RU2692973C2 - Cassette of surgical stapling instrument comprising recesses for fasteners, including control elements - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medical equipment, specifically to surgical staplers. Fastener cartridge for use with a surgical suturing instrument comprises a cartridge body, a projection, a cavity for fasteners and a fastener. Cartridge body includes a platform configured to support tissue. Ledge extends from platform, wherein projection comprises conical slot. Cavity for fasteners is made in a platform. Cavity for fasteners has the first end of the cavity and the second end of the cavity. First end of the cavity has the first lateral wall and the second side wall. First side wall and second side wall converge at one point. Fastening element is arranged with the possibility of release into the cavity for fasteners. Fastening element comprises base, first leg and second leg. First leg extends from the base. First leg is releasably arranged at first end of said cavity. First side wall and the second side wall are configured to hold the first leg at a distance from convergence of the side walls at one point such that between the sidewalls converging at one point and the first leg there is a gap. Second leg extends from the base. Second leg is releasably arranged at the second end of the cavity. In the second version, the fastener cartridge for use with a surgical suturing instrument comprises a cartridge body, a projection, a cavity for fasteners and a fastener. Cavity for fasteners contains the first end of the cavity, the second end of the cavity and the wedge. Fastening element comprises base, first leg and second leg. First leg extends from the base. First leg is releasably disposed relative to the first end of the cavity. Wedge is configured to hold the first leg at a distance from the first end of the cavity so that there is a gap between the first end of the cavity and the first leg. Second leg extends from the base. Second leg is releasably arranged relative to the second end of the cavity. In the third version, the fastener cartridge for use with the surgical suturing instrument comprises a cartridge body, a projection, a cavity for fasteners and a fastener. Cavity for fasteners is made in a platform. Cavity for fasteners comprises a longitudinal slot including the first end of the cavity and the second end of the cavity. Fastening element is arranged with the possibility of release into the cavity for fasteners. Fastening element comprises a base, a first leg extending from the base, a second leg extending from the base, a first biasing means for displacing the first leg from the first end of the cavity and a second biasing means for displacing the second leg from the second end of the cavity.

EFFECT: invention enables tissue fixation.

9 cl, 102 dwg

Description

CROSS REFERENCE TO RELATED APPLICATION

This unconditional patent application claims priority in accordance with 119 (e) of Art. 35 of the United States Code on provisional application for US patent No. 61 / 980,291 FASTENING INSTRUMENTS AND FASTENING CARTRIDGES FOR USE THEREWITH, filed April 16, 2014, which is fully incorporated into this document by reference.

BACKGROUND OF THE INVENTION

The present invention relates to suturing instruments, as well as, in various embodiments, to a surgical suturing instrument for applying one or more rows of brackets.

The stapling instrument can include two interacting elongated branches, each of which can be adapted to be inserted into the patient’s body and placed relative to the stitched and / or cut tissue. In various embodiments, one of the branches can support a cassette with brackets with at least two longitudinally arranged rows of brackets, and the other can support an emphasis with sockets for forming brackets located opposite the rows of brackets in the cassette with brackets. Typically, the stapling instrument may further comprise a pusher and a knife blade that move relative to the jaws to successively push the staples out of the cassette of the stapling instrument through the cam surface on the push rod and / or the cam surface on the guide blade that is advanced by the push rod. In at least one embodiment, the cam surfaces can be configured to set in motion several levers for feeding the brackets (one for each bracket) in the cassette, which push the brackets onto the support with the formation of rows of deformed located laterally from each other. brackets in the tissue sandwiched between the branches. In at least one embodiment, the blade of the knife may follow the cam surface and cut the fabric along the line between the rows of brackets. Examples of similar crosslinking tools are described in US Patent No. 7,794,475 entitled SURGICAL STAPLES HAVING COMPRESSIBLE OR CRUSHABLE THEMEERS AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME referred to in this document.

The above description is intended only to illustrate various aspects of the relevant technology in the field of application of the invention at present, and should not be construed as limiting the scope of the claims.

SUMMARY OF INVENTION

According to a first embodiment of the present invention, there is provided a cassette with fasteners for use with a surgical stapling instrument, comprising: a cassette body including a platform adapted to support a fabric; the protrusion extending from the platform, the protrusion contains a conical groove; cavity for fasteners made in the platform, and the cavity for fasteners has a first end of the cavity and a second end of the cavity, the first end of the cavity has a first side wall and a second side wall, and the first side wall and the second side wall converge at one point; and a fastener placed with the possibility of release in the cavity for fasteners, comprising: a base; the first leg extending from the base, the first leg being disposed at the first end of the cavity, wherein the first side wall and the second side wall are arranged to keep the first leg at a distance from the convergence of the side walls at one point so that between the convergence of the side walls one point and the first leg there is a gap; and a second leg extending from the base, the second leg being disposed in the second end of the cavity.

According to one embodiment, the second end of the cavity has a first side wall and a second side wall configured to hold the second leg at a distance from the toe of the second side at one point such that there is a gap between the second side toe and the second leg.

According to another embodiment, the cassette further comprises a recess extender extending from the platform, wherein the recess expander is configured to support the first leg when pushing the fastener out of the cavity for fasteners.

According to another embodiment, the cassette further comprises a second recess expander extending from the platform, the second recess expander being configured to support the second leg when pushing the fastener out of the cavity for the fasteners.

According to a second embodiment of the invention, a cassette with fasteners for use with a surgical stapling instrument is proposed, comprising: a cassette body including a platform adapted to support a fabric; the protrusion extending from the platform, the protrusion contains a conical groove; a cavity for fasteners, made in the platform, and the cavity for fasteners contains the first end of the cavity, the second end of the cavity and a wedge; and a fastener placed with the possibility of release in the cavity for fasteners, comprising: a base; the first leg extending from the base, the first leg being disposed with respect to the first end of the cavity, the wedge being configured to hold the first leg at a distance from the first end of the cavity so that there is a gap between the first end of the cavity and the first leg; and the second leg extending from the base, the second leg being disposed with respect to the second end of the cavity.

According to one embodiment, the cassette further comprises a second wedge configured to hold the second leg at a distance from the second end of the cavity so that there is a gap between the second end of the cavity and the second leg.

According to another embodiment, the cassette further comprises a recess extender extending from the platform, wherein the recess expander is configured to support the first leg when pushing the fastener out of the cavity for fasteners.

According to another embodiment, the cassette further comprises a second recess expander extending from the platform, the second recess expander being configured to support the second leg when pushing the fastener out of the cavity for the fasteners.

According to a third embodiment of the present invention, a cassette with fasteners for use with a surgical stapling instrument is proposed, comprising: a cassette body including a platform adapted to support a fabric; the protrusion extending from the platform, the protrusion contains a conical groove; a cavity for fasteners made platform, and the cavity for fasteners contains a longitudinal groove, which includes the first end of the cavity and the second end of the cavity; and a fastener placed with the possibility of release in the cavity for fasteners, comprising: a base; the first leg extending from the base; and the second leg extending from the base; the first biasing means for displacing the first leg from the first end of the cavity; and a second biasing means for biasing the second leg from the second end of the cavity.

BRIEF DESCRIPTION OF GRAPHIC MATERIALS

The various design features of the embodiments described herein are detailed in the appended claims. For a better understanding of the various embodiments of the invention, as well as methods and organizational features of their use, including the advantages thereof, descriptions and accompanying drawings are given below:

in FIG. 1 shows the vertical projection of the surgical stapling instrument;

in FIG. 2 is a cross-sectional view of the end effector of the surgical stapling instrument shown in FIG. 1 (section taken along line 2-2 in FIG. 1);

in FIG. 3 is a perspective view in cross section of the end effector shown in FIG. one;

in FIG. 4 is a cross-sectional view of the end effector shown in FIG. 1, showing brackets in unused form;

in FIG. 5 is a drawing showing the brackets in FIG. 4 as used;

in FIG. 6. presents a drawing showing the end effector shown in FIG. 1, used for stitching and cutting tissue;

in FIG. 7 is a perspective view of a cassette with brackets in accordance with at least one embodiment comprising a plurality of protrusions extending from the cassette body;

in FIG. 8 is a detailed view of a cassette with brackets shown in FIG. 7;

in FIG. 8A is a cross-sectional view of the staple cassette shown in FIG. 7;

in FIG. 9 is a detailed view showing the brackets located in the recesses for the brackets, which are shown in FIG. 7 (cassette with brackets);

in FIG. 10 is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of transverse projections extending from the cassette case;

in FIG. 11 is a partial perspective view of a cassette with brackets according to at least one embodiment, comprising a plurality of transverse protrusions extending from the cassette case;

in FIG. 12 is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of protrusions surrounding the proximal and distal ends of the gaps in the recesses for the brackets, which are shown in the drawing of the cassette case;

in FIG. 13 shows a partial perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of protrusions surrounding the proximal and distal ends of the lumens of the recesses for the brackets, which are shown in the drawing of the cassette case;

in FIG. 14 is a partial perspective view of a cassette with brackets according to at least one embodiment, comprising a plurality of grooved protrusions extending from the cassette case;

in FIG. 15 is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of grooved protrusions extending from the cassette case;

in FIG. 15A is a perspective view of a pyramidal corrugation according to at least one embodiment;

in FIG. 15B is a perspective view of a truncated cone shaped corrugation in accordance with at least one embodiment;

in FIG. 15C is a perspective view of a triangular grooved in accordance with at least one embodiment;

in FIG. 16 is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of protrusions, completely framing the recesses of the recesses for the brackets indicated in the drawing of the cassette case;

in FIG. 16A is a partial perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of protrusions completely framing the recesses of the recesses for the brackets indicated in the drawing of the cassette case;

in FIG. 17 is a perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of longitudinal projections extending from the cassette case;

in FIG. 18 presents a detailed view of the cassette with brackets shown in FIG. 17;

in FIG. 19 is a perspective view of a surgical instrument that has a replaceable core assembly functionally connected to it;

in FIG. 20 is an exploded view of the component of the replaceable core assembly and the surgical instrument shown in FIG. nineteen;

in FIG. 21 is an exploded view of a component of a portion of a surgical instrument shown in FIG. 19 and 20;

in FIG. 22 shows another view of the assembly with the spatial separation of the components of the replaceable core assembly and the surgical instrument shown in FIG. 19-21;

in FIG. 23 is a perspective view of a staple cartridge located in the end effector of a surgical instrument according to at least one embodiment, the staple cartridge contains a plurality of projections extending from the body of the bracket with brackets;

in FIG. 24 is a vertical elevation view of a bracket in accordance with at least one embodiment;

in FIG. 25 is a vertical elevational view of the bracket shown in FIG. 24, located inside the grooves for brackets in the cassette with brackets;

in FIG. 26 is an elevational view of a bracket in accordance with at least one embodiment;

in FIG. 27 is a vertical projection view of an asymmetric bracket according to at least one embodiment;

in FIG. 28 is a vertical projection view of another asymmetric bracket according to at least one embodiment;

in FIG. 29 is a vertical projection view of another asymmetric bracket in accordance with at least one embodiment;

in FIG. 30 is a vertical projection view of a bracket shown in a partially deformed state;

in FIG. 31 is a vertical elevation view of the bracket shown in FIG. 30 fully deformed;

in FIG. 32 is a perspective view from below of the elongated channel;

in FIG. 33 is a perspective view from below of another elongated channel;

in FIG. 34 is a cross-sectional view of the elongated duct shown in FIG. 33, with a cutting head shown schematically;

in FIG. 35 is a bottom view of the elongated duct shown in FIG. 33 and 34;

in FIG. 36 is a bottom view of another elongated channel;

in FIG. 37 is a bottom view of another elongated channel;

in FIG. 38 is a bottom view of another elongated channel;

in FIG. 39 is a bottom view of another elongated channel;

In FIG. 40 shows a partial side view of the elongated channel and the cutting head with an elongated channel shown in cross section, with parts of the cassette with surgical brackets omitted for clarity, and with the cutting head in the unlocked position ready for launch;

in FIG. 41 shows another partial view of the elongated channel with the cutting head shown in FIG. 40, with a cutting head positioned in the locked position;

in FIG. 42 is a perspective view of an embodiment of the cutting head and the trigger bar;

in FIG. 43 is a perspective view of another design of the end effector and barrel;

in FIG. 44 is another perspective view of the design of the end effector and the barrel shown in FIG. 43, with the outer stem portion omitted for clarity;

in FIG. 45 is a partial side view of another design of the end effector and the barrel;

in FIG. 46 is a partial side elevational view of the design of the end effector, with the elongated channel omitted for clarity;

in FIG. 47 is a top view of an embodiment of the stop;

in FIG. 48 is a top view of another embodiment of the stop;

in FIG. 49 is a cross-sectional view of an end effector of a surgical instrument according to at least one embodiment, comprising a staple cartridge including a stepped cassette platform;

in FIG. 49A is the same cross sectional view shown in FIG. 49, showing the different values of the height of the gap between the cassette's stepped platform and the stop opposite it;

in FIG. 50 is an elevational view of an asymmetric bracket in accordance with at least one embodiment;

in FIG. 51 is a vertical projection view of another asymmetric bracket in accordance with at least one embodiment;

in FIG. 52 is a view in elevation of another asymmetric bracket in accordance with at least one embodiment;

in FIG. 53 is a perspective view of a slide for brackets in accordance with at least one embodiment;

in FIG. 54 is a top view of the slide for the brackets shown in FIG. 53;

in FIG. 54A is a partial top view of the cassette with brackets shown in FIG. 23, showing the slide for the brackets shown in FIG. 53, in a non-activated position;

in FIG. 54B is a partial cross-sectional perspective view of the staple cartridge shown in FIG. 23;

in FIG. 54C is a partial perspective view from the rear of the cassette with brackets shown in FIG. 23;

in FIG. 54D is a perspective view of the slide for the brackets shown in FIG. 53;

in FIG. 55 is a perspective view of the distal end of the cassette with brackets shown in FIG. 23;

in FIG. 55A is a perspective view of a protrusion protruding from a cartridge with brackets shown in FIG. 23;

in FIG. 56 is a perspective view of a cassette with brackets in accordance with at least one embodiment, comprising a plurality of protrusions extending from the platform of the cassette with brackets;

in FIG. 57 is a detailed view of the protrusions and the platform of the cassette with brackets shown in FIG. 56;

in FIG. 58 is a partial perspective view of a cassette with brackets according to at least one embodiment, comprising a plurality of protrusions extending from the platform of the cassette with brackets;

in FIG. 59 is a partial perspective view of a cassette with brackets according to at least one embodiment, comprising a plurality of protrusions made in the platform of the cassette with brackets;

in FIG. 60 is a detailed view of the protrusion shown in FIG. 59;

in FIG. 61 is a partial perspective view of a cassette with brackets according to at least one embodiment, comprising a plurality of domes protruding from the platform of the cassette with brackets;

in FIG. 62 is a detailed view of the dome shown in FIG. 61;

in FIG. 63 is a perspective view of protrusions extending from the platform of a cassette with brackets, according to at least one embodiment;

in FIG. 64 is an exploded perspective view of a cassette with surgical brackets and a cassette lid;

in FIG. 65 is a cross-sectional view of a cassette with brackets and a cassette cover shown in FIG. 64, with a cassette lid mounted on a cassette with brackets;

in FIG. 66 is a perspective view of the stop of the surgical stapling instrument in accordance with at least one embodiment, comprising protrusions extending therefrom;

in FIG. 67 is a detailed view of the protrusions shown in FIG. 66;

