patent application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP9/100528CIP9)；
Entitled " METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS The U.S. Patent application of FOR SURGICAL STAPLERS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP10/100528CP10)；
The U.S. Patent application No._______________ of entitled " TISSUE THICKNESS COMPENSATORS " (attorney number END6843USCIP11/100528CP11)；
The United States Patent (USP) Shen of entitled " LAYERED TISSUE THICKNESS COMPENSATOR " Please _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP12/100528CP12)；
Entitled " TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS " U.S. Patent application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END6843USCIP13/100528CP13)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A The U.S. Patent application of LOW PRESSURE ENVIRONMENT " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7100USNP/110601)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF The U.S. Patent application of MATERIALS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7101USNP/110602)；
Entitled " MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR's " U.S. Patent application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7107USNP/110603)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF The U.S. Patent application of MEDICAMENTS " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7102USNP/110604)；
Entitled " TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME's " U.S. Patent application _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7103USNP/110605)；
The United States Patent (USP) Shen of entitled " TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS " Please _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7104USNP/110606)；
Entitled " TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH The U.S. Patent application of FEATURES " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7105USNP/110607)；And
Entitled " DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS The United States Patent (USP) Shen of COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS " Please _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (attorney number END7106USNP/110608).
Certain exemplary embodiments will now be described, with provide to the structural principles of apparatus and method as disclosed herein, Function, manufacture and the whole of purposes understand.One or more examples of these embodiments are shown in the accompanying drawings.This field it is common It will be appreciated by the skilled person that specifically describing herein and being illustrated in the device and method in attached drawing is unrestricted exemplary reality Apply example.In conjunction with the feature that an exemplary embodiment is illustrated or described, group can be carried out with the feature of other embodiments It closes.Such modifications and variations are included within the scope of the invention.
Can be used it is disclosed herein or it is claimed for manufacture, formed or in other words article of manufacture or Any of method of product is manufactured, is formed or in other words produces whole or the portion of considered product or product Point, and in the case where the such method of use manufactures, formed or changes sentence and changes the part for saying production considered product or product, Can the rest part of article of manufacture or product in any way, including by using disclosed herein and be claimed For manufacturing, being formed or in other words any of article of manufacture or the other methods of product, and can be with any side Formula combines the various pieces so produced.Similarly, disclosed herein or claimed any product or product Can individualism, in conjunction with so disclosed any other product or product compatible exist or as its entirety portion Divide and exists.Therefore, a particular feature, structure, or characteristic shown or described in a kind of product, product or method can will be combined with whole Or part way is unlimitedly combined with the feature or characteristic of other one or more biocompatible articles, product or method.It is such to repair Change and is included within the scope of the invention with modification.
Referring to certain figures or in other words in the specific embodiment of invention disclosed herein or certain products, production In the case that product or method may include certain structures, characteristic or feature, reader should be appreciated that this indicate those structures, characteristic or Feature can be embodied in considered product, product or method with any compatible combination.In particular, multiple optional structures, Such disclosure of characteristic or feature should be understood as in addition disclosing all that structure, characteristic or feature in combination, But except the case where as structure disclosed in form alternative each other, characteristic or feature.Make in this class formation, characteristic or feature In the case where disclosed in form alternative each other, this should be understood as being disclosed as those alternative forms to be used for mutual replace It changes.
Terms used herein " nearside " and " distal side " be relative to manipulation surgical instruments handle portions clinician and Speech.Term " nearside " refers near the part of clinician, and term " distal side " refers to the part far from clinician.Also It should be appreciated that for the sake of succinct and be clear, can be used herein in conjunction with attached drawing such as "vertical", "horizontal", "up" and "down" it The spatial terminology of class.However, surgical instruments is used with many orientations and position, and these terms are not intended to be restrictive And/or absolute.
Various exemplary means and method are provided to execute laparoscopic type and minimally invasive surgical procedures.However, reader Will be apparent from, various method and apparatus disclosed herein can be used for many surgical procedures and application, including with opening The application that formula surgical procedures combine.With continued reference to present embodiment, reader be will be further understood that, disclosed herein Various instruments can be inserted into any way in vivo, such as by natural hole, pass through the notch being formed in tissue or puncture Hole etc..The working portion or end effector portion of instrument can be inserted directly into patient's body or can be by with service aisles Enter device and be inserted into, the end effector and elongated shaft of surgical instruments can be promoted by the service aisle.
Attached drawing is gone to, wherein the similar component of similar digital representation, Fig. 1, which is shown, to be practiced in multiple views The surgical instruments 10 of several unique benefits.Surgery suturing appliance 10 is designed to manipulate and/or activate operationally to be attached To its various forms and size end effector 12.In Fig. 1-Fig. 1 E, such as end effector 12 includes elongated passageway 14, which forms the lower jaw 13 of end effector 12.Elongated passageway 14 can support " implanted " nail bin 30 and The anvil block 20 of the upper jaw 15 as end effector 12 can also be supported with moving.
Elongated passageway 14 can be made of such as 300 and 400 series 17-4 and 17-7 stainless steels, titanium etc., and between being formed with Every side wall 16.Anvil block 20 can be made of such as 300 and 400 series 17-4 and 17-7 stainless steels, titanium etc., and can have under nail forming Surface, the nail shaped lower face are generally indicated as 22, are formed with multiple nail shapes pits 23.Referring to Figure 1B-Fig. 1 E. In addition, anvil block 20 have from its to nearside it is raised be divided into two-part slide assemblies 24.Anvil block pin 26 is from slide assemblies 24 It is each transverse direction lateral process, with receive in the side wall 16 of elongated passageway 14 respective slots or opening 18 in, thus be conducive to by Anvil block pin is movable or is pivotably attached to the respective slots or opening.
Various forms of implanted nail bins can be used together with surgical instruments disclosed herein.It will discuss in more detail below State specific nail bin configuration and construction.However, in figure 1A, showing implanted nail bin 30.Nail bin 30 has main part 31, The main part is by compressible hemostasis agent material (such as oxidized regenerated cellulose (" ORC ") or bioabsorbable foam) structure At wherein being supported by the not formed metal nail 32 of multirow.It is impacted and prevent hemostasis agent material from introducing and fixed for anti-non-magnetic shim It is activated during the process of position, entire storehouse can be coated with or be enclosed with biodegradable film 38, such as with trade markIt sells Polydioxanone film polyglycerol sebacate (PGS) film or by PGA (polyglycolic acid, with trade mark Vicryl sale), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, with trade mark Monocryl sell) or PGA, PCL, PLA, PDS compound formed other biodegradable films, it is described biodegradable Film it is only just permeable in broken dissipate.The main body 31 of nail bin 30 be sized to removedly be supported on it is as shown in the figure In elongated passageway 14, so that each nail 32 therein is and in anvil block when anvil block 20 is driven to and contacts with the formation of nail bin 30 Corresponding nail shapes pit 23 is aligned.
In use, once end effector 12 is positioned adjacent to target tissue, end effector 12 is just manipulated to target Tissue capture is clamped between the top surface 36 of nail bin 30 and the staple forming surface 22 of anvil block 20.32 shape in the following way of nail At: move anvil block 20 in the path for being arranged essentially parallel to elongated passageway 14 so as to staple forming surface 22 and more specifically make it In nail shapes pit 23 substantially simultaneously contact the top surface 36 of nail bin 30.When anvil block 20 continues to move in nail bin 30, nail 32 leg 34 contacts corresponding nail shapes pit 23 in anvil block 20, and the nail shapes pit is for being bent nail leg 34 so that nail 32 It is configured to " B shape ".The further movement of anvil block 20 towards elongated passageway 14 will compress further nail 32 so that its be configured to it is desired Final forming height " FF ".
Above-mentioned nail forming process is substantially illustrated in Figure 1B-Fig. 1 E.For example, Figure 1B shows end effector 12, wherein target Tissue " T " is located between anvil block 20 and the top surface 36 of implanted nail bin 30.Fig. 1 C shows the initial clamped position of anvil block 20, wherein Anvil block 20 has been closed on target tissue " T ", and target tissue " T " is clamped between anvil block 20 and the top surface 36 of nail bin 30.Figure 1D shows initial nail forming, and wherein anvil block 20 has started to compress nail bin 30, so that the leg 34 of nail 32 is begun through in anvil block 20 Nail shapes pit 23 and shape.Fig. 1 E shows the nail 32 that final molding condition is in across target tissue " T ", for clarity Remove anvil block 20.Once nail 32 shapes and is fastened to target tissue " T ", surgeon just makes anvil block 20 move to open position, with Warehouse 31 and nail 32 is set to be able to maintain and be attached to target tissue when end effector 12 is withdrawn from from patient.When two jaws 13,15 When common clamping, end effector 12 makes all nails while shaping.Remaining " is crushed " material of main part 31 as hemostat (ORC) and staple line enhances (other film compositions 38 of PGA, PDS or any of above).Further, since nail 32 need not during forming Leave warehouse 31, therefore followed closely for 32 a possibility that becoming deformity during forming to be minimized.As used herein, term " implanted " Refer in addition to nail, the warehouse material of support nail also would be held in patient's body and can finally be absorbed by patient body.It is such Implanted nail bin is different from previous nail bin structure, which still completely positions after it is fired In end effector.
In various specific implementations, end effector 12 can be connected to the elongation assembly from 100 protrusion of handle assembly 40.End effector 12 (in closure) and elongation assembly 40 can have similar cross-sectional shape, and its size is set It is fixed at passing through trocar tube or service aisle with another access instruments formal operations.As used herein, term " is operatively worn Cross " refer at least part of end effector and elongation assembly can be inserted into or may pass through by channel or tube opening channel or Tube opening, and it can be manipulated to complete surgery stitching operation if necessary in channel or tube opening.When in closure position When setting, the jaw 13 and 15 of end effector 12 can provide the cross-sectional shape of substantial circular for end effector so that it is worn Cross circular access/opening.It is contemplated, however, that end effector and elongation assembly embodiment of the invention are equipped with other cross Cross sectional shape passes through entering path and opening with non-circular transverse cross-section so as to other modes.Therefore, closure The overall dimension of the cross section of end effector by end effector intend across channel or opening size it is related.Cause This, an end effector is for example referred to alternatively as " 5mm " end effector, this refers to that it can operatively be at least across diameter The opening of about 5mm.
Elongation assembly 40 can have the outer diameter of substantially equal with the outer diameter of end effector in the close position 12.Example Such as, 5mm end effector can be connected to the elongation assembly 40 with 5mm cross-sectional diameter.However, specific real with continued reference to this Apply mode, it will be apparent that, the present invention can be effectively combined various sizes of end effector and use.For example, the end 10mm Portion's actuator could attach to the elongated shaft with 5mm cross-sectional diameter.On the contrary, being opened for wherein providing 10mm or bigger entrance For the application in mouth or channel, elongation assembly 40 can have the cross-sectional diameter of 10mm (or bigger), but can also activate 5mm Or 10mm end effector.Therefore, the outer diameter of outer shaft 40 can be with the outer diameter phase for the end effector 12 for being attached to closure thereon It is same or different.
As shown, elongation assembly 40 is distally extending substantially along straight line from handle assembly 100, to limit longitudinal direction Axis A-A.For example, elongation assembly 40 can be about 9-16 inches (229-406mm) length.However, elongation assembly 40 is settable For other length, and alternatively, in elongation assembly there can be connector or can otherwise be conducive to hold Portion's actuator 12 carries out joint motions relative to the other parts of axis or handle assembly, as follows to will be discussed in more detail.Elongation Shaft assembly 40 includes ridge component 50, which extends to end effector 12 from handle assembly 100.End effector 12 it is thin The proximal extremity of long-channel 14, which has from a pair of of its protrusion, keeps trunnion 17, this is sized to receive to holding trunnion In corresponding trunnion opening or bracket 52 provided in the distal end of ridge component 50, so that end effector 12 can Remove ground connection elongation assembly 40.Ridge component 50 can be made of such as 6061 or 7075 aluminium, stainless steel, titanium etc..
Handle assembly 100 includes pistol grasping type shell, which can be made into for assembly purposes Two or more parts.For example, handle assembly 100 as shown in the figure includes by polymer or plastic material molding or with other Made of mode and it is designed to the right hand housing member 102 being combined together and left hand housing member (not shown).It can pass through In snap fastener structure, bolt and the pod for wherein molding or otherwise being formed, and/or will be such by adhesive, screw etc. Housing member is attached together.Ridge component 50 has proximal extremity 54, and flange 56 is formed in the proximal extremity.56 energy of flange It is enough pivotally supported in groove 106, the groove is by the counterpart ribs from housing member 102, each of 104 to inner process 108 form.Such construct is conducive to ridge component 50 and is attached to handle assembly 100, while enabling ridge component 50 relative to shank Component 100 is rotated along 360 ° of paths around longitudinal axis A-A.
It can further be shown that ridge component 50 passes through axle bush 60 and supported by axle bush 60, the installation such as in Fig. 1 Bushing 60 is pivotally attached to handle assembly 100.Axle bush 60 have proximal flange 62 and distal lip 64, limit rotation Turn groove 65, which can be rotatably received within the leading edge portion 101 of handle assembly 100 therebetween.Such construct Axle bush 60 are enable to rotate relative to handle assembly 100 around longitudinal axis A-A.Ridge component 50 can not be revolved by ridge pin 66 Turn ground pin joint to axle bush 60.In addition, knob 70 is attached to axle bush 60.For example, knob 70 has hollow mounting flange Portion 72, the hollow mounting flange portion are sized to receive a part of axle bush 60 wherein.Knob 70 can be by Such as glass or carbon filled nylon, polycarbonate,Etc. being made, and axle bush 60 are attached to also by ridge pin 66. It is formed in axle bush 60 in addition, being formed in mounting flange portion 72 and can extend to the holding flange 74 of inner process In radial groove 68.Therefore, surgeon can make ridge by firmly grasping knob 70 and rotating it relative to handle assembly 100 Component 50 (and be attached to end effector 12) thereon is rotated around longitudinal axis A-A along 360 ° of paths.
Anvil block 20 is maintained at open position by anvil block spring 21 and/or another biased configuration.By being substantially marked as 109 trigger system, anvil block 20 can selectively move to various closures or clamped position and firing position from open position. Trigger system 109 includes " firing member " 110 comprising hollow firing tube 110.Hollow firing tube 110 can be in ridge component 50 It moves axially, therefore forms the outside of elongation assembly 40.Firing tube 110 can be by polymer or other suitable material systems At, and there is the proximal extremity for the percussion yoke 114 for being attached to trigger system 109.For example, percussion yoke 114 can be over-molded to percussion The proximal extremity of pipe 110.However, other fasteners construction can also be used.
As can be seen in Figure 1, percussion yoke 114 can be pivotally supported in support lining ring 120, the support lining ring energy It is enough to be axially moved in handle assembly 100.Support lining ring 120 has a pair of fin extended laterally, which sets It is fixed at being slidably received in the fin slit being formed in left hand housing member and right hand housing member.Therefore, support lining Circle 120 can slide axially in shank shell 100, while enable percussion yoke 114 and firing tube 110 relative to support lining ring 120 rotate around longitudinal axis A-A.Firing tube 110 is provided with longitudinal slit, so that ridge pin 66 can pass through extension Into ridge component 50, while being conducive to firing tube 110 and axially advancing in ridge component 50.
Trigger system 109 further includes firing trigger 130, and the firing trigger is for controlling firing tube 110 in ridge component Axial traveling on 50.Referring to Fig. 1.This move to along distal direction of firing tube 110 carries out percussion phase interaction with anvil block 20 Axial movement is referred to herein as " firing action ".It can be seen that as shown in figure 1, firing trigger 130 passes through pivot pin 132 Movably or it is pivotally coupled to handle assembly 100.Firing trigger 130 is biased using torsionspring 135 far from handle The pistol grip portions 107 of parts 100 and reach " opening " or the initial position not activated.As can be seen in Figure 1, it fires Trigger 130 has top 134, which is movably attached (pin joint) to percussion chain link 136, and the percussion chain link is movably It is attached (pin joint) and arrives support lining ring 120.Therefore, firing trigger 130 is from initial position (Fig. 1) towards adjacent to handle assembly 100 The movement of the end position of pistol grip portion 107 will be such that percussion yoke 114 and firing tube 110 moves along distal direction " DD ".It hits The movement (under the biasing of torsionspring 135) of hair pistol grip portion 107 of the trigger 130 far from handle assembly 100 will make Percussion yoke 114 and firing tube 110 move in ridge component 50 along proximal direction " PD ".
The present invention can be used together from different sizes with the implanted nail bin of configuration.For example, when combining the first percussion linking Son 140 is in use, surgical instruments 10 can be held with the end 5mm of the about 20mm long (or with other length) of support implanted nail bin 30 Row device 12 is used together.This end effector size can be particularly well-suited in for example realizing dissection and the blood vessel of opposite fine Processing.However, institute as follows is described in more detail, such as can also be by the way that the first percussion adapter 140 is changed to the second percussion rank It connects son and surgical instruments 10 is used in combination with the end effector of other sizes and nail bin.In other alternative form, Elongation assembly 40 can be attached to the end effector of only a kind of form or size.
A kind of method that end effector 12 is removably coupled to ridge component 50 will be illustrated now.By that elongated will lead to Start connection process in the trunnion mounting 52 in holding trunnion 17 insertion ridge component 50 on road 14.Then, surgeon will The pistol grip 107 of firing trigger 130 towards casing assembly 100 promotes, by firing tube 110 and the first percussion adapter 140 are advanced distally on the proximal end portions 47 of elongated passageway 14, so that trunnion 17 is maintained at its respective bracket In 52.Such position of first percussion adapter 140 above trunnion 17 is referred to herein as " coupled position ".The present invention There can be end effector locked component, to be used for firing trigger after end effector 12 is attached to ridge component 50 130 lockings are in place.
More specifically, one embodiment of end effector locked component 160 includes retaining pin 162, retaining pin quilt can It is supported in the top 134 of firing trigger 130 to movement.As described above, firing tube 110 must be distad advanced first Coupled position, wherein the holding trunnion 17 of end effector 12 is maintained at the ear in ridge component 50 by the first percussion adapter 140 In bracing strut 52.Percussion is connected by surgeon and pulling firing trigger 130 towards pistol grip 107 from initial position Son 140 is advanced distally into coupled position.When firing trigger 130 is activated first, 162 distal motion of retaining pin, directly First percussion adapter 140 is advanced to coupled position to firing tube 110, retaining pin 162, which is biased to, at this time is formed in shell In latch well 164 in component.When retaining pin 162 enters in latch well 164, capable of emitting audible " clicker " sound of pin 162 Or other sound, and the tactile instruction that end effector 12 has been " locked " in ridge component 50 is provided for surgeon.Separately Outside, as long as retaining pin 162 is not intentionally biased out latch well 164, surgeon just will not continue unintentionally actuating percussion touching Device 130 is sent out to start to make the nail 32 in end effector 12 to shape.Similarly, if surgeon's release is in coupled position Firing trigger 130, then retaining pin 162 can be such that firing trigger 130 keeps in the position, to prevent firing trigger 130 from returning It is back to initial position and therefore discharges end effector 12 from ridge component 50.
The present invention can further include trigger system locking press button 137, which is attached pivotally to shank Component 100.In one form, trigger system locking press button 137 has the latch 138 formed in its distal end, the door bolt Lock is oriented to engage percussion yoke 114 when firing release button and being in the first latch position.As can be seen in Figure 1, latch Spring 139 is used to trigger system locking press button 137 being biased to the first latch position.In all cases, latch 138 is used for Percussion yoke 114 is engaged at certain point, at this point, the position of the percussion yoke 114 in ridge component 50 corresponds to wherein the first percussion rank Connect the point that son 140 will be advanced in the clamping slideway 28 on anvil block 20 towards distal side.It should be appreciated that with the first percussion adapter 140 axially promote in clamping slideway 28, and anvil block 20 will be moved along path, so that staple forming surface part 22 is substantially parallel In the top surface of nail bin 30 36.
After end effector 12 is connected to ridge component 50, opened and depressing trigger system locking press button 137 first Begin nail forming process, so that percussion yoke 114 further distal motion and finally can compress anvil block 20 in ridge component 50 Into nail bin 30.After depressing trigger system locking press button 137, surgeon, which continues to activate towards pistol grip 107, to be fired Trigger 130, thus by the driving of the first nail lining ring 140 to corresponding nail forming slideway 29, to force anvil block 20 and nail bin 32 shaping contact of nail in 30.Trigger system locking press button 137 prevents from being not intended to before surgeon is ready to start the process Ground makes 32 forming of nail.In this example, surgeon must depress percussion before firing trigger 130 can be further actuated System lock button 137 is to start to follow closely forming process.
Surgical instruments 10 optionally can be used only as tissue apposition device.However, the present invention may also comprise tissue cutting system System, the tissue diced system are substantially marked as 170.In at least one form, tissue diced system 170 includes cutter component 172, can by actuating cutter traveling trigger 200 by selectively from the proximal extremity of adjacent side terminal part actuator 12 not Actuated position is advanced to actuated position.Cutter component 172 is movably supported in ridge component 50, and be attached to knife bar 180 or Otherwise from 180 protrusion of knife bar.Cutter component 172 can be by for example with the hardness for being greater than 38HRC (Rockwell hardness C grade) 420 or 440 stainless steels are made, and can have the tissue cutting edge 176 being formed in its distal end 174, and can slide The slit in anvil block 20 and the slit being centrally located in nail bin 30 33 are extended through dynamicly, are clamped in end execution to cut through Tissue in device 12.Knife bar 180 extends through ridge component 50 and has the proximal extremity portion with Cutter conveyer driving handover Point, which is operably attached to cutter traveling trigger 200.Cutter traveling trigger 200 is attached to pivot pin 132, So that it can be pivoted in the case where being not necessarily to and activating firing trigger 130 or or in other words activate.First cutter tooth wheel 192 It is also attached to pivot pin 132, so that the actuating of cutter traveling trigger 200 also pivots first cutter tooth wheel 192.First cutter tooth wheel Be attached between 192 and shank shell 100 percussion return spring 202, by cutter traveling trigger 200 be biased to initial position or Unactuated position.
Cutter conveyer further includes the second cutter tooth wheel 194, which is pivotally supported on second gear axis And it is engaged with first cutter tooth wheel 192.Second cutter tooth wheel 194 is engaged with the 3rd gear shaft 196 being supported on third gear shaft.The Four cutter tooth wheels 198 are also supported on third gear shaft 195.4th cutter tooth wheel 198 is suitable for being drivingly engaged to the close of knife bar 180 A series of gear teeths or ring on the end of side.Therefore, this construction enables 4th cutter tooth wheel 198 along distal direction " DD " Or proximal direction " PD " axially trigger shaft 180, while making trigger shaft 180 relative to 4th cutter tooth wheel 198 around longitudinal axis Line A-A rotation.Therefore, surgeon can pull cutter traveling trigger 200 by the pistol grip 107 towards handle assembly 100 And make trigger shaft 180 axially promote and most all morning distal side push cutter component 172.
The present invention may also include cutter locking system 210, which prevents the propulsion of cutter component 172, unless percussion Trigger 130 has been pulled to complete firing position.Therefore, this feature will prevent the activation of knife propulsion system 170, unless nail It is fired or is formed in tissue first.As can be seen in Figure 1, the various specific implementations of cutter locking system 210 include knife Locking level 211, the cutter securing rod are pivotally supported in the pistol grip portion 107 of handle assembly 100.Cutter securing rod 211 has There is activated end 212, when firing trigger 130 is in complete firing position, activated end 212 is suitable for being connect by firing trigger 130 It closes.In addition, cutter securing rod 211 has on the other end thereof keeps suspension hook 214, which is suitable for engaging the in a manner of suspension hook Latch bar 216 on one cutting gear 192.Cutter securing rod 211 is biased to by " locking " position using Lock spring 218, The holding of suspension hook 214 is wherein kept to engage with latch bar 216, so that the actuating of cutter traveling trigger 200 is prevented, unless percussion triggering Device 130 is in complete firing position.
After nail is " fired " (forming) into target tissue, surgeon can depress percussion trigger release button 167, So that firing trigger 130 can be back to initial position under the biasing of torsionspring 135, to enable anvil block 20 in bullet The biasing of spring 21 biases downwards into open position.When in open position, surgeon can withdraw from end effector 12 and leave Implanted nail bin 30 and nail 32.In the application that wherein end effector passes through channel, service aisle etc. and is inserted into, surgery doctor Life will be by activating firing trigger 130 that anvil block 20 is made to be back to closed position, so that end effector 12 can be by logical Road or service aisle are withdrawn by.However, if surgeon wants to cut target tissue after percussion nail, more than surgeon The mode of stating activates cutter traveling trigger 200, passes through the end that target tissue reaches end effector with trigger shaft 172.Then, outside The releasable cutter traveling trigger 200 of section doctor, so that percussion return spring 202 can make percussion transmission device return knife bar 172 It is back to starting and (does not activate) position.Once knife bar 172 is back to initial position, surgeon can open end effector jaw 13,15, implanted storehouse 30 is released to patient's body and then withdraws from end effector 12 from patient's body.Therefore, such Surgical instruments is conducive to using the small implanted nail bin that can be inserted by relatively small service aisle and channel, simultaneously Following selection is provided for surgeon: the percussion nail or if necessary in also cutting after percussion nail in the case where not cutting tissue Tissue.
Various unique and new embodiments of the invention use compressible nail bin, and the compressible nail bin support is in Substantially fixed position is for by the nail of anvil block shaping contact.By anvil block driving into unshaped nail, wherein for example being reached Nail forming degree depend on anvil block be driven to nail in how far.Such construct, which allows a surgeon to adjust, is applied to nail Forming or percussion pressure amount, to change the final forming height of nail.In other embodiments of the invention, surgical stapling Nail driving element can be used in construction, which can promote nail towards anvil block.Hereafter such embodiment has been carried out more in detail Thin description.
Referring to the embodiment of above-detailed, the amount for being applied to the firing action of removable anvil block depends on percussion triggering The degree of the actuating of device.For example, only needing if surgeon goes for the nail of only part forming towards pistol grip 107 Partially inwardly depress firing trigger.More nail formings are obtained, surgeon only needs further to compress firing trigger, So that anvil block is further driven to be formed and contact with nail.As used herein, term " shaping contact " refers to nail forming table Face or nail shapes pit have contacted the end of nail leg and have started to shape leg or be bent to shaping position.Following closely the degree shaped is Refer to the degree that nail leg is folded and the forming height for finally referring to nail referred to above.Those skilled in the art will It further understands, because anvil block 20 is to carry out with the substantially parallel relationship of nail bin when applying firing action to anvil block 20 Movement, so nail substantially simultaneously shapes and has basically the same forming height.
Fig. 2 and Fig. 3 show alternative end effector 12 ", except it is following can accommodate the difference of knife bar 172 ' in addition to, End effector 12 " is similar to above-mentioned end effector 12 '.Knife bar 172 ' is connected to knife bar 180 or from 180 protrusion of knife bar, and And in addition to this to be operated above in connection with mode described in knife bar 172.However, in this embodiment, 172 ' foot of knife bar Enough long whole lengths to traverse end effector 12 ", therefore individual distal side cutter component is not used in end effector 12 ". Cross member 173 ' and lower cross member 175 ' are formed on knife bar 172 '.Upper cross member 173 ' is oriented to slideably The corresponding elongated slot 250 in anvil block 20 ", and lower cross member 175 ' is oriented to traverse end effector 12 " Elongated slot 252 in elongated passageway 14 ".It is also equipped in anvil block 20 " and is detached from slit (not shown), so that working as 172 ' quilt of knife bar When driving to end position in end effector 12 ", upper cross member 173 ' passes through corresponding slit and falls, so that anvil block 20 " can move to open position, to be detached from the tissue of suture and cutting.Anvil block 20 " can in addition to this with above-mentioned anvil block 20 is identical, and elongated passageway 14 " can be in addition to this identical as above-mentioned elongated passageway 14.
In these embodiments, anvil block 20 " is biased to fully open position by spring or other open configuration (not shown) (Fig. 2).Anvil block 20 " is clamped in open position with complete by axial advance that percussion adapter 150 carries out in the above described manner It is moved between position.Once percussion adapter 150 is advanced into fully clamped position (Fig. 3), surgeon can be then with above-mentioned Mode promotes knife bar 172 " towards distal side.If surgeon wants end effector carrying out manipulating tissue as grasp device, Percussion adapter can proximally be moved, to allow anvil block 20 " to move far from elongated passageway 14 ", as shown in phantom in figure 4. In this example, as knife bar 172 " moves toward the far side, upper cross member 173 ' and lower cross member 175 ' pull anvil block together 20 " and elongated passageway 14 ", realize that desired nail shapes to pass through when end effector 12 " is promoted towards distal side in knife bar 172 ".Ginseng See Fig. 5.Therefore, in this embodiment, nail forming is to occur simultaneously with tissue cutting, but following closely itself can be in knife bar 172 " towards distal side It is sequentially shaped when driving.
Unique and novel structure of various surgery nail bins and surgical instruments of the invention enables the nail in the nail bin It is arranged to one or more line linearly or nonlinearly.A plurality of this staple line can be equipped on each side of elongated slot, it is described thin Long slit is centrally arranged in nail bin, for receiving the tissue cutting element passed through.In a kind of construction, such as at The nail of one line can be substantially parallel to the nail in the adjacent lines of nail but bias with it.In other alternative form, one Item or a plurality of staple line can be essentially nonlinear.That is, at least one of staple line nail base portion can along substantially with The axis that the base portion of other nails in same staple line is crosscutting extends.For example, as follows will be discussed in more detail, in alternative implementation In example, the staple line on each side of elongated slot can have sawtooth appearance.It is each employed in nail bin compared with the prior art Less nail can be used to obtain preferably tissue tightening results for the linear pin structure of kind, such nonlinear pin structure.
Fig. 6 shows the use of 612 ' Chinese and foreign department nail bin embodiment 900 of end effector embodiment.As in figure 6 and figure 7 It can be seen that, the embodiment of surgery nail bin 900 has warehouse 902, which has the elongated slot 904 being centrally located, this is elongated Slit passes through proximal extremity 903 and extends to the region adjacent with distal end 905.Elongated slot 904 can be with above-mentioned side Formula allows knife main body to pass through axial movement during carrying out tissue cutting actions.Warehouse 902 is by such as oxidation regeneration fibre Tie up plain (" ORC ") or for example (poly- by PGA (polyglycolic acid, with trade mark Vicryl sale), PCL (polycaprolactone), PLA or PLLA Lactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, with trade mark Monocryl Sell) or the compound of PGA, PCL, PLA and PDS made of bioabsorbable foam compressible hemostasis agent material structure At, this it is compressible hemostasis agent material in be supported by unshaped nail 922 line 920,930.However, warehouse 902 can be by other Material is made, which is used to for unshaped nail 922 being supported in expectation orientation, so that when anvil block 910 ' is in contact with it, It can be compressed.As the other embodiments having been described, nail bin 900 is implanted, and after suture operation completion Remain attached to the tissue being sewn.For anti-non-magnetic shim 922 it is impacted and hemostasis agent material introduce and position fixing process during quilt Activation, entire storehouse 900 can be coated with or be wrapped in biodegradable film 906, such as with trade markPoly- two sold Oxa- cyclohexanone film or polyglycerol sebacate (PGS) film or for example by PGA (polyglycolic acid, with trade mark Vicryl sale), PCL (polycaprolactone), PLA or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, with trade mark Monocryl sell) or PGA, PCL, PLA, PDS compound formed other biodegradable films, this is biodegradable Film is only just permeable in broken dissipate.The size of the warehouse 902 of nail bin 900 is set to removedly to be supported on end effector In 612 ' elongated passageway.
In Fig. 6, Figure 10 and Figure 11, surgery nail bin 900 is operationally on a cross side 907 of elongated slot 904 The First Line 920 of support nail 922, and on another cross side 909 of elongated slot 904 support nail 922 the second line 930.Nail 922 can be by such as, such as titanium, titanium alloy (such as 6Al-4V titanium, 3al-2.5V titanium), stainless steel and other metal materials are made and have There are base portion 924 and two upright nail legs 926 from its protrusion.Organized puncture top can be formed in each nail leg 926 928.In the First Line 920 of nail 922, the base portion 924 of at least one nail 922 is Chong Die with the base portion of another nail 922.? In preferred embodiment, other than the base portion 924 of the last nail 922 on each end of the first staple line 920, each nail 922 Base portion 924 with two it is adjacent nail 922 base portion 924 it is Chong Die.Referring to Figure 10.Therefore, the first staple line 920 has basic Upper nonlinear shape.More specifically, when viewed from above, the first staple line 920 has substantially zigzag appearance.
It such as can be seen that in Fig. 9, there are two longitudinal nail shapes pit 912 of sequence, longitudinally in each nail formings for the tool of anvil block 90 Pit has the corresponding substantially saw-toothed shape of the shape of First Line 920 with nail 922 so that when anvil block 910 and nail 922 into When row shaping contact, the leg 926 of nail shapes as shown in figure 11.Therefore, the far leg of a nail and next nail in the longitudinal direction Near leg shares same pit.Such construct allows more dense pit pattern, even up to follows closely the (example that itself interacted Such as across folding each other) degree.In the nail pocket configuration of the prior art, in general, one group of pit and next group it is recessed There must be metal/space between 0.005 and 0.015 inch between hole.However, for example, the embodiment of the invention has 0 To 0.02 inch of interference/section gap construction (substantially, a-0.020 "), this is because a nail cooperates with next nail. This construction allows to have more 15% to 30% nail in identical space.In addition, when the interlocking of each nail, to multiple lateral staples Demand reduce.Existing construction is followed closely usually on every side of tissue cut line using three rows, and to prevent, there are blood to flow The open approach crossed.It is smaller that interlocking staple line forms a possibility that path that blood can flow through.Various interlocking pin structures of the invention Another provided clear advantage is related to improvement " broken scattered intensity " relevant to the amount of power needed for staple line is open is torn.
Another nail shapes pit construction may include shared nail shapes pit.As used herein, term " shared nail at Shape pit " refers to, with the anvil block that the prior art for being individually formed pit is wherein arranged for every leg of each preform nail Design is different, and a forming pit can be such that all nails in single staple line shape.
Figure 12 shows another nail embodiment 922 ', and wherein base portion 924 ' has offset part 929, in favor of each base portion 924 ' Carry out closer overlapping.As described above, nail bin 900 has the nail being supported on the second cross side 909 of elongated slot 904 922 the second line 930.Second line 930 of nail 922 is substantially the same with the First Line 920 of nail 922.Therefore, anvil block 910 has Corresponding to the second shared nail shapes pit 912 of the second staple line 930, with 930 shaping contact of the second staple line.However, as another A kind of selection, follow closely 922 the second line 930 can in shape and may nail number on be different from nail First Line 920.
Fig. 8 is shown in addition to the line 920 ', 930 ' for being supported in nail 922 therein, substantially the same with above-mentioned nail bin 900 Surgery nail bin 900 '.For example, in this embodiment, the line 920 ' for following closely 922 is set so that at least one nail relative to each other The base portion axis S-S of base portion 924 extends substantially transversely to the base portion axis S-S of the base portion 924 of at least another adjacent nail 922. When viewed from above, this scheduled nail pattern includes substantially zigzag construction.In Figure 13,922 each base is followed closely In addition there can be base support member 927 by overmolding in portion 924, as shown in the figure.Base support member 927 can be by can not for example inhale The plastics (such as polyether-ether-ketone " PEEK ") of receipts or absorbable plastics (such as polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", polydioxanone " PDS ", PCL (polycaprolactone), PHA (polyhydroxyalkanoatefrom), polyglycerol sebacate (PGS), PGCL (Poliglecaprone 25, with trade mark Monocryl sale) or PGS, PDS, PLA, PGA and PCL's is various compound mixed Close object) it is made.Base support member 927 is conducive to make to be interlocked between nail in the case where not making and following closely itself overlapping.Therefore, This construction can make nail be configured to " B " shape or " W " shape in the case where being overlapped the leg for following closely itself.However, due to bizet It is connected by base support member, so they work as overlapping nail.Such construct allow combine pit have be directed to Two discreet paths of every leg.
Embodiment shown in Figure 14 uses staple line 920 ", wherein the leg 926 of neighbouring nail 922 passes through to mold or other modes The coupling portion 929 for being attached to leg 926 is linked together.Each coupling portion 929 can be by such as polyether-ether-ketone " PEEK " or can (such as polyglycolic acid " PGA ", polylactic acid " PLA " or " PLLA ", polydioxanone " PDS ", PCL (gather oneself to the plastics of absorption Lactone), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, with trade mark Monocryl sale) or PGS, PDS, PLA, The various compound mixtures of PGA and PCL) it is made.When viewed from above, this staple line 920 " has outside substantially zigzag It sees.Although various surgery nail bin embodiments 900,900 ' are explained in the use of junction end actuator 612 ', should manage Solution, nail bin 900,900 ' can be effectively used together with various other end effectors described above and surgical instruments, wherein Suitable nail shapes pit construction is provided in the anvil block of these instruments, to reach when anvil block is moved to nail shaping contact Desired nail shaping amount.
Figure 15 and Figure 16 show another surgery nail bin 940 implementations in the elongated passageway 14 for being supported on surgical instruments 10 Example.Surgery nail bin 940 includes warehouse 942, which has the elongated slot 944 being centrally located, and the elongated slot is at least partly Ground extends through wherein.Elongated slot 944 can allow surgical instruments 10 during carrying out tissue cutting actions in the above described manner Knife main body pass through axial movement.Warehouse 942 is by such as oxidized regenerated cellulose (" ORC ") or above-mentioned or following types The compressible hemostatic material of bioabsorbable foam constitute, wherein be supported by the line 946 of unshaped nail 922,948, 950,952.For anti-non-magnetic shim 922 it is impacted and hemostasis agent material introduce and position fixing process during be activated, entire storehouse 940 can It is coated with or is wrapped in biodegradable film 954, such as with trade markThe poly- dioxa cyclohexanone film or poly- sold Glycerol sebacate (PGS) film or for example by PGA (polyglycolic acid, with trade mark Vicryl sale), PCL (polycaprolactone), PLA Or PLLA (polylactic acid), PHA (polyhydroxyalkanoatefrom), PGCL (Poliglecaprone 25, with trade mark Monocryl sale) or PGA, Other biodegradable films that the compound of PCL, PLA, PDS are formed, the biodegradable film is only in broken scattered Shi Caike Infiltration.
In Figure 15, storehouse 940 further includes the storehouse supporting member 960 for being connected to warehouse 942.Storehouse supporting member 960 can be by all Such as titanium, stainless steel, aluminium, above-mentioned any alloy rigid material are made, and can be partially embedded into warehouse 942.Storehouse supporting member 960 can be held in place by such as film 954.Need restricted combination it is alternative in the case where, can sporadically use cyanogen Base acrylates adhesive by two components " gluing " together.In other alternate forms, warehouse 942 can be heated simultaneously And " welding " or " melting " arrives storehouse supporting member 960.Storehouse supporting member 960 forms at least one of the bottom surface of warehouse 942 Divide to cooperate with elongated passageway 14.Storehouse supporting member 960 has one or more snap fastener structures 962 from its protrusion, to be used for Storehouse supporting member 960 is releasably attached to elongated passageway 14.Snap fastener structure/fastener construction that other forms can be used will Storehouse supporting member 960 is releasably attached to elongated passageway 14.
A series of support ridges 964,966,968,970,972,974,976 are formed in storehouse supporting member 960, with to staple line 946, the base portion 924 of the nail 922 in 948,950,952 provides some lateral supports, as shown in figure 15.Thus, for example, support ridge It is substantially coextensive with staple line.Figure 17 shows the alternative nail bin embodiment 940 ' substantially the same with storehouse 940, difference It is, nail bin embodiment 940 ' includes respectively from 964,966,968,970,972,976 protrusion of support ridge to provide volume to nail 922 The upstanding fins portion 978,979,980,981,982,983 of outer lateral support.Fin part can be formed as one with storehouse supporting member 960 Body, and its height can be about the 1/2 or smaller of storehouse height.Thus, for example, any rising structure of support foam can not prolong Reach the solid height of foam or more.Therefore, if storehouse is designed to for example be compressed to its original height when being fired 1/3, then fin will be between the 66% of uncompressed height 10% to uncompressed height on the way down.
In use, it shapes and once nail 922 is by contact anvil block 20 in the above described manner, then opens anvil block 20 and by end Portion's actuator 12 is pulled away from sutured tissue.When end effector 12 is pulled away from sutured tissue, warehouse 942 keeps fastening It then separates to the tissue being sutured and with the storehouse supporting member 960 for remaining coupled to elongated passageway 14.Storehouse supporting member 960 Color is different from the color of the material including warehouse 942 and the color of elongated passageway 14.Such construct provides for surgeon The instruction of nail bin easily identified is not present in end effector.Therefore, surgeon will not unintentionally attempt do not existing Installed in end effector in the case where new nail bin again insertable into/use end effector.For this purpose, surgeon only needs storehouse The snap fastener structure of supporting member 960 is detached from from elongated passageway 14, so that the storehouse supporting member 960 of new nail bin 940 can be put It sets wherein.Although explaining nail bin 940,940 ' with reference to surgical instruments 10, it being understood, however, that do not departing from spirit of the invention In the case where range, these storehouses can be effectively used together with many other surgical instrument embodiments disclosed herein.
Nail bin may include warehouse and multiple nails for being stored in warehouse.In use, nail bin can be introduced operative site In and be located at the side of handled tissue.In addition, can be by nail forming anvil positioning on the opposite side of tissue.Anvil block It can be carried by the first jaw and nail bin can be carried by the second jaw, wherein the first jaw and/or the second jaw can be towards another pincers Mouth movement.Once nail bin and anvil block are positioned relative to tissue, then nail can be projected from staple cartridge body, so that following closely pierceable tissue simultaneously Contact stud shapes anvil block.Once disposing nail from staple cartridge body, then then staple cartridge body can be removed from operative site.As described herein, At least part of nail bin or nail bin is implantable nail.For example, as follows be more fully described, nail bin may include warehouse, when When anvil block moves to closed position from open position, which can be compressed, crushes and/or be collapsed by anvil block.When warehouse compressed, When being crushed and/or collapsing, the nail being located in warehouse can be deformed by anvil block.Alternatively, the pincers of support nail cartridge Mouth can move to closed position towards anvil block.Two kinds of situations it is any in, when nail is positioned at least partially in warehouse, nail It is deformable.Nail can not be projected from nail bin, and following closely can project from nail bin together with a part of warehouse.
Referring now to Figure 18 A- Figure 18 D, compressible nail bin (such as nail bin 1000) for example may include compressible, implanted storehouse Body 1010, and the multiple nails 1020 being also located in compressible warehouse 1010, but Figure 18 A- Figure 18 D only shows a nail 1020.Figure 18 A shows the nail bin 1000 supported by nail bin supporting member or staple cartridge channel 1030, and wherein nail bin 1000 is shown in Uncompressed condition.In this uncompressed condition, anvil block 1040 is accessible or does not contact tissue T.In use, anvil block 1040 can Contact tissue T is moved to from open position, as shown in figure 18b, and tissue T is positioned against warehouse 1010.Even if anvil block 1040 can be located against tissue T the tissue contacting surface 1019 of staple cartridge body 1010, however referring again to Figure 18 B, staple cartridge body 1010 can be subjected to few (if any) compressing force or pressure at this time, and follow closely 1020 and be positively retained at unshaped or do not fire Condition.As shown in Figure 18 A and Figure 18 B, staple cartridge body 1010 may include one or more layers, and the nail leg 1021 of nail 1020 can be worn These layers are crossed to upwardly extend.Warehouse 1010 may include first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014, Wherein the second layer 1012 can be positioned among first layer 1011 and third layer 1013, and wherein third layer 1013 can be positioned on the second layer 1012 and the 4th layer 1014 among.For example, the base portion 1022 of nail 1020 can be positioned in the cavity 1015 in the 4th layer 1014, and And nail leg 1021 can be upwardly extended from base portion 1022 and across the 4th layer 1014, third layer 1013 and the second layer 1012.Each Deformable leg 1021 may include top, such as sharp top 1023, such as when nail bin 1000 is in uncompressed condition, the cutting edge of a knife or a sword The top of benefit can be positioned in the second layer 1012.For example, top 1023 can be not extend to and/or pass through first layer 1011, wherein When nail bin 1000 is in uncompressed condition, top 1023 not projecting can pass through tissue contacting surface 1019.It is selected as another kind It selects, when nail bin is in uncompressed condition, sharp top 1023 can be positioned on third layer 1013 and/or any other is suitable In layer.Alternatively, the warehouse of nail bin can have any suitable number of layers, such as less than four layers or more than four layers.
As follows to be more fully described, first layer 1011 can be by buttress material and/or plastic material (such as poly- dioxy Heterocycle hexanone (PDS) and/or polyglycolic acid (PGA)) it constitutes, and the second layer 1012 can be by bioabsorbable foamed material And/or compressible hemostatic material (such as oxidized regenerated cellulose (ORC)) is constituted.First layer 1011, the second layer 1012, third layer 1013 and the 4th layer one or more of 1014 nail 1020 can be maintained in staple cartridge body 1010, and in addition can make nail 1020 Holding is mutually aligned.Third layer 1013 can be by buttress material or quite incompressible or non-elastic material is constituted, the material The nail leg 1021 for following closely 1020 can be held in place relative to each other.In addition, being located in the opposite side of third layer 1013 On the second layer 1012 and the 4th layer 1014 can stablize or reduce nail 1020 movement, even if the second layer 1012 and the 4th layer 1014 It can be made of compressible foam or elastic material.The screw top end 1023 of nail leg 1021 can be partially embedded into first layer In 1011.For example, nail leg 1021 collaboratively and firmly can be maintained at appropriate position by first layer 1011 and third layer 1013 It sets.First layer 1011 and third layer 1013 (such as can be sold respectively by such as bioabsorbable material with trade name Vicryl Polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with quotient Poliglecaprone 25 (PGCL) that name of an article Monocryl is sold, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/ Or the compound of PCL) thin slice constitute, and the second layer 1012 and the 4th layer 1014 can be stopped blooding agent material by least one respectively Or hemostat is constituted.
Although first layer 1011 can be to be compressible, the second layer 1012 substantially can be pressed more than first layer 1011 Contracting.For example, the compression ratio of the second layer 1012 can for first layer 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 for first layer 1011 about Twice, about three times, about four times, about five times, and/or about ten times.The compression ratio of the second layer 1012 may be, for example, between The compression ratio of first layer 1011 approximately twice as between about ten times.The second layer 1012 may include being defined in multiple gas therein Gap, wherein the amount and/or size of the air gap in the second layer 1012 can be controlled to provide the expectation compression ratio of the second layer 1012.With Similar to the above, although third layer 1013 can be to be compressible, the 4th layer 1014 can substantially have more than third layer 1013 Compression ratio.For example, the 4th layer 1014 of compression ratio can for 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 4th layer 1014 of compression degree can be third layer 1013 Approximately twice as, about three times, about four times, about five times, and/or about ten times.4th layer 1014 of compression ratio can between The compression ratio of third layer 1013 approximately twice as between about ten times.4th layer 1014 may include being defined in multiple gas therein Gap, wherein the amount and/or size of the air gap in the 4th layer 1014 can be controlled to provide the 4th layer 1014 of expectation compression ratio. In all cases, warehouse or warehouse can be expressed by compression ratio (that is, distance that layer is compressed for the power of given size) The compression ratio of layer.For example, the layer with high compression rate, which is directed to, is applied to the given of this layer compared with having compared with the layer of little compressible The compressing force of size will compress bigger distance.For so, the second layer 1012 has higher compression than first layer 1011 Rate；Similarly, there is higher compression ratio than third layer 1013 for the 4th layer 1014.The second layer 1012 and the 4th layer 1014 can be by Identical material constitutes and can compression ratio having the same.The second layer 1012 and the 4th layer 1014 can be by with different compression ratios Material constitute.Similarly, first layer 1011 and third layer 1013 can be made of identical material and having the same can press Shrinkage.First layer 1011 and third layer 1013 can be made of the material with different compression ratios.
When anvil block 1040 is moved towards its closed position, anvil block 1040 can contact tissue T and apply to tissue T and nail bin 1000 Compressive forces, as shown in figure 18 c.In this case, anvil block 1040 can push down on warehouse 1010 towards nail bin supporting member 1030 Top surface or tissue contacting surface 1019.Nail bin supporting member 1030 may include storehouse stayed surface 1031, can be in nail bin 1000 are compressed in support nail cartridge 1000 when between storehouse stayed surface 1031 and the tissue contacting surface 1041 of anvil block 1040.Due to 1040 pressure applied of anvil block, warehouse 1010 can be compressed and the accessible nail 1020 of anvil block 1040.More specifically, warehouse The moving downward of 1010 compression and tissue contacting surface 1019 can make the top 1023 of nail leg 1021 pierce through the of warehouse 1010 In forming pit 1042 in one layer 1011, puncture tissue T and entrance anvil block 1040.When warehouse 1010 is by anvil block 1040 into one When step compression, the accessible wall for limiting forming pit 1042 in top 1023, and for example therefore leg 1021 can be deformed inward or roll up Song, as shown in figure 18 c.When nail leg 1021 is deformed, equally as shown in figure 18 c, the base portion 1022 for following closely 1020 can contact nail bin Supporting element 1030 is supported by nail bin supporting member 1030.As described in greater detail below, nail bin supporting member 1030 may include multiple Support construction, such as nail support trenches, slit or slot 1032, such as the multiple support construction can be when nail 1020 be deformed The base portion 1022 of support nail 1020 or at least nail 1020.Equally as shown in figure 18 c, the compressing force for being applied to staple cartridge body 1010 can make Cavity 1015 in 4th layer 1014 is collapsed.In addition to cavity 1015, it is (all that staple cartridge body 1010 may also include one or more gaps Such as gap 1016), for example, in one or more of gaps may include or do not include the nail being positioned in a part, it is described One or more gaps can allow for warehouse 1010 to collapse.Cavity 1015 and/or gap 1016 can collapse, so that limiting cavity And/or the wall of wall bends downwards and contacts storehouse stayed surface 1031 and/or contact warehouse 1010 and is positioned at cavity and/or gap The layer of lower section.
In relatively Figure 18 B and Figure 18 C, it is clear that the second layer 1012 and the 4th layer of 1014 pressure applied by anvil block 1040 Compression pressure substantially compresses.It may also be noted that first layer 1011 and third layer 1013 are also compressed.It is closed when anvil block 1040 moves to it When coincidence is set, anvil block 1040 can continue further to press and pushing down on tissue contacting surface 1019 towards nail bin supporting member 1030 Contracting warehouse 1010.When warehouse 1010 is further compressed, anvil block 1040 can make nail 1020 be deformed into it and be fully formed shape, such as Shown in Figure 18 D.Referring to Figure 18 D, it is each nail 1020 leg 1021 can towards it is each nail 1020 base portion 1022 downwards deform, so as to will Tissue T, first layer 1011, the second layer 1012, third layer 1013 and the 4th layer 1014 at least part are captured in deformable leg Between 1021 and base portion 1022.In relatively Figure 18 C and Figure 18 D, more obviously, the second layer 1012 and the 4th layer 1014 further by The compression pressure that anvil block 1040 is applied is significantly compression.In relatively Figure 18 C and Figure 18 D it may also be noted that first layer 1011 and Also it is further compressed for three layer 1013.After nail 1020 is fully shaped completely or at least, anvil block 1040 can be far from tissue T And it is lifted, and nail bin supporting member 1030 can the separate and/or disengaging movement of nail bin 1000.As shown in Figure 18 D and due to above Described, warehouse 1010 is implantable nail 1020.In various embodiments, the warehouse 1010 being implanted can be along staple line supporting tissue. In some cases, the hemostat and/or any other suitable therapeutic agent for including in the warehouse 1010 of implantation can with when Between passage to handle tissue.Hemostat as described above can reduce the tissue bleeding of suture and/or cutting, while bonding agent or group Intensity can be provided as time goes by for tissue by knitting adhesive.The warehouse 1010 being implanted into can be by such as ORC (oxidation regeneration fiber Element), extracellular protein (such as collagen), with trade name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), Polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 sold with trade name Monocryl (PGCL), the composite material of polycaprolactone (PCL), and/or such as PGA, PLA, PDS, PHA, PGCL and/or PCL are constituted.At certain In a little situations, warehouse 1010 may include the antibiosis and/or anti-biotic material a possibility that capable of for example reducing surgical site infection, all Such as collargol and/or triclosan.
The layer of warehouse 1010 can be connected to each other.For example, using at least one adhesive (such as fibrin and/or Protein hydrogel) second layer 1012 is adhered to first layer 1011, third layer 1013 is adhered to the second layer 1012, and by It is adhered to third layer 1013 for four layer 1014.Although being not shown, the layer of warehouse 1010 can be connected by interlocking machine feature structure Together.For example, first layer 1011 and the second layer 1012 can respectively include corresponding interlocking features structure, such as tenon groove structure And/or dovetail structure.Similarly, the second layer 1012 and third layer 1013 can respectively include corresponding interlocking features structure, Third layer 1013 and the 4th layer 1014 can respectively include corresponding interlocking features structure simultaneously.Although being not shown, nail bin 1000 may include for example one or more rivets, which can extend across the one or more of warehouse 1010 Layer.For example, each rivet may include the first end that adjacent first layer 1011 positions or head and it is neighbouring 4th layer 1014 and Second head of positioning, the 4th layer can be mounted to the second end of rivet or be formed by the second end of rivet.For example, by In the compression ratio matter of warehouse 1010, rivet compressible warehouse 1010, so that the head of rivet can be relative to the tissue of warehouse 1010 Contact surface 1019 and/or bottom surface 1018 are recessed.For example, rivet can be made of bioabsorbable material, material is such as With the polyglycolic acid (PGA) of trade name Vicryl sale, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly- hydroxyl Phenylalkanoic acid ester (PHA), Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or the example sold with trade name Monocryl Such as the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL.In addition to through nail 1020 accommodated in warehouse 1010, storehouse The layer of body 1010 can not be connected to each other.For example, the frictional engagement between nail leg 1021 and warehouse 1010 for example can be by warehouse 1010 Layer keep together, and once nail forming, then the layer can be trapped in nail 1020 in.At least part of nail leg 1021 It may include the roughened surface or rough coatings that can increase the frictional force between nail 1020 and warehouse 1010.
As described above, surgical instruments may include the first jaw and the second jaw, the first jaw includes nail bin supporting member 1030, Second jaw includes anvil block 1040.Described in greater detail below, nail bin 1000 may include one or more holding feature structures, The one or more keeps feature structure that can engage nail bin supporting member 1030 and therefore releasably hold nail bin 1000 To nail bin supporting member 1030.For example, can be incited somebody to action by least one adhesive (such as, fibrin and/or protein hydrogel) Nail bin 1000 adheres to nail bin supporting member 1030.In use, at least one situation, especially in laparoscopic type and/or In endoscopic surgery, the second jaw is moveable to the closed position opposite with the first jaw, such as makes the first jaw and Two jaws can be inserted into operative site by trochar.For example, trochar can limit hole or the intubation of about 5mm, the first pincers Mouth and the second jaw can be inserted by it.Second jaw is moveable to the part in an open position between closed position Closed position, which allows the first jaw and the second jaw to be inserted into across trochar, without making nail bin The deformation of nail 1020 accommodated in body 1010.For example, when the second jaw is in the middle position of its part closure, anvil block 1040 Compressing force can not be applied to staple cartridge body 1010, and alternatively, when the second jaw is in the interposition of its part closure When setting, 1040 compressible nail bin body 1010 of anvil block.Although the compressible nail bin body when anvil block 1040 is in this middle position 1010, however anvil block 1040 can incompletely compress staple cartridge body 1010, so that 1040 contact stud 1020 of anvil block and/or to follow closely 1020 are deformed by anvil block 1040.Once the first jaw and the second jaw are inserted into operative site by trochar, then and second Jaw can be opened again, and anvil block 1040 and nail bin 1000 can be positioned relative to target tissue as described above.
Referring now to Figure 19 A- Figure 19 D, the end effector of surgical stapling device may include being positioned at anvil block 1140 and nail bin Implanted nail bin 1100 among supporting element 1130.Similar to the above, anvil block 1140 may include tissue contacting surface 1141, nail bin 1100 may include tissue contacting surface 1119, and nail bin supporting member 1130 may include the support surface for capableing of support nail cartridge 1100 1131.Referring to Figure 19 A, using anvil block 1140 by tissue T be located against the tissue contacting surface 1119 of nail bin 1100 without Deform nail bin 1100, and when anvil block 1140 is in this position, tissue contacting surface 1141 can be positioned so that and nail bin 1131 distance 1101a of support surface, and tissue contacting surface 1119 can be positioned so that and 1131 phase of nail bin support surface Away from distance 1102a.Then, when anvil block 1140 is moved towards nail bin supporting member 1130, referring now to Figure 19 B, anvil block 1140 can be to The first layer 1111 and the second layer of the lower top surface for pushing nail bin 1100 or tissue contacting surface 1119 and nail bin support member 1110 1112.Referring again to Figure 19 B, as layer 1111 and layer 1112 are compressed, the second layer 1112 can be crushed, and follow closely 1120 leg 1121 pierceable first layers 1111 simultaneously enter in tissue T.For example, nail 1120 can be positioned at least partially in the second layer 1112 Nail cavity or gap 1115 in, and when the second layer 1112 is compressed, nail cavity 1115 is collapsible and therefore allows the second layer 1112 collapse around nail 1120.The second layer 1112 may include cover 1116, which may extend away on nail cavity 1115 simultaneously Encapsulate or be at least partially enveloping nail cavity 1115.Figure 19 B shows the covering part 1116 for being pressed downward and bursting into nail cavity 1115.The Two layer 1112 may include one or more weakening parts, can be conducive to collapsing for the second layer 1112.Such weakening part can wrap Include the scratch controllably collapsed that can be for example conducive to warehouse 1110, perforation and/or thin cross section.First layer 1111 may include It can be conducive to one or more weakening parts that nail leg 1121 penetrates first layer 1111.Such weakening part may include for example can Enough scratch, perforation and/or thin cross sections for being aligned with nail leg 1121 or being at least substantially aligned.
Referring again to Figure 19 A, when anvil block 1140 is in the non-firing position of part closure, anvil block 1140 be can be positioned so that With 1131 distance 1101a of storehouse stayed surface so that defining gap therebetween.This gap can be by with nail bin height 1102a Nail bin 1100 and tissue T filling.When anvil block 1140 is moved downward to compress nail bin 1100, referring again to Figure 19 B, tissue is connect Touching the distance between surface 1141 and storehouse stayed surface 1131 can be limited by the distance 1101b of shorter than distance 1101a.In various feelings Under condition, the gap limited by distance 1101b between the tissue contacting surface 1141 and storehouse stayed surface 1131 of anvil block 1140 can Greater than original undeformed nail bin height 1102a.Referring now to Figure 19 C, when anvil block 1140 is moved to closer to storehouse support table When face 1131, the second layer 1112 can continue to collapse and the distance between nail leg 1121 and forming pit 1142 can reduce.It is similar Ground, the distance between tissue contacting surface 1141 and storehouse stayed surface 1131 can be reduced to distance 1101c, which can be greater than, Equal to or less than original undeformed storehouse height 1102a.Referring now to Figure 19 D, anvil block 1140 is moveable to final percussion position It sets, wherein nail 1120 is fully formed or is at least shaped to Desired Height.In this position, the tissue contacting surface of anvil block 1140 1141 can be with 1131 distance 1101d of storehouse stayed surface, wherein distance 1101d can be shorter than original undeformed storehouse height 1102a.Equally as shown in figure 19 D, nail cavity 1115 can completely or at least substantially collapse, and following closely 1120 can completely or at least base The second layer 1112 collapsed in sheet surrounds.In all cases, anvil block 1140 then can be moved far from nail bin 1100.For example, Once anvil block 1140 is detached from from nail bin 1100, then warehouse 1110 can for example, at least partly spread over various positions (that is, phase again Position between adjacent nail 1120) in.The warehouse 1110 of conquassation may not resiliently extend again.1120 He of nail of forming In addition pressure or compressing force can be applied to tissue T by being located in the warehouse 1110 between adjacent nail 1120, this can provide various control Treat benefit.
As described above, each nail 1120 may include the nail leg 1121 extended from referring again to Figure 19 A.For example, although nail 1120 are shown as including two nail legs 1121, however can also be used and may include a nail leg or alternatively include super Cross the various nails of two nail legs (such as three nail legs or four nail legs).As shown in Figure 19 A, the embeddable storehouse of each nail leg 1121 In the second layer 1112 of body 1110, so that nail 1120 is fixed in the second layer 1112.Nail 1120 can be inserted into warehouse 1110 In nail cavity 1115, so that the top 1123 of nail leg 1121 advancing into chamber 1115 in base portion 1122.It is inserted on top 1123 After chamber 1115, top 1123 can be pressed against in cover 1116 and cut the second layer 1112.Nail 1120 can be arranged to the Enough depths in two layer 1112, so that nail 1120 is not moved relative to the second layer 1112 or do not moved at least substantially.Nail 1120 can be arranged to enough depths in the second layer 1112, so that base portion 1122 is positioned or is embedded in nail cavity 1115.Make For another kind selection, base portion 1122 can not be positioned or be embedded in the second layer 1112.Referring again to Figure 19 A, base portion 1122 can Extend below the bottom surface 1118 of warehouse 1110.Base portion 1122 can bear against in storehouse stayed surface 1130 or directly abut storehouse Support surface 1130 positions.Storehouse stayed surface 1130 may include from its extend and/or be defined in support construction therein, for example, The base portion 1122 of nail 1120 can be positioned in one or more support trenches, slit or slot in such as nail bin supporting member 1130 It is supported in 1132 or by the one or more support trenches, slit or slot 1132, as described in more detail below.
It is further described herein above, referring now to Figure 20, nail bin supporting member 1130 can be directly abutted by following closely 1120 base portion 1122 Support surface 1131 and position.In the case where base portion 1122 includes round or arcuate shaped bottom surface 1124, such as nail base Portion 1122 can move or slide along nail bin support surface 1131.When anvil block 1140 is compressed against nail leg 1121 during following closely forming process Top 1123 when this sliding can occur.As described above and referring now to Figure 21, nail bin supporting member 1130 can wrap wherein One or more support slits 1132 are included, base portion 1122 and storehouse can be eliminated or at least be reduced to one or more support slit Relative motion between support surface 1131.For example, each support slit 1132 can be limited by surface profile, the surface profile With the outline of nail bottom surface being positioned in or at least substantially match.For example, base portion 1122 shown in Figure 21 Bottom surface 1124 may include round or at least substantially circular surface, and it is round or extremely to support slit 1132 may also comprise Few substantially circular surface.For example, the surface for limiting slit 1132 can limit the song of bottom surface 1124 by being greater than or equal to The radius of curvature of rate radius limits.Although slit 1132 can be helped prevent or be reduced between nail 1120 and nail bin supporting member 1130 Sliding relative movement, however slit 1132 can also prevent or reduce the relative rotation between nail 1120 and nail bin supporting member 1130 Movement.More specifically, slit 1132 can closely receive base portion 1122, to prevent or reduce nail 1120 around axis 1129 Rotation, such as nail 1120 is made not rotate or distort in deformation.
Further described above, each nail 1120 can be formed by round or at least substantially round wire rod.Example Such as, multiple legs of each nail and base portion can be formed by the wire rod with non-circular cross sections (such as rectangular cross section).For example, Nail bin supporting member 1130 may include corresponding non-circular slit (such as rectangular slot), which can receive such nail Base portion.Referring now to Figure 22, each nail 1120 may each comprise the bizet on overmolding to pedestal 1122, such as bizet 1125, wherein each bizet 1125 can be positioned in the support slit in nail bin supporting member 1130.For example, each bizet 1125 It may each comprise the cross section of such as square and/or rectangle, which can be received in such as nail bin supporting member 1130 Square and/or rectangle slit 1134 in.Bizet 1125 can be made of bioabsorbable plastics, such as with trade name The polyglycolic acid (PGA) of Vicryl sale, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly (hydroxy alkanoate) Ester (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or such as PGA, The compound of PLA, PDS, PHA, PGCL and/or PCL, and can for example, by injection molding method around nail 1120 base portion 1122 and shape At.Various bizets and the method for being used to form various bizets are disclosed on September 29th, the 2006 entitled " SURGICAL submitted STAPLES HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN It, should in the U.S. Patent application 11/541,123 of AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " The complete disclosure of patent is herein incorporated by reference.Referring again to Figure 22, slit 1134 may also include introduction part or oblique Angle 1135, the introduction part or oblique angle can be conducive to for being inserted into slit 1134 bizet 1125.When nail bin 1100 is assembled to nail When the supporting element 1130 of storehouse, following closely 1120 base portion and/or bizet be can be positioned in slit 1134.When nail bin 1100 is assembled to nail bin When supporting element 1130, following closely 1120 bizet 1125 can be aligned with slit 1134.For example, bizet 1125 can not enter slit 1134 In, until being pushed down into slit 1134 to the base portion and/or bizet of the application compressing force of nail leg 1121 and nail 1120.
Referring now to Figure 23 and Figure 24, nail bin (such as nail bin 1200) for example may include compressible implanted warehouse 1210, which includes outer layer 1211 and internal layer 1212.Similar to the above, nail bin 1200 may include being located in warehouse 1210 Multiple nails 1220.Each nail 1220 may each comprise base portion 1222 and one or more nail legs 1221 extending therefrom.For example, nail Leg 1221, which can be inserted into internal layer 1212 and be arranged to, for example makes the adjacent and/or neighbouring internal layer 1212 of the base portion 1222 of nail 1220 The depth that bottom surface 1218 positions.In Figure 23 and Figure 24, internal layer 1212 does not include a part that can receive nail 1220 Nail cavity, and alternatively, internal layer 1212 may include such nail cavity.Further described above, internal layer 1212 can By compressible material (such as bioabsorbable foam that can allow for warehouse 1210 to collapse when applying compressive load to it And/or oxidized regenerated cellulose (ORC)) constitute.Internal layer 1212 can be by for example comprising polylactic acid (PLA) and/or polyglycolic acid (PGA) freeze dried foam is constituted.ORC can it is commercially available with trade name Surgicel and may include loose Woven fabric (as Surgical sponge is the same), loose fiber (as cotton balls) and/or foam.Internal layer 1212 can be by wherein including and/or applying above The material for being covered with drug (fibrin ferment and/or fibrin that are such as freeze-dried) is constituted, which for example can be by patient's body Interior fluid water activation and/or activation.For example, the fibrin ferment and/or fibrin of freeze-drying are positively retained at for example In Vicryl (PGA) matrix.However, in some cases, such as when in the operative site that nail bin 1200 is inserted into patient's body When, activable drug can be activated unintentionally.Referring again to Figure 23 and Figure 24, outer layer 1211 can be by water impervious or extremely Few substantially water impervious material is constituted, so that liquid does not contact or do not contact at least substantially internal layer 1212, Zhi Daocang After body 1210 is compressed and nail leg has penetrated after outer layer 1211 and/or outer layer 1211 cut in some manner. For example, outer layer 1211 can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)) it constitutes.Outer layer 1211 may include the wrappage of wrappage around internal layer 1212 and nail 1220.More specifically, nail 1220 can be inserted into It is wrapped up and is subsequently sealed in internal layer 1212 and outer layer 1211 and around the sub-component for including internal layer 1212 and nail 1220.
Referring now to Figure 25 and Figure 26, nail bin (such as nail bin 1300) for example may include compressible implanted warehouse 1310, which includes outer layer 1311 and internal layer 1312.Similar to the above, nail bin 1300, which may also include, to be located in warehouse 1310 Nail 1320, wherein each nail 1320 may each comprise base portion 1322 and one or more leg 1321 extending therefrom.It is similar to Nail bin 1200, following closely 1320 base portion 1322 can extend below the bottom surface 1318 of internal layer 1312, and outer layer 1311 can enclose Around base portion 1322.For example, outer layer 1311 can have enough flexibilities to surround each base portion 1322, so that outer layer 1311 is suitable Shape is in the profile of base portion 1322.Alternatively, referring again to Figure 24, outer layer 1211 can have enough rigidity, so that It extends around base portion 1222 without conforming to each base portion 1222.In any case, outer layer 1311 can be positioned in nail Between 1320 base portion 1322 and the nail bin support surface (such as support surface 1031 or 1131) of support nail cartridge 1300.For example, Outer layer 1311 can be positioned in base portion 1322 be limited in nail bin support surface support slit (such as slit 1032 or 1132) between.For example, further described above, outer layer 1311 can limit the movement of base portion 1322 and/or increase base Coefficient of friction between portion 1322 and nail bin support surface and/or support slit is to reduce relative motion therebetween.As another A kind of selection, referring now to Figure 27 and Figure 28, the outer layer of nail bin (such as nail bin 1400) for example can be surrounded incompletely and is located in Nail therein.For example, before the nail leg 1421 of nail 1420 is inserted into warehouse 1410, outside compressible implanted warehouse 1410 Layer 1411 can be assembled to internal layer 1412.For example, following closely 1420 base portion 1422 may extend away in outer layer 1411 due to described above Outside, and such as base portion 1422 can be positioned directly in the support slit 1032 or 1132 in nail bin support surface 1031 or 1131 In.When nail leg 1421 is inserted through outer layer 1411, nail leg 1421 can cut into outer layer 1411.In all cases, by nail leg 1421 holes formed can closely around nail leg 1421 so that leaked between nail leg 1421 and outer layer 1411 it is few (if there is If) fluid, this is able to reduce or prevent the drug accommodated in staple cartridge body 1410 and is prematurely activated and/or leaked out warehouse 1410 a possibility that.
As described above, following closely in the 1220 embeddable warehouse 1210 of leg 1221 referring again to Figure 23 and Figure 24, and follow closely 1220 Base portion 1222 can extend outwardly from the bottom surface 1218 of internal layer 1212.Further described above, internal layer 1212 can It does not include the nail cavity that can receive nail 1220.Alternatively, referring now to Figure 29 and Figure 30, nail bin (such as nail bin It 1500) for example may include compressible implanted warehouse 1510, which includes that can wherein receive at least the one of nail 1520 Partial nail cavity 1515.For example, nail 1520 nail leg 1521 the embeddable internal layer 1512 in top in, and the bottom of nail leg 1521 and Base portion 1522 can be positioned in nail cavity 1515.Base portion 1522 can be fully located in nail cavity 1515, and base portion 1522 can at least portion Ground is divided to extend below the bottom surface 1518 of internal layer 1512.Similar to the above, outer layer 1511 can encapsulate internal layer 1512 and be located at Nail 1520 in internal layer 1512.Alternatively, referring now to Figure 31, nail bin 1600 may include being located in compressible plant Enter the nail 1620 in the nail cavity 1615 in formula warehouse 1610, wherein at least part of nail 1620 is not encapsulated by outer layer 1611.Example Such as, it is each nail 1620 may each comprise the nail leg 1621 being at least partially embedded in internal layer 1612 and in addition around outer layer 1611 to The base portion 1622 of outer extension.
Referring now to Figure 32 and Figure 33, nail bin (such as nail bin 1700) for example may include compressible implanted warehouse 1710 And it is positioned at least partially at multiple nails 1720 in warehouse 1710.Warehouse 1710 may include outer layer 1711, internal layer 1712 with And in addition nail 1720 can be aligned and/or be held in place in warehouse 1710 by alignment matrix 1740, the alignment matrix. Internal layer 1712 may include can be in the groove 1741 for wherein receiving alignment matrix 1740.Alignment matrix 1140 can be press-fitted in groove It is in 1741 and/or in other words suitably solid using at least one adhesive (such as fibrin and/or protein hydrogel) Determine to internal layer 1712.Groove 1741 enables to the bottom surface 1742 of alignment matrix 1740 and the bottom surface of internal layer 1712 1718 alignment are at least substantially aligned.The bottom surface 1742 of alignment matrix can be relative to the bottom surface of the second layer 1712 1718 recess and/or from its 1718 extend.It is each to follow closely 1,720 one for may each comprise base portion 1722 and extending from base portion 1722 Or multiple legs 1721, wherein at least part of nail leg 1721 can extend across alignment matrix 1740.Alignment matrix 1740 may be used also Including for example extending through multiple holes therein and/or slit, the multiple hole and/or slit can receive nail leg wherein 1721.For example, each hole can closely receive nail leg 1721, so that very little occurs between nail leg 1721 and the side wall in hole (if any) relative motion.Alignment matrix hole can not extend completely through alignment matrix 1740, and work as nail leg 1721 When being pushed through wherein, nail leg 1721 can need to cut alignment matrix 1740.
Alignment matrix 1740 can be made of the plastic body molded, and the main body is more than internal layer 1712 and/or outer layer 1711 Have rigidity or compression ratio is lower.For example, alignment matrix 1740 can by plastic material and/or any other suitable material (such as Polydioxanone (PDS) and/or polyglycolic acid (PGA)) it constitutes.Alignment matrix 1740 can be assembled to internal layer 1712, and Subsequent nail leg 1721 can be inserted through alignment matrix 1740 and be embedded in internal layer 1712.The bottom surface 1742 of alignment matrix 1740 can One or more grooves, slit or slot including can at least partly receive the base portion 1722 of nail 1720.It is similar to the above, outside Layer 1711 can be placed in around the sub-component including internal layer 1712, alignment matrix 1740 and nail 1720.It is selected as another kind It selects, outer layer 1711 can be placed in around the sub-component including internal layer 1712 and alignment matrix 1740, wherein nail 1720 then can It is inserted through outer layer 1711, alignment matrix 1740 and internal layer 1712.It is internal layer 1712, right due to described above in any case Nail 1720 can be held in place by neat matrix 1740 and/or outer layer 1711, until and/or nail 1720 is as described above After deflection.For example, alignment matrix 1740 can be used for that 1720 will be followed closely before nail bin 1700 is implanted patient's body It is held in place, and in addition after nail bin 1700 is implanted along staple line fixing organization.For example, nail 1720 can be fixed Without being embedded in internal layer 1712 and/or outer layer 1711 in alignment matrix 1740.
Referring now to Figure 34-Figure 40, nail (such as following closely 1820) can be inserted into internal layer 1812 by compressing internal layer 1812, And nail bin (such as nail bin 1800) is assembled with 1811 wrapping inner layer 1812 of outer layer.Referring first to Figure 34, compressible internal layer 1812 are shown as including to be defined in multiple nail cavities 1815 therein, however do not wrap it can also be envisaged that going out wherein internal layer 1812 as described above Include the other embodiments of nail cavity.Referring now to Figure 35, compressible internal layer 1812 can be positioned in transfer plate 1850 and support plate It is compressed between its compressive surfaces 1852 and 1862 between 1860 and respectively.As shown in figure 35, the top surface of internal layer 1812 And bottom surface can be compressed towards each other, and in response to this, internal layer 1812 can expand outward in a lateral direction.Internal layer 1812 can be compressed to the height of the about one third of such as its original height, and can have example in its compressive state Such as the height or thickness between about 0.06 " to about 0.08 ".Same as shown in figure 35, transfer plate 1850 may also include for example The multiple nails being located in multiple nail wells 1853 such as follow closely 1820.In addition, transfer plate 1850 may also include multiple drivers 1851, The multiple driver can will be followed closely outside 1820 upward push nail wells 1853.It, will using driver 1851 referring now to Figure 36 The nail leg 1821 of nail 1820 is pushed into the internal layer 1812 of compression and passes through the internal layer 1812 of compression.Driver 1851 can make When proper nail 1820 is fully deployed from the nail well 1853 of transfer plate 1850, the top surface of driver 1851 is oriented and passes The compressive surfaces 1852 of plate 1850 are sent to flush or at least almost flush.Same as shown in figure 36, support plate 1860 may include multiple Receiver hole 1861 can receive nail leg 1821 or at least nail leg 1821 after nail leg 1821 is pushed through internal layer 1812 Top.In the case where internal layer 1812 has been compressed at the height for shorter than following closely 1820 height, receiver hole 1861 or similar knot Structure can be required, therefore when nail 1820 projects completely from nail well 1853, nail leg 1821 can be from the internal layer 1812 of compression Top surface protrusion.Alternatively, internal layer 1812 can be compressed to the height higher than 1820 height of nail, therefore be not required to Want the receiver hole 1861 in support plate 1860.
Referring now to Figure 37, after nail 1820 is inserted into internal layer 1812, support plate 1860 can be far from transfer plate 1850 And move, to allow internal layer 1812 to decompress.In this case, at the beginning of internal layer 1812 can extend to it again with elastic type Begin or at least close to initial uncompressed height.When internal layer 1812 extends again, the height of internal layer 1812, which can increase to, is more than It follows closely 1820 height and makes the nail leg 1821 of nail 1820 no longer from the top surface protrusion of internal layer 1812.In various situations Under, nail leg 1821 can be held in place by receiver hole 1861, at least up to support plate 1860 have moved to it is remote enough and It is located in leg 1821 no longer in receiver hole 1861.In this case, receiver hole 1861 can be when internal layer 1812 extends again The nail 1820 facilitated in internal layer 1812 keeps alignment relative.In all cases, internal layer 1812 and the nail 1820 being located therein It may include sub-component 1801, referring now to Figure 38, which can be for example inserted into outer layer 1811.For example, outer layer 1811 can Including being defined in cavity 1802 therein, which can receive sub-component 1801 wherein.In all cases, using work Have (such as tweezers 1855) to pull outer layer 1811 to sub-component 1801.Referring now to Figure 39, once sub-component 1801 is complete It is located in outer layer 1811, then outer layer 1811 can be sealed.The thermal energy applied to a part of outer layer 1811 can be utilized to seal Outer layer 1811.More specifically, outer layer 1811 can be made of plastic material, wherein the open end of outer layer 1811 can be by one or more Element or iron 1856 hot melt being heated, to combine and/or be sealed the periphery of the open end of outer layer 1811.Example Such as, referring now to Figure 40, the redundance 1857 of outer layer 1811 can be removed, and can then be come as described herein using nail bin 1800。
As described above, nail bin can be positioned in nail bin attachment and/or be fixed to nail bin attachment.Referring now to Figure 41 and Figure 42, nail bin attachment may include staple cartridge channel (such as staple cartridge channel 1930), which can for example receive wherein At least part of nail bin (such as nail bin 1900).Staple cartridge channel 1930 may include bottom support surface 1931, the first side to branch Wall 1940 and the second side are supportted to supporting walls 1941.In use, nail bin 1900 can be positioned in staple cartridge channel 1930, so that nail Storehouse 1900 against and/or adjacent bottom support surface 1931 position, and be located in the first lateral support wall 1940 and the second side to Between supporting walls 1941.First lateral support wall 1940 and the second side can limit laterally to supporting walls 1941 between both Gap.For example, nail bin 1900 may include lateral width 1903, which is identical to and/or is wider than to be limited to supporting walls Sideshake between 1940 and 1941, so that the compressible implanted warehouse 1910 of nail bin 1900 can be fitted securely into wall Between 1940 and 1941.Alternatively, the lateral width 1903 of nail bin 1900 is comparable is limited in the first side wall 1940 Gap between second sidewall 1941 is short.For example, at least part and bottom support surface 1931 of wall 1940 and 1941 can It is limited by the metal passage of punching press, and at least part of lateral support wall 1940 and/or lateral support wall 1941 can be by flexibility Material (such as elastomeric material) is constituted.Referring first to Figure 41, the first side wall 1940 and second sidewall of staple cartridge channel 1930 1941 can upwardly extend by the rigid element 1933 that upwardly extends from bottom support surface 1931 and from rigid element 1933 Flexible portion 1934 constitute.
Further described above, the warehouse 1910 of nail bin 1900 can be by one or more compressible layers (such as First layer 1911 and the second layer 1912) it constitutes.When warehouse 1910 is compressed against bottom support surface 1931 as described above by anvil block When, the side of warehouse 1910 can laterally extend.In the case where nail bin 1930 is made of rigid sidewalls, rigid sidewalls can be prevented Or laterally expanding for warehouse 1910 is at least limited, therefore can produce the internal pressure or stress of significant quantity in warehouse 1910.It is following closely In the case that at least part in storehouse 1930 is made of flexible sidewall, flexible sidewall can laterally bend and allow warehouse 1910 side laterally expands, to reduce the internal pressure generated in warehouse 1910 or stress.It does not include transverse direction in warehouse channel In the case that side wall or included lateral sidewalls are relatively shorter than nail bin, the side of nail bin can be not inhibited ground or at least basic On laterally expand with being not inhibited.Referring now to Figure 42, in any case, staple cartridge channel 2030 may include lateral sidewalls 2040 With 2041, which can be made of flexible material (such as elastomeric material) completely.Staple cartridge channel 2030 may also include along nail bin The lateral slit 2033 that the side of the bottom support surface 2031 in channel 2030 extends, the lateral slit can accommodate wherein simultaneously At least part of fixed lateral side wall 2040 and 2041.Lateral sidewalls 2040 and 2041 can be via snap-fitted and/or press-fitting It constructs and is fixed in slit 2033 or lateral sidewalls 2040 and 2041 can be fixed on slit by one or more adhesives In 2033.Side wall 2040 and 2041 can be separated with bottom support surface 2031 during use.In any case, work as warehouse When being implanted with nail 2020 in 2010, compressible implanted warehouse 2010 can be separated and/or be detached from side wall 2040 and 2041.
