RU2599335C2 - Surgical suturing instrument with compact joint control facilities - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: group of inventions refers to medical equipment, namely to surgical instruments, particularly to surgical cutting and suturing instruments. Surgical instrument comprises handle assembly, articulated rod unit, first hinged element, second hinged element and articulated joint control unit. Articulated rod assembly sets lengthwise axis and has proximal section projecting from handle assembly. At that, proximal segment is articulated with distal section capable of selectively turn relative to proximal section around first axis, which essentially lateral to lengthwise axis. First hinged element and second hinged element are connected to distal section of pivot rod assembly. Articulated joint control unit is movable installed in handle, connected to first and second hinged elements and able to selectively apply pushing and pulling forces thereto. When moving articulated joint control unit in at least one first adjustment position, control unit applies first pull force to first hinged element and first pushing force to second hinged element making distal central section of rod to turn about first axis in first direction. When moving articulated joint control unit in at least one second adjustment position, control unit applies second pull force to second hinged element and second pushing force to said first hinged element making distal central section of rod to turn about first axis in second direction. At that, proximal segment of rod is attached to rotary head, rotary resting on handle assembly and articulated joint control unit comprises ball element installed in seat in rotary head. Ball element contains multiple holders, formed on it, capable of selectively enter in contact with plurality of corresponding locking elements in section of socket with fixing ball element in any of its positions, neutral or at least one, first or second, adjusting positions. In second version surgical instrument comprises handle assembly, rotary head and hinged rod assembly. Rotary head is fixed on handle assembly in rotary manner. Rotary rod assembly is connected with rotary head and sets longitudinal axis. Articulated rod assembly comprises proximal central segment, distal central segment, proximal working tubular segment and distal working tubular segment. Proximal central segment is connected to rotary head and protrudes from it. Distal central segment is hinged to proximal central segment for implementation of selective turn relative to proximal central segment about first axis, which is, in fact, lateral to lengthwise axis. Proximal working tubular segment is movably supported on proximal central segment and interacts with rotary head so that proximal working tubular segment can be turned by means of rotary head relative to handle assembly around longitudinal axis and can move relative to rotary head in response to motion, causing actuation of device and created by means of starting control system, which functionally maintained in handle. Distal working tubular segment is movably supported on distal central segment. Surgical instrument additionally includes first hinged element, second hinged element, ball element. First and second hinge elements are connected to distal central segment of rotary rod assembly. Ball element additionally makes distal central segment to turn about first axis in first direction, and to second adjustment position, in which articulated joint control unit applies second pull force to first hinged element making distal central segment to turn about first axis in second direction. At that, surgical instrument additionally contains first handle of hinge projecting from ball element in first direction, as well as second handle projecting from ball element in second direction, which is diametrically opposite first one.

EFFECT: inventions provide optimum operational actuation force.

11 cl, 243 dwg

Description

BACKGROUND OF THE INVENTION

Technical field

This invention relates to surgical instruments and, in various embodiments, to surgical cutting and stapling instruments, as well as to staple cassettes that are designed to cut and stitch tissues.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments often have an advantage over traditional devices for open surgical interventions, since a smaller incision reduces the recovery time after surgery and also reduces the risk of complications. Based on this, a significant assortment of endoscopic surgical instruments has been developed to accurately position the end clamp in the surgical field using a cannula or trocar. Such end clamps carry out various operations with body tissues, allowing to achieve a diagnostic or therapeutic effect (this can be, for example, an endoscopic knife, forceps, a cutter, a device for applying brackets, a device for applying clips, an access device, a device for delivering drugs / drugs gene therapy, as well as energy devices using ultrasound, radio frequency energy, laser, etc.).

In many cases, in endoscopic surgery, it is desirable to use end clamps of the minimum size necessary for a specific surgical procedure. Reduced end clamps provide a better view of the surgical field. The reduced end clamps also provide improved access and improved handling in tight spaces. Designers of such distal nozzles face many difficulties in developing small distal working nozzles. The ability to manufacture small distal workpieces, in particular, small endoscopic knives designed for cutting and stitching tissues, is limited by the need to provide sufficient working force for laying a number of staples and cutting tissue. The magnitude of the working effort may vary depending on the thickness and composition of the tissues exposed. For example, cutting and stitching thicker fabrics usually requires a more significant working force. Less force is usually required to cut and staple finer fabrics. For this reason, many of the existing endoscopic knives usually have strong locking systems with a thrust plate and bracket feeding systems that are designed to work in a specific range of tissue thicknesses. Such devices, however, are often not adapted to work with thinner fabrics.

Previous models of endoscopic cutters usually cut tissue, while feeding and placing a series of brackets on both sides of the cut. Although such tools are very effective for procedures that require cutting and then stitching the fabric, they do not allow the surgeon to install fastening elements without first cutting the fabric. Similarly, models of endoscopic knives with flexible jaws provide improved access to the surgical field, however, the components that are commonly used in such devices must be large enough to accommodate the mechanism for creating and transmitting the force necessary to push the brackets and close the end clamps from the handle to end clamp. Therefore, such end clamps are often too large to effectively penetrate narrow body cavities.

Thus, there is a need for surgical instruments for cutting and stitching tissues and cassettes for them to solve many of the problems mentioned above.

The explanations above are provided solely for the purpose of highlighting some of the disadvantages currently found in the technical field to which the invention relates, and do not limit the scope of the invention.

SUMMARY OF THE INVENTION

In accordance with general aspects of at least one embodiment of the invention, there is provided a surgical instrument equipped with a handle module. The proximal section of the modular articulated rod protrudes from the handle assembly, defining the longitudinal axis of the device. Between the proximal and distal sections of the modular rod there is a hinge that allows selective rotation of the distal section relative to the proximal section along the first axis, which is essentially transverse to the longitudinal axis. The first and second hinge elements are attached to the distal portion of the modular articulated rod. The swivel control unit is movably supported on the handle assembly and connected to the first and second hinge elements. The design of the swivel control unit allows selectively pushing and pulling forces to the first and second hinge elements so that when the swivel control unit moves at least to the first adjusting position, the swivel control unit applies a first pulling force to the first hinge element and the first pushing force to the second hinge element, which leads to the rotation of the distal portion of the rod around the first axis in the first direction. When the swivel control unit is translated into at least one of the other (second) adjusting positions, the swivel control unit applies a second pulling force to the second hinge element and a second pushing force to the first hinge element, as a result of which the distal portion of the rod rotates about the first axis taking the second position.

In accordance with other general aspects of at least one embodiment of the invention, there is provided a surgical instrument equipped with a handle module. The proximal section of the modular articulated rod protrudes from the handle assembly, defining the longitudinal axis of the device. The proximal section is pivotally attached to the distal section, which has the ability to selectively rotate relative to the proximal section along the first axis, which is essentially transverse to the longitudinal axis. At least one hinge element is attached to the distal portion of the modular articulated rod. The swivel control unit is slidably supported on the handle assembly and connected to at least one hinge element. The design of the articulated joint control unit allows it to selectively apply pushing and pulling forces to at least one articulated element so that when the articulated joint is moved in the first axial direction, at least one articulated element rotates the distal portion of the modular articulated rod around the first axis in the first articulated direction, and when moving the articulated control unit in the second axial direction, at least one articulated member rotates the distal portion of the modular hinge rod so that it moves around a first axis in a second pivot direction.

In accordance with further general aspects of at least one of the embodiments of the invention, there is provided a surgical instrument equipped with a handle module with a rotary adjuster head rotationally fixed therein. A modular articulated rod is attached to the pivoting head, which defines the longitudinal axis of the device. In various embodiments, the modular articulated rod includes a proximal central segment that is connected to the pivoting head and protrudes outward. A distal central segment is pivotally connected to the proximal central segment, allowing selective rotation relative to the proximal segment around the first axis, which is essentially transverse to the longitudinal axis. The proximal working tubular segment is movably supported on the proximal central segment. The proximal working tubular segment interacts with the rotary head of the regulator in such a way that the proximal working tubular segment can be rotated using the rotary head relative to the handle assembly along the longitudinal axis and can axially move relative to the rotary head in response to the movement of the actuation mechanism, which is transmitted by the actuation control system mounted in the handle assembly. The distal working tubular segment is movably supported on the distal central segment, and the first and second hinged elements are attached to it. In the pivoting head, a spherical hinge element movably fixed is connected to the first and second hinge elements. The hinge ball element is selectively moved from a neutral position in which it does not transmit any articulated force to the first and second hinge elements, to a first adjusting position in which the articulated joint control unit transfers the first pulling force to the first hinge element and the first pushing force - to the second hinge element, which leads to the rotation of the distal central segment around the first axis in the first direction, and to the second adjustment position, in which the control unit pivot connection transmits a second pulling force on the second hinge member and a second pushing force - to the first hinge member, causing the distal central segment to rotate about a first axis in a second direction.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages of the present invention and methods for their implementation will become apparent, and the essence of the invention will become more clear after reading the description of embodiments of the invention with the accompanying drawings.

FIG. 1 is a cross section of a surgical instrument in one embodiment of its implementation according to this invention.

FIG. 1A is a perspective view of one embodiment of an implantable cassette with brackets according to this invention.

FIG. 1B-1E illustrate end clamp portions, in various embodiments according to the present invention, during gripping and stapling tissue using an implantable cassette with brackets according to one embodiment of the present invention.

FIG. 2 is a three-dimensional image of an end clamp in one embodiment, with details of individual components, and a cross-sectional image of a portion of a surgical stapler according to this invention.

FIG. 3 is a side elevational view of a thrust plate in one of its variants according to this invention.

FIG. 4 is a cross section of part of the handle assembly of FIG. one.

FIG. 5 is a partial cross section of the handle assembly of FIG. 1 (section along line 5-5 in FIG. 1).

FIG. 6 is a perspective view of part of a working transmission in one of its variants according to this invention.

FIG. 7 is a partial cross section of the handle assembly of FIG. 1 (section along line 7-7 in FIG. 1).

FIG. 8 is a partial cross section of the handle assembly of FIG. 7 (section along line 8-8 in FIG. 7).

FIG. 9 is a cross-sectional view of a surgical instrument in one embodiment of the present invention after attaching an end clamp to a central portion of the surgical instrument and before fixing this organ in the operating position.

FIG. 9A is an enlarged view of the end clamp and part of the surgical instrument of FIG. 10.

FIG. 10 is a cross section of the surgical instrument of FIG. 9 after fixing the end clamp in the central portion of the surgical instrument.

FIG. 10A is an enlarged view of the end clamp and parts of the surgical instrument of FIG. 10.

FIG. 11 is a cross section of the surgical instrument of FIG. 9 and 10 after the first working adapter has been brought to the inclined clamping surface of the thrust plate.

FIG. 11A is an enlarged view of the end clamp and part of the surgical instrument of FIG. 11 with fabric sandwiched between the thrust plate and the cassette with brackets.

FIG. 12 is a cross-sectional view of the surgical instrument of FIG. 9-11 after the first working adapter has been inserted through the inclined clamping surface of the thrust plate.

FIG. 12A is an enlarged view of the end clamp and part of the surgical instrument of FIG. 12.

FIG. 13 is a cross section of the surgical instrument of FIG. 9-12 after the first working adapter passed along the inclined part of the bracket-forming surface and completely formed the brackets in the implantable cassette with brackets.

FIG. 13A is an enlarged view of a portion of the surgical instrument of FIG. 13.

FIG. 14 is a cross-sectional view of the surgical instrument of FIG. 9-13 after the first working adapter passed along the inclined part of the bracket-forming surface and completely formed the brackets in the implantable cassette with brackets, and the cutting bar extended in the longitudinal direction through the end clamp.

FIG. 14A is an enlarged view of a portion of the surgical instrument of FIG. fourteen.

FIG. 15 is a three-dimensional image of another embodiment of an end clamp according to this invention with details of individual components, as well as a cross section of a portion of a central module of a surgical instrument in one of its variants according to this invention.

FIG. 16 is a partial cross section of an end clamp in the embodiment of FIG. 15 in the open position attached to the surgical instrument in one of its variants.

FIG. 17 is another partial cross section of an end clamp in the embodiment of FIG. 15 and 16 in the fully closed position.

FIG. 18 is another partial cross section of an end clamp in the embodiment of FIG. 15-17 in the extreme working position before the extension of the distal knife element.

FIG. 19 is another partial cross section of an end clamp in the embodiment of FIG. 15-18 in the extreme working position after the full extension of the distal knife element.

FIG. 20 is a cross-sectional view of a portion of a handle assembly in another embodiment according to the invention.

FIG. 21 is a partial cross section of a portion of the handle assembly of FIG. 20 (section along line 21-21 in FIG. 20).

FIG. 22 is a partial cross section of a portion of the handle assembly of FIG. 20 (section along line 22-22 in FIG. 20).

FIG. 23 is a partial cross section of a portion of the handle assembly of FIG. 20 (section along line 23-23 of FIG. 20).

FIG. 24 is a cross-sectional view of a part in another embodiment according to the invention.

FIG. 25 is a partial cross-sectional side view of an end clamp in another embodiment of this invention connected to a corresponding portion of a surgical instrument in one embodiment of this invention, with an end clamp supporting a cassette with surgical braces in one of its embodiments according to this invention, and with the thrust plate of the cartridge in the open position.

FIG. 26 is another partial cross-sectional side view of an end clip of FIG. 25 in the closed position.

FIG. 27 is another partial cross-sectional side view of an end clip of FIG. 25 and 26 at the moment when the cutting bar begins to advance through the end clamp.

FIG. 28 is another partial cross-sectional side view of an end clip of FIG. 25-27 with a cutting bar passing through it.

FIG. 29 is a partial cross-sectional side view of an end clamp in another embodiment of this invention connected to a corresponding portion of a surgical instrument in one embodiment of this invention, with an end clamp supporting a cassette with surgical braces in another embodiment of this invention, and with the thrust plate of the cartridge in the open position.

FIG. 30 is another partial cross-sectional side view of an end clip of FIG. 29 with a cutting bar passing through it.

FIG. 31 is a cross-sectional view of a surgical instrument in another embodiment according to the present invention with an end clamp stop plate in an open position.

FIG. 32 is a three-dimensional image of the end clamp in one embodiment with details of the individual components, as well as a cross section of a portion of the surgical stapling instrument in the embodiment of FIG. 31.

FIG. 33 is a top view of the end clamp and part of the elongated stem of the surgical instrument of FIG. 31, parts of which are shown in cross section taken along lines 33-33 of FIG. 31.

FIG. 34 is a top view of the end clamp and part of the elongated stem of the surgical instrument of FIG. 31, parts of which are shown in cross section.

FIG. 35 is another top view of the end clamp and part of the elongated stem of the surgical instrument of FIG. 31 with an end clamp in a curved configuration and with an end clamp in an open position.

FIG. 36 is another top view of the end clip of FIG. 35, with the end clamp in the closed or clamping position.

FIG. 37 is an enlarged view of a portion of the end clamp and the surgical instrument of FIG. 36.

FIG. 38 is a cross-sectional view of a portion of the handle assembly of the surgical instrument of FIG. 31.

FIG. 39 is another cross section of a portion of the handle assembly of FIG. 38 (section along line 39-39 in FIG. 38).

FIG. 40 is a partial perspective three-dimensional view of a ball joint with details of individual components in various embodiments of the invention.

FIG. 41 is a plan view of an end clamp and part of an elongated rod of a surgical instrument in another embodiment of the present invention in an unbent orientation.

FIG. 42 is another top view of the end clamp and part of the elongated stem of FIG. 41, in a curved position.

FIG. 43 is a cross-sectional view of a surgical instrument in another embodiment according to the present invention.

FIG. 44 is a partial cross section of a portion of a hinge rod of a surgical instrument in the embodiment of FIG. 43.

FIG. 44A is a cross-sectional view of a portion of the articulated rod of FIG. 44.

FIG. 44B is another cross section of another part of the hinge rod of FIG. 44.

FIG. 44C is another cross section of another part of the articulated rod of FIG. 44.

FIG. 44D is another cross section of another part of the hinge rod according to FIG. 44.

FIG. 44E is another cross section of another part of the hinge rod according to FIG. 44.

FIG. 44F is another cross section of another part of the hinge rod of FIG. 44.

FIG. 45 is a partial cross section of the hinge rod of FIG. 44 (section along line 45-45 in FIG. 44).

FIG. 46 is a partial cross section of the articulated rod of FIG. 44 (section along line 46-46 in FIG. 44).

FIG. 47 is a cross-sectional view of the surgical instrument of FIG. 43 with the end clamp in the most curved position.

FIG. 48 is a cross-sectional view of an end clamp according to FIG. 47, with a sleeve in the form of an accordion located on top of the hinge joint.

FIG. 49 is a cross-sectional view of a handle assembly of a surgical instrument in another embodiment according to the invention.

FIG. 50 is a cross-sectional view of a three-dimensional image of an end clip and a distal end of an elongated stem according to FIG. 49 detailing the individual components.

FIG. 51 is another cross section of an end clip and a portion of the elongated stem of FIG. 50, with the end clamp in the open position.

FIG. 52 is another cross section of an end clamp and parts of an elongated stem with an end clamp in a closed position.

FIG. 53 is another cross section of an end clamp and a portion of an elongated stem according to FIG. 49-52 with a knife segment in the extreme working position.

FIG. 54 is a perspective view of the end clip of FIG. 51-53 in the open position.

FIG. 55 is a partial cross section of an end clamp according to FIG. 51-54 (section along the line 55-55 in Fig. 51).

FIG. 56 is a partial perspective view of an elongated rod according to another embodiment of the present invention attached to an end clip in one embodiment of the invention.

FIG. 57 is a partial cross-sectional view of the handle assembly of a surgical instrument in another embodiment of this invention.

FIG. 58 is a cross section of a portion of the elongated stem of FIG. 56 and 57 (section along line 58-58 in FIG. 57).

FIG. 59 is an enlarged view of a portion of the handle assembly of FIG. 57.

FIG. 60 is a cross-sectional view of a distal portion of an elongated stem according to FIG. 56-59.

FIG. 61 is a partial perspective view of an elongated stem according to another embodiment of the present invention attached to an end clip in one embodiment of its implementation according to this invention.

FIG. 62 is a cross-sectional view of a variable configuration rod segment belonging to the elongated rod of FIG. 61.

FIG. 63 is a partial perspective view of an elongated stem according to another embodiment of the present invention attached to an end clamp in one embodiment of its implementation according to this invention.

FIG. 64 is a cross section of the handle assembly of a surgical instrument in another embodiment according to the invention.

FIG. 65 is a cross section of a portion of the elongated stem of FIG. 63 and 64 (section along line 65-65 in FIG. 64).

FIG. 66 is an enlarged view of a portion of the handle assembly of FIG. 64.

FIG. 67 is a cross-sectional view of a portion of a variable configuration rod segment of FIG. 63 with tubular links connected practically in a straight line.

FIG. 68 is a cross-sectional view of a portion of a variable configuration rod segment of FIG. 63 and 67, where the tubular links form a practically curved (non-coaxial) configuration.

FIG. 69 is a perspective view of an alternative embodiment of a cassette with brackets according to this invention installed in a surgical cutting and stapling instrument in one embodiment of its implementation according to this invention.

FIG. 70 is a plan view of a cassette with surgical braces and an elongated channel of the device of FIG. 69.

FIG. 71 is a top view of another embodiment of a cassette with surgical brackets according to this invention mounted in an elongated channel of an end clamp in one embodiment of its implementation according to this invention.

FIG. 72 is a bottom view of a thrust plate in one embodiment of the present invention.

FIG. 73 is a partial perspective view of a plurality of brackets forming part of a series of brackets according to one embodiment of the present invention.

FIG. 74 is another partial perspective view of a series of brackets in the embodiment of FIG. 73, with brackets that have formed after contact with the thrust plate of a surgical cutting and stapling instrument.

FIG. 75 is a partial perspective view of an alternative embodiment of brackets forming part of a series of brackets according to another embodiment of the present invention.

FIG. 76 is a partial perspective view of an alternative embodiment of brackets forming part of a series of brackets according to another embodiment of the present invention.

FIG. 77 is a partial perspective view of an alternative embodiment of brackets forming part of a series of brackets according to another embodiment of the present invention.

FIG. 78 is a cross section of an end clamp in one embodiment of its implementation according to this invention with an installed cassette with brackets in one of its embodiments according to this invention.

FIG. 79 is a cross-sectional view of a portion of the elongated channel of the end clamp of FIG. 78 after removing the body of the implantable cartridge with brackets and the brackets themselves.

FIG. 80 is a cross-sectional view of an end clamp in one embodiment of the invention, with a cassette with brackets installed according to another embodiment of the invention.

FIG. 81 is a partial cross section of a surgical stapling instrument in one embodiment of the present invention with a cassette with brackets mounted in a distal workpiece of said device when the cassette lock system is ready to move into an unlocked position.

FIG. 82 is another partial cross section of the surgical stapling instrument of FIG. 81, when the cassette with brackets is removed from the distal working nozzle and the cassette locking system is in the blocking position.

FIG. 83A-83D are a diagram of a deformation of a surgical brace located inside a crushable cassette with brackets in accordance with at least one embodiment of the invention.

FIG. 84A is a diagram illustrating a bracket arrangement inside a squeezable cassette case with brackets.

FIG. 84B is a diagram illustrating how the cassette case with brackets according to FIG. 84A is compressed by a thrust plate.

FIG. 84C is a diagram illustrating how the cassette case with brackets according to FIG. 84A is pressed even further by the thrust plate.

FIG. 84D is a diagram illustrating a bracket according to FIG. 84A in a fully formed configuration and a crushable cassette according to FIG. 84A in a completely crushed state.

FIG. 85 is a diagram illustrating the position of the bracket relative to the surface of the bracket cartridge and illustrating their potential mutual movement.

FIG. 86 is a cross section of the surface of the cassette with brackets in which there is a groove (or trough), the shape of which is intended to stabilize the base of the bracket according to FIG. 85.

FIG. 87 is a cross-sectional view of a bracket including an additional crown formed on top and a groove (or trough) for holding a portion of the crown in accordance with at least one alternative embodiment.

FIG. 88 is a plan view of a cassette with brackets in accordance with at least one embodiment, with charged brackets placed in a cassette of the cassette.

FIG. 89 is a vertical projection of a cassette with brackets according to FIG. 88.

FIG. 90 is a vertical projection of a cassette with brackets in accordance with at least one embodiment, with a protective layer surrounding the brackets inside the casing of the cassette.

FIG. 91 is a cross-sectional view of the cassette with brackets according to FIG. 90 (section along line 91-91 in FIG. 90).

FIG. 92 is a vertical projection of a cassette with brackets in accordance with at least one embodiment, with brackets that at least partially extend beyond the creaseable cassette body and the protective layer surrounding the cassette body.

FIG. 93 is a cross section of a cassette with brackets according to FIG. 92 (section along line 93-93 in FIG. 92).

FIG. 94 is a partial perspective view of individual parts of the cartridge with brackets in accordance with at least one embodiment, with brackets that are at least partially enclosed in a crushable cassette body, with the brackets at least partially immersed in a recess with brackets provided in cassette case.

FIG. 95 is a cross-sectional view of a cassette with brackets according to FIG. 94 (section along line 95-95 in FIG. 94).

FIG. 96 is a partial perspective view of individual parts of a cassette with brackets in accordance with at least one embodiment.

FIG. 97 is a partial perspective view of individual parts of the cartridge with brackets in accordance with at least one embodiment, with brackets that are at least partially enclosed in a crushable cassette body, as well as with an alignment matrix that connects the brackets and aligns them with each other to friend.

FIG. 98 is a cross-sectional view of the cassette with brackets according to FIG. 97 (section along line 98-98 in FIG. 97).

FIG. 99 is a partial sectional view of the inner layer of a compressible cartridge case.

FIG. 100 is a diagram showing the inner layer of FIG. 99, squeezed between the transfer and support plates.

FIG. 101 is a diagram showing brackets inserted in a compressed inner layer according to FIG. one hundred.

FIG. 102 is a diagram showing a support plate according to FIG. 100 withdrawn from the inner layer.

FIG. 103 is a diagram showing a substructure consisting of an inner layer according to FIG. 99 and the brackets according to FIG. 101 passing through the outer layer.

FIG. 104 is a diagram showing how the outer layer depicted in FIG. 103, is tightened, forming a clogged cassette with brackets.

FIG. 105 is a cross-sectional view of a clogged cassette with brackets according to FIG. 104.

FIG. 106 is a cross-sectional view of a cassette with brackets and a channel for a cassette with brackets in accordance with at least one embodiment.

FIG. 107 is a diagram showing a portion of a cassette with brackets according to FIG. 106 deformed.

FIG. 108 is a vertical projection of a distal working nozzle of a surgical stapler, including a stop plate in the open position and a cassette with brackets located inside the channel for the cassette.

FIG. 109 is a vertical projection of a distal working nozzle according to FIG. 108, which shows the stop plate in the closed position and the cassette with brackets sandwiched between the stop plate and the cassette channel.

FIG. 110 is a vertical projection of a distal working nozzle according to FIG. 108 showing a cassette with brackets according to FIG. 108 located inside the cassette channel in an alternative manner.

FIG. 111 is a cross-sectional view of a distal working nozzle of a surgical stapler with a compressible cassette with brackets located inside the channel for the cassette, and with additional plugging material attached to the abutment plate.

FIG. 112 is a cross section of the distal working nozzle according to FIG. 111, in which the thrust plate is depicted in the closed position.

FIG. 113 is a cross-sectional view of an alternative embodiment of a distal working nozzle of a surgical stapler, including a cassette with brackets with a waterproof layer.

FIG. 114 is a cross-section of another alternative embodiment of a distal working nozzle of a surgical stapler.

FIG. 115 is a cross-section of an alternative embodiment of a distal working nozzle of a surgical stapler having a stepped thrust plate and a cassette with brackets, the body of which also has a stepped shape.

FIG. 116 is a cross-section of another alternative embodiment of a distal working nozzle of a surgical stapler.

FIG. 117 is a cross-sectional view of an alternative embodiment of a distal working head of a surgical stapler with inclined surfaces in contact with body tissues.

FIG. 118 is a cross-section of another alternative embodiment of a distal working nozzle of a surgical stapler with inclined surfaces in contact with body tissues.

FIG. 119 is a cross-sectional view of an alternative embodiment of a distal working head of a surgical stapling instrument, including a support insert for supporting a cassette with brackets.

FIG. 120 is a cross-sectional view of an alternative embodiment of a distal working nozzle of a surgical stapler, including a cassette with brackets with multiple compressible layers.

FIG. 121 is a cross-sectional view of an alternative embodiment of a distal working head of a surgical stapler having a stepped thrust plate and a cassette with brackets, the compressible body of which also has a stepped shape.

FIG. 122 is a cross-section of another alternative embodiment of a distal working nozzle of a surgical stapler having a stepped thrust plate and a cassette with brackets, the compressible body of which also has a stepped shape.

FIG. 123 is a cross-section of an alternative embodiment of a distal working nozzle of a surgical stapler, including a cassette with brackets, in which the surfaces in contact with body tissues have a curved shape.

FIG. 124 is a cross-sectional view of an alternative embodiment of a distal working head of a surgical stapler, including a cassette with brackets, in which the surfaces in contact with body tissues are oblique.

FIG. 125 is a cross-section of a compressible cassette with brackets, inside of which are brackets and at least one drug.

FIG. 126 is a diagram showing a compressible cartridge according to FIG. 125 after it was compressed and the brackets contained in it were deformed.

FIG. 127 is a partial sectional view of individual parts of a cassette with brackets in accordance with at least one embodiment.

FIG. 128 is a cross section of a cassette with brackets according to FIG. 127.

FIG. 129 is a perspective view of an implantable cassette with brackets corresponding to at least one alternative embodiment.

FIG. 130 is a cross-sectional view of an implantable cassette with brackets according to FIG. 129.

FIG. 131 is a perspective view of an alternative embodiment of a cartridge with brackets, including deformable parts protruding outward from the outer layer of the cartridge case with brackets.

FIG. 132 is a perspective view of an alternative embodiment of a cassette with brackets, including the outer part of the cassette body, attached to the inner part.

FIG. 133 is a cross section of an alternative embodiment of a cassette with brackets with many brackets, a compressible layer and a layer of gaskets.

FIG. 134 is a perspective view of the gasket layer of FIG. 133.

FIG. 135 is a perspective view of a spacer separated from the spacer layer of FIG. 133, and brackets aligned with the groove in the gasket.

FIG. 136 is a perspective view of two connected gaskets from the gasket layer of FIG. 133.

FIG. 137 is a perspective view of the support frame of the gasket layer of FIG. 133 during the separation of the gaskets.

FIG. 138 is a three-dimensional perspective view detailing the individual components for an alternative embodiment of a compressible cassette with brackets, including brackets and a system for moving the brackets to the thrust plate.

FIG. 138A is a partial sectional view of an alternative embodiment of the cassette with brackets according to FIG. 138.

FIG. 139 is a cross section of a cassette with brackets according to FIG. 138;

FIG. 140 is a vertical projection of a slide designed to move the cartridge of FIG. 138 and moving the brackets in the direction of the thrust plate.

FIG. 141 is a diagram of a staple bar that is lifted by the slide according to FIG. 140 towards the thrust plate.

FIG. 142 is a perspective view of individual parts of a cassette with brackets in accordance with at least one alternative embodiment, where brackets are used to position the brackets.

FIG. 143 is a cross-section of a cassette with brackets according to FIG. 142 located in the channel for the cartridge.

FIG. 144 is a cross section of the cassette with brackets according to FIG. 142, which shows a thrust plate in the closed position and brackets inside the cassette deformed by contact with the thrust plate.

FIG. 145 is a cross-sectional view of the bracket cassette of FIG. 142, which shows how the brackets move up towards the thrust plate.

FIG. 146 is a perspective view of an alternative embodiment of a cassette with brackets in which the flexible sides of the cassette are connected by stripes.

FIG. 147 is a perspective view of a slide and a cutting segment assembly.

FIG. 148 is a diagram showing how the slide and the cutting segment of FIG. 147 are used to raise the brackets of the cassette shown in FIG. 142.

FIG. 149 is a diagram showing a slide designed to engage and lift the brackets by moving them toward the thrust plate, and a locking system that allows the slide to be selectively moved in the distal direction.

FIG. 150A-150C illustrate the gradual entry of a bracket into a bracket crown.

FIG. 151 is a cross-sectional view of a cassette with brackets equipped with a support tray or stopper.

FIG. 152 is a partial cross section of a compressible cassette with brackets in accordance with at least one alternative embodiment.

FIG. 153 is a diagram showing a cassette with brackets according to FIG. 152 in the implanted state.

FIG. 154 is a partial sectional view of a compressible cassette with brackets in accordance with at least one alternative embodiment.

FIG. 155 is a partial cross section of a cassette with brackets according to FIG. 154.

FIG. 156 is a diagram showing a cassette with brackets according to FIG. 154 in the implanted state.

FIG. 157 is a partial cross-sectional view of a crushable cassette with brackets in accordance with at least one alternative embodiment.

FIG. 158 is a partial sectional view of a crease cartridge with brackets according to at least one embodiment with a plurality of crease elements.

FIG. 159 is a perspective view of a crease member according to FIG. 158 uncompressed.

FIG. 160 is a perspective view of a crease member according to FIG. 159 in a compressed state.

FIG. 161A is a partial cross-sectional view of a distal working nozzle of a stapling surgical instrument, including a jaw, a cassette channel with brackets located against the jaw, and a cassette with brackets inside the cassette channel, the jaw equipped with a retaining matrix attached to it.

FIG. 161B is a partial cross section of a distal working nozzle according to FIG. 161A, which shows the jaw in movement toward the channel for the cassette with brackets, the cassette being squeezed between the retaining plate and the retaining matrix, as well as the bracket, at least partially protruding through the tissue placed between the retaining matrix and the cassette with brackets.

FIG. 161C is a partial cross section of the distal working nozzle of FIG. 161A, which shows the jaw in the final position and the retaining matrix meshed with the bracket according to FIG. 161B.

FIG. 161D is a partial cross section of a distal working nozzle according to FIG. 161A, which shows how the jaw and cassette channel are retracted from the implanted bracket and retainer matrix.

FIG. 162 is a perspective view of a locking slot of a locking matrix according to at least one alternative embodiment with a plurality of individual locking elements for engaging with locking legs passing through them.

FIG. 163 is a perspective view of the locking slots of the locking matrix according to at least one alternative embodiment with six separate locking elements.

FIG. 164 is a perspective view of the locking slots of the locking matrix according to at least one alternative embodiment with eight separate locking elements.

FIG. 165 is a perspective view of retaining slots of a retaining matrix according to at least one alternative embodiment with a plurality of individual retaining elements for engaging with locking legs passing through them.

FIG. 166 is a perspective view of retaining slots of a retaining matrix according to at least one alternative embodiment with six separate retaining elements.

FIG. 167 is a perspective view of the locking slots of the locking matrix according to at least one alternative embodiment with eight separate locking elements.

FIG. 168 is a perspective view of the locking slots of the locking matrix according to at least one alternative embodiment with a plurality of individual locking elements stamped from sheet metal.

FIG. 169 is a perspective view of the locking slots of the locking matrix according to at least one alternative embodiment with a plurality of holes located around the perimeter of the locking slots.

FIG. 170 is a plan view of the locking slots of the locking matrix in accordance with at least one alternative embodiment.

FIG. 171 is a plan view of the locking slots of the locking matrix in accordance with at least one alternative embodiment.

FIG. 172 is a plan view of the locking slots of the locking matrix in accordance with at least one alternative embodiment.

FIG. 173 is a plan view of the locking slots of the locking matrix in accordance with at least one alternative embodiment.

FIG. 174 is a plan view of the locking slots of the locking matrix in accordance with at least one alternative embodiment.

FIG. 175 is a plan view of the locking slots of the locking matrix including a locking tab protruding into the slot according to at least one embodiment.

FIG. 176 is a plan view of the locking slots of the locking matrix, including the locking tab protruding into the slot according to at least one embodiment.

FIG. 177 is a perspective view of a fixing system consisting of a plurality of brackets, a locking matrix engaged with the brackets, and an alignment matrix for aligning the brackets.

FIG. 178 is a perspective view of a retainer matrix according to FIG. 177.

FIG. 179 is a perspective view of the alignment matrix of FIG. 177.

FIG. 180 is a partial top view of the retainer matrix of FIG. 177 engaged with brackets according to FIG. 177.

FIG. 181 is a partial bottom view of the retainer matrix of FIG. 177 engaged with brackets according to FIG. 177.

FIG. 182 is a partial elevational view of the locking system of FIG. 177.

FIG. 183 is a partial perspective view of the locking system of FIG. 177.

FIG. 184 is a partial cross-sectional view of the retainer matrix of FIG. 177 engaged with brackets according to FIG. 177.

FIG. 185 is a partial cross-sectional view of the locking system of FIG. 177.

FIG. 186 is a perspective view of the locking system of FIG. 177, equipped with additional protective caps worn on the legs of the brackets.

FIG. 187 is a bottom perspective view of the locking system of FIG. 186.

FIG. 188 is a partial perspective view of the locking system of FIG. 186.

FIG. 189 is a partial cross-sectional view of the locking system of FIG. 186.

FIG. 190 is a vertical projection of a distal working nozzle according to at least one embodiment, including an open jaw, a retaining matrix and a plurality of protective caps placed on the jaw, as well as a cassette with brackets located in the cassette channel.

FIG. 191 is a vertical projection of a distal working nozzle according to FIG. 190 in the closed position.

FIG. 192 is a vertical projection of a distal working nozzle according to FIG. 190 in working position.

FIG. 193 is a vertical projection of a retaining matrix and protective caps according to FIG. 190 in a cassette assembly with brackets according to FIG. 190.

FIG. 194 is a detailed view of the assembly of FIG. 193.

FIG. 195 is a vertical projection of a distal working nozzle according to FIG. 190, which shows the jaw in the open position with a thin layer of tissue placed between the retaining matrix and the cassette with brackets.

FIG. 196 is a vertical projection of a distal working nozzle according to FIG. 190, which shows the jaw in the closed position on a thin layer of tissue according to FIG. 195.

FIG. 197 is a vertical projection of a distal working nozzle according to FIG. 190, which shows a jaw in the working position, clamping a thin layer of fabric according to FIG. 195 placed between the retaining matrix and the cassette with brackets.

FIG. 198 is a vertical projection of a retaining die and protective caps according to FIG. 190 in a cassette assembly with brackets according to FIG. 190, with a thin layer of fabric placed between them according to FIG. 195.

FIG. 199 is a detailed view of the assembly of FIG. 198.

FIG. 200 is a cross-sectional view of a protective cap placed on the tip of a bracket leg in accordance with at least one alternative embodiment.

FIG. 201 is a perspective view of a plurality of protective caps pressed into a sheet of material.

FIG. 202 is a perspective view of a jaw having a plurality of recesses for accommodating a plurality of protective caps.

FIG. 203 is a detailed view of a portion of a jaw including a sheet covering protective caps placed inside the jaw of FIG. 202.

FIG. 204 is a cross-sectional view of a protective cap placed on the tip of a bracket leg in accordance with at least one alternative embodiment, wherein the protective cap has an internal forming surface.

FIG. 205 is another cross section of the protective cap of FIG. 204, which shows how the bracket leg deforms against a forming surface.

FIG. 206 is a top view of an alternative embodiment of a retaining matrix consisting of a plurality of connected matrix elements.

FIG. 207 is a top view of an alternative embodiment of a retaining matrix consisting of a plurality of connected matrix elements.

FIG. 208 is a plan view of an alternative embodiment of a retaining matrix consisting of a plurality of connected matrix elements.

FIG. 209 is a plan view of an alternative embodiment of a series of retainer matrices consisting of a plurality of connected matrix elements.

FIG. 210 is a top view of an alternative embodiment of a retaining matrix consisting of a plurality of connected matrix elements.

FIG. 211 is a partial three-dimensional image detailing the individual components of a jaw equipped with a retaining matrix including a compressible cover.

FIG. 212 is a detailed view of the locking matrix of FIG. 211.

FIG. 213 is a partial cross section of a fixing system, including a retaining matrix, including a compressible layer and a plurality of cells in which one or more drugs are enclosed.

FIG. 214 is a diagram showing the brace legs piercing the cell of FIG. 213, during their contact with the retaining matrix.

FIG. 215 is a partial cross-sectional view of a locking system, including a retaining matrix including a compressible layer.

FIG. 216 is a vertical projection of a cartridge installation module that includes a holder, a first installation cartridge and a second installation cartridge.

FIG. 217 is a vertical projection of a distal working nozzle of a surgical stapler consisting of a first jaw and a second jaw shown in an open configuration.

FIG. 218 is a vertical projection of a distal working nozzle according to FIG. 217, in which the second jaw is shown in the closed position, and the cartridge installation module according to FIG. 216 is used for the first jaw by the first cassette and the second jaw by the second cassette.

FIG. 219 is a vertical projection of a loaded distal working nozzle according to FIG. 218, on which the cartridge installation module is removed from the distal working nozzle, the second jaw is again in the open position, and a layer of tissue is located between the first and second jaws.

FIG. 220 is a vertical projection of a loaded distal working nozzle according to FIG. 219 in working configuration.

FIG. 221 is a vertical projection of a first cartridge and a second cartridge in an implanted state.

FIG. 222 is a vertical projection of a distal working nozzle according to FIG. 217, showing a portion of a first cartridge still engaged with the first jaw, in accordance with at least one embodiment.

FIG. 223 is a vertical projection of an alternative embodiment of a cartridge installation module, which includes a holder, a first installation cartridge and a second installation cartridge.

FIG. 224 is a vertical view of the cartridge mounting module of FIG. 223 during loading of the first cartridge into the first jaw of the distal working nozzle and the second cartridge into the second jaw.

FIG. 225 is a cross-sectional view of the loaded distal working nozzle of FIG. 224.

FIG. 226 is a perspective view of a surgical stapler consisting of upper and lower jaws, in accordance with at least one embodiment, with some parts of the surgical stapler removed.

FIG. 227 is a perspective view of the surgical stapler of FIG. 226 with the upper jaw removed.

FIG. 228 is a perspective view of a sliding stop system of the upper jaw of the surgical stapler of FIG. 226, which consists of a first sliding thrust plate and a second sliding thrust plate.

FIG. 229 is an end view of a sliding stop system according to FIG. 228.

FIG. 230 is a plan view of the sliding stop system of FIG. 228.

FIG. 231 is a diagram showing a sliding stop system according to FIG. 228 inoperative.

FIG. 232 is a diagram showing a first sliding thrust plate of the sliding thrust system according to FIG. 228 inoperative and not yet installed brackets located in the lower branch.

FIG. 233 is a diagram showing the brackets already installed in the lower jaw and the first sliding thrust plate of those shown in FIG. 232, pulled in the proximal direction to deform the first group of legs of brackets.

FIG. 234 is a diagram showing a first group of brackets according to FIG. 233 in a completely deformed state.

FIG. 235 is a diagram showing a second sliding thrust plate of the sliding thrust system according to FIG. 228, advanced in the distal direction to deform the second group of legs of brackets.

FIG. 236 is a partial perspective view of a thrust plate with a plurality of bracketing pockets in at least one embodiment.

FIG. 237 is a cross section of a thrust plate according to FIG. 236.

FIG. 238 is a diagram showing a first step of manufacturing the staple pockets of FIG. 236.

FIG. 239 is a diagram showing a second step of manufacturing the staple pockets of FIG. 236.

In FIG. 240 is a plan view of a bracket-shaped pocket system for a thrust plate according to FIG. 236.

FIG. 241 is a diagram showing a first step of a thrust plate manufacturing process.

FIG. 242 is a diagram showing a second step of the manufacturing process of the device of FIG. 241. and

FIG. 243 is a diagram showing the third step of the manufacturing process of the device of FIG. 241.

To indicate similar elements in different images, similar numeric notations are used. The illustrations appended to this application are intended solely to demonstrate preferred embodiments of the invention and do not limit the scope of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The author of this application also owns the following US patent applications, filed on the same number as this application, and fully incorporated into this application by reference:

US Patent Application Serial Number ______, entitled “Surgical Stapling Instrument With a Variable Staple Forming System”, entry in registration book No. END6848USNP / 100533.

US Patent Application Serial Number ______, entitled “Surgical Stapling Instrument With Interchangeable Staple Cartridge Arrangements”, entry in registration book No. END6849USNP / 100534.

US Patent Application Serial Number ______, entitled “Surgical Cutting and Fastening Instruments With Separate and Distinct Fastener Deployment and Tissue Cutting Systems”, entry in the registration book number END6839USNP / 100524.

US Patent Application Serial Number ______, entitled “Jaw Closure Arrangements For Surgical Instruments”, entry in registration book No. 100060.

US Patent Application Serial Number ______, entitled “Surgical Instruments With Reconfigurable Shaft Segments”, entry in registration book No. END6734USNP / 100058.

US Patent Application Serial Number ______, entitled “Surgical Staple Cartridges Supporting Non-Linearly Arranged Staples and Surgical Stapling Instruments With Common Staple-Forming Pockets”, entry in the registration book No. END6735USNP / 100059.

US Patent Application Serial Number ______, entitled “Surgical Staple Cartridges With Detachable Support Structures and Surgical Stapling Instruments With Systems For Preventing Actuation Motions”, with surgical brackets with removable support structures and surgical stapling instruments with systems to prevent triggering when the cassette is missing. When a Cartridge is Not Present), entry in registration book No. END6855USNP / 100540.

US Patent Application Serial Number ______, entitled “Implantable Fastener Cartridge Having a Non-Uniform Arrangement”, entry in registration book No. END6840USNP / 100525;

US Patent Application Serial Number ______, entitled Implantable Fastener Cartridge Comprising a Support Retainer, entry in registration book No. END6841USNP / 100526.

US Patent Application Serial Number ______, entitled “Implantable Fastener Cartridge Comprising Multiple Layers”, entry in registration book No. END6842USNP / 100527.

US Patent Application Serial Number ______, entitled “Selectively Orientable Implantable Fastener Cartridge”, entry in Registration Book No. END6843USNP / 100528.

US Patent Application Serial Number ______, entitled “Implantable Fastener Cartridge Comprising Bioabsorbable Layers”, entry in Registration Book No. END6856USNP / 100541.

US Patent Application Serial Number ______, entitled “Compressible Fastener Cartridge”, entry in Registration Book No. END6857USNP / 100542.

US Patent Application Serial Number ______, entitled Fasteners Supported By a Fastener Cartridge Support, entry in registration book No. END6858USNP / 100543.

US Patent Application Serial Number ______, entitled “Collapsible Fastener Cartridge”, entry in registration book No. END6859USNP / 100544.

US Patent Application Serial Number ______, entitled “Fastener System Comprising a Plurality of Connected Retention Matrix Elements”, entry in registration book No. END6860USNP / 100546.

US Patent Application Serial Number ______, entitled “Fastener System Comprising a Retention Matrix and an Alignment Matrix”, entry in registration book No. END6861USNP / 100547.

US Patent Application Serial Number ______, entitled "Fastener System Comprising a Retention Matrix", entry in registration book No. END6862USNP / 100548.

US Patent Application Serial Number ______, entitled “Fastening Instrument For Deploying a Fastener System Comprising a Retention Matrix”, entry in registration book No. END6863USNP / 100549.

US Patent Application Serial Number ______, entitled Fastener System Comprising a Retention Matrix and a Cover, entry in Registration Book No. END6864USNP / 100550 and

US Patent Application Serial Number ______, entitled “Fastener System Comprising a Plurality of Fastener Cartridges”, entry in registration book No. END6865USNP / 100551.

For a more complete understanding of the design, principles of operation, production and use of the devices and methods described herein, the following is a description of individual examples of embodiments. One or more examples of such embodiments are presented in the accompanying figures. Professionals with sufficient experience in this field will understand that the devices and methods described in detail herein and shown in the accompanying illustrations are non-limiting examples of embodiments and the scope of various embodiments of the present invention is determined only by the claims. Features illustrated or described with reference to one embodiment may be combined with features of other embodiments. The scope of the present invention is intended to cover all modifications and variations.

The expressions “various embodiments”, “some embodiments”, “one embodiment” or simply “an embodiment” and the like occurring in the text mean that this characteristic, design or property described in connection with a particular embodiment, relate to at least one embodiment. Thus, the appearance in the specification texts of the phrases “in various embodiments”, “in one embodiment” or “in an embodiment” and the like expressions does not necessarily mean that they all refer to the same embodiment. Moreover, certain characteristics, properties or designs may be combined in any suitable manner in one or more embodiments. Thus, the specific properties, characteristics or structures shown or described in connection with one embodiment may be combined in whole or in part, without limitation, with the properties, structures and characteristics of one or more embodiments. The scope of the present invention is intended to cover all modifications and variations.

The terms "proximal" and "distal" in this document are defined with respect to the physician managing the handle of the surgical instrument. The term "proximal" refers to the part lying closer to the doctor, and the term "distal" refers to the part removed from the doctor. It is also proposed for convenience and clarity in relation to the figures to use in this document such spatial terms as “vertical”, “horizontal”, “up” and “down”. However, since the use of surgical instruments involves many orientations and provisions, these terms should not be interpreted as limiting and (or) absolute.

For carrying out laparoscopic and minimally invasive surgical interventions, various device models and various techniques are used. However, for specialists with sufficient experience in this field, it will be very valuable that the various methods and devices described in this document can be used for a wide variety of surgical procedures and activities associated with open surgical operations. In the course of this detailed description, specialists with sufficient experience in this field will be able to further appreciate that the various tools described in this document can be inserted into the body in any way - either through natural holes, or through an incision or a puncture hole, done in tissues, etc. The working bodies or distal working nozzles of such instruments can be inserted directly into the patient’s body or through an access device having a working channel through which the distal working nozzle and the elongated stock of the surgical instrument can be passed.