in FIG. 68 is a partial perspective view of the anvil of a surgical stapling instrument according to at least one embodiment, comprising protrusions extending therefrom;

in FIG. 69 is a cross-sectional view of an abutment of a surgical stapling instrument in at least one embodiment comprising a first row of protrusions having a first height corresponding to the first row of recesses for brackets, a second row of protrusions having a second height corresponding to the second row of recesses for brackets and a third row of projections having a third height corresponding to the third row of recesses for the brackets;

in FIG. 70 is a perspective view of a cassette with brackets in accordance with at least one embodiment, comprising protrusions extending from the surface of the stepped platform of the cassette with brackets;

in FIG. 71 is a detailed view of the distal end of the surface of the stepped platform of the cassette with brackets, and the protrusions shown in FIG. 70;

in FIG. 72 is a detailed view of the proximal end of the surface of the stepped platform of the cassette with brackets, and the protrusions shown in FIG. 70;

in FIG. 73 is a perspective view of a cassette with brackets in accordance with at least one embodiment, comprising protrusions extending from the surface of the stepped platform of the cassette with brackets;

in FIG. 74 is a partial perspective view of a staple cartridge in accordance with at least one embodiment;

in FIG. 75 is a cross-sectional view of an end effector of a surgical instrument according to at least one embodiment, comprising a plurality of disposable elements cooperating with a tissue;

in FIG. 76 is a cross-sectional view of an end effector of a surgical instrument according to at least one embodiment, comprising a plurality of protrusions extending from the stepped surface of the cassette platform;

in FIG. 77 is a cross-sectional view of a platform of a cassette with brackets and a protrusion extending from a platform intended to support the bracket when it is removed from the recess for brackets in accordance with at least one embodiment;

in FIG. 78 is a cross-sectional view of another platform of a cassette with brackets and a protrusion extending from the platform intended to support the bracket when it is removed from the recess for the brackets in accordance with at least one embodiment;

in FIG. 79 shows a partial view in horizontal view of a platform of a cassette with brackets containing protrusions extending from a platform intended to support a bracket detachably disposed in a recess for brackets made in a cassette with brackets in accordance with at least one embodiment;

in FIG. 80 is a partial cross-sectional view of a staple cartridge containing a first protrusion for supporting the first leg of a bracket detachably disposed in a recess for brackets, and a second protrusion for supporting the second leg of the bracket according to at least one embodiment;

in FIG. 81 shows a perspective view of a distal end of a cassette with brackets containing a platform, a plurality of recesses for brackets made in the platform, and a series of protrusions extending from the platform, according to at least one embodiment;

in FIG. 82 is a partial perspective view of a staple cassette containing a platform, a plurality of recesses for brackets made in the platform, and a plurality of protrusions extending from the platform that surround the ends of some recesses for the brackets in at least one embodiment;

in FIG. 83 is a partial perspective view of a cassette with brackets containing a platform, a plurality of recesses for brackets made in the platform, and a plurality of protrusions extending from the platform that surround certain ends of the recesses for the brackets in at least one embodiment;

in FIG. 84 shows a partial cross-sectional view of a cassette with brackets containing a platform and a plurality of recesses for brackets made in the platform, a set of brackets located in recesses for brackets located between the proximal end and the distal end of the cassette with brackets, with a set of brackets consisting of a plurality of brackets , and a series of protrusions extending from a platform located between the proximal end and the distal end of the cassette with brackets, the row of protrusions comprising a series of heights according to at least one embodiment purposes;

in FIG. 85A is a partial cross-sectional view of a cassette cassette with brackets and a protrusion extending from the platform, the protrusion being made of an elastic material and depicted in an uncompressed state in accordance with at least one embodiment;

in FIG. 85B is a partial cross-sectional view of a cassette cassette with brackets and a protrusion shown in FIG. 85A, showing the protrusion in a partially compressed state;

in FIG. 85C is a partial cross-sectional view of a cassette cassette with brackets and a protrusion shown in FIG. 85A, showing the protrusion in a compressed state;

in FIG. 86A is a partial cross-sectional view of a staple cassette comprising a cassette body made of a flexible material according to at least one embodiment, shown in an unbent state;

in FIG. 86B is a partial cross-sectional view of the staple cartridge shown in FIG. 86A, in the bent state;

in FIG. 87 is a perspective view of an anvil containing a plurality of recesses extending from the anvil in accordance with at least one embodiment;

in FIG. 88 is a detailed view of a portion of the abutment shown in FIG. 87;

in FIG. 89 is a partial perspective view of an abutment comprising a plurality of recesses extending from the abutment according to at least one embodiment;

in FIG. 90 is a perspective view of a assembly comprising a staple ejector and movable pockets for pockets in accordance with at least one embodiment;

in FIG. 91 is an exploded view of the component of FIG. 90;

in FIG. 92 is a cross-sectional perspective view of a cartridge with brackets using the assembly shown in FIG. 90, shown in a non-activated state;

in FIG. 93 is a cross-sectional view in elevation of a cassette with brackets shown in FIG. 92, showing the node shown in FIG. 90 in the inactivated state, and the node shown in FIG. 90 in activated condition;

in FIG. 94 is a top view of the ejector of surgical brackets;

in FIG. 95 is a perspective view of the ejector of surgical brackets shown in FIG. 94;

in FIG. 96 is a perspective view of another surgical ejector ejector;

in FIG. 97 shows a top view of the pocket of the ejector brackets in the part of the cassette with surgical brackets;

 in FIG. 98 shows a vertical elevation view of an emphasis according to at least one embodiment, comprising protrusions with different heights extending from it;

in FIG. 99 is a perspective view of a cassette of a surgical stapling instrument according to at least one embodiment;

in FIG. 100 is a view in plan view of the cassette of the surgical instrument shown in FIG. 99;

in FIG. 101 is a partial perspective view of the proximal end of the surgical instrument cassette shown in FIG. 99; and

in FIG. 102 shows a partial view in horizontal projection of the proximal end of the cassette of the surgical instrument shown in FIG. 99

Corresponding elements on different types are designated by the corresponding symbols. The illustrative examples presented in this document demonstrate various embodiments. These illustrative examples are not to be construed as limiting the scope of the invention.

DETAILED DESCRIPTION

The applicant for this application belongs to the following patent applications filed on the same day, each of which is fully incorporated into this document by reference:

US Patent Application Ser. No. __________ entitled FASTENER CARTRIDGES INCLUDING EXTENSIONS HAVING DIFFERENT CONFIGURATIONS (file of patent attorney No. END7460USNP / 140136);

US Patent Application Ser. No. __________ entitled END EFFECTOR COMPRISING AN ANVIL INCLUDING PROJECTIONS EXTENDING THEREFROM (file of patent attorney No. END7462USNP / 140138);

US Patent Application Ser. No. __________ entitled SURGICAL FASTENER CARTRIDGES WITH DRIVER STABILIZING ARRANGEMENTS (file of patent attorney No. END7463USNP / 140139);

US Patent Application Ser. No. __________, entitled SURGICAL END EFFECTORS WITH FIRING ELEMENT MONITORING ARRANGEMENTS (file of patent attorney No. END7464USNP / 140140);

US Patent Application Ser. No. __________ entitled FASTENER CARTRIDGE COMPRISING NON-UNIFORM FASTENERS (file of patent attorney No. END7465USNP / 140141);

US Patent Application Ser. No. __________ entitled FASTENER CARTRIDGE COMPRISING DEPLOYABLE TISSUE ENGAGING MEMBERS (file of patent attorney No. END7466USNP / 140142);

US Patent Application Ser. No. __________ entitled FASTENER CARTRIDGE COMPRISING TISSUE CONTROL FEATURES (file of patent attorney No. END7467USNP / 140143);

US Patent Application Ser. No. __________ entitled FASTENER CARTRIDGE ASSEMBLIES AND STAPLE RETAINER COVER ARRANGEMENTS (file of patent attorney No. END7468USNP / 140144); and

US Patent Application Ser. No. __________ entitled FASTENER CARTRIDGE INCLUDING A LAYER ATTACHED THERETO (file of patent attorney No. END7469USNP / 140145).

The applicant of this application also owns the following patent applications filed on March 1, 2013, each of which is fully incorporated into this document by reference:

US Patent Application Ser. No. 13 / 782,295, entitled ARTICULATABLE SURGICAL INSTRUMENTS WITH CONDUCTIVE PATHWAYS FOR SIGNAL COMMUNICATION;

US Patent Application Ser. No. 13 / 782,323, entitled ROTARY POWERED ARTICULATION JOINTS FOR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 782,338, entitled THUMBWHEEL SWITCH ARRANGEMENTS FOR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 782,499 entitled ELECTROMECHANICAL SURGICAL DEVICE WITH SIGNAL RELAY ARRANGEMENT;

US Patent Application Ser. No. 13 / 782,460 entitled MULTIPLE PROCESSOR MOTOR CONTROL FOR MODULAR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 782,358 entitled JOYSTICK SWITCH ASSEMBLIES FOR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 782,481 entitled SENSOR STRAIGHTENED END EFFECTOR DURING REMOVAL THROUGH TROCAR;

US Patent Application Ser. No. 13 / 782,518, entitled CONTROL METHODS FOR SURGICAL INSTRUMENTS WITH REMOVABLE IMPLEMENT PORTIONS;

US Patent Application Ser. No. 13 / 782,375, entitled ROTARY POWERED SURGICAL INSTRUMENTS WITH MULTIPLE DEGREES OF FREEDOM; and

US Patent Application Ser. No. 13 / 782,536, entitled Surgical Instrument Soft Stop.

The applicant of this application also owns the following patent applications filed on March 14, 2013, each of which is fully incorporated into this document by reference:

US Patent Application Ser. No. 13 / 803,097, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE;

US Patent Application Ser. No. 13 / 803,193 entitled CONTROL ARRANGEMENTS FOR A DRIVE MEMBER OF A SURGICAL INSTRUMENT;

US Patent Application Ser. No. 13 / 803,053, entitled INTERCHANGEABLE SHAFT ASSEMBLIES FOR USE WITH A SURGICAL INSTRUMENT;

US Patent Application Ser. No. 13 / 803,086, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK;

US Patent Application Ser. No. 13 / 803,210, entitled SENSOR ARRANGEMENTS FOR ABSOLUTE POSITIONING SYSTEM FOR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 803,148 entitled MULTI-FUNCTION MOTOR FOR A SURGICAL INSTRUMENT;

US Patent Application Ser. No. 13 / 803,066 entitled DRIVE SYSTEM LOCKOUT ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 803,117, entitled ARTICULATION CONTROL SYSTEM FOR ARTICULATABLE SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 13 / 803,130 entitled DRIVE TRAIN CONTROL ARRANGEMENTS FOR MODULAR SURGICAL INSTRUMENTS; and

US Patent Application Ser. No. 13 / 803,159, entitled METHOD AND SYSTEM FOR OPERATING A SURGICAL INSTRUMENT.

The applicant for this application belongs to the following patent applications filed on March 26, 2014, each of which is fully incorporated into this document by reference:

US Patent Application Ser. No. 14 / 226,106, entitled POWER MANAGEMENT CONTROL SYSTEMS FOR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 14/226,099 entitled STERILIZATION VERIFICATION CIRCUIT;

US Patent Application Ser. No. 14 / 226,094, entitled VERIFICATION OF NUMBER OF BATTERY EXCHANGES / PROCEDURE COUNT;

US Patent Application Ser. No. 14 / 226,117 entitled POWER MANAGEMENT THROUGH SLEEP OPTIONS OF SEGMENTED CIRCUIT AND WAKE UP CONTROL;

US Patent Application Ser. No. 14/226,075 entitled MODULAR POWERED SURGICAL INSTRUMENT WITH DETACHABLE SHAFT ASSEMBLIES;

US Patent Application Ser. No. 14 / 226,093 entitled FEEDBACK ALGORITHMS FOR MANUAL BAILOUT SYSTEMS FOR SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 14/226,116 entitled SURGICAL INSTRUMENT UTILIZING SENSOR ADAPTATION;

US Patent Application Ser. No. 14/226,071 entitled SURGICAL INSTRUMENT CONTROL CIRCUIT HAVING A SAFETY PROCESSOR;

US Patent Application Ser. No. 14/226 097 entitled SURGICAL INSTRUMENT COMPRISING INTERACTIVE SYSTEMS;

US Patent Application Ser. No. 14/226 126, entitled INTERFACE SYSTEMS FOR USE WITH SURGICAL INSTRUMENTS;

US Patent Application Ser. No. 14/226,133 entitled MODULAR SURGICAL INSTRUMENT SYSTEM;

US Patent Application Ser. No. 14 / 226,081 entitled SYSTEMS AND METHODS FOR CONTROLLING A SEGMENTED CIRCUIT;

US Patent Application Ser. No. 14 / 226,076, entitled POWER MANAGEMENT THROUGH SEGMENTED CIRCUIT AND VARIABLE VOLTAGE PROTECTION;

US Patent Application Ser. No. 14 / 226,111, entitled SURGICAL STAPLING INSTRUMENT SYSTEM; and

US Patent Application Ser. No. 14 / 226,125 entitled SURGICAL INSTRUMENT COMPRISING A ROTATABLE SHAFT.

The applicant of this application is also the owner of applications for US patents indicated below, each of which is fully incorporated herein by reference:

US patent application No. 12 / 894,311, entitled SURGICAL INSTRUMENTS WITH RECONFIGURABLE SHAFT SEGMENTS; the current publication of US Patent No. 2012/0080496;

US patent application No. 12 / 894,340, entitled SURGICAL STAPLE CARTRIDGES SUPPORTING NON-LINEARLY ARRANGED STAPLES AND SURGICAL STAPLING INSTRUMENTS WITH COMMON STAPLE-FORMING POCKETS; the current publication of US Patent No. 2012/0080482;

US patent application No. 12 / 894,327, entitled JAW CLOSURE ARRANGEMENTS FOR SURGICAL INSTRUMENTS; the current publication of US Patent No. 2012/0080499;

US Patent Application No. 12 / 894,351 entitled SURGICAL CUTTING AND FASTENING INSTRUMENTS WITH SEPARATE AND DISTINCT FASTENER DEPLOYMENT AND TISSUE CUTTING SYSTEMS; the current publication of US Patent No. 2012/0080502;

US patent application No. 12 / 894,338, entitled IMPLANTABLE FASTENER CARTRIDGE HAVING A NON-UNIFORM ARRANGEMENT; the current publication of US Patent No. 2012/0080481;

US patent application No. 12 / 894,369, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING A SUPPORT RETAINER; the current publication of US Patent No. 2012/0080344;

 US patent application No. 12 / 894,312, entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING MULTIPLE LAYERS; the current publication of US Patent No. 2012/0080479;

US Patent Application No. 12 / 894,377 entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE; currently US patent No. 8,393,514;

US patent application No. 12 / 894,339, entitled SURGICAL STAPLING INSTRUMENT WITH COMPACT ARTICULATION CONTROL ARRANGEMENT; the current publication of US Patent No. 2012/0080500;

US patent application No. 12 / 894,360, entitled SURGICAL STAPLING INSTRUMENT WITH A VARIABLE STAPLE FORMING SYSTEM; the current publication of US Patent No. 2012/0080484;

US patent application No. 12 / 894,322, entitled SURGICAL STAPLING INSTRUMENT WITH INTERCHANGEABLE STAPLE CARTRIDGE ARRANGEMENTS; currently US patent No. 8,740,034;