Referring now to Figure 43, surgical instruments may include axis 2150 and execute from the end that the distal end of axis 2150 extends Device.Similar to the above, end effector may include staple cartridge channel 2130, the anvil that can move between the open position and the closed position Seat 2140 and the nail bin 2100 being located between staple cartridge channel 2130 and anvil block 2140.It is also similarly to above, nail bin 2100 It may include compressible implanted warehouse 2110 and multiple nails 2120 in warehouse 2110.Staple cartridge channel 2130 may include 1) bottom support surface 2131, nail bin 2100 can position, 2 against the bottom support surface) distal end 2135 and 3) nearside End 2136.As shown in figure 43, nail bin 2100 may include can be positioned in the distal end 2135 of staple cartridge channel 2130 One end 2105 and the second end 2106 that can be positioned in the proximal extremity 2136 of staple cartridge channel 2130.Staple cartridge channel 2130 Distal end 2135 may include at least one distal side keep feature structure (such as keeping wall 2137)；Similarly, proximal extremity 2136 may include that for example, at least a nearside keeps feature structure (such as keeping wall 2138).For example, distal side keeping wall 2137 with Nearside keeping wall 2138 can limit the gap to fall between, the gap can be equal to or less than nail bin 2100 length so that When nail bin 2100 is inserted into staple cartridge channel 2130, nail bin 2100 can be securely fitted in staple cartridge channel 2130.
Referring again to Figure 23 and Figure 24, nail bin (such as nail bin 1200) for example may include flat or at least substantially flat Tissue contacting surface 1219.For example, the staple cartridge body 1210 of nail bin 1200 may include that can be limited by the first height or thickness 1207 First end 1205 and can be by the second height or the second end 1206 that limit of thickness 1208, wherein the first height 1207 can wait In or substantially equal at least second height 1208.Warehouse 1210 can include between first end 1205 and second end 1206 Constant or at least substantially constant height or thickness.For example, tissue contacting surface 1219 can in parallel or at least substantially be put down Row is in the bottom surface 1218 of warehouse 1210.Referring again to Figure 43, the first end 2105 of the warehouse 2110 of nail bin 2100 can be by First height 2107 limits, which is different from the second height 2108 of second end 2106.In the shown embodiment, One height 2107 is greater than the second height 2108, however in alternative embodiment, the second height 2108 can be greater than the first height 2107.The height of warehouse 2110 can linearly and/or geometrically reduce between first end 2105 and second end 2106.Example Such as, the tissue contacting surface 2119 extended between first end 2105 and second end 2106 can be limited along between two ends Fixed angle is orientated.For example, tissue contacting surface 2119 can be not parallel to the bottom surface 2118 and/or not of warehouse 2110 It is parallel to the support surface 2131 of staple cartridge channel 2130.
Referring again to Figure 43 and Figure 44, anvil block 2140 may include tissue contacting surface 2141, when anvil block 2140 is in closure When position, the tissue contacting surface can be parallel to or at least substantially parallel to staple cartridge channel 2130 support surface 2131, such as Shown in Figure 44.When anvil block 2140 is in the close position, anvil block 2140 can first end 2105 to nail bin 2100 compress Degree is greater than second end 2106, this is because the height of first end 2105 is higher, and the height of second end 2106 is lower. In some cases, have including the tissue T that is wherein located between tissue contacting surface 2119 and 2141 constant or at least In the case where substantially constant thickness, tissue T and storehouse 2100 at the distal end of end effector caused by pressure can Greater than pressure caused by the proximal extremity of end effector.More specifically, between anvil block 2140 and nail bin 2100 When tissue T has substantially constant thickness, it is located in the distal end 2145 of anvil block 2140 and the first end of nail bin 2100 The compressed degree of tissue T between 2105 can be greater than the second of the proximal extremity 2146 and nail bin 2100 that are located in anvil block 2140 Tissue T between end 2106.It can produce pressure in tissue T between the proximal extremity and distal end between end effector Force gradient.More specifically, when the tissue T between anvil block 2140 and nail bin 2100 has substantially constant thickness and nail bin When 2100 height linearly reduces from the distal end of end effector to proximal extremity, the pressure in tissue T can be from end The proximal extremity of the distal end of actuator to end effector linearly reduces.Similarly, when anvil block 2140 and nail bin 2100 Between tissue T have the height of substantially constant thickness and nail bin 2100 from the distal end of end effector to nearside When end geometrically reduces, the pressure in tissue T can be from the distal end of end effector to the proximal extremity of end effector Geometrically reduce.
Referring again to Figure 43, the tissue T being located among nail bin 2100 and anvil block 2140 can be without perseverance throughout which Fixed thickness.At least one in this case, be located in anvil block 2140 proximal extremity 2146 and nail bin 2100 second end End 2106 between tissue T can be thicker than be located in anvil block 2140 distal end 2145 and nail bin 2100 first end 2105 it Between tissue T.Therefore, in this case, thicker tissue T can be conventionally positioned at the lower proximal extremity 2106 of nail bin 2100 Top, and relatively thin tissue T can be usually located at higher 2105 top of distal end.In use, the percussion lining ring of axis 2150 2152 can promote along axle ridge 2151 towards distal side, so that percussion lining ring 2152 engages the cam part 2143 of anvil block 2140, and make anvil Seat 2140 is rotated towards nail bin 2100, as shown in figure 44.Once anvil block 2140 is rotated to the position being closed completely, then tissue T can quilt It is compressed between tissue contacting surface 2119 and 2141, and although the height of nail bin 2100 can be at the nearside end of end effector It is non-constant between end and distal end, but it is applied to the pressure of tissue T or compressing force can be constant or at least in tissue T It is substantially constant.More specifically, when relatively thin tissue T can be with the higher highly relevant and thicker tissue T of nail bin 2100 Can lower highly relevant with nail bin 2100 when, the sum of the cumulative height or height of tissue T and nail bin 2100 can be held in end It is constant or at least substantially constant between the proximal extremity and distal end of row device, therefore anvil block 2140 is to this cumulative height Being compressed in cumulative height for degree can be constant or at least substantially constant.
Referring again to Figure 43 and Figure 44, nail bin 2100 may include asymmetric configuration.For example, nail bin 2100 is in its first end Height at 2105 can be higher than height of the nail bin 2100 at its second end 2106.Nail bin 2100 and/or staple cartridge channel 2130 May include one or more alignment and/or keep feature structure, can ensure nail bin 2100 can only an orientation (that is, Wherein first end 2105 is positioned in the distal end 2135 of staple cartridge channel 2130 and second end 2106 is positioned at nearside Orientation in end 2136) on be located in staple cartridge channel 2130.Alternatively, nail bin 2100 and/or staple cartridge channel 2130 may include one or more alignment and/or holding feature structure, can allow for nail bin 2100 in more than one orientation It is located in staple cartridge channel 2130.It can be positioned in staple cartridge channel 2130 referring now to Figure 45, such as nail bin 2100, so that nail The first end 2105 in storehouse 2100 can be positioned in the proximal extremity 2136 of staple cartridge channel 2130, and second end 2106 can quilt It is located in distal end 2135.Therefore, the nail bin 2100 of lower height can be positioned adjacent to distal side keeping wall 2137, and higher The nail bin 2100 of degree can the neighbouring positioning of nearside keeping wall 2138.For example, nail bin 2100 can be suitably arranged to apply tissue T Constant or at least substantially constant clamping pressure, the tissue T have thicker portion in the distal end of end effector And there is thinner part in the proximal extremity of end effector.Nail bin 2100 for example can be in staple cartridge channel 2130 selectively Orientation.For example, the alignment of nail bin 2100 and/or holding feature structure can be symmetrical, and surgeon can be along such as Figure 43 Selection sexual orientation is carried out to nail bin 2100 in staple cartridge channel 2130 with direction shown in Figure 45.
Further described above, implanted warehouse 2110 may include longitudinal axis 2109, when nail bin 2100 is determined When position is in staple cartridge channel 2130, which can extend between the proximal extremity and distal end of end effector.Storehouse The thickness of body 2110 can substantially reduce between first end 2105 and second end 2106 along longitudinal axis 2109 and/or big Body increases.For example, the distance between bottom surface 2118 and tissue contacting surface 2119 or height can first end 2105 with Substantially reduce between second end 2106 and/or substantially increases.The thickness of warehouse 2110 can both increase along longitudinal axis 2109 It can also reduce.For example, the thickness of warehouse 2110 may include the one or more parts increased on thickness and can on thickness One or more parts of reduction.Nail bin 2100 may include the multiple nails 2120 being positioned in.In use, as described above, When anvil block 2140 moves in closed position, nail 2120 is deformable.Each nail 2120 can be having the same or at least substantially Identical height.For example, the height of nail can be measured for example from the bottom of base portion to the top of nail highest leg or top.
Nail in nail bin can have different staple heights.For example, nail bin may include first group of nail with the first staple height With second group of nail with the second staple height, which is positioned in the first part of compressible warehouse, and the Two groups of nails are positioned in the second part of compressible warehouse.First staple height can be higher than the second staple height, and first group Nail can be positioned in the first end 2105 of nail bin 2100, and second group of nail can be positioned in second end 2106.As Another kind selection, higher first group of nail can be positioned in the second end 2106 of nail bin 2100, and lower second group of nail It can be positioned in first end 2105.Using multiple nail groups, wherein every group has different staple heights.For example, in having Between the third group of staple height can be positioned in the warehouse 2110 among first group of nail and second group of nail.In staple in nail bin Each nail may include different staple height.Highest nail in staple can be positioned in the first end of staple, and minimum Nail can be positioned on the opposing end portions of the staple.For example, the nail being located between highest nail and minimum nail can be arranged to make Staple height is obtained for example to decline between highest nail and minimum nail.
Referring now to Figure 46, the end effector of surgical stapling device may include anvil block 2240, staple cartridge channel 2230 and by The nail bin 2200 that staple cartridge channel 2230 supports.Nail bin 2200 may include compressible implanted warehouse 2210 and, for example, be located in Multiple nails in warehouse 2210, such as nail 2220a and nail 2220b.Staple cartridge channel 2230 may include storehouse stayed surface 2231 and Such as it is defined in multiple nail support slot therein, such as support slit 2232a and 2232b.For example, nail bin 2200 may include two Outer nail 2220a and two interior nail 2220b, wherein support slit 2232a can support nail 2220a, and support slit 2232b It being capable of support nail 2220b.6 and Figure 47 referring to fig. 4, anvil block 2240 may include being defined in multiple nail shapes pits 2242 therein, When anvil block 2240 is moved towards nail bin 2200, the multiple nail shapes pit can receive nail 2220a and 2220b and make its change Shape.For example, the bottom surface of support slit 2232a can with the top surface of nail shapes pit 2242 2201a away from the first distance, And support the bottom surface of slit 2232b can be with the top surface of nail shapes pit 2242 2201b away from the second distance.For example, Due to having raised step in the support surface 2231 for wherein limiting support slit 2232b, support slit 2232b is more It is positioned close to anvil block 2240.Due to variable with different distance 2201a and 2201b, outer nail 2220a and interior nail 2220b Shape is to different forming heights.In all cases, the nail for being deformed into differing formed height can apply not the tissue T sutured Same clamping pressure or power.Further described above, originally nail can have different unshaped staple heights.For example, Referring again to Figure 46, the initial unshaped height that 2220a is followed closely in outside can be greater than the initial unshaped height of inside nail 2220b.Such as Shown in Figure 46 and Figure 47, inside nail 2220b of the unshaped height lower than outside nail 2220a, which can also have, follows closely 2220b lower than outside Forming height.Alternatively, nail 2220b in inside can have the unshaped height higher than outside nail 2220a and have Lower than the deformation staple height of outside nail 2220a.
Further described above, as shown in figure 47, anvil block 2240 is moveable in closed position, so as to compression bin Body 2210 simultaneously makes to follow closely 2220a and 2220b deformation.E.g., including the surgical stapling device of end effector shown in Figure 46 and Figure 47 It may also include cutting element, which crosscutting can be positioned at the tissue T among anvil block 2240 and nail bin 2200.For example, Anvil block 2240, staple cartridge channel 2230 and/or nail bin 2200 can limit slit, which can receive cutting slidably therein Component.More specifically, anvil block 2240 may include slot portion 2249, staple cartridge channel 2230 may include slot portion 2239, and nail bin 2200 may include slot portion 2203, described narrow when anvil block 2240 is in the close position or at least substantially in the close position Groove portion can be mutually aligned or at least substantially be aligned.After anvil block 2240 is closed and follows closely 2220a, 2220b deformation, cutting Component can be moved from the distal end of proximal extremity towards the end effector of end effector.Cutting element can be deformed with nail The incoherent mode of journey moves.Cutting element can promote while following closely deformation.In any case, cutting element can be along fixed Cut tissue in path of the position among interior staple 2220b.
As shown in figure 47, nail 2220b in inside can be shaped to the height lower than outside nail 2220a, wherein 2220b is followed closely in inside Biggish clamping pressure or power can be applied to the adjacent tissue of cutting line is formed by with cutting element.For example, 2220b is followed closely in inside It is formed by larger clamping pressure or power can provide various treatment benefits, such as make to be cut into tissue T reduction bleeding, and outside is followed closely 2220a, which is formed by lesser clamping pressure, to provide flexibility in the tissue of suture.Referring again to Figure 46 and Figure 47, anvil block 2240 may also include at least buttress material, such as buttress material 2260 being for example attached to thereon.For example, nail The leg of 2220a, 2220b can be compressed by anvil block 2240 in nail bin 2200 and then contact the nail shapes pit in anvil block 2240 Buttress material 2260 and/or the hole in buttress material 2260 are cut when 2242.When the leg deformation of nail 2220a, 2220b When, the leg can be contacted again and/or cut buttress material 2260.Buttress material 2260 can improve stopping for sutured tissue Blood ability and/or intensity is provided to be sutured tissue.
Referring again to Figure 46 and Figure 47, the bottom surface of warehouse 2210 may include stepped profile, the stepped profile with The stepped profile of storehouse stayed surface 2231 is matched or is at least substantially matched.The bottom surface of warehouse 2210 is deformable with matching Or at least substantially match the profile of storehouse stayed surface 2231.Referring now to Figure 48, similar to end effector shown in Figure 46 End effector for example may include the nail bin 2300 being positioned in.Nail bin 2300 may include with internal layer 2312 and outer layer 2311 Compressible implanted main body 2310, wherein further described above, outer layer 2311 can be by water impervious material Material is constituted.Outer layer 2311 can extend around nail 2220a, 2220b and can be respectively positioned at nail 2220a, 2220b and support slit Among 2232a, 2232b.Referring now to Figure 49, the end effector similar to end effector shown in Figure 46 for example may include fixed Position is in nail bin 2400 wherein.Similar to nail bin 2300, the compressible implanted warehouse 2410 of nail bin 2400 may include internal layer 2412 and outer layer 2411；However, may not include cutting element slit wherein in warehouse 2410.For example, cutting element may need for example Incision internal layer 2412 and/or outer layer 2411 when it passes through nail bin and is pushed into.
Referring now to Figure 50, the end effector of surgical stapling device may include anvil block 2540, staple cartridge channel 2530, Yi Jiding Nail bin 2500 of the position in staple cartridge channel 2530.It is similar to the above, nail bin 2500 may include compressible implanted warehouse 2510, Outer nail 2220a and interior nail 2220b.Staple cartridge channel 2530 may include flat or at least substantially flat storehouse support Surface 2531 and it is defined in nail therein support slit 2532.Anvil block 2540 may include stepped surface 2541 and be defined in Multiple nail shapes pits (such as forming pit 2542a and 2542b) therein.It is similar to the above, forming pit 2542a and support Distance can be defined between slit 2532, the distance is greater than the distance between forming pit 2452b and support slit 2532.Anvil Seat 2540 may also include a buttress material 2560 of the stepped surface 2541 for being attached to anvil block 2540.For example, supporter Material 2560 can conform to or at least substantially conform to stepped surface 2541.Buttress material 2560 can pass through at least one Adhesive (for example, fibrin and/or protein hydrogel) is removably attached to surface 2541.Warehouse 2510 may also include Staged shape, the staged shape be parallel to or at least substantially parallel to anvil block 2540 stepped surface 2541.More Body, anvil block 2540 may include the step 2548 extended towards nail bin 2500, and wherein step 2548 may include step height, the step Height is equal to or is substantially equal at least the step height of the step 2508 extended from warehouse 2510.For example, due to described above, Such as compressible warehouse 2510 first nail 2220a in can captured amount may differ from compressible warehouse 2510 second nail It can captured amount in 2220b.
Referring now to Figure 51, end effector may include anvil block 2640, staple cartridge channel 2530 and the nail being positioned in Storehouse 2600.Nail bin 2600 may include compressible implanted warehouse 2610, the warehouse include internal layer 2612, outer layer 2611 and The multiple nails (such as nail 2220a and 2200b) being positioned in.Anvil block 2640 can include that the forming of multiple nails is recessed in surface 2641 Hole 2642, and staple cartridge channel 2530 may include the multiple nail formed slots 2532 being limited in support surface 2531.Such as Figure 51 Shown, anvil faces 2641 can be parallel to or at least substantially parallel to storehouse stayed surface 2531, wherein each forming pit 2642 can be positioned so that with opposite and corresponding nail support slit 2532 at a distance from being equal or is at least substantially equivalent.Nail Storehouse 2600 may include nail, which can have identical or at least substantially identical initial unshaped staple height and identical or at least Substantially the same forming nail height.Alternatively, outer staple may include nail 2220a and interior staple may include nail 2220b, wherein as described above, nail 2220a and 2220b can have different unshaped staple heights.When anvil block 2640 is towards nail bin 2600 when moving to closed position, and nail 2220a and 2220b may be shaped such that their having the same or at least substantially phases Same forming nail height.For example, can be accommodated in the outside nail 2220a and inside nail 2220b of forming identical due to described above Or at least substantially identical amount compressible warehouse 2610.However, being higher than inside nail 2220b when outside nail 2220a has Unshaped staple height and can forming nail height having the same when, such as outside nail 2220a in generated clamping pressure Generated clamping pressure in the nail 2220b of inside can be greater than.
Referring now to Figure 52, the end effector of surgical stapling device may include anvil block 2740, staple cartridge channel 2530, Yi Jiding Nail bin 2700 of the position in staple cartridge channel 2530.Similar to the above, nail bin 2700 may include compressible implanted warehouse 2710, The warehouse includes internal layer 2712, outer layer 2711 and the multiple nails (such as nail 2220a and 2220b) being positioned in.Warehouse 2710 thickness can change on its entire width range.For example, warehouse 2710 may include central part 2708 and side 2709, wherein the thickness of central part 2708 can be greater than the thickness of side 2709.The most thick part of warehouse 2710 can be located at center At portion 2708, and the most thin part of warehouse 2710 can be located at side 2709.For example, the thickness of warehouse 2710 can be in central part It is gradually reduced between 2708 and side 2709.The thickness of warehouse 2710 can be between central part 2708 and side 2709 linearly And/or geometrically reduce.For example, the tissue contacting surface 2719 of warehouse 2710 may include from central part 2708 towards side 2709 to Under inclined two inclinations or angled surfaces.Anvil block 2740 may include two inclinations or angled surface, and the surface is flat It goes in or at least substantially parallel to inclined tissue contacting surface 2719.Anvil block 2740 can further include being attached to anvil block 2740 At least one piece of buttress material 2760 of inclined surface.
Further described above, the interior staple in nail bin 2700 may include higher nail 2220a and outer staple It may include lower nail 2220b.Higher nail 2220a can be positioned in it is in thicker central part 2708 and/or adjacent thereto, and Nail 2220b can be positioned in side 2709 and/or adjacent thereto.For example, higher nail 2220a is comparable due to described above Lower nail 2220b captures the material of more implanted warehouses 2710.Such case can make to follow closely 2220a ratio nail 2220b to group It knits T and applies bigger clamping pressure.Although higher nail 2220a captures more warehouses 2710 than lower nail 2220b Material, however due to the oblique structure of nail shapes pit 2742a and 2742b, higher nail 2220a is than lower nail 2220b has higher forming nail height.Can using such Consideration in the tissue that is captured of nail 2220a and 2220b come Desired clamping pressure is realized, wherein as a result, the clamping pressure for example followed closely in 2220a can be greater than, be less than or be equal to nail The clamping pressure that 2220b applies tissue.In the various alternative embodiments of the end effector shown in Figure 52, lower nail 2220b can be positioned in the thicker central part 2708 of warehouse 2710 and/or adjacent thereto, and higher nail 2220a can It is positioned in relatively thin side 2709 and/or adjacent thereto.In addition, although nail bin 2700 is shown as including inside and outside nail Row, however nail bin 2700 may include additional staple, the staple being such as located between inside staple and outside staple.In for example, Between staple unshaped staple height can between nail 2220a unshaped staple height and follow closely 2220b unshaped staple height between, and And the forming nail height of intermediate staple is between the forming nail height of nail 2220a and the forming nail height of nail 2220b.
Referring now to Figure 53, the end effector of surgical stapling device may include anvil block 2840, staple cartridge channel 2530, Yi Jiding Nail bin 2800 of the position in staple cartridge channel 2530.Similar to the above, nail bin 2800 may include compressible implanted warehouse 2810, The warehouse includes internal layer 2812, outer layer 2811 and the multiple nails (such as nail 2220a and 2220b) being positioned in.Warehouse 2810 thickness can change on its entire width range.For example, warehouse 2810 may include central part 2808 and side 2809, wherein central part 2808 can have the thickness of the thickness less than side 2809.The most thin part of warehouse 2810 can be located at At central part 2808, and the most thick part of warehouse 2810 can be located at side 2809.For example, the thickness of warehouse 2810 can be in It is gradually increased between center portion 2808 and side 2809.The thickness of warehouse 2810 can be linear between central part 2808 and side 2809 Ground and/or geometrically increase.For example, the tissue contacting surface 2819 of warehouse 2810 may include from central part 2808 towards side 2809 Two inclinations than drop or angled surface upwards.Anvil block 2840 may include two inclinations or angled surface, the table Face is parallel to or at least substantially parallel to inclined tissue contacting surface 2819.Anvil block 2840, which may also include, is attached to anvil block At least one piece of buttress material 2860 of 2840 inclined surface.Further described above, the outside in nail bin 2800 Staple may include higher nail 2220a and inside staple may include lower nail 2220b.Higher nail 2220a can be positioned It is in thicker side 2809 and/or adjacent with thicker side 2809, and following closely 2220b can be positioned in central part 2808 And/or it is adjacent with central part 2808.For example, higher nail 2220a is captured more than lower nail 2220b due to described above The material of more implanted warehouses 2810.
As described in the embodiment above with reference to Figure 46, for example, staple cartridge channel 2230 may include stepped support surface 2231, The stepped support surface can be supported at different height relative to anvil block 2240 by 2220a and 2220b is followed closely.Staple cartridge channel 2230 can consist of metal, and the step in support surface 2231 can be formed in support surface for example, by grinding operation In 2231.Referring now to Figure 54, the end effector of surgical instruments may include staple cartridge channel 2930, which includes positioning In support insert 2935 wherein.More specifically, staple cartridge channel 2930 can be formed such that its have it is for example flat or At least substantially flat support surface 2931, the support surface can support insert 2935, the insertion piece include for will The nail 2220a and 2220b of nail bin 2200 is supported on the stepped surface at different height.For example, insertion piece 2935 may include putting down Smooth or at least substantially flat bottom surface, the bottom surface can be positioned against support surface 2931.Insertion piece 2935 It may also include support slit, groove or slot 2932a and 2932b, nail 2220a and 2220b can be respectively supported at different height At degree.Similar to the above, insertion piece 2935 may include being defined in cutter slit 2939 therein, which can allow for cutting structure Part passes through.Staple cartridge channel 2930 can be made of the material for being same or different from support insert 2935.Staple cartridge channel 2930 Both can for example consist of metal with support insert 2935, and alternatively, staple cartridge channel 2930 can for example by Metal is constituted, and support insert 2935 can be for example made of plastics.Support insert 2935 can be fastened and/or be welded to nail In warehouse channel 2930.Support insert 2935 can be snap-fitted and/or be press-fitted into staple cartridge channel 2930.It can be used adhesive will Support insert 2935 is fixed in staple cartridge channel 2930.
Referring now to Figure 55, the end effector of surgical stapling device may include anvil block 3040, staple cartridge channel 3030, Yi Jiding Compressible implanted nail bin 3000 in staple cartridge channel 3030.Similar to the above, anvil block 3040 may include being defined in it In multiple nail shapes pits 3042 and cutting element can be slidably received within to cutter slit 3049 therein.Same class It is similar to above, staple cartridge channel 3030 may include being defined in multiple nail support slot 3032 therein and also can be by cutting element It is slidably received within cutter slit 3039 therein.Nail bin 3000 may include first layer 3011, the second layer 3012 and, for example, determine Position is in multiple nails (such as nail 3020a and 3020b) wherein.Follow closely 3020a unshaped staple height can be higher than nail 3020b not at Staple height.First layer 3011 can be made of the first compressible material, and the second layer 3012 can be by the second compressible material structure At.The compression ratio of first compressible material can be higher than the second compressible material, and alternatively, the first compressible material Compression ratio can be lower than the second compressible material.First compressible material can be by that can have the elastic material of the first device of spring stiffness coefficient Material is constituted, and the second compressible material can be by that can have the elastic material of two device of spring stiffness coefficient to constitute, the second spring Stiffness factor is different from first device of spring stiffness coefficient.The device of spring stiffness coefficient of first compressible material, which can be greater than second, to press The device of spring stiffness coefficient of compression material.Alternatively, the device of spring stiffness coefficient of the first compressible material be smaller than second can The device of spring stiffness coefficient of compression material.First compressible stratum can have the first rigidity, and the second compressible stratum can have second Rigidity, wherein the first rigidity is different from the second rigidity.The rigidity of first compressible stratum can be greater than the rigidity of the second compressible stratum.Make For another kind selection, the rigidity of the first compressible stratum is smaller than the rigidity of the second compressible stratum.
Referring again to Figure 55, the second layer 3012 of nail bin 3000 can include constant or at least basic on its entire width Upper constant thickness.The thickness of first layer 3011 can change on its entire width.For example, first layer 3011 may include one A or multiple steps 3008, the step can increase the thickness of warehouse 3010 in certain parts (such as central part) of warehouse 3010 Degree.Referring again to Figure 55, lower nail 3020b can be positioned in step 3008 (i.e. the thicker portion of warehouse 3010) or with platform Rank 3008 be aligned, and higher nail 3020a can be positioned in the thinner part of warehouse 3010 or with the thinner part pair Together.As warehouse 3010 thicker portion and thinner part as a result, the rigidity of inner row of the edge nail 3020b of warehouse 3010 can Greater than the rigidity of the outer skidding along nail 3020a.First layer 3011 may be connected to the second layer 3012.For example, first layer 3011 and Two layer 3012 may include interlocking features structure, which can keep together layer 3011 and 3012.First layer 3011 may include the first laminates and the second layer 3012 may include the second laminates, wherein the first laminates can by a kind of or A variety of adhesives adhere to the second laminates.Nail bin 3000 may include cutter slit 3003, which can wherein slidably Ground accommodates cutting element.
Referring now to Figure 56, nail bin 3100 may include compressible implanted warehouse 3110, which includes that single layer can press Compression material and the multiple nails being in addition for example positioned in (such as nail 3020b).The thickness of warehouse 3110 can be entire wide at it Change on degree.For example, warehouse 3110 may include the step 3108 extended along its side.Referring now to Figure 57, nail bin 3200 can be wrapped Compressible implanted warehouse 3210 is included, which includes single layer compressible material and be in addition for example positioned in multiple Nail (such as nail 3020b).The thickness of warehouse 3210 can change on its entire width.For example, warehouse 3210 may include along its side The step 3208 that portion extends.Referring now to Figure 58, nail bin 3300 may include compressible implanted warehouse 3310, wherein with above Similar, the thickness of warehouse 3310 can change on its entire width.The thickness of warehouse 3310 can be in the side of warehouse 3310 in Geometrically increase between center portion.For example, the thickness of warehouse 3310 can be limited by arch or curved shape and may include arch or Curved tissue contacting surface 3319.The thickness of warehouse 3310 and the profile of tissue contacting surface 3319 can be by a such as curvature Radius, or alternatively limited by several radius of curvature.Referring now to Figure 59, nail bin 3400 may include compressible plant Enter formula warehouse 3410, the thickness of middle warehouse 3410 can be linearly or at least basic between the side and central part of warehouse 3410 On linearly increase.
Referring now to Figure 60, nail bin 3500 may include compressible implanted warehouse 3510 and be positioned in multiple Nail 3520.Implanted warehouse 3510 may include the first internal layer 3512, the second internal layer 3513 and outer layer 3511.First internal layer 3512 It may include first thickness and the second internal layer 3513 may include second thickness, wherein the second internal layer 3513 can be thicker than the first internal layer 3512.Alternatively, the first internal layer 3512 is thick than the second internal layer 3513.In another alternative form, the first internal layer 3512 and second internal layer 3513 can have identical or at least substantially identical thickness.Each nail 3520 may include pedestal 3522 with And the deformable leg 3521 of one or more extended from pedestal 3522.Each leg 3521 may include in the first internal layer 3511 of insertion In addition top 3523 is followed closely in 3520 embeddable second internal layer 3512 of each base portion 3522.In first internal layer 3512 and/or second Layer 3513 may include at least one drug being stored therein in and outer layer 3511 can encapsulate and seal the first internal layer 3512 and the Two internal layers 3513, so that drug just flows out staple cartridge body 3510 until outer layer 3511 is pierced through by nail 3520.More specifically, to upper Text is described further, and the tissue that can be abutted against the tissue contacting surface 3519 against nail bin 3500 and position pushes down on anvil Seat, so that warehouse 3510 is compressed and surface 3519 towards screw top end 3523 and is at least partly transported downwards below screw top end 3523 It is dynamic, so that top 3523 makes outer layer 3511 is broken to dissipate or pierce through outer layer 3511.After nail leg 3521 makes outer layer 3511 is broken to dissipate, at least A kind of drug M can flow out the warehouse 3510 around nail leg 3521.In all cases, the additional compression of warehouse 3510 can will add Drug M squeeze out warehouse 3510, as shown in Figure 61.
Referring again to Figure 60, outer layer 3511 may include water impervious or at least substantially impermeable wrappage, The wrappage can one, prevent drug from prematurely flowing out nail bin 3500；And two, prevent fluid mistake in such as operative site Early enter in nail bin 3500.First internal layer 3512 may include storing or being absorbed in the first drug therein, and the second internal layer 3513 may include storing or being absorbed in the second drug therein, wherein the second drug may differ from the first drug.Warehouse 3510 So that outer layer 3511 is broken scattered initial compression can usually make the first internal layer 3512 release the first drug, and warehouse 3510 is subsequent Compression can usually make the second internal layer 3513 release the second drug.However, in this case, the first drug and the second drug The medicine that the major part for the drug that part can be released simultaneously, but initially be released can be constituted by the first drug, and be subsequently released The major part of object can be made of the second drug.Further described above, the first internal layer 3512 can be by than the second internal layer 3513 materials with bigger compression ratio are constituted, so that can be lower than the initial compression force or pressure of subsequent compression power or pressure The initial deflection bigger than in the second internal layer 3513 is generated in first internal layer 3512.It is this biggish first in first internal layer 3512 Flexure of beginning can make to release from the second internal layer 3513 from being partially larger than for the first drug released in the first internal layer 3512 Second drug.First internal layer 3512 is more porous than the second internal layer 3513 and/or more flexible.For example, the first internal layer 3512 May include be defined in multiple holes or gap 3508 therein, and the second internal layer 3513 may include be defined in multiple holes therein or First drug can be stored in the first internal layer 3512 by gap 3509, mesoporous 3508, and hole 3509 can be by the second medicine Object is stored in the second internal layer 3513.The size in the hole 3508 in the first internal layer 3512 and the hole 3509 in the second internal layer 3513 and Density can be selected to provide required result as described herein.
Referring again to Figure 60 and Figure 61, outer layer 3511, the first internal layer 3512 and/or the second internal layer 3513 can be by that biological can inhale The material of receipts is constituted.First internal layer 3512 can be made of the first bioabsorbable material, and the second internal layer 3513 can by second The material of bio-absorbable is constituted, and outer layer 3511 can be made of the bioabsorbable material of third, wherein first can biology suction The bioabsorbable material of the material of receipts, the second bioabsorbable material and/or third can be made of different materials.First Bioabsorbable material can be with first rate by bio-absorbable, and the second bioabsorbable material can be biological with the second rate Absorb, and the bioabsorbable material of third can with third speed by bio-absorbable, wherein first rate, the second rate and/ Or third speed can be different.For example, when material with specific rate by bio-absorbable when, this rate can be defined as in unit The amount of the quality of materials absorbed in time by patient body.It is well known that the body of different patients can be different rate absorb Different materials, therefore this rate can be expressed as Mean Speed to explain this changeability.In any case, compared with Slower rate phase, faster rate can be the wherein absorbed rate of more quality within the unit time.Referring again to figure The constituent material of 60 and Figure 61, the first internal layer 3512 and/or the second internal layer 3513 than outer layer 3511 constituent material quickly By bio-absorbable.For example, the first internal layer 3512 and/or the second internal layer 3513 can by bioabsorbable foam, tissue seal, And/or hemostatic material (such as oxidized regenerated cellulose (ORC)) constitute, and for example outer layer 3511 can by buttress material and/ Or plastic material is (such as with the polyglycolic acid (PGA) of trade name Vicryl sale, polylactic acid (PLA or PLLA), poly- dioxane Hexanone (PDS), polyhydroxyalkanoatefrom (PHA), Poliglecaprone 25 (PGCL), the polycaprolactone sold with trade name Monocryl (PCL), and/or the compound of PGA, PLA, PDS, PHA, PGCL and/or PCL) constitute.In this case, the first internal layer 3512 and/or second internal layer 3513 can for example immediately treat tissue and tissue bleeding can be reduced, such as wherein outer layer 3514 can Long-term structural support is provided and can be slower rate by bio-absorbable.
Further described above, the bioabsorbable rate due to outer layer 3511 is slower, outer layer 3511 Supporting tissue or tissue can be enhanced in structure in the organization healing in staple line.First internal layer 3512 and the second internal layer 3513 it One constituent material than another one constituent material quickly by bio-absorbable, one of described layer can provide treatment material just Begin to discharge, and another layer can provide the sustained release of identical treatment material and/or different treatment materials.For example, wherein treating material The absorbability for wherein absorbing or being dispersed with the basal layer of drug can be may depend on from the rate that layer 3512,3513 is released.Example Such as, substrate including the first internal layer 3512 than the substrate including the second internal layer 3513 quickly by bio-absorbable, therefore for example Drug can be faster than the speed of the release from the second internal layer 3513 from the speed that the first internal layer 3512 discharges.As described herein, warehouse One or more of 3510 layer 3511,3512 and 3513 can be for example, by least one adhesive (such as fibrin And/or protein hydrogel) adhere to each other.Adhesive can for it is water soluble and can when nail bin 3500 is implanted and/or by It is implanted into the connection discharged after certain time between each layer.For example, adhesive can than outer layer 3511, the first internal layer 3512 and/ Or second internal layer 3513 quickly by bio-absorbable.
Referring now to Figure 62 and Figure 63, for example, the nail bin of such as nail bin 3600 may include warehouse 3610, which includes can The first layer 3611 of compression, the second layer 3612 for being attached to first layer 3611 and it is attached to the removable of the second layer 3612 Compressible stratum 3613.For example, first layer 3611 can be made of compressible foamed material, the second layer 3612 may include utilizing one kind Or a variety of adhesives adhere to the laminate of first layer 3611, and third layer 3613 may include utilizing one or more bondings Agent is removably adhered to the compressible foam material of the second layer 3612.Nail bin 3600, which may also include, is for example located in warehouse 3610 In multiple nails (such as follow closely 3620).For example, it is each nail 3620 may include the base portion 3622 being positioned in third layer 3613 and The second layer 3612 is passed through from base portion 3622 and the deformable leg 3621 that one or more of extends up to first layer 3611.Make In, further described above, the top surface 3619 of staple cartridge body 3610 can be pushed down on by anvil block, until nail leg 3621 is worn Face 3619 and target tissue and contact anvil block thoroughly.After nail leg 3621 is badly deformed, anvil block can be moved far from nail bin 3600, be made The compressible stratum for obtaining nail bin 3600 can at least partly extend again.In all cases, can make when nail is inserted into across tissue Tissue bleeding.Third layer 3613 can be made of absorbing material (such as protein hydrogel), and the absorbing material for example can be from being stitched The tissue of conjunction absorbs blood.In addition to above or as substitution above, third layer 3613 can be close by hemostatic material and/or tissue It seals agent (such as freeze-dried fibrin ferment and/or fibrin) to constitute, the hemostatic material and/or tissue seal energy Enough reduce tissue bleeding.Third layer 3613 can provide structural support to first layer 3611 and the second layer 3612, wherein third layer 3613 can be made of bioabsorbable material and/or not bioabsorbable material.In any case, in 3610 quilt of nail bin After implantation, third layer 3613 can be separated with the second layer 3612.It include the material with implanted characteristic in third layer 3613 In situation, surgeon may choose whether to remove the third layer 3613 of warehouse 3610.Third layer 3613 can with integral form from The second layer 3612 removes.
First layer 3611 can be made of the first foamed material, and third layer 3613 can be made of the second foamed material, should Second foamed material may differ from the first foamed material.First foamed material can have the first density and the second foamed material can With the second density, wherein the first density may differ from the second density.For example, the second density can be higher than the first density, wherein making For as a result, third layer 3613 it is smaller than the compression ratio of first layer 3611 or have lower compression ratio.Alternatively, First density can be higher than the second density, wherein as a result, first layer 3611 it is smaller than the compression ratio of third layer 3613 or tool There is lower compression ratio.Referring now to Figure 64 and Figure 65, it is similar to nail bin 3600, nail bin 3700 may include warehouse 3710, the storehouse Body includes the first compressible froth bed 3711, is attached to the second layer 3712 of first layer 3711 and is removably attached to Dismountable third compressible foam layer 3713 of the second layer 3712.For example, third layer 3713 may include that multiple nails accommodate slit Or notch 3709, it respectively can be in at least part (such as base portion 3622) for wherein accommodating nail 3620.Nail 3620 can It accommodates in slit 3709 and slides in nail, or in other words, such as when nail bin 3700 is positioned against target tissue and is compressed by anvil block When, third layer 3713 can be slided relative to nail 3620.Nail 3620 can be made and accommodate the side of slit 3709 by accommodating slit 3709 There are gaps between wall.For example, when nail 3620 deforms, nail 3620 can not be by one of third layer 3713 due to described above Divide capture wherein, as shown in Figure 64 and Figure 65.Alternatively, nail accommodates the neighbouring second layer 3712 of slit 3709 End can be closed by a part of third layer 3713, therefore when nail 3620 deforms, at least part of third layer 3713 can quilt Capture is in nail 3620.In any case, third layer 3713 for example may include one or more perforation and/or scratch 3708, It can allow for third layer 3713 to be removed with two parts or more part from the second layer 3712, as shown in Figure 64.In Figure 64, A portion of third layer 3713 is illustrated as removing by tool 3755.Perforation 3708 can follow closely and second along the first row is located in The intermediate line arrangement of row nail.
Referring again to Figure 64 and Figure 65, following closely 3620 base portion 3622 can be located in receiving slit 3709, wherein accommodating slit 3709 side wall can contact nail leg 3621 and nail leg 3621 is releasably held in appropriate location.Although being not shown, Third layer 3713 may include the elongated slot around all nails in staple line.E.g., including the nail bin of four staples for example may include The elongated slot being aligned with each staple in nail bin bottom.Further described above, nail bin 3600 and/or nail bin 3700 at least part can be implanted patient's body, and at least part of nail bin can be removed from patient's body.Join again See that Figure 64 and Figure 65, first layer 3711 and the second layer 3712 can be trapped in nail 3620 and can be implanted together with nail 3620, And third layer 3713 can be removed or be separated optionally from nail bin 3700.In all cases, it removes and has been implanted into the one of nail bin Part can reduce the amount for the material that patient body must reabsorb, this can provide various treatment benefits.Such as passing through laparoscope In the situation that a part of nail bin is separated and removed by formula tool 3755, separated nail bin part can be by trochar (such as Trochar with the hole 5mm) it is removed from operative site.Warehouse may include the layer that more than one can be removed.For example, warehouse 3710 may include the 4th layer, and the third layer 3713 of middle warehouse 3710 can be made of hemostatic material, and the 4th layer can be by supporting Layer is constituted.For example, surgeon for example can be removed supporting layer and then choose whether to remove hemostatic layer.
Referring now to Figure 66, nail bin (such as nail bin 3800) for example may include warehouse 3810, which includes outer layer 3811 With internal layer 3812.Internal layer 3812 can be made of compressible foamed material, and outer layer 3811 can be at least partly around internal layer 3812 are wrapped up.For example, outer layer 3811 may include first part 3811a and second part 3811b, which can determine Position is on the first side of internal layer 3812, which can be located in second side of internal layer 3812, wherein first part 3811a and second part 3811b can be connected by flexible hinge (such as hinge 3809).For example, can be to the first of internal layer 3812 Side and/or second side coat at least one adhesive (such as fibrin and/or protein hydrogel) so as to by outer layer 3811 Be fixed to thereon.Outer layer 3811 may include one or more fastening members extending therefrom.For example, outer layer 3811 can wrap It includes and extends from the side of outer layer 3811 and multiple deformable legs 3821 in compressible internal layer 3812 can be placed in.For example, leg 3821 can not be from the second lateral process of internal layer 3812, or alternatively, leg 3821 can be from internal layer 3812 at least partly Protrusion.When compressible warehouse 3810 is compressed, in use, leg 3821 can pierce through the of internal layer 3812 and outer layer 3811 Two part 3811b.The second part 3811b of outer layer 3811 may include for example being defined in hole therein (such as hole 3808), the hole Nail leg 3821 can be accommodated.At least some of nail bin 3800 may include cutter slit 3803, which can wherein may be used Slidingly receive cutting element.For example, cutter slit 3803 can not entirely through warehouse 3810 thickness and extend, therefore when cutting When component is moved relative to warehouse 3810, cutting element can cut into warehouse 3810.
Referring now to Figure 67, nail bin 3900 similar with nail bin 3800 may include warehouse 3910, which includes internal layer 3812 and outer layer 3811, wherein outer layer 3811 may include the first side of neighbouring internal layer 3812 and the first part 3811a that positions with And neighbouring internal layer 3812 second side and the second part 3811b that positions.Similar to the above, outer layer 3811 may include extending from One or more fastening members.For example, outer layer 3811 may include extending from the side of outer layer 3811 and being placed in and can press Multiple deformable legs 3921 in contracting internal layer 3812.Each deformable leg 3921 may include from least one suspension hook of its protrusion or Barb 3923, at least one described suspension hook or barb can engage the second part 3811b of outer layer 3811, and therefore by outer layer 3811 remain to internal layer 3812.For example, barb 3923 from the second lateral process of internal layer 3812 and can extend through outer layer Hole 3808 in 3811 second part 3811b, so that the outer surface of the engageable outer layer 3811 of barb 3923 and by outer layer 3811 It is locked to internal layer 3812.To construct nail bin 3900, internal layer 3812 can be at least partially compressed, so as to make barb from its protrusion simultaneously And in access aperture 3808.For example, nail bin 3900 can be by least partly precommpression when nail bin 3900 is inserted into nail bin.It is right It is described further above, in the first part 3811a of the embeddable outer layer 3811 of at least part of leg 3921, wherein outer layer 3811 can be made of plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA)), and for example described Plastic material can surround at least part overmolding of leg 3921.
Referring now to Figure 68-Figure 72, for example, the nail bin of such as nail bin 4000 may include warehouse 4010, the warehouse includes Compressible first layer 4011 and the second layer 4012 and the multiple nails 4020 being in addition located in warehouse 4010.Referring to Figure 70, Each nail 4020 may include base portion 4022 and at least one deformable leg 4023 from the extension of base portion 4022.Referring to Figure 68, nail Storehouse 4000 can be positioned between the anvil block 4040 of the end effector of staple cartridge channel 4030 and surgical stapling device, middle warehouse 4010 second layer 4012 and/or the base portion 4022 of nail 4020 can be positioned against staple cartridge channel 4030.Referring now to Figure 69, second Layer 4012 may include one layer of absorbent cotton 4060, interconnected amongst one another by absorbent cotton support frame 4061.For example, 4060 He of absorbent cotton Absorbent cotton support frame 4061 can be made of the plastic material (such as polyglycolic acid (PGA)) molded.Each absorbent cotton 4060 can Including one or more holes or slit 4062, one or more of holes or slit can accommodate and extend through nail leg therein 4021, as shown in Figure 70 and Figure 71.Each absorbent cotton 4060, which may also include, is defined in receiving slit 4063 therein, and the receiving is narrow Slot can accommodate the base portion 4022 of nail 4020.Referring again to Figure 69, absorbent cotton 4060 and/or absorbent cotton support frame 4061 can be wrapped Multiple scratches, perforation etc. are included, absorbent cotton 4060 can allow for separate in desired locations with absorbent cotton support frame 4061.Phase As, referring to Figure 71, one or more absorbent cotton 4060 can for example be connected to each other along the line for including perforation and/or scratch 4064. In use, compressible froth bed 4011 can be positioned against target tissue T, and warehouse 4010 can be compressed by anvil block 4040, So that anvil block 4040 can make 4020 deformation of nail.When nail 4020 deforms, the nail leg 4021 of each nail 4020 can be by tissue T, first A part and absorbent cotton 4060 of layer 4011 capture in the nail of deformation.When staple cartridge channel 4030 is far from the nail bin being implanted into When 4060 movement, such as absorbent cotton support frame 4061 can be separated with absorbent cotton 4060 and/or absorbent cotton 4060 can be separated from each other. In some cases, when follow closely 4020 by anvil block 4040 as described above deform when, absorbent cotton 4060 can be separated with frame 4061 and/or It is separated from each other.
When anvil block moves to closed position, the nail of nail bin can be fully formed by anvil block.Alternatively, join now See Figure 73-Figure 76, the nail of such as nail bin of nail bin 4100 for example can by the anvil block when anvil block moves to closed position, and It is deformed additionally by the Staple drivers system followed closely towards the anvil block movement of closure is made.Nail bin 4100 may include compressible warehouse 4110, which can for example by foamed material and be positioned at least partially at multiple in compressible warehouse 4110 Nail 4120 is constituted.Staple drivers system may include driver clamper 4160, be located in it is multiple in driver clamper 4160 Staple drivers 4162 can be maintained at driver clamper 4160 by staple drivers 4162 and cartridge tray 4180, the cartridge tray In.For example, staple drivers 4162 can be positioned in one or more slits 4163 in driver clamper 4160, wherein slit 4163 side wall can help to boot up staple drivers 4162 towards anvil block.Nail 4120 can be supported on slit by staple drivers 4162 In 4163, wherein nail 4120 can be fully located in slit when following closely 4120 and staple drivers 4162 are in its non-firing position In 4163.Alternatively, when following closely 4120 and staple drivers 4162 are in its non-firing position, at least the one of 4120 is followed closely The open end 4161 that part may pass through slit 4163 upwardly extends.For example, the base portion for following closely 4120 can quilt referring now primarily to Figure 74 It is located in driver clamper 4160, and in the embeddable compressible warehouse 4110 in top of nail 4120.Nail 4120 is about The height of one third can be positioned in driver clamper 4160, and about 2/3rds height of nail 4120 can position In warehouse 4110.It may also include the water around warehouse 4110 and driver clamper 4160 referring to Figure 73 A, such as nail bin 4100 Impermeable wrappage or film 4111.
In use, for example, nail bin 4100 can be positioned in staple cartridge channel, and anvil block can be moved to towards nail bin 4100 and be closed Coincidence is set.When anvil block moves to its closed position, anvil block can contact and compress compressible warehouse 4110.When anvil block is in it When closed position, anvil block can not contact stud 4120.Alternatively, when anvil block moves to its closed position, anvil block can The leg of contact stud 4120 and at least partly make nail 4120 deformation.In any case, nail bin 4100 may also include one or Multiple sliding parts 4170, one or more of sliding parts can promote along longitudinal direction in nail bin 4100, so that sliding part 4170 can be with Afterwards jointing nail driver 4162 and make staple drivers 4162 and nail 4120 towards anvil block move.Sliding part 4170 can be in cartridge tray It is slided between 4180 and staple drivers 4162.In the case where the closure of anvil block starts the forming process of nail 4120, nail 4120 move upwards achievable forming process towards anvil block and nail 4120 are made to be deformed into the height or at least desired that it is fully formed Highly.In the case where the closure of anvil block does not make 4120 deformation of nail, nail 4120 is moved upwards towards anvil block can start and complete to shape Process and nail is made 4120 to be deformed into the height or at least desired height that it is fully formed.Sliding part 4170 can be from nail bin 4100 Proximal extremity be advanced to the distal end of nail bin 4100 so that the nail 4120 in the distal end for being positioned at nail bin 4100 is complete Before full forming, the nail 4120 being positioned in the proximal extremity of nail bin 4100 is fully formed.Referring to Figure 75, sliding part 4170 can be each From including at least one angled or inclined surface 4711, can be slided below staple drivers 4162 and such as Figure 76 institute Show and promotes staple drivers 4162.
Further described above, nail 4120 can be shaped, so as to by least part of tissue T and nail bin 4100 Compressible warehouse 4110 at least part capture wherein.After the forming of nail 4120, the anvil block and nail of surgical stapling device Warehouse channel 4130 can be moved far from the nail bin 4100 being implanted into.In all cases, nail bin can be fixedly engaged in storehouse dish 4180 Channel 4130, wherein as a result, when staple cartridge channel 4130 is pulled away from the warehouse 4110 being implanted into, storehouse dish 4180 can with can press The warehouse 4110 of contracting separates.Referring again to Figure 73, storehouse dish 4180 may include opposite side wall 4181, and warehouse 4110 can be removed Ground is located between the opposite side wall 4181.For example, compressible warehouse 4110 can be compressed between side wall 4181, so that Warehouse 4110 can be removably retained in therebetween during use, and when storehouse dish 4180 are pulled away from, and warehouse 4110 is from storehouse dish 4180 are releasedly detached from.For example, driver clamper 4160 may be connected to storehouse dish 4180, so that working as storehouse dish 4180 from Surgery When displacement removes, driver holder 4160, driver 4162 and/or sliding part 4170 are positively retained in storehouse dish 4180.As another A kind of selection, driver 4162 can be projected from driver clamper 4160 and be stayed in operative site.For example, driver 4162 Can by bioabsorbable material (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), Polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), the Poliglecaprone 25 sold with trade name Monocryl (PGCL), the compound of polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) it constitutes.Driver 4162 could attach to nail 4120, so that driver 4162 is deployed with nail 4120.For example, each driver 4162 may include for example can The slot of enough base portions for accommodating nail 4120, wherein the slot can be in a manner of pressure cooperation and/or snap fit accommodates nail base Portion.
Further described above, driver clamper 4160 and/or sliding part 4170 can be projected from storehouse dish 4180. For example, sliding part 4170 can slide between storehouse dish 4180 and driver clamper 4160 so that when sliding part 4170 promote with When driving up staple drivers 4162 and nail 4120, sliding part 4170 can also make driver clamper 4160 move upward to storehouse dish Except 4180.For example, driver clamper 4160 and/or sliding part 4170 can be by bioabsorbable materials (such as with commodity Name Vicryl sell polyglycolic acid (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), poly- hydroxyalkanoate Acid esters (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, The compound of PDS, PHA, PGCL and/or PCL) it constitutes.Sliding part 4170 can be integrally formed and/or be attached to driving rod or cut Component is cut, the driving rod or cutting element pass through nail bin 4100 and push sliding part 4170.In this case, sliding part 4170 can not project and can keep together with surgical stapling device from storehouse dish 4180, and sliding part 4170 is not attached to wherein In the other embodiments of driving rod, sliding part 4170 can be stayed in operative site.In any case, it is carried out further to above Description, the compression ratio of warehouse 4110 are allowed using thicker nail bin in the end effector of surgical stapling device, this is because When the anvil block of stitching unstrument closure, warehouse 4110 is compressible or collapses.It is at least partly deformed as being followed closely when anvil block is closed As a result, higher nail (such as with about 0.18 " nail of staple height) can be used, such as wherein 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-Figure 80, for example, the nail bin of such as nail bin 4200 may include compressible warehouse 4210, be positioned at Multiple nails 4220 therein and multiple flexible lateral support components 4234.Referring now to Figure 78, nail bin 4200 can be positioned in Among anvil block 4240 and staple cartridge channel 4230, wherein lateral support component 4234 could attach to staple cartridge channel 4230.Work as anvil block 4240 move downward with nail bin support member 4210 and when at least partly deforming nail 4220, as shown in Figure 79, warehouse 4210 Side can laterally expand and push out lateral support component 4234.For example, lateral support component 4234 could attach to warehouse 4210, and when warehouse 4210 laterally expands as described above, lateral support component 4234 can be separated with warehouse 4210, such as be schemed Shown in 79.Lateral support component 4234 can be viscous using at least one adhesive (such as fibrin and/or protein hydrogel) It is attached to warehouse 4210.Similar to the above, the closure of anvil block 4240 can only partially make 4220 deformation of nail, wherein can pass through such as Figure 80 It is shown to promote one or more sliding parts 4270 across nail bin 4200 to complete the forming of nail 4220.Referring now to Figure 82 and figure 83, sliding part 4270 can be advanced to the distal end of nail bin 4200 by cutting element 4280 from the proximal extremity of nail bin 4200.Example Such as, cutting element 4280 may include cutting element or knife 4283, and the cutting element or knife 4283 may pass through tissue T and/or can Nail bin support member 4210 and promote.Cutting element 4280 may include cam member 4282, which can be along 4230 He of jaw It advances and jaw is moved or is held in place in 4240 outer surface.Due to described above, nail 4220 can be cut in tissue T While entering or at least substantially while being shaped to its final shape.For example, sliding part 4270 can be determined relative to knife 4283 Position is in distal side, such as makes only that tissue T is just cut into when the propulsive units of tissue are sutured completely.
Referring again to Figure 82 and Figure 83, sliding part 4270 may include individual slidable member, the slidable member one It rises and is promoted by cutting element 4280.For example, sliding part 4270 can be accommodated in nail bin 4200, and cutting element 4280 can quilt Trigger shaft 4281 is advanced into nail bin 4200 so that 4280 engaging slide part 4270 of cutting element and towards distal side promote sliding part 4270.The sliding part 4270 can be connected to each other.In any situation, each sliding part 4270 may include angled surface or Cam 4271, the angled surface or cam are able to ascend the nail 4220 being aligned in staple.Angled surface 4271 can It is integrally formed with cutting element 4280.Referring again to Figure 82 and Figure 83, each nail 4200 may include base portion and bizet 4229, at least One deformable member extends from base portion, and bizet 4229 overmolding is to the base portion and/or deformable member for following closely 4200 In at least part, and/or position around described at least part.For example, this bizet 4229 can be by sliding part 4270 It directly drives.More specifically, the bizet 4229 of nail 4220 enables to angled surface 4271 and hat in sliding part 4270 In the case that no-fix has staple drivers between portion 4229, angled surface 4271 can be slided and direct below bizet 4229 Contact bizet 4229.In this case, each bizet 4229 includes the angled or inclined surface of at least one cooperation, The surface can be engaged by the angled surface 4271 of sliding part 4270, so that when sliding part 4270 slides below nail 4220 When, the angled surface of cooperation can drive up nail 4220.
Referring now to Figure 81, for example, the nail bin of such as nail bin 4300 may include compressible body 4310 and be located in can Multiple nails 4320 in compress body 4310.Similar to the above, nail bin 4300 may include lateral supports 4334 flexible, this is soft The lateral supports of property could attach to staple cartridge channel and/or adhere to compressible main body 4310.Over and above what is described above, flexible Lateral supports 4334 can be connected together by one or more pillars or connecting elements 4335, one or more of pillars Or connecting elements can keep together lateral supports 4334.In use, connecting elements 4335 can prevent or at least Lateral supports 4334 are inhibited prematurely to separate with warehouse 4310.Connecting elements 4335 can compress it by anvil block in nail bin 4300 Lateral supports 4334 are kept together afterwards.In this case, lateral supports 4334 can resist the side of warehouse 4310 Lateral expansion or displacement.Cutting element (such as cutting element 4280) for example can be in cutting element 4280 in warehouse 4310 Crosscutting connecting elements 4335 when moving toward the far side.For example, cutting element 4280 can push one or more sliding parts towards distal side (such as sliding part 4270), to shape nail 4320 against anvil block.The bootable cutting edge 4283 of sliding part 4270, so that Cutting element 4280 will not crosscutting connecting elements 4335, until the Feng Ding 4320 of neighbouring connecting elements 4335 is fully formed or at least Until being shaped to Desired Height.In all cases, connecting elements 4335 cooperates with lateral supports 4334 and can prevent or at least The lateral movement of compressible warehouse 4310 is reduced and at the same time preventing or at least reducing the nail 4320 being located in warehouse 4310 Lateral movement.In this case, nail 4320 can be held in place by connecting elements 4335, until 4320 deformation of nail, and And connecting elements 4335 then can be cut to discharge the side of warehouse 4310.As described above, lateral supports 4334 may be connected to Staple cartridge channel, therefore after nail bin 4300 is implanted, lateral supports 4334 can be displaced together with staple cartridge channel from Surgery It removes.Lateral supports 4334 can be made of implanted material and can be left in operative site.Connecting elements 4335 can be determined Position is among warehouse 4310 and tissue T, and after connecting elements 4335 is separated with lateral supports 4334, connecting elements 4335 can stay implanted in patient's body.For example, connecting elements 4335 can be made of implanted material, and connecting elements 4335 It can be for example made of material identical with lateral supports 4334.Connecting elements 4335 and/or lateral supports 4334 can be by soft Property bioabsorbable material it is (polyglycolic acid (PGA) such as sold with trade name Vicryl, polylactic acid (PLA or PLLA), poly- Dioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), The compound of polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) it constitutes.Connecting elements may include connecting Connect the material piece of lateral supports 4334.Nail bin may include the connecting elements for extending through the top surface of warehouse 4310, and In addition the connecting elements extended around the bottom surface of warehouse 4310.
Referring now to Figure 84, nail bin may include nail (such as following closely 4420), and the nail for example may include being inserted into bizet Wire rod portion.Wire rod portion can by metal (such as titanium and/or stainless steel) and/or plastics (such as polydioxanone (PDS) and/ Or polyglycolic acid (PGA) is constituted.Crown moieties can be by metal (such as titanium and/or stainless steel) and/or plastics (such as poly- dioxane Hexanone (PDS) and/or polyglycolic acid (PGA)) it constitutes.The Wire rod portion of each nail 4420 may include base portion 4422 and from base portion The 4422 deformable legs 4421 extended, wherein the bizet of each nail 4420 may include hat 4429, which can accommodate base wherein At least part in portion 4422.It can be by the leg of Wire rod portion for the part for assembling each nail 4420 referring now to Figure 85 A- Figure 85 C In opening 4426 in 4421 insertion bizets 4429, split shed 4426 can guide leg 4421 into base portion chamber 4427. Wire rod portion can be also inserted into hat 4429, so that leg 4421 leaves base portion chamber 4427 and the base portion 4422 of Wire rod portion enters base In portion's chamber 4427.For example, base portion chamber 4427 is enabled to when base portion 4422 enters base portion chamber 4427, Wire rod portion is being preced with It is rotated in 4429, so that nail leg 4421 is directed toward upward or at least substantially upwardly direction.Referring again to Figure 84, hat 4429 can Including outlet opening 4425, which can accommodate nail leg 4421 wherein.
Further described above, surgical stapling device may include sliding part 4470, which can traverse nail bin 4400 and staple cartridge channel 4430 and make the nail 4420 being contained in warehouse 4410 towards anvil block move.In all cases, it slides Part 4470 can move to the distal end of warehouse channel 4430 from the proximal extremity of staple cartridge channel 4430, to be implanted into 4410 He of warehouse Stapling 4420.In some cases, 4470 regracting of sliding part or the proximal extremity back to warehouse channel 4430, and another Nail bin 4400 can be inserted into warehouse channel 4430.Once new nail bin 4400 is positioned in warehouse channel 4430, then sliding part 4470 can promote towards distal side again.Surgical stapling device may include one or more locking structures, one or more of locking knots Structure can prevent in the case that no-fix has new nail bin 4400 in warehouse channel 4430 sliding part 4470 from promoting again towards distal side.Example Such as, referring again to Figure 84, staple cartridge channel 4430 may include locking shoulder 4439, which can prevent or at least limit cunning Moving part 4470 moves toward the far side.More specifically, unless sliding part 4470 be at least partly lifted up by lift structure 4428 it is super Cross shoulder 4439, otherwise sliding part 4470 can abut shoulder 4439, the lift structure 4428 for example in nail bin 4400 most Extend between nearside nail 4420.In other words, when proximal nail 4420 is not present in new nail bin 4400,4470 nothing of sliding part Method promotes.Therefore, when there are not there is nail bin when used nail bin 4400 or in warehouse channel 4430 in warehouse channel 4430 When 4400, sliding part 4470 can not promote in warehouse channel 4430.
Further described above, nail bin (such as nail bin 4500) can for example be positioned in nail referring now to Figure 86 In warehouse channel 4530 and may include compressible warehouse 4510, the multiple nails 4520 being located in warehouse 4510 and storehouse dish or Retainer 4580.Compressible warehouse 4510 may include outer layer 4511 and internal layer 4512, and wherein outer layer 4511 can be in a sealing fashion Surround internal layer 4512.For example, outer layer 4511 can extend between internal layer 4512 and storehouse dish 4580.Alternatively, outer layer 4511 can be only partially about internal layer 4512, and for example, outer layer 4511 and storehouse dish 4580 can cooperate to surround or at least basic Upper encirclement internal layer 4512.Further described above, nail 4520 can be supported by storehouse dish 4580, wherein storehouse dish 4580 may include It is capable of one or more nail supports channel of support nail 4520.Storehouse dish 4580 could attach to warehouse 4510, wherein such as warehouse 4510 can laterally be compressed between the opposite side wall of storehouse dish 4580.The side wall of storehouse dish 4580 can laterally support warehouse 4510, and for example, storehouse dish 4580 may include extending up to one or more of warehouse 4510 from bottom support 4583 Wall or fin 4582.For example, may include one or more slits or channel in warehouse 4510, wherein one or more of slits Or channel can accommodate wall 4582 and/or interlock with wall 4582.Wall 4582 can partly or almost all extend through warehouse 4510.For example, wall 4582 can extend longitudinally through nail bin 4500 between the first row of nail 4520 and the second row of nail 4520.
Warehouse 4510 and/or storehouse dish 4580 may include that cooperation keeps feature structure, which keeps feature structure can be in storehouse It is provided between disk 4580 and warehouse 4510 snap-fitted.Nail bin 4500 can be positioned in warehouse channel 4530, so that storehouse dish 4580 Warehouse channel 4530 is positioned and/or is attached to against warehouse channel 4530.Storehouse dish 4580 can be detachably coupled to warehouse channel 4530, so that storehouse dish 4580 can divide with warehouse channel 4530 after nail bin 4500 is compressed by anvil block 4540 and follows closely 4520 deformations From and can be implanted together with warehouse 4510.For example, storehouse dish 4580 can be by bioabsorbable material (such as with trade name The polyglycolic acid (PGA) of Vicryl sale, polylactic acid (PLA or PLLA), polydioxanone (PDS), poly (hydroxy alkanoate) Ester (PHA), with trade name Monocryl sell Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, The compound of PDS, PHA, PGCL and/or PCL) it constitutes.Surgical stapling device may also include firing lock and/or driver, described Firing lock and/or driver can be in storehouse dish 4580 at staple cartridge channel 4530 and bottom driving surface middle slip, the bottom Portion's driving surface can promote or project storehouse dish 4580 from warehouse channel 4530.Warehouse 4510 can be detachably coupled to storehouse dish 4580, so that warehouse 4510 can be separated with storehouse dish 4580 after nail bin 4500 is compressed by anvil block 4540 and follows closely 4520 deformations. For example, storehouse dish 4580 can engage warehouse channel 4530 with being kept fixed, so that storehouse dish 4580 are with warehouse channel 4530 together from Surgery Position is removed.Surgical stapling device may also include firing lock and/or driver, and the firing lock and/or driver can be in warehouses In cartridge tray 4580 and bottom driving surface middle slip on 4510, the bottom driving surface can be promoted from storehouse dish 4580 Or project warehouse 4510.For example, nail bin 4500 may also include the staple drivers being located among storehouse dish 4580 and nail 4520, so that When firing lock is slided towards distal side, staple drivers and nail 4520 can be driven upwardly towards anvil block.For example, staple drivers can be at least It is partially embedded into compressible warehouse 4510.
Similar to the above, nail bin 4500 may include locking structure, and the locking structure can prevent or at least limit cutting Component moves toward the far side, unless the nail bin 4500 not fired has been located in staple cartridge channel 4530.Cartridge tray 4580 may include example It is such as lifted up cutting element in staple cartridge channel 4530 and it is made to be more than the surface of locking surface.It is not deposited in warehouse channel 4530 In the situation of nail bin 4500 for including storehouse dish 4580, cutting element can not be promoted.Proximal nail in nail bin 4500 and/or appoint The nail that he is suitble to may include promoting surface, which can be lifted beyond locking surface for cutting element completely.Except upper Except described in literary or substitution is described above, and each section of nail bin 4500 can be made of the material with different colours.In this feelings Under condition, surgeon can visually identify in staple cartridge channel 4530 when there is the nail bin for not firing and/or firing.Example Such as, 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 With third color.If surgeon sees the first color, surgeon may know that exist in staple cartridge channel 4530 and not hit The storehouse 4500 of hair；If surgeon sees the second color, surgeon, which may know that, has percussion in staple cartridge channel 4530 It storehouse 4500 and needs to remove remaining storehouse dish 4580；And if surgeon sees third color, surgeon is known Any part of nail bin 4500 is not remained in road warehouse channel 4530.
Referring now to Figure 87, nail bin (such as nail bin 4600) for example may include compressible implanted warehouse 4610 and determine Position is in multiple nails 4620 wherein.Warehouse 4610 may include outer layer 4611 and internal layer 4612.Internal layer 4612 may include for example limiting In multiple pits (such as pit or cavity 4615) therein, the multiple pit can be conducive to collapsing for warehouse 4610.For example, Internal layer 4612 may include corrugated or honeycomb configuration dot matrix, and the dot matrix is able to bear compressing force or pressure, as long as the compression Power or pressure are no more than specific threshold value.When being less than threshold value, internal layer 4612 can be about the compressing force or pressure applied Power and with linear or at least substantially linear rate deformation.After compressing force or pressure are more than threshold value, internal layer 4612 can It is collapsed under pressure suddenly due to compressive load to bending greatly and collapse or be bent.The dot matrix of internal layer 4612 can be by that can link together Multiple sub-layer 4612a constitute.Each sub-layer 4612a may include multiple alternate ditches and ridge or wave, the multiple alternate ditch It can be aligned with the alternate ditch of adjacent sublayers 4612a with ridge with ridge or wave.For example, the ditch of the first sub-layer 4612a can be positioned so that It is adjacent with the ridge of the second sub-layer 4612a；And similarly, the ridge of the first sub-layer 4612a can be positioned so that and the second sub-layer 4612a Ditch it is adjacent.Adjacent sub-layer 4612a can pass through at least one adhesive (such as fibrin and/or protein hydrogel) phase Mutually adhere to and/or adhere to outer layer 4611.Figure 88 shows to have collapsed in warehouse 4610 and followed closely 4620 and deform against storehouse Body 4610 captures and keeps the nail bin 4600 after tissue T.
Referring now to Figure 89-Figure 91, for example, nail bin (such as nail bin 4700) may include compressible implanted warehouse 4710 And it is located in multiple nails 4720 in warehouse 4710.Similar to the above, warehouse 4710 may include outer layer 4711 and internal layer 4712, Wherein internal layer 4712 may include multiple sub-layer 4712a.Same similar to the above, each sub-layer 4712a may include alternate ditch 4717 and ridge 4718, the alternate zastrugi can be mutually aligned to define therebetween pit or cavity 4715.For example, ditch 4717 And/or ridge 4718 can along it is being parallel to each other and/or be parallel to longitudinal axis 4709 axis extend.Nail 4720 can be in multiple nails Be aligned in row, the multiple staple can along it is being parallel to each other and/or be parallel to longitudinal axis 4709 axis extend.As another Kind selection, referring again to Figure 87 and Figure 88, nail 4620 accommodated in warehouse 4600 can extend along axis, and the axis traverses Or perpendicular to axis defined by the zastrugi as sub-layer 4612a.Referring again to Figure 89-Figure 91, nail 4720 can extend across ditch 4717 and ridge 4718, wherein nail 4720 can be maintained in warehouse 4710 by the frictional force between 4720 and sub-layer 4712a of nail.It is multiple Sub-layer 4712a can be by buttress material and/or plastic material (such as polydioxanone (PDS) and/or polyglycolic acid (PGA) nail 4720 can be for example maintained at upright orientation, and/or will by composition, above support material and/or plastic material Nail 4720 is kept into be aligned relative to each other, as shown in Figure 89 and Figure 90.Figure 91, which is shown, to have collapsed and has followed closely in warehouse 4710 4720 have deformed to capture against warehouse 4710 and keep the nail bin 4700 after tissue T.
Referring again to Figure 89-Figure 91, when warehouse 4710 is compressed, warehouse 4710 can it is with resilience ground or with elastic type It collapses.For example, ditch 4717 and ridge 4718 wave formed in each sub-layer 4712a can be put down when warehouse 4710 is compressed Change or at least substantially by graduation, this can make between ditch 4717 and ridge 4718 defined by cavity 4715 collapse or at least substantially It collapses.In all cases, after removing compressing force or pressure from warehouse 4710, at least portion of warehouse 4710 or warehouse 4710 Point can it is with resilience ground or extended again with elastic type.For example, when warehouse 4710 is compressed, the ditch of adjacent sublayers 4712a Connection between 4717 and ridge 4718 can keep undamaged or at least substantially undamaged, so that removing pressure from warehouse 4710 After contracting power, sub-layer 4712a can bias ditch 4717 and ridge 4718 makes it away from each other in itself, and therefore make warehouse 4710 at least Partly extend again.When warehouse 4710 is compressed, it can deform or be crushed in plastic manner, therefore from warehouse 4710 After upper removal compressing force or pressure, warehouse 4710 can not extend again.Referring now to Figure 92, nail bin (such as nail bin 4800) example It such as may include the warehouse 4810 that can be crushed, which includes outer layer 4811 and internal layer 4812, and wherein internal layer 4812 can Including corrugated, honeycomb configuration dot matrix, the dot matrix has multiple pits defined therein or cavity 4815.In restriction The wall of the dot matrix of layer 4812 may include one or more reductions or thin cross section 4819, one or more of reductions or It is scattered that thin cross section can allow for limiting the wall of dot matrix to break when warehouse 4810 is compressed.In this case, when nail bin 4800 When being implanted, warehouse 4810 can be crushed.
Referring now to Figure 93-Figure 95, nail bin (such as nail bin 4900) for example may include warehouse 4910, which includes for example Outer layer 4911 and the multiple crushable members 4912 being located between the top and bottom of outer layer 4911.Referring first to Figure 93 and Figure 94, nail bin 4900 may also include multiple nails 4920, wherein each nail 4920 can be positioned in crushable member 4912.More Body, each crushable member 4912 may include first part 4912a, second part 4012b and Part III 4012c, described First part 4912a, second part 4012b and Part III 4012c can cooperate to limit cavity 4915, the cavity wherein Nail 4920 can be accommodated.In use, further described above, nail bin 4900 can be positioned in staple cartridge channel and Compressing force can be applied to tissue contacting surface 4919 so as to nail bin support member 4910.When tissue contacting surface 4919 moves downward, Crushable member 4912 is collapsible.In this case, the second part 4912b of each crushable member 4912 is collapsible to right In the first part 4912a answered；Similarly, the Part III 4912c of each crushable member 4912 collapsible to corresponding In two part 4912b.When warehouse 4910 is compressed and crushable member 4912 is collapsed, it is located in crushable member 4912 Nail 4920 it is deformable, as shown in Figure 95.The second part 4912b of each crushable member 4912 can frictionally engage corresponding It first part 4912a and/or is press-fitted in corresponding first part 4912a, so that once crushable member 4912 is applied Compressing force is more than the retentivity for being maintained at first part 4912a and second part 4912b in its extended position (Figure 94), Then first part 4912a and second part 4912b can start to slide relative to each other.Similarly, each crushable member 4912 Part III 4912c can frictionally engage corresponding second part 4912b and/or be press-fitted in corresponding second part 4912b In, so that being more than once for by second part 4912b and Part III 4912c to the compressing force that crushable member 4912 applies The retentivity being maintained in its extended position (Figure 94), then second part 4912b and Part III 4912c can start relative to that This sliding.
It may include multiple nails in nail bin in many embodiments as described herein.Such nail can be by being deformed into substantially U The metal wire rod for nail leg that there are two shape configurations and tool is constituted.It is contemplated that wherein nail may include that various configuration (is such as engaged with Together and with three or more nail legs two or more wire rods) other embodiments.Be used to form one of nail or Multiple wire rods may include circle or at least substantially round cross section.Staple line material may include any other suitable cross section, all Such as the cross section of square and/or rectangle.Nail can be made of plastic wire.Nail can be made of the metal wire rod for being coated with plastics. Substitution in addition to nail or as nail, storehouse may include the fastener of any suitable type.For example, this fastener may include can pivot The arm turned, the arm can be folded when being engaged by anvil block.Two-part fastener can be used.For example, nail bin may include multiple First fastener portion, and anvil block may include multiple second fastener portions；When anvil block is compressed against nail bin, the second fastening Part portion is connected to the first fastener portion.As described above, sliding part or driver can be promoted in nail bin to complete the forming of nail Process.Sliding part or driver can be promoted in anvil block, so as to make one or more formed parts move downwardly to it is opposite Nail bin and nail or the fastener being located in nail bin engagement.
Nail bin may include being stored in four staples therein.Four staples can be configured to two inside staples and two A outside staple.For example, inside staple and outside staple can be positioned in the first side of the cutting element in nail bin or cutter slit On；Similarly, inside staple and outside staple can be positioned in second side of cutting element or cutter slit.It is selected as another kind It selects, nail bin may not include cutting element slit wherein；However, the substitution as nail bin slit, this nail bin may include can be by cutting The specified portions of component incision.Similarly, inside staple can be arranged in nail bin so that its with cutting element slit wherein equidistantly Or it is at least substantially equally spaced.Similarly, outside staple can be arranged in nail bin, so that itself and cutting element slit wherein It is equally spaced equidistantly or at least substantially.Nail bin may include being stored in nail bin to be more or less than four staples.Nail Storehouse may include six staples.For example, nail bin can include three staples on the first side of cutting element slit wherein, and in cutting structure It include three staples in second side of part slit.Nail bin may include odd number staple.For example, nail bin can be in cutting element slit wherein Include two staples on first side, and includes three staples in second side of cutting element slit wherein.Staple may include having The nail of identical or at least substantially identical unshaped staple height.Alternatively, one or more staples may include tool There is the nail that different unshaped staple heights are followed closely from other.For example, the nail on the first side of cutting element slit wherein can not have first not Forming height, and the nail in second side of cutting element slit wherein can have the second unshaped height, the second unshaped height Different from the first height.
Referring now to Figure 96 A- Figure 96 D, the end effector of surgical stapling device may include such as storehouse attachment (such as nail bin Channel 5030), the fastener cartridge (such as nail bin 5000) being removably positioned in staple cartridge channel 5030, and with nail bin 5000 The jaw 5040 relatively positioned with staple cartridge channel 5030.Nail bin 5000 may include compressible body 5010 and it is multiple nail 5020, And/or any other suitable fastener being positioned at least partially in compressible body 5010.For example, each nail 5020 can Including base portion 5022, and the leg 5021 in addition upwardly extended from base portion 5022, wherein at least part of leg 5021 can be embedding Enter in warehouse 5010.Compressible body 5010 may include top surface or tissue contacting surface 5019 and bottom surface 5018, Middle bottom surface 5018 can against staple cartridge channel 5030 support surface 5031 and position and supported by the support surface 5031.With Similar to the above, support surface 5031 for example may include for example being defined in multiple support slits 5032 (Figure 96 D) therein, described more A support slit 5032 can accommodate and the base portion 5022 of support nail 5020.The end effector of surgical stapling device may also include Holding matrix (such as holding matrix 5050), the holding matrix can jointing nail 5020, and will tissue capture therebetween.Example Such as, holding matrix 5050 is removably attached to jaw 5040.In use, once nail bin 5000 is positioned in staple cartridge channel In 5030, then jaw 5040 and the holding matrix 5050 being attached to thereon can be moved towards nail bin 5000 and staple cartridge channel 5030.Pincers Mouth 5040 can be moved downward along axis 5099, so that jaw 5040 and staple cartridge channel 5030 keep that when jaw 5040 is closed This is parallel or at least substantially parallel.More specifically, for example, jaw 5040 can be closed in some way, so that working as jaw 5040 When moving towards nail bin 5000, the tissue contacting surface 5051 of holding matrix 5050 is parallel to or at least substantially parallel to nail bin 5000 tissue contacting surface 5019.
Referring now to Figure 96 A, holding matrix 5050 can be detachably secured to jaw 5040, so that working as holding matrix 5050 when being attached to jaw 5040, there is that seldom (if any) is opposite to be transported between holding matrix 5050 and jaw 5040 It is dynamic.Jaw 5040 may include one or more holding feature structures, and one or more of holding feature structures can will be kept Matrix 5050 is held in place.For example, holding matrix 5050 can be snap-fitted and/or be pressure fitted into jaw 5040. Holding matrix 5050 is adhered to jaw 5040 using at least one adhesive.In any case, jaw 5040 is movable Tissue T and tissue T are contacted against the position that the tissue contacting surface 5019 of nail bin 5000 positions to wherein holding matrix 5050 In setting.When tissue T is located against nail bin 5000 by jaw 5040, the compressible body 5010 of nail bin 5000 can be by jaw 5040 compressions can not be compressed by it.In either case, the tissue of nail bin 5000 can be not passed through and connect by following closely 5200 leg 5021 5019 protrusion of surface is touched, as shown in Figure 96 A.In addition, same as shown in Figure 96 A, in reservation matrix 5050 not jointing nail 5020 In the case of, jaw 5040 can keep tissue T against compressible body 5010.Such embodiment allows surgeon repeatedly to beat Jaw 5040 is closed in open and close, for example to obtain phase of the end effector in operative site in the case where not damaging tissue T Hope positioning.It is contemplated, however, that other embodiments, wherein screw top end 5023 can before warehouse 5010 is compressed by anvil block 5040 from 5019 protrusion of tissue contacting surface.Referring now to Figure 96 B, once end effector is properly positioned, then jaw 5040 can court Staple cartridge channel 5030 moves downward, so that compressible body 5010 is compressed by anvil block 5040, and makes tissue contacting surface 5019 are pushed down relative to nail 5020.When tissue contacting surface 5019 is pushed down, the top 5023 of nail leg 5021 Pierceable tissue contacting surface 5019 and at least part for piercing through tissue T.In this case, holding matrix 5050 can quilt It is located in 5020 top of nail, so that the retaining hole 5052 of holding matrix 5050 is aligned with the top 5023 of nail leg 5021 or at least base It is aligned on this.
Referring now to Figure 96 C, when pushing down on holding matrix 5050 along axis 5099, the nail leg 5021 for following closely 5020 can be into Enter in retaining hole 5052.The side wall of the engageable retaining hole 5052 of nail leg 5021.Described in greater detail below, holding matrix 5050 May include extend in retaining hole 5052 and/or around retaining hole 5052 one or more holding members, it is one or more A engageable nail leg 5021 of holding member.In any situation, nail leg 5021 can be maintained in retaining hole 5052.Various In the case of, the top 5023 of nail leg 5021 can enter in retaining hole 5052 and can frictionally engage holding member and/or hole 5052 Side wall.When the base portion 5022 of holding matrix 5050 towards nail 5020 is pushed, nail leg 5021 can be relative to side wall and/or holding Member slide.Due to described above, force of sliding friction can produce between nail leg 5021 and holding matrix 5050, wherein this sliding Frictional force can resist holding matrix 5050 and be inserted on nail 5020.When holding matrix 5050 along nail 5020 nail leg 5021 to downslide When dynamic, the force of sliding friction between holding matrix 5050 and nail 5020 can be constant or at least substantially constant.For example, by In nail leg 5021, retaining hole 5052 and/or holding member in retaining hole 5052 and/or around retaining hole 5052 is extended to several What variation in shape, when holding matrix 5050 is along 5021 slide downward of nail leg, force of sliding friction can be increased and ord reduce. The compressible body 5010 of nail bin 5000 can also resist holding matrix 5050 and be inserted into nail 5020.More specifically, compressible master Body 5010 can be made of elastic material, and the elastic material for example can apply drag to holding matrix 5050；When wherein compressible When the compressed distance of main body 5010 increases, the drag increases.For example, the increase of the drag as caused by warehouse 5010 can phase It is linearly proportional or at least substantially linearly proportional for its compressed distance of middle warehouse 5010.By 5010 institute of warehouse The increase of the drag of generation can be relative to its compressed geometric distance of middle warehouse 5010 proportional.