As for the figures and drawings shown in the document, the same numbers indicate the same components in different images, for example in FIG. 1 shows a surgical instrument 10, which has several unique positive properties in the framework of the present invention. Surgical stapling instrument 10 is designed to perform manipulations and / or to move the distal working nozzles 12 of various sizes and shapes, which can be attached to it in a movable manner. In the embodiment shown in FIG. 1 and 2, for example, the distal working nozzle 12 includes an elongated channel 14, which forms the lower jaw 13 of the distal working nozzle 12. The elongated channel 14 is designed to support the “implantable” cassette with brackets 30, and also to serve as a movable support for thrust plate 20, which acts as the upper jaw 15 of the distal working nozzle 12.

In various embodiments, the elongated channel 14 can be made, for example, of stainless steel grades 300 and 400, 17-4 and 17-7, titanium, etc., and may also have side walls located at some distance from each other friend 16. The thrust plate 20 can be made, for example, of stainless steel 300 and 400, 17-4 and 17-7, titanium, etc. and have an inner surface for forming brackets, which is usually indicated by the number 22 and in turn has many pockets for forming brackets 23.

See FIG. 1B-1E. In addition, the thrust plate 20 has a forked inclined module 24 protruding from it in the proximal direction. A pin of the thrust plate 26 protrudes from each side of the inclined module 24 for engagement with a corresponding hole or groove 18 in the side walls 16 of the elongated channel 14, which facilitates the movable or articulated connection of these parts.

With the various embodiments of the surgical instruments described herein, various models of implantable cassettes with brackets can be used. The specific configurations of the cassettes with brackets and their design will be discussed in more detail below. In the embodiments shown in FIG. 1A and 9-14, an implantable cassette with brackets 30 is depicted. In at least one embodiment, the cassette with brackets 30 has a body portion 31 consisting of compressible hemostatic material such as oxidized and reduced cellulose (OVC), or biodegradable foam materials on which the rows of unformed metal brackets 32 are supported. To prevent exposure to the brackets and to prevent activation of the hemostatic material during refueling of the cartridge into the device and positioning In at least some embodiments, the entire cartridge may be coated or wrapped with a biodegradable film 38, for example, a polydioxanone film sold under the brand name PDS®, or a polyglycerin sebacate (PGS) film or other biodegradable films made from PGC ( polyglycolic acid, Vicryl trademark), polycaprolactone (PCL), PMA or PMK-L (lactic acid polymers), PHA (polyhydroxyalkanoates), PHCL (polyglexaprone 25, Monocryl trademark) or from composite materials, containing aschih PGA, PCL, PLA, or MPC, which preserve tightness as long as no gap will appear in them. The cassette case 31 with brackets 30 is dimensioned so that it can freely pass into and out of the elongated channel 14, as shown in the figures, so that each bracket 32 in it is flush with the corresponding bracket-forming pocket 23 on the thrust plate when the abutment plate 20 comes into contact with the cartridge 30 to form brackets.

During use of the device, the distal working nozzle 12 is placed opposite the target tissue of the body, after which this distal working nozzle 12 is manipulated so that it grasps or grips the target tissue between the upper surface 36 of the bracket cassette 30 and the bracket-forming surface 22 of the stop plate 20. Brackets 32 formed by the movement of the thrust plate 20 along a path that is almost parallel to the elongated channel 14, resulting in a staple-forming surface 22 (more precisely, staple-forming pockets 23 on it), comes into almost simultaneous contact with the upper surface 36 of the cassette 30. As the thrust plate 20 moves inside the cassette with the brackets 30, the legs 34 of the brackets 32 come into contact with the corresponding bracket-forming pockets 23 on the thrust plate 20, which serve to bend the legs of the bracket 34 and give the brackets 32 the shape of the letter “B”. Further movement of the thrust plate 20 in the direction of the elongated channel 14 leads to further compression of the brackets 32 to the desired final formation height, indicated by “FH”.

The above process is generally shown in FIG. 1B-1E. For example, in FIG. 1B shows a distal working nozzle 12 with a target tissue (indicated by the letter “T”) between the abutment plate 20 and the upper surface 36 of the implantable cassette with brackets 30. FIG. 1C shows the initial clamping position of the abutment plate 20 when the abutment plate 20 closes on the fabric marked with the letter “E” to grip this target fabric “T” between the abutment plate 20 and the upper surface 36 of the cassette with brackets 30. In FIG. 1D shows the initial moment of formation of the bracket, when the stop plate 20 begins to compress the cassette with the brackets 30 so that the legs 34 of the brackets 32 begin to take the desired shape due to contact with the brace pockets 23 on the stop plate 20. FIG. 1E shows a bracket 32 in its final formed state, passing through the target tissue indicated by the letter “T”; while the thrust plate 20 is removed for greater clarity of the image. As soon as the brackets 32 are formed and fixed in the target tissue, marked with the letter “T”, the surgeon moves the thrust plate 20 to the open position so that the cassette body 31 and the brackets 32 remain fixed in the target tissue and the distal workpiece 12 can be removed from the body the patient. The distal working nozzle 12 forms all the brackets simultaneously at the moment when the branches 13 and 15 are closed. The “crushed” material of the body 31 remaining in the body simultaneously performs a hemostatic function (OVC) and strengthens a number of superimposed brackets (PGC, MPC or other film composite materials 38 mentioned above). Thus, since the brackets 32 do not leave the cassette 31 during formation, the likelihood that the brackets 32 will be improperly formed is minimized. In this document, the term “implantable” means that, in addition to the brackets, the material of the cassette case, in which the brackets are located, also remains in the patient’s body and completely dissolves over time. Such implantable cassettes with brackets differ from previously used cassette designs, which remained inside the distal working nozzle and were taken out with it. Such “removable” cassettes with brackets typically include components for advancing the brackets and therefore can be much larger than the distal workpads provided by this invention, which are designed to be used in conjunction with unique and innovative implantable cassette brackets, embodiments of which are the subject of this invention.

In various embodiments, the distal working nozzle 12 is designed to be connected to an elongated stem 40 that extends outwardly from the handle assembly 100. The distal working nozzle 12 (in the closed position) and the elongated stem 40 may have similar cross-sectional shapes and sizes, allowing them to quickly pass through the tube of a trocar or the working channel of another instrument designed to provide access. As used herein, the phrase “pass operatively” means that the distal working nozzle and at least a portion of the elongated stem can be inserted or inserted through the opening of the channel or tube and can be manipulated inside the channel or tube to perform a surgical stapling procedure. In some embodiments, when the jaws 13 and 15 of the distal working nozzle 12 are closed, its cross section is approximately circular, which facilitates passage through round openings and passages. However, the distal working nozzles in various embodiments according to the present invention, as well as elongated rods in various embodiments, can be specially made with a cross section of another shape that will allow passage through openings and channels for access with a cross section of a non-circular shape. Thus, the total cross-sectional size of the closed distal working nozzle will be related to the size of the passage or hole through which it is supposed to be passed. Thus, for example, if the distal working nozzle is said to have a size of 5 mm, this means that such a distal working nozzle can quickly pass through an opening of at least 5 mm in diameter.

In various embodiments of the invention, the elongated stem 40 may have an outer diameter substantially equal to the outer diameter of the distal working nozzle 12 in the closed position. For example, a distal working nozzle of 5 mm in size may be connected to an elongated stem 40 having a cross-sectional diameter of 5 mm. In the course of this detailed description, it will become apparent that various embodiments of the present invention can be effectively used in combination with a distal working nozzle of various sizes. For example, a distal working nozzle of 10 mm in size can be attached to an elongated stem having a cross-sectional diameter of 5 mm. In contrast, for an opening or passage with a diameter of 10 mm or more, the elongated stem 40 may have a cross section with a diameter of 10 mm or more, but be able to actuate a distal working nozzle with a diameter of 10 or 5 mm. Thus, the outer stem 40 may have an outer diameter equal to or different from the outer diameter of the distal working nozzle 12 attached to it in the closed state.

According to the description, the elongated stem 40 protrudes in the distal direction from the handle assembly 100, forming an almost straight line along the longitudinal axis AA. In various embodiments, for example, the elongated stem 40 may have a length of about 229-406 mm (9-16 inches). However, the elongated stem 40 may also be available in a different length, and in other embodiments, may be hinged or have any other configuration that facilitates changing the position of the distal working nozzle 12 relative to other parts of the stem or handle assembly, as will be discussed in detail below. In various embodiments, the elongated stem 40 has a central modular portion 50, which extends from the handle assembly 100 to the distal working nozzle 12. The proximal end of the elongated channel 14 of the distal working nozzle 12 has a pair of retaining spikes 17 emerging from it, the size of which is such that precisely fit into the corresponding holes (or cradles) 52 located on the distal end of the central modular part 50, which allows you to push the distal working nozzle 12 on the elongated rod 40 and remove it from there. The central modular part 50 may, for example, be made of aluminum alloy 6061 or 7075, stainless steel, titanium, and the like.

In various embodiments, the implementation of the node handle 100 includes a housing with a grip pistol type, which may be prefabricated and consist of two or more parts. For example, the handle assembly 100 shown in the figures includes the right side of the body 102 and the left side of the body 104 (Figs. 5, 7 and 8), which are molded or otherwise molded from polymer or plastic and are structurally aligned with each other. Such parts of the housing 102 and 104 can be latched, using molded or otherwise molded spike-type structures, and can also be connected with glue, screws, etc. The central modular part 50 has a proximal end 54 with a flange 56. The flange 56 has a rotational support inside a groove 106 formed by a pair of compatible ribs 108 that protrude from parts of the housing 102, 104. This design facilitates the connection of the central modular part 50 to the handle 100, allowing the central the modular part 50 rotate relative to the handle 100 around the longitudinal axis AA 360 °.

As shown further in FIG. 1 and 4, the central modular part 50 passes through a mounting sleeve 60, which is secured to the handle assembly 100 so that it can rotate therein. The mounting sleeve 60 has a proximal flange 62 and a distal flange 64, which form a rotational groove 65, designed to rotate the protruding end portion 101 of the handle assembly 100. This design allows the mounting sleeve 60 to rotate around the longitudinal axis AA relative to the handle assembly 100. Central portion 50 fixedly attached to the mounting sleeve 60 with a key 66. In addition, a turning head 70 is attached to the mounting sleeve 60. In one embodiment, for example, the turning head 70 has a hollow part - mounting flange 72, the size of which corresponds to the insertion in it of the mounting bushing 60. In various embodiments, the swivel head 70 may be made of, for example, from glass or nylon with carbon fiber as a filler, polycarbonate, Ultem® material, etc. and is attached to the mounting sleeve 60 by a key 66. In addition, a retaining flange 72 protruding inwardly forms on the part of the mounting flange 74, which is structurally located inside the radial groove 68 created in the mounting sleeve 60. Thus, the surgeon can rotate the central part 50 (and the distal the working nozzle 12 attached to it) around the longitudinal axis AA through 360 °, holding onto the rotary head 70 and rotating it relative to the handle assembly 100.

In various embodiments, the thrust plate 20 is held open by the spring of the thrust plate 21 or other deflecting structure, as shown in FIG. 1, 9A, 10A and 11A. The thrust plate 20 selectively moves from the open position to various closed, or clamping, and working positions using the actuation system, which is generally indicated by the number 109. The actuation system 109 includes a "working part" 110, which in various embodiments is a hollow working the tube 110. The hollow working tube 110 makes axial movements along the central modular part 50, thereby forming the outer part of the elongated rod 40. The working tube 110 may be made of polymer or other suitable material and has a proximal end 112, which is attached to the trigger lever 114 of the trigger system 109. See FIG. 4. In various embodiments, for example, the release lever 114 may be reshaped at the proximal end 112 of the working tube 110. However, other fixation options are possible.

As seen in FIG. 1 and 4, the actuation lever 114 may have a rotational support in the form of a support sleeve 120, which is structurally capable of axial movements within the handle assembly 100. In various embodiments, the support sleeve 120 has a pair of protruding side ribs 122, the size of which allows them to fit into special grooves 103 and 105, made in the right and left parts of the body (102 and 104, respectively). See FIG. 7. Thus, the support sleeve 120 is capable of axially sliding inside the handle body 100, which allows the actuating lever 114 and the working tube 110 to rotate relative to the body about the longitudinal axis AA. As seen in FIG. 4, a longitudinal groove 111 is cut out in the working tube 110 to pass a key 66 through it, which enters the central modular part 50 and facilitates the axial movement of the working tube 110 along the central modular part 50.

The actuation system 109, in addition, includes a trigger trigger 130, which serves to control the axial movement of the working tube 110 along the central modular part 50. See FIG. 1. Such axial movement of the working tube 110 in the distal direction in working interaction with the thrust plate 20 in this document is called the working movement or actuation. As seen in FIG. 1, the trigger trigger 130 is movably or pivotally connected to the handle module 100 with an axial pin 132. To release the trigger trigger 130 from the pistol grip 107 of the handle assembly 100 to the “open”, or initial, position, a torsion spring 135 is used. As shown in FIG. 1 and 4, the trigger trigger 130 has an upper part 134, which is movably (using a pin) connected to the working rods 136, which are also movably (using pins) connected to the support sleeve 120. Thus, the movement of the trigger trigger 130 from the initial position (Fig. 1 and 9) in the direction of the final position closer to the pistol portion 107 of the handle assembly 100 (Fig. 14) leads to the fact that the trigger lever 114 and the working tube 110 are moved distally in the direction DD. Moving the trigger 130 in the direction from the pistol portion 107 of the handle assembly 100 (under the influence of the torsion spring 135) will cause the trigger lever 114 and the working tube 110 to move in the proximal direction PD along the central modular part 50.

Various embodiments of the present invention can be used with implantable cassettes of a wide variety of sizes and configurations. For example, for a surgical instrument 10 that works in conjunction with the first working adapter 140, you can use a distal working nozzle 12 with a diameter of 5 mm, which has a length of about 20 mm (another length is also possible), where an implantable cassette with brackets 30 is inserted. Such distal working nozzles can be especially convenient, for example, for performing relatively thin dissections and vascular operations. However, as will be described in more detail below, the surgical instrument 10 can also be used, for example, in combination with distal working nozzles of other sizes and with other cassettes with brackets by replacing the first working adapter 140 with the second working adapter 150. In other embodiments, the elongated stem 40 may have a structure that allows only a distal working nozzle of the same shape or size to be attached to it. In such embodiments, for example, clamping surfaces 146 or 158 (typically provided on the working adapters 140 and 150, respectively) are integrated into the distal end of the working tube 110 depending on the particular size of the distal working nozzle with which it will be used.

As shown in FIG. 2, the first working adapter 140 is substantially hollow and has a first spring portion 142 that protrudes into the open distal end 116 of the working tube 110. On the first spring part 142, a first stop button 144 is installed so that it fits into the stop hole 117 provided in the distal end of the working tube 110. See FIG. 1 and 2. Thus, in order to disconnect the first work adapter 140 from the work tube 110, the user simply presses the lock button 144 to release it from the lock hole 117 and removes the work adapter 140 from the work tube 110. As can be seen in FIG. 2, the first working adapter 140 has an internal clamping surface 146, the design of which provides for interaction with the bifurcated module of the inclined guides 24 of the thrust plate 20.

In various embodiments, the forked inclined guides 24 of the abutment plate 20 include a pair of teeth 45 between which there is a groove for a blade (not shown). Each tooth 45 has a proximal surface 27, which is almost parallel to the lower part of the elongated channel 14, when the thrust plate 20 is in the closed position. The proximal surface 27 then passes into a clamping inclined surface 28 located distally with respect to the proximal surface 27. See FIG. 3. The clamping inclined surface 28 is oriented at a pressing angle “A” with respect to the proximal surface 27. In various embodiments, for example, the pressing angle “A” can be from about 15 to 30 degrees. As will be discussed in detail below, when the first pressing surface 146 of the first working adapter 140 is in contact with the clamping inclined surface 28, the thrust plate 20 moves towards the elongated channel 14, and more precisely in the direction of the inside of the cassette with brackets 30. As the first working further moves adapter 140 in the distal direction, the first clamping surface 146 is in contact with the bracket-forming inclined surface 29 on each of the teeth 45 of the thrust plate and presses the stop deeper and deeper plate 20 into the cassette 30, facilitating the formation of brackets 32 within it. As also shown in FIG. 3, the bracket-forming inclined surface 29 is oriented at a forming angle “B” with respect to the clamping inclined surface 27. In various embodiments, for example, the forming angle “B” can be from about 5 to 20 degrees. The inclined module 24 of the thrust plate 20 may further have an inclined inner surface 25 (located at an angle “C” of approximately 5 to 40 degrees), and when the thrust plate 20 is in the open position, the inclined lower surface 25 allows the thrust plate 20 to rotate 15 ° in the open position (angle "β" in Fig. 11A).

Now we turn to the explanation of one of the methods for removably connecting the distal working nozzle 12 and the central modular part 50. The connection process begins with the locking studs 17 on the elongated channel 14 being inserted into the cradles 52 in the central modular part 50. After that, the surgeon presses the trigger 130 in the direction of the pistol portion 107 of the handle assembly 100, so that the working tube 110 moves in the distal direction, and the first working adapter 140 is over the proximal end portion 47 of the elongated channel 14, so simultaneously holding the spikes 17 in the respective cradles 52. See FIG. 10 and 10A. This position of the first working adapter 140 over the spikes 17 is called connected. Various embodiments of the present invention may also have a locking module for the distal working nozzle 160 for holding the trigger trigger 130 in a certain position after the distal working nozzle 12 has been attached to the central modular part 50.

More specifically (see FIGS. 5, 7 and 8), one embodiment of a locking module 160 for a distal working nozzle includes a locking pin 162 that is movably supported by the upper portion 134 of the trigger trigger 130. Under the action of the spring 166, the locking pin 162 is deflected toward the left side of the housing 104. When the trigger 130 is in the unpressed (initial) position, the locking pin 162 is deflected adjacent to the stop of the initial position 163, which protrudes inward from the left side of the housing 104. See FIG. 7 and 8. As discussed above, the working tube 110 should initially be moved distally to the connected position, in which the first working adapter 140 holds the locking spikes 17 of the distal working nozzle 12 in the cradle pins 52 in the central modular part 50. The surgeon advances the working adapter 140 distally to the connected position, pulling the trigger trigger 130 from the initial position to the pistol portion of the handle 107. When the trigger trigger 130 is first pressed, the locking pin 162 slides adjacent to the stopper of the initial position 163, until the working tube 110 pushes the first working adapter 140 into the connected position, in which the locking pin 162 goes into the locking cavity 164 formed on the left side of the housing 104. See FIG. 8. In various embodiments, the locking pin 162 enters the locking cavity 164, making an audible click or other sound, and also creating a tactile sensation of the surgeon that the distal working nozzle 12 is fixed on the central modular part 50. In addition, the surgeon cannot inadvertently continue to press the trigger 130 to form the brackets 32 in the distal working nozzle 12, because to begin the formation of the brackets he must deliberately reject the locking pin 162 to remove it from the locking cavity 164. Similar In the same way, if the surgeon releases the trigger trigger 130 when the device is in the connected position, the locking pin 162 will hold it in this position, preventing the trigger trigger 130 from returning to its initial position and thus freeing the distal working nozzle 12 from the connection with the central modular part fifty.

In various embodiments, inside the left side of the housing 104 of the handle assembly 100, an unlock button for the trigger trigger 167 is installed, allowing the surgeon to deliberately release the locking pin 162 to be able to press the trigger trigger 130 or allow it to return to its initial position. See FIG. 5, 7 and 8. The release button for the trigger trigger 167 is movably mounted in the locking cavity 164 and is held by the spring in the unpressed position (see Fig. 8). When you press the unlock button trigger trigger 167 it comes into contact with the locking pin 162 and pushes it out of the locking cavity 163, which allows you to press the trigger trigger 130 again.

As described above, the surgical instrument 10 can be used as forceps for manipulating tissues and arranging them in the desired order. Further movement of the trigger trigger 130 towards the pistol portion 107 after the trigger trigger 130 has been released (by pressing the release button 167) will cause the working adapter 140 to come into contact with the clamping inclined surface 28 of the thrust plate 20. As as the clamping surface 146 of the first working adapter moves along the clamping inclined surface 28, the stop plate moves toward the cassette with brackets 30 in the elongated channel 14. Thus, the surgeon can manipulate the stop Lastin 20 toward the cassette 30 and from it to grasp and release tissue located therebetween without forming the staples.

Various embodiments of the present invention may further include an unlock button for the entire actuation system 137, which is pivotally attached to the handle assembly 100. See FIG. 1 and 4. In one embodiment, the release button of the actuation system 137 has a latch 138 at the distal end that is oriented to engage the actuation lever 114 when the release button of the actuation system is in the first locking position. As seen in FIG. 1 and 4, the spring of the latch 139 serves to hold the release button of the actuation system 137 in the first locking position (Figs. 11 and 12). As will be explained below, the latch 138 serves to fix the release lever 114 at a point where the position of the release lever 114 on the central modular part 50 corresponds to the point where the clamping surface 146 of the first working adapter 140 is ready to distally advance the clamping inclined surface 28 over the thrust plate 20. It becomes clear that as the first working adapter 140 axially moves along the clamping inclined surface 28, the thrust plate 20 will move along the path at which its bracket-forming surface 22 will become substantially parallel to the upper surface 36 of the cassette 30.

After the distal working nozzle 12 is attached to the central modular part 50, you can begin the process of forming brackets by pressing the release button of the entire actuation system 137 to allow the actuation lever 114 to move further in the distal direction along the central modular part 50 and, finally, to press the thrust plate 20 to the cassette with brackets 30. See FIG. 13. After pressing the release button for the actuation system 137, the surgeon continues to press the trigger 130 in the direction of the pistol grip 107, thereby forcing the clamping surface 146 of the first bracket clutch 140 to raise the corresponding bracket-forming inclined surface 29, which presses the thrust plate 20 against the brackets 32 cartridge 30. The lock button of the actuation system 137 prevents the inadvertent formation of brackets 32 until the surgeon is ready to start the process. In this embodiment, the surgeon is required to press the lock button of the actuation system 137 before he can continue to press the trigger trigger 130 further to begin the process of forming the brackets.

Surgical instrument 10, if necessary, can only be used as a device for stitching tissues. However, in various embodiments of the invention, the device may also comprise a cutting system, generally indicated by 170. In at least one embodiment, the cutting system 170 includes a blade member 172 that can be selectively pulled out of position near the proximal end of the distal the working nozzle 12 (Fig. 1 and 9-13) to the working position (Fig. 14) by pressing the trigger trigger of the knife 200. The knife element 172 is movably fixed inside the central modular clock and 50 and is attached or otherwise protrudes from the knife bar 180. The knife element 172 can be made, for example, of stainless steel grade 420 or 440 with a hardness of more than 38 HRC (Rockwell hardness index) and has a cutting edge 176 at the distal end 174 ; it can slide out smoothly through the groove 31 in the thrust plate 20 and through the groove 33 in the center of the cassette 30 and cut the tissue clamped in the distal working nozzle 12. See Fig. 14A. As seen in FIG. 4, the knife shaft 180 protrudes from the central portion 50 and has a proximal end 182. The proximal end 182 is movably interacted with the knife transmission 190, which is operatively connected to the trigger trigger of the knife 200. In various embodiments, the trigger trigger of the knife 200 is attached to the rotary pin 132 such that it can be deployed or otherwise actuated without causing the trigger to fire 130 simultaneously. In various embodiments, it also attaches to the pivot pin 132 I first gear blade 192, so that clicking on the launcher knife trigger 200 also rotates the first knife gear 192. The return spring 202 is secured between the first gear 192 of the knife handle and the housing 100 to retain the starting trigger blade 200 in the initial or normal position. See FIG. 1 and 4.

As shown in FIG. 5 and 6, various embodiments of the transmission of the knife 190 also include a second gear of the knife 194, which rotationally rests on the spindle of the second gear 193 and is engaged with the first gear of the knife 192. The second gear of the knife 194 is meshed with the third gear of the knife 196, which leans on the spindle of the third gear 195. The fourth gear of the knife 198 is also worn on the spindle of the third gear 195. The fourth gear of the knife 198 is designed to engage in movable engagement with several ring teeth and or rings 184 formed at the proximal end of the knife bar 180. Thus, this design allows the fourth gear of the knife 198 to move the bar of the knife 180 in the axial direction — distally (DD) or proximal (PD), allowing the bar 180 to rotate around the horizontal axis A- And relative to the fourth gear of the knife 198. Accordingly, the surgeon can move the rod 180 in the axial direction, and as a result, the knife element 172 in the distal direction, pulling the trigger trigger of the knife 200 towards the pistol grip 107 of the node p koyatki 100.

Various embodiments of the invention further include a knife locking system 210 that prevents the blade member 72 from being pulled out until the trigger trigger 130 is brought to its extreme operating position (fully pressed) (see FIGS. 13 and 14) . This feature, therefore, prevents the inclusion of the extension system of the knife 170 until then, until you first put the brackets or until they are placed and formed in the tissues of the body. As seen in FIG. 1, various ways of implementing a knife lock system 210 include a knife retainer 211 that is pivotally mounted within the pistol portion 107 of the handle assembly 100. The knife retainer 211 has an activation end 212 that is designed to engage with the trigger 130 when the trigger 130 is in the extreme working (pressed) position. In addition, the locking bar 211 has a locking hook 214 at the other end, which is adapted to hook the latch pin 216 of the first cutting gear 192. The blade lock spring 218 is used to hold the bar 211 in a locked position in which the locking hook 214 maintains engagement with the latch rod 216, thereby preventing pressing on the trigger trigger of the knife 200 until the trigger trigger 130 is in the extreme working position. See FIG. 9.

Various methods of operating a surgical instrument in at least one embodiment of the invention will now be explained with reference to FIGS. 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14 and 14A. As can be imagined based on FIG. 1, 9 and 9A, when the cutting bar 172 is in the depicted initial, or unextended, position, the cutting edge 176 is located proximal to the distal end of the first working adapter 140 so that the user cannot touch the sharp cutting edge 176. In alternative embodiments embodiments in which the elongated stem is adapted for use with the distal working nozzle of only one shape or only one size (i.e., when adapters 140 and 150 are not used), cutting edge 176 of cutting bar 172 will be located ozhena proximal to the distal end of the working tube, so that the user can not in these embodiments by negligence touch the cutting edge 176.

FIG. 9 and 9A show the distal working nozzle 12 after it was attached to the central modular part 50 when the spikes 17 on the distal working nozzle 12 were inserted into special cradles 52 on the central modular part 50. As shown in FIG. 9, the trigger trigger 130 is in the non-pressed (or initial) position, and the distal working nozzle 12 is not yet connected to the central modular part 50 by the first working adapter 140. “P _O ” means the distance that the trigger trigger 130 can go before as the first working adapter 140 begins to move upward, the clamping inclined surface 28, which is part of the thrust plate 20. The trigger trigger of the knife 200 is also in the unlocked locked position.

FIG. 10 and FIG. 10A illustrate the position of the trigger trigger 130 after it has been extended to a position in which the distal working nozzle 12 is locked on the central modular part 50 by the first working adapter 40. In the context of this document, this position is called “connected”. In the connected position, the locking pin 162 enters the locking cavity 164 (Fig. 8), thereby providing audible and tactile confirmation that the distal working nozzle 12 is now fixed on the central modular part 50. The trigger trigger 130 cannot be pressed harder until until the surgeon intentionally presses the release button of the trigger trigger 167 (Fig. 5, 7 and 8) to withdraw the locking pin 62 from the locking cavity 164. The distance that the distal end 141 of the first working adapter 140 passes is indicated as the distance "l" (Fig. 10A), and the corresponding distance that the actuation lever 114 has traveled along the central modular part 50 is indicated as the distance “l”. In FIG. 11 and 11A show the position of the trigger trigger 130 after pressing the unlock button (not shown) and after the surgeon pressed the trigger trigger 130, so that the first working adapter 140 moves to the beginning of the clamping inclined surfaces 28 of the thrust plate 20. As can be seen in these figures, the spring 21 of the thrust plate 20 holds the thrust plate in an open position. The stroke of the distal end of the first working adapter 140 is indicated as the distance “l ₁ ”, and the corresponding distance traveled by the actuation lever 114 along the central modular part 50 is indicated as the distance “l ' ₁ ”. FIG. 12 and 12A show the position of the first working adapter 140 after it has advanced to the beginning of the brace-forming inclined plane 29 of the abutment plate 20. This position shows how deeply the tissue can be clamped before the formation of the brackets begins. This position is referred to herein as the “maximum clamp position”. As shown in FIG. 12, the actuation lever 114 has come into contact with the latch 138 on the release button of the trigger trigger 137, so it cannot be advanced further in the distal direction until the button 137 is pressed. As shown in FIG. 12A, the bracket-forming surface 22 of the thrust plate 20 is substantially parallel to the upper surface 31 of the cassette with brackets 30. The distance between the bracket-forming surface 22 of the thrust plate 20 and the upper holding surface of the elongated channel 14 is indicated as “C _max ”. In various embodiments, C _max may be, for example, from 2.15 to 3.65 mm (about 0.085-0.144 inches) for cassettes 30 with housing 31 of approximately the same thickness. In at least one embodiment, the thickness of the cartridge exceeds the size of the bracket by about 0.25-0.76 mm (about 0.01-0.03 inches). The total distance that the first working adapter 140 has passed from the initial position to the maximum clamp position is indicated as “l ₂ ”, and the corresponding distance traveled by the actuation lever 114 along the central modular part 50 is indicated as “l ' ₂ ”. FIG. 13 and 13A show the position of the actuation lever 114 in the extreme operating position when the brackets 32 in the cassette 30 are already fully formed. In this position, the distance between the bracket-forming part 22 of the thrust plate 20 and the upper retaining surface of the elongated channel 14 is indicated as “C _min ”. In various embodiments, the implementation of the distance C _min can be, for example, from 0.38 to 0.76 mm (0.015-0.030 inches) for cassettes that hold brackets with legs in length (in an unformed state) of about 1.90-3.40 mm (approximately 0.075-0.134 inches) (designated as the “UF” distance in Fig. 1A), and in a fully formed form, have a height of, for example, from 0.63 to 1.01 mm (approximately 0.025-0.04 inches), which denoted by the distance “FF” in FIG. 1D. The total distance that the first working adapter 140 travels from the initial position to the extreme working position is indicated as “l ₃ ”, and the corresponding distance traveled by the actuation lever 114 along the central modular part 50 is indicated as “l ' ₃ ”. In FIG. 13, it is also seen that the trigger trigger 130 is in its extreme operating position and is in contact with the activation edge 212 of the retaining plate of the knife 211 in order to disengage the locking hook 214 from the latch pin 216 on the first gear of the knife 192.

Dissection of tissues, especially vessels, can be one of the most stressful moments of any surgical operation. In the case of a laparoscopic operation, the voltage is even higher, since in case of failure of any manipulation it will be necessary to immediately turn the laparoscopic operation into an open one in order to avoid catastrophic consequences. Thus, it is highly desirable to use a surgical stapling instrument, which makes it possible, according to the doctor’s choice, to cut the tissue after the brackets have been installed. This need is met by various embodiments of the present invention.

After the brackets have been installed (formed) in the target tissue, the surgeon can press the release button of the actuation system 167 to return the trigger 130 to its initial position under the action of torsion spring 135, which allows the thrust plate 20 to be held open under the action of the spring 21. Using the open position, the surgeon can remove the distal working nozzle 12, leaving the implantable cassette 30 and brackets 32 in the patient’s body. In cases where the distal working nozzle was inserted through the passage, the working channel, etc., the surgeon returns the thrust plate 20 to the closed position by pressing the trigger trigger 130 so that the distal working nozzle 12 can be removed through the passage or working channel. If, however, the surgeon wishes to cut the target tissue after setting the braces, he presses the trigger of the knife 200 in the manner described above so that the cutting bar 72 passes through the target tissue to the end of the distal working nozzle, as shown in FIG. 14, 14A. In FIG. 14 shows what distance the trigger of the knife 200 travels in various embodiments for different lengths of the distal working nozzle / cartridge with brackets when the cutting bar 72 is pulled to the extreme working position inside the distal working nozzle 12. After that, the surgeon can press the trigger of the knife 200, so that the return spring 202 by acting on the transmission brings the cutting bar 72 to the initial (non-extended) position (Fig. 13, 13A). After the cutting bar 72 has returned to its initial position, the surgeon can open the jaws of the distal working nozzle 13 and 15 to leave the implantable cartridge 30 inside the patient, and then remove the distal working nozzle 12 from the patient’s body. Thus, the surgical instruments of this invention facilitate the use of small implantable cassettes with brackets that can be inserted through relatively small working channels and passages, while allowing the surgeon to install brackets without cutting tissue or, if necessary, also cutting tissue after the brackets have been set.

As indicated above, the surgical instrument 10 can be used in combination with other distal working nozzles supporting cassettes of different sizes with brackets of a different size and quantity. In FIG. 15-19 illustrate the use of a distal working nozzle 12 ′ that operatively supports a larger cassette 30 ′ than the cassette 30, with brackets 32 ′ that are larger than the brackets 32. For example, the brackets 32 in the cassette 30 can have a value from about 2.03 to 2.15 mm (approximately 0.080-0.085 inches), while the brackets 32 'in the cartridge 30' may have a size of 1.90 mm (approximately 0.075 inches). In various embodiments, the cartridge 30 'is longer than the cartridge 30. For example, the cartridge 30 may have a length of 20 mm (about 0.78 inches), while the cartridge 30' may have a length of 40 mm (about 1.57 inches). In FIG. 15 is a three-dimensional diagram of parts of a distal working nozzle 12 ′, a second working adapter 150, and a distal end 55 of the central portion 50. As can be seen in FIG. 15, the elongated channel 14 'has a pair of side walls 16' spaced apart from each other, each of which has a groove or hole 18 'for engagement with a corresponding pin of the thrust plate 26'. The thrust plate 20 'and the elongated channel 14' may together form a distal working nozzle 12 ', which will have such a common diameter that will allow the distal working nozzle 12' to pass through an opening with a diameter of about 5.0 mm (about 0.20 inches). The thrust plate 20 'also has a staple-forming surface 22' with a plurality of staple-forming pockets and a forked inclined surface 24 'protruding in the proximal direction. The proximal end 15 'of the elongated channel 14' is equipped with a pair of retaining spikes 17 'that protrude outward and are equal in size to the cradles for the spikes 52 in the central modular part 50.

As shown in FIG. 15, the second working adapter 150 has a practically hollow body 151 and a proximal sleeve 152, in which there is a protruding protrusion 154 inward. Between the body 151 and the proximal sleeve 152 there is a groove 156, which allows the sleeve 152 to deviate relative to the body 151 and thereby facilitate the insertion of a stop the protrusion 154 into the corresponding hole 117 on the working tube 110. To separate the second working adapter 150 from the working tube 110, the surgeon needs to press the proximal sleeve 152 and remove the locking protrusion 154 from the hole 117, after which the second working dapter 150 can be removed from the working tube 110.

In various embodiments, the abutment plate 20 'has an inclined bifurcated module 24', consisting of a pair of teeth 45 ', each of which has a proximal surface 27', turning into a clamping inclined surface 28 ', located distally relative to the proximal surface 27'. See FIG. 15. The clamping inclined surface 28 'is located at an angle "A" "with respect to the proximal surface 27'. In various embodiments, for example, the angle "A '" may be from about 50 to 30 degrees. As will be discussed in detail below, when the second clamping surface 158 of the second working adapter 150 is in contact with the clamping inclined surface 28 ', the stop plate 20' moves towards the elongated channel 14 ', more precisely, in the direction of the cassette with brackets 30' located inside it. See FIG. 17. As the second working adapter 150 moves further in the distal direction, the second clamping surface 158 contacts the bracket-forming inclined surface 29 'on each of the teeth 45 of the thrust plate and pushes the thrust plate 20' deeper into the cassette 30 ', facilitating the formation of brackets 32 inside '. See FIG. 18. The brace-forming inclined surface 29 'is located at an angle "B" "with respect to the pressing inclined surface 27'. In various embodiments, for example, the angle "B '" may be from about 5 to 20 degrees. Between the module of the inclined plane 24 'and the bottom of the elongated channel 14', a spring (not shown) can be installed to hold the thrust plate 20 'in this open position.

FIG. 16 shows the position of the second working adapter 150 after the surgeon advanced the second working adapter 150 distally to the beginning of the clamping inclined surface 28 ′. The operation of the second working adapter 150 is controlled by the trigger trigger 130 in the same manner as described above for the first working adapter 140. In FIG. 17 shows the position of the second working adapter 150 in the maximum clamp position. In FIG. 18 shows the position of the second working adapter 150 in the extreme working position when the brackets 32 'in the cassette 30' are formed and embedded in the clamped body tissue (not shown).

As shown above, the implantable cartridge 30 'is longer than the implantable cartridge 30. Thus, as shown in FIG. 15, the distal working nozzle 12 'also includes a distal knife element 124, which is movably located inside the elongated channel 14'. The distal knife element 124 has a cutting edge 125 and a proximal part 126, which is designed to engage with the cutting bar 72. Thus, if the surgeon intends to cut the body tissue after he placed the braces, he presses the trigger 200, as it was described above, and moves the knife bar 172 distally so that it comes into contact with the knife element 124 and moves the knife part 124 through the body tissues, as shown in FIG. 19. The distal knife element 124 may have at least one retaining part that slides through a correspondingly made slot (not shown) in the elongated channel 14 '. Thanks to this design, it becomes possible to open the distal working nozzle 12 'after the brackets have been installed and the tissues are cut. The distal knife element 124 remains on the abutment plate 20 'and is removed along with the distal working nozzle 12' when it is removed from the patient’s body.

Thus, various embodiments of the surgical instrument 10 offer separate mechanisms for stitching and cutting tissue, that is, the surgeon can set brackets without cutting tissue. Various embodiments of the stapling instrument of the present invention can be successfully used with distal work nozzles of various sizes, capable of using cartridges of different sizes and capacities. Surgical instruments can be supplied in the form of a kit, which includes an instrument 10 and a first working adapter 140, as well as a second working adapter 150, which allows the tool to work with implantable cartridges of different sizes.

In various unique and innovative embodiments of the invention, compressible cassettes with brackets are used that support the brackets in a stationary position to come into contact with the thrust plate. Unlike previous designs of surgical staplers, which use elements to move the brackets, the brackets in the cassettes in various embodiments of the present invention do not move to the thrust plate. In various embodiments of the invention, the thrust plate itself moves toward unformed brackets. The degree of formation of the brackets depends on how deeply the thrust plate is pressed against the brackets. This design allows the surgeon to adjust the degree of the forming effect applied to the brackets, thereby changing the height of the finished brackets.

In various embodiments, the degree of movement of the movable thrust plate when triggered depends on how much the trigger is pressed. For example, if the surgeon needs to receive only partially formed brackets, the trigger should not be fully pressed in the direction of the pistol grip 107. To obtain more formed brackets, the surgeon just needs to press the trigger more firmly, as a result of which the thrust plate will press more firmly against the brackets, joining them in more tight contact. In this document, the term “come into contact” means that the staple-forming surface (or staple-forming pockets) came into contact with the ends of the legs of the brackets and began to deform, or bend, the legs, forcing them to take a formed position. The degree of formation refers to how much the legs of the brackets were bent, which ultimately affects the height of the formed bracket, as indicated above. Specialists with sufficient experience in this field will also be able to understand that, since the thrust plate 20 moves almost parallel to the cassette with brackets in the process of applying a pushing force to it, this leads to the fact that the brackets are formed almost simultaneously and have almost the same height.

FIG. 20-23 depict an alternative embodiment of a surgical instrument 10 with a bracket height indicator module 220. In various embodiments, the bracket height indicator 220 includes a strip of pointer 222 connected to an upper portion 134 of the trigger trigger 130 and capable of moving around the axis of rotation with it. As the trigger trigger 130 rotates relative to the pistol portion 107 of the handle assembly 100, pushing the stop plate 20 into the cassette with brackets 30, as described above, the strip of the pointer 222 becomes visible in the window 223 on the left side of the housing 104. In this embodiment, the pointer module the height of the bracket 220 also has three latches 24, 26, 28 on the left side of the housing 104, which correspond to the three stages of formation of the bracket. In particular, upon first pressing the trigger trigger 130, the locking pin 162 slides adjacent to the stopper of the initial position 163 until the working tube 110 pushes the working adapter 140 or 150 to the aforementioned connected position, in which the locking pin 162 goes into the locking cavity 164, formed on the left side of the body 104. When the surgeon wants to close the jaws 13 and 35 of the distal working nozzle 12, he presses the unlock button 167 to get the opportunity to press the trigger trigger 130 even more. When you press the button, unlock After starting trigger 167, it touches the locking pin 162 and pushes it out of the locking cavity 163, which allows pressing on the trigger trigger 130. As described above, the surgeon can now use the upper and lower branches (13 and 15) of the distal working nozzle 12 to capture tissue and manipulate them. When the surgeon wants to start the process of forming the brackets, he presses the release button of the trigger trigger 167, thereby allowing the trigger lever 114 to move in the distal direction as the pressure on the trigger trigger 130.

Further pressing on the trigger trigger 130 moves the thrust plate 20 forward until it comes into contact with the brackets 32 in the cartridge 30. As the trigger is further pressed, the flat part 165 of the locking pin 162 slides off the stopper of the initial position 163 and rests on the first latch 224, corresponding to the first degree of deformation of the bracket, which is represented by the first symbol of the height 230 of the bracket on the left side of the housing 104. See FIG. 20. As shown in the figure, the first character of the height of the bracket 230 is a picture that depicts a bracket that has just begun to deform. Other symbols / notation can be used to indicate this stage of deformation. When the locking pin 162 comes into contact with the first latch 224, the surgeon may hear a click. The engagement of the locking pin 162 with the first latch 224 also gives some tactile response that the surgeon can sense through the trigger trigger 130. In addition, in the window 223 adjacent to the first symbol of the height of the bracket 230, you can see the strip of the height indicator bracket 222. If the surgeon wants to continue forming the brackets 32 in the cassette with brackets, he presses the unlock button 240 on the left side of the housing 104 to slide the locking pin 162 from the first latch 224. In various embodiments, the button 240 may be integrated left into the housing 104 with the hinge element 242, which is part of the left side of the housing 104. This design allows you to press the button 240, pushing it into the end 165 of the locking pin 162 and sliding it from the first, second and third latches 224, 226, 228. After the locking pin 162 has moved from the first latch 224, the trigger trigger 130 can be pressed further until the locking pin 162 engages with the second latch brackets 226. This position of the trigger trigger 130 will cause the thrust plate 20 to enter more tight contact with the brackets 32 in the cassette 30. In this case, the locking pin 162 will again engage with the bracket for forming the brackets 226 (second), notifying the surgeon with a click and tactile sensation that the trigger trigger 130 has taken the second forming position. In this position, in the window 223, you can see the strip of the height indicator of the brackets 222, which is located next to the second symbol of the height of the brackets 232. If the surgeon wants to continue the formation of brackets 32 in the cassette with brackets 30, he presses the unlock button 240 to move the locking pin 162 from the second the latch 226. After that, the trigger trigger 130 can be pressed further until the locking pin 162 engages with the third latch brackets 228, which corresponds to the final stage of the formation of brackets. In this case, the locking pin again 162 will engage with the clamp forming brackets 228 (third), notifying the surgeon with a click and a tactile sensation that the trigger trigger 130 has taken the third forming position. In this position, in the window 223, you can see the stripe height indicator bar 222, which is located next to the third symbol of the bracket height 234. Upon reaching the desired degree of deformation of the brackets, the surgeon can move the locking pin 162 from the third bracket height bracket 228 so that the trigger trigger 130 can return to starting position. If necessary, the surgeon can then perform tissue dissection, as described above, before returning the trigger trigger 130 to its original position.

FIG. 24 illustrates an alternative embodiment in which the bracket height indicator module, generally indicated by 220 ′, does not have latches corresponding to different degrees of brace deformation. However, in this embodiment, there is a strip of the height indicator of the bracket 222 and a window 223. Thus, the surgeon can control the degree of deformation of the bracket by the position of the strip of the height indicator of the bracket 222 in the window 223. In this embodiment, there are also symbols of the height indicator 230, 232, 234 described above. In addition to this, this embodiment may also include an unformed bracket symbol 229, which corresponds to a position where the brackets 32 have not yet begun to deform under the influence of the thrust plate 20. Otherwise, this embodiment functions in the same manner as described above.

FIG. 25 and 26 show an alternative embodiment of the distal working nozzle 12 ″, similar to the above described variant of the distal working nozzle 12 ′, with the exception of the differences described below regarding the location of the cutting bar 172 ′. The cutting bar 172 'is connected to or protrudes from the knife shaft 180, and the rest of its operation is similar to the operation of the cutting bar 172 described above. However, in this embodiment, the cutting bar 172' has a length sufficient to pass through the entire distal working nozzle 12 ", and therefore, in the distal working nozzle 12" there is no distal knife element. The cutting bar 172 'has an upper transverse segment 173' and a lower transverse segment 175 'formed on it. The upper transverse segment 173 'is oriented so as to slide freely in the corresponding elongated groove 250 in the abutment plate 20 ", and the lower transverse segment 175' is oriented so as to slide in the elongated groove 252 of the elongated channel 14" of the distal working nozzle 12 ". The thrust plate 20 ”also has a disengagement groove (not shown) that is designed so that when the cutting bar 172 ′ reaches the end position within the distal working nozzle 12”, the upper transverse segment 173 ′ slides out of the corresponding groove, allowing the most resistant 20 ”plate, return to the open position and release the stapled and cut fabric. The thrust plate 20 ″ may otherwise be identical to the thrust plate 20 described above, and the elongated channel 14 ″ may otherwise be identical to the elongated channel 14 ″ described above.

In this embodiment, the thrust plate 20 ”is retracted to the fully open position (FIG. 25) by a spring or other opening structure (not shown). The thrust plate 20 ”is moved from the open position to the maximum clamping position by axial movement of the working adapter 150, as described above. After the working adapter 150 has reached the maximum clamping position (FIG. 26), the surgeon can extend the cutting bar 172 ”distally, as described above. If the surgeon wishes to use the distal workpiece as forceps for manipulating tissues, he can move the working adapter proximally so that the stop plate 20 ”moves away from the elongated channel 14”, as shown in FIG. 27 with a dashed line. In this embodiment, as the cutting bar 172 ″ moves distally, the upper transverse segment 173 ′ and the lower transverse segment 175 ′ bring together the stop plate 20 ″ and the elongated channel 14 ″, providing the desired degree of formation of the brackets as the cutting bar 172 "moves in the distal direction through the distal working nozzle 12". See FIG. 28. Thus, in this embodiment, the formation of the brackets occurs simultaneously with the cutting of the tissues, but the brackets themselves can be sequentially formed as the cutting plate 172 ”moves distally.

FIG. 29 and 30 illustrate the use of a 12 ”distal working nozzle with a 20” thrust plate made, for example, of stainless steel, titanium, PGA (polyglycolic acid) or other absorbable plastic and therefore possesses a known elasticity. These drawings also illustrate the use of the retainer matrix 6250 and the alignment matrix 6206, which will be described in more detail below. As seen in FIG. 29, the thrust plate 20 ”deviates to the position of complete formation of the brackets as the cutting bar 172” passes through it in the distal direction.

In many surgical situations, it is highly desirable (or associated with significant advantages) that the cutting and stapling instrument is designed so that the distal working nozzle can be positioned at an angle to the elongated stem. In previous embodiments of such devices, the ability to reach narrow areas was limited by the size and design of the tools, which made it possible to rotate the distal working nozzle at the required angle. In FIG. 31-40 show another embodiment of a surgical instrument constituting the subject of the present invention, which allows the distal working nozzle to be positioned at an angle to the elongated stem and which implements a relatively compact solution for controlling the articulated joint using the handle assembly.