US patent application No. 12 / 894,350, entitled SURGICAL STAPLE CARTRIDGES WITH DETACHABLE SUPPORT STRUCTURES; the current publication of US Patent No. 2012/0080478;

US patent application No. 12 / 894,383 entitled IMPLANTABLE FASTENER CARTRIDGE COMPRISING BIOABSORBABLE LAYERS; currently US patent No. 8,752,699;

US patent application No. 12 / 894,389, entitled COMPRESSIBLE FASTENER CARTRIDGE; currently US patent No. 8,740,037;

US patent application No. 12 / 894,345, entitled FASTENERS SUPPORTED BY A FASTENER CARTRIDGE SUPPORT; the current publication of US Patent No. 2012/0080483;

US patent application No. 12 / 894,306, entitled COLLAPSIBLE FASTENER CARTRIDGE; the current publication of US Patent No. 2012/0080332;

US Patent Application No. 12 / 894,318, entitled FASTENER SYSTEM COMPRISING A PLURALITY OF CONNECTED RETENTION MATRIX ELEMENTS; the current publication of US Patent No. 2012/0080480;

US patent application No. 12 / 894,330 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND AN ALIGNMENT MATRIX; currently US Patent No. 8,757,465;

US patent application No. 12 / 894,361, entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX; currently US Patent No. 8,529,600;

US Patent Application No. 12 / 894,367 entitled FASTENING INSTRUMENT FOR DEPLOYING A FASTENER SYSTEM COMPRISING A RETENTION MATRIX; the current publication of US Patent No. 2012/0080485;

US Patent Application No. 12 / 894,388 entitled FASTENER SYSTEM COMPRISING A RETENTION MATRIX AND A COVER; currently US patent No. 8,474,677;

US patent application No. 12 / 894,376 entitled FASTENER SYSTEM COMPRISING A PLURALITY OF FASTENER CARTRIDGES; the current publication of US Patent No. 2012/0080486;

US Patent Application No. 13 / 097,865 entitled SURGICAL STAPLER ANVIL COMPRISING A PLURALITY OF FORMING POCKETS; the current publication of US Patent No. 2012/0080488;

US Patent Application No. 13 / 097,936, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER; currently US patent No. 8,657,176;

US Patent Application No. 13 / 097,954, entitled STAPLE CARTRIDGE COMPRISING A VARIABLE THICKNESS COMPRESSIBLE PORTION; the current publication of US Patent No. 2012/0080340;

US Patent Application No. 13 / 097,856, entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF; the current publication of US Patent No. 2012/0080336;

US Patent Application No. 13 / 097,928, entitled TISSUE THICKNESS COMPENSATOR COMPRISING DETACHABLE PORTIONS; currently US patent No. 8,746,535;

US patent application number 13 / 097,891, entitled TISSUE THICKNESS COMPENSATOR FOR A SURGICAL STAPLER COMPRISING AN ADJUSTABLE ANVIL; the current publication of US Patent No. 2012/0080489;

US Patent Application No. 13 / 097,948, entitled STAPLE CARTRIDGE COMPRISING AN ADJUSTABLE DISTAL PORTION; the current publication of US Patent No. 2012/0083836;

US patent application No. 13 / 097,907 entitled COMPRESSIBLE STAPLE CARTRIDGE ASSEMBLY; the current publication of US Patent No. 2012/0080338;

US Patent Application No. 13 / 097,861, entitled TISSUE THICKNESS COMPENSATOR COMPRISING PORTIONS HAVING DIFFERENT PROPERTIES; the current publication of US Patent No. 2012/0080337;

US patent application number 13 / 097,869, entitled STAPLE CARTRIDGE LOADING ASSEMBLY; the current publication of US Patent No. 2012/0160721;

US Patent Application No. 13 / 097,917 entitled COMPRESSIBLE STAPLE CARTRIDGE COMPRISING ALIGNMENT MEMBERS; the current publication of US Patent No. 2012/0083834;

US Patent Application No. 13 / 097,873, entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE PORTION; currently US patent No. 8,740,038;

US Patent Application No. 13 / 097,938, entitled STAPLE CARTRIDGE COMPRISING COMPRESSIBLE DISTORTION RESISTANT COMPONENTS; the current publication of US Patent No. 2012/0080491;

US Patent Application No. 13 / 097,924, entitled STAPLE CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2012/0083835;

US Patent Application No. 13 / 242,029, entitled SURGICAL STAPLER WITH FLOATING ANVIL; the current publication of US Patent No. 2012/0080493;

US patent application number 13 / 242,066, entitled CURVED END EFFECTOR FOR A STAPLING INSTRUMENT; the current publication of US Patent No. 2012/0080498;

US Patent Application Ser. No. 13 / 242,086, entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK; The current publication of US Patent No. 2013/0075450;

US Patent Application Ser. No. 13 / 241,912 entitled STAPLE CARTRIDGE INCLUDING COLLAPSIBLE DECK ARRANGEMENT; the current publication of US Patent No. 2013/0075448;

US Patent Application Ser. No. 13 / 241,922 entitled SURGICAL STAPLER WITH STATIONARY STAPLE DRIVERS; the current publication of US Patent No. 2013/0075449;

US Patent Application No. 13 / 241,637, entitled SURGICAL INSTRUMENT WITH TRIGGER ASSEMBLY FOR GENERATING MULTIPLE ACTUATION MOTIONS; the current publication of US Patent No. 2012/0074201;

US patent application No. 13 / 241,629, entitled SURGICAL INSTRUMENT WITH SELECTIVELY ARTICULATABLE END EFFECTOR; the current publication of US Patent No. 2012/0074200;

US patent application number 13 / 433,096, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF CAPSULES; the current publication of US Patent No. 2012/0241496;

US patent application number 13 / 433,103, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF LAYERS; the current publication of US Patent No. 2012/0241498;

US patent application number 13 / 433,098, entitled EXPANDABLE TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2012/0241491;

US Patent Application No. 13 / 433,102, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A RESERVOIR; the current publication of US Patent No. 2012/0241497;

US Patent Application No. 13 / 433,114, entitled RETAINER ASSEMBLY INCLUDING A TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2012/0241499;

US patent application number 13 / 433,136, entitled TISSUE THICKNESS COMPENSATOR COMPRISING AT LEAST ONE MEDICAMENT; the current publication of US Patent No. 2012/0241492;

US Patent Application No. 13 / 433,141, entitled TISSUE THICKNESS COMPENSATOR COMPRISING CONTROLLED RELEASE AND EXPANSION; the current publication of US Patent No. 2012/0241493;

US patent application number 13 / 433,144, entitled TISSUE THICKNESS COMPENSATOR COMPRISING FIBERS TO PRODUCE A RESILIENT LOAD; the current publication of US Patent No. 2012/0241500;

US Patent Application No. 13 / 433,148 entitled TISSUE THICKNESS COMPENSATOR COMPRISING STRUCTURE TO PRODUCE A RESILIENT LOAD; the current publication of US Patent No. 2012/0241501;

US patent application number 13 / 433,155, entitled TISSUE THICKNESS COMPENSATOR COMPRISING RESILIENT MEMBERS; the current publication of US Patent No. 2012/0241502;

US patent application No. 13 / 433,163, entitled METHODS FOR FORMING TISSUE THICKNESS COMPENSATOR ARRANGEMENTS FOR SURGICAL STAPLERS; the current publication of US Patent No. 2012/0248169;

US Patent Application Ser. No. 13 / 433,167 entitled TISSUE THICKNESS COMPENSATORS; the current publication of US Patent No. 2012/0241503;

US patent application number 13 / 433,175, entitled LAYERED TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2012/0253298;

US patent application number 13 / 433,179, entitled TISSUE THICKNESS COMPENSATORS FOR CIRCULAR SURGICAL STAPLERS; the current publication of US Patent No. 2012/0241505;

US patent application number 13 / 763,028, entitled ADHESIVE FILM LAMINATE; the current publication of US Patent No. 2013/0146643;

US Patent Application Ser. No. 13 / 433,115 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CAPSULES DEFINING A LOW PRESSURE ENVIRONMENT; the current publication of US Patent No. 2013/0256372;

US Patent Application Ser. No. 13 / 433,118, entitled TISSUE THICKNESS COMPENSATOR COMPRISED OF A PLURALITY OF MATERIALS; the current publication of US Patent No. 2013/0256365;

US Patent Application Ser. No. 13 / 433,135 entitled MOVABLE MEMBER FOR USE WITH A TISSUE THICKNESS COMPENSATOR; The current publication of US Patent No. 2013/0256382;

US Patent Application Ser. No. 13 / 433,140 entitled TISSUE THICKNESS COMPENSATOR AND METHOD FOR MAKING THE SAME; The current publication of US Patent No. 2013/0256368;

US Patent Application No. 13 / 433,129, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A PLURALITY OF MEDICAMENTS; the current publication of US Patent No. 2013/0256367;

US Patent Application Ser. No. 11 / 216,562, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, currently US Patent No. 7,669,746;

US Patent Application Ser. No. 11 / 714,049, entitled SURGICAL STAPLING DEVICE WITH ANVIL HAVING STAPLE FORMING POCKETS OF VARYING DEPTHS, is currently published in US Patent No. 2007/0194082;

US Patent Application Ser. No. 11 / 711,979, entitled SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, currently published US Patent No. 8,317,070;

US Patent Application Ser. No. 11/711,975, entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVERS OF DIFFERENT HEIGHT, is currently published US Patent No. 2007/0194079;

US Patent Application Ser. No. 11 / 711,977 entitled SURGICAL STAPLING DEVICE WITH STAPLE DRIVER THAT SUPPORTS MULTIPLE WIRE DIAMETER STAPLES, currently US Patent No. 7,673,781;

US Patent Application Ser. No. 11 / 712,315, entitled SURGICAL STAPLING DEVICE WITH MULTIPLE STACKED ACTUATOR WEDGE CAMS FOR DRIVING STAPLE DRIVERS, is currently US Patent No. 7,500,979;

US Patent Application Ser. No. 12 / 038,939, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, currently US Patent No. 7,934,630;

US Patent Application Ser. No. 13/020 263, entitled SURGICAL STAPLING SYSTEMS THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, currently published US Patent No. 8,636,187;

US Patent Application Ser. No. 13 / 118,278, entitled ROBOTICALLY-CONTROLLED SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, currently published US Patent No. 2011/0290851;

US Patent Application Ser. No. 13 / 369,629, entitled ROBOTICALLY-CONTROLLED CABLE-BASED SURGICAL END EFFECTORS, currently US Patent Publication No. 2012/0138660;

US patent application number 12 / 695,359, entitled SURGICAL STAPLING DEVICES FOR FORMING STAPLES WITH DIFFERENT FORMED HEIGHTS, is currently US patent No. 8,464,923;

US Patent Application Ser. No. 13/072 923, entitled STAPLE CARTRIDGES FOR FORMING STAPLES HAVING DIFFERING FORMED STAPLE HEIGHTS, currently US Patent No. 8,567,656;

US patent application number 13 / 766,325, entitled LAYER OF MATERIAL FOR A SURGICAL END EFFECTOR; The current publication of US Patent No. 2013/0256380;

US Patent Application Ser. No. 13 / 763,078, entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTO; the current publication of US Patent No. 2013/0256383;

US Patent Application Ser. No. 13 / 763,094, entitled LAYER COMPRISING DEPLOYABLE ATTACHMENT MEMBERS; the current publication of US Patent No. 2013/0256377;

US Patent Application Ser. No. 13/763,106, entitled END EFFECTOR COMPRISING A DISTAL TISSUE ABUTMENT MEMBER; The current publication of US Patent No. 2013/0256378;

US Patent Application Ser. No. 13 / 433,147 entitled TISSUE THICKNESS COMPENSATOR COMPRISING CHANNELS; the current publication of US Patent No. 2013/0256369;

US patent application No. 13/763 112, entitled SURGICAL STAPLING CARTRIDGE WITH LAYER RETENTION FEATURES; the current publication of US Patent No. 2013/0256379;

US Patent Application Ser. No. 13 / 763,035 entitled ACTUATOR FOR RELEASING A TISSUE THICKNESS COMPENSATOR FROM A FASTENER CARTRIDGE; the current publication of US Patent No. 2013/0214030;

US Patent Application Ser. 13 / 763,042 entitled RELEASABLE TISSUE THICKNESS COMPENSATOR AND FASTENER CARTRIDGE HAVING THE SAME; the current publication of US Patent No. 2013/0221063;

US Patent Application Ser. No. 13/763,048 entitled FASTENER CARTRIDGE COMPRISING A RELEASABLE TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2013/0221064;

US Patent Application Ser. No. 13/763,054, entitled FASTENER CARTRIDGE COMPRISING CUTTING MEMBER FOR RELEASING A TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2014/0097227;

US Patent Application Ser. No. 13/763,065 entitled FASTENER CARTRIDGE COMPRISING A RELEASABLY ATTACHED TISSUE THICKNESS COMPENSATOR; the current publication of US Patent No. 2013/0221065;

US Patent Application Ser. No. 13 / 763,021 entitled STAPLE CARTRIDGE COMPRISING A RELEASABLE COVER;

US Patent Application Ser. No. 13 / 763,078, entitled ANVIL LAYER ATTACHED TO A PROXIMAL END OF AN END EFFECTO; the current publication of US Patent No. 2013/0256383;

US Patent Application Ser. No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; the current publication of US Patent No. 2013/0161374;

US Patent Application Ser. No. 13 / 463,147 entitled IMPLANTABLE ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES; The current publication of US Patent No. 2013/0292398;

US Patent Application Ser. No. 13 / 763,192 entitled MULTIPLE THICKNESS IMPLANTABLE LAYERS FOR SURGICAL STAPLING DEVICES; the current publication of US Patent No. 2013/0146642;

US Patent Application Ser. No. 13/763 161 entitled RELEASABLE LAYER OF MATERIAL AND SURGICAL END EFFECTOR HAVING THE SAME; the current publication of US Patent No. 2013/0153641;

US Patent Application Ser. No. 13 / 763,177, entitled ACTUATOR FOR RELEASING A LAYER OF MATERIAL FROM A SURGICAL END EFFECTOR; the current publication of US Patent No. 2013/0146641;

US Patent Application No. 13 / 763,037 entitled STAPLE CARTRIDGE COMPRISING A COMPRESSIBLE PORTION;

US Patent Application Ser. No. 13 / 433,126, entitled TISSUE THICKNESS COMPENSATOR COMPRISING TISSUE INGROWTH FEATURES; the current publication of US Patent No. 2013/0256366;

US Patent Application Ser. No. 13 / 433,132 entitled DEVICES AND METHODS FOR ATTACHING TISSUE THICKNESS COMPENSATING MATERIALS TO SURGICAL STAPLING INSTRUMENTS; The current publication of US Patent No. 2013/0256373.