Further described above, enough percussion forces can be applied to jaw 5040 and holding matrix 5050, so as to Overcome above-mentioned drag and frictional force.In use, holding matrix 5050 can be arranged to any suitable depth relative to nail 5020 At degree.Holding matrix 5050 can be arranged at certain depth relative to the base portion 5022 of nail 5020, so as to by two layers or more Layer tissue is secured together and generates compressing force or pressure within the organization.In all cases, including holding matrix 5050 and The system of nail 5020 allows surgeon by selecting the depth that wherein holding matrix 5050 is placed to select to apply tissue The amount of the compressing force or pressure that add.For example, holding matrix 5050 can be pushed down towards the base portion 5022 of nail 5020, until protecting It holds matrix 5050 and is arranged to the bottom with support slit 5032 until the certain depth 5011, wherein shallower depth 5011 It can produce the higher compressing force or pressure for being applied to tissue T, and deeper depth 5011 can produce and be applied to the lower of tissue T Compressing force or pressure.The depth 5011 that the compressing force or pressure for being applied to tissue T can be placed with wherein holding matrix 5050 It is linearly proportional or at least substantially linearly proportional.In all cases, the compressing force or pressure for being applied to tissue T can Thickness depending on the tissue T being positioned between matrix 5050 and nail bin 5020.More specifically, for given distance 5011, the presence that the presence compared with thick tissue T may compare thin tissue T generates higher compressing force or pressure.
In all cases, further described above, the adjustable wherein holding matrix 5050 of surgeon is pacified The depth set, to illustrate to be located in the thicker and/or relatively thin tissue in end effector, and with unrelated with tissue thickness Mode certain or scheduled pressure is applied to tissue T.For example, surgeon can will keep when fastening relatively thin tissue T Matrix 5050 is arranged to shallower depth 5011, or deeper depth 5011 is arranged to when the tissue T of fastening thicker, with Just reach identical or at least substantially identical compressing force within the organization.Further described above, surgeon is optional Determine to selecting property the amount of the compressing force applied to the tissue T being positioned between matrix 5050 and nail bin 5010.In various feelings Under condition, surgeon can engage holding matrix 5050 with nail 5020, and holding matrix 5050 is positioned to the base with nail 5020 Portion 5022 away from the first distance, so as to tissue apply the first compression pressure.Alternatively, surgeon can will keep Matrix 5050 is positioned to base portion 5022 away from the second distance, and the second distance is shorter than the first distance, so as to tissue It is applied more than the second compression pressure of first pressure.Alternatively, holding matrix 5050 can be positioned to by surgeon With base portion 5022 at a distance of third distance, the third distance is shorter than the second distance, to be applied more than the second pressure to tissue The third compression pressure of power.Fastening system including holding matrix 5050 and nail 5020 can allow for surgeon to apply target tissue The compression pressure of widening range.
Referring now to Figure 96 D, nail leg 5021 may pass through holding matrix 5050 and be inserted into, so that nail leg top 5023 extends To the top surface of holding matrix 5050.Referring again to Figure 96 C, jaw 5040, which may also include, is defined in mesopore therein 5042, when nail leg top 5023 passes through the retaining hole 5052 in holding matrix 5050, which can accommodate nail leg top 5023.For example, mesopore 5042 can be aligned with retaining hole 5052, so that not contact jaw 5040 of leg 5021.Mesopore 5042 can With enough depth, no matter so that the distance that wherein holding matrix 5050 is placed why, the not contact jaw of nail leg 5021 5040.Referring now to Figure 96 D, after holding matrix 5050 engages with nail 5020 and is arranged to required position, nail bin is logical Road 5030 and jaw 5040 can be moved far from tissue T.More specifically, staple cartridge channel 5030 can divide with the nail bin 5000 being implanted into From, and anvil block 5040 can be separated with the holding matrix 5050 being implanted into.When jaw 5040 moves simultaneously far from holding matrix 5050 And when following closely supporting element 5032 far from the movement of base portion 5022, although jaw 5040 and staple cartridge channel 5030 are no longer to holding matrix 5050 and base portion 5022 support is provided, however can still keep the distance between the bottom of holding matrix 5050 Yu base portion 5022 5011.Although compressed warehouse 5010 and/or compressed tissue T apply bias force, nail leg to holding matrix 5050 Stiction between 5021 and holding matrix 5050 can be enough for holding matrix 5050 to be held in place.For example, warehouse 5010 can be made of elastic material, and the elastic material when compressed can be in some way to holding matrix 5050 and nail 5020 Apply elastic bias force so that the elastic bias force be propulsive holding matrix 5050 and nail 5020 so that its separate, however Confrontation of this movement by the frictional engagement between nail leg 5021 and holding matrix 5050.
As described above, holding matrix may include multiple retaining holes, wherein each retaining hole can accommodate fastener wherein Leg.Referring now to Figure 97, there is shown with a part of holding matrix 5150, which may include the guarantor limited by periphery 5156 Hold hole 5152.The periphery 5156 in hole 5152 may include round or at least substantially circular shape and/or any other is suitable Shape.Holding matrix 5150 may include for example one or more holding members (such as holding member 5153), one or more A holding member extends in hole 5152 and can engage the fastener leg when fastener leg is inserted.For example, Each holding member 5153 may include the cantilever to extend internally towards central axis 5159 (that is, towards the center in hole 5152).It is each outstanding Arm may include first end and second end, and the first end is attached to holding matrix main body 5158, the second end shape At the periphery 5156 of retaining hole 5152.The periphery 5156 of retaining hole 5152 can be limited by first diameter or width, and fastener Supporting leg can be limited by second diameter or width, and wherein second diameter can be greater than the first diameter.For example, fastener leg can One or more of contact holding member 5153 simultaneously makes its deflection, makes when so as in fastener leg insertion retaining hole 5152 The diameter of retaining hole 5152 increases.Further described above, periphery defined by fastener leg can be greater than retaining hole 5152 periphery 5156, so that fastener leg can be such that periphery 5156 extends when in fastener leg insertion periphery 5156.
Referring again to Figure 97, hole 5152 can be limited by deformable member 5153, wherein each deformable member 5153 can Relative to or independently of the deflection of other deformable members 5153.For example, adjacent deformable member 5153 can be divided by slit 5154 It opens, which can allow for each deformable member 5153 to bend relative to other deformable members 5153.Each slit 5154 may include first end 5155 in the holding matrix main body 5158, opening in retaining hole 5152 second end, And the constant or at least substantially constant width extended between first end 5155 and second end.As another kind Selection, the width of each slit 5154 can be inconsistent, and each slit 5154 is between its first end and second end Width can increase and or reduce.The first end 5155 of slit 5154 may include enlarging section (such as rounded portions), the enlarging section It may be either the base portion offer tension release for being attached to the deformable member 5153 of holding matrix main body 5158, can also increase deformable The flexibility of component 5153.The geometry of deformable member 5153 and/or slit 5154 can be selected as deformable member 5153 provide required flexibility.For example, slit 5154 can be lengthened out, to form longer deformable member 5153, this is longer Deformable member is more flexible than the deformable member 5153 with short length.The width of each deformable member 5153 can It is selected to flexible needed for it is provided.More specifically, the deformable member with relatively thin width is than with thicker width Deformable member is more flexible.Referring again to Figure 97, the cantilever of deformable member 5153 is attached to holding matrix main body 5158 First end can be wider than the second end of cantilever.For example, cantilever can between its first end and second end with linear or At least substantially linear mode is tapered.
Referring again to Figure 97, holding matrix main body 5158 may include flat or at least substantially flat material piece, tool Organized contact surface 5151 and top surface 5157.For example, tissue contacting surface 5151 can mutually be put down with top surface 5157 Row is at least substantially parallel to each other.Each deformable member 5153 may include first part 5153a and second part 5153b, Wherein first part 5153a can extend in a first direction, and second part 5153b can be on different directions or second direction Extend.Holding matrix main body 5158 can limit plane, and the first part 5153a of deformable member 5153 can be located at this plane It is interior.The second part 5153b of deformable member 5153 can angularly extend relative to first part 5153a.For example, second Dividing can upwardly extend in the side of the top surface 5157 far from holding matrix main body 5158, and second part 5153b can be towards guarantor The central axis 5159 for holding hole 5152 is assembled.In any case, second part 5153b can pass through second in fastener leg It is deflected when being partially inserted into far from central axis 5159.In the case where the nail leg 5021 for following closely 5020 is inserted into retaining hole 5152, Deformable member 5153 can be upwardly-deformed in the side of the base portion 5122 generally away from nail 5120.Therefore, deformable member 5153 can The direction that is inserted into nail leg 5021 is identical or at least substantially identical general direction on deflect.
Referring again to figure BD, the second part 5153b of deformable member 5153 for example can respectively include sharp top, institute Stating sharp top can slide when nail leg 5021 is inserted against nail leg 5021.If nail leg 5021 is in the opposite direction (that is, by nail leg 5021 from the direction that retaining hole 5052 removes) is pulled, then the sharp top of second part 5153b also can It is snapped in nail leg 5021.In some cases, second part 5153b can be tilted more than 90 degree relative to the side of nail leg 5021 Angle, therefore when nail leg 5021 is tended to withdraw from the power of nail leg 5021 from retaining hole 5052, second part 5153b can be dug Enter or is dug into the side of nail leg 5021.Nail leg 5021 can include for example impression and/or be recessed (such as micro-indentations) in its surface, The impression and/or recess can be for example on the tops for wherein accommodating deformable member 5053.For example, applying when to nail leg 5021 When withdrawing from power, the top of deformable member 5053 can be trapped in or be dug into the impression of nail leg 5021.It is dug as second part 5153b Enter in nail leg 5021 as a result, can be only by second part 5153b for the power for removing nail leg 5021 from retaining hole 5022 and acting on The deeper inside that is arranged in nail leg 5021 and increase remove nail leg 5021 needed for power.Further, since second part 5153b to Upper inclination, second part 5153b can more allow in the insertion retaining hole 5152 of nail leg 5021 and withdrawing from more resistant to nail leg 5021. Therefore, nail leg 5021 power needed for retaining hole 5022 is inserted into be smaller than needed for removal nail leg 5021 in retaining hole 5022 Power.For example, the power needed for removing nail leg 5021 in retaining hole 5022, which can be greater than, is inserted into institute in retaining hole 5022 for nail leg 5021 The power about 50% needed.Alternatively, for example, power needed for removing nail leg 5021 can be greater than needed for insertion nail leg 5021 Between power about 10% to about 100%.For example, power needed for removing nail leg 5021 can be greater than power described in insertion nail leg 5021 about 100%, about 150%, about 200%, and/or be greater than 200%.
Referring again to Figure 97, second part 5153b can circumferentially be arranged around hole 5152 and can be in second part 5153b Pit is limited between hole 5152.More specifically, second part 5153b can limit pit 5160, which can be in fastener The top of fastener leg is accommodated when supporting leg is inserted into retaining hole 5152.The second part 5153b of deformable member 5153 can Including annular or at least substantially annular profile, the profile for example can collaboratively limit the annular of pit 1560 or at least Substantially annular shape.For example, second part 5153b can limit taper or truncated cone shape pit.Pit can be by properly counting (such as four deformable members 5153 (Figure 97), six deformable members 5153 (Figure 98) or eight can for purpose deformable member Deformation element 5153 (Figure 99)) it limits.Referring now to Figure 100, the deformable member of holding matrix (such as holding matrix 5250) Such as can be formed cone shape or at least substantially be cone shape.Holding matrix 5250 for example may include multiple retaining holes (such as retaining hole 5252), the multiple retaining hole can be limited by periphery 5256.Periphery 5256 may include polygon or at least The substantially shape of polygon and/or other suitable shapes.Holding matrix 5250 may include one or more holding members (such as holding member 5253), one or more of holding members are extended in hole 5252 and can be inserted in fastener leg The fastener leg is engaged when entering in hole 5252.For example, each holding member 5253 may include towards central axis 5259 (that is, court The center in hole 5252) cantilever that extends internally.Each cantilever may include first end and second end, the first end attachment To holding matrix main body 5258, the second end forms the periphery 5256 of retaining hole 5252.The periphery 5256 of retaining hole 5252 It can be limited by first diameter or width, and fastener leg can be limited by second diameter or width, wherein second diameter can be big In the first diameter.For example, fastener leg can contact one or more of holding member 5253 and make its deflection, with Increase the diameter of retaining hole 5252 when just in fastener leg insertion retaining hole 5252.Further described above, Periphery defined by fastener leg can be greater than the periphery 5256 of retaining hole 5252, so that when fastener leg is inserted into periphery 5256 When middle, fastener leg can be such that periphery 5256 extends.
Referring again to Figure 100, hole 5252 can be limited by deformable member 5253, wherein each deformable member 5253 can Relative to or independently of the deflection of other deformable members 5253.For example, adjacent deformable member 5253 can be divided by slit 5254 It opens, which can allow for each deformable member 5253 to bend relative to other deformable members 5253.Holding matrix Main body 5258 may include the flat or at least substantially flat material with tissue contacting surface 5251 and top surface 5257 Tablet.For example, tissue contacting surface 5251 can be parallel to each other with top surface 5257 or at least substantially be parallel to each other.Each may be used Deformation element 5253 may include first part 5253a and second part 5253b, and wherein first part 5253a can be in a first direction Upper extension, and second part 5253b can be upwardly extended in different directions or second party.For example, holding matrix main body 5258 can Plane is limited, and the first part 5253a of deformable member 5253 can be located in this plane.The second of deformable member 5253 Part 5253b can angularly extend relative to first part 5253a.For example, second part 5253b can be far from holding matrix The side of the top surface 5257 of main body 5258 upwardly extends, and second part 5253b can be towards the central axis of retaining hole 5252 5259 assemble.In any case, second part 5253b can be when fastener leg passes through second part and is inserted into far from Mandrel line 5259 deflects.Referring again to Figure 100, second part 5253b can circumferentially be arranged around hole 5252 and can be at second Divide and limits pit between hole 5252.More specifically, second part 5253b can limit pit, the pit can be in fastener The top of fastener leg is accommodated when supporting leg is inserted into retaining hole 5252.The second part 5253b of deformable member 5253 is for example Can limit polygon or at least substantially be polygon pit.Pit (such as can be limited by suitable number of deformable member Four deformable members 5253 (Figure 100) of fixed square, six deformable members 5253 (Figure 101) that hexagon can be limited, Or octagonal eight deformable members 5253 (Figure 102) can be limited) limit.
Referring now to Figure 103, holding matrix (such as holding matrix 5350) for example can be by flat or at least substantially put down Smooth material piece (for example, titanium and/or stainless steel) formation.For example, can be by one or more punching courses in holding matrix Multiple holes 5352 are formed in 5350 main body 5358.Material piece can be positioned in stamping die, which can incite somebody to action at the time of activation Certain parts of material stamp out, to form such as week of the hole 5355 of slit 5354, slit 5354 and/or retaining hole 5352 Side 5356.Deformable member 5353 can also be bent to suitable configuration by stamping die.For example, stamping die can make second Divide 5353b upwardly-deformed relative to first part 5353a along crease line 5353c.Referring now to Figure 104, holding matrix (is such as protected Hold matrix 5450) it for example may include multiple retaining holes 5452.Similar to the above, the periphery 5456 of each retaining hole 5452 can be by quilt Multiple deformable members 5453 that slit or slit 5454 are spaced apart limit.For example, each deformable member 5453 is whole equal It can be bent upwards, periphery 5456 can be limited including the free end of the cantilever of deformable member 5453.Holding matrix 5450 It may include surrounding or at least substantially around multiple holes 5455 of retaining hole 5452.For example, hole 5455 can surround or surround by can Periphery that the fixing end of the cantilever of deformation element 5453 limits and be arranged to circular array.Each hole 5455 may include it is round or At least substantially circular periphery and/or any other suitable periphery.In use, hole 5455 may be either to be attached to holding square The base portion of the deformable member 5453 of battle array main body 5458 provides tension release, and can increase the flexibility of deformable member 5453.Compared with Big hole 5455 can provide bigger flexibility compared with lesser hole 5455 for deformable member 5453.In addition, closer to variable The hole 5455 of shape component 5453 can provide bigger flexibility compared with farther hole 5455.
Referring now to Figure 105, holding matrix (such as holding matrix 5550) for example may include multiple retaining holes 5552.Each Retaining hole 5552 may each comprise elongated slot 5554, which has the round or at least substantially circular end of amplification 5555.For example, end 5555 can be limited by the diameter for being wider than slit 5554.Elongated slot 5554 and end 5555 can axis along longitudinal direction The positioning of line 5559 and/or placed in the middle.Slit 5554 and end 5555 can limit two opposite inserted sheets 5553, described two opposite Inserted sheet 5553 is capable of the leg of jointing fastener, and make when fastener leg passes through inserted sheet 5553 and is inserted into two it is opposite Inserted sheet 5553 deflects.End 5555 with larger perimeter or diameter can limit longer inserted sheet 5553, and the inserted sheet 5553 can It is more more flexible than inserted sheet 5553 defined by the end 5555 with smaller perimeter or diameter.It end 5555 can week having the same Long and diameter, for example, each inserted sheet 5553 can be about the axisymmetrical vertical or at least substantially vertical with longitudinal axis 5559. Alternatively, end 5555 can have different perimeter and/or diameter, wherein each inserted sheet 5553 can be not in relation to its axis Line is symmetrical.For example, inserted sheet 5553 can be distorted around its axis when fastener leg passes through retaining hole 5552 and is inserted into.It is existing Referring to Figure 106, holding matrix (such as holding matrix 5650) for example may include multiple retaining holes 5652.Each retaining hole 5652 It may each comprise elongated slot 5654, which includes round or at least substantially circular end 5655.For example, elongated narrow Slot 5654 and end 5655 can the positioning of axis 5659 and/or placed in the middle along longitudinal direction.Each end 5655 can by with slit 5654 Of same size or at least substantially identical diameter limits.
Referring now to Figure 107, holding matrix (such as holding matrix 5750) for example may include multiple retaining holes 5752.Each Retaining hole 5752 may include such as multiple slits (such as slit 5754) with enlarged end 5755.For example, 5754 He of slit End 5755 can position and/or placed in the middle along longitudinal axis 5759.Axis 5759 can be mutually perpendicular to or across direction on prolong It stretches.Slit 5754 and end 5755 can for example limit four inserted sheets 5753, and four inserted sheets 5753 being capable of jointing fastener branch Leg, and the deflection when fastener leg passes through retaining hole 5752 and is inserted into.For example, each inserted sheet 5753 may include triangle Or at least substantially be triangle configuration (such as equilateral triangle).Alternatively, it referring now to Figure 108, protects Holding matrix (such as holding matrix 5850) for example may include multiple retaining holes 5852.Each retaining hole 5852 may include with end 5855 multiple slits (such as slit 5854), wherein slit 5854 and end 5855 can along longitudinal direction the positioning of axis 5859 and/or Between two parties.Axis 5859 can be mutually perpendicular to or across side upwardly extend.Slit 5854 and end 5855 can limit inserted sheet 5853, Inserted sheet 5853 can jointing fastener supporting leg, and pass through retaining hole 5852 and deflection when being inserted into fastener leg.Each Inserted sheet 5853 may include bowed shape.More specifically, different from end sharp shown in Figure 105, each inserted sheet 5853 can Including curved end, the end being capable of contact securing member supporting leg.
Referring now to Figure 109, holding matrix (such as holding matrix 5950) for example may include multiple retaining holes 5952.Each Retaining hole 5952 for example may include multiple slits (such as slit 5954), wherein each slit 5954 can extend along axis 5959 And/or it is placed in the middle.Axis 5959 can transversely to one another, for example, axis 5959 may be arranged so that all axis 5959 extend through Cross the center of retaining hole 5952 and it is equally spaced from each other ground or be at least substantially equally spaced.Each slit 5954 may include towards The open end at the center of retaining hole 5952 and second end or closed end 5955 at the opposite end of slit 5954.With it is above Similar, slit 5954 and end 5955 can for example limit three inserted sheets 5953, and three inserted sheets 5953 being capable of jointing fastener Supporting leg, and the deflection when fastener leg passes through retaining hole 5952 and is inserted into.Each inserted sheet 5953 may include in slit The arcuate configuration extended between 5954 adjacent end portion 5955.Referring now to Figure 110, holding matrix (such as holding matrix 6050) It such as may include multiple retaining holes 6052.Each retaining hole 6052 may include inserted sheet 6053, and inserted sheet 6053 being capable of jointing fastener Supporting leg, and the deflection when fastener leg is inserted into retaining hole 6052.For example, inserted sheet 6053 may include being fixed to keep square The base portion of battle array main body 6058 and free end including arch or curved profile 6056, the free end being capable of contact securing member branch Leg.Fastener leg can be the nail leg that is made of round wire rod, wherein curved profile 6056 can with outside the bending of round wire rod Surface matching at least substantially matches.
Referring again to Figure 110, holding matrix main body 6058 may include multiple slits 6054 and hole 6055, the multiple slit The various pieces of inserted sheet 6053 and retaining hole 6052 can be limited with hole.Inserted sheet 6053 may include rectangular configuration, the rectangle structure Type includes parallel or at least substantially parallel side.Referring now to Figure 111, holding matrix (such as holding matrix 6150) is for example It may include multiple retaining holes 6152.Each retaining hole 6152 may include inserted sheet 6153, the inserted sheet can jointing fastener supporting leg, and And the deflection when fastener leg is inserted into retaining hole 6152.For example, inserted sheet 6153 may include being fixed to holding matrix main body 6158 base portion and free end including arch or curved profile 6156, the free end being capable of contact securing member supporting leg.It protects Holding matrix main body 6158 may include multiple slits 6154 and hole 6155, and the multiple slit and hole can limit inserted sheet 6153 and protect Hold the various pieces in hole 6152.Inserted sheet 6153 may include tapered configuration, and the tapered configuration includes bowed side.For example, Inserted sheet 6153 can geometrically be tapered, such as base portion is made to be wider than free end.
As described above, fastening system may include multiple nails, the multiple nail includes multiple holdings in holding matrix Hole and the nail leg being inserted into.As follows to be more fully described, nail can be maintained in the first jaw, and holding matrix can be protected It holds in the second jaw, wherein at least one of the first jaw and the second jaw can be moved towards another one.In all cases, The nail being located in the first jaw can be fixed wherein, so that when holding matrix is engaged with nail leg, nail leg and retaining hole pair Together.Referring to Figure 112 and Figure 113, fastener system may include the nail bin being for example located in the first jaw of surgical stapling device 6200, and, for example, the holding matrix 6250 being located in the second jaw of surgical stapling device.Referring now to Figure 119 and Figure 120, Further described above, holding matrix 6250 may include multiple retaining holes 6252, wherein each retaining hole 6252 can wrap Include the periphery 6256 limited by one or more deflection components 6253.For example, further described above, limiting each The deflection component 6253 in hole 6252 can limit pit 6201.Each pit 6201 may include for example bending and/or concave surface, The bending and/or concave surface can be unjustified in nail leg and retaining hole 6252 and contact deflection component 6253 first And/or the top of nail leg is directed in hole 6252 in the situation of tissue contacting surface 6251.
Further described above, fastening system may also include multiple nails 6220, the multiple nail 6220 includes can Retaining hole 6252 in holding matrix 6250 and the nail leg 6221 being inserted into.For example, each nail 6220 may include for example basic The configuration of upper U-shaped, the configuration include base portion 6222, and nail leg 6221 can be upwardly extended from the base portion 6222.Referring now to Figure 115 And Figure 116, for example, the retaining hole 6252 in holding matrix 6250 can be arranged to two it is parallel or at least substantially parallel Lengthwise rows, the lengthwise rows can along holding matrix longitudinal axis or be parallel to the longitudinal axis and extend.In the first row Retaining hole 6252 can be deviated relative to the retaining hole 6252 in the second row or stagger arrangement.For example, each nail 6220 may include being located in The second nail in the retaining hole 6252 of the first nail leg 6221 and positioning in a second row in retaining hole 6252 in the first row Leg 6221, wherein as a result, base portion 6222 can be upwardly extended in the side of the longitudinal axis across holding matrix 6250.For example, Nail 6220 can be parallel to each other or at least substantially be parallel to each other.More specifically, the base portion 6222a for for example following closely 6220a can be parallel to Or the base portion 6222b at least substantially parallel to nail 6220b, the base portion 6222b of the nail 6220b can be parallel to or at least basic On be parallel to nail 6220c base portion 6222c.Such as plane defined by the nail leg 6221a of nail 6220a can be parallel to or at least base Plane defined by the nail leg 6221b of nail 6220b is parallel in sheet, plane defined by the nail leg 6221b of the nail 6220b can It is parallel to or at least substantially parallel to plane defined by the nail leg 6221 for following closely 6220c.
Referring now to Figure 112 and Figure 114, nail bin 6200 may include multiple nails 6220, and in addition there are multiple alignment to lead To the alignment matrix 6260 in device (such as slit, groove and/or hole), the multiple alignment guider can be aligned nail 6220.? In various situations, alignment matrix 6260 enables to follow closely 6220 nail leg before holding matrix 6250 engages nail leg 6221 6221 are aligned with the retaining hole 6252 in holding matrix 6250.Referring now to Figure 117 and Figure 118, alignment matrix 6260 may include Multiple alignment holes 6262, the multiple alignment hole can be closely received the nail leg 6221 of nail 6220.For example, each nail 6220 can Including base portion 6222 and two nail legs 6221 extended from base portion 6222, wherein the base portion 6222 of nail 6220 can be around holding square The bottom surface 6264 of battle array 6260 extends, and nail leg 6221 may pass through alignment hole 6262 and upwardly extend.Each alignment hole 6262 can be circular or at least substantially circular, and the diameter for limiting alignment hole 6262 can be equal to or slightly larger than across it In and extend nail leg 6221 diameter.Alignment matrix 6260 may also include multiple raised members 6263, the multiple protrusion structure Part can be upwardly extended from the top surface 6261 of alignment matrix 6260 and be surround or at least partly about alignment hole 6262.It is convex Playing component 6263 can provide longer alignment hole 6262, wherein in all cases, longer hole 6262 may compare short hole 6262 preferably control the alignment of nail leg 6221.
In use, the first jaw of support nail cartridge 6200 can be positioned on the side of tissue to be stapled, and support Second jaw of holding matrix 6250 can be positioned on the other side of tissue.Once jaw is relative to tissue by suitably fixed Position, then the second jaw and holding matrix 6250 can be moved towards nail bin 6200.When nail leg 6221 passes through the holding of holding matrix 6250 Hole 6252 and when being inserted into, the tissue contacting surface or bottom surface 6251 of holding matrix 6250 can contact tissue and against alignment The tissue contacting surface or top surface 6261 of matrix 6260 press tissue.Alternatively, as follows will in more detail Description, nail bin 6200 can also for example including the top of top surface 6261 and accessible tissue for being positioned at alignment matrix 6260 can Nail bin support member.Referring again to Figure 114 and Figure 118, alignment matrix 6260, which may also include, is defined in one or more of holes 6203；When alignment matrix 6260 is positioned against tissue, one or more of holes can be at one of wherein receiving tissue Point.Above compressible warehouse is positioned at alignment matrix 6260 and/or in the case where against alignment matrix 6260, when warehouse is pressed When contracting, a part of compressible warehouse can be in access aperture 6203.Similarly, holding matrix 6250 may include multiple holes 6202, institute At least part of tissue can be accommodated wherein when holding matrix 6250 is positioned against tissue by stating multiple holes 6202.
Further described above, when nail 6220 nail leg 6221 pass through holding matrix 6250 retaining hole 6252 and When insertion, the top of nail leg 6221 can be upward from the top surface 6257 of holding matrix 6250.In all cases, as above Described, the top of nail leg 6221 can keep not being bent after being inserted into across retaining hole 6252.Referring now to Figure 121-figure 124, the fastening system including nail bin 6200 and holding matrix 6250 may also include multiple protectiveness top covers or lid (such as cap 6270), the multiple protectiveness top cover or lid may fitted in the nail leg 6221 for being projected on 6250 top of holding matrix.Each cap 6270 can completely or at least partially cover the sharp end of nail leg 6221, so that the sharp end does not contact and its phase The tissue of neighbour's positioning.Referring now to Figure 124, each cap 6270 may include being defined in hole 6271 therein, which can be wherein It is closely received the top of nail leg 6221.Such as cap 6270 can be by elastic material (such as siloxanes, polyisoprene, santoprene (santoprene) and/or natural rubber) constitute.The perimeter or diameter in hole 6271 are smaller than the week for the nail leg 6221 being inserted Long or diameter.For example, hole 6271 in protectiveness top cover 6270 is expansible to accommodate nail leg 6221 wherein.As another kind Selection, cap 6270 may not include hole, and the top of nail leg 6221 can cut cap 6270 when leg 6221 is inserted into cap 6270. Under any circumstance, each cap 6270 can be arranged in nail leg 6221, until the base portion 6272 of cap 6270 is adjacent or neighbouring The top surface 6257 of holding matrix 6250 and position.In all cases, cap 6270 enables to it to be closely arranged to On the top of nail leg 6221, so as not to being removed from the top easily.Each cap 6270 can be for example including taper Or at least substantially be taper outer surface.Cap 6270 may include any suitable shape, such as including parabola shaped or extremely It is less substantially the shape of parabola shaped outer surface.
Such as surgical stapling device shown in Figure 125-Figure 127 can be used to dispose for example above-mentioned fastener system.End Actuator may include the first jaw or staple cartridge channel 6230 and the second jaw 6240, and the first jaw or staple cartridge channel 6230 can incite somebody to action Nail bin 6200 supports wherein, and the second jaw 6240 can support holding matrix 6250 and the multiple protectiveness top cover 6270.Referring first to Figure 125, the second jaw 6240 in open configuration is shown, jaw 6230 and 6240 can be relative to group It knits T and is positioned such that tissue T is positioned between matrix 6250 and nail bin 6200.As described above, nail bin 6200 can also wrap Compressible warehouse (such as warehouse 6210) is included, for example, nail 6220 and alignment matrix 6260 can wherein be located.For example, tissue T can Against warehouse 6210 top surface and position.Second jaw 6240 may include multiple grooves or hole 6245 and another or Multiple holding feature structures or retainer, the multiple groove or hole 6245 can accommodate multiple protectiveness top covers 6270, described One or more keeps feature structure or retainer that can be held in place holding matrix 6250 on cap 6270.Example Such as, cap 6270 can be maintained in hole 6245 by holding matrix 6250.Referring now to Figure 137, each hole 6245 can be by cap Part or all of 6270 is accommodated therein.Such as the size in hole 6245 is sufficiently set to and enables to that pressure can be passed through Match and/or cap 6270 is fixed in hole 6245 by least one of snap-fit arrangement.Can using at least one adhesive come Cap 6270 is fixed in hole 6245.For example, this adhesive, which may be chosen such that, has engaged nail leg 6221 simultaneously in cap 6270 And second jaw 6240 move away from the fastener assembly being implanted into after, cap 6270 can be separated with the second jaw 6240.Now Referring to Figure 138, the second jaw 6240 may also include at least one emulsion sheet 6246, at least one described emulsion sheet can be assembled to Two jaws 6240 and it can extend above cap 6270 and cap 6270 is maintained in hole 6245.Such as it is viscous using at least one At least part of emulsion sheet 6246 is fixed to jaw 6240 by mixture.In use, operative site is inserted into end effector Before, emulsion sheet 6246 can be separated at least partly with jaw 6240.Emulsion sheet 6246 can by implanted material (such as PDS and/ Or PGA) constitute, for example, the implanted material can be cut by nail leg 6221 when nail leg 6221 is exposed from holding matrix 6250 Enter.For example, emulsion sheet 6246 can be fixed in fastening system among lid 6270 and holding matrix 6250.
Referring now to Figure 126, further described above, jaw 6240 can move to closure position from open position It sets, wherein tissue T is positioned against holding matrix 6250 and warehouse 6210.In this position, holding matrix 6250 can not be connect Dowel 6220.Jaw 6240 can be moved between its open position and its closed position by actuator 6235.For example, jaw 6240 may include the distal pin 6243 and proximal pin 6244 extended from, and wherein distal pin 6243 can be limited to warehouse channel 6230 In distal side slit 6233 in be vertically slidably movable vertically or at least substantially, and wherein proximal pin 6244 can limited equally It is vertically slidably movable vertically or at least substantially in the proximal slot 6234 in staple cartridge channel 6230.In use, actuator 6235 can proximally retract, into the upper end of its corresponding slit 6233 and 6234, such as to scheme the driving of pin 6243 and 6244 Shown in 126.For example, actuator 6235 may include distally driving slit 6236 and nearside driving slit 6237, wherein driving slit 6236 and 6237 side wall can contact distal pin 6243 and proximal pin 6244 respectively, and when actuator 6235 proximally moves Drive up pin 6243 and 6244.More specifically, distal pin 6243 can be such that distal side drives when actuator 6235 proximally moves The inclined first part 6236a upward sliding of slit 6236 is into middle section or second part 6236b；Similarly, nearside Pin 6244 can make the inclined first part 6237a upward sliding of distally driving slit 6237 to middle section or second part In 6237b.When pin 6243 and 6244 both moves upwards, jaw 6240 can rotate down to closed position towards tissue T.
Referring now to Figure 127, further described above, actuator 6235 further can be proximally pulled, with Just the second jaw 6240, nail bin support member 6210 are pushed down on towards the first jaw 6230, and makes holding matrix 6250 and multiple guarantors Shield property top cover 6270 is engaged with the nail leg of nail 6220.For example, the additional proximal movement of actuator 6235 can make to drive slit 6236 and 6237 side wall distinguishes contact plug 6243 and 6244, and respectively towards the downward drive pin in the bottom end of slit 6233 and 6234 6243 and 6244.In this case, actuator 6235 can be proximally pulled, so that distal pin 6243 leaves driving slit 6236 second part 6236b simultaneously enters inclined Part III 6236c, and similarly, it is narrow that proximal pin 6244 leaves driving The second part 6237b of slot 6237 simultaneously enters inclined Part III 6237c.When pin 6243 and 6244 both moves downward When, the second jaw 6240 can move downwardly to firing position towards the first jaw 6230.For example, the second jaw 6240 can be transported downwards It is dynamic so that holding matrix 6250 remain parallel to or at least substantially parallel to warehouse 6210 top surface and/or be parallel to Or at least substantially parallel to alignment matrix 6260.In any case, once holding matrix 6250 and protectiveness top cover 6270 The nail leg 6221 of jointing nail 6220, as shown in Figure 129, then the second jaw 6240 may return to open or at least substantially open Position.For example, actuator 6235 can be pushed towards distal side, pin 6243 and 6244 is respectively driven to slit 6233 and 6234 Top, and then once pin is then caused across the middle section 6236b and 6237b of corresponding driving slit 6236 and 6237 The bottom end of dynamic device 6235 towards slit 6233 and 6234 is driven downwards.Once the second jaw 6240 is opened, then the first jaw 6230 can separate with the nail bin 6200 being implanted into, and the first jaw 6230 and the second jaw 6240 can be far from the fastenings being implanted into Part component and be removed, as shown in Figure 128.
Referring again to Figure 127, reader will note that, although holding matrix 6250 and cap 6270 have engaged nail leg 6221, Pin 6243 and 6244 is not shown as being placed in the bottommost of its respective slots 6233 and 6234 in figure.As thick tissue T This thing happens for meeting when being positioned between matrix 6250 and warehouse 6210.It is fixed in relatively thin tissue T referring now to Figure 130 In the case where position is between holding matrix 6250 and warehouse 6210, pin 6243 and 6244 can further be driven downwards corresponding to it Slit 6233 and 6234 in, as shown in Figure 132.In general, for example, actuator 6235 can be proximally pulled, to lead to It crosses process shown in above-mentioned and Figure 130-Figure 132 and carrys out upwardly or downwardly drive pin 6243 and 6244, and since tissue T is relatively thin, Holding matrix 6250 and protectiveness top cover 6270 can be further driven in the nail leg 6221 of nail 6220, such as Figure 133 and Figure 134 It is shown.As adjustability provided by holding matrix 6250 as a result, it is thick for no matter capturing the tissue in end effector Or it is thin, identical or at least substantially identical compression pressure can be obtained in the tissue fastened.Holding matrix Adjustability provided by 6250 allows surgeon to pass through the depth for selecting holding matrix 6250 to be placed to select to group It knits and applies biggish compression pressure or lesser compression pressure.For example, wherein holding matrix 6250 can be arranged to nail leg Range on 6221 can for example be determined by the length or range of slit 6233 and 6234.
As described above, protectiveness top cover 6270 can by can for example firmly grasp nail leg 6221 end it is soft or flexible Material is constituted.Protectiveness top cover 6270 can be by the bioabsorbable plastics (polyglycolic acid such as sold with trade name Vicryl (PGA), polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA), with trade name Poliglecaprone 25 (PGCL) that Monocryl is sold, polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or The compound of PCL) and/or biocompatibility metal (such as titanium and/or stainless steel) composition.As shown in Figure 124, each cap 6270 Other caps 6270 can be not attached to.Alternatively, one or more caps 6270 can be mounted to holding matrix 6250.Example Such as, cap 6270 for example can be connected to holding matrix 6250 by least one adhesive, and wherein the hole 6271 in cap 6270 can be with Retaining hole 6252 in holding matrix 6270 is aligned or is at least substantially aligned.Referring now to Figure 135, protectiveness top cover is (such as Cap 6370) inner cavity or dome 6374 can be for example limited, the top of nail leg 6221 can be for example contained in by the inner cavity or dome Wherein.For example, cap 6370 may include bottom 6372 and the hole 6371 for extending through bottom 6372.It hole 6371 can be by one or more Deflection component 6373 limits, and one or more of deflection components 6373 can be passed through in nail leg 6221 and are inserted into When deflect.Such as two or more caps 6370 can be connected together to form the array of cap 6370.For example, referring now to figure 136, multiple caps 6370 can be linked together by material piece 6375.Piece 6375 can have enough rigidity to keep cap 6370 desired arrangement and/or alignment thereof.Cap 6370 can be by biocompatibility metal (such as titanium and/or stainless steel) structure At, and piece 6375 can be by bioabsorbable plastics (polyglycolic acid (PGA), the poly- cream such as sold with trade name Vicryl Sour (PLA or PLLA), polydioxanone (PDS), are sold polyhydroxyalkanoatefrom (PHA) with trade name Monocryl The compound of Poliglecaprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL) structure At.Piece 6375 can be by wherein storing and/or being dispersed with the bioabsorbable material of antibacterial agent (such as collargol and/or triclosan) Material is constituted, such as when piece 6375 is by bio-absorbable, the antibacterial agent can be released.
Further described above, using injection molding method by 6375 injection molding of piece around cap 6370, such as make Cap 6370 is embedded into piece 6375.Alternatively, such as piece 6375 can be molded using injection molding method, wherein for example existing During injection molding method and/or after injection molding method, hole 6376 is formed in piece 6375 using process for stamping.In any situation In, cap 6370 can be inserted into hole 6376 and be consolidated using press-fitting and/or snap-fitted interconnection and/or at least one adhesive It is scheduled in hole 6376.Each cap 6370 may include surround or at least partly around 6370 periphery of cap ring-shaped groove, the ring Shape groove can accommodate on the periphery in hole 6376 wherein.Piece 6375 can be by can allow for carrying out relative motion between cap 6370 Flexible and/or pliable material is constituted.For example, flexible sheets 6375 can be made of such as rubber, plastics, and/or silicone compositions, and And cap 6370 can be made of rigid material (such as metal).It is similar to the above, flexible material can be molded into around cap 6370.Example Cap 6370 can be such as pressed into the piece 6375 molded in advance.The hardness of flexible material can be chosen to needed for piece 6375 is provided Rigidity.It includes flexible-belt that piece 6375, which enables to it,.In any case, piece 6375 can be conducive to cap 6370 being assembled to end In actuator, this is because can multiple caps 6370 be positioned and/or be aligned in end effector simultaneously.In addition, attachment cap 6370 piece 6375 is once implanted, then can for example be strengthened along staple line or supporting tissue.Other than the piece of attachment cap 6370 Or as described substitution, cap 6370 can be linked together by multiple chain links.For example, this chain link can be flexible and can Allow to carry out relative motion between cap 6370.
Referring now to Figure 139 and Figure 140, protectiveness top cover (such as cap 6470) for example may include forming surface, it is described at Shape surface can be such that the top of nail leg deforms.For example, cap 6470 may include base portion 6472, which may include extending through wherein Hole 6471.Nail leg (such as nail leg 6221) can be closely received in wherein by hole 6471.Limit diameter or the week in hole 6471 It is long can be equal to or greater than nail leg 6221 diameter or perimeter.Cap 6470 may also include cavity or dome 6474, the cavity or dome The top of nail leg 6221 can be accommodated when nail leg 6221 is inserted into cap 6470.Referring first to Figure 140, cap 6470 may also include anvil Seat or forming surface 6473, the anvil block or forming surface can make nail leg 6221 deflect and deform.In all cases, table is shaped Face 6473 may be, for example, curved and/or spill, and can make nail leg volume 6221 when nail leg 6221 is inserted into cap 6470 It is bent.Nail leg 6221 can be deformed sufficiently so that its can not through hole 6471 and be withdrawn by, therefore cap 6470 can be locked to nail Leg 6221.For example, the base portion 6472 of cap 6470 can limit the antelabium extended around hole 6471, the antelabium can prevent from having deformed Nail leg 6221 from cavity 6474 be removed.In all cases, due to described above, one or more caps 6470 can be prevented Or holding matrix (such as holding matrix 6250) is inhibited to fall back or be detached from from nail 6220.Although being not shown, cap 6470 can be right Claim ground or be at least substantially asymmetrically formed, and hole 6471 can be positioned along the central axis 6479 that cap 6470 extends is passed through. Alternatively, referring again to Figure 139, hole 6471 can be deviated relative to central axis 6479.For example, the hole 6471 of offset It allows the side on the contact forming of nail leg 6221 surface 6473 and is crimped onto the other side on forming surface 6473, rather than make contact to The center on shape surface 6473, as may be occurred in the above-mentioned embodiment including the hole 6471 being centrally located.
As described above, holding matrix (such as holding matrix 6250) by material piece and can pass through multiple holdings of extension Hole 6252 is constituted.It can be rigidity or substantially not bending for constituting the material piece of holding matrix 6250.It is selected as another kind It selects, holding matrix can be by the array of holding matrix element and the multiple flexible connecting members or chain link structure of connection holding matrix element At.Referring now to Figure 141, a part of holding matrix or holding matrix 6550 may include multiple element main body 6505, described more A element body can be linked together by one or more connection chain links 6507.Each element body 6505 may each comprise it is multiple can Deformation element 6553, the multiple deformable member can limit retaining hole 6552 wherein.The element body of holding matrix 6550 6505 and connection chain link 6507 may be integrally formed and may include integral type material block.Holding matrix 6550 can be for example by metal material Material (such as titanium and/or stainless steel) punching press is cast.Holding matrix 6550 can by plastics (such as polyether-ether-ketone (PEEK), Polypropylene, the polyester, gathering with trade name Ethibond and Mersilene sale sold with trade name Pu Liling (Prolene) Ethylene glycol terephthalate, polyvinylidene fluoride, polyvinylidene fluoride -co- hexafluoropropene, with trade name Pronova sale Polyhexafluoropropylene-VDF, and/or with trade name Ethilon&Nurolon sell long chain aliphatic polymer nylon 6 and Buddhist nun Dragon 6,6) it constitutes, and can be formed for example, by injection molding method.Element body 6505 can not be integrally formed with connection chain link 6507.It can Multiple single element main bodys 6505 are generated, the multiple single element main body 6505 is then connected to together and is embedded in holding square In battle array.For example, element body 6505 can be stamped to form by metal material (such as titanium and/or stainless steel) and be placed on plastics note It penetrates in mold, wherein plastic material can be injected to the side for forming circular or at least partly about element body 6505 in mold Edge 6506 and the connection chain link 6507 extended from edge 6506.Alternatively, one or more connector dot matrix can It is formed to include the hole being limited in multiple edges 6506, wherein element body 6505 can be contained in by each this hole Wherein.Each element body 6505 may include circular or be at least substantially circular outer periphery；Similarly, each edge Can be defined in 6506 it is circular or at least substantially for circular hole, wherein the diameter in the hole can be equal to or be less than element master The diameter of body 6505.For example, element body 6505 can be press-fitted or built-in edge 6505 in hole in.It is bonded using at least one Element body 6505 is fixed in hole by agent.
Further described above, holding matrix may include multiple element main body 6505 and multiple connection chain links 6507, the multiple connection chain link 6507 can be connected with any suitable array those of (such as Figure 142-Figure 145 shown in) Element body 6505.No matter why is the pattern of array, connection chain link 6507 can allow for element body 6505 and retaining hole 6552 It is movable with respect to each other.For example, constitute holding matrix 6550 element body 6505 and connection chain link 6507 dot matrix once with Tissue engagement just can be stretched, distorts, bounces back, and/or otherwise be bent, to allow at least some movements in tissue And resisted organize carries out biggish movement simultaneously.Each connection chain link 6507 may include flexible member, and the flexible member can It stretches, distort, and/or bounces back, for example to allow holding matrix 6550 to bend among holding matrix element 6505.Join again See Figure 141, the width for limiting each chain link 6507 extended from edge 6506 can be narrower than element body 6505 and/or edge 6506 Width.Referring to Figure 142-Figure 145, one or more chain links 6507 may include straight part, the straight part for example along Line between adjacent elements main body 6506 extends.For example, each chain link 6507 may include be attached to first edge 6506 first End and the second end for being attached to second edge 6506.Referring again to Figure 141, two or more chain links 6507 can connect each other It connects.For example, two or more chain links 6507 can be connected at middle hinge 6509.Such as the tranverse sectional thickness of hinge 6509 Can reduce along one or more directions compared with the tranverse sectional thickness of chain link 6507, this allow connected chain link 6507 relative to It moves each other.Holding matrix 6550 may also include hinge 6508, hinge 6508 chain link 6507 can be connected to edge 6506 and Allow the relative motion between chain link 6507 and edge 6506.It is similar to hinge 6509, such as the tranverse sectional thickness of hinge 6508 It can reduce along one or more directions compared with the tranverse sectional thickness of chain link 6507.
Further described above, connected chain link 6507 can extend in a different direction.For example, the first chain link 6507 can extend in a first direction, and the second chain link 6507 can extend in a second direction, wherein the first direction can Different from the second direction.Such as first chain link 6507 can extend along First Line, and the second chain link 6507 can be along the second line Extend, wherein the First Line and second line can be at an angle of (such as about 30 degree, about 45 degree, about 60 degree, and/or About 90 degree) intersect.Hinge 6508 and/or hinge 6509 may include hinges, and the hinges allow chain link 6507 repeatedly move without being broken relative to each other.Hinge 6508 and/or hinge 6509 may include frangible or easy fracture portion Point, described frangible or easy fracture part is broken when can repeatedly bend in excessive deflection and/or excessively.For example, this frangible portion can Another part of the one or more parts and holding matrix 6550 that allow holding matrix 6550 disconnects.Hinge 6508 and/or hinge Chain 6509 for example may include the section of holding matrix 6550, this section is easier to cut than the other parts of holding matrix 6550.More Body, the tissue of the holding matrix being implanted into and the fastening of the holding matrix by being implanted into can be often for various reasons by cutting structure Part incision, and it is this crosscutting in order to be conducive to carry out, and hinge 6508 and/or hinge 6509 for example can provide approach or thin layer, Cutting element may pass through the approach or thin layer more readily passes through holding matrix 6550.Further described above, even Chain link section 6507 may include for example being defined in one or more of cast structures or material upsetting, one or more of castings The bending, fracture, and/or incision of connection chain link 6507 can be conducive to by making structure or material upsetting.
Holding matrix may include multiple holding matrix elements (such as matrix element main body 6505), such as the multiple holding In the embeddable piece of flexible material of matrix element or material strips.Piece of flexible material can be by bioabsorbable elastomeric material (such as Siloxanes) it is formed, wherein the flexible sheets, which can produce, is defined in multiple holes therein.For example, can be molded solid flexibility Piece and multiple holes can be pierced by the flexible sheets.Alternatively, flexible sheets and can be in moulding process be can be molded Middle formation is defined in hole therein.In any situation, holding matrix element 6505 can for example be inserted into and be maintained at soft In property piece.Alternatively, similar to the above, flexible sheets can be formed in around matrix element 6505.Flexible sheets can be such as It is made of woven net and/or any other suitable material.Further described above, this woven net can be easy to cross It cuts.
Referring now to Figure 146 and Figure 147, the fastener system including holding matrix (such as holding matrix 6250) can also be wrapped It includes lid (such as lid 6670), such as when the top of nail leg 6221 extends to 6257 top of top surface of holding matrix 6250, The lid can cover the top.Lid 6670 could attach to holding matrix 6250.Lid 6670 and/or holding matrix 6250 may include Feature structure is kept, lid 6670 can be remained to holding matrix 6250 by the holding feature structure.It is viscous using at least one Lid 6670 is adhered to holding matrix 6250 by mixture.Lid 6670 can be made of single layer, however lid 6670 is shown as including two A layer, it is as follows to be more fully described.Referring first to Figure 147, the top of nail leg 6221 can extend across the bottom of lid 6670 Surface 6673；However, lid 6670 may include enough thickness, so that screw top end does not extend through the top surface of lid 6670 6675.Thus, for example, the top of nail leg 6221 can not be from 6670 protrusion of lid.Lid 6670 may include multiple layers.For example, lid 6670 It may include first layer 6671 and the second layer 6672.First layer 6671 and the second layer 6672 can be attached to each other, wherein the second layer 6672 It may include the bottom surface 6676 for being attached to first layer 6671.First layer 6671 and the second layer 6672 may include different thickness or Person its may include identical thickness.First layer 6671 and the second layer 6672 may include substantially the same width and/or length.Make For another kind selection, layer 6671 and 6672 may include different width and/or length.
Further described above, first layer 6671 can be by the compressible foam that can for example be cut by nail leg 6211 Foam, Web materials, and/or hydrogel are constituted.The second layer 6672 can by for example more tough and tensile material or skin (such as PGA and/or PDS) and/or any suitable buttress material is constituted.For example, nail leg 6221 can penetrate first layer 6671；However, nail leg 6221 possibly can not penetrate the second layer 6672.The second layer 6672 can be described by constituting with sufficiently resilient and/or toughness material Material allow the second layer 6672 contacted and shifted by nail leg 6221, but not by nail leg 6221 screw top end incision or it is only a small amount of Ground incision.Although being not shown, lid may include more than two layer, and wherein one or more of these layers can be resistance to infiltration 's.In use, for example, holding matrix 6250 can be positioned and be pushed down against tissue to be tightened, so that nail 6220 nail leg 6221 passes through tissue T and retaining hole 6252 in holding matrix 6250 and is pushed, and enters lid 6270 In first layer 6271.The top of nail leg 6221 can not enter or not enter at least substantially in the second layer 6272 of lid 6270.? After holding matrix 6250 is properly positioned, jaw 6240 can be opened, and lid 6670 and holding matrix 6250 can be with pincers Mouth 6240 separates, as shown in Figure 146.As shown in Figure 146, jaw 6640 is able to maintain more than one holding matrix 6250 and lid 6670.For example, jaw 6640 may include two channels 6679, described two channels 6679 can accommodate wherein lid 6670 and The holding matrix 6250 positioned on it, so that the tissue contacting surface 6251 of each holding matrix 6250 is from the bottom of jaw 6240 Portion downwardly against.For example, holding matrix 6250 and lid 6270 can be contained in jaw 6640 on every side of cutter slit 6678.Make In, both holding matrix 6250 and lid 6670 can be disposed simultaneously and/or relative to the opposite nail bins for passing through it and positioning (such as storehouse 6200) is deployed in identical depth.It then, can be by traversing the cutting element of cutter slit 6678 along cutting line Fastening tissue is cut, wherein jaw 6640 then can be opened again.Lid 6670 can be not attached to holding matrix 6250.For example, Lid 6670 can be positioned in channel 6679 and can be maintained at by that can be fixed to the holding matrix 6250 of jaw 6640 In channel 6679.Each holding matrix 6250 can be wider than and/or be longer than its corresponding lid 6670, so that holding matrix 6250 can incite somebody to action Its lid 6670 is generally held in appropriate location.Each holding matrix 6250 can for example its corresponding lid 6670 include it is identical Width and/or length.
As described above, fastener system may include the material that can be for example attached to holding matrix (such as holding matrix 6250) The bed of material.Referring now to Figure 150, material layer 6870 could attach to the bottom surface 6251 of holding matrix 6250.Layer 6870 and/or guarantor Holding matrix 6250 may include keeping feature structure, and layer 6870 can be remained to holding matrix 6250 by the holding feature structure. Layer 6870 is adhered into holding matrix 6250 using at least one adhesive.In any case, layer 6870 may include bottom Surface or tissue contacting surface 6873, the bottom surface or tissue contacting surface can be downward towards nail 6220 in holding matrix 6250 Movement is so that retaining hole 6252 contacts tissue T when engaging with nail leg 6221.For example, layer 6870 can be (all by such as compressible material Such as bioabsorbable foam) constitute, the compressible material can be compressed bottom surface 6251 in holding matrix 6250 with Between tissue T.Layer 6870 may also include storage and/or be absorbed at least one drug therein, and at least one drug can It is discharged from layer 6870 when layer 6870 is compressed.The drug may include for example, at least a kind of tissue seal, hemostat, And/or anti-biotic material (such as silver and/or triclosan of ionization).The compression of layer 6870 can squeeze out drug from layer 6870, so that The whole on the surface of tissue T is at least greatly coated with drug.In addition, working as, layer 6870 is compressed and nail leg 6221 is worn When saturating tissue T and layer 6870, drug can be flowed down for example along nail leg 6221 and treat the tissue just cut by nail leg 6221.It protects The main body for holding matrix 6250 may include the first layer being for example made of biocompatible materials (such as titanium and/or stainless steel), and And bottom 6870 may include for example by bioabsorbable material (such as oxidized regenerated cellulose (ORC), such as (liquid or by Freeze-drying) bioactivators such as fibrin and/or fibrin ferment, glycerol, in fluffy or foam configuration absorbable The antibacterial of pig gelatin, and/or the silver such as ionized and/or triclosan) constitute the second layer.Other bioabsorbable material It may include such as Surgicel Nu-Knit, Surgicel Fibrillar, the collagen/ORC sold with trade name Promogran (it is the mixture with collagen matrix form construction), with the polyglycolic acid (PGA) of trade name Vicryl sale, polylactic acid (PLA or PLLA), polydioxanone (PDS), polyhydroxyalkanoatefrom (PHA) are gathered with what trade name Monocryl was sold The compound of caprone 25 (PGCL), polycaprolactone (PCL), and/or PGA, PLA, PDS, PHA, PGCL and/or PCL.Although figure One layer 6870 is only shown in 150, however any suitable number of layer can be used.First layer including the first drug could attach to Holding matrix 6250, and the second layer including the second drug or different pharmaceutical could attach to first layer.For example, can be used multiple Layer, wherein each layer may include being contained in different pharmaceutical therein and/or different pharmaceutical compositions.
Referring now to Figure 148, fastener system may include the material for being attached to the bottom surface 6251 of holding matrix 6250 Layer 6770.Layer 6770 and/or holding matrix 6250 may include keeping feature structure, and the holding feature structure can be by layer 6770 Remain to holding matrix 6250.Layer 6770 is adhered into holding matrix 6250 using at least one adhesive.In any situation In, layer 6770 may include bottom surface or tissue contacting surface 6773, and the bottom surface or tissue contacting surface can kept Matrix 6250 is moved downward towards nail 6220 so that retaining hole 6252 contacts tissue T when engaging with nail leg 6221.For example, layer 6770 can It is made of such as compressible material (such as bioabsorbable foam), the compressible material can be compressed in holding matrix Between 6250 surface 6251 and tissue T.Layer 6770 may also include one or more packaging parts or unit 6774, it is one or Multiple packaging parts or unit 6774 can store at least one drug wherein.Referring to Figure 149, packaging part 6774 can be with retaining hole 6252 alignment are at least substantially aligned, so that nail leg 6221 can when nail leg 6221 passes through tissue T and layer 6770 and pushed It pierces through packaging part 6774 and/or otherwise makes packaging part 6774 is broken to dissipate.After packaging part 6774 breaks and dissipates, it is stored in encapsulation At least one of part 6774 drug M can be flowed out in tissue T.For example, drug M may include fluid, the fluid can be along nail leg 6221 flow down or wick downwards and treat the tissue T cut by nail leg.Due to described above, it is stored in packaging part 6774 Drug can provide local treatment to tissue.It may include the different pharmaceutical being stored therein in packaging part 6774 in piece 6770.Example It such as, may include the first drug or the first pharmaceutical composition being stored therein in first group of packaging part 6774, and second group of encapsulation It may include the different drugs or different pharmaceutical compositions being stored therein in part.Layer 6770 can be by siloxane sheet structure flexible At, and packaging part 6774 can represent the gap in siloxane sheet.For example, siloxane sheet may include two for capable of being attached to each other Layer, wherein packaging part 6774 can be limited between described two layers.Layer 6770 may include for example one or more thin parts or Weakening part (such as local perforations), one or more of thin layers or weakening part can be conducive to leg 6221 and cut layer 6770 simultaneously Make packaging part 6774 is broken to dissipate.At least part of packaging part 6774 can be positioned in dome 6777, and wherein dome 6777 can be from Piece 6770 upwardly extends.For example, at least part of dome 6777 and/or packaging part 6774 can be positioned in holding matrix 6250 Formed in pit 6201 in.Packaging part 6774 may include the independent unit not being connected to each other.Alternatively, it seals One or more of piece installing 6774 can be via one or more accesses, conduit, and/or the channel for for example extending through layer 6770 And it is in fluid communication with each other.It is published on August 24th, 2010 entitled " ADHESIVE AND MECHANICAL FASTENER " The disclosure of United States Patent (USP) 7,780,685 be incorporated by reference be incorporated herein accordingly.
Further described above, the nail bin including warehouse, nail, and/or alignment matrix can be loaded on end In first jaw of portion's actuator, and similarly, holding matrix and/or one or more lids can be loaded on end effector The second jaw in.Referring now to Figure 151, such as instrument (such as storehouse filler 6990) can be used to fasten two or more Part storehouse is inserted into end effector simultaneously.Such as warehouse loader 6990 may include shank 6991 and warehouse carrier 6992, wherein storehouse carries Body 6992 may include the first maintaining part and the second maintaining part, and first maintaining part can keep the warehouse 6210 of nail bin 6200 To warehouse carrier 6992, and in addition, second maintaining part is able to maintain warehouse 6980, which supports multiple wherein Protectiveness top cover 6270 simultaneously supports holding matrix 6250 along its bottom surface.First maintaining part and the second maintaining part can respectively include One or more holding members, one or more of holding members can be releasably engaged warehouse 6210 and 6980.Now Referring to Figure 152 and Figure 153, in use, end effector may include the first jaw or bottom jaw 6230 and the second jaw Or top jaw 6940, wherein nail bin 6200 can be loaded in the first jaw 6230, and warehouse 6980 can be loaded on In two jaws 6940.In all cases, top jaw 6940 can be rotated by actuator 6235 from open position (Figure 152) To closed position (Figure 153), wherein the operation of actuator 6235 is as described above, details are not described herein again for simplicity.Ginseng now See Figure 153, once top jaw 6940 is in its closed position, then the distal end 6993 of warehouse carrier 6992 can be inserted into end In actuator, so that nail bin 6200 passes through the distal end 6938 of the first jaw 6930 and slides into the in the first jaw 6230 In one attachment or channel 6939.Similarly, the distal end 6993 of warehouse carrier 6992 can be inserted into end effector, so that Warehouse 6980 passes through the distal end 6948 of the second jaw 6940 and slides into the second attachment in the second jaw 6940 or logical In road 6949.The surgeon or other clinicians of the shank 6991 of hand-held warehouse loader 6990 can be each passed through channel 6939 With 6949 and push nail bin 6200 and warehouse 6980, until nail bin 6200 and warehouse 6980 are fully disposed 6939 He of channel In 6949.
When nail bin 6200 and warehouse 6980 are placed, nail bin 6200 and warehouse 6980 can engage its corresponding jaw respectively One or more maintaining parts in 6230 and 6940, it is as follows to be more fully described.Referring now to Figure 154, in any situation In, once nail bin 6200 and warehouse 6980 are placed, then warehouse loader 6990 can be separated with nail bin 6200 and warehouse 6980 and from It is removed on end effector.For example, nail bin 6200, which is maintained at the retentivity in the first jaw 6230, can be greater than nail bin 6200 The retentivity of warehouse carrier 6992 is remained to, so that nail bin 6200 can when warehouse carrier 6992 is pushed out end effector towards distal side It is maintained at 6230 rear of the first jaw.Similarly, general can be greater than by warehouse 6980 being maintained at the retentivity in the second jaw 6940 Warehouse 6940 remains to the retentivity of warehouse carrier 6992, so that when warehouse carrier 6992 is pushed out end effector towards distal side, storehouse Body 6940 is positively retained at 6940 rear of the second jaw.Once warehouse loader 6990 is removed from end effector, then loaded First jaw 6230 and the second jaw 6940 loaded can be positioned relative to tissue T to be stapled.Referring now to Figure 155, Two jaws 6940 can move to firing position (Figure 155) from open position (Figure 154), so as to the holding for carrying warehouse 6980 Matrix 6250 and multiple protectiveness top covers 6270 are engaged with the nail 6220 being located in nail bin 6200.
Referring now to Figure 156 and Figure 157, the second jaw 6940 can be opened again, and multiple protectiveness top covers 6270 And holding matrix 6250 can be separated with warehouse 6980, so that cap 6270 and holding matrix 6250 can be kept and tissue T and nail bin 6200 engagements.Warehouse 6980 may include multiple pits and one or more holding slits, and multiple caps 6270 can be removedly It is located in the multiple pit, and one or more of holding slits can removedly keep holding matrix 6250 It arrives thereon.After the second jaw 6940 opening, the holding member of the second jaw 6940 engaged with warehouse 6980 can be by warehouse 6980 are maintained in the second jaw 6940.Warehouse 6980 can be torn when the second jaw 6940 is opened, so that warehouse 6980 A part is implanted together with cap 6270 and holding matrix 6250, and a part of warehouse 6980 is retained in the second jaw 6940 In.Similarly, referring again to Figure 156 and Figure 157, after the second jaw 6940 opening, the first jaw 6230 and warehouse Warehouse 6210 can be maintained in the first jaw 6230 by the holding member of 6210 engagements.Warehouse 6210 can be in the first jaw 6230 Tearing when being pulled far from the storehouse 6200 that has been implanted into, so that a part of warehouse 6210 and nail 6220 and alignment matrix 6260 are together It is implanted, and a part of warehouse 6210 remaines in the first jaw 6230.Referring now to Figure 158-Figure 160, nail bin is (such as Nail bin 6900) it for example may include the longitudinal holding slit 6913 of one or more extended along the length of warehouse 6910, work as nail bin 6900 when being inserted into jaw 6930, one or more of longitudinal to keep slits 6913 that for example accommodate wherein from jaw The 6930 longitudinal holding guide rails 6916 of one or more extended.In use, it such as is passed through in nail bin 6900 and keeps channel 6939 Distal end 6938 slide before, keep slit 6913 end can with keep guide rail 6916 distal end be aligned.
Referring again to Figure 160, jaw 6940 may include two holding channels 6949, wherein each holding channel 6949 can Wherein accommodating the warehouse 6980 including multiple caps 6270 and holding matrix 6250.Each warehouse 6980 may include one or more It is longitudinal to keep shoulder 6917, when in its corresponding holding channel 6949 that warehouse 6980 is inserted into jaw 6940, described one A or multiple longitudinal holding shoulders 6917 are slided along the longitudinal holding guide rails 6918 of one or more of the second jaw 6940.Work as storehouse Body 6980 with when being stored in cap 6270 and holding matrix 6250 therein and separating, keep guide rail 6918 and keep shoulder 6917 that can assist Make so that warehouse 6980 to be maintained in the second jaw 6940.Referring now to Figure 159, the second jaw 6940, which may also include, to be extended from One or more distally projections or holding member 6915, one or more of distally projections or holding member can be by warehouses 6980 are removedly locked in its corresponding holding channel.For example, the second jaw 6940 may include distally projection 6915, distal side Convex block 6915 relative to each holding channel 6949 can be located so that when warehouse 6980 is inserted into channel 6949, often A warehouse 6980 can be bent around convex block 6915, wherein just when warehouse 6915 is fully disposed in channel 6949, warehouse The cleanable convex block of 6980 distal end 6915 and hasp is above convex block 6915.To be moved after warehouse 6980 is previously used It removes, as described above, warehouse 6980 can be withdrawn into 6915 top of convex block and remove it from holding channel 6949.With phase above Seemingly, the first jaw 6930 may include that one or more distal sides extending therefrom keep convex block 6914, one or more of distal sides Keep convex block 6914 that can be accommodated in one or more holding grooves in warehouse 6910 when nail bin 6900 is by complete anvil block Or in slit 6912 (Figure 158).
Further described above, the first fastener cartridge of multiple first fasteners, which is wherein located, to be positioned in In first jaw of surgical fastening device, and the second fastener cartridge that multiple second fasteners are wherein located can be positioned in In second jaw of surgical fastening device.In use, the first jaw and/or the second jaw can be moved towards another one, to make First fastener engages with the second fastener and fixes tissue therebetween.When the first fastener is engaged with the second fastener, First fastener cartridge can be engaged with each other with the second fastener cartridge.The main body of first fastener cartridge can be by the first compressible material structure At, and the main body of the second fastener cartridge can be made of the second compressible material, wherein the first main body and/or the second main body can support It is compressed by the tissue fastened.After tissue is fastened, the first jaw can be far from the first fastener cartridge fortune being implanted into It is dynamic, and the second jaw can be far from the second fastener cartridge movement being implanted into.Then, the first jaw can be again loaded with another First fastener cartridge or similar component, and the second jaw can be again loaded with another second fastener cartridge or similar component, And reuse surgical fasteners tool can be reused.Although can be in some embodiments using nail, it can also be envisaged that going out includes other classes The other embodiments of the fastener (what is such as locked together when being interconnected is divided into two-part fastener) of type.For example, First fastener cartridge may include the first storage unit for storing the first fastener portion, and the second fastener cartridge may include being used for Store the second storage unit of the second fastener portion.Fastening system as described herein is using the material for including any suitable type And/or the fastener of form.Fastener may include penetrating component.This penetrating component can for example by polymer, compound and/or Multiple field substrate is constituted.The example of multiple field substrate can be wire rod or sheet substrate with elastomer or polymer coating.Its It can be thin slice, and be formed so that penetrating component is oriented to perpendicular to or is at least substantially orthogonal to connecting elements.It wears Saturating component may include the shape, semicircular shape, and/or any crossbeam shape of rectangle.It is (all using any suitable method Wire rod extrusion method) manufacture fastener as described herein.Another possibility be formed using precision machining method it is hollow Penetrating component.These penetrating components can be by being process different from wire rod extrusion method and using the method for combination of materials.
As described above, the top that nail leg passes through holding matrix protrusion can be covered by one or more caps and/or lid.Nail leg Top is deformable after it is inserted through holding matrix.It keeps the jaw of holding matrix may also include to be positioned within above hole And/or the anvil block pit being aligned with retaining hole, the anvil block pit can make nail leg when nail leg is projected on above holding matrix Deformation.The nail leg of each nail can for example towards each other and/or towards nail center inward curl.Alternatively, the nail leg of nail One or more of can far from other nail legs and/or far from nail center and crimp outward.No matter nail leg is along which direction Curling, the top of nail leg can contact the main body of holding matrix and can not be again introduced into and clenched in solid tissue.Nail leg Deformation after passing through holding matrix can lock holding matrix in place.
Referring now to Figure 161 and Figure 162, surgery suturing appliance (such as surgical stapling device 7000) may include the first jaw 7030 and second jaw 7040, wherein the second jaw 7040 can be by the movement court of actuator 6235 and far from the first jaw 7030 movements.The operation of actuator 6235 is as described above, details are not described herein again for simplicity.First jaw 7030 may include remote Side end 7031 and proximal extremity 7032, wherein the first jaw 7030 can be limited to distal end 7031 and proximal extremity 7032 it Between the channel that extends, the channel can accommodate nail bin.For the warehouse of this nail bin convenient for illustrating, is not shown in Figure 161, however This nail bin may include warehouse, be located in the intracorporal nail 6220 in storehouse and be located in the staple drivers 7012 of 6220 lower section of nail.To the greatest extent Pipe is not shown in Figure 161 for simplicity, however the second jaw 7040 can be by holding matrix (such as holding matrix 6250) It keeps for example above nail 6220 and/or as described above moves to holding matrix to engage with the leg of nail 6220.Surgical stapling device 7000 may also include the sliding part 7010 being for example positioned in the first jaw 7030, which can be from the first jaw 7030 Distal end 7031 proximally end 7032 sliding and towards the holding matrix of the second jaw 7040 promoted 7012 He of staple drivers The nail 6220 being supported on.Alternatively, for example, sliding part 7010 can proximally end 7032 towards distal end 7031 movements, to dispose nail 6020.Sliding part 7010 may include one or more inclined slopes or cam 7011, described one A or multiple inclined slopes or cam can slide below staple drivers 7012 and be lifted up staple drivers 7012.Surgery Stitching unstrument 7000 may also include the pull rod or push rod for being for example operably linked to sliding part 7010, and the pull rod or push rod can lead to The actuator crossed on the shank and/or axis of surgical stapling device 7000 and proximally and/or move toward the far side.
Referring again to Figure 161, the second jaw 7040 of surgical stapling device 7000 may include frame 7041, distal end 7048 and the proximal extremity 7049 with 7048 relative positioning of distal end.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 frame 7041, such as It is hereafter more fully described, one or more of guide rails, which can guide pass through in the nail leg 6221 of nail 6220, keeps square The nail leg of jointing nail 6220 and the one or more anvil blocks or cam that deform it after battle array.For example, guide rail 7045 and 7046 can Including guide line material or cable, the guide line material or cable for example surround distal side column along the top of frame 7041 or top surface 7047, and return to top or the top surface along frame 7041 and extend.As described above, and now referring first to Figure 163 And Figure 165, the second jaw 7040 may also include one or more anvil blocks or cam (such as the first anvil block 7050 and the second anvil block 7060), one or more of anvil blocks or cam can longitudinally be moved along the second jaw 7040, to pass through in the leg of nail 6220 Deform the leg after holding matrix.Surgical stapling device 7000, which may also include, is connected to and/or is operably linked to first The the first anvil block driver or actuator 7051 of anvil block 7050, the first anvil block driver or actuator can be pulled proximally First anvil block 7050 and/or towards distal side push the first anvil block 7050.Similarly, surgical stapling device 7000, which may also include, is connected to And/or be operably linked to the second anvil block driver or actuator of the second anvil block 7060, the second anvil block driver or Actuator can push the second anvil block 7060 towards distal side and/or proximally pull the second anvil block 7060.First anvil block 7050 can wrap Guide slit 7052 is included, and the second anvil block 7060 may include guide slit 7062, the guide slit 7052 and guide slit 7062 can respectively can be slidably received in guide rail 7045 or guide rail 7046 wherein.For example, guide rail 7045 and 7046 can quilt It is closely received in guide slit 7052 and 7062, so that guide rail 7045 and 7046 and guide slit can be prevented or at least be limited Opposite lateral movement or side-to-side movement between 7052 and 7062.
Further described above, can proximally pull the first anvil block 7050 and the second anvil block can be pulled towards distal side 7060.Referring to Figure 161, guide rail 7045 and 7046 and distal side column 7047 may include pulley system, and the pulley system being capable of court Distal side pulls the second anvil block 7060 and/or proximally pulls the second anvil block 7060.For example, guide rail 7045 and guide rail 7046 may include The continuous wire or cable extended around distal side column 7047, wherein a part of the continuous wire can be pulled so that wire rod It is rotated around distal side column 7047.Guide rail 7046 can for example be mounted to the second anvil block 7060, so that when continuous cable is first When being rotated on direction, the second anvil block 7060 can towards jaw 7040 distal end 7048 and be pulled to distal side, and work as continuous cable When line is rotated along second direction or opposite direction, the second anvil block 7060 can proximally end 7049 and be pulled to nearside.Now Referring to Figure 163, guide rail 7046 be can be fixed in guide slit 7062, so that traction force can be transmitted therebetween.For example, guide rail 7045 can slide in other guide slits 7062.First anvil block 7050 can be unrelated with the second anvil block 7060 mode work Make, and pulley system and the guide slit 7052 being limited in the first anvil block 7050 can slidably receive guide rail 7045 and 7046, allow the relative motion between pulley system and guide slit 7052 and guide rail 7045 and 7046.Constitute guide rail 7045 and 7046 continuous cable can have enough flexibilities, to adapt to the opening and closing of top jaw 7040.Continuous cable Line can also have it is enough it is flexible so as to adapt to the second jaw 7060 towards and far from bottom jaw 7030 vertical movement, hereafter will It is more fully described.
Referring again to Figure 163 and Figure 165, the first anvil block 7050 may include cam follower 7055 extending therefrom, this is convex Wheel driven member 7055 can ride one or more cam slots in the frame 7041 for being limited to the second jaw 7040 or draw Slit is led, in such as cam slot 7070 (Figure 166).More specifically, frame 7041 may include the first side along frame 7041 The first cam slot 7070 longitudinally extended and the second cam longitudinally extended along second side of frame 7041 or opposite side 7070, wherein can ride from the cam follower 7055 that the first side of the first anvil block 7050 extends in the first cam slot 7070 In, and can be ridden in the second cam slot 7070 from the cam follower 7055 that second side of the first anvil block 7050 extends. For example, the profile of each cam slot 7070 can be to be identical or at least substantially identical, and can be mutually aligned or at least Substantially it is mutually aligned.Similarly, the second anvil block 7060 may include the cam follower 7065 extended from, the cam follower 7065 can ride in the cam slot 7070 (Figure 166) in the frame 7041 for being limited to the second jaw 7040.More specifically, The cam follower 7065 extended from the first side of the second anvil block 7060 can ride in the first cam slot 7070, and from the The cam follower 7065 that second side of two anvil blocks 7060 extends can ride in the second cam slot 7070.In use, The cam follower 7065 of the cam follower 7055 of one anvil block 7050 and the second anvil block 7060 can be slided in cam slot 7070 It is dynamic, so that when the first anvil block 7050 and the second anvil block 7060 are pulled to nearside and/or are pushed to distal side, 7050 He of the first anvil block Second anvil block 7060 is promoted along the profile of cam slot 7070.Each cam slot 7070 may include multiple part or top of resting 7071 and multiple driver portions or lower part 7072, the multiple portion or top 7071 and the multiple driver portion of resting Or lower part 7072 can be longitudinal in anvil block 7050 and 7060 (that is, in the distal end 7048 and proximal extremity 7049 of frame 7041 Between) movement while vertically (that is, court and far from bottom jaw 7030) movement anvil block 7050 and 7060, it is as follows more in detail Carefully describe.
When surgical stapling device 7000, which is in, does not fire condition, referring to Figure 166, the first anvil block 7050 can be located in frame At 7041 distal end 7048, and the second anvil block 7060 can be located at the proximal extremity 7049 of frame 7041；In addition, Referring now to Figure 167, when surgical stapling device 7000, which is in, does not fire condition, the nail 6220 in the first jaw 7030 can be still It is not inserted into tissue T and/or is located in the holding matrix above tissue T.Referring now to Figure 168, in use, staple drivers 7012 can drive up nail 6220 in the nail cavity 7033 of nail bin；In addition, the first anvil block 7050 can be from the distal side of frame 7041 end End 7048 is towards 7049 proximal motion of distal end, so as to the nail leg 6221 of jointing nail 6220.In the first anvil block 7050 and nail 6220 nail leg 6221 can drive up nail 6220 before engaging.The first anvil block 7050 be advanced to contact nail leg 6221 it Before, sliding part 7010 can dispose all nails 6220 upwards, or alternatively, and sliding part 7010 can be in the first anvil block 7050 proximally move while proximally moving, however sliding part 7010 can guide the first anvil block 7050 fully will follow closely 6220 are deployed in 7050 front of the first anvil block.As shown in Figure 168, for example, cam slot 7070 can be arranged such that work as First cam 7050 passes through when resting portion or top, forming surface (such as forming surface or cam face of the first cam 7050 7053 and it 7054) can contact at least some of nail leg 6221.In all cases, the cam follower of the first anvil block 7050 7055 can be respectively positioned at the resting in portion 7071 of cam slot 7070, so that forming surface 7053 and 7054 is in and raises Position, and make when anvil block 7050 is there through in rest position, nail leg 6221 only partially deforms.When the first cam 7050 When along 7070 further movement of cam slot, as shown in Figure 169, the cam follower 7055 of the first anvil block 7050 can be driven to In the driving portion of cam slot 7070 or lower part 7072, so that forming surface 7053 and 7054 is transported downward vertically towards nail leg 6021 It is dynamic, to drive nail leg 6021 in the configuration finally shaped to it.Then, when the first anvil block 7050 is further along cam slot 7070 when promoting, and the first anvil block 7050 can be vertically driven to another group of cam slot 7070 upwards and be rested in portion 7071.Such as Shown in Figure 168 and Figure 169, reader will note that, the first anvil block 7050 can only engage certain nail legs without engaging other nail legs.Example Such as, the first anvil block 7050 for example can only make include follow closely 6220 distal side nail leg 6221 one group of nail leg deformation.For example, the first anvil Seat 7050 can make distal side nail leg 6221 towards the center deformation of nail 6220.Each nearside nail leg 6221 can be twice by the first anvil block 7050 (that is, by the first forming surface 7053 and second forming surfaces 7054 being aligned with the first forming surface 7053) contact.Example Such as, when the first anvil block 7050, which is in, to rest in portion or top, the first forming surface 7053 can be such that distal side nail leg 6221 is deformed into Part deformed configuration, and when the first anvil block 7050 moves in driving portion or lower part, the second forming surface 7054 can make far Side nail leg 6221, which is deformed into, is fully formed configuration.Referring now to Figure 163 and Figure 164, the first anvil block 7050 may include multiple first Surface 7053 and multiple second formings surface 7054 are shaped, to make to follow closely when nail leg 6221 is arranged to more than a line or a row 6220 distal side nail leg 6221 deforms.It is as follows to be more fully described, for example, the second anvil block 7060 can make nail 6020 nearside Nail leg 6221 deforms.
Further described above, the first anvil block 7050 can move to nearside from the distal end 7048 of frame 7041 End 7049, to make all distal side nail legs 6221 deformation of nail 6220.Reader will note that the first anvil block 7050 can be relative to not The nearside nail leg 6221 of deformation moves up and down, and to adapt to this relative motion, the first anvil block 7050 may include one A or multiple clearance slots 7057 (Figure 165), one or more of clearance slots 7057 can make far in the first anvil block 7050 Side nail leg 6221 accommodates unbent nearside nail leg 6221 when being bent.Similarly, referring again to Figure 163, the second anvil block 7060 can Including clearance slot 7067, which can rest at it as described above in the first anvil block 7050 and transport between portion and driving portion The vertical movement of the first cam actuator 7051 to move up and down is adapted to when dynamic.After all distal side nail legs 6221 are bent, Anvil actuator 7061 can make the second anvil block 7060 move to distal end 7048 from the proximal extremity 7049 of frame 7041.With it is upper Text is similar, can slide in cam slot 7070 referring now to the cam follower 7065 of Figure 170, such as the second anvil block 7060, So that the second anvil block 7060 moves between the portion of resting or top and driving portion or lower part, to make nearside nail leg 6221 towards nail 6220 center is deformed inward.It is similar to the above, the second anvil block 7060 may include it is multiple first forming or cam face 7063 with And multiple second formings or cam face 7064, the multiple first forming or cam face 7063 and the second one-tenth the multiple Shape or cam face 7064 can be able to make one or more of nearside nail leg 6021 at least partly to deform and/or completely Deformation.Referring again to Figure 164, the second anvil block 7060 may include multiple first forming surfaces 7063 and multiple second formings surface 7064, the multiple first forming surface 7063 and the multiple second forming surface 7064 can make to be arranged to multiple rows or more The nearside nail leg 6221 of the nail 6220 of row deforms.Equally as shown in Figure 164, the first forming 7063 He of surface of the second anvil block 7060 Second forming surface 7064 can not shape surface 7053 and the second forming surface 7054 with the first of the first anvil block 7050 and be aligned, In as a result, nail 6220 near leg 6221 can from nail 6220 far leg 6221 be located in different line or rows.Reader is also It should be noted that the second anvil block 7060 can push the first anvil block 7050 when the second anvil block 7060 moves toward the far side.For example, the second anvil First anvil block 7050 can be back into the distal end 7048 of frame 7041 by seat 7060, so that the first anvil block 7050 can return to Its initial position or non-firing position.After all nearside nail legs 6221 of nail 6220 deform, the second anvil block 7060 can court Proximal retraction is simultaneously back to its initial position or non-firing position.In this way, surgical stapling device 7000 can be reset to make New nail bin can be positioned in the first jaw 7030 by obtaining, and can position new holding matrix in the second jaw 7040, so as to Reuse surgical stapling device 7000.