The surgical instrument 310 of this embodiment is substantially similar to the various surgical instruments 10 described above, except that in this embodiment a modular articulated rod 312 is used that facilitates the selective positioning of the distal workpiece 12 with respect to the elongated longitudinal axis AA. Although the surgical instrument 310 will be described herein in combination with the distal workpiece 12 of the type described above, those with sufficient experience in the art will also appreciate the fact that the surgical instrument 310 can also be used in combination with the second working adapter 150 to work with distal working nozzle 12 'or distal working nozzles of other designs. As seen in FIG. 31 and 32, the hinge rod module 312 includes a distal portion of the rod 314 pivotally connected to the proximal portion of the rod 316, which is operably controlled by the handle assembly 100. In various embodiments, for example, the distal portion of the rod 314 includes a central distal segment 320 equipped with a pair of cradles for spikes 322 into which the spikes 17 are inserted. See FIG. 32. The central distal segment 320 has a proximal end 324 with a swivel base 326, from which a swivel pin 328 protrudes.

As seen in FIG. 32, the proximal portion of the stem 316 includes a central proximal segment 330 equipped with a proximal rotary base to which the knife guide 332 is attached. The knife guide 332 can, for example, be welded or glued to the central proximal segment 330 or otherwise attached to it. The pivot hole 334 in the blade guide 332 on the pivot base of the proximal portion receives a pivot pin 328, which allows the central distal segment 320 to rotate relative to the central proximal segment 330 around the first axis of rotation FA-FA, which is essentially transverse to the longitudinal axis AA. Surgical instrument 310 also includes a distal working tubular segment 370, which is pivotally connected to a pair of working tube links 380, 382, providing rotational movement around the second axis SA-SA. The distal working tubular segment 370 has a locking hole 372, which includes a locking button for 144 of the first working adapter 140. A pair of working tube links 380, 382 are pivotally connected to the proximal working tubular segment 390, which allows them to rotate relative to the third axis of rotation TA-TA . See FIG. 32.

In various embodiments, the proximal working tubular segment of the tube 390 is attached to the pivoting head 400, which is rotationally attached to the handle assembly 100. See FIG. 31, 38 and 39. The pivoting head 400 may be molded from a polymer material or plastic and consists of a sleeve 402 and a flange portion 404 located at a distance from the sleeve 402. The end portion 101 of the handle assembly 100 takes place between the sleeve 402 and the flange portion 404, which allows the rotary head 400 to rotate relative to the node handle 100 around the longitudinal axis AA. In other embodiments, the swivel head 400 may be made of other materials. In the depicted embodiment, the proximal working tubular segment 390 and the proximal central segment 330 are fixedly connected to the pivoting head 400. As can be seen in FIG. 38 and 39, the proximal central segment 330 and the proximal working tubular segment 390 are connected to the rotary head 400 by a key 406. Thus, the surgeon can rotate the distal working nozzle 12 relative to the handle body 100 360 ° about the longitudinal axis A-A by turning the head 400.

As shown in FIG. 37, 38, and 40, in various embodiments, the distal working nozzle 12 can selectively occupy different positions relative to the longitudinal axis AA with a pair of hinge elements 420, 430 mounted on the distal pivot base 326 and a ball joint member 440 that is rotationally mounted in the socket 408 in the pivoting head 400. In various embodiments, the hinge elements 420, 430 may include cables made of stranded beams, the material for which is nitinol, titanium, and the like. The first, or right, hinge element 420 has a distal end 422, which is provided with an eye 424, pressed into the first mounting hole of the cable 327 on the distal rotary base 326. Similarly, the second, or left, hinge element 430 has an eye 434 pressed on the distal end 432 into the first mounting hole of the cable 329 on the distal pivot base 326. See FIG. 37. Thus, the distal working nozzle 12 can rotate to the right around the first axis of the FA-FA (Figs. 35 and 36) by pulling the right hinge element 420, and the distal working nozzle 12 can rotate to the left around the first axis of the FA-FA, if pull the second, or left, hinge element 430. In various embodiments, the right hinge element 420 can slide in the right cable channel 336 formed in the proximal center segment 330, and the left hinge element 430 can slide in the left cable channel 338 formed in the proximal center c ntralnom segment 330.

Turning to FIG. 38-40, we will see that the first hinge element 420 has a proximal end 426 with a locking ball 428, mounted on it or otherwise attached to it to enter the first locking groove 442 of the ball element 440, which is rotationally mounted in the socket 401 of the rotary head 400. Similarly, the second hinge element 430 has a proximal end 436 on which a locking ball 438 is inserted or otherwise secured into the second locking groove 444 on the ball element 440. FIG. 40 it is especially clearly seen that the ball element 440 has a groove for the actuator 446, which ensures unhindered passage of the proximal working tubular segment 390 through the hinge. As shown in FIG. 38, the groove 446 may taper from the wider inlet portion 448, 450 to the passage 452 in the center of the ball element 440, whereby the proximal working tubular segment 390 passes through the hinge. As will be described in detail below, the ball element of the hinge 440 is able to rotate freely or can be pivotally mounted in the socket 401; it can also be selectively moved from the neutral position (shown in Fig. 38 by a solid line) to the first and second adjustment positions (shown in Fig. 38 by a dashed line). The ball element of the hinge 440 can also perform axial movements in the socket 401.

As seen in FIG. 40, the surgical instrument 310 may include a locking structure, generally indicated by number 453, for fixing the ball element 440 in any of the adjustment positions — neutral, first or second. In various embodiments, the stopper structure 453 consists of a series of stoppers 454 provided on the ball element 440 that align with the stop ribs 410 in the recess 408 in the sleeve 402 oriented inside the socket 401 of the swivel head 400. The passage for the actuator 412 goes through the sleeve 402 and is aligned with the groove for the actuator 446 in the ball element 440 so that the proximal working tubular segment 390 can pass through it. As can be seen in FIG. 38 and 39, the hinge spring 456 abuts against the spring retaining sleeve 414, which is part of the rotary head 400, deflecting the ball element 440 in the proximal direction so that the locking clips 454 engage with the locking ribs 410 in the sleeve 402.

To facilitate the articulated movement of the ball element 440, a pair of handles 458, 460 protruding diametrically opposite sides protrude from it on the sides. In various embodiments, the implementation of the ball element of the hinge 440 may be made, for example, of polycarbonate, nylon, Ultem® material, may not have a filling, have a glass filling, mineral filling, and the like; it may also have stoppers 454, fused to or cut into it. The handles 458 and 460 can be pressed onto the spherical element of the hinge 440, welded to it, etc. Such designs allow the ball element 440 to be fixed in any of the adjustment positions — neutral, first or second. By moving the ball element 440 to the position providing the desired angular position of the distal working nozzle, the surgeon can release the ball element 440, which will allow the spring of the actuator 456 to deflect the ball element 440 proximally so that the retaining clips 454 engage with the retaining ribs 410 on the sleeve 402 In various embodiments, the spring 456 may be sized such that the ball member 440 can return to its neutral position when it is acted upon when the distal slave is angled tea nozzle forcibly pulled back through the trocar or similar opening. Moreover, the use of handles 458, 460 allows you to "adjust" the degree of articulation deviation in relation to a specific surgical procedure.

As seen in FIG. 38, the first or right hinge handle 458 protrudes through the right groove 416 in the pivoting head 400, and the second, or left, pivoting arm 460 protrudes through the left groove 418 in the pivoting head 400. To give the distal working nozzle 12 a curved position relative to longitudinal axis AA, the surgeon first moves the right and left handles 458 and 460 axially in the distal direction DD to disengage the locking latches 454 and ribs 410 in the sleeve 402 of the rotary head 400. After that, the surgeon can rotate the ball element 440 in the circle of the axis of rotation, moving the handles 458 and 460 in the desired direction and causing the hinge elements 420 and 430 to move accordingly. For example, the distal working nozzle 12 can be rotated around the axis of rotation to the right by moving the right handle 458 in the proximal direction PD, and the left handle 460 in the distal direction DD, thereby applying a pulling force (bending force) to the right hinge element 420 and a pushing force to the left hinge element 430. Similarly, the distal working nozzle 12 can be turned around si rotation to the left, moving the left handle 460 in the proximal direction PD, and the right handle 458 in the distal direction DD, thereby applying a pulling force (bending force) to the left hinge element 430 and pushing force to the right hinge element 420. Various ranges of motion the right and left handles of the hinge 458 and 460 are shown with a dashed line in FIG. 38. Thus, the distal working nozzle 12 can optimally occupy a wide variety of angular positions, i.e. can deviate from the main position clockwise and against it, without requiring the rotation of the elongated rod 40. In FIG. 35 shows an angle α, which in various embodiments can range from 0 ° to 45 °.

Various embodiments of a surgical instrument 310 include a cutting bar 472 that is movably mounted within the hollow proximal central segment 330 and extends through a knife support groove 333 that extends from the narrow proximal portion 335 to the wide distal portion 337, allowing the cutting bar 472 to flexibly extend inside , adapting to the articulated movements of the distal working nozzle 12 relative to the axis AA. See FIG. 37. In various embodiments, the implementation of the cutting bar 472 may be made, for example, of stainless steel grade 300 or 400 and have a cutting edge 476 formed at the distal end. As seen in FIG. 37, the cutting bar 472 slides through the knife groove 473 in the distal rotary base 326. The proximal end 478 of the cutting bar 472 is attached to the knife bar 480, which extends through the central proximal segment 330 and engages the drive gear with the working transmission 190, as described above . See FIG. 31. The locking pin 406 passes through the longitudinal groove 392 (Fig. 38) in the proximal working tubular segment 390, and then through the hole 339 in the proximal central segment 330 (Fig. 39), after which it enters the longitudinal groove 482 in the knife shaft 480 that allows the proximal working tubular segment 390 and the knife shaft 480 to move in the axial direction with respect to the proximal central segment 330 and the handle assembly 100. Thus, the surgeon is able to selectively work with a cutting bar 472 for dissecting tissue second, acting knife trigger trigger 200, as described above.

Various options for the implementation of the swivel connection are set forth in US patent application No. 12/775 809 (entry in the registration book number END6755USNP), entitled "Laparoscopic devices with articulated distal working nozzles" (Laparoscopic Devices With Articulating End Effectors), issued in the name of Frederick E. Shelton IV (Frederick E. Shelton IV), filed May 7, 2010, and in the application for US patent No. 12/775 699 (entry in the registration book No. END6756USNP), entitled "Flexible rods for positioning using handles" (Bendable Shaft For Handle Positioning), designed in the name of Frederick E. Shelton IV et al. (Frederick E. Shelton IV, et al.), Filed May 7, 2010, the contents of which are incorporated herein in their entireties by reference to these applications. In FIG. 41 and 42 show an alternative version of the hinge rod 490, which is almost identical to the hinge rod 340 and functions in much the same way, with the exception of the intermediate tubular working segment 492, which replaces the link of the working tube 380 used in the hinge rod 340. As can be seen in FIG. 41 and 42, the intermediate working tubular segment 492 extends from the distal working tubular segment 370 and goes towards the proximal working tubular segment 390. In various embodiments, the intermediate working tubular segment 492 may be made of nylon, Isoplast® material or other flexible plastic. In various embodiments, the intermediate working tubular segment 492 has two longitudinal central compression sections 494, from which numerous rib segments 496 are separated by gaps 498, thereby forming a substantially hollow tubular segment through which other components of the central module and the cutting bar can quickly pass. The central sections 494 are designed to transmit compressive movement from the proximal working tubular segment 390 to the distal working tubular segment 370, which are of sufficient size to bring the thrust plate 20 to its extreme working position, which makes it possible to give the distal working nozzle 12 a selectively defined position at an angle to the longitudinal axis Aa. The intermediate working tubular segment 492 has a distal end 491 that is attached to the distal working tubular segment, for example, with keys, a combination of a protrusion and a groove, spikes, and the like, and a proximal end 493 that is attached to the proximal working tubular segment 390 with the same or in similar ways. In this embodiment, the distal working nozzle 12 can optimally accept a wide variety of angular positions, i.e. can deviate from the main position clockwise and against it, while not requiring the rotation of the elongated rod 490. In FIG. 42 shows an angle α, which in various embodiments can range from 0 ° to 45 °.

FIG. 43-47 are images of another embodiment of a surgical instrument constituting the subject of this invention. The surgical instrument 510 in this embodiment is substantially similar to the surgical instrument in embodiment 310 described above, with the exception of the various differences described below. Although a surgical instrument 510 will be described herein in combination with a distal workpiece 12 of the type described above, those with sufficient experience in the art will also appreciate the fact that this surgical instrument can also be used in combination with a second working adapter 150 to work with distal working nozzle 12 'or with distal working nozzles of a different design. Various embodiments of a surgical instrument 510 include an articulated rod 512 that facilitates giving certain positions to the distal workpiece 12 relative to the longitudinal axis AA. As seen in FIG. 43 and 44, the hinge rod 512 includes a distal central segment 520 having a pair of cradles for spikes 522 into which the spikes 17 are inserted. The distal central segment 520 has a proximal end 521 that is pivotally mounted on the distal end 531 of the proximal central segment 530. B in particular, the proximal end 521 of the distal central segment 520 has a pair of spatially separated distal protrusions 523 that support the hinge 524 passing through the distal end 531 of the proximal central segment 530, thereby defining the axis of bending AA-AA, which is essentially transverse to the longitudinal axis AA. See FIG. 46.

In various embodiments, the implementation of the distal working nozzle 12 can be bent in various positions relative to the longitudinal axis AA. For example,

angle α 'in FIG. 47 may have a value from 180 ° to 90 °. The distal working nozzle 12 is bent by means of at least one hinge element 550 connected to the hinge link 540. The hinge link 540 is pivotally connected to the distal end 521 of the distal central segment 520 (using the distal pin 542). See FIG. 43. The hinge 540 also has a hinge connection to the distal end 552 of the hinge rod 550 (using the keys of the hinge rod 554), as shown in FIG. 46. As can be seen in FIG. 43, the hinge element 550 extends inside the hinge rod 512 and has a proximal end 556 included in the pivoting head 560, which in turn is pivotally connected to the handle module 100. The proximal end 556 of the hinge element 550 is connected to the control unit of the hinge or button 558, which slidably connected to the rotary head 560 and is capable of selective axial movement relative to it. Thus, the axial movement of the button 558 in the distal direction DD will cause the distal working nozzle 12 to rotate around the longitudinal axis AA, as shown in FIG. 47. In order to return the distal working nozzle to its initial non-bent position, in which the distal working nozzle is coaxial with respect to the longitudinal axis AA, the surgeon simply moves the button 558 in the proximal direction PD on the rotary head 560.

As in some of the embodiments described above, the pivoting head 560 is rotatably mounted on a mounting sleeve 570, which is rotationally mounted on the handle assembly 100. See FIG. 43 and 47. The mounting sleeve 570 has a proximal flange 572 and a distal flange 574, which form with each other a rotational groove 575 designed to rotate the protruding end portion 101 of the handle assembly 100. This design allows the mounting sleeve 570 to rotate about the longitudinal axis AA relative to handle assembly 100. The proximal central segment 530 is tightly mounted on the dowels or otherwise attached (welded, glued) to the mounting sleeve 570 so that the rotation of the rotary head 560 around the longitudinal axis AA leads to that the entire distal working nozzle 12 rotates around the longitudinal axis AA. It becomes clear that such a design can facilitate the rotation of the distal working nozzle 12 by 360 ° around the longitudinal axis AA.

This embodiment also provides a distal working tubular segment 580, which is connected to the first working adapter 140 and is able to axially move along the distal central segment 520. In particular, the locking button 144 on the first working adapter 140 enters the locking hole 581 on the distal working tubular segment 580 as described above. The distal working tubular segment 580 is driven by at least one working part attached to it. In a preferred embodiment, the distal working tubular segment 580 is driven by a pair of rods 582, 584 attached to it. The rods 582, 584 are attached to the mounting section 585, which is connected to the proximal working tubular segment 590, which in turn is attached to the lever 114 as described above. Also, the outer tube 592 abuts against the proximal central segment 530, which is connected to the rotary head 560 and rotates with it. The proximal working tube 590 and the mounting portion 585 may axially move relative to the outer tube 592. The rods 582, 584 slide in the side channels 526 in the distal central portion 520, as shown in FIG. 44C. In various embodiments, the rods 582, 584 are thin flexible parts that can, for example, be made of stainless steel and capable of pushing the distal working tubular segment 580 so that it moves or closes the thrust plate 20 in the manner described above, whereby the implantable cassette with brackets 30 is the formation of brackets 32. The operation of the rods 582, 584 is achieved by clicking on the trigger trigger 130, as described above. Returning the trigger 130 to its initial position pulls the rods 582, 584 and causes the first working adapter 140 to move the thrust plate 20 either to the open position or to a position in which the thrust plate 20 can be moved to the open position by means of a spring (not shown).

Surgical instrument 510 may also include a knife 534, which is movably secured to a groove 528 in the distal central segment 520. See Figure 44B. In various embodiments, the implementation of the cutting strip 534 can be made, for example, of stainless steel grade 300 or 400 and have a cutting edge 535 formed at the distal end. The cutting bar 534 is attached to the rod 536, which can be made of stainless steel grade 300 or 400. Such a rod can have, for example, a thickness of steel equal to 0.178-0.3005 mm (0.007-0.012 inches), and be made of a material harder than the rod. The thrust of the knife 536 passes through the distal central segment 520 and the proximal central segment 530 and is attached to the stem of the knife 480, which has movable drive engagement with the transmission 190, as described above. Thus, the surgeon is able to selectively work with the cutting strip 534 for dissecting tissues, acting as a trigger trigger knife 200, as described above. In various embodiments, it is also possible to use a cover 594 having the form of an accordion that prevents the ingress of dirt, fabrics, debris, and the like. swivel. See FIG. 48.

FIG. 49-53 are images of yet another embodiment of a surgical instrument according to this invention. The surgical instrument 610 according to this embodiment is substantially similar to the surgical instrument according to embodiment 10 described above, with the exception of the various differences described below. Surgical instrument 610 is designed to control the distal working nozzle 612 with two movable jaws 613, 615. In various embodiments, the distal working nozzle 612 has a structure that allows it to be connected to an elongated stem 655 protruding outward from the handle assembly 100. See FIG. 49. The elongated stem 655 includes an elongated central module 658 and an elongated locking tubular module 680, which is able to move axially along the central module 658 (both distally and proximal). As shown in the figures, the elongated stem 655 protrudes in the distal direction from the handle assembly 100, forming an almost straight line along the longitudinal axis AA. In various embodiments, the length of the elongated stem 655 may reach 228.8 to 406.4 mm (approximately 9 to 16 inches), however, the elongated stem 655 may also have a different length.

As shown in FIG. 50 and 51, in various embodiments, the lower jaw 613 of the distal nozzle 612 may have an elongated channel 614, and the upper jaw 615 a thrust plate 620. The elongated channel 614 has a pair of space-separated walls 616, each of which ends in a protruding locking tip 618 The elongated channel 614 can be made, for example, of stainless steel grade 17-4 or 400 and is suitable in size to fit a cassette with brackets 630 or a cassette with brackets of a different configuration. The thrust plate 620 may be made of stainless steel grades 416, 17-4, 17-7, etc. At least in one embodiment, for example, the distal working nozzle 612 (in the closed position) and the elongated stem 655 have a maximum outer diameter, allowing the device to quickly pass through an opening that has a diameter of at least 8-12 mm (approximately 0.31-0.47 inches). However, the distal working nozzle 612 and the elongated main shaft 655 may also have other diameters and a different shape. The distal working nozzle 612 further includes a distal central segment 660, which can be removably connected to the distal end of the proximal central segment 670, as will be explained below.

The thrust plate 620 has a staple-forming surface 622 with many staple-forming pockets. In addition, the thrust plate 620 has a bifurcated locking part 624, which is equipped with one, and often two locking ends 625, directed downward. As seen in FIG. 50-53, in at least one embodiment, the locking tips 625 and their corresponding locking ends 618 of the elongated channel 614 are pivotally mounted on the axial eyes 663 of the bifurcated distal end 662 of the distal central segment 660 (see FIG. 55) in the central module 658 by pivot pin 626 so that when viewed from the side, the locking tips 625 and 618 form a scissor-like structure, generally indicated by 628. In other embodiments, the support plate 620 may be movably connected to an elongated cable 614 scarlet.

Various embodiments of the distal working nozzle 612 also include an axially movable knife module 640, which includes a knife plate 642 equipped with spatially separated cutting strips 644 that extend distally from it, which axially slide between the eyes 663 of the distal central segment 660. See FIG. 55. The blade member 646 is attached or formed at the distal end of the cutting bars 644. In various embodiments, the cutting bars 644 and the blade member 646 may, for example, be made of 300 or 400 stainless steel. A cutting edge 648 is formed at the distal end of the blade member 646. The lower portion 649 of the knife member 646 is formed so as to grip the rails that move the brackets (650) and are movably placed in the elongated channel 614. The rails 650 can be mounted in a slot or in a series of slots (not yet an) in the elongated channel 614, which facilitate the axial movement of the slide 650 from the initial position (Fig. 50-52) to the final (Fig. 53) while maintaining contact with the elongated channel 614. The slide 650 has a surface (or surfaces) 652 that moves brackets and is oriented so that it grabs the brackets 632 in the cassette 630 and moves the brackets 632 up in the direction of the bracket-forming surface 622 of the abutment plate 620, while the knife element 646 extends distally through the distal working nozzle 612.

Also in various embodiments, the nut 668 of the distal central segment is rotationally connected to the proximal end 664 of the distal central segment 660, which allows it to move, rotating around the longitudinal axis AA. The nut 668 has a pair of inwardly projecting spikes 669, the dimensions of which are such that the spikes fit into the corresponding slots 674 at the distal end 672 of the proximal central segment 670 protruding from the handle 100, which allows the distal central segment 660 to rotate relative to the proximal central segment 670. As can be seen in FIG. 49, the proximal central segment 670 is connected via a pin 66 to a pivoting head 70, which is rotationally mounted on the handle 100, as described above, which allows the distal working nozzle 612 to rotate 360 ° around the longitudinal axis AA.

In FIG. 49, it is also seen that a flange 676 is formed at the proximal end 671 of the proximal central segment 670. The flange 676 has a rotational support inside a groove 106 formed by a pair of compatible ribs 108 that protrude from parts of the housing 102, 104. This design facilitates the connection of the central proximal segment 670 to the handle 100, allowing the central proximal segment 670 to rotate relative to the handle 100 around the longitudinal axis AA by 360 °. The proximal closure tubular segment 682 may be made of polymer or other suitable material and have a proximal end 683 that is attached to the actuation lever 114, movably mounted inside the handle assembly 100 (methods of such fastening were discussed above). In various embodiments, for example, the actuation lever 114 may be reshaped at the proximal end 683 of the proximal gate tubular segment 682. However, other fixation options are possible. As described above, the operation lever 114 may have a rotational support in the form of a support sleeve 120, which is structurally capable of axial movements within the handle assembly 100. As can be seen in FIG. 49, a longitudinal groove 681 is provided along the proximal closure of the tubular segment 682 so that a key of the central portion 66 can exit through it into the proximal central segment 670, facilitating the axial movement of the proximal closure of the tubular segment 682 along the distal central segment 670.

As seen in FIG. 49, the trigger trigger 130 has an upper portion 134, which is pivotally connected to work rods 636, 638, which are articulated with a support sleeve 120. Thus, moving the trigger trigger 130 in the direction of the pistol grip 107 of the handle assembly 100 will result in that the actuation lever 114 and the proximal gate tubular segment 682 will move in the proximal direction PD (shown by the dashed line in Fig. 49). Moving the trigger trigger 130 in the direction from the pistol grip 107 of the handle assembly 100 will cause the trigger lever 114 and the proximal closure tubular segment 110 to move in the distal direction DD along the proximal center segment 670.

As seen in FIG. 50-53, the proximal closure tubular segment 682 has a distal end 684 that is configured to attach to the proximal end 692 of the distal closure tubular segment 690. In the illustrated embodiment, the distal closure tubular segment 690 has a structure that allows it to be screwed to the distal end 684 of the proximal gate tubular segment 682. The distal end 694 of the distal gate tubular segment 690 has a tapered drive portion 696, which is pre Classifi- cation to interact with the scissor structure 628 such that, when distal tubular segment shutter 690 is in the position shown in FIG. 51, the spring of the distal working nozzle or spring 617, located between the elongated channel 614 and the thrust plate 620, serve to bring the thrust plate 620 to the open position, as shown in this drawing. However, when the distal gate tubular segment 690 extends in the proximal direction PD, the threaded drive portion 696 contacts the scissor structure 628 and expands the branches 613 (elongated channel 614) and 615 (thrust plate 620) towards each other. See FIG. 52 and 53.

Surgical instrument 610 may further include a knife extension system 639 consisting of a knife shaft 700 that extends through the proximal central segment 670 and has a proximal end portion 702; the latter interacts in a drive manner with a working transmission 190, which is attached in a working manner to the trigger of the knife 200, as described above. Thus, the surgeon can distally advance the blade shaft 700 by pressing the trigger trigger of the knife 200, as described above. As seen in FIG. 52 and 53, the blade shaft 700 has a bifurcated distal end 704 that includes an upper shaft segment 706 and a lower shaft segment 708 in which the blade plate 642 is clamped. FIG. 51-54, it is shown that the upper segment 706 is able to pass through the upper groove 773 in the central nut 668, and the lower segment of the knife shaft 708 is able to pass through the lower groove 775 in the central nut 668.

To use the surgical instrument 610, the distal workpiece 612 is attached to the distal end 672 of the proximal central segment 670 by inserting the spikes 669 of the central nut 668 into their respective cradles 674 on the proximal central segment 670. See FIG. 50. After that, the surgeon can rotate the distal working nozzle 612 relative to the elongated rod 655 to screw the distal valve tubular segment 690 onto the proximal valve tubular segment 682 and obtain the valve tubular module 680. The distal working nozzle 612 may include a cassette 630 with brackets, or the doctor may insert such a cartridge into the elongated channel 614 at this time or later. When the distal working nozzle 612 is attached to the elongated stem 655 of the surgical instrument 610, the surgeon can insert the distal working nozzle 612 and the elongated rod 655 through the passage for access to the patient's body (for example, through a trocar, endoscope, etc., or through an incision, if open surgery) to clamp the target tissue between the branches 613, 615 of the distal working nozzle. As in the various embodiments described above, the jaws 613, 615 are closed by moving the trigger trigger 130 relative to the pistol grip 107 on the handle assembly 100. By clamping the target tissues between the jaws 613, 615 of the distal working nozzle, the surgeon can “shoot” the brackets 632 or form them into the fabric by pressing the stop plate 620 into the cassette with brackets 630, as described above. If the procedure does not require cutting tissue, the surgeon can then release the trigger trigger 130 so that the thrust plate 620 can return to the open position (under the deflecting action of the spring 617) and thereby release the implantable cassette with brackets 630 from the distal working nozzle 612. After that, the surgeon can again close the jaws 613, 615 so that the distal working nozzle 612 can be removed through the passage or working channel. However, if the surgeon wishes to cut the target tissue between the rows of brackets 632, he can release the knife module 640 by pressing the trigger 200 as described above so that the knife element 648 extends distally through the target tissue. As the blade member 648 moves distally through the distal working nozzle 612, it makes contact with the slide 650, which enhances the contact of the brackets 632 with the bracket-forming surface 622 of the thrust plate 620 to further form the brackets 632. See FIG. 53. After that, the surgeon can open the distal working nozzle 612 and release the cut or stitched tissue and the implantable cassette 630.

Thus, the unique and innovative design of the shutter tube, which closes the jaws of the distal working nozzle by moving the shutter tube in the distal direction, makes it possible to use the shutter structures of small dimensions, while maintaining the possibility of applying significant closing force required to form the brackets. In addition, this embodiment of the present invention allows the surgeon to staple tissue with brackets without dissecting them in cases where the nature of the operation does not require this.

FIG. 56-60 illustrate an alternative embodiment of a surgical instrument 810 that is substantially identical to the surgical instrument 610 described above, except for the differences indicated below. Surgical instrument 810, for example, includes a flexible central module 820 having a proximal end with a flange 822 on it that rotates in a groove 106 formed by compatible ribs 108 that protrude inward from each half of the body 102, 104, forming together a handle assembly 100. See Fig. 57 and 58. This design facilitates the rotational movement of the flexible module 820 relative to the handle assembly 100. In various embodiments, the flexible central module 820 may be made of, for example, nylon, acrylonitrile butadiene styrene (ABS), polycarbonate, liquid crystal polymers, stainless steel, titanium, etc. .P. and have a configuration that allows you to use it with a distal working nozzle 612 of the type described above.

In addition, the surgical instrument 810 includes an elongated rod, generally designated 830. In various embodiments, the elongated rod 830 consists of a variable segment rod 840 and a proximal segment 844. As can be seen in FIG. 56, for example, a configurable stem 840 may have a distal mounting sleeve 842 that is fixedly mounted to a portion of the flexible central module 820 using, for example, glue, welding, fasteners, and the like. Variable configuration rod 840 allows for selective configuration change between the linear version, in which all portions of the segmented configuration rod 840 are practically coaxial with respect to each other (i.e., form an almost straight hollow tubular structure), and configurations in which at least one of such parts is non-coaxial or non-linear with respect to the remaining parts of the variable-configuration rod 840. In the embodiment shown in FIG. 56, for example, a customizable rod 840 may be made of nylon, acrylonitributadiene styrene (ABS) or polycarbonate, and the like. and has many ribs 846 that facilitate changing the configuration of segment 840 from the state of linearity or coaxiality of all sections to non-linear or non-coaxial orientations (for example, serpentine, curved, etc.), as well as maintaining this orientation until the user changes the configuration of the rod 840 manually or using other surgical instruments, such as forceps, etc. Thus, the reconfigurable rod 840 is a “passively bending mechanism”, which means that the device actually has no hinge mechanisms designed to actively change the bending angle of individual elements of segment 840.

In various embodiments, the proximal segment 844 is connected to the variable configuration segment 840 by, for example, connecting elements or pins and serves to facilitate the rotational attachment of the variable configuration rod 840 to the handle assembly 100. In at least one embodiment, the proximal segment 844 is connected to the mounting the sleeve 60 so that it is rotationally attached to the handle assembly 100, as described above. See FIG. 57 and 59.

Also, in various embodiments, the closure tube segment 832 is movably fixed to a portion of the flexible central module 820, which allows it to selectively move around this module. See FIG. 56 and 60. As can be seen in FIG. 60, in at least one embodiment, the valve tubular segment 832 and the central module 820 are formed with opposing flanges 833 and 821, respectively, so that the valve tubular segment 832 cannot slide off the module 820 while remaining movably connected to it. In various embodiments, the flexible gate segment 848 is connected to, or forms part of, the trigger lever 114. See FIG. 57 and 59. The flexible gate segment 848 can be made, for example, of stainless steel, etc., and has a distal end 849 that extends through an elongated groove 834 in the central module 820 and is connected to the gate tube segment 832. This design facilitates the movement of the gate segment 832 in the distal direction DD and the proximal direction PD along the central module 820 using the trigger trigger 130, as described above.

As shown in FIG. 56, a surgical instrument 810 may be used with a distal workpiece 612, which has been described in detail above. In particular, the distal workhead 612 can be detachably attached to the flexible central module 820 by inserting the spikes 669 on the nut 668 into the special grooves 825 at the distal end 825 of the central module 820. See FIG. 60. The distal end 835 of the gate tubular segment 832 has a structure that allows it to be threadedly attached to the distal end 692 of the proximal gate tubular segment 690, as described above.

In at least one embodiment, the surgical instrument 810 may further include a knife extension system 639 consisting of a knife shaft 700 that extends through the proximal central segment 820 and has a proximal end portion 702; the latter interacts in a drive manner with the working transmission 190 in a working manner attached to the trigger of the knife 200, as described above. Thus, the surgeon can distally advance the blade shaft 700 by pressing the trigger trigger of the knife 200, as described above. The blade shaft 700 has a bifurcated distal end 704 including an upper shaft segment 706 and a lower shaft segment 708 in which the blade plate 642 of the distal working nozzle 612 is clamped. See FIG. 60.

To use the surgical instrument 810, the distal workpiece 612 is attached to the distal end 823 of the proximal central segment 820 by inserting the spikes 669 of the central nut 668 into their respective cradles on the proximal central segment 825. After that, the surgeon or doctor can rotate the distal workpiece 612 and screw the distal shutter tubular segment 690 to shutter tubular segment 832. The distal working nozzle 612 may include a cassette 630 with brackets, or the doctor can insert such a checkout one in the elongated channel 614 at this moment. As soon as the distal working nozzle 612 is connected to the module of the elongated closure tube 830 of the surgical instrument 810, the surgeon can shape the rod with a variable configuration 840 so that the portions of the elongated rod are coaxially aligned for insertion through openings or working channels that enter the patient’s body (for example, through a trocar or endoscope or through an incision if an open operation is performed). After that, the surgeon can reconfigure the movable segment of the stem 840 so that some of its sections are not parallel to others and orient the distal working nozzle 612 attached to them in the desired direction relative to the target tissues. As in the various embodiments described above, the jaws 613, 615 are closed by moving the trigger trigger 130 relative to the pistol grip 107 on the handle assembly 100. By clamping the target tissue between the jaws 613, 615 of the distal working nozzle, the surgeon can “shoot” with brackets 632 or form them into the fabric by pressing the stop plate 620 into the cassette with brackets 630, as described above. If the procedure does not require cutting tissue, the surgeon can then release the trigger 130 so that the thrust plate 620 can return to the open position (under the deflecting action of the spring 617) and thereby release the implantable cassette with brackets 630 from the distal working nozzle 612. The surgeon can then re-close the branches of the distal working nozzle 613, 615 and reconfigure the movable stem segment 840 so that the distal working nozzle 612 can be removed through the passage or working channel. However, if the surgeon wishes to cut the target tissue between the rows of brackets 632, he can release the knife module 640 by pressing the trigger 200 as described above so that the knife element 648 extends distally through the target tissue. As the knife element 648 moves distally through the distal working nozzle 612, it makes contact with the slide 650, which enhances the contact of the brackets 632 with the bracket-forming surface 622 of the retaining plate 620 to further form the brackets 632. After that, the surgeon can open the distal working nozzle 612 and release the cut or stitched fabrics and implantable cassette 630.

FIG. 61 and 62 illustrate another embodiment of a surgical instrument 810 ′ that is substantially identical to the instrument 810 described below, with the exception of a variable configuration rod 850 including a portion of an elongated rod 830 ′ that is operatively connected to a handle module 100 to control the distal workpiece 612. In various embodiments, the variable configuration rod segment 850 consists of a plurality of movably connected tubular links 852. Each tubular link 852 may be made, for example, of non bosom, acrylonitrile butadiene styrene (ABS), polycarbonate with or without glass or carbon filling and the like, and also has a tubular body 854. The tubular body 854 may have a spherical or spherical portion of the connection 856 formed on it through which passage 858 omits the central structural member. In addition, the tubular passage 858 extends into a hollow socket 860 formed in the tubular portion 854, which is sized to fit the spherical portion 856 of the adjacent tubular link 852. The spherical sockets 860 are dimensioned relative to the spherical protrusions 856 so that the protrusions 856 are easily inserted and are fixed in them, maintaining the desired configuration, starting from the one in which the stem segment is an almost straight line to the one in which the segment 850 can be bent (Fig. 62) or have a snake-like configuration (Fig. 61).

Although the ball segments 856 and their corresponding slots 860 are fitted to each other so that a certain frictional force arises between them, which keeps the segment 850 in the required orientation until an external force is applied to it, the embodiment shown in FIG. . 60 and 61, has a locking system 862 that reversibly holds or immobilizes the tubular links 852 together in the desired configuration. As can be seen in these figures, the locks 862 are at least one, and most often several flexible latches with protrusions or links 864 formed around the perimeter of the tubular link 852 closer to one of the ends 853. In a preferred embodiment, four such latches 864 are used. In other embodiments, latches 864 may be 1, 2, 3, or more. Each tubular link 852 also has a locking part 866 corresponding to each latch 864 located on the other end 865 of each link 852. Each such locking part 866 has a groove 868, which includes part of the corresponding latch 864 formed on the adjacent tubular link 852.

To work with a surgical instrument 810 ', a distal workpiece 612 is attached to the distal end 823 of the central module 820 as described above. The distal closure segment 690 of the distal working nozzle 612 is screwed onto the closure tubular segment 832. As soon as the distal working nozzle 612 is connected to the extension of the extended closure tube 830 of the surgical instrument 810 ', the surgeon will shape the rod with a configurable configuration 850 so that portions of the elongated stem are coaxially aligned for insertion through openings or working channels that enter the patient’s body (for example, through a trocar or endoscope or through an incision if an open procedure is performed I am). After that, the surgeon can, for example, use forceps 869 to give the desired orientation to the movable links 852 of the movable segment of the rod 850, and then click on the corresponding locking tabs 864 on each link 852, inserting them into the corresponding slots 868 to fix the links 852 in the desired orientation. See FIG. 62. As in the various embodiments described above, the jaws 613, 615 are closed by moving the trigger trigger 130 relative to the pistol grip 107 on the handle assembly 100. By clamping the target tissue between the jaws 613, 615 of the distal working nozzle, the surgeon can “shoot” with brackets 632 or to form them in the fabric by pressing the stop plate 620 into the cassette with brackets 630, as described above. If the procedure does not require cutting tissue, the surgeon can then release the trigger 130 so that the thrust plate 620 can return to the open position (under the deflecting action of the spring 617) and thereby release the implantable cassette with brackets 630 from the distal working nozzle 612. The surgeon can then re-close the jaws of the distal working nozzle 613, 615 and use forceps 869 to remove the latches 864 from the corresponding slots 868 so that the links 852 can align and the device can be removed through the passage or workers th channel. However, if the surgeon wishes to cut the target tissue between the rows of brackets 632, he can release the knife module 640 by pressing the trigger 200 as described above so that the knife element 648 extends distally through the target tissue. As the knife element 648 moves distally through the distal working nozzle 612, it makes contact with the slide 650, which enhances the contact of the brackets 632 with the bracket-forming surface 622 of the retaining plate 620 to further form the brackets 632. After that, the surgeon can open the distal working nozzle 612 and release the cut or stitched fabrics and an implantable cassette 630 with brackets.

FIG. 63-68 illustrate another embodiment of a surgical instrument 810 ″ that is substantially identical to the embodiments 810 and 810 ′ described above, with the exception of the variable stem segment 870 and the corresponding locking system 882 on the elongated stem. In various embodiments, the configurable stem segment 870 includes a plurality of tubular links 872 movably connected to one another and is connected to a proximal stem segment 871 that connects to a mounting sleeve 60 having a rotational support within the handle assembly 100, as described in detail above. Each tubular unit 872 can be made, for example, of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate with or without glass or carbon filling and the like, and also has a tubular body 874. See FIG. 67. The tubular body portion 874 may have a spherical or spherical portion of a joint 876 formed on it through which a central structural member is passed through passage 878. In addition, the tubular passage 878 extends into a hollow socket 880 formed in the tubular portion 854, which is sized to connect to the ball portion 876 of the adjacent tubular link 872. The spherical nests of at least 876 are sized relative to the ball protrusions 880 such that the protrusions 876 easily inserted and fixed into them, maintaining the desired configuration, starting from the one in which the stem segment is an almost straight line to the one in which the segment 870 can be bent (Fig. 67) and accept a curved (Fig. 68) or serpentine configuration.

Although the ball protrusions 876 and sockets 880 can be fitted in at least one embodiment so that a small frictional force arises between them, holding the tubular links 872 of the variable rod 870 in the desired orientation until they are external force will be applied, the embodiments shown in FIG. 63-68, use the locking system 882 in order to reversibly hold or immobilize the tubular links 872 in the desired configuration. As seen in FIG. 67 and 68, the locks 882 are at least one, and more often two selectively inflated locking balloons 884 that pass through the tubular links 872 in diametrically opposite directions. In various embodiments, shut-off cylinders 884 may be made, for example, of nylon film or the like. and adapted to fill them with pressurized medium from a corresponding source 886. In the embodiment shown in FIG. 64, the source of pressure medium 886 is a pump 888, the purpose of which is to supply pressure air to the shut-off cylinders 884. In particular, in at least one embodiment, the pump 888 includes a cylinder 889 with a piston 890 inside. The piston 890 is provided with an annular seal 891 or another type of seal around the perimeter and is attached to the threaded handle 892, which through the thread engages with part of the handle assembly 100. Thus, by screwing the pump handle 892 into the handle assembly 100, air can be pumped from cylinder 890 under pressure through the supply pipe 893, which leaves the cylinder 890 to the manifold 894, mounted on the central module 820. Pressure relief from the shut-off cylinders 884 can be performed by rotating the handle of the pump 894 in the opposite direction.

As seen in FIG. 65, manifold module 894 has an annular portion 895 that is sealed by annular gaskets 896 or other types of gaskets at both ends. The annular portion of the manifold 895 communicates with a supply line 897 passing through the proximal segment of the rod 871, which is connected to the discharge line to the shut-off cylinders 884. This design allows the supply of compressed air to the shut-off cylinders 884, while simultaneously facilitating the rotational movement of the central module 820 around axis A-A relative to the handle assembly 100. As used herein, the term “pressure medium” may mean, for example, air, saline, or most often glycerin. In alternative embodiments, the tubular sections may be filled with very low rigidity rubber or an elastomer. When pressure is applied to such a rubber material, it deforms, filling the voids and fixing the stem in much the same way as with a liquid.

To use the surgical instrument 810 ", the distal workpiece 612 is attached to the distal end 823 of the central module 820 ', as described above. The distal closure segment 690 of the distal working nozzle 612 is screwed onto the shutter tubular segment 832. Once the distal working nozzle 612 is attached to the elongated shaft 830 ″ of the surgical instrument 810 ″, the surgeon can shape the rod with a configurable 870 so that portions of the elongated rod 830 ″ Were coaxially aligned for insertion into the patient’s body through openings or working channels (for example, through a trocar or endoscope or through an incision if an open operation is performed). Thus, the surgeon can, for example, use forceps to give the movable segments 872 of the reconfigurable rod 870 the desired orientation. Once the rod with the reconfiguration 870 is orientated in the desired way, the surgeon can screw the pump handle 892 into the handle body 100 to apply pressure to locking cylinders 884 and locking the movable links 872 in position as shown in FIG. 68. As in the various embodiments described above, the jaws 613, 615 are closed by moving the trigger trigger 130 relative to the pistol grip 107 on the handle assembly 100. By clamping the target tissue between the jaws 613, 615 of the distal working nozzle, the surgeon can “shoot” with brackets 632 or to form them in the fabric by pressing the stop plate 620 into the cassette with brackets 630, as described above. If the procedure does not require cutting tissue, the surgeon can then release the trigger 130 so that the retaining plate 620 can return to the open position (under the deflecting action of the spring 617) and thereby release the implantable cassette with brackets 630 from the distal working nozzle 612. The surgeon can then re-close the branches of the distal working nozzle 613 and 615 and relieve pressure from the shut-off cylinders 884 by rotating the handle of the pump 892 in the opposite direction. For manipulating the movable links 872, forceps can be used with which the links are given either an almost linear coaxial configuration (see FIG. 67) or any other configuration in which the tool can be removed from the patient’s body. However, if the surgeon wishes to cut the target tissue between the rows of brackets 632, he can release the knife module 640 by pressing the trigger 200 as described above so that the knife element 648 extends distally through the target tissue. As the knife element 648 moves distally through the distal working nozzle 612, it makes contact with the slide 650, which enhances the contact of the brackets 632 with the bracket-forming surface 622 of the retaining plate 620 to further form the brackets 632. After that, the surgeon can open the distal working nozzle 612 and release the cut or stitched fabrics and an implantable cassette 630 with brackets.

The various embodiments described herein, which include a configurable stem, represent a significant improvement over standard articulated bend designs that utilize lockable hinges. Such surgical instruments are usually limited to 1 or 2 degrees of freedom in placing the distal workpiece on the incision site. Various embodiments of the present invention allow the surgeon to more diversify the position of the distal working nozzle, giving him more flexibility in using the same tool through the same inlet.

The unique and innovative properties of various surgical cassettes with brackets and surgical instruments that are the subject of this invention make it possible to arrange the brackets in these cassettes in one flat or broken line, as well as in several such rows. A plurality of such rows of brackets can be installed on both sides of an elongated slot located in the center of the cartridge through which the cutting segment passes. In one configuration, for example, the brackets in one row can be almost parallel to the brackets in the next row or rows, but have an offset relative to them. In other embodiments, one or more rows of brackets may be nonlinear. That is, the base of at least one bracket in a row can be located along an axis that is substantially transverse to the bases of other brackets in the same row. For example, as will be discussed in detail below, in alternative embodiments, rows of brackets on each side of the elongated slot may be zigzagged. Such a non-linear arrangement may become possible because the brackets do not move upward, pushing into the thrust plate. Instead, in the various embodiments described herein, the thrust plate is brought into contact with the legs of the fixed brackets. Such non-linear options for the location of the brackets can provide better bonding of fabrics using fewer brackets than in various kinds of linear options for their location, which were used in previous models of cartridges, when the brackets were actually pressed into the thrust plate.

FIG. 69 illustrates a method of using one embodiment of a surgical cassette with brackets 900 in a distal workpiece 612 'according to the present invention. The distal workpiece 612 'can be used in combination with the surgical instrument 610 in various ways, as described above. The distal working nozzle 612 'may be identical to the distal working nozzle 612, as described above, except for the differences described below. As shown in FIG. 69 and 70, in one embodiment, the surgical cassette with brackets 900 has a body 902 in which a groove 904 is made in the center, passing through the proximal end 903 to a portion adjacent to the distal end 605. The design of the elongated groove 904 allows the knife 646 to pass through it surgical instrument 610, which then axially moves and dissects the tissue, as described above. In at least one embodiment, the cassette body 902 consists of a compressible hemostatic material, such as oxidized reduced cellulose (OVC), or a biodegradable foam material made, for example, of PGA (polyglycolic acid, Vicryl trademark), PCL ( polycaprolactone), PMC or PMK-L (polymers of lactic acid), MPC (polydioxanone), PHA (polyhydroxyalkanoates), PHCL (polyglexaprone 25, Monocryl trademark) or from composite materials containing PHC, PCL, PMC or MPC on which rows 920 and 930 of unformed brackets 922 are supported. However, the cassette body 902 can also be made of other materials that support the unformed brackets 922 in the desired orientation so that they can be compressed after contact with the thrust plate 910. How and in the various other embodiments described above, the cassette 900 is implantable and remains on the stapled tissue at the end of the stapling procedure. In order to prevent exposure to the brackets 922 and to prevent the activation of the hemostatic material while refilling the cartridge into the device and positioning the device, in at least some embodiments, the entire cartridge 900 may be coated or wrapped with a biodegradable film 906, for example, a polydioxanone film sold under the trademark PDS®, or polyglycerin sebacate (PGS) film, or other biodegradable films made of PGC (polyglycolic acid, Vicryl trademark), polycaprolac it (PCL), PMA or PMK-L (polymers of lactic acid), PHA (polyhydroxyalkanoates), PHCL (polyglecaprone 25, Monocryl trademark) or from composite materials containing PHC, PCL, PMC or MPC, which remain impermeable until until a gap appears in them. The casing 902 of the cassette 900 is dimensioned to be inserted into and removed from the elongated channel 614 of the distal working nozzle 612 '.