US Patent Application No. 13 / 851,703, entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR INCLUDING OPENINGS THEREIN;

US Patent Application No. 13 / 851,676, entitled TISSUE THICKNESS COMPENSATOR COMPRISING A CUTTING MEMBER PATH;

US Patent Application No. 13 / 851,693, entitled FASTENER CARTRIDGE ASSEMBLIES;

US Patent Application Ser. No. 13 / 851,684 entitled FASTENER CARTRIDGE COMPRISING A TISSUE THICKNESS COMPENSATOR AND A GAP SETTING ELEMENT;

US Patent Application Ser. No. 14 / 187,387, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; the current publication of US Patent No. 2014/0166724;

US Patent Application Ser. No. 14/187,395, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; the current publication of US Patent No. 2014/0166725;

US Patent Application Ser. No. 14 / 187,400, entitled STAPLE CARTRIDGE INCLUDING A BARBED STAPLE; the current publication of US Patent No. 2014/0166726;

US Patent Application Ser. No. 14/187,383 entitled IMPLANTABLE LAYERS AND METHODS FOR ALTERING IMPLANTABLE LAYERS FOR USE WITH SURGICAL FASTENING INSTRUMENTS;

US Patent Application Ser. No. 14 / 187,386, entitled IMPLANTABLE LAYERS AND FESTENING;

US Patent Application Ser. No. 14 / 187,390, entitled IMPLANTABLE LAYERS FOR USE WITH A SURGICAL FASTENING INSTRUMENT;

US Patent Application Ser. No. 14/187,389, entitled IMPLANTABLE LAYER ASSEMBLIES;

US Patent Application Ser. No. 14/187,385 entitled IMPLANTABLE LAYERS COMPRISING A PRESSED REGION; and

US Patent Application Ser. No. 14/187,384 entitled FASTENING SYSTEM COMPRISING A FIRING MEMBER LOCKOUT.

This document provides detailed information necessary to understand the overall design, functionality, features of manufacturing and use of various embodiments of the product (the description provided in the specifications and illustrated in the accompanying drawings). Professionals with skill in the art should understand that the various embodiments of the product can be applied without taking into account the detailed information set forth in this document. Well-known principles of operation, components and elements have not been given in this document a detailed description in order not to complicate the understanding of the embodiments described in the specification. Professionals with an average skill in this field should understand that the embodiments described and illustrated herein are not restrictive. It should be borne in mind that certain structural and functional features described in this document may be illustrative or explanatory. Modification and modification of this document may be made within the scope of the invention.

In the present description, reference to “various embodiments”, “certain embodiments”, “one embodiment”, “embodiment” or the like means that a particular feature, structure or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, the phrases “in various embodiments,” “in some embodiments,” “in one embodiment,” or “in an embodiment,” as well as similar phrases in the specification text do not necessarily refer to the same embodiment. Moreover, specific elements, structures or characteristics can be combined in any suitable way in one or more embodiments. Thus, the particular features, structures, or characteristics illustrated or described in connection with one embodiment may be combined without distinction, in whole or in part, with the features, designs, or characteristics of one or more other embodiments. It should be understood that for brevity and clarity, spatial terms such as “vertical”, “horizontal”, “up” and “down” can be used in this document in relation to the described embodiments. These terms are used to facilitate understanding of the text and are not restrictive or absolute.

Presented in FIG. 1, a surgical stapling-cutting instrument 10 may include a handle 12, which allows adjusting the position of the working portion 14 in the surgical field. In various embodiments, the implementation of the working part 14 may have an end effector 16 attached to an elongated shaft 18. In various circumstances, the working part 14 can be adjusted and resized to be inserted through the cannula of a trocar (not shown) into the surgical field to perform, for example, endoscopic or laparoscopic procedure. The end effector 16 may consist of the upper branch or the stop 20 and the lower branch 22, in which the stop 20 may move between the open and closed position when moving or pressing the closing trigger 24 of the handle 12 towards the pistol grip handle 26 of the handle 12. In various embodiments pressing the closing trigger 24 can advance the outer locking sleeve 28 of the elongated shaft 18 so that the outer locking sleeve 28 can come into contact with the stop 20 and rotate the stop 20 to the closed position. In certain circumstances, the surgeon can rotate the working part 14 along the longitudinal axis by turning the rotary knob of the shaft 30. In any case, after inserting the end effector 16 into the infused body cavity, the closing trigger 24 can be released, allowing the spring (not shown) to open the stop 20 and place it relative to the target tissue. In various embodiments, the implementation of the closing trigger 24 may be locked in the depressed state, and in at least one embodiment, the handle 12 may further comprise a lock release lever 44, which can be pressed to release the lock of the closing trigger 24. After placing the stop 20 and The lower branch 22 can be pressed against the fabric in the operating field again by closing the trigger mechanism 24 to close the stop 20 and press the fabric to the cassette 42 with brackets attached to the lower branch 22.

As soon as the stop 20 is closed, the trigger 32 can be retracted or pressed in the direction of the closing trigger 24 and the pistol grip 26 to activate or actuate the trigger element and advance it from the non-activated position. In various embodiments, the starting element may include a starting rod in the proximal part 34, which is connected to the starting rod in the distal part 36. In at least one embodiment, the starting lever 34 and (or) the starting rod 36 may be supported in the main shaft housing 38 18, which passes between the handle 12 and the end effector 16. When starting the starting element, the starting rod 36 can be moved distally in the elongated channel of the cartridge with brackets 40 inside the lower jaw 22 and the cartridge with brackets 42 located in the channel of the cassette 40. In various embodiments, the implementation (see FIG. 2) of the starting rod 36 may contain an adjacent part 48 connected to the E-shaped element 50, which can progressively move in the end clamp 16. The E-shaped element 50 may consist of a vertical part 52, which can pass through a narrow longitudinal groove of the stop 58 and facing to the fabric surface 60 of the stop 20, a narrow vertical groove 62 in the cassette with brackets 42 and a narrow longitudinal channel 64 in the elongated channel for brackets 40 when the E-shaped element 50 relocation etsya distally. As for FIG. 2 and 3, the groove of the anvil 58 may be located higher in the anvil 20 and at one end have a longitudinal channel 66 extended to the sides, having an appropriate size and shape for receiving the upper spoke 54, which expands to the sides starting from the vertical part 52. The channel 64 may be located lower in the channel 40 and at one end have a longitudinal channel 68 expanded to the sides, having an appropriate size and shape for receiving one or more lower legs 70 extending to the sides of the vertical part 52.

In addition to the above, in various embodiments of the invention, the E-shaped element 50 may additionally contain one (or more) middle rod 72, which can move away from the vertical part 52 and which can be configured to slide along the upper surface of the lower groove 74 of the cartridge with brackets 42. In certain embodiments, the middle rods 72 can be configured to accommodate a cassette with brackets 42 and to accommodate a cassette with brackets 42 in channel 40. Longitudinal working cavity 75, sf accommodated in a cassette with brackets 42 over the lower chute 74, has a certain size, allowing middle rods 72 to pass through the cassette with brackets 42. In various embodiments, the E-shaped element 50 may additionally have a distal mating surface 76 transmitting torque, which may be made so as to pass through the vertical groove 62 in the cassette with brackets 42 and distally advance the blade guide 78 through the cassette with brackets 42. In certain embodiments, the blade guide 78 can It may be embedded in the E-shaped element 50, while in other embodiments the blade guide 78 may be located in the staple cartridge 42 and come into contact with the mating surface 76 transmitting the torque when the E-shaped element 50 moves distally. The vertical portion 52 of the E-shaped element 50 may additionally have a cutting surface 80, which extends along the distal end above the distal mating surface 76 transmitting torque, and below the upper rod 54, which cuts the clamped fabric 46 as the fabric 46 is stapled . In FIG. 4, the blade guides 78 may be configured to engage one or more levers for feeding brackets 82 and move the levers for feeding brackets 82 up toward the stop 20. In various embodiments of the invention, brackets, for example brackets 83, may be located on the levers for feeding brackets 82 and (or) supported by them so that when lifting the levers for feeding brackets 82 upward, brackets 83 also rise upwards. In at least one embodiment of the invention, brackets 83 may also be partially located in recesses, or sockets, for brackets 84 in case 85 of a cassette with brackets 42. In this case, when brackets 83 are raised upward, brackets 83 may come into contact with an anvil plate 20 and shot out of the recesses for the brackets 84. In at least one embodiment of the invention (see FIG. 4), the lower trough 74 may be connected to the body of the cassette 85 so as to hold the levers for feeding the brackets 82 and the brackets 83 in the cassette with brackets 42 until brackets 83 will not be used according to the method described above.

When using (see FIGS. 5 and 6), the abutting surface 20 may be located on one side of the fabric 46, and the lower tab 22 on the other side of the fabric 46 so that when the stop 20 is closed on the fabric, the surface 60 of the support 20 and facing the cloth plate 90 of the cartridge with brackets 42 could squeeze the fabric 46 with uncompressed 91 to a compressed thickness 92. To connect the brackets and cut the fabric 46 according to the method described above, the blade guide 78 can be moved distally in the bracket with brackets 42 to raise the arms for feeding the brackets 82 in the direction of the stop 20 and d form brackets 83. In various embodiments, each lever for feeding brackets 82 can have one or more slots specified in this document, which can be made to accept and hold brackets 83 in the desired position with the possibility of subsequent removal of base 87. At least at least in one embodiment, each bracket 83 may contain one or more legs of bracket 88, originating from the base 87. The legs of bracket 88 may be directed upward into the recesses for brackets 84. In various embodiments, eniya tips of the legs of brackets 88 may be recessed with respect to the plate or to the tissue facing surface 90 of the staple cartridge 85 when the brackets 83 are in unused condition. When the brackets 83 are lifted up by the levers 82, the tips of the legs of the brackets 88 can exit the recesses for the brackets 84, pass through the fabric 46 and come into contact with the slots to form the brackets on the stop 89, opposite the recesses for the brackets 84. 89 can be designed in such a way as to give the brackets 83 the desired shape, for example, the B-shape shown in FIG. 5. When engaging the brackets 83 (see FIG. 6), the cutting edge 80 may cut the fabric 46 into the part 94 that is stitched with brackets.

As described above, the branches of the end effector can be made to compress the fabric stitched with brackets. However, in different circumstances, the fabric may be slippery, for example, and at least part of the fabric may slide relative to the branches. Under certain circumstances, the fabric can slide out of the distal end of the end effector in the longitudinal direction and (or) slip out on the sides of the end effector in the direction transverse to the longitudinal direction. In some situations, a part of the tissue may exit the distal end of the end effector and (or) on the sides of the end effector at the time of compression. In various embodiments of the invention described herein, a staple cartridge may have one or more design features for holding tissue that can be used to prevent or at least reduce the likelihood of tissue slipping relative to the end effector.

In various embodiments of the present invention, see FIG. 7 and 8, a cassette, such as, for example, cassette 142, may include a cassette case 185 and a plurality of brackets, for example, staples 187 (FIG. 9), partially housed within the cassette case 185. The cassette case 185 may have a proximal end 141 and a distal end 143, while the proximal end 141 can be made so that it can be inserted into the proximal end of the channel of the cartridge with brackets, and the distal end 143 can be made so that it can be inserted into the distal end of the channel of the cartridge with brackets. In at least one embodiment of the invention, the cassette case 185 may have a plurality of recesses for brackets 184, each of which may be designed to receive the brace 187. In certain alternative embodiments of the invention, which are not shown in FIG. brackets can contain more than one brace. In any case, the recesses for the brackets 184 may be arranged in several rows inside the cassette case 185. In particular, in at least one embodiment of the invention, the recesses for the brackets 184 may be arranged in three rows, for example, on the first side 145 of the cassette body 185 and in three rows, for example, on the second side 147 of the body of the cassette 185. In at least one such embodiment of the invention, the first side 145 and the second side 147 of the body of the cassette 185 can be separated by a chute for the knife 162, which can be designed so that would take with the possibility of sliding cutting tools. In various embodiments, the cassette may have any other number of rows of brackets, for example, two rows of brackets or four rows of brackets, on each side of the chute for the knife 162. In various embodiments of the invention (see FIG. 9), the cartridge with brackets 142 may additionally contain a plurality levers for feeding brackets 182, designed to support brackets 187 and (or) push brackets 187 out of recesses for brackets 184. In certain embodiments, each recess for brackets 184 may have an open end ( light) 110 to the removable top portion 190 of the cassette housing with brackets 185 through which the bracket 187 may be pushed.

In various embodiments, the implementation (mainly in the embodiment shown in FIG. 8) the recesses for brackets 184 may be staggered relative to each other. For example, the recesses for brackets 184 on the first side 145 of the body of the cassette 185 may be located in the closest to the center row of recesses for brackets 184, the middle row of recesses for brackets 184 and the outermost row of recesses for brackets 184, and the grooves for brackets 184 in one the row may not be parallel in the transverse direction to the recesses for the staples 184 in one or both of the other rows. In at least one embodiment, each recess for brackets 184 may have a proximal end 111 and a distal end 112. The proximal end 111 of each recess for brackets 184 may be located closer to the proximal end 141 of the cassette case 185 than the distal end 112. Similarly, distal the end 112 of each recess for brackets 184 may be located closer to the distal end 143 of the body of the cassette 185 than the proximal end 111. In various embodiments of the invention, the number of recesses closest to the center for brackets 184 can be positioned in such a way that the distal ends 112 of the recesses for brackets 184 in the row closest to the center are distal with respect to the distal ends of the 112 grooves for brackets 184 in the middle row of the grooves for brackets 184. Similarly, the most distant from the center of the grooves for brackets 184 may be located in such a way that the distal ends 112 of the recesses for brackets 184 in the row furthest from the center are located distally with respect to the distal ends of the 112 grooves for the brackets in the middle row of the corner tions staple 184. For example, the most extreme distal recess brackets 184 in the closest to the center of the row may be located distal to the most distal extreme deepening of the staple 184 in the middle row. Similarly, the outermost distal groove for brackets 184 in the row furthest from the center may be located distally with respect to the outermost distal groove for brackets 184 in the middle row. In certain embodiments of the invention, the recesses for the staples 184 in the closest to the center row and the recesses for the staples 184 in the furthest from the center row may be parallel to each other in the transverse direction, so that, firstly, the distal ends 112 of the closest recesses to the center for brackets 184 are located parallel to the distal ends 112 of the most distant from the center of the recesses for brackets 184 and, secondly, the proximal ends 111 of the closest to the center of the recesses for brackets 184 are located parallel to the proximal m ends 111 of the most distant from the center of the recesses for brackets 184. In various embodiments, each recess for brackets 184, as well as their lumens 110, can have the same or at least approximately the same configuration, and in at least one embodiment of the invention, the recesses for brackets 184 may be equidistant or at least practically equidistant with respect to each other in a series of brackets.

In various embodiments of the invention (see FIG. 7 and 8), the body 185 of the cassette with brackets 142 may additionally contain one or more protrusions, for example protrusions 113, 114 and 115, which can be made to come into contact and compress the target tissue . In particular (see FIG. 8A), the end effector stop 120 can be closed to press fabric T to the cassette with brackets 142. In this case, the platform 190 facing the fabric and the protrusions 113, 114 and 115 extending from it can capture the fabric. Under certain conditions, when the stop 120 is closed, the stop 120 can push the fabric to the cassette with brackets 142 so that the fabric first comes in contact with the protrusions 113, 114 and 115, and then touches the cassette case 190. Under other conditions, the cassette with brackets 142 can be placed close to the fabric so that the protrusions 113, 114 and 115 come into contact with the fabric before the fabric contacts the platform 190. In any case, the contact of the projections 113, 114 and 115 with the fabric can prevent or at least reduce the probability of relative movement of the fabric and cassette with brackets 142. In certain embodiments of the invention, the protrusions 113, 114 and 115 may extend upward from the flat or at least substantially flat body of the cassette 190 and may denote one or more sockets or channels, which, for example, can be designed so that take a portion of the fabric and prevent the relative movement of tissue in the longitudinal and (or) transverse direction of the end effector, especially if the fabric is only partially clamped between the stop 120 and the protrusions 113, 114 and 115. In various embodiments, Due to the fact that the protrusions 113, 114 and 115 extend above the cassette case 190, the fabric between the stop 120 and the protrusions 113, 114 and 115 can be clamped before the fabric between the stop 120 and the case 190 is clamped. As a result, under certain conditions, the fabric located between the stop 120 and the protrusions 113, 114 and 115 can be pre-compressed, i.e. at least partially compressed, before other parts of the fabric between the stop 120 and the body are compressed. cassette 190. Under various conditions, such pre-compression of a piece of fabric allows you to control the fabric and prevents the fabric from slipping out of the end effector before the fabric is fully clamped according to the above detailed description.

