RU2602946C2 - Implanted staple unit comprising of several layers - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine. Staple unit consists of a body and clamps. Clamps are built into housing which is used for tissue stitching. At operation unit brackets can be located in the first branch surgical suturing instrument, that is located opposite the second branch or a thrust element. Thrust element engages with brackets for compression, flattening and/or crushing unit housing and deformation or other method actuation of staples into action. In course of deformation or actuation clamps are gripped, at least part of block body clamps together with at least part of pierced tissue.

EFFECT: housing with staples may contain multiple layers of different materials creating pressure on fabric with different stiffness and/or elasticity ratio.

7 cl, 243 dwg

Description

TECHNICAL AREA

The present invention relates to surgical instruments and, in various embodiments, to surgical cutting and stapling apparatuses and brace blocks designed to dissect and staple tissue with brackets.

BACKGROUND OF THE INVENTION

Endoscopic surgical instruments are often preferred to traditional surgical devices, since a small incision helps to reduce the recovery postoperative period and reduces the risk of complications. Accordingly, considerable work has been done to create a number of endoscopic surgical instruments suitable for accurately introducing the distal end clamp into the desired surgical site through a cannula or trocar. These distal end clamps capture tissue in various ways to achieve a diagnostic or therapeutic effect (for example, endoscopic cutting devices, grips, scalpels, staplers, bracing devices, access devices, drug / gene delivery devices, and energy devices in which uses ultrasound, radio frequency energy, laser radiation, etc.).

With many endoscopic techniques, it is desirable to use the smallest end clamps possible to complete a specific surgical procedure. Smaller end clamps provide better visibility to the surgical field. In addition, smaller end clamps provide better access and manipulation in tight spaces. The developers of these end clamps face many difficulties when trying to create small end clamps. The possibilities for producing small end clamps and, more specifically, small endoscopic cutting tools designed to dissect and staple tissue with brackets are limited by the amount of force required to actuate, usually required to form a stitch seam and dissect the tissue. This force required for actuation can also vary depending on the thickness and composition of the treated fabric. For example, more effort is usually required to cut and stap a stitch seam on thick tissue. At the same time, the amount of force to actuate the tool, that is, dissection and stitching, is usually less with a smaller thickness of tissue. Therefore, many existing devices for endoscopic dissection of tissues usually have a rigid system with a stop element for clamping tissues and a system of pushing surgical brackets, designed for a specific range of tissue thickness. However, such devices are often poorly suited for processing thinner fabrics.

In addition, previous devices for endoscopic dissection of tissues usually dissected tissue simultaneously with the ejection of brackets and the formation of a seam on both sides of the incision. Although such devices are very effective for interventions requiring dissection and tissue attachment, they do not allow the surgeon to install brackets without dissecting the tissue. Similarly, although various forms of endoscopic devices have been developed for dissecting tissues with movable joints to improve access, the components typically included in such devices must be strong enough to contain structures capable of creating and transmitting significant forces necessary for driving and closing the end clamp, from the handle of the device. Thus, such end clamps are often too large to effectively penetrate the narrow spaces of the body.

Accordingly, there is a need for surgical cutting and stapling tools and brace blocks to overcome many of the difficulties described above.

The explanations above are provided solely to reveal 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 at least one embodiment, the bracket block may comprise a plurality of brackets and an implantable bracket block housing comprising a first compressible layer made of a first material into which brackets are embedded and a second compressible layer made of a second material, wherein the first the compressible layer has a first stiffness, and the second compressible layer has a second stiffness, and the first stiffness is different from the second.

In at least one embodiment, the block of brackets may comprise a plurality of brackets and an implantable body comprising a first compressible layer made of a first material into which brackets are embedded and a second compressible layer made of a second material, wherein the first compressible thin layer has a first stiffness, and the second compressible thin layer has a second stiffness, and the first stiffness is different from the second.

In at least one form, the bracket block may comprise a plurality of brackets, and the implantable housing of the bracket block may comprise elements for storing a plurality of brackets and a compressible layer, wherein the storage elements have a first stiffness and the compressible layer has a second stiffness and the first stiffness is different from the second stiffness.

BRIEF DESCRIPTION OF THE DRAWINGS

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

FIG. 1. A sectional view of a surgical instrument in accordance with an embodiment of the present invention;

FIG. 1A. A perspective view of one embodiment of an implantable bracket unit in accordance with the present invention;

FIG. 1B-1E. Parts of the end clamp according to various embodiments of the present invention, clamping tissues and mounting brackets using an implantable bracket unit according to an embodiment of the present invention;

FIG. 2. A schematic sectional view of end clamp parts according to an embodiment of the present invention and a section of a surgical stapling instrument according to an embodiment of the present invention;

FIG. 3. The vertical projection of the thrust element according to one of the embodiments of the invention, side view;

FIG. 4. A view of a portion of the handle assembly shown in FIG. 1, in a section;

FIG. 5. A view of a portion of the handle assembly shown in FIG. 1, in section along the line 5-5.

FIG. 6. A perspective view of a portion of a transmission mechanism according to an embodiment of the present invention;

FIG. 7. A view of a portion of the handle assembly shown in FIG. 1, in section along the line 7-7.

FIG. 8. A view of a portion of the handle assembly shown in FIG. 7, in section along line 8-8.

FIG. 9. A sectional view of a surgical instrument according to an embodiment of the present invention after connecting the end clamp to the main part of the surgical instrument, but before it is fixed;

FIG. 9A. An enlarged image of the end mechanism and part of the surgical instrument shown in FIG. 10;

FIG. 10. View of the surgical instrument shown in FIG. 9, in section after fixing the end clamp to the main part of the surgical instrument;

FIG. 10A. An enlarged image of the end mechanism and part of the surgical instrument shown in FIG. 10;

FIG. 11. View of the surgical instrument shown in FIG. 9 and 10, in section, after moving the first adapter of the actuator to the beginning of the clamping inclined part of the thrust element;

FIG. 11A. An enlarged image of the end clamp and part of the surgical instrument shown in FIG. 11, with a fabric located between the stop element and the block of brackets;

FIG. 12. View of the surgical instrument shown in FIG. 9 to 11, in section, after moving the first adapter of the actuator above the clamping inclined part of the thrust element;

FIG. 12A. An enlarged image of the end mechanism and part of the surgical instrument shown in FIG. 12;

FIG. 13. The image of the surgical instrument shown in FIG. 9-12, in section, after moving the first adapter of the actuator over the beveled forming part for the complete formation of the brackets in the implantable block of brackets;

FIG. 13A. An enlarged image of the end mechanism and part of the surgical instrument shown in FIG. 13;

FIG. 14. View of the surgical instrument shown in FIG. 9-13, in section, after moving the first adapter of the actuator above the beveled forming surface for the complete formation of the brackets in the implantable block of brackets and after moving the scalpel rod in the longitudinal direction through the end clamp;

FIG. 14A. An enlarged image of the end mechanism and part of the surgical instrument shown in FIG. fourteen;

FIG. 15. Scheme of parts of the end clamp according to one of the embodiments of the present invention with a part of the core of the surgical instrument according to one of the embodiments of the present invention in section;

FIG. 16. The view of the part of the end clamp according to one of the embodiments of the invention shown in FIG. 15, in section, in an open position, attached to a surgical instrument according to an embodiment of the invention;

FIG. 17. Another view of a portion of an end clamp according to an embodiment of the invention shown in FIG. 15 and 16, in section, in a fully closed position;

FIG. 18. Another image of part of the end clamp according to the embodiment of the invention shown in FIG. 15-17, in section, in the final operating position and before the actuation of the distal cutting element;

FIG. 19. Another image of part of the end clamp according to the embodiment of the invention shown in FIG. 15-18, in section, in the final operating position and after actuation of the distal cutting element;

FIG. 20. A sectional view of a part of a handle assembly according to another embodiment of the present invention;

FIG. 21. A view of a portion of the handle assembly shown in FIG. 20, in section along the line 21-21;

FIG. 22. A view of a portion of the handle assembly shown in FIG. 20, in section along the line 22-22.

FIG. 23. View of a portion of the handle assembly shown in FIG. 20, in section along line 23-23 of FIG. twenty;

FIG. 24. A sectional view of a portion of a handle assembly according to another embodiment of the present invention;

FIG. 25. Sectional view of a portion of an end clip according to an embodiment of the present invention; an end clamp is connected to a part of a surgical instrument according to an embodiment of the present invention, wherein the end clamp holds a block of surgical brackets according to an embodiment of the present invention and the stop member is in an open position;

FIG. 26. Another image of part of the end clamp shown in FIG. 25, in section, side view, in the closed position;

FIG. 27. Another image of a portion of the end clamp shown in FIG. 25 and 26, on the side, in section, at the beginning of the phase of advancement of the scalpel rod to the end clamp;

FIG. 28. Another image of a portion of the end clamp shown in FIG. 25-27, side view, in section, with a partially extended scalpel rod;

FIG. 29. A sectional side view of a portion of an end clip according to an embodiment of the present invention; an end clamp is connected to a part of a surgical instrument according to an embodiment of the present invention, wherein the end clamp holds a block of surgical brackets according to an embodiment of the present invention and the stop member is in an open position;

FIG. 30. Another image of a portion of the end clamp shown in FIG. 29 is a side view, in section, with a partially extended scalpel rod;

FIG. 31. A sectional view of a surgical instrument according to another embodiment of the present invention, with a stop element of the end clamp in the open position;

FIG. 32. A diagram of parts of an end clamp according to an embodiment of the present invention and a part of a surgical stapling instrument according to an embodiment of the present invention shown in FIG. 31, in a section;

FIG. 33. Top view of the end clamp and part of the elongated trunk of the surgical instrument shown in FIG. 31, with parts shown in section along line 33-33 of FIG. 31;

FIG. 34. Top view of the end clamp and part of the elongated trunk of the surgical instrument shown in FIG. 31, with parts shown in section;

FIG. 35. Another view of the end clamp and part of the elongated shaft of the surgical instrument shown in FIG. 31, from above, with an end clamp in a bent position and with an end clamp in an open position;

FIG. 36. Another image of the end clamp shown in FIG. 35, from above, with an end clamp in a closed or clamped position;

FIG. 37. An enlarged view of a portion of an end clamp and a surgical instrument according to an embodiment of the invention shown in FIG. 36;

FIG. 38. A view of a portion of a handle assembly of a surgical instrument shown in FIG. 31, in a section;

FIG. 39. Another image of a portion of the handle assembly shown in FIG. 38, a section along line 39-39 of FIG. 38;

FIG. 40. A perspective view of a fragment of a spherical portion and a depression of a hinge according to various embodiments of the present invention;

FIG. 41. Top view of the end clamp and part of the elongated shaft of a surgical instrument according to another embodiment of the present invention, in the upright position;

FIG. 42. Another top view of the end clamp and part of the elongated trunk shown in FIG. 41, in a bent position;

FIG. 43. A sectional view of another embodiment of a surgical instrument in accordance with the present invention;

FIG. 44. View of a fragment of the trunk of a surgical instrument in accordance with the embodiment of the invention shown in FIG. 43, with a hinge, in section;

FIG. 44A. View of a fragment of the barrel of a surgical instrument with a hinged connection shown in FIG. 44, in a section;

FIG. 44B. Another image of a fragment of the barrel of a surgical instrument with a hinged connection shown in FIG. 44, in a section;

FIG. 44C. Another image of a fragment of the barrel of a surgical instrument with a hinged connection shown in FIG. 44, in a section;

FIG. 44D. Another image of a fragment of the barrel of a surgical instrument with a hinged connection shown in FIG. 44, in a section;

FIG. 44E. Another image of a fragment of the barrel of a surgical instrument with a hinged connection shown in FIG. 44, in a section;

FIG. 44F. Another image of a fragment of the barrel of a surgical instrument with a hinged connection shown in FIG. 44, in a section;

FIG. 45. The view of the part of the barrel with a swivel shown in FIG. 44, in section along the line 45-45 in FIG. 44;

FIG. 46. The view of the part of the barrel with a swivel shown in FIG. 44, in a section along line 46-46 of FIG. 44;

FIG. 47. Another image of a surgical instrument shown in FIG. 43, in section, with an end clip in a fully bent position;

FIG. 48. The image of the end clamp shown in FIG. 47, in section, with a corrugated cover over a hinged joint;

FIG. 49. A sectional view of the handle assembly of a surgical instrument in accordance with another embodiment of the present invention;

FIG. 50. The view of the parts of the end clamp and the distal end of the elongated trunk shown in FIG. 49, in a section;

FIG. 51. Another image of the end mechanism and part of the elongated trunk shown in FIG. 50, in section, with the end clamp in the open state;

FIG. 52. Another sectional view of the end mechanism and part of the elongated barrel, with the end clamp in the closed state;

FIG. 53. Another image of the end mechanism and part of the elongated trunk shown in FIG. 49-52, in section, with the cutting element in the fully extended position;

FIG. 54. A perspective view of the end clamp shown in FIG. 51-53, in the open state;

FIG. 55. The view of the end mechanism shown in 51-54, in section along the line 55-55 in FIG. 51;

FIG. 56. A perspective view of a portion of an elongated stem in accordance with another embodiment of the present invention attached to an end clip in accordance with an embodiment of the present invention;

FIG. 57. A sectional view of a portion of a handle assembly of a surgical instrument in accordance with another embodiment of the present invention;

FIG. 58. View of the elongated trunk shown in FIG. 56 and 57, in section along the line 58-58 in FIG. 57;

FIG. 59. An enlarged image of a portion of the handle assembly shown in FIG. 57;

FIG. 60. View of the distal portion of the elongated trunk depicted in FIG. 56-59;

FIG. 61. A perspective view of a portion of an elongated stem in accordance with another embodiment of the present invention attached to an end clip in accordance with an embodiment of the present invention;

FIG. 62. The view of the portion of the barrel segment of the variable configuration shown in FIG. 61, in a section;

FIG. 63. A perspective view of a portion of an elongated barrel in accordance with another embodiment of the present invention attached to an end clip in accordance with an embodiment of the present invention;

FIG. 64. Sectional view of a portion of a handle assembly of a surgical instrument in accordance with another embodiment of the present invention;

FIG. 65. View of the elongated trunk shown in FIG. 63 and 64, in section along the line 65-65 in FIG. 64;

FIG. 66. An enlarged image of a portion of the handle assembly shown in FIG. 64;

FIG. 67. A cross-sectional view of a portion of a barrel segment of a variable configuration shown in FIG. 63, with tubular connecting parts located essentially in a straight line;

FIG. 68. The view of the part of the barrel with the variable configuration shown in FIG. 63 and 67, in section, with tubular connecting parts oriented with a bend relative to each other (not along one axis);

FIG. 69. A perspective view of an alternative embodiment of a block of brackets in accordance with the present invention installed in a surgical cutting and stapling tool in accordance with an embodiment of the present invention;

FIG. 70. A top view of the block of surgical brackets and the elongated channel of the device depicted in FIG. 69;

FIG. 71. Top view of another block of surgical brackets in accordance with an embodiment of the invention inserted into an elongated channel of an end clamp in accordance with an embodiment of the present invention;

FIG. 72. A bottom view of a thrust member according to an embodiment of the invention;

FIG. 73. A perspective view of part of a plurality of brackets forming a line of brackets in a seam, in accordance with an embodiment of the present invention;

FIG. 74. Another perspective view of a portion of the line of brackets in accordance with the embodiment of the invention shown in FIG. 73, with brackets that are shaped by contact with the thrust element of a surgical cutting and stapling instrument;

FIG. 75. A perspective view of part of the brackets forming a line of brackets, in accordance with an embodiment of the present invention;

FIG. 76. A perspective view of a portion of alternative brackets forming a line of brackets in accordance with an embodiment of the present invention;

FIG. 77. A perspective view of part of alternative brackets forming part of another line of brackets, in accordance with an embodiment of the present invention;

FIG. 78. A sectional view of an embodiment of an end clamp enclosing a bracket assembly in accordance with an embodiment of the present invention;

FIG. 79. A sectional view of a portion of the oblong channel of the end clamp shown in FIG. 78, after removing the implantable block body of the brackets and the brackets themselves;

FIG. 80. A sectional view of an embodiment of an end clamp accommodating a bracket unit in accordance with another embodiment of the present invention;

FIG. 81. A sectional view of a portion of a surgical stapling instrument in accordance with an embodiment of the present invention, with a block of brackets located in an end clamp to move the block fixing system to a free position;

FIG. 82. Another image of a portion of a surgical stapling instrument depicted in FIG. 81, in section, with a block of brackets removed from the end clamp and a locking system for the block in the locked position;

FIG. 83A-83D. A diagram showing the deformation of surgical braces located in a compressible body of a bracket unit in accordance with at least one embodiment of the invention;

FIG. 84A. A diagram showing the brackets located in the compressible body of the bracket unit;

FIG. 84B. A diagram showing the compressible body of the bracket unit shown in FIG. 84 squeezed by a thrust member;

FIG. 84C. A diagram showing the compressible body of the bracket unit shown in FIG. 84, even more compressed by the thrust element;

FIG. 84D. The diagram showing the brackets with FIG. 84A in a fully formed configuration and a compressible block of brackets shown in FIG. 84A, in a fully compressed state;

FIG. 85. A diagram depicting a bracket located opposite the supporting surface of a block of brackets, and the potential relative movement of these elements;

FIG. 86. A transverse image of the supporting surface of the block of brackets, including a slot or recess with a configuration to stabilize the base of the brackets shown in FIG. 85;

FIG. 87. A sectional view of a bracket consisting of a crown obtained by multicomponent casting and a slot or recess with an appropriate configuration to receive a portion of the crown in accordance with at least one alternative embodiment;

FIG. 88. A top view of a bracket block in accordance with at least one embodiment of the invention, with brackets embedded in a compressible housing of the bracket block;

FIG. 89. The vertical projection of the block of brackets shown in FIG. 88;

FIG. 90. A vertical projection of a block of brackets in accordance with at least one embodiment of the invention, comprising a protective layer surrounding the brackets located in a compressible block body;

FIG. 91. The view of the block of brackets shown in FIG. 90, in cross section along line 91-91 of FIG. 90;

FIG. 92. A vertical projection of a block of brackets in accordance with at least one embodiment of the invention, comprising brackets at least partially protruding outside the compressible block body, and a protective layer surrounding the block body of the brackets;

FIG. 93. The view of the block of brackets shown in FIG. 92, in cross section along line 93-93 of FIG. 92;

FIG. 94. A view of parts of a block of brackets in accordance with at least one embodiment of the invention, comprising brackets at least partially embedded in a compressible block body, wherein the brackets are at least partially located in the bracket cavity formed in bracket block housing;

FIG. 95. The view of the block of brackets shown in FIG. 94, in section along the line 95-95 in FIG. 94;

FIG. 96. A view of the components of a bracket block in accordance with at least one embodiment of the invention;

FIG. 97. A view of the components of a portion of a block of brackets in accordance with at least one embodiment of the invention, comprising brackets at least partially integrated in a compressible block body, and a leveling material connecting the brackets and aligning them with respect to each other;

FIG. 98. The view of the block of brackets shown in FIG. 97, in cross section along line 98-98 of FIG. 97;

FIG. 99. A partial view of the components of the inner layer of the compressible housing of the block brackets;

FIG. 100. Scheme of the inner layer shown in FIG. 99 compressed between the transfer plate and the support plate;

FIG. 101. A diagram showing brackets inserted in a compressed inner layer depicted in FIG. one hundred;

FIG. 102. Scheme of the base plate shown in FIG. 100 remote from the inner layer;

FIG. 103. Scheme of an additional node containing the inner layer shown in FIG. 99, and the brackets shown in FIG. 101 inserted into the outer layer;

FIG. 104. A diagram showing the inner layer depicted in FIG. 103 soldered to form a sealed block of brackets;

FIG. 105. View of the sealed block of brackets shown in FIG. 104, in a section;

FIG. 106. A sectional view of a bracket block and a channel of a bracket block in accordance with at least one embodiment of the invention;

FIG. 107. A diagram showing a portion of the bracket block shown in FIG. 106, in a deformed state;

FIG. 108. A vertical projection of the end clamp of a surgical stapling instrument containing a stop member in an open position and a block of brackets located in a channel for the block;

FIG. 109. The vertical projection of the end clamp shown in FIG. 108, showing the stop element in the closed position and the block of brackets sandwiched between the stop element and the channel for the block;

FIG. 110. The vertical projection of the end clamp shown in FIG. 108 showing a block of brackets shown in FIG. 108 located in the channel for the block in an alternative way;

FIG. 111. A sectional view of an end clamp of a surgical stapling instrument comprising a compressible block of brackets located in a channel for the block and part of the backing material attached to the thrust member;

FIG. 112. A sectional view of the end clip shown in FIG. 111, with a stop element in the closed position;

FIG. 113. A cross-sectional view of an alternative embodiment of an end clamp of a surgical stapling instrument comprising a bracket block with a waterproof layer;

FIG. 114. A sectional view of another alternative embodiment of an end clamp of a surgical stapling instrument;

FIG. 115. View of an alternative embodiment of an end clamp of a surgical stapling instrument comprising a stepped stop member and a brace block with a stepped case;

FIG. 116. A sectional view of another alternative embodiment of the end clamp of a surgical stapling instrument;

FIG. 117. A sectional view of an alternative embodiment of an end clamp of a surgical stapling instrument with tissue contact surfaces;

FIG. 118. A sectional view of yet another alternative embodiment of an end clamp of a surgical stapling instrument with tissue contact surfaces;

FIG. 119. A cross-sectional view of an alternative embodiment of an end clamp of a surgical stapling instrument including a brace block comprising a support insert with such a configuration as to support the brace block;

FIG. 120. A sectional view of an alternative embodiment of an end clamp of a surgical stapling instrument comprising a bracket block with a plurality of compressible layers;

FIG. 121. View of an alternative embodiment of an end clamp of a surgical stapling instrument comprising a stepped stop member and a bracket block with a stepped compressible body;

FIG. 122. View of another alternative embodiment of the end clamp of a surgical stapling instrument, including a stepped stop element and a block of brackets, with a stepped compressible body;

FIG. 123. A cross-sectional view of an alternative embodiment of an end clamp of a surgical stapling instrument comprising a bracket unit and a curved tissue contact surface;

FIG. 124. A cross-sectional view of an alternative embodiment of an end clamp of a surgical stapling instrument comprising a bracket unit with an inclined tissue contact surface;

FIG. 125. A sectional view of a compressible block of brackets containing brackets and at least one medicament inside;

FIG. 126. A diagram showing a compressible block of brackets with FIG. 125 after compression, the brackets inside it are deformed;

FIG. 127. A view of the components of a bracket block in accordance with at least one embodiment of the invention;

FIG. 128. The view of the block of brackets shown in FIG. 127, in a section;

FIG. 129. A perspective view of an implantable bracket unit in accordance with at least one alternative embodiment;

FIG. 130. View of the implantable block of brackets depicted in FIG. 129, in a section;

FIG. 131. A perspective view of an alternative embodiment of a block of brackets containing deformable elements protruding from the outer layer of the block;

FIG. 132. A perspective view of an alternative embodiment of a block of brackets with an outer layer attached to an inner layer;

FIG. 133. A sectional view of an alternative embodiment of a block of brackets comprising a plurality of brackets, a compressible layer and a plug layer;

FIG. 134. A perspective image of the plugging layer shown in FIG. 133;

FIG. 135. A perspective view of a single press of the plug layer shown in FIG. 133, and brackets aligned with the groove of the press;

FIG. 136. A perspective image of two connected presses from the plugging layer shown in FIG. 133;

FIG. 137. A perspective view of the support frame of the plugging layer shown in FIG. 133 extracted from split presses;

FIG. 138. A perspective view of parts of an alternative embodiment of a compressible block of brackets, including brackets and a system for pushing brackets to the stop element;

FIG. 138A View of components of an alternative embodiment of a bracket block shown in FIG. 138;

FIG. 139. The view of the block of brackets shown in FIG. 138, by section;

FIG. 140. The upper projection of the slide, allowing you to move along the block of brackets shown in FIG. 138, and move the brackets to the stop member;

FIG. 141. Scheme of the ejector brackets, which can rise to the thrust element under the action of the slide 140;

FIG. 142. View of fragments of a block of brackets in accordance with at least one alternative embodiment of the invention, containing brackets located in the ejector brackets;

FIG. 143. A sectional view of a block of brackets shown in FIG. 142 located in the channel for the block of brackets;

FIG. 144. A sectional view of a block of brackets shown in FIG. 142, showing the movement of the thrust member to the closed position and the deformation of the brackets contained in the block by the thrust member;

FIG. 145. A sectional view of a block of brackets shown in FIG. 142 showing the upward movement of the brackets in the direction of the stop member;

FIG. 146. A perspective view of an alternative embodiment of a block of brackets containing tapes connecting the flexible sides of the block of brackets;

FIG. 147. The perspective image of the slide and the node of the cutting element;

FIG. 148. Scheme of the slide and the node of the cutting element shown in FIG. 147, used to raise the brackets in the bracket block and shown in FIG. 142;

FIG. 149. A diagram showing a slide capable of engaging and raising brackets in the direction of the thrust member, and a locking system allowing selective movement of the slide in the distal direction;

FIG. 150A-150C. Sequential movement of the bracket inserted into the crown of the bracket;

FIG. 151. A sectional view of a block of brackets containing a support panel or stop;

FIG. 152. A sectional view of a portion of a compressible block of brackets in accordance with at least one alternative embodiment;

FIG. 153. A diagram showing a block of brackets shown in FIG. 152, in an implanted state;

FIG. 154. A sectional view of elements of a portion of a compressible block of brackets in accordance with at least one alternative embodiment;

FIG. 155. A view of a portion of the sealed block of brackets shown in FIG. 154, in section;

FIG. 156. A diagram showing a block of brackets shown in FIG. 154, in an implanted state;

FIG. 157. A sectional view of a portion of a compressible block of brackets in accordance with at least one alternative embodiment;

FIG. 158. An image of elements of a part of a compressible block of brackets in accordance with at least one embodiment comprising a plurality of compressible elements;

FIG. 159. A perspective image of a compressible element with FIG. 158 uncompressed;

FIG. 160. A perspective image of a compressible element with FIG. 159 in a compressed state;

FIG. 161A. A sectional view of a portion of the end clamp of a surgical stapling instrument containing a jaw, a channel for a block of brackets located opposite the jaw, and a block of brackets located in the channel for the block, while the jaw contains a supporting material attached to it;

In FIG. 161B is a view of a portion of the end clamp shown in FIG. 161A, in section; the jaw moves to the channel for the block of brackets, the block of brackets is compressed by a stop element, and the supporting material and brackets protrude at least partially through the fabric located between the supporting material and the block of brackets;

FIG. 161C. An image of a portion of the end clamp shown in FIG. 161A, in section, showing the jaw in the final position and supporting material in contact with the bracket shown in FIG. 161B;

FIG. 161D. A sectional view of a portion of the end clamp shown in FIG. 161A, in which the jaw and channel of the brace block are moved away from the implanted brace block and supporting material;

FIG. 162. A perspective view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention comprising a plurality of retaining elements of such a configuration as to engage with a protruding leg of the bracket;

FIG. 163. A perspective view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention comprising six retaining elements;

FIG. 164. A perspective view of a retaining hole in a supporting material in accordance with at least one alternative embodiment of the invention comprising eight retaining elements;

FIG. 165. A perspective view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention, comprising a plurality of retaining elements allowing engagement with a protruding leg of the bracket;

FIG. 166. A perspective view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention comprising six retaining elements;

FIG. 167. A perspective view of a holding hole in a supporting material in accordance with at least one alternative embodiment of the invention comprising eight holding elements;

FIG. 168. A perspective view of a retaining hole in a supporting material according to at least one alternative embodiment of the invention, comprising a plurality of retaining elements obtained by stamping from a metal sheet;

FIG. 169. A perspective view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention, comprising a plurality of holes located around the perimeter of the holding hole;

FIG. 170. An overhead view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention;

FIG. 171. Top view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention;

FIG. 172. An overhead view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention;

FIG. 173. Top view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention;

FIG. 174. Top view of a retaining hole in a support material in accordance with at least one alternative embodiment of the invention;

FIG. 175. A top view of a holding hole in a support material comprising a holding protrusion included in a holding hole in accordance with at least one embodiment of the invention;

FIG. 176. Top view of a holding hole in a supporting material comprising a holding protrusion included in a holding hole in accordance with at least one alternative embodiment of the invention;

FIG. 177. A perspective view of a crosslinking system consisting of a plurality of brackets, a supporting material engaged with the brackets, and a leveling material with a configuration for aligning the brackets;

FIG. 178. A perspective image of the supporting material depicted in FIG. 177;

FIG. 179. A perspective view of the leveling material shown in FIG. 177;

FIG. 180. Top view of part of the supporting material shown in FIG. 177, in engagement with the brackets depicted in FIG. 177;

FIG. 181. Bottom view of the supporting material shown in FIG. 177, in engagement with the brackets depicted in FIG. 177;

FIG. 182. An upper view of a portion of the crosslinking system shown in FIG. 177;

FIG. 183. An upper perspective view of a portion of the crosslinking system shown in FIG. 177;

FIG. 184. View of a portion of the supporting material shown in FIG. 177, in engagement with the brackets depicted in FIG. 177, in a section;

FIG. 185. View of a portion of the crosslinking system depicted in FIG. 177, in a section;

FIG. 186. A perspective view of the crosslinking system shown in FIG. 177, further comprising protective caps on the legs of the brackets;

FIG. 187. A perspective view of the configuration of the crosslinking system shown in FIG. 186, bottom view;

FIG. 188. A perspective view of a portion of the crosslinking system shown in FIG. 186;

FIG. 189. A view of the configuration of a part of the crosslinking system shown in FIG. 186;

FIG. 190. A perspective view of an end clamp in accordance with at least one embodiment of the invention, comprising a jaw in an open position, supporting material and a plurality of protective caps in a jaw, as well as a block of brackets located in a channel for the block;

FIG. 191. The vertical projection of the end clamp shown in FIG. 190, in the closed position;

FIG. 192. The vertical projection of the end clamp shown in FIG. 190, after actuation;

FIG. 193. The vertical projection of the supporting material and the protective caps shown in FIG. 190 connected to the bracket unit shown in FIG. 190;

FIG. 194. A detailed image of the configuration depicted in FIG. 193;

FIG. 195. The vertical projection of the end clamp shown in FIG. 190, with a branch in the open position and a piece of thin tissue located between the supporting material and the block of brackets;

FIG. 196. The vertical projection of the end clamp shown in FIG. 190, with the jaw in the closed position, pressed against the thin fabric shown in FIG. 195;

FIG. 197. The vertical projection of the end clamp shown in FIG. 190, with the jaw in the closed position to capture the thin tissue depicted in FIG. 195 between the supporting material and the bracket block;

FIG. 198. The vertical projection of the supporting material and the protective caps shown in FIG. 190 attached to the bracket block shown in FIG. 190, with a thin cloth between them;

FIG. 199. A detailed image of the configuration shown in FIG. 198;

FIG. 200. A cross-sectional view of a protective cap located at the end of a bracket leg in accordance with at least one alternative embodiment;

FIG. 201. A perspective view of a plurality of protective caps embedded in a sheet of material;

FIG. 202. A perspective view of a jaw with a plurality of recesses to receive a plurality of protective caps;

FIG. 203. A detailed image of a part of the jaw with a sheet of material covering the protective caps located on the jaw 202;

FIG. 204. A sectional view of a protective cap located at the end of a bracket leg in accordance with at least one alternative embodiment of the invention, in which the protective cap has an inner forming surface;

FIG. 205. Another view in section of the protective cap shown in FIG. 204, showing the deformation of the bracket leg while abutting against the forming surface;

FIG. 206. Top view of an alternative embodiment of a support material consisting of a plurality of connected elements;

FIG. 207. Top view of an alternative embodiment of a support material consisting of a plurality of connected elements;

FIG. 208. Top view of an alternative embodiment of a support material consisting of a plurality of connected elements;

FIG. 209. Top view of an alternative embodiment of a series of fragments of a retaining material consisting of a plurality of connected elements;

FIG. 210. Top view of an alternative embodiment of a supporting material consisting of a plurality of connected elements;

FIG. 211. View of the part of the jaw containing the supporting material with a compressible cover;

FIG. 212. A detailed image of the supporting material depicted in FIG. 211;

FIG. 213. A sectional view of a part of a crosslinking system containing a supporting material, including a compressible layer and a plurality of cells in which one or more drugs are encapsulated;

FIG. 214. A diagram showing the legs of the brackets piercing the cells shown in FIG. 213, as you enter the supporting material;

FIG. 215. A sectional view of part of a crosslinking system containing a supporting material with a compressible layer;

FIG. 216. A vertical projection of a bracket block assembly comprising a bracket block holder, a first bracket block and a second bracket block;

FIG. 217. A vertical projection of the end clamp of a surgical stapling instrument containing a first jaw and a second jaw, the second jaw shown in open form;

FIG. 218. The vertical projection of the end clamp shown in FIG. 217, with a second jaw in the closed position and a node for mounting the bracket block shown in FIG. 216, which is used to install the first block in the first jaw and the second block in the second jaw;

FIG. 219. The vertical projection of the charged end clamp shown in FIG. 218, with the assembly for mounting the bracket block removed from the end clamp, the second jaw in the open position, and the tissue located between the first jaw and the second jaw;

FIG. 220. The vertical projection of the charged end clamp shown in FIG. 219, after actuation;

FIG. 221. The vertical projection of the first block of brackets and the second block of brackets in the implanted state;

FIG. 222. The vertical projection of the end clamp shown in FIG. 217, with a portion of the first block still engaged with the first jaw, in accordance with at least one embodiment;

FIG. 223. A vertical projection of an alternative embodiment of a brackets block mounting unit including a bracket block holder, a first bracket block and a second bracket block;

FIG. 224. The vertical projection of the installation site of the bracket unit shown in FIG. 223, which is used to charge the first jaw of the end clamp with the first block and the second jaw with the second block;

FIG. 225. View of the charged end clamp shown in FIG. 224, in section;

FIG. 226. A perspective view of a surgical stapling instrument comprising a lower jaw and an upper jaw in accordance with at least one embodiment of the invention, some parts of the stapling instrument are removed;

FIG. 227. A perspective view of the surgical stapling instrument shown in FIG. 226, with the upper jaw removed;

FIG. 228. A perspective view of a sliding system of a thrust member of the upper jaw of a surgical stapling instrument shown in FIG. 226, comprising a first sliding stop element and a second sliding stop element;

FIG. 229. View of the sliding system of the thrust element shown in FIG. 228, from the end;

FIG. 230. View of the sliding system of the thrust element shown in FIG. 228, from above;

FIG. 231. A diagram showing a system of a sliding thrust member shown in FIG. 228, before actuation;

FIG. 232. A diagram showing a first sliding stop element of the sliding stop element system shown in FIG. 228, before actuation, the brackets are located in the lower jaw in an unexpanded position;

FIG. 233. A diagram showing the brackets in the lower jaw in an unexpanded configuration, the first sliding stop element shown in FIG. 232, shifted in the proximal direction for deformation of the legs of the first group of brackets;

FIG. 234. A diagram showing a first group of brackets shown in FIG. 233, in a completely deformed state;

FIG. 235. A diagram showing a second sliding stop element of the sliding stop element system shown in FIG. 228, distally shifted to deform the legs of the second group of brackets;

FIG. 236. A perspective view of a portion of a thrust member comprising a plurality of forming pockets in accordance with at least one embodiment of the invention;

FIG. 237. The view of the thrust element shown in FIG. 236, in a section;

FIG. 238. The diagram showing the first stage of the production of forming pockets depicted in FIG. 236;

FIG. 239. A diagram showing a second stage in the production of forming pockets shown in FIG. 236;

FIG. 240. The location of the forming pockets of the thrust element shown in FIG. 236, top view;

FIG. 241. Scheme showing the first stage of the manufacturing process of the thrust element;

FIG. 242. A diagram showing a second stage of the manufacturing process shown in FIG. 241; and

FIG. 243. The diagram showing the third stage of the production process shown in 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 No. .____, entitled “Surgical Stapling Instrument with Adjustable Bracket Formation System,” Patent Attorney No. END6848USNP / 100533;

US Patent Application Serial No. .____, entitled “Surgical Stapling Instrument with Interchangeable Surgical Brace Unit”, Patent Attorney No. END6849USNP / 100534;

US Patent Application Serial No. .____, entitled “Surgical Cutting and Stapling Instruments with Separate and Individual Systems for Brackets and Tissues,” Patent Attorney No. END6839USNP / 100524;

US Patent Application Serial No. .____, entitled “Surgical Stapler with Compact Bending Adjustment System,” Patent Attorney No. END6847USNP / 100532;

US Patent Application Serial No. .____, entitled “Jaw Closure Configuration for Surgical Instruments,” Patent Attorney No. END6736USNP / 100060;

US Patent Application Serial No. .____, entitled “Surgical Instruments of Variable Configuration of Barrel Segments”, Patent Attorney No. / END6734USNP100058;

Patent application serial No. .____, entitled “block with surgical brackets with non-linear arrangement of brackets and surgical stapling instruments with common pockets for forming brackets”, patent attorney No. END6735USNP / 100059;

US Patent Application Serial No. .____, entitled “Surgical Staple Blocks with Detachable Supporting Structures and Surgical Stapling Instruments with Trigger Lock Systems in the Absence of Staple Block”, Patent Attorney No. END6855USNP / 100540;

US Patent Application Serial No. .____, entitled “Implantable Bracket Block with Inhomogeneous Arrangement of Brackets”, Patent Attorney No. END6840USNP / 100525;

US Patent Application Serial No. .____, entitled “Implantable Bracket Block Containing Retainer,” Patent Attorney No. END6841USNP / 100526;

US Patent Application Serial No. .____, entitled “Implantable Brace Unit with Orientation Choice”, Patent Attorney No. END6843USNP / 100528;

US Patent Application Serial No. .____, entitled “Implantable Brace Block Containing Biologically Absorbable Layers”, Patent Attorney No. END6856USNP / 100541;

US Patent Application Serial No. .____, entitled “Compressible Bracket Block”, Patent Attorney No. END6857USNP / 100542;

US Patent Application Serial No. .____, entitled “Stapling Tools with Lock Brackets for Bracket Block”, Patent Attorney No. END6858USNP / 100543;

US Patent Application Serial No. .____, entitled “Compressible Bracket Block”, Patent Attorney No. END6859USNP / 100544;

US Patent Application Serial No. .____, entitled “Staple Systems Containing Multiple Connected Elements of Supporting Material,” Patent Attorney No. END6860USNP / 100546;

US Patent Application Serial No. ____, entitled “Crosslinking Systems Containing Supporting Material and Leveling Material,” Patent Attorney No. END6861USNP / 100547;

US Patent Application Serial No. .____, entitled “Crosslinking Systems Containing Supporting Material,” Patent Attorney No. END6862USNP / 100548;

US Patent Application Serial No. .____, entitled “Stapling Tool for Operating the Suture System Containing Supporting Material”, Patent Attorney No. END6863USNP / 100549;

US Patent Application Serial No. .____, entitled “Staple Systems Containing Supporting Material and Cover”, Patent Attorney No. END6864USNP / 100550; and

US Patent Application Serial No. .____, entitled “Staple Systems Containing Multiple Bracket Blocks,” Patent Attorney 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 embodiments are presented in the accompanying drawings. Specialists in this field. It should be borne in mind 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 example of an embodiment may be combined with features of other embodiments. It is intended that the scope of the present invention covers all modifications and changes.

References in the text to “various embodiments”, “some embodiments”, “one embodiment” or “embodiment”, etc., mean that a particular property, structure or characteristic described in connection with the invention included in at least one embodiment of its implementation. Thus, the phrases “in various embodiments”, “in some embodiments”, “in one embodiment” or “in an embodiment”, and the like. specifications do not necessarily refer to the same embodiment of the invention. In addition, specific characteristics, structures, or features may be combined in any suitable manner in one or more embodiments of the invention. Thus, specific properties, structures, or characteristics shown or described in connection with one embodiment may be combined, in whole or in part, with the properties, structures, or characteristics of one or more embodiments without limitation. It is intended that the scope of the present invention covers all modifications and changes.

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 drawings to use in this document such spatial terms as “vertical”, “horizontal”, “up” and “down”. However, the use of surgical instruments involves many orientations and provisions, therefore, these terms are not absolute and (or) do not limit the present invention.

Various examples of devices and methods for performing laparoscopic and minimally invasive surgical interventions have been developed. However, it will be clear to those skilled in the art that the various methods and devices described herein can be used for a wide variety of surgical interventions and techniques, including, for example, being used in combination with open surgery. As you read this detailed description, it will also become clear to a person skilled in the art that the various tools described herein can be introduced into the body by any means, for example, through natural openings, through an incision or puncture of tissues, and the like. The working parts of the end clamp of these instruments can be inserted directly into the patient’s body, or can be introduced using the insertion devices having a working channel through which the end clamp and the elongated shaft of the surgical instrument are held.

We turn to the drawings, in which similar figures indicate similar components in several projections; in FIG. 1 illustrates a surgical stapler 10 having several unique advantages of the present invention. Surgical stapler 10 is designed to manipulate and / or actuate end clamps 12 of various shapes and sizes that are functionally connected to the apparatus. In the embodiment of the invention depicted in FIG. 1 and 2, the end clamp 12 has an elongated channel 14 formed in the lower jaw 13 of the end clamp 12. The elongated channel 14 is configured to hold the “implantable” block of brackets 30, as well as to hold the stop element 20, acting as the upper jaw 15 of the end clamp 12.

In various embodiments of the invention, the elongated channel 14 may be made, for example, of stainless steel series 300 & 400, 17-4 & 17-7, titanium, etc., and formed with space-separated side walls 16. The stop element 20 may to be made, for example, from steel of a series 300 & 400, 17-4 & 17-7, titanium, etc. and have a bottom surface for forming brackets, usually labeled 22, in which a plurality of pockets are formed to form brackets 23. See FIG. 1B-1E. In addition, the thrust member 20 has a fork-shaped inclined portion 24 protruding proximally. A pin of the thrust member 26 protrudes from each side of the inclined portion 24 to enter a corresponding slot or hole 18 in the side walls 16 of the elongated channel 14, in order to provide mobility or articulation.

Various forms of implantable brace blocks can be used with the surgical instruments described herein. The specific configurations of the bracket blocks and constructions will be described in more detail below. However, in the embodiment shown in FIG. 1A and 9-14, an implantable bracket block 30 is shown. In at least one embodiment, the bracket block 30 has a body portion 31 consisting of a compressible hemostatic material, for example, oxidized regenerated cellulose (ORC) or bioabsorbable foam, in which rows are embedded homogeneous metal brackets 32. In at least some embodiments, to prevent deformation of the brackets and activation of hemostatic material during insertion and placement of the instrument, the entire block may be coated or wrapped bi a degradable film 38, for example, of polydioxanone sold under the brand name PDS® or polyglyceryl sebacate (ASG), or another biodegradable film consisting of PGC (polyglycolic acid sold under the brand name Vikril), PCL (polycaprolactone), PMA (polylactic acid ), PHA (polyhydroxyalkanoate), polyglexaprone 25, sold under the brand name Monocryl, or a mixture of PGK, PKL, PMK, PHA, polyglexaprone, impermeable until it is broken. The housing 31 of the bracket block 30 is suitably sized to be movably located in the elongated channel 14, as shown in the figure, so that each suture bracket 32 is opposite the respective pockets to form the brackets 23 in the stop member when the stop member 20 moves toward the bracket block 30 and contacts with him.

During operation, when the end clamp 20 is located next to the tissue, the surgeon manipulates the end clamp 12 to grab or clamp the tissue between the upper surface 36 of the bracket block 30 and the surface for forming the brackets 22 of the stop member 20. The brackets 32 are given the necessary shape when the stop element 20 along a path essentially parallel to the elongated channel 14, and essentially simultaneously bringing the surface 22 to form brackets and, more specifically, pockets 23 to form brackets in contact with the upper surface 36 of the bracket unit 30. As the stop member 20 continues to move toward the bracket unit 30, the legs 34 of the brackets 32 are in contact with the corresponding pocket to form the brackets 23 in the stop member 20, which leads to the bending of the legs of the brackets 34 and giving the brackets 32 V -shaped. Further movement of the thrust element 20 to the elongated channel 14 leads to further compression and the formation of brackets 32 to reach the final height "FH".

The above process of forming brackets is generally shown in FIG. 1B-1E. For example, in FIG. 1B shows an end clip 12 with a “T” fabric between the abutment member 20 and the upper surface 36 of the implantable bracket unit 30. In FIG. 1C shows the initial clamping position of the stop member 20 when the stop member 20 is superimposed on the fabric “T” located between the stop member 20 and the upper surface 36 of the bracket block 30. FIG. 1D shows the initial stage of the formation of the bracket, when the stop element 20 began to compress the block of brackets 30 so that the legs 34 of the brackets 32 began to bend under the pressure of the forming pockets 23 of the stop element 20. In FIG. 1E shows the bracket 32 of the final shape; T fabric and abutment member 20 are removed for better visibility. After the brackets 32 are formed and secured to the “T” tissue, the surgeon puts the stop element 20 in the open position so that the block body 31 and the brackets 32 remain attached to the tissue when the end clamp 12 is removed from the patient’s body. The end clamp 12 bends all the brackets at the same time as the two jaws 13, 15 approach each other. The remaining “squeezed” material of the block 31 body acts simultaneously as a hemostatic means (ORC) and for strengthening the brace seam (PMC, PDS or any other film material, as described above 38). In addition, since the brackets 32 do not leave the body of the block 31 during bending, the likelihood of the brackets 32 being irregularly shaped is minimized. As used herein, the term “implantable” means that, in addition to the brackets, the block body materials supporting the brackets also remain in the patient’s body and ultimately resolve. Such implantable blocks of brackets are different from previously used blocks that remained in the end clamp and were removed with it. Such “removable” bracket blocks typically comprise a bracket ejector and therefore can be much larger than the end clamps of the present invention, designed to be used in conjunction with certain unique new implantable bracket blocks in accordance with embodiments of the present invention.