In the embodiments shown in FIG. 69, 73 and 74, the surgical cassette with brackets 900 operatively supports the first row 920 of brackets 922 on one side 907 of the elongated groove 904 and the second row 930 of brackets 922 on the other side 909 of the elongated groove 904. In various embodiments, the brackets 922 may be made of metal for example, from titanium, titanium alloys (for example, 6AI-4V Titanium, 3al-2.5V Titanium), stainless steel, etc., and also have a bracket base 924 and two legs 926 directed upward, coming out of it. On each leg 926 there is a point for piercing fabrics 928. In the first row 920 of brackets 922, the base of the bracket 924 at least in one bracket 922 extends beyond the base of another bracket 922. In a preferred embodiment, the base 924 of each bracket 922 extends beyond the base 924 of two adjacent brackets 922, with the exception of the base 924 of the last bracket 922 at each end of the first row of brackets 920. See FIG. 73. Thus, the number of brackets 920 has an almost non-linear configuration. More precisely, when viewed from above, the first row of brackets 920 has an almost zigzag appearance.

As can be seen from FIG. 72, on the stop plate 90 there are two consecutive longitudinally arranged staple pockets 912, each of which has a substantially zigzag shape corresponding to the shape of the first row 920 of brackets 922, that is, when the stop plate 910 is in contact with the brackets 922, their legs 926 take on the shape shown in FIG. 74. Thus, the distal leg of one bracket enters the same pocket as the proximal leg of the next bracket when viewed in the longitudinal direction. This arrangement allows you to place your pockets more tightly until the situation in which the brackets begin to interact with each other, i.e. stacked on top of each other. In previous versions of the layout of the pockets between them generally maintained a distance of from 0.127 to 0.381 mm (from 0.005 to 0.015 inches). In the embodiment of the invention, the distance between the pockets is from 0 to 0.51 mm (0 to 0.02 inches) with overlapping (essentially -0.51 mm (-0.020 inches)), since one a bracket, for example, connects to the following. This scheme allows you to place 15-30% more brackets in the same area. In addition, when brackets interact, fewer parallel side rows of brackets are required. In previous embodiments, the implementation usually required three rows of brackets on each side of the incision to prevent the wound from diverging from which bleeding could begin. Rows of interacting brackets significantly reduce the likelihood of passages through which blood may protrude. Another notable advantage of the various brackets according to the invention is the increased tensile strength, i.e. in order to open such a series of brackets, you need to make a much greater effort.

Another embodiment of a staple pocket according to this invention may include a common staple pocket. In this document, the expression “common bracket-forming pocket” means that one forming pocket can form all the brackets in one row, whereas in the previous designs of the stop plates, a separate pocket was provided for each leg of each bracket.

FIG. 75 illustrates yet another embodiment of the brackets 922 ', in which the base 924' has a protruding portion 928, which provides a more dense overlap of the bases 924 '. As shown above, the cassette 900 has a second row 930 of brackets 922, which is located on the other side 909 from the elongated groove 904. The second row 930 of brackets 922 is substantially identical to the first row 920 of brackets 922. Thus, the stop plate 910 has a second common staple pocket 912, which corresponds to the second row of brackets 930 and comes into contact with them. In alternative embodiments, the second row 930 of brackets 922 may differ from the first row 920 of brackets in shape and possibly in the number of brackets.

FIG. 71 illustrates a surgical cassette with brackets 900 ', which is almost identical to the cassette with brackets 900 described above, with the exception of the rows of brackets 922' located therein 922. For example, in this embodiment, the row 920 'of brackets 922 is arranged so that the axis of the bases SS of at least one base of the bracket 924 is substantially transverse to the axis SS of the base of the bracket 924 of at least one adjacent bracket 922. This predetermined arrangement of the brackets when viewed from above looks almost zigzag. In the embodiment shown in FIG. 76, the respective bases 924 of the brackets 922 may further have a support portion 927 molded from above on the base, as shown in the figure. In various embodiments, the support portion 927 may be made of materials such as polyetherketone (PEEK) that are not degradable in the body, or plastics, such as PHC (polyglycolic acid, Vicryl brand), polydioxanone (MPC), polycaprolactone ( PCL), PMK or PMK-L (polymers of lactic acid), PHA (polyhydroxyalkanoates), PGKL (polyglecapron 25, Monocryl trademark), or from composite materials containing PGS, PDK, PMK, PGK and PKL. The supporting part of the base 927 facilitates the interaction between the brackets, while the brackets themselves do not need to overlap. Thus, in this scheme, the brackets are formed in the form of the letter “B” or inverted “W”, while the legs of the brackets themselves do not overlap. However, the crowns are joined by supporting parts, so they behave like overlapping brackets. This design allows combined pockets to have two separate passes for each leg.

The embodiment shown in FIG. 77, offers a series of brackets 920 ”, where the legs 926 of adjacent brackets 922 are connected using a connector 929 formed or otherwise put on the legs. In various embodiments, the implementation of the connecting part 929 can be made of materials such as polyetherketone (PEEK), or from degradable plastics in the body, such as PHC (polyglycolic acid, Vicryl trademark), polycaprolactone (PCL), PMC or PMK-L ( polymers of lactic acid), polydioxanone (MPC), PHA (polyhydroxyalkanoates), PGCL (polyglecapron 25, Monocryl trademark), or from composite materials containing PGS, PDK, PMK, PGK and PKL. Such a series of brackets 920 "when viewed from above looks almost zigzag. Although when describing the design of surgical cartridges with brackets 900, 900 'the description of the distal working nozzle 612' and surgical stapling tool 610 was used, it should be understood that cartridges 900, 900 'can be successfully used with various other distal working nozzles and surgical instruments described above, as well as with the corresponding designs of staple-forming pockets on the thrust plates of these instruments used for obtaining the required degree of clamping brackets formation due to the thrust plate brackets at their formation.

FIG. 78 and 79 illustrate another embodiment of a surgical cassette 940 located in an elongated channel 14 of a surgical stapling instrument 10 constituting the subject of this invention. In at least one embodiment, the surgical cassette with brackets 940 includes a cassette body 942 having a central elongated groove 944 that intersects the body at least partially. The design of the elongated groove 944 allows the knife of the surgical instrument 10 to be passed through it, which then axially moves and dissects the tissue, as described above. In various embodiments, the cassette body 942 consists of a compressible hemostatic material, such as oxidized reduced cellulose (OVC) or a biodegradable film of the types described above or below, in which rows 946, 948, 950, 952 of unformed brackets 922 are located. In order to prevent exposing the brackets 922 and preventing the activation of the hemostatic material during loading the cartridge into the device and positioning the device in at least some embodiments, the entire cartridge 940 can coated or wrapped with a biodegradable 954 film, for example a polydioxanone film sold under the PDS® trademark, or a polyglycerin sebacate (PGS) film, or other biodegradable films made of PGC (polyglycolic acid, Vicryl trademark), polycaprolactone (PCL) , ПМК or ПМК-L (polymers of lactic acid), PHA (polyhydroxyalkanoates), PGKL (polyglecaprone 25, Monocryl trademark) or from composite materials containing PGK, PKL, PMK or MPK that remain impermeable until they are impermeable not by vitsya gap.

In the embodiment shown in FIG. 78, the cassette 940 further includes a support portion 960 connected to the housing of the cassette 942. In various embodiments, the support portion of the cassette 960 may be made of rigid material such as titanium, stainless steel, aluminum or alloys of the previously mentioned materials, etc. p., and partially embedded in the cassette 942. In various embodiments, the support part of the casing 960 can be held in place, for example, by film 954. In other embodiments, in which a limited connection of the two parts with each other is desired, from time to time Cyanoacrylate can be used to “glue” the two components together. In other embodiments, the cartridge case 942 may be heated and “welded” or “soldered” to the support portion 960. In various embodiments, the support portion of the cartridge 960 forms at least a portion of the lower surface of the cartridge case 942 to align with the elongated channel 14. In a preferred In an embodiment, the support portion of the cassette 960 has one or more spikes 962 protruding from it, which allows the support portion 960 to be reversibly inserted into the elongated channel 14. Other spike-groove embodiments may also e be used to reversibly connect the support portion 960 to the elongated channel 14.

In various embodiments, the support portion of the cartridge 960 is equipped with a series of support protrusions 964, 966, 968, 970, 972, 974, 976 formed on it to provide some lateral support to the bases 924 of the brackets 922 in the rows of brackets 946, 948, 950, 952, as shown in FIG. 78. Thus, in at least some embodiments, the support projections overlap substantially with the rows of brackets. In FIG. 80 shows an alternative embodiment of a cassette 940 ', substantially identical to the cassette 940, with the exception of the upward directed ribs 978, 979, 980, 981, 982, 983 protruding from the support projections 964, 966, 968, 970, 972, 976, respectively, to provide additional lateral support to the brackets 922. In various embodiments, the ribs can be formed integrally with the supporting part of the cartridge 960 and have a height of about 1/2 the height of the cartridge or less. Thus, in preferred embodiments, for example, any means for supporting the foam does not extend beyond the maximum height of compression of the foam. Therefore, if the cassette is designed to shrink to 1/3 of the original height during installation, the ribs will protrude to a height of 66 to 10% of its height in an unpressed state.

During use, as soon as the brackets 922 are formed due to contact with the abutment plate 20, as described above, the abutment plate 20 is opened and the distal working nozzle 12 is removed with stitched fabric. When the distal working nozzle 12 is removed with stapled tissue, the cassette body 942 remains attached to the stitched tissue and thereby separates from the supporting portion 960, which remains in contact with the elongated channel 14. In various embodiments, the supporting portion of the cassette 960 is colored so as to differ in color from the material forming the housing 942, as well as from the elongated channel 14. This scheme allows the surgeon to easily determine the absence of a cassette with brackets in the distal working nozzle. Thus, the surgeon will not be able to inadvertently try to use the distal working nozzle again without first inserting a new cartridge into it. To do this, the surgeon just needs to remove the spikes of the support part 960 from the slots in the elongated channel 14 so that the support part 960 of the new cassette 940 can be placed there. Although the cassettes with brackets 940, 940 'were considered in combination with the surgical stapling tool 10, it should be understood that these cassettes can be effectively used with a variety of other surgical instruments described herein without any violation of the intent and scope of the present invention.

FIG. 81 and 82 illustrate an embodiment of a surgical instrument 10 in combination with a distal working nozzle 990, which is almost identical to the distal working nozzle 12 previously described, with the exception of the locking circuit 991, which is movably fixed or otherwise placed in the elongated channel 14. In various In embodiments, the locking circuit 991 includes a locking lever 992 having a distal end 993 and a proximal end 994. The lever 992 is movably fixed in the elongated channel using an axial part or a spike 995. The distal the drain has a leaf spring 996 or another deflecting part attached to it to deflect the shutter lever 992 in the pressed, or locking, position in which the proximal end 994 engages with the distal end 141 of the first working adapter 141, not allowing the first working clutch 140 distally move to the trigger position. However, when a cassette 30 is inserted into the elongated channel 14, this cassette 30 advances the shutter lever 992 to the idle, or open, position in which the sleeve 140 can move distally along the lever 992 to carry out the bracketing process. See FIG. 81.

In the locked position, the sleeve 140 cannot move distally and carry out the brackets installation process. In addition, the trigger trigger 130 cannot be fully pressed to the extreme working position, in which the locking bar of the knife 210 is moved to the unlocked position, allowing the surgeon to extend the cutting bar 172. Thus, in the absence of a cartridge in the distal working nozzle 990, the locking system 991 is in the locking position and prevents the extension of the cutting strip 172. This means that the surgeon will not be able to extend the cutting strip 172 for cutting tissues, if the cartridge 30 is not installed in the distal working nozzle 990. examines understood that the closure system 991, as described above, may be incorporated into many embodiments of the surgical instruments described herein without affecting the basic concept and scope of the invention.

In various embodiments, the cassette with brackets may consist of a cassette body and a plurality of brackets inside the cassette body. During use, the cassette with brackets can be inserted into the surgical field and is located on the side of the treated tissue. On the other side of the tissue, there may be a brace-forming thrust plate. In various embodiments, the thrust plate can be mounted on the first jaw, and the cassette with brackets on the second, while the first and second jaws can be moved towards each other. Once the cassette with brackets and the thrust plate have reached the desired position relative to body tissues, the brackets can be extended from the cassette body so that they pierce the tissue and come into contact with the thrust plate. After the brackets left the cassette case, the case can be removed from the surgical field. In various embodiments presented herein, a cassette with brackets, or at least a portion thereof, can be implanted with brackets. In at least one embodiment, as will be described in more detail below, the cassette with brackets may include a cassette housing that allows compression, crushing and / or elastic deformation of the thrust plate when moving the thrust plate from the open position to the closed. When compressing the cassette case, crushing it or elastic deformation, the brackets are deformed inside the case. In an alternative embodiment, the jaw containing the cartridge may move toward the abutment plate in the closing position. In any case, in various embodiments, the brackets may be deformed when they are at least partially located inside the cassette body. In some embodiments, the brackets may not be ejected from the cartridge, while in other embodiments, they may be ejected from the cartridge along part of the cartridge body.

As shown in FIG. 83A-83D, a compressible cartridge, for example a cartridge with brackets 1000, may include a compressible implantable housing 1010 and, in addition, a plurality of brackets 1020 located inside the compressible housing 1010, although in FIG. 83A-83D, only one bracket 1020 is shown. In FIG. 83A shows a cassette with brackets 1000 mounted on a support portion or located in a channel for a cassette with brackets 1030, the cassette 1000 being shown in an uncompressed position. In such an uncompressed position, the abutment plate 1040 may be in contact with tissue T or not in contact with them. In use, the abutment plate 1040 can be moved from the open position into contact with the T fabrics, as shown in FIG. 83B, thereby bringing the fabric “T” to a specific position relative to the cassette 1010. Although the thrust plate 1040 can be used to place the tissue “T” over the contact surface 1019 of the cassette 1010 (see FIG. 83B), the cassette 1010 itself this practically does not undergo compressive action or pressure at a given point, so that the brackets 1020 can remain in their original uncompressed, or inoperative, position. As shown in FIG. 83A and 83B, the cartridge case 1010 may consist of one or more layers, and the legs 1021 of the brackets 1020 may protrude upward through these layers. In various embodiments, the cassette body 1010 may consist of a first layer 1011, a second layer 1012, a third layer 1013 (the second layer 1012 being located between the first layer 1011 and the third layer 1013), and the fourth layer 1014 (the layer 1013 is between the second layer 1012 and the fourth layer 1014). In at least one embodiment, the bases 1022 of the brackets 1020 may be located in the cavities 1015 in the fourth layer 1014, and the legs of the brackets 1021 may protrude upward from the bases 1022 and pass, for example, through the fourth level 1014, third level 1013 and second level 1012. In various embodiments, each deformable leg 1021 may have a tip, such as a sharp tip 1023, which may be located in the second layer 1012 of the cartridge 1000 in an uncompressed state. In at least one embodiment, the tips 1023 may not penetrate the first layer 1011 and / or pass through it, while in other embodiments, the tips 1023 may not pass through the contact surface 1019 when the cartridge 1000 is in an uncompressed state. In some other embodiments, the sharp tips 1023 may be located at the third level 1013 and / or at any other suitable level when the cartridge is in an uncompressed state. In various alternative embodiments, the cassette body or cassette with brackets may have any desired number of layers, for example, there may be less than four or more than four.

In various embodiments, as will be described in more detail below, the first layer 1011 may consist of a plugging material and / or plastic material such as polydioxanone (MAC) and / or polyglycolic acid (PGC), and the second layer 1012 may be biodegradable films and / or compressible hemostatic material, such as oxidized and reduced cellulose (OVC). In various embodiments, one or more layers, including the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014, can hold the brackets 1020 inside the cassette 1010 and, in addition, ensure the relative position of the brackets 1020 relative to each other. In various embodiments, the third layer 1013 may be made of a plugging material or made of an incompressible or inelastic material, which may have a shape designed to hold the legs 1021 of the brackets 1020 in a certain position relative to each other. In addition, the second layer 1012 and the fourth layer 1014, located on opposite sides of the layer 1013, can stabilize or reduce the movement of the brackets 1020, even though the second layer 1012 and the fourth layer 1014 can be made of compressible foam or elastic material. In some embodiments, the ends 1023 of the legs of the brackets 1021 can be at least partially immersed in the first layer 1011. In at least one embodiment, the first layer 1011 and the third layer 1013 can be designed to jointly and firmly support the legs 1021 in desired position. In at least one embodiment, the first layer 1011 and the third layer 1013 may each consist of a biodegradable plastic sheet such as polyglycolic acid (PGA), marketed under the trademark Vicryl, polylactic acid (PMA or PMA-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGKL), known on the market under the brand name Monocryl, polycaprolactone (PKL), and / or composite PGK, PMK, PDK, PHA, PGKL and / or PKL, and the second layer is 1012 and the fourth layer 1014 each may consist of at least one hemostasis a substance or material.

Although the first layer 1011 may be compressible, the second layer 1012 may be significantly more compressible than the first layer 1011. For example, the second layer 1012 may be approximately twice, three, four, five and / or ten times more compressible than, for example, the first layer 1011. In other words, the second layer 1012 can compress approximately two, three, four, five and / or ten times stronger than the first layer 1011 under the same force. In some embodiments, the second layer 1012 may be between layers whose compressibility is about two to ten times greater than, for example, the compressibility of the first layer 1011. In at least one embodiment, the second layer 1012 may include multiple air voids, the number and / or the size of the air voids in the second layer 1012 can be adjusted to give the second layer 1012 the desired compressibility. Similar to the above, although the third layer 1013 can be compressible, the fourth layer 1014 can be significantly more compressible than the third layer 1013. For example, the fourth layer 1014 can be approximately twice, three, four, five and / or ten times more compressible, than, for example, the third layer 1013. In other words, the fourth layer 1014 can compress approximately two, three, four, five and / or ten times stronger than the third layer 1013, under the action of the same force. In some embodiments, the fourth layer 1014 may be between layers whose compressibility is about two to ten times greater than, for example, the compressibility of the third layer 1013. In at least one embodiment, the fourth layer 1014 may include a plurality of air voids, wherein and / or the size of the air voids in the fourth layer 1014 can be adjusted to give the fourth layer 1014 the desired compressibility. Under various circumstances, the compressibility of the cartridge case or the layer of the cartridge case can be expressed in terms of compression ratio, i.e. as the distance over which the layer is compressed by a given force. For example, a layer with a high degree of compression will compress over a greater distance under the action of a certain compressive force than a layer having a lower degree of compression. Thus, it can be said that the second layer 1012 may have a greater compression ratio than the first layer 1011, and the fourth layer 1014 may have a greater compression ratio than the third layer 1013. In various embodiments, the second layer 1012 and the fourth layer 1014 may consist of the same material and have the same compression ratio. In various embodiments, the second layer 1012 and the fourth layer 1014 may be made of materials with varying degrees of compression. Similarly, in various embodiments, the third layer 1013 and the first layer 1011 may consist of the same material and have the same compression ratio. In various embodiments, the first layer 1011 and the third layer 1013 may be made of materials with different compression ratios.

As the thrust plate 1040 advances toward the closed position, the thrust plate 1040 can come into contact with the “T” fabrics and apply a compressive force to the “T” fabrics and the cassette with brackets 1000, as shown in FIG. 83C. In such circumstances, the abutment plate 1040 may push the upper surface (or tissue contacting surface) 1019 of the cartridge case 1010 downward toward the support portion of the cartridge with brackets 1030. In various embodiments, the cartridge with brackets 1030 may include a support surface of the cartridge 1031, which may be designed to support the cartridge 1000 as the cartridge 1000 is compressed between the abutment surface 1031 and the surface in contact with the tissues 1041 of the abutment plate 1040. As a result, the lining provided by the abutment plate 1040, the cassette 1010 may contract and the abutment 1040 may come into contact with the brackets 1020. In particular, in various embodiments, the compression of the cassette 1010 and the downward movement of the tissue contacting surface 1019 may result in the fact that the tips 1023 of the legs of the brackets 1021 pierce the first layer 1011 of the cassette 1010, will pass through the fabric “T” and will go into the brace-forming pockets 1042 on the thrust plate 1040. As the cassette case 1010 is more and more compressed by the thrust plate nd 1040 1023 ends can enter into contact with the walls defining the position skobkoformiruyuschih pockets 1042 and, consequently, the legs 1021 can be deformed or bent inwardly as shown for example in FIG. 83C. While the legs 1021 are deformed, as shown in FIG. 83C, the bases 1022 of the brackets 1020 may remain in contact or supported by the supporting surface of the cassette 1030. In various embodiments, as will be explained in more detail below, the cassette with brackets 1030 may consist of a plurality of supporting devices, such as grooves, grooves or recesses 1032, which can be designed to support the brackets 1020 or at least their bases 1022 as the brackets 1020 themselves become deformed. In FIG. 83C also shows cavities 1015 in the fourth layer 1014, which can be wrinkled by a compressive force exerted on the cassette 1010. In addition to the cavities 1015, the cassette 1010 may also contain one or more cavities, such as the cavities 1016, which may contain part brackets or not contain it and which have a design that allows the cassette 1010 to crumple. In various embodiments, the implementation of the cavity 1015 or the void 1016 may have a design that allows them to wrinkle so that the walls defining the cavity and / or void deflect downward and touch the supporting surface of the cartridge 1031 and / or touch the layer of the cassette 1010 located under the cavities and / or voids.

If we compare the images in FIG. 83B and 83C, it will become apparent that the second layer 1012 and the fourth layer 1014 have undergone significant compression by the compressive force exerted by the thrust plate 1040. It is also noticeable that the first layer 1011 and the third layer 1013 were also compressed. As the thrust plate 1040 moves to the closed position, the thrust plate 1040 may continue to compress the cassette 1010, lowering the contact surface 1019 lower and lower toward the cassette support 1030. As the cassette 1010 is more compressed, the thrust plate 1040 may deform brackets 1020 so that they take on the final shape shown in FIG. 83D. As seen in FIG. 83D, the legs 1021 of each bracket 1020 can be folded downward toward the base 1022 of each bracket 1020 to grab at least a portion of the “T” fabric of the first layer 1011, the second layer 1012, the third layer 1013 and the fourth layer 1014 between the deformable legs 1021 and the base 1022. If we compare the images in FIG. 83C and 83D, it will become apparent that the second layer 1012 and the fourth layer 1014 have undergone significant compression by the compressive force exerted on them by the thrust plate 1040. When comparing FIG. 83C and 83D, it can also be seen that the first layer 1011 and the third layer 1013 have also undergone compression. After the brackets 1020 have been completely or at least sufficiently formed, the abutment plate 1040 can be pulled away from the fabric “T” and the support of the cassette 1030 can be pulled away and / or detached from the cassette with the brackets 1000. As shown in FIG. 83D, as a result of the above actions, the cassette 1010 can be implanted with brackets 1020. In various embodiments, the implantable cassette 1010 can support tissue along a series of brackets. In some circumstances, a hemostatic agent and / or other appropriate therapeutic drugs contained in the body of the implantable cassette 1010 may be used to act on stitched tissues for some time. A hemostatic agent, as mentioned above, can reduce bleeding of stapled and / or dissected tissues, while a tissue bonding or constricting substance can provide tissue strength over time. The implantable casing of 1010 cassette may consist of materials such as OVC (oxidized and reduced cellulose), protein matrix, polyglycolic acid (PGA), marketed under the trademark Vicryl, polylactic acid (PMC or PMK-L), polydioxanone (MPC) , polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGKL), known on the market under the brand name Monocryl, polycaprolactone (PKL) and / or composite PGK, PMK, PDK, PHA, PGKL and / or PKL. In some circumstances, the cassette body 1010 may contain an antibiotic and / or antimicrobial agent such as colloidal silver and / or triclosan, thereby reducing the likelihood of infection of the surgical field.

In various embodiments, the layers of the cassette 1010 can be connected to each other. In at least one embodiment, the second layer 1012 can be glued to the first layer 1011, the third layer 1013 can be glued to the second layer 1012, and the fourth layer 1014 can be glued to the third layer 1013 using at least one bonding agent, such as fibrin and / or protein hydrogel. In certain embodiments, although not shown in the illustrations, the layers of the cassette 1010 can be connected to each other by coupling mechanical elements. In at least one embodiment, the first layer 1011 and the second layer 1012 may have corresponding bonding elements, such as a tongue and groove, or a tongue-and-groove connection. Similarly, the second layer 1012 and the third layer 1013 may each contain the respective bonding elements, while the third layer 1013 and the fourth layer 1014 may also contain the corresponding bonding elements. In some, although not shown, embodiments, the cassette 1000 may comprise one or more rivets, for example, which may extend through one or more layers of the cassette 1010. At least in one such embodiment, each rivet may consist of a first end , or a head located close to the first layer 1011, and a second head located near the fourth layer 1014, which is either worn on or formed on the second end of the rivet. Due to the compressibility of the cartridge case 1010, at least one embodiment allows the rivet to compress the cartridge case 1010 so that the rivet heads are deepened relative to the contact surface 1019 and / or, for example, the bottom 1018 of the cartridge case 1010. In at least one of Such rivet options can consist of materials such as OVC (oxidized and reduced cellulose), protein matrix, polyglycolic acid (PGA), marketed under the trademark Vicryl, polylactic acid (PMA or PMK-L), poly dioxanone (MPC), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PHCL), known on the market under the trademark Monocryl, polycaprolactone (PCL) and / or composite PGK, PMK, MPC, PHA, PHCL and / or PCL. In some embodiments, the layers of the cassette 1010 may not be connected to each other except for those contained within the brackets 1020. In at least one embodiment, friction contact between the legs of the brackets 1021 and the cassette 1010, for example, can hold the layers of the cassette 1010 together and after the brackets are formed, the layers are caught in brackets 1020. In certain embodiments, at least a portion of the legs 1021 may have a rough surface or a rough coating that Increases the friction force between the brackets 1020 and the cassette 1010.

As described above, the surgical instrument may have a first jaw equipped with a support for the cassette 1030 and a second jaw with a support plate 1040. In various embodiments, as will be described in more detail below, the cassette with brackets 1000 may have one or more locking devices, shape which is such that they engage with the support of the cartridge 1030 and thereby reversibly hold the cartridge 1000 on the support 1030. In some embodiments, the cartridge with brackets 1000 may be glued to the support 1030 with at least one view an adhesive, for example fibrin and / or protein hydrogel. During use in at least one of the circumstances, in particular during laparoscopic and endoscopic operations, the second jaw can be brought into the closed position relative to the first, for example, so that the first and second jaws can be inserted into the surgical field through a trocar. In at least one of such embodiments, the trocar may have an internal opening or cannula with a diameter of 5 mm through which the first and second branches can be inserted. In some embodiments, the second jaw can be brought into a partially closed position intermediate with the fully open and closed position, which allows the first and second jaws to be inserted through the trocar without deforming the brackets 1020 located in the cartridge case 1010. In at least one in such an embodiment, the thrust plate 1040 may not apply compressive force to the cassette body with brackets 1010 when the second jaw is in an intermediate half-closed position, whereas in certain embodiments of the stop plate 1040 may compress the staple cartridge body 1010, when the second semi-closed jaws is in an intermediate position. Despite the fact that the thrust plate 1040 can compress the cartridge case 1010 while being in such an intermediate position, the thrust plate 1040 can compress the cartridge case with brackets 1010 with a force not sufficient for the thrust plate 1040 to come into contact with the brackets 1020, and / or so that the thrust plate 1040 can deform the brackets 1020. As soon as the first and second jaws are inserted through the trocar into the surgical field, the second jaw can be opened again, and the thrust plate 1040 and cassette 1000 can be located relative to woven fabric as described above.

In the various embodiments shown in FIG. 84A-84D, the distal working tip of the surgical stapler may have an implantable cassette 1100 located between the abutment plate 1140 and the support cassette 1130. Similarly, the abutment plate 1140 may include a contact surface 1141, the cassette 1100 may have a contact surface 1119, and the cassette support 1130 may include a support surface 1131 that may be designed to support the cassette 1100. In FIG. 84A shows how the abutment plate 1140 can be used to place tissue “T” between the contact surface 1119 of the cassette with brackets 1100 without deforming the cassette 1100 itself. When the abutment plate 1140 is in this position, its contact surface 1141 can be located at a distance of 1101a from the supporting surface of the cartridge 1131, and the contact surface 1119 may be located at a distance of 1102a from the supporting surface of the cartridge 1131. After that, as the stop plate 1140 moves in the direction of the cartridge support s with brackets 1130 (see FIG. 84B), it can push the top surface or contact surface 1119 of the cassette with brackets 1100 down and compress the first layer 1111 and the second layer 1112 of the cassette 1110. As the layers 1111 and 1112 are compressed (again see Fig. 84B), the second layer 1112 can be crushed, the legs 1121 of the brackets 1120 can pierce the first layer 1111 and enter the tissue "T". In at least one embodiment, the brackets 1120 can be at least partially located in the cavities or voids for the brackets 1115 in the second layer 1112 and, when the second layer 1112 is compressed, the cavities 1115 can be wrinkled and, as a result, allow the second layer 1112 to wrinkle around the brackets 1120. In various embodiments, the second layer 1112 may include covers 1116 that may extend over the brackets for the brackets 1115 and close or at least partially close the brackets for the brackets 1115. FIG. 84B, covers 1116 are shown that have been partially depressed into the cavity for the brackets 1115. In certain embodiments, the second layer 1112 may include one or more weakened portions that can facilitate wrinkling of the second layer 1112. In various embodiments, such weakened portions may be, for example , cuts, perforations and / or thin transverse cuts that can facilitate controlled crushing of the cassette 1110. In at least one embodiment, the first layer 1111 may include one or not how many weakened areas that can facilitate the penetration of the legs of the brackets 1121 through the first layer 1111. In various embodiments, such weakened areas can be, for example, cuts, perforations and / or thin transverse cuts that can match or substantially coincide with the legs of the brackets 1121.

When the abutment plate 1140 is in an inoperative, partially closed, position (again see FIG. 84A), the abutment plate 1140 may be spaced 1101a from the supporting surface of the cartridge 1131 so that a gap is formed between them. This gap can be filled with a cassette with brackets 1100 high 1102a and body tissue "T". As the abutment plate 1140 moves downward to compress the cartridge 1100 (again see FIG. 84B), the distance between the contact surface 1141 and the abutment surface 1131 can be defined as a distance 1101b that is shorter than the distance 1101a. In various situations, the gap between the contact surface 1141 of the abutment plate 1140 and the supporting surface of the cartridge 1131, determined by the distance 1101b, may be greater than the original height of the undeformed cartridge with brackets 1102a. As the thrust plate 1140 approaches the supporting surface of the cassette 1131 (see Fig. 84C), the second layer 1112 continues to wrinkle, and the distance between the legs of the brackets 1121 and staple-forming pockets 1142 may decrease. Similarly, the distance between the contact surface 1141 and the supporting surface of the cartridge 1131 may decrease to a distance 1101c, which in various embodiments may be greater than, equal to, or less than the height of the undeformed cartridge 1102a. As shown in FIG. 84D, the thrust plate 1140 may be brought to the final, extreme working position in which the brackets 1120 are either fully formed or at least have reached the desired height. In this position, the surface 1141 of the abutment plate 1140 in contact with the tissues may be at a distance 1101d from the supporting surface of the cartridge 1131, while the distance 1101d may be shorter than the original height of the undeformed cartridge 1102a. In FIG. 84D also shows that the cavities for the brackets 1115 may be completely or substantially wrinkled, and the brackets 1120 may be completely or substantially surrounded by a wrinkled second layer 1112. In various situations, the stop plate 1140 may then move away from the cartridge with brackets 1100. After the abutment plate 1140 comes out of contact with the cassette with brackets 1100, the cassette 1110 can at least partially expand again in various areas, for example, in the spaces between adjacent brackets 1120. In at least one embodiment, Under pressure, the crushed cassette 1110 does not experience elastic expansion again. In various embodiments, the formed brackets 1120 and, in addition to them, the cassette body 1110 located between adjacent brackets 1120, can exert a compressive effect (pressure) on the tissue “T”, which can have a useful therapeutic effect.

As discussed above and as shown in FIG. 84A, each bracket 1120 in this embodiment may have legs 1121 extending from it. Although the brackets 1120 are shown with two legs 1121, different kinds of brackets can be used that have one leg or, conversely, more than two legs (for example, three or four) . As shown in FIG. 84A, each leg of the bracket 1121 can penetrate the second layer 1112 of the cartridge case 1110 so that the brackets 1120 are held in place by the layer 1112. In various embodiments, the brackets 1120 can be inserted into the cavity for the brackets 1115 in the cartridge case 1110 so that the tips 1123 the legs of the brackets 1121 enter the cavities 1115 before the bases 1122. After the tips 1123 have entered the cavities 1115, in various embodiments, the tips 1123 can be pressed into the covers 1116, thereby dissecting the second layer 1112. In various embodiments, the brackets 1120 may be deep inside the second layer 1112 to a sufficient depth so that the brackets 1120 do not move or hardly move relative to the second layer 1112. In certain embodiments, the brackets 1120 can be immersed in the second layer 1112 to a sufficient depth so that the bases 1122 are located in the brackets 1115 or immersed inside these cavities. In various other embodiments, the implementation of the base 1122 may not be located in the second layer 1112 or immersed in it. In certain embodiments (see Fig. 84A), the bases 1122 may protrude beyond the lower surface 1118 of the cassette 1110. In some embodiments, the bases 1122 may rest on or be directly opposite to the cassette 1130. In various embodiments, the support surface of the cassette 1130 may have support devices protruding therefrom and / or devices arranged within it, and in at least one of such embodiments, the base 1122 of the brackets 1120 may be located inside it and supported by one or more support grooves , grooves or grooves 1132, for example, on the supporting surface of the cassette 1130, as described in more detail below.

In addition to the above (see Fig. 85), the bases 1122 of the brackets 1120 can be placed directly opposite the supporting surface 1131 of the support of the cassette 1130. In various embodiments, including variants in which the bases of the brackets 1122 have circular or arched lower surfaces 1124, for example, the bases of the brackets 1122 can move or slide along the supporting surface of the cassette 1131. Such sliding can occur when the stop plate 1140 is pressed against the tips 1123 of the legs of the brackets 1121 during the formation of the brackets. In some embodiments, as described above and as shown in FIG. 86, the support of the cartridge 1130 may include one or more support grooves 1132, the purpose of which is to eliminate or at least reduce the relative movement of the bases of the brackets 1122 along the support surface of the cartridge 1131. In at least one embodiment, each support groove 1132 may be described by a surface contour that fully or substantially coincides with the contour of the bottom surface of the bracket mounted inside it. For example, the lower surface 1124 of the base 1122 shown in FIG. 86 may be round or very close to round, and the support groove 1132 also has a circle shape or a shape very close to it. In at least one of these embodiments, the surface forming the groove 1132 may be determined by or equal to the radius of curvature greater than or equal to the radius of curvature forming the bottom surface 1124. Although the grooves 1132 can help prevent or reduce relative slippage between the brackets 1120 and the support of the cassette with brackets 1130, the grooves 1132 can also be used to prevent or reduce rotational movement between the brackets 1120 and the support of the cartridge 1130. In particular, in at least one embodiment, the grooves 1132 can be made so that the bases 1122 fit tightly into them, thereby preventing or significantly reducing the rotational movement of the brackets 1120 around the axes 1129, due to which the brackets 1120 are not in aschayutsya not deviate from its position during deformation.

In various embodiments (in addition to the foregoing), each bracket 1120 may be made of round or substantially round wire. In some embodiments, the legs and bases of each bracket can be formed from a wire of non-circular cross section, for example, this section can be rectangular. In at least one embodiment, the support of the cassette 1130 may include corresponding non-circular slots, for example rectangular, designed to set the base of these brackets. In various embodiments (see FIG. 87), each bracket 1120 may have a crown, for example a crown 1125 formed on the base 1122, with each crown 1125 being located in a support groove on the support of the cassette 1130. In at least one embodiment, each the crown 1125 may have a square and / or rectangular cross section designed to fit into the slot of a square and / or rectangular section, for example, into a groove 1134 made in the support of the cassette 1130. In various embodiments, the crown 1125 may be made of biol a biodegradable plastic such as polyglycolic acid (PGA), marketed under the brand name Vicryl, polylactic acid (PMA or PMA-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PHCL), known on the market under trademark Monocryl, polycaprolactone (PCL), and / or from composite materials PGK, PMK, PDK, PHA, PGKL and / or PKL and is formed around the bases 1122 of brackets 1120, for example, by injection molding. Various crown patterns and methods for creating them are set forth and described in US Patent Application Serial Number 11/541 123, entitled “SURGICAL BRACKETS WITH COMPLETABLE OR CRUSHED PARTS FOR FIXING INSIDE THEIR FABRICS, WRONG FIXED HAVING COMPRESSIBLE OR CRUSHABLE MEMBERS FOR SECURING TISSUE THEREIN AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME), filed September 29, 2006, the entire contents of which are incorporated herein by reference. See FIG. 87, which shows that the groove 1134 may have additional guide or chamfered edges 1135 designed to facilitate placement of the crowns 1125 in the grooves 1134. In various embodiments, the base and / or crowns of the brackets 1120 may be located within the grooves 1134 when the cartridge 1100 is connected to the support of the cassette 1130. In various embodiments, the crowns 1125 of the brackets 1120 may be flush with the grooves 1134 when the cartridge 1100 is connected to the support of the cassette 1130. At least in one embodiment, the crowns 1125 may not be included in PS 1134 up until 1121 to the legs of the brackets will not be applied and the pressing force bases and / or crowns brackets in 1120 will not be forcibly pushed into the grooves 1134.

In various embodiments, as shown in FIG. 88 and 89, a cassette with brackets, for example a cassette with brackets 1200, may include a compressible implantable housing 1210 consisting of an outer layer 1211 and an inner layer 1212. Like the cassettes described above, the cassette 1200 may include a plurality of brackets 1220 located inside the housing 1210. B in various embodiments, each bracket 1220 may consist of a base 1222 and one or more legs 1221 emerging from it. In at least one embodiment, the legs of the brackets 1221 can be inserted into the inner layer 1212 and immersed to such a depth that the bases 1222 of the brackets 1220 abut and / or are located opposite the lower surface 1218 of the inner layer 1212. In the embodiments shown in FIG. 88 and 89, the inner layer 1212 does not have cavities for the brackets designed to accommodate part of the brackets 1220, while in other embodiments, the inner layer 1212 may have such cavities for the brackets. In addition to the above, in various embodiments, the inner layer 1212 may consist of a compressible material, such as a biodegradable film and / or oxidized reduced cellulose (OVC), the construction of which allows the housing 1210 to crumple when subjected to a compressive load. In various embodiments, the implementation of the inner layer 1212 may consist of a lyophilized foam, consisting, for example, of polylactic acid (PMA) and / or polyglycolic acid (PGA). OVC is sold under the trade name Surgicel and may take the form of sparse weave (like surgical tampons), loose fibers (cotton balls) and / or foam. In at least one embodiment, the inner layer 1212 may consist of a material including medications, such as frozen dried thrombin and / or fibrin, which are located inside the layer or applied as a coating and can, for example, be activated by exposure to water and / or body fluids. In at least one such embodiment, dry frozen thrombin and / or fibrin can be applied, for example, to a matrix of Vicryl material (PGA). Under certain circumstances, however, activated medications may be inadvertently activated when a cassette with brackets 1200 is delivered to the surgical site. In the various embodiments shown in FIG. 88 and 89, the outer layer 1211 may consist of a waterproof or almost impermeable to water material through which liquids cannot penetrate or at least practically cannot fall onto the inner layer 1212 until the cassette 1210 is compressed, the legs of the brackets will not pass through the outer layer 1211, and / or the outer layer 1211 will not be cut in one way or another. In various embodiments, the outer layer 1211 may consist of a plugging material and / or plastic, such as polydioxanone (MPC) and / or polyglycolic acid (PGA). In some embodiments, the outer layer 1211 may include a wrapper surrounding the inner layer 1212 and the brackets 1220. More specifically, in at least one embodiment, the brackets 1220 can be immersed in the inner layer 1212 and the outer layer 1211 can be wrapped around the supporting structure formed by the inner layer 1212 and the brackets 1220, and then sealed.

In various embodiments, as shown in FIG. 90 and 91, the cassette with brackets, for example 1300, may include a compressible implantable casing 1310, consisting of an outer layer 1311 and an inner layer 1312. Like the device described above, the cassette with brackets 1300 may also contain brackets 1320 located inside the cassette 1310, each bracket 1320 may consist of a base 1322 and one or more legs of the legs 1321 extending from it. Like a cassette with brackets 1200, the bases 1322 of the brackets 1320 may extend beyond the lower surface 1318 of the inner layer 1312, and the outer layer 1311 may circle the base 1322. In at least one embodiment, the outer layer 1311 may be sufficiently flexible to wrap the base of each bracket 1322 so that the outer layer 1311 follows the outline of the bases 1322. In at least one alternative implementation (see Fig. 89) the outer layer 1211 can be stiff enough to wrap around each of the bases 1222 without repeating their shape. In any case, in various embodiments, the outer layer 1311 may be located between the bases 1322 of the brackets 1320 and the supporting surface of the cassette with brackets, for example the supporting surfaces 1031 or 1131, on which the cassette with brackets 1300 rests. At least in one embodiment, the outer layer 1311 may be located between the bases 1322 and supporting grooves, such as 1032 or 1132, made in the supporting surface of the cartridge. In addition to the foregoing, in at least one embodiment, in addition to the aforementioned, the outer layer 1311 may be designed to restrict the movement of the bases 1322 and / or increase the coefficient of friction between the bases 1322 and the supporting surface of the cartridge and / or supporting grooves to reduce their displacement relative to each other. In various alternative embodiments shown in FIG. 92 and 93, the outer layer of the cassette with brackets, such as cassette 1400, may not completely surround the inside brackets. In at least one such embodiment, the outer layer 1411 of the compressible implantable cassette 1410 can be attached to the inner layer 1412 before the legs 1421 of the brackets 1420 are inserted into the cassette 1410. As a result of the above, the bases 1422 of the brackets 1420 can protrude the outer layer 1411 and in at least one of such embodiments, the bases 1422 can be located directly in the supporting grooves 1032 or 1132, made, for example, in the supporting surfaces of the cassette 1031 or 1131. In various embodiments suschestvleniya brackets legs 1421 can incise the outer layer 1411 as they pass therethrough. In various situations, the holes made by the legs of the brackets 1421 can tightly surround the legs of the brackets 1421, completely or almost completely preventing any liquid from flowing between the legs 1421 and the outer layer 1411, which prevents or greatly reduces the possibility of leakage and / or premature activation of medications in the case of the cartridge 1410.

As discussed above and as shown in FIG. 88 and 89, the legs 1221 of the brackets 1220 may be located inside the cassette 1210 and the bases 1222 of the brackets 1220 may protrude outward from the bottom surface 1218 of the inner layer 1212. In addition to the above, in various embodiments, the inner layer 1212 may not have cavities for the brackets intended for accommodating brackets 1220 therein. In various other embodiments shown in FIG. 94 and 95, the cassette with brackets, for example cassette 1500, may have a compressible implantable housing 1510, in which cavities for brackets 1515 are made, the design of which allows placing at least part of the bracket 1520 inside. In at least one embodiment, the upper part of the legs 1521 the brackets 1520 can be immersed in the inner layer 1512, while the lower part of the legs 1521 and the bases 1522 can be located inside the cavities for the brackets 1515. In some embodiments, the bases 1522 can be completely placed inside the cavities 1515, then as in some other embodiments, the bases 1522 may at least partially protrude above the bottom surface 1518 of the inner layer 1512. Similar to the foregoing, the outer layer 1511 may surround the inner layer 1512 and the inside brackets 1520. In some other embodiments of FIG. 96, the cassette 1600 may include brackets 1620 located inside cavities 1615 in a compressible implantable casing of the cartridge 1610, with at least a portion of the brackets 1620 not inside the outer layer 1611. In at least one embodiment, each bracket 1620 may include legs 1621 which are at least partially located inside the inner layer 1612, and, in addition, the base 1622, which protrude outward around the outer layer 1611.

In the various embodiments shown in FIG. 97 and 98, a cassette with brackets, such as a cassette 1700, may have a compressible implantable cassette body 1710 and a plurality of brackets 1720 that are at least partially located inside the casing 1710. The cassette body 1710 may consist of an outer layer 1711, an inner layer 1712, and in addition to them from the alignment matrix 1740, which may have a design that allows you to align and / or hold the brackets 1720 in a certain position inside the cassette 1710. In at least one embodiment, the inner layer 1712 may have a recess 1741, p designed to house the alignment matrix 1740. In various embodiments, the alignment matrix 1140 can be pressed into the recess 1741 and / or otherwise suitable for this is fixed in the inner layer 1712, for example, using at least one bonding agent such as fibrin and / or protein hydrogel. In at least one embodiment, the recess 1741 may be such that the lower surface 1742 of the alignment matrix 1740 is in a position that is substantially or substantially coaxial with the lower surface 1718 of the inner layer 1712. In some embodiments, the lower surface 1742 of the alignment matrix may be recessed relative to the lower surface 1718 of the second layer 1712 and / or protrude from it. In various embodiments, each bracket 1720 may have a base 1722 and one or more legs 1721 protruding from the base 1722, with at least a portion of the legs of the bracket 1721 extending through the alignment matrix 1740. The alignment matrix 1740 may further include multiple holes and / or grooves through which the legs of the brackets 1721 pass. At least in one embodiment, each hole may have a configuration that allows the leg 1721 to fit snugly into it, thereby providing almost the floor a complete lack of mutual movement between the leg 1721 bracket and the walls of the hole. In some embodiments, the holes of the alignment matrix may not pass through the entire matrix 1740, so the legs of the brackets 1721 will need to pierce or cut through the matrix 1740 as these legs 1721 go through it.

In various embodiments, the alignment matrix 1740 may consist of a molded plastic housing, which in at least one embodiment may be more rigid or less compressible than the inner layer 1712 and / or the outer layer 1711. In at least one such embodiment matrix 1740 may consist of plastic material and / or other other suitable material, such as polydioxanone (MPC) and / or polyglycolic acid (PGA). In some embodiments, the alignment matrix 1740 may be connected to the inner layer 1712 and the legs of the brackets 1721 may then pass through the alignment matrix 1740 and enter the inner layer 1712. In various embodiments, the bottom surface 1742 of the alignment matrix 1740 may have one or more grooves, grooves or grooves, the configuration of which is such that they can at least partially accommodate the base 1722 of the brackets 1720. Similar to the above, the outer layer 1711 can be wrapped around the auxiliary structure a cell consisting of an inner layer 1712, a leveling matrix 1740 and brackets 1720. On the contrary, the outer layer 1711 can be placed around an auxiliary structure consisting of an inner layer 1712 and a leveling matrix 1740, while the brackets 1720 can then be inserted through the outer layer 1711, the alignment matrix 1740 and the inner layer 1712. In any case, as a result of the foregoing, the inner layer 1712, the alignment matrix 1740 and / or the outer layer 1711 can be configured to hold the brackets 1720 in the same dix as long as they will not be deformed by the thrust plate, as described above. In at least one such embodiment, the alignment matrix 1740 can serve to hold the brackets 1720 in place before the cassette with brackets 1700 is implanted into the patient, and, in addition, it holds the tissue in place along a series of brackets after the cassette 1700 will be implanted. In at least one embodiment, the brackets 1720 can be locked in place by the alignment matrix 1740 without being inserted into the inner layer 1712 and / or the outer layer 1711.