In various embodiments, the implementation (see FIG. 7 and 8) the protrusions 113 extending from the body of the cassette 190 can extend around the proximal ends of the 111 clearances of the recesses for the brackets 110. Similarly, the projections 114 go from the body of the cassette 190 and can pass around the distal ends 112 lumens of the recesses for brackets 110. In various embodiments, the proximal protrusions 113 and distal protrusions 114 can be made to grab the fabric located above and / or around the recesses for the brackets 184, and to keep these segments of the fabric in need position as the tissue shrinks and (or) stitched brackets. In other words, holding the fabric above and / or around the recesses for brackets 184 can provide local control of the tissue segments that will be stitched with brackets and prevent or at least limit the relative movement of the tissue segments relative to the bracket with brackets 142. In various embodiments, the protrusions 113 and 114 may be located around the lumens 110 of all the recesses for brackets 184 or only a few recesses for brackets 184. In at least one embodiment of the invention, the box body you may have protrusions 113 and 114 extending only around recesses for brackets 184 in the first and second side rows 145 and 147 furthest from the center. In such embodiments, the protrusions surrounding the rows of recesses most distant from the center for brackets 184 can effectively block the displacement fabric in the terminal clamp in the transverse direction. In certain embodiments, the cassette body may contain only proximal protrusions 113 extending around the proximal ends 111 of the most proximal recesses for brackets 184, and / or distal protrusions 114 passing around the distal ends 112 of the most distal recesses for brackets 184. In such embodiments, the protrusions surrounding the most proximal and distal grooves for the staples 184 can effectively block the longitudinal movement of the fabric in the terminal clamp.

In addition to the above, in various embodiments of the invention, each proximal protrusion 113 may have, for example, an arcuate or curved profile that surrounds the proximal end 111 of the lumen 110. The arcuate profile of each proximal protrusion 113 may be determined by one radius of the bend line or several radii of the bend line. Similarly, each distal protrusion 114 may have, for example, an arcuate or curved profile that surrounds the distal end 112 of the lumen 110. The arcuate profile of each distal protrusion 114 may be determined by one or several bend radii. In addition to the above, in certain embodiments of the invention, each protrusion 113 and 114 may form a recess that can receive a segment of clamped tissue and prevent the segment of tissue from being displaced in the longitudinal and / or transverse direction relative to the cartridge with brackets 142. In various embodiments of the invention, the cartridge with brackets 142 can additionally have intermediate protrusions 115, which can pass between adjacent protrusions 113 and 114 and (or) connect them in adjacent rows of recesses with brackets and 184. In at least one embodiment, one or more protrusions 113, 114 and 115 may jointly form a wavy protuberance overlapping the first side 145 or the second side 147 of the cassette 185, and in at least one embodiment the wavy protrusion may pass between the middle part and the side part of the body of the cassette 142. In various embodiments, each undulating protrusion may consist of a plurality of undulating parts wrapping, for example, the proximal and distal ends of the recesses for I brackets 184. In various embodiments of the invention, each protrusion 113, 114 and 115 may have a height determined by the platform 190 of the cassette; in certain embodiments, the height of each protrusion 113, 114 and 115 may be the same or at least substantially the same throughout the length of the protrusion. In at least one embodiment, each protrusion 113, 114, and 115 may have the same or at least substantially the same height.

As described above, in various embodiments, the staples in the cassette case may include a staple located therein, while the entire amount of staples may be located below the top surface or the cassette platform facing the fabric when the staple is in an unused position. In other specific embodiments of the invention, at least a portion of the bracket, such as the tips of the legs of the bracket, may protrude above the top surface or the cassette-facing platform when the brackets are in an unused position. In some such embodiments of the invention, the tips of the brackets may protrude from the body and hook the fabric when inserting the cartridge with the brackets into the surgical field. In at least one embodiment of the invention (see FIG. 9), for example, the protrusions 113 and 114, which protrude above the cassette-facing platform 190, may at least partially surround and protect the legs 183 of the brackets 187 when they protrude above platform 190 cassettes in unused position. Although the protrusions 113 and 114 may not completely surround each lumen 110, in various embodiments of the invention, the proximal protrusion 113 may sufficiently surround one of the tips of the stem of the bracket, and the distal protrusion 114 may sufficiently surround the other tip of the stem of the bracket to they didn’t touch the fabric before the fabric was pressed to the cassette with brackets 142 and (or) brackets 187 pushed out of the cassette case 142. At least in one embodiment of the invention, the tips of the brace legs can to protrude below the upper surface 116 of the projections 113 and 114. In certain embodiments of the invention, the tips of the legs of the bracket may be in the same plane with the upper surface 116 of the projections 113 and 114. In various embodiments of the invention, the protection provided by, for example, the projections 113 and 114 allows the use of larger brackets without the risk of protrusion of the ends of the brackets from the cassette with brackets 142 in an unused position. In certain embodiments of the invention (see FIG. 9), the protrusions 113 and 114 may increase the length of the legs 183 of the brackets 187. This length may be controlled and / or maintained. In at least one such embodiment, each protrusion 113 and 114 may increase the length of the legs of the bracket 183, which is supported on three sides. Such embodiments of the invention can prevent or at least reduce the likelihood of bending the legs of the staples 183 when inserted into dense tissue, such as bronchial tissue.

In various embodiments of the invention (see FIG. 4), the cassette case 85 may have, for example, cavities 84, grooves 62 and channels 86, which can reduce the strength of the cassette case 85. In various circumstances, especially when the cassette case 85 is compressed, for example, the stop 20, the body of the cassette 85 may deviate from the normal position due to the force applied. In at least one embodiment, portions of the platform 90 of the cassette, for example, passing over the channels 86, may be particularly thin and are most susceptible to deviations from the normal position and / or breakage. In certain embodiments of the implementation (see FIG. 7 and 8) the protrusions 113, 114 and (or) 115 can be made so that increased strength and (or) increased rigidity of the body of the cassette 185. In at least one embodiment, for example , the protrusions 113 and 114 may extend around the lumens 110 to increase the strength and (or) increase the rigidity of the parts of the cassette case 185 surrounding the recesses for the brackets 184. In certain embodiments, the protrusions 115 may extend perpendicular to the channels 86 or the like ssety 185, the protrusions 115 may increase the strength and (or) to increase the rigidity of the cassette body 185 around the channel 86. In other various embodiments, the cassette body 185 may include any corresponding requirements the number of projections of a certain configuration, which are necessary to provide the above described advantages.

In various embodiments of the invention, the cassette case with brackets 185 may consist, for example, of plastic, metal, and / or ceramic. Some of the materials may contain liquid crystal polymers, for example Vectra material, thermoplastic polymers such as polycarbonate, ABS resins, noryl, polyamides (polyamide resins), polyethersulfones, polyetherimides, for example Ultem, and (or) polymer blends of two or more of the above thermoplastic polymers, while in various embodiments, the implementation of the body of the cartridge 185 can be manufactured, for example, using injection molding. Some of these materials may contain thermosetting polymers, such as thermosetting polyesters, precision stainless steel castings, such as 17-4 PH, and / or die-cast stainless steel, such as 17-4 PH. In at least one such embodiment, the protrusions 113, 114 and / or 115 may be an integral part of the platform 190 of the cassette with brackets 185. In certain embodiments of the invention, the projections 113, 114 and / or 115 may be attached to the platform 190 of the cassette , at least one adhesive material.

In various embodiments of the invention (see FIG. 12) a cassette with brackets, such as a cassette with brackets 342, may have a cassette case 385, a plurality of recesses for brackets 384 in the case 385, and also brackets located in each of the recesses for brackets 384. In certain embodiments, the cassette case 385 may also have a first side 345 that includes a first group of recesses for brackets 384, a second side 347 that includes a second group of recesses for brackets 384, as well as a platform 390 of the cassette. In various embodiments of the invention, the cassette case 385 may further comprise a plurality of protrusions 315 extending from the cassette platform 390, which may be located between adjacent recesses for brackets 384 in a series of recesses for brackets 384. In at least one embodiment of the invention, each protrusion 315 may have, for example, a cruciform configuration. In at least one such embodiment of the invention, each protrusion 315 may comprise a V-shaped portion 313, which may at least partially surround the proximal end 311 of the recess lumen for brackets 310, and a V-shaped portion 314, which may at least partially surround the distal the end 312 of another recess lumen for brackets 310. In certain embodiments, only the most distant from the center rows of recesses for brackets 384 in the body of the cassette 385 may be at least partially surrounded by protrusions 315. In others In these embodiments (see FIG. 13), the cassette case with brackets 385 'may have protrusions 315 that at least partially surround the lumen 310 of each recess for brackets 384 in the cassette case. In any case, in various embodiments of the invention, each protrusion 315 may be designed to compress and hold the fabric pressed against the cassette with brackets 342, according to the method described above, and / or surround the legs of the brackets protruding above the platform 390.

In various embodiments of the invention (see FIG. 16) a cassette with brackets, such as a cassette with brackets 542, may have a cassette case 585, a plurality of recesses for brackets 584 in the case 585, and also brackets located in each of the recesses for brackets 584. In certain embodiments, the cassette case 585 may also have a first side 545 that includes a first group of recesses for brackets 584, a second side 547 that includes a second group of recesses for brackets 584, and also a platform 590 of the cassette. In various embodiments, the cassette case 585 may additionally have a plurality of protrusions 515 that extend beyond the cassette platform 590. In addition, each protrusion 515 may completely surround the lumen of the recess for the bracket 510. As shown in FIG. 16, some openings of the recesses 510 in the body of the cassette 585 may not be surrounded by a protrusion 515; In various alternative embodiments (see Fig. 16A), each lumen of the recess 510 in the body of the cassette 585 'may be surrounded by a protrusion 515. In various embodiments, the body of the cassette includes the first group of recesses for brackets 584 that are surrounded by the protrusion 515, and the second group of recesses brackets 584, which are not surrounded by a protrusion 515. In this case, brackets of greater height can be positioned in the first group of recesses 584, and brackets of lesser height can be positioned in the second group of recesses 584 in such a way that neither higher nor more dumb brackets will not protrude from cassette 542. In at least one such embodiment, the cassette body may be configured to use higher brackets in one row of recesses 584 and shorter brackets in another row of recesses 584. In certain embodiments, protrusions 515 may surround all recesses for brackets 584 in the extreme rows in the cassette case. Higher brackets can be placed in the outermost rows, and lower - in the near and (or) middle rows of recesses 584.

In various embodiments of the invention (see FIG. 14) a cassette with brackets, such as a cassette with brackets 442, may have a cassette case 485, a plurality of recesses for brackets 484 in the case 485, and also brackets located in each of the recesses for brackets 484. In certain embodiments, the cassette case 485 may also have a first side 445 that includes a first group of recesses for brackets 484, a second side 447 that includes a second group of recesses for brackets 484, and also a cassette platform 490. In various embodiments, the cassette case 445 may also include a plurality of protrusions 415 that extend beyond the plate of the cassette 490, with each protrusion 415 may have a plurality of convexities of a certain shape that constitute corrugation. During use of the product, the stop can be used to position the fabric relative to the grooves so that the fabric conforms to the contour of the grooves. In various embodiments, each protrusion 415 may have a plurality of grooves in the shape of a pyramid or diamond, and at least partially surround the gaps of one recess for brackets 410 or more. In this case, in at least one embodiment, the pyramid-like corrugation elements can be directed away from the plate of the cassette 490. In at least one embodiment, each corrugation elements having the shape of a pyramid can have four triangular sides that converge in one point and form the tip. In certain embodiments of the implementation (see FIG. 15A) pyramid-shaped elements of the corrugation of the protrusions 415 can be shortened. In addition, each corrugation element may include a flat surface surrounded by inclined sides. In addition to pyramid-like corrugations with quadrilateral elements (see FIG. 15C), there are other options that have more than four or less than four sides, for example, three sides. In various embodiments, the one or more protrusions 415 may have a plurality of conical corrugations. Each cone-shaped element can have a round (or almost round) base from which a cone extends, which ends in a point. In certain embodiments of the implementation (see FIG. 15B) cone-shaped corrugation elements can be shortened. In addition, each corrugation element may include a flat surface surrounded by a ring side. In various embodiments (see FIG. 14), the ribs of the protrusions 415 may protrude along the sides of the recesses of the recesses for brackets 410 and / or between adjacent recesses of the recesses for brackets 410. In at least one embodiment, the corrugations may surround the proximal the ends 411 and / or the distal ends 412 of the recesses of the recesses for the brackets 410. In certain embodiments, the grooved elements of the protrusions 415 may surround only some of the recesses for the brackets 484. In other embodiments (see FIG. 15), elements The grooves can completely (or almost completely) cover the cassette plate 490.

In various embodiments of the invention (see FIG. 10) a cassette with brackets, such as a cassette with brackets 242, may have a cassette case 285, a plurality of recesses for brackets 284 in the case 285, and also brackets located in each of the recesses for brackets 284. In certain embodiments, the cassette case 285 may also have a first side 245 that includes a first group of recesses for brackets 284, a second side 247 that includes a second group of recesses for brackets 284, and also a plate of the cassette 290. In various embodiments The cassette case 285 may also have a plurality of protrusions 215 protruding from the plate of the cassette 290. In at least one such embodiment, each of the protrusions 215 may extend transversely between the central (middle) part of the cassette case 245, which is located near the knife chute 262 and the side of the body of the cassette 245. With regard to the first side 245 of the body of the cassette 285: each protrusion 215 may have a first end 213 located next to the chute for the knife 262, and a second end 214 located next to the first side 261 of the cassette case S 285. Similarly, with respect to the second side 247 of the body of the cassette 285, the following is stated: each protrusion 215 may have a first end 213 located near the chute for the knife 262 and a second end 214 located near the second side 263 of the body of the cassette 285. At least In one embodiment, each protrusion 215 may have a height measured from the plate 290, and in at least one such embodiment, the height of the protrusions 215 may vary throughout the length of the body. In certain embodiments, the second end 214 may be higher than the first end 213, and the height of the protrusions 215 may gradually decrease throughout the body from the second end 214 to the first end 213. In certain alternative embodiments (not shown in the figures) the first end 213 of the protrusion 215 may be higher than the second end 214. In at least one embodiment, the height of the protrusions 215 may decrease linearly (or almost linearly) as you move from the end 213 to the end 214. In at least one such embodiment, impl The height of the protrusions 215 may decrease from the maximum height at the second end 214 to the lack of height at the first end 213. In certain embodiments, the height of each protrusion 215 may vary geometrically between the ends 213 and 214. In certain alternative embodiments of the invention (see FIG. 11 ) each protrusion 215 'may have a uniform height throughout the entire length of the body.