In various embodiments, the end clamp 12 is configured to connect to an elongated barrel 40 extending from the handle assembly 100. The end clamp 12 (when closed) and the oblong barrel 40 may have a similar cross-sectional shape and size that allows them to be guided through the trocar or a working channel in another form of instrument for providing surgical access. The term “conduct” as used herein means that the end clamp and at least a portion of the elongated stem can be inserted or inserted through the channel or opening of the tube and manipulated as required to complete the suture stapling procedure. In some embodiments of the invention, the jaws 13 and 15 of the end clamp 12, when in the closed position, can give the end clamp an approximately circular cross-sectional shape that facilitates its passage through the round passage / hole. However, the end clamps in accordance with various embodiments of the present invention, as well as elongated shafts in accordance with various embodiments of the invention, can presumably have a different cross-sectional shape, allowing them to pass through channels and openings with a different cross-section. Thus, the total size of the closed end clamp in cross section will depend on the size of the channel or hole through which it is inserted. Thus, for example, the size of the end clamp can be indicated as “5 mm”, which means that it can be passed through an opening with a diameter of approximately 5 mm.

In various embodiments of the present invention, the elongated barrel 40 may have an outer diameter substantially corresponding to the outer diameter of the end clamp 12 in the closed position. For example, an end clamp with a diameter of 5 mm can be connected to an elongated barrel 40 with a diameter of 5 mm in cross section. However, as you read the present detailed description, it will become apparent that various embodiments of the present invention can be effectively used in combination with terminal clips of different sizes. For example, an end clamp with a diameter of 10 mm can be connected to an elongated barrel with a diameter of 5 mm in a section. Conversely, for techniques in which the size of the access channel or opening is 10 mm or more, the elongated barrel 40 may have a diameter of 10 mm or more, but can also be used to actuate an end clip with a diameter of 5 or 10 mm. Accordingly, the outer barrel 40 may have an outer diameter equal to or different from the outer diameter of the closed end clamp 12 attached to it.

As shown in the figure, the elongated barrel 40 extends distally from the handle assembly 100 and forms a substantially straight line defining a longitudinal axis A-A. In various embodiments, for example, an elongated barrel 40 may have a length of about 229-406 mm (9-16 inches). However, the elongated barrel 40 may have a different length and, in other embodiments, may have articulated joints or another configuration allowing bending of the end clamp 12 with respect to parts of the barrel or handle assembly, as will be described in detail below. In various embodiments, the elongated barrel 40 comprises a core 50 occupying a space from the handle assembly 100 to the end clamp 12. At the proximal end of the oblong channel 14 of the end clamp 12 there is a pair of protruding locking trunnions 17 having dimensions corresponding to the notches 52 located at the distal end core element 50 for the purpose of detachable connection of the end clamp 12 to the elongated barrel 40 The core 50 may be made of, for example, aluminum 6061 or 7075, stainless steel, titanium and etc.

In various embodiments, the handle assembly 100 has a pistol grip housing that may be made of two or more assemblies. For example, the handle assembly 100, as shown in the figure, includes a right housing element 102 and a left housing element 104 (FIGS. 5, 7 and 8), made by molding or otherwise of a polymer or plastic material and suitable for each other. Such housing elements 102 and 104 can be connected to each other using snap-on elements, pins and recesses obtained by molding or by other means, and / or using adhesives, screws, and the like. The flange 56 is configured to be held in the groove 106 formed by corresponding ribs 108 protruding inward from each element of the housing 102 and 104, while maintaining the ability to rotate. This configuration facilitates the connection of the core 50 with the handle assembly 100, allowing rotation of the core 50 with respect to the handle assembly 100 along the longitudinal axis AA through an angle of 360 °.

As seen in FIG. 1 and 4, the core 50 passes through a support sleeve 60, which is connected to the handle assembly 100 while maintaining rotational ability. The support sleeve 60 has a proximal flange 62 and a distal flange 64, creating a rotational groove 65 with such a configuration as to receive the nose 101 of the handle assembly 100 while maintaining the ability to freely rotate. This configuration allows the support sleeve 60 to rotate along the longitudinal axis A-A with respect to the handle assembly 100. The core 50 is attached to the support sleeve 60 with a pin 66 and cannot rotate. In addition, a rotary handle 70 is attached to the support sleeve 60. For example, in one embodiment of the invention, the rotary handle 70 has a hollow portion with a support flange 72 of a suitable size to receive a portion of the support sleeve 60. In various embodiments, the rotary handle 70 may be manufactured from, for example, carbon-filled glass or nylon, polycarbonate, Ultem® material and the like. and attached to the support sleeve 60 with a pin 66. In addition, a retaining flange 74 that protrudes inwardly can be formed on the support flange 72 and, due to its configuration, fits into the radial groove 68 formed in the support sleeve 60. Thus, the surgeon can rotate the core 50 (and the end clamp 12 attached to it) along the longitudinal axis AA at an angle of 360º, capturing the rotary handle 70 and turning it relative to the handle assembly 100.

In various embodiments, the thrust member 20 is held open by the spring 21 of the thrust member or other deflecting member, as shown in FIG. 1, 9A, 10A and 11A. The thrust element 20 is capable of selectively moving from an open position to various closed or pinched and end positions under the action of the cutting-stitching system, usually indicated by 109. The cutting-stitching system 109 has a “trigger” 110, which, in various embodiments, includes the hollow tube of the trigger mechanism 110. The hollow tube of the trigger mechanism 110 is capable of longitudinal movement along the core 50 and, therefore, forms the outer part of the elongated barrel assembly 40. The tube of the trigger mechanism and 110 may be made of a polymer or other suitable material and having a proximal end 112 attached to the clamp 114 of the cutting-crosslinking system 109. See. FIG. 4. For example, in various embodiments, the collar 114 can be obtained by multi-component casting of the proximal end 112 of the tube of the trigger 110. However, other bonding methods may be used.

As seen in FIG. 1 and 4, the collar of the trigger 114 may be rotationally connected to a support washer 120, the configuration of which allows axial movement in the handle assembly 100. In various embodiments of the invention, the support washer 120 has a pair of protruding side ribs 122 that can slide in slots 103 and 105, formed in the right and left elements of the handle 102 and 104, respectively. See FIG. 7. Thus, the support washer 120 can slide along the axis inside the handle housing 100, while the trigger clamp 114 and the trigger tube 110 can rotate about it along the longitudinal axis AA. As seen in FIG. 4, the tube 110 has a longitudinal slot 111 so that the pin 66 can enter the core 50 while maintaining the ability of the tube 110 to move along the core 50.

Cutting-stapling system 109 further comprises a trigger lever 130, which serves to adjust the axial movement of the tube 110 along the core 50. See FIG. 1. Such axial movement of the tube 110 in the distal direction leads to interaction with the thrust element 20 and is referred to by the term “initiating movement”. As seen in FIG. 1, the trigger lever 130 is movably or pivotally connected to the handle assembly 100 by an axis of the hinge 132. A torsion spring 135 is used to deflect the trigger lever 130 from the pistol grip part 107 of the handle assembly 100 to an “open” or initial idle position. As seen in FIG. 1 and 4, the release lever 130 has an upper portion 134 movably connected to the links of the release mechanism (connected by pins) 36, which are movably connected (by pins) to the support washer 120. Thus, the movement of the release lever 130 from its initial position (FIG. 1 and 9) to the final position in the direction of the pistol grip 107 of the handle assembly 100 (FIG. 14), the trigger clamp 114 and the tube 110 will begin to move in the distal direction “DD”. The movement of the trigger mechanism 130 from the pistol grip 107 of the handle assembly 100 (under the action of the torsion spring 135) will cause the collar of the trigger mechanism 114 and the tube 110 to move in the proximal direction “PD” along the core 50.

In various embodiments of the present invention, implantable brace blocks may have different sizes and configurations. For example, the surgical instrument 10, when used in conjunction with the first trigger adapter 140, can be used with an end clamp 12 of 5 mm in size having a length of about 20 mm (or another length) and accommodating an implantable bracket unit 30. This end clamp size may be particularly suitable , for example, to complete an incision requiring high precision and vascular operations. However, as will be discussed in more detail below, the surgical instrument 10 can also be used, for example, in combination with end clamps and brace blocks of other sizes by replacing the first trigger adapter 140 with the second trigger adapter 150. In other embodiments, the elongated barrel assembly 40 may have such a configuration that only connects to the end clamp of the same shape and size. In such embodiments, for example, the pressure surfaces 146 or 158 (normally found on the trigger adapters 140 and 150, respectively) are an integral part of the distal end of the tube of the trigger 110, depending on the particular size of the end clip to be used.

As shown in FIG. 2, the first trigger adapter 140 is substantially hollow and has a first spring 142 configured to fit into the open distal end 116 of the trigger tube 110. A first locking button 144 is formed on the first spring portion 142 and is sized to fit into the locking hole 117, available at the distal end portion of the trigger tube 110. See FIG. 1 and 2. Thus, in order to disconnect the first trigger adapter 140 from the tube 110, the user simply needs to press the locking button 144 so that it comes out of the locking hole 117 and remove the first trigger adapter 140 from the tube 110. As also seen in FIG. . 2, the first trigger adapter 140 has an inner pressure surface 146 so configured to engage the fork-shaped inclined portion 24 of the stop member 20.

In various embodiments of the invention, the fork-shaped inclined portion 24 of the abutment member 20 has a pair of teeth 45 separated by a groove into which a blade (not shown) enters. Each tooth 45 has a proximal surface 27 substantially parallel to the bottom of the oblong channel 14 when the stop member 20 is closed. 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 clamping angle “A” with respect to the proximal surface 27. In various embodiments, for example, the clamping angle “A” may be approximately 15-30 degrees. As will be discussed in more detail below, when the first pressing surface 146 of the first trigger adapter 140 is in contact with the inclined surface 28, the stop member 20 moves toward the elongated channel 14, and more specifically, to the bracket block 30 located therein. As the trigger adapter 140 moves further distally the first pressing surface 146 is in contact with the inclined surface 29 to form brackets on each of the teeth of the stop element 45 and causes the stop element 20 to press the block of brackets 30, and the brackets 32 to fight. As also shown in FIG. 3, the inclined surface 29 for forming the brackets is oriented at a forming angle “B” relative to the clamping inclined surface 27. In various embodiments, for example, the forming angle “B” can be approximately 5-20 degrees. The inclined portion 24 of the stop element 20 may further have an inclined bottom surface 25 (in particular, an angle “C” of about 5-40 degrees), so that when the stop element 20 is in the open position, the inclined lower surface 25 allows rotation of the stop element up to 15 ° ( angle "β" in FIG. 11A).

The method for releasably connecting the end clamp 12 to the core 50 is explained below. The connection is made by inserting the locking studs 17 on the elongated channel 14 into the notches 52 in the core 50. Subsequently, the surgeon moves the trigger lever 130 to the pistol grip 107 of the handle assembly 100 to move the trigger tube 110 in the distal direction, and the first trigger adapter 140 is above the proximal end 47 of the oblong channel 14 so that the pins 17 fit into the corresponding notches 52. See FIG. 10 and 10A. This position of the first trigger adapter 140 over the pins 17 is referred to by the term “connected position”. Various embodiments of the present invention may also include an end clamp 160 locking system designed to lock the release lever 130 in a certain position after attaching the end clamp 12 to the core 50.

More specifically, and as shown in FIG. 5, 7, and 8, one embodiment of the end clamp 160 locking system includes a locking pin 162 movably secured in the upper portion 134 of the release lever 130. The locking pin 162 is biased by the spring toward the left side of the housing 104 due to the locking spring 166. When the release lever 130 is in the non-pressed (initial) position, the locking pin 162 is deflected and adjacent to the stopper 163, protruding inward from the left side of the housing 104. See FIG. 7 and 8. As discussed above, the trigger tube 110 must first move distally to the connected position, with the first trigger adapter 140 holding the pins 17 of the end clamp 12 in the cutouts 52 of the core member 50. The surgeon shifts the trigger adapter 140 distally to the connected position by pressing the trigger lever 130, moving it from the initial position in the direction of the pistol grip 107. At the beginning of pressing the trigger lever 130, the locking pin 162 slides in contact with the stopper 163 until Single firing mechanism 110 does not transfer the first adapter release mechanism 140 in the connected position, wherein the locking pin 162 enters the locking recess 164 formed in the left housing portion 104. See. FIG. 8. In various embodiments, when the locking pin 162 enters the retaining recess 164, the pin 162 may make an audible “click” or other sound, and also give the surgeon a tactile sense of “blocking” the end clip 12 on the core 50. In addition, the surgeon cannot inadvertently trigger the trigger 130 further and start forming brackets 32 in the end clamp 12 without removing the locking pin 162 from the locking recess 164 Similarly, if the surgeon releases the trigger 130 in the connected Assumption, it remains in this position by the locking pin 162 to prevent return of the trigger lever 130 to the initial position and releasing the clamp terminal 12 of the compound with the core 50.

In various embodiments of the invention, the release button of the release lever 167 is located on the left side of the housing 104 of the handle 100 so that the surgeon can release the locking pin 167 and make it possible to further press the release lever 130 or return to its initial position. See FIG. 5, 7 and 8. The release button of the release lever 167 is movably located in the locking recess 164 and deviates under the action of the spring to an inactive position (FIG. 8). When you press the release button of the release lever 167, it is in contact with the locking pin 162 and pushes it out of the locking recess 163, allowing further pressing the release lever 130.

As already described, the surgical instrument 10 can be used as a gripper for manipulating / positioning tissues. Further pressing the trigger lever 130 to the part of the pistol grip 107 after releasing the trigger lever 130 (by pressing the release button 167) will cause the trigger adapter 140 to come into contact with the clamping inclined portion 28 of the stop member 20. As the pressure surface 146 advances the first adapter of the trigger to the inclined pressure surface 28, the stop element moves to the block of brackets 30 in the elongated channel 14. Thus, the surgeon can manipulate the stop element 20, moving closer or closer Thread it from the brackets of the block 30 in order to capture and release tissue therebetween without bending brackets.

Various embodiments of the present invention may further include a release button lock button 137 movably connected to a handle assembly 100. See FIG. 1 and 4. In one form, the release button lock button 137 has a latch 138 formed at the distal end and oriented so as to engage the collar 114 when the release button is released in the first locked position. As can be seen in FIG. 1 and 4, the spring of the latch 139 serves to reject the lock button of the trigger system 137 in the first locked position (FIG. 11 and 12). As will be described in more detail below, the latch 138 serves to engage the clamp 114 at the point where the position of the clamp 114 on the core 50 corresponds to the point at which the pressing surface 146 of the first adapter of the trigger 140 is ready to move distally to the pressing inclined surface 28 of the stop member 20 It should be borne in mind that as the axial movement of the first adapter of the trigger mechanism 140 to the clamping inclined surface 28, the thrust element 20 will move along such a path so that its forming surface 22 races olagalas substantially parallel to the upper surface 36 of block 30 parentheses.

After the end clamp is connected to the core 50, the process of forming the brackets begins, first by pressing the lock button of the trigger system 137 to distally move the clamp 114 along the core element 50, and finally by pressing the stop element 20 against the bracket block 30. See FIG. 13. After pressing the lock button of the trigger system 137, the surgeon continues to press the trigger lever 130 towards the pistol grip 107, thereby bringing the pressure surface 146 of the washer of the first bracket 140 to the corresponding inclined surface 29 to form the brackets, causing the stop member 20 to come into contact with brackets 32 in the block of brackets 30. The lock button of the trigger system 137 prevents the random formation of brackets 32 until the surgeon is ready to start the process. In this embodiment, the surgeon must press the lock button of the trigger system 137 to press the trigger lever 130 further and begin the brace process.

If desired, the surgical instrument 10 can be used solely as a tool for bracketing. However, various embodiments of the present invention may also include a tissue dissection system, usually indicated by 170. In at least one form, the tissue dissection system 170 includes a cutting element 172 that can selectively extend from an inactive position at the proximal end of the end clamp 12 (FIG. 1 and 9-13) to the operating position (FIG. 14) by pressing the trigger lever to actuate the scalpel 200. The scalpel 172 is movably located in the core 50 and is attached or otherwise protrudes from scalpel stem 180. The scalpel 172 can be made, for example, of stainless steel 420 or 440 with a hardness of more than 38HRC (Rockwell hardness scale) and have a cutting edge 176 at the distal end 174, and also have a configuration that allows it to slide in the slot 31 of the stop element 20 and the central slot 33 in the block of brackets 30 for dissecting the tissues captured by the end clamp 12. See Fig. 14A. As seen in FIG. 4, the scalpel shaft 180 passes through the core 50 and has a proximal end 182. The proximal end 182 is in contact with the scalpel drive 190, transmitting a drive force thereto, while the scalpel drive is operatively connected to the scalpel trigger 200. In various embodiments, the trigger for extending the scalpel 200 is connected to the axis 132 so that it can be rotated or otherwise actuated without pressing the trigger lever 130. In various embodiments, the first the grinder of the scalpel 192 is also connected to the axis 132 so that pressing the trigger to extend the scalpel 200 also rotates the first gear of the scalpel 192. The return spring of the trigger 202 is located between the first gear of the scalpel 192 and the body of the handle 100 and is designed to return the trigger of the scalpel 200 to the initial non-working position. See FIG. 1 and 4.

As shown in FIG. 5 and 6, various embodiments of the transmission mechanism of the scalpel 190 may include a second gear of the scalpel 194, which is located on the spindle of the second gear 193 and can rotate freely and engage with the first gear 192. The second gear of the scalpel 194 is meshed with the third gear of the scalpel 196 mounted on the spindle of the third gear 195. The fourth gear of the scalpel 198 is also attached to the spindle of the third gear 195. The fourth gear of the scalpel 198 is meshed with a number of circular gear poles ren or rings 184 located at the proximal end of the rod 180 a scalpel, in order to transmit the driving force. Thus, this configuration allows the fourth gear of the scalpel 198 to move the shaft of the scalpel 180 longitudinally in the distal direction "DD" or the proximal direction "PD", while allowing rotation of the rod of the trigger mechanism 180 along the longitudinal axis AA with respect to the fourth gear of the scalpel 198. Accordingly, the surgeon can advance the trigger rod 180 along the axis and ultimately advance the scalpel 172 distally by pressing the trigger of the scalpel 200 towards the pistol portion 107 of the handle assembly 100 ki.

Various embodiments of the present invention further include a scalpel 210 locking system that prevents the scalpel 72 from extending until the trigger lever 130 is fully depressed (FIGS. 13 and 14). Therefore, this feature prevents the activation of the scalpel actuator system 170 until the brackets are formed and a stitch seam is applied to the tissue. As seen in FIG. 1, various embodiments of a scalpel 210 locking system include a locking rod 211 pivotally mounted to a portion of the pistol grip 107 of the handle assembly 100. The scalpel locking rod 211 has an activating end 212 capable of engaging with the release lever 130 when the release lever 130 is fully engaged. pressed position. In addition, the scalpel blocking rod 211 has a locking hook 214 at the other end that engages with the latch rod 216 on the first gear gear 192. The scalpel 218 retaining spring is designed to deflect the rod 211 to a “locked” position when the locking hook 214 is held in engagement with the rod the latch 216 and prevents the trigger of the scalpel 200 from being actuated until the trigger 130 is fully engaged. See FIG. 9.

Now, we will consider various operating methods of one of the embodiments of the present invention of a surgical instrument, as shown in FIG. 9, 9A, 10, 10A, 11, 11A, 12, 12A, 13, 13A, 14 and 14A. As seen in FIG. 1, 9 and 9A, when the bar of the scalpel 172 is in the “initial” position shown in the figure, the cutting edge 176 is located proximal to the distal end of the first trigger adapter 140 so that the sharp cutting edge 176 does not protrude. In alternative embodiments, when the elongated barrel is made for use with one shape or size of the end clamp (for example, when adapters 140, 150 are not used), the cutting edge 176 of the scalpel 172 will be located proximal to the distal end of the trigger tube so that the cutting edge 176 also did not speak.

FIG. 9 and 9A depict end clamp 12 after attaching to core 50 by inserting pins 17 on end clamp 12 into cutouts 52 of core 50. As shown in FIG. 9, the release lever 130 is in the initial or inoperative position, and the end clip 12 is not yet attached to the core 50 by the first adapter of the release mechanism 140. “P _O ” is the distance that the release lever 130 can be moved until the first adapter trigger 140 will not begin to move upwardly on the downward inclined portion 28 of the stop member 20. The trigger of the scalpel 200 is also in a locked inoperative position.

In FIG. 10 and 10A show the position of the trigger lever 130 after it has been moved to a position in which the end clamp 12 is fixed to the core 50 by the first adapter of the trigger mechanism 40. This position is called the “connected” position. In the connected position, the locking pin 162 enters the holding recess 164 (FIG. 8) to give the surgeon an audible and tactile signal that the end clip 12 is now secured to the core 50. The trigger lever 130 cannot be pressed further until the surgeon presses the release button of the trigger mechanism 167 (FIGS. 5, 7 and 8) to eject the locking pin 62 from the locking recess 164. The distance traveled by the distal end 141 of the first adapter of the trigger mechanism 140 is indicated as the distance “l” (FIG. 10A), and corresponding distance, pr walked by collar 114 through core 50, denoted by “l '”. In FIG. 11 and 11A show the position of the trigger lever 130 after pressing the release button of the trigger mechanism (not shown) and actuating the trigger lever 130 by a surgeon to move the trigger adapter 140 to the beginning of the pressing inclined surface 28 on the stop member 20. As can be seen in these figures, due to the action of the spring 21, the stop element 20 has moved to the open position. The movement of the distal end of the first trigger adapter 140 is represented as the distance “l ₁ ”, and the corresponding distance by which the collar 114 has moved along the core 50, as the distance “l ' ₁ ”. In FIG. 12 and 12A show the position of the first trigger adapter 140 after moving it to the beginning of the inclined surface 29 of the stop member 20 for forming the brackets. This position corresponds to the maximum clamping force possible before starting to bend the brackets. This position will hereinafter be called the “maximum clamped position”. As seen in FIG. 12, the trigger clip 114 has come into contact with a latch 138 on the release button of the release lever 137 and, therefore, cannot move further distally until the release button of the release mechanism 137 is pressed. As shown in FIG. 12A, the forming surface 22 of the abutment member 20 is substantially parallel to the upper surface 31 of the bracket unit 30. The distance between the forming portion 22 of the abutment member 20 and the upper holding surface of the elongated channel 14 is referred to in various embodiments as “C _max ”. In various embodiments, C _max may be, for example, from about 2.15 to 3.65 mm (0.085-0.144 inches) for the brace blocks 30 with a portion of the housing 31 having a substantially equivalent thickness. In at least one embodiment, for example, the thickness of the block may exceed the size of the bracket by approximately 0.25 mm to 0.76 mm (approximately 0.01-0.03 inches). The total distance traveled by the trigger adapter 140 from the starting position to the maximum clamped position is shown as “l ₂ ”, and the corresponding distance traveled by the collar 114 along the core 50 as “l ' ₂ ”. In FIG. 13 and 13A show the position of the clamp 114 in the extreme position when the brackets 32 in the bracket block 30 are fully bent. In this position, the distance between the forming part 22 of the thrust member 20 and the top of the holding surface of the elongated channel 14 is represented as “C _min ”. In various embodiments, “C _min ” may be, for example, from about 0.38 mm to 0.76 mm (about 0.015-0.030 inches) for brace blocks containing brackets that, when deployed, have legs of about 1 in length, 90 mm to 3.40 mm (approximately 0.075-0.134 inches) (UF distance in FIG. 1A), and when fully collapsed, have a height of, for example, from approximately 0.63 mm to 1.01 mm (approximately 0.025- 0.04 inches), which is shown as the distance "FF" in FIG. 1D. The total distance traveled by the trigger adapter 140 from the starting position to this end position is indicated by “l ₃ ”, and the corresponding distance traveled by the collar 114 through the core is indicated by “l ' ₃ ”. As also seen in FIG. 13, the trigger lever 130 is in the fully depressed position and is in contact with the activating end 212 of the scalpel blocking rod 211, whereby the locking hook 214 is disconnected from the latch rod 216 on the first gear gear 192.

Dissection, especially of blood vessels, can be the most intense stage of any operation. With laparoscopic operations, this is an even more stressful stage, since in case of failure, it may be necessary to almost immediately switch to open intervention in order to avoid catastrophic consequences. Thus, it may be desirable to use a surgical stapler capable of further dissecting the tissue after the braces are applied. Various embodiments of the present invention meet these requirements.

After the brackets are “installed” (inserted into the tissue and formed), the surgeon can press the release button of the trigger 167 so that the trigger 130 can return to its original position under the action of the torsion spring 135, so that the stop element 20 can move to the open position under the action of the spring 21. In the open position of the stop element, the surgeon can remove the end clamp 12, leaving the implantable block of brackets 30 and brackets 32 in the tissue. In techniques, when an end clip is inserted through a tube, a working channel or the like, the surgeon returns the stop member 20 to the closed position by activating the trigger lever 130 so that the end clip 12 can be removed through the tube or working channel. However, if the surgeon decides to dissect the tissue after installing the brackets, he activates the trigger of the scalpel 200 as described above, causing the stem of the scalpel 72 to move through the dissected tissue in the direction of the end clamp, as shown in FIG. 14, 14A. In FIG. 14 shows the distance by which the trigger of the scalpel 200 is shifted in various embodiments with different lengths of the end clamps / bracket blocks, while the stem of the scalpel 72 is advanced to the end position in the end clamp 12. Subsequently, the surgeon can release the trigger of the scalpel 200 to return spring 202 through the transmission system returned the stem of the scalpel 72 to its original (inoperative) position (FIG. 13, 13A). When the scalpel 72 returns to its original position, the surgeon can open the jaws 13 and 15 of the end clamp to release the implantable block of brackets 30, leaving it in the patient’s tissues and remove the end clamp 12 from the patient’s body. Thus, the surgical instruments of the present invention facilitate the use of small implantable staple blocks that can be inserted through relatively small working channels and passages, while allowing staples to be inserted without dissecting the tissue or, if required, to dissect the tissue after stapling.

As shown above, the surgical instrument 10 can be used in combination with other end clamps capable of holding brace blocks of other sizes containing a different number of brackets or brackets of a different size. In FIG. 15-19 illustrate the use of an end clamp 12 ′ functionally holding a bracket block 30 ′ in which brackets 32 ′ are larger than the brackets 32 in block 30. For example, the brackets 32 in block 30 can have a size of from about 2.03 to 2 15 mm (approximately 0.080-0.085 inches), while the brackets 32 'in block 30' may have a size of approximately 1.90 mm (approximately 0.075 inches). In various embodiments, the bracket block 30 ′ is longer than the bracket block 30. For example, the bracket block 30 may have a length of approximately 20 mm (approximately 0.78 inches); while the block 30 'may have a length of approximately 40 mm (approximately 1.57 inches). In FIG. 15 is a diagram of parts of the end clamp 12 ′, the second adapter of the trigger system 150, and the distal end 55 of the core 50. As shown in FIG. 15, the elongated channel 14 ' has a pair of side walls 16 ' separated by a space, each of which has a slot or hole 18 ' of a corresponding size to receive a corresponding pin 26 ' of the thrust member. The stop member 20 'and the elongated channel 14' may together form an end clamp 12 'with a common diameter allowing the end clamp 12' to pass through an opening with a diameter of at least about 5.0 mm (about 0.20 inches). The stop element 20 'also has a part 22' for forming brackets, having many pockets for forming brackets, and a fork-shaped inclined part 24 ', protruding proximally. The proximal end 15 'of the elongated channel 14' has a pair of protruding pins 17 'of such a size as to fit into the corresponding notches 52 in the core 50.

As seen in FIG. 15, the second trigger adapter 150 has a substantially hollow body portion 151 and a proximal constricted portion 152 with a retaining protrusion 154 protruding inward. Between the body 151 and the proximal constricted portion 152 there is a gap allowing the constricted portion 152 to deviate with respect to the housing 151 and to facilitate the entry of the holding protrusion 154 into the holding hole 117 of the trigger tube 110. To detach the trigger adapter 150 from the trigger tube 110, the surgeon presses on the proximal constricted portion 152 to displace the retaining protrusion 154 from the retaining hole 117, thereby allowing the second trigger adapter 150 to be removed from the tube 110 in the distal direction lion.

In various embodiments of the invention, the abutment element 20 ′ has an inclined fork portion 24 ′ with a pair of teeth 45 ′, each of which has a proximal surface 27 ′ turning into a pressing inclined surface 28 ′ located distal to the proximal surface 27 ′. See FIG. 15. The clamping inclined surface 28 'is oriented at an angle "A" with respect to the proximal surface 27.' In various embodiments, for example, the angle "A" may be approximately 50 to 30 degrees. As will be discussed in more detail below, when the second pressing surface 158 of the second trigger adapter 150 is in contact with the inclined surface 28, the abutment element 20 ′ moves to the elongated channel 14 ′, and more specifically, to the bracket block 30 ′ located therein. See FIG. 17. As the second trigger adapter 150 advances further, the distal second pressing surface 158 contacts the inclined surface 29 'on the teeth of the abutment element 45 and forces the abutment element 20' to press against the bracket block 30 ', and the brackets 32' to bend. See FIG. 18. The surface 29 'for forming the brackets is oriented at a forming angle "B" relative to the pressing inclined surface 27'. In various embodiments, for example, the angle "B" may be approximately 5-20 degrees. Between the inclined surface 24 'and the bottom of the elongated channel 14', a spring (not shown) can be placed to translate the thrust member 20 'into such an open position.

FIG. 16 shows the position of the second trigger adapter 150 after the surgeon advances the second trigger adapter 150 distally to the beginning of the inclined surface 28 ′. The operation of the second trigger adapter 150 is controlled by the trigger lever 130 as described above for the first trigger adapter 140. In FIG. 17 shows the position of the second trigger adapter 150 in the fully clamped position. In FIG. 18 shows the position of the second trigger adapter 150 in the final position when the brackets 32 'in the block of brackets 30' formed a seam in the fabric (not shown).

As shown above, the implantable bracket unit 30 'is longer than the implantable bracket unit 30. Thus, as shown in FIG. 15, the end clamp 12 ′ also includes a distal scalpel 124 that is movably located in the elongated channel 14 ′. The distal scalpel 124 has a cutting edge 125 for dissecting tissues and a proximal portion 126 of such a configuration that it engages with the stem of the scalpel 72. Thus, if the surgeon decides to cut the tissue after setting the braces, he activates the trigger lever 200 as described above, forcing the stem the scalpel 172 move in the distal direction until it touches the scalpel 124, which leads to the movement of the scalpel 124 through the tissue, as shown in FIG. 19. The distal scalpel 124 may have at least one fixing part capable of sliding in a slot of a corresponding shape (not shown) in an elongated channel 14 '. This configuration allows you to open the end clamp 12 'after the formation of the brackets and incision of the fabric. The distal scalpel 124 remains in the abutment member 20 ′ and is removed along with the end clamp 12 ′ when the latter is removed from the patient’s body.

Thus, in various embodiments of the invention, the surgical instrument 10 has separate mechanisms for stitching and dissection of tissues, which allows the surgeon to stitch a staple without cutting the tissue. Various embodiments of the stapling tool in accordance with the present invention can be successfully used with end clamps of different sizes, designed for different sizes and the number of brackets. Surgical instruments can be supplied in the form of a kit including an instrument 10 and a first trigger adapter 140, as well as a second trigger adapter 150, allowing the tool to be used with implantable brace blocks of different sizes.

Various unique and new embodiments of the present invention include a compressible block of brackets holding the brackets in a substantially stationary position for their contact with the stop element during the formation of the seam. Unlike previous surgical stapling instruments that use brackets to eject, the brackets in the blocks according to various embodiments of the present invention are not ejected in the direction of the abutment element. In various embodiments of the invention, the thrust member moves toward unformed brackets. The degree of resulting bending of the brackets depends on the distance by which the thrust element approaches the brackets. This configuration allows the surgeon to adjust the degree of folding of the brackets and, therefore, the final height of the formed brackets by adjusting the element pressure on the brackets.

In various embodiments of the invention, the driving force of the trigger applied to the movable thrust element depends on the pressure of the trigger. For example, if the surgeon wants to receive only partially folded brackets, he does not press the trigger lever in the direction of the pistol grip 107 to the end. To bend the brackets more, the surgeon simply presses the trigger further, forcing the stop element to press harder on the brackets and give them the desired shape. As used herein, the term “shaping” means that the forming surface of the pockets for forming the brackets is in contact with the tips of the legs of the brackets and begins to bend or curl them. The degree of formation of the brackets means the degree of folding of their legs and, ultimately, the height of the folded brackets, as described above. Specialists in this field will understand that, due to the fact that when actuating the thrust element 20 during movement remains essentially parallel to the block of brackets, the brackets are formed essentially simultaneously and have essentially the same height.

FIG. 20-23 depicts an alternative surgical instrument 10 with a bracket height indicator system 220. In various embodiments, the bracket height indicator 220 comprises an indicator rod 222 attached to the upper portion 134 of the trigger lever 130 for pivoting movement with it. As the trigger lever 130 rotates in the direction of the pistol grip 107 of the handle assembly 100 to press the stop member 20 against the bracket unit 30, as described above, the indicator rod 222 becomes visible in the window 223 of the left side of the housing 104. In this embodiment, the system the indicator of the height of the brackets 220 also includes a series of stoppers 24, 26, 28 formed on the left side of the housing 104 and corresponding to the three stages of formation of the brackets. In particular, at the start of pressing the trigger lever 130, the locking pin 162 slides in contact with the stopper 163 until the trigger tube 110 moves the first trigger adapter 140 or 150 to the above locked position, in which the locking pin 162 engages in a holding a recess 164 formed on the left side of the body 104. If the surgeon needs to close the jaws 13, 35 of the end clamp 12, he presses the release button 167 so that you can press the trigger 130 further. When the release button 167 is pressed, it contacts the locking pin 162 and pushes it out of the retaining recess 163, allowing further pressing of the release lever 130. As described above, the surgeon can now use the lower and upper branches 13, 15 of the end clamp 12, respectively, for capture and manipulation of tissues. When the surgeon decides to start the process of forming the brackets, he presses the release button of the trigger 167, allowing the clamp 114 to move in the distal direction as you further press the trigger lever 130.

Further pressing the trigger lever 130 causes the thrust element 20 to press on the brackets 32 in the bracket block 30. As the trigger lever 130 is further pressed, the flat end 165 of the locking pin 162 slides from the initial stopper 163 and comes into contact with the first stopper 224, which corresponds to the first stage of formation the brackets shown by the height symbol of the brackets 230 on the left side of the housing 104. See FIG. 20. As shown in the figure, the symbol of the height of the brackets 230 includes an image of the bracket at the beginning of its formation. Other symbols / pointers may be used to indicate this stage of parenthesis formation. When the locking pin 162 engages with the first stopper 224, the surgeon may hear a click. When the locking pin 162 engages with the first stopper 224, the surgeon may also experience certain tactile sensations transmitted through the release lever 130. In addition, an indicator rod of the height of the brackets 222 can be seen in the window 223 next to the first symbol of the height of the brackets 230. If the surgeon decides to continue the formation of the brackets 32 in the bracket block, the locking pin 162 is pushed out of the first stopper 224 by pressing the release button 240 in the second part of the housing 104. In various embodiments of the invention, for example, the release button 240 m It can be an integral part of the left part of the housing 104 with a part on the hinges 242, which is part of the left half of the housing 104. With this configuration, the pressed button 240 presses the end 165 of the locking pin 162, forcing it to disengage from the first, second or third stops 224, 226 , 228. When the locking pin 162 is pushed out of the first stopper 224, the trigger lever 130 can be pressed further until the locking pin 162 engages in the second stopper to form the brackets 226. This position of the trigger lever 130 leads to further movement at pore element 20 and pressing the brackets 32 in the block of brackets 30. And again, the locking pin 162 engages in the second stop of the formation of brackets 226, while the surgeon hears a click and gets a tactile sensation of the release lever 130 in the second position in the process of forming the brackets. In this position, the indicator bar of the height of the brackets 222 can be seen in the window 223 next to the second symbol of the height of the brackets 232. If the surgeon decides to continue forming the brackets 32 in the bracket unit, the locking pin 162 is pushed out of the second stopper 226 when the release button 240 is pressed. After that, the trigger the lever 130 can be pressed further until the locking pin 162 engages with the third brace forming stopper 228 corresponding to the final brace forming stage and again, the locking pin 162 engages the third brace forming stopper 228, When this surgeon hears a click and tactile sense of being received the trigger lever 130 in the third position in the formation of brackets. In this position, in the window 223, the indicator bar of the height of the brackets 222 can be seen next to the symbol of the height of the brackets 234. After the brackets are given the required height, the surgeon can push the locking pin 162 out of the third stopper 228 to return the trigger lever 130 to its original position. Or, if necessary, the surgeon can make a tissue incision, as described above, and then return the trigger lever 130 to its original position.

FIG. 24 shows an alternative embodiment of the invention in which the indicator of the height of the brackets, usually denoted 220 ', does not have a series of stoppers corresponding to different heights of the folded brackets. However, this embodiment includes an indicator bar of the height of the brackets 222 and a window 223. Thus, the surgeon can monitor the degree of formation of the brackets by the position of the rod of the indicator 222 in the window 223. This embodiment includes symbols for the height of the brackets 230, 232, 234, as described above . In addition, this embodiment may also include an expanded brackets symbol 229 corresponding to the initial position when the formation of the brackets 32 by the stop member 20 has not yet begun. In other respects, the operation of this embodiment is not different from that described above.

FIG. 25 and 26 show an alternative end clamp 12 ″ similar to the end clamp 12 ′ described above, except for the following differences necessary for using the scalpel rod 172 ’. The scalpel stem 172 'is connected to or protrudes from the stem of the scalpel 180, and functions as described above for the stem of the scalpel 172. However, in this embodiment, the stem of the scalpel 172' is long enough to cover the full length of the end clamp 12 '' and, therefore, a separate distal cutting element in the end clamp 12 ″ is not used. The scalpel rod 172 'has an upper transverse element 173' and a lower transverse element 175 'formed on it. The upper transverse element 173 ′ is oriented so as to slide in the corresponding elongated slot 250 in the abutment element 20 ″, and the lower transverse element 175 ′ is oriented so as to slide in the elongated slot 252 of the elongated channel 14 ″ of the end clamp 12 ″. A releasing slot (not shown) is also provided in the abutment member 20 ″ so that when the scalpel 172 ′ moves to the end position in the end clamp 12 ’, the upper transverse member 173’ is lowered into the corresponding slot, allowing the abutment member 20 ″ to move into the open position to release tissue stapled and dissected. The stop element 20 ″ can be otherwise identical to the stop element 20 described above, and the elongated channel 14 ″ can be otherwise identical to the elongated channel 14 described above.

In these embodiments of the invention, the stop element 20 ″ is moved to the fully open position (FIG. 25) by the action of a spring or other mechanism (not shown). The stop element 20 ″ is moved between the open and fully closed positions during axial movement of the trigger adapter 150 as described above. After the trigger adapter 150 is moved to the fully clamped position (FIG. 26), the surgeon moves the stem of the scalpel 172 ″ in the distal direction, as described above. If the surgeon decides to use the end clamp as a means to grip tissue, the trigger adapter can be moved proximally so that the stop member 20 ″ can move away from the oblong channel 14 ″, as shown in FIG. 27 broken lines. In this embodiment, the scalpel 172 ″ moves distally, the upper transverse element 173 ’and the lower transverse element 175 ″ push the abutment element 20 ″ and the elongated channel 14 ″ towards each other to achieve the required degree of formation of the brackets as The scalpel rod 172 ″ moves distally through the end clamp 12 ″. See FIG. 28. Thus, in this embodiment, the formation of the brackets occurs simultaneously with the dissection of the tissues, but the brackets themselves can form after the rod 172 ″ is moved in the distal direction.

FIG. 29 and 30 depict the use of an end clamp 12 ″ with a stop member 20 ″ made of, for example, stainless steel, titanium, PGA (polyglycolic acid) or other absorbable plastic materials and having some flexibility. These figures also illustrate the use of support material 6250 and leveling material 6206, which will be described in more detail below. As seen in FIG. 29, the abutment member 20 ″ is bent to a fully formed state as the scalpel 172 ″ distally moves.

For many surgical interventions, it is desirable or recommended to use surgical cutting and stapling instruments having an end clamp that can bend relative to the elongated trunk. However, access to narrow spaces with previously used articulated tools is often limited due to the size and design of the elements used to create the articulated end-clamp joints. In FIG. 31 to 40 show another embodiment of the present invention of a surgical instrument with an end clamp capable of bending relative to an elongated shaft and having a relatively compact configuration of a bend control in the handle assembly.

The surgical instrument 310 in accordance with this embodiment of the invention is essentially similar to the various embodiments of the surgical instruments 10 described above, except that in this embodiment there is a shaft assembly with a hinge 312 to facilitate the selective location of the end clamp 12 along the longitudinal axis AA. Although the surgical instrument 310 will be described when used in conjunction with the end clamp 12 of the above type, one skilled in the art should keep in mind that the surgical instrument 310 can also be used in combination with the second trigger adapter 150 to actuate the end clamp 12 ′ or end clamps of a different configuration. As seen in FIG. 31 and 32, the stem assembly with articulation 312 includes a distal portion of the stem 314 articulated to the proximal portion of the stem 316 that is operatively connected to the handle assembly 100. In various embodiments, for example, the distal stem assembly 314 includes a distal core member 320 c a pair of notches 322, which includes the pins 17. See FIG. 32. The distal element of the core 320 has a proximal end 324, including the base of the hinge 326 with a protruding axis of rotation 328.

As seen in FIG. 32, the proximal portion of the stem 316 includes a proximal segment of the core 330 with a proximal hinge base and a scalpel guide 332 attached thereto. The scalpel guide 332 can, for example, be welded or attached to the proximal segment of the core 330 with glue or other fixing methods. A hole in the hinge 334 is provided in the proximal guide of the scalpel 332 to insert the axis of rotation 328 so that the distal segment of the core 320 can rotate relative to the proximal segment of the core 330 along the first axis of rotation FA-FA, essentially perpendicular to the longitudinal axis A-A. Surgical instrument 310 further includes a distal segment of the trigger tube 370 pivotally connected to a pair of links of the trigger tube 380, 382 to rotate about a second SA-SA axis. The distal segment of the trigger tube 370 has a holding hole 372, which includes the holding button 144 of the first trigger adapter 140. A pair of trigger tube links 380, 382 are pivotally connected to the proximal trigger tube 390 to provide rotation about the third rotation axis TA-TA. See FIG. 32.

In various embodiments, the proximal trigger tube 390 is attached to a rotary handle 400 connected to a handle assembly 100. See FIG. 31, 38 and 39. The rotary handle 400 may be molded from a plastic or plastic material and includes a hub 402 and an edge 404 separated from the hub 402. The front portion 101 of the handle assembly 100 enters the space between the hub 402 and the edge 404 so that the handle 400 can rotate relative to the handle assembly 100 along the longitudinal axis AA. In other embodiments, the rotary handle 400 may be made of other suitable materials. In the illustrated embodiments, the proximal trigger tube 390 and the proximal core segment 330 are fixedly connected to the rotary handle 400. As shown in FIG. 38 and 39, the proximal segment of the core 330 and the proximal tube of the trigger 390 are fastened to the rotary handle 400 by a pin 406. Thus, the surgeon can rotate the end clamp 12 relative to the handle body 100 through an angle of 360 ° along the longitudinal axis A-A by rotating the handle 400.

As shown in FIG. 37, 38 and 40, in various embodiments, the end clamp 12 can selectively bend along the longitudinal axis AA under the action of a pair of bending elements 420, 430 attached to the distal base of the hinge 326 and the ball 440, rotating in the recess 408 in the rotary handle 400 In various embodiments, the bending elements 420, 430 may be, for example, wires made of stranded wire, nitinol, titanium, and the like. The first or right bending element 420 has a distal end 422 with a tooth 424 formed thereon for pressing into a first hole for attaching a wire 327 to the distal base of the hinge 326. Similarly, the second or left bending element 430 has a distal end 432 with a tooth 434 formed on it the appropriate size for pressing into the second hole for attaching the wire 329 in the distal base of the hinge 326. See FIG. 37. Thus, the end clamp 12 can deviate to the right along the first axis of the FA-FA (FIGS. 35 and 36) when pulling the first or right bending element 420, or the end clamp 12 can deviate to the left along the first axis of the FA-FA when pulling the second or left bending element 430. In various embodiments of the invention, the right bending element 420 can slide in the right cable channel 336 formed in the proximal segment of the core element 330, and the left bending element 430 can slide in the left cable channel 338 in the proximal nome segment of the core 330.

As shown in FIG. 38-40, the first bending element 420 has a proximal end 426 with a locking ball 428 obtained by stamping or otherwise attached to the bending element, which is included in the first holding slot 442 in the ball of the hinge 440, rotating in the recess 401 of the round handle 400. Similarly , the second bending element 430 has a proximal end 436 with a locking ball 438 obtained by stamping or otherwise attached to the bending element, which can enter the second holding slot 444 in the ball of the hinge 440. As m You can see, in particular, in FIG. 40, the hinge ball 440 further has a slot for the drive mechanism 446 into which the proximal segment of the tube of the drive mechanism 390 freely passes. As shown in FIG. 38, the slot for the actuator 446 may taper from the wide part of the hole 448, 450 to the channel 452 in the center of the ball of the hinge 440, which allows the proximal segment of the tube of the trigger mechanism 390 to pass. As will be discussed in more detail below, the ball of the hinge 440 is located in the recess 401 and is capable of freely rotate or rotate, and can selectively move from a neutral position (shown in FIG. 38 by solid lines) to the first and second positions to adjust the bend (shown in FIG. 38 by dashed lines). The ball of the hinge 440 is also capable of axial movement in the recess 401.