As described above, surgical stapling device may include two or more anvil blocks, the two or more anvil blocks can be longitudinal It advances to engage the leg of multiple nails in a lateral direction in ground.Surgical stapling device may include the anvil block proximally moved, such as with Just make first group of nail leg deformation, and for example make second group of nail leg deformation.For example, this anvil block may include for example towards nearside Shape surface and the forming surface towards distal side.
Referring now to Figure 171, anvil block (such as anvil block 7140) for example may include bottom surface or tissue contacting surface 7141 And it is defined in multiple forming pits 7142 therein.Anvil block 7140 may include for example can be soldered to it is more than in frame 7144 One plate, such as crater plate 7143.For example, each crater plate 7143 can be positioned in the board channel 7145 in frame 7144 And frame 7144 is soldered to by extend through the welding slit 7146 of frame 7144 to form longitudinal welding pieces 7147.In various embodiments, longitudinal welding pieces 7147 may include the company for example extended along the whole length of welding slit 7146 Continuous weldment or a series of pads spatially spaced apart extended along a length thereof.Each crater plate 7143 may each comprise Two or more plate parts being welded together.For example, may each comprise can be along seam 7148 for each crater plate 7143 The the first plate part 7143a and the second plate part 7143b being welded together.It is logical that the plate in frame 7144 is soldered in plate 7143 Before in road 7145, the first plate part 7143a of each plate 7143 and the second plate part 7143b can be soldered together.For example, First plate part 7143a and the second plate part 7143b may include that may be fitted to the cooperation to form impervious seam 7148 together Shape, tooth profile shown in such as Figure 171.Each plate 7143 may include the height of for example, about .02 ", and the height can be high In the depth of board channel 7145, so that its tissue contacting surface 7141 extends from the frame 7044 of anvil block 7040.Referring now to figure 172, for example, plate 7143 can connect together and at least one weldment 7149 at the distal end in plate 7143.
As shown in Figure 171 and Figure 172, each crater plate 7143, which may each comprise, is defined in multiple forming pits therein 7142.Can be formed in plate 7143 by any suitable manufacturing method (such as grinding method and/or electrode combustion method) at Shape pit 7142.For example, each forming pit can be manufactured for example, by as described below referring now to Figure 173 and Figure 174 7142: being initially formed deep-well 7150, then bowed or curved surface 7151 is formed around deep-well 7150, then in curved surface Guide groove 7152 is formed in 7151.Alternatively, these steps can execute in any suitable order.Ginseng now See Figure 175, nail shapes pit 7142 can be formed such that be spaced apart with consistent or at least substantially consistent gap 7154 The inward flange 7153 of the forming pit.For example, gap 7154 may be about .008 ".In addition, for example, forming pit 7142 can edge The positioning of two or more line or rows, center line can be spaced apart by consistent or at least substantially consistent spacing 7155. For example, the spacing 7155 between center line may be about .035 ".Referring again to Figure 175, each forming pit 7142 can be narrow It is tapered between width 7156 and wide width 7157.For example, narrow width 7156 may be about .045 ", and wide width Degree 7157 can be such as about .075 ".Plate 7143 can be made of material identical with frame 7144.For example, plate 7143 and frame 7144 can be both made of such as stainless steel (such as 300 series or 400 series stainless steels) and/or titanium.It is selected as another kind It selects, plate 7143 and frame 7144 can be made of different materials.For example, plate 7143 can be made of such as ceramic material, and frame Frame 7144 can be made of such as stainless steel and/or titanium.In all cases, according to used material, such as except above-mentioned welding Substitution except method or as above-mentioned welding method also can be used at least one solder brazing method that plate 7143 is fixed on frame In 7144.
Referring now to Figure 176-Figure 178, anvil block 7240 may include frame 7244 and can be inserted into more in frame 7244 A crater plate 7243.Similar to the above, each crater plate 7243 may include being defined in multiple forming pits 7242 therein.Anvil block Frame 7244 may include being defined in holding slit 7246 therein, which can respectively accommodate extends from crater plate 7243 Holding guide rail 7247.For crater plate 7243 is assembled to anvil block frame 7244, the side wall 7245 of the anvil block frame 7244 can be to Outer flexure or expansion, as shown in Figure 177, so as to keep slit 7246 to broaden, so that each holding slit 7246 can hold wherein Receive the holding guide rail 7247 of crater plate 7243.Once keeping guide rail 7247 to be positioned in keep in slit 7246, side wall 7245 is It can be released, as shown in Figure 178, so that frame 7244 be allowed to retract and/or be back to its non-deflected with elastic type.? In this case, it keeps 7246 regracting of slit and therefore will keep the capture of guide rail 7247 wherein.Keep guide rail 7247 and/or Keeping slit 7246 may include the conical surface of one or more cooperations；After the holding slit 7246 of flexure is released, institute The conical surface for stating one or more cooperations can form and guide rail 7247 can will be kept to be maintained at the taper kept in slit 7246 It is engaged by locking.Similar to the above, crater plate 7243 can be made of the material identical or different with frame 7244.For example, plate 7243 It can be made of such as ceramic material, and frame 7244 can be made of such as stainless steel and/or titanium.In all cases, according to Used material, such as at least one solder brazing method and/or at least one welding method can be used to be fixed on plate 7243 In frame 7244.
In Figure 179 and Figure 180, surgical stapling and cutting off apparatus 8010 may include anvil block 8014, which can surround it To elongate staple channel 8016 pivotal attachment and be repeatedly opened and be closed.Nail administration assembly 8012 may include anvil block 8014 and lead to Road 8016, wherein component 8012 can proximally be attached to the elongated shaft 8018 to form execution part 8022.Work as nail administration assembly When 8012 closure, or when being at least substantially closed, sufficiently small cross section can be presented in execution part 8022, which is suitable for making Nail administration assembly 8012 is inserted by trochar.Component 8012 can be manipulated by the shank 8020 for being connected to axis 8018.Shank 8020 It may include user control such as knob 8030, which makes elongated shaft 8018 and nail administration assembly 8012 surround the longitudinal direction of axis 8018 Axis rotation.Closure trigger 8026 can be depressed to be closed nail administration assembly 8012, which can hold in pistol type 8036 front walls are pivoted around across 8154 side of shank shell to the closure trigger pin 8152 (Figure 181) of engagement.When closure triggers When device 8026 is clamped, closure release button 8038 can be present in outward on shank 8020, so that release button 8038 can be pressed Under to unclamp closure trigger 8026 and open nail administration assembly 8012, as described in more detail below.It can be in closure trigger The firing trigger 8034 pivoted before 8026 can make nail administration assembly 8012 while cutting and suture are clamped in tissue therein. In all cases, as described in more detail below, firing trigger 8034 can be used to use multiple firing schedules to reduce every row The amount for the power that journey needs to be applied by surgical hand.Shank 8020 may include the rotatable right finger that can indicate percussion progress Show device wheel 8040 and/or left indicator wheel 8041 (Figure 181).For example, firing schedule completely may need firing trigger 8034 Three complete firing schedules, thus indicator wheel 8040,8041 respectively can every stroke of firing trigger 8034 rotate to More one thirds turn.As described in more detail below, if it is desired, percussion trip lever 8042 allows trigger system complete manually Full firing schedule bounces back before completing, and in addition, if trigger system is blocked and/or failed, percussion trip lever 8042 can Allow surgeon or other clinicians that trigger system is made to bounce back.
In conjunction with Figure 179 and 181, elongated shaft 8018 may include external structure, which includes reciprocal in the longitudinal direction transport Dynamic closed tube 8024, the closed tube push in response to the nearside of the closure trigger 8026 of shank 8020 and make 8014 court of anvil block Its closed position pivots.Elongated passageway 8018 can be connected to shank by the frame 8028 (Figure 181) inside closed tube 8024 8020.Frame 8028 is rotatably engaged to shank 8020, so that the rotation of knob 8030 (Figure 179) can make execution part 8022 Rotation.Referring specifically to Figure 181, knob 8030 can be made of two half-shells, which may include one or more inwardly prominent Portion 8031 out, the protruding portion can extend across the elongated side opening 8070 of one or more of closed tube 8024 and engage frame 8028.Therefore, knob 8030 and frame 8028 can be rotated together or simultaneously, so that the rotation position of knob 8030 determines to execute The rotation position of part 8022.The longitudinal length long enough of longer opening 8070, to allow longitudinal closure fortune of closed tube 8024 Dynamic and open movement.About the closing motion for generating closed tube 8024, referring first to Figure 181 and Figure 183, closure trigger 8026 Top 8160 can push forward closed yoke 8162 by closed connecting rod 8164.Closed connecting rod 8164 passes through at its distal end Yoke pin 8166 is closed can pivotably be attached to closed yoke 8162, and passes through closed connecting rod pin at its proximal extremity 8168 by can pivotably be attached.Closure trigger 8026 can be closed trigger extension spring 8246 and be advanced into opening Position, the extension spring are proximally connected to the top 8160 of closure trigger 8026 and by right half-shell 8156 and left shell halfs 8158 shank shells 8154 formed.The tension applied by extension spring 8246 can be applied to the closure of closure trigger 8026 Power overcomes, to promote yoke 8162, closed connecting rod 8164 and closed tube 8024 towards distal side.
When closure trigger 8026 is activated or depresses, as described above, if it is desired, closure release button 8038 can quilt It is located so that surgeon or other clinicians can press closure release button 8038, and makes closure trigger 8026 And the rest part of surgical instruments is back to unactuated state.Being closed release button 8038 can be by central lateral pivot 8173 It is connected to pivot locking arm 8172, so that movement can be shifted between release button 8038 and lock arm 8172.Referring again to figure 181, compressed spring 8174 can proximally bias closure release button 8038, that is, such as from the right side, around the lateral pivot in center Axis 8173 biases clockwise, and the top 8160 of closure trigger 8026 may include the proximal tooth top with rear recess 8171 8170.When closure trigger 8026 is depressed, pivot locking arm 8172 can be straddled in proximal tooth top 8170, and when closure When trigger 8026 reaches its fully depressed position, it should be understood that rear recess 8171 is present in pivot locking arm 8172 in the following, should Pivot locking arm causes to fall and break into the urgent of compressed spring 8174 and locks rear recess 8171.At this point, closure release button 8038 Manual depression makes pivot locking arm 8172 upwards and rotates out of from rear recess 8171, thus simultaneously by the unlock of closure trigger 8026 Closure trigger 8026 is set to be back to its unclamped position.
Once closure trigger 8026 is proximally clamped, as described above, then firing trigger 8034 can be pulled to pistol Formula handle 8036, to promote percussion connecting rod 8032 from shank 8020 towards distal side.Firing trigger 8034 can be around percussion triggering Device pin 8202 pivots, which is horizontally through the right half-shell 8156 of shank 8020 and left shell half 8158 and connects with it It closes.When activated, firing trigger 8034 can promote link transmission firing lock 8150.Link transmission firing lock 8150 can Retraction, non-firing position is forced to by spring 8184, the spring one, the pistol grip 8036 for being attached to shank 8020；With And two, be attached to for example link transmission firing lock 8150 one of connecting rod, as described in more detail below.Spring 8184 can Non-athletic end 8186 and the movement end for the proximal extremity 8190 for being connected to steel band 8192 including being connected to shell 8154 8188.The end 8194 for being set to distal side of steel band 8192 attaches the front rod 8196a into multiple connecting rod 8196a-8196d On attachment structure 8195, the multiple connecting rod forms link tooth bar 8200.Link tooth bar 8200 can be to be flexible, so that it can It is easily retracted into pistol grip 8036 and minimizes the length of shank 8020, however form the rack assembly of straight rigidity, Significant percussion force can be transferred to and/or be passed through percussion connecting rod 8032 by the rack assembly.As described in more detail below, percussion touching Hair device 8034 can be engaged in the first activating of firing trigger 8034 with first connecting rod 8196a, in firing trigger 8034 The second activating engaged with second connecting rod 8196b, in the third activating and third connecting rod of firing trigger 8034 8196c engagement, and engaged in the 4th activating of firing trigger 8034 with fourth link 8196d, wherein percussion triggering Link tooth bar 8200 can be promoted incremental amount towards distal side by each actuating of device 8034.Further described above, percussion Multiple strokes of trigger 1034 can be such that right indicator wheel 1040 and left indicator wheel 1041 rotates, to indicate link tooth bar 8200 The distance promoted.
Referring now to Figure 181 and Figure 183, anti-inversion organization 8250 can prevent combination stretching/compressing spring 8184 from making to link Rack gear 8200 bounces back between firing schedule.Couple the adjacent first connecting rod 8196a of sliding tube 8131 and is connected to percussion connecting rod 8032 with transmitting percussion movement.Percussion connecting rod 8032 extends proximally out the proximal extremity of frame 8028 and extends through anti-turn The through-hole 8408 of plate 8266.The size of through-hole 8408 is set to slidingly receive percussion when with 8032 vertical alignment of percussion connecting rod Connecting rod 8032, and it is motionless to tighten percussion connecting rod in through-holes.Lower part insert attachment 8271 is from frame 8028 The lower lip of proximal extremity extends proximally, and extends through the hole 8269 on the lower edge of anti-down flap 8266.The lower part inserted sheet The lower part of anti-down flap 8266 is drawn to neighbouring frame 8028 by attachment 8271, so that when percussion connecting rod 8032 is pushed away towards distal side Into when anti-down flap 8266 be vertical, and tilted backwards at the top of anti-permission to constraint when percussion connecting rod 8032 attempts to bounce back State.Anti-reverse compression spring 8264 is constrained by the proximal extremity of frame 8028 towards distal side, and proximally abuts anti-down flap 8266 top, so that anti-down flap 8266 is biased to lock state.Anti-reverse cam tube 8268 is resisted spring biasing and is slided Dynamicly around connection sliding tube 8131 and adjacent anti-down flap 8266.It is attached to proximally protruding for anti-reverse cam tube 8268 Anti-reversing yoke 8256 extend beyond closed yoke 8162.
Referring to Figure 181, the automatic retracted mechanism 8289 of connecting rod triggering is integrated in surgical stapling and cutting off apparatus 8010, with Knife is set to bounce back at the end of complete firing schedule.For this purpose, distal link 8196d includes tang 8290, when distal link 8196d quilt It is upward to be advanced into tang when in the rack passage 8291 (Figure 181) being formed in closed yoke 8162.It is aligned the tang 8290 to start the bottom proximal cam 8292 on anti-reversing trip lever 8248 (Figure 186).Referring specifically to Figure 186 and Figure 187, It is formed in the movement of the structural constraint anti-reversing trip lever 8248 in right half-shell 8156 and left shell half 8158.It is respectively formed in the right side Pin socket 8296 and circular pegs 8293 between half-shell 8156 and left shell half 8158 pass through longitudinally elongated hole 8294 and are received, should Hole is formed in the anti-reversing trip lever 8248 in 8292 distal side of bottom proximal cam, to allow longitudinal translation and around circle Shape pin 8293 rotates.In right half-shell 8156, the channel 8295 proximally opened includes and is at an angle of upward and towards distal side The nearside horizontal component 8295a of part 8295b connection, the part 8295b being at an angle of upward and towards distal side accommodate anti-turn Rear pin 8297 (Figure 187) to the right near the proximal extremity of trip lever 8248, thus when anti-reversing trip lever 8248 arrives Up to its translation farthest side section when, this upward and towards distal side be at an angle of part 8295b assign upward rotation.Once anti- It reverses trip lever 8248 to be assembled, the barrier structure being formed in the right half-shell 8156 of neighbouring anti-reversing trip lever 8248 is anti- Only anti-reversing trip lever 8248 proximally moves, so that rear pin 8297 to the right is maintained at the channel 8295 proximally opened In.
Further described above, as shown in Figure 187 and Figure 188, the distal end of anti-reversing trip lever 8248 8254 are thus forced to towards distal side and downwards, the preceding pin 8298 for making to the right fall into be formed in right half-shell 8156 towards distal side opening Hierarchic structure 8299 in, this, which is engaged through for compressed spring 8300 (Figure 188) to be fixed to, is located at preceding pin 8298 to the right and vertical Hook 8301 to the left in the anti-reversing trip lever 8248 between slot 8294 and realize.Compressed spring 8300 it is another One end is attached to the (figure of hook 8302 being formed in right half-shell 8156 at the immediately above closer and lower position of closed yoke 8266 186,188,189).Compressed spring 8300 thus downwardly and rearwardly leads the distal end 8254 of anti-reversing trip lever 8248 It draws, is locked to preceding pin 8298 to the right when being pushed into towards distal side in the hierarchic structure 8299 opened towards distal side.Therefore, once It is released, referring to Figure 189, anti-reversing trip lever 8248 keeps forward, anti-down flap 8266 being held vertically throughout, to make to link Rack gear 8200 bounces back.When closed yoke 8266 then bounces back in the case where free end actuator 8012, on closed yoke 8266 Upward reset tangs 8303 contact the bottom distal cam 8305 of anti-reversing trip lever 8248, by preceding pin to the right 8298 lift from the hierarchic structure 8299 opened towards distal side, so that anti-reverse compression spring 8264 can be by anti-reverse cam tube 8268 and anti-reversing trip lever 8248 be proximally pushed to its retraction position (Figure 186).
Referring to Figure 179 and Figure 189, firing trigger 8034 can be operatively engaged to link in any suitable manner Rack gear 8200.Referring specifically to Figure 180 and Figure 185, firing trigger 8034 surrounds the firing trigger pin for being connected to shell 8154 8202 pivot.When firing trigger 8034 is depressed towards pistol grip 8036, the top 8204 of firing trigger 8034 is surrounded Firing trigger pin 8202 moves toward the far side, so that the firing trigger extension spring 8206 (Figure 181) proximally placed be drawn It stretches, which is proximally connected between the top 8204 of firing trigger 8034 and shell 8154.In each percussion touching During sending out device pushing, the top 8204 of firing trigger 8034 links tooth via the engagement of side lever mechanism 8210 of spring biasing Item 8200.When firing trigger is released, side lever mechanism is separated with link tooth bar 8200, and firing trigger can be returned It is back to non-depressed or non-firing position.In use, by the inclined-plane in each of connecting rod 8196a-8196d towards nearside and to the right 8284 are formed by inclined right rail is engaged by side lever assembly 8285.In particular, (the figure of turning bar slider system 8270 181 and Figure 183) there is lower left quarter guider and right lower quadrant guider 8272, the lower left quarter guider and right lower quadrant guider point Not in the left track 8274 (Figure 181) in the closed yoke 8266 being formed in below rack passage 8291 and in closed yoke guide rail It is slided in right track 8275 in 8276, which is parallel to rack passage 8291 and is attached to rack channel cover 8277, which closes the opening part to the right of the rack passage 8291 in closed yoke 8266, the opening portion to the right Quartile is in the distal side of the traveling of turning bar slider system 8270.In Figure 181, Figure 182 and Figure 185, compressed spring 8278 is attached at On on the right side of the distal end of the hook 8279 in the proximal position of top on closed yoke guide rail 8276 and turning bar slider system 8270 Between hook 8280, this promotes turning bar slider system 8270 proximally to contact with the top 8204 of firing trigger 8034.
Referring specifically to Figure 181, system switch block 8318 is located in turning bar slider system 8270, around vertical 8320 pivot of rear pin Turn, the rear pin is across the left proximal turning of system switch block 8318 and turning bar slider system 8270.Block groove 8322 is kicked out of to be formed in In the distal part of the top surface of block 8318, to accommodate by normal pin 8326 can pivotably be fixed on therein kick Block 8324 out, the bottom end of the normal pin extend to the pawl spring groove on the top surface of turning bar slider system 8270 In 8328.Pawl spring 8330 in pawl spring groove 8328 extends to the right side of vertical preceding pin 8326, forces system Bull stick block 8318 rotates counterclockwise to when viewed from above to be engaged with inclined right rail 8282.It kicks out of in block groove 8322 Small wind spring 8332 force and kick out of block 8324 and rotated clockwise when viewed from above, so that its proximal extremity is forced and is formed in Wavy antelabium 8334 in the closed yoke 8266 of 8291 top of rack passage contacts.As shown in Figure 184,8330 phase of pawl spring Mean that system switch block 8318 is easy to and rotates clockwise compared with possessed stronger mechanical dominance for small wind spring 8332 Kick out of block 8324 engagement.In Figure 185, when firing trigger 8034 is fully depressed and starts to be released, block is kicked out of 8324 encounter the ridge 8336 of wavy antelabium 8334 when turning bar slider system 8270 bounces back, and force and kick out of block 8324 viewed from above When rotate clockwise, so that system switch block 8318 is kicked out of the engagement with link tooth bar 8200.Kick out of the shape of block groove 8322 Make the direction for rotating clockwise stopping, being at perpendicular to wavy antelabium 8334 for kicking out of block 8324, during being fully retracted The disengaging is kept to eliminate ratcheting noise.
In Figure 181, Figure 183, Figure 190 and Figure 195, surgical stapling and cutting off apparatus 8010 may include manual retract mechanism 8500, which provides the manual releasing of firing lock, manual retrieving, and in a kind of pattern (Figure 196-figure 202) automatic retracted is also executed at the end of complete firing schedule in.Referring now to Figure 181, Figure 190 and Figure 191, in particular, Preceding idler gear 8220 is engaged with the dentation upper left surface 8222 of link tooth bar 8200, wherein preceding idler gear 8220 also engages tool There is the rear idler gear 8230 of smaller right-side ratchet gear 8231.Preceding idler gear 8220 and rear idler gear 8230 are rotatably It is connected to the shank shell 8154 being located on front idler axis 8232 and rear idler wheel axis 8234.Rear idler wheel axis 8232 Every end extends through corresponding right half-shell 8156 and left shell half 8158, and is attached to left indicator wheel 8040 and right indicator wheel 8041, and rotated freely in shank shell 8154 due to hind axle 8234 and backgear 8230 is bonded to bonding pattern, Thereby indicate that device wheel 8040,8041 and backgear 8230 rotate together.Link tooth bar 8200, idler gear can be advantageously selected Gear relationship between 8220 and backgear 8230 so that dentation upper surface 8222 has intensity teeth size appropriate, and makes It obtains during the complete firing schedule of link transmission firing lock 8150, the rotation of backgear 8230 is no more than a circle.Gear mechanism Other than intuitively indicating firing schedule or progress, gear mechanism 8502 can also be used to make knife manual retrieving structure 8502.It is empty afterwards The lesser right-side ratchet gear 8231 of rotating disk 8230 extends in the wheel hub 8506 of manual retrieving lever 8042, specifically The vertical longitudinally-aligned slit 8508 (Figure 190) divided is aligned with by wheel hub 8506.8510 He of lateral through-hole of wheel hub 8506 Upper grooves 8512 are connected to.Front 8514 is shaped as the locking pawl 8516 for accommodating and proximally guiding, the locking pawl Lateral pin 8518 to the right in the distal end for being formed in upper grooves 8512 pivots.Rear portion 8520 is shaped as receiving L shape spring tab 8522, the spring tab force locking pawl 8516 to engage with the lesser ratchet gear 8231 in right side downwards. Barrier structure 8524 (Figure 186 and Figure 193) projects into upper grooves 8512 from right half-shell 8156；When manual retrieving lever 8042 When downwards (Figure 193), which prevents locking pawl 8516 from engaging lesser right-side ratchet gear 8231.Wind spring 8525 (Figure 181) forces manual retrieving lever 8042 downward.
In use, as shown in Figure 192 and Figure 193, combination stretching/compressing spring 8184 can be located in linking for distal side Rack gear is detached from.In Figure 194 and Figure 195, when manual retrieving lever 8042 is lifted, locking pawl 8516 is rotated clockwise simultaneously And it is no longer blocked the prevention of structure 8524, and engage lesser right-side ratchet gear 8231, so that rear idler gear 8230 be made to exist It is rotated clockwise when from left sides.Therefore, the preceding response counterclockwise of idler gear 8220, makes link tooth bar 8200 bounce back.In addition, Curved ridges 8510 to the right are prominent from wheel hub 8506, and its size is set to contact and moves toward the far side anti-reversing trip lever 8248, to discharge anti-inversion organization 8250 when manual retrieving lever 8042 rotates.
In Figure 196-Figure 20 2, the automatic retracted mechanism 8600 of surgical stapling and cutting off apparatus 8010a can fire completely Automatic retracted is integrated in the preceding idler gear 8220a with tooth 8602 at the end of stroke；The preceding idler gear is in cam Movement in circular groove 8604 in 8606 meets with obstruction until until the nearly whole rotation for corresponding to three firing schedules Object 8608.In such cases, ridge 8610 to the right is rotated upwardly to contact bottom cam groove 8612, anti-to move toward the far side Reverse trip lever 8248a.Referring specifically to Figure 197, anti-reversing trip lever 8248a includes the distal side end operated as described in the preceding End 8254.The circular pegs 8293 and pin socket 8296 being respectively formed between right half-shell 8156 and left shell half 8158 be formed through in The hole 8294a of general rectangular in the subsequent anti-reversing trip lever 8248a of bottom cam 8192 is received, to allow longitudinal direction The downward lock motion of the distal end 8254 of translation and anti-reversing trip lever 8248a.It is horizontal in right half-shell 8156 The channel 8295a proximally opened accommodates the rear pin 8297 to the right near the proximal extremity of anti-reversing trip lever 8248a.
In operation, before the percussion in Figure 198, Figure 198 A, at link tooth bar 8200 and anti-reverse cam tube 8268 In retraction position, thus when anti-reverse compression spring 8264 tilts anti-down flap 8266 proximally, anti-inversion organization 8250 It is locked.Automatic retracted mechanism 8600 is in original state, and wherein anti-reversing trip lever 8248a bounces back, and connecting rod 8196a is with before Idler gear 8220a contact.Tooth 8602 is in the position of six o'clock sharps, and wherein the total travel of circular groove 8604 carries out counterclockwise, The just adjacent teeth 8602 of ridge 8610 to the right.In Figure 199, Figure 199 A, a firing schedule occurs, by a distal link 8196b is moved upward to be contacted with preceding idler gear 8220a.Before tooth 8602 has passed through the circular groove 8604 of fixed cam 8606 Turn into one third.In Figure 200, Figure 200 A, second firing schedule has occurred, another connecting rod 8196c has been transported upwards It moves and is contacted with preceding idler gear 8220a.The circular groove 8604 that tooth 8602 has passed through fixed cam 8606 advanced three/ Two turns.In Figure 20 1, Figure 20 1A, third firing schedule has occurred, a distal link 8196d has been moved upward to before Idler gear 8220a contact.Tooth 8602 has surrounded 8604 whole process of circular groove and proceeds to be contacted with obstruction 8608, to start The rotation (when being observed from the right) counterclockwise of cam 8606, to make ridge 8608 and anti-reversing trip lever 8248a to the right Contact.In Figure 20 2, anti-reversing trip lever 8248a has been moved toward the far side in response, so that preceding pin 8298 to the right be locked Determine into the hierarchic structure 8299 opened towards distal side and discharges anti-inversion organization 8250.Similar surgery suturing appliance is disclosed in In on August 1st, 2006 United States Patent (USP) 7,083,075 announced, the complete disclosure of the patent is herein incorporated by reference.
Referring to fig. 2 03, the nail administration assembly 9012 of surgery suturing appliance 9010 implements function such as: organizationally clamp, By driving nail and cutting tissue relative to the longitudinal two kinds of different motions transmitted downwards of pedestal 9070 along axis 9016.Pedestal 9070 shanks for being proximally attached to surgery suturing appliance are coupled to it, to be rotated about longitudinal axes.For surgical stapling Illustrative multi-stroke handle with cutting off apparatus is in co-pending and jointly owned entitled " SURGICAL STAPLING INSTRUMENT INCORPORATING A MULTISTROKE FIRING POSITION INDICATOR AND It is described in more detail in the U.S. Patent application 10/374,026 of RETRACTION MECHANISM ", the patent application Disclosure be incorporated by reference be incorporated to accordingly.Meet other application of the invention in combination with single firing schedule, such as exists Co-pending and jointly owned entitled " SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS " U.S. Patent application 10/441, described in 632, the patent Shen Disclosure please is incorporated by reference accordingly to be incorporated to.
Referring specifically to Figure 20 4, the distal end of pedestal 9070 is attached to nail channel 9018.Anvil block 9022 is pivoted with nearside End 9072, which is placed exactly in can pivotably be contained in the proximal extremity 9074 of nail channel 9018 The distal side of itself and 9070 joint of pedestal.When anvil block 9022 downwards pivot when, anvil block 9022 make tissue contacting surface 9028 and at Shape pit 9026 is as follows further described in more detail towards opposite cartridge movement.The hub switch side 9072 of anvil block 9022 includes closing Structure 9076 is closed, the closing structure is at its pivotal attachment with nail channel 9018 but at it is with nail channel pivotal attachment Distal side.Therefore, closed tube 9078 (its distal end includes engaging the shape of a hoof hole 9080 of the closing structure 9076) selectivity Ground assigns open movement to anvil block 9022 during nearside longitudinal movement, and during the distal side longitudinal movement of closed tube 9078 Assign closing motion to anvil block 9022, which slides on pedestal 9070 in response to closure trigger, be similar to It is described above.The two cuttves and trigger shaft that pedestal 9070 promotes and firing action is guided to pass through longitudinally reciprocating motion from shank 9090.In particular, pedestal 9070 includes longitudinal trigger shaft slit 9092, which accommodates two cuttves and percussion The portions of proximal of bar 9090, in particular to laminated tapered trigger shaft 9094.It should be appreciated that laminated tapered trigger shaft 9094 It can be replaced by solid trigger shaft and/or any other suitable material.
E type crossbeam 9102 is the distal part of two cuttves and trigger shaft 9090, is conducive to individually be closed and fire, and Anvil block 9022 and elongate staple channel 9018 are spaced apart during percussion.Referring specifically to Figure 20 4 and Figure 20 5, in addition to any attachment It handles outside such as solder brazing or adhesive, knife and trigger shaft 9090 are also vertically attached by the spill being formed in E type crossbeam 9102 Hole 9104 is formed, which accommodates the correspondingly convex attachment members 9106 presented by laminated tapered trigger shaft 9094 in distal side, To make each part be formed by the selected material and method for being suitable for its different function (such as intensity, flexibility, frictional force). E type crossbeam 9102 can be formed advantageously by the material with desired material properties, intermediate to form a pair of of top pin 9110, a pair Pin 9112 and base pins or stabilizer blade 9114, and sharp knife edges 9116 can be obtained.It hangs down in addition, holding each of blade 9116 The integrated molding of straight end and proximally top director 9118 outstanding and intermediate guide 9120 also define tissue build-up area Domain 9122 facilitates before cutting off tissue to guide to sharp knife edges 9116.Intermediate guide 9120 is also used to pass through neighbour The staged central member 9124 of wedge-shaped slides 9126 (Figure 20 6) is connect to engage simultaneously percussion nail application equipment 9012, thus logical The forming that nail administration assembly 9012 realizes nail is crossed, as described in more detail below.For being assembled by multiple components, It is advantageous that these structures (for example, top pin 9110, intermediate pin 9112 and bottom supports 9114) are integrally formed with E type crossbeam 9102 Manufactured under the tolerance of closer degree relative to each other, ensure that percussion and/or with nail administration assembly 9012 Various locking structures effective interaction during carry out desired operation.
In Figure 20 7 and Figure 20 8, nail administration assembly 9012 is illustrated as open, and wherein E type crossbeam 9102 is fully retracted. In period of assembly, the lower leg 9114 of E type crossbeam 9102 passes through expanded hole 9130 and falls into nail channel 9018, and E type is horizontal Beam 9102 is then pushed into, so that E type crossbeam 9102 is slided along the lower railway 9132 being formed in nail channel 9018 towards distal side. In particular, lower railway 9132 includes narrower slots 9133, opened on the lower surface of nail channel 9018 as expansion slit 9134, it is such as specifically shown in Figure 20 8 and Figure 20 9 to form the T shape of reversion in lateral cross section；The narrower slots 9133 It is connected to expanded hole 9130.Once being assembled, do not allow lower part in the component that nearside is attached to laminated tapered trigger shaft 9094 Stabilizer blade 9114 marches to expanded hole 9130 proximally again to allow to be detached from.Referring to fig. 2 10, laminated tapered trigger shaft 9094 has It is inserted into conducive to by nail administration assembly 9012 across trochar.In particular, when E type crossbeam 9102 is fully retracted, farther side Downward protruding portion 9136 lifts E type crossbeam 9102.This is subjected to displacement in certain point by downward protruding portion 9136 to realize； At this point, the protruding portion upward cam in the proximal of the expanded hole 9130 in nail channel 9018.Referring now to figure 211, laminated tapered trigger shaft 9094 also enhances the operation of certain locking structures, and the locking structure can be by including more nearside Upward protruding portion 9138 and be integrated in nail channel 9018；The protruding portion is during the initial part of firing schedule by axis Frame 9070 drives downwards.In particular, lateral rod 9140 be limited at the square holes 9142 in pedestal 9070 (Figure 20 4) it Between.The clip springs 9144 for surrounding lateral rod 9140 downwards force a part of laminated tapered trigger shaft 9094 from longitudinal percussion It is prominent towards distal side in bar slit 9092, it is ensured that certain advantageous locking structures are engaged when appropriate.When upward protruding portion When 9138 contacts clip spring 9144, which becomes apparent or is limited only to the part of firing schedule.
In Figure 20 7 and Figure 20 8, E type crossbeam 9102 bounces back, and top pin 9110 is located at the pivot nearside end of anvil block 9022 In anvil block pit 9150 near end.The vertical anvil block slot 9152 (Figure 20 3) opened downwards is by 9022 side of anvil block to being expanded into Anvil block inner tracks 9154, when the top pin 9110 of E type crossbeam 9102 promotes during percussion towards distal side, anvil block inner tracks Anvil block 9022 and nail channel 9018 are spaced by the top pin 9110 for capturing E type crossbeam 9102 absolutely as shown in Figure 21 0 and 211 It opens.Therefore, after E type crossbeam 9102 bounces back, surgeon can be repeatedly opened and be closed nail administration assembly 9012, until to catching Obtain in wherein it is to be stapled and cutting tissue placement and orientation please oneself, and E type crossbeam 9102 even for have subtract Few diameter and correspondingly reduce the appropriate positioning that tissue is also contributed to for the nail administration assembly 9012 of rigidity.In Figure 20 3, figure 204, in Figure 20 6, Figure 20 7, Figure 20 9 and Figure 21 5, nail administration assembly 9012 be shown as with including wedge-shaped slides 9126 can Replace nail bin 9020.Longitudinally-aligned and parallel multiple wedge slots 9202 (Figure 20 9) opened downwards accommodate wedge-shaped slides Corresponding wedge 9204 necessary to 9126.In Figure 20 9- Figure 21 1, therefore cam movement is multiple upwards for wedge-shaped slides 9126 Staple drivers 9206, the multiple staple drivers can vertical sliding motions in staple drivers groove 9208.In the illustrative pattern, Each staple drivers 9206 include two vertical contact pins, and each vertical contact pin translates up corresponding nail hole 9210 or cavity In 9024, the nail 9023 in staple forming surface 9214 (Figure 21 1) will rest against anvil block 9022 squeezes out upwards and makes its deformation.Limit Center percussion groove 9216 (Figure 20 4) being scheduled in the nail bin 9020 of neighbouring nail channel 9018 allows the bottom of wedge-shaped slides 9126 The intermediate pin 9112 of portion's horizontal component 9218 (Figure 20 6) and E type crossbeam 9102 passes through.In particular, (the figure of nail bin pallet 9220 204, Figure 20 9) it is attached to polymer staple cartridge body 9222 and is positioned below；The polymer staple cartridge body has nail formed therein Driver recess 9208, nail hole 9210 and center percussion groove 9216.When nail 9023 therefore in either side forming, sharp knife edges 9116 enter vertical through slot 9230, and other than the only farthest side end of the vertical through slot, which passes through nail bin 9020 Longitudinal axis.
As shown in Figure 21 1, proximally pull when by two cuttves and trigger shaft 9090 until downward protruding portion 9136 is by E type Intermediate guide 9120 on crossbeam 9102 upwardly and rearwardly cam when, start to fire nail administration assembly 9012, to work as anvil block When 9022 such as Figure 20 3 and Figure 20 7 opening, it is inserted into new nail bin 9020 in nail channel 9018.In Figure 21 2, two cuttves and hit Hair bar 9090 is pushed into a small distance towards distal side, so that when clip springs 9144 act on laminated tapered trigger shaft When 9094 upward protruding portion 9138, downward protruding portion 9136 is fallen into the expanded hole 9130 of lower railway 9132.It leads centre To device 9120 prevent due in the staged central member 9124 for being resisted against wedge-shaped slides 9126 and generate it is further to Lower rotation, so that the intermediate pin 9112 of E type crossbeam is maintained in center percussion groove 9216.In Figure 21 3, two cuttves and hit Hair bar 9090 is fired towards distal side, to promote wedge-shaped slides 9126, will be clamped in anvil block 9022 and with sharp to work as Tissue 9242 between the nail bin 9020 of blade 9116 makes 9023 forming of nail when cutting off.Then, it in Figure 21 4, two cuttves and hits It sends out bar 9090 to bounce back, positions wedge-shaped slides 9126 in distal side.In Figure 21 5, intermediate pin 9112 is allowed to move to downwards It is formed in the latch recess 9240 in nail channel 9018 (referring also to Figure 20 8, Figure 21 1).Therefore, when wedge-shaped slides 9126 (not shown in Figure 21 5) not it is proximally-oriented (for example, nail bin 9020 missing or nail bin 9020 exhaust) when, if intermediate pin 9112 encounter the distal side edge of latch recess 9240, then operator will be received into tactile instruction.Similar surgery suturing appliance Disclosed in having in the United States Patent (USP) 7,380,696 that on June 3rd, 2008 announces, the complete disclosure of the patent is with the side of reference Formula is incorporated herein.
As described above, nail bin may include warehouse, which includes multiple being defined in nail cavity therein.Warehouse may include platform And top platform surface, wherein each nail cavity can limit the opening in platform surface.As also described above, nail can be positioned in each In nail cavity, so that nail is stored in warehouse until it is emitted from warehouse.Before being emitted from warehouse, nail can be accommodated in In warehouse, so that it is more than platform surface that nail is not projecting.It in such embodiments, can when nail is positioned in below platform surface Nail is reduced to be damaged and/or a possibility that premature contact destination organization.In all cases, nail can be in non-firing position and percussion It is moved between position, in non-firing position, not from warehouse protrusion, in firing position, exposes and can connect from warehouse Touching is positioned in the anvil block on nail bin opposite.Anvil block and/or the forming pit being defined in anvil block can be positioned so that away from platform surface The predetermined distance in top, so that nail is deformed into predetermined forming height when nail is disposed from warehouse.In some feelings Under condition, it is trapped in the thickness variable of the tissue between anvil block and nail bin, therefore, thicker tissue can be trapped in certain nails Interior and relatively thin tissue can be trapped in other certain nails.In either case, the clamping pressure of tissue is applied to by nail Or power for example can be different because of nail, or changes between the nail on the other end of nail and staple on one end of staple.In certain feelings Under condition, the gap between anvil block and nail bin platform can control, so that nail applies a certain the smallest clamping pressure in each nail.So And in some such cases, the significant changes of the clamping pressure in different nails may possibly still be present.
Nail bin may include the device compensated for the thickness to the tissue captured out of cartridge deployment nail.Referring to figure 216, nail bin (such as nail bin 10000) for example may include rigid first part (such as support section 10010) and, for example, can The second part (such as tissue thickness compensation part 10020) of compression.Referring first to Figure 21 8, support section 10010 may include storehouse Body, top platform surface 10011 and multiple nail cavities 10012.Wherein, similarly as described above, each nail cavity 10012 can limit flat Opening in platform surface 10011.Nail 10030 can be for example removably positioned in each nail cavity 10012.For example, joining first See Figure 24 5 and as described in more detail below, it is each nail 10030 may include base portion 10031 and from base portion 10031 extend one Or multiple legs 10032.In nail 10030 by before disposing, also as described in more detail below, the base portion 10031 for following closely 10030 can be by fixed Staple drivers support of the position in support section 10010, and at the same time, following closely 10030 leg 10032 can at least be partly accommodated in In nail cavity 10012.Nail 10030 can be disposed between non-firing position and firing position, so that leg 10032 moves across tissue Thickness compensation part 10020 penetrates the top surface of tissue thickness compensation part 10020, penetrates tissue T, and contact and be positioned in The anvil block on 10000 opposite of nail bin.When leg 10032 is against deflection, the leg 10032 of each nail 10030 can capture tissue thickness A part of compensating part 10020 and a part of the tissue T in each nail 10030 are spent, and applies compressive force to tissue. Further described above, the leg 10032 of each nail 10030 can be made to deform downwardly toward the base portion 10031 of nail, to form nail Retention area 10039, in the nail retention region, tissue T and tissue thickness compensation part 10020 can be captured.In all cases, Nail retention region 10039 can be limited between the inner surface of strained leg 10032 and the inner surface of base portion 10031.Nail is cut Stay the size in region to may depend on a number of factors, for example, the length of leg, the diameter of leg, base portion width, and/or for example leg deforms Degree.
In the past, the nail appropriate that surgeon usually needs to have appropriate staple height for the organizational choice to be sutured.Example Such as, surgeon may be selected high nail and be used together and select low nail to be used together with thin tissue with thick tissue.However Under some cases, the tissue being just sewn does not have consistent thickness, and therefore, some nails cannot achieve desired percussion configuration. For example, Figure 25 0 is shown for the high nail in thin tissue.Referring now to Figure 25 1, when tissue thickness compensation part (is such as organized Thickness compensation part 10020) when being for example used together with thin tissue, such as biggish nail can shape as desired percussion configuration.
Due to the compression ratio of tissue thickness compensation part, tissue thickness compensation part can be to the thickness of tissue of the capture in each nail Degree compensates.More specifically, referring now to Figure 24 5 and Figure 24 6, tissue thickness compensation part (such as tissue thickness compensation part 10020) each nail 10030 can be for example occupied according to the thickness of the tissue accommodated in nail retention region 10039 and/or type The larger and/or lesser part of nail retention region 10039.For example, being trapped in the feelings in nail 10030 in thicker tissue T Under condition, if relatively thin tissue T is trapped in nail 10030, tissue thickness compensation part 10020 can occupy nail retention region 10039 major part.Correspondingly, in the case where relatively thin tissue T is trapped in nail 10030, if thicker tissue T It is trapped in nail 10030, then tissue thickness compensation part 10020 can occupy the smaller portions of nail retention region 10039.In this way, Tissue thickness compensation part can compensate for compared with thin tissue and/or compared with thick tissue, and ensure that compressing force is applied to tissue, regardless of or extremely No matter few tissue thickness being substantially trapped in nail.In addition to the above, tissue thickness compensation part 10020 can The tissue of the different type or different compression ratios that are trapped in different nails 10030 is compensated.Referring now to Figure 24 6, group Knit thickness compensation part 10020 and can apply compressive force to may include blood vessel V vascular tissue T, and therefore limit blood flows through not Too compressible blood vessel V, but desired compressing force is still applied to the tissue T of surrounding.In all cases, to above into Row further describes, and tissue thickness compensation part 10020 can also compensate for strained nail.Referring to fig. 2 47, the change of various nails 10030 Shape can lead to the biggish nail retention region 10039 being limited in such nail.Due to the rebound of tissue thickness compensation part 10020 Power, it is fixed even if being limited at this nail retention region 10039 deformed in nail 10030 can be extended referring now to Figure 24 8 Position this deformed nail 10030 in tissue thickness compensation part 10020 still enough compression pressures can be applied to tissue T. In all cases, the tissue thickness compensation part 10020 among adjacent nail 10030 can have been deformed around nail 10030 The nail 10030 suitably shaped is biased against tissue T, and is therefore applied to compression pressure and is for example surrounded and/or be trapped in Tissue in deformation nail 10030.In all cases, tissue thickness compensation part can compensate for different tissue densities, the difference Tissue density can for example due to calcification, zone of fiber, and/or previously the tissue that has sutured or handled and generate.
Fixed or unmodifiable tissue space can be limited between support section and anvil block, no matter therefore captured Why the thickness of tissue in nail can make nail be deformed into predetermined height.When tissue thickness compensation part and these implementations Example is when being used together, and tissue thickness compensation part is suitable for the tissue being trapped between anvil block and support section nail bin, and by In the screen resilience of tissue thickness compensation part, additional compressing force can be applied to tissue by tissue thickness compensation part.Referring now to figure 252- Figure 25 7 follows closely 10030 formed to scheduled height H.Referring to Figure 25 2, tissue thickness compensation part is not used, and Tissue T occupies entire nail retention region 10039.Referring to Figure 25 9, a part of tissue thickness compensation part 10020 has been captured In nail 10030, tissue T is compressed, and occupied at least part of nail retention region 10039.Referring now to figure 254, thin tissue T have been trapped in nail 10030.In this embodiment, for example, compressed tissue T is with about 2/9H's Height and compressed tissue thickness compensation part 10020 have the height of about 7/9H.Referring now to Figure 25 5, there is centre The tissue T of thickness has been trapped in nail 10030.In this embodiment, for example, compressed tissue T is with about 4/9H's Height and compressed tissue thickness compensation part 10020 have the height of about 5/9H.Referring now to Figure 25 6, there is centre The tissue T of thickness has been trapped in nail 10030.In this embodiment, for example, compressed tissue T is with about 2/3H's Height and compressed tissue thickness compensation part 10020 have the height of such as about 1/3H.Referring now to Figure 25 5, thick group T is knitted to be trapped in nail 10030.In this embodiment, for example, compressed tissue T with about 8/9H height and Compressed tissue thickness compensation part 10020 has the height of about 1/9H.In all cases, tissue thickness compensation part can wrap Compression height is included, which includes: such as about 10% nail retention height, about 20% nail retention height, about 30% nail retention height, about 40% nail retention height, about 50% nail retention height, about 60% nail retain it is high Degree, about 70% nail retention height, about 80% nail retention height, and/or about 90% nail retention height.
Nail 10030 may include any suitable unshaped height.Nail 10030 may include for example between about 2mm and about Unshaped height between 4.8mm.Nail 10030 may include such as about 2.0mm, about 2.5mm, about 3.0mm, about The unshaped height of 3.4mm, about 3.5mm, about 3.8mm, about 4.0mm, about 4.1mm, and/or about 4.8mm.Nail can The height H being deformed into can be determined by the distance between the platform surface 10011 of support section 10010 and opposite anvil block.It is flat The distance between platform surface 10011 and the tissue contacting surface of anvil block may be, for example, about 0.097 ".Height H can also be by being limited to The depth of forming pit in anvil block determines.Forming pit can for example have the depth measured from tissue contacting surface.It is as follows Described in more detail, nail bin 10000 may also include staple drivers, which can promote nail 10030 towards anvil block, and will mention It rises or " excessively driving " arrives 10011 top of platform surface.In this case, the forming height H for following closely 10030 can also be by following closely 10030 distances being overdriven determine.For example, nail 10030 can be overdriven such as about .028 ", and can lead to Nail 10030 is shaped to such as about 0.189 " height.Nail 10030 can be shaped as such as about 0.8mm, about 1.0mm, The height of about 1.5mm, about 1.8mm, about 2.0mm, and/or about 2.25mm.Nail can be shaped as example between about Height between 2.25mm and about 3.0mm.Further described above, the height of the nail retention region of nail can be by following closely The width and diameter of forming height and the wire rod including nail are determined.The height of the nail retention region 10039 of nail 10030 can wrap The forming height H for including nail subtracts two diameter widths of wire rod.Staple line may include such as about 0.0089 " diameter.Staple line can Including the diameter for example between about 0.0069 " and about 0.0119 ".For example, the forming height H of nail 10030 can be big About 0.189 ", the nail retention height that and staple line diameter may be about 0.0089 ", to for example generate about 0.171 ".
Further described above, tissue thickness compensation part may include height that is unpressed or disposing in advance, and One for capable of being deformed into multiple compression heights.Tissue thickness compensation part may include such as about 0.125 " uncompressed height Degree.The compensating part of tissue thickness may include be greater than be equal to about 0.080 " uncompressed height.Tissue thickness compensation part can Including height that is unpressed or disposing in advance, this is highly greater than the non-firing height of nail.Tissue thickness compensation part it is unpressed Or the height disposed in advance is for example high than the non-firing height of nail about 10%, Gao great Yue 20%, Gao great Yue 30%, Gao great Yue 40%, Gao great Yue 50%, Gao great Yue 60%, Gao great Yue 70%, Gao great Yue 80%, Gao great Yue 90%, and/or height about 100%. The non-firing height height such as up to about 100% of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part. The non-firing height height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part is for example more than 100%.Tissue Thickness compensation part may include equal to the uncompressed height of the non-firing height of nail.Tissue thickness compensation part may include being less than nail not The uncompressed height of firing height.The non-firing height of the comparable nail of height that is unpressed or disposing in advance of tissue thickness compensation part Such as low about 10%, it is low about 20%, low about 30%, low about 40%, low about 50%, low about 60%, low about 70%, low about 80%, and/or low about 90%.Compressible second part may include uncompressed height, the uncompressed height Higher than the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, the uncompressed height etc. In the uncompressed height for the tissue T being just sewn.Tissue thickness compensation part may include uncompressed height, which is lower than The uncompressed height for the tissue T being just sewn.
As described above, whether thick tissue or thin tissue are trapped in nail, tissue thickness compensation part can be multiple It is compressed in forming nail.For example, the nail in staple line or staple can be made to deform, so that the nail retention region of each nail includes for example big The height of about 2.0mm, wherein tissue T and tissue thickness compensation part can be compressed in the height.In some cases, tissue T It may include the compression height of the about 1.75mm in nail retention region, and tissue thickness compensation part may include in nail retention region The compression height of interior about 0.25mm, to obtain adding up to the nail retention region height of such as about 2.0mm.In certain feelings Under condition, tissue T may include the compression height of the about 1.50mm in nail retention region, and tissue thickness compensation part may include The compression height of about 0.50mm in nail retention region, so that the nail retention region for obtaining adding up to such as about 2.0mm is high Degree.In some cases, tissue T may include the compression height of the about 1.25mm in nail retention region, and tissue thickness is mended Repaying part may include the compression height of the about 0.75mm in nail retention region, to obtain adding up to such as about 2.0mm's Nail retention region height.In some cases, tissue T may include the compression height of the about 1.0mm in nail retention region, and Tissue thickness compensation part may include the compression height of the about 1.0mm in nail retention region, to obtain adding up to for example big The nail retention region height of about 2.0mm.In some cases, tissue T may include the about 0.75mm in nail retention region Compression height, and tissue thickness compensation part may include the compression height of the about 1.25mm in nail retention region, to obtain Add up to the nail retention region height of such as about 2.0mm.In some cases, tissue T may include in nail retention region The compression height of about 1.50mm, and tissue thickness compensation part may include the compression height of the about 0.50mm in nail retention region Degree, to obtain adding up to the nail retention region height of such as about 2.0mm.In some cases, tissue T may include cutting in nail Stay the compression height of the about 0.25mm in region, and tissue thickness compensation part may include in nail retention region about The compression height of 1.75mm, to obtain adding up to the nail retention region height of such as about 2.0mm.
Further described above, tissue thickness compensation part may include less than the uncompressed height of the firing height of nail Degree.Tissue thickness compensation part may include equal to the uncompressed height of the firing height of nail.Alternatively, tissue thickness compensation part may include Higher than the uncompressed height of the firing height of nail.For example, the uncompressed height of tissue thickness compensation part may include for example following thick Degree: should with a thickness of forming nail height about 110%, about the 120% of forming nail height, forming nail height about 130%, Forming nail height about 140%, about the 150% of forming nail height, about the 160% of forming nail height, forming nail height About 170%, about the 180% of forming nail height, about the 190% of forming nail height, and/or forming nail height about 200%.Tissue thickness compensation part may include uncompressed height, this is highly twice or more of the firing height of nail.Tissue thickness Compensating part may include compression height, this is highly about the 85% to about 150% of such as forming nail height.As described above, group Knitting thickness compensation part can be compressed between uncompressed thickness and compressed thickness.The compressed thickness of tissue thickness compensation part can For example, its uncompressed thickness about 10%, about the 20% of its uncompressed thickness, its uncompressed thickness about 30%, its Uncompressed thickness about 40%, about the 50% of its uncompressed thickness, about the 60% of its uncompressed thickness, its uncompressed thickness Degree about 70%, about the 80% of its uncompressed thickness, and/or its uncompressed thickness about 90%.Tissue thickness's compensation The uncompressed thickness of part can it is for example thicker than its compressed thickness approximately twice as, about ten times, about 50 times, and/or about 100 Times.The compressed thickness of tissue thickness compensation part can be between about the 60% to about 99% of its uncompressed thickness.Tissue thickness is mended The uncompressed thickness of part is repaid than its compressed thickness thickness at least 50%.The uncompressed thickness of tissue thickness compensation part is than its compression Thickness thickness is up to 100 times.Compressible second part can be elastic or at least partly elastic, and can be by tissue T Strained leg against nail biases.For example, compressible second part can between tissue T and the base portion of nail resilient expansion, To push tissue T against the leg of nail.It is discussed in detail as discussed further below, tissue thickness compensation part can be positioned in tissue T Among the nail leg of deformation.In all cases, due to described above, tissue thickness compensation part can be eliminated in nail retention region Any gap.
Any tissue thickness compensation part as described herein may include the material for being characterized in that one or more of following characteristic Material: for example, biocompatibility, bioresorbable, bioresorbability, biodurable, biological degradability, compression ratio, fluid Absorbability, swellability, from scalability, bioactivity, Drug, pharmaceutical activity, resistance to blocking, hemostatic, antibiosis disposition, anti- Bacterium property, antiviral property, trophism, adhesiveness, permeability, hydrophily and/or hydrophobicity.In all cases, including anvil block and Nail bin or any surgical stapling or fastening instrument of fastener cartridge may also comprise tissue thickness associated with anvil block and/or nail bin Compensating part.Such tissue thickness compensation part can be any tissue thickness compensation part of tissue thickness compensation part as described herein, and And can be with, or furthermore may include hemostat (such as fibrin and fibrin ferment), antibiotic (such as doxycpl) and drug At least one of (such as matrix metalloproteinase (MMPs)).
Tissue thickness compensation part may include synthesis and/or non-synthetic materials.Tissue thickness compensation part may include polymer group Object is closed, the polymer composition includes one or more synthetic polymers and/or one or more non-synthetic polymers.Synthesis Polymer may include the absorbable polymer of synthesis and/or the non-absorbable polymer of synthesis.Polymer composition may include example Such as biocompatible foam.Biocompatible foam may include for example porous open celled foam and/or porous closed-cell foam.It is raw Object biocompatible foam can have uniform pore morphology or can have gradient pore form (that is, in one direction on entire depth of foam, Orifice size, which gradually increases, becomes macropore).Polymer composition may include porous support, porous matrix, gel-type vehicle, hydrogel Matrix, solution matrix, thread matrix, tubulose matrix, composite interstitial substance, membrane matrix, Biostatic polymer and biodegradable One of polymer or a variety of and their combination.For example, tissue thickness compensation part may include being enhanced by thread matrix Foam, or may include the foam with additional hydrogel layer, which extends in the presence of body fluid, with Tissue further provides for compressing.Tissue thickness compensation part can be also made of the coating on material and/or the second layer or third layer, The coating extends in the presence of body fluid, organizationally to further provide for compressing.Such layer can be hydrogel, which can be Synthesize and/or natural source material, and it is durable and/or biodegradable to may be, for example, biology.Tissue thickness compensation part It may include microgel or nanogel.Hydrogel may include the microgel and/or nanogel for carrying out self-carbon water compound.It can be used Fibrous nonwoven material or the fiber mesh type element of additional flexibility, rigidity, and/or intensity can be provided to enhance tissue thickness Spend compensating part.Tissue thickness compensation part has porous form, which shows gradient-structure, such as on a surface Aperture and biggish hole on the other surface.Such form is more managed for tissue growth or hemostasis behavior Think.In addition, gradient can be also combined with the bio-absorbable section of variation.Absorption profile can be preferred in short term, to solve to stop blooding Problem, and Long-term absorption section can solve the problems, such as to make tissue more preferably heal in the case of ne-leakage.
The example of non-synthetic materials includes but is not limited to lyophilized polysaccharide, glycoprotein, bovine pericardium, collagen, gelatin, fibrin Albumen, fibrinogen, elastin laminin, proteoglycans, keratin, albumin, hydroxyethyl cellulose, cellulose, oxidized fibre Element, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, deacetylated shell Polysaccharide, casein, alginates and their combination.
It synthesizes the example including but not limited to poly- (lactic acid) (PLA) of absorbable material, poly (L-lactic acid) (PLLA), gather in Ester (PCL), polyglycolic acid (PGA), poly(trimethylene carbonate) (TMC), polyethylene terephthalate (PET), poly- hydroxyl The copolymerization of the copolymer, glycolide and trimethylene carbonate of phenylalkanoic acid ester (PHA), glycolide and 6-caprolactone (PGCL) Object, poly- (dioxanone) (PDS), polyester, poly- (ortho esters), polyoxy acid ester, gathers poly- (decanedioic acid glyceride) (PGS) Ether-ether, polycarbonate, polyesteramide, polyanhydride, polysaccharide, poly- (ester-acid amide), tyrosine-based polyarylate, polyamine, tyrosine-based are poly- Imido-carbonic ester, tyrosine-based polycarbonate, poly- (D, L- lactide-carbamate), poly- (butyric ester), poly- (B- hydroxyl Base butyrate), poly- (E- caprolactone), polyethylene glycol (PEG), poly- [two (carboxyphenoxy) phosphonitriles], poly- (amino acid), quasi- poly- (amino acid), absorbable polyurethane, poly- (phosphine piperazine), polyphosphazene, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, Polyvinylpyrrolidone, poly- (caprolactone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerol, is total to polyvinyl alcohol Poly- (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene diol ester and it Combination.Polyester can be selected from polylactide, polyglycolide, trimethylene carbonate, polydioxanone, polycaprolactone, Polybutester and their combination.
The absorbable polymer of synthesis may include for example can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. commercially available 90/10 poly- (glycolide-L- lactide) copolymer, can with brand name DEXON from American Cyanamid Co. commercially available polyglycolide, can be with brand name PDS from Ethicon, Inc. is commercially available Polydioxanone, can be commercially available from American Cyanamid Co. with brand name MAXON poly- (glycolide- Trimethylene carbonate) statistic copolymer, can with brand name MONOCRYL from Ethicon company it is commercially available 75/ One of 25 poly- (glycolide-s-caprolactone-poliglecaprolactone 25) copolymers are a variety of.
Synthesis non-absorbable material include but is not limited to polyurethane, polypropylene (PP), polyethylene (PE), polycarbonate, Polyamide, such as nylon, polyvinyl chloride (PVC), polymethyl methacrylate (PMMA), polystyrene (PS), polyester, polyethers ether Ketone (PEEK), polytetrafluoroethylene (PTFE) (PTFE), polytrifluorochloroethylene (PTFCE), polyvinyl fluoride (PVF), fluorinated ethylene propylene (FEP), polyacetals, polysulfones, silicon and their combination.The non-absorbable polymer of synthesis may include, but are not limited to foamed elastic Body and porous elastomers, such as siloxanes, polyisoprene and rubber.Synthetic polymer may include can be with brand name GORE- TEX Soft Tissue Patch is from W.L.Gore&Associates, Inc. commercially available expanded PTFE (ePTFE), it and can be steeped with brand name NASOPORE from Polyganics commercially available co-poly ether-ether carbamate Foam.
Polymer composition may include the polymer composition of such as by weight about 50% to about 90% PLLA, And by weight about 50% to about 10% PCL polymer composition.Polymer composition may include for example by weight The PLLA of meter about 70%, and by weight about 30% PCL.Polymer composition may include for example big by weight The polymer composition of about 55% to about 85% PGA, and by weight 15% to 45% PCL combination of polymers Object.Polymer composition may include such as by weight about 65% PGA, and by weight about 35% PCL.Polymerization Compositions may include the polymer composition of such as by weight about 90% to about 95% PGA, and by weight The polymer composition of about 5% to about 10% PLA.
The absorbable polymer of synthesis may include bioabsorbable, biocompatible elastomers copolymer.Suitably may be used Bio-absorbable, biocompatible elastomers copolymer include but is not limited to that (ε-is in oneself for the copolymer of 6-caprolactone and glycolide The molar ratio of ester and glycolide is preferably about 30:70 to about 70:30, it is therefore preferable to 35:65 to about 65:35, and more preferably Ground is 45:55 to 35:65)；6-caprolactone and lactide are (total including L- lactide, D- lactide, their blend or lactic acid Polymers) elastomer copolymer (molar ratio of 6-caprolactone and lactide is preferably about 35:65 to about 65:35, and more excellent Selection of land is 45:55 to 30:70)；To dioxanone (1,4- dioxane -2- ketone) and lactide, (including L- third is handed over Ester, D- lactide and lactic acid) elastomer copolymer (40 are preferably about to the molar ratio of dioxanone and lactide: 60 to about 60:40)；6-caprolactone and to the elastomer copolymer of dioxanone (6-caprolactone with to dioxanone Molar ratio be preferably about 30:70 to about 70:30)；Elastomer copolymerization to dioxanone and trimethylene carbonate Object (is preferably from about 30:70 to about 70:30 to the molar ratio of dioxanone and trimethylene carbonate)；Trimethylene carbonic acid Ester and glycolide elastomer copolymer (molar ratio of trimethylene carbonate and glycolide is preferably from about 30:70 to about 70: 30)；The elastomer copolymer of trimethylene carbonate and lactide, including L- lactide, D- lactide, they blend or Lactic acid copolymer (molar ratio of trimethylene carbonate and lactide is preferably from about 30:70 to about 70:30)；And they are total to Mixed object.δ elastomer copolymer is the copolymer of glycolide and 6-caprolactone.For another example, elastomer copolymer be lactide and ε-oneself The copolymer of lactone.
It is published in the United States Patent (USP) 5 of entitled " the ELASTOMERIC MEDICAL DEVICE " on November nineteen ninety-five 21, 468,253 and it is published in entitled " the FOAM BUTTRESS FOR STAPLING APPARATUS " on December 4th, 2001 The disclosure of United States Patent (USP) 6,325,810 be respectively incorporated by reference be incorporated herein accordingly.
Tissue thickness compensation part may include emulsifier.The example of emulsifier may include but be not limited to water-soluble polymer, all Such as polyvinyl alcohol (PVA), vinylpyrrolidone (PVP), polyethylene glycol (PEG), polypropylene glycol (PPG), pluronic (PLURONICS), tween (TWEENS), polysaccharide and their combination.
Tissue thickness compensation part may include surfactant.The example of surfactant may include but be not limited to polypropylene Acid, methylcellulose, ethyl cellulose, propyl cellulose, hydroxy ethyl cellulose, carboxy methyl cellulose, gathers methylase Ethylene oxide cetyl ether, polyoxyethylene lauryl ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene Oleyl ether, Tween 20, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, two Poly- (ethyleneoxy) ethyl alcohol of alkyl phenoxy and poloxamer (polyoxamer).
Polymer composition may include pharmaceutically active agents.Releasably therapeutically a effective amount of drug is living for polymer composition Property agent.When polymer composition is desorbed/absorbs, pharmaceutically active agents can be released.It is all that pharmaceutically active agents can be released to fluid It such as flows through in the blood on polymer composition or across polymer composition.The example of pharmaceutically active agents may include but unlimited In hemostat and drug, such as fibrin, fibrin ferment and oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as double chlorine Fragrant acid, aspirin, naproxen, sulindac and hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as Triclosan, ionic silver, ampicillin, gentamicin, polymyxin B, chloramphenicol；And anticancer agent, such as cis-platinum, mitogen are mould Element, adriamycin.
Polymer composition may include hemostatic material.Tissue thickness compensation part may include hemostatic material comprising poly- (cream Acid), poly- (glycolic), poly- (butyric ester), poly- (caprolactone), poly- (dioxanone), polyoxyalkylene, copolymerization (ether- Ester), collagen, gelatin, fibrin ferment, fibrin, fibrinogen, fibronectin, elastin laminin, albumin, hemoglobin, Ovalbumin, polysaccharide, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethyl cellulose, cellulose, oxycellulose, Hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, agarose, maltose, malt Magma essence, alginate, coagulation factor, methacrylate, polyurethane, acrylate, platelet agonist, vessel retraction Agent, alum, calcium, RGD peptide, protein, protamine sulfate, ε-aminocaproic acid, ferric sulfate, ferric subsulfate, iron chloride, zinc, Zinc chloride, aluminium chloride, aluminum sulfate, aluminum acetate, permanganate, tannic acid, bone wax, polyethylene glycol, fucosan and they Combination.The feature of tissue thickness compensation part can be haemostatic properties.
The polymer composition of tissue thickness compensation part is characterized in that such as percent porosity, pore size, and/or hard Degree.Polymer composition can have such as about 30 volume % to the percent porosity of about 99 volume %.Polymer composition There can be such as about 60 volume % to the percent porosity of about 98 volume %.Polymer composition can have such as about 85 Percent porosity of the volume % to about 97 volume %.Polymer composition may include such as PLLA of about 70 weight % and big The PCL of about 30 weight %, and may include the porosity of such as about 90 volume %.For example, therefore polymer composition will wrap Include the copolymer of about 10 volume %.Polymer composition may include such as PGA of about 65 weight % and about 35 weight % PCL, and can have such as about 93 volume % to the percent porosity of about 95 volume %.Polymer composition may include Greater than the porosity of 85 volume %.Polymer composition can have such as about 5 microns to about 2000 microns of pore size.It is poly- Polymer composition can have the pore size for example between about 10 microns to about 100 microns.For example, polymer composition It can copolymer for example comprising PGA and PCL.Polymer composition can have for example micro- between about 100 microns to about 1000 Pore size between rice.For example, polymer composition can copolymer for example comprising PLLA and PCL.
According in some terms, the hardness of polymer composition can indicate that the Shore hardness can be defined as with Shore hardness The tolerance of the permanent dent to material such as measured by sclerometer.In order to assess the durometer value of given material, According to the ASTM of entitled " Standard Test Method for Rubber Property-Durometer Hardness " Program D2240-00 applies pressure to material with hardness head pressure feet, and the full text is incorporated as a reference herein.It can will be hard Degree meter pressure head foot is administered to material and continues enough a period of times, such as 15 seconds, reads for example, wherein reading from suitable scale It takes.According to scale type used, when pressure head foot complete penetration material, reading 0 can get, and when material is not pierced When, it can get reading 100.The reading dimensionless.It can be for example according to ASTMD2240-00 according to any suitable scale such as A class And/or OO class scale determines hardometer.The polymer composition of tissue thickness compensation part may have about 4A to about 16A's Durometer A hardness value, the Durometer A hardness value is for example in the Shore OO range of about 45OO to about 65OO.For example, combination of polymers Object may include such as PLLA/PCL copolymer or PGA/PCL copolymer.The polymer composition of tissue thickness compensation part can have Durometer A hardness value less than 15A.The polymer composition of tissue thickness compensation part can have the Durometer A hardness value less than 10A. The polymer composition of tissue thickness compensation part can have the Durometer A hardness value less than 5A.Polymer material can have for example big The Shore OO composition value of about 35OO to about 75OO.
Polymer composition can have at least two in the above-mentioned characteristic identified.Polymer composition can have above-mentioned At least three kinds in the characteristic identified.Polymer composition can have the porosity of such as 85 volume % to 97 volume %, 5 micro- Rice to 2000 microns pore size and 4A to 16A Durometer A hardness value and 45OO to 65OO Shore hardness OO value.Polymerization Compositions may include the polymer composition of the polymer composition of the PLLA of 70 weight % and the PCL of 30 weight %；Institute State Xiao of porosity, 100 micron to 1000 micron of pore size and 4A to 16A of the polymer composition with such as 90 volume % The Shore hardness OO value of family name's hardness A value and 45OO to 65OO.Polymer composition may include the polymer of the PGA of 65 weight % The polymer composition of the PCL of composition and 35 weight %；The polymer composition has for example from 93 volume % to 95 The Durometer A hardness value of the porosity of volume %, 10 microns to 100 microns of pore size and 4A to 16A and 45OO to 65OO's Shore hardness OO value.
Any tissue thickness compensation part as described herein may include the material of extension.As described above, tissue thickness compensation part It may include the compression material extended in uncompressed or deployment.In addition to this or alternatively, this any class loading is thick Degree compensating part may include that can be formed in situ from expansion material.For example, tissue thickness compensation part may include at least one precursor, it should Precursor is chosen so as to the spontaneous crosslinking when contacting at least one of another precursor or other precursors, water and/or body fluid.Ginseng See that Figure 53 4, other accessible one or more precursors of the first precursor are mended to form expansible and/or swellable tissue thickness Repay part.Tissue thickness compensation part may include the swollen composition of fluid-soluble, the composition of such as water-swellable and/or include water Gel.
Referring to Figure 51 8A and Figure 51 8B, for example, the tissue thickness for representing any tissue thickness compensation part as described herein is mended Repaying part 70000 may include at least one hydrogel precursor 70010, which is chosen so as to original position and/or in body Interior formation hydrogel, so that tissue thickness compensation part 70000 be made to extend.Figure 51 8A shows such tissue thickness including packaging part Compensating part 70000, the packaging part include the first hydrogel precursor 70010A and the second hydrogel precursor 70010B before extension. As shown in Figure 51 8A, the first hydrogel precursor 70010A and the second hydrogel precursor 70010B can physics in identical packaging part Ground is separated from one another.Alternatively, the first packaging part may include the first hydrogel precursor 70010A and the second encapsulation Part may include the second hydrogel precursor 70010B.Thickness tissue when Figure 51 8B shows when hydrogel original position and/or formed in vivo The extension of compensating part.As shown in Figure 51 8B, packaging part can break it is scattered, and the first hydrogel precursor 70010A can contact the second water-setting Glue precursor 70010B is to form hydrogel 70020.As shown, hydrogel may include expansible material.For example, its is expansible Up to 72 hours.
Any of the tissue thickness compensation part those of discussed in the previous paragraphs as described herein for including may include can Biodegradable foam, the biodegradable foam have the envelope including dried hydrogel particle or the granule being embedded Piece installing.Packaging part in foam can be by contacting the aqueous solution of hydrogel precursor and the organic solution of biocompatible materials It is formed, to form foam.As shown in Figure 53 5, aqueous solution and organic solution can form micella.Aqueous solution and organic solution Dried hydrogel precursor or the granule in foam can be encapsulated by drying.For example, hydrogel precursor (such as hydrophilic polymer Object) water is dissolvable in water to form the dispersion of micella.The accessible dioxy comprising poly- (glycolic) and polycaprolactone of aqueous solution The organic solution of azacyclohexane.Aqueous solution and organic solution can be lyophilized to be formed to have to disperse hydrogel particle therein Or the biodegradable foam of granule.It is believed that micella can be formed with the dried hydrogel being dispersed in foaming structure The packaging part of grain or granule.The packaging part then can break scattered, and then accessible fluid is (all for hydrogel particle or granule Such as body fluid) and extend.
In general, such as when being contacted with activator (such as fluid), any tissue thickness compensation part as described herein It can be configured to extend.Referring to Figure 51 9, for example, representing tissue thickness's compensation of any tissue thickness compensation part as described herein Part 70050 may include swellable material, such as hydrogel, and the swellable material is for example in contact 70055 (such as body of fluid It is extended when liquid, saline solution, water and/or activator.The example of body fluid may include but be not limited to blood, blood plasma, peritoneal fluid, brain ridge Marrow liquid, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content, bile, and/or gas (such as CO2).One In a little situations, when tissue thickness compensation part 70050 absorbs fluid, tissue thickness compensation part 70050 is expansible.In other situations Under, tissue thickness compensation part 70050 may include non-cross-linked hydrogels, and the non-cross-linked hydrogels are in the activation that contact includes crosslinking agent Extension is when agent 70055 to form cross-linked hydrogel.In all cases, tissue thickness compensation part can be configured to from contact start Extension or swelling up to 72 hours, such as from 24 hours to 72 hour, up to 24 hours, up to 48 hours and at most To 72 hours, to for example provide the pressure and/or compression continuously enlarged to tissue.As shown in Figure 51 9, connect in fluid 70055 After touching tissue thickness compensation part 70050, therefore the original depth of tissue thickness compensation part 70050 is less than extension thickness.
Referring to Figure 51 6 and Figure 51 7, nail bin 70100 may include the group for representing any tissue thickness compensation part as described herein Knit thickness compensation part 70105 and respectively including multiple nails 70110 of nail leg 70112.As shown in Figure 51 6, tissue thickness compensation part 70105 can have the original depth or compression height of the firing height for being less than nail 70110.Tissue thickness compensation part 70100 can It is extended in situ and/or in vivo when being contacted with fluid 70102 (such as body fluid, saline solution and/or activator), thus for example Tissue T is pushed against the leg 70112 of nail 70110.As shown in Figure 51 7, tissue thickness compensation part 70100 with fluid 70102 Expansible and/or swelling when contact.Tissue thickness compensation part 70105 can compensate for the thickness of the tissue T captured in each nail 70110 Degree.As shown in Figure 51 7, tissue thickness compensation part 70105 can have the extension thickness for the firing height for being less than nail 70110 or not press Contracting height.
Described herein or claimed any tissue thickness compensation part may include original depth and extension Thickness.In all cases, the original depth of tissue thickness compensation part can extend about the 0.001% of thickness, its extension for it Thickness about 0.01%, its extend thickness about 0.1%, its extend thickness about 1%, its extend thickness about 10%, it extends about the 20% of thickness, about the 30% of its extension thickness, about the 40% of its extension thickness, its extension thickness Degree about 50%, its extend thickness about 60%, its extend thickness about 70%, its extend thickness about 80%, It extends about the 90% of thickness.Alternatively, in all cases, the extension thickness of tissue thickness compensation part is comparable About 2 times of its original depth thickness, about 5 times, about 10 times, about 50 times, about 100 times, about 200 times, about 300 times, about 400 times, about 500 Again, about 600 times, about 700 times, about 800 times, about 900 times, about 1000 times.Alternatively, in all cases, it organizes The original depth of thickness compensation part can be up to its extend thickness 1%, up to its extend thickness 5%, up to its expansion It opens up the 10% of thickness or up to it extends the 50% of thickness.Alternatively, in all cases, tissue thickness compensates The extension thickness of part is than its original depth thickness at least 50%, thicker than its original depth at least 100%, thicker than its original depth extremely Few 300% or thicker than its original depth at least 500%.Therefore, tissue thickness compensation part can eliminate appointing in nail retention region What gap.
Any tissue thickness compensation part as described herein may include hydrogel.Hydrogel may include homopolymer hydrogel, be total to Polymers hydrogel, multipolymer hydrogel, interpenetrating polymer hydrogel or their combination.Hydrogel may include microgel, Nanogel or their combination.Hydrogel can generally include the hydrophilic polymer network that can absorb and/or retain fluid. Hydrogel may include noncrosslinking hydrogel, the hydrogel of crosslinking or their combination.Hydrogel may include chemical cross-linking agent, object Manage crosslinking agent, hydrophobic patch and/or the undissolved segment of water.Hydrogel can be crosslinked and/or be polymerize by polymerization reaction, small molecule Object-crosslinked polymer is chemically crosslinked.Hydrogel can be mutual by ionic interaction, hydrophobic interaction, Hydrogenbond Effect, stereocomplex and/or supramolecular chemistry are physically crosslinked.Due to crosslinking agent, hydrophobic patch and/or undissolved, water Section, hydrogel can be substantially undissolved, but due to the absorption and/or holding of fluid, hydrogel is expansible and/or is swollen. In addition, hydrogel precursor can be used for the crosslinking with endogenic material and/or tissue.
In any of tissue thickness compensation part comprising hydrogel, hydrogel may include enviromental sensitive hydrogel (ESH).ESH may include the material with fluid swollen characteristic relevant to environmental condition.Environmental condition may include but unlimited In physical condition, biotic factor and/or electrochemical conditions in operative site.For example, strong in response to temperature, pH, electric field, ion Degree, enzyme and/or chemical reaction, electricity and/or Neural stem cell or other physiological and environment variables, hydrogel is swellable or shrinks. ESH may include polyfunctional acrylate, hydroxyethyl methacrylate (HEMA), elastomeric acrylate or relevant monomer.
Any of tissue thickness compensation part comprising hydrogel (including comprising hydrogel or be modified comprising water Any tissue thickness compensation part described herein or claimed of gel) it may include above-mentioned non-synthetic materials and conjunction At at least one of material.Hydrogel may include synthetic hydrogel and/or non-synthetic hydrogel.Additionally or alternatively, Tissue thickness compensation part may include multiple layers.Multiple layers may include porous layer and/or non-porous layer.For example, tissue thickness compensation part It may include non-porous layer and porous layer.For another example, tissue thickness compensation part may include more among the first non-porous layer and the second non-porous layer Aperture layer.For another example, tissue thickness compensation part may include the non-porous layer among the first porous layer and the second porous layer.Non-porous layer and porous Layer can position in any order relative to the surface of nail bin and/or anvil block.
Previous paragraphs in the example of non-synthetic materials that is mentioned to include but is not limited to albumin, alginates, carbon hydrate Object, casein, cellulose, chitin, chitosan, collagen, blood, glucan, elastin laminin, fibrin, fibre Fibrillarin original, gelatin, heparin, hyaluronic acid, keratin, protein, serum and starch.Cellulose may include hydroxy ethyl fiber Element, oxycellulose, oxidized regenerated cellulose (ORC), hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose and Their combination.Collagen may include bovine pericardium.Carbohydrate may include polysaccharide, such as lyophilized polysaccharide.Protein may include Glycoprotein, proteoglycans or their combination.
Equally, the example for the synthetic material mentioned before including but not limited to poly- (lactic acid), poly- (glycolic), poly- (hydroxyl Butyrate), poly- (phosphine piperazine), polyester, polyethylene glycol, polyethylene oxide, polyethylene oxide-polypropylene oxide copolymers, copolymerization ring Oxidative ethane, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone), polyvinyl alcohol, poly- (oneself Lactone), poly- (dioxanone), polyacrylic acid, poly- acetic acid esters, polypropylene, aliphatic polyester, glycerol, poly- (amino acid), copolymerization (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), polyoxy acid ester, polyorthoester, polyphosphazene And their combination.Conventional method can be used synthetically to prepare these non-synthetic materials, such as synthesis hyaluronic acid.
It (including comprising hydrogel or is modified comprising water in any of tissue thickness compensation part comprising hydrogel Any tissue thickness compensation part described herein or claimed of gel) in, hydrogel can be by one or more Hydrogel precursor is made.Such precursor may include monomer and/or macromonomer.Hydrogel precursor may include electrophilic body functional group And/or nucleophile electrophilic body functional group.In general, electrophilic body can be with nucleophilic precursor reactant to form chemical bond.It is used herein Term " functional group " refer to the electrophilic group or nucleophilic group for being capable of reacting with each other to form chemical bond.Electrophilic functional group shows Example includes but is not limited to n-hydroxysuccinimide (" NHS "), sulfosuccinimide, carbonyl dimidazoles, sulfonic acid chloride, aryl halide Compound, sulfosuccinic ester, N-hydroxy-succinamide ester, succinimide ester, such as succinimidyl succinate and/or amber Amber propionates, isocyanide ester, thiocyanates, carbodiimides, Benzotriazole carbonate, epoxide, aldehyde, Malaysia Acid imide, imidoate, their combination etc..In a specific example, electrophilic functional group may include succinimide ester. The example of nucleophilic functional group includes but is not limited to-NH2、-SH、-OH、-PH2With-CO-NH-NH2。
Hydrogel can be formed by single precursor or multiple precursors.For example, hydrogel can be by the bodily form before the first precursor and second At.First hydrogel precursor and the second hydrogel precursor can form hydrogel in situ or in vivo at the time of contact.Hydrogel precursor It may generally refer to polymer, functional group, macromolecular, small molecule and/or can participate in reacting to form the crosslinking agent of hydrogel.Precursor It may include such as homogeneous solution, the non-uniform or solution that is mutually separated in appropriate solvent, such as water or buffer.Buffer PH can be for example, about 8 to about 12, such as about 8.2 to about 9.The example of buffer includes but is not limited to borate buffer solution.One In a little situations, precursor can be in lotion.Therefore, the first precursor can be with the second precursors reaction to form hydrogel.For example, before first Body can when with the second precursor thereof spontaneously crosslinking and/or first group of electrophilic functional group on the first precursor can with second Second group of electrophilic functional group reactions on precursor.When precursor is blended in the environment for allowing to react (for example, working as and pH, temperature And/or when solvent correlation), functional group can react with each other to form covalent bond.At least some of precursor with extra one its When his precursors reaction, precursor can become crosslinking.