As indicated above, the inner ends 213 of the protrusions 215 may be shorter than the outer ends of the 214 protrusions 215. As a result, the inner ends 213 may in different circumstances put less pressure on the fabric sandwiched between the abutment and the cassette with brackets 242, compared to the outer ends 214. In different embodiments, as described above, each protrusion 215 may protrude transversely with respect to the plate of the cassette 290. In certain embodiments, each protrusion 215 may protrude along an axis that intersects the longitudinal axis 299 of the plate to Assets 285. In at least one such embodiment, the axes of the projections may be perpendicular (or nearly perpendicular) to the longitudinal axis 299. In various embodiments of the invention, the recesses for the brackets 284 may be in a plurality of rows, with each row of the recesses 284 along the longitudinal axis, which can run parallel (or almost parallel) to the longitudinal axis 299. In at least one embodiment, the axes of the protrusions 215 may protrude in a direction that intersects the longitudinal axes of the angle ubleny staple 284. In at least one such embodiment, the axis 215 of the projections can act in a direction perpendicular (or nearly perpendicular) to the longitudinal axes of the recesses brackets 284. In various embodiments (see. FIG. 10) each protrusion 215 may have a ridge 209 and (optionally) inclined surfaces 208 that protrude between the ridge 209 and the cassette plate 290. In certain embodiments, each inclined surface 208 may have one (or more) flat surface, a curved surface, a concave surface and (or) a convex surface. In various embodiments, each protrusion 215 may protrude above a line laid over one or more lumens 210 of recesses for brackets 284. In at least one such embodiment, these lumens 210 may protrude upwardly through the protrusions 215. The protrusions 215 run transversely relative to the cassette plate 290. The protrusions 215, as well as the protrusions 115, may increase the strength and / or stability of the body of the cassette 285.

In various embodiments (see FIGS. 17 and 18), a cassette with brackets, such as cassette 642, may include a cassette case 685, a plurality of recesses for brackets 684 made in the cassette case 685, as well as brackets located in the recesses 684. In certain embodiments of the case of the cassette 685 may also have a first side 645, which includes the first group of recesses for brackets 684, the second side 647, which includes the second group of recesses for brackets 684, as well as the plate of the cassette 690. In various embodiments, the case of the cassette 685 may also have multiple protrusions 615 protruding from the plate of cassette 690. In at least one such embodiment, each of the protrusions 615 may protrude in the longitudinal direction. Each protrusion 615 may have a distal end 613 and a proximal end 614, while the distal end 613 of the protrusion 615 may be located closer to the distal end 643 of the body of the cassette 685, and the proximal end 614 of the protrusion 615 closer to the proximal end 641. At least In one embodiment, each protrusion 615 may have a height measured from the plate 690, and in at least one such embodiment, the height of the protrusions 615 may vary throughout the length of the body. In certain embodiments, the proximal end 614 may be higher than the distal end 613, and the height of each protrusion 615 may gradually decrease as it moves from the proximal end 614 to the distal end 613. In certain alternative embodiments of the invention (not shown in the figures), the distal end 613 the protrusion 615 may be higher than the proximal end 614. In at least one embodiment, the height of the protrusions 615 may decrease linearly, or at least almost linearly, as end 613 to end 614. In at least one such embodiment, the height of the protrusions 615 may decrease from the maximum height at the proximal end 614 to the lack of height at the distal end 613. In certain embodiments, the height of each protrusion 615 may vary geometrically between the ends 613 and 614. In certain alternative embodiments of the invention, each protrusion 615 may have a uniform height over the entire length of the body.

As stated above, the distal ends 613 of the projections 615 may be shorter than the proximal ends 614 of the projections 615. As a result, the distal ends 613 may in different circumstances put less pressure on the tissue clamped between the abutment and the cassette with staples 642, compared to the proximal ends 614. various embodiments, as described above, each protrusion 615 may protrude longitudinally with respect to the cassette platform 690. In certain embodiments, each protrusion 615 may protrude along an axis that is parallel (or nearly parallel) to the longitudinal axis 699 of the body of the cassette 685. In various embodiments, the recesses for the staples 684 may be located in a plurality of rows, each row of the recesses 684 may be made along the longitudinal axis, which can go parallel (or almost parallel) to the axis of the protrusions 615. In at least one embodiment (see FIG. 18), each protrusion 615 may have an inclined surface that may have one ( Whether a) a flat surface, curved surface, concave surface and (or) a convex surface. In at least one such embodiment, the bottom of the inclined surface may be distal. This can facilitate the sliding of the fabric along the staple cartridge 642 when the fabric is placed in the end clip. In various embodiments, each protrusion 615 may protrude above a line laid over one or more lumens 610 recesses for brackets 684. In at least one such embodiment, these lumens 610 may protrude upwardly through the lugs 615. The lugs 615 extend transversely relative to the platform 690 cassette. The tabs 615 can increase the strength and / or stability of the cassette 685.

In various embodiments, in addition to the above, the surgical brace may be made of titanium, for example, titanium wire. In some embodiments, the surgical brace may be made of an alloy, for example, containing titanium, aluminum, and (or) vanadium. In at least one such embodiment, the surgical brace may be made of surgical stainless steel and / or an alloy, for example, containing cobalt and chromium. In any case, a surgical brace may consist of a metal, for example titanium, and have an outer surface of a metal oxide, for example titanium oxide. In various embodiments, the implementation of the outer surface of the metal oxide may be coated with some material. In some embodiments, the coating material may be polytetrafluoroethylene (PTFE), such as Teflon, and (or) tetrafluoroethylene (TFE), such as ethylene tetrafluoroethylene (ETFE), perfluoroalkoxy ethylene tetrafluoroethylene (PFA) and (or) fluorinated ethylene propylene (IEF) (ETE) and (a) ETE (EPA) (ET). Coatings may contain silicone. In various embodiments, such coating materials may prevent or at least prevent further oxidation of the metal. In some embodiments, the coating materials may create one or more smooth surfaces along which the stop or recesses for the staples may contact the staples to reduce the friction force between them. In some embodiments, lower frictional forces between the brackets and recesses for the brackets may reduce the force required to deform the brackets.

Descriptions of the publication of US Patent Application No. 2012/0074198, entitled "STAPLE CARTRIDGE", filed September 29, 2010, currently US Patent No. 8,733,613, and the publication of US patent application No. 2013/0161375, entitled "STAPLE CARTRIDGE", filed February 21, 2013, fully incorporated herein by reference.

The end effector of the surgical stapling instrument is shown in FIG. 23 and 55. The end effector may contain an emphasis, for example, an emphasis 20, and a branch or channel of a cassette with brackets, 22, made with the possibility of detachable fastening in it of a cassette with brackets. A cassette 2000 with brackets, for example, is located in the channel 22 of the cassette. The staple cassette 2000 may include a cassette body 2010, including a plurality of recesses 2050 for brackets provided therein. Each recess 2050 for brackets can be made with the possibility of removable storage brackets in it. Case 2010 cassettes may contain the surface of the platform 2011 and a longitudinal groove 2015 in the surface 2011 of the platform, made with the ability to removably take the trigger element and / or cutting edge. Cassette case 2010 may also contain the distal end of 2013, the proximal end of 2016, and opposite longitudinal sides 2012, located between the distal end of 2013 and the proximal end of 2016. In various cases, each longitudinal side of 2012 may contain an adjacent or continuous edge without interruptions performed in it. When comparing FIG. 7 and 23, for example, the reader will understand that the longitudinal edges of the cassette 142 with the brackets shown in FIG. 7, contain at least one groove made in them, and the longitudinal sides of 2012 do not have such grooves.

As predominantly shown in FIG. 55, the cassette case 2010 may further comprise a plurality of protrusions 2051 extending from the surface 2011 of the platform. The protrusions 2051 can be configured to engage the fabric located between the stop 20 and the cassette 2000, and control the movement of the fabric relative to the cassette 2000. The fabric can be moved relative to the cassette 2000 in various cases. In at least one case, the fabric can move relative to the cassette 2000 when the stop 20 moves between the open position (FIG. 23) and the closed position in which the fabric is clamped between the stop 20 and the cassette 2000. In such cases, the fabric can move sideways to the longitudinal 2012, distal to the distal end of 2013 and / or proximal to the proximal end of 2016. In at least one other case, the tissue can move relative to the cassette 2000 when the cutting edge advances distally through the tissue caught between the stop 20 and cassette 2000. In such cases, the tissue can move sideways, distally and / or proximally, but it mostly moves distally, due to the distal movement of the cutting edge. In various cases, the protrusions 2051 can be made with the possibility of limiting or preventing the movement of the fabric relative to the cartridge with brackets. The protrusions 2051 may be located at the proximal end and / or the distal end of the recesses 2050 for the brackets. In various cases, each protrusion 2051 may contain a cuff protruding around the end of the recess 2050 for brackets. In certain cases, each protrusion 2051 may include a curved protrusion located around the end of the recess for brackets 2050.

As predominantly shown in FIG. 55, the cassette case 2010 may comprise a sloping transition 2014 protruding between the distal tip of the cassette case 2010 and the surface 2011 of the platform. Oblique transition 2014 can facilitate the movement of the cassette 2000 relative to the tissue when positioning the cassette 2000 and the stop 20 in the surgical field. In such cases, the fabric may slide along an inclined surface 2014. In various cases, the inclined surface 2014 may contain a rounded surface. In various cases, the inclined surface 2014 may contain an inclined surface. In certain cases, the inclined surface 2014 may contain a concave and / or convex surface. In at least one case, as shown in FIG. 55, the inclined surface 2014 may comprise, for example, a distal concave surface that passes into a flat inclined surface that passes into a proximal convex surface.

The recesses 2050 for brackets, made in the body of the cassette 2010, can be located in the longitudinal rows. For example, three longitudinal rows of recesses 2050 for brackets can be located on the first side of the longitudinal groove 2015, and three longitudinal rows of recesses 2050 for brackets can be made on the second side of the longitudinal groove 2105. Each longitudinal row can contain an extreme distal recess 2050 for brackets next to the distal end of 2013 and the extreme proximal groove 2050 for brackets near the proximal end of 2016. In various cases, the cassette case 2010 may additionally contain protrusions 2053 extending from the surface 2011 of the platform. The protrusions 2053 may be located at the distal ends of the extreme distal recesses 2050 for the staples. Each protrusion 2053 may include a distal inclined surface, for example, which facilitates insertion of tissue between the cassette 2000 with brackets and the stop 20. In various cases, the extreme distal recesses 2050 may include a protrusion 2053 located at their distal end and a protrusion 2051 located at their proximal the end.

Each protrusion 2051 and / or protrusion 2053 may be configured to support at least a portion of a bracket detachably disposed in a recess 2050 for brackets. In various cases, each protrusion 2051 may project beyond the end wall 2052 of the recess 2050 for brackets above the platform 2011. In certain cases, as shown mainly in FIG. 24 and 26-29, the bracket located in the recess 2050 for the brackets may have a base, a first knife protruding from the base at a first angle, and a second leg protruding from the base at a second angle. The first leg may be in contact with the first end wall 2052 (FIG. 55) of the recess 2050 for brackets, and the second leg may be in contact with the second end wall 2052 of the recess for brackets. In certain cases, the distance between the first leg and the second leg of the bracket may be wider than the distance between the end walls 2052 so that when the bracket is located inside the recess 2050 for the brackets, the legs are displaced inside the end walls 2052. When the bracket is placed in the recess 2050 for the brackets in the unused (not lifted) position, the ends of the legs of the bracket can be located in the protrusions 2051. In such cases, the projections 2051 can support and protect the ends of the legs of the bracket over the platform 2011. In some cases, the ends of the legs of the bracket They are located below the protrusions 2051 when the bracket is in the unused position, and thus the protrusions 2051 may not support the legs of the bracket when the bracket is in the unused position. When pushing or lifting such a bracket from the recess 2050 for the bracket, the legs of the bracket can come into contact with the protrusions 2051 and be supported by them. In any case, the protrusions 2051 can continue to support the brackets when they are removed, until the brackets are pushed out and / or lifted out of the recess 2050 for the brackets sufficiently so that the brace legs no longer come into contact with the projections 2051. The projections 2053 can work in the same way as described for protrusions 2051.

In various cases, in addition to the above, the protrusion 2051 may continue the recess 2050 for brackets above the platform 2011 of the cassette housing 2010. In certain cases, the protrusion 2051 can be designed in such a way that the end wall 2052 of the recess 2050 for brackets easily goes into the protrusion 2051. In other words, a seamless surface can be made between the end wall 2052 and the protrusion 2051. Such a seamless surface can reduce the possibility of pressing the leg of the bracket end wall 2052 and the contact of the protrusion 2051 with the edge or step, made in the recess 2050 for brackets and / or indented into the side wall of the recess 2050 for brackets. In FIG. 55A depicts a step 2056 made between the protrusion 2051 and the end wall 2052. Although the step 2056 contains an outer, not an inner step, the step 2056 can be removed to provide a seamless surface, as discussed above. In embodiments in which the cartridge case 2010 is formed during the injection molding process, the cartridge 2010 may be formed in a cavity formed between the two halves of the injection molding mold. The two halves of the die casting mold can contact each other to seal, or at least significantly seal, the mold cavity. The interface between the two halves of the mold is often called a sealing line or a connector line, and often a small edge is formed in the cassette case along the sealing line. This is especially the case when the sealing line is used to release air from the mold cavity during the injection molding process. This edge is often called a burr. The injection mold can be carefully designed so that the sealing line does not form edges in the end wall 2052 and / or the inwardly directed surface of the protrusion 2051. In at least one case, the protrusion 2051 may contain a portion of the end cuff 2057 and the transition section 2058 from the opposite sides of the cuff section to the platform 2011. The sealing line between the two halves of the mold can be chosen so that it runs along the upper surface of the protrusion 2051. An example of a sealing line and 2059 is shown in FIG. 55A, although other suitable sealing lines may be selected.

Cassette 2800 with brackets is shown in FIG. 56 and 57. A cassette 2800 with brackets may include a cassette body 2810. Cassette housing 2810 may include a distal end 2813, a proximal end 2816, and opposite lateral sides 2812. As described above, each lateral side 2812 may contain an adjacent edge without grooves in it. Cassette case 2810 may further comprise a platform 2811, a plurality of recesses 2850 for brackets made in platform 2811, and a longitudinal groove 2815 adapted to receive, for example, a starting element blade. Cassette case 2810 may further comprise a plurality of protrusions 2851 extending from platform 2811. In various cases, protrusions 2851 may form a circuit. In at least one case, each protrusion 2851 may be positioned between the lateral side 2812 and the longitudinal groove 2815. Each protrusion 2851 may have any suitable configuration, such as, for example, a plateau. One or more recesses 2850 for brackets can pass through a protrusion 2851. In some cases, at least part of recess 2850 for brackets in the internal row of recesses 2850 for brackets, at least the fate of recess 2850 for brackets in the middle row of recess 2850 for brackets and / or at least part of the recess 2850 for the staples in the outer row of the recesses 2850 for the staples may pass through the plate of the protrusion 2851. Each protrusion 2851 may include an inner edge 2858 located near the longitudinal groove 2815 and an outer edge 2859 located ohm with side 2812. In certain cases, the inner edge 2858 may be distal with respect to the outer edge 2859. In other cases, although not shown, the outer edge 2859 may be distal with respect to the inner edge 2858. For example, the protrusions 2851 may be parallel. In certain cases, the protrusions 2851 may form, for example, a layout. In at least one case, the protrusions 2851 extending from the platform 2811 on the first side of the longitudinal groove 2815 may include a mirror image of the protrusions 2851 extending from the platform on the second side of the longitudinal groove 2815. Gaps may be made between the projections 2851. The fabric may enter the gaps when it is pressed against the cassette platform 2811, for example, with an emphasis. The gaps can be made with the ability to set the movement of the fabric in the desired direction.