As seen in FIG. 40, the surgical instrument 310 may include a locking system, usually indicated by the number 453, to fix the ball of the hinge 440 in a neutral, first or second bend adjustment position. In various embodiments of the invention, the locking system 453 includes a series of locking segments 454 on the ball of the hinge 440, which correspond to the locking ribs 410 formed in the recess 408 of the hub 402 within the zone of the recess 401 of the rotary handle 400. An opening for the passage of the drive mechanism 412 passes through the hub 402 and sits in line with a slot for the actuator 446 in the ball of the hinge 440 to accommodate the proximal segment of the tube of the trigger mechanism 390. As can be seen in FIG. 38 and 39, the ball spring of the drive mechanism 456 rests on the hub 414 of the rotary handle 400 holding the spring to bias the ball of the hinge 440 in the proximal direction so that the stops 454 engage the locking ribs 410 in the part of the hub 402.

To facilitate the transfer of bending movement to the ball of the hinge 440, a pair of side handles are provided for controlling the bend 458, 460 extending from the ball of the hinge 440 in diametrically opposite directions. In various embodiments of the invention, the hinge ball 440 can be made, for example, of polycarbonate, nylon, Ultem® material, without filling, with glass, carbon, mineral and other filling and have locking protrusions 454 obtained by machining or casting. Handles 458, 460 for controlling the bend can be attached to the ball of the hinge 40 by pressing, welding, etc. This configuration allows the ball 440 to be locked in a neutral, first or second bend position. Once the surgeon has moved the ball of the hinge 440 to the desired position to obtain the necessary bend of the end clamp, he can release the ball of the hinge 440 so that the spring of the ball of the drive mechanism 456 displaces the ball of the hinge 440 in the proximal direction so that the stops 454 engage with the stop ribs 410 in part hubs 402. In various embodiments of the invention, the ball spring of the drive mechanism 456 may be sized so that the ball of the hinge 440 can bounce back into the neutral position when bent end of the clamp through a trocar or similar opening. In addition, the use of handles to control the bend 458, 460 allows you to "fine-tune" the degree of bending for a particular surgical method.

As seen in FIG. 38, the first or right bend control handle 458 protrudes through the right slot 416 in the rotary handle 400, and the second or left bend control handle 460 projects through the left slot 418 in the rotary handle 400. To bend the end clamp 12 along the longitudinal axis AA, the surgeon first moves the right and left knobs of bending control 458, 460 along the axis in the distal direction “DD” to release the stoppers 454 from engaging with the locking ribs 410 in the part of the hub 402 of the rotary handle 400. Subsequently, the surgeon can turn the ball 440 by turning the handle the bend control ring 458, 460 in the desired direction to drive the bending elements 420, 430 in motion. For example, the end clamp 12 can be turned to the right by moving the right bend control handle 458 in the proximal direction “PD”, or to the left by turning the left bend control handle 460 in the distal direction “DD” for tensioning (driving force) of the right bending element 420 and pressing on the left bending element 430. Similarly, the end clamp 12 can be rotated to the left by moving the left bend control handle 460 to the proximal ohm direction "PD", and the right control knob bend 458 in the distal direction "DD" for tension (drive force) of the left bending element 430 and pushing the right bending element 420. The range of motion of the right and left control knobs bend 458, 460 shown intermittent lines in FIG. 38. Thus, the end clamp 12 can be optimally positioned in various angular positions, for example, by bending it clockwise or counterclockwise, without rotation or other movement of the elongated barrel 40. In FIG. 35 shows an angle α, which in various embodiments may take values from 0º to 45º.

Various embodiments of a surgical instrument 310 include a scalpel 472 that is movably located in the hollow proximal segment of the core 330 and extends through a slot for the scalpel 333 that is cone-shaped, expanding from the narrow proximal portion 335 to the wide distal portion 337 so that the scalpel 472 can bend within these limits in accordance with the bend of the end clamp 12 along the longitudinal axis AA. See FIG. 37. In various embodiments, the scalpel 472 can be made, for example, of a 300 or 400 series stainless steel and have a cutting edge 476 at its distal end. As further seen in FIG. 37, the scalpel shaft 472 slides through the distal base of the scalpel 473 of the hinge 326. The proximal end 478 of the scalpel shaft 472 is attached to the shaft of the scalpel 480 passing through the proximal segment of the core 330 to connect to the drive system 190 to transmit drive force, as described above . See FIG. 31. The locking pin 406 enters the longitudinal slot 392 (FIG. 38) in the proximal segment of the trigger tube 390, passes through the hole 339 in the proximal segment of the core 330 (FIG. 39), and enters the longitudinal slot 482 in the scalpel shaft 480 so that the proximal the tube segment 390 and the scalpel shaft 480 could move axially relative to the proximal segment of the core 330 and the handle assembly 100. Thus, the surgeon can selectively act on the scalpel shaft 472 to cut tissue by pressing the release lever 200 to extend eniya scalpel as described above.

Various swivel configurations are described in US Patent Application Serial No. 12 / 775,809, (Patent Attorney No. END6755USNP), entitled “Laparoscopic Swivel End Clamps,” Frederick E. Shelton IV, filed May 7, 2010, and US Patent Application Serial No. 12 / 775,699, (Patent Attorney No. END6756USNP), entitled “Flexible Shaft for Grip Position Adjustment” by Frederick E. Shelton IV, et al., Filed May 7, 2010, each of which is incorporated herein by reference. In FIG. 41 and 42 show an alternative embodiment of a barrel assembly with a swivel 490, substantially identical to the shaft assembly of a barrel 340 and acting essentially in the same way, except that it has an intermediate segment of the trigger tube 492 that replaces the trigger link 380 which is used in the barrel with swivel 340. As can be seen in FIG. 41 and 42, an intermediate segment of the trigger tube 492 is located between the distal segment of the trigger tube 370 and the proximal segment of the trigger tube 390. In various embodiments, the intermediate segment of the trigger tube 492 may be made of nylon, Isoplast® material or other flexible plastic . In various embodiments, the intermediate tube segment of the trigger 492 has two longitudinal core pressing parts 494 on which a plurality of protruding ribs 496 are separated by spaces 498 to form a substantially hollow tubular segment through which the remaining components of the core assembly and the scalpel can pass . The core portions 494 are configured to transmit pressure from the proximal segment of the trigger tube 390 to the distal segment of the trigger tube 370, which is sufficient to translate the thrust member 20 into a fully pressed position, while allowing selective bending of the end clamp 12 along the longitudinal axis A-A. The intermediate segment of the trigger tube 492 has a distal end 491 attached to the distal segment of the trigger tube using, for example, pins, stops with slots, latches, and the like, and the proximal end 493 attached to the proximal segment of the trigger tube 390 such or similar methods. In this embodiment, the end clamp 12 can be optimally positioned in various angular positions, for example, bending it clockwise or counterclockwise, without rotation or other movement of the elongated barrel 490. In FIG. 42 shows an angle α, which in various embodiments can range from 0º to 45º.

FIG. 43-47 show a surgical instrument in accordance with another embodiment of the present invention. The surgical instrument 510 in accordance with this embodiment of the invention is essentially similar to the surgical instrument 310 described above, with the exception of a number of differences discussed below. Although the surgical instrument 510 will be described as intended for use in conjunction with the end clamp 12 of the type described above, those skilled in the art should be aware that the surgical instrument may also be used in combination with the second trigger adapter 150 to actuate the end clamp 12 ′ or in combination with end clamps of other configurations. Various embodiments of a surgical instrument 510 include an articulated shaft assembly 512 for selectively adjusting the position of the end clamp 12 along the longitudinal axis A-A. As seen in FIG. 43 and 44, the swivel stem assembly 512 includes a distal core member 520 with a pair of notches 522 into which trunnions 17 can be inserted. The distal core member 520 has a proximal end 521 movably connected to the distal end 531 of the proximal segment of the core 530. In particular, the proximal end 521 of the distal segment of the core 520 has a pair of spaced apart distal teeth 523 supporting an axis 524 protruding from the distal end 531 of the proximal segment of the core 530 to create an axis of rotation AA-AA, essentially stvu perpendicular to the longitudinal axis A-A. See FIG. 46.

In various embodiments of the present invention, the end clamp 12 may be bent in different directions along the longitudinal axis A-A. For example,

angle α 'in FIG. 47 may vary from 180º to 90º. The end clamp 12 is bent under the action of at least one bending element 550 connected to the link of the bending mechanism 540. The articulated link 540 is movably connected to the distal end 521 of the distal segment of the core 520 by the distal pin 542. See FIG. 43. The articulated link 540 is movably connected to the distal end 552 of the joint shaft 550 by a pin of the shaft 554, as shown in FIG. 46. As can be seen in FIG. 43, the articulation element 550 extends through the swivel shaft assembly 512 and has a proximal end 556 included in the rotary handle 560 rotationally connected to the handle assembly 100. The proximal end 556 of the articulation element 550 is connected to a bend control or button 558 with a sliding connection rotary handle 560, allowing selective movement along the axis relative to it. Thus, sliding the bend adjustment button 558 axially in the distal direction “DD” causes the end clamp 12 to rotate relative to the longitudinal axis A-A, as shown in FIG. 47. To return the end clamp to its initial unbent position when the end clamp is parallel to the longitudinal axis A-A, the surgeon simply slides the actuator button 558 in the proximal direction “PD” on the rotary handle 560.

As in some embodiments described herein, the rotary handle 560 is fixedly connected to a support sleeve 570 rotationally connected to the handle assembly 100. See FIG. 43 and 47. The support sleeve 570 has a proximal flange 572 and a distal flange 574, creating a rotational groove 575 with such a configuration as to accommodate the nose 101 of the handle assembly 100, allowing free rotation. This configuration allows the rotation of the support sleeve 570 along the longitudinal axis AA with respect to the handle assembly 100. The proximal segment of the core 530 is fixedly fastened with a pin or otherwise (by welding, glue, etc.) to the support sleeve 570 so that the rotation of the handle 560 relative to the longitudinal axis AA caused the end clamp 12 to rotate relative to the longitudinal axis AA. It is understood that such a configuration may facilitate the rotation of the end clamp 12 360 ° relative to the longitudinal axis A-A.

In addition, in this embodiment, the distal segment of the trigger tube 580 is connected to the first trigger adapter 140 and can move axially along the distal segment of the core 520. In particular, the holding button 144 of the first trigger adapter 140 enters the holding hole 581 in the distal segment trigger tubes 580 in the manner described above. The distal segment of the trigger tube 580 is driven by at least one trigger element attached to it. In a preferred embodiment, the distal segment of the trigger tube 580 is driven by a pair of trigger strips 582, 584 attached thereto. The trigger strips 582, 584 are attached to a mount 585 connected to the proximal segment of the trigger tube 590 that is attached to the trigger collar 114 as described above. In addition, a cover tube 592 supported by a rotary handle 560 for rotation with it rests on the proximal segment of the core 530. The proximal trigger tube 590 and the tape mount 585 can move axially relative to the cover tube 592. The trigger strips 582, 584 slide in the side channels of the bands 526 in the distal core member 520, as shown in FIG. 44C. In various embodiments, trigger strips 582, 584 include a thin flexible member that can be made of, for example, stainless steel, and is capable of pushing the distal segment of the trigger tube 580 to actuate or close the stop member 20 in the manner described above to form brackets 32 in the implantable block of brackets 30. The actuation of the wires of the trigger 582, 584 occurs by pressing the trigger lever 130 as described above. When the trigger lever 130 is returned to its initial position, the cables 582, 584 are pulled, whereby the first trigger adapter 140 pulls the stop element 20 to the open position or moves to a position in which the spring (not shown) deflects the stop element 20 to the open position.

Surgical instrument 510 may further comprise a scalpel 534 movably located in the supporting slot for scalpel 528 in the distal segment of the core 520. See Figure 44B. In various embodiments, the scalpel 534 may be made, for example, from 300 or 400 series stainless steel and the like. and have a cutting edge 535 at the distal end. The scalpel rod 534 is attached to the scalpel ribbon 536, which can be made of 300 or 400 series stainless steel. The scalpel ribbon may include, for example, a stainless steel tape 0.18-0.30 mm (0.007-0.012 in) thick, material which is harder than the core material. The scalpel wire 536 passes through the distal portion of the core 520 and the proximal segment of the core 530 and is attached to the scalpel shaft 480 in such a way that it participates in the transmission of the drive force in the drive system 190, as described above. Thus, the surgeon can selectively act on the stem of the scalpel 534 to cut tissue by pressing the trigger lever 200 to extend the scalpel, as described above. Various embodiments of the invention may also include a corrugated cover element 594 that prevents swiveling of dust, fabrics, degraded organic material, and the like. See FIG. 48.

FIG. 49-53 show a surgical instrument in accordance with another embodiment of the present invention. The surgical instrument 610 in accordance with this embodiment of the invention is essentially similar to the surgical instrument 10 described above, with the exception of a number of differences discussed below. Surgical instrument 610 is configured to actuate the end clamp 612 with two movable branches 613, 615. In various embodiments, the end clamp 612 is configured to connect to an elongated shaft 655 extending from the handle assembly 100. See FIG. 49. The elongated barrel 655 includes an elongated core 658 and an elongated closure tube 680, capable of axial movement along the core 658 in the proximal and distal directions. As shown in the figure, the elongated barrel 655 extends distally from the handle assembly 100 along a substantially straight line along the axis A-A. In various embodiments, the elongated barrel 655 may have a length of about 228.8 to 406.4 mm (about 9-16 inches). However, the elongated barrel 655 may have a different length.

As shown in FIG. 50 and 51, in different embodiments, the lower jaw 613 of the end clamp 612 includes an elongated channel 614, and the upper jaw 615 includes a thrust element 620. The elongated channel 614 has a pair of side walls 616, each of which ends at the upward end 618. The elongated channel 614 can be made of, for example, stainless steel series 17-4 or 400 and have such dimensions as to functionally hold the bracket block 630 or another shape of the bracket block. The stop element 620 may be made of stainless steel 416, 17-4, 17-7, and the like. In at least one embodiment, the end clamp 612 (when it is in the closed position) and the elongated barrel 655 have a minimum outer diameter allowing the device to be guided through an opening of at least about 8-12 mm diameter (about 0.31 -0.47 inches). However, end clamp 612 and elongated barrel 655 may have other diameters and shapes. The end clamp 612 further has a distal segment of the core 660 capable of movably connecting to the distal end of the proximal segment of the core 670, as will be explained in more detail below.

The stop element 620 has a part 622 for forming brackets, in which many pockets are formed for forming brackets. In addition, the abutment element 620 has a fork-shaped closure portion 624 having at least one, preferably a pair of closure ends 625. As can be seen in FIG. 50-53, in at least one embodiment of the invention, the closing ends 625 and the corresponding closing ends or tops 618 of the elongated channel 614 are pivotally connected to the teeth 663 of the fork-shaped distal end 662 of the distal segment of the core 660 (FIG. 55) of the core 658 with an axis 626 thus that when viewed from the side, the closing ends 625 and the closing ends 618 form a movable “scissor-like” closing structure, usually denoted by the number 628. In other embodiments, the implementation of the stop element 620 may be movably connected n with an elongated channel 614.

Various embodiments of end clamp 612 also include an axial-motion scalpel assembly 640, which includes a scalpel plate 642 with a pair of divided scalpel rods 644 protruding distally and configured to slide axially between the teeth 663 of the distal segment of the core 660. See FIG. 55. The scalpel 646 is attached to, or otherwise formed on, the distal ends of the rods of the scalpel 644. In various embodiments of the invention, the rods of the scalpel 644 and the scalpel 646 can be made of, for example, stainless steel 300 or 400. The cutting edge 648 is formed on the distal the end of the scalpel 646. The lower portion 649 of the scalpel 646 is configured to mesh with the slide 650 to move the brackets that are movably located in the elongated barrel 614. The slide for moving the brackets 650 may be in the slot or slot system (not shown) in the oblong channel 614 and be able to axially move from the initial position (FIG. 50-52) to the final position (FIG. 53), remaining in the oblong channel 614. The slide for moving the brackets 650 have the surface or surfaces for moving the brackets 652, which are oriented so as to engage with the brackets 632 in the block of brackets 630 and move the brackets 632 up to the forming part 622 of the abutment element 620 while distally moving the scalpel 646 through the end clamp 612.

In addition, in various embodiments, the distal nut of the core 668 is rotationally connected to the proximal end 664 of the distal segment of the core 660 to rotate about it along the longitudinal axis A-A relative to it. The distal core nut 668 has a pair of inwardly extending studs 669 to fit into corresponding slots 674 at the distal end 672 of the proximal segment of the core 670 protruding from the handle assembly 100 so that the distal segment of the core 660 can rotate relative to the proximal segment of the core 670. As seen in FIG. 49, the proximal segment of the core 670 is attached to a rotary handle 70 (pin 66) attached to the handle assembly 100 while maintaining rotational ability, as described above, so that the end clamp 612 can rotate along the longitudinal axis A-A through 360 °.

As also seen in FIG. 49, a flange 767 is formed at the proximal end 671 of the proximal segment of the core 670. The flange 676 is configured to rotate in a groove 106 formed by corresponding ribs 108 protruding inward from each of the elements of the housing 102, 104. This configuration facilitates the connection of the proximal segment the core 670 with the handle assembly 100, allowing rotation of the proximal segment of the core 670 with respect to the handle assembly 100 along the longitudinal axis AA through an angle of 360 °. The proximal segment of the closure tube 682 may be made of polymer or other suitable material and have a proximal end 683 attached to the collar of the trigger 114, capable of moving within the handle assembly 100 in various ways, as described above. In various embodiments of the invention, the clamp 114 can be obtained by multi-component molding of the proximal end 683 of the proximal segment of the closure tube 682. However, other bonding methods may be used. As described above, the trigger collar 114 may be rotationally connected to a support washer 120, the configuration of which allows axial movement in the handle assembly 100. As seen in FIG. 49, there is a longitudinal slot 681 in the proximal segment of the closure tube 682 so that the pin 66 can protrude through it into the proximal segment of the core 670, allowing axial movement of the proximal segment of the closure tube 682 along the distal segment of the core 670.

As seen in FIG. 49, the trigger lever 130 has an upper portion 134, movably connected (via a pin) to the links of the trigger 636, 638, which are movably connected (via a pin) to a support washer 120. Thus, the movement of the trigger lever 130 to the pistol portion of the handle 107 of the handle assembly 100 causes the collar 114 and the proximal segment of the closure tube 682 to move in the proximal direction “PD” (shown by a dashed line in FIG. 49). The movement of the clamp and the release lever 130 from the pistol portion of the handle 107 of the handle assembly 100 causes the clamp 114 and the proximal segment of the closure tube 110 to move in the proximal direction "DD" along the proximal segment of the core 670.

As seen in FIG. 50-53, the proximal segment of the closure tube 682 has a distal end 684 with a configuration that allows it to be attached to the proximal end 692 of the distal segment of the closure tube 690. In the shown embodiment, the distal segment of the closure tube 690 is threaded to the distal end 684 of the proximal segment of the closure tube 682. The distal end 694 of the distal segment of the closure tube 690 has a cone-shaped drive element 696 with such a configuration as to be in contact with the scissor oh closure structure 628 so that when the distal closure tube segment 690 is in the position shown in FIG. 51, a spring or springs of the end clamp 617 located between the oblong channel 614 and the stop member 620 serve to deflect the stop member 620 to the open position, as shown in the figure. However, when the distal segment of the closure tube 690 is pulled in the proximal “PD” direction, the cone-shaped drive member 696 contacts the scissor-like closure structure 628, causing the jaws 613 (oblong channel 614) and 615 (stop member 620) to move towards each other. See FIG. 52 and 53.

Surgical instrument 610 may further include a scalpel extension system 639, comprising a scalpel shaft 700 extending through the proximal segment of the core 670 and having a proximal end 702 adjacent to the transmission system 190 to transmit a driving force that is operatively connected to the trigger for extending the scalpel 200, as described above. Thus, the surgeon can move the shaft of the scalpel 700 distally by pressing the trigger lever of the scalpel 200, as described above. As seen in FIG. 52 and 53, the scalpel shaft 700 has a fork-shaped distal end 704 including an upper segment of the shaft 706 and a lower segment of the shaft 708 so configured to engage the scalpel plate 642. As shown in FIG. 51-54, the upper segment of the scalpel shaft 706 is configured to slide through the upper slot 773 in the nut of the core 668, and the lower segment of the shaft of the scalpel 708 is configured to slide through the lower slot 775 in the nut of the core 668.

To use the surgical instrument 610, an end clamp 612 is attached to the distal end 672 of the proximal segment of the core 670 by inserting the pins 669 on the nut of the core 668 into the corresponding notches 674 in the proximal segment of the core 670. See FIG. 50. Subsequently, the surgeon or clinician can rotate the end clamp 612 relative to the elongated shaft 655 to screw the distal segment of the closure tube 690 onto the proximal segment of the closure tube 682 to form the closure tube assembly 680. The end clamp 612 may include a bracket block 630 inside, or the clinician can insert block brackets in the elongated channel 614 immediately or later. After attaching the end clamp 612 to the elongated barrel 655 of the surgical instrument 610, the surgeon can insert the end clamp 612 and the elongated barrel 655 into the patient’s body through the access channel (for example, a trocar or endoscope, etc., or through an incision in case of an open operation) to grip the desired tissue between the jaws of the end clamp 613, 615. As in the various embodiments described here, the jaws 613, 615 are closed when the trigger lever 130 is brought to the pistol grip 107 of the handle assembly 100. As soon as the tissue is caught between jaws 613, 615, the surgeon may bring the tool or by a bracket 632 to form a crosslinkable fabric, pressing the stop element 620 to the block brackets in the manner described above. If the procedure does not require a tissue incision, the surgeon can release the trigger lever 130 to move the stop element 620 to the open position (under the action of the spring 617) and thereby release the implantable bracket block 630 from the end clamp 612. Then, the surgeon can re-close the jaws of the end clamp 613, 615 to remove the end clamp 612 through the access section or working channel. However, if the surgeon decides to cut the tissue between the rows of brackets 632, he can activate the scalpel assembly 640 by pressing the trigger of the scalpel 200, as described above, to cause the scalpel 648 to move distally through the captured tissue. As the scalpel 648 moves distally through the end clamp 612, it makes contact with the slide 650, which press the brackets 632k more firmly against the forming surface 622 of the abutment element 620 to further fold the brackets 632. See FIG. 53. Subsequently, the surgeon can open the end clamp 612 to release the dissected / stitched tissue and the implantable block of brackets 630 from it.

Thus, the unique new configuration of the clamping tube, which closes the jaws of the end clamp during distal movement, allows the size of the clamping mechanism to be reduced while maintaining the ability to create significant clamping forces required to form the brackets. In addition, this embodiment of the present invention allows the surgeon to stitch a stitch on the tissue without dissecting it in cases where a tissue incision is not required.

FIG. 56-60 depict an alternative embodiment of a surgical instrument 810 that is substantially identical to the surgical instrument 610 described above, except for the differences discussed below. For example, a surgical instrument 810 includes a flexible core assembly 820 that has a proximal end with a flange 822 that rotates in a groove 106 formed by corresponding ribs 108 protruding inward from each element of the body 102, 104 forming the handle assembly 100. See FIG. 57 and 58. This configuration allows rotation of the flexible core assembly 820 relative to the handle assembly 100. In various embodiments of the invention, the flexible core assembly 820 may be made, for example, of nylon, acetonitrile butadiene-styrene rubber (ABS), polycarbonate, a liquid crystal polymer, stainless steel, titanium, etc. and may be configured for use in conjunction with the end clamp 612 of the type described above.

Surgical instrument 810 further includes an elongated trunk assembly, usually designated 830. In various embodiments, the elongated trunk assembly 830 includes a variable configuration trunk segment 840 and a proximal trunk segment 844. As seen in FIG. 56, for example, a segment of the barrel of a variable configuration 840 may have a distal support ring 842 fixedly connected to part of the flexible assembly of the core 820 using, for example, glue, welding, fasteners, and the like. The segment of the barrel of a variable configuration 840 can selectively change its configuration from linear, when all parts of segment 840 are located on one axis (i.e., form a substantially straight hollow tubular structure) to a configuration in which at least one of parts is not located on the same axis or is not oriented parallel to another part of the variable configuration segment 840. In the embodiment shown in FIG. 56, for example, the barrel segment of the variable configuration 840 may be made of nylon, acrylonitrile butadiene styrene rubber (ABS), polycarbonate, and the like. and have many ribs 846 that allow changing the configuration of the segment 840 from linear or on the same axis to non-linear and not on the same axis (tortuous, curved, etc.), while the segment remains in this orientation as long as the user will not change the configuration of segment 840 manually or using other surgical instruments, such as grabbing devices, etc. Thus, the barrel segment of the variable configuration 840 can be “passively bent,” that is, the device does not have mechanisms for actively adjusting the bending of segment 840.

In various embodiments of the invention, the barrel segment 844 is connected to the variable configuration segment 840 using, for example, interlocking mechanisms or pins and is used to enable rotation of the variable configuration barrel segment 840 relative to the handle assembly 100 attached to it. In at least one embodiment of the invention, the proximal segment of the barrel 844 is connected to a support sleeve 60 connected to the handle assembly 100 and capable of rotation, as described above. See FIG. 57 and 59.

In addition, in various embodiments of the invention, the segment of the locking tube 832 is movably fixed to a portion of the flexible assembly of the core 820 to selectively move along it. See FIG. 56 and 60. As can be seen in FIG. 60, in at least one embodiment of the invention, the segment of the locking tube 832 and the assembly of the core 820 are formed by opposing flange portions 833, 821, respectively, so that the segment of the locking tube 832 cannot slide off the assembly of the core 820 while maintaining the ability to move freely on it. In various embodiments, a flexible closure member 848 is coupled to, or includes, a portion of the trigger clamp 114. See FIG. 57 and 59. The flexible closure member 848 may be made, for example, of stainless steel or the like. and have a distal end 849 protruding through an elongated slot 834 in the core 820 to connect to the segment of the connecting tube 832. This configuration allows the movement of the segment of the connecting tube 832 in the distal direction "DD" and the proximal direction "PD" along the node of the core 820 when you press the trigger lever 130 as described above.

As seen in FIG. 56, surgical instrument 810 may be used with end clamp 612, described in detail above. In particular, the end clamp 612 can be detachably connected to the flexible assembly of the core 820 by inserting the spikes 669 on the nut of the core 668 into the corresponding slots 825 at the distal end 825 of the assembly of the core 820. See FIG. 60. The distal end 835 of the connecting tube 832 has a threaded connection with the proximal end 692 of the distal segment of the connecting tube 690, as described above.

In at least one embodiment, the surgical instrument 810 further includes a scalpel extension system 639, comprising a scalpel shaft 700 extending through a core 820 and having a proximal end 702 adjacent to a transmission system 190 that is operatively connected to a trigger to extend the scalpel 200, as described above, in order to transmit drive force. Thus, the surgeon can move the shaft of the scalpel 700 distally by pressing the trigger lever of the scalpel 200, as described above. The scalpel shaft 700 has a fork-shaped distal end 704 including an upper segment of the shaft 706 and a lower segment of the shaft 708 so configured to engage the scalpel plate 642 of the end clamp 612. See FIG. 60.

To use the surgical instrument 810, the end clamp 612 is attached to the distal end 823 of the proximal segment of the core 820 by inserting the pins 669 on the nut of the core 668 into the corresponding notches 825. Subsequently, the surgeon or clinician can rotate the end clamp 612 to screw the distal segment of the connector tube 690 onto the segment the connecting tube 832. The end clamp 612 may contain a block of brackets 630 inside, or the clinician can insert a block of brackets into the elongated channel 614 immediately or later. After attaching the end clamp 612 to the node of the elongated connecting tube 830 of the surgical instrument 810, the surgeon can reconfigure the segment of the trunk segment of the variable configuration 840 so that the parts of the oblong trunk are aligned on the same axis for insertion through the hole or working channel into the patient’s body (for example, through a trocar or endoscope, etc., or through an incision in case of an open operation). Subsequently, the surgeon can change the configuration of the trunk segment of the variable configuration 840 so that its parts are not located on the same axis with each other to give the end clamp 612 the desired orientation with respect to the stitched fabric. As in the various embodiments described above, the jaws 613, 615 are closed by pressing the trigger 130 in the direction of the pistol portion 107 of the handle assembly 100. Once the tissue is trapped between the jaws 613, 615, the surgeon can actuate the tool or form brackets 632 in stitched fabric, pressing the stop element 620 to the block of brackets as described above. If the procedure does not require a tissue incision, the surgeon can release the trigger lever 130 to move the stop element 620 to the open position (under the action of the spring 617) and thereby release the implantable bracket block 630 from the end clamp 612. Then the surgeon can again close the jaws of the end clamp 613, 615 and return the original configuration to the segment of the barrel 840 to remove the end clamp 612 through the opening for surgical access or the working channel. However, if the surgeon decides to cut the tissue between the rows of brackets 632, he can actuate the scalpel assembly 640 by pressing the trigger of the scalpel 200 as described above to cause the scalpel 648 to move distally through the clamped tissue. As the scalpel 648 moves distally through the end clamp 612, it makes contact with the slide 650, which press the brackets 632 more firmly against the forming surface 622 of the abutment element 620 to further fold the brackets 632. Subsequently, the surgeon can open the end clamp 612 to release the dissected / stitched from it. tissue and implantable block brackets 630.

FIG. 61 and 62 depict yet another embodiment of a surgical instrument 810 ′ substantially identical to the embodiment of a surgical instrument 810 described above, with the exception of a segment of a variable configuration barrel 850 comprising a portion of an elongated shaft assembly 830 ′ operatively connected to a handle assembly 100 for controlling the end clamp 612. In various embodiments, a variable configuration barrel segment 850 includes a plurality of interconnected tubular links 852. Each tubular link 852 can be made, for example, of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate with or without glass or carbon filling, and the like. and have a tubular portion of the housing 854. The tubular portion of the housing 854 may have a spherical or spherical connecting portion 856 formed on it with an opening for the passage of the core 858. In addition, the tubular channel 858 receiving the core enters a hollow recess 860 formed in the portion of the tubular housing 854 and having such dimensions as to be able to move, the spherical connecting part 856 of the adjacent tubular link 852. The spherical connecting parts 856 are of such dimensions with respect to the recesses 860, so that the spherical connecting portion 856 can be fixed and held in the desired configuration, while the barrel segment forms a substantially straight line, while the barrel 850 may have a curved (FIG. 62) or tortuous configuration (FIG. 61).

Although the spherical connecting portions 856 and the recesses 860 may be dimensioned so as to create slight friction holding the segment 850 in the desired orientation until external force is applied to it, the embodiment of the invention shown in FIG. 60 and 61, includes a locking system 862 for releasably securing or immobilizing the tubular links 852 together in the desired configuration. As can be seen in these figures, the locking means 862 include at least one, preferably a plurality of flexible snap-in tabs 864 around the circumference of the tubular link 852 adjacent to one end of 853. In a preferred embodiment, four snap-in tabs 864 are used. In other embodiments 1, 2, 3, or more than four snap protrusions 864 can be used. Each tubular link 852 further comprises a locking member 866 corresponding to each snap protrusion 864, rilegayuschemu the other end of link 865 852. Each locking member 866 has a cutting, which includes a latching protrusion 868, with such a configuration as to allow releasable connection with the corresponding part of the latching protrusion 864 formed on the adjacent tubulars 852.

To use the surgical instrument 810 ', an end clamp 612 is attached to the distal end 823 of the core assembly 820 as described above. The distal segment of the closure tube 690 of the end clamp 612 is screwed onto the segment 832 of the closure tube. After attaching the end clamp 612 to the node of the elongated connecting tube 830 ′ of the surgical instrument 810, the surgeon can reconfigure the segment of the trunk of the variable configuration 850 so that parts of the elongated trunk are aligned on the same axis for insertion through the opening or working channel into the patient’s body (for example, through a trocar or an endoscope, etc., or through an incision in case of an open operation). Subsequently, the surgeon can use, for example, a gripping tool 869 to give the movable links 852 of the trunk segment a variable configuration 850 of the desired orientation, and then click on the corresponding snap-on tabs 864 on each link 852 so that they fit into the notch 868 and fix the link 852 in the desired orientation . See FIG. 62. As in the various embodiments described here, the jaws 613, 615 are closed when the trigger lever 130 is brought to the pistol grip 107 of the handle assembly 100. Once the tissue is trapped between the jaws 613, 615, the surgeon can actuate the tool or form brackets 632 in stitched fabric by pressing the stop element 620 to the block of brackets as described above. If the procedure does not require a tissue incision, the surgeon can release the trigger 130 to move the stop element 620 to the open position (under the action of the spring 617) and thereby release the implantable bracket block 630 from the end clamp 612. After that, the surgeon can close the jaws of the end clamp 613 again. 615 and use the gripping tool 869 to remove the snap tabs 864 from the corresponding notches 868 to position the links 852 so that the device can be pulled out through the surgical access hole UPA or working channel. However, if the surgeon decides to cut the tissue between the rows of brackets 632, he can actuate the scalpel assembly 640 by pressing the trigger of the scalpel 200 as described above to cause the scalpel 648 to move distally through the clamped tissue. As the scalpel 648 moves distally through the end clamp 612, it makes contact with the slide 650, which press the brackets 632 more firmly against the forming surface 622 of the abutment element 620 to further fold the brackets 632. Subsequently, the surgeon can open the end clamp 612 to release the dissected / stitched from it. tissue and implantable block brackets 630.

FIG. 63-68 depicts yet another embodiment of a surgical instrument 810 ″ substantially identical to the embodiments 810, 810 ′ described above, with the exception of a segment of a variable configuration barrel 870 and an associated oblong barrel fixation system 882. In various embodiments, a variable configuration barrel segment 870 comprises a plurality of interconnected tubular links 872 and is connected to a proximal segment of the barrel 871, which is connected to a support sleeve 60 that rotates in the handle assembly 100, as described in detail above. Each tubular unit 872 may be made, for example, of nylon, acrylonitrile butadiene styrene (ABS), polycarbonate with or without glass or carbon filling, and the like. and have a tubular portion of a housing 874. See FIG. 67. The tubular portion of the housing 874 may have a spherical or spherical connecting portion 876 formed on it with an opening for the passage of the core 878. In addition, the tubular channel 878 receiving the core enters a hollow recess 880 formed in the portion of the tubular housing 854 and having such dimensions so as to be able to displace the spherical connecting part 876 of the adjacent tubular link 872. The spherical connecting parts 876 are dimensioned relative to the recesses 880 so that the spherical connecting part The second part 876 could be fixed and held in the desired configuration, while the segment of the barrel of the variable configuration 870 may form a substantially straight line (FIG. 67), or the barrel 870 may have a curved (FIG. 68) or tortuous configuration.

Although the spherical connecting parts 876 and recesses 880 may have, in at least one embodiment of the invention, such relative dimensions as to create slight friction capable of holding the tubular links 872 of the barrel segment of the variable configuration 870 in the desired configuration as long as it is no external force will be applied, in the embodiment shown in FIG. 63-68, the 882 locking system is used to detachably hold or rigidly fix the tubular links 872 together in the desired configuration. As seen in FIG. 67 and 68, the locking means 882 include at least one, preferably two, selectively expanding locking bubbles 884 protruding from the tubular links 872 in diametrically opposite directions. In various embodiments, the fixing bubbles 884 may be made, for example, from a nylon film or the like. and be able to fill with fluid under pressure from a fluid source under pressure 886. In the embodiment shown in FIG. 64, the pressure source 886 is a liquid pump 888 that delivers pressure air to the retaining bubbles 884. In particular, in at least one embodiment, the liquid pump 888 comprises a cylinder 889 with a piston 890 inside. The piston 890 has a sealing ring or other sealing gasket 891 around the perimeter and is attached to the threaded handle of the pump 892, screwed to part of the handle assembly 100. Thus, when screwing the handle of the pump 892 to the handle assembly 100, air from the cylinder 890 is pumped under pressure through the supply pipe 893 going from the cylinder 890 to the distribution line 894 connected to the core assembly 820. The air pressure in the fixing bubbles 884 can be relieved by turning the handle of the pump 894 in the opposite direction.

As seen in FIG. 65, the distribution line 894 includes an annular distribution zone 895 with O-rings or other gaskets 896 on both sides. The annular distribution region 895 communicates with a delivery tube 897, which enters the proximal segment of the barrel 871 and opens into the retaining bubbles 884. This configuration serves to supply pressurized air to the fixing bubbles 884, while simultaneously allowing the rotation of the core assembly 820 along the longitudinal axis AA with respect to to the handle assembly 100. The pressurized fluid may be, for example, air, saline, or, preferably, glycerin. In alternative embodiments, the tubular elements may be filled with rubber or very low hardness elastomer. Under pressure on the rubber, it deforms, filling the cavity and fixing the barrel in much the same way as a liquid.

To use the surgical instrument 810 ″, an end clamp 612 is attached to the distal end 823 of the core assembly 820 ′, as described above. The distal segment of the closure tube 690 of the end clamp 612 is screwed onto the segment 832 of the closure tube. After attaching the end clamp 612 to the elongated shaft 830 "of the surgical instrument 810", the surgeon can reconfigure the segment of the trunk segment of the mutable configuration 870 so that parts of the elongated shaft 830 "are on the same axis with the aim of introducing the instrument through the hole or working channel into the patient’s body ( for example, through a trocar or endoscope, etc., or through an incision with open intervention). Subsequently, the surgeon can use, for example, a gripping tool to change the configuration of the movable links 872 of the trunk segment of the variable configuration 870 in accordance with the need. After the desired orientation is given to the segment of the barrel of variable configuration 870, the surgeon can screw the handle of the pump 892 to the body of the handle 100 in order to fill the locking bubbles 884 and fix the movable links 872 in the position shown in Fig. 68. As in the various embodiments described here , branches 613, 615 are closed when the trigger lever 130 is brought to the pistol grip 107 of the handle assembly 100. As soon as the tissue is caught between the branches 613, 615, the surgeon can actuate the tool or form brackets 632 in the joint Vai fabric, pressing the stop element 620 to the block brackets in the manner described above. If the procedure does not require a tissue incision, the surgeon can release the trigger lever 130 to move the stop element 620 to the open position (under the action of the spring 617) and thereby release the implantable bracket block 630 from the end clamp 612. Then the surgeon can again close the jaws 613, 615 and Relieve pressure in retaining bubbles 884 by turning pump handle 892 in the opposite direction. For manipulating the movable links 872, a gripping tool can be used to give the device a substantially axial orientation (FIG. 67) or other orientation that allows the tool to be removed from the patient’s body. However, if the surgeon decides to cut the tissue between the rows of brackets 632, he can actuate the scalpel assembly 640 by pressing the trigger of the scalpel 200 as described above to cause the scalpel 648 to move distally through the clamped tissue. As the scalpel 648 moves distally through the end clamp 612, it makes contact with the slide 650, which press the brackets 632 more firmly against the forming surface 622 of the abutment element 620 to further fold the brackets 632. Subsequently, the surgeon can open the end clamp 612 to release the dissected / stitched from it. tissue and implantable block brackets 630.

The various embodiments described herein, including a variable-configuration barrel segment, are a huge improvement over traditional fixed-hinge surgical instruments. In such a surgical instrument, the insertion of the end clamp into the incision site is usually limited to 1-2 degrees of freedom. Various embodiments of the present invention allow a wider range of possible positions of the end clamp and, therefore, give the surgeon greater flexibility when inserting the device through a single incision.

The unique and new properties of various blocks with surgical brackets and surgical instruments of the present invention allows brackets to be placed in these blocks in one or more linear or non-linear rows. On each side of the elongated slot located in the center of the block of brackets and intended for the passage of the scalpel, there can be many such brackets. For example, in one embodiment of the invention, the brackets that are on the same line can be essentially parallel to the brackets of the adjacent line (s), but be offset. In other embodiments, one or more rows of brackets may be non-linear. Thus, the base of at least one bracket in a row of brackets can be located on an axis substantially perpendicular to the bases of other brackets in the same row. For example, as will be described in more detail below, in alternative embodiments of the invention, the rows of brackets on each side of the elongated slot may have a zigzag shape. This non-linear arrangement of the brackets may be possible due to the fact that when installed in the thrust element, the brackets do not move up. Instead, in these various embodiments, the thrust member is brought into contact with the tips of the fixed brackets. Such a non-linear orientation of the brackets allows for more durable stitching of fabrics with fewer brackets than the various linear configurations used in the previous blocks of brackets, when the brackets were actually pushed up to press them against the stop element.

FIG. 69 depicts an embodiment of a suture brace block 900 in an embodiment of an end clip 612 ′ in accordance with the present invention. The end clamp 612 'can be used in combination with the surgical instrument 610 in various ways described above. The end clamp 612 'may be identical to the end clamp 612 described above, except for the differences described below. As seen in FIG. 69 and 70, in this embodiment, the block of brackets 900 provides a block body 902 with a centrally located oblong slot 904 passing through the proximal end 903 to the area adjacent to the distal end 605. The configuration of the oblong slot 904 allows axial movement of the scalpel 646 of the surgical instrument 610 during surgery tissue dissection as described above. In at least one embodiment of the casing of the block of brackets 902, the latter comprises a compressible hemostatic material, such as, for example, oxidized regenerated cellulose (ORC) or bioabsorbable foam material made, for example, of PGA (polyglycolic acid sold under the trademark Vikril), PCL (polycapronolactone), PMA (polylactic acid), PDS (polydioxanone), PHA (polyhydroxyalkanoate), polyglecaprone 25, sold under the brand name Monocryl, or a mixture of PMC, polyglecapron, PCL and PDS, which contains I rows 920, 930 of unfolded brackets 922. However, the body of the bracket block 902 can be made of other materials suitable for holding the unfolded brackets 922 in the desired orientation so that they can be compressed when the stop element 910 contacts them. As in various other embodiments described above, the bracket block 900 is implantable and remains attached to the stitched tissue after completion of the stapling process. In at least some embodiments of the invention, to prevent deformation of the brackets and activation of the hemostatic material during insertion and the instrument and positioning it, the entire block of brackets 900 can be coated or wrapped with a biodegradable film 906, for example, of polydioxanone sold under the brand name PDS ®, or polyglyceryl sebacate (PGS), or another biodegradable film made from PGC (polyglycolic acid sold under the brand name Vikril), PCL (polycaprolactone), PMC (polymol acid), PHA (polyhydroxyalkanoate), polyglexaprone 25 sold under the brand name Monocryl, or a mixture of PGK, PKL, PMK, PDS, impermeable until it is broken. The housing 902 of the bracket block 900 is sized to enter and exit the oblong channel 614 of the end clamp 612 '.

In the embodiments shown in FIG. 69, 73 and 74, the bracket block 900 comprises a first row 920 of brackets 922 on one side 907 of an elongated slot 904 and a second row 930 of brackets 922 on the other side 909 of an oblong slot 904. In various embodiments, the brackets 922 can be made, for example, of metal, such as titanium, titanium alloys (in particular titanium 6AI-4V, titanium 3al-2.5V), stainless steel, and the like. and consist of a base 924 and two straight protruding legs 926. Each leg of the bracket 926 may have a tip formed on it to pierce the fabric 928. In the first row 920 of brackets 922, the base 924 of at least one bracket 922 is superimposed on the base of another bracket 922. B in a preferred embodiment, the base 924 of each bracket 922 overlaps 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 line of brackets 920. See FIG. 73. Thus, the first row of brackets 920 has a substantially non-linear shape. More specifically, when viewed from above, the first row of brackets 920 has a substantially zigzag appearance.

As seen in FIG. 72, the stop member 90 has two consecutive longitudinal pockets for forming brackets 912, each of which has a zigzag shape corresponding to the shape of the first row 920 of brackets 922, so that when the stop member 910 is pressed against the brackets 922, the bracket legs 926 take the shape as shown in FIG. 74. Thus, the distal pedicle of the brace falls into the same pocket as the proximal pedicle of the next brace. This configuration allows a more dense arrangement of pockets, up to the fact that the brackets begin to interact with each other (i.e., are wrapped one above the other). In previous configurations of pockets for brackets in general, the distance from one set of pockets to the next should have been from 0.13 to 0.38 mm (0.005-0.015 inches) of metal / space. However, in this embodiment, the brackets touch / overlap 0-0.51 mm (0-0.02 inches), essentially -0.51 mm (-0.020 "), since the bracket joins the next bracket. This configuration allows you to set 15-30% more brackets in the same space. In addition, when the brackets cross, the need for several side rows of brackets decreases. In previous configurations, three rows were usually used on each side of the tissue incision line so that no open paths for bleeding were created. In lines of overlapping brackets, there is less chance of empty spaces through which bleeding is possible. Another obvious advantage of various configurations of overlapping brackets in accordance with the present invention is a large "tensile strength", expressed in the force required to break the line of brackets.

Another configuration of pockets for forming brackets of the present invention may include a common pocket for forming brackets. As used herein, the term “common pocket for forming brackets” means that one pocket can be used to form all brackets in one row, unlike previous designs of stop elements, when a separate pocket was provided for each leg of each bracket.

FIG. 75 shows another embodiment of a block of brackets 922 ', in which the base 924' has a deflection 928 to more closely overlap the bases 924 '. As indicated above, the bracket block 900 has a second row 930 of brackets 922 located on the other side 909 of the elongated slot 904. The second row 930 of brackets 922 is substantially identical to the first row 920 of brackets 922. Thus, the stop member 910 has a second common pocket for forming brackets 912 corresponding to the second row of brackets 930 for forming a contact. However, in an alternative embodiment, the second row 930 of brackets 922 may differ from the first row 920 of brackets in shape and possibly the number of brackets.