In the various embodiments shown in FIG. 99-105, a cassette with brackets, for example 1800, can be assembled by compressing the inner layer 1812, installing brackets, for example brackets 1820, in the inner layer 1812 and wrapping the outer layer 1811 around the inner layer 1812. Looking first at FIG. 99, it can be seen that the compressible layer 1812 is shown as containing a plurality of cavities for the brackets 1815 formed therein, although other embodiments are provided in which the inner layer 1812 does not contain the cavities described above. Now referring to FIG. 100, it can be seen that the compressible layer 1812 can be positioned between the transfer plate 1850 and the support plate 1860 and that it is compressed between the respective compression surfaces 1852 and 1862. As shown in FIG. 100, the upper and lower surfaces of the inner layer 1812 may contract toward each other, in response to this, the inner layer 1812 will protrude laterally. In some embodiments, the inner layer 1812 may be compressed to a height of approximately one third of its original height. For example, the height or thickness thereof in a compressed state may range from about 1.52 mm (0.06 inches) to about 2.03 mm (0.08 inches). In FIG. 100, it is also shown that the transfer plate 1850 may furthermore comprise a plurality of brackets, such as brackets 1820 arranged in a plurality of brackets 1853. In addition, the transfer plate 1850 may also comprise a plurality of guides 1851, the structure of which is designed to push the brackets 1820 up and out of the sockets 1853. As can be seen in FIG. 101, guides 1851 can be used to push the legs 1821 of the brackets 1820 into and through the compressed inner layer 1812. In various embodiments, the guides 1851 may be designed such that their upper surfaces are flush or substantially flush with the compression surface 1852 of the transfer plate 1850 when the brackets 1820 are completely removed from the slots 1853 of the plate 1850. In some embodiments, as also shown in FIG. 101, the support plate 1860 may include a plurality of receiving holes 1861, which may be designed to receive the legs of the brackets 1821 or at least the ends of the legs 1821 as they are pushed through the inner layer 1812. The receiving holes 1861 or the like may be needed in those embodiments in which the inner layer 1812 has been compressed to a lower height than the height of the brackets 1820. Thus, when the brackets 1820 are completely ejected from the sockets 1853, the legs 1821 may protrude outward from the upper surface of the brackets the outer layer 1812. In certain other embodiments, the inner layer 1812 may be compressed to a height which is greater than the height of the brackets 1820, whereby there is no need to equip the support plate 1860 receiving holes 1861.

After the brackets 1820 have been inserted into the inner layer 1812 (see FIG. 102), the support plate 1860 can be retracted from the transfer plate 1850 so that the inner layer 1812 can recover in size. In such a situation, the inner layer 1812 may experience elastic expansion to the original or practically to the original height of the uncompressed layer. As the layer 1812 undergoes repeated expansion, the height of the inner layer 1812 may increase so that it exceeds the height of the brackets 1820, and the legs 1821 of the brackets 1820 will no longer protrude from the upper surface of the inner layer 1812. In various embodiments, the receiving holes 1861 may have a shape that allows them to hold the legs of the brackets 1821 in the same position until the base plate 1860 is sufficiently moved away and the legs 1821 will no longer be inside the receiving holes 1861. Under such circumstances ax receiving holes 1861 can help maintain the relative relative position of the brackets 1820 within the inner layer 1812 as it undergoes repeated expansion. Under various circumstances, the inner layer 1812 and the brackets 1820 located therein may constitute an auxiliary structure 1801, which, as shown in FIG. 103 can be inserted into the outer layer 1811. In at least one embodiment, the outer layer 1811 may include an inner cavity 1802, the shape of which allows the auxiliary structure 1801 to be inserted into it. Under various circumstances, using an instrument, such as pliers 1855, you can pull the outer layer 1811 to the auxiliary structure 1801. Once the auxiliary structure 1801 is satisfactorily placed inside the outer layer 1811 (as shown in FIG. 104), the outer layer 1811 can be sealed Vat. In various embodiments, the outer layer 1811 may be sealed by thermal exposure to a specific portion of the shell. In particular, in at least one embodiment, the outer layer 1811 can be made of plastic material, the open end of the outer layer 1811 can be sealed by heating with one or more heating elements, or “irons” 1856, to fasten and / or seal the perimeter the open end of the outer layer 1811. In at least one embodiment, as shown in FIG. 105, excess 1857 of the outer layer 1811 can be removed, after which the cassette with brackets 1800 can be used as described above.

As described above, the cartridge with brackets may be located inside the nozzle for the cartridge and / or fixed inside it. In various other embodiments shown in FIG. 106 and 107, the cartridge nozzle may have a channel for the cartridge with brackets, for example channel 1930, which may be configured to accommodate a portion of the cartridge with brackets, such as cartridge 1900. In at least one embodiment, the channel of the cartridge with brackets 1930 may have a bottom surface 1931, a first side support wall 1940 and a second side support wall 1941. During use, the cassette with brackets 1900 can be located inside the channel 1930 so that the cassette 1900 is opposite and / or adjacent to the lower the pore surface 1931 and is located between the first side support wall 1940 and the second side support wall 1941. In certain embodiments, the first side support wall 1940 and the second side support wall 1941 may have a lateral gap between them. In at least one such embodiment, the cassette with brackets 1900 may have a lateral width 1903 that reaches and / or exceeds the lateral gap formed by the support walls 1940 and 1941 so that the housing of the compressible implantable cassette 1910 of the cassette 1900 can be securely placed between the walls 1940 and 1941. In some other embodiments, the lateral width 1903 of the cartridge 1900 may be shorter than the gap between the first and second walls 1940 and 1941. In various embodiments, at least a portion of the walls 1940 and 1941 and the lower support the surface 1931 may be formed by a stamped metal channel, and in at least one embodiment, at least a portion of the side support wall 1940 and / or the side support wall 1941 may be made of an elastic material, such as an elastomeric material. As shown primarily in FIG. 106, the first side 1940 and the second side 1941 of the cassette channel with brackets 1930 may consist of a rigid portion 1933 protruding upward from a lower abutment surface 1931, and a flexible portion 1934 that protrudes upward from a rigid portion 1933.

In various embodiments (in addition to the above), the cartridge case 1910 of the cartridge with brackets 1900 may consist of one or more compressible layers, for example, the first layer 1911 and the second layer 1912. When the cartridge case 1910 is compressed by a stop plate in the direction of the lower supporting surface 1931, as described above, the side portions of the cassette 1910 may protrude laterally. In embodiments in which the cassette 1930 has rigid side walls, lateral expansion of the cassette 1910 can be prevented or at least limited by the hard side walls, resulting in significant internal pressure or stress developing within the casing 1910. In those embodiments in which at least part of the cassette 1930 has flexible side walls, these flexible sides are designed so that they can deflect laterally, thereby reducing the internal pressure or stress created inside the cassette body 1910. In those embodiments where the cassette channel does not have side walls or has side walls that are much shorter than the cassette itself, the side walls of the cassette body can protrude laterally or almost unhindered. In any case, as shown in FIG. 107, the cassette with brackets 2030 may have side walls 2040 and 2041, which may consist entirely of a flexible material, such as an elastomeric material. The channel of the cassette 2030, in addition, may have side grooves 2033 extending along the sides of the lower supporting surface 2031 of the channel for the cartridge 2030, which can be designed so that the side walls 2040 and 2041 are included in them and fixed there at least partially. In certain embodiments, the side walls 2040 and 2041 may be snapped or pressed into grooves 2033, while at least in some embodiments, the sides 2040 and 2041 may be secured to grooves 2033 with one or more bonding agents. In at least one embodiment, the side walls 2040 and 2041 may be removed from the lower abutment surface 2031 during use. In any case, the compressible implantable cartridge case 2010 may be removed and / or separated from the side walls 2040 and 2041 when the cartridge case 2010 is implanted together with brackets 2020.

In various embodiments (see FIG. 108), the surgical instrument may have a rod 2150 and a distal working nozzle that extends from the distal end of the rod 2150. A distal working nozzle similar to the above may include a cassette channel with brackets 2130, a thrust plate 2140, which moves from the open position to the closed, as well as the cassette with brackets 2100, which is located between the channel of the cassette with brackets 2130 and the thrust plate 2140. Like the above, the cassette with brackets 2100 can have a compressible implantable housing 2110 and a plurality of brackets 2120 located in the cassette 2110. In various embodiments, the channel of the cassette with brackets 2130 may include, firstly, a lower supporting surface 2131, which is in contact with the cassette with brackets 2100, and secondly, the distal end 2135 and thirdly, the proximal end 2136. In at least one embodiment (see FIG. 108), the cassette with brackets 2100 may have a first end 2105 that can be positioned at the distal end 2135 of the cassette channel with brackets 2130, as well as a second end 2106 that can be disassembled lay down in the proximal end of the staple channel 2136 2130. Cassette In various embodiments, the distal end of the cartridge channel 2135 with brackets 2130 may have at least one distal locking element, for example a retaining wall 2137; similarly, the proximal end 2136 may have at least one proximal retaining element, for example a retaining wall 2138. In at least one such embodiment, the distance between the distal retaining wall 2137 and the proximal retaining wall 2138 may be equal to or less than the length of the cassette with brackets 2100 . Thus, the cassette with brackets 2100 can be reliably fixed when it is placed in the channel 2130 of the cassette with brackets 2100.

In various embodiments (see Figs. 88 and 89), the cassette with brackets, for example the cassette with brackets 1200, may have a flat (or substantially flat) tissue-facing surface 1219. In at least one such embodiment, the cassette body 1210 with the brackets 1200 may include a first end 1205 having a first height (thickness) 1207, as well as a second end 1206 having a second height (thickness) 1208, while the first height 1207 may be equal to (or practically equal to) the second height 1208. In certain embodiments the implementation of the cassette 1210 can it may have a constant (or substantially constant) height (thickness) between the first end 1205 and the second end 1206. In at least one such embodiment, the tissue-facing surface 1219 may be parallel (or substantially parallel) to the lower surface 1218 of the cassette 1210. B various embodiments (see FIG. 108), the first end 2105 of the cassette body 2110 with brackets 2100 may have a first height 2107 that is different from the second height 2108 of the second end 2106. In the embodiment shown, the first height 2107 is greater narrower than the second height 2108, and in alternative embodiments, the second height 2108 may be larger than the first height 2107. In various embodiments, the height of the cassette 2110 may decrease linearly or geometrically between the first end 2105 and the second end 2106. At least in one such embodiment, the tissue-facing surface 2119 located between the first end 2105 and the second end 2106 can be oriented between them at a certain angle. In at least one such embodiment, the tissue-facing surface 2119 may not be parallel to the bottom surface 2118 of the cassette 2110 and / or parallel to the supporting surface 2131 of the cassette channel with brackets 2130.

In various embodiments (see FIGS. 108 and 109), the abutment plate 2140 may include a tissue-facing surface 2141 that may be parallel (or substantially parallel) to the support surface 2131 of the cassette channel with brackets 2130 when the abutment plate 2140 is in closed position as shown in FIG. 109. When the stop plate 2140 is in the closed position, it can compress the first end 2105 of the cassette with brackets 2100 to a greater extent than the second end 2106. This is because the first end 2105 may be higher than the shorter second end 2106. In some circumstances, including when the “T” fabric located between the fabric faces 2119 and 2141 has the same (or almost the same) thickness, the pressure created by the “T” fabric and cassette 2100 may be higher at the distal end distal working nozzle by comparison with its proximal end. In particular, when the fabric “T” between the stop plate 2140 and the cassette with brackets 2100 is almost the same thickness, the section of fabric “T” located between the distal end 2145 of the stop plate 2140 and the first end 2105 of the cassette with brackets 2100 may be more compressed, than the portion of tissue "T" located between the proximal end 2146 of the abutment plate 2140 and the second end 2106 of the cassette with brackets 2100. In various embodiments, inside the tissue "T" between the proximal and distal ends of the distal working nozzle can be created Pressure gradients. In particular, in at least one embodiment, when the tissue “T” between the abutment plate 2140 and the cassette with brackets 2100 has practically the same thickness, and the height of the cassette with brackets 2100 decreases linearly from the distal end to the proximal, the pressure inside the tissue “T” can linearly increase from the distal end of the distal working nozzle to its proximal end. Similarly, in at least one embodiment, when the tissue “T” between the abutment plate 2140 and the cassette with brackets 2100 is almost the same thickness and the height of the cassette with brackets 2100 decreases geometrically from the distal end to the proximal, the pressure inside the tissue “T” can grow geometrically from the distal end of the distal working nozzle to its proximal end.

In various embodiments (see FIG. 108), different portions of the “T” fabric located between the cassette with brackets 2100 and the abutment plate 2140 may have different thicknesses. In at least one such situation, the tissue portion “T” located between the proximal end 2146 of the retainer plate 2140 and the second end 2106 of the cassette with brackets 2100 may be thicker than the tissue portion “T” located between the distal end 2145 of the retainer plate 2140 and the first end 2105 cassettes with brackets 2100. Under similar circumstances, it is advisable to place a thicker tissue section “T” above the shorter proximal end 2106 of the cassette with brackets 2100, and a thinner tissue section “T” should be placed above a higher distal end 2105. When using the product, the working sleeve 2152 of the rod 2150 can be displaced distally along the central module 2151 and come into contact with the cam part 2143 of the stop plate 2140 so that the stop plate 2140 rotates in the direction of the cassette with brackets 2100, as shown in FIG. 109. After the abutment plate 2140 is rotated to the fully closed position, the tissue “T” can be squeezed between the surfaces 2119 and 2141 facing the fabric. Despite the fact that the height of the cassette with brackets 2100 may not be the same between the proximal and distal ends of the distal working nozzles, the pressure (compressive force) exerted on the fabric "T" will be the same or almost the same throughout the distal working nozzle. In particular, a thinner section of fabric "T" may be associated with a higher portion of the cassette with brackets 2100, and a thicker section of fabric "T" may be associated with a lower portion of the cartridge with brackets 2100. Total (total) fabric height "T "And the cassettes with brackets 2100 can be the same or almost the same between the proximal and distal ends of the distal working nozzle, as a result, the pressure exerted by the thrust plate 2140 to the above cumulative height can be the same (or almost the same) throughout Pulling the distal working tip.

In various embodiments (see FIGS. 108 and 109), the cassette with brackets 2100 may have an asymmetric configuration. In at least one such embodiment, the height of the cartridge with brackets 2100 at the level of the first end 2105, for example, may be greater than the height of the cartridge with brackets 2100 at the level of the second end 2106. In certain embodiments, the cartridge with brackets 2100 and / or channel cassettes with brackets 2130 may include one or more alignment and (or) locking elements that ensure that the cassettes with brackets 2100 are placed in the channel of the cassette 2130 in a single correct orientation, i.e. the orientation at which the first end 2105 is located at the distal end 2135 of the channel 2130, and the second end 2106 is located at the proximal end 2136 of the channel. In various alternative embodiments, the cassette with brackets 2100 and / or the channel of the cassette with brackets 2130 may include one or more alignment and (or) locking elements that arrange the cassette with brackets 2100 in the channel of the cassette 2130 with different orientations. For example (see FIG. 110), a cassette with brackets 2100 can be placed inside the channel of the cassette 2130 so that the first end 2105 of the cassette with brackets 2100 is located at the proximal end 2136 of the channel of the cassette 2130, and the second end 2106 is located at the distal end of the 2135 channel cassettes. As a result, in various embodiments, the lower end of the cassette with brackets 2100 can be placed closer to the distal retaining wall 2137, and its higher end 2100 can be placed closer to the proximal retaining wall 2138. In at least one such embodiment, the cassette with brackets 2100 can suitably placed so that it exerts the same (or almost the same) compressive force on a thicker section of tissue “T” in the distal section of the distal workpiece and on a thinner section of tissue no "T" in the proximal part of the distal working tip. In various embodiments, the cassette with brackets 2100 can be selectively oriented within the channel of the cassette 2130. In at least one such embodiment, the alignment and / or locking elements of the cassette with brackets 2100 can be symmetrical, so that the surgeon can selectively orient the cassette with brackets 2100 inside channel cassette 2130 using the orientation options shown as an example in FIG. 108 and 110.

In addition to the above, the body of the implantable cassette 2110 may include a longitudinal axis 2109 that can expand between the proximal and distal portions of the distal working nozzle if the cassette with brackets 2100 is placed in the channel of the cassette 2130. In various embodiments, the thickness of the cassette 2110 may decrease and ( or) increase along the longitudinal axis 2109 between the first end 2105 and the second end 2106. In at least one such embodiment, the distance (height) between the lower surface 2118 and the ar The tissue-adhered surface 2119 may decrease and / or increase in the direction from the first end 2105 to the second end 2106. In certain embodiments, the thickness of the cassette 2110 may increase and decrease along the longitudinal axis 2109. In at least one such embodiment, the housing cassettes 2110 may include one or more parts that have a greater or lesser thickness. In various embodiments (see FIG. Z), a cassette with brackets 2100 may include a plurality of brackets 2120 located within it. During use of the product (see above), the brackets 2120 can be deformed when the thrust plate 2140 is moved to the closed position. In certain embodiments, each bracket 2120 may have the same (or substantially the same) height. For example, in at least one such embodiment, the height of the bracket is the distance from the bottom of the base of the bracket to the top (tip) of its longest leg.

In various embodiments, the brackets in the cassette may have different heights. In at least one such embodiment, the cassette with brackets may include a first group of brackets that have a first height and are located in the first part of the compressible cassette body, as well as a second group of brackets that have a second height and are located in the second part of the compressible cassette body. In at least one embodiment, the first height of the brackets may be greater than the second height, the first group of brackets may be located at the first end 2105 of the cassette with brackets 2100, and the second group at the second end 2106. According to an alternative embodiment, a higher group of brackets may be located at the second end 2106 of the cassette with brackets 2100, and the lower second group of brackets at the first end 2105. In certain embodiments, many groups of brackets can be used, with each group having different heights. In at least one such embodiment, a third group having an average height may be located in the cassette 2110 housing between the first and second groups of brackets. In various embodiments, each bracket in a row of cassettes may have a different height. In at least one embodiment, the highest bracket in the row can be located at the first end of the row, and the lowest at the opposite end of the row. In at least one such embodiment, the brackets located between the highest and lowest brackets may have a gradually decreasing height (for example, the height of the brackets may decrease from the highest to the lowest).

In various embodiments (see FIG. 111), the distal working tip of the surgical stapler may include a thrust plate 2240, a cassette channel with brackets 2230, and a cassette with brackets 2200 supported by said channel 2230. The cassette with brackets 2200 may include a compressible an implantable cartridge case 2210 and a plurality of brackets, such as 2220a and 2220b, which are located in the housing. In various embodiments, the cassette channel with brackets 2230 may include a surface 2231 supporting the cassette, as well as a plurality of supporting grooves for the brackets, for example supporting grooves 2232a and 2232b, which are formed on this surface. In at least one such embodiment, the cassette with brackets 2200 may include two outer rows of brackets 2220a and two inner rows of brackets 2220b, while the supporting grooves 2232a may support the brackets 2220a, and the supporting grooves 2232b may include brackets 2220b. In accordance with FIG. 111 and 112, the stop plate 2240 may include a plurality of bracket-shaped recesses (pockets) 2242 formed in the plate so as to accept and deform the brackets 2220a and 2220b while moving the stop plate 2240 toward the cassette with brackets 2200. In at least one such embodiment the lower surfaces of the supporting grooves 2232a may be at a first distance 2201a from the upper surfaces of the brace pockets 2242, while the lower surfaces of the supporting grooves 2232b may be in a second standing 2201b from the upper surfaces of the bracket pockets 2242. In at least one such embodiment, the support grooves 2232b are located closer to the abutment plate 2240. This is because the supporting surface 2231 in which these grooves are made has an elevation. Due to differences in distance 2201a and 2201b in different embodiments, the outer rows of brackets 2220a and the inner rows of brackets 2220 may take different heights when deformed. Under various circumstances, brackets with deformation that accept different heights may exert different forces on the stitched fabric “T”. In addition to the above, the brackets may have different heights in an undeformed state. In at least one such embodiment (see FIG. 111), the initial (undeformed) height of the outer brackets 2220a is greater than the initial (undeformed) height of the inner brackets 2220b. As shown in FIG. 111 and 112, the inner brackets 2220b, whose undeformed height is lower than that of the outer brackets 2220a, can also have a deformed height lower than that of the outer brackets 2220a. In various alternative embodiments, the inner brackets 2220b may have an undeformed height higher than that of the outer brackets 2220a, and their deformed height may be lower than that of the outer brackets 2220a.

In various embodiments (in addition to the foregoing), the thrust plate 2240 may be brought into the closed position, as shown in FIG. 112 to compress the cartridge case 2210 and deform the brackets 2220a and 2220b. In certain embodiments, a surgical stapler comprising the distal workpiece of FIG. 111 and 112 may also include a cutting segment for dissecting tissue “T” located between the thrust plate 2240 and the cassette with brackets 2200. In at least one such embodiment, the thrust plate 2240, the cassette channel with brackets 2230 and (or) the cassette with brackets 2200 may have a groove (groove) that slidably receives the cutting segment. In particular, the thrust plate 2240 may have a portion with a groove 2249, the cassette channel with brackets 2230 may have a portion with a groove 2239, the cartridge with brackets 2200 may have a portion with a groove 2203; these areas can be combined (or practically combined) with each other when the thrust plate 2240 is in the closed or almost closed position. In various embodiments, the cutting segment can be moved from the proximal portion of the distal working nozzle to the distal portion of the distal working nozzle after the thrust plate 2240 has been closed and the brackets 2220a and 2220b have been deformed. In at least one embodiment, the cutting segment can move independently of the deformation process of the brackets. In certain embodiments, the cutting segment can be moved simultaneously with the deformation of the brackets. In any case, in at least one embodiment, the cutting segment can be used to dissect the tissue along the line laid between the inner rows of brackets 2220b.

In various embodiments (see FIG. 112), the inner brackets 2220b in a deformed state may have a height less than the outer brackets 2220a, while the inner brackets 2220b may exert a greater pressing force on the fabric adjacent to the cut line created by the cutting segment. In at least one such embodiment, the increased clamping force generated by the inner brackets 2220b can provide various therapeutic benefits, such as reducing bleeding from the dissected tissue “T”, while the reduced clamping force created by the outer brackets 2220a can improve the elasticity of the stitched fabric. In various embodiments (see FIGS. 111 and 112), at least one portion of the plugging material, such as 2260, may be attached to the thrust plate 2240. In at least one such embodiment, the legs of the brackets 2220a and 2220b may cut the plugging material 2260 and (or) pass through the holes in the plugging material 2260 when the cassette with brackets 2200 is compressed by the stop plate 2240 and comes into contact with the brace pockets 2242 in the stop plate 2240. As the legs of the brackets 2220a and 2220b deform, the legs may vtorno come into contact, and (or) the cut bridging material 2260. In various embodiments, the bridging material 2260 may improve hemostasis and (or) to provide adequate strength tissue suturing staples.

In various embodiments (see Figs. 111 and 112), the lower surface of the cassette 2210 may include a step contour that matches (or almost completely matches) the stepped contour of the cassette supporting surface 2231. In certain embodiments, the lower surface of the cassette 2210 may be deformed , aligning (or almost completely aligning) with the contour of the supporting surface 2231 of the cartridge. In various embodiments (see FIG. 113), a distal working nozzle similar to that shown in FIG. 111 may include a cassette with brackets 2300 housed therein. A cassette with brackets 2300 may include a compressible implantable housing 2310 that has an inner layer 2312 and an outer layer 2311, while the outer layer 2311 may include waterproof material in at least one embodiment. In various embodiments, the outer layer 2311 may expand around the brackets 2220a and 2220b and extend between the brackets 2220a and 2220b and the supporting grooves 2232a and 2232b, respectively. In various embodiments (see FIG. 114), a distal working nozzle similar to that shown in FIG. 111 may include a cassette with brackets 2400 located inside it. Like a cassette with brackets 2300, a compressible, implantable casing 2410 of a cassette 2400 may include an inner layer 2412 and an outer layer 2411, however, in at least one embodiment, the cassette 2410 may not have a groove for the cutting segment. In at least one such embodiment, a cutting segment may be required to dissect the inner layer 2412 and / or the outer layer 2411 as it moves through the cassette with brackets.

In various embodiments (see FIG. 115), the distal working nozzle of the surgical stapler may include an abutment plate 2540, a cassette channel with brackets 2530, and a cassette with brackets 2500 located in said cassette channel 2530. Like the above, the cassette with brackets 2500 may include a compressible implantable cartridge case 2510, the outer rows of brackets 2220a and the inner rows of brackets 2220b. The cassette channel with brackets 2530 may include a flat (or substantially flat) support surface 2531, in which support grooves 2532 are made. The thrust plate 2540 may include a stepped surface 2541 and a plurality of brace-forming pockets formed therein, for example 2542a and 2542b. Similar to the above, the distance between the brace pockets 2542a and the support grooves 2532 may be greater than the distance between the brace pockets 2452b and the support grooves 2532. In various embodiments, the stop plate 2540 may also include a portion of the plugging material 2560 attached to the stepped surface 2541 of the stop plate 2540. In at least one such embodiment, the plugging material 2560 may be aligned (or almost fully aligned) with the step over 2541. In various embodiments, the plugging material 2560 may be removably attached to the surface 2541 by at least one bonding agent, such as fibrin and / or protein hydrogel. In certain embodiments, the cassette housing 2510 may also include a stepped profile that in at least one embodiment is parallel (or substantially parallel) to the stepped surface 2541 of the thrust plate 2540. In particular, in at least one embodiment, the thrust plate 2540 may include steps 2548 protruding from the cassette with brackets 2500, while the height of the steps 2548 may be equal to (or practically equal to) the height of the steps 2508 protruding from the cassette 2510. As a result, at least one such embodiment, the amount of compressible cassette case 2510 captured by the first brackets 2220a, may differ from the number of compressible cassette housing 2510, the second gripping bracket 2220b.

In various embodiments (see FIG. 116), the distal working nozzle may include a thrust plate 2640, a cassette channel with brackets 2530, and a cassette with brackets 2600 located between them. The cassette with brackets 2600 may include a compressible implantable casing of the cassette 2610, which contains the inner layer 2612, the outer layer 2611 and many brackets, for example 2220a and 2200b. In various embodiments, the thrust plate 2640 may include a plurality of bracketing recesses 2642 in the surface 2641, and the cassette channel with brackets 2530 may include a plurality of bracketing grooves 2532 formed in the supporting surface 2531. As shown in FIG. 116, the abutment plate 2641 may be parallel (or substantially parallel) to the supporting surface of the cartridge 2531, with each bracket-forming pocket 2642 being equally spaced (or substantially equal) from the opposite corresponding supporting groove 2532. In various embodiments, the cartridge with brackets 2600 may include brackets with the same (or almost the same) initial (undeformed) height, as well as the same (or almost the same) deformed height. In some other embodiments, the outer rows may include brackets 2220a and the inner rows may include brackets 2220b, while (as described above) the brackets 2220a and 2220b may have different undeformed heights. When the stop plate 2640 moves toward the cassette with the brackets 2600 to the closed position, the brackets 2220a and 2220b can be deformed so that they have the same (or substantially the same) deformed height. In at least one such embodiment, the deformed outer brackets 2220a and inner brackets 2220b may have the same (or substantially the same) amount of compressible cassette body 2610, however, because the outer brackets 2220a have a greater height in undeformed state than internal brackets 2220b, and while they can have the same height in a deformed state, external brackets 2220a can create a greater clamping force than internal brackets 2220b.

In various embodiments (see FIG. 117), the distal working tip of the surgical stapler may include a thrust plate 2740, a cassette channel with brackets 2530, and a cassette with brackets 2700 located inside said channel 2530. Like the above, the cassette with brackets 2700 may include a compressible implantable cassette body 2710 that includes an inner layer 2712, an outer layer 2711, and a plurality of brackets, for example 2220a and 2220b. In at least one embodiment, the thickness of the cassette body 2710 may vary over its width. In at least one such embodiment, the cassette body 2710 may include a central part 2708 and side parts 2709, the central part 2708 may be thicker than the side parts 2709. In various embodiments, the thickest portion of the cassette body 2710 may be located in its central parts 2708, and the thinnest sections of the cassette body 2710 in its side parts 2709. In at least one such embodiment, the thickness of the cassette body 2710 may gradually decrease between the central part 2708 and more malleable parts 2709. In certain embodiments, the thickness of the cassette 2710 may linearly and / or geometrically decrease between the central part 2708 and the side parts 2709. In at least one such embodiment, the tissue-facing surface 2719 of the cassette 2710 may include two inclined ( angular) surfaces that have a downward slope from the central part 2708 to the side parts 2709. In various embodiments, the thrust plate 2740 may include two inclined (angled) surfaces which e are not parallel (or nearly parallel) to the inclined surfaces facing the fabric 2719. In at least one embodiment, the abutment plate 2740 may also include at least one portion of the plugging material 2760 attached to the inclined surfaces of the abutment plate 2740.

In various embodiments, the inner rows in the cassette with brackets 2700 may comprise higher brackets 2220a and the outer rows lower brackets 2220b. In at least one embodiment, the higher brackets 2220a may be located inside and / or near the thickest part 2708, and the brackets 2220b may be located inside and / or near the side parts 2709. As a result, in at least one such embodiment, more high brackets 2220a can capture more material from the implantable cassette body 2710 than lower brackets 2220b. Such circumstances can lead to the fact that the brackets 2220a will exert a greater clamping force on the fabric "T" than the brackets 2220b. In certain embodiments, although the high brackets 2220a can capture a larger volume of cassette body material 2710 than the low brackets 2220b, the high brackets 2220a can have a greater deformed height than the low brackets 2220b (this is due to the inclined design of the brace pockets 2742a and 2742b ) These features can be taken into account to achieve the required clamping force in the fabric captured by the brackets 2220a and 2220b, for example, the clamping force of the brackets 2220a may be greater than, equal to or less than the clamping force of the brackets 2220b. In various alternative embodiments of the distal working nozzle of FIG. 117, the short brackets 2220b can be placed inside and / or near the thickest central part 2708 of the cartridge case 2710, and the high brackets 2220a can be placed inside and / or near the lowest side parts 2709. In addition, although the cassette shown in the figure with brackets 2700 has external and internal rows of brackets; a cassette with brackets 2700, it can also have additional rows of brackets, for example rows located in the middle between the inner and outer rows. In at least one such embodiment, the middle rows may include brackets whose undeformed height value can be between the undeformed height values of the brackets 2220a and 2220b, and the deformed height value can be between the deformed height values of the brackets 2220a and 2220b.

In various embodiments (see FIG. 118), the distal working tip of the surgical stapler may include an abutment plate 2840, a cassette channel with brackets 2530, and a cassette with brackets 2800 that is located inside the channel 2530. Like the above, the cassette with brackets 2800 may include a compressible implantable cassette body 2810 that includes an inner layer 2812, an outer layer 2811, and a plurality of brackets, such as 2220a and 2220b. In at least one embodiment, the thickness of the cassette body 2810 may vary over its width. In at least one such embodiment, the cassette body 2810 may include a central portion 2808 and side portions 2809, while the central portion 2808 may have a thickness less than that of the side portions 2809. In various embodiments, the thinnest portion of the cassette body 2810 may be located in the central part 2808, and the thickest portion of the cassette body 2810 in the side parts 2809. In at least one such embodiment, the thickness of the cassette 2810 may gradually increase between the central part 2808 and side portions 2809. In certain embodiments, the thickness of the cassette body 2810 may increase linearly and / or geometrically between the central part 2808 and the side parts 2809. In at least one such embodiment, the tissue-facing surface 2819 of the cassette 2810 may include two inclined (angular) surfaces that have an upward slope from the central portion 2808 to the side portions 2809. In various embodiments, the abutment plate 2840 may include two inclined (angled) surfaces those that are parallel (or nearly parallel) to the inclined surfaces 2819 facing the fabric. In at least one embodiment, the abutment plate 2840 may also include at least one portion of the plugging material 2860 attached to the inclined surfaces of the abutment plate 2840. In various embodiments (in addition to the above), the outer rows in the cassette with brackets 2800 may contain more high brackets 2220a and inner rows lower brackets 2220b. In at least one embodiment, the higher brackets 2220a may be located inside and / or near the thickest sides 2809, and the brackets 2220b may be located inside and / or near the central part 2808. As a result, in at least one such embodiment higher brackets 2220a can capture more material from the implantable cassette body 2810 than lower brackets 2220b.

As described above (see the embodiment of FIG. 111), the cassette channel with brackets 2230 may have a stepped support surface 2231 that is designed to support brackets 2220a and 2220b with different heights relative to the thrust plate 2240. In various embodiments, the cassette channel with the brackets 2230 can be made of metal, and the steps of the supporting surface 2231 can be formed in this surface 2231, for example, by grinding. In various embodiments (see FIG. 119), the distal working tip of the surgical instrument may include a cassette channel with brackets 2930, within which a support sleeve 2935 is located. In particular, in at least one embodiment, the cassette channel with brackets 2930 may have a flat ( or a substantially flat) supporting surface 2931, which is intended to support the insert 2935 having stepped surfaces for brackets 2220a and 2220b of different heights (from a cassette with brackets 2200). In at least one such embodiment, the liner 2935 may have a flat (or substantially flat) lower surface that is placed on the supporting surface 2931. The liner 2935 may also have supporting grooves (grooves) 2932a and 2932b that are designed to support brackets of different heights 2220a and 2220b, respectively. Similar to the above, the insert 2935 may have a groove for the knife 2939, which is designed to receive the cutting segment. In various embodiments, the cassette channel with brackets 2930 may be made of the same material as the support liner 2935 (or of another material). In at least one embodiment, the cassette channel with brackets 2930 and the supporting liner 2935 can both be made of metal, and in other embodiments, for example, the cassette channel with brackets 2930 can be made of metal, and the supporting liner 2935 of plastic. In various embodiments, the support liner 2935 may be secured and / or welded to the cassette channel with brackets 2930. In certain embodiments, the support liner 2935 may be secured (latched or pressed in) to the cassette channel with brackets 2930. In at least one embodiment the implementation of the supporting liner 2935 can be attached to the channel of the cassette with brackets 2930 using a bonding agent.

In various embodiments (see FIG. 120), the distal working tip of the surgical stapler may include a thrust plate 3040, a cassette channel with brackets 3030, and a compressible implantable cassette with brackets 3000 located in said channel 3030. Like the above, the thrust plate 3040 may include a plurality of brace-forming pockets 3042 made therein, as well as a groove for a knife 3049, which can slidably receive the cutting segment. Similar to the above, the cassette channel with brackets 3030 may include a plurality of support grooves 3032 and a groove for the knife 3039, which is capable of slidingly accepting the cutting segment. In various embodiments, the cassette with brackets 3000 may include a first layer 3011, a second layer 3012, and a plurality of brackets, for example 3020a and 3020b. In at least one embodiment, the brackets 3020a may have an undeformed height higher than that of the brackets 3020b. In various embodiments, the first layer 3011 may consist of a first compressible material and the second layer 3012 of a second compressible material. In certain embodiments, the first compressible material may have a compression ratio higher than that of the second compressible material, while in some other embodiments, the first compressible material may have a compression ratio lower than that of the second compressible material. In at least one embodiment, the first compressible layer may consist of an elastic material with a coefficient of flexibility higher than that of the elastic material of the second compressible layer. In various embodiments, the elastic coefficient of the first compressible material may be higher than the elastic coefficient of the second compressible material. In some other embodiments, the elastic coefficient of the first compressible material may be lower than the elastic coefficient of the second compressible material. In various embodiments, the first compressible layer may have a first stiffness and the second compressible layer a second stiffness, with the first stiffness being different from the second. In various embodiments, the first compressible layer may have a stiffness higher than that of the second compressible layer. In some other embodiments, the first compressible layer may have a stiffness lower than that of the second compressible layer.

In various embodiments (see FIG. 120), the second cassette layer 3012 with brackets 3000 may have the same or substantially the same thickness over the entire width of the cassette. In at least one embodiment, the thickness of the first layer 3011 may vary over the width of the cartridge. In at least one such embodiment, the first layer 3011 can have one or more steps 3008 that can increase the thickness of the cassette 3010 in certain parts, for example, in the central part. As shown in FIG. 120, lower brackets 3020b can be positioned on steps 3008 (associated with steps), that is, on thicker parts of cassette case 3010, and higher brackets 3020a can be positioned on thinner parts of cassette case 3010. In various embodiments, due to differences in the thickness of the cassette case 3010, the stiffness of the case 3010 can be higher along the inner rows of brackets 3020b than along the outer rows of brackets 3020a. In various embodiments, the first layer 3011 may be connected to the second layer 3012. In at least one similar embodiment, the first layer 3011 and the second layer 3012 may include bonding elements that bond layers 3011 and 3012. In certain embodiments, the first layer 3011 may include the first plate, and the second layer 3012 may include a second plate, while the first plate can be bonded to the second plate using one or more adhesives. In various embodiments, the cassette with brackets 3000 may include a knife groove 3003, which is capable of slidingly accepting the cutting segment.

In various embodiments (see FIG. 121), the cassette with brackets 3100 may include a compressible implantable cassette casing 3110, which contains one layer of compressible material and further a plurality of brackets, such as brackets 3020b. In at least one embodiment, the thickness of the cassette 3110 may vary over the width of the cassette. In at least one such embodiment, the cassette body 3110 may have steps 3108 protruding along its side portions. In various embodiments (see FIG. 122), the cassette with brackets 3200 may include a compressible implantable casing of the cassette 3210, which contains one layer of compressible material and additionally many brackets, such as brackets 3020b. In at least one embodiment, the thickness of the cassette 3210 can vary over the width of the cassette. In at least one such embodiment, the cassette housing 3210 may have steps 3208 protruding along its central portion. In various embodiments (see FIG. 123), the cassette with brackets 3300 may include a compressible implantable cassette 3310, and, like the above, the thickness of the cassette 3310 may vary over its width. In at least one embodiment, the thickness of the cartridge case 3310 may increase geometrically between the side portions and the central part of the cartridge case 3310. In at least one such embodiment, the thickness of the cartridge case 3310 may be determined by an arcuate (curved) profile, the housing may have an arcuate (curved) ), the surface 3319 facing the fabric. In certain embodiments, the thickness of the cassette 3310 and the outline of the surface 3319 facing the fabric may be determined by one or several kimi bending radii. In various embodiments (see FIG. 124), the cassette with brackets 3400 may include a compressible implantable cassette body 3410, while the thickness of the cassette body 3410 may increase linearly (or almost linearly) between the side portions and the middle part of the housing 3410.

In various embodiments (see FIG. 125), a cassette with brackets 3500 may include a compressible implantable casing of the cassette 3510, as well as many brackets 3520 placed inside it. The implantable cartridge case 3510 may include a first inner layer 3512, a second inner layer 3513 and an outer layer 3511. In at least one embodiment, the first inner layer 3512 may have a first thickness and the second inner layer 3513 may have a second thickness, with the second inner layer 3513 may be thicker than the first inner layer 3512. In at least one alternative embodiment, the first inner layer 3512 may be thicker than the second inner layer 3513. In another alternative embodiment, p the first inner layer 3512 may have the same (or substantially the same) thickness with the second inner layer 3513. In certain embodiments, each bracket 3520 may include a base 3522 and one or more deformable legs 3521 extending from the base 3522. In various embodiments, each leg 3521 may include a tip 3523 that is embedded in the first inner layer 3511, and each base 3522 of the brackets 3520 can be embedded in the second inner layer 3512. In at least one embodiment, the first inner layer 351 2 and / or the second inner layer 3513 may contain the drug, and in various embodiments, the outer layer 3511 may hermetically cover the first inner layer 3512 and the second inner layer 3513, preventing leakage of the drug from the cassette body with brackets 3510 before piercing the outer layer 3511 with brackets 3520. In addition to the above, the abutment plate can be pressed down in the direction of the fabric located on the fabric facing surface 3519 of the cassette with brackets 3500, so that the housing Sset 3510 shrinks, surface 3519 moves below (or almost lower) the ends of the brackets 3523, and the ends of the brackets 3523 violate the integrity of the outer layer (pierce it) 3511. After piercing the outer layer 3511 with the legs of the brackets 3521, at least one drug “M” can leak from the cassette case 3510 around the legs of the brackets 3521. Under various circumstances, additional compression of the cassette case 3510 can lead to additional extrusion of the drug “M” from the cassette case 3510, as shown in FIG. 126.

In various embodiments (see FIG. 125), the outer layer 3511 may include a waterproof (or substantially waterproof) coating that is designed to prevent premature leakage of the drug from the cassette with brackets 3500, as well as to prevent fluid from entering the surgical field into the cassette with brackets 3500. In certain embodiments, the first inner layer 3512 may comprise a first drug (be impregnated with it), and the second inner layer 3513 may contain a second drug GUT, wherein the second drug may be different from the first. In at least one embodiment, the initial compression of the cassette body 3510, resulting in a violation of the integrity of the outer layer 3511, as a rule, can lead to the release of the first drug from the first inner layer 3512, and subsequent compression of the cassette 3510 can usually lead to the release of the second drug from the second inner layer 3513. In such embodiments, portions of the first and second drugs can be released simultaneously, however, most th drug is released at an initial compression body, and a large portion of the second drug - during a subsequent compression of the housing. In certain embodiments, like the above, the first inner layer 3512 may contain more compressible material than the second inner layer 3513, and the initial clamping force, which is less than the subsequent clamping force, can cause the first inner layer 3512 to have a larger initial deflection than in the second inner layer 3513. An increased initial deflection in the first inner layer 3512 can lead to an increase in the release of the first drug from the first inner layer 3512 (compared to second medicament in the second inner layer 3513). In at least one embodiment, the first inner layer 3512 may be more porous and / or more flexible than the second inner layer 3513. In at least one similar embodiment, the first inner layer 3512 and the second inner layer 3513 may have multiple pores 3508 and 3509, respectively, in various embodiments, the pores 3508 can be used to store the first drug in the first inner layer 3512, and the pores 3509 can be used to store the second drug in the second inner layer 3513. definiteness embodiments may be selected pore size and density of 3508 in the first inner layer 3512 and then 3509 in the second inner layer 3513 to achieve the desired result, as described herein.

In various embodiments (see Figs. 125 and 126), the outer layer 3511, the first inner layer 3512, and / or the second inner layer 3513 may consist of bioabsorbable material. In at least one embodiment, the first inner layer 3512 may be made of a first bioabsorbable material, the second inner layer 3513 may be made of a second bioabsorbable material, and the outer layer 3511 of a third bioabsorbable material, the first, second, and / or the third bioabsorbable materials may be different materials. In certain embodiments, the first bioabsorbable material may have a first bioabsorption rate, the second bioabsorbable material may have a second bioabsorption rate, and the third bioabsorbable material a third bioabsorption rate, wherein the first, second and (or) third bioabsorption rate may be different. In at least one such embodiment, when the material is bioabsorbed at a certain rate, this rate can be determined by the volume of material that is absorbed by the patient’s body per unit time. As you know, the organisms of different patients can absorb various materials at different speeds; taking into account this variability, the bioabsorption rate is expressed in average values. In any case, a higher speed indicates a larger volume of material absorbable per unit time. In various embodiments (see Figs. 125 and 126), the first inner layer 3512 and / or the second inner layer 3513 may be made of material that dissolves faster than the material of the outer layer 3511. In at least one such embodiment, the first the inner layer 3512 and / or the second inner layer 3513 may consist of a bioabsorbable foam, a sealing and (or) hemostatic material, for example, oxidized reduced cellulose (OVC), and the outer layer 3511 may consist of a plugging material and (or) plastics, for example polyglycolic acid (PGA) (trade name - Vicryl), polylactic acid (PMC or PMK-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PHCL) (trade name - Monocryl), polycaprolactone ( PKL) and (or) mixtures of PGK, PMK, PDK, PHA, PGKL and (or) PKL. In such embodiments, the first inner layer 3512 and / or the second inner layer 3513 can have an immediate therapeutic effect on the tissue, for example, reduce bleeding from the tissue, while the outer layer 3514 can provide long-term structural support and is capable of bioabsorption at a lower rate.

Due to the lower bioabsorption rate, the outer layer 3511 can support or structurally strengthen the tissue with brackets during its healing. In certain embodiments, one of the inner layers (the first inner layer 3512 or the second inner layer 3513) may consist of a material that is bioabsorbed faster than the other inner layer; in at least one embodiment, one of the layers may provide initial release of the therapeutic material, and the other layer may provide a sustained release of the same and / or different therapeutic material. In at least one such embodiment, the rate at which therapeutic material can be released from layer 3512 or 3513 may be determined by the bioabsorbability function of the substrate in which the drug is distributed. For example, in at least one embodiment, the substrate that makes up the first inner layer 3512 can undergo bioabsorption (bioabsorption) faster than the substrate that makes up the second inner layer 3513, as a result, the drug can be released faster from the first inner layer 3512 than from the second inner layer 3513. In various embodiments, as described herein, one or more layers 3511, 3512 and 3513 of the cassette housing 3510 can be bonded to each other using one sludge and several bonding agents, for example fibrin and / or protein hydrogel. In certain embodiments, the adhesive may be water soluble and facilitate separation of the layers during implantation of the cassette with brackets 3500 or some time after implantation. In at least one such embodiment, the adhesive may bioabsorb faster than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

In various embodiments (see FIGS. 127 and 128), the cassette with brackets, for example the cassette with brackets 3600, may include a cassette 3610 that includes a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, as well as a removable compressible a layer 3613 attached to the second layer 3612. In at least one such embodiment, the first layer 3611 may consist of compressible foam material, the second layer 3612 may consist of a layered material attached to the first layer 3611 using one or several FIR gluing substances, the third layer 3613 can be composed of a compressible foam material, which is removably attached to the second layer 3612 using one or more of gluing substances. In various embodiments, the cassette with brackets 3600 may also include many brackets, such as brackets 3620, located in the cassette 3610. In at least one similar embodiment, each bracket 3620 may have a base 3622 located in the third layer 3613, as well as one or more deformable legs 3621 extending from the base 3622 upward through the second layer 3612 and entering the first layer 3611. During use of the product (in addition to the above), the upper surface 3619 of the cassette body with brackets 3610 may be remeschena down via the swashplate such that the legs of staples 3621 penetrate an upper surface 3619 and the target tissue and engage the backing plate. After the legs of the brackets 3621 are successfully deformed, the thrust plate can be removed from the cassette with brackets 3600; in this case, the compressible layers can at least partially expand. Under various circumstances, the introduction of brackets into the tissue leads to bleeding from the tissue. In at least one embodiment, the third layer 3613 may consist of an absorbent material, for example a protein hydrogel, which is capable of absorbing blood from stitched tissue. In addition to the above (or as a substitute), the third layer 3613 may consist of hemostatic and (or) sealing material, for example lyophilized thrombin and (or) fibrin, which can be used to reduce bleeding from the tissue. In certain embodiments, the third layer 3613 may provide structural support for the first layer 3611 and the second layer 3612, wherein the third layer 3613 may consist of bioabsorbable and / or non-bioabsorbable materials. In any case, in various embodiments, the third layer 3613 may be disconnected from the second layer 3612 after implantation of the cassette with brackets 3610. In embodiments where the third layer 3613 consists of material suitable for implantation, the surgeon may leave the third layer 3613 of the cassette 3610 or delete it. In at least one embodiment, the third layer 3613 may be entirely removed from the second layer 3612.