Tissue thickness compensation part may include at least one monomer, and the monomer is selected from 3- sulfopropyl acrylic acid sylvite (" KSPA "), sodium acrylate (" NaA "), N- (three (hydroxymethyl) methyl) acrylamide (" triacryl ") and 2- acryloyl Amine-2- methyl-1-propane sulfonic acid (AMPS).Tissue thickness compensation part may include copolymer, which includes two or more Selected from KSPA, NaA, triacryl, AMPS monomer.Tissue thickness compensation part may include from KSPA, NaA, three propylene The homopolymer of acyl group, AMPS.Tissue thickness compensation part may include the hydrophilically modified monomer that can be copolymerized with it.Hydrophilically modified list Body may include methyl methacrylate, butyl acrylate, cyclohexyl acrylate, styrene, styrene sulfonic acid.
Tissue thickness compensation part may include crosslinking agent.Crosslinking agent may include low molecular weight two or polyvinyl crosslinking agents, such as Glycol diacrylate or dimethylacrylate, two, three or tetravinyl-glycol diacrylate or dimethyl allene Acid esters, allyl (methyl) acrylate, C2-C8Alkylidene diacrylate or dimethylacrylate, divinyl ether, diethyl Alkene sulfone, two and trivinylbenzene, trimethylolpropane trimethacrylate or trimethyl acrylic ester, pentaerythritol tetraacrylate Or tetramethyl acrylate, bisphenol a diacrylate or dimethylacrylate, methylene-bisacrylamide or dimethyl allene Amide, ethylene bisacrylamide or ethylene dimethylacrylamide, triallyl phthalate or diallyl phthalate third Ester.As specific example, crosslinking agent may include N, N'- methylene-bisacrylamide (" MBAA ").
Tissue thickness compensation part may include acrylate and/or methacrylate function hydrogel, biocompatibility light At least one of initiator, alkyl-cyanoacrylate, isocyanate-functional macromonomer optionally include amine function Macromonomer, optionally includes amine and/or Mercaptofunctional macromonomer, ring at succinimide ester function macromonomer Oxygroup function macromonomer, the mixing for optionally including amine function macromonomer, protein and/or polypeptide and aldehyde cross-linking agent Carbodiimides, anion polysaccharide and the polyvalent cation of object, Geniposide (Genipin) and water dissolvable.
Tissue thickness compensation part may include unsaturated organic acid monomer, acrylic acid substituted alcohols and/or acrylamide.Tissue Thickness compensation part may include methacrylic acid, acrylic acid, glyceryl acrylate, glycerol methacrylate, 2- hydroxyethyl first Base acrylate, 2- hydroxy-ethyl acrylate, 2- (dimethyl aminoethyl) methacrylate, n-vinyl pyrrolidone, first Base acrylamide and/or N, N- dimethylacrylamide are poly- (methacrylic acid).
Tissue thickness compensation part may include reinforcing material.Reinforcing material may include above-described non-synthetic materials and synthesis At least one of material.Reinforcing material may include collagen, gelatin, fibrin, fibrinogen, elastin laminin, angle egg White, albumin, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose Element, chitosan, alginates, poly- (lactic acid), poly- (glycolic), poly- (butyric ester), poly- (phosphine piperazine), gathers chitin Ester, polyoxyalkylene, polyacrylamide, poly hydroxy ethyl acrylate, polyvinylpyrrolidone, polyvinyl alcohol, gathers polyethylene glycol (caprolactone), poly- (dioxanone), poly- acetic acid esters, pla-pcl, polypropylene, aliphatic polyester, glycerol, gather polyacrylic acid (amino acid), copolymerization (ether-ester), poly- oxalic acid alkylidene diol ester, polyamide, poly- (iminocarbonic ester), poly- oxalic acid alkylidene Diol ester, polyoxy acid ester, polyorthoester, polyphosphazene and their combination.
Tissue thickness compensation part may include the layer comprising reinforcing material.The porous layer of tissue thickness compensation part and/or non-porous Layer may include reinforcing material.For example, porous layer may include reinforcing material and non-porous layer can not include reinforcing material.Reinforcing layer can Including the internal layer among the first non-porous layer and the second non-porous layer.Reinforcing material constitute tissue thickness compensation part outer layer and/or The outer surface of tissue thickness compensation part.
Reinforcing material may include mesh sheet, monofilament, multifilament weave fabric, fiber, pad, felt, particle and/or pulvis.Reinforcing material It can be coupled in the layer of tissue thickness compensation part.Reinforcing material can be coupled at least one of non-porous layer and porous layer.It can Using routine techniques, such as knitting, braiding, tatting and/or knitting, to form the mesh sheet comprising reinforcing material.Multiple strengthening materials Material can be orientated with random direction and/or common direction.Common direction can be for example parallel or vertical with staple line with staple line.Monofilament and/ Or multifilament weave fabric can be orientated with random direction and/or common direction.Monofilament and multifilament weave fabric can be with non-porous layers and/or porous Layer is associated.Tissue thickness compensation part may include multiple multiple reinforcings being orientated in non-porous layer with random direction or common direction Fiber.
Referring to Figure 52 8, anvil block 70300 may include the tissue thickness's benefit for representing any tissue thickness compensation part as described herein Part 70305 is repaid, tissue thickness compensation part 70305 includes the first non-porous layer 70307 and the second nothing of hermetically sealed reinforcing layer 70310 Aperture layer 70309.Reinforcing layer 70310 may include hydrogel, which includes the ORC particle or fiber that are embedded, and nothing Aperture layer may include ORC.As shown in Figure 52 8, the tissue thickness compensation part of any tissue thickness compensation part as described herein is represented 70305 can conform to the profile of anvil block 70300.The internal layer of tissue thickness compensation part 70305 can conform to the interior of anvil block 70300 Surface comprising form pit 70301.
In the case where reinforcing fiber and being used for all situations in tissue thickness compensation part, fiber can form such as non-woven material, Such as pad or felt.Fiber can have any length appropriate, such as from 0.1mm to 100mm and 0.4mm to 50mm.As another Kind selection, reinforcing material can be ground into powder.Powder can have the granularity for example from 10 microns to 1 centimetre.Powder is combinable Into tissue thickness compensation part.
Any of described herein or claimed tissue thickness compensation part can be formed in situ or part It is formed.For example, hydrogel can be formed in situ in the case where tissue thickness compensation part includes hydrogel.Tissue thickness compensation part It can be formed in situ by covalent ion and/or hydrophobic bond.(non-covalent) crosslinking of physics can be by complexing, hydrogen bonding, desolvation, model De Waersi interaction, ionic bonding or their combination cause.(covalent) crosslinking of chemistry can pass through appointing in multiple mechanism One is realized, the mechanism includes: Raolical polymerizable, polycondensation reaction, anion or cationic polymerization, staged Growth polymerization reaction, electrophile-nucleophile reaction and their combination.
For example, being formed in situ for tissue thickness compensation part may include making two or more precursors reactions, the precursor is by object It separates to reason until in situ contact and/or reacts to react with each other to form hydrogel to environmental condition.Original position can gather The polymer of conjunction can be prepared by precursor, and the precursor can be reacted to form polymer in operative site.Tissue thickness compensation part can It is formed by the cross-linking reaction of precursor in situ.At least one precursor may include that can cause in situ tissue thickness compensation part Formation polymerization reaction initiator.Tissue thickness compensation part may include can quilt when forming the application of such as cross-linked hydrogel The precursor of activation.Being formed in situ for tissue thickness compensation part may include activating at least one precursor to form chemical bond, thus shape At tissue thickness compensation part.The activation can by the change in operative site physical condition, biotic factor and/or electrochemical conditions come It realizes, it includes but is not limited to temperature, pH, electric field, ionic strength, enzyme and/or chemical reaction, electricity and/or magnetic that the condition, which changes, Stimulation and other physiological and environmental variances.Alternatively, precursor can be contacted and can be introduced into portion outside the main body To operative site.
It is in situ or formed in vivo or part formed tissue thickness compensation part another method be related to using include can One or more packaging parts of wherein at least one component or the tissue thickness compensation part of unit are stored, the method is suitable for this Any tissue thickness compensation part described in text.For example, packaging part can store hydrogel precursor therein.Packaging part can be by two Plant component storage wherein, such as already described above.Packaging part can store the first hydrogel precursor therein and second Hydrogel precursor.Alternatively, the first packaging part can store the first hydrogel precursor therein and the second encapsulation Part can store the second hydrogel precursor therein.As described above, these packaging parts can be aligned or at least substantially right with nail leg It is neat to be dissipated to pierce through packaging part when nail leg contacts packaging part and/or otherwise break packaging part.When disposing nail, the envelope Piece installing, which can be compressed, be crushed, collapsing and/or in other words breaking, to be dissipated.Packaging part is broken dissipate after, envelope can be flowed out by storing component therein Piece installing.Storing component therein can contact the layer and/or tissue of other components, tissue thickness compensation part.These other components It may be from identical or different packaging part, provided in tissue thickness compensation part or provided in the layer of tissue thickness compensation part And/or operative site is used for by clinician.As above-described as a result, the component being stored in packaging part can provide group Knit the extension and/or swelling of thickness compensation part.
Tissue thickness compensation part may include the layer comprising these packaging parts.This class wrapper may include sky associated with layer Gap, pit, dome, pipe and their combination.The packaging part may include the gap in layer.For example, layer may include that can invest Mutual two layers, wherein packaging part can be defined between two layers.Packaging part may include the dome in layer surface.For example, envelope At least part of piece installing can be positioned in out of, layer upwardly extends dome.Packaging part may include the pit formed in layer. For example, the first part of packaging part may include dome, and the second part of packaging part may include pit.Packaging part may include in layer The pipe being embedded in.The pipe may include any non-synthetic materials as described herein and/or synthetic material, such as PLA.Tissue thickness Compensating part may include the foam of biological absorbable, such as ORC, and the foam of the biological absorbable includes the PLA pipe being embedded, And the pipe can encapsulate such as hydrogel.Packaging part may include mutual unconnected separate unit.Alternatively, it encapsulates One or more of part can be via one or more accesses, conduit, and/or the channel for extending through layer and mutually fluid connects It is logical.
The release rate of component from packaging part can be controlled by as described below: the thickness of such as tissue thickness compensation part, The component part of tissue thickness compensation part, the size of component, the hydrophily of component, and/or the physics in component and/or change Learn the component part, and/or surgical instruments of interaction, tissue thickness compensation part.Layer may include one or more thin portions or weak Change part (such as local perforations), such as one or more of thin portions or weakening part can be conducive to cut layer and make packaging part It is broken to dissipate.These local perforations can run through the only only a part of layer, or alternatively, perforation can be completely through layer.
Referring to Figure 52 3 and Figure 52 4, the tissue thickness compensation part of any tissue thickness compensation part as described herein is represented 70150 may include outer layer 70152A and the internal layer 70152B including packaging part 70154.Packaging part may include the first encapsulating component and Second encapsulating component.Alternatively, packaging part can independently include in the first encapsulating component and the second encapsulating component One.First encapsulating component can be separated with the second encapsulating component.Outer layer 70152A may include tissue contacting surface.Internal layer 70152B It may include Device contacts surface.Device contacts surface 70152B can be releasably attached to anvil block 70156.Outer layer 70152A can Internal layer 70152B is attached to limit gap between outer layer 70152A and internal layer 70152B.As shown in Figure 52 3, each packaging part 70154 may include the dome in the Device contacts surface of internal layer 70152B.The dome may include local perforations to pass through nail leg With the broken incision for dissipating promotion layer of packaging part.As shown in Figure 52 4, anvil block 70156 may include multiple forming pit rows 70158, The dome of middle packaging part 70154 can be aligned with forming pit 70158.Tissue contacting surface may include the flat table for lacking dome Face and/or tissue contacting surface may include one or more packaging parts, packaging part 70154 such as extending therefrom.
The anvil block of any surgery suturing appliance may include tissue thickness compensation part, and the tissue thickness compensation part includes to have The encapsulating component of at least one microsphere particle.According to the above, tissue thickness compensation part may include packaging part, the packaging part It may include with the first microsphere particle and the comprising the first encapsulating component and the second encapsulating component and/or tissue thickness compensation part The packaging part of two microsphere particles.
Referring to Figure 52 5, robotic suturing device may include anvil block 70180 and nail bin (being shown in other accompanying drawings).The nail 70190 of nail bin Can deform and/or pass through by anvil block 70180 when anvil block 70180 moves into closed position will follow closely 70190 to closed anvil 70180 mobile Staple drivers systems 70192 deform.The leg 70194 of nail can contact anvil block 70180, so that at least portion of nail 70190 Divide ground deformation.Anvil block 70180 may include tissue thickness compensation part 70182 comprising outer layer 70183A, internal layer 70183B.Tissue Thickness compensation part 70182 may include the first encapsulating component and the second encapsulating component.Packaging part 210185 can be aligned or at least basic Upper alignment, so that nail leg 70194 can pierce packaging part when nail leg 70194 passes through tissue T and outer layer 70183A and pushed 70185 and/or otherwise make packaging part 70185 is broken to dissipate.As shown in Figure 52 5, nail 70190C is in complete firing position, nail 70190B is in just fired during, and follow closely 70190A and be in its non-firing position.Follow closely the leg of 70190C and 70190B The internal layer 70183B of tissue T, outer layer 70183A and tissue thickness compensation part 70182 is had been moved across, and has contacted positioning Anvil block 70180 on nail bin opposite.Packaging part 70185 is broken dissipate after, for example, encapsulating component can flow out and the body fluid that is in contact with each other And/or tissue T.Encapsulating component can be reacted to form reaction product (such as hydrogel), with for example the base portion of tissue T and nail it Between extend and against the leg of nail push tissue T.Therefore, tissue thickness compensation part can eliminate any in nail retention region Gap.
As described herein includes all in situ or formation or partially formation or expansible tissue thickness compensation part in vivo It may be adapted to be used together with any surgical instruments.As described above, tissue thickness compensation part can be associated with nail bin and/or anvil block. Tissue thickness compensation part may be configured to any shape, size and/or dimension that are adapted for engagement with nail bin and/or anvil block.Such as this paper institute It states, tissue thickness compensation part can be releasably attached to nail bin and/or anvil block.Before sewing process and in sewing process Period, tissue thickness compensation part can be able to maintain any machinery that tissue thickness compensation part is contacted with nail bin and/or anvil block And/or the mode of chemistry is attached to nail bin and/or anvil block.It, can be from nail bin and/or anvil after sting wears tissue thickness compensation part Tissue thickness compensation part is removed or discharged in seat.It, can be from nail bin when nail bin and/or anvil block move away from tissue thickness compensation part And/or tissue thickness compensation part is removed or discharged in anvil block.
Referring to Figure 52 0- Figure 52 2, any robotic suturing device 70118 may include anvil block 70120 and nail bin 70122, the nail bin 70122 include firing member 70124, multiple nails 70128, blade 70129 and tissue thickness compensation part 70130.Represent this paper institute The tissue thickness compensation part 70130 for any tissue thickness compensation part stated may include at least one encapsulating component.Work as tissue thickness When compensating part is by compression, suture and/or cutting, encapsulating component can break scattered.Referring to Figure 52 1, for example, nail 70128 can be deployed in not Between firing position and firing position, so that nail leg moves across tissue thickness compensation part 70130, tissue thickness compensation part is penetrated 70130 bottom surface and top surface penetrates tissue T, and contacts the anvil block 70120 for being positioned in 70118 opposite of nail bin. Encapsulating component can interreaction, reacted with the lyophilic powder for being embedded in and being dispersed in tissue thickness compensation part and/or and body fluid It reacts so that the extension of tissue thickness compensation part 70130 or swelling.When leg is against deflection, the leg of each nail can capture group It knits a part of thickness compensation part 70130 and a part of the tissue T in each nail 70128 and compressing force is applied to tissue T. As shown in Figure 52 1 and Figure 52 2, tissue thickness compensation part 70130 can compensate for the thickness of the tissue T captured in each nail 70128.
Referring to Figure 52 6, surgical instruments 70200 may include anvil block 70205 and nail bin 70215, and the anvil block 70205 includes upper Portion's tissue thickness compensation part 70210, the nail bin 70215 include the lower part tissue thickness with outer layer 70200 and internal layer 70225 Compensating part.Top tissue thickness compensation part 70210 can be positioned on the first side of destination organization, and lower part tissue thickness compensates Part can be positioned in second side of tissue.Top tissue thickness compensation part 70210 may include ORC, the compensation of lower part tissue thickness The outer layer of part may include the hydrogel with the ORC particle being embedded, and the internal layer of Lower tissue thickness compensation part can wrap Include such as ORC.
Referring to Figure 52 9- Figure 53 1, surgical instruments 70400 may include nail bin 70405 and anvil block 70410.Nail bin 70405 can wrap Include tissue thickness compensation part 70415 comprising bioabsorbable foam.Bioabsorbable foam may include packaging part, Including encapsulating component 70420.Bioabsorbable foam may include ORC and encapsulating component may include such as drug.Anvil block 70410 tissue thickness compensation part 70415 may include internal layer 70425 and outer layer 70430.Internal layer 70425 may include can biology suction The foam of receipts, and outer layer 70430 may include the hydrogel for for example optionally including reinforcing material.In the exemplary percussion sequence phase Between, referring first to Figure 53 0, sliding part 70435 contact stud 70440A first and can start follow closely and be lifted up.Work as sliding part 70435 towards farther side when being further promoted, sliding part 70435 can start will to follow closely 70440B-D and any other follow-up nail with Sequential order is promoted.Sliding part 70435 can drive up nail 70440, so that the leg of nail contacts opposite anvil block 70410 and deforms At required shape.Referring to the percussion sequence shown in Figure 53 0, the complete firing position that 70440A-C has been moved to them is followed closely, Nail 70440D is in just fired during, and follow closely 70420E and be still within its non-firing position.In exemplary percussion sequence Period, encapsulating component 70470 can be dissipated by the way that nail leg is broken.Encapsulating component 70420 may be from the packaging part around nail leg to contact Tissue T.In all cases, additional drug can be squeezed out packaging part by the additional compression of tissue thickness compensation part.The drug can Tissue is treated immediately and can reduce tissue bleeding.
In all cases, surgeon or other clinician can by fluid delivery into tissue thickness compensation part with Manufacture is included therein the tissue thickness compensation part of at least one drug of storage and/or absorption.Nail bin and/or anvil block may include It is capable of providing the mouth into tissue thickness compensation part.Referring to Figure 53 2B, nail bin 70500 may include the mouth for example in its distal end 70505.Mouth 70505 can receive needle 70510, perforated needle shown in such as Figure 53 2A.Needle 70510 can be inserted into and wear by clinician It crosses mouth 70505 and enters tissue thickness compensation part 70515 with by fluid delivery to tissue thickness compensation part 70515.Fluid can wrap Include such as drug and hydrogel precursor.As described above, fluid can be from tissue when tissue thickness compensation part is broken scattered and/or compression Thickness compensation part is discharged into tissue.For example, drug can be thick from tissue when tissue thickness compensation part 70515 carries out biodegrade It is discharged in degree compensating part 70515.
Referring now to Figure 21 6, nail bin (such as nail bin 10000) for example may include support section 10010 and compressible group Knit thickness compensation part 10020.Referring now to Figure 21 8- Figure 22 0, support section 10010 may include platform surface 10011 and limit Multiple nail cavities 10012 in support section 10010.The size of each nail cavity 10012 can for example be set to and can be wherein Removedly storage nail such as follows closely 10030.Nail bin 10000 may also include multiple staple drivers 10040, when nail 10030 and nail drive When dynamic device 10040 is in its non-firing position, each staple drivers can support one or more nails in nail cavity 10012 10030.For example, each staple drivers 10040 may include for example one or more brackets or slot referring first to Figure 22 4 and Figure 22 5 10041, the bracket or slot support nail and can limit the relative motion between nail 10030 and staple drivers 10040.Referring again to Figure 21 8, nail bin 10000 may also include nail percussion sliding part 10050；The nail percussion sliding part can be from the proximal extremity of nail bin 10001 move to the distal end 10002 of nail bin, so as to successively by staple drivers 10040 and nail 10030 from its non-firing position It is promoted to the anvil block for being positioned in 10000 opposite of nail bin.Referring first to Figure 21 8 and Figure 22 0, each nail 10030 may include base portion 10031 and from base portion 10031 extend one or more legs 10032, wherein each nail can be for example substantially U-shaped and basic V-shaped At least one of.Nail 10030 is enabled to when nail 10030 is in its non-firing position, the top of nail leg 10032 relative to The platform surface 10011 of support section 10010 is recessed.Nail 10030 is enabled to when nail 10030 is in its non-firing position, The top of nail leg 10032 is flushed relative to the platform surface 10011 of support section 10010.Nail 10030 is enabled to when nail 10030 be in its non-firing position when, the top of nail leg 10032 or at least certain part of nail leg 10032 are in support section 10010 Platform surface 10011 above extend.In such cases, when nail 10030 is in its non-firing position, nail leg 10032 can It extends to and is embedded in tissue thickness compensation part 10020.For example, nail leg 10032 can for example extend beyond platform surface 10011 tops about 0.075 ".Nail leg 10032 can for example extend beyond 10011 top about 0.025 of platform surface " and about 0.125 the distance between ".Further described above, tissue thickness compensation part 10020 may include such as about 0.08 " About 0.125 " the uncompressed thickness between.
In use, as further described above and referring first to Figure 23 3, anvil block (such as anvil block 10060) is for example It is moveable to the closed position opposite with nail bin 10000.As described in more detail below, anvil block 10060 can will be organized against tissue Thickness compensation part 10020 positions and, for example, presses to tissue thickness compensation part 10020 platform surface of support section 10010 10011.Once anvil block 10060 is appropriately positioned, then nail 10030 can be disposed, equally as shown in Figure 23 3.As described above, nail is hit Sending out sliding part 10050 can be mobile from 10001 distal end 10002 of proximal extremity of nail bin 10000, as shown in Figure 23 4.Work as cunning When moving part 10050 is pushed into, sliding part 10050 can contact staple drivers 10040 and in nail cavity 10012 by staple drivers 10040 are lifted up.Sliding part 10050 and staple drivers 10040 can respectively include one or more slopes or inclined-plane, and this Or multiple slopes or inclined-plane can cooperate so that staple drivers 10040 are moved upwards from its non-firing position.For example, with reference to Figure 22 1- Figure 22 5, each staple drivers 10040 may include at least one inclined-plane 10042, and sliding part 10050 may include one or more A inclined-plane 10052 is enabled to when sliding part 10050 is pushed into nail bin towards distal side, and inclined-plane 10052 is on inclined-plane 10042 lower sliders.When staple drivers 10040 are moving upward in its respective nail cavity 10012, staple drivers 10040 can Nail 10030 is lifted up, so that nail 10030 can be exposed from its nail cavity 10012 by the opening in nail platform 10011.? During exemplary percussion sequence, referring first to Figure 22 7- Figure 22 9, sliding part 10050 contact stud 10030a first and can start Nail 10030a is lifted up.When sliding part 10050 is further promoted towards distal side, sliding part 10050 can start follow closely 10030b, 10030c, 10030d, 10030e and 10030f and any other follow-up nail are promoted in order.As shown in Figure 22 9, Sliding part 10050 can drive up nail 10030 so that the leg 10032 of the nail contacted with opposite anvil block be deformed into it is desired Shape, and be emitted from support section 10010.In all cases, as a part of percussion sequence, sliding part 10030 Multiple nails can be made to move upwards simultaneously.The percussion sequence referring to shown in Figure 22 9, nail 10030a and 10030b have moved to it completely Firing position and be emitted from support section 10010, nail 10030c and 10030d is in fired during and by extremely It is partially contained in support section 10010, and follows closely 10030e and 10030f and be still within its non-firing position.
As described above and referring to fig. 2 35, when nail 10030 is in its non-firing position, the nail leg 10032 for following closely 10030 can Extend beyond the platform surface 10011 of support section 10010.Percussion sequence shown in 29 referring further to Figure 2, nail 10030e and 10030f is illustrated at its non-firing position, and its nail leg 10032 extends beyond platform surface 10011 and extends to group It knits in thickness compensation part 10020.When nail 10030 is in its non-firing position, the top of nail leg 10032 or nail leg 10032 Any other part convex may not wear the top tissue contacting surface 10021 of tissue thickness compensation part 10020.As shown in Figure 22 9, When nail 10030 moves to its firing position from its non-firing position, the end of nail leg convex can wear tissue contacting surface 10032. The top of nail leg 10032 may include the sharp top that can cut and penetrate tissue thickness compensation part 10020.Tissue thickness is mended Repaying part 10020 may include multiple holes, and the multiple hole can receive nail leg 10032 and allow nail leg 10032 relative to tissue Thickness compensation part 10020 is slided.Support section 10010 may also include the multiple guiders extended from platform surface 10011 10013.Guider 10013 can be positioned so that the nail cavity opening of neighbouring platform surface 10011, so that nail leg 10032 can at least portion Ground is divided to be supported by guider 10013.Guider 10013 can be positioned at the proximal extremity and/or distal end of nail cavity opening. First guider 10013 can be positioned in the first end of each nail cavity opening, and the second guider 10013 can be positioned in The second end of each nail cavity opening, so that the first nail leg 10032 of the sustainable nail 10030 of each first guider 10013, and And the second nail leg 10032 of the sustainable nail of each second guider 10013.Referring to fig. 2 35, each guider 10013 may include Groove or slit, such as groove 10016, such as nail leg 10032 can be slidably received in the groove 10016.Each guiding Device 10013 may include that can extend and may extend into the anti-skid stud in tissue thickness compensation part 10020 from platform surface 10011, dash forward Rise, and/or spike.As described in more detail below, anti-skid stud, protrusion, and/or spike can reduce tissue thickness compensation part 10020 Relative motion between support section 10010.The top of nail leg 10032 can be positioned in guider 10013 and when nail 10030 can be not extended past the top surface of guider 10013 when being in its non-firing position.In at least such embodiment, Guider 10013 can limit guiding height, and guiding height can be not extended past when nail 10030 is in its non-firing position Degree.
Tissue thickness compensation part (such as tissue thickness compensation part 10020) can be for example made of single material piece.Tissue is thick Spending compensating part may include continuous sheet, which can cover the whole top platform surface of support section 10010 10011, or alternatively, covering is less than entire platform surface 10011.Material piece can cover in support section 10010 Nail cavity opening, however alternatively, material piece can be aligned with nail cavity opening or at least partly be aligned Opening.Tissue thickness compensation part can be made of multilayer material.Referring now to Figure 21 7, tissue thickness compensation part may include compressible Core and wrappage around compressible core.Compressible core can be releasably held support section by wrappage 10022 10010.For example, support section 10010 may include one or more protruding portions for example extending therefrom, such as protruding portion 10014 (Figure 22 0), the protruding portion can be received in one or more holes and/or slit, such as be limited to the hole in wrappage 10022 In 10024.Protruding portion 10014 and hole 10024 enable to protruding portion 10014 wrappage 10022 can be remained to support section 10010.It the end of protruding portion 10014 can be such as by hot melt processing deformation, for example, to expand the end of protruding portion 10014 End, and therefore limit the relative motion between wrappage 10022 and support section 10010.Wrappage 10022 may include one Or multiple perforation 10025, it can be conducive to discharge wrappage 10022 from support section 10010, as shown in Figure 21 7.Ginseng now See Figure 22 6, tissue thickness compensation part may include wrappage 10222, which includes multiple holes 10223, and mesoporous 10223 can It is aligned with the nail cavity opening in support section 10010 or is at least partly aligned.The core of tissue thickness compensation part may also include and wrap Wrap up in the hole that the hole 10223 in object 10222 is aligned or is at least partly aligned.Alternatively, the core of tissue thickness compensation part It may include continuous main body and can extend below hole 10223, so that the nail cavity in continuous main body covering platform surface 10011 Opening.
As described above, tissue thickness compensation part may include for compressible core to be releasably held support section 10010 wrappage.For example, with reference to Figure 21 8, nail bin may also include retainer fixture 10026, which is able to suppress Wrappage and compressible core are prematurely separated with support section 10010.Each retainer fixture 10026 may include can receive from The hole 10028 for the protruding portion 10014 that support section 10010 extends, so that retainer fixture 10026 can be held support section 10010.Retainer fixture 10026 can include respectively at least one flat of bottom 10027, which can be in support section Extend below 10010 and in 10010 inner support of support section and keeps staple drivers 10040.As described above, tissue thickness is mended Support section 10010 can be removably attachable to by nail 10030 by repaying part.More specifically, as also described above, when following closely at 10030 When Yu Qiwei firing position, following closely 10030 leg be may extend into tissue thickness compensation part 10020, and therefore mend tissue thickness It repays part 10020 and releasably holds support section 10010.The leg of nail 10030 can the side wall of its corresponding nail cavity 10012 connect Touching, wherein due to the friction between nail leg 10032 and side wall, nail 10030 and tissue thickness compensation part 10020 can be maintained at Appropriate location, until nail 10030 is disposed from nail bin 10000.After nail 10030 is disposed, tissue thickness compensation part 10020 can It is trapped in nail 10030 and is kept against the tissue T of suture.When anvil block is subsequently moved into open position with release group When knitting T, support section 10010 is movable far from the tissue thickness compensation part 10020 for having been secured to tissue.Can be used adhesive with Tissue thickness compensation part 10020 is removedly remained into support section 10010.Two-part adhesive can be used, wherein bonding The first part of agent can be placed on platform surface 10011, and the second part of adhesive can be placed to tissue thickness On compensating part 10020, so that first part is accessible when tissue thickness compensation part 10020 is close to the placement of platform surface 10011 Second part is to activate adhesive and tissue thickness compensation part 10020 is removably bonded to support section 10010.It can be used Tissue thickness compensation part is separably remained to the support section of nail bin by any other suitable method.
Further described above, sliding part 10050 proximally can be advanced to distal end in end 10001 10002 dispose all nails 10030 being accommodated in nail bin 10000 with complete.Referring now to Figure 25 8- Figure 26 2, sliding part 10050 can be in the longitudinal cavity 10016 in support section 10010 by 10052 court of knife bar of firing member or surgical stapling device Distal side promotes.In use, nail bin 10000 can be inserted into the staple cartridge channel in the jaw of surgical stapling device, such as such as be followed closely In warehouse channel 10070, and firing member 10052 can be advanced to and contact with sliding part 10050, as shown in Figure 25 8.Work as sliding When part 10050 is promoted by firing member 10052 towards distal side, sliding part 10050 can contact the staple drivers or driver of recent side 10040, and nail 10030 is fired or projected from warehouse 10010, as described above.As shown in Figure 25 8, firing member 10052 is also It may include cutting blade 10053, when following closely 10030 and being fired, which can be by the cutter slit in support section 10010 towards distal side quilt It promotes.Corresponding cutter slit can extend across the anvil block for being positioned in 10000 opposite of nail bin, so that cutting blade 10053 can be in anvil block Extend between support section 10010 and cuts the tissue and the tissue thickness compensation part that are positioned in therebetween.In all cases, Sliding part 10050 can be promoted by firing member 10052 towards distal side, until sliding part 10050 reaches the distal end of nail bin 10000 10002, as shown in Figure 26 0.At this point, firing member 10052 can proximally bounce back.Referring now to Figure 26 1, sliding part 10050 can It proximally bounces back with firing member 10052, but when firing member 10052 bounces back, sliding part 10050 can be left on nail bin In 10000 distal end 10002.Once firing member 10052 sufficiently bounces back, anvil block can be opened again, tissue thickness Compensating part 10020 can be separated with support section 10010, and the remaining non-implanted portion of the nail bin 10000 exhausted, including Support section 10010 can be removed from staple cartridge channel 10070.
The nail bin 10000 exhausted from staple cartridge channel be removed after, further described above, new nail Storehouse 10000 or any other suitable nail bin can be inserted into staple cartridge channel 10070.Further described above, nail bin Channel 10070, firing member 10052, and/or nail bin 10000 may include cooperation feature structure, which can be new Do not fire and prevent firing member 10052 again or then towards remote when nail bin 10000 is not located in staple cartridge channel 10070 Side is pushed into.More specifically, referring again to Figure 25 8, when firing member 10052, which is advanced to, to be contacted with sliding part 10050, and And when sliding part 10050 is in the non-firing position of its nearside, the support nose 10055 of firing member 10052 can be positioned in On support lugn 10056 on sliding part 10050 and/or above it, so that firing member 10052 is maintained at enough upwards Position, with prevent from firing member 10052 extend lock or crossbeam 10054 fall into the lock crossbeam being limited in staple cartridge channel In.When will not fall into lock crossbeam due to lock 10054, in such cases, when firing member 10052 is pushed into, lock 10054 can The distal side side wall 10057 of not adjacent lock crossbeam.When firing member 10052 pushes sliding part 10050 towards distal side, firing member 10052 can be supported on its upward firing position due to leaning against the support nose 10055 on support lugn 10056.Work as percussion When component 10052 bounces back relative to sliding part 10050, as described above and as shown in Figure 26 1, when support nose 10055 does not rely on When on the support lugn 10056 of sliding part 10050, firing member 10052 can fall from its upward position.For example, surgical staples It may include the spring 10058 that firing member 10052 can be biased in its down position and/or any other suitable biasing Element.Once firing member 10052 has been fully retracted, as shown in Figure 26 2, firing member 10052, which cannot again pass through, to be used up Nail bin 10000 is pushed into towards distal side.More specifically, when the sliding part 10050 for being now in operation order has been left on nail bin When at 10000 distal end 10002, firing member 10052 cannot keep position at an upper portion thereof by sliding part 10050.Therefore, As described above, lock beams 10054 will connect if firing member 10052 is re-advanced in the case where no replacement nail bin The side wall 10057 of lock crossbeam is touched, this will prevent firing member 10052 to be advanced in nail bin 10000 towards distal side again.In other words It says, once the nail bin 10000 used up is replaced by new nail bin, new nail bin is somebody's turn to do with proximally-oriented sliding part 10050 Firing member 10052 can be maintained at its upward position by proximally-oriented sliding part, and make firing member 10052 again towards remote Side is pushed into.
As described above, sliding part 10050 can be by staple drivers 10040 in the first non-firing position and the second firing position Between move, projected from support section 10010 so that 10030 will be followed closely.It has been emitted from support section 10010 in nail 10030 After, staple drivers 10040 can be accommodated in nail cavity 10012.Support section 10010 may include that can prevent staple drivers The 10040 one or more holding feature structures for projecting or dropping out from nail cavity 10012.Alternatively, sliding part 10050 can project staple drivers 10040 from the support section 10010 with nail 10030.For example, staple drivers 10040 It can be made of for example bioabsorbable and/or biocompatible materials, such as polyetherimide (Ultem).Staple drivers can It is attached to nail 10030.For example, staple drivers can be molded on the base portion of each nail 10030 and/or surrounding, so that driving Device and nail are integrally formed.Entitled " the SURGICAL STAPLES HAVING COMPRESSIBLE submitted on September 29th, 2006 OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME " U.S. Patent application 11/541,123, which is incorporated by reference, to be incorporated herein.
In various embodiments, further described above, compressible tissue thickness compensation part can be relative to nail Rigid support portion movement, distortion, and/or flexure below storehouse.The suitable portion of any other of support section and/or nail bin Dividing may include the one or more features structure that can limit relative motion between tissue thickness compensation part and support section.As above Described, at least part for following closely 10030 can extend over the platform surface 10011 of support section 10010, referring now to Figure 26 3 With Figure 26 4, wherein in some cases, being applied to the lateral force of tissue thickness compensation part 10120 for example can be by from support section 10010 nails 10030 extended and/or anti-skid stud 10013 are kept out.In all cases, nail 10030 is keeping out tissue thickness's compensation When the lateral movement of part 10120 can it is tilted in nail cavity 10012 and/or bending, wherein nail cavity 10012 and nail 10030 size It can be set and be able to maintain between the forming pit 10062 in the leg 10032 and opposite anvil block 10060 of nail 10030 Alignment relative, so that nail 10000 correctly shapes during following closely forming process.Nail 10030 and/or anti-skid stud 10013 can prevent Or the lateral deformation at least in limitation tissue thickness compensation part 10020, as shown in Figure 26 4.For example, nail 10030 and/or anti-skid stud 10013 can for example reinforce or limit the first surface of tissue thickness compensation part or tissue contacting surface 10021 relative to second The lateral and/or longitudinal movement of surface or bottom surface 10029.Nail bin and/or the staple cartridge channel that nail bin is wherein located can wrap At least one minimizing twisting component is included, which can upwardly extend to limit the lateral of tissue thickness compensation part And/or longitudinal movement or deformation.As described above, at least partly around tissue thickness compensation part wrappage prevented also from or extremely The lateral and/or longitudinal movement or deformation of tissue thickness compensation part are limited less.
Referring again to Figure 26 3 and Figure 26 4, tissue thickness compensation part (such as tissue thickness compensation part 10120) can for example be wrapped Include core 10128 and crust 10122.Crust 10122 and compressible core 10128 can be made of different materials or identical material.It is in office In a kind of situation, crust 10122 can have than the higher density of core 10128.It include tissue thickness compensation part in crust 10122 In the case where 10120 top, in the embeddable crust 10122 in the top of nail leg 10032.Wherein crust includes tissue thickness's compensation The bottom of part 10120, nail leg 10032 can extend across crust and enter in core.In either case, tissue thickness compensates The crust of part can help to that nail leg 10032 is kept to be aligned with the forming pit 10062 of anvil block 10060.Crust 10122 may include as Lower density: the density is larger about for example 10% than the density of core 10128, is larger about 20%, compares core than the density of core 10128 10128 density is larger about 30%, is larger about 40%, is larger about 50%, ratio than the density of core 10128 than the density of core 10128 The density of core 10128 is larger about 60%, than core 10128 density be larger about 70%, than core 10128 density be larger about 80%, Density than core 10128 is larger about 90%, is larger about 100% than the density of core 10128.Crust 10122 may include such as lower density, The density is greater than the density of core 10128 and is less than twice of the density of core 10128.Crust 10122 may include following close Degree, the density are greater than twice of the density of core 10128.Further described above, crust 10122 and core 10128 It can be shaped or be manufactured simultaneously.For example, the fluid comprising any suitable material disclosed herein can be introduced into dish or by mould Modeling, and when fluid sets, fluid, which can be formed, has crust more highdensity than surplus material or layer.Multiple layers in material Can be formed by using following method: in the method, one or more succeeding layers of material are poured into the layer of prior cured On.Two or more layers are bonded to each other using such as adhesive.Two or more layers can be for example, by one or more A fastener and/or one or more mechanical interlocking features structures are attached to each other.For example, adjacent layer can be for example, by one Or multiple dovetail joints are bonded together.Crust may include the enclosed watch that can be prevented or at least limit fluid and pass through flowing Face.Alternatively, crust may include the porous structure of such as aperture.
Further described above, crust can be cut from tissue thickness compensation part.Tissue thickness compensation part can be from Biggish material block excision, so that tissue thickness compensation part does not include crust.For example, tissue thickness compensation part can by for example including The homogeneous material of macropore or at least substantially uniform material are constituted.
Nail bin may include multiple nail cavities, and each nail cavity accommodates the nail being positioned in, and wherein nail cavity can be arranged to multiple rows of, And the anvil block for being wherein positioned in nail bin opposite may include multiple forming pits corresponding with the nail cavity in nail bin.In other words It says, anvil block may include multiple forming pit rows, wherein each forming pit can be positioned in the opposite of the nail cavity in nail bin.Each Forming pit may include that can receive two forming cups of the nail leg 10032 of nail 10030, wherein each forming cup can receive nail Leg 10032, and nail leg 10032 is made for example to shape or crimp towards other nail legs 10032.In all cases, leg 10032 may It does not enter forming cup or does not properly enter forming cup, therefore nail leg 10032 may deform during percussion sequence.Anvil Seat may include forming pit array or grid, can respectively receive and form nail leg.For example, forming pit array may include one Quantitative forming pit, the quantity of the forming pit are more than the quantity of the nail accommodated in nail bin.Nail bin may include such as six vertical To the nail cavity of row, wherein anvil block may include six row's forming pits being aligned with six nail chambers, and furthermore forming pit is positioned In the centre of forming pit row.For example, anvil block may include can be positioned in above first row nail cavity on the side of anvil block One row's forming pit, the second row forming pit that can be positioned adjacent to above the second row nail cavity of first row nail cavity and this The row's forming pit being positioned among first row forming pit and second row forming pit outside.Scheme referring now to Figure 27 6- 279, anvil block 10260 may include six row's forming pits 10261, corresponding six nail that can be placed in nail bin 10200 On chamber.For example, multiple rows of intermediate forming pit 10262 can be positioned among multiple rows of forming pit 10261 and/or adjacent to multiple rows of Forming pit 10261.Referring now to Figure 27 7, Figure 27 8 and Figure 28 0, each forming pit 10261 and 10262 may include two at Shape cup, wherein each forming cup includes the distal part 10263 that nail leg 10032 can be made proximally to shape or crimp and can The portions of proximal 10264 for making nail leg 10032 shape or crimp towards distal side.In various other situations, nail 10030 can it is a variety of its He shapes mode.For example, nail 10030 it is formable so that a leg 10032 outward forming and another leg 10032 to internal shaping (Figure 28 1), or make all formings (Figure 28 2) outward of two legs 10032, this is depended on for example, and 1) nail leg 10032 enters forming cup, And/or 2) whether leg 10032 enters the portions of proximal 10263 or distal part 10064 of each forming cup.
Further described above, each forming pit 10261 and/or forming pit 10262 may include such as three Angular or diamond shape.The each distal part 10263 and/or each portions of proximal 10264 of forming pit may include triangle Shape, wherein for example, distal part 10263 and the triangular shaped of portions of proximal 10264 may be arranged so that it has finger To the vertex of relative direction.Anvil block may include for example a series of substantially square forming pits.For example, each square The forming surface of forming pit may include the arcuate surfaces extended between the side of square.Anvil block may include for example a series of Round or spherical pit.It is described further above, forming pit 10261 can be positioned along one or more line, and phase As, forming pit 10262 can also be positioned along one or more line.Alternatively, forming pit 10261 and/or Forming pit 10262 can be arranged to one or more circular rows.For example, forming pit 10261 can be arranged along main circumference, and And forming pit 10262 can be arranged along different circumference.Main circumference and different circumference can be concentric or substantially concentric 's.Forming pit 10262 can be for example along the inner periphery radially-inwardly positioned relative to main circumference and/or relative to main circumference radial direction The excircle positioned outward is arranged.Main circumference can be limited by full diameter, and inner periphery can be limited by interior diameter, and excircle can It is limited by overall diameter.For example, interior diameter can be shorter than full diameter, and overall diameter can be longer than full diameter.
As described above, anvil block for example can move to closed position from open position, to mend against the tissue thickness of nail bin Part such as tissue thickness compensation part 10020 is repaid to compress tissue.In all cases, in tissue thickness compensation part relative to tissue Before positioning, tissue thickness compensation part can be positioned adjacent to the support section of nail bin.Tissue thickness compensation part 10020 can be at as follows Position: in the position, before anvil block moves to its closed position, the adjacent support section 10018 of tissue thickness compensation part.As Another kind selection, tissue thickness compensation part 10020 can be at following position: in the position, gap is present in tissue thickness's compensation Between part 10020 and support section 10018.For example, anvil block can be such that tissue and tissue thickness compensation part 10020 shifts downwards, directly To the adjacent support section 10018 of tissue thickness compensation part 10020, wherein during this time, anvil block is moveable to its closure at this time Position and within the organization generation compression.If surgeon feels dissatisfied to the positioning of the tissue between anvil block and nail bin, The then openable anvil block of surgeon adjusts the position of anvil block and nail bin, and closed anvil again.Since nail bin is relative to tissue Such positioning and repositioning, in all cases, the distal end of tissue thickness compensation part 10020 can for example with support portion Divide 10010 separation.In some such cases, the distal end of tissue thickness compensation part 10020 can contact tissue, and from support It removes or is rolled relative to support section 10010 in part 10010.As detailed further below, nail bin may include can be by group Knit the one or more features structure for the support section that thickness compensation part is releasably held below nail bin.
Referring now to Figure 26 5, nail bin 10300 may include support section 10310, the tissue that is supported by support section 10310 Thickness compensation part 10320 and distal end 10302 including nose 10303, which can be by tissue thickness compensation part 10320 distal end 10325 is releasably held in appropriate location.Nose 10303 may include that can receive tissue thickness's benefit Repay the slit 10305 of the distal end 10325 of part 10320.Distal end 10325 be can be compressed or be wedged in slit 10305, So that distal end 10325 can be maintained at appropriate location when nail bin 10300 is relative to tissue positioning.For example, slit 10305 can be orientated along the direction for the platform surface 10311 for being parallel to or being at least substantially parallel to support section 10310.Slit 10305 can be horizontal relative to platform surface 10311.Alternatively, referring now to Figure 26 6, nail bin 10400 can Including support section, by the tissue thickness compensation part 10420 of support section support and the distal end including nose 10403 10402, which can be releasably held in appropriate location for the distal end 10425 of tissue thickness compensation part 10420.Far Side end 10425 may include protruding portion extending therefrom, and nose 10403 may include that can receive distal end 10425 The vertical slit 10405 of protruding portion.Distal end 10425 and/or protruding portion extending therefrom can be compressed or are wedged in slit In 10405, so that distal end 10425 can be maintained at appropriate location when nail bin 10400 is relative to tissue positioning.Tissue Thickness compensation part 10420 may include such as slit such as slit 10429, which wherein can receive nose 10403 extremely Few a part.Slit 10405 can along perpendicular to or be at least substantially perpendicular to the direction of platform surface 10411 of support section and take To.Referring now to Figure 26 7, nail bin 10500 may include support section, by support section support tissue thickness compensation part 10520, And the distal end 10502 including nose, the nose can by the distal end 10525 of tissue thickness compensation part 10520 It is releasably retained in appropriate location.Nose may include can receive tissue thickness compensation part 10520 distal end 10525 it is narrow Slot 10505.Distal end 10525 be can be compressed or be wedged in slit 10505, so that when nail bin 10500 is fixed relative to tissue When position, distal end 10525 can be maintained at appropriate location.
Referring again to Figure 26 5, tissue thickness compensation part 10320 may include top surface 10324, which can be determined Position is above the top surface 10304 of nose 10303.Figure 23 8 shows another exemplary embodiment, such as exemplary at this In embodiment, the top surface of tissue thickness compensation part is positioned in above the nose of nail bin, wherein tissue thickness compensation part 10720 top surface 10721 is positioned in 10004 top of top surface of nose 10003.In use, referring again to figure 265, tissue can slide above the top surface 10304 of nose 10303, and in some cases, organize accessible tissue The distal end 10325 of thickness compensation part 10320, and tissue thickness compensation part 10320 can be exerted a force to, to make tissue Thickness compensation part 10320 is removed from support section 10310.In the embodiments described herein, which can be by nose 10303 It is resisted the part of the distal end 10325 of interior wedging.Under any circumstance, once tissue is appropriate relative to nail bin 13000 Positioning, anvil block can be rotated to closed position to compress tissue and tissue thickness compensation part 10320 against support section 10310. For example, anvil block can be rotated in following position: in this position, anvil block contacts the top surface 10304 of nose 10303, and And therefore it can prevent anvil block from further rotating.In all cases, due to the top surface of tissue thickness compensation part 10320 10324 are positioned in 10304 top of top surface of nose 10303, and when anvil block is just closed, top surface 10324 can court Support section 10310 is pushed down, and in some cases, and top surface 10324 can for example be pushed to nose 10303 The lower section of top surface 10304.As described herein, when the nail being contained in nail bin 10300 is disposed and tissue thickness is mended It repays after part 10320 cut, support section 10310 and the movable separate tissue thickness compensation part 10320 of nose 10303 make The distal end 10325 for obtaining tissue thickness compensation part 10320 can skid off slit 10305.
As described above, anvil block (such as anvil block 10060) can for example be rotated to closed position, wherein anvil block 10060 is contacted The top nose surface 10004 of nail bin (such as nail bin 10000).Once anvil block arrived its closed position, then tissue thickness is mended Tissue thickness compensation part will be depended on not inter alia by repaying part (such as tissue thickness compensation part 10020) compressed amount The thickness of compressed thickness or height and tissue.Referring now to Figure 23 6 and Figure 23 7, tissue thickness compensation part 10920 may include with The top surface that the top surface 10004 of nose 10003 is flushed or is at least substantially flush.In such cases, tissue thickness is mended The top surface for repaying part 10920 can push below the top surface 10004 of nose 10003.Referring now to Figure 24 1 and Figure 24 2, Tissue thickness compensation part (such as tissue thickness compensation part 10820) for example may include top surface 10821, compensate in tissue thickness Before part 10820 is compressed by tissue T and anvil block 10060, which is positioned in 10004 lower section of top nose surface.Such as Shown in Figure 23 9 and Figure 24 0, in the case where tissue T is relatively thin, tissue thickness compensation 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 compensation part 10820 can suffer from larger Compression.As shown in Figure 24 3 and Figure 24 4, in the case where tissue T has thin portion and thicker simultaneously, tissue thickness compensation part 10820 can be relatively large by compression when it is positioned in compared with below thick tissue T, and when it is positioned in compared with below thin tissue Compressed lesser amount.As described above, in this way, tissue thickness compensation part can compensate for different tissue thickness.
Referring now to Figure 26 8-270, surgery suturing appliance may include one, can receive the warehouse channel of nail bin 16600 16670 and the two, anvil block 16660 for being attached to warehouse channel 16670 that can pivot.Nail bin 16600 may include support section 16610 and tissue thickness compensation part 16620, wherein the distal end 16625 of tissue thickness compensation part 16620 can be by nail bin Nose 16603 at 16600 distal end 16602 can remain to support section 16610 with discharging.Nose 16603 can wrap Slit 16605 is included, and can be made of flexible material.In use, referring first to Figure 26 9, nose 16603 can be bent downwards, with Just expand the opening of slit 16605.Nose 16603 may include notch or cut out 16606, which can make nose 16603 flexures downwards.Anyway, in all cases, the widened opening of slit 16605 can be conducive to mend tissue thickness The distal end 16625 for repaying part 16620 is inserted into slit 16605.Once tissue thickness compensation part 16620 appropriately positions, nose Portion 16603 can be released, and the screen resilience of the material due to composition nose 16603, and nose 16603 can return to or at least basic It is back to its non-deflected, and captures the distal end 16625 of tissue thickness compensation part 16620 on platform surface 16611, As shown in graph 270.In use, similarly as described above, when support section 16610 moves away from the tissue of suture, distal side End 16625 can be pulled out slit 16605.In all cases, when tissue thickness compensation part 16620 and support section When 16610 separation, flexible nose 16603 can be deflected.Referring again to Figure 27 0, tissue thickness compensation part 16620 may include and nose The top surface 16604 in portion 16603 is aligned or at least substantially aligned top surface 16621.
Referring to fig. 2 71, surgery suturing appliance may include that 1) can receive the channel 10770 of nail bin 10700 and 2) can It is rotationally coupled to the anvil block 10760 in channel 10770.Nail bin 10700 may include support section 10710 and tissue thickness compensation part 10720.Tissue thickness compensation part 10720 can be held in place by nose set 10703, which can be in support section It is slided on 10710.Referring first to Figure 27 2, nose set 10703 may include one or more side slits 10707, this or more A side slit can removedly receive the one or more attachment guide rails for example extended along support section 10710.Tissue thickness Compensating part 10720 can be positioned among side slit 10707.Nose set 10703 may also include distal end 10702 and be limited to Chamber 10706 in distal end 10702, lumen 10706 can also wherein receive at least the one of such as support section 10710 Part.In use, nose set 10703 can be slided on support section 10710 from distal side to the direction of nearside.Tissue thickness is mended Nose set 10703 can be removably mountable to by repaying part 10720, so that having fired in nail across tissue thickness compensation part 10720 Afterwards, when support section 10710 and nose set 10703 move away from tissue thickness compensation part 10720, tissue thickness compensation part 10720 can separate with nose set 10703.The top surface 10721 of tissue thickness compensation part 10720 can be positioned in nose 10703 10704 lower section of top surface.
Referring now to Figure 27 3 and Figure 27 4, surgery suturing appliance may include the staple cartridge channel that 1) can receive nail bin 11000 11070 and the anvil block 11060 in channel 11,070 2) can be rotationally coupled to.Nail bin 11000 may include support section 11010 With tissue thickness compensation part 11020.Tissue thickness compensation part 11020 can be by extending from the platform 11011 of support section 11010 One or more longitudinal rails 11019 are held in place.Longitudinal rail 11019 can be embedded in tissue thickness compensation part In 11020.Referring first to Figure 27 4, tissue thickness compensation part 11020 may include can receive longitudinal rail 11019 longitudinal direction it is recessed Slot 11029.For example, the size of groove 11029 can be set and can receive the guide rail 11019 of such as press-fit construction.To upper Text is described further, and such feature structure can prevent or at least limit tissue thickness compensation part 11020 and support section Opposite lateral movement between 11010, and in addition, tissue thickness compensation part 11020 is limited for example by prematurely from support portion Divide 11010 releases.Referring now to Figure 27 5, surgery suturing appliance may include the staple cartridge channel that 1) can receive nail bin 11100 11170 and the anvil block 11160 in channel 11,170 2) can be rotationally coupled to.Nail bin 11100 may include support section 11110 With tissue thickness compensation part 11120.Tissue thickness compensation part 11120 can be by extending from the platform 11111 of support section 11110 One or more tandem spikes or tooth 11119 are held in place.Longitudinal platoon leader's nail 11119 can be embedded in tissue thickness It spends in compensating part 11120.
Referring to Figure 27 3, further described above, when nail is emitted from being defined in nail cavity 10012 therein When, the tissue thickness compensation part 11020 of nail bin 11000 can gradually be discharged from support section 11010.More specifically, to above It is described further, the nail being located in nail cavity 10012 can be in the proximal extremity 11001 and nail bin 11000 of nail bin 11000 It is successively projected between distal end 11002, so that upward bias force is applied to tissue thickness and mended by nail when nail is emitted Part 11020 is repaid, which acts on so that tissue thickness compensation part 11020 is pushed away guide rail 11019.In such cases, work as nail When being emitted from recent side nail cavity 10012, the proximal extremity 11006 of tissue thickness compensation part 11020 can be from support section 11010 It is released.When nail from the support section 11010 between the proximal extremity 11001 and distal end 11002 of nail bin 11000 by gradually When injection, tissue thickness compensation part 11020 then can gradually be discharged from support section 11010.When being located in farthest side nail cavity When nail in 10012 is emitted from support section 11010, the distal end 11007 of tissue thickness compensation part 11020 can be from support Part 11010 is released.Referring to Figure 27 5, when nail proximally the nail bin between end 11101 and distal end 11102 by gradually When injection, tissue thickness compensation part 11120 can gradually be discharged from the spike 1119 that self-supporting part 11110 extends.
As described above, when nail is gradually projected simultaneously contact tissue thickness compensation parts from support section, tissue thickness's compensation Part can gradually be discharged from the support section of nail bin.Such as the case where tissue thickness compensation part is not discharged from support section Under, such as the leg (such as nail leg 10032) of nail can pass through tissue thickness compensation part.In such cases, tissue thickness compensates Part can keep engaging with support section, until nail base portion (such as base portion 10031) contact tissue thickness compensation parts and by its to Upper promotion.However, anti-skid stud and/or other holding feature structures extended from support section can for example hinder tissue thickness to compensate Release of the part from support section.As described in more detail below, support section may include keep feature structure, when nail from nail bin by by When gradually firing, which can gradually discharge tissue thickness compensation part from support section.Referring now to Figure 28 3, Nail bin (such as nail bin 11200) for example may include support section 11210, which includes can be by tissue thickness compensation part 11220 (Figure 28 4) releasably hold the holding feature structure 11213 of support section 11210.Keep feature structure 11213 It can be positioned in the end of for example each nail cavity 11212, wherein each holding feature structure 11213 may include being defined in wherein Guide groove 11216, the guide groove can slideably received within nail 10030 nail leg 10032.In such cases, it follows closely Tissue thickness compensation part 11220 can be releasably held support section by leg 10032 and holding feature structure 11213 11210.In use, referring now to Figure 28 4, the staple drivers 10040 being contained in support section 11210 can be by sliding part 10050 drive up, as described above, wherein staple drivers 10040 can contact holding feature structure 11213, make to keep feature Structure 11213 is at least partly separated with support section 11210, and makes that feature structure 11213 is kept to be outwardly and away from nail 10030 and nail cavity 11212 shift.When keeping feature structure 11213 to separate and/or shift outward with support section 11210, such as Shown in Figure 28 4, keep feature structure 11213 that can be no longer able to tissue thickness compensation part 11220 remaining to support section 11210, therefore, tissue thickness compensation part 11220 can be released from support section 11210.It is similarly as described above, work as nail 10030 for example from nail bin towards anvil block such as anvil block 11260 is gradually projected when, tissue thickness compensation part 11220 can be from support portion 11210 are divided gradually to be discharged.When staple drivers 10040 top surface for example with the platform surface 11211 of support section 11210 When coplanar or at least substantially coplanar, staple drivers 10040 are accessible to keep feature structure 11213.In such cases, it is following closely 10030, which are shaped as it, is fully formed or while complete firing configuration and/or is just shaped as it in nail 10030 and is fully formed Or before complete firing configuration, tissue thickness compensation part 11220 can be discharged from support section 11210.For example, referring first to figure 285, driver 10040 can be overdriven so that its pushed above platform surface 11211 so that follow closely 10030 completely at Shape, and during the process being overdriven, make that feature structure 11213 and support section 11210 is kept to be detached from.Referring again to Figure 28 4 keeps feature structure 11213 to may extend into or dangle before separation or outward displacement to going forward side by side on nail cavity 11212 Enter into nail cavity, so that driver 10040 is accessible to keep feature just when driver 10040 reaches platform surface 11211 Structure 11213.Under any circumstance, once tissue thickness compensation part 11220 is released from support section 11210, join now See Figure 28 5, then the movable tissue thickness compensation part 11220 far from implantation of support section 11210.
As described above, the compressible tissue thickness compensation part of nail bin can be from nail bin when nail is fired or disposed from nail bin Support section or warehouse gradually discharged.In all cases, such release may include making tissue thickness compensation part from support Part is gradually unclamped, wherein in some cases, until anvil block be opened and support section move away from implantation tissue it is thick Compensating part is spent, tissue thickness compensation part is likely to be kept completely separate with support section.Referring now to Figure 28 9, nail bin (such as nail bin It 11300) for example may include the tissue thickness compensation part 11320 for releasably holding support section 11310.Support section 11310 may include multiple holding members 11313 extending therefrom, and multiple holding member can be by tissue thickness compensation part 11320 longitudinal direction side is releasedly compressed and remains to support section 11310.For example, each holding member 11313 may include energy Enough in inward-facing channel or the slit 11316 for wherein receiving the longitudinal direction side of tissue thickness compensation part 11320.In various situations Under, multiple holding members 11313 can extend along the first longitudinal side of support section 11310, and multiple holding members 11313 can Second longitudinal side along support section 11310 extends.Wherein, in some cases, holding member 11313 can prevent or at least Lateral movement opposite between tissue thickness compensation part 11320 and support section 11310 is limited, and furthermore prevents or at least limits Tissue thickness compensation part 11320 processed discharges too early from support section 11310.Holding member 11313 can be with support section 11,310 1 It is body formed, and referring to fig. 2 90, holding member 11313 can be separated or be at least partially separate with support section 11310, so as to Separate tissue thickness compensation part 11320 with support section 11310, such as shown in Figure 29 1.Anvil block (such as anvil block 11360) Such as tissue thickness compensation part 11320 can be compressed, and the pressure in response to generating in tissue thickness compensation part 11320, group Knitting thickness compensation part 11320 can laterally expand to dividing holding member 11313 at least partly with tissue thickness compensation part 11320 From or be detached from.As described above, cutter component is promoted to pass through anvil block 11360 and nail bin 11300, it can dispose and be accommodated in nail bin Nail keeps its closer to each other and at the same time squeezing anvil block 11360 and nail bin 11300, and increased compressing force can be applied to group by this Thickness compensation part 11320 is knitted, to make holding member 11313 successively separate when cutter component passes through nail bin 11300.
Referring now to Figure 29 2-294, nail bin such as nail bin 11400 for example may include being removably attached to support section 11410 tissue thickness compensation part 11420.Nail bin 11400 may include that can protect the longitudinal direction side of tissue thickness compensation part 11420 Hold one or more retainer bars 11413 of platform surface 11411.For example, each retainer bars 11413 may include opposing arms 11418, which can limit channel 11416 therebetween.In such cases, one in arm 11418 can be thick in tissue Extend on degree compensating part 11420, and another arm 11418 can be under the antelabium 11419 that support section 11410 extends Fang Yanshen.Referring first to Figure 29 2, the size in the channel 11416 of each retainer bars 11413 can be set and can be using nail The longitudinal direction side of tissue thickness compensation part 11420 is applied compressive force to before storehouse 11400.During use, referring first to Figure 29 3, Nail bin 11400 can be positioned in staple cartridge channel, once and the appropriately positioning of nail bin 11400, anvil block (such as anvil block 11460) Such as it is moveable in the position of its compressible tissue thickness compensation part 11420.It is similarly as described above, when pressurised, group It knits thickness compensation part 11420 can be lateral or to extend to the outside, and separates retainer bars 11413 with nail bin 11400.As another The closure of a kind of outer selection, anvil block 11460 can make retainer bars 11413 not separate or be not kept completely separate with nail bin with nail bin.Example Such as, as described above, nail 10030 can be disposed from support section 11410 by promoting trigger shaft to pass through nail bin 11400, and at the same time squeezing Anvil block 11460 and nail bin 11400 keep its closer to each other, to apply compressive force to tissue thickness compensation part 11420, the pressure Contracting power is enough to laterally expand tissue thickness compensation part 11420, and separates retainer bars 11413 with nail bin 11400.Once Retainer bars 11413 are separated with nail bin 11400, and referring to fig. 2 94, the movable tissue far from implantation of support section 11410 is thick It spends compensating part 11420 and is removed from operative site.In certain alternative embodiments, referring now to Figure 29 5, nail bin 11400 ' can Including retainer bars 11413 ', the retainer bars similarly as described above may include arm 11418 ' extending therefrom.For example, arm Each of 11418 ' may include wedge-lock inclined-plane that retainer bars 11413 ' can be releasedly latchable to nail bin 11400 ' 11417'.More specifically, the support section 11410 ' of nail bin 11400 ' may include undercutting 11419 ', the undercutting and wedge-lock inclined-plane Retainer bars 11413 ', can be releasably held nail bin 11400, and inhibit tissue thickness compensation part by 11417 ' cooperations 11420 prematurely separate with support section 11410 '.During use, similarly as described above, when enough compressing forces are applied When being added to tissue thickness compensation part 11420, retainer bars 11413 ' can be separated with nail bin 11400 '.
In all cases, as described above and referring again to Figure 25 9 and 260, the sliding part 10050 of nail bin 10000 and outer The firing member 10052 of section's suture instruments can move to the distal side end of nail bin 10000 from the proximal extremity 10001 of nail bin 10000 10002 (Figure 21 9) are held, to follow closely 10030 from the deployment of support section 10010.In at least one such situation, each nail 10030 never can move to firing position by firing position, and project from support section 10010 to be positioned at 10060 He of anvil block Tissue between nail bin 10000 captures entire tissue thickness compensation part 10020.In some cases, surgeon may not Need to fire all nails 10030 from nail bin 10000, and surgeon may make sliding part 10050 and trigger shaft 10052 Advance and is barred from the point of 10002 centre of proximal extremity 10001 and distal end of nail bin 10000.In such case Under, tissue thickness compensation part 10020 can be only by the implanting tissue T of part, to make not being implanted into for tissue thickness compensation part 10020 Part is separated with support section 10010.The tissue thickness compensation part that support section 10010 can be implanted by surgeon far from part 10020 drawings, so that non-implant part is removed or fallen off from support section 10010.Although such embodiment is suitable for various situations, Figure 30 0-302 shows improvement, and wherein the tissue thickness compensation part 11520 of tissue thickness compensation part such as nail bin 11500 is for example It may include the multiple junction fragments that can be separated from each other.For example, tissue thickness compensation part 11520 may include first or nearest lateral plate Section 11520a, the second segment 11520b for being removably connected to the first segment 11520a, it is removably connected to the second segment The third segment 11520c of 11520b, the 4th segment 11520d for being removably connected to third segment 11520c and can be removed Ground is connected to the 5th segment 11520e of the 4th segment 11520d.Tissue thickness compensation part 11520 may include being located in any two At least one thin portion that can limit predetermined broken scatterplot or burble point among a adjacent segment 11520a-11520e 11529, tissue thickness compensation part segment can break scatterplot at this or burble point is separated from each other.Tissue thickness compensation part may include any Suitable perforation configuration, thin portion, and/or any other device for generating burble point in tissue thickness compensation part.First Referring to Figure 30 1, anvil block 11560 is shown as in the close position, and firing member 10052 is shown as partially being advanced through nail bin 11500, so that the nail 10030 below the first segment 11520a, the second segment 11520b and third segment 11520c is fired To capture tissue thickness compensation part 11520 in tissue T.In such position, firing member 10052 is not pushed into also to dispose Such as the 4th nail 10030 below segment 11520d and the 5th segment 11520e.Referring now to Figure 30 2, anvil block 11560 has been moved Into open position, and the support section 11510 of nail bin 11500 has moved away from the implantation of tissue thickness compensation part 11520 Part.As shown in Figure 30 2, the thin portion 11529 (Figure 30 0) among third segment 11520c and the 4th segment 11520d has made The non-implant part of tissue thickness compensation part 11520 is separated with implant part.
Further described above, nail bin may include multiple fasteners, multiple fastener can be by tissue thickness Compensating part releasably holds the support section of nail bin.Support section may include for example be limited to it is multiple in platform surface Hole, wherein fastener can extend across tissue thickness compensation part and can be releasably retained in support section hole.Make In, when nail is gradually projected from support section, fastener can gradually be discharged from support section.For example, fastener can be with Tissue thickness compensation part is implanted together, and fastener can be for example made of at least one bioabsorbable material.In group It knits after thickness compensation part is at least partly implanted into, and when support section moves away from the tissue thickness compensation part of implantation When, fastener can be separated with support section.Referring now to Figure 32 3-325, nail bin (such as nail bin 11600) for example may include passing through Multiple fasteners 11613 are releasably attached to the tissue thickness compensation part 11620 of support section 11610.Each fastener 11613 may include being embedded in the first end engaged in tissue thickness compensation part 11620 and/or with tissue thickness compensation part 11620 11618, the second end 11618 that engages with support section 11610 and first end 11618 is connected to second end 11618 connector 11616.Fastener 11613 can extend across the cutter slit 11615 being limited in support section 11610.? In use, as described above, firing member 10052 can make blade move across the cutter slit 11615 in support section 11610 and Fastener 11613 is cut, to discharge tissue thickness compensation part 11620 from support section 11610.For example, trigger shaft 10052 can It is advanced to the distal end 11602 of nail bin 11600, from the proximal extremity 11601 of nail bin 11600 so as to 1) by sliding part 10050 promote and gradually percussion nail 10030 towards distal side, as described above, and 2) gradually cutting fastener 11613 and/or making tightly Firmware 11613 is broken gradually to discharge tissue thickness compensation part 11620 from support section 11610.It is similarly as described above, tissue Thickness compensation part 11620 may include multiple separable segment 11620a-11620e, and multiple separable segment for example can respectively lead to It crosses one or more fasteners 11613 and remains to support section 11610.As shown in Figure 32 4, if firing member 10052 is hindered It is blocked among the proximal extremity 11601 and distal end 11602 of nail bin 11600, is opened and support section in anvil block 11660 After 11610 move away from tissue T, as shown in Figure 32 5, fastener 11613 be can help to tissue thickness compensation part 11620 Non- implant part remains to support section 11610.Further described above, 10053 energy of cutting blade of firing member 10052 It enough cuts fastener 11613 and/or is broken fastener 11613.In certain alternative embodiments, referring now to 7 He of Figure 32 328, nail deployment sliding part such as sliding part 11650 for example may include blade 11653, when sliding part 11650 traverses nail bin 11600 When, which can cut the connector 11616 of fastener 11613.For example, each connector 11616 may include in fastener The cylindrical member extended between 11613 T shape end 11618, wherein blade 11653 may include concave profile 11653, this is interior Arcwall face can for example receive cylindrical connector 11616.
As described above, nail bin can be loaded onto the staple cartridge channel of surgery suturing appliance.In all cases, surgeon Or nail bin can be inserted into staple cartridge channel to lock nail bin by other clinicians and downward power is applied on nail bin It is in place.In certain such situations, its thumb can be for example placed on the top surface of nail bin to apply by clinician Add such downward power.The top surface of nail bin may include the top surface of tissue thickness compensation part, wherein as described above, group It can be compressible for knitting thickness compensation part, and the downward power for being applied to tissue thickness compensation part can make tissue thickness compensation part It is compressed to the point of the thumb of clinician and the tip contact for the nail being stored in support section.It will using nail bin application device Nail bin is inserted into staple cartridge channel, which can prevent or at least limit clinician to touch nail in nail bin Possibility.After nail bin has been correctly positioned in staple cartridge channel, as described in more detail below, application device can be with nail bin point From.
Referring now to Figure 30 5 and 306, nail bin application device can be all for example including the rigid cap that could attach to nail bin 10000 Such as lid 10080.Further described above, when nail bin 10000 is inserted into staple cartridge channel, for example, lid 10080 can It prevents or the top of the nail 10030 that at least inhibits the thumb contact of clinician to be located in nail bin 10000.Referring now to figure 307 and 308, the top surface 10021 or top surface 10021 that lid 10080 may extend into tissue thickness compensation part 10020 are extremely It on few a part, and may include that 1) may extend on tissue thickness compensation part 10020 and/or subjacent tissue's thickness compensation The bottom surface 10081 of part 10020 and pressing surface can be provided for clinician 2) to apply the top of downward power to it Surface 10082.In use, clinician can grasp the handle portions 10084 of lid 10080, by the support section of nail bin 10000 10010 are aligned with staple cartridge channel, and at least partly nail bin 10000 is inserted into staple cartridge channel.Then, clinician can pass through Apply downward power to the top surface 10082 of lid 10880 be fully disposed in nail bin 10000 in staple cartridge channel, this is downwards Power can be directly transferred to support section 10010.For example, lid 10080 may include proximal supports 10087, which can Extend downwardly and contact the platform surface 10011 of support section.Lid 10080 may also include the distal side that can abut nose 10003 Support section 10083.When applying downward power to lid 10080, the downward power can by proximal supports 10087 and/or Distal side support section 10083 is passed, without or at least substantially the downward power will not be passed through tissue thickness compensation part 10020 are transmitted to support section 10010.In all cases, due to described above, clinician can be not directly contacted with tissue thickness Spend compensating part 10020.Due also to described above, when nail bin 10000 is inserted into staple cartridge channel, lid 10080 can not compress or Tissue thickness compensation part 10020 is not compressed at least substantially.Lid may include any appropriate number of supporting element, which can Downward power is transmitted to support section, without or at least substantially will not transmit that this is downward by tissue thickness compensation part Power.Supporting element may extend into around the proximal extremity, distal end, and/or longitudinal direction side of tissue thickness compensation part.Supporting element can Extend through tissue thickness compensation part.For example, supporting element can extend across the hole in tissue thickness compensation part and adjacent support portion The platform divided.Before downward power is applied to lid, at least some of supporting element can not be with contact with platform；However, lid energy Enough flexures downwards or movement, until the platform of supporting element contact support section.At this point, lid can be prevented or at least substantially be prevented Downward flexure or movement further flexure.
As described above, lid 10080 could attach to nail bin 10000 and can be used for regulating and controlling the position of nail bin 10000.Lid 10080 It may include any appropriate number of clamping components, which for example can releasably hold nail bin for lid 10080 10000 support section 10010.For example, lid 10080 for example may also include one or more holding members, such as latch arms 10088 and/or 10089.Latch arms 10089 can extend to the side periphery of nose 10003 and engage the bottom of nose 10003 Surface 10009 (Figure 30 6).Similarly, latch arms 10088 may extend into the side periphery of lock protrusion 10008, the lock protrusion Extend and engage the bottom surface of lock protrusion 10008 from support section 10010.These latch arms can position lid 10080 On following area or region: in the area or region, nail is stored in support section 10010.Under any circumstance, once Nail bin 10000 has been properly oriented, and lid 10080 can be separated with nail bin 10000.Clinician can apply upwards to shank 10084 Lifting force, so that the distal end of lid 10080 is separated with the distal end 10002 of nail bin 10000.For example, in shank 10084 when being moving upward, and latch arms 10088 and 10089 can be bent outward, so that latch arms 10088 and 10089 can enclose respectively It is bent around lock protrusion 10008 and nose 10003.Then, the proximal extremity of lid 10080 can be subsequently lifted the proximal extremity of nail bin 10001, and the movable separate nail bin 10000 of lid 10080.
Referring now to Figure 30 9 and Figure 31 0, in addition to nail bin (such as nail bin 10600) is for example located in staple cartridge channel it Outside, nail bin application device (such as nail bin application device 10680) for example can also such as organize Top tissue thickness compensation part Thickness compensation part 10690 is for example relative to anvil positioning.Similarly as described above, application device 10680 may include can be with lock The latch arms 10688 that protruding portion 10608 is releasably engaged, the lock protrusion are prolonged from the support section 10610 of nail bin 10600 It stretches, so that application device 10680 can be maintained at the position on the tissue thickness compensation part 10620 of nail bin 10600.Top Tissue thickness compensation part 10690 can be removably attached to nail bin application device 10680, so that the anvil block of surgical instruments is (all Such as anvil block 10060) it can be for example closed on application device 10680, tissue thickness compensation part 10690 is engaged, and make tissue thickness Compensating part 10690 is separated with application device 10680.Tissue thickness compensation part 10690 and/or anvil block 10060 may include one or Tissue thickness compensation part 10690 can be releasably held anvil block by multiple holding feature structures, the holding feature structure 10060.For example, tissue thickness compensation part 10690 may include the top surface 10691 for example from tissue thickness compensation part 10690 The longitudinal rail 10695 of extension, the longitudinal rail can be received in the longitudinal knife slot 10065 being limited in anvil block 10060. Tissue thickness compensation part 10690 and longitudinal rail 10695 can be for example made of any suitable compressible material, be such as described in Those of in the patent application, wherein longitudinal rail 10695 for example be can be compressed and/or be wedged in cutter slit 10065.Once Anvil block 10060 is engaged with tissue thickness compensation part 10690, then anvil block 10060 can return to open position, and in this feelings Under condition, tissue thickness compensation part 10690 can be separated with application device 10680.Then, application device 10680 can be with nail bin 10600 Separation, so that anvil block 10060 and nail bin 10600 can be relative to the tissue positioning that will be sewn and/or cut.In use, it follows closely Deployment sliding part such as sliding part 10050 (Figure 23 6) for example can be advanced through nail towards distal side by firing member 10052 (Figure 23 6) Storehouse 10600, such as projected to follow closely from nail bin 10060, as described above.Due to nail deform, each nail can capture against A part of the tissue thickness compensation part 10690 of the top surface of tissue and the tissue thickness for capturing the bottom surface against tissue Spend a part of compensating part 10620.Meanwhile firing member 10052 can promote blade 10053 (Figure 23 6) to mend across tissue thickness Part 10620 and/or tissue thickness compensation part 10690 are repaid, wherein blade 10053 can be pushed by longitudinal rail 10695, so as to It cuts guide rail 10695 and is gradually disengaged tissue thickness compensation part 10690 with anvil block 10060.After nail is disposed, anvil Seat 10060 can be opened again and move away from the tissue thickness compensation part 10690 of implantation, and similarly, nail bin 10600 The movable tissue thickness compensation part 10620 far from implantation of support section 10610.Further described above, tissue is thick It spends compensating part 10620 and/or tissue thickness compensation part 10690 may include multiple separable segments.If only tissue thickness compensates When the part of part 10620 and 10690 is by by nail implantation, separable segment can be separated from each other.
Further described above, application device 10680 may include that can release tissue thickness compensation part 10690 It remains to the one or more of application device 10680 with putting keeps feature structure.For example, referring first to Figure 31 0, application device 10680 may include that can be received in longitudinal longitudinal holding guide rail 10685 kept in slit 10694, this longitudinally keeps slit It is limited in the bottom surface 10692 of tissue thickness compensation part 10690 with press-fit manner.In all cases, it keeps leading Tissue thickness compensation part 10690 can be remained to application device 10680 by rail 10685 and holding slit 10694, until passing through anvil Seat 10060 applies enough upward lifting forces to tissue thickness compensation part 10690, as described above.For example, from application device The 10680 holding guide rails 10685 extended may also include the proximal extremity for being positioned within guide rail 10685 and the end at distal end Portion's stop part 10686, the end stop can prevent or at least limit tissue thickness compensation part 10690 and application device Relative longitudinal motion between 10680.Referring again to Figure 31 0, such as longitudinal adhesive tape 10693 of one or more adhesives is for example It can be placed in the contact surface 10691 of tissue thickness compensation part 10690, so that when anvil block 10060 contacts tissue thickness's compensation When part 10690, as described above, tissue thickness compensation part 10690 can be releasably attached to anvil block 10060 by adhesive.It removes Above-mentioned compressible holding feature structure is outer or replaces above-mentioned compressible holding feature structure, such as can be used a kind of or more Kind adhesive.One or more adhesives can be used that tissue thickness compensation part is releasably held nail bin application device.It is existing Referring to Figure 31 0A, such as lid 10080 may include one or more adhesive pads 12185, which can will Top tissue thickness compensation part such as tissue thickness compensation part 12190 for example releasably holds the top surface of lid 10080 10082.For example, being similar to above-described embodiment, anvil block can be closed to engage tissue thickness in tissue thickness compensation part 12190 The longitudinal of compensating part 12190 keeps guide rail 12195.Relieving mechanism can be positioned in tissue thickness compensation part 12190 and lid 10080 It is intermediate.The relieving mechanism can be used for breaking the bonding that tissue thickness compensation part 12190 is remained to lid 10080, and make tissue Thickness compensation part 12190 is separated with lid 10080.Relieving mechanism may include pull tab 12196 and lantern ring 12197, wherein lantern ring 12197 It may include the first end and second end for being attached to pull tab 12196.Lantern ring 12197 can be for example including suture, the suture The periphery of defining bonding pad e 12185 can be limited, so that suture can be in tissue thickness when pull tab 12196 is pulled towards distal side It is slided between compensating part 12190 and lid 10080 and contacts tissue pad 12185.In such cases, suture it is for example achievable with It is at least one of lower: to separate adhesive pad 12185 with tissue thickness compensation part 12190；Make adhesive pad 12185 and lid 10080 Separation；And/or cutting adhesive pad 12185.
Referring now to Figure 31 1, nail bin can be for example including support section 10710.Similarly as described above, which can Including through the longitudinal knife slot 10715 extended.For example, nail bin application device such as application device 10780 for example may include indulging To holding and alignment member 10786, which is kept and alignment member may extend into the cutter slit in support section 10710 In 10715.Holding member 10786 can engage the side wall of cutter slit 10715 for example with press-fit manner, so that application device 10780 can be releasably retained support section 10710.Although being not shown, the first part of tissue thickness compensation part can It is positioned on the first side of holding member 10786, and the second part of tissue thickness compensation part can be positioned in holding structure In opposite or second side of part 10786.It is similarly as described above, the first part of tissue thickness compensation part and second part example The support section 10710 of nail bin can be such as mounted to by holding member 10013.It is also similar to described above, top tissue thickness Spending compensating part 10790 can be and longitudinal holding member 10785 for loading the extension of surface 10782 from application device 10780 It is removably attachable to application device 10780, wherein holding member 10785 can be for example limited to by being releasedly press-fitted into In longitudinal slit 10794 in the bottom surface 10792 of tissue thickness compensation part 10790.It is also similar to described above, tissue thickness Degree compensating part 10790 may also include the longitudinal holding member extended from the top surface 10791 of tissue thickness compensation part 10790 10795, which can for example be releasably retained in the longitudinal knife slot being defined in anvil block 10060 In 10065.For example, longitudinal holding member 10795 may include wedge-shaped cross-section, which includes the top greater than bottom Portion, wherein holding member 10795 can be for example attached to tissue thickness compensation part 10790 by bottom.