FIG. 71 shows a block of surgical braces 900 'substantially identical to the block of brackets 900 described above, with the exception of the rows of brackets 922' located therein 922. For example, in this embodiment, in a row 920 ', the brackets 922 are thus oriented relative to each other that the axis of the base 924 SS of at least one bracket substantially transverse to the axis of the base 924 SS of at least one adjacent bracket 922. This arrangement of brackets when viewed from above has a substantially zigzag shape. In the embodiment shown in FIG. 76, the respective bases 924 of the brackets 922 may further have an element for supporting the base 927 obtained by multi-component casting, as shown in the figure. In various embodiments, the base support member 927 may be made of, for example, non-absorbable plastic, such as PEEK polyetheretherketone or absorbable plastic, such as polyglycolic acid “PHC”, polylactic acid “PMK”, polydioxanone “PDS”, polycapronolactone, PHA (polyhydroxyalkanoate), polyglexaprone 25, sold under the brand name Monocryl, or various mixtures of PDS, polydioxanone, PMA, PHA or polyglexaprone. Supporting elements 927 facilitate engagement of adjacent brackets without overlapping the brackets themselves. Thus, with such configurations, it is possible to form brackets of a “B” -shaped shape or a “W” -shaped shape without overlapping the legs of the brackets. However, the brackets crowns are joined by supporting elements for the bases, so they act as overlapping brackets. This configuration allows the use of combined pockets with two separate paths for each leg.

In the embodiment shown in FIG. 77, a series of brackets 920 ″ is used, in which the legs 926 of adjacent brackets 922 are connected using a connecting part 929 obtained by casting or otherwise bonded. Each connecting part 829 can be made, for example, of absorbable plastic, such as PEEK polyetheretherketone, or absorbable plastic, such as polyglycolic acid “PHC”, polylactic acid “PMK”, polydioxanone “PDS”, polycapronolactone, PHA (polyhydroxyalkano ), polyglecaprone 25 sold under the brand name Monocryl, or various mixtures of PDS, polydioxanone PMK, PHA or polyglecaprone. This row of brackets 920 ″ has a substantially zigzag appearance when viewed from above. Although the use of the various embodiments of the brace blocks 900, 900 'has been explained using the end clamp 612' and the surgical stapler 610, it is understood that the brace blocks 900, 900 'can be effectively used with the various other end clamps and surgical instruments described above, with the corresponding configuration of the pockets for the formation of brackets in the stop elements, to achieve the necessary degree of formation of brackets when they are pressed by the stop element.

FIG. 78 and 79 depict an embodiment of a block of brackets 940 located in an elongated channel 14 of a surgical instrument 10 in accordance with the present invention. In at least one embodiment of the invention, the block of suture brackets 940 consists of a body 942 with a centrally located elongated slot 944 extending through at least a portion thereof. The configuration of the elongated slot 944 allows the axial movement of the scalpel of the surgical instrument 10 during tissue dissection, as described above. In various embodiments, the bracket block body 942 consists of a compressible hemostatic material, for example, oxidized regenerated cellulose (ORC) or a bioabsorbable foam material of the type described above or below, in which rows 946, 948, 950, 952 of unformed brackets 922 are located. at least in some embodiments of the invention, to prevent deformation of the brackets and activation of the hemostatic material during insertion and instrument and giving it the desired position, the entire block 940 can it can be coated or wrapped with a biodegradable film 954, for example, of polydioxanone sold under the brand name PDS®, or polyglyceryl sebacate (ASG), or another biodegradable film consisting of PGC (polyglycolic acid sold under the brand name Vicryl), PCL (polycaprolactone) , PMA (polylactic acid), PHA (polyhydroxyalkanoate), polyglexaprone 25, sold under the brand name Monocryl or a mixture of PGC, PCL, PMK, PDS, impermeable until it is broken.

In the embodiment depicted in FIG. 78, the bracket block 940 further comprises a support member 960 connected to the housing of the block 942. In various embodiments, the support member of the block 960 may be made of rigid material, such as, for example, titanium, stainless steel, aluminum, or an alloy of these metals, and the like, and can be partially integrated into the housing of the block 942. In various embodiments of the invention, the support element of the bracket block 960 can be held in place by, for example, film 954. In other embodiments of the invention when a strong bond is undesirable, it is possible to sporadically use cyanolactate to “glue” the two components. In other embodiments, the bracket block body 942 may be heated and “welded” or “fused” with a support member 960. In various embodiments, member 960 forms at least a portion of the bottom surface of the bracket block body 942 to correspond to an elongated channel 14. In a preferred embodiment of the invention, the supporting element 960 has one or more snap protrusions 962 for releasably connecting the supporting element of the bracket unit 960 to an elongated 14. Alternatively, other forms of snap elements / fasteners may be used to detach the support element of the bracket unit 960 to the elongated channel 14.

In various embodiments of the invention, the support element of the bracket block 960 has a series of support ridges 964, 966, 968, 970, 972, 974, 976 formed on it and provide some lateral support for 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 ridges have substantially the same length as the rows of brackets. In FIG. 80 shows an alternative embodiment of the bracket block 940 ', substantially identical to the bracket block 940, with the exception of the protruding ribs 978, 979, 980, 981, 982, 983 protruding from the ridges 964, 966, 968, 970, 972, 976, respectively , for additional lateral support of the brackets 922. In various embodiments of the invention, the parts of the ribs may be integral with the supporting element 960 and have a height of about ½ or less from the height of the block of brackets. Thus, in preferred embodiments, for example, any vertical member supporting the foam material cannot have a height greater than the height of the foam material in the most compressed state. Thus, if, after actuation, the block of brackets is compressed by 1/3 of its original height, the ribs should be from 66% to 10% of the height of the block in an uncompressed state.

In operation, as soon as the brackets 922 have taken the desired shape in contact with the stop element 20, as described above, the stop element 20 is opened and the end clip 12 is removed from the stitched fabric. When the end clamp 12 is removed from the stitched fabric, the body of the block 942 remains attached to the stitched fabric and then separated from the support member 960 remaining in the elongated channel 14. In various embodiments of the invention, the support member of the block 960 has a color different from the color of the material of the body of the block 942 , as well as the color of the oblong channel 14. Thanks to this configuration, the surgeon can immediately see if there is no block with suture brackets in the end clamp. Thus, the possibility of erroneous insertion / use of the end clamp without installing a new block of brackets is eliminated. To mount the brace block, the surgeon simply detaches the latched parts of the retaining element of the brace block 960 from the elongated channel 14 to insert the retaining element 960 of the new block with suture brackets 940 there. Although the operation of the blocks with suture brackets 940, 940 'in combination with a surgical instrument is described above 10, it will be understood by those skilled in the art that these units can be effectively used with surgical instruments in accordance with many other embodiments of the invention described herein without being modified. neniya nature and scope of the invention.

FIG. 81 and 82 depict the use of an embodiment of a surgical instrument 10 in combination with an end clamp 990 substantially identical to an end clamp 12 described above, except for the clamp locking mechanism 991 movably connected or otherwise secured to an elongated channel 14. In various embodiments of the invention the clamp fixing system 991 includes a fixing bracket 992 having a distal end 993 and a proximal end 994. The fixing bracket 992 is pivotally connected to the elongated channel by th axis or spike 995. In the distal part there is a leaf spring 996 or other deflecting element designed to translate the locking bracket 992 in the working or locking position, while the proximal end part 994 enters the distal end 141 of the first washer of the trigger 141, preventing the first the washers of the trigger 140 in the distal direction, that is, the transition to the "working" position. However, when the bracket block 30 is inserted into the elongated channel 14, the bracket block 30 causes the locking bracket 992 to move to the unlocked or unlocked position, so that the washer of the trigger 140 can move distally behind the locking bracket 992 to complete the stitching process of the fabric with brackets. See FIG. 81.

When in a locked position, the washer of the trigger 140 cannot move distally to complete the process of flashing the fabric. In addition, the trigger lever 130 cannot be pressed fully if the blocking lever of the scalpel 210 is not in the unlocked position, after which the surgeon can extend the stem of the scalpel 172. Thus, if the bracket block is not in the end clamp 990, the clamp locking system 991 is locked condition, preventing the extension of the scalpel 172. Thus, the surgeon cannot extend the stem of the scalpel 172 for dissection of tissue until the block of brackets 30 is inserted into the end clamp 990. It is understood that the locking system 991 describes The above can be effectively used in many other embodiments of the surgical instruments described herein without changing the nature and scope of the application of the present invention.

In various embodiments of the invention, the block of brackets may consist of a block body and a plurality of brackets located in the case. When using a block of brackets can be entered into the surgical field and is located on one side of the treated tissue. In addition, on the other side of the fabric, a stop element can be arranged to form brackets. In various embodiments of the invention, the thrust element may be located in the first jaw, and the block of brackets in the other jaw, while the first and / or second jaws move towards each other. After the brackets block and the stop element are positioned relative to the fabric, the brackets can be pushed out of the bracket block body so that the brackets pierce the fabric and come into contact with the stop plate to form them. As soon as the brackets come out of the block body, the block body can be removed from the surgical site. In the various embodiments described herein, a block of brackets, or at least a portion of a block of brackets, can be implanted with brackets. In at least one such embodiment, which will be described in more detail below, the block of brackets may include a block body that can be compressed, squeezed, and / or flattened by a stop member as it moves from an open position to a closed position. When the block body is compressed, squeezed and / or flattened, the brackets located in it can be deformed by the stop element. Alternatively, the jaw on which the block of brackets is located can move in the direction of the thrust element, moving into the closed position. In any case, in various embodiments of the invention, the brackets can be deformed when they are at least partially located in the block body. In certain embodiments, the brackets cannot be pushed out of the block, while in some embodiments, the brackets can be pushed out of the block together with part of the block body.

As shown in FIG. 83A-83D, a compressible block body, such as, for example, block 1000, may be a compressible implantable block body 1010 and further comprise a plurality of brackets 1020, although in FIG. 83A-83D, only one bracket 1020 is shown. FIG. 83A depicts a bracket block 1000 held by a block mount or channel of a bracket block 1030, wherein the bracket block 1000 is shown in an uncompressed state. In this uncompressed state, the abutment 1040 may or may not be in contact with fabric T. In use, the abutment 1040 may move from the open position to the tissue contact position T, as shown in FIG. 83B, the fabric T being positioned opposite the body of the block 1010. Although the abutment member 1040 can position the fabric T opposite the contact surface with the fabric 1019 of the bracket block 1010, as shown in FIG. 83B, the bracket block body 1010 may be subjected to a slight (if any) compressive force or pressure, while the brackets 1020 may remain in an unformed or unfolded state. As shown in FIG. 83A and 83B, the bracket block body 1010 may consist of one or more layers, and the legs 1021 of the brackets 1020 may protrude upward through the layers of fabric. In various embodiments, the housing of the block 1010 may comprise a first layer 1011, a second layer 1012, and a third layer 1013, wherein the second layer 1012 may be located between the first layer 1011 and the third layer 1013, and the fourth layer 1014, while the third layer 1013 may lie between a second layer 1012 and a fourth layer 1014. In at least one embodiment of the invention, 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 through, for example, the fourth layer 1014, the third with oh 1013 and second layer 1012. In various embodiments, the deformable leg may include tip 1021, such as a sharp tip 1023 which can be located in the second layer 1012, e.g., if the block brackets 1000 is in an uncompressed state. In at least one such embodiment, the tips 1023 may not enter or pass through the first layer 1011, while in at least one embodiment, the tips 1023 may not protrude through the tissue-contacting surface 1019 when the brace block 100 is located in an uncompressed state. In certain other embodiments, the sharp tips 1023 may be located in the third layer 1013 and / or in another suitable layer when the brace block is in an uncompressed state. In various alternative embodiments of the invention, the bracket block housing may include a suitable number of layers, for example, less than four or more than four.

In various embodiments of the invention, as described in more detail below, the first layer 1011 may contain backing material and / or plastic material, for example, polydioxanone (PDM and / or polyglycolic acid (PGA)), and the second layer 1012 may consist of bioabsorbable and / or hemostatic material, for example, oxidized regenerated cellulose (ORC). In various embodiments, one or more of the following layers: the first layer 1011, the second layer 1012, the third layer 1013, and the fourth layer 1014 may include brackets 1020 in the housing of the bracket block 1010 and, in addition, hold the brackets 1020 in the necessary orientation relative to each other. In various embodiments, the third layer 1013 may consist of a backing or inelastic material 1021 and may be configured to hold the legs of the brackets 1020 in the desired orientation with respect to each other. In addition, the second layer 1012 and the fourth layer 1014, located on opposite sides of the third layer 1013, can stabilize or reduce the mobility of the brackets 1020 even if the second layer 1012 and the fourth layer 1014 consist of a compressible foam or elastic material. In certain embodiments of the invention, the tips 1023 of the legs of the brackets 1021 can be at least partially embedded in the first layer 1011. In at least one such embodiment, the first layer 1911 and the third layer 1013 can be configured to be together and firmly hold the legs of the brackets 1021 in position. In at least one embodiment, the first layer 1011 and the third layer 1013 may consist of a biodegradable plastic sheet, for example, polyglycolic acid (PGA) sold under the trade name Vikril, polylactic acid (PMA), polydioxanone (PDS), polyhydroxyalkanoate (PHA) ), polyglecaprone 25 sold under the trade name Monocryl, polycapronolactor (PCL) and / or a mixture consisting, for example, of PGC, PMK, PDS, PHA, polyglecapron and / or PCL, and the second layer 1012 and fourth layer 1014 may consist of at least one hemostat other material or substance.

Although the first layer 1011 can be compressible, the second layer 1012 can be substantially more compressible than the first layer 1011. For example, the second layer 1012 can be about twice as compressible, about three times more compressible, about four times more compressible, about five times more compressible and / or about 10 times more compressible than, for example, the first layer 1011. In other words, the second layer 1012 can compress about twice, about three times, about four, about five times and / or about 10 times stronger than the first layer 1011, with the same strength. In certain embodiments, the compressibility of the second layer 1012 may be from about two times to about ten times the compressibility of the first layer 1011. In at least one embodiment, the second layer 1012 may include a plurality of air-filled voids, the number and / or size of which the second layer 1012 can be adjusted to obtain the desired compressibility of the second layer 1012. Similarly, although the third layer 1013 can be compressible, the fourth layer 1014 can be substantially more compressible than the third layer 1013. For example, the fourth layer 1014 can be about twice as compressible, about three times more compressible, about four times more compressible, about five times more compressible and / or about 10 times more compressible than, for example, the third layer 1013. In other words, the fourth layer 1014 can compress approximately twice, approximately three times, approximately four times, approximately five times and / or approximately 10 times stronger than the third layer 1013, with the same strength. In certain embodiments, the compressibility of the fourth layer 1014 may be from about two times to about ten times the compressibility of the third layer 1013. In at least one embodiment, the fourth layer 1014 may include a plurality of air-filled voids, the number and / or size of which in the fourth layer 1014 can be adjusted to obtain the desired compressibility of the fourth layer 1014. In various circumstances, the compressibility of the block body, or the layer of the block body, can be expressed in terms of tiyah compression ratio, i.e. the distance that the layer contracts when exposed to a given force. For example, a layer with a higher compression ratio will compress more at a given compressive force acting on the layer than a layer with a lower compression ratio. Thus, the second layer 1012 may have a greater compression ratio than the first layer 1011 and, likewise, 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 contain the same material and shrink with the same degree. In various embodiments, the second layer 1012 and the fourth layer 1014 may consist of materials with varying degrees of compression. Similarly, the first layer 1011 and the third layer 1013 may contain the same material and compress with the same degree. In certain embodiments, the first layer 1011 and the third layer 1013 may consist of materials with varying degrees of compression.

As the stop member 1040 moves to the closed position, the stop member 1040 may come in contact with the fabric T and press on the fabric T and the bracket block 1000, as shown in FIG. 83C. In such circumstances, the abutment member 1040 may push the top surface, or the contact surface of the fabric 1019, of the body of the block 1010 downward in the direction of attachment of the block 1030. In various embodiments, the attachment of the bracket block 1030 may include a bracket surface of the bracket block 1031 so configured to support the bracket block 1000 as the bracket block 1000 is compressed between the mounting surface of the block 1031 and the contact surface with the fabric 1041 of the stop element 1040. Due to the pressure created by the stop element 1040, the block body 1010 can be compressed and the abutment element 1040 can come into contact with the brackets 1020. More specifically, in different embodiments, squeezing the block body 1010 and moving the contact surface of the fabrics 1019 down can cause the tips 1023 of the brackets 1021 to pierce the first layer 1011 of the case block 1010, pierce the fabric T and enter the forming pockets 1042 in the stop element 1040. As the block 1010 further compresses with the stop element 1040, the tips 1023 can come into contact with the walls of the forming pockets 1042 and, as a result, the legs 1021 may deform or wrap inward, for example, as shown in FIG. 83C. As the legs of the brackets deform 1021, as also shown in FIG. 3C, the bases 1022 of the brackets 1020 may be in contact with or supported by the bracket unit holder 1030. In various embodiments, as described in more detail below, mounting the bracket unit 1030 may include a plurality of supporting elements, for example supporting grooves for the brackets 1032, which may be configured to hold the brackets 1020, or at least the bases 1022 of the brackets 1020 as the brackets 1020 deform. As also shown in FIG. 83C, the cavities 1015 in the fourth layer 1014 may collapse as a result of pressure on the bracket block body 1010. In addition to the cavities 1015, the bracket block housing 1010 may further comprise, for example, one or more voids 1016, which may or may not include part of the bracket and may have a configuration that allows compression of the housing of the block of brackets 1010. In various embodiments of the invention, the cavities 1015 and / or voids 1016 may have a configuration that allows them to collapse so that the walls of the cavities and / or voids are displaced down and in contact with the mounting surface of the bracket block 1031 and / or the layer of the bracket block 1010 located under the cavities and / or voids.

When comparing FIG. 83B and 83C, it becomes apparent that the second layer 1012 and the fourth layer 1014 are substantially compressed under the pressure of the thrust member 1040. In addition, it can be noted that the first layer 1011 and the third layer 1013 are also compressed. As the stop element 1040 moves to the closed position, the stop element 1040 can continue to squeeze the bracket block body 1010, pushing the contact surface with the fabric 1019 down towards the bracket block 1030. As the bracket block 1010 is further compressed, the stop element 1040 can deform the brackets 1020 giving them a fully folded shape, as shown in FIG. 83D. As shown in FIG. 83D, the legs 1021 of each bracket 1020 can bend down towards the base 1022 of each bracket 1020 to grab at least a portion of fabric T, a first layer 1011, a second layer 1012, a third layer 1013 and a fourth layer 1014 between the deformable legs 1021 and the base 1022. When comparing FIG. 83C and 83D, it becomes apparent that the second layer 1012 and the fourth layer 1014 are substantially compressed even more under the pressure of the thrust member 1040. In addition, when comparing FIG. 83C and 83D, it can be noted that the first layer 1011 and the third layer 1013 are also compressed. After the brackets 1020 are fully formed, or at least sufficiently, the abutment element 1040 can be lifted to separate it from the fabric T and remove and / or separate the fastener of the bracket block 1030 from the bracket block 1000. As shown in FIG. 83D and, as a result of the foregoing, the bracket block body 1010 may be implanted together with the brackets 1020. In various circumstances, the implantable block body 1010 may support tissue along a series of brackets. In some circumstances, a hemostatic agent and / or any other suitable therapeutic drug contained in the implantable casing of block 1010 may act on the tissue for some time. A hemostatic agent, as mentioned above, can reduce bleeding from stitched and / or dissected tissue, and a binder or adhesive for tissues can contribute to lasting tissue bonding. The implantable casing of the bracket block 1010 may contain materials such as ORC (oxidized regenerated cellulose), polyglycolic acid (PGA), sold under the trade name Vikril, polylactic acid (PMA), polydioxanone, polyhydroxyalkanoate (PHA), polyglexaprone 25, sold under the trade name Monocryl, polycapronolactone (PCL) and / or a mixture of PGC, PMA, polydioxanone, PHA, polyglecapron and / or PCL. In certain circumstances, the bracket block body 1010 may contain an antibiotic and / or antimicrobial material, for example, colloidal silver and / or triclosan, which can reduce the likelihood of infection in the surgical field.

In various embodiments, the implementation of the layers of the housing unit 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 adhesive substances, for example, fibrin and / or protein hydrogel. In certain embodiments of the invention, although not shown in the figures, the layers of the housing of the block 1010 can be joined together using mechanical engaging elements. In at least one such embodiment, the first layer 1011 and the second layer 1012 may comprise corresponding engaging elements, for example, a tongue and groove and / or dovetail connection. Similarly, the second layer 1012 and the third layer 1013 may contain corresponding engaging elements, as well as the third layer 1013 and the fourth layer 1014 may contain corresponding engaging elements. In certain embodiments of the invention, although not shown, the bracket block 1000 may comprise one or more rivets, for example, which may extend through one or more layers of the housing of the block 1010. In at least one such embodiment, each rivet may have a first end or a head located adjacent to the first layer 1011 and a second head located adjacent to the fourth layer 1014, which may be assembled or formed by the second end of the rivet. Due to the compressible nature of the block body 1010, in at least one embodiment, rivets can squeeze the block body 1010 so that the rivet heads can be recessed with respect to the contact surface with fabrics 1019 and / or the bottom surface 1018 of the bracket block body 1010 In at least one embodiment, the rivets may consist of a bioabsorbable material, such as polyglycolic acid (PGA) sold under the trade name Vikril, polylactic acid (PMA), polydio Sanon, polyhydroxyalkanoate (PHA), poliglekapron 25, sold under the tradename single crystal of, polikapronolakton (PCL) and / or mixtures of PGA, PLA, polydioxanone, PHA poliglekaprona and / or PCL. In certain embodiments, the layers of the block body 1010 can only be connected to each other by means of the brackets 1020 contained therein. In at least one embodiment, friction coupling between the legs of the brackets 1021 and the block body 1010 can hold the layers of the block body 1010 together, and after the formation of the brackets, the layers may remain within the brackets 1020. In certain embodiments, at least a portion of the legs of the brackets 1021 may include a rough surface or a rough coating, enhancing the friction forces m forward brackets 1020 and 1010 housing staples unit.

As described above, the surgical instrument may comprise a first jaw including a bracket block 1030 and a second jaw containing a stop member 1040. In various embodiments, as will be described in more detail below, the bracket block 1000 may comprise one or more holding elements, which may have such a configuration so as to engage with the mounting of the bracket block 1030 and, as a result, releasably hold the bracket block 1000 in the bracket of the block 1030. In certain embodiments, the bracket block 1000 may adhere the holder brackets unit 1030 at least one adhesive, e.g., fibrin and / or protein hydrogel. During operation in at least one situation, especially during laparoscopic and / or endoscopic surgery, the second jaw can be moved to the closed position opposite the first jaw, for example, so that the first and second jaws can be inserted through the trocar into the operating room field. In at least one such embodiment, the trocar may have an opening of about 5 mm, or a cannula through which the first and second branches can be inserted. In certain embodiments, the second jaw can be moved to a partially closed position intermediate between the open and closed position and allowing the first and second jaws to be inserted through the trocar without deforming the brackets 1020 contained in the case of the bracket block 1010. In at least one such embodiment the stop element 1040 may not press on the case of the bracket block 1010 while the second jaw is in a partially closed intermediate state, however, in certain other embodiments of the invention an abutment member 1040 may compress the block body 1010 when the brackets second jaws are in a partially closed intermediate position. Although the stop element 1040 can compress the body of the block of brackets 1010 while being in such an intermediate position, the stop element 1040 may not compress the body of the block 1010 sufficiently so that the stop element 1040 comes into contact with the brackets 1020 and / or the brackets 1020 are deformed by the stop element 1040. When the first and the second jaw inserted through the trocar into the surgical field, the second jaw can again be moved to the open position, and the thrust element 1040 and the block of brackets 1000 to position relative to the tissue, as described above.

In various embodiments of the invention shown in FIG. 84A-84D, the end clamp of the stapling tool may include an implantable bracket block 1100 located between the stop member 1140 and the bracket block mount 1130. Similar to the above, the stop member 1140 may have a contact surface with the fabric 1141, the bracket block 1100 may have a contact surface with fabric 1119, and the bracket unit bracket 1130 may have a supporting surface 1131 configured to hold the bracket unit 1100. As shown in FIG. 84A, the stop member 1140 can be used to position the fabric T opposite the contact surface 1119 of the bracket block 1100 without deforming the bracket block 1100, and when the stop member 1140 is in this position, the contact surface with the fabric 1141 can be located at a distance 1101a from the attachment surface of the bracket block 1131, and the contact surface with the fabric 1119 may be located at a distance 1102a from the attachment surface of the bracket unit 1131. Subsequently, the stop member 1140 is moved to the attachment of the bracket unit 1130; see FIG. 84B; the abutment element 1140 can push the upper surface, or the contact surface with the fabric 1119, of the bracket block 1100 down and squeeze the first layer 1111 and the second layer 1112 of the bracket block housing 1110. As the layers 1111 and 1112 are compressed, as shown in FIG. 84B, the second layer 1112 may collapse and the legs 1121 of the brackets 1120 may pierce the first layer 1111 and enter tissue T. In at least one such embodiment, the brackets 1120 may be located at least partially in the cavities or voids for the brackets 1115 in the second layer 1112 and, when the second layer 1112 is compressed, the cavities for the brackets 1115 can collapse, as a result of which the second layer 1112 also collapses around the brackets 1120. In various embodiments, the second layer 1112 may have cover parts 1116 that can be located above the cavities d I brackets 1115 and comprise, at least partially, the staple cavity 1115. In FIG. 84B shows cover parts 1116 that are depressed into brackets 1115. In certain embodiments, the second layer 1112 may include one or more weakened parts that facilitate collapse of the second layer 1112. In various embodiments, such weakened parts may include notches, perforations, or thin cross-sections. , for example, facilitating controlled compression of the housing of the block 1110. In at least one embodiment, the first layer 1111 may include one or more weakened portions contributing to penetration legs of staples 1121 through the first layer 1111. In various embodiments, such weakened areas may include notches, perforations and / or cross-sections that may be aligned at least substantially aligned, with the legs of brackets 1121.

When the abutment member 1140 is in a partially closed, inoperative position, as shown in FIG. 84A, the abutment member 1140 may be spaced 1101a from the mounting surface of the bracket block 1131, so a gap remains between them. This gap can be filled with a block of brackets 1100 with a height of 1102a and a fabric T. As the stop element moves down to compress the block of brackets 1100, as shown in FIG. 84B, the distance between the tissue contact surface 1141 and the surface of the block holder 1131 may be defined as a distance 1101b that is shorter than the distance 1101a. In different circumstances, the gap between the contact surface with fabrics 1141 of the abutment element 1140 and the attachment surface of the bracket block 1131, determined by the distance 1101b, may be greater than the initial height of the block with undeformed brackets 1102a. As the stop element 1140 approaches the surface of the holder of the block 1131, see FIG. 84C, the second layer 1112 may continue to contract and the distance between the legs of the brackets 1121 and the forming pockets 1142 may decrease. Similarly, the distance between the attachment surface of the bracket block 1131 may decrease to a distance 1101c, which, in various embodiments, may be greater than, equal to, or less than the original height of the undeformed block 1102a. As shown in FIG. 84D, the thrust member 1140 may be moved to the final operating position in which the brackets 1120 are fully formed, or at least formed to the desired height. In this position, the contact surface with the fabric 1141 of the abutment element 1140 may be at a distance 1101d from the mounting surface of the block 1131, while the distance 1101d may be shorter than the original height of the undeformed block 1102a. As also shown in FIG. 84D, the cavities for the brackets 1115 can be completely or at least partially collapsed and the brackets 1120 can be completely, or at least partially, surrounded by the collapsed second layer 1112. Under various circumstances, the stop element 1140 can subsequently be moved away from the block of brackets 1100. After the stop element 1140 is disconnected from the block of brackets 1100, the housing of the block 1110 can at least partially expand again in different places, for example, directly near the brackets 1120. At least in one embodiment implementation of The casing of the block 1110 may not have the ability to resiliently restore its shape. In various embodiments, the formed brackets 1120 and, in addition, the body of the block of brackets 1110 directly near the brackets 1120 can press or compress tissue T, which can have various beneficial therapeutic effects.

As discussed above, and in the embodiment shown in FIG. 84A, each bracket 1120 may have protruding legs 1121. Although the brackets 1120 are shown with two legs 1121, different brackets having one leg or, alternatively, more than two legs, for example, three legs or four legs, can be used. As shown in FIG. 84A, each leg of the bracket 1121 can be embedded in the second layer 1112 of the housing of the block 1110, so that the brackets 1120 are fixed in the second layer 1112. In various embodiments, the brackets 1120 can be inserted into the cavity for the brackets 1115 in the housing of the block 1110, thus that the ends 1123 of the legs of the brackets 1121 enter the cavities 1115 to the bases 1122. After the ends 1123 enter the cavities 1115, in various embodiments, the ends 1123 can be pressed into the cover parts 1116 and pierce the second layer 1112. In various embodiments of the braces 1120 can be located at a sufficient depth in the second layer 1112, so that the brackets 1120 do not move, or at least remain essentially stationary, relative to the second layer 1112. In certain embodiments, the brackets 1120 can be located at a sufficient depth in the second layer 1112, so that the bases 1122 are embedded in the cavities for the brackets 1115. In various other embodiments, the bases 1122 may or may not be located outside the second layer 1112. In certain embodiments, refer again to FIG. 84A, the bases 1122 may reach the area below the bottom surface 1118 of the bracket block body 1110. In certain embodiments, the bases 1122 may also lie on the surface, or may lie directly opposite the surface of the block holder 1130. In various embodiments, the surface of the block holder 1130 may include fasteners protruding from or in it. In at least one such embodiment, the bases 1122 of the brackets 1120 may be positioned within and held by one or more supporting grooves, slots, or recesses 1132, for example, in a bracket assembly of brackets 1130, as described in more detail below.

In addition to the above, see FIG. 85, the bases 1122 of the brackets 1120 can be located directly opposite the supporting surface 1131 of the bracket holder of the brackets 1130. In various embodiments, including variants in which the bases of the brackets 1122 have round or curved lower surfaces 1124, for example, the bases of the brackets 1122 can move or slide along the mounting surface of the bracket block 1131. Such sliding is possible when the thrust element 1140 is pressed against the tips 1123 of the legs of the brackets 1121 during the formation of the brackets. In certain embodiments of the invention, as described above and shown in FIG. 86, the mounting of the bracket block 1130 may have one or more supporting slots 1132 so configured to eliminate, or at least reduce, the relative movement of the bases of the brackets 1122 and the surface of the holder of the block 1131. In at least one embodiment of the invention, each the supporting slot 1132 may be determined by the contour of the surface that matches, or at least substantially matches, the contour of the bottom surface of the bracket therein. For example, the lower surface 1124 of the base 1122 in FIG. 86 may have a circular, or substantially circular, shape, and the supporting slot 1132 may also have a circular, or substantially circular, shape. In at least one such embodiment, the surface defining the slot 1132 may be determined by a radius of curvature that is greater than or equal to the radius of curvature defining the bottom surface 1124. Although the slots 1132 can help prevent or reduce the sliding movement of the brackets 1120 relative to the holder of the block 1130, the slots 1132 may also be configured to prevent or reduce the rotational movement of the brackets 1120 relative to the attachment of the bracket block 1130. More specifically, in at least one embodiment, According to the invention, the slots 1132 can have a configuration that closely matches the shape of the bases 1122 that are included in them to prevent or reduce the rotation of the brackets 1120 along the axis 1129, for example, so that the brackets 1120 do not rotate and do not rotate during their deformation.

In various embodiments, in addition to those described above, each bracket 1120 may be formed from a round, or at least substantially circular cross-section, of a wire. In certain embodiments, the legs and base of each bracket may be formed from a wire of a non-circular, for example, rectangular cross-section. In at least one such embodiment, the attachment of the bracket block 1130 may have corresponding slots of non-circular shape, for example of a rectangular shape, capable of accommodating the bases of such brackets. In various embodiments of the invention, see FIG. 87, each bracket 1120 may include a crown, for example, a crown 1125 attached to the base 1122 by multicomponent casting, with each crown 1125 being located in a fixing slot in the bracket of the bracket block 1130. In at least one such embodiment, each crown 1125 may have a square and / or rectangular section, for example, with such a configuration as to fit into the square and / or rectangular slots 1134 in the holder of the bracket block 1130. In various embodiments, the crowns 1125 may be made made from resorbable plastic, for example polyglycolic acid (PGA) sold under the trade name Vikril, polylactic acid (PMA), polydioxanone, polyhydroxyalkanoate (PHA), polyglexaprone 25 (sold under the trade name Monocryl), polycapronolactone (PCL) and / or mixtures of PGC, PMC, polydioxanone, PHA, polyglecapron and / or PCL and can be formed around the bases 1122 of brackets 1120 during injection molding. Various crowns and methods for forming them are described in US Patent Application Serial No. 11 / 541,123, entitled SURGICAL BRACKETS WITH COMPRESSIBLE OR PRESSURE ITEMS FOR FASTENING TISSUES AND SEWING INSTRUMENTS FOR SEPARATING THESE INSTRUCTIONS OF THIS SEPTEMBER 2006 and included therein. As shown in FIG. 87, the slots 1134 may further have an inlet or cone-tapering portion 1135, which may be configured to facilitate insertion of the crowns 1125 into the slots 1134. In various embodiments, the base and / or crowns of the brackets 1120 may be located in the slots 1134 when the bracket block 1100 is installed in securing the block 1130. In certain embodiments, the crowns 1125 of the brackets 1120 may correspond to the slots 1134 when the block of brackets 1100 is installed in the holder of the block 1130. In at least one such embodiment, detecting crown 1125 may not be included in the slot 1134 until the leg until the staples 1121 has no effect pressures to a base and / or crown staples 1120 move downwardly and enter into the slot 1134.

In various embodiments of the invention, see FIG. 88 and 89, the bracket block, for example, the bracket block 1200, may comprise an implantable compressible block body 1210, consisting of an outer layer 1211 and an inner layer 1212. Similar to the above, the block block 1200 may include a plurality of brackets 1220 located in the block 1210. In various embodiments, each bracket 1220 may have a base 1222 and one or more protruding legs 1221 from it. At least in one such embodiment, the legs of the brackets 1221 can be inserted into the inner layer 1212 and are located at a depth at which the bases 1222 brackets 1220 are adjacent and / or are located next to the lower surface 1218 of the inner layer 1212. In the embodiment shown in FIG. 88 and 89, the inner layer 1212 does not have cavities for receiving part of the brackets 1220, however, in other embodiments, the inner layer 1212 may include such cavities for the brackets. In various embodiments, in addition to those described above, the inner layer 1212 may comprise a compressible material, for example, bioabsorbable foam material and / or oxidized regenerated cellulose (ORC), such that the bracket block body 1210 can be compressed under pressure thereon. In various embodiments of the invention, the inner layer 1212 may consist of a lyophilized foam material, including polylactic acid (PMA) and / or polyglycolic acid (PHA). ORC is marketed under the trade name Surgicel and may include loose woven material (resembling a surgical sponge), loose fibers (like a cotton ball) and / or foam. In at least one embodiment, the inner layer 1212 may consist of a material containing medicaments, for example, lyophilized thrombin and / or fibrin, which may be contained within or applied in the form of a coating and may be activated by water or liquids in the patient's body. In at least one such embodiment, lyophilized thrombin and / or fibrin may be contained on a matrix of Vikril (PGC). However, under certain circumstances, activated drugs may be activated randomly by inserting a bracket block 1200 into the surgical field. In various embodiments of the invention, refer again to FIG. 88 and 89, the outer layer 1211 may consist of a waterproof, or essentially waterproof, material so that the liquid does not come into contact, or essentially does not contact, with the inner layer 1212 until the body of the bracket block 1210 is compressed and the legs of the brackets will not pierce the outer layer 1211 and / or until the integrity of the outer layer 1211 is broken in any way. In various embodiments, the outer layer 1211 may consist of a backing material and / or plastic material, for example, polydioxanone (PDS) and / or polyglycolic acid (PGC). In certain embodiments, the outer layer 1211 may comprise a shell surrounding the inner layer 1212 and brackets 1220. More specifically, in at least one embodiment, the brackets 1220 can be inserted into the inner layer 1212 and the outer layer 1211 can be wrapped around a system consisting of from the inner layer 1212 and the brackets 1220, and then sealed.

In various embodiments of the invention, see FIG. 90 and 91, the bracket block, for example, the bracket block 1300, may comprise an implantable compressible casing of the block 1310 containing the outer layer 1311 and the inner layer 1312. Similar to the above, the casing of the block 1300 may further comprise brackets 1320 located in the housing 1310, each bracket 1320 may have a base 1322 and one or more protruding legs 1321. Like the block of brackets 1200, the bases 1322 of the brackets 1320 can extend into the area below the lower surface 1318 of the inner layer 1312 and the outer layer 1311 can surround the bases 1322. At least in one Embodiment outer layer 1311 may be sufficiently flexible to wrap around the base of each bracket 1322 so that the outer layer 1311 corresponds to the contour of the base 1322. In at least one alternative embodiment, Referring again to FIG. 89, the outer layer 1211 may be stiff enough to be located around the bases 1222, not adhering tightly to each base 1222. In any case, in different embodiments, the outer layer 1311 may be located between the bases 1322 of the brackets 1320 and the attachment surface of the bracket block, for example, supporting surfaces 1031 or 1131 holding the bracket block 1300. In at least one such embodiment, the outer layer 1311 may be located between the bases 1322 and the holding slots, for example, slots 1032 or 1132, located and a surface mount block brackets. In at least one such embodiment, in addition to those described above, the outer layer 1311 may be configured to restrict the movements of the bases 1322 and / or increase the coefficient of friction between the bases 1322 and / or the fixing slots in order to reduce the relative movement between them . In various alternative embodiments, as shown in FIG. 92 and 93, the outer layer of the bracket block, for example, the bracket block 1400, may completely surround the brackets located therein. In at least one such embodiment, the outer layer 1411 of the compressible implantable block body 1410 may be attached to the inner layer 1412 before the legs 1421 of the brackets 1420 are inserted into the block body 1410. As a result of the above, the bases 1422 of the brackets 1420 may extend beyond the outer layer 1411 and, according to at least one embodiment, the bases 1422 can be located directly in the locking slots 1032 or 1132 in the surface of the holder of the block of brackets 1031 or 1131. In various embodiments, the invention ki brackets 1421 may puncture the outer layer 1411 when inserted into it. In various embodiments, the holes made by the legs of the brackets 1421 can closely surround the legs of the brackets 1421, so a very small amount of liquid can, if at all, seep between the legs of the brackets 1421 and the outer layer 1411, which reduces the likelihood or prevents premature activation of the drug contained in the housing of the block brackets 1410, or its premature leakage from the body of the block 1410.

As discussed above, see FIG. 88 and 89, the legs 1221 of the brackets 1220 can be embedded in the housing of the block 1210 and the bases 1222 of the brackets 1220 can protrude outward from the bottom surface 1218 of the inner layer 1212. In various embodiments, in addition to the above, the inner layer 1212 may not contain cavities intended for accepting brackets 1220. In various embodiments, as shown in FIG. 94 and 95, a bracket block, for example a bracket block 1500, may comprise a compressible implantable block housing 1510 with cavity for the brackets 1515, which may be configured to receive at least a portion of the brackets 1520. In at least one such In an embodiment, the upper part of the legs 1521 of the brackets 1520 can be embedded in the inner layer 1512, while the lower part of the legs of the brackets 1521 and the base 1522 can be located in the cavities for the brackets 1515. In certain embodiments, the bases 1522 can be fully extended laid in the cavities for brackets 1515, while in some embodiments, the implementation of the base 1522 may at least partially protrude beyond the lower surface 1518 of the inner layer 1512. Similar to the above, the outer layer 1511 may include an inner layer 1512 and located therein, brackets 1520. In certain other embodiments, as shown in FIG. 96, the bracket block 1600 may comprise brackets 1620 located in cavities 1615 of the compressible implantable housing of the bracket block 1610, with at least a portion of the brackets 1620 not embedded in the outer layer 1611. In at least one such embodiment, each bracket 1620 may have legs 1621 at least partially embedded in the inner layer 1612 and, in addition, the bases 1622 protruding outwardly outside the outer layer 1611.

In various embodiments, as shown in FIG. 97 and 98, a bracket block, for example, a bracket block 1700, may include a compressible implantable housing 1710 and a plurality of brackets 1720 at least partially located in the housing 1710. The housing of the block 1710 may include an outer layer 1711, an inner layer 1712, and further a leveling material 1740, which may be configured to align and / or hold the brackets 1720 in position in the housing of the block 1710. In at least one embodiment, the inner layer 1712 may have a recess 1741 so as to receive a leveling mat series 1740. In various embodiments, the leveling material 1140 may be pressed into a recess 1741 and / or attached to the inner layer 1712 in another suitable manner using at least one adhesive, such as fibrin and / or protein hydrogel. In at least one embodiment, the recess 1741 may be configured such that the bottom surface 1742 of the leveling material 1740 is aligned, or at least substantially aligned, with the bottom surface 1718 of the inner layer 1712. In certain embodiments, the bottom the surface 1742 of the leveling material may be deepened with respect to and / or protrude from the lower surface 1718 of the second layer 1712. In various embodiments, each bracket 1720 may have a base 1722 and one or more legs 1721 protruding from the base 1722, while at least a portion of the legs of the brackets 1721 can protrude through the leveling material 1740. The leveling material 1740 may further comprise a plurality of holes and / or slots, for example, through and configured to receive the legs brackets 1721. In at least one such embodiment, each such hole can be configured to closely fit the bracket leg 1721, so that between the bracket leg 1721 and the side walls of the hole can dribble a small amount of fluid, or the fluid does not leak out. In certain embodiments of the invention, the holes in the alignment material may not be through, and the legs of the brackets 1721 need to pierce the alignment material 1740 while pushing the brackets 1721 through the material.

In various embodiments, the leveling material 1740 may be a molded plastic sheet that, in at least one embodiment, may be stiffer or less compressible than the inner layer 1712 and / or the outer layer 1711. In at least one In such an embodiment, the leveling material 1740 may consist of a plastic material and / or any other suitable material, for example, polydioxanone (PDS) and / or polyglycolic acid (PGC). In certain embodiments, the leveling material 1740 may be attached to the inner layer 1712, and the legs of the brackets 1721 may subsequently be inserted through the leveling material 1740 and embedded in the inner layer 1712. In various embodiments, the bottom surface 1742 of the leveling material 1740 may include one or more of the following types of elements: grooves, slots or recesses with such a configuration that, at least partially, to accept the base 1722 brackets 1720. Similarly described above, the outer layer 1711 can subsequently be placed around a subsystem including the inner layer 1712, the alignment material 1740 and brackets 1720. Alternatively, the outer layer 1711 can be placed around the subsystem, which includes the inner layer 1712 and the alignment material 1740, with the brackets 1720 be subsequently inserted through the outer layer 711, the leveling material 1740 and the inner layer 1712. In any case, as a result of the above, the inner layer 1712, the leveling material 1740 and / or the outer layer 1711 can be configured so that s to hold the brackets 1720 in the desired position until and / or also after they are deformed by the stop element, as described above. In at least one such embodiment, the alignment material 1740 can serve to hold the brackets 1720 in place until the brace block 1700 is implanted into the patient’s body and, in addition, to hold the tissue along the brace line after implantation of the brace block 1700 In at least one embodiment, the brackets 1720 may be secured in the alignment material 1740 without being embedded, for example, in the inner layer 1712 and / or the outer layer 1711.

In various embodiments, as shown in FIG. 99-105, a bracket block, for example, a bracket block 1800, can be assembled by compressing the inner layer 1812, inserting the brackets, for example, the brackets 1820, into the inner layer 1812 and wrapping the inner layer 1812 with the outer layer 1811. As shown in FIG. 99, the compressible layer 1812 has a plurality of cavities for the brackets 1815, although there are other embodiments not involving the presence of cavities for the brackets in the inner layer 1812, as described above. As shown in FIG. 100, a compressible inner layer 1812 may be located between the transfer plate 1850 and the support plate 1860 and be compressed between the pressure surfaces 1852 and 1862, respectively. As shown in FIG. 100, the upper and lower surfaces of the inner layer 1812 may approach one another under compression and, accordingly, the inner layer 1812 may protrude outward in the lateral direction. In certain embodiments, the inner layer 1812 may be compressed to a height of about 1/3 of the original height, for example, it may have a height and thickness of from about 1.52 mm (0.06 ") to about 2.03 mm ( 0.08 ") in such a compressed state. As also shown in FIG. 100, the transfer plate 1850 may further comprise a plurality of brackets, for example, brackets 1820, for example, located in a plurality of holes for the brackets 1853. In addition, the transfer plate 1850 may further comprise a plurality of guides 1851 with such a configuration as to push the brackets 1820 up and out of the holes 1853. As shown in FIG. 101, the guides 1851 can be used to push the legs 1821 of the brackets 1820 through the compressed inner layer 1812. In various embodiments of the invention, the guides 1851 can be configured so that their upper surface is flush, or approximately flush, with the pressing surface 1852 of the transfer plate 1850 when the brackets 1820 are completely out of the holes 1853 of the transfer plate 1850. In certain embodiments, as also shown in FIG. 101, the support plate 1860 may have a plurality of receiving holes 1861 so configured to receive the legs of the brackets 1821, or at least the ends of the legs of the brackets 1821 after pushing them through the inner layer 1812. The receiving holes 1861, or the like, may be needed in embodiments in which the inner layer 1812 is compressed to a height less than the height of the brackets 1820 and, thus, when the brackets 1820 are completely out of the holes 1853, the legs of the brackets 1821 may protrude from the upper surface of the compressed inner layer 1812. In particular ennyh other embodiments, the inner layer 1812 can be compressed to a height exceeding the height of brackets 1820 and, as a result, the need for receiving openings 1861 in base plate 1860 can not be performed.