Cassette 2900 with brackets shown in FIG. 58. A cassette 2900 with brackets may comprise a cassette body 2910. Cassette housing 2910 may comprise a distal end 2913, a proximal end, and opposite lateral sides 2912. As described above, each lateral side 2912 may contain an adjacent edge without grooves made therein. The cassette housing 2910 may additionally comprise a platform 2911, a plurality of recesses 2950 for brackets made in the platform 2911, and a longitudinal groove 2915 adapted to receive, for example, a starting element blade. The cassette housing 2910 may further comprise a plurality of protrusions 2951 extending from the platform 2911. In various cases, the protrusions 2951 may form a circuit. Each protrusion 2951 may be located between the distal end 2913 and the proximal end of the cassette case 2910. In at least one case, each protrusion 2951 may go to the side 2912 and to the longitudinal groove 2915. In various cases, each protrusion 2951 may contain corner portions 2954 that are directed inwards and proximally, straight portions 2955 that are longitudinally and angular sections 2956, which are directed inward and distal. The protrusions 2951 may be located around the recesses 2950 for brackets and / or between them. In at least one case, the corner portions 2954 and the corner portions 2956 may be located between the recesses 2950 for the staples in the longitudinal row of the recesses 2950 for the staples. For example, the protrusions 2951 may be parallel to each other. In certain cases, the protrusions 2951 can form, for example, a layout. In at least one case, the protrusions 2951 extending from the platform 2911 on the first side of the longitudinal groove 2915 may include a mirror image of the projections 2951 extending from the platform on the second side of the longitudinal groove 2915. Gaps may be made between the protrusions 2951. The fabric can enter the gaps when it is pressed against the cassette platform 2911, for example, with an emphasis. The gaps can be made with the ability to set the movement of the fabric in the desired direction.

A cassette with brackets may contain a homogeneous matrix of protrusions extending from it. In other cases, the matrix may be heterogeneous. In certain cases, the protrusions in the matrix may not continue to groove for brackets. In various cases, the protrusions in the matrix may not support the bracket.

Cassette 3000 with brackets is shown in FIG. 59 and 60. A cassette 3000 with brackets may comprise a cassette body 3010. Cassette body 3010 may include a distal end 3013, a proximal end, and opposite sides 3012. As described above, each side 3012 may contain an adjacent edge without grooves made therein. The cassette housing 3010 may additionally comprise a platform 3011, a plurality of recesses 3050 for brackets made in the platform 3011, and a longitudinal groove 3015, configured to receive, for example, a starting element blade. Cassette housing 3010 may additionally comprise protrusions 3051 extending from platform 3011. In various cases, protrusions 3051 may form a circuit. In at least one case, each protrusion 3051 may have a pyramidal configuration. The pyramid configuration can have four sides, which are completed, for example, by one point. In addition, four sides can be completed, for example, with a flat surface. In addition, the pyramidal configuration can have three sides, which are completed, for example, by one point. In any case, as shown in FIG. 59, the protrusion matrix 3051 may extend along the platform 3011 between the longitudinal groove 3015 and the sides 3012. The protrusions 3051 may be placed around the recesses 3050 for the brackets. The recesses 3050 for the brackets may be arranged in the form of longitudinal rows, and the protrusions 3051 may be located between the recesses 3050 for the brackets within the longitudinal row of the recesses 3050 for the brackets. The protrusions 3051 may be located between the recesses 3050 for the brackets in the adjacent longitudinal rows of the recesses 3050 for the brackets. The protrusions 3051 can be located between the outermost rows of the recesses 3050 for the staples and the longitudinal channel 3015. The protrusions 3051 can be positioned between the outermost rows of the recesses 3050 for the staples and the side edges 3012. The protrusions 3051 can be located distal to the extreme distal recesses 3050 for brackets. The protrusions 3051 can be located proximal to the extreme proximal recesses 3050 for the brackets. The protrusions 3051 may be located distal with respect to the distal end of the longitudinal groove 3015. In other cases, the protrusions 3051 may be located distally with respect to the distal end of the longitudinal groove 3015.

The cassette 3100 with brackets is shown in FIG. 61 and 62. A cassette 3100 with brackets may include a cassette body 3110. Cassette housing 3110 may include a distal end 3113, a proximal end, and opposite lateral sides 3112. As described above, each lateral side 3112 may contain an adjacent edge without grooves made therein. The cassette housing 3110 may further comprise a platform 3111, a plurality of recesses 3150 for brackets made in the platform 3111, and a longitudinal groove 3115 adapted to receive, for example, a starting element blade. The cassette housing 3110 may further comprise protrusions 3151 extending from the platform 3111. In various cases, the protrusions 3151 may form a circuit. In at least one case, each protrusion 3151 may have a dome configuration. Dome configuration may have, for example, a hemispherical protrusion. In some cases, the dome can be completed with a flat surface. As shown in FIG. 61, the projection matrix 3151 may extend along the platform 3111 between the longitudinal groove 3115 and the sides 3112. The projections 3151 may be positioned around the recesses 3150 for the brackets. The recesses 3150 for the brackets may be arranged in the form of longitudinal rows, and the protrusions 3151 may be located between the recesses 3150 for the brackets within the longitudinal row of the recesses 3150 for the brackets. The protrusions 3151 may be located between the recesses 3150 for the brackets in the adjacent longitudinal rows of the recesses 3150 for the brackets. The protrusions 3151 may be located between the innermost rows of the recesses 3150 for the staples and the longitudinal channel 3115. The protrusions 3151 may be positioned between the outermost rows of the recesses 3150 for the brackets and the side edges 3112. The protrusions 3151 may be located distal to the extreme distal recesses 3150 for brackets. The protrusions 3151 can be located proximal to the extreme proximal recesses 3150 for the brackets. The protrusions 3151 may be located distal with respect to the distal end of the longitudinal groove 3115. In other cases, the projections 3151 may be located distally with respect to the distal end of the longitudinal groove 3115.

A cassette 3200 with brackets is shown in FIG. 63. A cassette 3200 with brackets may comprise a cassette body 3210. Cassette housing 3210 may include a distal end 3213, a proximal end, and opposite lateral sides 3212. As described above, each lateral side 3212 may contain an adjacent edge without grooves made therein. The cassette housing 3210 may further comprise a platform 3211, a plurality of recesses 3250 for brackets made in the platform 3211, and a longitudinal groove 3215 adapted to receive, for example, a starting element blade. Cassette housing 3210 may additionally comprise protrusions 3251 extending from platform 3211. Similar to protrusions 2051, protrusions 3251 may be configured to engage the fabric located between the abutment and cassette 3200 and control movement of the fabric relative to the cassette 3200. In various cases, the protrusions 3251 may be made with the possibility of limiting or preventing the movement of tissue relative to the cassette with brackets. The protrusions 3251 may be located at the proximal end and / or the distal end of the recesses 3250 for brackets. In various cases, each protrusion 3251 may contain a cuff protruding around the end of the recess 3250 for brackets. In certain cases, each protrusion 3251 may include a curved protrusion located around the end of the recess for brackets 3250. In various cases, each protrusion 3251 may contain one or more protrusions 3254 formed on it. The tabs 3254 can provide a textured surface that improves grip or retention, which the tabs 3251 can attach to the fabric located between the abutment and the cassette 3200 with brackets. In various cases, each protrusion 3254 may contain, for example, a thickening. In certain cases, each protrusion 3254 may be a dome. In at least one case, the protrusions 3254 may be made of an elastomeric material, for example, rubber, a thermoplastic elastomer, and / or, for example, Santoprenum applied to the protrusions 3251, which may be made, for example, of plastic. In various cases, the protrusions 3254 may be made of plastic material that does not allow injury to the tissue sandwiched between the protrusions 3254. The cassette case 3210 may additionally contain protrusions 3253. Similar to the protrusions 2053, the protrusions 3253 may be located at the distal ends of the extreme distal recesses 3250 for the brackets. Each protrusion 3253 may include a distal inclined surface, such as one that facilitates the insertion of tissue between the cassette 3200 with brackets and the stop. In various cases, the extreme distal recesses 3250 may include a protrusion 3253 located at their distal end, and a protrusion 3251 located at their proximal end. In addition, similar to that described above, each protrusion 3251 and / or protrusion 3253 may be configured to support at least a portion of a bracket that is removably housed in a recess 3250 for brackets.

Bracket 2130 is depicted in FIG. 24 and comprises a base 2131, the first leg 2132a of the bracket extending from the first end of the base 2131, and a second leg 2132b of the bracket extending from the second end of the base 2131. The distance between the first end of the base 2131 and the second end of the base 2131 is called the crown distance, it is indicated by the size E The first leg 2132a of the bracket comprises a first part 2133a extending from the base 2131 and a second part 2134a extending from the first part 2133a. The first part 2133a can go at the first angle from the base of 2131. This first angle can be indicated by the angle F, which is measured from the vertical direction. The second part 2134a may extend at a second angle from the first part 2133a. This second angle can be indicated by the angle K, which is also measured from the vertical direction. The reader will understand that the first part 2133a and the second part 2134a are not collinear; rather, the first part 2133a goes along the first axis 2137a, and the second part 2134a goes along the second axis 2138a, which is different from the first axis 2137a. Articulation 2135a connects the first part 2133a and the second part 2134a and is located at a distance D, measured from the supporting surface 2139, formed on the lower part of the base 2131. The second part 2134a contains the tip of the leg 2136a, which is located at a distance C, measured from the supporting surface 2139 of the base. The first part 2133a may comprise a first cantilever extending from the base 2131, and the second part 2134a may comprise a second cantilever extending from the first part 2133a. The distance D can determine the distance to the first cantilever, and the difference between the distance C and the distance D can determine the distance to the second cantilever.

The second leg 2132b of the bracket includes a first part 2133b, extending from the base 2131, and a second part 2134b, extending from the first part 2133b. The first part 2133b can go at the first angle from the base of 2131. This first angle can be indicated by the angle G, which is measured from the vertical direction. The angle G may or may not be equal to the angle F described above. When the second leg 2132b of the bracket is distal with respect to the first leg 2132a of the bracket, in at least one case, the angle G may be, for example, smaller than the angle F. Also, when the first leg 2132a of the bracket is distal with respect to the second leg 2132b brackets, at least in one case, the angle F can be, for example, less than the angle G. The second part 2134b can go at the second angle from the first part 2133b. This second angle may be indicated by the angle H, which is also measured from the vertical direction. The angle H may be equal to or not equal to the angle K described above. When the second leg 2132b of the bracket is distal with respect to the first leg 2132a of the bracket, in at least one case, the angle H may be, for example, less than the angle K. Moreover, when the first leg 2132a of the bracket is distal with respect to the second leg 2132b brackets, at least in one case, the angle K may be, for example, less than the angle H. The reader will understand that the first part 2133b and the second part 2134b are not collinear; in contrast, the first part 2133b goes along the first axis 2137b, and the second part 2134b goes along the second axis 2138b, which differs from the first axis 2137b. Articulation 2135b connects the first part 2133b and the second part 2134b and is located at a distance B, measured from the support surface 2139, formed on the lower part of the base 2131. The distance B may or may not be equal to the distance D described above. The second part 2134b contains the tip of the leg 2136b, which is located at a distance A, measured from the support surface 2139 of the base. The distance A may or may not be equal to the distance C described above. The first part 2133b may comprise a first cantilever extending from the base 2131, and the second part 2134b may comprise a second cantilever extending from the first part 2133b. The distance B can determine the distance to the first cantilever, and the difference between the distance A and the distance B can determine the distance to the second cantilever. The distance between the first tip 2136a of the first leg 2132a of the bracket and the second tip 2136b of the second leg 2312 of the bracket can determine the distance between the legs 2132a, 2132b of the bracket and is indicated by the distance J. The distance J can be wider or not wider than the distance of the crown E described above.

In FIG. 25 depicts a bracket 2130 located in a recess 2150 for brackets made in a cassette 2110 and supported by an ejector 2040 of brackets. The reader will understand that the legs 2132a and 2132b of the bracket 2130 were offset or bent inward by the end walls of the recess 2150 for the brackets. As a result, the distances A, B, C, D, E and J could change and are represented by the values A ', B', C ', D', E 'and J', respectively. Bracket 2130 can be made of an elastic material, such as stainless steel and / or titanium, and changes in these distances can be turned in the opposite direction or partially turned in the opposite direction when the bracket 2130 is removed from the recess 2150 for the brackets. Similarly, the angles F, G, H and K could change as a result of the arrangement of the bracket 2130 in the recess 2150 for the brackets and are represented by the angles F ', G', H 'and K', respectively. As described above, the bracket 2130 can be made of an elastic material, and changes in these angles can be turned in the opposite direction or at least partially turned in the opposite direction when the bracket 2130 is removed from the recess 2150 for the brackets. In FIG. 25 shows a bracket 2130 and an ejector 2040 in a non-activated position. In this non-activated position, the tip 2136a of the first leg 2132a of the bracket can extend over the platform surface 2111 of the cassette 2110 and can be positioned inside and protected by the protrusion 2150a extending from the platform surface 2111 and, similarly, the tip 2136b of the second leg 2132b of the bracket can extend above the platform surface 2111 may be located inside and protected by a protrusion 2150b extending from the surface 2111 of the platform.

Bracket 2230 is depicted in FIG. 26. Bracket 2230 may include a base 2231, a first leg 2232a extending from a base 2231, and a second leg 2232b extending from a base 2231. The first leg 2232a may include a first portion 2233a connected to a base 2231, and a second portion 2234a extending from the first parts 2233a. The second leg 2232b may comprise a first part 2233b connected to a base 2231, and a second part 2234b extending from the first part 2233b. The base 2231, the first part 2233a and the first part 2233b may be generally V-shaped. In various cases, the second part 2234a may be directed inward from the first part 2233a at the articulation 2235a and, similarly, the second part 2234b may be directed inward from the first part 2233b at the articulation 2235b. The base 2231, the first leg 2232a and the second leg 2232b can be made and arranged so that the bracket 2230 is symmetrical in its unformed, or unused, shown in FIG. 26. In various cases, the first leg 2232a may be located distally with respect to the second leg 2232b. In addition, the first leg 2232a may be located proximal to the second leg 2232b.

Bracket 2330 is depicted in FIG. 27. Bracket 2330 may include a base 2331, a first leg 2332a extending from a base 2331, and a second leg 2332b extending from a base 2331. The first leg 2332a may comprise a straight portion 2333a connected to the base 2331, which is axially positioned. The second leg 2332b may comprise a first part 2333b connected to a base 2331, and a second part 2334b extending from the first part 2333b. The base 2331, the straight part 2333a and the first part 2333b may be generally V-shaped. In various cases, the second part 2334b may be directed inward from the first part 2333b at the joint 2335b. The base 2331, the first leg 2332a and the second leg 2332b can be made and positioned so that the bracket 2330 is asymmetric in its unformed, or unused form shown in FIG. 27. In various cases, the first leg 2332a may be distal with respect to the second leg 2332b. In addition, the first leg 2332a may be located proximal to the second leg 2332b.