In various embodiments, the first layer 3611 may consist of a first foam material, and the third layer 3613 may consist of a second foam material, which may be different from the first foam material. In at least one embodiment, the first foam material may have a first density and the second foam material a second density, wherein the first density may differ from the second density. In at least one such embodiment, the second density may be higher than the first density, resulting in the third layer 3613 may be less compressible (have a lower compression rate) than the first layer 3611. In at least one alternative embodiment, the first density may be higher than the second density, as a result, the first layer 3611 may be less compressible (have a lower compression rate) than the third layer 3613. In various embodiments (see Figs. 129 and 130), a cassette with brackets 3700, similar to a cassette with staples kami 3600 may include a cartridge case 3710 that includes a first compressible foam layer 3711, a second layer 3712 attached to the first layer 3711, and a removable third compressible foam layer 3713 that is removably attached to the second layer 3712. In at least one such In an embodiment, the third layer 3713 may include a plurality of bracket receiving slots (slots) 3709, each of which may receive at least a portion of the bracket 3620, for example, the base of the bracket 3622. In certain embodiments, the brackets 3620 may slide in staple-receiving grooves 3709 or, in other words, the third layer 3713 can slide relative to the brackets 3620 when the cassette with brackets 3700 is located opposite the target fabric and is compressed by the stop plate. In at least one embodiment, the receiving grooves 3709 may have a gap between the brackets 3620 and the side walls 3709. In at least one such embodiment, as a result of the foregoing, the brackets 3620 may not capture part of the third layer 3713 during the deformation of the brackets 3620, as shown in FIG. 129 and 130. In some other embodiments, the ends of the bracket slots 3709 located near the second layer 3712 may be covered by part of the third layer 3713, resulting in at least a portion of the third layer 3713 being gripped by brackets 3620 during their deformation. In any case, the third layer 3713 may include one or more perforated holes and / or notches 3708, which can be used to facilitate the removal of the third layer 3713 from the second layer 3712 with one or more pieces, as shown in FIG. 129. In FIG. 129 shows the removal of one of the parts of the third layer 3713 using a tool 3755. In various embodiments, perforation 3708 can be made along a line located between the first and second rows of brackets.

In various embodiments (see FIGS. 129 and 130), bases 3622 of brackets 3620 may be located in receiving grooves 3709; however, in at least one embodiment, the side walls of the receiving grooves 3709 can contact the legs of the brackets 3621 and loosely hold them in place. In certain embodiments (not shown), the third layer 3713 may include an elongated groove that surrounds all the brackets in the row of brackets. In at least one such embodiment, the cassette with brackets comprising four rows of brackets may have an elongated groove associated with each row of brackets in the bottom layer of the cassette. In addition to the above, at least a portion of the cartridge with brackets 3600 and / or a cartridge with brackets 3700 can be implanted inside the patient’s body, and a portion of the cartridge with brackets can be removed from the patient’s body. In at least one embodiment (see Figs. 129 and 130), the first layer 3711 and the second layer 3712 can be grasped with brackets 3620 and implanted with them, the third layer 3713 can be separated from the cassette 3700 with brackets 3620. Under various circumstances, removing a portion of the implanted cassette with brackets can reduce the amount of material that should be absorbed by the patient, which can provide various therapeutic benefits. In the case of separation and removal of the cassette part with brackets, for example, using a laparoscopic instrument 3755, the detachable part of the cassette can be removed from the surgical field using a trocar, for example a trocar with an opening with a diameter of 5 mm. In certain embodiments, the cartridge case may include one or more removable layers. For example, the cassette housing 3710 may include a fourth layer, the third layer 3713 of the cassette 3710 may consist of hemostatic material, and the fourth layer of supporting material. In at least one such embodiment, the surgeon may remove the support layer and, if necessary, the hemostatic layer.

In various embodiments (see FIG. 131), the cassette with brackets, for example the cassette with brackets 3800, may include a cassette body 3810 comprising an outer layer 3811 and an inner layer 3812. The inner layer 3812 may consist of compressible foam material and the outer layer 3811 may at least partially be wrapped around the inner layer 3812. In at least one embodiment, the outer layer 3811 may include a first portion 3811a located on the first side of the inner layer 3812, as well as a second portion 3811b located on the first side of the inner layer 3812, wherein the first part 3811a and the second part 3811b can be connected by a flexible loop, for example, loop 3809. In at least one such embodiment, at least one bonding agent, for example fibrin and / or protein hydrogel, can be applied to the first side and (or) the second side of the inner layer 3812 to attach parts of the outer layer 3811 to it. In various embodiments, the outer layer 3811 may include one or more fasteners that protrude from it. In at least one such embodiment, the outer layer 3811 may include a plurality of deformable legs 3821 protruding from one side of the outer layer 3811 that can be placed in the compressible inner layer 3812. In at least one such embodiment, the legs 3821 may not protrude the second side of the inner layer 3812, in one alternative embodiment, the legs 3821 can at least partially protrude from the inner layer 3812. In the process of compressing the compressible housing of the cassette 3810 (when using elium) the legs 3821 can pierce the inner layer 3812 and the second part 3811b of the outer layer 3811. In certain embodiments, the second part 3811b of the outer layer 3811 may include holes, for example holes 3808, that can receive the legs of brackets 3821. In certain embodiments, at least part the cassettes with brackets 3800 may have a groove for knife 3803, which can slidely receive the cutting segment. In at least one such embodiment, the knife groove 3803 may not extend through the entire thickness of the cassette 3810. As a result, the cutting segment may notch the cassette 3810 during movement relative to the casing.

In various embodiments (see FIG. 132), a cassette with brackets 3900 may include (like a cassette with brackets 3800) a cassette case 3910 that includes an inner layer 3812 and an outer layer 3811, while the outer layer 3811 may include a first portion 3811a located near the first side of the inner layer 3812, as well as the second part 3811b located near the second side of the inner layer 3812. In at least one embodiment (like the above), the outer layer 3811 may include one or more fasteners protruding from go. In at least one such embodiment, the outer layer 3811 may include a plurality of deformable legs 3921 protruding from one side of the outer layer 3811 that can be housed in a compressible inner layer 3812. In certain embodiments, each deformable leg 3921 may include at least one the hook or tooth 3923 that protrudes from it, the teeth can come into contact with the second part 3811b of the outer layer 3811 and as a result hold the outer layer 3811 on the inner layer 3812. In at least one like In an embodiment, the teeth 3923 can protrude from the second side of the inner layer 3812 and pass through holes 3808 in the second part 3811b of the outer layer 3811 so that the teeth 3923 come into contact with the outer surface of the outer layer 3811 and fix the outer layer 3811 on the inner layer 3812. When forming the construction of the cassette with brackets 3900, the inner layer 3812 can be at least partially compressed so that the teeth pierce it and enter the holes 3808. In at least one such embodiment, the cassette with brackets 3900 may be pre-compressed when installed in the cassette channel. In certain embodiments (in addition to the foregoing), at least a portion of the legs 3921 may be embedded in the first portion 3811a of the outer layer 3811, while in at least one embodiment, the outer layer 3811 may consist of a plastic material, such as polydioxanone (MAC) and (or) polyglycolic acid (PGA), plastic material may surround (at least partially) the legs 3921.

In various embodiments (see FIGS. 133-137), a cassette with brackets, for example a cassette with brackets 4000, may include a cassette body 4010 containing a compressible first layer 4011 and a second layer 4012, as well as a plurality of brackets 4020 located inside the cassette 4010 In certain embodiments (see FIG. 135), each bracket 4020 may include a base 4022 and at least one deformable leg 4023 extending from the base 4022. In at least one embodiment (see FIG. 133), a cassette with brackets 4000 may be located between kana scrap of the cartridge with brackets 4030 and a thrust plate 4040 of the distal working nozzle of the surgical stapler, while the second layer 4012 of the cartridge case 4010 and / or the base 4022 of the brackets 4020 can be located opposite the channel of the cartridge with brackets 4030. In various embodiments (see FIG. 134) the second layer 4012 may include a layer of gaskets 4060 connected to each other by means of a support frame for gaskets 4061. In at least one similar embodiment, the gaskets 4060 and the support frame for gaskets 4061 can be made of molded plastics material, such as polyglycolic acid (PGA). Each gasket 4060 may have one (or more) slots or grooves 4062 that are capable of receiving the leg of the bracket 4021 (the leg passes through the groove, as shown in Figs. 135 and 136). Each gasket 4060 may also include a receiving groove 4063 that receives the base 4022 of the bracket 4020. In various embodiments (see FIG. 134), the gaskets 4060 and / or the support frame of the gaskets 4061 may include a plurality of perforated holes, notches, and similar devices that Allow the 4060 gaskets to be disconnected from the support frame 4061 at the desired location. Similarly (see FIG. 136), one gasket 4060 or more can be joined together along a line of perforated holes and / or notches 4064. When using the product, the compressible foam layer 4011 can be placed opposite the target fabric “T”, and the body the cassettes 4010 can be compressed by the stop plate 4040 so that the stop plate 4040 deforms the brackets 4020. When the brackets 4020 are deformed, the legs 4021 of each bracket 4020 can grab the “T” fabric, part of the first layer 4011, as well as the gasket 4060. After removing the cassette channel from brackets 4030 of implanted of the cassette with brackets 4060, the support frame for the gaskets 4061 can be disconnected from the gaskets 4060 and / or the gaskets 4060 can be disconnected from each other. Under certain circumstances, gaskets 4060 may be disconnected from the frame 4061 and / or from each other when the brackets 4020 are deformed by the thrust plate 4040, as described above.

In the various embodiments described herein, the cassette brackets may be completely deformed by the abutment plate as the plate moves to the closed position. In other various embodiments (see Figs. 138-141), the brackets in the cassette, for example the cassette 4100, can be deformed by the stop plate when it moves to the closed position, and also due to the brace feed system, which moves the brackets in the direction of the closed stop plates. The cassette with brackets 4100 may include a compressible cassette 4110, which may contain foam, as well as a plurality of brackets 4120 at least partially located inside the compressible cassette 4110. In various embodiments, the brackets may include a bracket holder 4160, a plurality of brackets strips 4162 located in the holder 4160, as well as a cassette tray with brackets 4180, which can hold the bracket rails 4162 in the holder 4160. In at least one such Embodiment skobkonapravlyayuschie strap 4162 may be located in one (or more) of the slot 4163 of the holder 4160, whereby the side walls of the grooves 4163 may contribute towards skobkonapravlyayuschih strips 4162 upwardly toward the swashplate. In various embodiments, the brackets 4120 can be supported in the grooves 4163 by the brackets 4162, with at least one embodiment, the brackets 4120 can be completely located in the grooves 4163 when the brackets 4120 and the brackets 4162 are in an idle position. In some other embodiments, at least a portion of the brackets 4120 may protrude upwardly through the open ends 4161 of the grooves 4163 when the brackets 4120 and the bracket rails 4162 are in an idle position. In at least one such embodiment (see FIG. 139), the bases of the brackets 4120 can be located inside the holder 4160, and the ends of the brackets 4120 can be embedded in the compressible housing of the cassette 4110. In certain embodiments, approximately one third of the height of the brackets 4120 can be located inside the holder 4160 and about two-thirds of the height of the brackets 4120 may be located inside the cassette 4110. In at least one embodiment (see FIG. 138A), the cassette with brackets 4100 may also include a waterproof a cover (membrane) 4111 that surrounds the cassette body 4110 and the bracket holder 4160.

When using the product, the cassette with brackets 4100 can be located inside the channel of the cassette, and the thrust plate can be moved in the direction of the cassette with brackets 4100 to the closed position. In various embodiments, the implementation of the thrust plate may come into contact and compress the compressible housing of the cartridge 4110 when moving to the closed position. In certain embodiments, the thrust plate may not come into contact with the brackets 4120 when moving to the closed position. In some other embodiments, the implementation of the thrust plate may come into contact with the legs of the brackets 4120 and at least partially deform the brackets 4120 when moving to the closed position. In all embodiments, the cassette with brackets 4100 may also include a slide 4170 that can move longitudinally inside the cassette with brackets 4100; the slide 4170 can come into contact with the bracket rails 4162 and move the bars 4162 and the brackets 4120 in the direction of the thrust plate. In various embodiments, the slide 4170 may slide between the pallet of the cassette with brackets 4180 and the bracket rails 4162. In embodiments in which closing the thrust plate begins the process of forming the brackets 4120, the upward movement of the brackets 4120 towards the thrust plate may complete the forming process and deform the brackets 4120, leading them to a fully formed (or at least required) height. In embodiments in which the closure of the thrust plate does not deform the brackets 4120, the upward movement of the brackets 4120 towards the thrust plate may begin and complete the formation and deformation of the brackets 4120, leading them to a fully formed (or at least desired) height. In various embodiments, the slide 4170 can move from the proximal end of the cassette with brackets 4100 to the distal end of the cassette with brackets 4100 so that the brackets 4120 located at the proximal end of the cassette with brackets 4100 are completely formed until the brackets 4120 located at the distal end of the cassette are fully formed with brackets 4100. In at least one embodiment (see FIG. 140), the slide 4170 may include at least one angular or inclined surface 4711 that slides under the levers for feeding the brackets 41 62 and lifts them, as shown in FIG. 141.

In various embodiments (in addition to the above), the brackets 4120 can be formed so that they grab at least a portion of the fabric “T” and at least a portion of the compressible cassette body 4110 with brackets 4100. After the brackets 4120 are formed, the abutment plate and the cassette channel with brackets 4130 of the surgical stapler can be moved away from the implanted cassette with brackets 4100. Under various circumstances, the pallet of the cassette 4180 can be firmly attached to the cassette channel with brackets 4130, while cassettes 4180 can be detached from the compressible cassette 4110 as the channel of the cassette with brackets 4130 is pulled away from the implanted cassette 4110. In various embodiments (see FIG. 138), the cassette pallet 4180 may have opposite side walls 4181 between which are removable In this way, the cartridge case 4110 can be located. In at least one such embodiment, the compressible cartridge case 4110 can be compressed between the side walls 4181 so that it remains possible to disconnect the case 4110 from the pallet of the cartridge 4180 while pulling the pallet 4180. In at least one such embodiment, the bracket holder 4160 may be connected to the pallet of the cartridge 4180 so that the holder of the bracket 4160, strap 4162 and / or the slide 4170 can remain in the pallet of the cartridge 4180 when the pallet 4180 is removed from the surgical field. In some other embodiments, the straps 4162 can be removed from the strap holder 4160 and left in the surgical field. In at least one such embodiment, the laths 4162 may consist of a bioabsorbable material, for example polyglycolic acid (PGA) (trade name Vicryl), polylactic acid (PMA or PMA-L), polydioxanone (MAC), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PGKL) (trade name - Monocryl), polycaprolactone (PKL) and (or) a mixture of PKL, PMK, PDK, PHA, PGKL and (or) PKL. In various embodiments, the strips 4162 may be attached to the brackets 4120 so that the strips 4162 are deployed in the surgical field with the brackets 4120. In at least one such embodiment, each bracket 4162 may include a tray receiving bases of the brackets 4120; however, in at least one embodiment, the bases of the brackets are secured to the trays by a snap or press-fit method.

In addition to the foregoing, in certain embodiments, the bracket holder 4160 and / or the slide 4170 may be removed from the pallet of the cartridge 4180. In at least one such embodiment, the bracket 4170 may slide between the cartridge tray 4180 and the bracket holder 4160 in this manner that the slide 4170 moves the bracket rails 4162 and the brackets 4120 upward; the slide 4170 may also move the bracket holder 4160 upward from the pallet of the cartridge 4180. In at least one such embodiment, the bracket holder 4160 and / or the slide 4170 may consist of a bioabsorbable material, such as polyglycolic acid (PGA) (trade name Vicryl ), polylactic acid (PMA or PMK-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PHCL) (trade name - Monocryl), polycaprolactone (PCL) and (or) a mixture of PGC, PMC, MPC, PHA , PGKL and (or) PKL. In various embodiments, the slide 4170 may be an integral part or attached to a drive shaft or cutting segment that pushes the slide 4170 through the cassette with brackets 4100. In such embodiments, the slide 4170 may not be removed from the pallet of the cassette 4180 and remain in the surgical stapler; in other embodiments, in which the slide 4170 is not attached to the drive shaft, the slide 4170 may be left in the surgical field. In any case, the compressibility of the cassette 4110 may allow the use of thicker cassettes with brackets in the distal working nozzle of the surgical stapler (the cassette 4110 can be compressed when the thrust plate of the stapler is closed). In certain embodiments, as a result of at least partial deformation of the brackets when closing the thrust plate, higher brackets can be used, for example brackets with a height of approximately 4.57 mm (0.18 inches), brackets with an approximate height of 3.05 mm (0.12 inch) may be located in the compressible layer 4110, while the compressible layer 4110 may have an uncompressed height equal to approximately 3.56 mm (0.14 inch).

In various embodiments (see FIGS. 142-145), a cassette with brackets, for example a cassette with brackets 4200, may include a compressible cassette 4210, a plurality of brackets 4220 located in the cassette, and a plurality of flexible side support elements 4234. In various embodiments (see FIG. 143), the cassette with brackets 4200 may be located between the abutment plate 4240 and the channel of the cassette with brackets 4230, while in at least one embodiment, the lateral support elements 4234 can be attached to the channel to ssety with brackets 4230. When the thrust plate 4240 moves downward to compress the cassette housing 4210 and at least partially deforms the bracket 4220, as shown in FIG. 144, the side portions of the cassette 4210 may protrude laterally and extrude the side support members 4234 outward. In at least one such embodiment, the side support members 4234 can be attached to the cassette 4210. When the cassette 4210 extends laterally as described above, the side support 4234 can be detached from the cassette 4210, as shown in FIG. 144. In at least one embodiment, the lateral support elements 4234 may be adhered to the cassette 4210 body using at least one bonding agent, such as fibrin and / or protein hydrogel. Similar to the above, closing the thrust plate 4240 can only result in partial deformation of the brackets 4220, while the formation of the brackets 4220 can be completed by moving one or more slides 4270 through the cassette with brackets 4200, as shown in FIG. 145. In various embodiments (see FIGS. 147 and 148), the slide 4270 can be moved from the proximal end of the bracket with brackets 4200 to the distal end of the cartridge with brackets 4200 of the cutting segment 4280. In at least one such embodiment, the cutting segment 4280 may include a cutting element (knife) 4283, which passes through the fabric "T" and / or compressible casing of the cartridge 4210. In certain embodiments, the cutting segment 4280 may include cam elements 4282, which extend along the outer surfaces of branches 4230 and 4240, ne edvigaya or holding the jaws in place. In various embodiments, as a result of the foregoing, the brackets 4220 may be finalized simultaneously (or almost simultaneously) with the dissection of the “T” tissue. In at least one such embodiment, the slide 4270 may be distal to the knife 4283. Thus, the “T” fabric is notched only after, for example, the part of the fabric to be treated has been completely stitched with brackets.

In various embodiments (see FIGS. 147 and 148), the slide 4270 may include separate slide elements that are moved together by the cutting segment 4280. In at least one such embodiment, the slide 4270 may be in the cassette with brackets 4200, and the cutting segment 4280 can pass into the cassette with brackets 4200 using the trigger rod 4281. Thus, the cutting segment 4280 comes into contact with the slide 4270 and moves them in the distal direction. In certain embodiments, the slide 4270 may be coupled to each other. In any case, each slide 4270 may include a corner (cam) surface 4271, which may be designed to raise the brackets 4220 aligned in one row. In certain embodiments, angular surfaces 4271 may be components of the cutting segment 4280. In at least one embodiment (see FIGS. 147 and 148), each bracket 4200 may include a base, at least one deformable member extending from the base, and crown 4229, applied to at least part of the base and (or) deformable elements of the bracket 4200 and (or) located around it. In various embodiments, such crowns 4229 may be directly driven by slides 4270. In particular, in at least one embodiment, crowns 4229 of brackets 4220 may be configured such that angular surfaces 4271 of slide 4270 can slide under and directly enter with crowns 4229. into contact without placing between them brackets. In such embodiments, each crown 4229 may include at least one interacting corner (inclined) surface that can come into contact with the corner surface 4271 of the slide 4270. Thus, the interacting corner surfaces can move the brackets 4220 upward when the slide 4270 slides under the brackets 4220.

In various embodiments (see FIG. 146), the cassette with brackets, such as the cassette with brackets 4300, may include a compressible housing 4310 and a plurality of brackets 4320 located within the compressible housing 4310. Like the above, the cassette with brackets 4300 may include flexible side supports elements 4334 that can be attached to the cassette channel with brackets and / or glued to a compressible housing 4310. In addition to the above, the flexible side support elements 4334 can be connected to one another by one or more bundles and (connecting elements) 4335, which are designed to hold the side support elements 4334 together. When using the product, the connecting elements 4335 can prevent (or at least reduce) prematurely detaching the side supporting elements 4334 from the cassette body 4310. In certain embodiments, the connecting elements 4335 can hold the side supporting elements 4334 together after the cassette with brackets 4300 is successfully compressed thrust plate. In such embodiments, the lateral support elements 4334 can withstand the swelling (lateral displacement) of the side portions of the cartridge case 4310. In certain embodiments, a cutting segment, for example 4280, can dissect the connecting elements 4335 as they move distally inside the cartridge case 4310. At least in at least one such embodiment, the cutting segment 4280 may push one or more slides, for example a slide 4270, in the distal direction to form brackets 4320 with thrust plate. The slide 4270 can guide the cutting edge 4283 in such a way that the cutting segment 4280 does not intersect the connecting element 4335 until the brackets 4320 located near this connecting element 4335 are fully formed (or at least get the desired height). In various circumstances, the connecting elements 4335 in combination with the side supporting elements 4334 can prevent (or at least reduce) the lateral movement of the compressible cassette 4310. In addition, they can prevent (or at least reduce) the lateral movement of the brackets 4320 located in the case cassettes 4310. In such circumstances, the connecting elements 4335 can hold the brackets 4320 in position until they are deformed. Subsequently, the connecting elements 4335 can be cut to release the side parts of the cassette 4310. As indicated above, the side supporting elements 4334 can be connected to the cassette channel with brackets. As a result, they can be removed from the surgical field along with the cassette channel after implantation of the cassette 4300. In certain embodiments, the lateral support elements 4334 may consist of implantable material and be left in the surgical field. In at least one embodiment, the connecting elements 4335 may be located between the cassette 4310 and the fabric "T". After disconnecting the connecting elements 4335 from the lateral supporting elements 4334, the connecting elements 4335 may remain implanted in the patient’s body. In at least one such embodiment, the connecting elements 4335 may consist of an implantable material. In certain embodiments, the connecting elements 4335 may consist of the same material as the side supporting elements 4334. In various embodiments, the connecting elements 4335 and / or side supporting elements 4334 may consist of a flexible bioabsorbable material, for example polyglycolic acid (PCG) (trade name - Vicryl), polylactic acid (PMC or PMK-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglecaprone 25 (PHCL) (trade name - Monocryl), polycaprolactone (PCL) and (or) mixtures of PGK, PMK, PDK, PHA, PGKL and (or) PKL. In various embodiments, the connecting element may include a sheet of material that fastens the side supporting elements 4334. In certain embodiments, the cassette with brackets may include connecting elements protruding from the upper surface of the cassette 4310, and further connecting elements protruding around the lower surface of the cassette 4310 .

In various embodiments (see FIG. 149), the cassette with brackets may include brackets, for example brackets 4420, which may have a wire portion inserted into the crown portion. In at least one embodiment, the wire portion may consist of metal, for example titanium and (or) stainless steel, and (or) plastic, for example polydioxanone (MPC) and (or) polyglycolic acid (PGA). In at least one embodiment, the coronal part may consist of metal, for example titanium and (or) stainless steel, and (or) plastic, for example polydioxanone (MPC) and (or) polyglycolic acid (PGA). In certain embodiments, the wire portion of each bracket 4420 may include a base 4422 and deformable legs 4421 that protrude from the base 4422, while the crown portion of each bracket 4420 may have a crown 4429 that receives at least a portion of the base 4422. For assembling various parts of each bracket 4420 (see Fig. 150A-150C) the legs 4421 of the wire part can be inserted into the lumen 4426 in the crown 4429, while the gap 4426 can direct the legs 4421 into the chamber of the base 4427. The wire part can be inserted into the crown 4429 so once the legs 4421 exit the base chamber 4427 and the base 4422 of the wire portion enters the base chamber 4427. In at least one such embodiment, the base chamber 4427 can rotate the wire portion in crown 4429 when the base 4422 enters the chamber 4427, legs brackets 4421 can be directed up (or almost up). In various embodiments (see FIG. 149), crown 4429 may have outlet openings 4425 that receive the legs of brackets 4421.

In various embodiments (in addition to the above), the surgical stapler may include a slide 4470 directed across the cassette with brackets 4400 and the channel of the cassette with brackets 4430, and the slide can move the brackets 4420 contained in the cassette 4410 towards the abutment plate. Under various circumstances, the slide 4470 can be moved from the proximal end of the cassette 4430 to the distal end of the cassette 4430 to implant the cassette 4410 and the brackets 4420. Under certain circumstances, the slide 4470 can be returned to the proximal end of the cassette 4430, then to the cassette channel 4430 another cassette with brackets 4400 can be inserted. After placing a new cassette with brackets 4400 in the channel of the cassette 4430, the sled 4470 can be moved again in the distal direction. In various embodiments, the surgical stapler may include one or more locking elements that can prevent re-distal displacement of the slide 4470 until a new cartridge 4400 is inserted in the channel of the cassette 4430. In at least one such embodiment (see Fig. 149) the cassette channel with brackets 4430 may include a locking arm 4439, which can prevent (or at least limit) the distal displacement of the slide 4470. In particular, the slide 4470 can support the plate 4439 until the rails 4470 are at least partially raised up above the shoulder 4439 using the lifting element 4428, which, for example, protrudes between the most proximal brackets 4420 in the cassette with brackets 4400. In other words, in the absence of the most proximal brackets 4420 in the new cassette with brackets 4400, the slide 4470 cannot be distally displaced. Thus, the slide 4470 cannot be moved in the channel of the cassette 4430 if there is no cassette with brackets 4400 in the channel 4430 or a used cassette with brackets 4400 is located.

In addition to the above (see Fig. 151), a cassette with brackets, for example a cassette with brackets 4500, can be placed in the channel of the cassette with brackets 4530 and include a compressible cassette case 4510, many brackets 4520 located in the cassette body 4510, and cartridge tray 4580. In various embodiments, the compressible cartridge case 4510 may include an outer layer 4511 and an inner layer 4512, while in at least one embodiment, the outer layer 4511 may seal the inner layer 4512. In at least one In a further embodiment, the outer layer 4511 may protrude from the inner layer 4512 and the tray of the cartridge 4580. In some other embodiments, the outer layer 4511 may only partially surround the inner layer 4512, in at least one such embodiment, the outer layer 4511 and the tray of the cartridge 4580 may together surround (or almost completely surround) the inner layer 4512. In various embodiments (in addition to the above), the brackets 4520 may be supported by a cassette tray 4580, while the cassette tray 4580 may include one or more support channels for supporting brackets 4520. In certain embodiments, the cassette tray 4580 may be attached to the cassette body 4510, while in at least one such embodiment, the cassette body 4510 may be compressed laterally between opposite side walls of the pallet cassettes 4580. In various embodiments, the side walls of the pallet of the cassette 4580 may support the cassette body 4510 laterally in at least one such embodiment under the bottom of the cassette 4580 may include one or more stabilizing walls 4582 that protrude upward from the lower support member 4583 into the cassette body 4510. In at least one such embodiment, the cassette body 4510 may include one or more channels that can receive and / or block the stabilizing walls 4582. In various embodiments, the stabilizing walls 4582 may partially (or almost partially) protrude through the housing of the cartridge 4510. In at least one such embodiment, iliziruyuschie wall 4582 may act longitudinally through the staple cartridge 4500 between the first row of staples 4520 and a second row of staples 4520.

In various embodiments, the cartridge case 4510 and / or the cartridge tray 4580 may include interacting locking elements that can press the cartridge tray 4580 and the cartridge case 4510 against each other. In certain embodiments, the cassette with brackets 4500 can be located inside the channel of the cassette 4530 so that the cassette pallet 4580 is opposite and / or attached to the channel of the cassette 4530. In at least one embodiment, the cassette pallet 4580 can be removably attached to the channel cassettes 4530 so that after compressing the cassette with brackets 4500 with the stop plate 4540 and deforming the brackets 4520, the pallet of the cassette 4580 can be disconnected from the channel of the cassette 4530 and implanted with the cassette body 4510. By m In at least one such embodiment, the cartridge tray 4580 may consist of a bioabsorbable material, for example polyglycolic acid (PGA) (trade name Vicryl), polylactic acid (PMA or PMA-L), polydioxanone (MAC), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGKL) (trade name - Monocryl), polycaprolactone (PKL) and (or) a mixture of PGK, PMK, PDK, PHA, PGKL and (or) PLC. In certain embodiments, the surgical stapler may also include a trigger and / or a lever that can be biased between the channel of the cassette with brackets 4530 and the lower mating surface that transmits torque to the cassette of the cassette 4580, and the trigger can lift or pop the cassette of the cassette 4580 from the cassette channel 4530. In certain embodiments, the cassette body 4510 can be removably attached to the pallet of the cassette 4580 so that after compressing the cassette with the brackets 4500 of the thrust plate 4540 and deformation of the brackets 4520, the cartridge case 4510 can be disconnected from the cartridge tray 4580. In at least one such embodiment, the cartridge tray 4580 can remain attached to the cartridge channel 4530 so that the cartridge tray 4580 is removed from the surgical field along with the cartridge channel 4530 In certain embodiments, the surgical stapler may also include a trigger and / or a lever that can be biased between the pallet of the cassette with brackets 4580 and the lower mating surface, torque, the cartridge case 4510, and the trigger can lift or push the cartridge case 4510 from the pallet 4580. In at least one such embodiment, the cartridge with brackets 4500 may also include brackets located between the pallet of the cartridge 4580 and brackets 4520 so that as the trigger is distally displaced, the brackets and brackets 4520 can move upward in the direction of the thrust plate. In at least one such embodiment, the brackets may be at least partially embedded in the compressible cassette of the cassette 4510.

In various embodiments (like the above), the cartridge with brackets 4500 may include a locking element that prevents (or at least limits) the distal displacement of the cutting segment until an unused cartridge with brackets 4500 is placed inside the channel of the cartridge 4530. B In certain embodiments, the cassette tray with brackets 4580 may include a surface that lifts the cutting segment up and above the retaining surface within the channel of the cassette 4530. In the case of a cassette with obkami 4500 with the pallet cassette 4580 is absent in the cartridge channel 4530, a cutting segment can not be moved. In at least one embodiment, the most proximal brackets and / or any other suitable brackets within the cartridge 4500 may have a lifting surface that can sufficiently raise the cutting segment above the locking surface. In addition to the above (or as a replacement), the various parts of the cassette with brackets 4500 may consist of materials having a different color. In such embodiments, the surgeon can visually determine if an unused and / or used cartridge with brackets is present in the channel of the cartridge with brackets 4530. In at least one such embodiment, the outer layer 4511 of the cartridge case 4510 may have a first color, the cartridge tray 4580 may have a second color, and the cassette channel with brackets 4530 is the third color. Upon seeing the first color, the surgeon will determine that there is an unused cartridge with brackets 4500 in the cassette channel 4530. Having seen the second color, the surgeon will determine that there is a used cassette with brackets 4500 in the channel of the cassette 4530 and the pallet of the cartridge 4580 needs to be moved. When the third color is seen, the surgeon will determine that no part of the cassette with brackets 4500 is present in the channel of the cassette 4530.

In various embodiments (see FIG. 152), a cassette with brackets, for example a cassette with brackets 4600, may include a compressible implantable cassette body 4610 and a plurality of brackets 4620 located in this case. The cassette body 4610 may include an outer layer 4611 and an inner layer 4612. In certain embodiments, the inner layer 4612 may include a plurality of recesses therein, such as recesses (pockets) 4615, which facilitate wrinkling of the cassette 4610. In at least one such embodiment the inner layer 4612 may have a corrugated (honeycomb) lattice that withstands compressive force (pressure) to a certain threshold value. If the threshold value is not exceeded, the inner layer 4612 can deform with a linear (or almost linear) speed as a compressive force is applied. After the compressive force (pressure) exceeds the threshold value, the inner layer 4612 may suddenly crumple (curl) under the influence of a large compressive load. In various embodiments, the implementation of the mesh inner layer 4612 may consist of many sublayers 4612a, which can be interconnected with each other. In at least one embodiment, each sublayer 4612a may include a plurality of successive protrusions and grooves (waves), which may be associated with successive protrusions and furrows of an adjacent sublayer 4612a. In at least one such embodiment, the grooves of the first sublayer 4612a can abut against the protrusions of the second sublayer 4612a, similarly, the protrusions of the first sublayer 4612a can abut against the furrows of the second sublayer 4612a. In various embodiments, the adjacent sublayers 4612a may be bonded to each other and / or the outer layer 4611 via at least one bonding agent, such as fibrin and / or protein hydrogel. In FIG. 153, the cassette with brackets 4600 is shown after the casing of the cassette 4610 has been wrinkled and the brackets 4620 have been deformed to grasp and hold the fabric “T” against the cassette 4610.

In various embodiments (see FIGS. 154-156), a cassette with brackets, such as a cassette with brackets 4700, may include a compressible implantable cassette body 4710 and a plurality of brackets 4720 located in this body 4710. Like the above, the cassette body 4710 may include the outer layer 4711 and the inner layer 4712, while the inner layer 4712 may include many sublayers 4712a. Similar to the above, each sublayer 4712a may include successive furrows 4717 and protrusions 4718, which can be juxtaposed to form pockets (indentations) 4715. In at least one such embodiment, the furrows 4717 and / or protrusions 4718 may go along axes parallel to each other and / or axes parallel to the longitudinal axis 4709. In various embodiments, the brackets 4720 can be aligned in many rows that run along axes parallel to each other and / or axes parallel to the longitudinal axis 4709. In various alternative embodiments (see FIGS. 152 and 153), the brackets 4620 contained in the cartridge case 4600 may extend along axes transverse to the axes along which the furrows and protrusions of the sublayer 4612a extend. As shown in FIG. 154-156, the brackets 4720 may extend along the furrows 4717 and the protrusions 4718, while the frictional force between the brackets 4720 and the sublayers 4712a can hold the brackets 4720 inside the cassette 4710. In certain embodiments, the plurality of sublayers 4712a may be made of support material and (or ) of a plastic material, for example polydioxanone (MAC) and (or) polyglycolic acid (PGA), the sublayers can hold the brackets 4720 upright and (or) keep the brackets 4720 aligned relative to each other, as shown in FIG. 154 and 155. In FIG. 156, a cassette with brackets 4700 is shown after the cassette body 4710 has been wrinkled and the brackets 4720 have been deformed to grasp and hold fabric “T” close to the cassette body 4710.

In various embodiments (see FIGS. 154-156), the cassette body 4710 may flexibly wrinkle under compression. In at least one such embodiment, waves generated in each sublayer 4712a by grooves 4717 and protrusions 4718 can flatten (or almost completely flatten) as the cassette body 4710 contracts, resulting in crease (or almost total crease) of the cavities 4715 between the sublayers . Under various circumstances, the cassette body 4710 or at least part of the cassette body 4710 can elastically re-expand after the compressive force (pressure) is no longer applied to the cassette body 4710. In at least one such embodiment, the connection between the furrows 4717 and the protrusions 4718 adjacent sublayers 4712a may remain unaffected (or virtually unaffected) by compressing the cassette body 4710. Thus, after the compressive force (pressure) ceases to affect the casing cassettes 4710, sublayers 4712a can be displaced relative to each other, which will lead to at least partial re-expansion of the cassette 4710. In certain embodiments, the cassette 4710 may be elastically deformed (squeezed) by compression, resulting in the cassette 4710 not being exposed re-expansion after the compressive force (pressure) is no longer acting on the cassette body 4710. In certain embodiments, see FIG. 157) a cassette with brackets, for example, a cassette with brackets 4800, can include a squeezable cassette case 4810 with an outer layer 4811 and an inner layer 4812, while the inner layer 4812 can have a corrugated (honeycomb) lattice in which there are many recesses (pockets) 4815. In various embodiments, the walls performing the mesh of the inner layer 4812 may include one (or more) weakening (thinning) section 4819, which violates the integrity of the walls of the mesh during compression of the cassette 4810. Under such circumstances, the body The mustache of the 4810 cassette can be squeezed during implantation of the cassette with brackets 4800.

In various embodiments (see FIGS. 158-160), the cassette with brackets, for example the cassette with brackets 4900, may include a cassette body 4910 comprising an outer layer 4911 and a plurality of crease elements 4912 located between the upper and lower parts of the outer layer 4911. How shown mainly in FIG. 158 and 159, the cassette with brackets 4900 may also include a plurality of brackets 4920, wherein each bracket 4920 may be located in the crease element 4912. In particular, each crease element 4912 may have a first part 4912a, a second part 4012b and a third part 4012c, which jointly form a recess 4915 receiving a bracket 4920. When using the product (in addition to the above), a cassette with brackets 4900 can be located inside the channel of the cassette with brackets and a compressive force can be applied to the fabric surface 4919 for c the case of the cassette 4910. As the surface 4919 moves downward, collapse of the element 4912 may occur. Under similar circumstances, the second part 4912b of each wrinkled element 4912 may be wrinkled into the corresponding first part 4912a, similarly the third part 4912c of each roll-up element 4912 may be wrinkled into the corresponding second part 4912b. As the cassette body 4910 is compressed and the elements 4912 are crushed, the brackets 4920 located inside the crease elements 4912 can be deformed, as shown in FIG. 160. In various embodiments, the second portion 4912b of each crease member 4912 can be secured by friction or pressed onto the corresponding first portion 4912a. After the compressive force applied to the collapsible member 4912 exceeds the holding force of the first part 4912a and the second part 4912b in the deployed position (FIG. 159), the first part 4912a and the second part 4912b can begin to slide relative to each other. Similarly, a third portion 4912c of each crease member 4912 may be secured by friction or pressed onto the corresponding second portion 4912b. After the compressive force applied to the crease member 4912 exceeds the holding force of the second part 4912b and the third part 4912c in the deployed position (FIG. 159), the second part 4912b and the third part 4912c can begin to slide relative to each other.

In many of the embodiments described herein, a cassette with brackets may contain many brackets. In various embodiments, the implementation of such brackets can be made of metal wire and have a U-shaped (or almost U-shaped) shape with two legs. There are other embodiments in which the brackets may have different configurations, for example, consisting of two or more wires connected to each other, and also have three or more legs. In various embodiments, the wire (or wires) used to form the brackets may include a round (or almost round) notch. In at least one embodiment, the staple wires may include another suitable notch, for example, square or rectangular. In certain embodiments, the brackets may consist of plastic wire. In at least one embodiment, the brackets may be made of plastic coated metal wire. In various embodiments, the cartridge may include other suitable fasteners in addition to or instead of brackets. In at least one such embodiment, such a fastener may have pivoting arms that fold under the action of the thrust plate. In certain embodiments, two-part fasteners may be used. In at least one such embodiment, the cassette with brackets may include a plurality of first mounting parts and a thrust plate, which may include a plurality of second fastening parts, wherein the first and second fastening parts are connected to each other when the thrust plate is pressed against the cassette with brackets. In certain embodiments of the implementation, as described above, to complete the process of forming the brackets can be used movable slide to feed the brackets located inside the cassette with brackets. In certain embodiments, the brackets can slide in the thrust plate to slide one (or more) of the bracketing element downward in the direction of the cassette and the brackets (fasteners) located therein.

In various embodiments described herein, a cassette with brackets may include four rows of brackets. In at least one embodiment, four rows of brackets may comprise two inner rows of brackets and two outer rows of brackets. In at least one such embodiment, the inner row of brackets and the outer row of brackets can be located on the first side of the groove for the cutting segment (knife) in the cassette with brackets. Similarly, the inner row of brackets and the outer row of brackets can be located on the second side of the groove for the cutting segment (knife). In certain embodiments, the cassette with brackets may not have a groove for the cutting segment, instead of the groove, such a cassette with brackets may have a special part that is cut by the cutting segment. In various embodiments, the implementation of the inner rows of brackets can be inside the cartridge with brackets so that they are located at an equal (or almost equal) distance from the groove of the cutting segment. Similarly, the outer rows of brackets can be inside the cassette with brackets so that they are located at an equal (or almost equal) distance from the groove of the cutting segment. In various embodiments, the cassette with brackets may include four rows of brackets (as well as more or less than four such rows). In at least one embodiment, the cassette with brackets may include six rows of brackets. In at least one such embodiment, the cassette with brackets may include three rows of brackets on the first side of the groove of the cutting segment and three rows of brackets on the second side of the groove of the cutting segment. In certain embodiments, a cassette with brackets may include an odd number of rows of brackets. For example, a cassette with brackets may include two rows of brackets on the first side of the groove of the cutting segment and three rows of brackets on the second side of the groove of the cutting segment. In various embodiments, the rows of brackets may include brackets with the same (or substantially the same) undeformed height. In some other embodiments, one (or more) row of brackets may include brackets whose undeformed height differs from that of other brackets. In at least one such embodiment, the brackets on the first side of the groove of the cutting segment may have a first undeformed height, and the brackets on the second side of the groove of the cutting segment may have a second undeformed height that is different from the first.

In various embodiments (see Fig. 161A-161D), the distal working tip of the surgical stapler may include a cassette mount portion, such as a cassette channel with brackets 5030, a cassette with fasteners, such as cassette 5000, can be removably housed in the cassette duct with brackets 5030, and the jaw 5040 is located opposite the cartridge with brackets 5000 and the channel of the cartridge with brackets 5030. The cartridge with brackets 5000 may include a compressible housing 5010 and many brackets 5020 and (or) any other suitable fasteners, p at least partially located in the compressible housing 5010. In at least one such embodiment, each bracket 5020 may include a base 5022 and additionally legs 5021 that protrude upward from the base 5022, while at least a portion of the legs 5021 can be embedded in the housing cassettes 5010. In various embodiments, the compressible housing 5010 may include an upper (fabric facing) surface 5019 as well as a lower surface 5018, with the lower surface 5018 being adjacent to the supporting surface 5031 channel cassettes with brackets 5030 (and supported by this surface). Similar to the above, the supporting surface 5031 may include a plurality of supporting grooves 5032 made therein (FIG. 161D) that can receive and support the bases 5022 of the brackets 5020. In various embodiments, the distal working nozzle of the surgical stapler may also include a retainer matrix, for example a retainer a matrix 5050, which can come into contact with the brackets 5020 and capture the tissue located between them. In at least one such embodiment, the retaining matrix 5050 can be removably mounted on the jaw 5040. When using the product, after the cartridge with brackets 5000 is placed in the channel of the cartridge 5030, the jaw 5040 and the locking matrix 5050 can be moved in the direction of the cartridge with brackets 5000 and the cassette channel 5030. In at least one embodiment, the jaw 5040 can be moved down along the axis 5099 so that the jaw 5040 and the cassette channel with brackets 5030 remain parallel (or substantially parallel l) to each other after closing the jaw 5040. In particular, in at least one such embodiment, the jaw 5040 can be closed so that the tissue-facing surface 5051 of the retaining matrix 5050 is parallel (or substantially parallel) to the tissue-facing surface 5019 of the cartridge with brackets 5000 as the jaw 5040 moves in the direction of the cassette with brackets 5000.

In various embodiments (see FIG. 161A), the retainer matrix 5050 can be detachably attached to the jaw 5040, while during attachment of the retainer matrix 5050 to the jaw 5040, the retainer matrix 5050 and the jaw 5040 remain substantially stationary relative to each other. In at least one embodiment, the jaw 5040 may include one or more locking elements that are designed to hold the matrix 5050 in place. In at least one such embodiment, the retainer matrix 5050 may be secured to the jaw 5040 by snapping-in or press-fitting. In certain embodiments, the retainer matrix 5050 may be attached to the jaw 5040 using at least one bonding agent. In any case, the jaw 5040 can be placed in a position where the retaining matrix 5050 comes into contact with the fabric “T” and the fabric “T” is placed close to the surface of the fabric 5019 of the cassette with brackets 5000. If the fabric “T” is placed closely to the cassette with brackets 5000 using the jaw 5040, the compressible casing 5010 of the cassette with brackets 5000 may or may not be squeezed using the jaw 5040. Under any circumstances, in various embodiments, the legs 5021 of the brackets 5200 may not pass through the tissue surface 5019 of the cassette with bracket E 5000, as shown in FIG. 161A. In addition, as shown in FIG. 161A, jaw 5040 can hold fabric “T” against the compressible body 5010 without contacting the retainer 5050 with brackets 5020. Such embodiments may allow the surgeon to open and close the jaw 5040 several times to achieve the desired position of the distal working nozzles in the operative field without damaging the “T” tissue. There are other embodiments in which the ends of the brackets 5023 can protrude through the fabric-facing surface 5019 before the cartridge case 5010 is compressed by the thrust plate 5040. After the distal working nozzle is properly positioned (see Fig. 161B), the jaw 5040 can be shifted downward in the direction of the cassette channel with brackets 5030 so that the compressible body 5010 is compressed by the stop plate 5040 and the tissue surface 5019 is moved downward in the direction of the brackets 5020. As you move down, turn constant to the tips 5023 of brackets 5021 surface feet 5019 can pierce the tissue facing surface of the tissue 5019 and (at least) partially pierce tissue «T». Under such circumstances, the retaining matrix 5050 may be located above the brackets 5020 so that the locking slots 5052 of the retaining matrix 5050 are matched (or practically matched) with the tips 5023 of the legs of the brackets 5021.

As the retainer matrix 5050 is pushed down along the axis 5099 (see FIG. 161C), the legs 5021 of the brackets 5020 can enter the stop slots 5052. In various embodiments, the legs of the brackets 5021 can come into contact with the side walls of the stop slots 5052. B certain embodiments, as described in detail below, the retaining matrix 5050 may include one or more retaining elements that are directed inward and / or around the retaining slots 5052 in contact with the legs of the brackets 5021. In any case, the legs of the brackets 5021 can hold holes in the holes 5052. Under various circumstances, the ends 5023 of the legs of the brackets 5021 can go into the locking slots 5052 and rub against the locking elements and (or) the side walls of the slots 5052. As the stop matrix 5050 moves in the direction of the bases 5022 of the brackets 5020, the legs of the brackets 5021 can slide relative to the side walls and / or locking elements. As a result of the above, between the legs of the brackets 5021 and the retaining matrix 5050 when sliding, friction force can occur. This frictional force can resist mounting the retainer matrix 5050 on the brackets 5020. In various embodiments, the friction force between the retainer matrix 5050 and the brackets 5020 may be constant (or substantially constant) as the retainer matrix 5050 slides down along the legs 5021 of the brackets 5020. In certain embodiments, the friction force may increase and / or decrease as the retainer matrix 5050 slides down along the legs 5021. This may be due to geometric differences in the legs of the brackets 5021, the stop slots. it 5052 and (or) the locking elements, which are directed inward and (or) around the locking slots 5052. In various embodiments, the installation of the locking matrix 5050 in the brackets 5020 may also be opposed by a compressible cassette body 5010 with brackets 5000. In particular, a compressible body 5010 may consist of an elastic material that can exert a counteracting force on the retainer matrix 5050, this force can increase with the compression distance of the housing 5010. In at least one such embodiment, the increase counteracts to it, the force generated by the cartridge case 5010 can be linearly proportional (or almost linearly proportional) to the distance that the cartridge case 5010 is compressed. In certain embodiments, the increase in the opposing force generated by the cartridge case 5010 can be geometrically proportional (or almost geometrically proportional) the distance that the cassette 5010 is compressed.