After the brackets 1820 are inserted into the inner layer 1812, see FIG. 102, the support plate 1860 can be moved away from the transfer plate 1850 to relieve pressure from the inner layer 1812. In such circumstances, the inner layer 1812 due to its elasticity can restore its original, or at least close to the original, shape. As the shape of the inner layer 1812 is restored, 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 circumstances, the receiving holes 1861 may be configured so that hold the legs of the brackets 1821 in the desired position until the base plate 1860 is moved away enough so that the legs 1821 are no longer located in the receiving holes 1861. In such circumstances receive are holes 1861 may help to maintain the relative orientation of staples 1820 in the inner layer 1812 as it expands. In various circumstances, the inner layer 1812 and the brackets 1820 located therein may include an additional assembly 1801, which, as shown in FIG. 103 may be inserted, for example, into the outer layer 1811. In at least one such embodiment, the outer layer 1811 may include a cavity 1802 formed therein so as to accommodate an auxiliary assembly 1801. In various circumstances, to pull the outer layer 1811 tool, for example, tongs 1855, can be used on the sub-assembly 1801. Once the sub-assembly 1801 is correctly located within the outer layer 1811, as shown in FIG. 104, the outer layer 1811 can be hermetically sealed. In various embodiments, the implementation of the outer layer 1811 can be sealed by applying thermal energy to part of it. More specifically, in at least one embodiment, the outer layer 1811 may consist of plastic material, wherein the open end of the outer layer 1811 can be sealed with one or more heated elements or heat seal devices 1856 for bonding and / or sealing the open end of the outer layer 1811 around the perimeter. In at least one such embodiment, as shown in FIG. 105, excess 1857 of the outer layer 1811 can be removed, and then use the bracket block 1800, as described.

As described above, the block of brackets can be located within and / or fixed to the connecting part of the block of brackets. In various embodiments, as shown in FIG. 106 and 107, the part for attaching the bracket block may comprise a channel for the bracket block, for example, a channel for the bracket block 1930, which may be configured to receive at least a portion of the bracket block, for example, the bracket block 1900. At least , in one embodiment, the channel for the brackets block 1930 may have a lower abutment surface 1931, a first side abutment wall 1940 and a second side abutment wall 1941. In operation, the bracket block 1900 may be located in the channel for the block 1930 so that the bracket block 1900 positions I opposite and / or adjacent to the lower support surface 1931 and located between the first lateral support wall 1940 and a second lateral support wall 1941. In certain embodiments, the first lateral support wall 1940 and a second lateral support wall 1941 may create a lateral gap therebetween. In at least one such embodiment, the bracket block 1900 may have a lateral width 1903 equal to or greater than the width of the lateral gap between the support walls 1940 and 1941, so that the compressible implantable housing 1910 of the bracket block 1900 can be held firmly between the walls 1940 and 1941 In certain other embodiments, the lateral width 1903 of the bracket block 1900 may be less than the gap between the first and second side walls 1940 and 1941. In various embodiments, at least a portion of the walls 1940 and 1941 and the lower the supporting surface 1931 may be a stamped metal channel, while in at least one embodiment, at least a portion of the lateral supporting wall 1940 and / or the lateral supporting wall 1941 may consist of a flexible material, for example, an elastomer . As shown mainly in FIG. 106, the first side wall 1940 and the second side wall 1941 of the channel for the bracket block 1930 may include a rigid portion 1933 extending upward from a lower abutment surface 1931 and a flexible portion 1934 extending upward from a rigid portion 1933.

In various embodiments, in addition to the above, the bracket block body 1910 may consist of one or more compressible layers, for example, the first layer 1911 and the second layer 1912. When the block body 1910 is pressed against the lower abutment surface 1931 by a stop member, as described above , the side parts of the housing of the block 1910 can expand in the lateral directions. In embodiments in which the brackets block 1930 has rigid side walls, lateral expansion of the block body 1910 can be prevented, or at least limited, by rigid side walls; as a result, significant internal pressure or stress may be generated within the housing of block 1910. In embodiments where at least a portion of the bracket unit 1930 consists of flexible side walls, the flexible side walls may be configured to bend laterally and allow the lateral parts of the housing of the block 1910 to expand laterally, thereby reducing internal pressure or stress, created inside the block body 1910. In embodiments where the channel for the block does not have side walls or has side walls that are shorter than the bracket block, the side parts of the bracket block can expand sideways indefinitely, or, by m nshey least substantially unlimited. In any case, as shown in FIG. 107, the channel for the block of brackets 2030 may have side walls 2040 and 2041, which can be made entirely of flexible material, for example, elastomeric material. The channel of the bracket block 2030 may further comprise lateral longitudinal slots 2033 extending along the sides of the lower supporting surface 2031 of the channel for the bracket block 2030, which may be configured to receive and securely hold at least a portion of the side walls 2040 and 2041. In certain embodiments, the side walls 2040 and 2041 may be secured in the slots 2033 by means of snap elements or press fit, while, in at least some embodiments, the side walls 2040 and 2041 may be closed captives in slots 2033 using one or more adhesive materials. In at least one embodiment, the side walls 2040 and 2041 may separate from the lower abutment surface 2031 during operation. In any case, the compressible implantable housing of the bracket block 2010 can be separated and / or detached from the side walls 2040 and 2041 when implanting the housing of the bracket block 2010 of the brackets 2020.

In various embodiments, as shown in FIG. 108, the surgical instrument may include a barrel 2150 and an end clip extending from the distal portion of the barrel 2150. The end clip may comprise, as described above, a channel for the bracket block 2130, a stop member 2140 moving from the open position to the closed position and vice versa, and the block the brackets 2100 located between the channel for the block 2130 and the abutment element 2140. In addition, as described above, the block of brackets 2100 may include a compressible implantable case of the block 2110 and a plurality of brackets 2120 located inside the case 2110. In various embodiments, The channel for the bracket block 2130 may have, firstly, one lower supporting surface 2131, opposite which the bracket block 2100 can be placed, secondly, the distal end 2135 and, thirdly, the proximal end 2136. In at least one embodiment, as shown in FIG. 108, the bracket block 2100 may have a first end 2105, which may be located at the distal end 2135 of the channel for the bracket block 2130, and a second end 2106, which may be located at the proximal end of the channel 2136 for the bracket block 2130. In various embodiments, the distal end of the channel 2135 the block of brackets 2130 may include at least one distal retaining element 2137, and, similarly, the proximal end 2136 may include at least one proximal retaining element, for example, a retaining wall 2138. At least one In such an embodiment, the distal retaining wall 2137 and the proximal retaining wall 2138 can create a gap between them, the length of which can be equal to or less than the length of the bracket block 2100, so that the bracket block 2100 can be securely fixed in the channel 2130 when the bracket block 2100 is inserted .

In various embodiments, as shown in FIG. 88 and 89, the bracket block, for example, the bracket block 1200, may have a flat, or at least substantially flat, tissue contact surface 1219. In at least one such embodiment, the housing 1210 of the bracket block 1200 may have a first an end 1205 having a first height or thickness 1207 and a second end 1206 having a second height or thickness 1208, wherein the first height 1207 may be equal to or substantially equal to the second height 1208. In certain embodiments, the housing of block 1210 may be constant, or essentially constant, height or t the gap between the first end 1205 and the second end 1206. In at least one such embodiment, the contact surface with the fabric 1219 may be parallel, or at least substantially parallel to the lower surface 1218 of the bracket block body 1218. In various embodiments, as shown in FIG. 108, the first end 2105 of the body 2110 of the bracket block 2100 may be determined by a first height 2107 different from the second height 2108 of the second end 2106. In the illustrated embodiment, the first height 2107 is greater than the second height 2108, although the second height 2108 may be larger than the first height 2107 in alternative embodiments. In various embodiments, the height of the block body 2110 between the first end 2105 and the second end 2106 may decrease linearly and / or geometrically. In at least one such embodiment, the tissue contact surface 2119 located between the first end 2105 and the second end 2106 may be oriented along the angle they form. In at least one such embodiment, the contact surface with the fabric 2119 may not be parallel to the bottom surface 2118 of the housing of the block 2110 and / or parallel to the supporting surface 2131 of the channel for the block 2130.

In various embodiments, see FIG. 108 and 109, the abutment member 2140 may have a tissue contact surface 2141 that may be parallel, or at least substantially parallel, to the channel abutment surface 2131 for the bracket block 2130 when the abutment element 2140 is in the closed position, as shown in FIG. 109. When the stop member 2140 is in the closed position, its configuration may be such as to compress the first end 2105 of the bracket block 2100 more than the second end 2106, due to the greater height of the first end 2105 and the lower height of the second end 2106. In some circumstances, including circumstances where the tissue T located between the contact surfaces with the tissues 2119 and 2141 has a constant, or at least substantially constant, thickness, the pressure created in the tissue T and the block of brackets 2100 may be greater at the distal end to end clamp than the proximal end of the end clamp. More specifically, when the tissue T between the abutment member 2140 and the brace block 2100 has a substantially constant thickness, the tissue T located between the distal end 2145 of the abutment member 2140 and the first end 2105 of the brace block 2100 can be compressed more than the tissue T located between the proximal the end 2146 of the abutment member 2140 and the second end 2106 of the bracket block 2100. In various embodiments, a pressure gradient can be created within the tissue T between the proximal end and the distal end of the end clamp. More specifically, in at least one embodiment, when the tissue T between the abutment member 2140 and the block of brackets 2100 has a substantially constant thickness, and the height of the block of brackets 2100 decreases linearly from the distal to the proximal end of the end clamp, the pressure inside the fabric T can decrease linearly from the distal end of the end clamp to the proximal end of the end clamp. Similarly, in at least one embodiment, when the tissue T between the abutment member 2140 and the bracket block 2100 has a substantially constant thickness and the height of the bracket block 2100 decreases geometrically from the distal to the proximal end of the end clamp, the pressure inside the tissue T can decrease geometrically from the distal end of the end clamp to the proximal end of the end clamp.

In various embodiments, as shown in FIG. 108, the fabric T, located between the bracket block 2100 and the abutment element 2140, may have a variable thickness throughout. In at least one such situation, the tissue T located between the proximal end 2146 of the stop member 2140 and the second end 2106 of the bracket block 2100 may be thicker than the tissue located between the distal end 2145 of the stop member 2140 and the first end 2105 of the bracket block 2100. As a result, in such a situation, a thicker tissue T can generally be located above the shorter proximal end 2106 of the bracket block 2100, and a thinner tissue T can generally be located above the thicker distal end 2105. In use, the washer is released a barrel mechanism 2152 2150 can move distally along the barrel of the core 2151 so that the trigger washer 2152 engages a curved portion 2143 anvil member 2140 and rotate anvil member 2140 in a direction to block brackets 2100 as shown in FIG. 109. After the abutment element 2140 has moved to the fully closed position, the tissue T can be squeezed between the contact surfaces 2119 and 2141 and, despite the fact that the height of the bracket block 2100 between the distal and proximal ends of the end clamp may be unstable, pressure or the compressive force acting on the tissue T may be constant, or at least substantially constant, over its entire area. More specifically, since a thinner fabric T may correspond to a larger height of the bracket block 2100 and a thicker fabric T may correspond to a lower height of the bracket block 2100, the total or total height of the tissue T and the bracket block 2100 between the proximal and distal ends of the end clamp may be constant, or at least substantially constant, and as a result, the compressive force of this fabric by the abutment member 2140 may be constant, or substantially constant, over its entire length.

In various embodiments, as shown in FIG. 108 and 109, the bracket block 2100 may have an asymmetric configuration. In at least one such embodiment, for example, the height of the bracket block 2100 at the first end 2105 may be greater than the height of the bracket block 2100 at the second end 2106. In certain embodiments, the bracket block 2100 and / or channel for the bracket block 2130 may contain one or more elements for alignment and / or fixing, due to which the bracket block 2100 can be placed in the channel 2130 in only one orientation, that is, in the orientation at which the first end 2105 is located at the distal end 2135 of the channel for block 2130, and the second end 2106 - at p of the maximum end 2136. In various embodiments of the invention, the bracket block 2100 and / or channel for block 2130 may have one or more alignment / fixing elements with a configuration that allows the bracket block 2100 to be positioned in the channel for block 2130 in more than one orientation. As shown in FIG. 110, for example, the bracket block 2100 can be located inside the channel for the block 2130 so that the first end 2105 of the bracket block 2100 can be located at the proximal end 2136 of the channel for the block 2130, and the second end 2106 can be located at the distal end 2135. In various embodiments the implementation, as a result, part of the block of brackets 2100 of lower height can be located in close proximity to the distal abutment wall 2137, and part of the block of brackets 2100 of greater height can be located in close proximity to the proximal support wall 2138. At least , in one such embodiment, the bracket block 2100 can be oriented appropriately to create constant, or at least substantially constant pressure on tissue T with a thicker part at the distal end of the end clamp and a thinner part at the proximal end of the end clamp . In various embodiments, the bracket block 2100 may have a selective orientation within the channel for block 2130. In at least one such embodiment, the elements for aligning and / or fixing the bracket block 2100 may be symmetrical, and the surgeon may selectively position the bracket block 2100 in the channel for block 2130 in the orientations shown, for example, in FIG. 108 and 110.

In addition to the above, the implantable bracket block body 2110 may include a longitudinal axis 2109, which, when the bracket block 2100 is located in the channel 2130, may extend between the proximal and distal ends of the end clamp. In various embodiments of the invention, the thickness of the housing of the bracket block 2110 may generally decrease and / or generally increase from the first end 2105 to the second end 2106 along the longitudinal axis 2109. In at least one such embodiment, the distance, or height, between the bottom surface 2118 and the tissue contact surface 2119, may generally decrease and / or generally increase from the first end 2105 to the second end 2106. In certain embodiments, the thickness of the body of the block 2110 may both increase or decrease along the longitudinal axis 2109. In at least one such embodiment, the thickness of the body of the block 2110 may include one or more sections with increasing thickness and one or more sections with decreasing thickness. In various embodiments, as shown in FIG. Z, the bracket block 2100 may comprise a plurality of brackets 2120 located therein. During operation, as described above, the brackets 2120 may become deformed when the stop member 2140 is moved to the closed position. In certain embodiments, each bracket 2120 may have the same, or substantially the same, height. In at least one such embodiment, the height of the bracket can be measured from the bottom of the base of the bracket to the top, or tip, of the longest leg of the bracket.

In various embodiments, the brackets inside the block may have legs of different heights. In at least one such embodiment, the block of brackets may comprise a first group of brackets of a first height, which is located in the first part of the compressible block body, and a second group of brackets of the second height, which is located in the second part of the compressible block body. In at least one embodiment, the first height of the brackets may be greater than the second height and the first group of brackets may be located at the first end 2105 of the block body 2100, while the second group of brackets may be located at the second end 2106. Alternatively, the higher first group brackets may be located at the second end 2106 of the bracket block 2100, while a shorter second group of brackets may be located at the first end 2105. In certain embodiments, multiple groups of brackets may be used, each and of which has its own height. In at least one such embodiment, a third group of brackets of intermediate height is used, which may be located in the housing of block 2110 between the first and second groups of brackets. In various embodiments, each bracket in a row of block brackets may have a different height. In at least one embodiment, the highest bracket in a row may be located on the first horse of the row of brackets, and the shortest bracket may be located at the opposite end of the row of brackets. In at least one such embodiment, the brackets located between the highest and shortest brackets may have a height decreasing from the highest bracket to the lowest.

In various embodiments, as shown in FIG. 111, the end clamp of the surgical instrument may include a stop member 2240, a channel for the bracket block 2230 and a bracket block 2200 held in the channel for the block 2230. The bracket block 2200 may comprise a compressible implantable block 2210 body and a plurality of brackets 2220b located within the body. In various embodiments, the channel for the bracket block 2230 may include a bearing surface 2231 and a plurality of supporting slots formed therein for the brackets 2232a and 2232b. In at least one such embodiment, the block of brackets 2200 may comprise two outer rows of brackets 2220a and two inner rows of brackets 2220b, while the supporting slots 2232a may be configured to hold the brackets 2220a and the supporting slots 2232b so that hold brackets 2220b. As shown in FIG. 111 and 112, the stop member 2240 may include a plurality of pockets 2242 for forming brackets that can be configured to hold and deform the brackets 2220a and 2220b as the stop member 2240 moves in the direction of the bracket block 2200. In at least one such embodiment the lower surfaces of the supporting slots 2232a may be located at a first distance 2201a from the upper surfaces of the pockets to form brackets 2242, while the lower surfaces of the supporting slots 2232b may be located on the second race standing 2201b from the upper surfaces of the pockets to form brackets 2242. In at least one such embodiment, the support slots 2232b are located closer to the abutment element 2240 due to a raised shoulder in the abutment surface 2231 where they are formed. Due to the different distances 2201a and 2201b in various embodiments of the invention, the outer rows of brackets 2220a and the inner rows of brackets 2220b can have different heights in a deformed state. Under various circumstances, brackets having different heights after deformation can create different pressures on the stitched fabric T. In addition to the above, brackets can have different heights before deformation. In at least one such embodiment, as shown in FIG. 111, the outer brackets 2220a may have an initial height in an unformed state that is greater than the height of the inner brackets 2220b in an initial unformed state. As shown in FIG. 111 and 112, the inner brackets 2220b, which are in an unformed state below the outer brackets 2220a, can also have a lower height in the formed state than the outer brackets 2220b. In various alternative embodiments, the inner brackets 2220b may be higher in the unformed state than the outer brackets 2220a, but lower in the deformed state than the outer brackets 2220a.

In various embodiments of the invention, in addition to the above, the abutment member 2240 can be moved to the closed position, as shown in FIG. 112 to compress the block body 2210 and deform the brackets 2220a and 2220b. In certain embodiments of the invention, a surgical stapler comprising an end clip depicted in FIG. 111 and 112 may further comprise a cutting element with such a configuration as to cut through the fabric T located between the stop element 2240 and the block of brackets 2200. In at least one such embodiment, the stop element 2240, a channel for the block of brackets 2230 and / or block the brackets 2200 can form a slot with a configuration such that the cutting element can slide in it. More specifically, the stop member 2240 may comprise a part with a slot 2249, a channel for the bracket block 2230 may have a part with a slot 2239, and the block of brackets 2200 may have a part with a slot 2203 that can be aligned with each other, or at least substantially aligned when the thrust member 2240 is in a closed, or at least substantially closed, position. In various embodiments, the cutting member 2240 may move from the proximal end of the end clamp to the distal end of the end clamp after the stop member 2240 has moved to the closed position and the brackets 2220a, 2220b are deformed. In at least one embodiment, the cutting element can move independently of the deformation process of the brackets. In certain embodiments, the cutting element may move simultaneously with the deformation of the brackets. In any case, in at least one embodiment, the cutting element may be configured to cut the fabric along the line between the inner rows of brackets 2220b.

In various embodiments, as shown in FIG. 112, the inner brackets 2220b in the formed state may have a lower height than the outer brackets 2220a, while the inner brackets 2220b can compress or press more heavily on the fabric near the cut line by the cutting element. In at least one such embodiment, more pressure created by the internal brackets 2220b can provide various therapeutic benefits, for example, reducing bleeding from dissected tissue T, while less pressure created by the external brackets 2220a contributes to the flexibility of the stitched fabric. In various embodiments, as shown in FIG. 111 and 112, the abutment element 2240 may further comprise at least one piece of abutment material, for example, a backing material 2260 attached to it. In at least one such embodiment, the legs of the brackets 2220a, 2220b may be configured to pierce the backing material 2260 and / or pass through the holes in the backing material 2260 while squeezing the block of brackets 2200 with the stop element 2240 and subsequently come into contact with forming pockets 2242 in the abutment element 2240. As the legs of the brackets 2220a, 2220b deform, the legs come into contact again and / or pierce the backing material 2260. In various embodiments, the backing material 2260 may contribute to the rest ovke bleeding and / or strength seamable fabric.

In various embodiments, as shown in FIG. 111 and 112, the lower surface of the housing of the block 2210 may have a step contour corresponding to, or at least substantially corresponding to, the stepped contour of the surface of the attachment of the bracket block 2231. In certain embodiments, the lower surface of the housing of the block of brackets 2210 may be deformed to fit, or at least substantially match the contour of the mounting surface of block 2231. In various embodiments, as shown in FIG. 113, an end clip similar to the end clip shown in FIG. 111 may comprise a bracket block 2300. The bracket block 2300 may comprise a compressible implantable housing 2310 of an inner layer 2312 and an outer layer 2311, wherein, in addition to the above, the outer layer 2311 may consist of a waterproof material according to at least one an embodiment. In various embodiments, the outer layer 2311 may be located around the brackets 2220a, 2220b and may be located between the brackets 2220a, 2220b and the supporting slots 2232a, 2232b, respectively. In various embodiments, as shown in FIG. 114, an end clip similar to the end clip shown in FIG. 111, for example, may include a bracket block 2400. Similar to the bracket block 2300, the compressible implantable housing 2410 of the bracket block 2400 may comprise an inner layer 2412 and an outer layer 2411; However; in at least one embodiment, the housing of block 2410 may not include slots for the cutting element. In at least one such embodiment, it may be necessary for the cutting element to cut the inner layer 2412 and / or the outer layer 2411 as it moves through the block of brackets.

In various embodiments, as shown in FIG. 115, the end clamp of the surgical instrument may include a stop member 2540, a channel for the bracket block 2530 and a bracket block 2500 located in the channel for the block 2530. Similar to the above, the bracket block 2500 may include a compressible implantable block body 2510, the outer rows of brackets 2220a and inner rows of brackets 2220b. The channel for the bracket block 2530 may have a flat, or at least substantially flat, bearing surface for the block 2531 and supporting slots 2532. The stop element 2540 may include a stepped surface 2541 and a plurality of pockets for forming brackets, for example, pockets formed therein 2542a and 2542b. Similar to the above, the forming pockets 2542a and the supporting slots 2532 can define a distance between them that is greater than the distance between the forming pockets 2452b and the supporting slots 2532. In various embodiments, the stop member 2540 may further comprise a piece of backing material 2560 attached to the stepped surface 2541 thrust member 2540. In at least one such embodiment, the backing material 2560 may correspond, or at least substantially match amb stepped surface 2541. In various embodiments, the sustaining material 2560 can be releasably attached to surface 2541 with at least one adhesive, e.g., fibrin and / or protein hydrogel. In certain embodiments of the invention, the block body 2510 may also have a step profile that, in at least one embodiment, is parallel, or substantially parallel, to the step surface 2541 of the abutment member 2540. More specifically, in at least one embodiment, the stop element 2540 may include ledges 2548 protruding in the direction of the bracket block 2500, while the ledges 2548 may have a height equal to or at least substantially equal to the height of the ledges 2508 protruding from the housing of the block 2510. shey least one such embodiment, as a result of the above, a part of the compressible body assembly 2510 that can be captured by the first brackets 2220a, may differ from the parts of the compressible body assembly 2510 that can be captured by the second bracket 2220b.

In various embodiments, as shown in FIG. 116, the end clamp of a surgical instrument may include a stop member 2640, a channel for a bracket block 2530, and a bracket block 2600 located between them. The bracket block 2600 may include a compressible implantable housing 2610 having an inner layer 2612, an outer layer 2611 and a plurality of brackets 2220a and 2200b located inside. In various embodiments of the invention, the stop member 2640 may include multiple pockets for forming brackets 2642 on the surface 2641, and the channel for the block of brackets 2530 may include many slots for forming brackets 2532 in the supporting surface 2531. As shown in FIG. 116, the surface of the abutment member 2641 may be parallel or substantially parallel to the surface of the holder of the block 2531, wherein each forming pocket 2642 may be located at an equal, or at least substantially equal distance from the opposite and corresponding support slot for the brackets 2532 In various embodiments, the bracket block 2600 may comprise brackets of the same or at least substantially the same initial height and, in addition, the same, or substantially the same, height in formed state. In certain other embodiments, the outer rows of brackets may comprise brackets 2220a, and the inner rows of brackets may comprise brackets 2220b, and as discussed above, the brackets 2220a and 2220b may have different heights in an unformed state. When the stop member 2640 moves in the direction of the bracket block 2600, that is, to the closed position, the brackets 2220a and 2220b may be formed so that they have the same, or at least substantially the same height in the formed state. In at least one such embodiment, as a result of the above, the formed outer brackets 2220a and inner brackets 2220b may enclose the same, or at least substantially the same, portion of the compressed housing of block 2610; However, since the outer brackets 2220a have a greater height in the unformed state than the inner brackets 2220b, and yet can have the same height in the formed state, the outer brackets 2220a can create more pressure than the inner brackets 2220b.

In various embodiments, as shown in FIG. 117, the end clamp of the surgical instrument may include a stop member 2740, a channel for the bracket block 2530 and a bracket block 2700 located in the channel for the block 2530. Similar to the above, the bracket block 2700 may include a compressible implantable body 2710 having an inner layer 2712, an outer layer 2711, and a plurality of brackets 2220a and 2220b located inside. In at least one embodiment, the thickness of the block body 2710 may vary across its width. In at least one such embodiment, the housing of the block 2710 may have a central portion 2708 and side portions 2709, the central portion 2708 may be thicker than the lateral portions 2709. In various embodiments, the thickest portion of the housing of the block 2710 may be located in center 2708, while the thinnest portion 2710 may be located on the sides 2709. In at least one such embodiment, the thickness of the body of the block 2710 may gradually decrease from the center 2708 to the sides 2709. In certain embodiments the implementation of the thickness of the casing of the block 2710 may linearly and / or geometrically decrease from the Central part 2708 to the side parts 2709. In at least one such embodiment, the contact surface with the fabric 2719 of the casing of the block 2710 may include two inclined, or angled, surfaces with an inclined downward direction from the central part 2708 to the side parts 2709. In various embodiments, the thrust member 2740 may include two inclined, or angled, surfaces parallel to, or at least substantially parallel to, the inclined surface contact with fabric 2719. In at least one embodiment, thrust member 2740 may further comprise at least one piece of backing material 2760 attached to the inclined surfaces of thrust member 2740.

In various embodiments, in addition to those described above, the inner rows of brackets in the bracket block 2700 may contain higher brackets 2220a, and the outer rows of brackets may contain shorter brackets 2220b. In at least one embodiment, the higher brackets 2220a may be located within and / or close to the thicker central portion 2708, while the brackets 2220b may be located within and / or close to the side portions 2709. In at least one in such an embodiment, as a result of the above, the higher brackets 2220a can capture more material of the implantable block body 2710 than the shorter brackets 2220b. This can lead to the fact that the brackets 2220a will create more pressure on the fabric T than the brackets 2220b. In certain embodiments, although higher brackets 2220a can capture more body material of block 2710 than shorter brackets 2220b, higher brackets 2220a can have greater height in the formed state than shorter brackets 2220b due to the tilted configuration of pockets for forming brackets 2742a and 2742b. This can be taken into account to achieve the desired pressure when clamping the tissue gripped by the brackets 2220a and 2220b, and as a result, the pressure created by the brackets 2220a can be greater, less than or equal to the pressure on the fabric created by the brackets 2220b. In various alternative embodiments, the implementation of the end clamp shown in FIG. 117, the shorter brackets 2220b may be located within and / or adjacent to the thicker central portion 2708 of the block body 2710, and the higher brackets 2220a may be located within and / or adjacent to the thinner side portions 2709. Furthermore, although the bracket block 2700 is depicted as containing the inner and outer rows of brackets, the bracket block 2700 may contain additional rows of brackets, for example, rows of brackets located between the inner and outer rows of brackets. In at least one such embodiment, the intermediate rows of brackets may include brackets having, in an unformed state, having a height intermediate between the height of brackets 2220a and 2220b, and in the formed state, having a height intermediate between the height of brackets 2220a and 2220b.

In various embodiments, as shown in FIG. 118, the end clamp of the surgical instrument may include a stop member 2840, a channel for the bracket block 2530 and a bracket block 2800 located in the channel for the block 2530. Similar to the above, the bracket block 2800 may include a compressible implantable housing 2810 having an inner layer 2812, an outer layer 2811 and a plurality of brackets 2220a and 2220b located inside. In at least one embodiment, the thickness of the block body 2810 may vary across its width. In at least one such embodiment, the block body 2810 may have a central portion 2808 and side portions 2809, while the central portion 2808 may be smaller in thickness than the side portions 2809. In various embodiments, the thinnest portion of the block body 2810 may be located in the center 2808, while the thickest part 2810 may be located on the sides 2809. In at least one such embodiment, the thickness of the block body 2810 may gradually increase from the center 2808 to the sides 2809. In certain variations In embodiments, the thickness of the block body 2810 may linearly and / or geometrically increase from the central part 2808 to the side portions 2809. In at least one such embodiment, the contact surface with the fabric 2819 of the block body 2810 may include two inclined, or angled, surfaces with an inclination upward from the central portion 2808 to the side portions 2809. In various embodiments, the thrust member 2840 may include two inclined, or angled, surfaces parallel to, or at least substantially parallel to, the inclined the contact surfaces with the fabric 2819. In at least one embodiment, the abutment member 2840 may further comprise at least one piece of pressure material 2860 attached to the inclined surfaces of the abutment member 2840. In various embodiments, in addition to those described above, the outer rows of brackets in the bracket block 2800 may contain higher brackets 2220a, and the inner rows of brackets may contain shorter brackets 2220b. In at least one embodiment, the higher brackets 2220a may be located within and / or near the thicker side portions 2809, while the brackets 2220b may be located within and / or near the thinner center portion 2808. At least in one such embodiment, as a result of the above, the higher brackets 2220a can capture more material from the implantable block body 2810 than the shorter brackets 2220b.

As described above for the embodiment shown in FIG. 111, the channel for the bracket block 2230 may have a stepped abutment surface 2231, which may be configured to hold the brackets 2220a and 2220b at different heights with respect to the stop element 2240. In various embodiments, the channel for the bracket block 2230 may be made of metal, and the ledges on the supporting surface 2231 can be formed, for example, by grinding. In various embodiments, as shown in FIG. 119, the end clamp of the surgical instrument may have a channel for the brace unit 2930 including a supporting insert 2935 located therein. More specifically, in at least one embodiment, the channel for the brace block 2930 may be formed so as to create a flat, or, at least a substantially flat abutment surface 2931, which may be configured to hold an insert 2935 having stepped surfaces for holding the brackets 2220a and 2220b in the bracket block 2200 at different heights. In at least one such embodiment, insert 2935 may have a flat, or at least substantially flat, bottom surface that may be located opposite the abutment surface 2931. Insert 2935 may further comprise supporting slots, grooves, or recesses 2932a and 2932b with a configuration that allows holding brackets 2220a and 2220b, respectively, at different heights. Similar to the above, insert 2935 may have a slot for knife 2939 through which the cutting element can pass. In various embodiments, the channel of the block of brackets 2930 may be made of the same material as the support insert 2935, or of another material. In at least one embodiment, the channel for the bracket block 2930 and the support insert 2935 can be made, for example, of metal, while in other embodiments, the channel for the bracket block 2930 can be made, for example, of metal, and the support insert 2935 may be made, for example, of plastic. In various embodiments of the invention, the support insert 2935 can be glued and / or welded to the channel for the bracket unit 2930. In certain embodiments, the support insert 2935 can be pressed into the channel for the bracket unit 2930 or secured there using a snap-fit connection. In at least one embodiment, the support insert 2935 may be secured to the channel for the bracket block 2930 using adhesive material.

In various embodiments, as shown in FIG. 120, the end clamp of the surgical instrument may include a stop element 3040, a channel for the bracket block 3030 and a compressible implantable bracket block 3000 located in the channel for the bracket block 3030. Similar to the above, the stop element 3040 may include many pockets formed therein for forming brackets 3042 and a slot for the scalpel 3049 with such a configuration that the cutting element could slide in it. In addition, similar to the above, the channel of the block of brackets 3030 may have many supporting slots for brackets 3032 and a slot for the scalpel 3039, which may be configured to allow sliding of the cutting element. In various embodiments, the bracket block 3000 may comprise a first layer 3011, a second layer 3012, and a plurality of brackets, for example, brackets 3020a and 3020b located inside. In at least one embodiment, the brackets 3020a may have a height in unformed form greater than the height of the brackets 3020b in unformed form. In various embodiments, the first layer 3011 may consist of a first compressible material, and the second layer 3012 may consist of a second compressible material. In certain embodiments, the first compressible material may be compressed to a degree greater than the compression ratio of the second compressible material, while in certain other embodiments, the first compressible material may be compressed to a degree less than the compression ratio of the second compressible material. In at least one embodiment, the first compressible material may consist of an elastic material with a first coefficient of elasticity, and the second compressible material may consist of an elastic material with a second coefficient of elasticity different from the first. In various embodiments, the first compressible material may have an elastic coefficient greater than the elastic coefficient of the second compressible material. In certain other embodiments, the first compressible material may have an elastic coefficient less 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, wherein the first stiffness is different from the second stiffness. In various embodiments, the first compressible layer may have a stiffness exceeding that of the second compressible layer. In certain other embodiments, the first compressible layer may have a stiffness less than that of the second compressible layer.

In various embodiments, as shown in FIG. 120, the second layer 3012 of the bracket block 3000 may have a constant, or at least substantially constant thickness across the entire width. In at least one embodiment, the first layer 3011 may have a different thickness over its entire width. In at least one such embodiment, the first layer 3011 may have one or more ledges 3008, increasing the thickness of the casing of the block 3010 in certain parts of the casing 3010, for example, in its central part. As shown in FIG. 120, the shorter brackets 3020b may be located within or aligned with the ledges 3008, that is, the thicker parts of the block body 3010, and the higher brackets 3020a may be located within or aligned with the thinner parts of the block 3010. In various embodiments , due to the presence of thicker and thinner parts of the casing of the block 3010, the rigidity of the casing of the block 3010 may be higher along the inner row of brackets 3020b than the outer row of brackets 3020a. In various embodiments, the first layer 3011 may be connected to the second layer 3012. In at least one such embodiment, the first layer 3011 and the second layer 3012 may include meshing elements holding the layers 3011 and 3012 together. In certain embodiments, the first layer 3011 may be a first laminate and the second layer 3012 may be a second laminate, wherein the first laminate may be adhered to the second laminate using one or more adhesives. In various embodiments, the block of brackets 3000 may include a slot for the scalpel 3003 with a configuration that allows the sliding of the cutting element.

In various embodiments of the invention, see FIG. 121, the bracket block 3100 may include a compressible implantable housing 3110 containing one layer of compressible material and, in addition, a plurality of brackets 3020b located inside. In at least one embodiment, the thickness of the block body 3110 may vary across its width. In at least one such embodiment, the block body 3110 may include ledges 3108 along the side portions. In various embodiments of the invention, see FIG. 122, the bracket block 3200 may include a compressible implantable housing 3210 comprising one layer of compressible material and, in addition, a plurality of brackets 3020b located inside. In at least one embodiment, the thickness of the block body 3210 may vary across its width. In at least one such embodiment, the block body 3210 may have ledges 3208 along the central portion. In various embodiments, see FIG. 123, the bracket block 3300 may have a compressible implantable housing 3310, while similar to the above, the thickness of the housing 3310 may be heterogeneous over its entire width. In at least one such embodiment, the thickness of the block body 3310 may geometrically increase from the side portions to the center 3310. In at least one such embodiment, the block body 3310 may have an arcuate or curved cross-sectional shape and may have an arcuate or curved tissue contact surface 3319. In certain embodiments, the thickness of the block body 3310 and the contour of the tissue contact surface 3319 may be determined by the radius of curvature or, alternatively, by several radii rivizny. In various embodiments, as shown in FIG. 124, the bracket block 3400 may have a compressible implantable housing 3410, wherein the thickness of the housing of the block 3410 may increase linearly, or at least substantially linearly, from the side portions to the central portion of the housing of the block 3410.

In various embodiments, as shown in FIG. 125, the bracket block 3500 may include a compressible implantable housing 3510 and a plurality of brackets 3520 located therein. The implantable housing of block 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, wherein the second inner layer 3513 may be thicker than the first inner layer 3512. In at least one alternative embodiment, the first inner the middle layer 3512 may be thicker than the second inner layer 3513. In another alternative embodiment, the first inner layer 3512 may have the same, or substantially the same thickness as 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 have a tip 3523 embedded in the first inner layer 3511 and, in addition, each base 3522 of the brackets 3520 may be embedded is included in the second inner layer 3512. In at least one embodiment, the first inner layer 3512 and / or the second inner layer 3513 may contain at least one medicament and, in various embodiments, the outer layer 3511 may encapsulate and hermetically close the first inner layer 3512 and the second inner layer 3513 so that the medication does not flow out of the block body 3510 until the outer layer 3511 is pierced by brackets 3520. More specifically, in addition to the above, the stop element m can move down towards the fabric opposite the contact surface with the fabric 3519 of the housing of the block 3500, so that the housing of the block 3510 is compressed and the surface 3519 moves down in the direction and at least partially under the ends of the brackets 3523 so that the ends 3523 break or puncture the outer layer 3511. After puncturing the outer layer 3511 with the legs of the brackets 3521, at least one medication M can leak out of the block body 3510 around the legs of the brackets 3521. Under various circumstances, additional compression of the block body 3510 may squeeze out Tel'nykh medicament portion M of the housing unit 3510, as shown in FIG. 126.

In various embodiments, as shown in FIG. 125, the outer layer 3511 may include a waterproof, or at least partially waterproof shell, firstly, preventing the medication from leaking from the brackets 3500 and, secondly, preventing premature flow of 3500 fluids into the brackets from the surgical field. In certain embodiments, the first inner layer 3512 may contain a first medicament inside or absorbed, and the second inner layer 3513 may contain a second medicament inside or absorbed, the second medication being different from the first. In at least one embodiment, the initial compression of the block body 3510, causing rupture of the outer layer 3511, can generally lead to the release of the first medicament from the first layer 3512, and subsequent compression of the block body 3510 can generally lead to the release of the second medication from the second inner layer 3513. However, in such embodiments, a portion of the first medicament and a second medicament may be released at the same time, although most of the medicament that is released first may be in the first copper kament, and most of the medication that came out later can be in the second medication. In certain embodiments, in addition to those described above, the first inner layer 3512 may consist of more compressible material than the second inner layer 3513, so that the initial compression force or pressure, which may be lower than the subsequent compression force or pressure, can cause greater initial deformation in the first inner layer 3512 than in the second inner layer 3513. Such a large initial deformation of the first layer 3512 can lead to the fact that a larger volume of the first medication is released from the first layer 3512 than in the second medicament from the second layer 3513. In at least one embodiment, the first layer 3512 may be more porous and / or more flexible than the second layer 3513. In at least one such embodiment, the first inner layer 3512 may have many formed therein a pore, or voids, 3508, and the second inner layer 3513 may include a plurality of pores or voids 3509 formed therein, while, in various embodiments, the pores 3508 may be configured to contain the first medicament in the first inner layer 3512, and the pores 3509 may be configured to contain the second medicament in the second inner layer 3513. In certain embodiments, the size and density of the pores 3508 in the first layer 3512 and the pores 3509 in the second layer 3513 can be selected to obtain the described desired result.

In various embodiments, as shown in FIG. 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 consist of a first bioabsorbable material, the second inner layer 3513 may consist of a second bioabsorbable material, and the outer layer 3511 may consist of a third bioabsorbable material, wherein the first bioabsorbable material, the second bioabsorbable material and / or the third bioabsorbable material may be different. In certain embodiments, the first bioabsorbable material can be resorbed at a first speed, the second bioabsorbable material can be resorbed at a second speed, and the third bioabsorbable material can be resorbed at a third speed, with the first speed, second speed, and third speed being different. In at least one such embodiment, if the material is biologically absorbed at a certain rate, such a rate can be determined, for example, as the mass of material absorbed in the patient’s body per unit time. As you know, in the body of different patients, different materials can dissolve at different speeds and, thus, these speeds can be expressed as average speeds to take into account such variability. In any case, the faster the rate of biological resorption, the greater the mass of material resolved per unit time. In various embodiments of the invention, see FIG. 125 and 126, the first layer 3512 and / or the second layer 3513 can be made of material that is absorbable faster than the material of the outer layer 3511. In at least one such embodiment, the first inner layer 3511 and / or the second inner layer 3513 can consist of bioabsorbable foam material, for example, oxidized regenerated cellulose (ORC), and the outer layer 3511 may consist of backing material and / or plastic material, for example polyglycolic acid (PGA), sold under the trade name Vikril, polylactic acid (PMA or PMMA), polydioxanone (PDS), polyhydroxyalkanoate (PHA), polyglecaprone 25 sold under the trade name Monocryl, polycapronolactone (PCL) and / or a mixture consisting, for example, of PGA, PMA, PDS, PHA, polyglecapron and / or PKL. In such embodiments, for example, the first inner layer 3512 and / or the second inner layer 3513 can immediately act on the tissue and reduce bleeding from the tissue, while the outer layer 3514 can provide long-term structural support and dissolve at a lower rate.

Due to the slower resorption rate of the outer layer 3511, in addition to the above, the outer layer 3511 can support or structurally strengthen the fabric within the line of brackets as it heals. In certain embodiments, either the first inner layer 3512 or the second inner layer 3513 may consist of a material that is absorbable faster than the other, so in at least one embodiment, one of the layers provides a sustained release of the same therapeutic material and / or other therapeutic material. In at least one such embodiment, the rate of release of therapeutic material from layer 3512, 3513 may be a function of the bioabsorption capacity of the substrate layer in which the drug is distributed or absorbed. For example, in at least one embodiment, the substrate forming the first inner layer 3512 can dissolve faster than the substrate forming the second inner layer 3513 and, as a result, the drug can be released from the first inner layer 3512 faster than from the second layer 3513 In various embodiments, implementation, as described herein, one or more layers 3511, 3512, and 3513 of the body of the block 3510 can be attached to each other using at least one adhesive, for example fibrin and / or protein hydrogel. In certain embodiments, the adhesive may be water soluble and may weaken the adhesion between the layers when the bracket unit 3500 is implanted and / or some time thereafter. In at least one such embodiment, the adhesive can dissolve faster than the outer layer 3511, the first inner layer 3512 and / or the second inner layer 3513.

In various embodiments, as shown in FIG. 127 and 128, the bracket block 3600 may comprise a block housing 3610 comprising a compressible first layer 3611, a second layer 3612 attached to the first layer 3611, and a removable compressible layer 3613 attached to the second layer 3612. In at least one such embodiment the first layer 3611 may consist of a compressible foam material, the second layer 3612 may comprise a laminate glued to the first layer 3611 using one or more adhesives, and the third layer 3613 may comprise a compressible foam material releasably glued to the second layer w 3612 via one or more adhesive substances. In various embodiments, the bracket block 3600 may further comprise a plurality of brackets, such as brackets 3620, located in the housing of the block 3610. In at least one such embodiment, each bracket 3620 may have a base 3622 located in the third layer 3613 and one or more deformable legs 3621 protruding upward from the base 3622 through the second layer 3612 and entering the first layer 3611. In operation, the upper surface of the housing 3619 of the bracket block 3610 can be pressed down by the stop element 3621 until the legs of the brackets will not pass through the upper surface 3619 and the stitched fabric and will not come into contact with the stop element. After sufficient deformation of the legs of the brackets 3621, the thrust element can move away from the block of brackets 3600 so that the compressible layers of the latter can again expand, at least partially. In various circumstances, inserting brackets into the tissue can cause bleeding from the tissue. In at least one embodiment, the third layer 3613 may consist of an absorbent material, for example, a protein hydrogel capable of absorbing blood from stitched tissue. In addition to or instead of the above, the third layer 3613 may consist of a hemostatic material and / or a tissue soldering material, for example, lyophilized thrombin and / or fibrin, capable of reducing tissue bleeding. In certain embodiments, the third layer 3613 may provide structural support for the first layer 3611 and the second layer 3612, while the third layer 3613 may consist of bioabsorbable material or non-absorbable material. In any case, in different embodiments, the third layer 3613 may separate from the second layer 3612 after implantation of the bracket block 3610. In embodiments in which the third layer 3613 contains implantable material, the surgeon may remove or leave the third layer 3613 of the block 3610 case as desired. In at least one embodiment, the third layer 3613 may be separated from the second layer 3612 in one piece.

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. In at least one embodiment, the first foam material may have a first density and the second foam material may have 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, and as a result, the third layer 3613 may be less compressible or 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, and as a result, the first layer 3611 may be less compressible or have a lower compression rate than the third layer 3613. In various embodiments, as shown in FIG. 129 and 130, the bracket block 3700, similar to the bracket block 3600, may include a housing 3710 comprising a first compressible foam layer 3711, a second layer 3712 attached to the first layer 3711, and a detachable third compressible foam layer 3713 detachably connected to the second layer 3712 In at least one such embodiment, the third layer 3713 may comprise a plurality of slots for the brackets 3709, each of which may hold at least a portion of the bracket 3620, for example, the base of the bracket 3622. In certain embodiments, the brackets 3620 may have configured to slide in the slots 3709 of the staple or, otherwise, the third layer 3713 may be configured to slide relative to the brackets 3620, 3700 when the block brackets located opposite the stitched fabric and compressed abutment member. In at least one embodiment, the slots 3709 may be configured so that there is space between the brackets 3620 and the side walls of the slots 3709. In at least one such embodiment, as a result of the above, the brackets 3620 may not capture part of the third layer 3713 when the brackets 3620 are deformed as shown in FIG. 129 and 130. In certain other embodiments, the ends of the slots for the brackets 3709 adjacent to the second layer 3712 can be covered by part of the third layer 3713 and, as a result, at least part of the third layer 3713 can be caught by brackets 3620 after they are deformed. In any case, the third layer 3713 may have one or more perforations and / or notches 3708, for example, with such a configuration as to allow separation of the third layer 3713 from the second layer 3712 by two or more pieces, as shown in FIG. 129. In FIG. 129, one of the fragments of the third layer 3713 is shown at the time of removal by the tool 3755. In various embodiments, perforations 3708 may be located along the line between the first row of brackets and the second row of brackets.