Referring now to Figure 31 2 and Figure 31 3, for example, it will include support section 10810 that nail bin application device 10880, which can be used, It is loaded into staple cartridge channel with the nail bin 10800 of tissue thickness compensation part 10820.It is similarly as described above, nail bin application device 10880 for example can also position Top tissue thickness compensation part 10890 relative to anvil block such as anvil block 10060, such as make When anvil block 10060 is closed, anvil block 10060 is accessible and engages tissue thickness compensation part 10890.Tissue thickness compensation part 10890 may include the multiple holding legs 10895 extended from the top surface 10891 of tissue thickness compensation part 10890, the holding leg Anvil block 10060 can be engaged and tissue thickness compensation part 10890 is releasably held into anvil block 10060.For example, leg 10895 Longitudinal row can be arranged to, wherein each leg 10895 may include at least one foot, which is able to enter and engages quilt The cutter slit 10065 being limited in anvil block 10060.Some feet of leg 10895 can extend in one direction, and other feet can be along another One direction extends.Some feet can extend along opposite direction.Referring now to Figure 31 3 and 314, under any circumstance, once anvil Seat 10060 is engaged with tissue thickness compensation part 10890, and anvil block 10060 can be opened again, and clinician can be by nail bin Application device 10880 is moved away from tissue thickness compensation part 10820 and 10890.Then, referring to Figure 31 4A, thickness compensation is organized on top Part 10890 can be positioned in the first side of destination organization, and may include tissue thickness's compensation of Lower tissue thickness compensation part Part 10820 can be positioned in second side of tissue.Referring now to Figure 31 4B, when tissue thickness compensation part 10820 and 10890 After being properly oriented, the blade of firing member such as blade 10053 can for example be advanced through tissue and tissue thickness compensation part. Referring now to Figure 31 8, nail bin application device such as application device 12280 for example may include the tissue thickness for being detachably mounted to it Spend compensating part 12290.As shown in Figure 31 9, when anvil block 10060 moves in closed position, which can class It is similar to described above be inserted into staple cartridge channel and engaged by anvil block 10060.For example, tissue thickness compensation part 12290 may include The multiple holding members 12295 upwardly extended from the top surface 12291 of tissue thickness compensation part 12290.Wherein each holding Component 12295 may include multiple flexible legs 12296, and multiple flexible leg is inserted into the cutter slit 10065 in anvil block 10060 It is interior.Referring first to Figure 32 1 and 322, the flexible leg 12296 of each holding member 12295 can be separated by gap 12298, so that working as Leg 12296 be inserted into cutter slit 10065 in when, leg 12296 can inwardly be bent, once and flexible leg 12296 widened foot Across cutter slit 10065, then leg 12296 then to returning elastically outside.The widened foot of flexible leg 12296 can be defined to anvil It is bent behind opposite holding antelabium 12297 in seat 10060, and due to the interaction of leg 12296 and antelabium 12297, Tissue thickness compensation part 12290 can be held anvil block 10060.Then, nail bin application device 12280 is movable thick far from tissue Compensating part 12290 is spent, as shown in Figure 32 0.In use, once tissue thickness compensation part 12290 is for example by from nail bin The nail to the organization of 10000 deployment and be implanted, then anvil block 10060 can be opened again, and be moved away from when anvil block 10060 When the tissue thickness compensation part 12290 of implantation, the leg 12296 of holding member 12995 can inwardly be bent, so that it can be from cutter slit 10065 are pulled out.
Referring now to Figure 31 5 and Figure 31 6, tissue thickness compensation part such as tissue thickness compensation part 11990 can for example be indulged To being loaded into anvil block such as anvil block 11960.More specifically, tissue thickness compensation part 11990 may include one or more longitudinal Guide rail 11995, the one or more longitudinal rail can be inserted into the distal openings in the cutter slit 11965 of anvil block 11960, and with It proximally pushes afterwards, until tissue thickness compensation part 11990 is properly placed in anvil block 11960.For example, each guide rail 11995 may include that can be positioned in the subsequent longitudinal holding foot 11996 of longitudinal holding antelabium 11997, this longitudinally keeps antelabium example As at least partly limited cutter slit 11965.As shown in Figure 31 6, foot 11996 can extend along opposite direction, to be positioned in It keeps behind antelabium 11997, which is positioned on the opposite side of cutter slit 11965.It axial clearance 11998 can quilt It is limited between guide rail 11995, when tissue thickness compensation part 11990 is separated with anvil block 11960, which can make to lead The inwardly flexure towards each other of rail 11995.Referring now to Figure 31 7, tissue thickness compensation part such as tissue thickness compensation part 12090 is for example It may include the one or more hammerlocks 12098 for extending to the anvil block such as side periphery of anvil block 12060.In use, hammerlock Tissue thickness compensation part 12090 is simultaneously releasably held anvil block 12060 by 12098 engageable anvil blocks 12060.For example, anvil block 12060 for example may include one or more recesses or lock shoulder 12097, the one or more recess or lock shoulder can respectively receive from The foot that hammerlock 12098 extends.In use, after tissue thickness compensation part 12090 is at least partially implanted into, work as anvil block 12060 when moving away from tissue thickness compensation part 12090, and arm 12098 can bend outward and separate with anvil block 12060.
As described above, surgery suturing appliance may include the staple cartridge channel that can receive nail bin, be rotationally coupled to nail bin The anvil block in channel and firing member including blade, the firing member are movable relative to anvil block and staple cartridge channel.It is using In, nail bin can be positioned in staple cartridge channel, and after nail bin is at least partly consumed, nail bin can be removed from staple cartridge channel And it is replaced by new nail bin.In some such embodiments, staple cartridge channel, anvil block, and/or the firing member of surgery suturing appliance It can be reused together with replacement nail bin.Alternatively, nail bin may include the one of disposable loading unit component Part, the disposable loading unit component for example may include staple cartridge channel, anvil block, and/or firing member, these can be used as replacement A part of disposable loading unit component is replaced with nail bin.Certain disposable loading unit components are disclosed in 2008 Entitled " the END EFFECTOR COUPLING ARRANGEMENTS FOR A SURGICAL CUTTING submitted for 15 days 2 months In the U.S. Patent application 12/031,817 of AND STAPLING INSTRUMENT ", the complete disclosure of the patent application with Way of reference is incorporated herein.Referring now to Figure 37 0, disposable loading unit such as disposable loading unit 12500 can for example be wrapped Support section 12510 is included, the anvil block 12560 of support section 12510 is rotationally coupled to and prolongs from support section 12510 The axis of elongation 12570 stretched.Similar to nail bin as described herein, support section 12510 may include multiple nail cavities 10012 and nail, example The nail 10030 being such as located in each nail cavity 10012.Disposable loading unit 12500 may also include firing member 12552, should Firing member can be advanced to anvil block 12560 moving to closed position from open position towards distal side, as shown in Figure 37 0.One Secondary property loading unit 12500 may also include the tissue for being located on support section 12510 and/or being attached to support section 12510 Thickness compensation part 12520.Wherein, when anvil block 12560 is in its closed position, anvil block 12560 can be positioned in tissue thickness The opposite of compensating part 12520, and when anvil block 12560 is in its closed position, anvil block 12560 can at least partly compression groups Knit thickness compensation part 12520.In either case, firing member 12552 can be further promoted, to follow closely from support portion 12510 are divided to project.After nail is emitted, nail can be deformed by anvil block 12560, and capture tissue thickness compensation part therein 12520 at least part.Then, firing member 12552 can proximally bounce back, and anvil block 12560 can be opened again, and be propped up The movable tissue thickness compensation part 12520 far from implantation in support part point 12510.
Further described above, tissue thickness compensation part 12520 can be detachably mounted to support section 12510.For example, support section 12510 may include being installed to the longitudinal of each of which side to keep guide rail 12526, wherein each guide rail 12526 may include one or more holes 12528, which can receive tissue thickness compensation part 12520 wherein At least part.Once tissue thickness compensation part 12520 is at least partially implanted into, then it is displaced from support section 12510 When tissue thickness compensation part 12520 can be drawn out from hole 12528.Referring now to Figure 37 1-373, disposable loading unit 12600 may include support section 12610, the tissue thickness compensation part 12620 for being detachably mounted to support section 12610, and One or more keeps guide rail 12626, which keeps guide rail that can prolong below tissue thickness compensation part 12620 It stretches, and tissue thickness compensation part 12620 is installed to support section 12610.Each holding guide rail 12626 for example may include more A retaining hook 12628, multiple retaining hook can be engaged for example, by the holding slit 12614 being limited in support section 12610 To support section 12610.In use, for example, when tissue thickness compensation part 12620 is at least partially implanted into and support section After 12610 move away from tissue thickness compensation part 12620, tissue thickness compensation part 12620 can divide with guide rail 12626 is kept From.Referring now to Figure 37 4-376, disposable loading unit 12700 may include it is one or more keep guide rail 12726, this Or multiple to keep guide rails can respectively include the bottom bar 12725 that can extend below tissue thickness compensation part 12720 and can be in group Knit the mandril 12727 extended above the top surface 12621 of thickness compensation part 12620.Tissue thickness compensation part 12620 can push up It is at least partially compressed between bar 12727 and bottom bar 12725, so that keeping guide rail 12726 that can release relative to support section 12610 Keep tissue thickness compensation part 12620 with putting.For example, each holding guide rail 12726 may include one or more retaining hooks 12728, which can engage with support section 12610 guide rail 12726 will be kept to remain to support section 12610。
Referring now to Figure 37 7 and Figure 37 8, disposable loading unit 12800 may include holding member 12822, the holding structure Tissue thickness compensation part 12620 can be installed to support section 12610 by part.For example, holding member 12822 may include against branch The material piece that the platform surface 12611 of support part point positions, wherein tissue thickness compensation part 12620 for example can be viscous by least one Mixture is attached to material piece.Holding member 12822 may also include it is longitudinal keep guide rail 12825, this longitudinally keeps guide rail can be to Under extend in the cutter slit 12615 being limited in support section 12610.For example, keeping the size of guide rail 12825 can be set It is fixed and can be at compressing it between the side wall of cutter slit 12615.In use, firing member 12552 may include knife Sword, when firing member 12552 is pushed into towards distal side and longitudinal cutting tissue thickness compensation part 12620 is with guide rail 12825 is kept, The blade may pass through cutter slit 12615.In addition, in use, the nail projected from support section 12610 can penetrate holding member 12822, tissue thickness compensation part 12820 and the tissue being located between tissue thickness compensation part 12820 and anvil block 12560. Holding member 12822 can be made of biocompatibility and/or bioabsorbable material.Holding member 12822 can be by can be abundant The material of compression is constituted, to include the tissue thickness compensation part below tissue thickness compensation part 12620.Referring now to Figure 37 9- 381, disposable loading unit 12900 may include charging assembly, which includes that can be removably attached to support portion Divide 12610 bottom part 12922, the top section 12990 of anvil block 12560 can be removably attached to, and connection bottom The flexible joint 12991 of portion part 12922 and top section 12990.It is similarly as described above, it is longitudinal to keep guide rail 12825 It extends downwardly and is extended in the cutter slit 12615 being limited in support section 12610 from bottom part 12922, so that bottom Part 12922 can be releasably retained support section 12610.Similarly, longitudinal to keep guide rail 12995 be from top section 12990 extend up in the cutter slit being limited in anvil block 12560, so that top section 12990 can be releasably retained To anvil block 12560.As shown in Figure 38 0 and 381, tissue thickness compensation part 12620 can be mounted to the bottom part of charging assembly 12922, wherein in order to which relative to 12610 position tissue thickness compensation part 12620 of support section, clinician can make top Points 12990 and bottom part 12922 bend towards each other, by charging assembly be located in anvil block 12560 and support section 12610 it Between, and the charging assembly of flexure is discharged, so that charging assembly can come resilient expansion and biasing top section against anvil block 12560 12990, and come resilient expansion and biasing bottom part 12922 against support section 12610.Referring now to Figure 38 2-384, load Component may also include one or more latch hook such as latch hooks 12994 for example extending therefrom, which can be by top section 12990 are releasably connected to anvil block 12560, and/or bottom part 12922 is releasably connected to support section 12610.
Referring now to Figure 38 5, disposable loading unit 15900 for example may include anvil block 15960 and staple cartridge channel 15970, Wherein staple cartridge channel 15970 can be rotated relative to anvil block 15960.For example, anvil block 15960 may not be able to rotate.Tissue can be determined Staple cartridge channel 15970 can be towards tissue rotation against anvil block between anvil block 15960 and staple cartridge channel 15970, and then for position Clamp tissue.For example, disposable loading unit 15900 may also include the tissue thickness compensation part 15920 that can contact tissue.
As described above and referring to Figure 33 2, nail bin such as nail bin 10000 for example may include that support section 10010 and tissue are thick Compensating part 10020 is spent, plurality of nail 10030 can be at least by section store in support section 10010, and works as nail 10030 It may extend into tissue thickness compensation part 10020 when in its non-firing position.When nail 10030 is in its non-firing position, The top of nail 10030 is not from 10020 protrusion of tissue thickness compensation part.When nail 10030 does not fire position from it by staple drivers 10040 It sets when moving to its firing position, as described above, the top of nail 10030 may pass through tissue thickness compensation part 10020 and/or pass through Upper layer or crust 10022.In certain alternative embodiments, when nail 10030 is in its non-firing position, 10030 top is followed closely End convex can wear the top surface and/or crust 10022 of tissue thickness compensation part 10020.In either case, when nail 10030 When being extended upward support section 10010 before disposing, nail 10030 can be tilted and/or be deflected relative to support section, together Sample is as described above.Referring now to Figure 32 9, nail bin such as nail bin 13000 for example may include multiple guide members or retainer, this is more A guide member or retainer can be limited in the support section 13010 of nail bin 13000 and the top for the nail being located in nail bin Between relative motion.Referring first to Figure 33 0, nail bin 13000 may include the tissue thickness's compensation for being installed to support section 13010 Part 13020, and furthermore it is attached to multiple absorbent cotton 13022 of the top surface 13021 of tissue thickness compensation part 13020.Often A absorbent cotton 13022 may include being defined in multiple holes 13029 therein, multiple hole can receive slidably therein and/ Or the leg 13022 of guidance nail 13030.Other than hole or hole is replaced, absorbent cotton for example may include any suitable opening, such as Slit, guider, and/or groove, can slidably receive and/or lead leg 13022.As shown in Figure 33 0, work as nail 13030 be in its non-firing position when, the top of nail leg 13032 can be positioned in hole 13029.For example, when nail is in it not When firing position, the top of nail leg 13032 can project into 13022 top of absorbent cotton.Alternatively, when nail 13030 When in its non-firing position, the top of nail leg 13032 can be positioned in the lower section for being located just at absorbent cotton 13022, so that working as When nail 13030 is moved upwardly through tissue thickness compensation part 13020, nail leg 13032 can enter the hole of absorbent cotton 13022 In 13029 and slide through the hole.Under any circumstance, it when the leg 13032 for following closely 13030 is positioned in absorbent cotton, can limit The lateral and/or longitudinal movement of nail leg 13032 processed, and moving upwards for nail leg 13032 is not prevented when following closely 13030 and being disposed. When following closely 13030 and being disposed, referring now to Figure 33 1, nail leg 13032 can upward sliding pass through absorbent cotton 13022, to penetrate tissue T, contact are located in the anvil block on 13030 opposite of nail bin, and deform downwards to capture tissue T and tissue thickness compensation part therein 13030。
Further described above, absorbent cotton 13022 for example can be used at least one biocompatibility and/or can give birth to The adhesive that object absorbs is attached to tissue thickness compensation part 13020.Absorbent cotton 13022 and/or the guarantor extended from each absorbent cotton Holding component can be at least partially embedded in tissue thickness compensation part 13020.For example, tissue thickness compensation part 13020 may include limit Due to the pit therein that can at least partly receive absorbent cotton 13022.In molding manufacturing process, tissue thickness compensation part 13020 can integrally be molded or be shaped around absorbent cotton 13022.Absorbent cotton 13022 may include can move independently of one another from Scattered retainer.Referring first to Figure 33 0, each absorbent cotton 13022 may include interlocking and/or keyed feature structure, the interlocking and/ Or keyed feature structure can allow for simultaneously limiting laterally and longitudinally movement opposite between absorbent cotton 13022 to a certain extent.Example Such as, each absorbent cotton 13022 for example may include protruding portion 13026 and one or more grooves 13027, wherein the first absorbent cotton 13022 protruding portion 13026 can be positioned in the groove 13027 of adjacent the second absorbent cotton and third absorbent cotton 13022, And/or the groove 13027 relative to adjacent the second absorbent cotton and third absorbent cotton 13022 is aligned.Gap may be present in adjacent Absorbent cotton 13022 between, which can make absorbent cotton 13022 be movable with respect to each other or slide, until its contact it is adjacent Absorbent cotton 13022.Absorbent cotton 13022 can be interconnected loosely.Absorbent cotton 13022 can be detachably connected to each other.For example, de- Rouge cotton 13022 can be manufactured such that the absorbent cotton of a piece of interconnection, wherein when applying enough power to the piece, in absorbent cotton 13022 One or more can be detached from other absorbent cotton.Referring again to Figure 32 9, first 13024 of absorbent cotton 13022 can be positioned On the first side of longitudinal slit 13025, and second 13024 of absorbent cotton 13022 can be positioned in the of slit 13025 On two sides.Further described above, extending through the longitudinal slit 13025 of tissue thickness compensation part 13020 can have Tissue thickness compensation part 13020 is passed through conducive to the blade of firing member, and when firing member passes through tissue thickness compensation part, Firing member can be to described 13024 application compressing force, and at least some of makes absorbent cotton 13022 and separate or separation.
Absorbent cotton 13022 can be for example made of biocompatibility and/or bioabsorbable plastics.13022, absorbent cotton It can be such as made of solid material, semisolid material and/or flexible material.Absorbent cotton 13022 is embeddable in tissue thickness compensation part It is interior, so that absorbent cotton 13022 is moved with tissue thickness compensation part.For example, absorbent cotton 13022 can make to be sufficiently flexible Obtaining it can bend with the top surface of tissue thickness compensation part.Absorbent cotton 13022, which is able to maintain, is embedded in tissue thickness's compensation In part, and alternatively, absorbent cotton 13022 can be popped up from tissue thickness compensation part or and tissue thickness compensation part Separation.Absorbent cotton 13022 may include the top surface flushed with the top surface of tissue thickness compensation part.Absorbent cotton 13022 Top surface can be positioned in the top surface above and or below of tissue thickness compensation part.The top surface of absorbent cotton 13022 It is visible when can be disposed so that from the top surface from tissue thickness compensation part, and alternatively, The top surface of absorbent cotton 13022 can for example be positioned in the lower section of the layer of tissue thickness compensation part.Guidance feature structure is for example It can be molded onto the top surface of tissue thickness compensation part.For example, tissue thickness compensation part can not include composite material, and It such as may include integral piece material.
Referring now to Figure 33 8, nail bin for example may include tissue thickness compensation part 13620 and crust or top layer 13621.Example Such as, in one or more absorbent cotton or for example embeddable crust 13621 of retainer 13622.Each retainer 13622 may include The one or more holes 13629 wherein limited, when nail 13030 is in its non-firing position, which can be The nail leg 13032 for wherein receiving nail 13030, as shown in Figure 33 8.Further described above, in use, working as nail 13030 when moving to its firing position from its non-firing position, and nail leg 10032 can be slid through hole 13629, until nail 13030 13031 contact tissue thickness compensation parts 13620 of base portion, and for example compress group against the bottom surface of absorbent cotton 13622 Knit at least part of thickness compensation part 13620.Referring now to Figure 33 3, nail bin for example may include tissue thickness compensation part 13120 And crust or top layer 13122.For example, tissue thickness compensation part 13120 for example may include can be from tissue thickness compensation part 13120 Top surface 13121 the taper lug, protruding portion and/or the protrusion 13128 that upwardly extend.It is not fired when nail 13030 is in it When position, protruding portion 13128 can receive the top with the nail leg 13032 of encapsulated nail 13030, as shown in Figure 33 3.Top layer 13122 may also include taper lug, protruding portion, and/or the protrusion for being aligned with protruding portion 13128 or being at least substantially aligned 13129 in use, and nail leg 10032 can penetrate protruding portion 13128 and 13129, and expose from tissue thickness compensation part 13120. Referring now to Figure 33 7, nail bin for example may include tissue thickness compensation part 13520 and crust or top layer 13522.For example, crust 13522 for example may include the taper lug that can be upwardly extended from the top surface 13521 of tissue thickness compensation part 13520, protrusion Portion and/or protrusion 13529.Similarly as described above, when nail 13030 is in its non-firing position, protruding portion 13529 can The top with the nail leg 13032 of encapsulated nail 13030 is received, as shown in Figure 33 7.In use, nail leg 10032 can penetrate protruding portion 13529 and from crust 13522 expose.
Referring now to Figure 33 4, nail bin for example may include tissue thickness compensation part 13220 and crust or top layer 13222.Example Such as, tissue thickness compensation part 13220 for example may include the top surface that can extend downwardly into tissue thickness compensation part 13220 Pyramidal pits and/or groove 13128 in 13221.When nail 13030 is in its non-firing position, the top of nail leg 13032 can Groove 13128 is extended through, as shown in Figure 33 4.Top layer 13222 may also include can be aligned or at least substantially with groove 13228 The pyramidal pits and/or groove 13229 of alignment.Referring now to Figure 33 5, nail bin for example may include tissue thickness compensation part 13320 And crust or top layer 13322.For example, crust 13320 may include the top that can extend downwardly into tissue thickness compensation part 13320 Thick part 13329 in surface 13321.In various embodiments, when nail 13030 is in its non-firing position, thick portion Divide 13329 can follow closely at least part of 13030 nail leg 13032 in wherein reception, as shown in Figure 33 5.In such cases, Nail leg 13032 can be held in place by thick part 13329, so that leg 13032 and being located in tissue thickness compensation part The nail shapes pit of the anvil block on 13320 opposites is aligned or is at least substantially aligned.Referring now to Figure 33 6, nail bin for example may include Tissue thickness compensation part 13420 and crust or top layer 13422.For example, crust 13422 may include can be from tissue thickness compensation part The thick part 13429 that 13420 top surface 13421 upwardly extends.In various embodiments, when nail 13030 is in it not When firing position, thick part 13429 can be in at least part for the nail leg 13032 for wherein receiving nail 13030, such as Figure 33 6 It is shown.In such cases, nail leg 13032 can be held in place by thick part 13429, so that leg 13032 and positioning It is aligned in the nail shapes pit of the anvil block on 13420 opposite of tissue thickness compensation part or is at least substantially aligned.
Referring now to Figure 33 9 and 340, nail bin for example may include tissue thickness compensation part 13720 and crust or top layer 13721.For example, tissue thickness compensation part 13720 for example may include can be from the top surface of tissue thickness compensation part 13720 13721 tapers upwardly extended and/or staged lug, protruding portion and/or protrusion 13728.It is not hit when nail 13030 is in it When sending out position, protruding portion 13728 can receive and the top of the nail leg 13032 of encapsulated nail 13030, as shown in Figure 34 0.It is similar Ground, top layer 13721 may include the taper and/or staged lug, prominent that can be aligned with protruding portion 13728 or at least substantially be aligned Portion, and/or protrusion 13729 out.Crust 13721 may also include the one or more teeth upwardly extended from protruding portion 13729 13727, which can be engaged against the tissue of the positioning of top layer 13721, and prevent or be at least limited in tissue, top layer 13721 and/or nail leg 13032 top between opposite lateral and/or longitudinal movement.In use, when nail 13030 from its When non-firing position moves to its firing position, nail leg 13032 can penetrate protruding portion 13728 and 13729 and mend from tissue thickness Repay the exposing of part 13720.Referring now to Figure 34 1 and 342, nail bin for example may include tissue thickness compensation part 13820 and crust or Top layer 13821.For example, tissue thickness compensation part 13820 for example may include can be from the top surface of tissue thickness compensation part 13820 13821 tapers upwardly extended and/or staged lug, protruding portion and/or protrusion 13828.It is not hit when nail 13030 is in it When sending out position, protruding portion 13828 can receive and the top of the nail leg 13032 of encapsulated nail 13030, as shown in Figure 34 2.It is similar Ground, top layer 13821 may include the taper and/or staged lug, prominent that can be aligned with protruding portion 13828 or at least substantially be aligned Portion, and/or protrusion 13829 out.Top layer 13821 may also include one extended downwardly into tissue thickness compensation part 13820 or Multiple teeth 13827, the tooth can for example prevent or at least limit top layer 13821 and tissue thickness compensation part 13820 Between opposite lateral and/or longitudinal movement.In use, when nail 13030 moves to its firing position from its non-firing position When, nail leg 10032 can penetrate protruding portion 13828 and 13829 and expose from tissue thickness compensation part 13820.
Referring now to Figure 34 3, nail bin may include tissue thickness compensation part such as tissue thickness compensation part 13920, the tissue Thickness compensation part for example may include being defined in ridge 13923 therein and paddy 13924, paddy 13924 can be limited at ridge 13923 it Between.Each ridge 13923 may include identical height, substantially the same height or different height.Similarly, Mei Gegu 13924 may include identical depth, substantially the same depth or different depth.Multiple nails 13030 can be stored at least partly In tissue thickness compensation part 13920, so that the top of nail 13030 can be positioned in ridge 13923.For example, when 13030 quilts of nail When being stored in its non-firing position, the nail leg 13032 for following closely 13030 for example can not be from tissue thickness compensation part 13920 and/or attachment To 13921 protrusion of crust or top layer of tissue thickness compensation part 13920.Ridge 13923 and/or paddy 13924 can be lateral across nail bin Extend.For example, nail bin may include longitudinal knife slot, median ridge 13923 and paddy 13924 can be narrow transverse to and/or perpendicular to knife The direction of slot extends.In all cases, the top of nail leg 13032 can be held in place by ridge 13923, until nail 13030 move to its firing position from its non-firing position.Referring now to Figure 34 4, tissue thickness compensation part and/or covering tissue The crust of thickness compensation part may include longitudinal ridge and/or paddy.For example, tissue thickness compensation part may include by ridge 14023 and paddy 14024 top surfaces limited, wherein paddy 14024 can for example be limited between ridge 14023.Tissue thickness compensation part may include Crust 14021, the crust may include being defined in multiple holes 14029 therein, and each hole can respectively receive nail leg 13032.Hole 14029 can be limited in ridge 14023, and wherein the top of nail leg 13032 can be positioned in 14028 lower section of peak of ridge 14029, quilt It is positioned to flush with peak 14028, and/or is positioned in 14028 top of peak.In addition to the above or replacement is described above, Hole 14029 can be for example limited in paddy 14024.Each hole, which can be for example embossed, to be surrounded or at least partially surrounding the embossing can Enhancing surrounds the crust and/or tissue thickness compensation part in hole.Under any circumstance, further described above, crust 14021 can be attached to tissue thickness compensation part in any suitable manner, for example including using at least one adhesive.
As described above and referring again to Figure 23 3, surgery suturing appliance for example may include anvil block such as anvil block 10060, the anvil Seat can move between the open and the closed positions, for example to press against the tissue thickness compensation part 10020 of nail bin 10000 Contracting tissue T.In all cases, anvil block 10060 can be rotated towards nail bin 10000, until its move downward by nail bin 10000 certain Part and/or certain part in channel that nail bin 10000 is located are prevented.In at least one such embodiment, anvil block 10060 It can be rotated down, until it moves downward the nose 10003 by nail bin 10000 and/or is located in nose 10003 and nail bin Tissue T among 10000 is resisted.In some cases, anvil block 10060 can sufficiently compress tissue thickness compensation part 10020, with Make the top of tissue T contact stud 10030.In some cases, according to the thickness of tissue T, anvil block 10060 can sufficiently compress tissue Thickness compensation part 10020, so that anvil block 10060 connects with nail 10030 until anvil block 10060 arrived its fully closed position Touching.In other words, in such cases, before firing member 10052 is advanced in nail bin 10000 with percussion nail 10030, Anvil block 10060 can make 10030 deformation of nail.Such situation is acceptable in certain embodiments；However referring now to 8 He of Figure 35 359, it is contemplated to other embodiments.In the other embodiments, such as distant gap can be used to set element such as element 10059 limit following distance: before trigger shaft 10052 is advanced in nail bin 10000, anvil block 10060 can be in the distance Place is closed.Element 10059 can be upwardly extended from the top surface 10021 of tissue thickness compensation part 10020, so that working as tissue T When rest element 10059 is compressed and generates drag therebetween, moving downward for anvil block 10060 can be prevented from.In use, such as It is upper described, firing member 10052 can the distal end 10002 towards distal side towards nail bin 10000 be advanced in nail bin 10000, with Just nail 10030 is projected from support section 10010.Meanwhile the engageable anvil block 10060 of firing member 10052, and by anvil block 10060 are located on the nail 10030 just shaped, the expectation of platform surface 10011 (Figure 21 8) away from support section 10010 away from From.In this way, firing member 10052 can control the tissue contacting surface of anvil block 10060 and the platform surface in particular locations The distance between 10011 or gap.Wherein, when firing member 10052 is pushed into towards distal side, which can be towards distal side quilt It promotes.In all cases, which can be shorter than the gap between anvil block 10060 and platform surface 10011, the gap by Distant gap setting element 10059 at the distal end of tissue thickness compensation part 10020 is controlled or is determined.Referring now to figure 359, when firing member 10052 reaches the distal end of tissue thickness compensation part 10020, the blade of firing member 10052 10053 can crosscutting distant gap set element 10059 so that after element 10059 has been crosscut, firing member 10052 Anvil block 10060 can be pulled downwards towards support section 10010, and when the percussion nail 10030 at the distal end of nail bin 10000 When, by gap-closing to desired clearance height.In certain alternative embodiments, when firing member is last close to the distal side of nail bin When end, distant gap setting element can collapse.For example, distant gap setting element may include pillars, which can be such as The upper resistance provided for anvil block, and once reach setting member in gap when distal end of the firing member close to nail bin The fastening intensity of part, then then the pillars clasp suddenly.The tightening force may be, for example, about 10 ft lbfs.When to gap sets element When applying for example more than the power of predetermined amount, gap sets element can be dropped downward into the platform of support section.As other one Kind selection, distant gap can be controlled by the nose of nail bin.For example, moving downward for anvil block 10060 can be limited by nose, until hitting Hair component arrived the distal end in storehouse, wherein the compressing force for being applied to nose can make nose collapse at this time.Nose may include by The chamber that cavity wall limits.Once the compressing force for being applied to chamber is more than predetermined power, then chamber can be made to collapse.For example, chamber can be by can The wall collapsed limits.
As described above, anvil block such as anvil block 10060 can for example move between the open and the closed positions, so as in anvil Tissue thickness compensation part is compressed between seat and the support section of nail bin.In some cases, referring now to Figure 36 0 and 361, work as group When knitting thickness compensation part 14120 and being compressed against the support section 14110 of nail bin 14100, the tissue thickness compensation part of nail bin is all As the tissue thickness compensation part 14120 of nail bin 14100 for example can lateral and/or Longitudinal Extension.Tissue thickness compensation part 14120 End and/or side can not be supported part 14110 and/or anvil block 10060 constrains.Therefore, in tissue thickness compensation part 14120 In the case where not generating compression pressure or at least unexpected compression pressure inside, tissue thickness compensation part 14120 can be along those sides To extension.In such cases, firing member is such as across the firing member 10052 (Figure 23 6) of tissue thickness compensation part 14120 Such as it can will not be by the improper prevention of compressing force unexpected in tissue thickness compensation part 14120.Alternatively, again Referring to Figure 36 0, the distal end 14125 of tissue thickness compensation part 14120 can for example be constrained by the nose 14103 of nail bin 14100. In this specific embodiment, similarly as described above, the distal end 14125 of tissue thickness compensation part 14120 can be by nose 14103 constraints, to reduce a possibility that tissue thickness compensation part 14120 is with 14110 premature disengagement of support section.In any feelings Under condition, due to described above, big internal pressure be can produce in distal end 14125, which can prevent percussion structure The propulsion of part 10052, especially when firing member 10052 reaches distal end 14125.More specifically, in some cases, when When 10052 transecting patient tissue thickness compensation part 14120 of firing member, firing member can be pushed towards distal side, plough removes, and/or transfer group Knit thickness compensation part 14120.Therefore, even greater internal pressure can produce in the distal side of tissue thickness compensation part 14120 end In end 14125.In order at least partly eliminate the pressure in tissue thickness compensation part 14120, nose 14103 can be by flexible material It constitutes.The flexible material can make nose 14103 for example towards distal flex, and for tissue thickness compensation part 14120 generate it is additional Space.Referring now to Figure 36 2 and Figure 36 3, the nose of nail bin may include the part that can be slided towards distal side.More specifically, nail bin 14200 nose 14203 may include slidably part 14204, and slidably part can be slidably attached to nose for this 14203, so that when anvil block 10060 is closed and/or firing member 10052 is advanced in the distal end of nail bin 14200, Slidably part 14204 can be slided towards distal side and be that tissue thickness compensation part 14200 generates additional space, and at least partly Alleviate internal pressure therein.Nose 14203 and slidably one of part 14204 may include one or more guide rails, and And nose 14203 and slidably the other of part 14204 may include can wherein slidably receive one of guide rail or Multiple channels.Limitation slidably movement of the part 14204 to longitudinally distal channel for example, channel and guide rail can for example cooperate.
In all cases, further described above, such as farthest side nail in nail bin can for example capture tissue Nearside in the ratio nail bin of thickness compensation part follows closely bigger part.It in this case, therefore, can for compared to nearside nail The tissue distad captured in nail applies big clamping pressure.As described above, although tissue thickness compensation part can be by with base The material of the substantially homogeneity of constant thickness is constituted in sheet, but works as at least part of tissue thickness compensation part during use When being transferred to and/or be gathered at the distal end of nail bin, it may occur in which these situations.In all cases, it is expected that certain nails Apply bigger clamping pressure to tissue compared with other nails, wherein support section and/or tissue thickness compensation part can be constructed At and be arranged to control which nail can apply biggish clamping force to tissue and which nail can apply lesser folder to tissue Compaction forces.Referring now to Figure 36 4, nail bin 14300 may include support section 14310, and in addition to this be located in support section Tissue thickness compensation part 14320 on 14310 platform surface 14311.With present patent application disclosed in include have it is flat The other embodiments of the support section 14310 of smooth or at least substantially flat platform surface are compared, and platform surface 14311 can It tilts and/or declines between the distal end 14305 and proximal extremity 14306 of support section 14310.Support section 14310 Platform surface 14311 may include podium level at its distal end 14305, which is lower than its proximal extremity Podium level at 14306.For example, the nail 10030 at the distal end of nail bin 14300 is compared to the nail at proximal extremity 10030 may extend into the bigger distance in 14311 top of platform surface.In various alternative embodiments, the platform of support section Surface may include the height at its distal end, this is highly higher than the height at its proximal extremity.Referring again to Figure 36 4, tissue Thickness compensation part 14320 may include the thickness different along its longitudinal length.Tissue thickness compensation part 14320 for example may include that it is remote Thickness at side end 14325, the thickness are thicker than its proximal extremity 14326.For example, tissue thickness compensation part 14322 may include Bottom surface 14322, the bottom surface tiltable or decline are inclined with matching or at least substantially matching support section 14310 Oblique or decline platform surface 14311.Therefore, the top of tissue thickness compensation part 14320 or tissue contacting surface 14321 can wrap The flat of tissue T or at least substantially flat surface can be located above by including.Under any circumstance, since tissue thickness is mended It is thicker at its distal end 14325 to repay part 14320, thus distal side nail 10030 compared to nearside nail 10030 can capture it is therein The major part of tissue thickness compensation part 14320.Therefore, distal side nail 10030 can apply bigger compressing force to tissue T, especially When the clearance distance between anvil block 10060 and platform surface 14311 is constant at the proximal extremity and distal end of nail bin Or when at least substantially constant.However in some cases, anvil block 10060 possibly can not reach fully closed position, therefore Clearance distance between anvil block 10060 and platform surface 14311 at the distal end of nail bin 14300 than at proximal extremity more Greatly.In all cases, distal side nail 10030 may be fully formed, therefore distal side nail 10030 may not apply to tissue T Desired clamping pressure.In tissue thickness compensation part embodiment thicker at the distal end of nail bin, tissue thickness's compensation Part can compensate for unshaped nail and apply enough pressure to tissue T.
Referring now to Figure 36 5, nail bin such as nail bin 14400 for example may include support section 14410 and in addition to this by The tissue thickness compensation part 14420 being located on the platform surface 14411 of support section 14410.It is similarly as described above, platform 14411 tiltable of surface and/or decline, so that the distal end 14405 of support section 14410 can for example have lower than nearside end Hold the podium level of the podium level at 14406.Tissue thickness compensation part 14420 may include constant or at least base along its length Constant thickness in sheet.And therefore, the top of tissue thickness compensation part 14420 or tissue contacting surface 14421 can be parallel to Or the profile at least substantially parallel to platform surface 14411.When nail 10030 is in its non-firing position, nail bin 14400 Nail 10030 can be completely embedded into tissue thickness compensation part 14420 and support section 14410.Position is not fired when nail 10030 is in it When setting, tissue thickness compensation part 14420 and branch can be completely embedded by being positioned in the nail 10030 at the proximal extremity of nail bin 14400 In support part point 14410；And due to the decline slop of platform 14411 and top surface 14421, it is not fired when nail 10030 is in it When position, the top of 10030 (nails 10030 at the distal end including being positioned in nail bin 14400) of certain nails convex can wear group Knit the top surface 14421 of thickness compensation part 14420.
As described above, tissue thickness compensation part can be made of homogenous material, wherein entire tissue thickness compensation part can be such as Having the same from beginning to end or at least substantially identical material property, such as density, rigidity, device of spring stiffness coefficient, hardness, And/or elasticity.Alternatively, referring now to Figure 36 8, tissue thickness compensation part such as tissue thickness compensation part 14520 for example may include multiple material or material layer.Tissue thickness compensation part 14520 may include first or central stratum 14520a, It is attached to the second or middle layer 14520b of first layer 14520a on opposite sides thereof, and is attached in second layer 14520b The third or outer layer 14520c of each.At least one adhesive can be used that middle layer 14520b is attached to central stratum 14520a, and similarly, at least one adhesive can be used that outer layer 14520c is attached to the second layer 14520.In addition to bonding Except agent or replace adhesive, such as can be by one or more interlocking features structures and/or fastener by layer 14520a- 14520c keeps together.Under any circumstance, internal layer 14520a for example can be by the first material with first group of material property It constitutes；Middle layer 14520b can be made of the second material with second group of material property；And outer layer 14520c can be by having The third material of third group material property is constituted.This several groups of material properties for example may include density, rigidity, device of spring stiffness coefficient, Hardness, and/or elasticity.Nail bin for example may include six nails 10030, wherein a nail 10030 for example at least can be positioned partially In each of outer layer 14520c and in each of internal layer 14520b, and wherein two rows nail 10030 can be at least It is partially positioned in internal layer 14520a.In use, similarly as described above, nail 10030 can be projected from nail bin, so that nail 10030 nail leg 10032 penetrates the top surface 14521 of tissue thickness compensation part 14520, penetrates by anvil block against top surface 14521 and position tissue and then contact anvil block so that leg 10032 deformation with capture nail 10030 in tissue thickness compensate Part 14520 and tissue.Be also similar to it is described above, when firing member is advanced through nail bin, tissue thickness compensation part 14520 It can be crosscutting by firing member.For example, firing member for example can be along the crosscutting internal layer 14520a in path and group limited by axis 14529 It knits.
Further described above, the multiple rows of nail 10030 being located in internal layer 14520a may include closest to horizontal The staple at the edge for the tissue cut.Correspondingly, the multiple rows of nail 10030 being located in outer layer 14520c may include from the group being crosscut The farthest staple in the edge knitted.The first material for constituting internal layer 14520a for example may include higher than constituting the of middle layer 14520b The density of two materials；And similarly, the density of the second material can be higher than the density for constituting the third material of outer layer 14520c.? In various situations, therefore, compared to the compression generated in the nail 10030 being positioned in middle layer 14520b and outer layer 14520c For power, bigger compressing force can generate in the nail 10030 being located in internal layer 14520a.Similarly, compared to being determined For the compressing force that position generates in the nail 10030 in outer layer 14520c, bigger compressing force can be located in middle layer It is generated in nail 10030 in 14520b.Alternatively, it for example may include low for constituting the first material of internal layer 14520a In the density for the second material for constituting middle layer 14520b；And similarly, the density of the second material can be lower than composition outer layer The density of the third material of 14520c.In all cases, therefore, compared to being positioned in middle layer 14520b and internal layer For the compressing force generated in nail 10030 in 14520a, bigger compressing force can be in the nail being located in outer layer 14520c It is generated in 10030.Similarly, for compared to the compressing force generated in the nail 10030 being positioned in internal layer 14520a, more greatly Compressing force can be generated in the nail 10030 being located in middle layer 14520b.Alternatively, it can be used any Layer, material and/or the material property of other suitable constructions.Under any circumstance, the layer of tissue thickness compensation part 14520 14520a-14520c can keep being attached to each other after being implanted.Alternatively, tissue thickness compensation part 14520 Layer 14520a-14520c can be separated from each other after being implanted.For example, layer 14520a-14520c can utilize it is one or more Bioabsorbable adhesive combines, which can remain to one for layer first It rises, then makes layer from discharging each other over time.
As described above, the tissue thickness compensation part of nail bin such as tissue thickness compensation part 14520 for example may include multiple vertical To layer.Alternatively, referring now to Figure 36 9, nail bin may include that tissue thickness compensation part such as tissue thickness compensates Part 14620, the tissue thickness compensation part for example may include multiple level courses.For example, tissue thickness compensation part 14620 may include One or bottom 14620a, the second or middle layer 14620b for being attached to bottom 14620a, and it is attached to middle layer 14620b's Third or top layer 14620c.First layer 14620a for example may include flat or substantially flat bottom surface 14626a and The top surface 14625a of triangle or taper.For example, second layer 14620b may include the bottom surface of triangle or taper 14626b, the bottom surface can be parallel to and abut the top surface 14625a of first layer 14620a.It is similarly as described above, the Two layers of 14620b may include the top surface 14625b of triangle or taper, which can for example be parallel to and abut third The layer bottom triangle of 14620c or the bottom surface 14626c of taper.The top surface of third layer 14626c may include flat Or at least substantially flat tissue contacting surface 14621.It is also similar to described above, tissue thickness compensation part 14620 is for example Six rows nail such as nail 10030 can be at least partly stored wherein, and wherein firing member for example can be along extending through axis Tissue thickness compensation part 14620 between the crosscutting two innermost staples in 14629 channel.It is similarly as described above, each Layer 14620a, 14620b and 14620c can be made of the different materials including dissimilar material properties, and due to layer 14620a- The triangle or conical configuration of 14620c, tissue thickness compensation part 14620 can have different totality in it at each position Characteristic.For example, outermost staple 10030 can capture third layer 14620cs more more than first layer 14620a wherein, and most The staple 10030 of inside can capture third layer 14620c more less than first layer 14620a.Therefore, although tissue thickness compensation part 14620 can have across the identical of its or at least substantially identical general thickness, but tissue thickness compensation part 14620 It such as can be different from the mode for the tissue that compression is trapped in most inner side nail 10030 and be trapped in outermost nail to compress Tissue in 10030.
Referring now to Figure 28 6, the tissue thickness compensation part 14720 of the tissue thickness compensation part of nail bin such as nail bin 14700 Such as may include being defined in the changed gap of the thickness therein for making tissue thickness compensation part 14720, pit, channel, And/or groove.For example, tissue thickness compensation part 14720 can be against the platform surface of the support section 14710 of nail bin 14700 14711 positioning so that the gap 14723 being limited in the bottom surface 14722 of tissue thickness compensation part 14720 can overlay on it is certain Nail cavity 10012 is above rather than in other nail cavities.It gap 14723 for example can be transverse to the cutter slit of support section 14710 14715, perpendicular to cutter slit 14715, and/or it is parallel to the extension of cutter slit 14715.Gap 14723 can be compensated in tissue thickness Bearing surface pattern is limited in the bottom surface 14722 of part 14720.Under any circumstance, when nail such as nail 10030 is for example from support When part 14710 is disposed, referring now to Figure 28 7 and 288, certain nails 10030 can capture in the region comprising gap 14723 Tissue thickness compensation part 14720；And other nails 10030 can capture tissue thickness in the region being located among gap 14723 Spend compensating part 14720.In addition to the above or replacement is described above, and tissue thickness compensation part 14720 for example may include limit It is scheduled on top or the gap in tissue contacting surface 14721, pit, channel, and/or groove.Referring now to Figure 36 6 and Figure 36 7, Nail bin 14800 may include tissue thickness compensation part 14820, which may include multiple bearing surfaces 14823, this is more A bearing surface is, for example, at least one of following situations: being prolonged upwards from the top surface 14821 of tissue thickness compensation part 14820 It stretches, extend internally towards central groove 14825, and/or extend towards the distal end of nail bin 14800 towards distal side.For example, bearing surface 14823 can for example be separated by channel, slit and/or groove such as channel 14824.In all cases, due to described above, The general thickness of tissue thickness compensation part can change between staple and/or change between the nail in staple.In certain situations Under, the part of bearing surface or thickness may be structured to and be arranged so that when tissue thickness compensation part is compressed, bearing surface or thickness Part such as can inwardly be flowed along desired direction.
Referring now to Figure 30 3, nail bin such as nail bin 14900 for example may include support section 14910 and in addition to this support The tissue thickness compensation part 14920 positioned by support section 14910.Similarly as described above, support section 14910 may include The staple drivers that can be lifted up by nail deployment sliding part, to lift nail such as nail 10030, the nail is for example towards anvil block, such as It is positioned in the anvil block 10060 on 14900 opposite of nail bin and is at least partially positioned in support section 14910.Support section 14910 for example may include six nail chambers, such as the nail chamber of two rows of nail cavities in outside, inside, and be located in inboard row and outer The intermediate intermediate two rows of nail cavities of side row, wherein anvil block 10060 may include that six for being aligned with nail cavity or being at least substantially aligned line up Shape pit 10062.Inboard row nail cavity may include the staple drivers 14940a being positioned in；Intermediate row nail cavity may include being located in Staple drivers 14940b therein；And outboard row nail cavity may include the staple drivers 14940c being positioned in.Wherein nail drives Each of dynamic device 14940a may include the bracket 14949a for capableing of support nail 10030；Wherein in staple drivers 14940b Each may include the bracket 14949b for capableing of support nail 10030；And wherein each of staple drivers 14940c can be wrapped Include the bracket 14949c for capableing of support nail 10030.At its non-firing position, that is, when staple drivers 14940a-14940c is set to When extending on the driver supporting element 14926 below support section 14910, compared to the bracket of staple drivers 14940b The bracket 14949a of the bracket 14949c of 14949b and staple drivers 14940c, staple drivers 14940a can be closer to anvil blocks 10060 positioning.In such position, the first forming distance can be limited at bracket 14949a and be located in above bracket 14949a Between forming pit 10062；Second forming distance can be limited at bracket 14949b and be located in above bracket 14949b at Between shape pit 10062；And third forming distance can be limited at bracket 14949c and be located in above bracket 14949c Between forming pit 10062.Wherein such as the first forming distance can be shorter than the second forming distance, and the second forming distance can be short In third forming distance.When staple drivers 14940a-14940c moves to its firing position from its non-firing position (Figure 30 3) When, each staple drivers 14940a-14940c can move upwards equal or at least base towards anvil block 10060 by nail deployment sliding part Equal distance in sheet, so that its respective nail 10030 is driven the first forming height by the first driver 14940a；Second driving Its respective nail 10030 is driven the second forming height by device 14940b；And third driver 14940c is by its respective nail 10030 driving third forming heights.Wherein, such as the first forming height can be shorter than the second forming height, and the second forming is high Degree can be shorter than third forming height.Various other embodiments are contemplated, wherein the first staple drivers 14940a is by upward displacement One distance；Second staple drivers 14940b is by upward displacement second distance, and third staple drivers 14940c is by upward displacement Third distance.Wherein, one or more of first distance, second distance, third distance can be different.
Referring again to Figure 30 3, relative to the tissue contacting surface 10061 of anvil block 10060, the platform of support section 14910 Surface 14911 can be varied in height.The height change can be in lateral upper generation, and surrounds the platform of inboard row nail cavity The height on surface 14911 can for example be higher than the height of the platform surface 14911 around outboard row nail cavity.Tissue thickness compensation part 14920 bottom surface 14922 can be parallel to or at least substantially parallel to support section 14910 platform surface 14911.It is right It is described further above, tissue thickness compensation part 14920 can be also varied on thickness.Wherein tissue thickness compensation part 14920 top or tissue contacting surface 14921 can slope inwardly from its outer edge or lateral edge.For example, by institute above It states, tissue thickness compensation part 14920 for example can be relatively thin in the region being located in above inboard row nail cavity, and is being positioned It is thicker in region above the outboard row nail cavity.Referring now to Figure 30 4, the platform surface of support section 15010 for example may include Staged platform surface, wherein the highest step of stepped surface can for example surround inboard row nail cavity, and stepped surface Minimum step can surround outboard row nail cavity.For example, the step with intermediate altitude can surround intermediate row nail cavity.Tissue thickness's compensation Part such as tissue thickness compensation part 15020 for example may include bottom surface, which can be parallel to and abut support section 15010 platform surface.The top of tissue thickness compensation part or tissue contacting surface 15021 for example may include bowed, parabolic Line and/or curved surface, the surface can extend to tissue thickness from the first cross side of tissue thickness compensation part 15020 Second cross side of compensating part 15020, wherein vertex is for example aligned with the center of nail bin 15000 or is at least substantially aligned.It is existing Referring to fig. 2 99, nail bin 15300 for example may include support section 15310, be movably positioned in and be defined in support section Multiple staple drivers 15340 in nail cavity in 15310, and it is located in 15311 top of platform surface of support section 15310 Tissue thickness compensation part 15320.Nail bin 15300 may also include one or more flats of bottom 15326, which can be attached Be connected to support section 15310 and extend to the bottom periphery of support section 15310, and supporting driver 15340 and in its not The nail 15330 of firing position.When nail deployment sliding part is advanced through nail bin, as sliding part is by 15340 He of staple drivers Nail 15330 is lifted up across tissue thickness compensation part 15320, and sliding part can also be supported by bottom flat of bottom 15326.Tissue Thickness compensation part 15320 may include first or interior section 15322a, the row of being centrally positioned being located in above inboard row nail cavity Second above nail cavity or middle section 15322b, and it is located in third or exterior section 15322c above a nail chamber. Wherein, such as interior section 15322a can be thicker than middle section 15322b, and middle section 15322b can be thicker than exterior section 15322c.Tissue thickness compensation part 15320 for example may include being defined in vertical passage therein, which can produce tissue The thinner part 15322b and 15322c of thickness compensation part 15320.Alternatively, vertical passage can be limited at group It knits in the top surface and/or bottom surface of thickness compensation part.The top surface 15321 of tissue thickness compensation part 15320 is for example It may include flat or at least substantially flat surface.
Referring now to Figure 29 6, nail bin for example may include tissue thickness compensation part such as tissue thickness compensation part 15120, should Tissue thickness compensation part may include multiple portions with different thickness.Tissue thickness compensation part 15120 may include can have First or interior section 15122a of one thickness, from first part 15122a extend can respectively with second thickness second or Middle section 15122b, and the third or exterior section can respectively with third thickness extended from second part 15122b 15122c.For example, third thickness can be thicker than second thickness, and second thickness can be thicker than first thickness, but for example it is various its Any suitable thickness can be used in his embodiment.The part 15122a-15122c of tissue thickness compensation part 15120 may include tool There is the step of different-thickness.Similarly as described above, nail bin may include several nails 10030 and multiple nails with different height Driver, the staple drivers can make nail 10030 be deformed into different forming heights.It is also similar to described above, nail bin may include First staple drivers 15140a can drive 10030 to the first forming height of nail, the second staple drivers being supported on 15140b can drive 10030 to the second forming height of nail and third staple drivers being supported on, can drive branch Support nail 10030 on it is to third forming height.Wherein, such as the first forming height can be shorter than the second forming height, and Second forming height can be shorter than third forming height.As shown in Figure 29 6, each nail 10030 may include identical or substantially phase Same unshaped or non-firing height.Alternatively, referring now to Figure 29 6A, the first driver 15140a, second The sustainable nail with different unshaped height of driver 15140b and/or third driver 15140c.For example, the first nail driving Device 15140a sustainable nail 15130a, the second staple drivers 15140b with the first unshaped height be sustainable not to be had second not The nail 15130b of forming height, and the sustainable nail 15130c with third unshaped height of third staple drivers 15140c, Wherein, such as the first unshaped height can be shorter than the second unshaped height, and the second unshaped height can be shorter than third not at Shape height.Referring again to Figure 29 6A, the top for following closely 15130a, 15130b and/or 15130c can be located at or be at least substantially positioned at In identical plane, and alternatively, the top of nail 15130a, 15130b and/or 15130c can not be located at identical In plane.Referring now to Figure 29 7, nail bin may include the tissue thickness compensation part 15220 with multiple portions, multiple part tool There is different thickness, which can be located against tissue T by nail 15130a, 15130b and 15130c and be implanted into, As described above.Referring now to Figure 29 8, following closely 15130a, 15130b and/or 15130c can be deformed to different forming heights, wherein First nail 15130a can shape as the first forming height, and the second nail 15130b can shape as the second forming height, and third is followed closely 15130c can shape as third forming height, and wherein the first forming height can for example be shorter than the second forming height, and Two forming heights can be shorter than third forming height.Other embodiments are contemplated, wherein nail 15130a, 15130b and 15130c can be at Shape is any suitable forming height and/or any opposite forming height.
As described above, the anvil block of surgery suturing appliance can move between the open and the closed positions.In such case Under, when anvil block moves to its closed position, the tissue contacting surface of anvil block is moveable to its final or shaping position.Once Anvil block is in its closed position, and tissue contacting surface can no longer be adjustable.Alternatively, referring now to figure 351, surgical stapling device such as surgical stapling device 15500 for example may include anvil channel 15560 and be located in anvil channel Adjustable tissue in 15560 contacts anvil adjustment plate 15561.In such cases, anvil plate 15561 can be in anvil channel It is elevated and/or reduces in 15560, to adjust anvil plate 15561 relative to the nail bin for being located in 15561 opposite of anvil plate Tissue contacting surface position.Surgical stapling device 15500 may include adjusting slider 15564.Referring to Figure 35 6 and 357, the adjusting Sliding block can in 15561 middle slip of anvil channel 15560 and anvil plate, so as to control between anvil plate 15561 and nail bin away from From.Referring again to Figure 35 1 and 352, surgical stapling device 15500 may also include the actuator for being attached to adjusting slider 15564 15562, which can proximally slide to slide adjusting slider 15564 proximally, and/or slide towards distal side to make Adjusting slider 15564 is slided towards distal side.Referring again to Figure 35 6 and 357, actuator 15562 can limit in advance at two or more It is slided between fixed position, to adjust anvil plate 15561 between two or more positions respectively.It is such in advance to limit Position can for example be divided into line of demarcation 15563 (Figure 35 1) on surgical stapling device 15500.Referring to Figure 35 7, adjusting slider 15564 for example may include multiple support surfaces, such as the first support surface 15565a, the second support surface 15565b and third branch Surface 15565c is supportted, multiple support surface can position surface in alignment with multiple plates on the back side of anvil plate 15561 respectively, all If the first positioning surface 15569a, the second positioning surface 15569b and third position surface 15569c, so as to by anvil plate 15561 It is located in first position.In order to which by the positioning of anvil plate 15561, in the second position, actuator 15562 and sliding block 15564 for example may be used It proximally slides, so as to the positioning surface by the support surface 15565a-15565c of sliding block 15564 relative to anvil plate 15561 15569a-15569c is realigned.More specifically, referring to Figure 35 6, sliding block 15564 can be slided towards distal side, so that sliding block 15564 The first support surface 15565a can be positioned in behind the second positioning surface 15569b of anvil plate 15561, and to slide Second support surface 15565b of block 15564 can be positioned in behind the third positioning surface 15569c of anvil plate 15561, so as to Anvil plate 15561 is moved to closer to nail bin.When anvil plate 15561 moves to its second position from its first position, In this case, adjustable anvil plate 15561 can further tissue T of the compression set between anvil plate 15561 and nail bin.It removes Except described above, when anvil plate 15561 is conditioned and the forming pit being limited in anvil plate 15561 will be moved to more When close to and/or further from nail bin, the forming height of nail can be controlled by anvil plate 15561 relative to the position of nail bin.Although Foregoing describes only two positions, but sliding block 15564 is slid into appropriate number of position, and anvil plate 15561 is transported It moves closer to and/or further from nail bin.Under any circumstance, once anvil plate 15561 has been properly oriented, nail deployment sliding Part 15550 can slide in nail bin towards distal side, so that staple drivers 15540 and nail 15530 are lifted and stitched towards anvil plate 15561 Tissue T is closed, as shown in Figure 35 4.Similar surgical stapling device is disclosed on 2 28th, the 2011 entitled " SURGICAL submitted The U.S. Patent application 13/036,647 of STAPLING INSTRUMENT ", the entire disclosure are incorporated by reference this Text.
Referring now to Figure 35 3, nail bin can be positioned in the staple cartridge channel 15570 of surgical stapling device 15500, and the nail bin is logical Road for example may include tissue thickness compensation part, such as tissue thickness compensation part 15520.As described above, working as anvil plate 15561 towards nail When storehouse moves, the compressible tissue thickness compensation part 15520 of anvil plate 15561 and/or it is located in anvil plate 15561 and tissue thickness Tissue T among compensating part 15520.Referring to Figure 35 5, when nail 15530 is disposed from nail bin, nail 15530 can be against tissue T pressure Contract implanting tissue thickness compensation part 15520.When anvil plate 15561 is positioned against sliding block 15564 and organizes not to be placed in also It, can be when anvil plate 15561 be in first position in anvil plate when between anvil plate 15561 and tissue thickness compensation part 15520 Gap is limited between 15561 and the top surface 15521 of tissue thickness compensation part 15520.When anvil plate 15561 moves to second When position, anvil plate 15561 can contact tissue thickness compensation part 15520.Alternatively, when anvil plate 15561 supports When positioning by sliding block 15564 and organize not to be placed between anvil plate 15561 and tissue thickness compensation part 15520 also, it can work as On the top of anvil plate 15561 and tissue thickness compensation part 15520 when anvil plate 15561 is in first position and/or the second position Gap is limited between portion surface 15521.For example, anvil plate 15561 can not be contacted with tissue thickness compensation part 15520.In addition Alternative embodiment in, when anvil plate 15561 against sliding block 15564 position and organize not being placed in anvil plate 15561 also When between tissue thickness compensation part 15520, anvil plate 15561 for example can be with the top surface of tissue thickness compensation part 15520 15521 contacts, regardless of whether anvil plate 15561 is in first position and/or the second position.Although only describing anvil block herein Two positions of plate 15611, anvil plate 15611 can be positioned or be indexed in any appropriate number of position.
Due to described above, surgery suturing appliance may include the device of the forming height for regulating nail, which can be Different tissue thickness is compensated in various situations.In addition, surgery suturing appliance for example may include thick for compensating different tissues The device of degree and/or the thickness change in tissue.For example, anvil plate 15561 can be adjusted up or be adjusted to far from opposite Nail bin, to increase the forming or firing height of nail.Correspondingly, anvil plate 15561 can be adjusted downward or towards opposite nail bin tune Section, to reduce the forming or firing height of nail.It is for example adjustable to the adjusting of anvil plate 15561 to be limited in anvil plate 15561 Forming pit between gap and staple drivers firing height or more specifically such as nail drive bracket percussion Highly.Even if such ability of the forming height with regulating nail is to be for example responsible for the thicker and/or relatively thin tissue of processing, tissue Thickness compensation part can also compensate for the thickness change in thicker and/or relatively thin tissue, and/or compensation tissue, as described above.Herein In the case of class, several compensation devices can be provided for surgeon in the same surgery suturing appliance.
As described above and as shown in multiple embodiments, nail bin can be used in surgery suturing appliance, which has lineament Nail cavity and nail, wherein firing member can be advanced through towards distal side nail bin with from nail cavity dispose follow closely.Nail bin may include curved Multiple rows of nail cavity and nail.It referring now to Figure 34 5 and Figure 34 6, surgery suturing appliance such as stitching unstrument 15600, such as may include limiting The round or annular nail cavity of one or more in round or annular support portion 15610 is arranged.Such round nail row can for example wrap Include circular 15612 row of inside nail cavity and circular 15613 row of outside nail cavity.For example, circular nail cavity seniority among brothers and sisters can be around restriction Circle or looping pit 15615 in stitching unstrument 15600, which, which can accommodate, is movably positioned in therein round or annular Knife.In use, tissue can be positioned against the platform surface 15611 of support section 15610, and anvil block (not shown) can pass through It extends through and/or is located in the actuator in hole 15615 and be assembled to surgical stapling device 15600, so that when actuator is activated When, anvil block can be clamped towards support section 15610, and compress tissue against platform surface 15611.Once organizing abundant Compression, the nail being located in nail cavity 15612 and 15613 can project from support section 15610 and pass through tissue, so that nail is accessible Anvil block and fully deformed are to capture tissue therein.When nail just fire and/or when follow closely fired after, circular knife can be pushed away Into with transecting patient tissue.Then, it the movable separate support section 15610 of anvil block and/or is separated with surgical stapling device 15600, so that Anvil block and surgical stapling device 15600 can be removed from operative site.Such surgical stapling device 15600 and such surgical technic are available In the two parts for for example connecting large intestine.In all cases, circular staple line can be in the case where organization healing by the more of large intestine A part keeps together, and makes the multiple portions resilient expansion of large intestine at the same time.Similar surgery suturing appliance and surgery Technology is disclosed in entitled " the SURGICAL ANASTOMOSIS STAPLING INSTRUMENT " submitted on 2 15th, 1994 United States Patent (USP) 5,285,945 in, the entire disclosure is herein incorporated by reference.
Further described above, tissue thickness compensation part for example can be against the support portion of surgical stapling device 15600 Divide 15610 positioning and/or is attached to the support section 15610 of surgical stapling device 15600.Tissue thickness compensation part can by round or Annular material ring is constituted, and the rings of material is for example including inside radius and outer radius.In some cases, tissue can be against the rings of material Positioning, and when anvil block will be for that will organize to move towards support section 15610, tissue thickness compensation part can be in tissue and platform table It is compressed between face 15611.During use, nail can be fired across tissue thickness compensation part and tissue, so that nail is accessible Anvil block is simultaneously deformed into its firing position, will organize and the capture of the part of tissue thickness compensation part is in nail.In all cases, Further described above, the rings of material including tissue thickness compensation part must be flexible enough, so that around staple line The multiple portions of large intestine extend.Referring again to Figure 34 5 and Figure 34 6, tissue thickness compensation part 15620 flexible for example may include circle The flexible inner ring 15624 of ring shape, the inner ring can limit round or looping pit 15625.Inner ring 15624 enable to its not by Capture is out of, surgical stapling device 15600 is disposed nail；On the contrary, inner ring 15624 can relative to inboard row nail cavity 15612 it is radial to Interior positioning.For example, tissue thickness compensation part 15620 may include multiple attachments for example extending therefrom, such as interior attachment 15622 and outer attachment 15623, so that attachment at least can be captured partially in nail when following closely deformation.More specifically, first Referring to Figure 34 5, it is each in attachment 15622 may include be positioned in the nail cavity 15612 that is defined in surgical stapling device 15600 it On head, wherein head for example can be attached to inner ring 15624 by neck 15626；And similarly each outer attachment 15623 may include the head being positioned on the nail cavity 15613 being defined in surgical stapling device 15600, and wherein head is for example Inner ring 15624 can be attached to by neck 15627.The head of interior attachment 15622 and outer attachment 15623 for example may include appointing What suitable shape, it is such as round, oval and/or oval.Neck 15626 and/or 15627 may also include any suitable shape Shape, wherein the neck 15627 that the head of outer attachment 15623 is connected to inner ring 15624 can be in support section 15610 Adjacent inside nail cavity 15612 between extend so that neck 15627 be not trapped in from inside nail cavity 15612 dispose nail It is interior.
Referring now to Figure 34 7 and Figure 34 8, tissue thickness compensation part 15720 flexible for example may include circular or annular Flexible outer ring 15724.Outer ring 15724 enables to it not to be trapped in out of, surgical stapling device 15600 is disposed nail；Phase Instead, outer ring 15724 can be located radially outward relative to outboard row nail cavity 15613.For example, tissue thickness compensation part 15720 can wrap Multiple attachments for example extending therefrom are included, such as interior attachment 15622 and outer attachment 15623, so that attached when following closely deformation Fitting at least can be captured partially in nail.More specifically, each interior attachment 15622 may include as follows referring first to Figure 34 7 Head: the head is positioned on the nail cavity 15612 being defined in surgical stapling device 15600, and wherein head can for example pass through Neck 15726 is attached to outer ring 15724；And similarly each outer attachment 15623 may include such as head portion: be determined on the head Position is on the nail cavity 15613 being defined in surgical stapling device 15600, and wherein head can be for example attached to by neck 15727 Outer ring 15724.The head of interior attachment 15622 and outer attachment 15623 for example may include any suitable shape, such as round It is shape, oval and/or oval.Neck 15726 and/or 15727 may also include any suitable shape, wherein by interior attachment The neck 15726 that 15622 head is connected to outer ring 15724 can extend between adjacent outside nail cavity 15613, so that neck Portion 15726 is not trapped in out of, outside nail cavity 15613 is disposed nail.In certain alternative embodiments, tissue thickness's compensation Part may include round or annular flexible inner ring, circle or annular flexible outer ring and in addition to this can be connected to inner ring and/ Or multiple attachments of outer ring.Certain attachments can be connected to inner ring, and other certain attachments can be connected to outer ring.Attachment At least some of part can be connected to both inner ring and outer rings.Under any circumstance, further described above, tissue is thick The inner ring 15624 of degree compensating part 15620, the outer ring 15724 of tissue thickness compensation part 15720, and/or any other suitable group Knit thickness compensation part can resilient expansion and/or contraction, to adapt to the extension and/or contraction of tissue, tissue thickness compensation Part is implanted against the tissue.In addition, although various embodiments are being described herein as including round or annular brace ring, It is tissue thickness compensation part may include support construction for attachment to be connected to its any suitable shape.It is carried out to above It further describes, the circle to be cut to the tissue being trapped between anvil block and support section is promoted by surgical stapling device The also cleavable backing material of knife.For example, knife can for example be separated inside support ring and attachment by cutting the neck of attachment.
Further described above, tissue thickness compensation part may include separable and/or relatively movable position It sets, which can make tissue thickness compensation part extend and/or shrink, to adapt to the movement of tissue, tissue thickness compensation Part is implanted against the tissue.Referring now to Figure 34 9 and 350, when tissue thickness compensation part 15820 is just being implanted against tissue When, round or annular tissue thickness compensation part 15820 can be against the surgical stapling that can be maintained at non-expanding location (Figure 34 9) The platform surface 15611 of device 15600 positions, and/or the platform of the surgical stapling device 15600 by that can be maintained at non-expanding location Surface 15611 supports；After tissue thickness compensation part 15820 has been implanted, tissue thickness compensation part 15820 can be to extending out Exhibition, as shown in Figure 35 0.Tissue thickness compensation part 15820 may include multiple arcuate sections 15822, and multiple arcuate section is for example It can be joined together by inner ring 15824.Arcuate section 15822 can be separated from one another by seam 15828.At at least one its In his embodiment, arcuate section 15822 can be connected to each other, wherein for example perforation configuration can make arcuate section 15822 be separated It opens.In either case, arcuate section 15822 for example can respectively include interlocking features structure, such as 15826 He of protruding portion Recess 15823, the interlocking features structure can cooperate to limit arcuate section before tissue thickness compensation part 15820 is implanted Relative motion between 15822.Further described above, each arcuate section 15822 can for example pass through one or more A connector 15827 is connected to inner ring 15824, which can releasedly protect arcuate section 15822 It holds in place.When using the nail 10030 that nail is such as stored in support section 15610 come thick against tissue implanting tissue After spending compensating part 15620, referring first to Figure 35 0, connector 15827 can be separated with inner ring 15824, and make tissue thickness compensation part 15820 at least partly extensions are to adapt to the movement in following tissue.In all cases, all arcuate sections 15822 can be with Inner ring 15824 separates, and in other cases, can more only be separated with inner ring 15824 in arcuate section 15822.Certain In alternative embodiment, arcuate section 15822 can be connected by flexible portion, which can make arcuate section 15822 opposite In moving but be not separated from each other each other.For example, flexible portion can not receive nail wherein, and it can extend and/or shrink with suitable Answer the relative motion of arcuate section 15822.In Figure 34 9 and Figure 35 0, tissue thickness compensation part 15820 for example may include eight Arcuate section 15822.Alternatively, tissue thickness compensation part for example may include any appropriate number of arch portion Point, such as two or more arcuate sections.
Further described above, tissue thickness compensation part 15620,15720 and/or 15820 for example can compensate for The thicker and/or relatively thin tissue being trapped between anvil block and the support section 15610 of surgical instruments 15600.Similar to upper It, can be by making anvil block towards and/or far from the movement of support section 15610 come the forming or firing height of regulating nail described in text.More Body, anvil block are moveable to the forming height that nail is reduced closer to support section 15610, and correspondingly, and anvil block can be by into one Step moves to the forming height for increasing nail far from support section 15610.In such cases, therefore, surgeon can be by anvil Seat is adjusted to far from support section 15610 to be responsible for processing thick tissue, and is adjusted to towards support section 15610 to be responsible for processing Thin tissue.In various other embodiments, surgeon can determine not adjust anvil block, and be responsible for by tissue thickness compensation part Handle relatively thin and/or thicker tissue.Therefore, surgical instruments 15600 may include at least two devices for compensating different groups Knit thickness and/or tissue thickness's variation.
As described above, tissue thickness compensation part could attach to the support section of nail bin.The bottom table of tissue thickness compensation part Face may include one of hook layer or collar layer, and the platform surface of support section may include another in hook layer and collar layer Person.For example, hook and lantern ring can be engaged with each other and tissue thickness compensation part releasably held support section.Each hook example It such as may include from the widened head that neck extends.Multiple pads including lantern ring can for example be adhered to the bottom of tissue thickness compensation part Portion surface, and multiple pads including hook can be adhered to the platform surface of support section.Support section for example may include one or more A hole and/or recessed portion, the one or more hole and/or recessed portion can wherein receive the insertion including hook and/or lantern ring Object.In addition to the above or replacement is described above, and tissue thickness compensation part is for example able to use such hook and lantern ring construction It is removably attachable to anvil block.Hook and lantern ring for example may include fiber surface.
As described above, nail bin may include support section and the tissue thickness compensation part for being attached to support section.Institute also as above State, support section may include can wherein receive cutting element longitudinal slit, and tissue thickness compensation part may include can The holding member being maintained in longitudinal slit.Referring now to Figure 38 6, nail bin 16000 may include support section 16010, the branch Support part point includes platform surface 16011 and longitudinal slit 16015.Nail bin 16000, which may also include, to be located on platform surface 16011 The tissue thickness compensation part 16020 of side.Tissue thickness compensation part 16020 may include extending downwardly into longitudinal slit 16015 Longitudinal holding member 16025.For example, holding member 16025 can be pressed down in slit 16015, so that 16025 He of holding member Interaction between slit 16015 can resist the opposite fortune between support section 16010 and tissue thickness compensation part 16020 It is dynamic.The main body of tissue thickness compensation part 16020 can be made of the first material, and holding member 16025 can be by second or different Material is constituted.The main body of tissue thickness compensation part 16020 can be made of the material with the first hardness, and holding member 16025 can be made of the material with the second hardness, wherein the second hardness can for example be higher than the first hardness.In use, it follows closely 10030 can be pushed up by staple drivers 10040, so that the top of nail 10030 may pass through the master of tissue thickness compensation part 16020 Body simultaneously exposes from tissue contacting surface 16021, and against at least one of destination organization capture tissue thickness compensation part 16020 Point.When nail 10030 is just disposed, the cutting element across slit 16015 can crosscutting holding member 16025.Once tissue is thick Degree compensating part 16020 has been implanted, and various holding members 16025 can be pulled out slit 16015.Alternatively, The main body of tissue thickness compensation part 16020 can be separated with holding member 16025.
Referring now to Figure 38 7 and 389, nail bin 17000 may include support section 17010, which includes platform table Face 17011 and longitudinal slit 17015.Nail bin 17000 may also include the tissue thickness's compensation for being located in 17011 top of platform surface Part 17020.Tissue thickness compensation part 17020 may include the longitudinal holding member extended downwardly into longitudinal slit 17015 17025.For example, holding member 17025 can be pressed against in slit 17015 so that holding member 17025 and slit 17015 it Between interaction can resist the relative motion between support section 17010 and tissue thickness compensation part 17020.Holding member 17025 can extend across entire tissue thickness compensation part 17020 to its top surface 17021, wherein tissue thickness compensation part 17020 main part 17024 could attach to the opposite side of holding member 17025.For example, holding member 17025 can also example Such as resist the lateral deflection of tissue thickness compensation part 17020.Main part 17024 can be made of the first material, and keep structure Part 17025 can be made of second or different materials.Main part 17024 can be made of the material with the first hardness, and be protected Holding component 17025 can be made of the material with the second hardness, wherein the second hardness can for example be higher than the first hardness.To above into Row further describes, and when nail 10030 is just disposed, the cutting element across slit 17015 can crosscutting holding member 17025. Once tissue thickness compensation part 17020 has been implanted, various holding members 17025 can be pulled out slit 17015.As in addition A kind of selection, main part 17024 can be separated with holding member 17025.
Referring now to Figure 38 8, nail bin 18000 may include support section 18010, which includes platform surface 18011 and longitudinal slit 18015.Nail bin 18000 may also include the tissue thickness compensation part for being located in 18011 top of platform surface 18020.Tissue thickness compensation part 18020 may include the longitudinal holding member 18025 extended downwardly into longitudinal slit 18015. For example, holding member 18025 can be pressed down in slit 18015, so that the phase between holding member 18025 and slit 18015 Interaction can resist the relative motion between support section 18010 and tissue thickness compensation part 18020.Holding member 18025 can Entire tissue thickness compensation part 18020 is extended through to its top surface 18021, wherein the master of tissue thickness compensation part 18020 Body portion 18024 could attach to the opposite side of holding member 18025.Holding member 18025 may include the part 18026 of amplification, The amplifier section can be received in the cavity 18016 being defined in slit 18015.For example, amplifier section 18026 can resist guarantor Component 18025 is held to withdraw from from slit 18015.
Tissue thickness compensation part may include composition that is extrudable, can casting and/or can be molded, and it includes as described herein At least one of synthetic material and/or non-synthetic materials.Tissue thickness compensation part may include the film with two or more layers Or piece.Tissue thickness compensation part can be used conventional method obtain, such as mixing, be blended, combination, spraying, wicking, solvent evaporation, Dipping, brushing, gaseous phase deposition, extrusion, calendering, casting, molding etc..When extrusion, opening may include at least one opening The form of mold is that the extrudate exposed assigns shape.When calendering, opening may include the roll gap between two rollers.Conventional molding Method may include but be not limited to blow molding, injection molding, foam injection, compression moulding, hot forming, extrusion, foaming extrusion, film blow blowing, calendering, Spinning, solvent welding, coating method such as dip-coating and spin coating, solution curtain coating and film casting, plastisol processing (including scraper Coating, roller coating and casting) and their combination.When injection molding, opening may include nozzle and/or channel/runner and/or mold Cavity and feature structure.When compression moulding, composition be can be positioned in cavity body of mould, be heated to suitable temperature, and by opposite It is compressed and is shaped under high pressure.When casting, composition may include liquid or slurries, and mould is arrived in injection or otherwise offer The inside of tool or object, above and/or surrounding, with the feature structure of copy mold or object.After casting, composition can be done Dry, cooling and/or solidification is to form solid.
The method of manufacture tissue thickness compensation part can generally include: provide tissue thickness compensation part composition, liquefaction combination Object keeps its flowable, and by the composition of melting, semi-molten or mecystasis be formed to have expectation thickness layer and/or Film.Referring to Figure 52 7A, tissue thickness compensation part can be made up of following steps: hydrogel precursor be dissolved in aqueous solution, at it Middle dispersion biocompatible particles and/or fiber provide mold wherein with biocompatible particles, provide solution to mould In tool, make activator and solution contact and curing solution to form tissue thickness compensation part, which includes Outer layer containing biocompatible particles and the internal layer containing the biocompatible particles being embedded.It, can be by life as shown in Figure 52 7A Object biocompatibility layer 70250 is provided in the bottom of mold 70260, can will then be provided with biocompatible particles 70257 The aqueous solution of hydrogel precursor 70255 is provided to mold 70260, then can solidify aqueous solution to form tissue thickness's compensation Part, the tissue thickness compensation part have the first layer comprising biocompatible materials such as ORC, and comprising being provided with life The second layer of the object compatibility fiber such as hydrogel of ORC fiber.Tissue thickness compensation part may include foam, and the foam includes Outer layer containing biocompatible particles and the internal layer containing the biocompatible particles being embedded.Tissue thickness compensation part can pass through Following steps manufacture: dissolving mosanom in water, disperses ORC particle wherein, provides mold wherein with ORC particle, will Solution pours into mold, and spraying or injection calcium chloride are to contact solution, to cause the crosslinking of mosanom, be freeze-dried hydrogel with Form tissue thickness compensation part comprising the outer layer comprising ORC and comprising being embedded in hydrogel and ORC particle therein Layer.
Referring to Figure 52 7B, the method for manufacturing three-layer weave thickness compensation part can be generallyd include: dissolve in the first aqueous solution First hydrogel precursor disperses biocompatible particles and/or fiber in the first aqueous solution, and providing wherein has bio-compatible The mold 70260 of the first layer 70250 of property particle, the first aqueous solution is provided in mold, activator and the first aqueous solution are made Contact solidifies the first aqueous solution to form the second layer 70255, the second hydrogel precursor is dissolved in the second aqueous solution, by second Aqueous solution is provided into mold, solidifies the second aqueous solution to form third layer 70265.Three-layer weave thickness compensation part can by with The manufacture of lower section method: it dissolves mosanom in water to form the first aqueous solution, ORC particle is dispersed in the first aqueous solution, it is provided In the first layer with ORC particle mold, the first aqueous solution is poured into mold, spraying or injection calcium chloride are to contact the first water Solution is freeze-dried the first aqueous solution to cause the crosslinking of mosanom to be formed including having the ORC particle being embedded The second layer of hydrogel dissolves mosanom in water to form the second aqueous solution, the second aqueous solution is poured into mold, spraying or note Enter calcium chloride to contact the second aqueous solution, to cause the crosslinking of mosanom, is freeze-dried the second aqueous solution to be formed including water The third layer of gel.
Manufacture includes the method for at least one tissue thickness compensation part for saving and/or being absorbed in drug therein can be substantially Including offer tissue thickness compensation part, and make tissue thickness compensation part and medicament contact to retain the dose in tissue thickness's benefit It repays in part.Manufacture comprising antibacterial agent materials microstructure thickness compensation part method may include provide hydrogel, dried hydrogel, Swollen hydrogel in silver nitrate aqueous solution contacts hydrogel and sodium chloride solution, has the tissue of antibacterial characteristics thick to be formed Spend compensating part.Tissue thickness compensation part may include silver dispersed therein.
Referring to Figure 53 3, the method for manufacturing tissue thickness compensation part may include coetrusion and/or Method for bonding.For example, tissue Thickness compensation part 70550 may include lamilate, and the lamilate includes first layer 70555 and surrounded in a sealing manner comprising water The second layer 70560 of the internal layer 70565 of gel.Hydrogel may include such as dry film, dry foam, powder and/or granule.Water-setting Glue may include super-absorbent material, such as polyvinylpyrrolidone, carboxymethyl cellulose, polysulfide propyl acrylate.It can pass through By the raw material of first layer and the second layer respectively from hopper feed in extruder, first layer and the second layer are provided then sequentially to make Make first layer and/or the second layer.Extruder hopper can be added in the raw material of internal layer 70565.Raw material can squeeze at high temperature Dispersion mixing and compound in machine out.As raw material leave mold 70570 in opening, internal layer 70565 can be deposited into first layer On 70555 surface.Tissue thickness compensation part may include foam, film, powder and/or particle.First layer 70555 and the second layer 70560 can position face-to-face.The second layer 70560 can be aligned face-to-face by roller 70575 with first layer 70555.First layer 70555 may be affixed to the second layer 70560, and wherein first layer 70555 and the second layer 70560 can Physical entrapment internal layers 70565.Layer can With for example optical pressure, conventional hot calendering bonding technique and/or by using adhesive bond together, with formed tissue thickness compensation Part 70550.As shown in Figure 40 7, first layer 70555 and the second layer 70560 can be by, for example, the rollings of grooved roller 70580 Process is bonded together.It, can be by the way that the first layer 70555 and the second layer of outer layer or barrier can be collectively formed due to described above 70560 accommodate and/or seal internal layer 70565.Outer layer can prevent or reduce 70565 contact wetting of internal layer, dissipate until outer layer is broken.