In various embodiments (in addition to the foregoing), in order to overcome the frictional and counteracting forces described above, it will be necessary to apply a sufficient starting force to the jaw 5040 and the retainer matrix 5050. When using the product, the retainer matrix 5050 can be located at any suitable depth relative to the brackets 5020 In at least one embodiment, the retaining matrix 5050 may be located at a depth relative to the bases 5022 of the brackets 5020 to hold two or more layers of fabric and provide and tissue compression force (pressure). Under various circumstances, a system consisting of a retaining matrix 5050 and brackets 5020 allows the surgeon to select the amount of compressive force (pressure) that will be applied to the tissue by changing the depth of the retaining matrix 5050. For example, the retaining matrix 5050 can be moved down to the bases 5022 brackets 5020 until a certain depth 5011 of placement of the locking matrix 5050 is reached (distance to the bottom of the supporting grooves 5032). A shorter depth of 5011 may result in an increase in compressive force (pressure) to be applied to the “T” fabric. A large depth of 5011 can lead to a reduction in compressive force (pressure), which will be applied to the fabric "T". In various embodiments, the compressive force applied to the fabric “T” can be linearly proportional (or almost linearly proportional) to the depth 5011 at which the retainer matrix 5050 is located. Under various circumstances, the compressive force (pressure) applied to the fabric “T”, may depend on the thickness of the fabric "T" located between the retaining matrix 5050 and the cassette with brackets 5020. In particular, for a given distance 5011, the presence of a thicker fabric "T" can lead to an increase in compressive force (pressure) compared ju with thinner fabric “T”.

Under various circumstances (in addition to the above), the surgeon can adjust the depth of placement of the retaining matrix 5050 taking into account the thickness of the tissue "T" placed in the distal working nozzle. Thus, it is possible to provide a predetermined pressure on the fabric "T" (regardless of its thickness). For example, the surgeon may position the retainer matrix 5050 at a shallower depth 5011 for sewing thinner tissue “T” or at a greater depth 5011 for sewing up thicker tissue “T”. This can provide the same (or almost the same) compressive force throughout the fabric with variable thickness. In certain embodiments (in addition to the foregoing), the surgeon may determine the amount of compressive force to be applied to the “T” tissue located between the retainer 5050 and the cassette with brackets 5010. Under various circumstances, the surgeon may bring the retainer 5050 to the brackets 5020 and place the matrix 5050 at a first distance from the bases 5022 of the brackets 5020 in order to apply the first compressive force to the fabric. The surgeon may also place the retaining matrix 5050 at a second distance from the bases 5022 (less than the first distance) to apply a second compressive force (more than the first force) to the tissue. The surgeon may also place the retaining matrix 5050 at a third distance from the bases 5022 (less than the second distance) in order to apply a third compressive force (greater than the second force) to the tissue. In various embodiments, a fastening system consisting of a retaining matrix 5050 and brackets 5020 allows the surgeon to apply a wide range of compressive forces to the target tissue.

In various embodiments (see FIG. 161D), the legs of the brackets 5021 can be inserted through the retainer matrix 5050 so that the tips of the legs 5023 protrude above the upper surface of the retainer matrix 5050. In at least one embodiment (see FIG. 161C) the jaw 5040 may also have gaps 5042 that receive the ends of the legs of the brackets 5023 as they pass through the locking slots 5052 in the matrix 5050. In at least one such embodiment, the gaps 5042 can be matched with the locking slots 5052 in this way then the legs 5021 will not come into contact with the jaw 5040. In various embodiments, the gaps 5042 can be of sufficient depth so that the legs of the brackets 5021 do not come in contact with the jaw 5040, regardless of the distance at which the retaining matrix 5050 is placed. After the stop the matrix 5050 came into contact with the brackets 5020 and is located in the desired position (see Fig. 161D), the cassette channel with brackets 5030 and the jaw 5040 can be removed from the fabric "T". In particular, the cassette channel with brackets 5030 can be disconnected from the implanted cassette with brackets 5000, and the stop plate 5040 can be disconnected from the implanted stop matrix 5050. As the jaw 5040 moves away from the stop matrix 5050 and the bracket supports 5032 move away from the bases of the brackets 5022, the distance 5011 between the retaining matrix 5050 and the lower part of the bases 5022 is maintained, even though the jaw 5040 and the cassette channel with brackets 5030 no longer support them. In various embodiments, the resting friction force between the legs of the brackets 5021 and the retaining matrix 5050 may be sufficient to hold the matrix 5050 in place, despite the biasing force exerted on the retaining matrix 5050 by the compressed cartridge 5010 and / or the compressed fabric “T”. In at least one such embodiment, the cartridge case 5010 may consist of an elastic material that, when compressed, is capable of exerting an elastic biasing force on the retaining matrix 5050 and the brackets 5020, which can separate the locking matrix 5050 and the brackets 5020. This frictional force is counteracted by friction between legs of brackets 5021 and a lock matrix 5050.

In various embodiments, as described above, the retainer matrix may include a plurality of retaining slots, with each retaining slot may receive a leg of a fastener. In at least one embodiment (see FIG. 162), a portion of the retaining matrix 5150 shown in this figure may include a retaining slot 5152, which is defined by the perimeter 5156. In various embodiments, the perimeter 5156 of the hole 5152 may have a circular (or substantially circular) ) profile and (or) any other suitable profile. In certain embodiments, the locking matrix 5150 may include one or more locking elements, for example, locking elements 5153, which protrude into the slot 5152 and can come into contact with the leg of the fastener when it penetrates through the hole. In at least one such embodiment, each locking element 5153 may have a console that can protrude inwardly in the direction of the central axis 5159, that is, in the direction of the center of the slot 5152. In various embodiments, each console may include a first end that is attached to the housing of the locking matrices 5158, and a second end that forms the perimeter 5156 of the stopper slot 5152. In certain embodiments, the perimeter 5156 of the stopper slot 5152 can be defined by the first diameter (width), and the leg is stronger a solid element (brackets) can be determined by the second diameter (width), while the second diameter can be larger than the first. In at least one such embodiment, the leg of the fastener may come into contact and bend one (or more) locking element 5153 to increase the diameter of the retaining hole 5152 when the leg is inserted into this slot. In certain embodiments (in addition to the foregoing), the leg of the fastener may define a perimeter that exceeds the perimeter 5156 of the locking slot 5152, and expand the perimeter 5156 while it is being inserted into the slot.

In various embodiments (see FIG. 162), a slot 5152 may be formed by deformable elements 5153, wherein each deformable element 5153 may bend relative to or independently of the other deformable elements 5153. In at least one such embodiment, adjacent deformable elements 5153 can be separated from each other by grooves 5154, which can allow free deformation of each deformable element 5153 relative to each other. In certain embodiments, each groove 5154 may include a first end 5155 (in the housing of the retaining matrix 5158) and a second end opening into the retaining slot 5152, as well as the same (or substantially the same) width along its entire length (between the first end 5155 and the second end ) In various other embodiments, the implementation of the width of each groove 5154 may be uneven. The width of each groove 5154 may increase and / or decrease at a distance between the first and second ends. In certain embodiments, the first ends 5155 of the grooves 5154 may include an expanded part, for example, an annular one, which provides the following advantages: (1) unloading the tension of the bases of the deformable elements 5153 attached to the housing of the retainer matrix 5158, and (2) increasing the flexibility of the deformable elements 5153. B In various embodiments, it is possible to select the geometric shape of the deformable elements 5153 and / or grooves 5154. This allows you to adjust the flexibility of the deformable elements 5153. In certain cases In the embodiment, the grooves 5154 can be extended to form deformable elements 5153 of increased length, which are more flexible than deformable elements 5153 of shorter length. In at least one embodiment, it is possible to select the width of each deformable element 5153 to achieve the desired flexibility. In particular, deformable elements with a smaller width may be more flexible than deformable elements with a larger width. In certain embodiments (see FIG. 162), the first ends of the arms of the deformable elements 5153 attached to the housing of the retainer matrix 5158 may be wider than the second ends of the arms. In at least one such embodiment, the consoles may taper linearly (or nearly linearly) between the first and second ends.

In various embodiments (see FIG. 162), the housing of the retaining matrix 5158 may include a flat (or substantially flat) sheet of material that has a fabric-facing surface 5151 and an upper surface 5157. In at least one such embodiment, the fabric-facing surface 5151 and the upper surface 5157 may be parallel (or substantially parallel) to each other. In various embodiments, each deformable member 5153 may have a first part 5153a and a second part 5153b, with the first part 5153a projecting in the first direction and the second part 5153b projecting in the second direction other than the first. In at least one such embodiment, the housing of the retaining matrix 5158 can perform a plane, and the first parts 5153a of the deformable elements 5153 can lie in this plane. In various embodiments, the second parts 5153b of the deformable members 5153 may project at an angle with respect to the first parts 5153a. In at least one such embodiment, the second parts 5153b may protrude away from the upper surface 5157 of the housing of the retaining matrix 5158, in certain embodiments, the second parts 5153b may converge in the direction of the central axis 5159 of the locking slot 5152. In any case, in various embodiments, the second portions 5153b can be folded away from the central axis 5159 when the leg of the fastener is inserted into the hole. In embodiments in which the leg 5021 of the bracket 5020 is inserted into the stopper slot 5152, deformable elements 5153 can generally be deformed away from the bases 5122 of the brackets 5120. As a result, in certain embodiments, the deformable elements 5153 can be bent in the same (or practically the same) direction in which the legs of the brackets 5021 are inserted.

In various embodiments (see FIG. BD), the second portions 5153b of the deformable members 5153 may include a sharp tip that slides along the bracket leg 5021 when the bracket leg 5021 is inserted into the hole. The sharp ends of the second parts 5153b may also catch the bracket leg 5021 if the leg 5021 is pulled in the opposite direction, that is, in the direction of removal of the leg 5021 from the stopper slot 5052. Under certain circumstances, the second parts 5153b may tilt at an angle of more than 90 degrees with respect to the sides of the bracket leg 5021 as a result, the second parts 5153b can “bury” (penetrate) into the side of the leg of the bracket 5021 when a force is exerted on the leg 5021 to pull the leg 5021 out of the hole 5052. In certain embodiments, the legs with the shell 5021 may have dents and (or) concavities (for example, micro dents) on its surfaces that can receive the ends of deformable elements 5053. In at least one such embodiment, the ends of deformable elements 5053 may fall into these dents in the legs of the brackets 5021 when an extracting force is applied to leg 5021. In various embodiments, as a result of the introduction of the second parts 5153b into the legs of the brackets 5021, the effort to remove the legs of the brackets 5021 from the retaining slots 5022 can only further fix the second parts 5153b to the legs 5021 and increase the force required to remove the legs 5021. due to the fact that the second parts 5153b are tilted upwards, in at least one embodiment, the second parts 5153b can more facilitate the installation of the bracket foot 5021 into the locking slot 5152 and more likely prevent the foot of the foot from being removed slots 5021 from the slot. As a result, in at least one embodiment, the force required to install the bracket foot 5021 into the locking slot 5022 may be less than the force required to remove the bracket foot 5021 from the locking slot 5022. In various embodiments, the force required to remove the foot the brackets 5021 from the locking slot 5022 may be approximately 50% greater than the force required to install the bracket legs 5021 into the locking slot 5022. In other various embodiments, the force required to remove the bracket foot ki 5021 may be approximately 10-100% higher than the force required to install the leg 5021. In certain embodiments, the force required to remove the leg of the bracket 5021 may be approximately 100, 150, 200% and / or more than 200% higher than the force required to install the bracket foot 5021.

In certain embodiments (see FIG. 162), the second portions 5153b may be located around the opening 5152 and form a pocket. In particular, the second parts 5153b may have a pocket 5160 that receives the tip of the leg of the fastener when it is inserted into the hole 5152. In various embodiments, the second parts 5153b of the deformable elements 5153 may have a round (or almost round) contour that defines a round (or an almost round) profile of pocket 1560. In at least one such embodiment, the second portions 5153b may form a conical pocket or a truncated conical pocket. In various embodiments, the pocket may be formed by a suitable number of deformable elements, for example 4 deformable elements 5153 (see Fig. 162), 6 deformable elements 5153 (see Fig. 163) or 8 deformable elements 5153 (see Fig. 164). In certain embodiments (see FIG. 165), deformable elements of a retainer matrix, such as a retainer matrix 5250, may form a figure that has a pyramidal (or substantially pyramidal) shape. In various embodiments, the retainer matrix 5250 may include a plurality of retaining slots, for example retaining slots 5252, which may be defined by a perimeter 5256. In various embodiments, the perimeter 5256 may have a polygonal (or substantially polygonal) profile and / or any other suitable profile. In certain embodiments, the retainer matrix 5250 may include one or more retainer elements, such as retainer elements 5253, that protrude into the hole 5252 and may come into contact with the leg of the fastener when it is inserted into the hole. In at least one such embodiment, each locking element 5253 may have a cantilever that can protrude inward toward the center axis 5259, i.e. toward the center of the slot 5252. In various embodiments, each cantilever may include a first end that is attached to the housing of the stop matrix 5258, and the second end, which forms the perimeter 5256 of the locking slot 5252. In certain embodiments, the perimeter 5256 of the locking slot 5252 may be determined by the first diameter (width), and the leg is stronger a solid element (brackets) can be determined by the second diameter (width), while the second diameter can be larger than the first. In at least one such embodiment, the leg of the fastener may come into contact and bend one (or more) locking element 5253 to increase the diameter of the locking slot 5252 while the leg is being inserted into this slot. In certain embodiments (in addition to the foregoing), the leg of the fastener may define a perimeter that exceeds the perimeter 5256 of the stopper slot 5252, and the leg of the fastener can expand the perimeter 5256 while it is inserted into the slot.

In various embodiments (see Fig. 165), the hole 5252 may be formed by deformable elements 5253, with each deformable element 5253 may bend relative to other deformable elements 5253 or independently. In at least one such embodiment, adjacent deformable elements 5253 can be separated from each other by grooves 5254, which can allow free deformation of each deformable element 5253 relative to each other. In various embodiments, the housing of the retainer matrix 5258 may include a flat (or substantially flat) sheet of material that has a tissue surface 5251 and an upper surface 5257. In at least one such embodiment, the tissue surface 5251 and the upper surface 5257 may be are parallel (or almost parallel) to each other. In various embodiments, each deformable member 5253 may have a first part 5253a and a second part 5253b, with the first part 5253a protruding in the first direction and the second part 5253b protruding in a second direction other than the first. In at least one such embodiment, the housing of the retaining matrix 5258 can perform a plane, and the first parts 5253a of the deformable elements 5253 can lie in this plane. In various embodiments, the second parts 5253b of the deformable members 5253 may project at an angle with respect to the first parts 5253a. In at least one such embodiment, the second parts 5253b may protrude away from the upper surface 5257 of the housing of the retaining matrix 5258, in certain embodiments, the second parts 5253b may converge in the direction of the central axis 5259 of the retaining slot 5252. In any case, in various embodiments, the second parts 5253b may be folded away from the central axis 5259 when the leg of the fastener is inserted into the hole. In certain embodiments (see FIG. 165), the second portions 5253b may be located around the hole 5252 and form a pocket. In particular, the second parts 5253b may form a pocket that receives the tip of the leg of the fastener when it is inserted into the hole 5252. In various embodiments, the second parts 5253b of the deformable elements 5253 may form a polygonal (or substantially polygonal) pocket. In various embodiments, a pocket may be formed by a suitable number of deformable elements, for example 4 deformable elements 5253 (Fig. 165) that form a square, 6 deformable elements 5253 (Fig. 166) that form a hexagon, or 8 deformable elements 5253 (Fig. 167) that form the octagon.

In various embodiments (see FIG. 168), the retainer matrix, such as the retainer matrix 5350, may be made of flat (or substantially flat) sheet material, for example, titanium and (or) stainless steel. In at least one such embodiment, a plurality of slots 5352 may be formed in the housing 5358 of the retainer matrix 5350 using one (or more) stamping processes. A sheet of material may be located on a stamped stamp. When the stamp is actuated, in some parts of the material, for example, grooves 5354, holes 5355 of grooves 5354 and / or perimeter 5356 of the locking slot 5352 can be formed. The stamped stamp can bend deformable elements 5353, giving them a suitable configuration. In at least one such embodiment, the stamped die can deform the second parts 5353b upward relative to the first parts 5353a (along the crease line 5353c). In various embodiments (see FIG. 169), the retainer matrix, such as the retainer matrix 5450, may include a plurality of retaining slots 5452. Like the above, the perimeter 5456 of each retaining slot 5452 may be defined by a plurality of deformable elements 5453 that are separated by grooves (slots) 5454 In at least one such embodiment, each deformable element 5453 can be completely bent upward, while the free ends of the consoles constituting the deformable elements 5453 can define the perimeter 5456. In other embodiments, the retainer matrix 5450 may include a plurality of holes 5455 surrounding (or substantially surrounding) the stop slot 5452. In at least one such embodiment, the holes 5455 may be located in a circular array surrounding the perimeter (the perimeter is defined by the fixed ends of the brackets of the deformable elements 5453 ) In certain embodiments, each hole 5455 may have a circular (or substantially circular) perimeter and / or perimeter of another suitable shape. When using the product, openings 5455 can provide the following advantages: unloading the bases of the deformable elements 5453 attached to the housing of the stopper matrix 5458 and increase the flexibility of the deformable elements 5453. In various embodiments, larger openings 5455 can provide greater flexibility to the deformable elements 5453 than smaller openings 5455. In addition, holes 5455 located closer to deformable elements 5453 can provide greater flexibility than holes 5455 located Shae.

In various embodiments (see FIG. 170), the retainer die, such as the retainer array 5550, may include a plurality of retainer slots 5552. Each retainer slot 5552 may include an elongated groove 5554 having round (or substantially round) ends 5555. At least in in one such embodiment, the ends 5555 may have a diameter wider than the size of the groove 5554. In certain embodiments, the elongated groove 5554 and the ends 5555 may be located along and / or in the center of the longitudinal axis 5559. In various embodiments, the groove 55 54 and the ends 5555 can form two opposite edges 5553, which can come into contact with the leg of the fastener and bend as the legs of the fastener are installed. In at least one embodiment, ends 5555 having a larger perimeter (diameter) can form longer edges 5553 that exhibit greater flexibility than edges 5553 formed by ends 5555 with a smaller perimeter (diameter). In various embodiments, ends 5555 may have the same perimeter (diameter), in at least one similar embodiment, each edge 5553 may be symmetrical to another edge relative to an axis transverse (or substantially perpendicular) to longitudinal axis 5559. Ends 5555 may have different perimeters and (or) diameters, with each edge 5553 being asymmetrical to the other edge relative to its axis. In at least one such alternative embodiment, the edges 5553 may deviate from their axes as the foot of the fastener is inserted into the locking slot 5552. In various embodiments (see FIG. 171), a retainer matrix, such as a retainer matrix 5650, may include multiple locking slots 5652. Each locking slot 5652 may include an elongated groove 5654 having round (or substantially circular) ends 5655. In at least one such embodiment, the elongated groove 5654 and the ends 5655 could be located along and / or in the center of the longitudinal axis 5659. In various embodiments, each end 5655 may have a diameter that is equal to or substantially equal to the width of the groove 5654.

In various embodiments (see FIG. 172), a retainer matrix, such as a retainer matrix 5750, may include multiple retainer slots 5752. Each retainer slot 5752 may include multiple grooves, such as grooves 5754, with enlarged ends 5755. In at least one such In an embodiment, the grooves 5754 and the ends 5755 can be located along and / or in the center of the longitudinal axes 5759. In various embodiments, the axes 5759 can be directed transversely relative to each other. In certain embodiments, the grooves 5754 and the ends 5755 can form four edges 5753, the edges can come into contact with the leg of the fastener and fold back as the leg of the fastener is inserted into the locking slot 5752. In at least one embodiment, each edge 5753 may have a triangular (or almost triangular) shape, for example the shape of an equilateral triangle. In various other embodiments of the invention (see FIG. 173), a retainer matrix, such as a retainer matrix 5850, may include multiple retainer slots 5852. Each retainer slot 5852 may include multiple grooves, such as grooves 5854, with ends 5855, with grooves 5854 and the ends 5855 may be located along and / or in the center of the longitudinal axes 5859. In various embodiments, the axles 5859 may be laterally directed relative to each other. In certain embodiments, the grooves 5854 and the ends 5855 can form the edges 5853, the edges can come into contact with the leg of the fastener and fold back as the leg of the fastener is inserted into the locking slot 5852. In at least one embodiment, each edge 5853 can have an arched profile. In particular, each edge 5853 may include a curved end (as opposed to the pointed end shown in FIG. 170), which may come into contact with the leg of the fastener.

In various embodiments (see FIG. 174), a retainer matrix, such as a retainer matrix 5950, may include multiple retainer slots 5952. Each retainer slot 5952 may include multiple grooves, for example grooves 5954, with each groove 5954 extending along and (or ) in the center of the axis 5959. In various embodiments, the axles 5959 may be transverse to each other. In at least one such embodiment, the axles 5959 can be located so that they all go through the center of the locking slot 5952 and are located at an equal (or almost equal) distance from each other. In at least one embodiment, each groove 5954 may include an open end directed toward the center of the locking slot 5952, as well as a second closed end 5955, opposite the first end of the groove 5954. Like the above, grooves 5954 and ends 5955 can form three edges 5953. which can come into contact with the leg of the fastener and bend as the leg of the fastener is inserted into the locking slot 5952. In various embodiments, each edge 5953 may have an arcuate shape (an arc stretched between rilegayuschimi ends of the slots 5955 5954). In various embodiments (see FIG. 175), the retainer matrix, such as the retainer matrix 6050, may include a plurality of retainer slots 6052. Each retainer slot 6052 may include an edge 6053 that may come into contact with the leg of the fastener and fold back as as the foot of the fastener is inserted into the locking slot 6052. In at least one such embodiment, the edge 6053 may have a base attached to the housing of the locking matrix 6058, as well as a free edge having an arcuate (curved g) profile 6056, which may come into contact with the leg of the fastener. In certain embodiments, the fastener foot may be a bracket foot that is made of rounded wire, with the arcuate profile 6056 being able to match (or almost completely match) the curved surface of the rounded wire.

In various embodiments (see FIG. 175), the housing of the retainer matrix 6058 may include a plurality of grooves 6054 and holes 6055 that may form an edge 6053 and various parts of the retainer slot 6052. In at least one embodiment, the edge 6053 may have a rectangular configuration with parallel (or almost parallel) sides. In certain embodiments (see FIG. 176), the retainer matrix, such as the retainer matrix 6150, may include a plurality of retaining slots 6152. Each retaining slot 6152 may include an edge 6153 that can come into contact with the leg of the fastener and fold back as how the leg of the fastener is inserted into the locking slot 6152. In at least one similar embodiment, the edge 6153 may have a base attached to the housing of the locking matrix 6158, as well as a free end with an arcuate (curved) rofilem 6156, which may come into contact with a leg of the fastening element. In various embodiments, the housing of the retainer matrix 6158 may include a plurality of grooves 6154 and holes 6155 that can form an edge 6153 and various parts of the retaining slots 6152. In at least one embodiment, the edge 6153 may have a conically decreasing configuration with arched sides. In at least one such embodiment, the size of the edge 6153 may decrease geometrically (for example, the base may be wider than the free end).

In various embodiments, as described above, the fastening system may include a plurality of brackets having legs that are inserted into a plurality of locking slots in the locking matrix. In certain embodiments, as described in detail below, the brackets can be held in the first jaw and the retainer matrix can be held in the second jaw, with at least one of the jaws being moved in the direction of the other jaw. Under various circumstances, the brackets located in the first jaw can be fixed in it so that their legs are aligned with the locking slots when the locking matrix comes into contact with the brackets. In certain embodiments (see Figs. 177 and 178), the fastening system may include a cassette with brackets 6200 located in the first jaw of the surgical stapler and a retainer matrix 6250 located in the second jaw of the surgical stapler. In addition to the above (see Figs. 184 and 185), the retaining matrix 6250 may include a plurality of retaining slots 6252, each locking slot 6252 may have a perimeter 6256, which is defined by one or more deformable elements 6253. In at least one such In an embodiment (in addition to the foregoing), deformable elements 6253 defining each hole 6252 may also comprise a pocket 6201. In various embodiments, each pocket 6201 may include a curved and / or concave surface, which she can direct the tip of the bracket foot into the hole 6252 if the bracket foot is not correctly aligned with the locking slot 6252 and first comes into contact with deformable elements 6253 and / or the surface 6251 facing the fabric.

In various embodiments (in addition to the foregoing), the fastening system may also include a plurality of brackets 6220 that have legs 6221 inserted through retaining slots 6252 in the retaining matrix 6250. In at least one such embodiment, each bracket 6220 may have substantially U- a shaped configuration consisting of a base 6222, from which upwardly extending legs 6221 extend. In various embodiments (see Figs. 180 and 181), the retaining slots 6252 in the retaining matrix 6250 may be arranged in two parallel integral (or almost parallel) longitudinal rows that can extend along (parallel) the longitudinal axis of the retaining matrix. In certain embodiments, the locking slots 6252 in the first row may be staggered with the locking slots 6252 in the second row. In at least one such embodiment, each bracket 6220 may include a first leg 6221 located in the locking slot 6252 in the first row, as well as a second leg 6221 located in the locking slot 6252 in the second row. Thus, the bases 6222 may protrude in a direction transverse to the longitudinal axis of the retaining matrix 6250. In at least one such embodiment, the brackets 6220 may be parallel (or substantially parallel) to each other. In particular, the base 6222a of the bracket 6220a may be parallel (or substantially parallel) to the base 6222b of the bracket 6220b, which in turn may be parallel (or substantially parallel) to the base 6222c of the bracket 6220c. In at least one embodiment, the legs 6221a of the brackets 6220a can form a plane parallel to (or substantially parallel to) the plane formed by the legs 6221b of the brackets 6220b, which in turn can be parallel to the plane formed by the legs 6221 of the brackets 6220c.

In various embodiments (see Figs. 177 and 179), the cassette with brackets 6200 may include a plurality of brackets 6220 and further an alignment matrix 6260, which includes a plurality of guides, for example grooves, grooves and / or holes for aligning the brackets 6220. When In various circumstances, the alignment matrix 6260 can be designed so that the legs 6221 of the brackets 6220 align with the stop slots 6252 of the stop matrix 6250 before the stop matrix 6250 comes into contact with the legs of the brackets 6221. in various embodiments (see Figs. 182 and 183), the alignment matrix 6260 may include a plurality of alignment holes 6262 that can receive the legs 6221 of the brackets 6220. In at least one such embodiment, each bracket 6220 may include a base 6222 and two legs 6221, protruding from the base 6222, while the base 6222 of the brackets 6220 may protrude around the bottom surface 6264 of the retaining matrix 6260, and the legs of the brackets 6221 may protrude upward through the alignment holes 6262. In certain embodiments, each hole the winding hole 6262 may have a round (or almost round) shape and is determined by a diameter that is equal to (or almost equal to) the diameter of the leg of the bracket 6221. In various embodiments, the alignment matrix 6260 may also include a plurality of raised elements 6263 that protrude above the alignment surface 6261 matrices 6260 and surround (or partially surround) alignment holes 6262. In certain embodiments, raised elements 6263 can increase the depth of alignment holes 6262, while different circumstances deeper holes 6262 may provide a better alignment of the leg braces 6221 compared with the shallow holes 6262.

When using the product (in various embodiments), the first jaw supporting the cassette with brackets 6200 may be located on one side of the fabric to be sewn, and the second jaw supporting the retainer matrix 6250 may be located on the other side of the fabric. In certain embodiments, after the jaws are correctly positioned relative to the fabric, the second jaw and retainer matrix 6250 can be moved in the direction of the cassette with brackets 6200. As the legs of the brackets 6221 are inserted into the retaining slots 6252 of the retainer matrix 6250, in various embodiments the lower (facing the fabric) surface 6251 of the retaining matrix 6250 may come into contact with the fabric and press it against the upper (facing the fabric) surface 6261 of the alignment matrix 6260. In other various embodiments, of the arrangement, as described in detail below, the cassette with brackets 6200 may also include a compressible cassette housing located above the upper surface 6261 of the alignment matrix 6260. In certain embodiments (see FIGS. 179 and 183), the alignment matrix 6260 may also include one (or more ) hole 6203. When the alignment matrix 6260 is located close to the fabric, these holes can receive part of it. In embodiments in which a compressible cartridge case is located above and / or adjacent to the alignment matrix 6260, a portion of the compressible cartridge case may enter holes 6203 when it is compressed. Similarly, the retainer matrix 6250 may include a plurality of holes 6202 that can receive at least a portion of the fabric when the retainer matrix 6250 is adjacent to it.

In addition to the above, as the legs 6221 of the brackets 6220 are inserted into the locking slots 6252 of the locking matrix 6250, the ends of the legs 6221 may protrude upward from the upper surface 6257 of the locking matrix 6250. Under various circumstances, as described above, the ends of the legs of the brackets 6221 may remain unbent after being inserted into retaining slots 6252. In certain embodiments (see Fig. 186-189), a fastening system consisting of a cassette with brackets 6200 and a retaining matrix 6250 may also include a plurality of protective caps (roofs k), for example caps 6270, which can be worn on the legs of the brackets 6221 protruding from the locking matrix 6250. In various embodiments, each cap 6270 can completely (or partially) cover the sharp end of the legs of the bracket 6221 so that this sharp end will not come into contact with a cloth nearby. In at least one embodiment (see FIG. 189), each cap 6270 may have an opening 6271 that snugly fits the tip of the bracket foot 6221. In various embodiments, the caps 6270 may be made of an elastomeric material, for example, silicone, polyisoprene , sanoprene and (or) natural rubber. In at least one embodiment, the opening 6271 may have a perimeter (diameter) smaller than the perimeter (diameter) of the bracket foot 6221. In at least one such embodiment, the hole 6271 in the protective cap 6270 may expand to accommodate the bracket foot 6221. In various alternative embodiments, caps 6270 may not have holes. In such cases, the ends of the legs of the brackets 6221 can pierce the caps 6270 as the legs 6221 are inserted into them. In any case, in different embodiments, each cap 6270 will cover the legs of the brackets 6221 until the base 6272 of the cap 6270 comes into close contact with the top the surface 6257 of the retaining matrix 6250. Under various circumstances, the caps 6270 may fit snugly against the ends of the legs of the brackets 6221 (removing them from the legs will be difficult). In certain embodiments, each cap 6270 may have a conical (or nearly conical) outer surface. In various embodiments, caps 6270 may have any suitable shape, such as a parabolic (or nearly parabolic) outer surface.

In various embodiments, a fastening system, such as that described above, can be installed in tissues using a surgical stapler (see Fig. 190-192). In various embodiments, the distal working nozzle may include a first jaw (cassette channel with brackets) 6230, which can support a cassette with brackets 6200, and a second jaw 6240, which can support the retainer matrix 6250 and many protective caps 6270. Jaws 6230 and 6240 (see mainly Fig. 190, which shows the second jaw 6240 in an open configuration) can be positioned relative to the fabric "T" so that the fabric "T" is between the retaining matrix 6250 and the cassette with brackets 6200. In different cases In the embodiments as described above, the cassette with brackets 6200 may also include a compressible cassette case, for example a cassette case 6210, in which brackets 6220 and an alignment matrix 6260 can be located. In at least one such embodiment, the fabric “T” can be flush to the upper surface of the cartridge case 6210. In certain embodiments, the second jaw 6240 may include a plurality of recesses (holes) 6245 receiving a plurality of protective caps 6270, and further one or more retaining elements ENTOV intended for retaining the retaining matrix over 6250 caps 6270. In at least one such embodiment the locking matrix 6250 can retain the caps 6270 in apertures 6245. In various embodiments (see. FIG. 202) each orifice 6245 may receive (in whole or in part) the cap 6270. In certain embodiments, the orifices 6245 may be large enough to securely fasten the caps 6270 therein by a snap or press-fit method. In some embodiments, at least one adhesive may be used to secure caps 6270 in openings 6245. In at least one such embodiment, the bonding agent may be selected considering that the caps 6270 can be detached from the second jaw 6240 after interacting with the legs of the brackets 6221 when the second jaw 6240 is moved away from the implanted fastener set. In certain embodiments (see FIG. 203), the second jaw 6240 may also include at least one cover sheet 6246 that can be mounted on the second jaw 6240 and hold the caps 6270 in the openings 6245. In at least one such embodiment, although part of the cover sheet 6246 can be attached to the jaw 6240 using at least one bonding agent. When using the product (in at least one embodiment), the cover sheet 6246 can at least partially detach from the jaw 6240 before placing the distal working nozzle in the surgical field. In certain embodiments, the cover sheet 6246 may be made of an implantable material, such as polydioxanone (MPC) and / or polyglycolic acid (PGA), which can be pierced by the legs of brackets 6221 as they protrude from the retainer matrix 6250. At least in one such embodiment, the cover sheet 6246 may be attached to the mounting system between the covers 6270 and the retainer matrix 6250.

In addition to the above (see Fig. 191), the jaw 6240 can be moved from the open position to the closed position, in which the fabric "T" is located close to the retainer matrix 6250 and the cassette 6210. In this position, the retainer matrix 6250 may not yet make contact with the brackets 6220. In various embodiments, the jaw 6240 can be moved from the open position to the closed position using the feeding device 6235. In at least one similar embodiment, the jaw 6240 may include a distal pin 6243 and are proximal the pin 6244 that protrudes from it, while the distal pin 6243 can slide vertically (or almost vertically) in the distal groove 6233 of the cassette 6230, and the proximal pin 6244 can slide vertically (or almost vertically) in the proximal groove 6234 of the cassette 6230. When using the product, the feeding device 6235 can be shifted in the proximal direction to place the pins 6243 and 6244 in the upper ends of the corresponding grooves 6233 and 6234, as shown in FIG. 191. In at least one such embodiment, the feed device 6235 may include a distal feed chute 6236 and a proximal feed chute 6237, while the side walls of the feed chutes 6236 and 6237 can contact the distal pin 6243 and the proximal pin 6244, respectively, and guide the pins 6243 and 6244 upwards as the feed device 6235 moves proximal. In particular, as the feed device 6235 moves proximally, the distal pin 6243 may move from the inclined first diagonal portion 6236a steel trough 6236 in the middle (second) part of its 6236b. Similarly, the proximal pin 6244 can move from the inclined first part 6237a of the distal groove 6237 to its middle (second) part 6237b. As the pins 6243 and 6244 move up, the jaw 6240 can be rotated downward in the direction of the fabric "T" in the closed position.

In addition to the above (see FIG. 192), the feeder 6235 can be further biased proximally to push the second jaw 6240 down in the direction of the first jaw 6230, to compress the cassette 6210, come into contact with the retainer matrix 6250 and a plurality of protective caps 6270 on the legs of the brackets 6220. In at least one such embodiment, the additional proximal movement of the feed device 6235 may cause the side walls of the feed channels 6236 and 6237 to come into contact with the pins 6243 and 6244, respectively venno and direct the pins 6243 and 6244 downwards towards the lower end of the chute 6233 and 6234, respectively. Under such circumstances, the feed device 6235 can be moved proximally so that the distal pin 6243 exits the second part 6236b of the feed chute 6236 and enters the inclined third part 6236c, and the proximal pin 6244 exits the second part 6237b of the feed chute 6237 and enters the inclined third part 6237c. As the pins 6243 and 6244 move down, the second jaw 6240 can be moved down in the direction of the first jaw 6230 (to the operating position). In at least one such embodiment, the second jaw 6240 may be moved downward so that the retainer matrix 6250 remains parallel (or substantially parallel) to the upper surface of the cassette 6210 and / or parallel (or substantially parallel) to the alignment matrix 6260. In any case after the retainer matrix 6250 and the protective caps 6270 come into contact with the legs 6221 of the brackets 6220, as shown in FIG. 194, the second jaw 6240 may be returned to the open (or substantially open) position. In at least one such embodiment, the feeder 6235 may be distally offset to push the pins 6243 and 6244 into the upper ends of the grooves 6233 and 6234, respectively, and then shifted down towards the lower ends of the grooves 6233 and 6234 after the pins have passed through the middle parts 6236b and 6237b of the respective feed chutes 6236 and 6237. After the second jaw 6240 has been opened, the first jaw 6230 can be disconnected from the implantable cassette 6200, and the first and second jaws 6230, 6240 can be moved away from the implant Rowan sets of fastening elements, as shown in FIG. 193.

Looking again at FIG. 192, you can see that pins 6243 and 6244 are not shown, since they are located at the lowest point of the corresponding slots 6233 and 6234, even though the locking matrix 6250 and the caps 6270 were clamped by the legs of the bracket 6221. Similar circumstances may occur, when a thick fabric “T” is placed between the retainer 6250 and the cassette 6210. If a thinner fabric “T” is placed between the retainer array 6250 and the cassette 6210 housing (see FIG. 195), then the pins 6243 and 6244 can be pushed further downward in the respective grooves 6233 and 6234, as shown in FIG. 197. In general, in at least one such embodiment, the feed device 6235 can be displaced proximally to guide the pins 6243 and 6244 up and down using the steps described above and shown in FIG. 195-197. Due to the smaller thickness of the “T” fabric, the retainer die 6250 and the protective caps 6270 can be further advanced onto the legs 6221 of the brackets 6220, as shown in FIG. 198 and 199. In various embodiments, the degree of adjustability provided by the locking matrix 6250 allows for the same (or almost the same) downforce on the fabric being sewn, regardless of its thickness. In certain embodiments, the degree of adjustability provided by the retainer matrix 6250 allows the surgeon to select the amount of pressure exerted on the tissue by selecting the placement depth of the retainer matrix 6250. In at least one such embodiment, the range of depth of placement of the retainer matrix 6250 on the legs of brackets 6221 may be determined the length of the gutters 6233 and 6234.

In various embodiments, as described above, the protective caps 6270 may consist of a soft or flexible material that is capable of gripping the ends of the legs of the brackets 6221. In certain embodiments, the protective caps 6270 may consist of a bioabsorbable plastic, polyglycolic acid (PGC) (trade name - Vicryl), polylactic acid (PMA or PMA-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PHCL) (trade name - Monocryl), polycaprolactone (PCL) and (or) a mixture of PHC, PMC, MPC PHA, PGKL (Or) PLC, as well as of a biocompatible metal such as titanium, and (or) stainless steel. As shown in FIG. 189, in at least one embodiment, each cap 6270 may not be connected to the other caps 6270. In some other embodiments, one (or more) cap 6270 may be mounted to the retainer matrix 6250. In at least one such embodiment, the caps 6270 can be connected to the retaining matrix 6250 using at least one adhesive, while the holes 6271 in the caps 6270 can be matched (or practically matched) with the locking slots 6252 in the locking matrix 6270. In various embodiments (see FIG. 200), the protective cap, such as cap 6370, may have an inner recess (dome) 6374 that includes the tip of the bracket foot 6221. In at least one such embodiment, cap 6370 may include a bottom 6372 and an opening 6371 starting from the bottom 6372. In various embodiments, the opening 6371 may be defined by one or more deformable elements 6373 that are able to fold back when a bracket leg 6221 is inserted into the hole. In certain embodiments, Two or more caps 6370 may be connected to each other to form an array of caps 6370. In at least one such embodiment (see FIG. 201) a plurality of caps 6370 can be connected to each other by a sheet of material 6375. In certain embodiments, the sheet 6375 can be stiff enough to ensure proper arrangement of the caps 6370. In at least one embodiment, the caps 6370 may consist of a biocompatible metal, such as titanium and / or stainless steel, and sheet 6375 may consist of bioabsorbable plastic, polyglycolic acid (PGC) (trade name - Vicryl), polylactic acid (PMC or PMK-L), polydioxanone (MPC), p ligidroksialkanoata (PHA) poliglekaprona 25 (PGKL) (trade name - Monocryl), polycaprolactone (PCL) and (or) a mixture of PGA, PLA, MPC, PHA PGKL and (or) of PCL. In various embodiments, the sheet 6375 may consist of a bioabsorbable material comprising an antimicrobial agent, for example colloidal silver and / or triclosan, which is stored or distributed within the material and can be released as the bioabsorbable sheet 6375.

In addition to the above, in various embodiments, the sheet 6375 can be injection molded around the caps 6370 by an injection molding process such that the caps 6370 are integrated into the sheet 6375. In some other embodiments, the sheet 6375 can be molded by a molding process under pressure, with holes 6376 can be made in sheet 6375 during injection molding and / or after injection molding by stamping. In any case, the caps 6370 can be inserted and secured in the holes 6376 by a snap and / or press-in method and / or using at least one bonding agent. In certain embodiments, each cap 6370 may have a circular groove that surrounds (or almost completely surrounds) the perimeter of cap 6370 (this perimeter may receive the perimeter of hole 6376). In certain embodiments, sheet 6375 may consist of a flexible and / or ductile material that allows caps 6370 to be offset from one another. In at least one such embodiment, the flexible sheet 6375 may consist of rubber, plastic and / or silicone material, and the caps 6370 may consist of a rigid material, for example metal. Similarly, in at least one such embodiment, the flexible material may be molded around the caps 6370. In certain embodiments, the caps 6370 may be pressed into a preformed sheet 6375. In various embodiments, a durometer may be used to provide the required stiffness of the sheet 6375. In certain embodiments, sheet 6375 may have a flexible portion (strip). In any case, the sheet 6375 can provide for the simultaneous placement of multiple caps 6370 on the distal working nozzle and (or) aligning the caps 6370 simultaneously with the distal working nozzle. In addition, the sheet 6375 connecting the caps 6370, after implantation, can strengthen the tissue along a series of brackets. In addition to the sheet connecting the caps 6370 (or instead), the caps 6370 can be connected by a variety of connections. In at least one such embodiment, such ties may be flexible and allow caps 6370 to move relative to each other.

In various embodiments (see FIGS. 204 and 205), a protective cap, such as cap 6470, may include a shaping surface that is capable of deforming the tip of the bracket leg. In at least one such embodiment, the cap 6470 may have a base 6472, which may include a hole 6471. In various embodiments, the hole 6471 may tightly receive a bracket leg, such as a bracket leg 6221. In at least one embodiment, the hole 6471 may have a diameter (perimeter), which can be equal to the diameter (perimeter) of the legs of the bracket 6221 or exceed it. In various embodiments, cap 6470 may also have a recess (dome) 6474 that receives the tip of the bracket foot 6221 as the foot is inserted into the tip 6470 (see mainly FIG. 205). The cap 6470 may also include a thrust plate (brace-forming surface) 6473, which can bend and deform the leg of the bracket 6221. Under various circumstances, the brace-forming surface 6473 may be curved and / or concave and is able to round the bracket leg 6221 as it is inserted into the cap 6470. In certain embodiments, the leg of the bracket 6221 can be sufficiently deformed to prevent it from being removed from the hole 6471, resulting in the cap 6470 being fixed to the leg of the bracket 6221. At least in in one such embodiment, the base 6472 of the cap 6470 may have a lip protruding around the hole 6471. This lip may prevent the deformed leg of the bracket 6221 from being removed from the recess 6474. Under various circumstances, as a result of the above, one (or more) cap 6470 may prevent the retaining matrix from being detached, for example the locking matrix 6250, from the brackets 6220. In various embodiments (not shown in FIG.), the cap 6470 may be located symmetrically (or almost symmetrically), and the hole 6471 may align along the central axis 6479 of cap 6470. In various alternative embodiments (see FIG. 204) the hole 6471 can be offset relative to the central axis 6479. In at least one such embodiment, the offset hole 6471 allows the bracket leg 6221 to contact the side of the brace-forming surface 6473 and extend to the other side of this surface 6473 (as opposed to the contact with the center of the brace-forming surface 6473, which occurs in embodiments with a hole in the center 6471).

In various embodiments, as described above, the retainer matrix, such as the retainer matrix 6250, may consist of a sheet of material and a plurality of retainer slots 6252. In at least some embodiments, the sheet of material constituting the retainer matrix 6250 may be rigid or substantially inflexible. In some other embodiments, the implementation of the retainer matrix may consist of an array of elements of the retainer matrix and many flexible connections (links) that connect the elements of the matrix with each other. In various embodiments (see FIG. 206), the retainer matrix 6550 (or part thereof) may include a plurality of element bodies 6505 that are fastened to each other by one (or more) link 6507. In at least one embodiment, each housing element 6505 may include a plurality of deformable parts 6553 that form a locking slot 6552. In certain embodiments, the housing of elements 6505 and links 6507 of the locking matrix 6550 may consist of one material and be formed simultaneously. In various embodiments, the retainer die 6550 may be stamped or cast from a metal material, such as titanium and / or stainless steel. In at least one embodiment, the retaining matrix 6550 may consist of plastic, for example polyetheretherketone (PEEK), polypropylene (trade name Prolene), polyester, polyethylene terephthalate (trade names Ethibond and Mersilene), polyvinylidene fluoride, polyvinylidene fluoride fluoride-co-hexa polyhexafluoropropylene-vinylidene fluoride (trade name - Pronova) and (or) long chain aliphatic polymers nylon 6 and nylon 6,6 (trade name - Ethilon & Nurolon), and can be formed by injection molding ION. In certain embodiments, the housing of the elements 6505 may not be formed at the same time as the links 6507. In various embodiments, the manufacturing process may include the production of many individual elements 6505, their subsequent connection and incorporation into the retainer matrix. In at least one such embodiment, the elements 6505 can be stamped from a metal material, such as titanium and (or) stainless steel, and placed in a plastic mold, where plastic material is fed under pressure, forming a rim 6506, which is fully or partially surrounds the element housings 6505, as well as the connecting links 6507 exiting the rims 6506. In some other embodiments, one (or more) connecting lattice may be formed, which includes holes made in a plurality of rims 6506, wherein each such opening may receive an element 6505 casing. In at least one embodiment, each casing 6505 may have an outer circumference of a circular (or substantially circular) shape. Each rim 6506 may have a round (or substantially round) hole inside, and the diameter of the hole may be equal to or less than the diameter of the body of the element 6505. In at least one such embodiment, the element bodies 6505 can be pressed into or integrated into the holes in the rims 6505. In certain embodiments, the element bodies 6505 can be secured in the holes with at least one bonding agent.

In various embodiments (in addition to the foregoing), the retainer matrix may include a plurality of element housings 6505, as well as a plurality of connecting links 6507, which can connect the element housings 6505 to each other as any suitable array (examples are shown in Figs. 207-210) . Regardless of the type of array, in various embodiments, the connecting links 6507 can allow movement of the element housings 6505 and the locking slots 6552 relative to each other. In at least one such embodiment, a lattice consisting of element housings 6505 and connecting links 6507 (constituents of the retaining matrix 6550), after interacting with the fabric, can stretch, bend, contract and (or) deform in another suitable manner, which allows some movement of the matrix in the tissue, however, does not allow its significant movement. In various embodiments, each connecting link 6507 may include a flexible part capable of stretching, bending, and / or contracting, which allows the locking matrix 6550 to bend at the junction of the locking elements 6505. Each link 6507 (see FIG. 206) exiting the rim 6506 may be determined by the width. This width is smaller than the width of the element 6505 and / or rim 6506. In certain embodiments (see FIGS. 207-210), one (or more) link 6507 may include straight parts running along a line laid between adjacent element bodies 6506. In at least one similar embodiment, each link 6507 may include a first end attached to the first rim 6506, as well as a second end attached to the second rim 6506. In certain embodiments (see FIG. 206), two or more links 6507 can be connected to each other ohm In at least one such embodiment, two or more links 6507 may be connected to each other using an intermediate loop 6509. In various embodiments, the loop 6509 may have a reduced thickness of the cross section in one (or more) directions compared to the thickness of the cross section links 6507, which can facilitate the movement of the connected links 6507 relative to each other. In certain embodiments, the retainer matrix 6550 may also include loops 6508 connecting links 6507 and rims 6506; these loops may allow movement of links 6507 and rims 6506 relative to each other. Similarly with loops 6509, loops 6508 can have a reduced thickness of the cross section in one (or more) directions compared to the thickness of the cross section of the links 6507.