In various embodiments, as shown in FIG. 129 and 130, the bases 3622 of the brackets 3620 may be located in the slots 3709, while in at least one embodiment, the side walls of the slots 3709 may be configured to contact and detachably hold the legs of the brackets 3621 in position. In certain embodiments, although not shown, the third layer 3713 may include an oblong slot surrounding all brackets in the line of brackets. In at least one such embodiment, a block of brackets containing, for example, four rows of brackets, may have an oblong slot aligned with each row of brackets in the bottom layer of the block. In addition to the above, at least a portion of the bracket block 3600 and / or the bracket block 3700 can be implanted into the patient’s body and at least a portion of the bracket block can be removed from the patient’s body. In at least one embodiment, as shown in FIG. 129 and 130, the first layer 3711 and the second layer 3712 can be gripped by brackets 3620 and can be implanted with brackets 3620, while the third layer 3713 can be removed or separated as desired from the block of brackets 3700. In various circumstances, removal of a portion of the implanted block brackets can reduce the amount of resorption material in the patient’s body, which can provide various therapeutic benefits. In the case where a part of the bracket block is separated and removed, for example, by a laparoscopic instrument 3755, the separated portion of the bracket block can be removed from the surgical field through a trocar, for example, a trocar with an opening of 5 mm. In certain embodiments, a block body may include more than one layer that can be separated. For example, the casing of block 3710 may comprise a fourth layer, wherein the third layer 3713 of the casing of block 3710 may consist of hemostatic material, and the fourth layer may be a support layer. In at least one such embodiment, the surgeon may remove the support layer and then decide whether to remove the hemostatic layer.

In various embodiments of the invention, see FIG. 131, the bracket block, for example, bracket block 3800, may include an implantable compressible housing of block 3810 comprising an outer layer 3811 and an inner layer 3812. The inner layer 3812 may consist of a compressible foam material, and the outer layer 3811 may be at least partially wrapped around the inner layer 3812. In at least one embodiment, the outer layer 3811 may have a first portion 3811a configured to lie on a first side of the inner layer 3812, and a second portion 3811b configured to lie on the other side of the inner layer 3812, the first part 3811a and the second part 3811b can be connected using a flexible swivel, for example, connection 3809. In at least one such embodiment, at least one adhesive material, for example fibrin and / or a protein hydrogel, can be applied to the first side and / or second side of the inner layer 3812 to attach portions thereof to the outer layer 3811. In various embodiments, the outer layer 3811 may include one or more protruding fasteners. In at least one such embodiment, the outer layer 3811 may comprise a plurality of deformable legs 3821 protruding from one side of the outer layer 3811, which may be located in the compressible inner layer 3812. In at least one such embodiment, the legs 3821 may not protrude on the second side of the inner layer 3812, while in at least one alternative embodiment, the legs 3821 can at least partially protrude from the inner layer 3812. When the compressible housing of block 3810 is compressed during In operation, the legs 3821, due to their configuration, 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 contain holes, for example, holes 3808, for example, capable of receiving the legs of brackets 3821. In certain embodiments, at least parts of the brace unit 3800 may include a slot for the scalpel 3803 with a configuration that allows the cutting element to slide therein. In at least one such embodiment, the slot for the scalpel 3803 may not extend over the entire thickness of the body of the block 3810, and therefore, the cutting element may cut the body of the block 3810 as it moves.

In various embodiments, see FIG. 132, the bracket block 3900 may comprise, as a bracket block 3800, a housing 3910 with an inner layer 3812 and an outer layer 3811, wherein the outer layer 3811 may consist of a first portion 3811a adjacent to the first side of the inner layer 3812 and a second portion 3811b adjacent to the second side of the inner layer 3812. In at least one embodiment of the invention, similar to that described above, the outer layer 3811 may contain one or more protruding fasteners. In at least one such embodiment, the outer layer 3811 may comprise a plurality of deformable legs 3921 protruding from one side of the outer layer 3811, which may lie in a compressible inner layer 3812. In certain embodiments, each deformable leg 3921 may comprise at least , one protruding hook or beard 3923, which may fit into the second portion 3811b of the outer layer 3811 and, as a result, hold the outer layer 3811 in connection with the inner layer 3812. In at least one such embodiment those beards 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 beards 3923 can mesh with the outer surface of the outer layer 3811 and keep the outer layer 3811 attached to the inner layer 3812. When constructing the bracket block 3900, the inner layer 3812 may be at least partially compressed so that the barbs protrude and can enter the holes 3808. In at least one such embodiment, the bracket block 3900 may be of at least partially compressed when inserted into the unit casing. In certain embodiments, in addition to the ones described above, 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 plastic material, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA), and plastic material can be applied to at least a portion of the legs 3921 by multi-component casting.

In various embodiments, as shown in FIG. 133-137, the bracket block 4000, for example, may include a housing block 4010 containing a compressible first layer 4011, and a second layer 4012, and, in addition, many brackets 4020 located inside the housing 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, the bracket block body 4000 may be located between the channel for the bracket block 4030 and the stop clamp end member 4040 of the surgical stapler, while the second layer 4012 of the block body 4010 and / or the base 4022 of the brackets 4020 may be located opposite the channel for the bracket block 4030. In various embodiments, see FIG. 134, the second layer 4012 may comprise a series of presses 4060 connected to each other by a support frame 4061. In at least one embodiment, the presses 4060 and the support frame 4061 may be made of molded plastic, for example polyglycolic acid (PGA). Each press 4060 may have one or more holes or slots 4062 accommodating the legs of the brackets 4021 passing through them, as shown in FIG. 135 and 136. Each press 4060 may further have a groove 4063 to accommodate the base 4022 of the bracket 4020. In various embodiments, as shown in FIG. 134, presses 4060 and / or support frame 4061 may comprise a plurality of notches, perforations, and the like, so that presses 4060 can be detached from the support frame 4061 at the desired location. Similarly, as shown in FIG. 136, one or more presses 4060 can be connected to each other in a line with perforations or notches 4064. In use, a compressible foam material layer 4011 can be opposed to the fabric T to be sewn and block body 4010 and compressed by a stop member 4040 so that the stop member 4040 can deform the brackets 4020. When the brackets 4020 are deformed, the legs 4021 of each bracket 4020 can grab the fabric T, part of the first layer 4011 and the press 4060 inside the deformed bracket. When the channel for the brace block 4030 moves away from the implanted block 4060, the support frame 4061 can be disconnected from the presses 4060 and / or press 060 can be disconnected from each other. In certain circumstances, the presses 4060 may be disconnected from the frame 4061 and / or each of the presses when the brackets 4020 are deformed by the stop member 4040, as described above.

In the various embodiments described herein, brackets from a block of brackets can be completely formed by a stop element when it is moved to the closed position. In various other embodiments, as shown in FIG. 138-141, the brackets in the block of brackets 4100 can be deformed by the stop element when it is moved to the closed position and, in addition, by the system of pushing the brackets moving the brackets in the direction of the closed stop element. The bracket block 4100 may include a compressible housing 4110, which may consist of, for example, foam material, and a plurality of brackets 4120 at least partially located in the compressible housing of the block 4110. In various embodiments, the bracket ejection system may include a bracket ejector holder 4160, a plurality of ejector brackets 4162 located in the holder 4160 and a tray of the block of brackets 4180 so configured to hold the ejector brackets 4162 in the holder of the ejector 4160. In at least one embodiment eniya ejectors brackets 4162 may be located in one or more slots 4163 in holder pusher 4160, the slots 4163 may facilitate sidewalls direction ejectors brackets 4162 up to the abutment member. In various embodiments, the brackets 4120 can be held in the slots 4163 by the guide brackets 4162, in at least one embodiment, the brackets 4120 can be completely positioned in the slots 4163 when the brackets 4120 and the guide brackets 4162 are inoperative. In certain other embodiments, at least a portion of the brackets 4120 may protrude upwardly through the open ends 4161 of the slots 4163 when the brackets 4120 and the guide brackets 4162 are inoperative. In at least one such embodiment, see mainly FIG. 139, the bases of the brackets 4120 can be located in the holder of the ejector 4160 and the ends of the brackets 4120 can be integrated in the compressible housing of the block 4110. In certain embodiments, approximately 1/3 of the height of the brackets 4120 can be located in the holder of the ejector 4160, and approximately 2/3 of the height of the brackets 4120 may reside in a block housing 4110. In at least one embodiment, see FIG. 138A, the bracket block 4100 may further comprise a waterproof wrap or membrane 4111 surrounding the housing of the block 4110 and a bracket ejector holder 4160.

In operation, the block of brackets 4100 can be located inside the channel for the block and the stop element can move to the block of brackets 4100, moving to the closed position. In various embodiments, the implementation of the thrust element may come into contact and compress the compressible housing of block 4110 when moving to the closed position. In certain embodiments, the thrust member may not contact the brackets 4120 while in the closed position. In certain other embodiments, the thrust member may come into contact with the legs of the brackets 4120 and at least partially deform the brackets 4120 when moved to the closed position. In any case, the bracket block 4100 may further comprise one or more slides 4170 that can be moved longitudinally in the bracket block 4100 so that the slide 4170 sequentially engages with the ejector brackets 4162 and moves the ejector brackets 4162 and the brackets 4120 in the direction of the stop element. In various embodiments, the slide 4170 may slide between the tray for the bracket block 4180 and the ejectors of the brackets 4162. In embodiments in which the closing of the stop element begins the process of forming the brackets 4120, the upward movement of the brackets 4120 towards the stop element may complete the formation process and deform the brackets 4120 to fully collapsed state, or at least to the desired height. In embodiments in which the closure of the stop member does not deform the brackets 4120, the upward movement of the brackets 4120 towards the stop member can begin and complete the formation and deformation of the brackets 4120 to a fully folded state, or at least to a desired height. In various embodiments, the slide 4170 can move from the proximal end of the bracket block 4100 to the distal end of the bracket block 4100, so that the brackets 4120 located at the proximal end of the block 4100 are fully formed before the brackets 4120 located at the distal end of the block are formed 4100. In at least one embodiment, see FIG. 140, the slide 4170 may have at least one angular or inclined surface 4711 that can slide under the ejectors of the brackets 4162 and raise the ejectors of the brackets 4162, as shown in FIG. 141.

In various embodiments of the invention, in addition to those described above, the brackets 4120 may be formed to capture at least a portion of the fabric T and at least a portion of the compressible body 4110 of the bracket block 4100. After the brackets 4120 are formed, the stop element and the channel for the brace unit 4130 of the surgical stapler can be removed from the implanted brace unit 4100. Under various circumstances, the tray of the block 4180 can firmly engage with the channel for the block 4130, and, as a result, the tray of the block 4180 can from divided from the compressible case of block 4110 as the channel for block 4130 moves away from the implantable case of block 4110. In various embodiments, as shown in FIG. 138, the bracket block tray 4180 may have opposed side walls 4181, between which the block body 4110 can be detachably housed. In at least one such embodiment, the compressible block body 4110 may be compressed between the side walls 4181 so that the block body 4110 may be located between them during operation and removed from the tray of block 4180 after removing the tray 4180. In at least one such embodiment, the holder of the ejector 4160 may be connected to the tray of block 4180 in this manner m that the ejector holder 4160, the ejector brackets 4162 and / or the slide 4170 can remain in the tray for block 4180 when the tray 4180 is removed from the surgical field. In certain other embodiments, ejectors 4162 may be ejected from holder 4160 and remain in the surgical field. In at least one embodiment, the ejectors 4162 may consist of a bioabsorbable material, such as polyglycolic acid (PGA) sold under the trade name Vikril, polylactic acid (PMA), polydioxanone, polyhydroxyalkanoate (PHA), polyglexaprone 25, sold under the trade Monocryl, polycapronolactone (PCL) and / or a mixture of PGC, PMA, polydioxanone, PHA, polyglecaprone and / or PCL. In various embodiments, the pushers 4162 can be attached to the brackets 4120 so that the pushers 4162 move together with the brackets 4120. In at least one such embodiment, each pusher 4162 may have a recess to receive the bases of the brackets 4120, in at least one embodiment, the recesses may receive the bases of the brackets inserted therein by pressing or by means of a snap mechanism.

In certain embodiments, in addition to the above, the ejector holder 4160 and / or the slide 4170 can be ejected from the tray of the block 4180. In at least one such embodiment, the slide 4170 can slide between the tray of the block 4180 and the ejector holder 4160 so that the slide 4170 is moved to move the ejectors of the brackets 4162 and the brackets 4120 upward, while the slide 4170 can move the holder of the ejector 4160 upward outside the tray for the bracket block 4180. In at least one embodiment, The holder of the ejector 4160 and / or the slide 4170 may consist of a bioabsorbable material, such as polyglycolic acid (PGA) sold under the trade name Vikril, polylactic acid (PMK), polydioxanone, polyhydroxyalkanoate (PHA), polyglexaprone 25, sold under the trade name Monocryl, polycapronolactone (PCL) and / or a mixture of PGC, PMA, polydioxanone, PHA, polyglecapron and / or PCL. In various embodiments, the slide 4170 may be attached and / or be an integral part of a drive shaft or cutting element pushing the slide 4170 through the bracket block 4100. In such embodiments, the slide 4170 may not be ejected from the tray for block 4180 and may remain in the surgical stapler while in other embodiments in which the slide 4170 is not attached to the drive shaft, the slide 4170 may remain in the surgical field. In any case, in addition to the above, the compressibility of the body of the block 4110 may allow the use of thicker bracket blocks with an end clamp of the surgical stapler, since the body of the block 4110 can contract, or decrease in volume, when the stop element of the surgical stapler is closed. In certain embodiments, as a result of the brackets being at least partially deformed when the stop element is closed, it is possible to use higher brackets, for example, brackets with a height of about 4.57 cm (0.18 ”), with about 3 , 05 mm (0.12 ") of the height of the bracket can be located inside the compressible layer 4110 and the compressible layer 4110 may have a height in the uncompressed state, for example, approximately 3.56 mm (0.14").

In various embodiments, as shown in FIG. 142-145, a bracket block, for example a bracket block 4200, may include a compressible implantable housing 4234 and a plurality of brackets 4220 at least partially located in the housing 4210, and a plurality of flexible lateral locking elements 4234. In various embodiments, see FIG. . 143, the bracket block 4200 may be positioned between the stop member 4240 and the channel for the bracket block 4230, with at least one embodiment, the lateral locking members 4234 may be attached to the channel for the block 4230. When the stop member 4240 moves down to compress block body 4210 and at least partial deformation of the brackets 4220, as shown in FIG. 144, the side portions of the block 4210 body can protrude sideways and push the side support members 4234 out. In at least one such embodiment, the lateral support members 4234 may be attached to the body of the block 4210, and when the housing of the block 4210 extends sideways, as described above, the side support members 4234 may separate from the housing of the block 4210, as shown in FIG. 144. In at least one embodiment, the lateral support members 4234 may be adhered to the body of the block 4210 using one or more adhesives, such as fibrin and / or protein hydrogel. Similar to the above, the closed stop element 4240 can only partially deform the brackets 4220, while the formation of the brackets 4220 can be completed by moving one or more slides 4270 through the block of brackets 4200, as shown in FIG. 145. In various embodiments, as shown in FIG. 147 and 148, the slide 4270 can move from the proximal end of the brace block 4200 to the distal end of the brace block 4200 by the cutting element 4280. In at least one such embodiment, the cutting element 4280 may be a cutting element or scalpel 4283 that can move through tissue T and / or compressible housing of block 4210. In certain embodiments of the invention, the cutting element 4280 may comprise cam elements 4282 that move along the outer surfaces of the jaws 4230 and 4240, moving them or erzhivaya them in position. In various embodiments of the invention, as a result of the foregoing, brackets 4220 may be formed to take their final shape at the same time, or at least substantially concurrently with the incision of tissue T. relative to the scalpel 4283 so that tissue T is dissected, for example, only after suturing the previous tissue fragment.

In various embodiments of the invention, see FIG. 147 and 148, the slide 4270 may comprise separate sliding elements that come together under the action of the cutting element 4280. In at least one such embodiment, the slide 4270 may be located in the housing of the block 4200 and the cutting element 4280 may move into the housing of the block 4200 under the action of the rod trigger 4281 so that the cutting element 4280 engages with the slide 4270 and causes the slide 4270 to move distally. In certain embodiments, a slide 4270 may be coupled to each other. In any case, each slide 4270 may comprise an angled surface or cam 4271 so configured to lift the brackets 4220 forming a series of brackets. In certain embodiments of the invention, the angular surface 4271 may be integral with the cutting element 4280. In at least one such embodiment, see FIG. 147 and 148, each bracket 4200 may have a base, at least one deformable element extending from the base, and a crown 4229 applied to at least a portion of the base by multi-component casting and / or located around at least a portion of the base and / or deformable elements of the bracket 4200. In various embodiments of the invention, such crowns 4229 may be configured to be moved directly by the slide 4270. More specifically, in at least one such embodiment, the crowns 4229 of the brackets 4220 m They can be configured so that the angular surfaces 4271 of the slide 4270 can slide under and directly contact the crowns 4229 without the bracket ejector located between them. In such embodiments, each crown 4229 may include at least one corresponding angular or inclined surface, which may engage with the angular surface 4271 of the slide 4270 so that the respective angular surfaces move the slide 4220 upward when the slide 4270 slides under the brackets 4220.

In various embodiments, see FIG. 146, the bracket block, for example, the bracket block 4300, may include a compressible implantable housing 4310 and a plurality of brackets 4320 at least partially located in the compressible housing 4310. Similar to the above, the bracket block 4300 may include flexible side stops 4334, which may be attached to the channel for the bracket block and / or glued to the compressible housing of the block 4310. In addition to the above, the flexible side stops 4334 can be connected to each other by one or more spacers or connecting elements 4335 with such a configuration as to hold side stops 4334 together. During operation, the connecting elements 4335 may be configured to prevent, or at least slow, prematurely detaching the side stops 4334 from the housing of the block 4310. In certain embodiments, the connecting elements 4335 may be configured to hold the side stops 4334 together after compression of the block brackets 4300 thrust element. In such embodiments, the side stops 4334 can resist laterally protruding, or displacing, the side parts of the housing of the block 4310. In certain embodiments of the invention, the cutting element, such as the cutting element 4280, may be configured to intersect the connecting elements 4335 when the cutting element 4280 moves distally in the housing of the block 4310. In at least one such embodiment, the cutting element 4280 may be configured to push one or more slides 4270, for example, distal direction, in order to form brackets 4320 by contacting them with a stop element. The slide 4270 can direct the movement of the cutting edge 4283 so that the cutting element 4280 will not intersect the connecting element 4335 until the brackets 4320 next to the connecting element 4335 are fully formed, or at least formed to the desired height. Under various circumstances, the connecting elements 4335, in combination with the side stops 4334, can prevent, or at least reduce, the lateral movement of the compressible housing of the block 4310 and, at the same time, prevent, or at least reduce, the lateral movement of the brackets 4320 located inside the case of the block 4310. In such circumstances, the connecting elements 4335 can hold the brackets 4320 in place until they remain deformed, and subsequently the connecting elements 4335 can be cut to release of the lateral parts of the housing of the block 4310. As mentioned above, the side stops 4334 can be connected to the channel for the block of brackets and, as a result, can be removed from the surgical field with the channel for the block after implantation of the block 4300. In certain embodiments, the side stops 4334 may consist of implantable material left in the surgical field. In at least one embodiment, the connecting elements 4335 may be located between the body of the block 4310 and the tissue T and, after the connecting elements 4335 are separated from the side stops 4334, the connecting elements may remain implanted in the patient’s body. In at least one such embodiment, the connecting elements 4335 may consist of an implantable material and, in certain embodiments, the connecting elements 4335 may consist of the same material as the side stops 4334. In various embodiments, the connecting elements 4335 and / or 4334 side stops may consist of a flexible bioabsorbable material, such as polyglycolic acid (PGA), sold under the trade name Vikril, polylactic acid (PML), polydioxanone, polyhydroxy canoate (PHA), polyglexaprone 25, sold under the trade name Monocryl, polycapronolactone (PCL) and / or a mixture of PGC, PMK, polydioxanone PHA, polyglexaprone and / or PCL. In various embodiments of the invention, the connecting element may comprise a sheet of material connecting the side stops 4334. In certain embodiments, the bracket unit may comprise connecting elements passing through the upper surface of the block 4310 and, in addition, connecting elements passing through the lower surface of the block 4310 .

In various embodiments, as shown in FIG. 149, the bracket block may include brackets, for example, brackets 4420, for example, containing a wire portion inserted in 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 (PDS) and / or polyglycolic acid (PGA). In at least one embodiment, the crown may consist of metal, for example, titanium and / or stainless steel, and / or plastic, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA). In certain embodiments, the wire portion of each bracket 4420 may include a base 4422 and deformable legs 4421 extending from the base 4422, wherein the portion of the crown of each bracket 4420 may comprise a crown 4429 so configured to receive at least a portion of the base 4422. To assemble the parts of each bracket 4420, see FIG. 150A-150C, the legs 4421 of the wire part can be inserted into the hole 4426 in the crown 4429, while the hole 4426 can be configured to guide the legs 4421 into the base chamber 4427. The wire part can be further inserted into the crown 4429 so that the legs 4421 come out from the base chamber 4427 and the base portion 4422 of the wire portion entered the base chamber 4427. In at least one such embodiment, the base chamber 4427 may be configured such that the wire portion rotates inside the crown 4429 when the base 4422 enters the chamber about Considerations 4427, so that the legs of brackets 4421 are directed upwards, or at least substantially upwards. In various embodiments, see FIG. 149, the crown 4429 may have outlet openings 4425 of such a configuration as to receive the legs of the brackets 4421.

In various embodiments of the invention, in addition to those described above, the surgical stapler has a slide 4470 configured to move along the brace block 4400 and the channel for the brace block 4430 and move the brackets 4420 located in the body of the block 4410 to the stop member. In various embodiments, the slide 4470 may move from the proximal end of the channel for the brace block 4430 to the distal end of the channel for the brace block 4430 to implant the body of the block 4410 and the brackets 4420. In certain circumstances, the slide 4470 may retract or return to the proximal end of the channel for block 4430 and another bracket block 4400 can be inserted into the channel for block 4430. After the new bracket block 4400 is installed in the channel for block 4430, the slide 4470 can again move distally. In various embodiments, the surgical stapler may include one or more snap elements capable of obstructing the slide 4470 in the distal direction without a new bracket block 4400 installed in the channel for the block 4430. In at least one such embodiment, see FIG. . 149, the channel for the brace unit 4430 may include a snap arm 4439 so as to prevent, or at least limit, the distal movement of the slide 4470. More specifically, the slide 4470 may be configured to abut the shoulder 4439 until until the slide 4470 is at least partially lifted up above shoulder 4439 by a lifting element 4428, for example, located between the most proximal brackets 4420 in the bracket block 4400. In other words, in the absence of the most proximal brackets 4420 in the new bracket block 4400 slide 4470 will not be able to move. Thus, when there is a used block 4400 in the channel for block 4430, or there is no block 4400 in channel 4430, the slide 4470 will not be able to move along the channel for block 4430.

In addition to the above, see FIG. 151, a bracket block, for example, a bracket block 4500, may be located in the channel for block 4530 and may consist of a compressible block body 4510, a plurality of brackets 4520 located in the block body 4510, and a tray of the block or latch 4580. In various embodiments, the compressible block block 4510 may comprise an outer layer 4511 and an inner layer 4512, wherein in at least one embodiment, the outer layer 4511 may seal the inner layer 4512. In at least one such embodiment, the outer layer 4511 may be between the inner layer 4512 and the tray of the bracket block 4580. In certain other embodiments, the outer layer 4511 can only partially surround the inner layer 4512 and, in at least one such embodiment, the outer layer 4511 and the tray of the block 4580 can interact and embrace, or at least partially cover the inner layer 4512. In various embodiments of the invention, in addition to the above, the brackets 4520 can be held by the bracket block tray 4580, while the bracket block tray 4580 may have one or more supports living grooves for brackets with such a configuration to support brackets 4520. In certain embodiments, the tray of block 4580 can be attached to the body of block 4510, while in at least one such embodiment, the body of block 4510 can be compressed laterally between opposite side walls of the tray of block 4580. In various embodiments, the side walls of the tray for block 4580 may support the housing of the block 4510 laterally and, in at least one such embodiment, the tray for block 4580 may hold one or more walls, or ridges 4582, protruding upward from a lower abutment surface 4583 into a block body 4510. In at least one such embodiment, the bracket block body 4510 may comprise one or more slots or channels that may be configured in order to receive and / or engage with walls 4582. In various embodiments, walls 4582 may partially or almost completely pass through the housing of the bracket block 4510. In at least one such embodiment, the walls are 4582 m Gut continue longitudinally through brackets block 4500 between the first row of staples 4520 and a second row of staples 4520.

In various embodiments, the housing of the block 4510 and / or the tray of the block 4580 may contain locking elements corresponding to each other, allowing a snap connection to be made between the tray of the block 4580 and the housing of the block 4510. In certain embodiments, the housing of the block 4500 can be located in the channel for block 4530 such so that the tray of block 4580 is opposite and / or attached to the channel of block 4530. In at least one embodiment, the tray of block 4580 can be detachably connected to the channel for block 4530 in this way ohm, that after compression of the block 4500 by the stop element 4540 and deformation of the brackets 4520, the tray of the block 4580 can detach from the channel of the block 4530 and remain implanted together with the body of the block 4510. In at least one embodiment, the tray of the block of brackets 4580 may consist of bioabsorbable material, such as polyglycolic acid (PGA), sold under the trade name Vikril, polylactic acid (PMA), polydioxanone, polyhydroxyalkanoate (PHA), polyglecaprone 25, sold under the trade name Monocryl, polycapronolactone (PC ) And / or mixtures of PGA, PLA, PGA polydioxanone, poliglekaprona and / or PCL. In certain embodiments, the surgical stapler may further comprise a trigger and / or an ejector that can slide between the channel for the bracket block 4530 and the lower guide surface of the tray for the bracket block 4580 and may be configured to raise or pop the tray for the bracket block 4580 from the channel for the bracket block 4530. In certain embodiments of the invention, the housing of the bracket block 4510 can be detachably connected to the channel for the bracket block in such a way that e compressing the bracket block 4500 by the stop member 4540 and deforming the brackets 4520, the bracket block housing 4510 can be disconnected from the bracket block tray 4580. In at least one such embodiment, the bracket block tray 4580 can remain fixedly connected to the channel for the bracket block 4530 in this way that the bracket block tray 4580 is removed from the surgical field along with the channel of the bracket block 4530. In certain embodiments, the surgical stapler may further comprise a trigger and / or an ejector that th may slide between the channel for the bracket block 4580 and the lower guide surface of the bracket block body 4510 and may be configured to raise or push the bracket block body 4510 from the bracket block tray 4580. In at least one such embodiment, the bracket block 4500 may additionally contain brackets ejectors located between the tray for the block of brackets 4580 and brackets 4520 so that when the trigger is sliding in the distal direction, the brackets and brackets 4520 can move I was up towards the abutment member. In at least one such embodiment, the bracket ejectors may be at least partially integrated into the compressible housing of the bracket assembly 4510.

In various embodiments, similar to the above, the block of brackets 4500 may include a snap element with such a configuration to prevent, or at least limit, the distal movement of the cutting element until an unused block of brackets 4500 is installed in the channel for block brackets 4530. In certain embodiments, the tray for the block brackets 4580 may have a surface that lifts the cutting element up above the fixing surface in the channel for the block brackets 4530. In the case where the block the side 4500, including the tray of the block of brackets 4580, is absent in the channel 4530, the cutting element is blocked and cannot move. In at least one embodiment, the most proximal brackets, and / or any other suitable brackets in the block of brackets 4500 may have a lifting surface capable of sufficiently raising the cutting element above the locking surface. In addition to the above or instead of the above, the various parts of the bracket block 4500 may consist of materials of different colors. In such embodiments, the surgeon can visually determine if there is a bracket block, used or unused, in the channel for the brace block 4530. In at least one such embodiment, the outer layer 4511 of the housing 4510 may have a first color, the tray of the bracket block 4580 may have a second color, and the channel for the bracket block 4530 may have a third color. In the case when the surgeon sees the first color, he may know that the unused block of brackets 4500 is in the channel for block 4530; If the surgeon sees the second color, he may know that the used block of brackets 4500 is in the channel for block 4530 and the remaining tray of the block of brackets 4580 must be removed; and if the surgeon sees the third color, he may know that there are no parts of the bracket block 4500 left in the channel for block 4530.

In various embodiments, see FIG. 152, a bracket block, for example, a bracket block 4600, may have a compressible implantable body 4610 and a plurality of brackets 4620 located therein. Block body 4610 may have an outer layer 4611 and inner layer 4612. In certain embodiments, the inner layer 4612 may have multiple pockets, such as pockets or cavities 4615 formed therein, which compress the block body 4610. In at least one such embodiment the implementation of the inner layer 4612 may contain a corrugated or honeycomb-shaped mesh with such a configuration to withstand the compression force or pressure until the compression or pressure force exceeds a certain threshold. If the threshold value is not exceeded, the inner layer 4612 may deform with a linear, or at least substantially linear, speed with respect to the effective compressive force or pressure. After the compressive force or pressure exceeds a threshold value, the inner layer 4612 may suddenly deform and collapse, or crumple, as a result of this pressure load. In various embodiments, the mesh or inner layer 4612 may consist of a plurality of additional layers 4612a that can be joined together. In at least one embodiment, each additional layer 4612a may comprise a plurality of alternating ridges and grooves, or waves that can be aligned with alternating grooves and ridges of an adjacent additional layer 4612a. In at least one such embodiment, the grooves of the first additional layer 4612a may be adjacent to the ridges of the second additional layer 4612a and, likewise, the ridges of the first additional layer 4612a may be adjacent to the grooves of the second additional layer 4612a. In various embodiments, adjacent additional layers 4612a may be bonded to each other and / or to the outer layer 4611 by at least one adhesive, such as fibrin and / or protein hydrogel. In FIG. 153 shows a block of brackets 4600 after compression of the body of block 4610 and deformation of the brackets 4620 to capture and hold fabric T opposite the body of block 4610.

In various embodiments, as shown in FIG. 154-156, the bracket block, for example, the bracket block 4700, may comprise a compressible implantable housing 4710 and a plurality of brackets 4720 at least partially located in the housing 4710. Similar to the above, the housing of the bracket assembly 4710 may comprise an outer layer 4711 and an inner layer 4712, the inner layer 4712 may have many additional layers 4712a. Furthermore, similar to that described above, each additional layer 4712a may comprise alternating grooves 4717 and ridges 4718, which can be aligned with each other to form pockets or cavities 4715. In at least one such embodiment, the grooves 4717 and / or ridges 4718 may be arranged along axes parallel to each other and / or parallel to the longitudinal axis 4709. In various embodiments, brackets 4720 may be arranged in a plurality of rows of brackets that may extend along axes parallel to one another and / or parallel nyh longitudinal axis 4709. In various alternative embodiments, see. FIG. 152 and 153, the brackets 4620 in the body of the block 4600 may be located along axes transverse or perpendicular to the axes formed by grooves and ridges of the additional layers 4612a. As shown in FIG. 154-156, the brackets 4720 can pass through the grooves 4717 and ridges 4718 when the frictional forces between the brackets 4720 and the additional layers 4712a can hold the brackets 4720 in the housing of the block 4710. In certain embodiments, the plurality of additional layers 4712a may consist of backing material and / or a plastic material, for example, polydioxanone (PDS) and / or polyglycolic acid (PGA) and be configured to hold the brackets 4720 upright and / or to keep the brackets 4720 aligned with each other, as shown in FIG. 154 and 155. In FIG. 156, the brackets block 4700 is shown after compressing the block body 4710 and deforming the brackets 4720 to grasp and hold the fabric T opposite the bracket block body 4710.

In various embodiments, see FIG. 154-156, the block body 4710 may elastically or elastically compress upon compression. In at least one such embodiment, waves generated in each additional layer 4712a by grooves 4717 and ridges 4718 may flatten, or at least substantially flatten, by compressing the body of block 4710, which may result in collapse, or at least a substantial collapse of the cavities 4715 formed therein. In various circumstances, the housing of the block 4710, or at least parts of the housing of the block 4710, can elastically or elastically expand after the termination of the compressive force or pressure on the housing of the block 4710. In at least one such embodiment, the connection between the grooves 4717 and ridges 4718 of the adjacent additional layers 4712a can be maintained, or at least substantially maintained, when the case of the block 4710 is compressed so that after the compression force has ceased to act on the case block 4710 additional layers 4712a can depart from each other which, as a result, will lead to at least partial expansion of the casing of the block 4710. In certain embodiments of the invention, the casing of the block of brackets 4710 may plastic deform bending, or flattening, under pressure on it and, as a result, the body of the block of brackets 4710 may not expand back after the termination of the force of compression or pressure on the body of the block 4710. In certain embodiments, see FIG. 157, the bracket block, for example, bracket block 4800, may comprise a collapsible housing of block 4810 with an outer layer 4811 and an inner layer 4812, while the inner layer 4812 may comprise a corrugated bee-honeycomb lattice with many pockets or cavities 4815. In various embodiments of the invention, the walls creating the lattice of the inner layer 4812 may contain one or more weakened or thin section sections 4819 with such a configuration that the walls forming the lattice break when the case of the block 4810 is compressed. In such embodiments, uschestvleniya housing unit 4810 may be flattened at block 4800 of implantation.

In various embodiments of the invention, as shown in 158-160, the bracket block 4900 may comprise a bracket block body 4910 with an outer layer 4911 and a plurality of compressible elements 4912 located between the upper and lower portions of the outer layer 4911. As shown in FIG. 158 and 159, the bracket block 4900 may further comprise a plurality of brackets 4920, wherein each bracket 4920 may be located in the compressible member 912. More specifically, each compressible member 4912 may comprise a first portion 4912a, a second portion 4012b and a third portion 4012c jointly forming a cavity 4915 with such a configuration as to receive the bracket 4920. During operation, in addition to the above, the case of the block 4900 can be located in the channel for the block and the compressive force to compress the case of the block of brackets 4 can act on the contact surface with the fabric 4919 910. As the tissue contact surface 4919 moves downward, the compressible members 4912 may contract. In such circumstances, the second part 4912b of each compressible member 4912 may be pressed into the corresponding first part 4912a and, similarly, the third part 4912c of each compressible member 4912 may be pressed into the corresponding second part 4912b. As the housing of the block 4910 is compressed and the compressible elements 4912 are compressed, the brackets 4920 located in the compressible elements 4912 may become deformed, as shown in FIG. 160. In various embodiments, the second portion 4912b of each compressible member 4912 can be held by friction and / or pressed into the corresponding first portion 4912a so that if the compressive force acting on the compressible member 4912 exceeds the holding force of the first part 4912a and second part 4912b in the extended position (FIG. 159), the first part 4912a and the second part 4912b can begin to slide relative to each other. Similarly, the third part 4912c of each compressible member 4912 can be held by frictional forces and / or be pressed into the corresponding second part 4912b so that if the compressive force acting on the compressible element 4912 exceeds the holding force of the second part 4912b and the third part 4912c in the elongated position (FIG. 159), the third part 4912b and the second part 4912c may begin to slide relative to each other.

In many embodiments described herein, a block of brackets may contain multiple brackets inside. In various embodiments, the implementation of such brackets may consist of a metal wire deformed to give it a substantially U-shaped configuration, and have two legs. Other embodiments are provided in which the brackets may have different configurations, for example, two or more wires can be connected together and have three or more legs. In various embodiments, the wire or wires used to form the brackets may be round, or at least substantially round, in cross section. In at least one embodiment, the wires for making the brackets may have a different cross-sectional shape, for example, square or rectangular. In certain embodiments, the brackets may be made of plastic wire. In at least one embodiment, the brackets may be comprised of plastic coated metal wire. In various embodiments, the block of brackets may include any suitable type of fastening elements in addition to or instead of brackets. In at least one such embodiment, such a fastening element may have hinged brackets that are folded when engaged with the stop element. In certain embodiments, two-part fasteners may be used. In at least one such embodiment, the block of brackets may comprise a plurality of first parts of fastening elements, and the stop element may comprise a plurality of second parts of fastening elements connected to the first parts by pressing the stop element against the block of brackets. In certain embodiments, as described above, the slide or ejector can be moved within the block of brackets to complete the process of forming the brackets. In certain embodiments of the invention, the slide or ejector can move within the stop element to move one or more forming elements down to engage with the opposite block of brackets or clamps located therein.

In various embodiments described herein, a block of brackets may comprise four rows of brackets therein. In at least one such embodiment, four rows of brackets may be in the form of 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 slot for the cutting element or scalpel in the block of brackets and, similarly, the inner row of brackets and the outer row of brackets can be located on the second side of the slot for the cutting element or scalpel. In certain embodiments, the block of brackets may not have a slot for the cutting element; However, such a block of brackets may have a corresponding part with a configuration that allows its cutting by the cutting element, instead of a slot in the block of brackets. In various embodiments, the implementation of the inner rows of brackets can be located inside the block of brackets so that they are at equal, or at least substantially equal, distance from the slot for the cutting element. Similarly, the outer rows of brackets can be located inside the block of brackets so that they are at an equal, or at least substantially equal, distance from the slot of the cutting element. In various embodiments of the invention, the block of brackets may contain more or less than four rows of brackets located inside the block. In at least one embodiment, the bracket block may comprise six rows of brackets. In at least one such embodiment, the bracket block may comprise three rows of brackets on the first side of the slot for the cutting element and three rows of brackets on the second side of the slot for the cutting element. In certain embodiments, a block of brackets may comprise an odd number of rows of brackets. For example, the bracket block may contain two rows of brackets on the first side of the slot for the cutting element and three rows of brackets on the second side of the slot for the cutting element. In various embodiments, the rows of brackets may comprise brackets of the same, or at least substantially the same height in an unformed state. In certain other embodiments, one or more rows of brackets may comprise brackets different in height from an unformed state from other brackets. In at least one such embodiment, the brackets on one side of the slot for the cutting element and the brackets on the other side of the slot of the cutting element may have a second height in an unformed state that is different from the first height.

In various embodiments of the invention, see FIG. 161A-161D, the end clamp of the surgical stapler may include an area for attaching a bracket block, for example, a channel for a bracket block 5030, for example, a bracket block can be removably fixed to a channel for a block 5030, so that the jaw 5040 is opposite the bracket block 5000 and a channel for the bracket block 5030. The bracket block 5000 may consist of a compressible housing of the bracket block 5010 and a plurality of brackets 5020 and / or any suitable clamps at least partially located in the compressible housing 5010. In at least one such embodiment of implementation, each bracket 5020 may have a base 5022 and, in addition, legs 5021 extending upward from the base 5022, while at least a portion of the legs 5021 may be immersed in the housing of the bracket block 5010. In various embodiments, the compressible housing 5010 may have an upper or fabric contacting surface 5019 and a lower surface 5018, wherein the lower surface 5018 can be opposite and supported by the channel supporting surface 5031 for the bracket block 5030. Similar to the above, the supporting surface 5031 may have multiple in support slots 5032 (FIG. 161D) formed therein and configured to receive and support the bases 5022 of the brackets 5020. In various embodiments, the end clamp of the surgical stapler may further comprise supporting material 5050, for example, configured to engage with the brackets 5020 and grab the fabric between them. In at least one such embodiment, the supporting material 5050 can be detachably attached to the jaw 5040. In use, when the bracket unit 5000 is located in the channel for the block 5030, the jaw 5040 and the supporting material 5050 attached to it can move to the bracket block 5000 and the channel for the block 5030. In at least one embodiment, the jaw 5040 can move down along the axis 5099 so that the jaw 5040 and the channel for the block of brackets 5030 remain parallel, or essentially parallel, to each other when closed the jaws 5040. More specifically, in at least one such embodiment, the jaw 5040 can be closed in such a way that when the tissue contact surface 5051 of the support material 5050 is parallel, or at least substantially parallel, the tissue contact surface 5019 of the block brackets 5000 when the jaw 5040 moves to the block of brackets 5000.

In various embodiments, see FIG. 161A, the supporting material 5050 can be detachably attached to the jaw 5040 such that between the supporting material 5050 and the jaw 5040 only slight movement is possible, if at all possible, when the supporting material 5050 is attached to the jaw 5040. In at least one embodiment, the jaw 5040 may include one or more locking elements with such a configuration to fix the supporting material 5050 in the desired position. In at least one such embodiment, the support material 5050 can be pressed in or snap into place to connect to the jaw 5040. In certain embodiments, the support material 5050 can be glued to the jaw 5040 using one or more adhesives. In any case, the jaw 5040 can move to a position where the supporting material 5050 comes in contact with the fabric T and the fabric T is located opposite the contact surface with the fabric 5019 of the bracket block 5000. When the tissue T is opposite the bracket block 5000 of the jaw 5040, the compressible block body 5010 the brackets 5000 may or may not be compressed by the jaw 5040. In any situation, in various embodiments, the legs 5021 of the brackets 5200 may not protrude through the contact surface with fabrics 5019 of the bracket block 5000, as shown in FIG. 161A. In addition, as also shown in FIG. 161A, the jaw 5040 can hold the tissue T opposite the compressible body of the bracket block 5010 without engaging the supporting material 5050 with the brackets 5020. Such embodiments of the invention allow the surgeon to open and close the jaw 5040 repeatedly to achieve the desired location of the end clamp in the surgical field, for example, without damaging the tissue T. However, other embodiments are provided in which the ends of the legs 5023 may protrude from the contact surface with the tissues 5019 until the body of the bracket block 5010 is compressed by the stop member 5040. After the end clamp formed into the desired position, see. FIG. 161B, the jaw 5040 can be moved downward to the channel for the bracket block 5030 so that the compressible case of the block 5010 is compressed by the abutment plate 5040 and thus the contact surface with the fabric 5019 is pushed down with respect to the brackets 5020. As the contact surface with the fabric 5019 is pushed down, the ends 5023 of the legs of the brackets 5021 can pierce the contact surface with the fabric 5019, as well as at least part of the fabric T. In such circumstances, the supporting material 5050 can be located above the brackets 5020 so that the holding Verstov 5052 in the supporting material 5050 aligned, or at least substantially aligned with the tips of the legs 5023 of brackets 5021.

As the supporting material 5050 is pushed down the axis 5099, see FIG. 161C, the legs 5021 of the brackets 5020 may fit into the holding holes 5052. In various embodiments, the legs of the brackets 5021 may engage with the side walls of the holding holes 5052. In certain embodiments, as described in more detail below, the supporting material 5050 may have one or more holding elements protruding in and / or around the holding holes 5052, which may engage with the legs of the brackets 5021. In any case, the legs of the brackets 5021 can be fixed in the holding holes 5052. In various In the embodiments, the ends 5023 of the legs of the brackets 5021 can enter into the holding holes 5052 and functionally engage with the holding elements and / or the side walls of the holes 5052. As the supporting material 5050 is pushed to the bases 5022 of the brackets 5020, the legs of the brackets 5021 can slide along relative to the side walls and / or retaining elements. As a result of the foregoing, frictional forces can be created when sliding between the legs of the brackets 5021 and the supporting material 5050, while such a friction force can prevent the support material 5050 from entering the brackets 5020. In various embodiments, the sliding friction between the supporting material 5050 and the brackets 5020 can be constant, or at least substantially constant, as the support material 5050 slides down along the legs 5021 of the brackets 5020. In certain embodiments, the friction is sliding can increase and / or decrease as the supporting material 5050 slides down along the legs of the brackets 5021, for example, due to the different geometry of the legs of the brackets 5021, the holding holes 5052 and / or the holding elements protruding in and / or around the holding holes 5052 In various embodiments, the insertion of the supporting material 5050 into the brackets 5020 may also be counteracted by the compressible housing 5010 of the bracket unit 5000. More specifically, the compressible housing 5010 may consist of an elastic material, for example, which may provide resistance to the supporting material 5050, increasing with increasing compression of the compressible housing 5010. In at least one such embodiment, the reinforcement of the resistance created by the housing of the block 5010 may be linearly proportional, or at least substantially linearly proportional to the distance which compresses the housing of block 5010. In certain embodiments, the amplification of the resistance force generated by the housing of block 5010 can be geometrically proportional to the distance over which the housing is compressed at block 5010.

In various embodiments of the invention, in addition to those described above, sufficient actuation force can be exerted on the jaw 5040 and support material 5050, which exceeds the drag and friction forces described above. In use, the supporting material 5050 may be located at any suitable depth with respect to the brackets 5020. In at least one embodiment, the supporting material 5050 may be located at a depth with respect to the bases 5022 of the brackets 5020 for securing two or more layers of fabric together and creating compressive forces or pressure in the tissue. In various embodiments, a system comprising support material 5050 and brackets 5020 may allow the surgeon to select the compressive force or pressure applied to the tissue by selecting the depth of the support material 5050. For example, support material 5050 can slide down to the bases 5022 of the brackets 5020 until until the supporting material 5050 is located at a certain depth 5011 from the bottom of the retaining grooves 5032, while a smaller depth 5011 can lead to the fact that a large force will act on the fabric T Atia or pressures than at higher depths 5011, at which the fabric T acts on a smaller compressive force or pressure. In various embodiments, the compression or pressure forces acting on the fabric T may be linearly proportional, or at least substantially linearly proportional to the depth 5011 of the support material 5050. In various circumstances, the compression or pressure forces acting on the fabric T may depend on the thickness of the fabric T located between the supporting material 5050 and the block of brackets 5020. More specifically, at a given distance 5011, the presence of a thicker fabric T can lead to greater compression or pressure forces than ri thin tissue T.