Referring to Figure 39 0, the end effector 12 (Fig. 1) of surgical instruments 10 can receive fastener cartridge assembly, such as nail bin 20000.As shown in Figure 39 0, nail bin 20000 can cooperate the staple cartridge channel 20072 in the jaw 20070 of end effector 12 In.Alternatively, nail bin 20000 can be integral with end effector 12, so that nail bin 20000 and end execute Device 12 is formed as individual unit construction.Nail bin 20000 may include such as the first main part, such as rigid support portion 20010. Nail bin 20000 may also include such as the second main part, such as compressible portion or tissue thickness compensation part 20020.As another A kind of outer selection, tissue thickness compensation part 20020 may not include the integral part of nail bin 20000, but can execute relative to end Device 12 is positioned in other ways.For example, tissue thickness compensation part 20020 can be fixed the anvil block 20060 of end effector 12 Or it can otherwise be maintained in end effector 12.Referring to fig. 4 07, nail bin may also include retainer fixture 20126, energy Enough tissue thickness compensation part 20020 is inhibited prematurely to separate from support section 20010.Reader will be appreciated that, as described herein group Knit that thickness compensation part is mountable to be engaged in various end effectors or in other words with various end effectors, and such reality Apply example within the scope of the invention.
Similar to tissue thickness compensation part as described herein, referring now to Figure 40 7, tissue thickness compensation part 20020 can be from The release of surgical end-effector 12 is detached from.For example, the rigid support portion 20010 of nail bin 20000 can keep executing with end The fastener cartridge channel 20072 of device jaw 20070 engages, and tissue thickness compensation part 20020 is from rigid support portion 20010 It is detached from.Similar to various embodiments described herein, 20030 (Figure 40 7-412) will followed closely from rigid support portion 2010 After nail cavity 20012 is disposed, tissue thickness compensation part 20020 can be discharged from end effector 12.Nail 20030 can be from nail cavity 20012 Percussion, so that 20030 engagement tissue thickness compensation part 20020 of nail.It is also similar to various embodiments described herein, referring generally to Figure 39 2,411 and 412, nail 20030 can capture tissue T of a part together with suture of tissue thickness compensation part 20020.Tissue is thick Spending compensating part 20020 can be part that is deformable, and capturing the tissue thickness compensation part 20020 in percussion nail 20030 It can be compressed.Similar to tissue thickness compensation part as described herein, tissue thickness compensation part 20020 can compensate for different-thickness, pressure The tissue T of contracting and/or density being trapped in each nail 20030.In addition, also as described herein, tissue thickness compensation part 20020 can compensate for the gap that deformation nail 20030 generates.
Tissue thickness compensation part 20020 can be compressed between uncompressed height and compression height.Referring to fig. 4 07, tissue is thick Degree compensating part 20020 can have top surface 20021 and bottom surface 20022.The height of tissue thickness compensation part can be top The distance between portion surface 20021 and bottom surface 20022.It minimum force or is not applied when applying to tissue thickness compensation part 20020 When reinforcing, i.e., when tissue thickness compensation part 20020 is not compressed, the uncompressed height of tissue thickness compensation part 20020 can To be the distance between top surface 20021 and bottom surface 20022.Such as when to 20020 applied force of tissue thickness compensation part, Such as when percussion nail 20030 captures a part of tissue thickness compensation part 20020, the compression of tissue thickness compensation part 20020 Height can be the distance between top surface 20021 and bottom surface 20022.Tissue thickness compensation part 20020 can have far Side end 20025 and proximal extremity 20026.As shown in Figure 40 7, the uncompressed height of tissue thickness compensation part 20020 can be in group It is uniform for knitting between the distal end 20025 of thickness compensation part 20020 and proximal extremity 20026.Alternatively, Uncompressed height can change between distal end 20025 and proximal extremity 20026.For example, tissue thickness compensation part 20020 Top surface 20021 and/or bottom surface 20022 relative to other parts can angulation and/or staged so that uncompressed height Change between proximal extremity 20026 and distal end 20025.The uncompressed height of tissue thickness compensation part 20020 can be such as It is about 0.08 inch.Alternatively, the uncompressed height of tissue thickness compensation part 20020 can be for example about 0.025 Change between inch and about 0.10 inch.
It is such as described in greater detail herein, tissue thickness compensation part 20020 can be in its proximal extremity 20026 and distal end Different compression heights is compressed between 20025.Alternatively, tissue thickness compensation part 20020 can be entire at it It is equably compressed under length.The compression height of tissue thickness compensation part 20020 may depend on the geometry of such as end effector 12 Shape, the characteristic of tissue thickness compensation part 20020, the tissue T of engagement and/or nail 20030.Tissue thickness compensation part 20020 Compression height can be related with the tissue space in end effector 12.When anvil block 20060 is clamped towards nail bin 20000, tissue Gap can be limited at the top platform surface 20011 (Figure 40 7) of such as nail bin 20000 and the tissue contact table of anvil block 20060 Between face 20061 (Figure 39 0).Tissue space may be, for example, about 0.025 inch or be about 0.100 inch.Tissue space can be such as It is about 0.750 millimeter or is about 3.500 millimeters.The compression height of tissue thickness compensation part 20020 can for example be equal to or substantially Equal to tissue space.When tissue T is located in the tissue space of end effector 12, the compression height of tissue thickness compensation part It can reduce, to adapt to tissue T.Such as when tissue space is about 0.750 millimeter, the compression height of tissue thickness compensation part can It is about 0.500 millimeter.For example, the compression height of tissue thickness compensation part 20020 can when tissue space is about 3.500 millimeters It is about 2.5mm.In addition, tissue thickness compensation part 20020 may include minimal compressed height.For example, tissue thickness compensation part 20020 Minimal compressed height can be about 0.250 millimeter.It is limited between the platform surface of nail bin and the tissue contacting surface of anvil block Tissue space can for example be equal to or the uncompressed height of at least substantially equal to tissue thickness compensation part.
Referring primarily to Figure 39 1, tissue thickness compensation part 20020 may include the fibrous nonwoven material of fibre-bearing 20082 20080.Tissue thickness compensation part 20020 may include the material of felt or similar felt.Fiber 20082 in non-woven material 20080 It can be tightened together by any method as known in the art, including but not limited to needle point method, heat bonding, water entanglement, ultrasound Bonding, chemical adhesion and meltblowing adhesive.In addition, the layer of non-woven material 20080 can be by mechanical plus thermally or chemically fasten Together to form tissue thickness compensation part 20020.It is such as described in greater detail herein, the non-woven material 20080 of fiber can be with Be it is compressible, tissue thickness compensation part 20020 can be made compressible.Tissue thickness compensation part 20020 may also comprise uncompressed Part.For example, tissue thickness compensation part 20020 may include compressible non-woven material 20080 and uncompressed part.
Referring still primarily to Figure 39 1, non-woven material 20080 may include multiple fibers 20082.In non-woven material 20080 At least some fibers 20082 can be crimped fibre 20086.Crimped fibre 20086 in non-woven material 20080 can for As curling, distortion, coiling, it is curved, deformation, it is spiral, circular and/or bowed.As in further detail herein Description, crimped fibre 20086 can be formed with any suitable shape, so as to generate spring negative for the deformation of crimped fibre 20086 Carry power or restoring force.Crimped fibre 20086 can form the shape of coiling or substantially coiled type by thermoforming.Crimped fibre 20086 can be formed by non-crimped fiber 20084.For example, non-crimped fiber 20084 can be wrapped in around heated mandrel to be formed The substantially shape of coiled type.
Tissue thickness compensation part 20020 may include the absorbable polymer matrix of homogenization.Uniform absorbable polymerization Object matrix may include such as foam, gel and/or film.In addition, multiple fibers 20082 are dispersed in entirely uniformly absorbable gather It closes in object matrix.At least some of uniform absorbable polymer matrix fiber 20082 can be such as crimped fibre 20086.As described in more detail, the uniform absorbable polymer matrix of tissue thickness compensation part 2002 can be and can press Contracting.
Referring to Figure 39 4 and 395, crimped fibre 20086 can random dispersion at least one of entire non-woven material 20080 In point.For example, crimped fibre 20086 can random dispersion in entire non-woven material 20080 so that non-woven material 20080 A part than the other parts of non-woven material 20080 include more crimped fibres 20086.In addition, crimped fibre 20086 can It is gathered in such as fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e in non-woven material 20080.Volume The entanglement of fiber 20086 during the shape of bent fiber 20086 can cause non-woven material 20080 to manufacture；Crimped fibre 20086 The formation of fiber cluster 20085a, 20085b, 20085c, 20085d and 20085e can then be led to by tangling.In addition to this or make For another option, crimped fibre 20086 can in entire non-woven material 20080 random orientation.For example, with reference to Figure 39 1, First crimped fibre 20086a can be orientated along first direction, and the second crimped fibre 20086b can be orientated in a second direction, Yi Ji Three crimped fibre 20086c can be orientated along third direction.
Crimped fibre 20086 can systematically be distributed and/or be arranged at least part of entire non-woven material 20080. For example, crimped fibre 20186 can be positioned in construction 20185, plurality of crimped fibre 20186a referring now to Figure 39 6 It is arranged along first direction, other multiple crimped fibre 20186b are arranged in a second direction.Crimped fibre 20186 can be overlapped, and be made Them are obtained to intertwine with each other or interconnect.Crimped fibre 20186 systemic can be arranged, so that crimped fibre 20186a is arranged essentially parallel to Another crimped fibre 20186a.Another crimped fibre 20186b can extend substantially transversely to some crimped fibre 20186a.Volume Bent fiber 20186a can be substantially aligned with first axle Y, and crimped fibre 20186b can substantially with X pairs of second axis Together.For example first axle Y can be perpendicular or substantially perpendicular to second axis X in some cases.
Referring primarily to Figure 39 7, crimped fibre 20286 can be arranged in construction 20285.Each crimped fibre 20286 can Including the longitudinal axis being limited between the first end 20287 of crimped fibre 20286 and second end 20289.Crimped fibre 20286 can systematically be distributed in non-woven material 20080, so that the first end 20287 of a crimped fibre 20286 positions In the position of the second end 20289 adjacent to another crimped fibre 20286.For another example, referring now to Figure 39 8, fibrous structure 20385 may include the first crimped fibre 20386a being for example orientated along first direction, and the second curling being orientated in a second direction is fine Tie up 20386b, and the third crimped fibre 20386c being orientated along third direction.The single pattern or arrangement of crimped fibre 20286 It can be repeated in entire non-woven material 20080.Crimped fibre can be in entire non-woven material 20080 with different pattern cloth It sets.In other alternate forms, non-woven material 20080 may include at least one crimped fibre pattern and multiple random The crimped fibre of orientation and/or random distribution.
Referring again to Figure 39 1, multiple fibers 20082 in non-woven material 20080 may include that at least some non-crimpings are fine Dimension 20084.Non-crimped fiber 20084 and crimped fibre 20086 in non-woven material 20080 can be tangled or be interconnected.Curling is fine Dimension 20086 and the ratio of non-crimped fiber 20084 may be, for example, about 25:1.For another example, crimped fibre 20086 and non-crimped fiber 20084 ratio may be, for example, about 1:25.Alternatively, the ratio of crimped fibre 20086 and non-crimped fiber 20084 Rate may be, for example, about 1:1.As described in more detail, when non-woven material 20080 has deformed, non-woven material 20080 The quantity of crimped fibre 20086 can influence the restoring force of the generation of non-woven material 20080 in per unit volume.Such as herein equally more It describes in detail, the restoring force that non-woven material 20080 generates may also depend upon crimped fibre in such as non-woven material 20080 20086 and non-crimped fiber 20084 material and shape, size, position and/or orientation.
The fiber 20082 of non-woven material 20080 may include polymer composition.The polymer composition of fiber 20082 It may include the polymer, absorbable polymer or their combination of nonabsorable.Absorbable polymer may include can biology Absorb, biocompatible elastomeric polymer.In addition, the polymer composition of fiber 20082 may include synthetic polymer, it is non- Synthetic polymer or their combination.The example of synthetic polymer includes but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, fiber 20082 may include 90/ 10 poly- (glycolide-L- lactide) copolymers, for example, the copolymer can with brand name VICRYL (polyglactic 910) from Ethicon, Inc. are commercially available.The example of non-synthetic polymer includes but is not limited to lyophilized polysaccharides, glycoprotein, elastic egg White, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).Similar in tissue thickness compensation part as described herein Polymer composition, the polymer composition amount of may include of fiber 20082 different (such as by weight percentage) it is absorbable Polymer, nonabsorable polymer, synthetic polymer and/or non-synthetic polymer.
The crimped fibre 20086 of non-woven material 20080 may include first polymer composition, and non-woven material 20080 non-crimped fiber 20084 may include different polymer composition.For example, crimped fibre 20086 may include that synthesis is poly- Object, such as 90/10 poly- (glycolide-L- lactide) are closed, and non-crimped fiber 20084 may include non-synthetic polymer, such as oxygen Change regenerated cellulose.Alternatively, crimped fibre 20086 and non-crimped fiber 20084 may include identical polymerization Compositions.
As described herein, crimped fibre 20086 and non-crimped fiber 20084 can be for example, by needle point method, heat bonding, water Entanglement, ultrasonic bonding, chemical adhesion and meltblowing adhesive tighten together.Including synthetic fibers such as " VICRYL The crimped fibre 20086 of (polyglactic 910) ", and the non-crimped fiber 20084 including oxidized regenerated cellulose can lead to It crosses needle thorn and forms non-woven material 20080 together.Non-woven material 20080 may include for example, about 5% to 50% (by weight Meter) curling " VICRYL (polyglactic 910) " fiber 20086, and be the non-volume of about 5% to 50% (by weight) Bent oxidized regenerated cellulose (ORC) fiber 20084.Such as when non-woven material 20080 contacts tissue T, non-crimping ORC fiber 20084 can react rapidly with the blood plasma in tissue to form gel block.The formation of gel ORC block can be instantaneous or almost instantaneous Ground is contacted with tissue.In addition, after gel ORC block formation, " VICRYL (polyglactic 910) " fiber of curling 20086 can still be distributed in entire non-woven material 20080.For example, crimped fibre 20086 can be suspended in gel ORC block. Since gel ORC block is bioabsorbable, curling " VICRYL (polyglactic 910) " fiber 20086 can be in adjacent tissue Upper application screen resilience, as described in more detail.In addition, tissue can start in " VICRYL (polyglactic 910) " fibre It heals around dimension and/or forming nail 30030, also as described in more detail.
Referring primarily to Figure 40 7-410, the support section 20010 of nail bin 20000 may include warehouse 20017, top platform table Face 20011 and multiple nail cavities 20012.Each nail cavity 20012 can limit the opening in platform surface 20011.Nail 20030 can be by can It is located in nail cavity 20012 with removing.Single nail 20030 is arranged in each nail cavity 20012.Referring primarily to 1 He of Figure 41 412, and it is similar to nail as described herein, each nail 20030 may include with first end 20035 and second end 20036 Base portion 20031.Nail leg 20032 can extend from the first end 20035 of base portion 20031, and another nail leg 20032 can be from base The second end 20036 in portion 20031 extends.Referring again to Figure 40 7-410, before deployment nail 20030, each nail 20030 Base portion 20031 can be supported by staple drivers 20040, which is located in the rigid support portion 20010 of nail bin 20000 It is interior.In addition, the leg 20032 of each nail 20030 can be at least partially contained in nail cavity 20012 before deployment nail 20030.
Nail 20030 can be deployed between initial position and firing position.For example, nail 20030 can referring primarily to Figure 41 0 Positioned at initial position (nail 20030e, 20030f), part percussion or middle position (nail 20030c, 20030d) or firing position (nail 20030a, 20030b).Driver 20040 can drive the nail between initial position and firing position.For example, each The base portion 20031 of nail 20030 can be supported by driver 20040.Follow closely the leg of (such as nail 20030e, 20030f in Figure 40 9) 20032 can be positioned in nail cavity 20012.When firing member or nail percussion sliding part 20050 are from the proximal extremity of nail bin 20000 When 20001 distal ends 20002 translate, the inclined surface 20051 on sliding part 20050 be can contact on driver 20040 Inclined surface 20042, to dispose the nail 20030 being located on contacted driver 20040.Nail 20030 can be deployed in just Beginning position and firing position between so that leg 20032 moves across the non-woven material 20080 of tissue thickness compensation part 20020, The top surface 20021 for penetrating tissue thickness compensation part 20020 penetrates tissue T, and contact is located in end effector 12 The anvil block 20060 (Figure 39 0) on 20000 opposite of nail cavity.Nail leg 20032 can be directed to the deformation of anvil block 20060, each nail 20030 Leg 20032 can capture a part of non-woven material 20080 and a part of tissue T.
In percussion configuration (Figure 41 1 and 412), each nail 20030 can be to tissue T and the tissue being captured in nail 20030 Thickness compensation part 20020 applies compressing force.Referring primarily to Figure 40 9 and 410, the leg 20032 of each nail 20030 can be towards nail 20030 base portion 20031 deforms downwards, to form nail retention region 20039.Nail retention region 20039 can be tissue T and tissue The region that thickness compensation part 20020 can be captured by percussion nail 20030.In all cases, nail retention region 20039 can limit Between the inner surface of the base portion 20031 of the inner surface and nail 20030 of strained leg 20032.The retention area of nail 20030 20039 size may depend on a number of factors, for example, the length of leg, the diameter of leg, base portion the deformation of width and/or leg journey Degree.
When non-woven material 20080 is trapped in nail retention region 20039, the captured portion of non-woven material 20080 Dividing can be compressed.The compression height for being trapped in the non-woven material 20080 in nail retention region 20039 can be retained according to identical nail Tissue T in region 20039 and change in nail bin 20000.For example, in the case where tissue T is relatively thin, nail retention region 20039 can have the space for more giving non-woven material 20080, and therefore, the compressed degree of non-woven material 20080 may Unlike when tissue T is thicker its will be compressed it is big.Such as in the case where tissue T is thicker, non-woven material 20080 can quilt That compresses is more, to adapt to thicker tissue T.For example, with reference to Figure 41 1, non-woven material 20080 can be for example in the first nail retention It is compressed to the first height in the 20039a of region, the second height is compressed in the second nail retention region 20039b, is cut in third nail It stays in the 20039c of region and is compressed to third height, the 4th height is compressed in the 4th nail retention region 20039d, and the The 5th height is compressed in five nail retention region 20039e.Similarly, as shown in Figure 41 2, non-woven material 20080 can be first It is compressed to the first height in nail retention region 20039a, the second height is compressed in the second nail retention region 20039b, the It is compressed to third height in three nail retention region 20039c, the 4th height is compressed in the 4th nail retention region 20039d.Make Compression height for another option, non-woven material 20080 can be uniform in entire nail bin 20010.
The power applied can make non-woven material 20080 move to compressed configuration from initial uncompressed configuration.In addition, non-knit Producing material material 20080 can have elasticity, so that non-woven material 20080 can produce screen resilience or restoring force when being compressed.When deformation, The non-woven material 20080 can attempt to spring back from the configuration for compressing or deforming.When non-woven material 20080 attempts to spring back, It can apply screen resilience or restoring force in the tissue being also trapped in nail retention region 30039, such as retouch in further detail herein It states.When the power of application is then removed, restoring force can be such that non-woven material springs back from the configuration of compression.Non-woven material 20080 resiliently to initial uncompressed configuration or resiliently to the configuration for being substantially similar to initial uncompressed configuration.It is non-woven The deformation of material 20080 can be elastic.The deformation of non-woven material can be partial elastic and partially plastic.
When a part of non-woven material 20080 is compressed in nail retention region 20039, non-woven compensating part The crimped fibre 20086 in the part in 20039 can also be compressed or otherwise be deformed.The change of crimped fibre 20086 Shape amount can be corresponding with the decrement of the captured part of non-woven material 20080.For example, with reference to Figure 39 2, non-woven material 20080 nails 20030 that can be disposed capture.The nail 20030 that non-woven material 20080 is disposed compresses more, and curling is fine The average deformation of dimension 20086 can be bigger.In addition, the nail that non-woven material 20080 is disposed compresses fewer, crimped fibre 20086 average deformation can be smaller.Similarly, referring to fig. 4 11 and 412, in nail retention region 20039d, non-woven material 20080 are compressed more, and the crimped fibre 20086 in nail retention region 20039d usually can deform more.In addition, following closely In the 20039a of retention area, non-woven material 20080 is compressed fewer, the crimped fibre in nail retention region 20039a 20086 usually can deform fewer.
The ability that non-woven material 20080 is sprung back from the configuration of deformation, that is, the screen resilience of non-woven material 20080 can use Certainly in the screen resilience of crimped fibre 20086 in non-woven material 20080.Crimped fibre 20086 can deform with resiliencely.Curling The deformation of fiber 20086 can be partial elastic and partially plastic.The compression of each crimped fibre 20086 can make compressed volume Bent fiber 20086 generates screen resilience or restoring force.For example, when fiber 20086 attempts to spring back from its compressed configuration, quilt The crimped fibre 20086 of compression can produce restoring force.Fiber 20086 can attempt to be restored to its initial uncompressed configuration or substantially Similar to the configuration of its configuration.Crimped fibre 20086 can attempt to part and be restored to its initial configuration.In non-woven material 20080 The only a part of crimped fibre 20086 can have elasticity.It is compressed when crimped fibre 20086 includes linear elastic material The restoring force of crimped fibre 20086 may depend on the bullet of such as 20086 compressed quantity and crimped fibre 20086 of crimped fibre Spring stiffness factor.The device of spring stiffness coefficient of crimped fibre 20086 can be at least dependent on such as orientation of crimped fibre 20086, material Material, shape and/or size.
Crimped fibre 20086 in non-woven material 20080 may include uniform device of spring stiffness coefficient.Alternatively It selects, the device of spring stiffness coefficient of the crimped fibre 20086 in non-woven material 20080 can be variation.When with big spring When the crimped fibre 20086 of stiffness factor is greatly compressed, crimped fibre 20086 can produce big restoring force.It is same when having When the crimped fibre 20086 of the big device of spring stiffness coefficient of sample is compressed less, crimped fibre 20086 can produce smaller recovery Power.The summation of the restoring force generated by the crimped fibre 20086 of the compression in non-woven material 20080 can produce in tissue thickness Merging restoring force on the entire non-woven material 20080 of compensating part 20020.Non-woven material 20080 can be trapped in tool Have to apply in the tissue T in the percussion nail 20030 of the non-woven material 20080 of compression and merges restoring force.
In addition, the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 can influence non-woven material 20080 device of spring stiffness coefficient.For example, when the quantity of the crimped fibre 20086 of per unit volume non-woven material 20080 is lower When, the screen resilience in non-woven material 20080 can be lower；For example, working as the crimped fibre of per unit volume non-woven material 20080 When 20086 quantity is higher, the screen resilience of non-woven material 20080 can be higher；For example, and when the non-woven material of per unit volume When the quantity of the crimped fibre 20086 of material 20080 is even higher, the screen resilience of non-woven material 20080 can be higher.When non-woven When the screen resilience of material 20080 is lower, such as the quantity of the crimped fibre 20086 when per unit volume non-woven material 20080 When lower, the merging restoring force being applied in captured tissue T by tissue thickness compensation part 20020 can also be smaller.It is knitted when non- When the screen resilience of producing material material 20080 is higher, such as the number of the crimped fibre 20086 when per unit volume non-woven material 20080 When measuring higher, the sum of the restoring forces being applied in captured tissue T by tissue thickness compensation part 20020 can also be higher.
Referring primarily to Figure 39 3, the non-woven material 20080 ' of tissue thickness compensation part 20020 ' may include therapeutic agent 20088, such as drug and/or pharmaceutically active agents.The releasable therapeutically a effective amount of therapeutic agent of non-woven material 20080 ' 20088.For example, therapeutic agent 20088 can be released when non-woven material 20080 ' is absorbed.Therapeutic agent 20088 can be released To the fluid for flowing through on non-woven material 20080 ' or passing through non-woven material 20080 ', such as blood.Therapeutic agent 20088 Example may include but be not limited to hemostat and drug, such as, fibrin, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone；Antibiotic and Antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamicin, polymyxin B and/or Chloramphenicol；And anticancer agent, such as cis-platinum, mitomycin and/or adriamycin.Therapeutic agent 20088 may include biological agent, such as Stem cell.The fiber 20082 of non-woven material 20080 ' may include therapeutic agent 20088.Alternatively, therapeutic agent 20088 may be added to that non-woven material 20080 ' or otherwise be integrated into tissue thickness compensation part 20020 '.
Referring primarily to Figure 39 9-399B, the tissue thickness compensation part 20520 for end effector 12 (Figure 39 0) may include Multiple springs or coiled fiber 20586.Similar with crimped fibre 20086 as described herein, coiled fiber 20586 is in tissue thickness In compensating part 20520 can for (for example) crimp, distortion, coiling, it is curved, deformation, it is spiral, circular and/ Or it is bowed.Coiled fiber 20586 can be wrapped in the shape that coiling or substantially coiled type are formed around mandrel.Coiled fiber 20586 can in entire tissue thickness compensation part 20520 random orientation and/or random distribution.Alternatively, it coils Fiber 20586 can systematicness arrangement and/or inhomogenous distribution in entire tissue thickness compensation part 20520.For example, with reference to figure 399, coiled fiber 20586 may include the longitudinal direction between the first end 20587 of coiled fiber 20586 and second end 20589 Axis.The longitudinal axis of coiled fiber 20520 in tissue thickness compensation part 20520 can be parallel or substantially parallel.Each disk Around fiber 20520 first end 20587 can along the first longitudinal side 20523 of tissue thickness compensation part 20520 position and The second end 20589 of each coiled fiber 20586 can be fixed along the second longitudinal side 20524 of tissue thickness compensation part 20520 Position.In such construct, coiled fiber 20586 can laterally traverse tissue thickness compensation part.Alternatively, it coils Fiber 20586 can longitudinally or diagonally traverse tissue thickness compensation part 20520.
Similar with crimped fibre 20086 as described herein, coiled fiber 20586 may include polymer composition.Curling is fine Dimension 20586 can be at least partially elasticity, so that the deformation of crimped fibre 20586 generates restoring force.Coiled fiber 20586 Polymer composition may include such as polycaprolactone (PCL), so that coiled fiber 20586 is insoluble in chlorophyll solvent 's.Referring to Figure 39 9A, spring or coiled fiber 20520 are positively retained in compensating material 20580.Compensating material 20580 can be by disk It is maintained at loading position around fiber 20586, is being compensated so that coiled fiber 20586 applies load on spring to compensating material 20580 Apply load on spring in material 20580.Coiled fiber 20586 can be maintained at neutral position by compensating material 20580, in the situation Lower coiled fiber 20586, which will not apply load on spring to compensating material 20580 or apply spring in compensating material 20580, to be born It carries.Compensating material 20580 can be bioabsorbable, and may include foam, such as polyglycolic acid (PGA) foam.In addition, mending Repaying material 20580 can be soluble in such as chlorophyll solvent.Tissue thickness compensation part may include for example containing polycaprolactone (PCL) coiled fiber 20586 and the compensating material 20580 containing polyglycolic acid (PGA) foam, so that coiled fiber 20520 It is insoluble in chlorophyll solvent, and compensating material 20580 is soluble in chlorophyll solvent.Compensating material 20580 It can be at least partially elasticity, so that the compression of compensating material 20580 generates restoring force.In addition, tissue is thick referring to Figure 39 9B The compensating material 20580 for spending compensating part 20520 may include therapeutic agent 20588, such as stem cell.When compensating material 20580 is inhaled The releasable therapeutically a effective amount of therapeutic agent 20588 of time receiving compensating material 20580.
Similar with tissue thickness compensation part 20020 as described herein, tissue thickness compensation part 20520 can be compressible 's.For example, the engageable tissues of nail 20030 are thick when 20030 (Figure 40 7-410) of nail are deployed to firing position from initial position Spend a part of compensating part 20520.Nail 20030 can capture a part and adjacent tissue T of tissue thickness compensation part 20520.Nail 20030 can apply captured part from compressing force to tissue thickness compensation part 20520 and tissue T, so that tissue thickness compensation part 20520 are compressed to compression height from uncompressed height.It is fine that the compression of tissue thickness compensation part 20520 can lead to coiling therein The corresponding deformation of dimension 20586.As described in more detail, the deformation of each coiled fiber 20586 can produce restoring force, should Restoring force may depend on the screen resilience of coiled fiber, for example, the deflection of coiled fiber 20586 and/or coiled fiber 20586 Device of spring stiffness coefficient.The device of spring stiffness coefficient of coiled fiber 20586 can at least dependent on such as orientation of coiled fiber 20586, Material and shape and/or size.The deformation of coiled fiber 20586 can be mended in entire tissue thickness in tissue thickness compensation part 20520 It repays and generates restoring force on part 20520.Tissue thickness compensation part 20520 can to the captured tissue T in percussion nail 20030 apply by The sum of the restoring forces that the coiled fiber 20586 and/or elastic compensating material 20586 of deformation generate.
Referring primarily to Figure 40 0 and 401, the tissue thickness compensation part 20620 for end effector 12 may include multiple bullets Spring coil 20686.Similar with crimped fibre 20086 as described herein and coiled fiber 20586, spring coil 20686 is being organized It can be (for example) crimping, distortion, coiling, curved, deformation, spiral, circular in thickness compensation part 20620 And/or it is bowed.Similar with fiber and coil as described herein, spring coil 20686 may include polymer composition.In addition, Spring coil 20686 can be at least partially elasticity, so that the deformation of spring coil 20686 generates restoring force.Spring coil 20686 may include first end 20687, second end 20689 and longitudinal axis between the two.Referring to fig. 4 00, spring coil 20686 first end 20686 can be positioned at or near the proximal extremity 20626 of tissue thickness compensation part, and identical bullet The second end 20689 of spring coil 20686 can be positioned at or near the distal end 20625 of tissue thickness compensation part 20620, So that for example spring coil 20686 longitudinally traverses tissue thickness compensation part 20620.Alternatively, coiled fiber 20686 can laterally or diagonally traverse tissue thickness compensation part 20620.
Tissue thickness compensation part 20620 may include outer membrane 20680, and the outer membrane 20680 is at least partly around at least one Spring coil 20686.Referring to fig. 4 00, outer membrane 20680 can multiple spring coils in tissue thickness compensation part 20620 20686 periphery extends.Alternatively, outer membrane 20680 can bullet in fully enclosed tissue thickness compensation part 20620 Spring coil 20686 or at least one spring coil 20686.Spring coil 20686 can be maintained at end effector by outer membrane 20680 In 12.Spring coil 20686 can be maintained at loading position by outer membrane 20680, so that spring coil 20686 generates load on spring simultaneously And external membrane 20680 applies screen resilience.Alternatively, spring coil 20686 can be maintained at neutral by outer membrane 20680 Position.Tissue thickness compensation part 20620 also may include packing material 20624.Packing material 20624 can be kept by outer membrane 20680 In spring coil 20686 and/or around.Packing material 20624 may include therapeutic agent 20688, control similar to as described herein Treat agent.In addition, packing material 20624 can support the spring coil 20686 in tissue thickness compensation part 20620.Packing material 20624 can be compressible and be at least partially elasticity, so that packing material 20624 helps to be mended by tissue thickness The screen resilience or restoring force of the generation of part 20620 are repaid, as described in more detail.
Similar with tissue thickness compensation part as described herein, tissue thickness compensation part 20620 can be compressible.Work as nail When 20030 (Figure 40 7-410) are deployed to firing position from initial position, 20030 engageable tissue thickness compensation parts 20620 are followed closely A part.Each nail 20030 can capture a part of tissue thickness compensation part 20620 together with adjacent tissue T.Nail 20030 can Apply captured part from compressing force to tissue thickness compensation part 20620 and captured tissue T, so that tissue thickness compensation part 20620 are compressed between uncompressed height and compression height.The compression of tissue thickness compensation part 20620, which can lead to, is maintained at it In spring coil 20686 corresponding deformation (Figure 40 1).As described in more detail, the deformation of each spring coil 20686 It can produce restoring force, which depends on the screen resilience of spring coil 20686, for example, the deflection of spring coil 20686 And/or the device of spring stiffness coefficient of spring coil 20686.The device of spring stiffness coefficient of spring coil 20686 can be at least dependent on for example The material and shape and/or size of spring coil 20686.In addition, according to the screen resilience of packing material 20624 and outer membrane 20680, The compression of packing material 20624 and/or outer membrane 20680 also can produce restoring force.At least by tissue thickness compensation part 20620 The summation for the restoring force that deformed spring coil 20686, packing material 20624 and/or outer membrane 20680 generate can be thick in entire tissue Restoring force is generated on degree compensating part 20620.Tissue thickness compensation part 20620 can apply the captured tissue T in percussion nail 20030 Add the sum of the restoring forces generated by deformed spring coil 20686.
Referring primarily to Figure 40 2-404, the tissue thickness compensation part 20720 for end effector 12 may include multiple springs Coil 20786.Similar with coiled fiber as described herein and spring, spring coil 20786 is in tissue thickness compensation part 20720 It can be (for example) crimping, distortion, coiling, curved, deformation, spiral, circular and/or bowed.Spring Coil 20786 can be at least partially elasticity, so that the deformation of spring coil 20786 generates restoring force.In addition, spring coil 20786 may include first end 20787, second end 20789 and longitudinal axis between the two.Referring primarily to Figure 40 4, spring wire The first end 20787 of circle 20786 can be positioned at or near the proximal extremity 20726 of tissue thickness compensation part 20720, and The second end 20789 of spring coil 20786 can be positioned at the distal end 20725 of tissue thickness compensation part 20720 or attached Closely, so that spring coil 20786 longitudinally traverses tissue thickness compensation part 20720.Spring coil 20786 can be mended in tissue thickness It repays in part 20720 and longitudinally extends along two parallel rows.Tissue thickness compensation part 20720 can be positioned in end effector 12, make It obtains sliding part 20050 (Figure 39 0) or cutting element 20052 can be along the slit 20015 between the spring coil 20786 of parallel row Translation.Alternatively, spring coil 20786 can laterally or diagonally traverse tissue thickness compensation part 20720.
Referring again to Figure 40 4, spring coil 20786 can be kept or be embedded in compensating material 20780.Compensating material 20780 It can be bioabsorbable, and may include foam, such as polyglycolic acid (PGA) foam.Compensating material 20780 can have bullet Property, so that the deformation of compensating material 20780 generates screen resilience.Compensating material 20780 can be solvable in such as chlorophyll solvent 's.For example, tissue thickness compensation part can for example including containing polycaprolactone (PCL) spring coil 20786 and contain polyethanol The compensating material 20780 of sour (PGA) foam, so that spring coil 20786 is insoluble in chlorophyll solvent, and compensates material Material 20780 is soluble in chlorophyll solvent.Compensating material 20780 can be at least partially elasticity, so that compensating material 20780 deformation generates load on spring or restoring force.
Tissue thickness compensation part 20720 may include plait 20790, can be between the spring coil 20786 of parallel row Extend.For example, with reference to Figure 40 4, the first plait 20790 can diagonally traverse the spring coil 20786 of two parallel rows, and Second plait 20790 can also diagonally traverse the spring coil 20786 of two parallel rows.First and second plaits 20790 It can intersect.Plait 20790 can be crossed over many times along the length of tissue thickness compensation part 20720.Plait 20790 can be by spring Coil 20786 is maintained in loading configuration, so that spring coil 20786 is maintained at the base in tissue thickness compensation part 20720 This flat position.The plait 20790 for traversing tissue thickness compensation part 20720 can be directly attached to spring coil 20786.As Another option, plait 20790 can be connected to spring coil 20786 via supporting element 20792,20792 edge of supporting element The longitudinal axis of spring coil 20786 extend through each spring coil 20786.
As described in more detail, nail bin 20000 may include slit 20015, can receive including cutting element 20052 translational slidiing part 20050 (Figure 39 0).When sliding part 20050 is translated along slit 20015, sliding part 20050 can Nail 20030 is projected from the securing member chamber 20012 in nail bin 20000, and cutting element 20052 can be simultaneously or almost simultaneously Cut off tissue T.It also can be cut off when cutting element 20052 translates in tissue thickness compensation part 20720 referring again to Figure 40 4 In parallel row spring coil 20786 between the plait 20790 that intersects.When plait 20790 is cut off, each spring wire Circle 20786 can be released from its loading configuration, so that each spring coil 20786 is loaded from tissue thickness compensation part 20720 Substantially flat position restore to expanding location.When spring coil 20786 extends, around the compensation material of spring coil 20786 Material 20780 is also expansible.
When 20030 (Figure 40 7-410) of nail are deployed to firing position from initial position, the engageable tissues of nail 20030 are thick A part of compensating part 20720 is spent, and tissue thickness compensation part 20720 can extend in nail 20030 or attempt extension, and Compressing force can be applied to tissue T.At least one nail 20030 can capture a part of tissue thickness compensation part 20720 together with adjacent Tissue T.Nail 20030 can apply captured part from compressing force to tissue thickness compensation part 20720 and captured tissue T, make Tissue thickness compensation part 20720 is obtained to be compressed between uncompressed height and compression height.The pressure of tissue thickness compensation part 20720 Contracting can lead to the corresponding deformation of spring coil 20786 with the compensating material 20780 remained at.As retouched in further detail herein It states, the deformation of each spring coil 20786 can produce restoring force, which may depend on the screen resilience of spring coil, example Such as, the device of spring stiffness coefficient of the deflection of spring coil 20786 and/or spring coil 20786.The spring of spring coil 20786 Stiffness factor can be at least dependent on the orientation, material and shape and/or size of such as spring coil 20786.It is compensated by tissue thickness The summation for the restoring force that at least deformed spring coil 20786 and/or compensating material 30380 in part 20720 generate can be entire Restoring force is generated in tissue thickness compensation part 20720.Tissue thickness compensation part 20720 can be to captured tissue T and percussion nail 20030 apply the sum of the restoring forces generated by the deformed spring coil 20786 in tissue thickness compensation part 20720.
Referring primarily to Figure 40 5 and 406, the tissue thickness compensation part 20820 for surgical end-effector 12 may include bullet Spring coil 20886.Similar with fiber and coil as described herein, spring coil 20886 can in tissue thickness compensation part 20820 It is (for example) crimping, distortion, coiling, curved, deformation, spiral, circular and/or bowed.Spring wire Circle 20886 may include polymer composition and can be at least partially elasticity, so that the deformation of spring coil 20886 generates Screen resilience.In addition, spring coil 20886 may include first end 20887 and second end 20889.Referring to fig. 4 05, the first end End 20887 can be positioned at or near the proximal extremity 20826 of tissue thickness compensation part 20820, and second end 20889 can It is located at or near the distal end 20825 of tissue thickness compensation part 20820.Spring coil 20886 can be mended from tissue thickness It repays the winding of proximal extremity 20825 of part 20820 or is folded into distal end 20826.
Referring again to Figure 40 5, spring coil 20886 can be kept or be embedded in compensating material 20880.Compensating material 20880 It can be bioabsorbable, and may include foam, such as polyglycolic acid (PGA) foam.Compensating material 20880 is green in such as leaf It can be soluble in plain solvent.Tissue thickness compensation part can be for example including 20886 He of spring coil for containing polycaprolactone (PCL) Compensating material 20880 containing polyglycolic acid (PGA) foam, so that spring coil 20886 is insoluble in chlorophyll solvent , and compensating material 20880 is soluble in chlorophyll solvent.Compensating material 20880 can be at least partially elasticity, make The deformation for obtaining compensating material 20880 generates load on spring or restoring force.
It is similar with tissue thickness compensation part as described herein, for example, tissue thickness compensation part 20820 can be it is compressible 's.The compensating material that the compression of tissue thickness compensation part 20820 can lead to holding or be embedded in tissue thickness compensation part 20820 At least part of spring coil 20886 in 20880 deforms.As described in more detail, the deformation of spring coil 20886 It can produce restoring force, which may depend on the deflection of such as screen resilience of spring coil 20886, spring coil 20886 And/or the device of spring stiffness coefficient of spring coil 20886.It is produced by deformed spring coil 20886 and/or deformation-compensated material 20880 The summation of raw restoring force can generate restoring force in entire tissue thickness compensation part 20820.Tissue thickness compensation part 20820 can Sum of the restoring forces are applied to the captured tissue T in percussion nail 20030.
Referring now to Figure 41 3, surgical end-effector 12 may include that the tissue at least one tubular element 30080 is thick Spend compensating part 30020.Tissue thickness compensation part 30020 is positively retained in surgical end-effector 12.As retouched in further detail herein It states, the fastener in end effector 12 can be disposed, so that fastener moves to firing position and makes tissue thickness compensation part At least part of tubular element 30080 in 30020 deforms.Reader will be appreciated that, including as described herein at least one The tissue thickness compensation part of tubular element it is mountable or be otherwise engaged in a variety of surgical end-effectors, and it is such Embodiment is within the scope of the invention.
Referring also to Figure 41 3, tissue thickness compensation part 30020 can be positioned relative to the anvil block 30060 of end effector 12.Make For another option, tissue thickness compensation part 30020 can be relative to fastener cartridge assembly (such as nail bin of end effector 12 30000) it positions.Nail bin 30000 can cooperate in the warehouse channel 30072 of the jaw 30070 of end effector 12.For example, group Nail bin 30000 can be releasably secured to by knitting thickness compensation part 30020.The tubular element of tissue thickness compensation part 30020 30080 can neighbouring nail bin 30000 rigid support portion 30010 top platform surface 30011 and position.Tubular element 30080 can by adhesive or pass through wrappage (similar at least one of wrappage as described herein) (for example, Figure 21 8) Fixed to top platform surface 30011.Tissue thickness compensation part 30020 can be integral with the component including nail bin 30000, makes It obtains nail bin 30000 and tissue thickness compensation part 30020 is formed as individual unit construction.For example, nail bin 30000 may include such as One main part, such as rigid support portion 30010 and the second main part, such as tissue thickness compensation part 30020.
13-415 referring to fig. 4, the tubular element 30080 in tissue thickness compensation part 30020 may include elongated portion 30082, which, which has, at least partly extends through at least one lumen 30084 therein.Referring primarily to figure 415, the elongated portion 30082 of tubular element 30080 may include weaving or weave strand 30090, as described in more detail. Alternatively, elongated portion 30082 may include solid construction, such as polymer extrudate, rather than weaving strand 30090.The elongated portion 30082 of tubular element 30080 may include thickness.The thickness of elongated portion 30082 can be in whole length It is interior and around a diameter of substantially uniform；In other cases, thickness can be variation.Elongated portion 30082 can To be elongated, so that the length of such as elongated portion 30082 is greater than the diameter of elongated portion 30082.Elongated portion may include example Such as about 1.20 inches to about 2.60 inches of length and about 0.10 inch to about 0.15 inch of diameter.Tubular element 20080 length can be such as about 1.40 inches, and the diameter of tubular element 20080 can be such as about 0.125 inch. In addition, elongated portion 30082 can limit for example substantially circular or elliptical cross-sectional shape.Alternatively, Cross-sectional shape may include polygonal shape, such as triangle, hexagon and/or octagon.Referring again to Figure 41 3, tubulose member Part 30080 may include the first distal end 30083 and the second proximal extremity 30085.The cross-sectional shape of elongated portion 30082 can Narrow at first end 30083 and/or second end 30085, wherein at least one end 30083 of tubular element 30080, 30085 can be closed and/or seal.Alternatively, lumen 30084 can continue across the distal side of tubular element 30080 End 30083,30085, so that end 30083,30085 is open.
Tubular element 30080 may include the single central lumen at least partly extending through elongated portion 30084 30084.Lumen 30084 can extend across the whole length of elongated portion 30084.In other alternate forms, tubular element 30080 may include extending through multiple lumens 30084 therein.The lumen 30084 for extending through tubular element 30080 can be circle Shape, semicircle, wedge shape and/or their combination.Tubular element 30080 may also include support web, can be in lumen 30084 Interior formation for example modified " T " or X-shaped shape.Size, lumen and/or support web in tubular element 30080 can limit The cross-sectional shape of tubular element 30080.The cross-sectional shape of tubular element 30080 in its whole length can be consistent, Or alternatively, the cross-sectional shape of tubular element 30080 can be variation along its length.As in further detail herein Ground description, the cross-sectional shape of tubular element 30080 can influence the compression ratio and screen resilience of tubular element 30080.
Tubular element 30080 may include perpendicular diameter and horizontal diameter；Its size can be according to the pipe in end effector 12 The construction of the very best part 30080, the size (tissue space including end effector 12) of end effector 12 and nail retention region 30039 expection geometry is selected.For example, the perpendicular diameter of tubular element 30080 can be with the desired height of forming nail It is related.In such cases, the perpendicular diameter of tubular element 30080 may be selected, so that when tubular element 30080 is trapped in into When in staple 30030, perpendicular diameter can reduce about 5% to about 20%.For example, perpendicular diameter is about 0.100 inch Tubular element 30080 can be used for being expected the nail that forming height is about 0.080 inch to about 0.095 inch.Therefore, work as tubulose When element 30080 is trapped in forming nail 30030, even if not capturing any tissue T wherein, tubular element 30080 hangs down Straight diameter can also reduce about 5% to about 20%.When tissue T is trapped in forming nail 30030, tubular element 30080 Compression even can be bigger.Perpendicular diameter can be uniform in the whole length of tubular element 30080, or select as another kind It selects, perpendicular diameter can be variation along its length.
When tubular element 30080 is in undeformed or resilient configuration, the horizontal diameter of tubular element 30080 can be greater than, Equal to or less than the perpendicular diameter of tubular element 30080.For example, with reference to Figure 41 4, horizontal diameter is for example big greatly than perpendicular diameter About three times.In some cases, for example, horizontal diameter may be about 0.400 inch and perpendicular diameter may be about 0.125 English It is very little.Alternatively, referring now to Figure 41 6, when tubular element 31080 is in undeformed or resilient configuration, tubulose The horizontal diameter of element 31080 can be equal to or be substantially equal to the perpendicular diameter of tubular element 31080.In some cases, example Such as, horizontal diameter may be about 0.125 inch and perpendicular diameter also may be about 0.125 inch.Tubular element 30080 can wrap Include about 0.125 inch of perpendicular diameter, about 0.400 inch of horizontal diameter and about 1.400 inches of length.As herein It is more fully described, when power A is applied to tubular element 30080 and/or 31080, tubular element is deformable, so that cross section Geometry (including horizontal and vertical diameter) is alterable.
Referring again to Figure 41 3-415, the tubular element 30080 in tissue thickness compensation part 30020 can be deformable.It is whole A tubular element 30080 can be deformable.For example, tubular element 30080 can be from the proximal extremity of elongated portion 30082 30083 to distal end 30085 and around its entire perimeter can be deformable.Alternatively, tubular element 30080 only a part can be deformable.For example, the only intermediate length and/or tubular element 30080 of elongated portion 30082 The only a part of perimeter can be deformable.
When the contact point on the elongated portion 30082 that compressing force is applied to tubular element 30080, contact point can be inclined It moves, the cross sectional dimensions of this changeable tubular element 30080.For example, tubular element 30080 may include stretching referring again to Figure 41 4 Top apex 30086 and bottom apex 30088 on long part 30082.In the initial undeformed configuration, tubular element 30080 It may include undeformed cross-sectional dimension, including the undeformed vertical diameter between top apex 30086 and bottom apex 30088. When compressing force A is applied to top apex 30086, tubular element 30080 is moveable to deformed configuration.In deformed configuration, The cross sectional dimensions of pipe 30080 is changeable.For example, pipe 30086 may include between top apex 30086 and bottom apex 30088 Deformation perpendicular diameter, which is smaller than undeformed vertical diameter.Referring to fig. 4 16, for example, working as tubular element 30080 when never deformed configuration moves to deformed configuration, and the horizontal diameter of deformation tube 30080 can be lengthened out.Deformation tube 30080 Deformed cross-sectional dimension can be at least dependent on the position of exerted forces A, angle orientation and/or size.As described in more detail, The deformation of tubular element 30080 can produce screen resilience or restoring force, may depend on the screen resilience of tubular element 30080.
Referring also to Figure 41 4, tubular element 30080 can produce screen resilience or restoring force when compressed.In such cases, As described herein, when the contact point on the elongated portion 30082 that power A is applied to tubular element 30080, tubular element 30080 can move to deformed configuration from initial undeformed configuration.When removing applied power A, deformation tube 30080 can be from deformation Configuration rebound.Deformation tube 30080 resiliently to initial undeformed configuration or it is resilient to initial undeformed configuration substantially class As configuration.The ability that tubular element 30080 is sprung back from deformed configuration is related to the screen resilience of tubular element 30080.
Referring again to Figure 41 4, tubular element 30080 can apply screen resilience or restoring force.(scheme when for example passing through nail 30030 417 and when 418) applying applied power A to tubular element 30080, restoring force can be generated by tubular element 30080, such as herein It is more fully described.The cross sectional dimensions of tubular element 30080 can be changed in the power A applied.In addition, in linear elastic material In, the restoring force of each deformed part of tubular element 30080 may depend on the deformation size and tubulose member of tubular element 30080 The device of spring stiffness coefficient of the part of part 30080.The device of spring stiffness coefficient of tubular element 30080 can be at least dependent on such as tubulose Orientation, material, cross-sectional geometry and/or the size of element 30080.Tubular element in tissue thickness compensation part 30020 30080 may include uniform device of spring stiffness coefficient.Alternatively, device of spring stiffness coefficient can be along tubular element 30080 length and/or diameter change around tubular element 30080.When the tubular element with the first device of spring stiffness coefficient When 30080 a part is greatly compressed, tubular element 30080 can produce larger restoring force.When with identical first spring When a part of the tubular element 30080 of stiffness factor is compressed less, tubular element 30080 can produce smaller restoring force.
Referring again to Figure 41 3, the tubular element 30080 in tissue thickness compensation part 30020 may include polymer composition. The elongated portion 30082 of tubular element 30080 may include the polymer composition.In addition, the polymer composition may include to Small part elastic material, so that the deformation of tubular element 30080 generates restoring force.The polymer composition may include for example can not Polymer, absorbable polymer or the their combination of absorption.The example of synthetic polymer includes but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymer.For example, can inhale The polymer of receipts may include bioabsorbable biocompatible elastomeric polymer.In addition, the polymer of tubular element 30080 Composition may include synthetic polymer, non-synthetic polymer or their combination.The polymer composition of tubular element 30080 can Including for example different amounts of by weight percentage absorbable polymer, the polymer of nonabsorable, synthetic polymer and/or Non-synthetic polymer.
Referring to fig. 4 13 and 414, tubular element 30080 for example may include therapeutic agent 30098, such as pharmaceutically active agents or medicine Object.Therapeutic agent 30098 is positively retained in the lumen 30084 of tubular element 30080.Elongated portion 30082 can encapsulate or part is sealed Fill therapeutic agent 30098.Additionally or alternatively, the polymer composition of elongated portion 30082 may include controlling Treat agent 30098.The releasable therapeutically a effective amount of therapeutic agent 30098 of tubular element 30080.It can be in 30080 quilt of tubular element Therapeutic agent 30098 is discharged when absorption.For example, therapeutic agent 30098 is releasably first to flowing through on tubular element 30080 or passing through tubulose The fluid of part 30080, such as blood.It, can be for example when 30030 (Figure 41 7 and 418) of nail pierce through pipe in other alternative form The very best part 30080 and/or when in nail percussion sliding part 30050 cutting element 30052 (Figure 41 3) cut tubular element 30080 A part when, discharge therapeutic agent 30098.The example of therapeutic agent 30098 may include but be not limited to hemostat and drug, such as, Fibrin, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naphthalene General life, sulindac and/or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ion Silver, ampicillin, gentamicin, polymyxin B and/or chloramphenicol；Anticancer agent, such as cis-platinum, mitomycin and/or Ah mould Element；And/or biological agent, such as stem cell.
It can be disposed, be made from nail bin 30000 referring again to Figure 41 3,417 and 418, such as fastener (such as following closely 30030) 30030 engagement tissue thickness compensation parts 30020 must be followed closely and to 32080 applied force A of tubular element therein.As described herein, It can lead to tubular element 30080 to 30080 applied force A of tubular element to deform.It is similar with end effector 12 as described herein, nail The rigid support portion 30010 in storehouse 30000 may include warehouse 30017, platform surface 30011 and multiple nail cavities therein 30012.Each nail cavity 30012, which can limit the opening in platform surface 30011 and follow closely 30030, can be removably positioned in nail In chamber 30012 (Figure 43 3).Referring primarily to Figure 41 7 and 418, each nail 30030 may include base portion 30031 and from base portion 30031 Two nail legs 30032 extended.Before deployment nail 30030, the base portion 30031 of each nail 30030 can be by being located in nail bin Staple drivers 30040 (Figure 43 3) support in 30000 rigid support portion 30010.In addition before deployment nail 30030, often The leg 30032 of a nail 30030 can be at least partially contained in nail cavity 30012 (Figure 43 3).
As described in more detail, nail 30030 can be deployed between initial position and firing position.For example, nail is hit The engageable driver 30040 (Figure 43 3) of sliding part 30050 is sent out so that at least one nail 30030 is in initial position and firing position Between move.Referring primarily to Figure 41 7, nail 30030 is moveable to firing position, wherein the leg 30032 of nail 30030 engages tissue thickness The tubular element 32080 of compensating part 32020 is spent, tissue T is penetrated and is contacted and the nail bin 30000 in surgical end-effector 12 Opposite and positioning anvil block 30060 (Figure 43 3).Nail shapes pit 30062 in anvil block 30060 can be such that nail leg 30032 is bent, and make Obtain a part of the tissue T in a part and nail retention region 30039 for being captured tubular element 32080 by percussion nail 30030. As described in more detail, when nail 30030 moves between initial position and firing position, at least one nail leg 30032 The tubular element 32080 of pierceable tissue thickness compensation part 32020.Alternatively, nail leg 30032 can surround tubulose The peripolesis of element 32080, so that nail leg 30032 avoids piercing through tubular element 32080.With fastener class as described herein Seemingly, the leg 30032 of each nail 30030 can be deformed towards the base portion 30031 of nail 30030 to form nail retention region between the two downwards 30039.Nail retention region 30039 can be for wherein a part of tissue T and tissue thickness compensation part 32020 can be by percussion nail The region of 30030 captures.In firing position, it is each nail 30030 can to tissue T and be trapped in nail 30030 nail retention Tissue thickness compensation part 32020 in region 30039 applies compressing force.
Referring also to Figure 41 7, when tubular element 32080 is trapped in nail retention region 30039, tubular element 32080 Captured part it is deformable, as described herein.In addition, tubular element 32080 can be cut according to the identical nail is for example trapped in It stays thickness, compression ratio and/or the density of the tissue T in region 30039 and is deformed into the difference in different nail retention regions 30039 Deformed configuration.Tubular element 32080 in tissue thickness compensation part 32080 can extend longitudinally through continuous nail retention region 30039.In such construct, tubular element 32080 can be deformed into each nail retention region along row's percussion nail 30030 Different deformation configurations in 30039.Referring now to Figure 41 8, the tubular element 33080 in tissue thickness compensation part 33020 can edge Row's percussion nail 30030 be laterally arranged in nail retention region 30039.Tubular element 33080 can be by soft shell 33210 It keeps.In such construct, tubular element 33080 and soft shell 33210 be can be deformed in each nail retention region 30039 Different deformation configurations.For example, in the case where tissue T is relatively thin, tubular element 33080 is lessly compressible, and tissue T compared with In the case where thickness, tubular element 33080 is morely to adapt to compared with thick tissue T compressible.Alternatively, tubular element 33080 deformation size can be uniform in the whole length of tissue thickness compensation part 33020 and/or width range.
19-421 referring to fig. 4, the tubular element 34080 in tissue thickness compensation part 34020 may include more strands 34090.Referring primarily to Figure 41 9, strand 34090 can be woven or be woven into the tubulose dot matrix 34092 to form tubular element 34080 It is interior.The tubulose dot matrix 34092 formed by strand 34090 can be substantially hollow.The strand 34090 of tubular element 34080 can For solid strand, tubulose strand and/or other another suitable shapes.For example, with reference to Figure 42 0, tubulose dot matrix 34092 it is single Strand 34090 can be pipe.Referring to fig. 4 22, strand 34090 may include extending through at least one lumen 34094 therein.Lumen 34094 number, geometry, and/or dimension can determine the cross-sectional shape of strand 34090.For example, strand 34090 may include Circular tube chamber, semicircle tube chamber, wedge-shaped lumen and/or their combination.Strand 34090, which may also include, can form such as modification The support web 34096 of " T " or X-shaped shape.At least the diameter of strand 34090, extend through lumen therein and support is fine Dimension net can characterize the cross-sectional shape of strand 34090.As described in more detail, the cross-sectional shape of each strand 34090 The correspondence screen resilience or extensive that can be influenced the screen resilience generated by strand 34090 or restoring force and be generated by tubular element 34080 Multiple power.
Referring to fig. 4 23, the tubulose dot matrix 34092 of strand 34090 can be deformable.Tubulose dot matrix 34092 can produce or Facilitate the deformability and/or screen resilience of tubular element 34080.For example, the strand 34090 of tubulose dot matrix 34092 can be weaved Together, strand 34090 is enabled to slide and/or be bent relative to each other.When the elongated portion to tubular element 34080 When 34082 applied force, strand 34090 therein slidably and/or bending so that tubulose dot matrix 34092 moves to deformed configuration. For example, following closely 30030 compressible tissues tubulose dot matrix 34092 and be trapped in nail retention region 34039 referring also to Figure 42 3 T, this strand 34090 that can lead to tubulose dot matrix 34092 are slided and/or are bent relative to each other.When tubulose dot matrix 34092 is pressed When being reduced to deformed configuration, the top apex 34086 of tubulose dot matrix 34092 can be transported towards the bottom apex 34088 of tubulose dot matrix 34092 It is dynamic, to adapt to the captured tissue T in nail retention region 30039.In all cases, it is trapped in percussion nail 30030 Tubulose dot matrix 34092 will attempt to regain its undeformed configuration and restoring force can be applied to captured tissue T.This Outside, the part of the tubulose dot matrix 34092 of (that is, not capturing in percussion nail 30030) is located between nail retention region 30039 also Can due to the adjacent part of the tubulose dot matrix 34092 in nail retention region 30039 deformation and deform.In tubulose dot matrix 34092 In the case where deformation, tubulose dot matrix 34092 can attempt to spring back from deformed configuration or partly spring back.The portion of tubulose dot matrix 34092 Dividing resiliently only partly can spring back and/or keep to the other parts of its initial configuration and tubulose dot matrix 34092 to press completely Contracting.
Similar with the description of the tubular element of this paper, each strand 34090 can also be deformable.In addition, strand 34090 Deformation can produce restoring force, the restoring force depend on each strand 34090 screen resilience.Referring primarily to Figure 42 0 and 421, pipe Each strand 34090 of shape dot matrix 34092 can be tubulose.Alternatively, each strand of tubulose dot matrix 34092 34090 can be solid.In other alternative form, tubulose dot matrix 30092 may include at least one tubulose strand 34090, extremely A few solid strand 34090, at least one " X " or T shape strand 34090 and/or their combination.
Strand 34090 in tubular element 34080 may include polymer composition.The polymer composition of strand 34090 It may include the polymer, absorbable polymer or their combination of nonabsorable.The example of synthetic polymer includes but unlimited In polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), polydioxanone (PDO) and their copolymerization Object.For example, absorbable polymer may include bioabsorbable biocompatible elastomeric polymer.In addition, strand 34090 Polymer composition may include synthetic polymer, non-synthetic polymer and/or their combination.The polymer of strand 34090 Composition may include that for example different amounts of by weight percentage absorbable polymer, the polymer of nonabsorable, synthesis are poly- Close object and/or non-synthetic polymer.
Strand 34090 in tubular element 34080 also may include such as therapeutic agent 34098 (Figure 42 0), such as pharmaceutical activity Agent or drug.The releasable therapeutically a effective amount of therapeutic agent 34098 of strand 34090.It can be when tubulose strand 34090 be absorbed Discharge therapeutic agent 34098.For example, therapeutic agent 30098 is releasable to the stream flowed through on strand 34090 or across strand 34090 Body, such as blood.It, can be for example when nail 30030 pierces through strand 34090 and/or when nail percussion is slided in other alternative form When a part of cutting element 30052 (Figure 41 3) the cutting tubulose dot matrix 34092 on moving part 30050, therapeutic agent 34098 is discharged. The example of therapeutic agent 34098 may include but be not limited to hemostat and drug, and such as, fibrin, fibrin ferment and/or oxidation are again Raw cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, aspirin, naproxen, sulindac and/or hydrocortisone； Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ampicillin, gentamicin, more Acarasiales Plain B and/or chloramphenicol；Anticancer agent, such as cis-platinum, mitomycin and/or adriamycin；And/or biological agent, such as stem cell.
Referring to fig. 4 24 and 425, tubular element 35080 may include multiple layers 35100 of strand 35090.Tubular element 35080 may include multiple layers 35100 of tubulose dot matrix 35092.Referring to fig. 4 24, tubular element 35080 may include such as strand 35090 first layer 35100a and second layer 35100b.Referring now to Figure 42 5, the tubular element of tissue thickness compensation part 35120 35180 may include the third layer 35100c of such as strand 35090.In addition, the different layers 35100 in tubular element 35180 can wrap Containing different materials.Each layer of 35100a, 35100b, 35100c can be it is bioabsorbable, wherein each layer of 35100a, 35100b, 35100c may include different polymer compositions.For example, first layer 35100a may include first polymer combination Object；Second layer 35100b may include second polymer composition；And third layer 35100c may include third polymerization compositions. In such cases, layer 35100a, 35100b, 35100c of tubular element 35180 can be by different rates by bio-absorbable.Example Such as, first layer 35100a can quickly absorb, and second layer 35100b is than first layer 35100a more slow trapping, and third layer 35100c is than first layer 35100a and/or second layer 35100b more slow trapping.Alternatively, first layer 35100a Can slow-absorbing, second layer 35100b is faster absorbed than first layer 35100a, and third layer 35100c is than first layer 35100a and/or second layer 35100b faster absorb.
Similar with strand 34090 as described herein, the strand 35090 in tubular element 35180 may include drug 35098. Referring again to Figure 42 4, in order to control the elution or release of drug 35098, the first layer of the strand 35090 comprising drug 35098a 35100a can be by by second layer 35100b of the first rate by bio-absorbable and comprising the strand of drug 30098b 35090 Two rates are by bio-absorbable.For example, first layer 35100a can quickly be absorbed to allow drug 35098a rapid initial release, and Second layer 35100b can allow drug 30098b controlled release compared with slow trapping.Medicine in the strand 35090 of first layer 30100a Object 35098a may differ from the drug 35098b in the strand 35090 of second layer 35100b.For example, the stock in first layer 35100a Line 35090 may include that the strand 35090 in oxidized regenerated cellulose (ORC) and second layer 35100b may include solution, this is molten Liquid includes hyaluronic acid.In such cases, the releasable oxidized regenerated cellulose of the initial absorption of first layer 35100a is to help Bleeding is controlled, and the subsequent absorption of second layer 35100b releasably includes the solution of hyaluronic acid to help that tissue is inhibited to adhere to. Alternatively, layer 35100a, 35100b may include identical drug 35098a, 35098b.For example, referring again to figure 425, the strand 35090 in layer 35100a, 35100b and 35100c may include anticancer agent, such as cis-platinum.In addition, first layer 35100a can quickly be absorbed to allow cis-platinum rapid initial release, and second layer 35100b can be compared with slow trapping to allow cis-platinum by controlled release Put, and third layer 35100c can most slow trapping to allow the more extended controlled release of cis-platinum.
Referring to fig. 4 26 and 427, tissue thickness compensation part 36020 may include overmold material 36024.Overmolding material Material 36024 can be formed in 36080 outside of tubular element, 36080 inside of tubular element or 36080 inner side and outer side of tubular element The two.Referring to fig. 4 26, overmold material 36024 can be coextruded in 36080 inner side and outer side of tubular element simultaneously, and be managed The very best part 36080 may include the tubulose dot matrix 36092 of strand 36090.It is similar with polymer composition as described herein, overlapping note Moulding material 36024 may include such as polyglycolic acid (PGA), poly- (lactic acid) (PLA) and/or any other is suitable bioabsorbable Biocompatible elastomeric polymer.In addition, overmold material 36024 can be to be non-porous, so that overmold material 36024 form the impermeable layer of fluid in tubular elements 36080.Overmold material 36024, which can limit, to be passed through Lumen 36084.
If further discussed above, the strand 36090 in tubular element 36080 and/tubulose dot matrix 36092 may include treatment Agent 36098.Referring also to Figure 42 6 and 427, non-porous overmold material 36024 can include drug in interior lumen 36084a 36098.Alternatively or additionally, non-porous overmold material 36024 can wrap in intermediary canal 36084b Drug containing 36098, the intermediary canal 36084b of the tubulose dot matrix 36092 such as comprising the strand 36090 containing drug.With it is above-mentioned Similar, tubular element 36080 can position (Figure 41 3) relative to the cutting element 30052 in nail cavity 30012 and nail bin 30000. For example, the deployment of nail 30030 and/or the translation of cutting element 30052 can pierce through or keep non-porous overmold material 36024 broken It dissipates, so that the drug at least one lumen 36084 for being accommodated in tubular element 30080 can be discharged from lumen 30084 36098.Referring to fig. 4 28, tubular element 37080 may include non-porous film 37110.Non-porous film 37110 can be at least partly around pipe Shape dot matrix 37092 or the first layer 37100a and second layer 37100b of tubulose dot matrix 30092 with provide with it is as described herein overlapping The impermeable covering of the similar fluid of injected plastics material 36024.
As described herein, tubular element may include bioabsorbable material, therapeutic agent, more strands, tubulose dot matrix, pipes At least one of the layer of shape dot matrix, overmold material, non-porous film or combinations thereof.For example, with reference to Figure 42 9, tubular element 38080 may include overmold material 38024 and across tubular element 38080 central lumen 38084 and position more stocks Line 38090.Strand 38090 may include therapeutic agent 38098.Alternatively, for example, with reference to Figure 43 0, tubular element 39080 may include such as overmold material 39024 and the treatment being located in the central lumen 39084 of tubular element 39080 Agent 39098.At least one of tubular element 39080 and overmold material 39024 may include fluid treatment agent 39098.
Mainly referring again to Figure 41 3, tubular element 30080 can relative to nail bin 30000 rigid support portion 30010 and Positioning.Tubular element 30080 can neighbouring 30010 longitudinal register of rigid support portion.Tubular element 30080 can be arranged essentially parallel to With in rigid support portion 30010 longitudinal slit or cavity 30015 be aligned.Tubular element 30080 can be with longitudinal slit 30015 alignment, so that a part of tubular element 30080 is Chong Die with a part of longitudinal slit 30015.In such cases, Cutting element 30052 in nail percussion sliding part 30050 can be cut off when cutting edge 30052 is translated along longitudinal slit 30015 A part of tubular element 30080.Alternatively, tubular element 30080 can be longitudinal positioning of longitudinal slit 30015 The first side or second side on.In other alternative form, tubular element 30080 can be relative to the rigidity branch of nail bin 30000 Support part is divided 30010 and is positioned, so that tubular element 30080 laterally or diagonally traverses rigid support portion 30010 at least A part.
See, for example, Figure 43 1, tissue thickness compensation part 40020 may include multiple tubular elements 40080.Tubular element 40080 may include for example different length, cross-sectional shape and/or material.In addition, tubular element 40080 can be relative to nail bin 30000 rigid support portion 40010 and position so that the tubulose axis of tubular element 40080 is parallel to each other.Tubular element 40080 tubulose axis can be longitudinally-aligned, so that the first tubular element 40080 is positioned in another tubular element 40080. Alternatively, parallel tubular elements 40080 can longitudinally traverse such as nail bin 30000.In other alternative form In, parallel tubular elements 40080 can laterally or diagonally traverse nail bin 30000.Alternatively, non-parallel tubulose Element 40080 can be orientated at an angle relative to each other, so that its tubulose axis intersects with each other and/or not parallel.
31-434 referring to fig. 4, tissue thickness compensation part 40020 can have there are two tubular element 40080；First tubular element 40080a can be longitudinal positioning of the first side of the longitudinal slit 30015 in rigid support portion 30010, and the second tubular element 40080b can be longitudinal positioning of second side of longitudinal slit 30015.Each tubular element 40080 may include the pipe of strand 40090 Shape lattice 40092.Nail bin 30000 may include six nail chamber 30012 in total, wherein for example three nail chambers 30012 are located in longitudinal direction On every side of slit 30015.In such cases, it may not be necessary to translate the cutting edge in nail percussion sliding part 30050 A part of 30052 cutting tubular elements 40080.
Similarly, referring now to Figure 43 5-436, tissue thickness compensation part 41020 may include being longitudinally arranged in nail bin 30000 In two tubular elements 41080a, 41080b.It is similar to the above, the nail 30030 engageable one in three nail chambers 30012 A tubular element 41080a and another engageable tubular element of nail 30030 in three different nail chambers 30012 41080b.Referring also to Figure 43 5-436, the nail 30030 disposed can be in the different location of the cross section across tubular element 40080 Place's engagement tubular element 40080.As described herein, the rebound elasticity and corresponding restoring force applied by tubular element 41080 can use Certainly in the cross-sectional shape etc. of tubular element 41080.It is located at or near the arch section of tubular element 41080 Nail 30030 in nail retention region 30039 is than the nail being located in the nail retention region 30039 near non-arch section 30030 are subjected to bigger restoring force.Similarly, the nail retention region 30039 being located in the non-arch section of tubular element 41080 In nail 30030, can be subjected to being experienced than the nail 30030 at or near the arch section by being located in tubular element 30080 The smaller restoring force of restoring force.In other words, since large number of elasticity may be captured along the nail 30030 of such part The arch section of material, tubular element 41080 has more big spring stiffness system than the non-arch section of tubular element 41080 Number.Therefore, referring primarily to Figure 43 6, the restoring force generated by tissue thickness compensation part 41020 can be in tubular element 30080a It is bigger and smaller near nail 30030b nearby to follow closely 30030a and 30030c.Correspondingly, it is produced by tissue thickness compensation part 41020 Raw restoring force can be bigger than near nail 30030e near the nail 30030d and 30030f in tubular element 30080b.
Referring again to Figure 43 1-434, the cross-sectional geometry of the strand 40090 including tubulose dot matrix 40092 may be selected, In order to provide the required rebound elasticity applied by tubulose dot matrix 40092 and corresponding restoring force.For example, referring again to Figure 43 2, positioning Strand 40090a in the arch section of tubular element 40080 may include X-shaped cross-section, and be located in tubular element Strand 40090b in 40080 non-arch section may include tubular cross-section.Strand including different cross-sectional geometries 40090a can be weaved with 40090b together with to form tubulose dot matrix 40092.Alternatively, strand 40090a and 40090b can be used such as adhesive to be attached to each other.Referring to fig. 4 33 and 434, the strand 40090 in tubular element 40080 is not The restoring force being subjected in the nail retention region 30039 of nail bin 30000 can be made to optimize with cross-sectional geometry.It may be selected Specific cross-sectional geometry, so that the resilience constant in the nail retention region 30039 of nail bin substantially balances or equal.
Referring to fig. 4 37, tubular element 41080a, 41080b of tissue thickness compensation part 41120 can pass through adjacent part 41126 tighten together.Although translation cutting element 30052 can pass through between tubular element 41080a and 41080b, Cutting element 30052 may be needed to cut off at least part of adjacent part 41126.Adjacent part 41126 may include soft material Material, such as foam or gel are easy translated cutting element 30052 and cut off.Adjacent part 41026 can compensate tissue thickness Part 41120 is releasably secured to surgical end-effector 12.Adjacent part 41126 can be fixed to rigid support portion 30010 Top platform surface 30011 so that adjacent after discharging tubular element 41080a, 41080b from surgical end-effector 12 Part 41126 remains in surgical end-effector 12.
38-439 referring to fig. 4, tissue thickness compensation part 42020 may include multiple tubular elements 42080, so that such as tubulose The quantity of element 42080 is identical as the line number of nail cavity 30012 in nail bin 30000.Nail bin 30000 may include six nail chambers 30012 and tissue thickness compensation part 42020 may include six tubular elements 42080.Each tubular element 42080 can be with a row 30012 substantial alignment of nail cavity.When following closely 30030 by from a nail chamber 30012 injection, each nail 30030 from the row can Pierce through identical tubular element 42080 (Figure 43 9).The deformation of one pipe 42080 can have the deformation of adjacent tubes 42080 minimum It influences or does not influence.Therefore, tubular element 42080 can apply in the nail retention region 30039 across 30030 width of nail bin Substantially discrete and customization screen resilience.Identical tubular element 35080 is engaged in the nail 30030 fired from multiple rows of nail cavity 30012 In the case where (Figure 43 6), the deformation of tubular element 35080 less can be customized.For example, tubular element 35080 is in the first row Deformation in nail retention region 30039 can influence change of the tubular element 35080 in the nail retention region 30039 in another row Shape.Translating cutting edge 30052 can avoid cutting tubular element 42080.Alternatively, referring to fig. 4 40, tissue thickness Compensating part 43020 may include six or more tubular elements 43080, such as seven tubular elements 44080.In addition, tubular element 43080 can symmetrically or non-symmetrically be arranged in end effector 12.When 43080 longitudinal direction of odd number tubular element and it is arranged symmetrically When in end effector 12, translation cutting element 30052 can cut off the intermediate tube champion being covered on vertical passage 30015 Part.
Referring to fig. 4 41, tissue thickness compensation part 44020 may include central tubular element 44080b, at least partly with Longitudinal slit 30015 in the rigid support portion 33010 of nail bin 30000 is aligned.Tissue thickness compensation part 44020 may also include At least one peripheral tubular element 44080a, 44080c on 30015 side of longitudinal slit.For example, tissue thickness compensates Part 44020 may include that three tubular elements, 44080: the first peripheral tubular element 44080a can be longitudinal positioning of nail bin 30000 On first side of longitudinal slit 30015, central tubular element 44080b can be positioned substantially at the top of longitudinal slit 30015 and/ Or it is aligned with longitudinal slit 30015, and the second peripheral tubular element 44080c can be longitudinal positioning of the of longitudinal slit 30015 On two sides.It is the horizontal diameter substantially extended that central tubular element 44080b, which may include relative to perpendicular diameter,.Central tubular Element 44080b and/or any other tubular element can be Chong Die with multiple rows of nail cavity 30012.Referring also to Figure 44 1, for example, central tube The very best part 44080b can peripheral tubular element 44080a, 44080c Chong Die and each with four staples of nail cavity 30012 can be with Single nail cavity 30012 is overlapped.Alternatively, central tubular element 44080b can be for example and less than four nail chambers 30012 overlappings, for example, two rows of nail cavities 30012.In addition, peripheral tubular element 44080a, 44080c can be more than a nail chamber 30012 overlappings, such as two rows of nail cavities 30012.Referring now to Figure 44 2, the central tubular element of tissue thickness compensation part 44120 44180b can include therapeutic agent 44198 in the lumen 44184 of central tubular element 44180b.Central tubular element 44180b And/or at least one peripheral tubular element 44080a, 44080c may include therapeutic agent 44198 and/or any other is suitably controlled Treat agent.
Referring to fig. 4 43, tissue thickness compensation part 44220 may include shell 44224, the shell can with it is as described herein overlapping Injected plastics material 32024 is similar.Multiple tubular elements 44080 are held in place by shell 44224 in end effector 12. Shell 44224 can be coextruded with tubular element 44080.Tubular element 44080 may include the tubulose dot matrix 44092 of strand 44090. Similar to polymer composition as described herein, shell 44224 can be for example comprising polyglycolic acid (PGA), poly- (lactic acid) (PLA) And/or any other suitable bioabsorbable biocompatible elastomeric polymer.In addition, shell 44224 can be non-porous , so that shell 44224 forms the impermeable layer of fluid for example in tissue thickness compensation part 44220.Further such as this paper It discusses, the strand 44090 in tubular element 44080 and/or tubulose dot matrix 44092 may include therapeutic agent 44098.Non-porous shell 44224 can include therapeutic agent 44098 in tissue thickness compensation part.As described herein, tubular element 44080 can be relative to nail cavity 30012 and cutting element 30052 be positioned in nail bin 30000.For example, deployment and/or the cutting element 30052 of nail 30030 Translation can pierce through non-porous shell 44224 or make its it is broken dissipate so that therapeutic agent wherein included 44198 can be from tissue thickness It is discharged in compensating part 44020.
Referring to fig. 4 44, tissue thickness compensation part 44320 may include central tubular element 44380b, the central tubular element Including tubulose dot matrix 44392.Tubulose dot matrix 44392 can have nonwoven part or a gap 44381, the nonwoven part or Gap is substantially aligned with the longitudinal slit 30015 of rigid support portion 30010.In this case, tubular element 44380b The woven portion of tubulose dot matrix 44092 is not Chong Die with longitudinal slit 30015.Therefore, cutting in nail percussion sliding part 30052 is translated Cutting element 30052 can overlapping of the translation of slit 30015 without the woven portion of cutting tubulose dot matrix 44392 along longitudinal direction.Although adjacent The nail 30030c and 30030d that gap 44381 in nearly tubular element 44380b positions can be received from 44392 structure of tubulose dot matrix Less support, but other feature structure can be provided for these nails 30030 and be supported and/or in its nail retention region 30039 Other restoring force is provided.For example, as described in more detail, tubular element, supporting part, spring and/or pillar in addition Material can for example be positioned in the place at least one of the inside and outside tubular element 44380b near gap 44381.
Referring now to Figure 44 5-448, tissue thickness compensation part 45020 may include laterally traverse nail bin 30000 multiple Tubular element 45080.Tubular element 45080 can be positioned so that the rigidity of row and/or nail bin 30000 perpendicular to nail cavity 30012 The longitudinal axis of support section 30010.Referring to fig. 4 45, tubular element 45080 can traverse the longitudinal slit in nail bin 30000 30015, enable cutting element 30052 in nail percussion sliding part 30050 in the slit along longitudinal direction of nail percussion sliding part 30050 Tubular element 45080 is cut off when 30015 translation.Alternatively, referring now to Figure 44 6, tissue thickness compensation part 46020 may include two groups of tubular elements laterally traversed 46080.First group of tubular element 46080a laterally traversed can determine On the first side of longitudinal slit 30015, second group of tubular element 46080b laterally traversed can be positioned on longitudinal slit for position In 30015 second side.In such construct, cutting element 30052 can pass through between two groups of tubular elements 46080, and A part of tubular element 46080 is not cut off.Alternatively, when at least one other tubular element 46080 not When traversing longitudinal slit 30015 and not cut off by cutting element 30052, cutting element 30052 can cut off traverse it is longitudinal narrow At least one tubular element 46080 of slot 30015.
When tubular element 45080 laterally traverses nail bin 30000,47 and Figure 44 8, nail 30030 are engageable every referring to fig. 4 At least one tubular element 45080 in a nail retention region 30039.In such construct, each tubular element 45080 can edge The length of nail bin 30000 provides discrete restoring force.For example, being mended referring primarily to Figure 44 8 in the tissue thickness for organizing thinner place It repays the tubular element 45080 that the distal end of part 45020 is positioned about to compare, in the tissue thickness compensation part for organizing thicker place The tubular element 45080 that 45020 proximal extremity is positioned about can greatly be compressed.Therefore, with can be by thick closer to tissue The restoring force that the tubular element 46080 of the distal end positioning of degree compensating part 45020 generates is compared, and is compensated closer to tissue thickness The tubular element 45080 of the proximal extremity positioning of part 45020 can provide bigger restoring force.In addition, referring also to Figure 44 8, one The deformation of pipe 45080 can have minimum influence for the deformation of adjacent tubes 45080 or not influence.Therefore, tubular element 45080 can apply substantially discrete and customization screen resilience in the nail retention region 30039 of the length along nail bin 30030.? In the case that the multiple nails 30030 fired from single nail cavity 30012 engage identical tubular element 35080, tubular element 35080 Deformation less can customize.For example, the deformation of the tubular element 35080 in a nail retention region 30039 can influence the tubulose Deformation of the element 35080 in another nail retention region 30039.
In other alternate forms, 49-454 referring to fig. 4, the tubular element 47080 of tissue thickness compensation part 47020 can Diagonally traverse nail bin 30000.Tubular element 47080 can traverse the longitudinal slit 30015 in nail bin 30000, so that nail is hit Cutting element 30052 on hair sliding part 30050 can be cut when slit 30015 translates along longitudinal direction in nail percussion sliding part 30052 The disconnected tubular element 47080 diagonally traversed.Alternatively, tissue thickness compensation part 47020 may include two groups pairs The tubular element 47080 traversed to angle.First group of tubular element 47080 diagonally traversed can be positioned on longitudinal slit 30015 The first side on, second group of tubular element 47080 diagonally traversed can be positioned in second side of longitudinal slit 30015.? In such construct, cutting element 30052 can pass through between two groups of tubular elements 47080, and can not cut off any tubulose member Part 47080.