In addition to the above, in various embodiments, the connected links 6507 can go in different directions. In at least one such embodiment, the first link 6507 can go in the first direction, and the second link 6507 in the second direction, while the first direction may be different from the second. In certain embodiments, the first link 6507 may extend along the first line and the second link 6507 along the second line, with the first and second lines intersecting at an angle of approximately 30, 45, 60, and / or 90 degrees. In various embodiments, loops 6508 and / or loops 6509 may have a hinge that allows multiple movements of links 6507 relative to each other without breaking them. In certain embodiments, hinges 6508 and / or loops 6509 may have brittle (easily broken) portions that can break if bent too much and / or too often. In at least one such embodiment, such brittle portions may allow one (or more) parts of the retainer matrix 6550 to break off from another part of the retainer matrix 6550. In various embodiments, loops 6508 and / or loops 6509 may include parts of the retainer matrix 6550, which better cut than other parts of the retainer matrix 6550. In particular, the implanted retainer matrix and tissue fixed by the implanted retainer matrix are often (for various reasons) dissected by the cutting segment. To facilitate the passage of the cutting segment through the retaining die 6550, loops 6508 and / or loops 6509 may have thinned portions. In various embodiments (in addition to the foregoing), the connecting links 6507 may include one or more chased sections that facilitate folding, breaking and / or cutting of the connecting links 6507.

In various embodiments, the implementation of the retainer matrix may include many elements, for example elements of the housing of the matrix 6505, which can be embedded in a flexible sheet (strip) of material. In at least one embodiment, the flexible sheet may consist of a bioabsorbable elastomeric material, for example silicone, and have multiple openings. In at least one such embodiment, the manufacturing process of this sheet may include molding followed by perforation. In various alternative embodiments, the flexible sheet may be molded and perforated therein may be performed during the molding process. In any case, the elements of the retaining matrix 6505 can be inserted into the flexible sheet and fixed in it. In some other embodiments (like the above), the flexible sheet may be formed around matrix elements 6505. In at least one embodiment, the flexible sheet may be made of woven mesh and / or other suitable material. Such materials may be better suited to cutting.

In various embodiments (see FIGS. 211 and 212), a fastening system consisting of a retainer matrix, such as a retainer matrix 6250, may also include a cover, such as a cover 6670, that can cover the ends of the legs of brackets 6221 protruding from the upper surface 6257 of the retainer matrix 6250. In various embodiments, the cover 6670 may be attached to the retainer matrix 6250. In certain embodiments, the cover 6670 and / or retainer matrix 6250 may include retainer elements that hold the cover 6670 to the retainer mat Rice 6250. In at least one embodiment, at least one bonding agent may be used to attach the cap 6670 to the retainer die 6250. In at least one embodiment, cap 6670 may consist of one layer. The cover 6670 shown in the figure consists of two layers (a detailed description is given below). In various embodiments (see mainly Fig. 212), the ends of the legs of the brackets 6221 may protrude through the lower surface 6673 of the cover 6670, however, the cover 6670 may have a thickness sufficient to prevent the tips of the legs from penetrating the upper surface 6675 of the cover 6670. As a result, in at least one such embodiment, the ends of the legs of the brackets 6221 may not protrude from the cover 6670. In various embodiments, the cover 6670 may include multiple layers. In at least one such embodiment, the cap 6670 may include a first layer 6671 and a second layer 6672. In at least one embodiment, the first layer 6671 and the second layer 6672 may be attached to each other, in at least one embodiment the second layer 6672 may include a lower surface 6676 adhered to the first layer 6671. In various embodiments, the first layer 6671 and the second layer 6672 may have different thicknesses. In certain embodiments, these layers may have the same thickness. In at least one embodiment, the first layer 6671 and the second layer 6672 may have substantially the same thickness and / or length. In alternative embodiments, layers 6671 and 6672 may have different thicknesses and / or lengths.

In various embodiments (in addition to the foregoing), the first layer 6671 may consist of compressible foam, mesh and / or hydrogel, which can be cut by legs of brackets 6211. In at least one embodiment, the second layer 6672 may consist of more strong material, for example, Freight One, MPC and / or other suitable supporting material. In at least one such embodiment, the legs of the brackets 6221 may pierce the first layer 6671, however, in various embodiments, the legs of the brackets 6221 may not pierce the second layer 6672. In certain embodiments, the second layer 6672 may consist of a sufficiently rigid (strong) material which can come into contact with the leg of the bracket 6221 and not be cut (or only partially cut) by the tip of the leg of the bracket 6221. The cover can consist of more layers, one of the layers being m is resistant to puncture brackets (not shown in the figure). When using the product (in at least one such embodiment), the retainer matrix 6250 can be positioned close to the fabric to be fixed and pressed down so that the legs 6221 of the brackets 6220 are pushed through the fabric "T" and the locking slots 6252 of the retaining matrix 6250 and enter the first layer 6271 of the cover 6270. In various embodiments, the ends of the legs of the brackets 6221 may not enter (or only partially enter) the second layer 6272 of the cover 6270. After the locking matrix 6250 is positioned correctly, the jaw 6240 can be opened, and the cap 6670 and the retaining die 6250 can be detached from the jaw 6240, as shown in FIG. 211. As shown in FIG. 211, the jaw 6640 may hold more than one retainer matrix 6250 and a cover 6670. In at least one such embodiment, the jaw 6640 may include two channels 6679, each of which may receive a cover 6670 and a retainer matrix 6250, such that the tissue-facing surface 6251 of each retainer matrix 6250 will be directed downward from the bottom surface of the jaw 6240. In at least one such embodiment, the retainer matrix 6250 and the cap 6270 may be located in the jaw 6640 on both sides of the groove for 6678. When using the product, the locking matrix 6250 and covers 6670 can be installed simultaneously and (or) to the same depth relative to the opposite cassette with brackets, for example cassette 6200. Thus, in various embodiments, the stitched fabric can be cut along the cutting line with a cutting segment that abuts the groove for knife 6678, after this branch 6640 can be re-opened. In certain embodiments, the covers 6670 may not be attached to the retainer matrix 6250. In at least one such embodiment, the covers 6670 may be located in channels 6679 and held in channels 6679 by retainer matrices 6250 that are secured by jaw 6640. In various embodiments, each the locking matrix 6250 may be wider and / or longer than the corresponding covers 6670, the locking matrix 6250 can completely hold the cover 6670 in place. In certain embodiments, each retainer matrix 6250 may be the same length and / or width with cover 6670.

In various embodiments, as described above, the fastener system may include a layer of material that can be attached to a retainer matrix, such as a retainer matrix 6250. In at least one embodiment (see FIG. 215), a layer of material 6870 can be attached to the lower surface 6251 of the retainer matrix 6250. In certain embodiments, the layer 6870 and / or the retainer matrix 6250 may include retainer elements that are designed to hold the layer 6870 close to the retainer matrix 6250. In at least one In an embodiment, at least one bonding agent may be used to adhere the layer 6870 to the retainer matrix 6250. In any case, the layer 6870 may include a lower (fabric facing) surface 6873 that may come in contact with the “T” fabric when the retainer matrix 6250 moves down in the direction of the brackets 6220 to allow the locking slots 6252 to interact with the legs of the brackets 6221. In at least one such embodiment, the layer 6870 may consist of a compressible material, such as bioabsorbable foam, cat paradise can be compressed between the bottom surface of the stopper 6251 and the tissue matrix 6250 «T». In various embodiments, layer 6870 may also include at least one drug stored and / or distributed in layer 6870. This drug may be released from layer 6870 as it is compressed. In at least one embodiment, the medicament may include at least one tissue sealant, hemostatic agent and / or antimicrobial material, for example, ionized silver and / or triclosan. In various embodiments, the compression of layer 6870 can squeeze the drug out of layer 6870 so that the surface of the T fabric is completely (or mostly) covered by the drug. In addition, as the layer 6870 is compressed and the “T” fabric and layer 6870 are punctured by the legs of the brackets 6221, the drug can drain down the legs of the brackets 6221 and have a therapeutic effect on the tissue cut by the legs of the brackets 6221. In various embodiments, the housing of the retainer matrix 6250 may include the first layer consisting of a biocompatible material, for example titanium and (or) stainless steel, as well as the lower (second) layer 6870, consisting of a bioabsorbable material, for example, oxidized reduced OEC pulp), a biologically active overt substances such as fibrin and (or) thrombin (liquid or lyophilized), glycerol, absorbable porcine gelatin (in the form of flakes or foam) and (or) antimicrobial agents, e.g. ionized silver and (or) triclosan. Additional bioabsorbable materials: Surgicel Nu-Knit, Surgicel Fibrillar, a mixture of collagen and OVC embedded in a collagen matrix (trade name - Promogran), polyglycolic acid (PGC) (trade name - Vicryl), polylactic acid (PMC or PMK-L), polydioxanone (MPC), polyhydroxyalkanoate (PHA), polyglexaprone 25 (PGKL) (trade name - Monocryl), polycaprolactone (PCL) and (or) a mixture of PGK, PMK, PDK, PHA, PGKL and (or) PCL. Despite the fact that in FIG. 215, only one layer 6870 is shown; any suitable number of layers may be used. In at least one embodiment, the first layer comprising the first drug may be attached to the retainer matrix 6250, and the second layer comprising the second (other) drug may be attached to the first layer. In at least one such embodiment, multiple layers may be used, each layer may include different drugs and / or different combinations of drugs.

In various embodiments (see FIG. 213), the fastener system may include a layer of material 6770 attached to the bottom surface 6251 of the retainer matrix 6250. In certain embodiments, the layer 6770 and / or the retainer matrix 6250 may include retainer elements for holding the layer 6770 adjacent to the retainer die 6250. In at least one embodiment, at least one adhesive may be used to adhere the layer 6770 to the retainer die 6250. In any case, the layer 6770 may include a bottom (fabric-facing) surface 6773 that may come in contact with fabric “T” when the retainer matrix 6250 is moved downward in the direction of the brackets 6220 to allow the retaining slots 6252 to interact with the legs of the brackets 6221. In at least one such embodiment, layer 6770 may consist from a compressible material, for example, bioabsorbable foam, which can be compressed between the bottom surface 6251 of the retainer matrix 6250 and the fabric "T". In various embodiments, the implementation of the layer 6770 may also include one (or more) capsule (cell) 6774, in which at least one drug can be stored. In certain embodiments (see FIG. 214), capsules 6774 may be matched (or substantially matched) with retaining slots 6252 such that the legs of brackets 6221 pushed through fabric “T” and layer 6770 may pierce and / or other thus violating the integrity of the capsules 6774. After the integrity of the capsules 6774 is violated, at least one drug “M” in the capsules 6774 may leak onto the tissue “T”. In at least one such embodiment, the drug “M” may include fluid that can drain down the legs of the brackets 6221 and have a therapeutic effect on the tissue “T” cut by the legs of the brackets. As a result of the above, the drug stored in capsules 6774 may have a local therapeutic effect on the tissue. In certain embodiments, capsules 6774 in sheet 6770 may contain various drugs. For example, the first group of capsules 6774 may contain a first drug or a first combination of drugs, and the second group of capsules may contain another drug or a different combination of drugs. In various embodiments, the implementation of the layer 6770 may consist of a flexible silicone sheet, and capsules 6774 may represent spaces (voids) in the silicone sheet. In at least one such embodiment, the silicone sheet may include two layers that can be attached to each other, with capsules 6774 can be located between the two layers. In various embodiments, layer 6770 may include one (or more) thinning (weakening) sections, such as partial perforations, which may facilitate cutting of layer 6770 and integrity of capsules 6774 by legs 6221. In certain embodiments, at least a portion of capsules 6774 may be located inside the domes 6777, while the domes 6777 may protrude upward from the sheet 6770. In at least one such embodiment, the domes 6777 and / or at least a portion of the capsules 6774 may be located in pockets 6201 formed inside the retainer matrix 6250. In certain embodiments, the capsules 6774 may include separate cells that are not connected to each other. In other specific embodiments, the capsules 6774 may be in fluid communication with each other, that is, be connected to each other by strokes, tubes and / or channels within the layer 6770. The contents of US patent No. 7 780 685 entitled "MECHANICAL AND ADHESIVE FIXING SYSTEM" ( ADHESIVE AND MECHANICAL FASTENER), published on August 24, 2010, is fully incorporated into this application by reference.

In various embodiments (in addition to the foregoing), a cassette with brackets including a cassette body, brackets and / or alignment matrix may be loaded into the first jaw of the distal working nozzle; similarly, the retainer matrix and (or) one (or more) cover can be loaded into the second branch of the distal working nozzle. In certain embodiments (see FIG. 216), a tool, such as a cassette loader 6990, can be used to simultaneously insert two or more cassettes with fasteners into a distal work head. In at least one embodiment, the cartridge loader 6990 may include a handle 6991 and the cartridge carrier 6992. The cartridge carrier 6992 may include a first holding portion for holding the cartridge body 6210 with brackets 6200, and additionally a second holding portion for holding the cartridge body 6980 which supports a plurality of protective caps 6270 and a retaining matrix 6250 along the bottom surface. In various embodiments, the first and second holding portions may include one (or more) locking element that is in contact with the cases of the cassettes 6210 and 6980. When using the product (see Fig. 217 and 218), the distal working nozzle may include a first (lower) jaw 6230 and the second (upper) jaw 6940. A cassette with brackets 6200 can be loaded into the first jaw 6230, and the cassette body 6980 can be loaded into the second jaw 6940. Under various circumstances, the upper jaw 6940 can be moved from the open position (Fig. 217) to the closed position (Fig. 218) using feed device 6235. The use of feed device 6235 is described above and is not repeated for brevity. After the upper jaw 6940 is brought to the closed position (see FIG. 218), the distal end 6993 of the carrier of the cassette 6992 can be inserted into the distal work nozzle so that the cassette with brackets 6200 slip through the distal end 6938 of the first jaw 6930, and then in the first adjacent portion (channel) 6939 in the first jaw 6230. Similarly, the distal end 6993 of the cartridge carrier 6992 can be inserted into the distal working nozzle so that the cassette body 6980 slides through the distal end 6948 of the second jaw 6940, and then into the second the adjacent part (channel) 6949 in the second jaw 6940. A surgeon (or other doctor) holding the handle 6991 of the cassette loader 6990 can push the cassette with brackets 6200 and the cassette body 6980 through channels 6939 and 6949, respectively, until the cassette with brackets 6200 and the 6980 cassette case will not be fully installed in these channels.

After placing the cartridge with brackets 6200 and the cartridge case 6980, each of these elements can come into contact with one (or more) sections of the respective branches 6230 and 6940, as described in detail below. In any case, after placing the cartridge with brackets 6200 and the cartridge case 6980 (see Fig. 219), the cartridge loader 6990 can be disconnected from the cartridge 6200 and the case 6980 and removed from the distal working nozzle. In at least one such embodiment, the holding force between the cassette with brackets 6200 and the first jaw 6230 may be greater than the holding force between the cassette with brackets 6200 and the carrier of the cartridge 6992. Thus, when the carrier of the cartridge 6992 is removed distally from the distal working nozzles, the cassette with brackets 6200 may remain behind in the first jaw 6230. Similarly, the holding force between the cassette 6980 and the second jaw 6940 may be greater than the holding force between the cassette 6940 and the nose cartridge 6992. Thus, when the carrier of the cartridge 6992 is distally removed from the distal working nozzle, the cartridge case 6940 may remain behind in the second jaw 6940. After removing the cassette loader 6990 from the distal working nozzle, the loaded first jaw 6230 and the loaded second jaw 6940 can be appropriately positioned relative to the “T” stitched fabric. The second jaw 6940 (see. Fig. 220) can be shifted from the open position (Fig. 219) to the used position (Fig. 220) to ensure contact between the locking matrix 6250 (with many protective caps 6270 on the cassette 6980) and brackets 6220 located in cassette 6200.

The second jaw 6940 (see FIGS. 221 and 222) can be re-opened, and the plurality of protective caps 6270 and the holding matrix 6250 can be removed from the cassette body 6980 so that the caps 6270 and the locking matrix 6250 remain in contact with the “T” fabric ”And a cassette with brackets 6200. In at least one embodiment, the cassette body 6980 may include a plurality of pockets in which a plurality of caps 6270 can be removably disposed, as well as one or more locking grooves that are removably held close to the cassette for one hundred pore array 6250. In various embodiments, the retaining parts of the second jaw 6940 in contact with the cassette 6980 can hold the cassette 6980 in the second jaw 6940 after the second jaw 6940 has been opened. In certain embodiments, the cassette body 6980 may rupture as the second jaw 6940 opens. A portion of the cassette body 6980 is implanted with caps 6270 and holding matrix 6250, and a portion of the cassette body 6980 remains in the second jaw 6940. Similarly (see Fig. 221 and 222) holding parts of the first jaw 6230 in contact with the cassette 6210 can hold the cassette 6210 in the first jaw 6230 after the second jaw 6940 has been opened. In certain embodiments, the cartridge case 6210 may rupture as the first jaw 6230 moves away from the implanted cartridge 6200. A portion of the cartridge case 6210 is implanted with brackets 6220 and alignment matrix 6260, and a portion of the cartridge case 6210 remains in the first branch 6230. In various embodiments (see FIGS. 223-225), the cassette with brackets, for example the cassette with brackets 6900, may include one (or more) longitudinal locking groove 6913 extending along the length of the cassette 6910. When the cassette with brackets 6900 inserts In the jaw 6930, the retaining groove may receive one (or more) longitudinal retaining rails 6916 that protrudes from the jaw 6930. When using the product (in at least one embodiment), the end of the retaining grooves 6913 can be aligned with the distal ends of the retaining guides 6916 before the cassette with brackets 6900 is shifted towards the distal end 6938 of the holding channel 6939.

In various embodiments (see FIG. 225), the jaw 6940 may include two holding channels 6949, with each holding channel 6949 receiving a cassette body 6980 including a plurality of caps 6270 and a retaining die 6250. In certain embodiments, each cassette body 6980 may include one (or more) longitudinal retaining arms 6917, which may slide along one or more longitudinal retaining rails 6918 of the second jaw 6940 as the cassette bodies 6980 are inserted into respective guides shrinking channels 6949 in jaw 6940. In various embodiments, the locking guide rods 6918 and the locking arms 6917 can jointly hold the cassette body 6980 in the second jaw 6940 as the cassette bodies 6980 are separated from the caps 6270 and the stop matrix 6250. In various embodiments (see Fig. 224) the second jaw 6940 may also include one (or more) distal protrusion (retaining part) 6915, which protrudes from the jaw and is capable of reversibly fixing the cassettes 6980 in the respective holding channels. In at least one such embodiment, the second jaw 6940 may include a distal protrusion 6915, which may be positioned relative to each holding channel 6949 so that each cartridge case 6980 is able to round the protrusions 6915 as the cartridge cases 6980 are inserted into channels 6949 Once the cassette housings 6915 are completely located in the channels 6949, the distal ends of the cassette bodies 6980 can extend over the protrusions 6915. To remove the cassette bodies 6980 after use, as described above, they can pull back over the protrusions 6915 and remove the cartridge cases 6980 from the retaining channels 6949. Like the above, the first jaw 6930 may include one (or more) distal retaining protrusion 6914, which protrudes from the jaw and can take one (or more) retaining groove (groove ) 6912 (Fig. 223) of the cassette 6910 when the cassette with brackets 6900 is fully installed.

In various embodiments (in addition to the above), a first cassette with a plurality of first fasteners may be located in a first branch of a surgical stapler, and a second cassette with a plurality of second fasteners may be located in a second branch of a surgical stapler. When using the product, the first jaw and (or) the second jaw can be shifted to each other, which leads to the interaction between the first and second fasteners and stitching of the fabric located between them. In certain embodiments, the first cassette and the second cassette can interact with each other as the first fasteners interact with the second. In at least one embodiment, the housing of the first cartridge may consist of a first compressible material, and the housing of the second cartridge may consist of a second compressible material, wherein the first housing and / or the second housing may be pressed against the fabric to be sewn. After flashing the tissue, the first jaw can be removed from the implanted first cassette, and the second jaw can be removed from the implanted second cassette. After that, to reuse the surgical stapler, another first cassette can be inserted in the first jaw and a different cassette in the second jaw. In some embodiments, brackets are used, while in others, other types of fasteners are used, for example, two-piece elements that are locked in contact with each other. In at least one such embodiment, the first cartridge may include a first portion for storing the first parts of the two-component fasteners, and the second cartridge may include a second portion for storing the second parts of the two-component fasteners. In various embodiments, the fastening systems described herein may use various fasteners consisting of any suitable material and / or having any suitable shape. In certain embodiments, fasteners may include penetrating components. Such penetrating components may consist of a polymer, composite and / or multilayer substrate. An example of a multilayer substrate is a wire or sheet substrate with an elastomeric or polymer coating. The substrate may be a thin sheet, designed so that the penetrating components are oriented transversely (or almost perpendicularly) relative to the connecting parts. Penetrating components may have a rectangular profile, a semicircular profile and / or a beam profile. In various embodiments, the fasteners described herein may be fabricated using any suitable process (eg, extrusion molding process). Another possible method of manufacturing hollow penetrating components is microtechnology. Such penetrating components can be manufactured using a process other than the process of forcing the wire, a combination of materials may be used in their manufacture.

As described above, the ends of the legs of the brackets protruding through the retaining matrix can be covered with caps and (or) covers. In certain embodiments, the ends of the legs of the brackets may be deformed after passing through the retaining matrix. In at least one embodiment, the jaw that contains the retainer matrix may also include abutment pockets located above and / or associated with the retaining slots. These pockets can deform the legs of the brackets as the legs penetrate the retaining matrix. In various embodiments, the legs of each bracket may be bent inward toward each other and / or toward the center of the bracket. In other specific embodiments, one (or more) of the brace legs may be bent inward from other legs and / or from the center of the bracket. In various embodiments, regardless of the direction of bending of the staple legs, the ends of the staple legs can contact the housing of the retainer matrix and not re-enter the fabric stitched with brackets. In at least one embodiment, deformation of the legs of the brackets after they pass through the retainer matrix can lock the retainer matrix in place.

In various embodiments (see FIGS. 226 and 227), a surgical stapler, such as a surgical stapler 7000, may include a first jaw 7030 and a second jaw 7040, while the second jaw 7040 can be pushed forward and removed from the first jaw 7030 using feed device 6235. The use of feed device 6235 is described above and is not repeated for brevity. In various embodiments, the first jaw 7030 may include a distal end 7031 and a proximal end 7032, wherein the first jaw 7030 may have a channel extending from the distal end 7031 to the proximal end 7032 (this channel is for receiving a cassette with brackets). For illustrative purposes, the cartridge case is not shown in FIG. 226. Such a cartridge may include a housing, brackets 6220 located inside the housing, and brackets 7012 located under the brackets 6220. In certain embodiments (not shown in FIG. 226 for brevity), the second jaw 7040 may hold the retainer matrix (eg , retainer matrix 6250) over the brackets 6220 and / or move the retainer matrix in the direction of the legs of the brackets 6220, as described above. In at least one embodiment, the surgical stapler 7000 may also include a slide 7010 located on the first jaw 7030. The slide can slide from the distal end 7031 of the first jaw 7030 to the proximal end 7032 and lift the brackets 7012 as well as the brackets 6220 up in the direction the retainer matrix and the second jaw 7040. In various other embodiments, the slide 7010 may shift from the proximal end 7032 to the distal end 7031 (to set the brackets 6020). In at least one embodiment, the slide 7010 may include one or more inclined cam surfaces 7011 that can slide under the brackets 7012 and lift the brackets 7012 up. In various embodiments, the surgical stapler 7000 may also include a pushing (pulling) lever connected to the slide 7010. This lever can be displaced proximally and (or) distally using a feed device located on the handle and (or) on the stem of the surgical stapler 7000 .

In various embodiments (see FIG. 226), the second jaw 7040 of the surgical stapler 7000 may include a frame 7041, a distal end 7048, and a proximal end 7049 that is opposite the distal end 7048. In certain embodiments, the second jaw 7040 may also include a guide system , which consists of one or more guide rods, for example guide rods 7045 and 7046, which extend along the longitudinal axis of the frame 7041. The guides, as described in detail below, can guide one (or more) an orifice (cam) plate, which may come into contact with the brackets 6220 and deform them after the legs 6221 of the brackets 6220 have passed through the retaining matrix. In at least one such embodiment, the guide rods 7045 and 7046 may include a guide wire (cable) that runs along the upper surface of the frame 7041, bends around the distal pin 7047, and then re-runs along the upper surface of the frame 7041. In various embodiments, how indicated above (see mainly Figs. 228 and 230), the second jaw 7040 may also include one (or more) thrust (cam) plate, for example, the first thrust plate 7050 and the second thrust plate 7060, which can be displaced longitudinally along the length l of the second jaw 7040, deforming the legs of the brackets 6220 after they passed through the retaining matrix. In at least one embodiment, the surgical stapler 7000 may also include a first leading, or feeding, device 7051, coupled and / or acting in conjunction with the first thrust plate 7050, the feeding device may pull the first thrust plate 7050 in the proximal direction and (or ) push it in the distal direction. Similarly, in at least one embodiment, the surgical stapler 7000 may also include a second host device coupled and / or acting in conjunction with a second abutment plate 7060, the delivery device may push the second abutment plate 7060 distally and / or pull her in the proximal direction. In various embodiments, the first abutment plate 7050 may include guide grooves 7052, and the second abutment plate 7060 may include guide grooves 7062; the guide grooves can slidably receive the rods 7045 and 7046. In at least one such embodiment, the guide rods 7045 and 7046 can fit tightly into the guide grooves 7052 and 7062 so that lateral (lateral) displacement of the rods will be limited or impossible.

In certain embodiments (in addition to the foregoing), the first abutment plate 7050 can be extended in the proximal direction, and the second abutment plate 7060 can be extended in the distal direction. In at least one embodiment (see FIG. 226), the guide rods 7045 and 7046, as well as the distal pin 7047, can constitute a block system that can pull the second thrust plate 7060 in the distal and / or proximal directions. In at least one such embodiment, the guide rod 7045 and the guide rod 7046 may be a continuous wire (cable) that surrounds the distal pin 7047, while part of the continuous wire to cyclically advance (extend) around the distal pin 7047. In various embodiments, the guide the bar 7046 can be mounted on the second thrust plate 7060 so that when the continuous cable moves in the first direction, the second thrust plate 7060 can be displaced distally in the direction the distal end 7048 of the jaw 7040, and when the continuous cable moves in the second (opposite) direction, the second abutment plate 7060 can move proximally towards the proximal end 7049. In at least one embodiment (see FIG. 228), the guide rod 7046 can transmit pulling force along the guide groove 7062. In at least one such embodiment, the guide rod 7045 may slide in another guide groove 7062. In various embodiments, the first thrust plate 7050 may act independently of the second thrust plate 7060, and the block system and the guide grooves 7052 of the first thrust plate 7050 can slide the guide rods 7045 and 7046 in a sliding manner, allowing the relative movement of the rod into the groove. In various embodiments, a continuous cable including guide rods 7045 and 7046 may have sufficient flexibility to open and close the upper jaw 7040. The continuous cable may also have sufficient flexibility to facilitate the vertical movement of the second retainer plate 7060 toward the lower jaw 7030 and from her (this is described in more detail below).

In various embodiments (see Figs. 228 and 230), the first thrust plate 7050 may include cam followers 7055, which may engage in cam grooves (guide grooves), for example, grooves 7070 (Fig. 231) formed in a second jaw frame 7041 7040. In particular, in at least one embodiment, the frame 7041 may include a first cam groove 7070 extending along the first side of the frame 7041, and a second cam groove 7070 extending along the second (opposite) side of the frame 7041. The cam followers 7055, protruding from the first side of the first the thrust plate 7050 may enter the first cam groove 7070, and the cam followers 7055 protruding from the second side of the first thrust plate 7050 may enter the second cam groove 7070. In at least one such embodiment, the contours of each cam groove 7070 may be identical (or almost identical) to each other, and can also be combined (or almost completely combined) with each other. Similarly, in various embodiments, the second thrust plate 7060 may include cam pushers 7065 that can engage in cam grooves 7070 (FIG. 231) formed in frame 7041 of the second jaw 7040. In particular, in at least one embodiment, the cam pushers 7065 protruding from the first side of the second thrust plate 7060 can enter the first cam groove 7070, and cam followers 7065 protruding from the second side of the second thrust plate 7060 can enter the second cam groove 7070. When using and The cam pushers 7055 of the first thrust plate 7050 and the cam pushers 7065 of the second thrust plate 7060 can slide in the cam grooves 7070 so that the first thrust plate 7050 and the second thrust plate 7060 follow the contours of the grooves 7070 as the first thrust plate 7050 and the second the thrust plate 7060 moves in the proximal and (or) distal directions. In various embodiments, each cam groove 7070 may have a plurality of upper parts 7071 and a plurality of lower (leading) parts 7072 that can move the thrust plates 7050 and 7060 vertically (in and out of the lower jaw 7030) simultaneously with the longitudinal movement of the thrust plates 7050 and 7060 (between the distal end 7048 and the proximal end 7049 of the frame 7041), as described in detail below.

When the surgical stapler 7000 is inoperative (see FIG. 231), the first abutment plate 7050 may be located at the distal end 7048 of the frame 7041, and the second abutment plate 7060 may be located at the proximal end 7049 of the frame 7041. In addition, the brackets 6220 (see FIG. 232) located in the first jaw 7030 may not yet be inserted into the “T” tissue and / or retainer matrix when the surgical stapler 7000 is inoperative. When using the product (see Fig. 233), the brackets 6220 can be brought up into the recesses for the brackets 7033 of the cartridge using the brackets 7012. The first thrust plate 7050 can be displaced proximally from the distal end 7048 of the frame 7041 in the direction of the distal end 7049 to interact with the legs 6221 of the brackets 6220. In at least one embodiment, the brackets 6220 can be brought up before the first thrust plate 7050 comes into contact with the legs of the brackets 6221. In various embodiments, all brackets 6220 can be moved upwards by the slide 7010 before the first thrust plate 7050 is moved close to the legs of the brackets 6221. Alternative: the slide 7010 can be displaced proximally simultaneously with the proximal movement of the thrust plate 7050. In this case, the slide 7010 can go before the first thrust plate 7050 ( brackets 6220 will be placed before the first thrust plate 7050). In various embodiments (as shown in FIG. 233), the cam grooves 7070 may be positioned so that the brace-forming surfaces, for example the brace-forming (cam) surfaces 7053 and 7054 of the first cam 7050, can contact at least some of the legs of the brackets 6221 when the first cam 7050 goes through the upper position. Under various circumstances, cam pushers 7055 of the first thrust plate 7050 may be located in the upper part 7071 of the cam grooves 7070. The bracing surfaces 7053 and 7054 are in the raised position and the legs of the brackets 6221 are only partially deformed when the thrust plate 7050 is brought to the upper position. As the first cam 7050 moves along the cam grooves 7070, as shown in FIG. 234, cam pushers 7055 of the first thrust plate 7050 can be brought into the lower parts 7072 of the cam grooves 7070. The bracing surfaces 7053 and 7054 are shifted vertically downward towards the legs of the brackets 6021 to bring them into the final formed configurations. Thereafter, as the first thrust plate 7050 moves further along the cam grooves 7070, the first thrust plate 7050 can be shifted vertically upward to another set of upper parts 7071 of the cam grooves 7070. As shown in FIG. 233 and 234, the first thrust plate 7050 can only come into contact with some, but not all, legs of the brackets. In at least one such embodiment, the first thrust plate 7050 can deform only a group of bracket legs (for example, distal legs 6221 of brackets 6220). In at least one such embodiment, the first abutment plate 7050 can deform the distal legs of the brackets 6221 toward the center of the brackets 6220. In various embodiments, each proximal leg of the bracket 6221 can come into contact twice with the first abutment plate 7050 (with the first brace-forming surface 7053 and a second bracket-forming surface 7054, which is mapped to the first surface 7053). In at least one such embodiment, the brace-forming surfaces 7053 can deform the distal legs of the brackets 6221, leading them to a partially deformed configuration when the first stop plate 7050 is in the upper position; the second bracket-forming surfaces 7054 can deform the distal legs of the brackets 6221, leading them to a completely deformed configuration when the first thrust plate 7050 moves to the lower position. In various embodiments (see Figs. 228 and 229), the first thrust plate 7050 may include a plurality of first brace-forming surfaces 7053 and second brace-forming surfaces 7054 that deform the distal legs 6221 of the brackets 6220 if the legs of the brackets 6221 are installed in one or more rows (lines ) In various embodiments, as described in detail below, the proximal legs 6221 of the brackets 6020 may be deformed by a second abutment plate 7060.

In various embodiments (in addition to the foregoing), the first retainer plate 7050 can be moved from the distal end 7048 of the frame 7041 to the proximal end 7049 to deform all distal legs 6221 of the brackets 6220. It can be noted that the first retainer plate 7050 can move up and down relative to undeformed proximal legs of brackets 6221. To compensate for such relative movements in various embodiments, the first retaining plate 7050 may include one (or more) lumen 7057 (Fig. 230). The gaps may receive the bent proximal legs of the brackets 6221 as the first abutment plate 7050 bends the distal legs of the brackets 6221. Similarly (see FIG. 228), the second abutment plate 7060 may include a lumen 7067 that can compensate for the vertical movement of the first feed device 7051, moving up to down as the first thrust plate 7050 moves from the upper to the lower position, as described above. After all the legs of the brackets 6221 are bent (in at least one embodiment), the second abutment plate 7060 can be moved from the proximal end 7049 of the frame 7041 to the distal end 7048 by means of a feed device 7061 of the abutment plate. Like the above (see FIG. 235), cam followers 7065 of the second stop plate 7060 can slide in the cam grooves 7070 so that the second stop plate 7060 moves between the upper and lower (leading) positions, deforming the proximal legs of the brackets 6221 inward to the center of the brackets 6220. Like the above, the second thrust plate 7060 may include a plurality of first brace-forming (cam) surfaces 7063, as well as a plurality of second brace-forming (cam) surfaces 7064. These surfaces may at least partially and ( or) completely deform one (or more) proximal leg of bracket 6021. The second retaining plate 7060 (see FIG. 229) may include a plurality of first brace-forming surfaces 7063 and a plurality of second brace-forming surfaces 7064 that are able to deform the proximal legs 6221 of brackets 6220 located in many rows (lines). The first forming surfaces 7063 (see FIG. 229) and the second brace-forming surfaces 7064 of the second abutment plate 7060 may not align with the first brace-forming surfaces 7053 and the second brace-forming surfaces 7054 of the first abutment plate 7050. As a result, the proximal legs 6221 of the brackets 6220 can be located in rows (lines) other than rows (lines) of the distal legs 6221 of the brackets 6220. You can see that the second thrust plate 7060 can push the first thrust plate 7050 as the second thrust plate is distally displaced s 7060. In at least one such embodiment, the second abutment plate 7060 may push the first abutment plate 7050 back toward the distal end 7048 of the frame 7041 so that the first abutment plate 7050 can return to its initial (inoperative) position. After deformation of all proximal legs 6221 of brackets 6220, the second retaining plate 7060 can be moved proximally to its initial (inoperative) position. Thus, the surgical stapler 7000 can be reinstalled to place a new cassette with brackets in the first jaw 7030 and a new retainer matrix in the second jaw 7040, and then reused.

In various embodiments, as described above, a surgical stapler may include two or more thrust plates that move longitudinally, interacting with the legs of a plurality of brackets that are laterally arranged. In certain embodiments, the surgical stapler may include a retaining plate that is moved proximally, for example, to deform the first group of brace legs and distally, for example, to deform the second group of brace legs. In at least one such embodiment, such a thrust plate may include bracketing surfaces directed in the proximal and distal directions.

In various embodiments (see FIG. 236), a similar abutment plate, for example, abutment plate 7140, may include a lower (tissue facing) surface 7141, as well as a plurality of staple pockets 7142 formed on this surface. In at least one embodiment, the abutment plate 7140 may include more than one plate, for example a plate with bracketing pockets 7143, which may be welded to the frame 7144. In at least one such embodiment, the plate with pockets 7143 may be located in the channel of the plate 7145 in the frame 7144 and be welded to the frame 7144 using a welding groove 7146 extending along the frame 7144 and ensuring the formation of a longitudinal weld 7147. Under various circumstances, the longitudinal weld 7147 can be laid continuously along the entire length of the welding groove 7146 or can be a series of individual welding points. In various embodiments, each pocket plate 7143 may include two or more parts welded together. In at least one such embodiment, each plate with pockets 7143 may include a first part of the plate 7143a and a second part of the plate 7143b, which can be welded to each other by seam 7148. In various embodiments, the first part 7143a and the second part 7143b of each plate 7143 can be welded together before the plate 7143 is welded to the channels of the plate 7145 in the frame 7144. In at least one such embodiment, the first part of the plate 7143a and the second part of the plate 7143b can interact The forming profiles, for example the toothed profiles shown in FIG. 236. These profiles can be tightly bonded to each other (the place of attachment forms a tight seam 7148). In at least one embodiment, each plate 7143 may have a height of approximately 0.51 mm (0.02 inches), which may exceed the depth of the channels of the plates 7145. Thus, the tissue-facing surfaces 7141 will protrude from 7044 of the stop plate 7040. B certain embodiments (see FIG. 237) of the plate 7143 can be connected to each other using at least one weld 7149 at the distal ends of the plates 7143.

As shown in FIG. 236 and 237, each plate with pockets 7143 may include a plurality of staple pockets 7142. In various embodiments, staple pockets 7142 can be made in plates 7143 using any suitable manufacturing process, such as grinding and / or electrode welding. In at least one such embodiment (see FIGS. 238 and 239), the manufacturing process of each staple pocket 7142 may include the following successive steps: forming a deep socket 7150, forming a curved (arched) surface 7151 surrounding the deep socket 7150, forming a guide groove for the legs of the brackets 7152 in the curved surface 7151. In other various embodiments, the implementation of these production steps can be performed in another applicable sequence. In various embodiments (see FIG. 240), the brace pockets 7142 may be configured such that the inner edges 7153 of the brace pockets will be separated by the same (or substantially the same) gaps 7154. In at least one such embodiment, the gap 7154 may be approximately 0.20 mm (0.008 in.) In addition, in at least one such embodiment, the brace pockets 7142 may be located along two or more rows (center lines) separated by the same (or substantially identical) gaps 7155. In at least one similar embodiment, the gap 7155 between the center rows approximately equal 0.89 mm (0.035 in.). In various embodiments (see FIG. 240), each staple pocket 7142 may narrow (its width may vary from small width 7156 to large width 7157). In at least one such embodiment, a small size in width 7156 may be, for example, about 1.14 mm (0.045 inches), and a large size in width 7157 may be about 1.91 mm (0.075 inches). In various embodiments, the plates 7143 may consist of the same material as the frame 7144. In at least one such embodiment, the plates 7143 and the frame 7144 may consist of stainless steel, for example, 300 or 400 grade steel and / or titanium . In other various embodiments, the implementation of the plate 7143 and the frame 7144 may consist of other materials. In at least one such embodiment, the plates 7143 may consist of ceramic material, and the frame 7144 may be stainless steel and / or titanium. In various circumstances, depending on the materials used, at least one brazing process may be used to secure the plates 7143 to the frame 7144 (in addition to or as a substitute for the welding processes described above).

In various embodiments (see Figs. 241-243), the stop plate 7240 may include a frame 7244 and a plurality of plates with pockets 7243 that can be inserted into the frame 7244. Like the above, each plate with pockets 7243 may include a plurality of brace pockets 7242 In at least one embodiment, the thrust plate 7244 may include retaining grooves 7246 that may receive a retaining guide 7247 protruding from the plate with pockets 7243. For assembling the plates with pockets 7243 on the frame of the thrust plate 7244, lateral with the shadows 7245 of the frame of the abutment plate 7244 can be bent outward, as shown in FIG. 242. This leads to the expansion of the locking grooves 7246 so that each of the locking grooves 7246 is able to receive the locking guide 7247 of the plate with pockets 7243. After placing the locking guides 7247 in the locking grooves 7246, the side walls 7245 can be released, as shown in FIG. 243. This allows the frame 7244 to elastically compress and / or return to an uncompressed state. Under such circumstances, the locking grooves 7246 may be compressed and gripping the locking guides 7247. In certain embodiments, the locking guides 7247 and / or the locking grooves 7246 may include one or more co-operative conical surfaces that, after releasing the grooves 7246, may form a conical connection, locking guides 7247 in grooves 7246. Like the above, the plates with pockets 7243 may consist of a material identical to the material of the frame 7244 (or of another material). In at least one such embodiment, plates 7243 may consist of ceramic material, and frame 7244 may be stainless steel and / or titanium. Under various circumstances, depending on the material used, at least one brazing and / or welding process may be used to secure the plates 7243 to the frame 7244.

The devices described herein may be designed to be disposed of after a single use, or their design may be reusable. In any case, however, the device can be prepared for reuse after at least one use. Recovery may include any combination of the steps of disassembling the device, followed by cleaning or replacing specific parts, followed by assembly. In particular, the device can be disassembled, and any number of specific elements or parts of the device can be selectively replaced or removed in any combination. After cleaning and / or replacing specific parts, the device can be reassembled for later use either in the restoration workshop or by the surgical team immediately before the surgical procedure. It will be obvious to those skilled in the art that a variety of disassembling, cleaning / replacing and reassembling methods can be used to restore the device. The use of such methods and the resulting reconditioned device are included in the scope of this application.

Preferably, the subject matter described herein will undergo treatment prior to surgery. First, after receiving a new or already used tool, it should be cleaned if necessary. Then the instrument can be sterilized. According to one sterilization method, the instrument is placed in a closed and sealed container, for example a plastic bag or a Tyvek bag (TYVEK). The mentioned container with the instrument is then placed in the field of radiation capable of penetrating inside the container - this may be gamma radiation, x-ray radiation or a beam of fast electrons. Radiation kills bacteria on the surface of the device and in the container. The instrument thus sterilized can then be stored in its sterile container. A sealed container keeps the instrument sterile until it is opened in a medical facility.

Any patent, publication, or other information that is fully or partially incorporated herein by reference is an integral part of this document to the extent that they do not contradict the definitions, provisions and other information presented in this document. In this regard, the description presented in this document, to the necessary extent, has an advantage over any information contrary to the provisions of this document, which could be included in the specified document by reference. Any material or part thereof, incorporated herein by reference and contrary to the definitions, provisions or other information provided herein, is included in this document to the extent that there is no conflict between the material incorporated by reference and this document.

Since examples of embodiments are provided in the description of the present invention, the present invention can be modified within the spirit and scope of its content. This application covers all possible options, methods of application or modification of the invention, consistent with its basic principles. In addition, this application covers such deviations from the present description that fall under the well-known or generally accepted practice in the field of technology to which the present invention belongs.

Claims (11)

1. A surgical instrument, including:
handle assembly;
an articulated rod assembly defining a longitudinal axis and having a proximal portion protruding from said handle assembly, said proximal portion being pivotally connected to a distal portion capable of selectively rotating relative to said proximal portion around a first axis that is substantially transverse to said longitudinal axis;
a first hinge element attached to the specified distal portion of the hinge rod assembly;
a second hinge element attached to the specified distal portion of the hinge rod assembly, and
a swivel control unit movably mounted in said handle assembly, connected to said first and second hinge elements and capable of selectively applying a pushing and pulling force thereto, so that when the swivel control unit is moved to at least one first adjustment position, the hinge control unit exerts a first pulling force on said first articulated element and a first pushing force on said second articulated element, causing distal the central central portion of the rod rotates about the first axis in the first direction, and when the said swivel control unit is moved to at least one second adjustment position, the swivel control unit exerts a second pulling force on the second hinge element and a second pushing force on the first hinge element, causing the distal central portion of the rod to rotate around the first axis in the second direction, while the specified proximal portion of the rod and attached to a rotary head, rotationally supported by the specified node of the handle, and the specified control unit swivel includes a ball element mounted in a socket in the specified rotary head, while the ball element contains many locking latches formed on it that can selectively come into contact with a plurality of corresponding locking elements in the area of the specified socket, fixing the specified ball element in any of its positions - neutral or at least one, first or Oromo, adjusting position. 2. The surgical instrument of claim 1, wherein said articulated control assembly is capable of moving from a neutral position when said distal end portion is substantially coaxial with said proximal portion of said articulated rod assembly to at least one, first and second of specified regulatory provisions. 3. The surgical instrument according to claim 2, which is additionally equipped with a locking system on said swivel control unit, which allows reversibly holding said swivel control unit in said neutral and at least one, first or second, adjusting position. 4. The surgical instrument according to claim 1, wherein said articulated rod assembly is capable of selectively rotating about said longitudinal axis relative to said crank assembly. 5. The surgical instrument according to claim 1, wherein said spherical element is capable of selectively rotating and making axial movements in said socket. 6. The surgical instrument according to claim 1, further comprising a deflecting element within said socket, which deflects at least one of said locking tabs on said ball element to the engaged position with at least one of said locking elements. 7. The surgical instrument of claim 1, further comprising an end clamp operably connected to said distal portion of said articulated rod assembly and having a second jaw capable of selectively moving relative to the first jaw when applying a working force to it. 8. The surgical instrument of claim 7, wherein said proximal portion of said articulated rod assembly includes:
a proximal central segment operably connected to and protruding from the handle assembly, and
the proximal segment of the working tube, movably resting on the specified proximal Central segment and functionally interacting with the actuation system functionally supported by the specified node of the handle, and where the distal section of the specified node of the hinge rod includes:
a distal central segment connected to the specified proximal central segment for selective articulation relative to it around the specified first axis, and
a distal working tubular segment movably resting on the specified distal central segment and designed in such a way as to functionally interact with the specified second jaw to apply the specified working forces to it; wherein said surgical instrument also comprises a flexible intermediate working tubular segment connected to a distal end of said proximal working tubular segment and to a proximal end of said distal working tubular segment. 9. A surgical instrument, including:
handle assembly;
a rotary head rotationally mounted on the specified node of the handle;
an articulated rod assembly connected to said pivoting head and defining a longitudinal axis, where the articulated rod assembly includes:
a proximal central segment connected to and protruding from said pivoting head,
a distal central segment articulated with said proximal central segment to selectively rotate relative to said proximal central segment about a first axis that is substantially transverse to the longitudinal axis,
a proximal working tubular segment, movably resting on the specified proximal central segment and interacting with the indicated rotary head so that the specified proximal working tubular segment can be rotated with the specified rotary head with respect to the specified node of the handle around the specified longitudinal axis and can axially move relative to the specified rotary head in response to movements that trigger the device and created using the trigger system regulation, which is functionally supported in the handle assembly; and
a distal working tubular segment movably resting on said distal central segment;
wherein said surgical instrument further includes:
a first hinge element attached to said distal central segment of said hinge rod assembly;
a second hinge element attached to the specified distal Central segment of the specified node of the hinge rod, and
a ball element movably supported by said pivoting head and connected to said first and second hinge elements, capable of selectively moving from a neutral position, where said ball element does not exert any articulated force to said first and second hinge elements in a first adjusting position, with the articulated control unit exerts a first pulling force on said first articulated element and a first pushing force on said second articulated the element, causing the distal central segment to rotate about the first axis in the first direction, and to the second adjusting position, in which the articulated joint control unit exerts a second pulling force on the second articulated element and the second pushing force on the specified first articulated element, causing the distal central segment rotate around the first axis in the second direction, while the surgical instrument further comprises:
the first hinge handle protruding from the specified ball element in the first direction, and
a second hinge handle protruding from said ball element in a second direction that is diametrically opposed to said first direction. 10. The surgical instrument of claim 9, further comprising an end clamp operably connected to said distal central segment and having a second jaw capable of selectively moving relative to the first jaw when applying a working force to said distal working tubular segment. 11. The surgical instrument of claim 10, further comprising a cutting bar having a cutting edge for dissecting tissues and which is movably supported within the articulated rod assembly, the cutting bar operatively cooperating with a cutting system functionally supported within the handle assembly and allowing said cutting bar to be selectively make axial movements inside the end clamp.

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