In various circumstances, in addition to those described above, the surgeon can adjust the depth of the support material 5050 according to the thickness of the tissue located in the end clamp to create a specific or set pressure on the tissue T, regardless of its thickness. For example, the surgeon may place the supporting material 5050 at a shallower depth of 5011 while gripping a thinner tissue fragment or at a greater depth of 5011 while gripping a thicker tissue fragment T to obtain the same, or at least substantially the same, pressure on the tissue. In certain embodiments, in addition to the above, the surgeon can selectively determine the pressure force on the tissue T located between the supporting material 5050 and the block of brackets 5010. Under various circumstances, the surgeon can fix the supporting material 5050 and the brackets 5020 and position the supporting material 5050 at a first distance from the bases 5022 brackets 5020 to create the first tissue compression pressure. Alternatively, the surgeon may position the supporting material 5050 at a second distance from the bases 5022, which is shorter than the first distance, to create a second compression pressure on the tissue that is stronger than the first pressure. Alternatively, the surgeon may position the supporting material 5050 at a third distance from the bases 5022, which is shorter than the second distance, to create a third compression pressure on the tissue that is stronger than the second pressure. In various embodiments, a cross-linking system comprising support material 5050 and brackets 5020 may be configured to allow the surgeon to apply pressure to the treated tissue over a wide range.

In various embodiments, see FIG. 161D, the legs of the brackets 5021 can pass through the supporting material 5050 so that the ends of the legs 5023 protrude above the upper surface of the supporting material 5050. In at least one embodiment, see FIG. 161C, the jaw 5040 may further have a recess 5042 formed therein so as to receive the ends of the legs of the brackets 5023 as they pass through the retaining holes 5052 in the supporting material 5050. In at least one such embodiment, the recesses 5042 may be aligned with the retaining holes 5052 so that the legs 5021 do not touch the jaws 5040. In various embodiments, the recesses 5042 can have a sufficient depth, so that the legs of the brackets 5021 do not touch the jaw 5040 independently mo distance on which the supporting material 5050. After the supporting material 5050 engages with brackets 5020 and located in the correct position, see. FIG. 161D, the channel for the bracket block 5030 and the jaw 5040 can move away from the tissue T. More specifically, the channel for the bracket block 5030 can separate from the implanted block 5000 and the stop member 5040 can separate from the implanted supporting material 5050. As the jaw 5040 moves away from the supporting material 5050 and the movement of the stops for the brackets 5032 away from the bases of the brackets 5022, the distance 5011 between the supporting material 5050 and the lower part of the bases 5022 can remain equal, although the jaw 5040 and the channel for the block of brackets 5030 no longer provide ayut support. In various embodiments, the static frictional forces between the legs of the brackets 5021 and the supporting material 5050 may be sufficient to hold the supporting material 5050 in one position despite the deflecting force acting on the supporting material 5050 from the compressed body of block 5010 and / or the compressed fabric T. In at least one such embodiment, the housing of block 5010 may consist of an elastic material capable of deflecting support material 5050 upon compression and brackets 5020, which seeks to separate the supporting material 5050 and the brackets 5020, although friction between the legs of the brackets 5021 and the supporting material 5050 counteracts this movement.

In various embodiments of the invention, as described above, the supporting material may comprise a plurality of retaining holes, each opening may be configured to receive a foot or clip. At least one embodiment of the invention is shown in FIG. 162 depicting a portion of the supporting material 5150 comprising a holding hole 5152 with a perimeter 5156. In various embodiments, the perimeter 5156 of the hole 5152 may have a round, or at least substantially round, profile and / or any other suitable profile. In certain embodiments, the supporting material 5150 may include one or more retaining elements, for example, locking elements 5153, for example, which protrude into the hole 5152 and may be configured to engage the bracket leg when inserted through the material. In at least one such embodiment, each holding member 5153 may comprise a free support protruding inwardly toward a central axis 5159, i.e. to the center of the hole 5152. In various embodiments, each free support may have a first end attached to the supporting material 5158 and a second end that forms the perimeter 5156 of the holding hole 5152. In certain embodiments, the perimeter 5156 of the holding hole 5152 may be determined by a first diameter, or width and the bracket foot can be determined by the second diameter, or width, while the second diameter can be larger than the first diameter. In at least one such embodiment, the clamp leg may be configured to contact and press one or more retaining elements 5153 to increase the diameter of the retaining hole 5152 when a bracket leg is inserted through it. In certain embodiments, in addition to those described above, the bracket foot may define a perimeter that is larger than the perimeter 5156 of the holding hole 5152, so that the bracket foot can expand the perimeter 5156 when it is inserted.

In certain embodiments of the invention, as shown in FIG. 162, the opening 5152 may be defined by deformable elements 5153, wherein each deformable element 5153 may be configured to be pressed in relation to or independently of the other deformable elements 5153. In at least one such embodiment, additional deformable elements 5153 can be separated by slots 5154 with such a configuration as to allow each deformable element 5153 to bend with respect to the others. In certain embodiments, each slot 5154 may have a first end 5155 in the bulk of the supporting material 5158, a second end opening into the holding hole 5152, and a constant, or at least substantially constant, width between the first end 5155 and the second end. In various embodiments, the width of each slot 5154 may be unstable, and each slot 5154 may expand or contract from the first to the second end. In certain embodiments of the invention, the first ends 5155 of the slots 5154 can have an enlarged part, for example, a circular part, which can, firstly, relieve stresses from the bases of deformable elements 5153 attached to the formation of supporting material 5158 and, secondly, increase flexibility deformable elements 5153. In various embodiments, the geometry of the deformable elements 5153 and / or slots 5154 may be selected so as to give the deformable elements 5153 the desired flexibility. In certain embodiments of the invention, for example, slots 5154 can be elongated to provide longer deformable elements 5153, which provides greater flexibility than deformable elements 5153 of shorter length. In at least one embodiment, the width of each deformable member 5153 may be selected so as to provide the desired flexibility. More specifically, deformable elements of smaller widths may be more flexible than deformable elements of larger widths. In certain embodiments, see FIG. 162, the first ends of the free supports of deformable elements 5153 attached to the formation of supporting material 5158 may be wider than the second ends of the free supports. In at least one such embodiment, the free supports may uniformly linearly, or at least substantially linearly, taper from the first to the second end.

In various embodiments of the invention, see FIG. 162, the support material layer 5158 may be a flat, or substantially flat, sheet of material with a fabric contact surface 5151 and an upper surface 5157. In at least one such embodiment, the fabric contact surface 5151 and the upper surface 5157 may be parallel , or at least substantially parallel to each other. In various embodiments, each deformable member 5153 may include a first portion 5153a and a second portion 5153b, wherein the first portion 5153a may extend in the first direction and the second portion 5153b may extend in a different or second direction. In at least one such embodiment, the supporting material 5158 may form a plane and the first parts 5153a of the deformable elements 5153 may be located within that plane. In various embodiments, the second parts 5153b of the deformable members 5153 may be angled with respect to the first parts 5153a. In at least one such embodiment, the second parts 5153b may extend in directions directed from the upper surface 5157 of the support material layer 5158 and, in certain embodiments, the second parts 5153b may converge in the direction of the central axis 5159 of the holding hole 5152. In any case in various embodiments, the second parts 5153b may be configured to bend away from the central axis 5159 when the brace legs are inserted through them. In embodiments where the leg 5021 of the bracket 5020 is inserted into the holding hole 5152, the deformable elements 5153 can deform in a direction substantially away from the bases 5122 of the brackets 5120. In certain embodiments, as a result, the deformable elements 5153 can be folded in the general direction, the same, or at least substantially the same as the insertion direction of the legs of the brackets 5021.

In various embodiments of the invention, see FIG. BD, the second parts 5153b of the deformable elements 5153 may comprise a sharp tip, for example, configured to slide over the bracket leg 5021 when the bracket leg 5021 is inserted through the hole. The sharp tips of the second parts 5153b can also be configured to dig into the leg of the bracket 5021 if the leg of the bracket 5021 is pulled in the opposite direction, i.e. in the direction of removing the bracket 5021 from the holding hole 5052. In certain embodiments, the second parts 5153b may be tilted with respect to the side of the bracket foot 5021 at an angle of more than 90 degrees and, as a result, the second parts 5153b may sink into the side of the bracket foot 5021 when the leg of the bracket 5021 experiences a force directed at removing the leg 5021 from the holding hole 5052. In certain embodiments, the legs of the brackets 5021 may include recesses or recesses, for example, micro-recesses in them surfaces that can be configured to receive the ends of the deformable elements 5053. In at least one such embodiment, the ends of the deformable elements 5053 can engage and sink into recesses on the legs of the brackets 5021 when a force tending to pull them out is applied to the legs of the brackets 5021. In various embodiments, as a result of immersion of the second parts 5153b in the legs of the brackets 5021, forces seeking to pull the legs of the brackets 5021 out of the holding holes 5022 can only deepen the second parts 5153b in the legs of the brackets 5021 and increase the force required to pull the legs 5021. In addition , by tilting the second parts 5153b inwardly in at least one embodiment, the second parts 5153b can more easily allow the bracket legs 5021 to be inserted into the holding hole 5152 and have greater resistance to removing the bracket legs 5021. At least In at least one embodiment, as a result, the force required to insert the bracket leg 5021 into the holding hole 5022 may be less than the force required to remove the bracket leg 5021 from the holding hole 5022. In various embodiments, the force required to remove the legs of the bracket 5021 from the holding hole 5022 may be approximately 50% greater than the force required to insert the legs of the bracket 5021 into the holding hole 5022. In various other embodiments, the force required to remove the leg from the brackets 5021 may be approximately 10-100% greater than the force required to insert the brace legs 5021. In certain embodiments, the force required to remove the brace legs 5021 may be approximately 100%, approximately 150%, approximately 200% or more than about 200% more than the force required to insert the legs of the bracket 5021.

In certain embodiments, as shown in FIG. 162, the second portion 5153b may be arranged in a circle around the hole 5152 and form a pocket. More specifically, the second parts 5153b may form a pocket 5160, which may be configured to receive the tip of the bracket foot when it is inserted into the holding hole 5152. In various embodiments, the second parts 5153b of the deformable elements 5153 may have an annular, or at least a substantially circular pocket profile 1560. In at least one such embodiment, the second portions 5153b may create a cone or truncated cone shaped pocket. In various embodiments, a pocket may be formed by a suitable number of deformable elements, for example, four deformable elements 5153 (FIG. 162), six deformable elements 5153 (FIG. 163), or eight deformable elements 5153 (FIG. 164). In certain embodiments, see FIG. 165, deformable elements of the supporting material, for example, the supporting material 5250, may have, for example, a pyramidal shape or at least a substantially pyramidal shape. In various embodiments, the support material 5250 may comprise a plurality of retaining holes, for example, retaining holes 5252 defined by a perimeter 5256. In various embodiments, the perimeter 5256 may have a polygonal or at least substantially polygonal profile and / or any other suitable profile. In certain embodiments, the supporting material 5250 may include one or more locking elements, for example, locking elements 5253, for example, which protrude into the hole 5252 and may be configured to engage the bracket leg when inserted through the material. In at least one such embodiment, each locking element 5253 may comprise a free support protruding inwardly toward the central axis 5259, i.e. to the center of the hole 5252. In various embodiments, each free support may have a first end attached to the supporting material 5258 and a second end that forms the perimeter 5256 of the holding hole 5252. In certain embodiments, the perimeter 5256 of the holding hole 5252 may be determined by a first diameter or width and the bracket foot can be determined by the second diameter, or width, while the second diameter can be larger than the first diameter. In at least one such embodiment, the bracket leg may be configured to contact and press one or more locking elements 5253 to increase the diameter of the retaining hole 5252 when the bracket leg is inserted through it. In certain embodiments, in addition to those described above, the bracket foot may define a perimeter that is larger than the perimeter 5256 of the holding hole 5252, so that the bracket foot can expand the perimeter 5256 when inserted.

In various embodiments, as shown in FIG. 165, the hole 5252 may be defined by deformable elements 5253, with each deformable element 5253 may be configured to be pressed in relation to the remaining deformable elements 5253 or independently. In at least one such embodiment, additional deformable members 5253 may be separated by slots 5254 so configured that each deformable member 5253 bends with respect to the others. In various embodiments, the support material layer 5258 may include a flat or substantially flat sheet of material with a tissue contact surface 5251 and an upper surface 5257. In at least one such embodiment, the tissue contact surface 5251 and the upper surface 5257 may be parallel, or at least substantially parallel to each other. In various embodiments, each deformable member 5253 may include a first part 5253a and a second part 5153b, with the first part 5253a extending in the first direction and the second part 5253b extending in a different or second direction. In at least one such embodiment, the supporting material 5258 may form a plane and the first parts 5253a of the deformable elements 5253 may be located within that plane. In various embodiments, the second parts 5253b of the deformable members 5253 may be angled with respect to the first parts 5253a. In at least one such embodiment, the second portions 5253b may extend in directions from the upper surface 5257 of the support material layer 5258 and, in certain embodiments, the second portions 5253b may converge towards the central axis 5259 of the holding hole 5252. In any case, In various embodiments, the second portions 5253b may be configured to bend away from the central axis 5259 when the brace legs are inserted through them. In certain embodiments, as shown in FIG. 165, the second part 5253b may be arranged in a circle around the hole 5252 and form a pocket. More specifically, the second parts 5253b can form a pocket that can be configured to receive the tip of the bracket foot when it is inserted into the holding hole 5252. In various embodiments, the second parts 5253b of the deformable elements 5253 can form, for example, polygonal or at least essentially a polygonal pocket. In various embodiments, a pocket may be formed by a suitable number of deformable elements, for example, four deformable elements 5253 (FIG. 165) to form a square pocket, six deformable elements 5253 (FIG. 166) to form a hexagonal pocket, or eight deformable elements 5253 (FIG. 167) with the formation of an octagonal pocket.

In various embodiments of the invention, see FIG. 168, a support material, for example, support material 5350, may be formed from a flat, or at least substantially flat, sheet of material, such as a sheet of titanium and / or stainless steel. In at least one such embodiment, a plurality of holes 5352 may be formed in the main formation 5358 of the supporting material 5350 using one or more stamping processes. The layer of material can be placed in a die for stamping, which allows you to pierce certain parts of the material to form slots 5354, holes 5355 of slots 5354 and / or perimeter 5356 of the holding hole 5352. The stamp for embossing can also be configured to bend deformable elements 5353 to obtain appropriate configuration. In at least one such embodiment, the stamp may deform the second parts 5353b upward with respect to the first parts 5353a along the crease line 5353c. In various embodiments, see FIG. 169, the supporting material, for example, the supporting material 5450, comprises a plurality of holding holes 5452. Similar to the above, the perimeter 5456 of each holding hole 5452 may be defined by a plurality of deformable elements 5453 separated by slots and slots 5454. In at least one such embodiment, each the deformable element 5453 can be bent upward, while the free ends of the free supports containing the deformable elements 5453 can define the perimeter 5456. In various embodiments, support The material 5450 may have a plurality of holes 5455 surrounding, or at least substantially surrounding, a holding hole 5452. In at least one embodiment, the holes 5455 can be oriented in a circle, surrounding or limiting the perimeter defined by the fixed ends of the free supports for deformable elements 5453. In certain embodiments, each hole 5455 may have a round, or at least substantially round, perimeter, or any other suitable perimeter. During operation, openings 5455 can provide, firstly, stress relieving from the bases of deformable elements 5453 attached to the base layer of supporting material 5458 and, secondly, increase the flexibility of deformable elements 5453. In various embodiments, larger openings 5455 may contribute to a larger flexibility compared to similar openings 5455. In addition, openings 5455 located closer to deformable elements 5453 can provide greater flexibility than openings 5455 married further.

In various embodiments, see FIG. 170, the supporting material, for example, the supporting material 5550, comprises a plurality of holding holes 5552. Each holding hole 5552 may have an elongated slot 5554 with widened round, or at least substantially circular, ends 5555. In at least one such In an embodiment, the ends 5555 may have a diameter wider than the size of the slot 5554. In certain embodiments, the oblong slot 5554 and the ends 5555 may be located along, / or centered along the longitudinal axis 5559. In various embodiments suschestvleniya slot ends 5554 and 5555 may form two located opposite each other tab 5553 which can be configured to engage with a leg brace and sag when inserting the legs through them. In at least one embodiment, ends 5555 having a larger perimeter or diameter can form longer petals 5553, more flexible than tongues 5553 formed by ends 5555 with a smaller perimeter or diameter. In various embodiments, the ends 5555 may have the same perimeter and diameter, and in at least one such embodiment, each lobe 5553 may be symmetrical along an axis that is perpendicular, or at least substantially perpendicular, to the longitudinal axis 5559 Alternatively, the ends 5555 may have different perimeters and / or diameters, with at least one embodiment, each lobe 5553 may be asymmetrical in its axis. In at least one such alternative embodiment, the tabs 5553 may twist along their axis when the brace legs are inserted through the retaining hole 5552. In various embodiments, see FIG. 171, the supporting material, for example, the supporting material 5650, may comprise a plurality of holding holes 5652. Each holding hole 5652 may have an elongated slot 5654 with round, or at least substantially round, ends 5655. In at least one such an embodiment, the elongated slot 5654 and the ends 5655 may be located along, or be centered along the longitudinal axis 5659. In various embodiments, each end 5655 may be defined by a diameter of the same or at least substantially the same as slot width 5654.

In various embodiments, see FIG. 172, the supporting material, for example, the supporting material 5750, may comprise a plurality of retaining holes 5752. Each retaining hole 5752 may have a plurality of slots, for example, slots 5754, for example with widened ends 5755. In at least one such embodiment, the slots 5754 and the ends 5755 may be located along or centered along the longitudinal axis 5759. In various embodiments, the axis 5759 may extend in directions perpendicular or transverse to each other. In certain embodiments, the slots 5754 and the ends 5755 can form four tabs 5753, for example, configured to engage the bracket leg and fold back when the bracket leg is inserted into the holding hole 5752. In at least one embodiment, each tab 5753 may have a triangular, or at least essentially triangular, configuration, for example, in the form of an equilateral triangle. In various other embodiments, see FIG. 173, the supporting material, for example, the supporting material 5850, may comprise a plurality of retaining holes 5852. Each retaining hole 5852 may have a plurality of slots, for example, slots 5854, for example, ends 5855, while slots 5854 and ends 5855 may extend along or be centered along the longitudinal axis 5859. In various embodiments, the axis 5859 may extend in directions perpendicular or transverse to each other. In certain embodiments, slots 5854 and ends 5855 can form lobes 5853, for example, configured to engage with the staple leg and fold back when the staple leg is inserted into the holding hole 5852. In at least one embodiment, each lug 5853 can have arcuate shape. More specifically, each petal 5853 may have a curved end, 170, as opposed to the pointed end shown in FIG. 170, which may be configured to come into contact with the bracket foot.

In various embodiments, see FIG. 174, the supporting material, for example, the supporting material 5950, contains a plurality of retaining holes 5952. Each retaining hole 5952 may comprise a plurality of slots, for example, slots 5954, each slot 5954 may be located along, or be centered along the longitudinal axis 5959. In various embodiments, the axles 5959 may be transverse to each other and in at least one such embodiment, the axles 5959 may be oriented so that all axes 5959 pass through the center of the retaining hole rstiya 5952 and are at the same, or at least substantially the same distance from each other. In at least one such embodiment, each slot 5954 may have an open end directed toward the center of the retaining hole 5952, and a second, or closed, end 5955 at the opposite end of the slot 5954. Similar to the above, the slots 5954 and the ends 5955 may form three petal 5953, for example, with such a configuration that it engages with the bracket foot and bends when the bracket foot is inserted into the holding hole 5952. In various embodiments, each petal 5953 may have an arcuate configuration between the adjacent ends 5955 of slots 5954. In various embodiments, see FIG. 175, the supporting material, for example, the supporting material 6050, comprises a plurality of holding holes 6052. Each holding hole 6052 may comprise a tab 6053 so that it engages with the bracket leg and bends when the bracket leg is inserted into the holding hole 6052. At least , in one such embodiment, the lobe 6053 may have a base attached to the base layer of the supporting material 6058, and a free end of an arcuate or curved shape 6056 with such a configuration that in contact with a leg brace. In certain embodiments, the brace leg may be a brace leg consisting of a round wire, wherein the curved shape 6056 may be configured to match, or at least substantially match, the curved outer surface of the round wire.

In various embodiments, again see FIG. 175, the base layer of supporting material 6058 will be able to contain a plurality of slots 6054 and holes 6055, which may be configured to form a blade 6053 and various parts of the holding hole 6052. In at least one such embodiment, the blade 6053 may have a rectangular configuration with parallel , or at least essentially parallel, sides. In certain embodiments, see FIG. 176, the supporting material, for example, the supporting material 6150, comprises a plurality of holding holes 6152. Each holding hole 6152 may comprise a tab 6153 so as to engage with the bracket leg and bend when the bracket leg is inserted into the holding hole 6152. At least , in one such embodiment, the lobe 6153 may have a base attached to the base layer of the supporting material 6158, and a free end of an arcuate or curved shape 6156 with such a configuration that in contact with a leg brace. In various embodiments, the implementation of the main layer of supporting material 6158 may contain many slots 6154 and holes 6155, which may be configured to form a tab 6153 and various parts of the retaining hole 6152. In at least one embodiment, the tab 6153 may have a tapering shape with curved sides. In at least one embodiment, the lobe 6153 may taper, that is, its base may be wider than the free end.

In various embodiments, as described above, the crosslinking system may comprise a plurality of brackets having legs that are inserted through the plurality of holding holes into the supporting material. In certain embodiments, as will be described in more detail below, the brackets can be held in the first jaw, and the supporting material can be held in the second jaw, with at least one of the jaws - the first or second - can move towards the other. Under various circumstances, the brackets located in the first jaw can be fixed in it so that the legs of the brackets are aligned with the retaining holes when the legs of the brackets are in the supporting material. In certain embodiments, see FIG. 177 and 178, the stapling system may comprise a block of brackets 6200, for example, located in the first branch of the surgical stapler, and supporting material 6250, for example, located in the second branch of the surgical stapler. As shown in FIG. 184 and 185, in addition to the above, the supporting material 6250 may have a plurality of holding holes 6252, each holding hole 6252 may have a perimeter 6256 defined by one or more folding elements 6253. In at least one such embodiment, in in addition to the above, the folding elements 6253 forming each hole 6252 may form a pocket 6201. In various embodiments, each pocket 6201 may have a curved and / or concave surface, for example, with such a configuration iey to guide the tip of the bracket legs in a hole 6252 in the case bracket legs improperly positioned in the retaining hole 6252, which first comes into contact with folded elements 6253 and / or the surface of tissue contact 6251.

In various embodiments, in addition to the above, the crosslinking system may further comprise a plurality of brackets 6220 having legs 6221 that can be inserted through the retaining holes 6252 into the supporting material 6250. In at least one such embodiment, each bracket 6220 may have a substantially U-shaped configuration, for example, having a base 6222, from which legs 6221 extend upward. In various embodiments of the invention, see FIG. 180 and 181, the holding holes 6252 in the supporting material 6250 may be oriented in the form of two parallel, or at least substantially parallel, longitudinal rows, for example, extending along or parallel to the longitudinal axis of the supporting material. In certain embodiments, the holding holes 6252 in the first row may be offset, or staggered, relative to the holes 6252 in the second row. In at least one such embodiment, each bracket 6220 may have a first leg 6221 located in the retaining hole 6252 in the first row, and a second leg 6221 located in the retaining hole 6252 in the second row, and, as a result, the bases 6222 may be directed transversely to the longitudinal axis of the supporting material 6250. In at least one such embodiment, the brackets 6220 may be parallel, or at least substantially parallel, to each other. More specifically, the base 6222a of the bracket 6220a may be parallel, or at least substantially parallel, to the base 6222b of the bracket 6220b, which may be parallel, or at least substantially parallel, to the base 6222c of the bracket 6220c. In at least one embodiment, the legs 6221a of the bracket 6220a may form a plane parallel to, or at least substantially parallel to, the plane formed by the legs 6221b of the bracket 6220b, which may be parallel, or at least substantially parallel , the plane formed by the legs 6221 of the bracket 6220c.

In various embodiments, see FIG. 177 and 179, the bracket block 6200 may comprise a plurality of brackets 6220 and, in addition, a supporting material 6260 with a plurality of guide elements, for example, slots, grooves and / or holes with such a configuration as to give the brackets 6220 the desired position. Under various circumstances, the alignment material 6260 may be configured such that the legs 6221 of the brackets 6220 are aligned with the holes 6252 in the support material 6250 before the support material 6250 engages with the legs of the brackets 6221. In various embodiments, see FIG. 182 and 183, the leveling material 6260 may have a plurality of leveling holes 6262 so configured to fit the legs 6221 of the brackets 6220 tightly. In at least one such embodiment, each bracket 6220 may have a base 6222 and two legs 6221 extending from the base 6222 wherein the bases 6222 of the brackets 6220 may be located around the bottom surface 6264 of the supporting material 6260, and the legs of the brackets 6221 may protrude upward through the alignment holes 6262. In certain embodiments, each alignment hole 6262 can be circular, or at least substantially circular, and may have a diameter equal to or slightly larger than the diameter of the bracket legs 6221 extending through the opening. In various embodiments, the alignment material 6260 may further include a plurality of raised elements 6263 that may protrude upward from the upper surface 6261 of the alignment material 6260 and surround, or at least substantially surround, the alignment holes 6262. In certain embodiments, the raised elements 6263 can create longer holes for alignment 6262, while, under various circumstances, longer holes 6262 can provide better control of alignment but ek staples 6221 than shorter holes 6262.

During operation in various embodiments of the invention, the first jaw holding the brace block 6200 may be located on one side of the stitching fabric, and the second jaw holding the supporting material 6250 may be located on the other side of the fabric. After the jaws have been positioned appropriately with respect to the fabric, in certain embodiments, the second jaw and support material 6250 can be moved to the bracket block 6200. As the legs of the brackets 6221 are inserted through the retaining holes 6252 of the support material 6250, in various embodiments the fabric contacting or lower surface 6251 of the supporting material 6250 may come into contact with the fabric and press the fabric against the contact or upper surface 6261 of the leveling material 6260. In various embodiments, as will be described in detail below, the bracket block 6200 may further comprise a compressible block housing located above the upper surface 6261 of the leveling material 6260 that may come in contact with the fabric. In certain embodiments, see FIG. 179 and 183, the leveling material 6260 may further comprise one or more openings 6203 formed therein, which, when the leveling material 6260 is opposite the fabric, may receive part of the fabric. In embodiments in which a compressible block body is located above and / or opposite the leveling material 6260, a portion of the compressible block may enter holes 6203 when the block body is compressed. Similarly, the supporting material 6250 may comprise a plurality of holes 6202 so configured to receive at least a portion of the fabric when the supporting material 6250 is positioned opposite the fabric.

As the legs 6221 of the brackets 6220 are inserted through the retaining holes 6252 in the supporting material 6250, in addition to the above, the ends of the legs of the brackets 6221 may protrude upward from the upper surface 6257 of the supporting material 6250. In various circumstances, as described above, the ends of the legs of the brackets 6221 may remain unbent after being inserted into the retaining holes 6252. In certain embodiments, see FIG. 186-189, a crosslinking system including a bracket block 6200 and a supporting material 6250 may further comprise a plurality of protective caps or covers, for example, caps 6270, which can be worn on the legs of the brackets 6221 protruding above the supporting material 6250. In various embodiments, each the cap 6270 may completely or at least partially cover the sharp end of the leg of the bracket 6221 so that the sharp end does not come in contact with the adjacent tissue. In at least one embodiment, see FIG. 189, each cap 6270 may have an opening 6271 formed therein so as to receive the tip of the bracket foot 6221. In various embodiments, caps 6270 may be made of an elastomeric material, such as silicone, polyisoprene, sanoprene, and / or natural rubber. In at least one embodiment, the aperture 6271 may have a perimeter or diameter smaller than the perimeter or a diameter of a bracket leg 6221 inserted therein. In at least one such embodiment, the aperture 6271 in the protective cap 6270 may expand to receive the leg brackets 6221. In various alternative embodiments, the caps 6270 may not have holes and the ends of the legs of the brackets 6221 may be configured to puncture the caps 6270 when inserting the legs 6221. In any case, in different embodiments, Each cap 6270 can be put on the leg of the bracket 6221 until it stops against the base 6272, or until the base is positioned close to the top surface 6257 of the supporting material 6250. In various circumstances, the caps 6270 can be configured to fit tightly on the legs of the brackets 6221 so that they could not be easily removed. In certain embodiments, each cap 6270 may have a conical, or at least substantially conical, outer surface. In various embodiments, caps 6270 may have an outer surface of any suitable shape, for example parabolic, or at least substantially parabolic.

In various embodiments of the invention, the crosslinking system described above can be used in combination with the surgical crosslinking tool shown, for example, in FIG. 190-192. In various embodiments, the end clamp may have a first jaw or channel for the brace block 6230 so configured to hold the brace block 6200 inside, and a second jaw 6240 so configured to hold the supporting material 6250 and the plurality of protective caps 6270. As shown primarily in FIG. 190, depicting the second jaw 6240 in the open position, the jaws 6230 and 6240 may be positioned relative to the fabric T so that the tissue T is located between the supporting material 6250 and the block of brackets 6200. In various embodiments, as described above, the block of brackets 6200 may further comprise a compressible block body, for example, a body 6210, in which brackets 6220 and a leveling material 6260 can be placed. In at least one such embodiment, fabric T can be located opposite the upper surface of the body a block 6210. In certain embodiments, the second jaw 6240 may have a plurality of recesses or holes 6245 configured to receive a plurality of protective caps 6270 and, in addition, one or more retaining elements or clips to hold the supporting material 6250 in the desired position above the caps 6270. In at least one such embodiment, the supporting material 6250 may be configured to hold the caps 6270 in the openings 6245. In various embodiments implementation, see. FIG. 202, each hole 6245 may be configured to receive part of the cap, or the entire cap 6270. In certain embodiments, the holes 6245 may be of sufficient size and configuration so that the caps 6270 can be locked in them using at least one from mechanisms: press-fit or snap-fit elements. In some embodiments, at least one adhesive may be used to secure caps 6270 in openings 6245. In at least one such embodiment, such an adhesive may be selected so that the caps 6270 can detach from the second jaw 6240 after the caps 6270 mesh with the legs of the brackets 6221 and the second jaw 6240 moves away from the implanted unit. In certain embodiments, see FIG. 203, the second jaw 6240 may further comprise at least one cover layer 6246 that can be attached to the second jaw 6240 and can be positioned above the caps and hold the caps 6270 in the openings 6245. In at least one such embodiment, at least a portion of the coating layer 6246 may be attached to the jaw 6240 using at least one adhesive. In operation, in at least one embodiment, the cover layer 6246 may be at least partially detached from the jaw 6240 before inserting the end clamp into the operative field. In certain embodiments, the cover layer 6246 may consist of an implantable material, for example, PDS and / or PGC, which can be pierced by the legs of the brackets 6221 as the legs of the brackets 6221 emerge from the supporting material 6250. In at least one such embodiment the cover layer 6246 can be fixed in a crosslinking system between the covers 6270 and the supporting material 6250.

In addition to the above described, as shown in FIG. 191, the jaw 6240 may move from an open position to a closed position in which the tissue T is located opposite the supporting material 6250 and the housing of the block 6210. In this position, the supporting material 6250 may not yet engage with brackets 6220. In various embodiments, the jaw 6240 may move from open to closed position and, conversely, under the action of the actuator 6235. In at least one such embodiment, the jaw 6240 may have a protruding distal pin 6243 and a proximal pin 6244, while the steel pin 6243 can slide in the vertical, or at least substantially vertical direction in the distal slot 6233 formed in the channel for the block 6230, and the proximal pin 6244 can slide in the vertical, or at least substantially vertical, the direction in the proximal slot 6234, also formed in the channel for the block 6230. During operation, the actuator 6235 can be displaced in the proximal direction to force the pins 6243 and 6244 to enter the upper ends of the corresponding slots 6233 and 6234, as shown in FIG. 191. In at least one such embodiment, the actuator 6235 may include a distal guide slot 6236 and a proximal guide slot 6237, while the side walls of the slots 6236 and 6237 may be configured to contact the distal pin 6243 and the proximal pin 6244, respectively and force the pins 6243 and 6244 to move upward with the proximal movement of the actuator 6235. More specifically, as the proximal movement of the actuator 6235, the distal pin 6243 can slide up the inclined first distal portion 6236a the guide slot 6236 to the intermediate or second position 6236b and, likewise, the proximal pin 6244 can slide upward along the inclined first portion 6237a of the distal guide slot 6237 to the intermediate or second position 6237b. As the pins 6243 and 6244 move up, the jaw 6240 can rotate down to the tissue T, moving to the closed position.

In addition to the above, as shown in FIG. 192, the actuator 6235 can move further in the proximal direction to push the second jaw 6240 down to the first jaw 6230, squeeze the block body 6210 and force the supporting material 6250 and the plurality of protective caps 6270 to engage with the legs of the brackets 6220. At least one In such an embodiment, additional proximal movement of the actuator 6235 may cause the side walls of the guide slots 6236 and 6237 to touch the pins 6243 and 6244, respectively, and move the pins 6243 and 6244 down to the lower ends of the slots 62 33 and 6234, respectively. In such circumstances, the actuator 6235 can be moved proximally so that the distal pin 6243 exits the second part 6236b of the guide slot 6236 and enters the inclined third part 6236c and, similarly, the proximal pin 6244 leaves the second part 6237b of the guide slot 6237 and enters inclined third part 6237c. As the pins 6243 and 6244 move down, the second jaw 6240 can move down to the first jaw 6230 in the working position. In at least one such embodiment, the second jaw 6240 can be moved downward so that the supporting material 6250 remains parallel, or at least substantially parallel, to the upper surface of the block housing 6210 and / or parallel, or at least substantially parallel to the leveling material 6260. In any case, when the supporting material 6250 and the protective caps 6270 engage with the legs 6221 of the brackets 6220, as shown in FIG. 194, the second jaw 6240 may return to the open, or at least substantially open, position. In at least one such embodiment, the actuator 6235 may be distally shifted to cause the pins 6243 and 6244 to move to the upper ends of the slots 6233 and 6234, respectively, and then down to the lower ends of the slots 6233 and 6234 when the pins pass through the intermediate parts 6236b and 6237b of the respective guide slots 6236 and 6237. When the second jaw 6240 is moved to the open position, the first jaw 6230 can be separated from the implanted unit 6200 and the first and second jaws 6230, 6240 can be removed from the implanted brackets block as shown in FIG. 193.

If you look again at FIG. 192, the reader will note that pins 6243 and 6244 are shown not at the very bottom of the corresponding slots 6233 and 6234, although the supporting material 6250 and the caps 6270 are engaged with the legs of the brackets 6221. This situation is possible if between the supporting material 6250 and the block body 6210 thick fabric is located. In a situation where a thinner fabric is located between the supporting material 6250 and the housing of the block 6210, see FIG. 195, pins 6243 and 6244 can move further downward into corresponding slots 6233 and 6234, as shown in FIG. 197. In general, in at least one embodiment, the actuator 6235 can be moved proximally to cause the pins 6243 and 6244 to move up and down in the manner described above, as shown in FIG. 195-197 and, due to the thinner fabric T, the supporting material 6250 and the protective caps 6270 can move further to the legs 6221 of the brackets 6220, as shown in FIG. 198 and 199. In various embodiments, due to the adjustment provided by the supporting material 6250, it is possible to obtain the same, or at least substantially the same, compressive strength of the stitched fabric regardless of the thickness of the fabric gripped by the end clamp. In certain embodiments, the adjustment provided by the supporting material 6250 may allow the surgeon to choose whether to apply a greater or lesser compressive force to the tissue by adjusting the depth of the support material 6250. In at least one such embodiment, the depth range at which the the supporting material 6250 on the legs of the brackets 6221 can be determined, for example, by the lengths or ranges of the slots 6233 and 6234.

In the various embodiments described above, the protective caps 6270 may consist of a soft or flexible material, for example, configured to grip the ends of the legs of the brackets 6221. In certain embodiments, the protective caps 6270 may be made of bioabsorbable plastic, such as polyglycolic acid (PGC) ), sold under the trade name Vikril, polylactic acid (PMA), polydioxanone, polyhydroxyalkanoate (PHA), polyglecaprone 25 (sold under the trade name Monocryl), poly ronolaktona (PCL) and / or mixtures of PGA, PLA, polydioxanone, PHA poliglekaprona and / or EPM and / or a biocompatible metal such as titanium or stainless steel. As shown in FIG. 189, in at least one embodiment, each cap 6270 may not be connected to other caps 6270. In certain embodiments, one or more caps 6270 may be secured to support material 6250. In at least one such embodiment, caps 6270 can be attached to the supporting material 6250 with at least one adhesive, while the holes 6271 in the caps 6270 can be aligned, or at least substantially aligned, with the holding holes si 6252 in the supporting material 6270. In various embodiments, see FIG. 200, a protective cap, for example, cap 6370, may have an internal cavity or dome 6374 configured to receive the tip of the bracket foot 6221. In at least one such embodiment, cap 6370 may have a bottom 6372 and an opening 6371 passing through bottom 6372. In various embodiments, the opening 6371 may be formed by one or more sagging elements 6373 so as to bend when the bracket leg 6221 is inserted through the hole. In certain embodiments, two or more caps 6370, for example, can be connected to each other to form a group of caps 6370. In at least one such embodiment, see FIG. 201, a plurality of caps 6370 may be joined together by a sheet of material 6375. In certain embodiments, sheet 6375 may be rigid enough to maintain the desired orientation and / or arrangement of caps 6370. In at least one embodiment, the protective caps 6370 may be made of a biocompatible metal, for example titanium or stainless steel, and sheet 6375 can be made of bioabsorbable plastic, for example polyglycolic acid (PGA), sold under the trade name Vikril, polymolo acid (PMA), polydioxanone, polyhydroxyalkanoate (PHA), polyglexaprone 25 (sold under the trade name Monocryl), polycapronolactone (PCL) and / or a mixture of PHC, PMA, polydioxanone, PHA, polyglexaprone and / or PCL. In various embodiments, sheet 6375 may consist of a bioabsorbable material containing an antimicrobial agent, for example colloidal silver and / or triclosan, located and / or distributed in the sheet material and released by biological resorption of sheet 6375.

In various embodiments, in addition to the above, the formation 6375 can be positioned around the caps 6370 by injection molding, so that the caps 6370 are embedded in the sheet 6375. In certain other embodiments, the implementation of the sheet 6375 can be molded using the injection molding process by pressure, for example, during the casting process and / or after casting using the stamping process, holes 6376 can be formed in the sheet 63756. In any case, the caps 6370 can be inserted and secured into the holes 6376 by pressing or snap joints and / or use of at least one adhesive. In certain embodiments, each cap 6370 may have an annular groove surrounding, or at least partially surrounding, the perimeter of cap 6370, which may be configured to receive the perimeter of hole 6376. In certain embodiments, sheet 6375 may consist of flexible and / or folding material allowing relative movement between the caps 6370. In at least one such embodiment, the flexible sheet 6375 may consist of rubber, plastic and / or silicone, and the caps 6370 m gut consist of a rigid material such as metal. In at least one such embodiment, similar to the above, the flexible material can be molded around the caps 6370. In certain embodiments, the caps 6370 can be pressed into the pre-molded sheet 6375. In various embodiments, the hardness of the flexible material can be selected to obtain the desired the stiffness of the sheet 6375. In certain embodiments, the sheet 6375 may be configured to include a flexible tape. In any case, the sheet 6375 can facilitate the placement of the caps 6370 in the end clamp, since a plurality of caps 6370 can be located and / or aligned in the end clamp at the same time. In addition, the sheet 6375 connecting the caps 6370 after implantation can, for example, strengthen or support the fabric along the line of brackets. In addition to or instead of the sheet connecting the caps 6370, the caps 6370 may be connected by a plurality of links. In at least one embodiment, such links may be flexible and may allow caps 6370 to move relative to each other.

In various embodiments, see FIG. 204 and 205, a protective cap, for example, cap 6470, may have a shaping surface so configured to deform the tip of the bracket leg. In at least one such embodiment, cap 6470 may include a base 6472, which may have an opening 6471 passing therethrough. In various embodiments, the opening 6471 may be configured to closely fit the bracket leg, such as the bracket leg 6221. At least in at least one embodiment, the opening 6471 may be defined by a diameter or perimeter, which may be equal to or greater than the diameter or perimeter of the leg of the bracket 6221. In various embodiments, cap 6470 may further tively have a cavity, or dome, 6474, with such a configuration to receive the foot bracket 6221 when it is inserted into the cap 6470. As shown mainly in FIG. 205, cap 6470 may further comprise a thrust member, or forming surface, 6473, configured to bend and deform the bracket leg 6221. In various embodiments, forming surface 6473 may be curved or concave, and may also be configured to fold the bracket foot 6221 when inserted into the cap 6470. In certain embodiments of the invention, the bracket foot 6221 can be sufficiently deformed so that it cannot be removed through hole 6471 and, as a result, the count the stack 6470 may be firmly connected to the leg of the bracket 6221. In at least one such embodiment, the base 6472 of the cap 6470 may have an edge around the opening 6471 capable of preventing the deformed leg of the bracket 6221 from being removed from the cavity 6474. In various embodiments, as a result of the above , one or more caps 6470 may prevent, or prevent, the backing or detachment of supporting material, for example, supporting material 6250, from the brackets 6220. In various embodiments, Nia, although not shown, the cap 6470 may be symmetric, or at least substantially symmetrical and the opening 6471 can be located along the central axis 6479 through the cap 6470. In various alternative embodiments, see. FIG. 204, the hole 6471 may be offset from the central axis 6479. In at least one such embodiment, the offset hole 6471 may allow the leg of the bracket 6221 to contact the side of the forming surface 6473 and twist it over the other side of the forming surface 6473 instead of contacting the center of the forming surfaces 6473, as in embodiments with a centrally located opening 6471 mentioned above.

In various embodiments, as discussed above, the supporting material, for example, the supporting material 6250, may consist of a layer of material and a plurality of through holding holes 6252. In at least some embodiments, the implementation of the layer of material 6250 may be rigid or substantially inflexible. In certain embodiments, the support material may consist of a series of individual fragments of the support material and a plurality of flexible connectors or links connecting the support fragments. In various embodiments, see FIG. 206, the supporting material, or part of the supporting material 6550, may consist of many separate fragments 6505, which can be connected to each other by one or more connecting links 6507. In at least one such embodiment, each fragment 6505 may contain many deformable elements 6553 forming a holding hole 6552. In certain embodiments, fragments 6505 and connecting links 6507 of the supporting material 6550 can be formed as a unit from a single piece of m material. In various embodiments of the invention, the supporting material 6550 can be obtained by stamping or casting, for example, of metal, for example, titanium and / or stainless steel. In certain embodiments of the invention, the supporting material 6550 may consist of plastic, such as, for example, polyetheretherketone (PEEK), polypropylene sold under the trade name Prolen, polyester, polyethylene terephthalate sold under the trade names Etibond and Mersilen, polyvinylidene fluoride, polyvinylidene fluoride copolymer and hexafluoropropylene, polyhexafluoropropylene-VDF, sold under the trade name Pronova and / or double-stranded aliphatic polymers, for example, nylon 6 and nylon 6,6, sold under It is commercially available under the trade names Ethilon and Nurolon, and can be obtained by, for example, injection molding. In certain embodiments, fragments 6505 and connecting links 6507 may be formed separately. In various embodiments of the invention, it is possible to produce a plurality of individual fragments 6505, which are subsequently joined together and enclosed in supporting material. In at least one such embodiment, fragments 6505 can be obtained by stamping from a metal material, such as titanium and / or stainless steel, and placed in a plastic injection mold, and plastic material can be introduced into the injection mold to form firstly, a rim 6506 of material surrounding, or at least partially surrounding, fragments of material 6505 and, secondly, connecting links 6507 extending from rims 6506. In certain embodiments, the invention may use I am one or more connecting grids with openings formed therein, formed by a plurality of rims 6506, each such opening having a configuration capable of receiving a fragment 6505. In at least one embodiment, each fragment 6505 may have a round, or at least at least a substantially circular, outer perimeter and, similarly, each rim 6506 may form a round, or at least substantially circular, bore inside, wherein the diameter of the hole may be equal to or less than the diameter of the fragment ment 6505. In at least one such embodiment, fragments of material 6505 can be pressed into or embedded in holes in rims 6505. In certain embodiments, fragments 6505 can be secured in holes with at least one adhesive.

In various embodiments, in addition to the foregoing, the support material may include a plurality of individual fragments 6505 and a plurality of connecting links 6507 that can connect the fragments 6505 in any suitable manner, such as, for example, shown in FIG. 207-210. Regardless of the arrangement method, in various embodiments of the invention, the connecting links 6507 may be configured to allow the fragments 6505 to move relative to each other. In at least one such embodiment, the mesh of fragments 6505 and connecting links 6507 constituting the supporting material 6550 can be stretched, twisted, contracted and / or otherwise bent when placed on the fabric, allowing at least some degree of mobility in tissue, but at the same time preventing significant movements. In various embodiments, each link 6507 may comprise a flexible member that is capable of stretching, twisting and / or contracting to allow the supporting material 6550 to bend between the pieces of material 6505. As shown in FIG. 206, each link 6507 extending from the rim 6506 may have a width that is less than the width of the fragment body 6505 and / or rim 6506. In certain embodiments, see FIG. 207-210, one or more of the links 6507 may include a straight portion extending along a line between adjacent fragments 6506. In at least one such embodiment, each link 6507 may have a first end attached to a first rim 6506 and a second end, attached to the second rim 6506. In certain embodiments, see FIG. again. 206, two or more links 6507 may be connected to each other. In at least one such embodiment, two or more links 6507 may be connected, for example, through an intermediate hinge section 6509. In certain embodiments, the hinge section 6509 may have a section of lesser thickness in one or more directions than the thickness of the links 6507, which allows the connected links 6507 to move relative to each other. In certain embodiments, the supporting material 6550 may further comprise hinge portions 6508 that can connect the links 6507 to the rims 6506 and allow relative movement between the links 6507 and the rims 6506. Similar to the hinge sections 6509, the hinge sections 6508 can have a narrowing of the cross section in one or more directions compared to the cross section of 6507 links.