Referring still to Figure 44 9-452, the tubular element 47080 diagonally traversed be can be positioned in nail bin 30000, so that Gap is limited between tubular element 47080.When such as by capturing in the nail retention region 30039 of forming nail 30030 When tissue T applies compressing force to adjacent tubular elements 47080, the gap between adjacent tubular elements can be tubular element 47080 Horizontal extension provide space.Tubular element 47080 can be connected by material membrane or material piece 47024 across gap.Material piece It can be positioned in the platform surface 30011 of rigid support portion 30010 and/or the tissue contact side of tubular element 47080 extremely In few one.
53 and Figure 45 4 referring to fig. 4, at least one tubular element 47080 diagonally traversed can be fixed relative to nail cavity 30012 Position is in nail bin 30000, so that tubular element 47080 is located in the leg 30032 for the nail 30030 disposed from multiple rows of nail cavity 30012 Between.When nail 30030 moves to firing position from initial position, as described in more detail, nail leg 30032 can keep fixed Position is around tubular element 47080.In addition, for example, nail can deform, so that nail leg 30032 surrounds the week of tubular element 47080 Side package.In such construct, nail 30030 can move to firing position or shaping position, without piercing through tubular element 47080.In some cases, nail leg 30032 can prevent from unintentionally discharging remaining at around the movement of tubular element 47080 Therapeutic agent 47098.Each tubular element 47080 is orientated relative to the selected angle of the longitudinal slit 30015 of nail bin 30000 It may depend on position of the nail cavity 30012 in nail bin 30000.For example, tubular element 47080 can be relative to the vertical of nail bin 30000 It is positioned to slit 30015 at about 45 (45) degree angles.Alternatively, tubular element 47080 can for example relative to 30015 Cheng Shiwu of longitudinal slit (15) of nail bin 30000 spends angle to 75 (75) and positions.
Similar to the description of the disclosure in the whole text, multiple tubular elements in tissue thickness compensation part can be for example, by bonding Agent, wrappage, band, overmold material, compensating material and/or any other suitable connection adhesive or structure connect It connects.55-457 referring to fig. 4, soft shell 48024 can surround or encapsulate the tubular element in tissue thickness compensation part 48020 48080.Soft shell 48024 can limit the tubular element 48080 in end effector 12, and can make each tubular element 48080 are held in place, such as longitudinally-aligned with a nail chamber 30012.For example, tissue thickness compensation part 48020 can wrap Include six tubular elements 48080.Soft shell 48024 can be wherein wrapped up with limitation to be sufficiently deformable and flexible Tubular element 48020, while allowing the deformation and rebound of tubular element 48080.In addition, soft shell 48024 can enclose with tightening Around tubular element 48080, and can keep engaging with tightening for tubular element when tubular element 48080 deforms and/or springs back.
Referring to fig. 4 56, before deployment nail 30030, anvil block 30060 can be pivoted or be rotated downwards, to compress anvil block 30060 Tissue thickness compensation part 48020 and tissue T between nail bin 30000.The compression of tissue thickness compensation part 48020 may include soft Property the shell 48024 and wherein corresponding compression of tubular element 48020.When tubular element 48020 deforms, soft shell 48024 It can similarly deform.Tubular element 48020 can equably compress on the entire width of nail bin 30000, and soft shell 48024 can undergo the similar homogeneous compaction on entire tubular element 48080.Referring to fig. 4 57, when anvil block 30060 is from nail When the deployment of storehouse 30000 is opened after following closely 30030, tubular element 48080 can be sprung back from compressed configuration or partly rebound (is schemed 456).Tubular element 48080 can be sprung back, so that tubular element 48080 returns to its initial undeformed configuration.Tubular element 48080 can partly spring back, so that tubular element 48080 partly returns to its initial undeformed configuration.For example, tubulose is first The deformation of part 48080 can be partial elastic and partially plastic.When tubular element 48080 is sprung back, soft shell 48024 can be protected It holds to tighten with each tubular element 48080 and engage.Tubular element 48080 and soft shell 48024 can recoil to such journey Degree, the degree makes tubular element 48080 and tissue T fill nail retention region 30039, while tubular element 48080 is wherein Tissue T on apply restoring force appropriate.Referring to fig. 4 58, alternatively, including six are maintained at soft shell The tissue thickness compensation part 48120 of tubular element 48180 in 48124 can for example be positioned in the anvil block of end effector 12 On 30060.
59-462 referring to fig. 4, tissue thickness compensation part 49020 may include tubular element 49080, and the tubular element is along anvil block 30060 longitudinal axis longitudinal register.Tissue thickness compensation part 49020 can be fixed by compressible compensating material 49024 To the anvil block 30060 of end effector 12.In addition, compressible compensating material 49024 can surround or encapsulate tubular element 49080.Similar to description herein, tubular element 49080 may include at least one therapeutic agent 49098, which can pass through Following manner release: the various components of absorptive tissue thickness compensation part 49020, the nail 30030 by being fired by nail bin 30000 And/or cutting element 30052 pierces through tubular element 49080.
Referring to fig. 4 60, nail bin 30000 may include the nail 30030 being located in nail cavity 30012, wherein in deployment nail 30030 Before, the tissue thickness compensation part 49020 of anvil block 30060 and attachment thereon can be pivoted and be compressed towards nail bin 30000 and catch Obtain tissue T between the two.The tubular element 49080 of tissue thickness compensation part 49020 can be by pivotal anvil 30060 along nail bin 30000 length equably deforms (Figure 46 0).Referring to fig. 4 61 and 462, nail percussion sliding part 30050 can be along nail bin 30000 Longitudinal slit 30015 translate and engage each driver 30040 for the lower section of nail 30030 being located in nail cavity 30010, In each engagement driver 30040 can fire or project from nail cavity 30012 nail 30030.When anvil block 30060 discharges tissue T When with pressure in tissue thickness compensation part 49020, tissue thickness compensation part 49020 (including tubular element 49080 and compressible Compensating material 49024) can spring back from compressed configuration (Figure 46 0) or partly recoil to resilient configuration (Figure 46 1 and 462).Pipe Resiliently to such degree, the degree makes tissue thickness compensation part for the very best part 49080 and compressible compensating material 49024 49020 and tissue T fill nail retention region 30039, while tissue thickness compensation part 49020 restoring force is applied to it is captured In tissue T.
63-465 referring to fig. 4, two tissue thickness compensation parts 50020a, 50020b can be positioned in the end of surgical instruments In actuator 12.For example, the first tissue thickness compensation part 50020a can be attached to the nail bin 30000 in lower jaw 30070, and And minor microstructure thickness compensation part 50020b can be attached to anvil block 30060.The first tissue thickness compensation part 50020a may include Multiple tubular elements 50080, multiple tubular element are longitudinally arranged and are maintained in the first compensating material 50024a.At least One tubular element 50080 may include therapeutic agent 50098, be similar to therapeutic agent as described herein.First compensating material 50024a It can be deformable or substantially rigid.In addition, the first compensating material 50024a can make tubular element 50080 relative to nail channel 30000 are held in place.For example, the first compensating material 50024a can be such that each tubular element 50080 keeps and a nail Chamber 30012 is longitudinally-aligned.Minor microstructure thickness compensation part 50020b may include the first compensating material 50024a, the second compensating material 50024b and/or third compensating material 50024c.Second compensating material 50024b and third compensating material 50024c can be variable It is shape or substantially rigid.
Anvil block 30060 can pivot and apply compressive force to tissue thickness compensation part 50020a, 50020b and anvil block Tissue T between 30060 and nail bin 30000.The first tissue thickness compensation part 50020a and minor microstructure thickness compensation part 50020b does not need to be compressible.Alternatively, the first tissue thickness compensation part 50020a and/or second group It can be compressible for knitting at least one component in thickness compensation part 50020b.Referring now to Figure 46 4 and 465, when nail 30030 from When being fired in nail bin 30000, each nail 30030 can pierce through the tubulose being maintained in the first tissue thickness compensation part 50020a Element 50080.As shown in Figure 46 4, the therapeutic agent 50098 being maintained in tubular element 50080 can pierce through tubulose member in nail 30030 It is discharged when part 50080.In release, therapeutic agent 50098 can coat nail leg 30032 and the tissue T around percussion nail 30030. When nail 30030 is fired from nail bin 30000, nail 30030 also can pierce minor microstructure thickness compensation part 50020b.
66-469 referring to fig. 4, the tissue thickness compensation part 51020 for representing any tissue thickness compensation part described herein can wrap Include at least one tubular element 51080 for laterally traversing tissue thickness compensation part 51020.For example, with reference to Figure 46 6, tissue is thick Degree compensating part 51020 can be positioned relative to nail bin 30000, so that the first end of the tubular element 51080 laterally traversed 51083 can be positioned near the first longitudinal side of nail bin 30000, and the second of the tubular element 51080 laterally traversed End 51085 can be positioned near the second longitudinal side of nail bin 30000.For example, tubular element 51080 may include capsule shape shape Shape.As shown in Figure 46 7, tubular element 51080 can be perforated between first end 51083 and second end 51085, and be managed The very best part 51080 can be perforated at or near the center of tubular element 51,080 51087.For example, tubular element 51080 can wrap Containing polymer composition, such as bioabsorbable biocompatible elastomeric polymer.In addition, referring again to Figure 46 6, tissue Thickness compensation part 51020 may include multiple tubular elements 51080 laterally traversed.For example, 13 tubular elements 51080 can It is laterally arranged in tissue thickness compensation part 51020.
Referring again to Figure 46 6, tissue thickness compensation part 51020 may also include at least partly around tubular element 51080 Compensating material 51024.Compensating material 51024 may include bioabsorbable polymer, such as lyophilized polysaccharide, glycoprotein, Elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).Compensating material 51024 can make tubular element 51080 are held in place in tissue thickness compensation part 51020.In addition, compensating material 51024 can be fixed nail bin 30000 The top platform surface 30011 of rigid support portion 30010, so that compensating material 51020 is firmly positioned in end effector In 12.Compensating material 51024 may include at least one drug 51098.
Referring still to Figure 46 6, the tubular element 51080 of lateral register can be positioned relative to translation cutting element 30052, be made Tubular element 51080 can be cut off by obtaining cutting element 30052.Cutting element 30052 can be cut off at or near perforation wherein Tubular element 51080.When tubular element 51080 is cut to two halves, the cut-off part of tubular element 51080 can be swollen or Extension, as shown in Figure 46 8.For example, tubular element 51080 may include hydroaropic substance 51099, which can be in tubulose It discharges and/or exposes when element 51080 is cut off.In addition, when hydroaropic substance 51099 contacts the body fluid in tissue T, it is hydrophilic Property substance 51099 can attract the fluid, this can lead to tubular element 51080 swelling or extension.When tubular element 51080 expands Zhan Shi can deviate or be adapted to the tubular element 51080 of swelling around the compensating material 51024 of tubular element 51080. For example, the gelatin can be deviated to adapt to the tubular element 51080 of swelling when compensating material 51024 includes gelatin.Now Referring to fig. 4 69, the extension of tubular element 51080 and the offset of compensating material 51024 can lead to tissue thickness compensation part 51020 Corresponding extension.
Similar to other tissue thickness compensation parts that the disclosure is discussed in the whole text, tissue thickness compensation part 51020 can pass through The power deformation or compression applied.In addition, tissue thickness compensation part 51020 can be to be sufficiently flexible, so that it is passing through Screen resilience is generated when the power deformation of application, and then can be sprung back when removing applied power or partly be sprung back.Work as tissue When thickness compensation part 51020 is captured in nail retention region 30039, nail 30030 can be such that tissue thickness compensation part 51020 becomes Shape.For example, nail 30030 can make the tissue thickness compensation part 51020 captured in percussion nail 30030 tubular element 51080 and/ Or compensating material 51024 deforms.The non-capture portion of tissue thickness compensation part 51020 can also be because in nail retention region 30039 It deforms and deforms.In deformation, tissue thickness compensation part 51020 can attempt to spring back from deformed configuration.Such rebound can occur Before the hydrophilic extension of tubular element 51080, while the hydrophilic extension of tubular element 51080 and/or tubular element After 51080 hydrophilic extension.When tissue thickness compensation part 51020 attempts to spring back, it can also be trapped in nail retention Tissue in region 30039 applies restoring force, as described in more detail.
At least one of tubular element 51080 and/or compensating material 51024 can wrap in tissue thickness compensation part 51020 Containing therapeutic agent 51098.When the tubular element 51080 comprising therapeutic agent 51098 is cut off, it is included in tubular element 51080 Therapeutic agent 51098 can be released.In addition, therapeutic agent 51098 can be can when compensating material 51024 includes therapeutic agent 51098 The release when compensating material 51024 of bio-absorbable is absorbed.Tissue thickness compensation part 51020 can provide the fast of therapeutic agent 51098 Fast initial release is the controlled release of therapeutic agent 51098 later.For example, when the tubular element 51080 comprising therapeutic agent 51098 When being cut off, tissue thickness compensation part 51020 can provide the therapeutic agent 51098 from tubular element 51080 to tissue T along cutting line Rapid initial release.In addition, when the bioabsorbable compensating material 51024 comprising therapeutic agent 51098 is absorbed, tissue Thickness compensation part 51020 can provide the extended controlled release of therapeutic agent 51098.Compensating material is flowed into therapeutic agent 51098 Before 51024, at least some of therapeutic agent 51098 can be kept shorter a period of time in tubular element 51080.As another A kind of outer selection, at least some of therapeutic agent 51098 are positively retained in tubular element 51080 until 51080 quilt of tubular element It absorbs.The therapeutic agent 51098 and compensating material 51024 discharged from tubular element 51080 can be identical.As other one Kind selection, such as tubular element 51080 and compensating material 51024 may include different therapeutic agent or the combination of different therapeutic agents.
Referring still to Figure 46 9, end effector 12 can almost simultaneously or fast successive cut tissue T and percussion nail 30030 enter in the tissue T of cutting.In this case, nail 30030 can have been turned off adjacent tissue T's in cutting element 30052 It is deployed in tissue T immediately after tubular element 51080.In other words, nail 30030 can be in the swelling of tubular element 51080 And tissue thickness compensation part 51020 is engaged after the extension of tissue thickness compensation part 51020 immediately, or simultaneously carry out. After nail 30030 is entered in tissue T by percussion, tissue thickness compensation part 51020 can continue to increase or extend.It is followed closely in deployment When 30030, nail 30030 can pierce through tubular element 51080.In this case, cut-off tubular element is remained at Therapeutic agent 51098 in 51080 can be discharged from tubular element 51080, and can cover the leg 30031 of percussion nail 30030.
Referring to fig. 4 70, tissue thickness compensation part 51020 can be manufactured for example by molding technology.Frame or mold 51120 can Including first longitudinal side 51122 and second longitudinal side 51124.Side 51124 may include one or more recesses longitudinally in each 51130, one or more of recesses can respectively receive the first end 50183 or second end of tubular element 51080 50185.The first end 50183 of tubular element 51080 can be positioned in the first recess 51130a in first longitudinal side 51122 In, and the second end 50183 of tubular element 51080 can be positioned in the second recess in second longitudinal side 51124 In 51130b, so that tubular element 51080 laterally traverses frame 51120.Recess 51180 may include semi-circular grooves, should be partly Circular groove can be bonded the first end 50183 or second end 50185 of wherein tubular element 51080 securely.First is recessed Mouth 51130a can be positioned so that directly on the opposite of the second recess 51130b, and tubular element 51080 can be positioned so that vertically In or be at least substantially orthogonal to the longitudinal axis of frame 51120.Alternatively, the first recess 51130a can be from Two recess 51130b offset, so that tubular element 51080 is angularly positioned relative to the longitudinal axis of frame 51120.In addition Alternative form in, at least one tubular element 51080 can be longitudinal positioning of in frame 51120, so that tubular element is in frame Extend between the cross side 51126,51128 of frame 51120.In addition, for example, at least one tubular element can be angularly located in Recess and longitudinal direction side 51124 between two recesses on the cross side 51126,51128 of frame and/or on cross side 51126 On recess between frame in.Frame 51120 may include support lugn 51136, and the support lugn is sustainable to be located in frame Tubular element 51080 in 51120.
For example, frame 51120 may include recess 51130 to accommodate 12 tubular elements 51080.Frame recess 51130 It can be filled by tubular element 51080, and alternatively, and not all recess 51130 can be filled.At least one pipe The very best part 51080 can be positioned in frame 51120.For example, at least half recess 51130 can receive tubular element 51080.One Denier tubular element 51080 is positioned in frame 51120, and compensating material 51024 can be added to frame 51120.Added When being added to frame 51120, compensating material 51024 can be fluid.For example, compensating material 51024 can be poured into frame 51120 It is interior and can be flowed around tubular element 51080 therein is positioned at.Referring to fig. 4 71, the compensating material 51024 of flowing can surround It is flowed by the tubular element 51080 that the recess 51130 in frame 51120 supports.Solidify in compensating material 51024, or at least fills It, can be by the tissue thickness compensation part including compensating material 51024 and tubular element 51080 referring now to Figure 47 2 after dividing ground solidification 51020 remove from frame 51120.Tissue thickness compensation part 51020 can be trimmed.For example, can be by extra compensation material Material 51024 is removed from tissue thickness compensation part 51020, so that the longitudinal direction side of compensating material is substantially flat.In addition, ginseng See Figure 47 3, the first end 50183 and second end 50185 of tubular element 51080 can be pressed together, or make its closure with Sealed tubular element 51080.The end can be made to be closed before tubular element 51080 is placed in frame 51120.As Another option, trimming process can crosscutting end 51083,51085 and hot stack process can be used for sealing and/or closed tube The end 51083,51085 of the very best part 51080.
Referring again to Figure 47 0, rigid pins 51127 can be positioned in each tubular element 51080.For example, rigid pins 51127 can extend across the longitudinal direction tube chamber of tubular element 51080.Rigid pins 51127 can extend over each tubular element 51080, so that rigid pins 51127 can be positioned in the recess 51130 in frame 51120.For example, with rigid pins In 51127 embodiment, when compensating material 51204 is poured into frame 51120 and when the compensating material 51024 of flowing is enclosed When flowing around tubular element 51080, rigid pins 51127 can support tubular element 51080.Once compensating material 51024 solidifies, is hard Change and/or be lyophilized, or cures sufficiently, hardens and/or be lyophilized, it can be by tissue thickness compensation part 51020 from frame 51120 It removes, and rigid pins 51127 can be removed from the longitudinal direction tube chamber of tubular element 51080.Then such as drug can be used to fill out Fill tubular element 51080.It, can be to the end for example including tubular element 51080 after filling tubular element 51080 with drug 51083,51085 tissue thickness compensation part 51020 is trimmed.Tissue thickness compensation part 51020 can be for example punched, and/ Or for example pass through heat and/or pressure seal.
As described herein, tissue thickness compensation part 52020 may include multiple tubular elements 51080.Referring now to Figure 47 4, Tubular element 51080 may include different material properties, size and geometry.For example, the first tubular element 51080a can be wrapped Containing first thickness and the first material, and the second tubular element 51080b may include second thickness and the second material.Tissue thickness At least two tubular elements 51080 in compensating part 52020 may include identical material.Alternatively, tissue is thick The each tubular element 51080 spent in compensating part 5202 may include different material.Similarly, tissue thickness compensation part 52020 In at least two tubular elements 51080 may include identical geometry.Alternatively, tissue thickness compensation part Each tubular element 51080 in 52020 may include different geometry.
Referring now to Figure 53 7-540, tissue thickness compensation part 51220 may include laterally traversing tissue thickness compensation part 51220 at least one tubular element 51280.Referring to Figure 53 7, tissue thickness compensation part 51220 can be relative to end effector 12 anvil block 30060 positions.For example, tissue thickness compensation part 51220 can be fixed the anvil block 30060 of end effector 12 Fixation surface 30061.Referring primarily to Figure 53 8, for example, tubular element 51280 may include capsule shape.For example, tubular element 51280 may include polymer composition, such as bioabsorbable biocompatible elastomeric polymer.
Referring again to Figure 53 7, tissue thickness compensation part 51220 may also include at least partly around tubular element 51280 Compensating material 51224.For example, compensating material 51224 may include bioabsorbable polymer, such as lyophilized polysaccharide, sugared egg White class, elastin laminin, proteoglycans, gelatin, collagen and/or oxidized regenerated cellulose (ORC).It is similar as above, compensating material 51024 can be such that tubular element 51280 is held in place in tissue thickness compensation part 51220.In addition, compensating material 51224 can quilt Fixation surface 30061 fixed to anvil block 30060, so that compensating material 51220 is firmly positioned in end effector 12.It mends Repaying material 51224 may include at least one drug.
Referring still to Figure 53 7, the tubular element 51280 of lateral register can be relative to the cutting in translational slidiing part 30250 Element 30252 positions, and translatable cutting element 30252 is enabled to cut off tubular element 51280.For example, cutting element 30252 can cut off tubular element 51280 at or near each 51280 center of tubular element.When tubular element 51280 is cut to When two halves, the cut-off part of tubular element 51280 can be swollen or extend, as shown in Figure 53 7.Referring primarily to Figure 53 9, tubulose Element 51280 may include hydroaropic substance 51099, the hydroaropic substance can be discharged when tubular element 51280 is cut off and/or Exposure.In addition, referring now to Figure 54 0, when hydroaropic substance 51099 contacts the body fluid in tissue T, hydroaropic substance 51099 The fluid can be attracted, this can lead to the swelling of tubular element 51280 or extension.When tubular element 51280 extends, around pipe The compensating material 51224 of the very best part 51280 can deviate or be adapted to the tubular element 51280 of swelling.For example, when compensation When material 51224 includes gelatin, the gelatin can be deviated to adapt to the tubular element 51280 of swelling.Referring again to Figure 53 7, The extension of tubular element 51280 and the offset of compensating material 51224 can lead to the corresponding extension of tissue thickness compensation part 51220.
Similar to other tissue thickness compensation parts that the disclosure is discussed in the whole text, tissue thickness compensation part 51220 can pass through The power deformation or compression applied.In addition, tissue thickness compensation part 51220 can be to be sufficiently flexible, so that it is passing through Screen resilience is generated when the power deformation of application, and then can be sprung back when removing applied power or partly be sprung back.Work as tissue When thickness compensation part 51220 is trapped in nail retention region 30039 (Figure 41 7), nail 30030 can make tissue thickness compensation part 51220 deformations.For example, nail 30030 can make the tubular element of the tissue thickness compensation part 51220 captured in percussion nail 30030 51280 and/or compensating material 51224 deform.The non-capture portion of tissue thickness compensation part 51220 can also be because of nail retention region Deformation in 30039 and deform.In deformation, tissue thickness compensation part 51220 can attempt to spring back from deformed configuration.Such time Bullet can occur before the hydrophilic extension of tubular element 51280, while the hydrophilic extension of tubular element 51280, and/or After the hydrophilic extension of tubular element 51280.When tissue thickness compensation part 51220 attempts to spring back, can also be captured Tissue in nail retention region 30039 applies restoring force, as described in more detail.
75-478 referring to fig. 4, tissue thickness compensation part 52020 may include laterally traversing tissue thickness compensation part 52020 One or more tubular elements 52080 of (being similar at least one tissue thickness compensation part as described herein).Tissue thickness is mended Repaying part 52020 may include multiple tubular elements 52080 laterally traversed.Tissue thickness compensation part 52020 may also include one Or multiple material pieces 52024, the material piece keep or retain at least one tubular element in tissue thickness compensation part 52020 52080.One or more material pieces 52024 can be positioned in the above and or below of tubular element 52080, and can be secured Ground keeps each tubular element 52080 in tissue thickness compensation part 52020.Referring primarily to Figure 47 5, tissue thickness compensation part can Including the first material piece 52024a and the second material piece 52024b.Tubular element 52080 can be positioned in the first material piece Between 52024a and the second material piece 52024b.In addition, material piece 52024b can be fixed nail bin referring still to Figure 47 5 The top platform surface 30011 of 30000 rigid support portion, so that tissue thickness compensation part 52020 is firmly positioned in end In portion's actuator 12.Alternatively, one or more material pieces 52024 can be fixed anvil block 30060 or with it His mode is maintained in end effector 12.
Referring primarily to Figure 47 6, tissue thickness compensation part 52020 can be porous and/or permeable.For example, material piece 52024 may include multiple holes 52026.Hole 52026 can be substantially circular.Hole 52036 can be visible in material piece 52024 's.Alternatively, hole 52036 can be microcosmic.Referring still to Figure 47 6, tubular element 52080 may also comprise multiple Hole 52026.Referring to fig. 4 77, tissue thickness compensation part 52120 may include material piece 52124, which includes multiple non-circular Hole 52126.For example, hole 52126 may include diamond shape and/or fluting shape.Alternatively, referring to fig. 4 78, tissue Thickness compensation part 52220 may include tubular element 52280, which includes permeable tubulose dot matrix 52292.For example, Material piece 52224 may include bioabsorbable biocompatible elastomeric polymer and may include drug.
In any tissue thickness compensation part as described herein, at least one tubular element 52080 can be swollen or extend, As shown in Figure 47 9A-479D.For example, with reference to Figure 47 9A, tubular element 52080 can be positioned in tissue thickness compensation part 52020 In the first material piece 52024a and the second material piece 52024b among.When tissue thickness compensation part 52020 contacts tissue T, As shown in Figure 47 9B, tissue thickness compensation part 52020 can extend.For example, tubular element 52080 may include being exposed to tissue Within T and/or on fluid when the hydroaropic substance 52099 that extends.In addition, material piece 52024 and tubular element 52080 can To be permeable, as described herein, so that the fluid penetrable tissue thickness compensation part 52020 from tissue T is to allow to flow Body contacts the hydroaropic substance 52099 in tubular element 52080.When tubular element 52080 extends, tubular element is surrounded 52080 material piece 52024 can deviate or be adapted to the tubular element 52080 of swelling.Similar to disclosure institute in the whole text The various tissue thickness compensation parts discussed, the tissue thickness compensation part 52020 of extension can be by the power that are applied (such as by hitting The compressing force that hair nail applies) it deforms or compresses, as shown in Figure 47 9C.In addition, tissue thickness compensation part 52020 can be sufficiently to have bullet Property, so that it generates screen resilience when deforming by applied power, and then can the rebound when removing applied power. Referring now to Figure 47 9D and 479E, tissue thickness compensation part 52020 is resiliently to the tripe systems in different nail retention regions 30039 Type, suitably to adapt to captured tissue T.
80-485 referring to fig. 4, tissue thickness compensation part 53020 may include multiple vertically oriented tubular elements 53080.Often A tubular element 53080 may include tubulose axis, which is substantially perpendicular to the rigid support portion of nail bin 30000 30010 top platform surface 30011.In addition, the first end of each tubular element 53080 can be for example adjacent to top platform table Face 30011 positions.Tubular element 53080 may be, for example, deformable and may include elastomer polymer.As shown in Figure 48 1, Tubular element 53080 can be compressed when the tissue T being sewn captures in nail retention region 30039.Tubular element 53080 can Comprising elastic material, so that the deformation of tubular element 53080 generates when tubular element 53080 attempts to spring back from deformed configuration Restoring force.The deformation of tubular element 53080 can be at least partly elasticity and at least partly plasticity.Tubular element 53080 can Spring is served as under the power applied, and can not be fastened.Referring to fig. 4 82, tubular element 53080 can be substantially cylinder Shape.Referring to fig. 4 83, tubular element 53180 may include buckling region 53112.When applying compressing force to tubular element 53180, It can fasten or deform at buckling region 53112.Tubular element 53180 flexibly and/or can be deformed plastically, then It is designed to fasten suddenly at buckling region 53112 under pre-selected tightening force.
Referring primarily to Figure 48 4, the first tubular element 53080 can be positioned at the first end of nail cavity 30012, and another One tubular element 53080 can be positioned at the second end of nail cavity 30012.As shown in Figure 48 2, tubular element 53080 can Including extending through lumen 53084 therein.Referring again to Figure 48 1, when nail 30030 moves to firing position from initial position When, each nail leg 30032 can pass through the lumen 53084 of each tubular element 53080.Alternatively, main ginseng See Figure 48 5, vertically oriented tubular element 54080 can be disposed in tissue thickness compensation part 54020, so that tubular element 54080 adjacent to each other or contacts.In other words, tubular element 54080 can be clustered or concentrate in together.Tubular element 54080 It can be systematically arranged in tissue thickness compensation part 54020；However, alternatively, tubular element 54080 can be by nothing Rule ground arrangement.
Referring again to Figure 48 0,484 and 485, tissue thickness compensation part 53020 also may include material piece 53024, the material Piece makes tubular element 53080 keep or be retained in tissue thickness compensation part 53020.Material piece 53024 can be positioned in tubulose The above and or below of element 53080, and each tubular element in tissue thickness compensation part 53020 can be firmly held 53080.Tissue thickness compensation part 53020 may include the first and second material pieces 53024.Tubular element 53080 can be positioned in Between first and second material pieces 53024.In addition, material piece 53024 can be fixed the rigid support portion of nail bin 30000 Top platform surface 30011, so that tissue thickness compensation part 53020 is firmly positioned in end effector 12.As in addition A kind of selection, material piece 53024 can be fixed anvil block 30060 or be in other words maintained in end effector 12.Material piece 53024 can be sufficiently deformable, so that spring 55080 of the material piece 53024 in tissue thickness compensation part deforms when deforming.
Referring to fig. 4 86 and 487, tissue thickness compensation part 55020 may include at least one spring 55080, and the spring is It is sufficiently flexible, so as to generate screen resilience in deformation.Referring primarily to Figure 48 6, tissue thickness compensation part 55020 can Including multiple springs 55080, such as three row springs 55080.Spring 55080 can systematically and/or be randomly arranged in tissue In thickness compensation part 55020.For example, spring 55080 may include elastomer polymer.The shape of spring 55080 allows its change Shape.Spring 55080 can be deformed into deformed configuration from initial configuration.For example, a part when tissue thickness compensation part 55020 is caught When obtaining in nail retention region 30039, within nail retention region 30039 and/or the spring 55080 of surrounding can be deformed.For example, Spring 55080 can be fastened or be collapsed under the compressing force applied for percussion nail 30030, and spring 55080 can produce recovery Power, the restoring force depend on the device of spring stiffness coefficient of distortion spring 55080 and/or the deflection of spring 55080.Spring 55080 can serve as sponge under the compressing force applied by percussion nail 30030.In addition, spring 55080 may include compensating material, such as The disclosure is more fully described in the whole text.
Tissue thickness compensation part 55020 also may include one or more material pieces 55024, which keeps or reservation group Knit at least one spring 55080 in thickness compensation part 55020.Material piece 55024 can be positioned in the top of spring 55080 And/or lower section, and the spring 55080 in tissue thickness compensation part 55020 can be firmly held.Tissue thickness compensation part 55020 may include the first material piece 55024a and the second material piece 55024b.Tubular element 52080 can be positioned in the first material Between piece 55024a and the second material piece 55024b.Referring primarily to Figure 48 7, tissue thickness compensation part 55020 may also include third Material piece 55024c, the third material piece are positioned adjacent to the first material piece 55024a or the second material piece 55024b.At least one Material piece 55024 can be fixed the top platform surface 30011 of the rigid support portion of nail bin 30000, so that tissue thickness Compensating part 55020 is firmly positioned in end effector 12.Alternatively, at least one material piece 55024 can It is fixed to anvil block 30060 or is otherwise maintained in end effector 12.
Referring now to Figure 48 7, when following closely 30030 and being fired from nail bin 30000 (Figure 48 5), nail 30030 can engage group Knit thickness compensation part 55020.Percussion nail 30030 can follow closely a part capture of tissue T and tissue thickness compensation part 55020 In retention area 30039.Spring 55080 can be to be deformable, so that tissue thickness compensation part 55020 is by percussion nail 30030 It is compressed when capture.Spring 55080 can be positioned between the percussion nail 30030 in tissue thickness compensation part 55020.As in addition A kind of selection can capture at least one spring 55080 in nail retention region 30039.
Referring to fig. 4 88, tissue thickness compensation part 60020 may include at least two compensation layers 60022.Tissue thickness compensation part 60020 may include multiple compensation layers 60022, and multiple compensation layer can stack in top of each other, positioned side by side or their group It closes.As described in more detail, the compensation layer 60022 of tissue thickness compensation part 60020 may include for example different geometric form Shape and/or material property.In addition, as described in more detail, pit and/or channel may be present in the adjacent compensation layer stacked Between 60022.For example, tissue thickness compensation part 62020 may include six compensation layers 62022a, 62022b, 62022c, 62022d, 62022e, 62022f, six compensation layers can stack (Figure 50 3) top of each other is adjacent.
89,490 and 492-497 referring to fig. 4, tissue thickness compensation part may include the compensation of the first compensation layer 60122a and second Layer 60122b.First compensation layer 60122a can be stacked the top of the second compensation layer 60122b is adjacent.The adjacent compensation layer stacked 60122 can be separated by Separation or pit 60132.Referring primarily to Figure 48 9, tissue thickness compensation part 60120 may also comprise fixed At least one cantilever beam or support 60124 of position between the first compensation layer 60122a and the second compensation layer 60122b.Support Part 60124 can position the first compensation layer 60122a relative to the second compensation layer 60122b, so that compensation layer 60122 is by separating Gap 60132 separates.As described in more detail, the variation of supporting element 60124 and/or compensation layer 60122a, 60122b Separation 60132 can such as be reduced.
The supporting beam of tissue thickness compensation part may include multiple geometries and size.For example, supporting beam can be simple I Ellbeam, single-bend support beam 60124 (Figure 48 9) placed in the middle, eccentric single-bend support beam 60224 (Figure 49 0), elliptical support beam 60324 (Figure 49 2), multi-bend support beam 60424 (Figure 49 3), and/or symmetrical double cantilever support beams 60524 (Figure 49 4).In addition, Referring now to Figure 48 9,495 and 496, for example, supporting beam 60624 can be thinner than at least one compensation layer 60122 (Figure 49 5), support Beam 60724 can be thicker than at least one compensation layer 60122 (Figure 49 6) and/or supporting beam 60124 can be and at least one compensation layer 60122 (Figure 48 9) substantially the same thickness.Material, geometry and/or the size of supporting beam 60124 can for example influence group Knit the deformability and rebound elasticity of thickness compensation part 60120.
Referring still to Figure 48 9, for example, the compensation layer 60122 of tissue thickness compensation part 60120 and supporting beam 60124 can wrap Containing different materials, such as structured material, biomaterial and/or electric material.For example, at least one compensation layer 60122 can Include polymer composition.Polymer composition may include at least partly elastic material, so that compensation layer 60122 and/or branch The deformation of support beam 60124 can produce screen resilience.The polymer composition of compensation layer 60122 may include nonabsorable polymer, Absorbable polymer or their combination.For example, absorbable polymer may include bioabsorbable biocompatibility bullet Elastomer polymer.In addition, the polymer composition of compensation layer 60122 may include synthetic polymer, non-synthetic polymer or they Combination.The example of synthetic polymer include but is not limited to polyglycolic acid (PGA), poly- (lactic acid) (PLA), polycaprolactone (PCL), Polydioxanone (PDO) and their copolymer.The example of non-synthetic polymer includes but is not limited to polysaccharide, glycoprotein Class, elastin laminin, proteoglycans, gelatin, collagen and oxidized regenerated cellulose (ORC).For example, by weight percentage, compensation The polymer composition of layer 60122 may include different amounts of absorbable polymer, the polymer of nonabsorable, synthetic polymer And non-synthetic polymer.Each compensation layer 60022 in tissue thickness compensation part 60120 may include different combination of polymers Object, or alternatively, at least two compensation layers 60122 may include identical polymer composition.
Referring again to Figure 48 8, for example, at least one compensation layer 60022 may include therapeutic agent 60098, such as drug or medicine Object activating agent.The releasable therapeutically a effective amount of therapeutic agent 60098 of compensation layer 60022.Therapeutic agent 60098 can be in compensation layer 60022 releases when being absorbed.The example of therapeutic agent 60098 may include but be not limited to hemostat and drug, such as, fibrin egg White, fibrin ferment and/or oxidized regenerated cellulose (ORC)；Antiinflammatory medicine, such as Diclofenac, naproxen, are relaxed at aspirin Woods acid and/or hydrocortisone；Antibiotic and antimicrobial agents or antimicrobial, such as triclosan, ionic silver, ammonia benzyl are green Mycin, gentamicin, polymyxin B, and/or chloramphenicol；And/or anticancer agent, such as cis-platinum, mitomycin and/or adriamycin. For example, therapeutic agent 60098 may include biological agent, such as stem cell.Each compensation layer in tissue thickness compensation part 60020 60022 may include different therapeutic agents 60098, or alternatively, at least two compensation layers 60022 may include identical Therapeutic agent 60098.For example, the compensation layer 60022 comprising therapeutic agent 60098 (such as biological agent) can for example be wrapped in two Between structured compensation layer 60022, described two structured compensation layers include polymer composition, such as polyglycolic acid (PGA) Foam.Compensation layer 60022 also may include conductive material, such as copper.
Referring again to Figure 50 3, the compensation layer 62022 in tissue thickness compensation part 62020 can have different geometries. When layer 62022 is adjacently located in tissue thickness compensation part 62020, compensation layer 62022 can be formed between layer 62022 to A few three dimensional catheter 62032.For example, when the second compensation layer 62022b including channel is positioned in substantially flat third When the top of compensation layer 62022c, the channel of third compensation layer 62022c and flat surfaces can limit three dimensional catheter between the two 62032a.Similarly, for example, when the 5th compensation layer 62022e including channel is positioned in the 4th compensation including corresponding channel When the lower section of layer 62022d, the channel can be formed by the channel restriction in neighbouring the compensation layer 62022d, 62022e stacked Three dimensional catheter 62032b.When fluid flows through tissue thickness compensation part 62020, conduit 62032 can guide therapeutic agent and/or body Liquid.
Referring to fig. 4 99, tissue thickness compensation part 61020 may include compensation layer 61022, such as layer 60122a and 21022b, The layer can accommodate the nail 30030 disposed from nail bin 20000 (Figure 49 8).When nail 30030 moves to percussion from initial position When position, the geometry of at least one compensation layer 61022 can guide nail leg 30032 to firing position.At least one compensation Layer 61022 may include extending through hole 61030 therein, and mesoporous 61030 can be arranged in nail 30030 from nail bin 20000 The nail leg 30032 for having disposed nail 30030 is received when being fired in (Figure 49 8), as described in more detail.Alternatively Selection, referring again to Figure 50 3, for example, nail leg 30032 can pierce through at least one compensation layer, such as compensation layer 62022f, and Can through hole 62030 be received at least one compensation layer, such as compensation layer 62022a.
Referring primarily to Figure 49 9, tissue thickness compensation part 60120 may include compensation layer 61022a, on one of 61022b At least one support tabs 61026.Support tabs 61026 can protrude into the Separation being limited between adjacent compensation layer 61032, the gap 61032 between such as the first compensation layer 61020a and the second compensation layer 61020b.Support tabs 61026 can be from The longitudinal direction side of first compensation layer 61022a is prominent.In addition, support tabs 61026 can along longitudinal direction side length extend or only along one Part extends.At least one support tabs 61026 can be from compensation layer 61022a, and two longitudinal direction sides of 61022b are prominent.In addition, phase The compensation layer 61022a, 61022b of neighbour's positioning may include corresponding support tabs 60126, so that prolonging from the first compensation layer 60122a The support tabs 60126 stretched can be at least partly aligned with the support tabs 60126 extended from the second compensation layer 60122b.Again Referring to fig. 4 97, tissue thickness compensation part 60820 may include being located at adjacent compensation layer 60122a, the restrictor plate between 60122b 60828.It is defined between the first compensation layer 60122a and the second compensation layer 60122b for example, restrictor plate 60828 can be positioned on Gap 60132 in.As described in more detail, support tabs 61026 and/or restrictor plate 60828 can control supporting element The deformation and/or flexure of 60124 and/or compensation layer 60122a, 60122b.
As described herein, the compensation layer 60022 of tissue thickness compensation part 60020 may include different materials, geometry And/or size.Such tissue thickness compensation part 60020 can be assembled by a variety of manufacturing technologies.Referring primarily to Figure 48 8, tissue is thick Degree compensating part 60022 can be manufactured by lithographic printing, stereolithography (SLA) or silk-screen printing technique.For example, cubic light is scribed Tissue thickness compensation part 60020 can be formed by making technique, wherein each compensation layer 60022 includes different material and/or geometric form Feature structure.For example, the ultraviolet light in stereo lithography machine can draw the geometry of the first compensation layer 60022, so that including First compensation layer 60022 of one material, geometry and/or size is solidified by ultraviolet light.Ultraviolet light then can draw second The geometry of compensation layer 60022, so that the second compensation layer 60022 comprising the second material, geometry and/or size passes through Ultraviolet light solidification.Stereo lithography machine can on top of each other, side by side or the mode of their combination draws compensation layer 60022. In addition, compensation layer 60022 can be plotted as so that pit 60132 is present between adjacent compensation layer 60022.Due to cubic light Quarter, machine can form the very thin layer with unique geometry, therefore be compensated by the tissue thickness of stereolithography processes manufacture Part 60020 may include extremely complex 3 dimensional coil geometry.
Referring to fig. 4 98, tissue thickness compensation part 60920 can be positioned in the end effector 12 of surgical instruments 10 (Fig. 1). Tissue thickness compensation part 60920 can be positioned relative to the nail bin 20000 of end effector 12.For example, tissue thickness compensation part 60920 can be releasably secured to nail bin 20000.At least one compensation layer 60922 of tissue thickness compensation part 60920 can be adjacent Top platform surface 20011 (Figure 40 8) positioning of nearly nail bin 20000.For example, the second compensation layer 60922b can by adhesive or Top platform surface 20011 is fixed to by wrappage (similar at least one of wrappage as described herein) (Figure 21 8). Tissue thickness compensation part 60920 can be integral with nail bin 20000, so that 60920 shape of nail bin 20000 and tissue thickness compensation part As individual unit construction.For example, nail bin 20000 may include the first main part, such as (figure of rigid support portion 20010 408) and the second main part, such as tissue thickness compensation part 60920.
Referring still to Figure 49 8, tissue thickness compensation part 60920 may include the compensation of the first compensating part part 60920a and second Part part 60920b.First compensating part part 60920a can be positioned in the first longitudinal side of nail bin 20000, and the second compensation Part part 60920b can be positioned in the second longitudinal side of nail bin 20000.When tissue thickness compensation part 60920 is relative to nail bin When 20000 positioning, the longitudinal slit 20015 (Figure 40 7) in rigid support portion 20010 (Figure 40 7) can be in the first compensating part portion Divide and extends between 60920a and the second compensating part part 60920b.For example, when cutting on nail percussion sliding part 20050 (Figure 40 7) When cutting element 20052 and translating across end effector 12, cutting element 20052 may pass through the first compensating part part 60920a and Longitudinal slit 20015 between two compensating part part 60920b, a part without cutting off tissue thickness compensation part 60920.Make For another option, cutting element 20052 can cut off a part of tissue thickness compensation part 60920.
Referring now to Figure 49 1, tissue thickness compensation part 63020 can fit in the end effector of circular surgical apparatus In 12 '.Tissue thickness compensation part 62030 may include circular first compensation layer 63022a and circular second compensation layer 63022b.Second compensation layer 63022b can be positioned on the circular top platform surface 20011 ' of round nail bin 20000 ', wherein Second compensation layer 63022b may include the geometry of the geometry corresponding to platform surface 20011 '.For example, platform surface 20011 ' may include stepped portion, and the second compensation layer 63022b may include corresponding stepped portion.Tissue thickness compensation part It may also include, for example, around at least one supporting element 63024 and/or support tabs of the extension of tissue thickness compensation part 63020 63026。
Referring again to Figure 49 9, percussion nail 30030 can engage tissue thickness compensation part 60920.The disclosure in the whole text as described in As, percussion nail 30030 can capture a part and tissue T of tissue thickness compensation part 60920, and apply compressive force to Tissue thickness compensation part 60920.In addition, tissue thickness compensation part 60920 can be deformable referring primarily to Figure 50 0-502.Such as Described herein, the first compensation layer 60920a can be separated by Separation 60932 and the second compensation layer 60920b.Referring to Figure 50 0, Before compressing tissue thickness compensation part 60920, gap 60932 may include first distance.When for example passing through percussion nail 30030 When compressing force A is applied to tissue thickness compensation part 60920 and tissue T by (Figure 49 9), supporting element 60924 can be deformed.Ginseng now See that Figure 50 1, single bent support beam 60924 can be bent at compressing force A, so that the first compensation layer 60920a and the second compensation layer Separation 60932 between 60920b is reduced to second distance.Referring primarily to Figure 50 2, the first compensation layer 60922a and second Compensation layer 60922b can also be deformed at compressing force A.Support tabs 60926 can control the deformation of compensation layer 60920.For example, Support tabs 60926 can prevent the mistake of compensation layer 60920 and supporting its longitudinal direction side when compensation layer 60920 is in contact with each other Degree bending.Support tabs 60926 can be also bent at compressing force A or archwise.Additionally or alternatively, When compensation layer 60920 and/or support tabs 60926 contact restrictor plate 60128, limiter in greater detail herein Plate 60128 (Figure 49 7) can limit the deformation of compensation layer 60920.
In addition, being similar to various tissue thickness compensation parts as described herein, tissue thickness compensation part 60920 can be in deformation Generate screen resilience or restoring force.The restoring force that the tissue thickness compensation part of deformation generates can depend, at least partially, on tissue thickness Orientation, size, material and/or the geometry of compensating part 60920, and tissue thickness's compensation that the power because being applied due to deforms The amount of part 60920.In addition, at least part of tissue thickness compensation part 60920 can have elasticity, so that tissue thickness compensation part 60920 generate load on spring or restoring force when deforming by percussion nail 30030.Supporting element 60924 may include elastic material and/ Or at least one compensation layer 60922 may include elastic material, so that tissue thickness compensation part 60920 has elasticity.
Referring now to Figure 50 4, the end effector of surgery suturing appliance may include the first jaw and the second jaw, wherein At least one of one jaw and the second jaw can be movable with respect to each other.For example, end effector can have including nail bin First jaw in channel 19070 and the second jaw including anvil block 19060, wherein anvil block 19060 can be logical towards and/or far from nail bin Road 19070 pivots.Staple cartridge channel 19070 can receive nail bin 19000, for example, it can be removably retained in staple cartridge channel In 19070.Nail bin 19000 may include warehouse 19010 and tissue thickness compensation part 19020, wherein tissue thickness compensation part 19020 It can be removably attached to warehouse 19010.Referring now to Figure 50 5, warehouse 19010 may include multiple nail cavities 19012 and positioning Nail 19030 in each nail cavity 19012.In addition, nail 19030 can be by be located in warehouse 19010 staple drivers 19040 Support, the nail that wherein sliding part and/or firing member for example can be advanced through nail bin 19000 to be lifted up in nail cavity 19012 Driver 19040 as shown at block 506 *, and projects nail 19030 from nail cavity 19012.
Referring primarily to Figure 50 4 and Figure 50 5, tissue thickness compensation part 19020 may include elastic component 19022 and encapsulation elasticity The container 19024 of component 19022.Container 19024 can be sealed and can be limited the cavity comprising internal gas, the inside gas Body has the pressure different from ambient atmospheric pressure.The pressure of internal gas can be greater than the pressure of ambient atmosphere, while conduct Another option, the pressure of internal gas can be less than the pressure of ambient atmosphere.It include to be less than ambient atmosphere in container 19024 In the case where the pressure of pressure, the side wall of container 19024 can be with wrapped vacuum.In this case, the vacuum can cause The deformation of container 19024 is collapsed and/or graduation, wherein the elastic component 19022 being located in container 19024 can be elastically compressed In container 19024.When extracting vacuum on container 19024, elastic component 19022 can bend or deform downwards and can It is held in place under compression or vacuum sealing state by the side wall of container 19024.
Elastic component 19022 and container 19024 are made of biocompatible materials.For example, elastic component 19022 and/or Container 19024 can be made of bioabsorbable material (such as PLLA, PGA and/or PCL).Elastic component 19022 can be by elasticity Material is constituted.Elastic component 19022 may also comprise structural resiliency.For example, elastic component 19022 can be the form of hollow tube.
Further described above, tissue thickness compensation part 19020 can against or neighbouring warehouse 19010 platform Surface 19011 positions.Referring now to Figure 50 6, when nail 19030 is at least partly fired, appearance can be pierced through by following closely 19030 leg Device 19024 keeps it broken scattered.Container 19024 may include central part 19026, which can be positioned on warehouse 19010 The top of cutting slit 19016 so that when cutting element 19080 be advanced into incision be located in nail bin 19000 and anvil block 19060 it Between tissue T when, cutting element 19080 also can cut into the central part 19026 of container 19024, thus pierce through container 19024 or Keep it broken scattered.In either case, once container 19024 it is broken dissipate, then the internal gas in container 19024 can with surround The atmosphere of tissue thickness compensation part 19020 obtains balance, and allows 19022 resilient expansion of elastic component, to reacquire or At least partly reacquire the configuration of its undeformed and/or non-graduation.In this case, elastic component 19022 can will be inclined Set the tissue T that power is applied in the nail 19020 for being trapped in deformation.More specifically, recessed in anvil block 19060 by being limited to After the forming surface deformation in hole 19062, at least part of tissue T and elastic component 19022 can be caught by following closely 19030 leg It obtains in nail 19030, so that tissue thickness compensation part 19020, which can compensate, is trapped in nail when container 19024 is broken scattered The thickness of tissue T in 19030.For example, being trapped in the nail 19030 when the tissue T being trapped in nail 19030 is relatively thin Interior elastic component 19022 can be extended to fill the gap in nail 19030, and enough compressing forces are applied to tissue T. Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the elastic component 19022 being trapped in the nail 19030 can It keeps compression to think that the relatively thick tissue in nail 19030 concedes space, and same, enough compressing forces is applied to tissue T.
When container 19024 is pierced, as described above, elastic component 19022 can attempt to extension to be elastically returned to it Initial configuration.In some cases, a part of of the elastic component 19022 being trapped in nail 19030 possibly can not return To its initial undeformed shape.In this case, elastic component 19022 may include spring, which can apply compressing force To the tissue T being trapped in nail 19030.Elastic component 19022 can simulate Hookean spring, wherein by elastic component 19022 For the compressing force of application with amount or apart from Linear proportional, elastic member 19022 is maintained at flexure in nail 19030.As another A kind of outer selection, elastic component 19022 can simulate nonlinear spring, wherein the compressing force applied by elastic component 19022 is not With amount or apart from Linear proportional, elastic member 19022 is maintained at flexure in nail 19030.
Referring primarily to Figure 50 7 and Figure 50 8, nail bin 19200 may include tissue thickness compensation part 19220, which mends Repaying part can wherein include the container 19222 of one or more sealings.Each of container 19222 can be sealed and can be wrapped Containing internal gas.The pressure of internal gas in sealing container 19222 can be more than atmospheric pressure, while alternatively select It selects, the pressure of the internal gas in sealing container 19222 can be with subatmospheric power.Internal gas in container 19222 In the case where the subatmospheric power of pressure, container 19222 can be described as including vacuum.For example, one or more containers 19222 It can be wrapped up or be included in oversheath, case, wrappage and/or film 19224, wherein tissue thickness compensation part 19220 can be determined Position is above the platform surface 19011 of warehouse 19010.For example, each container 19222 can be by with round or at least substantially justify The pipe of shape cross section (for example, with closed end and open end) is made.Vacuum can be extracted on the open end of pipe, and when in pipe When inside reaching enough vacuum, open end can be closed and seal.For example, pipe can be made of such as polymer material, wherein managing Open end can be heated to be closed and seal the open end.Under any circumstance, the vacuum in each container 19222 can be to It is interior drawing pipe side wall and make tubular elastic deform and/or graduation.Container 19222 is shown as in Figure 50 8 at least portion Divide the state of graduation.
When nail 19030 is in its non-firing position, as shown in Figure 50 8, tissue thickness can be positioned in by following closely 19030 top Spend 19220 lower section of compensating part.For example, nail 19030 can be positioned in its respective nail cavity 19012 so that nail 19030 not with appearance Device 19222 contacts, until the non-firing position shown in Figure 50 8 of nail 19030 moves to its firing position shown in Figure 50 9.Group The wrappage 19224 for knitting thickness compensation part 19220 can protect container 19220 and not pierced through prematurely by nail 19030.Referring now to Figure 50 9, when nail 19030 is at least partly fired, container 19222 can be pierced through or keep it broken scattered by following closely 19030 leg.At this In the case of kind, internal gas in container 19222 can obtain balance with the atmosphere around container 19222, and resilient expansion with Reacquire or at least partly reacquire the configuration of its undeformed and/or non-graduation.In this case, it is pierced Container 19222 bias force can be applied to the tissue in the nail 19030 for being trapped in deformation.More specifically, being limited passing through After the forming surface deformation of the pit 19062 in anvil block 19060, the leg for following closely 19030 can be by tissue T and container 19222 At least part capture in nail 19030 so that when container 19222 is broken dissipate when, container 19222, which can compensate, is trapped in nail The thickness of tissue T in 19030.For example, being trapped in the nail 19030 when the tissue T being trapped in nail 19030 is relatively thin Interior container 19222 can be extended to fill the gap in nail 19030, and at the same time enough compressing forces are applied to tissue T. Correspondingly, when the tissue T being trapped in nail 19030 is thicker, the container 19222 being trapped in the nail 19030 can be kept Compression thinks that the relatively thick tissue in nail 19030 concedes space, and at the same time enough compressing forces are applied to tissue T.
When container 19222 is pierced, as described above, container 19222 can attempt to extension to be elastically returned to it initially Configuration.The part of container 19222 being trapped in nail 19030 possibly can not return to its initial undeformed shape.At this In the case of kind, container 19222 may include spring, which can apply compressive force to the tissue T being trapped in nail 19030. Container 19222 can simulate Hookean spring, wherein the compressing force and amount that are applied by container 19222 or apart from Linear proportional, Middle container 19222 is maintained at flexure in nail 19030.Alternatively, container 19222 can simulate nonlinear spring, The compressing force wherein applied by container 19222 is not with amount or apart from Linear proportional, and wherein container 19222 is maintained at nail 19030 Interior flexure.Container 19222 can be at which hollow and empty when its sealed configuration.Alternatively, container Each of 19222 can limit chamber, and may also include at least one drug wherein included.For example, container 19222 can wrap Containing at least one drug, which can be released and/or bio-absorbable.
The container 19222 of tissue thickness compensation part 19220 can be arranged in any suitable manner.As shown in Figure 50 7, limit The nail cavity 19012 being scheduled in warehouse 19010, and the nail 19030 being located in nail cavity 19012 can be arranged in rows.For example, such as figure institute Show, nail cavity 19012 can be arranged to six longitudinal straight line rows；However, any suitably-arranged mode of nail cavity 19012 can be used. Also as shown in Figure 50 7, tissue thickness compensation part 19220 may include six containers 19222, wherein each of container 19222 It can be aligned with a nail chamber 19012, or the side of being positioned on.Each of nail 19030 in one nail chamber 19012 can pierce Wear identical container 19222.In some cases, the container being positioned on can not be pierced through by following closely 19030 some nail legs 19222；However, in the case where container 19222 limits continuous inner cavity, for example, can be by least one of nail 19030 sufficiently Ground pierces through cavity, and the atmospheric pressure around the pressure and container 19222 to allow inner chamber gas obtains balance.Referring now to figure 514, tissue thickness compensation part for example may include container, such as container 19222 ', can prolong transverse to the direction of staple line 19030 It stretches.For example, container 19222 ' can extend across multiple staples.Referring now to Figure 51 5, tissue thickness compensation part 19220 " may include Multiple containers 19222 ", along perpendicular to or be at least substantially orthogonal to staple line 19030 direction extend.For example, container 19222 " some can be pierced through by nail 19030, and other can not be pierced through by nail 19030.For example, container 19222 " can be horizontal Across or pass through cutting path and extend, wherein cutting element crosscutting container 19222 " and can be such that it broken dissipates.
As described above, for example, tissue thickness compensation part such as tissue thickness compensation part 19220 for example may include multiple close Seal container, such as container 19222.As also described above, each of sealing container 19222 may include independent internal gas.Hold Device 19222 can have different internal pressures.For example, the first container 19222 may include there is the inner vacuum of first pressure, and And second container 19222 may include the inner vacuum with the second different pressures.For example, the deformation or graduation amount of container 19222 It may depend on the vacuum pressure of internal gas wherein included.For example, having compared with the container 19222 with smaller vacuum The amount that the container 19222 of relatively large vacuum can deform or graduation is bigger.The cavity of container can be segmented as two or more solely Vertical seal cavity, wherein each independent seal cavity may include independent internal gas.For example, some nails in staple can Such as the first cavity in a reservoir can be limited with being arranged as piercing through, while other nails in staple can be arranged as piercing through Limit the second cavity in a reservoir.In this case, the nail especially in staple is sequentially hit from an end of staple In the case where being dealt into another end, as described above, one of cavity can when another cavity is broken scattered, holding be complete and can Maintain its internal gas.For example, the first cavity there can be internal gas, there is the first vacuum pressure, and the second cavity can With internal gas, there are the second different vacuum pressures.Keep complete cavity that can maintain its internal pressure, until container quilt Bio-absorbable, to form timing pressure release.
Referring now to Figure 51 0 and Figure 51 1, tissue thickness compensation part such as tissue thickness compensation part 19120 is for example attachable To anvil block 19160.Similar as above, tissue thickness compensation part 19120 may include container 19124 and be positioned at multiple bullets therein Property component 19122.Also similar as above, container 19124 can limit the cavity comprising internal gas, which, which has, is less than Or the pressure greater than the atmospheric pressure around tissue thickness compensation part 19120.Internal gas in container 19124 includes vacuum In the case where, container 19124 and be positioned at elastic component 19122 therein can be by the vacuum and container in container 19124 The pressure difference between atmospheric pressure outside 19124 and deform, collapse and/or graduation.In use, anvil block 19160 can move To closed position, wherein anvil block is positioned relative to nail bin 19100, and the wherein tissue engagement surface 19121 on container 19124 The tissue T being located among tissue thickness compensation part 19120 and nail bin 19100 can be engaged.In use, firing member 19080 can promote towards distal side with percussion nail 19030, as described above, and at the same time incision tissue T.Tissue thickness compensation part 19120 may also include middle section 19126, which can be aligned with the cutting slit being limited in anvil block 19160, wherein When firing member 19080 is advanced through tissue thickness compensation part 19120 towards distal side, firing member 19080 can pierce through container 19124 or dissipate it broken.In addition, similar as above, firing member 19080 can be lifted up staple drivers 19040 and hit Hair nail 19030, allows nail 19030 to contact anvil block 19160 and be deformed to its deformed configuration, as shown in Figure 51 2.Work as nail 19030 when being fired, nail 19030 can pierce through tissue T then pierce through container 19124 or make its it is broken dissipate so that being located in container Elastic component 19122 in 19124 can at least partly extend, as described above.
Further described above, tissue thickness compensation part can be made of biocompatible materials.Biocompatibility Material (such as foam) may include tackifier, surfactant, filler, crosslinking agent, pigment, dyestuff, antioxidant and other Stabilizer and/or their combination, to provide required characteristic for material.Biocompatible foam may include surfactant.Table Face activating agent can be applied to material surface and/or be dispersed in material.It is not intended to be limited to any specific theory, is applied to The surfactant of biocompatible materials can reduce the surface tension of the fluid of contact material.For example, surfactant can To reduce the surface tension of the water of contact material, to accelerate water to penetrate into material.Water can serve as catalyst.Surfactant can be with Improve the hydrophily of material.
Surfactant may include anionic surfactant, cationic surfactant and/or non-ionic surface active Agent.The example of surfactant includes but is not limited to polyacrylic acid, methyl cellulose (methalose), methylcellulose, ethyl Cellulose, propyl cellulose, hydroxyethyl cellulose, carboxymethyl cellulose, polyoxyethylene cetyl ether, polyoxyethylene laural base Ether, polyoxyethylene octyl ether, NONIN HS 240, polyoxyethylene oleyl ether, polyoxyethylene sorbitan Dan Yue Cinnamic acid ester, polyoxyethylene stearyl base ether, ethylene nonyl phenyl ether, dialkylphenoxypoly (ethyleneoxy) ethyl alcohol and pool Lip river Sha Mu and their combination.Surfactant may include the copolymer of polyethylene glycol and polypropylene glycol.Surfactant can wrap Include non-phospholipid surfactants.Non-phospholipid surfactants can provide antibacterial stability and/or other materials be dispersed in bio-compatible In property material.Tissue thickness compensation part may include at least one drug.Tissue thickness compensation part may include as described herein natural One or more of material, non-synthetic materials, and/or synthetic material.Tissue thickness compensation part may include bio-compatible sex vesicle Foam, the biocompatible foam include gelatin, collagen, hyaluronic acid, oxidized regenerated cellulose, polyglycolic acid, polycaprolactone, Polylactic acid, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone and their combination.Tissue thickness compensation part can wrap Containing film, the film includes at least one drug.Tissue thickness compensation part may include Biodegradable films, and the Biodegradable films include At least one drug.Drug may include liquid, gel and/or powder.Drug may include anticancer agent, such as cis-platinum, mitomycin And/or adriamycin.
Tissue thickness compensation part may include biodegradation material, to provide at least one medicine when biodegradation material is degraded The controlled elution of object.When biodegradation material contacts activator such as activating solution, biodegradation material can degrade, Ke Yifen Solution, or lose structural intergrity.For example, activating solution may include saline solution or any other electrolyte solution.Biodegradable material Material can contact activating solution by routine techniques, and the technology includes but is not limited to spraying, dipping and/or brushing.In use, For example, surgeon can will include the end effector and/or nail bin of tissue thickness compensation part (it includes at least one drugs) It immerses in activating solution, the activating solution includes salting liquid, such as sodium chloride, calcium chloride, and/or potassium chloride.Tissue thickness's compensation Part can discharge drug when tissue thickness compensation part is degraded.Drug can be quickly from the feature of the elution of tissue thickness compensation part Initial eluting rate and at a slow speed persistently eluting rate.
Tissue thickness compensation part can be for example made of biocompatible materials, and the biocompatible materials may include oxidation Agent.Oxidant can be organic peroxide and/or inorganic peroxide.The example of oxidant may include but be not limited to peroxidating Hydrogen, urea peroxide, calper calcium peroxide and peromag and SODIUM PERCARBONATE.Oxidant may include peroxy oxidant and hypohalogenous acids Base oxidizer, such as hydrogen peroxide, hypochlorous acid, hypochlorite, hypocodites and percarbonate.Oxidant may include Alkali metal chlorate, hypochlorite and perborate, such as sodium chlorite, sodium hypochlorite and sodium perborate.Oxidant may include Vanadate.Oxidant may include ascorbic acid.Oxidant may include active oxygen generator.Organization bracket may include biocompatibility Material, the biocompatible materials include oxidant.
Biocompatible materials may include liquid, gel and/or powder.For example, oxidant may include particle and/or nanometer Particle.For example, oxidant can be ground into particle and/or nano particle.It can be by the way that oxidant be suspended in a polymer solution And it is integrated to oxidant in biocompatible materials.Oxidant can be integrated to biocompatible materials during lyophilized technique In.After freeze-drying, oxidant could attach to the cell wall of biocompatible materials, at the time of contact with tissue interaction.Oxygen Agent cannot be chemically bonded to biocompatible materials.Percarbonate dry powder can be embedded in biocompatible foam, with logical It crosses slow release oxygen and long-term biological effects is provided.Percarbonate dry powder can be embedded in the polymer fiber in non-woven structure It is interior, to provide long-term biological effects by slow release oxygen.Biocompatible materials may include oxidant and drug, such as strength Mycin and ascorbic acid.
Biocompatible materials may include quick release oxidant and/or sustained release oxidant at a slow speed.Oxidant is from life The feature of the elution of object compatibility material can be quickly initial eluting rate and continue eluting rate at a slow speed.When oxidant contacts body fluid When (such as water), oxidant produces oxygen.The example of body fluid may include but be not limited to blood, blood plasma, peritoneal fluid, myelencephalon Liquid, urine, lymph, synovia, vitreous humor, saliva, gastrointestinal cavity content and/or bile.It is not intended to be limited to any specific Theory, oxidant can reduce cell death, enhance organizational vitality and/or maintain to be broken in cutting and/or sewing process The mechanical strength of bad tissue to tissue.Biocompatible materials may include at least one particle and/or nano particle.Biofacies Capacitive material may include one or more of natural material, non-synthetic materials and synthetic material as described herein.Bio-compatible It is about 10nm to about 100nm and/or about 10 μm to about 100 μm that property material, which may include average diameter, such as 45-50nm and/or 45- 50 μm of particle.Biocompatible materials may include biocompatible foam, and the biocompatible foam includes being embedded At least one particle and/or nano particle.Particle and/or nano particle cannot be chemically bonded to biocompatible materials.It is micro- Grain and/or nano particle can provide the controlled release of drug.Particle and/or nano particle may include at least one drug.Example Such as, particle and/or nano particle may include hemostat, antimicrobial and/or oxidant.Tissue thickness compensation part may include life Object biocompatible foam, the biocompatible foam include hemostat (it includes oxidized regenerated cellulose), antimicrobial (its Including fortimicin and/or gentamicin) and/or oxidant (it includes percarbant).For example, particle and/or nanometer Grain can provide the controlled release of up to three days drugs.
Particle and/or nano particle can be embedded in biocompatible materials in the fabrication process.For example, biocompatibility Polymer (such as PGA/PCL) can contact solvent (such as dioxane) to form mixture.Biofacies can be ground Capacitive polymer is to form particle.Dry particl with or without ORC particle can be contacted with mixture to form suspension.It should Suspension can be lyophilized to form biocompatible foam, which includes with the dry particl being embedded And/or the PGA/PCL of ORC particle.
For example, tissue thickness compensation part disclosed herein or layer can be made of absorbable polymer.For example, tissue is thick Spending compensating part can be constituted by the following substances: foam, film, fibrous woven materials, fiber non-woven PGA, PGA/PCL (poly- (ethyl alcohol Sour -co- caprolactone)), PLA/PCL (poly- (lactic acid -co- polycaprolactone)), PLLA/PCL, PGA/TMC (poly- (glycolic -co- three Carbonate)), it is PDS, PEPBO or other absorbable polyurethane, polyester, polycarbonate, polyorthoester, polyanhydride, poly- Esteramides, and/or polyoxy acid ester.For example, tissue thickness compensation part can by PGA/PLA (poly- (glycolic -co- lactic acid)) and/ Or PDS/PLA (poly- (to dioxanone -co- lactic acid)) is constituted.For example, tissue thickness compensation part can be by organic material structure At.For example, tissue thickness compensation part can be by carboxymethyl cellulose, mosanom, cross-linked-hyaluronic acid, and/or oxidation regeneration fiber Element is constituted.For example, tissue thickness compensation part may include the hardness in 3-7 Shore A (30-50 Shore OO) range, wherein maximum rigid Degree is 15 Shore As (65 Shore OO).For example, tissue thickness compensation part can be subjected to 40% compression under the load of 3 ft lbfs, at 6 pounds It is subjected to 60% compression under power load, and/or is subjected to 80% compression under the load of 20 ft lbfs.One or more gases are (such as Air, nitrogen, carbon dioxide and/or oxygen) it can for example blast and/or be included in tissue thickness compensation part.Tissue thickness is mended Repaying part can be in the globule wherein comprising constituting tissue thickness compensation part, and the globule includes between about 50% and about 75% Material stiffness.
For example, tissue thickness compensation part may include hyaluronic acid, nutritional ingredient, fibrin, fibrin ferment, rich in blood it is small The blood plasma of plate, salicylazosulfapyridine (- 5ASA+ sulfadiazine diazo bond)-pro-drug-colon bacteria is (occasionally Nitrogen reductase), aminosalicylic acid (5ASA, have for sustained release different pro-drugs configure),(5ASA+ is outstanding Te Qi-S coating-pH > 7 (coating dissolution)),(5ASA+ ethylcellulose coat-is based on time/pH and slowly releases Put),(5ASA+5ASA-colon bacteria (the azo reduction of (5ASA+ Utech-L coating-pH > 6), Olsalazine Enzyme)), Balsalazide (5ASA+4 aminobenzoyl-B- alanine)-colon bacteria (azo reductase)), be granulated mesalazine, Lialda (mesalazine delay and controlled-release formulation), HMPL-004 (can inhibit the activation of TNF-α, Interleukin -1β and core-κ B Herbal mixture), CCX282-B (interference T lymphocyte enters the oral chemokine receptor antagonist of intestinal mucosa), Rifaximin (non-absorbability broad-spectrum antibiotic), infliximab, mouse chimera antibodies are (directly against the Dan Ke of TNF-α Grand antibody is approved for mitigating hyporeactive to conventional therapy with moderate/severe lumen and fistula type Crohn disease Adult/pediatric patient sign/symptom and maintain clinical remission), the adalimumab, (monoclonal of anti-tnf-alpha of people's total IgG 1 Antibody is approved for mitigating sign/symptom of Crohn disease, and for inducing and maintaining to react not conventional therapy Foot, or it is slow as the clinic with moderate/severe activity Crohn disease adult patient for not tolerating infliximab Solution), match trastuzumab, the anti-TNF FAB ' of humanization (be connected to the monoclonal antibody fragment of polyethylene glycol, be approved for subtracting Sign/symptom of light Crohn disease, and for inducing and maintaining hyporeactive to conventional therapy with moderate/severe disease Adult patients reaction), natalizumab, the first non-TNF-α inhibitor (biologic artifact that approval is used for Crohn disease), (directly against α -4 integrin, obtain FDA approval for inducing and maintaining confirms there is inflammation to Humanized monoclonal IgG4 antibody And to the treatment of conventional Crow grace and TNF-α inhibitor underaction or conventional Crow grace treatment and TNF-α inhibitor can not be resistant to Clinical response with moderate/severe disease patient and alleviation), the concomitant immunity tune of infliximab may be given Agent, imuran 6-MP (purine synthetic inhibitor-pro-drug), methotrexate (MTX) are saved (in conjunction with dihyrofolate reductase (DHFR) enzyme participates in the synthesis of tetrahydrofolic acid, inhibits the synthesis of all purine), allopurinol and the treatment of sulphur purine, PPI, use H2, clostridium difficile (C-Diff)-flagyl, vancomycin (the excrement transposition processing of healing line are protected in acid suppression；It is prebiotic Bacterium；Intracavitary normal flora is educated again), and/or rifaximin (bacterial overgrowth processing (especially hepatic encephalopathy)；In gastrointestinal tract In do not absorb and work to intracavitary bacterium).
As described herein, for example, tissue thickness compensation part can compensate be trapped in it is being projected from nail bin and/or comprising The variation of the thickness of the tissue in nail in staple line.In other words, certain nails in staple line can capture the thickness portion of tissue, And other nails in staple line can capture the thin part of tissue.In this case, tissue thickness compensation part can be presented in nail Different height or thickness, and the tissue being trapped in nail is applied compressive force to regardless of captured tissue is thick or thin. Tissue thickness compensation part can compensate the variation of tissue hardness.For example, the height that certain nails in staple line can capture tissue can Compression section, and other nails in staple line can capture the compression ratio smaller part of tissue.In this case, for example, tissue Thickness compensation part can be presented in nail (it has been captured with the tissue compared with little compressible) compared with low height or higher hardness, and Correspondingly, it can present in nail (it has captured the tissue with higher compression ratio) compared with big height or compared with soft.Any In the case of, for example, no matter whether tissue thickness compensation part compensates the variation of tissue thickness and/or the variation of tissue hardness, It is referred to alternatively as " tissue compensating part " and/or " compensating part ".
Apparatus as disclosed herein can be designed as being processed after a single use, or they may be designed to can be more Secondary use.However, in either case, described device can be repaired, to reuse after use at least once.It repairs Can include any combination of the following steps: then disassembly described device cleans or replaces particular elements and then ressembles. In particular, described device can be disassembled, and it selectively can replace or take out in any combination the arbitrary number of described device Particular elements or part.After cleaning and/or displacement particular elements, described device can at the repair facility or shortly It is ressembled by operating team before carrying out surgical operation then to use.Those skilled in the art will be understood that, device Reparation can utilize it is a variety of for dismantling, the technology for cleaning/replace and ressemble.The use and gained reparation of such technology fill It sets all within the scope of application.
Preferably, invention as described herein will be handled before surgery.Firstly, obtaining new or used device Tool, and instrument is cleaned if necessary.Then it carries out disinfection to instrument.In a kind of disinfection technology, device, which is placed on, to be closed In container, such as polybag or the TYVEK bag for merging sealing.Then container and instrument are placed in the spoke that can penetrate the container It penetrates in field, such as γ radiation, x- ray or high energy electron.The bacterium on instrument and in container is killed in radiation.It then will disinfection Instrument afterwards is stored in sterile chamber.Instrument is kept sterile by the sealing container, until opening the container in medical facilities Until.
Any patent, patent disclosure or other public materials incorporated in this article in full or in part by reference only exist Incorporated material not be incorporated to this in existing definition of the present invention, statement or the conflicting range of other public materials Text.As a result, under necessary degree, disclosure clearly described herein, which will replace, to be incorporated herein by reference Any conflicting material.If according to state be hereby incorporated herein by but with existing definition described herein, statement or its Conflicting any material of his public material or part thereof does not only generate punching between incorporated material and existing public material It is incorporated herein under prominent degree.
Although being described the present invention as exemplary design, it is also possible in spirit and scope of the present disclosure It is interior that the present invention will be further modified.Therefore present patent application be intended to cover using general principles any modification, Purposes or adaptive version.In addition, present patent application is intended to cover come from known in fields of the present invention or is used to have practical framework The interior pattern away from the disclosure.

Claims (18)

1. a kind of tissue thickness compensation part, includes:
Biocompatible materials；
First component；With
Second component；
Wherein first component and the second component suitably form reaction product so that the tissue thickness compensation part extends；
The tissue thickness compensation part further includes the outer layer comprising water impermeable material and is sealed in the outer layer and includes The internal layer of at least one of the biocompatible materials and first component and the second component.
It also include encapsulating component 2. tissue thickness compensation part according to claim 1, the encapsulating component includes described the One of one component and the second component, wherein the other of first component and second component are embedded in the biofacies In capacitive material.
3. tissue thickness compensation part according to claim 1, wherein first component includes to be embedded in the biofacies Hydrophilic material in capacitive material, and described second group is divided into body fluid.
4. tissue thickness compensation part according to claim 1, the tissue thickness compensation part includes to contain described first group The first encapsulating component divided and the second encapsulating component containing second component.
5. tissue thickness compensation part according to claim 4, wherein the biocompatible materials include at least one envelope Piece installing, at least one described packaging part include first encapsulating component and second encapsulating component.
6. tissue thickness compensation part according to claim 4, wherein when first encapsulating component is broken scattered, described first Encapsulating component can discharge first component, and when second encapsulating component is broken scattered, the second encapsulating component energy Enough discharge second component.
7. tissue thickness compensation part according to any one of the preceding claims, wherein the biocompatible materials include Albumin, alginates, carbohydrate, casein, cellulose, chitin,
Chitosan, collagen, blood, glucan, elastin laminin, fibrin, fibrinogen, gelatin, heparin, thoroughly Bright matter acid, keratin, protein, serum, starch, polylactic acid, polyglycolic acid, poly butyric ester, poly-phosphine piperazine, polyester, poly- second Glycol, polyalkylene oxides, polyacrylamide, polycarbonate, poly-hydroxyethyl methacrylate, polyvinylpyrrolidone, Polyvinyl alcohol, polycaprolactone, polydioxanone, polyacrylic acid, poly- acetic acid esters, polypropylene, glycerol, polyaminoacid, copolymerization Ether-ester, polyalkylenes oxalates, polyamide, poly- iminocarbonic ester, polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance Combination.
8. tissue thickness compensation part according to claim 1, wherein the reaction product by make first component and Second component is contacted and is formed in situ.
9. tissue thickness compensation part described in any one of -6 and 8 according to claim 1, wherein the reaction product is that fluid can The composition of swelling.
10. according to claim 1, tissue thickness compensation part described in any one of 4-6 and 8, wherein first component includes First hydrogel precursor, second component includes the second hydrogel precursor, and the reaction product includes hydrogel.
11. tissue thickness compensation part described in any one of -6 and 8 according to claim 1, wherein first component and second Component is independently selected from albumin, alginates, carbohydrate, casein, cellulose, chitin, chitosan, glue Original, blood, glucan, elastin laminin, fibrin, fibrinogen, gelatin, heparin, hyaluronic acid, keratin, albumen Matter, serum, starch, polylactic acid, polyglycolic acid, poly butyric ester, poly-phosphine piperazine, polyester, polyethylene glycol, polyalkylene oxidation Object, polyacrylamide, polycarbonate, poly-hydroxyethyl methacrylate, polyvinylpyrrolidone, polyvinyl alcohol, polycaprolactone, Polydioxanone, polyacrylic acid, poly- acetic acid esters, polypropylene, glycerol, polyaminoacid, copolymerization ether-ester, polyalkylene oxalic acid The combination of ester, polyamide, poly- iminocarbonic ester, polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance.
12. tissue thickness compensation part according to claim 1, wherein the water impermeable material includes polylactic acid, gathers Glycolic, poly butyric ester, poly-phosphine piperazine, polyester, polyethylene glycol, polyalkylene oxides, polyacrylamide, polycarbonate, Poly-hydroxyethyl methacrylate, polyvinylpyrrolidone, polyvinyl alcohol, polycaprolactone, polydioxanone, polypropylene Sour, poly- acetic acid esters, polypropylene, glycerol, polyaminoacid, copolymerization ether-ester, polyalkylenes oxalates, polyamide, poly- iminocarbonic acid The combination of ester, polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance.
13. tissue thickness compensation part described in any one of -6 and 8 according to claim 1, wherein the biocompatible materials Comprising the reinforcing material being embedded, and wherein, the reinforcing material includes mesh sheet, fiber, particle, powder or above-mentioned substance Combination.
14. tissue thickness compensation part according to claim 13, wherein the reinforcing material includes collagen, gelatin, blood fibre Fibrillarin, fibrinogen, elastin laminin, keratin, albumin, hydroxyethyl cellulose, cellulose, oxycellulose, hydroxypropyl Base cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitin, chitosan, alginate esters, polylactic acid, polyethanol Acid, poly butyric ester, poly-phosphine piperazine, polyester, polyethylene glycol, polyalkylene oxides, polyacrylamide, poly-hydroxyethyl methyl-prop Olefin(e) acid ester, polyvinyl alcohol, polycaprolactone, polydioxanone, polyacrylic acid, poly-vinegar acid esters, gathers oneself at polyvinylpyrrolidone Lactone, polypropylene, aliphatic polyester, glycerol, polyaminoacid, copolymerization ether-ester, polyalkylenes oxalates, polyamide, poly- imino group carbon The combination of acid esters, poly- oxalate, polyoxaesters, polyorthoester, polyphosphazene or above-mentioned substance.
15. tissue thickness compensation part described in any one of -6 and 8 according to claim 1 includes hemostat, anti-inflammatory agent, antibiosis Plain agent, the combination of antimicrobial, antiblocking agent, anticoagulant, drug, pharmaceutically active agents or above-mentioned substance.
16. a kind of product, the anvil block selected from robotic suturing device and the nail bin for robotic suturing device, the product include:
Tissue thickness compensation part according to claim 1, the tissue thickness compensation part include:
Outer layer, it includes pore-free materials；
Internal layer, it includes: porous material, the first encapsulating component containing first component and containing second component Two encapsulating components.
17. product according to claim 16, in which:
The outer layer includes polyglycolic acid, polylactic acid, polydioxanone, polyhydroxyalkanoatefrom, Poliglecaprone, gathers in oneself Ester or their combination；
The porous material includes oxidized regenerated cellulose, and first component includes the first hydrogel precursor, and described the Two components include the second hydrogel precursor；And
Wherein the reaction product is hydrogel, and first hydrogel precursor and the second hydrogel precursor suitably form institute Hydrogel is stated, extend the tissue thickness compensation part when first encapsulating component and the second encapsulating component are broken scattered.
18. according to claim 16 or claim 17 described in product, wherein the product according to circumstances limits nail from institute At least part for the nail forming path that storehouse to be followed to anvil block or from storehouse to the anvil block is stated, and wherein first encapsulation Component and the second encapsulating component are aligned with the nail forming path so that the sting for following the path wear the packaging part or with Other modes keep it broken scattered.
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US13/433,098 US9301753B2 (en) 2010-09-30 2012-03-28 Expandable tissue thickness compensator
US13/433,098 2012-03-28
PCT/US2013/033997 WO2013148762A2 (en) 2012-03-28 2013-03-27 Expandable tissue thickness compensator

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