In various embodiments, in addition to the above, the connecting links 6507 may extend in different directions. In at least one such embodiment, the first link 6507 may extend in a first direction, and the second link 6507 may extend in a second direction, wherein the first direction may be different from the second direction. In certain embodiments of the invention, the first link 6507 may extend along the first line, and the second link 6507 may extend along the second line, wherein the first and second lines may intersect to form an angle of, for example, about 30 degrees, about 45 degrees, about 60 degrees, and approximately 90 degrees. In various embodiments, the hinge sections 6508 and / or the hinge sections 6509 may include movable hinge sections allowing the links 6507 to move relative to each other repeatedly without breaking. In certain embodiments, the hinge portions 6508 and / or hinge portions 6509 may contain brittle, or easily tearing portions that may burst when subjected to excessive and / or repeated bending. In at least one such embodiment, such fragile parts may allow one or more parts of the supporting material 6550 to tear away from the remaining part of the supporting material 6550. In certain embodiments, the hinge sections 6508 and / or the hinge sections 6509 may include sections of the supporting material 6550, which it is easier to incise than other parts of the supporting material 6550. More specifically, the implanted supporting material and the tissue attached to it can often be cut by a cutting tool along for various reasons and, to facilitate such a cut, the hinge areas 6508 and / or hinge areas 6509 may have tracks, or thin sectors, which allow the cutting element 6550 to more easily pass through the supporting material. In various embodiments, in addition to the above, the connecting links 6507 may contain one or more embossed elements or depressed portions of the material, for example, contributing to the bending, tearing and / or cutting of the connecting links 6507.

In various embodiments, the supporting material may comprise a plurality of elements of the supporting material, for example fragments of the supporting material 6505, which can be embedded in a flexible sheet or tape of material. In at least one embodiment, the flexible sheet of material may be made of a biodegradable, elastomeric material, for example, silicone, and multiple holes may be made in the flexible sheet. In at least one such embodiment, a rigid flexible sheet can be obtained by casting and many holes can be punched in it. In various alternative embodiments, a flexible sheet can be obtained by molding, and holes can also be formed during the molding process. In any case, fragments of the supporting material 6505 can be inserted into and attached to the flexible sheet. In certain other embodiments, in addition to the above, a flexible sheet may be formed around fragments of the supporting material 6505. In at least one embodiment, the flexible sheet may consist, for example, of a woven mesh and / or other suitable material. Such a woven mesh, in addition to the above, can be easily cut.

In various embodiments of the invention, see FIG. 211 and 212, a crosslinking system comprising a supporting material, for example, supporting material 6250, may further comprise a cover, for example, a cover 6670, which can cover the ends of the legs of the brackets 6221 when they protrude above the upper surface 6257 of the supporting material 6250. In various embodiments the cover 6670 may be attached to the supporting material 6250. In certain embodiments, the cover 6670 and / or the supporting material 6250 may contain retaining elements of such a configuration so as to fix align cover 6670 to support material 6250. In at least one embodiment, at least one adhesive may be used to attach cover 6670 to support material 6250. In at least one embodiment, cover 6670 may consist of one layer although the cap 6670 in the figure is shown as consisting of two layers, as will be described in more detail below. In various embodiments of the invention, as shown primarily in 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 be thick enough so that the legs of the brackets do not protrude through the upper surface 6675 of the cover 6670. In at least one embodiment, as a result, the ends of the legs of the brackets 6221 may not protrude from the cover 6670. In various embodiments, the cover 6670 may consist of many layers. In at least one such embodiment, the cover 6670 may comprise 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 one another, with at least in one embodiment, the second layer 6672 may have 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, while in certain embodiments they may have the same thickness Well. In at least one embodiment, the first layer 6671 and the second layer 6672 may have substantially the same length and / or thickness. In alternative embodiments, layers 6671 and 6672 may have different thicknesses and / or lengths.

In various embodiments, in addition to the above, the first layer 6671 may consist of a compressible foamy, mesh material and / or hydrogel. For example, the brackets pierced by the legs 6211. In at least one such embodiment, the second layer 6672 may consist of a stiffer material or shell, for example, PGC and / or PDS, and / or any other suitable supporting material. In at least one such embodiment, the legs of the brackets 6221 may be configured to penetrate the first layer 6671; However, in various embodiments, the legs of the brackets 6221 may not be able to penetrate through the second layer 6672. In certain embodiments, the second layer 6672 may consist of material of sufficient elasticity and / or rigidity, allowing the second layer 6672 to come into contact with the leg of the bracket 6221 and deform, but not pierce, or only slightly pierce, with the tip of the bracket foot 6221. Although not shown in the figure, the cover may have more than two layers, and one or more of these layers may be puncture resistant. In operation in at least one embodiment, the support material may be positioned opposite the stitched fabric and experience downward pressure, so that the legs 6221 of the brackets 6220 are pressed through the fabric T and the retaining holes 6252 in the support material 6250, and then 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 at least substantially [not] enter, the second layer 6272 of the cover 6270. After the supporting mater alu 6250 imparted a suitable position, can open the jaws 6240 and the cover 6670 and the supporting material 6250 - 6240 separated from the jaws, as shown in FIG. 211. As shown in FIG. 211, jaw 6640 may be configured to hold more than one supporting material 6250 and cover 6670. In at least one embodiment, jaw 6640 may have two channels 6679, each of which is configured to receive cover 6670 and supporting material 6250 located above, so that the tissue contact surface 6251 of each supporting material 6250 is directed downward from the bottom of the jaw 6240. In at least one such embodiment, the supporting material 6250 and the lid 6270 can be located in jaw 6640 on each side of the slot for scalpel 6678. In use, both fragments of support material 6250 and covers 6670 can be activated simultaneously and / or at the same depth with respect to opposite blocks of brackets, for example, blocks of brackets 6200 , for example, located transversely. Then, in various embodiments of the invention, the stitched fabric can be cut along the cut line with a cutting element moving through the slot for the scalpel 6678, while the jaw 6640 can open again. In certain embodiments, covers 6670 may not be attached to support material 6250. In at least one embodiment, covers 6670 may be located in channels 6679 and held in channels 6679 by pieces of support material 6250 that may be attached to branch 6640. B in various embodiments, each layer of supporting material 6250 may be wider and / or longer than the respective covers 6670, so that the layers of supporting material 6250 can hold the entire cover 6670 in need Mr. position. In certain embodiments, each layer of support material 6250 may have the same width and / or length as the corresponding cap 6670.

In various embodiments, as described above, the crosslinking system may include a layer of material that can be attached to a supporting material, for example, supporting material 6250. In at least one embodiment, see FIG. 215, a layer of material 6870 may be attached to the bottom surface 6251 of the supporting material 6250. In certain embodiments, the layer 6870 and / or the supporting material 6250 may include retaining elements configured to fix the layer 6870 to the supporting material 6250. At least in in one embodiment, at least one adhesive may be used to adhere the layer 6870 to the supporting material 6250. In any case, the layer 6870 may have a lower, or tissue contact, surface span 6873, configured to contact tissue T as support material 6250 moves down to brackets 6220 so that legs of brackets 6221 enter holes 6252. In at least one such embodiment, layer 6870 may consist of compressible material, for example a bioabsorbable foam material, which, for example, can be squeezed between the bottom surface 6251 of the supporting material 6250 and the fabric in various embodiments of the invention; layer 6870 may additionally contain at least one medicament, which is inside or absorbed, which can be released from layer 6870 when it is compressed. In at least one embodiment, the medicament may be at least one of the following: a tissue fastener, a hemostatic substance and / or an antimicrobial substance, for example, ionized silver and / or triclosan. In various embodiments, squeezing the layer 6870 can squeeze the medication out of the layer 6870 so that all, or at least a significant portion, of the surface of the tissue T will be covered by the medication. In addition, as the layer 6870 contracts and the legs of the brackets 6221 penetrate the fabric T and the layer 6870, the medication can drain along the legs of the brackets 6221 and act on the fabric pierced by the legs of the brackets 6221. In various embodiments, the support material layer 6250 may include a first layer containing a biocompatible material, for example, titanium and / or stainless steel, and a lower layer 6870, consisting of a bioabsorbable material, for example, oxidized regenerated cellulose (ORC), biologically active substances, for example fibrin and / or thrombin (liquid or lyophilized), glycerol, absorbable porcine gelatin in a flowable or foamy configuration and / or antimicrobial agents, for example, ionized silver and / or triclosan. Additional bioabsorbable materials may include Surgicel Nu-Knit, Surgicel Fibrillar, collagen / ORC, which is a hybrid in the form of a collagen matrix and sold under the trade name Promogran, polyglycolic acid (PGC) under the trade name Vikril, polylactic acid (PMA), polydioxanone (PDS) ), polyhydroxyalkanoate (PHA), polyglexaprone 25, sold under the trade name monocryl, polycaprolactone (PCL) and / or a mixture of PGC, PMK, PDS, PHA, polyglecapron and / or PKG. Although only one layer 6870 is shown in FIG. 215, a suitable number of layers may be used. In at least one embodiment, the first layer containing the first medicament can be attached to the supporting material 6250, and the second layer containing the second or other medicament can be attached to the first layer. In at least one such embodiment, multiple layers may be used, which may contain various medications and / or various combinations of medications.

In various embodiments, as shown in FIG. 213, the crosslinking system may comprise a layer of material 6770 attached to the bottom surface 6251 of the formation of supporting material 6250. In certain embodiments, layer 6770 and / or supporting material 6250 may include locking elements so as to fix layer 6770 to supporting material 6250. By in at least one embodiment, at least one adhesive may be used to adhere layer 6770 to support material 6250. In any case, layer 6770 may have a lower, or contacting the tissues, the surface 6773 is configured to come into contact with the fabric T while moving the supporting material 6250 down to the brackets 6220 so that the legs of the brackets 6221 enter the holes 6252. In at least one such embodiment, the layer 6774 may consist of compressible material, such as bioabsorbable foam material, which, for example, can be squeezed between the lower surface 6251 of the supporting material 6250 and the fabric T. In various embodiments of the invention, layer 6770 may complement it is desirable to contain one or more capsules, or cells, of 6774, containing at least one medicament inside. In certain embodiments of the invention, see FIG. 214, the encapsulated materials 6774 can be aligned, or at least substantially aligned, with the holding holes 6252 such that when the legs of the brackets 6221 are pushed through the fabric T and the layer 6770, the legs of the brackets 6221 can pierce and / or otherwise tear capsules 6774. After capsule 6774 ruptures, at least one medication stored in capsule 6774 may leak onto tissue T. In at least one such embodiment, medicament M may contain fluid that can flow or move through wetting along n zhek brackets 6221, acting on the tissue T, has just punctured legs brackets. As a result of the above, the medication stored in capsules 6774 can provide local processing of tissue. In certain embodiments of the invention, capsules 6774 in a sheet of material 6770 may contain various medications. For example, the first group of capsules 6774 may contain a first medication, or a first combination of medicines, and the second group of capsules may contain another medication or another combination of medicines. In various embodiments, the implementation of the layer 6770 may consist of a flexible silicone layer, and the capsule 6774 may represent a cavity in the silicone layer. In at least one such embodiment, the silicone layer may consist of two layers that can be attached to each other, with capsules 6774 can be formed between the two layers. In various embodiments, the implementation of the layer 6770 may contain one or more thin sections of weakened material, for example, partial perforations, which can contribute to the cutting of the layer 6770 and rupture of the capsules 6774 legs 6221. In certain embodiments, at least part of the capsules 6774 may be located in the dome protrusions 6777, the domed protrusions 6777 may be bulges above the surface of the formation 6770. In at least one such embodiment, the domed protrusions 6777 and / or shey least part of the capsule 6774 may be positioned in the pockets 6201 formed in the supporting material 6250. In certain embodiments, the capsule 6774 may include discrete cells that are not connected to each other. In certain embodiments, one or more capsules 6774 may be connected to each other via one or more ducts, tubes, or channels, for example, passing through layer 6770. Disclosure of US Patent No. 7,780,685 under the title ADHESIVE AND MECHANICAL SEWING SYSTEM, published August 24, 2010, is included to this document by reference.

In various embodiments, in addition to the foregoing, a block of brackets consisting of a block body, brackets and / or alignment material may be installed in the first jaw of the end clamp and, similarly, the supporting material and / or one or more covers may be located in the second jaw end clamp. In certain embodiments, as shown in FIG. 216, a tool, for example, a tool for loading a block of brackets 6990, can be used to insert two or more blocks of suture brackets into the end clip. In at least one embodiment, the tool for loading block 6990 may comprise a handle 6991 and a holder of block 6992, wherein the holder of block 6992 may include a first holding portion so configured to hold the housing 6210 of the bracket block 6200, and, in addition, a second a holding portion with such a configuration as to hold the housing of block 6980, comprising, firstly, a plurality of protective caps 6270 and, secondly, supporting material 6250 along the bottom surface. In various embodiments, the first and second holding parts may comprise one or more holding elements with such a configuration as to engage with the bodies of blocks of brackets 6210 and 6980 with the possibility of separation. During operation, see FIG. 217 and 218, the end clamp may have a first or lower jaw 6230 and a second or upper jaw 6940, while the bracket block 6200 can be loaded into the first jaw 6230, and the body of the block 6980 can be loaded into the second jaw 6940. In various circumstances the upper jaw 6940 can be rotated from the open position (FIG. 217) to the closed position (FIG. 218) by the drive mechanism 6235, wherein the action of the drive mechanism 6235 is described above and is not repeated here for brevity. When the upper jaw 6940 is in the closed position, see FIG. 218, the distal end 6993 of the bracket block holder 6992 can be inserted into the end clamp so that the bracket block 6200 slides through the distal end 6938 of the first branch 6930 and into the first connecting part or channel 6939 in the first branch 6230. Similarly, the distal end 6993 of the holder block 6992 can be inserted into the end clamp so that the body of block 6980 slides through the distal end 6948 of the second jaw 6940 and into the second connecting part, or channel, 6949 in the second jaw 6940. A surgeon or other doctor holding the handle 6991 of the holder of block 699 0, can push the bracket block 6200 and the block body 6980 through the channels 6939 and 6949, respectively, until the block body 6200 and the block body 6980 are completely inside.

As the brackets block 6200 and the block body 6980 are installed, the brackets block 6200 and the block body 6980 may mesh with one or more holding parts in respective branches 6230 and 6940, as will be described in more detail below. In any case, after the bracket block 6200 and the housing of the block 6980 are located in the desired position, see FIG. 219, the holder of block 6990 can be separated from the bracket block 6200 and the housing of block 6980 and removed from the end clip. In at least one such embodiment, the holding force holding the bracket block 6200 in the first jaw 6230 may be greater in the holder of the block 6992, so when the holder of the block 6992 is pulled distally from the end clamp, the bracket block 6200 may remain in the first jaw 6230. Similarly, the force holding the case of the block 6980 in the second jaw 6940 may be greater than the holding force of the body of the block 6940 in the holder of the block 6992, so when the holder of the block 6992 is pulled distally from the end clamp, the housing Lok brackets 6940 may remain in the second jaw of 6940. After removing device for block 6990 of the terminal clamp 6230, a second jaw of the 6940 can be positioned opposite the tissue T for suturing. As shown in FIG. 220, the second jaw 6940 can be moved from the open position (FIG. 219) to the working position (FIG. 220) for engagement with the supporting material 6250 and a plurality of protective caps 6270 on the case of the block 6980 with brackets 6220 inside the block 6200.

As shown in FIG. 221 and 222, the second jaw 6940 can be reopened, and the plurality of protective caps 6270 and the supporting material 6250 can separate from the case of the block 6980 so that the caps 6270 and the supporting material 6250 can mesh with the fabric T and the brace block 6200. in at least one such embodiment, the bracket block body 6980 may have a plurality of pockets in which a plurality of caps 6270 are movably disposed and one or more retaining slots in such a configuration as to receive support material 6250. In various embodiments, the holding elements of the second jaw 6940 engaged with the body of the block 6980 can hold the body of the block 6980 in the second jaw 6940 after the second jaw 6940 is fully open. In certain embodiments, the bracket block body 6980 may be configured to tear after opening the second jaw 6940 such that a portion of the block body 6980 is implanted with caps 6270 and supporting material 6250, and a portion of the block body 6980 remains in the second jaw 6940. Similar way, see FIG. 221 and 222, the locking elements of the first jaw 6230 engaged with the block body 6210 can hold the block body 6210 in the first jaw 6230 after moving the second jaw 6940 to the open position. In certain embodiments, the block body 6210 may be configured to tear apart after the first jaw 6230 is moved away from the implanted brace block 6200 so that a portion of the brace block 6210 body is implanted with the brackets 6220 and the alignment material 6260 and the block body portion 6210 remain in first branch 6230. In various embodiments, see FIG. 223-225, the bracket block body 6900, for example, may have one or more longitudinal retaining slots 6913 along the entire length of the block body 6910, which, when the block 6900 is inserted into the jaw 6930, may be configured to receive one or more longitudinal locking rails 6916 extending from jaw 6930. In operation in at least one embodiment, the ends of the retaining slots 6913 can be aligned with the distal ends of the retaining rails 6916 before the block of brackets 6900 begins to slide through the distal end 6938 of the holding channel and 6939.

In various embodiments of the invention, see FIG. 225, jaw 6940 may comprise two holding channels 6949, each holding channel 6949 may be configured to receive a block body 6980 with a plurality of caps 6270 and supporting material 6250. In certain embodiments, each block 6980 body may contain one or more longitudinal retaining ledges 6917 with such a configuration as to slide along one or more longitudinal retaining rails 6918 of the second jaw 6940 when inserting the bodies of the block 6980 into the corresponding holding channels 6949 in the jaw 6940. In various embodiments, the retaining rail 6918 and 6917 may retaining ledges to hold together the housing unit 6980 in the second jaws 6940 when detaching housings brackets blocks 6980 located therein by caps supporting material 6270 and 6250. In various circumstances, see. FIG. 224, the second jaw 6940 may further comprise one or more distal protrusions, or retaining elements 6915, such as to detachably hold the housing of the bracket blocks 6980 in the respective holding channels. In at least one such embodiment, the second jaw 6940 may include a distal protrusion 6915 located relative to each holding channel 6949 so that each bracket block body 6980 can bend around the protrusions 6915 when inserting the bracket block bodies 6980 into the channels 6949, as soon as the enclosures of the bracket blocks 6915 are fully inserted into the channels 6949, the distal ends of the enclosures of the blocks of brackets 6980 can be released and catch on the tabs 6915. To remove the enclosures of the blocks of brackets 6980 after using them as As described above, the brace blocks 6980 can be pulled back through the protrusions 6915 and removed from the retaining channels 6949. Similar to the above, the first jaw 6930 may contain one or more distal retaining protrusions 6914 with such a configuration as to receive one or more retaining grooves or slots 6912 ( FIG. 223) in the case of block 6910, when the case of the block of brackets 6900 is fully inserted.

In various embodiments of the invention, in addition to the above, a first block of brackets containing a plurality of first brackets may be located in a first branch of a surgical stapling instrument, and a second block of brackets containing a plurality of second brackets may be located in a second branch of a surgical stapling instrument . During operation, the first jaw and / or the second jaw can move towards each other so that the first brackets engage with the second brackets, thereby securing the fabric between them. In certain embodiments of the invention, the first block of brackets and the second block of brackets may mesh with each other when the first brackets are engaged with the second brackets. In at least one such embodiment, the housing of the first block of brackets may consist of a first compressible material, and the housing of the second block of brackets may consist of a second compressible material, while the first housing and / or second housing may be pressed against the fabric to be sewn. After flashing the tissue, the first jaw can move away from the implanted first block, and the second jaw from the implanted second block. Subsequently, a new block of brackets and the like can be inserted into the first jaw, and a new second block of brackets and the like can be inserted into the second jaw and the surgical stapling instrument reused. Although brackets may be used in some embodiments, other embodiments include other types of fastening elements, for example, two-part clamps that are locked together by engagement with each other. In at least one such embodiment, the first block may comprise a first storage space for the first parts of the fastening clamps, and the second block may comprise a second storage space for the second parts of the clamps. In various embodiments, the crosslinking systems described herein may utilize clamps consisting of any suitable material and having any suitable shape. In certain embodiments, the clips may include piercing elements. Such piercing elements may consist, for example, of a polymer, a mixture and / or a multilayer substrate. An example of a multilayer substrate may be a wire or substrate with an elastomeric or polymer coating. This may be a thin sheet formed so that the piercing elements are oriented perpendicularly, or at least substantially perpendicularly to the connecting element. The piercing elements on the side can have a rectangular shape, a semicircular shape, or any oblong shape. In various embodiments, the clips described herein may be produced using any suitable process, for example, a wire extrusion process. Another possibility is the use of microprocessing to create hollow penetrating elements. These penetrating elements can be manufactured by a process different from the process of wire extrusion, possibly from a combination of materials.

As described above, the ends of the brace legs protruding through the supporting material may be coated with one or more caps or covers. In certain embodiments, the ends of the legs of the brackets may be deformed after insertion through the supporting material. In at least one such embodiment, the jaw holding the supporting material may further comprise abutment pockets located above and / or aligned with the holding holes so as to deform the legs of the brackets protruding through the supporting material. In various embodiments, the legs of each bracket may bend inward toward each other and / or toward the center of the bracket. In certain other embodiments, one or more legs of the brackets may bend outward, away from the legs of the other brackets and / or from the center of the bracket. In various embodiments of the invention, regardless of the direction in which the legs of the brackets are bent, the ends of the legs of the brackets can come in contact with the housing of the supporting material and cannot reenter the fabric sewn together with brackets. In at least one embodiment, deformation of the legs of the brackets after passing through the supporting material can fix the supporting material in a certain position.

In various embodiments of the invention, see FIG. 226 and 227, a surgical stapling instrument, for example, a surgical stapling instrument 7000, may comprise a first jaw 7030 and a second jaw 7040, with the second jaw 7040 being able to move in and out of the first jaw 7030 when the drive mechanism 6235 moves. The action of the drive mechanism 6235 described above and is not repeated here for brevity. In various embodiments, the first jaw 7030 may have a distal end 7031 and a proximal end 7032, wherein the first jaw 7030 may comprise a channel between the distal end 7031 and the proximal end 7032 so as to receive a block of brackets. For the purpose of illustration, the case of such a block of brackets is not shown in FIG. 226, although such a block of brackets may include a block body, brackets 6220 located in the body, and ejector brackets 7012 located under the brackets 6220. In certain embodiments, although not shown in FIG. 226 for clarity, the second jaw 7040 may be configured to hold support material 6250, for example, above the brackets 6220 and / or move the support material, forcing it to engage the legs of the brackets 6220 as described above. In at least one embodiment, the surgical stapler 7000 may further comprise a slide 7010 located in the first jaw 7030, which can slide from the distal end 7031 of the first jaw 7030 to the proximal end 7032, and raise the ejectors brackets 7012 and brackets 6220 resting on them in the direction of the supporting material and the second jaw 7040. In various embodiments, the slide 7010 can move from the proximal end 7032 to the distal end 7031 to move the brackets 6020. At least , in one embodiment, the slide 7010 may have one or more inclined surfaces, or protrusions 7011 with such a configuration as to slide under the ejector brackets 7012 and lift the ejector brackets 7012 up. In various embodiments, the surgical stapler 7000 may further have a pulling or pushing rod operably connected to the slide 7010, which can be moved proximally and / or distally under the action of a trigger located on the handle and / or trunk of the surgical stapling tool 7000.

In various embodiments, see FIG. 226, the second jaw 7040 of the surgical stapling instrument 7000 may comprise a frame 7041, a distal end 7048 and a proximal end 7049 opposite the distal end 7048. In certain embodiments, the second jaw 7040 may further comprise a guide system consisting of one or more rail guides, for example rail guides 7045 and 7046 extending along the longitudinal axis of the frame 7041, which, as will be described in more detail below, may be configured to guide one or more stop elements, or and protrusions that may engage and deform the legs of the brackets 6220 after the legs 6221 of the brackets 6220 have passed through the supporting material. In at least one such embodiment, rail guides 7045 and 7046 may comprise a conductor of wire or wire extending from the top or surface of the frame 7041 around the distal portion 7047 and again returning to the top or surface of the frame 7041. In various embodiments, as mentioned above and as shown mainly in FIG. 228 and 230, the second jaw 7040 may further comprise one or more thrust elements or protrusions, for example, the first thrust element 7050 and the second thrust element 7060, which can move longitudinally along the second jaw 7040 to deform the legs of the brackets 6220 after passing through the supporting material . In at least one embodiment, surgical stapling instrument 7000 may further comprise a drive or actuator of a first abutment member 7051 connected and / or operatively connected to a first abutment member 7050 so configured to push the first abutment member 7050 proximal and / or push the first thrust member 7050 distally. Similarly, in at least one embodiment, the surgical stapler 7000 may further comprise a second actuator or actuator coupled and / or operatively connected to the second abutment element 7060 with such a configuration as to push the second abutment element 7060 proximal and / or push the second thrust member 7060 distally. In various embodiments, the first stop member 7050 may include guide slots 7052, and the second stop member 7060 may include guide slots 7062, each of which may be configured to receive a slide rail 7045 or a slide rail 7046. In at least one embodiment, rail tracks 7045 and 7046 can fit snugly into slots 7052 and 7062 so that relative lateral movement or side-to-side movement between them becomes impossible or at least limited.

In certain embodiments, in addition to those described above, the first stop member 7050 can move proximally, and the second stop member 7060 can move distally. In at least one embodiment, as shown in FIG. 226, rail rails 7045 and 7046 and distal column 7047 may constitute a pulley system of such a configuration as to pull the second stop member 7060 in the distal direction and / or pull the second stop member 7060 in the proximal direction. In at least one such embodiment, rail 7045 and rail 7046 may comprise a continuous wire or wire extending around a distal column 7047, wherein a portion of the continuous wire may be tensioned to allow circular movement of the wire around the distal column 7047. In various embodiments, rail guide 7046, for example, can be mounted on a second stop member 7060 such that when the continuous wire 7060 moves in a circle in the first direction In this regard, the second abutment element 7048 can be pulled distally to the distal end 7048 of the jaw 7040 and, when the continuous wire moves in a circle in the second or opposite direction, the second abutment element 7060 can be pulled proximally to the proximal end 7049. In at least one embodiment implementation, see FIG. 228, the rail 7046 may be secured to the slot guide 7062 so that a tension force can be transmitted between them. In at least one such embodiment, the rail 7045 may be configured to slide in another guide slot 7062. In various embodiments, the first stop member 7050 may act independently of the second stop member 7060, and the belt system and the guide slots 7052, formed in the first abutment element 7050 may be configured to receive the slide rails 7045 and 7046 so that they allow relative movement between them izhenie. In various embodiments, rail guides 7045 and 7046 comprising a continuous wire may be flexible enough to accommodate the opening and closing upper jaws 7040. Furthermore, the continuous wire may be flexible enough to allow the second stop member 7060 to move vertically to the lower jaws. 7030 and from it, which will be described in detail below.

In various embodiments, see FIG. 228 and 230, the first stop member 7050 may include support rollers 7055 protruding therefrom, which may be configured to move in one or more grooves or guide grooves, such as a groove 7070 (FIG. 231) formed in the frame 7041 of the second jaw 7040. More specifically, in at least one embodiment, the frame 7041 may include a first shaped groove 7070 extending longitudinally along the first side of the frame 7041, and a second shaped groove 7070 extending longitudinally along the second opposite side of the frame 7041, wherein the support rollers 705 5, protruding from the first side of the first stop element 7050, can move in the first curly groove 7070, and support rollers 7055, protruding from the second side of the first stop element 7050, can move in the second curly groove 7070. In at least one such embodiment the contours of each groove 7070 may be identical, or at least substantially identical, and may lie on the same line, or substantially on the same line, with each other. Similarly, in various embodiments, the second stop member 7060 may include protruding support rollers 7065 so configured to move in the curly grooves 7070 (FIG. 231) formed in the frame 7041 of the second jaw 7040. More specifically, in at least one In an embodiment, the support rollers 7065 protruding from the first side of the stop element 7060 can move in the first curly groove 7070, and the support rollers 7065 protruding from the second side of the second stop element 7060 can move in the second stop p ABC 7070. In operation, the support rollers 7055 of the first stop element 7050 and the support rollers 7065 of the second stop element 7060 can slide in the curved slots 7070 so that the first stop element 7050 and the second stop element 7060 follow the contours of the figured grooves 7070 as the first thrust member 7050 and the second thrust member 7060 are attracted in the proximal direction or pushed distally. In various embodiments, each shaped groove 7070 may comprise a plurality of straight or upper parts 7071 and a plurality of guides or lower parts 7072 with such a configuration as to move the stop elements 7050 and 7060 vertically, i.e. towards the lower jaw 7030 and away from it, at the same time, the stop elements 7050 and 7060 move longitudinally, that is, between the distal end 7048 and the proximal end 7049 of the frame 7041, as will be described in more detail below.

When the surgical stapler 7000 is inoperative, see FIG. 231, the first stop member 7050 may be located at the distal end 7048 of the frame 7041, and the second stop member 7060 may be located at the proximal end 7049 of the frame 7041; In addition, as shown in FIG. 232, brackets 6220 located in the first jaw 7030 may not yet be inserted into tissue T and / or the supporting material located above them when the surgical stapler 7000 is not powered. During operation, see FIG. 233, the brackets 6220 can move upward in the spaces for the brackets 7033 of the bracket block 7012, and furthermore, the first stop member 7050 can move proximally from the distal end 7048 of the frame 7041 to the distal end 7049 to engage the legs 6221 of the brackets 6220. At least in In one embodiment, the brackets 6220 may move upward before the first stop member 7050 engages with the legs of the brackets 6221. In various embodiments, all the brackets 6220 may be pushed upward by the slide 7010 before the first stop member 7050 comes into contact contact with the legs of the brackets 6221 or, alternatively, the slide 7010 can move proximally at the same time that the first stop element 7050 moves proximally, although the slide 7010 can sufficiently act on the first stop element 7050 to move the brackets 6220 forward to the first stop element 7050. In various embodiments, as shown in FIG. 233, the shaped grooves 7070 may be configured such that forming surfaces, such as forming or curved surfaces 7053 and 7054 of, for example, the first protrusion 7050, can come into contact with at least some of the legs of the brackets 6221 when the first the protrusion 7050 passes through a straight or upper part. In various circumstances, the support rollers 7055 of the first stop element 7050 can be located in the straight part 7071 of the figured grooves 7070 so that the forming surfaces 7053 and 7054 are in a raised position and so that the legs of the brackets 6221 are only partially deformed when the stop element 7050 passes past them through the straight part of the groove. When the first protrusion 7050 moves further along the curly slots 7070, as shown in FIG. 234, the support rollers 7055 of the first thrust member 7050 can move to the working or lower position 7072 of the curly slots 7070 so that the forming surfaces 7053 and 7054 move vertically down to the legs of the brackets 6021 to move the legs of the brackets 6021 to the final, formed configuration. Subsequently, as the first stop element 7050 moves along the curly grooves 7070, the first stop element 7050 can move vertically upward into another set of straight parts 7071 of the figured slots 7070. As shown in FIG. 233 and 234, the reader will note that the first thrust member 7050 may engage only with certain brace legs. In at least one such embodiment, the first stop member 7050 may be configured to deform only a group of brace legs, including, for example, the distal legs 6221 of the brackets 6220. In at least one such embodiment, the first stop member 7050 may have such a configuration so as to deform the distal legs of the brackets 6221 to the center of the brackets 6220. In various embodiments, each proximal leg of the bracket 6221 can come into contact twice with the first stop member 7050, i.e., with the first a forming surface 7053 and a second forming surface 7054 aligned with the first forming surface 7053. In at least one such embodiment, the first forming surface 7053 can deform the distal legs of the brackets 6221 to form a partially deformed configuration when the first stop member 7050 is in straight, or upper, part, and the second forming surface 7054 can deform the distal legs of the brackets 6221 with the formation of a fully formed configuration, when the first a thrust plate 7050 moves in the business, or lower, position. In various embodiments, see FIG. 228 and 229, the first abutment member 7050 may have a plurality of first forming surfaces 7053 and a plurality of second forming surfaces 7054 for deforming the distal legs 6221 of the brackets 6220 when the legs of the brackets 6221 are arranged in more than one row or line. In various embodiments, as will be described in more detail below, the proximal legs 6221 of the brackets 6020 may be deformed, for example, by a second abutment element 7060.

In various embodiments, in addition to those described above, the first stop member 7050 can move away from the distal end 7048 of the frame 7041 to the proximal end 7049 to deform the distal legs 6221 of the brackets 6220. As the reader may note, the first stop member 7050 can move up and down relative to the undeformed proximal legs of the brackets 6221 and, to allow such relative movement, in different embodiments of the invention, the first stop element 7050 may contain one or more grooves 7057 (FI . 230) with such a configuration to receive nezagnutye proximal legs of brackets 6221, when the first stop element 7050 flexes the distal legs of brackets 6221. Similarly, as shown in FIG. 228, the second stop member 7060 may have a groove 7067 configured to allow vertical movement of the first cam actuator 7051, which moves up and down when the first stop member 7050 moves between the upper and operating positions, as described above. After bending all the distal legs of the brackets 6221, in at least one embodiment, the second stop member 7060 can move from the proximal end 7049 of the frame 7041 to the distal end 7048 of the actuator of the stop member 7061. Similar to the above, see FIG. 235, the support rollers 7065 of the second abutment element 7060 can slide in the figured grooves 7070 so that the second abutment element 7060 moves between the free or upper position and the working or lower position to deform the proximal legs of the brackets 6221 inward to the center of the brackets 6220 Similar to the above, the second abutment element 7060 may comprise a plurality of first forming or curved surfaces 7063 and a plurality of second forming or curved surfaces 7064 with such a configuration that at least the partially deformed and / or completely deform one or more of the proximal brackets legs 6021. As shown in FIG. 229, the second abutment member 7060 may have a plurality of first forming surfaces 7063 and a plurality of second forming surfaces 7064 so configured to deform the proximal legs 6221 of the brackets 6220 arranged in a plurality of rows or lines. As also shown in FIG. 229, the first forming surfaces 7063 and the second forming surfaces 7064 of the second abutment element 7060 may not coincide with the first forming surfaces 7053 and the second forming surfaces 7054 of the first abutment element 7050, while, as a result, the proximal legs 6221 of the brackets 6220 can be arranged in other rows, or lines than the distal legs 6221 of the brackets 6220. As the reader may note, the second stop element 7060 can push the first stop element 7050 while the second stop element 7060 moves distally. In at least one such embodiment, the second abutment member 7060 can push the first abutment member 7050 back toward the distal end 7048 of the frame 7041 so that the first abutment member 7050 can return to its initial or inactive position. After all the proximal legs 6221 of the brackets 6220 are deformed, the second abutment element 7060 can retract in the proximal direction and return to its original idle position. Thus, the surgical stapler 7000 can be prepared for reuse by installing a new block of brackets in the first jaw 7030 and new supporting material in the second jaw 7040 to reuse the surgical stapler 7000.

In various embodiments, implementation, as described above, the surgical stapler may include two or more stop elements that can move in the longitudinal direction and engage with the legs of many brackets located in the transverse direction. In certain embodiments, the surgical stapler may comprise a stop member that moves proximally to deform the first group of brace legs and distally to deform the second group of brace legs. In at least one such embodiment, such a thrust member may have forming surfaces directed in the proximal direction and forming surfaces directed in the distal direction.

In various embodiments, as shown in FIG. 236, the abutment element, for example, the abutment element 7140, may have a lower or tissue contact surface 7141 and a plurality of forming pockets formed therein 7142. In at least one embodiment, the abutment element 7140 may have more than one plate, for example plates with pockets 7143 that can be soldered to frame 7144. In at least one such embodiment, each plate with pockets 7143 can be located in the channel for plate 7145 in frame 7144 and soldered to frame 7144 with a weld seam 7146 passing through the frame 7144 for rofessional longitudinal seal 7147. In various circumstances, the longitudinal weld seam 7147 may comprise a continuous weld extending over the entire length of the slotted joint 7146, or a series of spaces separated by welds disposed longitudinally. In various embodiments, each pocket plate 7143 may consist of two or more parts welded together. In at least one such embodiment, each plate 7143 may consist of a first part 7143a and a second part 7143b that can be welded 7148. In various embodiments, the first part 7143a and the second part 7143b of each plate 7143 can be welded together before by welding the plates 7143 and the channels for the plates 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 may have contours corresponding to each other, for example, a serrated contour, as shown in FIG. 236, which can form a tight seam 7148 with each other. In at least one embodiment, each plate 7143 may have a height of approximately 0.51 mm (0.02 ”) that is higher than the depth of the channels for the plates 7145, so that the tissue contact surfaces 7141 extend from the frame 7044 of the abutment member 7040. In certain embodiments, see FIG. 237, plates 7143 may be joined together by at least one weld 7149 at the distal ends of plates 7143.

As shown in FIG. 236 and 237, each plate 7143 may have a plurality of forming pockets formed therein 7142. In various embodiments, forming pockets 7142 may be formed in the plates 7143 by any manufacturing process, for example, grinding and / or burning with an electrode. In at least one such embodiment, see FIG. 238 and 239, each forming pocket 7142 can be produced by forming a deep hole 7150, and then forming an arched or curved surface 7151 surrounding the deep hole 7150, and forming a guiding groove 7152 for the brace legs in the curved surface 7151. In various embodiments, these steps may be conducted in any suitable order. In various embodiments, see FIG. 240, pockets for forming the brackets 7142 can be formed in such a way that the inner edges 7153 of the forming pockets are separated by a constant, or at least substantially constant, gap 7154. In at least one embodiment, the gap 7154 may be, for example, approximately 0.20 mm (0.008 "). In addition, in at least one such embodiment, forming pockets 7142 may be located along two or more rows, or lines, the center of which may be divided by a constant, or at least substantially constant, gap 7155. At least , in one such embodiment, the gap 7155 between the center lines may be, for example, approximately 0.89 mm (0.035 "). In various embodiments, see FIG. 240, each forming pocket 7142 may have a different width, expanding from the narrow part 7156 to the wide part 7157. In at least one such embodiment, the narrow part 7156 may have, for example, a size of about 1.14 mm (0.045 "), and the wide portion 7157 may, for example, have a size of approximately 1.91 mm (0.075 "). In various embodiments, the plates 7143 may be made of the same material as the frame 7144. In at least one such embodiment, the plates 7143 and the frame 7144 may be made of stainless steel, for example, the 300 or 400 series, or, for example made of titanium. In various embodiments, the implementation of the plate 7143 and the frame 7144 may consist of different materials. In at least one such embodiment, the plates 7143 may consist, for example, of a ceramic material, and the frame 7144 may consist, for example, of stainless steel and / or titanium. In various circumstances, depending on the material used, at least one brazing process may be used to bond the plates 7143 and the frame 7144, in addition to or instead of the welding processes described above.

In various embodiments, see FIG. 241-243, the stop member 7240 may consist of a frame 7244 and a plurality of plates with pockets 7243 that can be inserted into the frame 7244. Similar to the above, each plate with pockets 7243 may have a plurality of forming pockets 7242 formed therein. At least in one such embodiment, the frame of the abutment member 7244 may have retaining slots formed therein 7246 so as to receive a rail 7247 protruding from the plate with pockets 7243. To assemble the plates with pockets 7243 on the frame pore element 7244, the side walls 7245 of the frame of the thrust element 7244 can be bent or bent outward, as shown in FIG. 242, to expand the holding slots 7246 so that each holding slot 7246 can receive the rail guide 7247 of the plate with pockets 7243. When the rail guides 7247 enter the holding slots 7246, the side walls 7245 can be released, as shown in FIG. 243, thereby allowing the frame 7244 to elastically contract and / or return to its original state. In such circumstances, the holding slots 7246 can be shortened, thereby holding the rail guides 7247 inside. In certain embodiments, rail guides 7247 and / or retaining slots 7246 may have one or more conical shaped surfaces that, after releasing the bent retaining slots 7246, can form a clamp connection holding rail guides 7247 in retaining slots 7246. Similar to as described above, the plates with pockets 7243 may consist of the same material as the frame 7244. In at least one such embodiment, the plates 7243 may consist, for example p, of ceramic material, and the frame 7244 may consist, for example, of stainless steel and / or titanium. In various circumstances, depending on the material used, at least one brazing process and / or at least one welding process may be used to bond the plates 7243 and the frame 7244.

The devices disclosed 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 apparent to those skilled in the art that a variety of disassembly, cleaning / replacing, and reassembly techniques can be used to rebuild the device. The use of such techniques 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, a new or used tool must be obtained and cleaned if necessary. Then the instrument can be sterilized. In one sterilization method, the instrument is placed in a closed and sealed container, such as a plastic bag or Tyvek bag (TYVEK). Said tool container is then placed in the field of radiation capable of penetrating into the container, such as gamma radiation, x-rays 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 extent necessary, prevails over any information that contradicts the provisions of this document, which was incorporated into this document by reference. Any material or part thereof that is incorporated herein by reference and which contradicts the definitions, provisions or other information presented in this document 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 may be modified within the spirit and scope of the description. This application covers all possible variations, 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 (7)

1. A block of brackets containing:
a plurality of brackets, each said bracket having a base and a deformable element extending from this base, with each said deformable element having a tip; and
an implantable bracket block housing comprising:
a first compressible layer comprising a first material, wherein said bases are embedded in said first compressible layer; and
a second compressible layer comprising a second material, wherein said tips are embedded in said second compressible layer, said first compressible layer having a first stiffness and said second compressible layer having a second stiffness and said first stiffness different from said second stiffness; and
the shell surrounding the first compressible layer and the second compressible layer, while these ends are configured to pierce this shell when compressing the specified implantable body of the bracket unit with a stop element. 2. A block of brackets containing:
many undeformed brackets, and
an implantable bracket block body containing a plurality of layers, said plurality of layers forming a single whole implantable piece of material and said plurality of layers comprising:
a first compressible layer comprising a first material, wherein said undeformed brackets are embedded in said first compressible layer; and
a second compressible layer comprising a second material, said first compressible layer having a first stiffness, and said second compressible layer having a second stiffness and said first stiffness is different from said second stiffness,
wherein said set of brackets is arranged in the form of a first inner row of brackets, a first outer row of brackets, a second inner row of brackets and a second outer row of brackets, said first compressible layer is thicker along said first inner row of brackets and said second inner row of brackets than along said first outer a row of brackets and a second outer row of brackets. 3. A terminal block comprising:
a plurality of clamps, each said clamp having a base and a deformable element extending from that base, with each said deformable element having a tip; and
an implantable terminal block housing comprising:
a first compressible layer comprising a first material, wherein said bases are embedded in said first compressible layer; and
a second compressible layer comprising a second material, wherein said tips are embedded in said second compressible layer, said first compressible layer having a first stiffness and said second compressible layer having a second stiffness and said first stiffness different from said second stiffness; and
the shell surrounding the first compressible layer and the second compressible layer, while these ends are configured to pierce this shell when compressing the specified housing of the implantable clamp block with a stop element. 4. A terminal block comprising:
a plurality of clamps, said plurality of clamps being in the form of a first inner row of clamps, a first outer row of clamps, a second inner row of clamps and a second outer row of clamps; and
an implantable terminal block housing comprising:
a first compressible layer comprising a first material, wherein said clips are embedded in said first compressible layer; and
a second compressible layer comprising a second material, said first compressible layer having a first stiffness, and said second compressible layer having a second stiffness and said first stiffness is different from said second stiffness,
wherein said first compressible layer is thicker along said first inner row of clamps and said second inner row of clamps than along said first outer row of clamps and said second outer row of clamps. 5. A terminal block comprising:
a plurality of clamps, said plurality of clamps being in the form of a first inner row of clamps, a first outer row of clamps, a second inner row of clamps and a second outer row of clamps; and
an implantable terminal block housing comprising:
a first compressible layer comprising a first material, wherein said clips are embedded in said first compressible layer; and
a second compressible layer containing a second material, said first compressible layer having a first stiffness, and said second compressible layer having a second stiffness and said first stiffness is different from said second stiffness, wherein said second stiffness is higher along said first inner row of clamps and said second inner row of clamps than along said first outer row of clamps and said second outer row of clamps. 6. A terminal block comprising:
a plurality of clamps, said plurality of clamps being in the form of a first inner row of clamps, a first outer row of clamps, a second inner row of clamps and a second outer row of clamps; and
an implantable terminal block housing comprising:
a first compressible portion comprising a first material, wherein said clips are embedded in said first compressible portion; and
a second compressible section containing a second material, said first compressible section having a first stiffness, and said second compressible section having a second stiffness and said first stiffness is different from said second stiffness, wherein said second stiffness is higher along said first inner row of clamps and said second inner row of clamps than along said first outer row of clamps and said second outer row of clamps. 7. A block of brackets containing:
a plurality of undeformed brackets arranged in the form of a plurality of longitudinal rows, the plurality of longitudinal rows comprising a first longitudinal row, a second longitudinal row,
an implantable bracket block body having a compressible structure containing cells, wherein said implantable bracket block body has a plurality of compressible sections forming a single whole implantable piece of material, while the plurality of compressible sections have:
a first portion aligned with said first longitudinal row and offset from said second longitudinal row, wherein the first portion has a first stiffness, and
a second section aligned with said second longitudinal row and offset from said first longitudinal row, wherein the second section has a second stiffness, wherein said first stiffness is different from said second stiffness.

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