Bracket 2430 is depicted in FIG. 28. Bracket 2430 may include a base 2431, a first leg 2432a extending from a base 2431, and a second leg 2432b extending from a base 2431. The first leg 2432a may contain a first portion 2433a connected to a base 2431, and a second portion 2434a extending from the first parts 2433a. The second leg 2432b may comprise a first part 2433b connected to a base 2431 and a second part 2434b extending from the first part 2433b. The base 2431, the first part 2433a and the first part 2433b may be generally V-shaped. In various cases, the second part 2434a may be directed inward from the first part 2433a at the first angle at the joint 2435a and, similarly, the second part 2434b may be directed inward from the first part 2433b at the second angle at the joint 2435b. The first angle and the second angle may be different. The base 2431, the first leg 2432a and the second leg 2432b can be made and arranged so that the bracket 2430 is symmetrical in its unformed, or unused, shown in FIG. 28. In various cases, the first leg 2432a may be located distally with respect to the second leg 2432b. In addition, the first leg 2432a may be located proximal to the second leg 2432b.

Bracket 2530 is depicted in FIG. 29. Bracket 2530 may include a base 2531, a first leg 2532a extending from a base 2531, and a second leg 2532b extending from a base 2531. The first leg 2532a may include a first portion 2533a connected to a base 2531, and a second portion 2534a extending from the first parts 2533a. The second leg 2532b may comprise a first portion 2533b connected to a base 2531, and a second portion 2534b extending from the first portion 2533b. The base 2531, the first part 2533a and the first part 2533b may be generally V-shaped. In various cases, the second part 2534a may be directed inward from the first part 2533a at the first angle at the joint 2535a and, similarly, the second part 2534b may be directed inward from the first part 2533b at the second angle at the joint 2535b. The first angle and the second angle may be different. The base 2531, the first leg 2532a and the second leg 2532b can be made and positioned so that the bracket 2530 is asymmetric in its unformed, or unused form shown in FIG. 29. Bracket 2530 may be similar to bracket 2430 in many ways and, in at least one case, may contain, for example, a wider base 2531 than a base 2431. In certain cases, a wider base bracket can be placed in a specific recess for brackets when leg 2532a of the bracket and / or leg of 2532b of the bracket protrude in directions that are closer to the vertical direction. In various cases, the first leg 2532a may be located distally with respect to the second leg 2532b. In addition, the first leg 2532a may be located proximal to the second leg 2532b.

As discussed above, tissue captured between the abutment and the staple cartridge of the surgical end effector can move within or relative to the end effector during use. Also as discussed above, this movement can be generally distal, since the trigger element of the end effector moves distally to impose brackets, which are detachably placed in a cassette with brackets, and to cut the tissue. If the starting element were moving proximally, the movement of the fabric as a whole would be proximal. However, distal displacement of the tissue can shift the brackets distally during the process of applying the brackets. This phenomenon is depicted in FIG. 30. In FIG. 30 depicts a bracket 2630 extracted from a recess 2650 for brackets made in the cassette case 2610. Bracket 2630 is depicted in at least a partially activated position, with the base 2631 of the bracket 2630 moving up to the stop 20 by the ejector 2640 of the bracket, and the legs 2632a, 2632b of the bracket 2630 protruded from the recess 2650 for the bracket and came into contact with the support 20. How will understandable to the reader, the recess 2650 for brackets may include a first protrusion 2651a and a first end wall 2652a, which are adapted to support the first leg 2632a of the bracket, and similarly, a second protrusion 2651b and a second end wall 2652b, which are adapted to Erzhanov second legs 2632b brackets, when removing braces from the recess 2630 to 2650 ejector bracket 2640. However, as shown in FIG. 30, the bracket 2630 may move distally during its application process so that the leg 2632a of the bracket moves away from the first end wall 2652a, and the leg 2632b of the bracket moves over the second protrusion 2651b. Although the bracket 2630 was offset distally, the first leg 2632a still entered the first forming hole 22a of the depression for the bracket 20, and the second leg 2632b still entered the second forming hole 22b of the bracket. Although the feet 2632a, 2632b of the staple may come into contact with their respective forming holes 22a, 22b, the distal offset of the staple 2630 may not lead, for example, to the formation of a symmetrical staple, as shown in FIG. 31. In FIG. 31 shows the bracket 2630 raised to a position above the platform 2611 of the cassette of the housing of the cartridge 2610 of the cartridge by the ejector 2640 of the brackets and deformed into a fully activated position.

As discussed above, symmetric brackets can be deformed asymmetrically as a result of their displacement by tissue captured in the end effector. In various cases, a cassette with brackets may use asymmetric brackets, for example, the brackets shown in FIG. 24 and 27-29, which compensate for this offset. The legs of these asymmetrical brackets can be designed in such a way that when asymmetrical brackets are displaced distally, they can be shifted to an orientation that can cause them to deform into a symmetrical, or at least more symmetrical, activated shape. In FIG. 84 depicts a staple cartridge 4800 that includes a cartridge case 4810, including a plurality of recesses 4850 for brackets provided therein, asymmetric brackets located in the recesses 4850 for the brackets and a plurality of ejectors 4840, configured to push the brackets out of the recesses 4850 for the brackets. The cassette case 4810 may comprise a distal end 4813 and a proximal end 4816, and the recesses 4850 for the brackets may be located in longitudinal rows made in the case 4810 of the cassette. Cassette case 4810 is shown in cross section in FIG. 84 so as to show one such longitudinal row of recesses 4850 for the brackets. In some cases, brackets that are removably placed in the longitudinal row of recesses 4850 for the brackets may have the same asymmetric shape, and in other cases, as shown in FIG. 84, the brackets may have a different asymmetric shape. For example, brackets 4830 'are located at the proximal end of the longitudinal row, and brackets 4830ʺ are located at the distal end of the longitudinal row. Similar to the above, each bracket 4830 'may contain the first leg 4832a' and the second leg 4832b ', with one or both of the leg brackets containing several segments, for example, segments 4833b' and 4834b 'of the second leg 4832b' of the bracket. In addition, as described above, each bracket 4830 'may contain the first leg 4832a' and the second leg 4832b ', and one or both of the leg brackets may contain several segments, for example, the segments 4833aʺ and 4834aʺ of the first leg 4832a brackets and the segments 4833bʺ and 4834b legs 4832b 'brackets. When comparing brackets 4830 'and brackets 4830ʺ, the reader will understand that the angle between segments 4833b 48 and 4834bʺ of brackets 4830ʺ is more pronounced, or greater than the angle between segments 4833b' and 4834b 'of brackets 4830'. In other words, the distal brackets 4830ʺ may become more asymmetric than the proximal brackets 4830 '. In some cases, the movement of the tissue at the distal end of the 4813 cassette 4800 with staples may be greater than the movement of the tissue at the proximal end of 4816 and, accordingly, the shift in orientation of the brace may be greater at the distal end of the 4813 cassette 4800 with brackets than at the proximal end 4816. Greater asymmetry of the distal brackets 4830ʺ can compensate for larger displacements of brackets, as compared to the smaller asymmetry of the proximal brackets 4830 ', which are subject to smaller displacements. This is just one example, and any suitable set of brackets can be used in a series of brackets to compensate for different shifts of brackets. It is considered, for example, that brackets located at the proximal end of the longitudinal row may have a greater asymmetry than brackets located at the distal end of the longitudinal row. In addition, it is believed that in the longitudinal row more than two groups of asymmetric brackets can be used.

As mentioned above, in various cases, the movement of tissue at the distal end of the end effector may be greater than the movement of tissue at the proximal end of the end effector. Such cases may occur as a result of the distal movement of the trigger element in the end effector. Although the trigger element is made with the possibility of gradual overlapping of brackets and dissection of the tissue during its distal movement, the trigger element can also distally press or push the fabric. This pushing or pushing effect can begin at the proximal end of the end effector and can be combined with the distal movement of the trigger element so that the maximum pushing or pressing effect is realized at the distal end of the end effector. Thus, in addition to the above, the gradient in the asymmetry of the brackets can be used in the longitudinal row of brackets to compensate for the gradient in the displacement of the fabric and the displacement of the brackets.

In addition to or in place of the above, tabs with different heights can be used in the staple cartridge to control the movement of the tissue in the end effector. In various cases, the protrusions described in this document, which protrude from the platform of the cassette with brackets, can reduce the gap between the cassette with brackets and the stop of the end effector. As a result, the protrusions can exert more localized pressure on the tissue located between the abutment and the bracket with brackets, compared with the implementation without protrusions. In various cases, protrusions having a greater height may exert a greater compressive force or pressure on the fabric, while protrusions having a smaller height may exert a relatively small compressive force or pressure to the fabric. According to this principle, higher protrusions provide greater control over the movement of the fabric than shorter protrusions. As the reader remembers, the movement of tissue at the proximal end of the end effector may be less than the movement of tissue at the distal end of the end effector and, as a result, as shown in FIG. 84, in a cassette 4800 with brackets, shorter protrusions 4851 'at the proximal end 4816 of the case 4810 of the cassette and higher protrusions 4851ʺ at the distal end 4813 can be used. the 4811 platform surfaces of the 4810 cassette case, and the higher protrusions of the 4851ʺ can go a distance of 4855ʺ from the shorter protrusions of 4851 '. In certain cases, the protrusions extending from the body of the cassette may have a height gradient located between the proximal end and the distal end of the body of the cassette. In at least one case, as discussed above, the highest projections of the gradient may be at the distal end of the cassette case, and the shortest protrusions of the gradient may be at the proximal end of the cassette case. In other cases, the highest gradient protrusions may be at the proximal end of the cassette case, and the shortest gradient protrusions may be at the distal end of the cassette case.

As discussed above, moving the tissue can cause the brackets to move when removed from the cassette case. In various cases, higher protrusions provide greater control over this movement than shorter protrusions. In particular, as shown in FIG. 84, higher distal protrusions 4851ʺ can project beyond recesses 4850 for brackets a greater distance than shorter proximal projections 4851 'so that brackets 4830 таким are controlled by distal projections 4851ʺ at a greater distance than brackets 4830', controlled by proximal projections 4851 '. Higher protrusions 4851ʺ can also increase the distance that the 4830ʺ brackets go up before the legs of the 4830ʺ brackets come out of the recesses 4850, compared to the distance that the brackets 4830 'go up before the legs of the 4830 brackets come out of the grooves 4850. This design allows you to reduce the distance and / or time by which the brackets 4830ʺ undergo significant tissue movements, for example, at the distal end of the 4800 cassette with brackets.

As discussed above, multiple bracket configurations within a longitudinal row of brackets can be used in a bracket with brackets. In different cases, you can use brackets with different configurations in different longitudinal rows of brackets. In at least one case, the cassette with brackets may contain brackets having a first configuration in the first longitudinal row of brackets and a second configuration in the second longitudinal row of brackets. As shown in FIG. 49 and 49A, a cassette 2700 with brackets, for example, may contain a plurality of longitudinal rows of recesses 2750 for brackets provided therein, and recesses 2750 for brackets made in the first row may contain a first bracket 2730 '(FIG. 50), removable in them, recesses 2750 for brackets, made in the second row may contain a second bracket 2730ʺ (FIG. 51), removably housed therein, and recesses 2750 for brackets, made in the third row, may contain a third bracket 2730 '' '(FIG. 52), removable placed in them. The first brackets 2730 'may be located in the extreme inner longitudinal rows of the recesses 2750 for brackets, the second brackets 2730ʺ may be located in the middle rows of the recesses 2750 for the brackets, and the third brackets 2730' '' may be located in the outermost longitudinal rows of the recesses 2750 for the brackets. When the first brackets 2730 ', having the first height A' (FIG. 50), and the second brackets 2730ʺ, having the second height Aʺ (FIG. 51), are in unused form, the second brackets 2730ʺ may be higher than the first brackets 2730 '. Similarly, when the second bracket 2730ʺ, and the third bracket 2730 '' ', having the third height A'ʺ (FIG. 52), are in unused form, the third bracket 2730' '' may be higher than the second bracket 2730 ''.

In various cases, each longitudinal row of brackets can be supported by a longitudinal row of ejector brackets. For example, the first longitudinal row of ejector brackets can support the first row of first brackets 2730 ', the second longitudinal row of ejector brackets can support the second row of second brackets 2730ʺ, and the third longitudinal row of ejector brackets can support the third row of third brackets 2730' ''. In certain cases, as shown in FIG. 49 and 49A, the row of ejector 2742 brackets can support the first row of the first brackets 2730 'and the second row of brackets 2730ʺ so that each ejector 2742 of brackets can support and push out, for example, at least one first bracket 2730' and at least one the second bracket is 2730ʺ. The row of ejector 2740 brackets can support the third row of third brackets 2730 '' 'in such a way that each ejector 2740 of brackets can support and push out at least one third bracket 2730' ''. Each ejector 2742 brackets may contain the first bed 2741 ', configured to support the first bracket 2730', and the second bed 2741 "', configured to support the second bracket 2730ʺ and, similarly, each ejector 2740 brackets may contain the third bed 2741" ', configured to support the third bracket 2730' ''. When the ejector 2740 and 2742 brackets are in the non-activated position, as shown in FIG. 49A, the first beds 2741 'can be supported at the first distance 2732' from the first row of forming pockets 23, made in support 20, the second beds 2741ʺ can be supported at the second distance 2732ʺ from the second row of forming pockets 23, made in stop 20, and the third bed 2741 '' 'can be maintained at a third distance 2732' '' from the third row of forming pockets 23, made in the stop 20. The first distance may differ from the second distance and / or the second distance may differ from the third distance. As shown in FIG. 49, the first distance is shorter than the second distance, and the second distance is shorter than the third distance. The first brackets 2730 ', the second brackets 2730ʺ, and / or the third brackets 2730' '' can be deformed to different heights in the formed state, for example, when the ejectors 2740 and 2742 are raised to the stop by 20 starting element 2760 to remove the brackets 2730 ', 2730ʺ and 2730 '' 'of recesses 2750 for brackets. For example, the innermost row of brackets, i.e. brackets 2730 ', can be formed to the first height, an intermediate row of brackets, i.e. 2730ʺ, can be formed to the second height, and the outer row of brackets, i.e. brackets 2730 '' ', can be formed to a third height. The first height may be less than the second height, and the second height may be less than the third height. US Patent No. 8,317,070, entitled SURGICAL STAPLING DEVICES THAT PRODUCE FORMED STAPLES HAVING DIFFERENT LENGTHS, issued November 27, 2012, is fully incorporated into this document by reference.

In various cases, the platform of the cassette with brackets may be flat. In such cases, the protrusions described herein may extend from the flat surface of the platform. In other cases, the platform of the cartridge with the brackets may contain a stepped surface consisting of at least, for example, two stepped surfaces. As shown in FIG. 49 and 49A, the body 2710 of the cassette 2700 with the staples may comprise a first side of the platform located on the first side of the longitudinal channel 2715 of the scalpel, and a second side of the platform located on the second side of the longitudinal channel 2715 of the scalpel. Each side of the platform contains, for example, the first step 2711 ', the second step 2711ʺ, and the third step 2711' ''. The first longitudinal row of recesses 2750 for brackets can be made, at the first stage, 2711 ', the second longitudinal row of recesses 2750 for brackets can be performed at the second stage 2711ʺ, and the third longitudinal row of recesses 2750 for brackets can be performed at the third stage 2711 " . When the stop 20 is in the closed position, the surface 21 of the stop 20 that is in contact with the tissue may be located near the surface of the platform of the cassette case 2710. In such cases, the fabric-contacting surface 21 may be located at a first distance of 2712 'from the first step of 2711', at a second distance of 2712 from the second step of 2711 and at a third distance of 2712 "" from the third step of 2711 ". In various cases, the first distance, second distance, and / or third distance may be different. As shown in FIG. 49 and 49A, the first distance is 2712 'shorter than the second distance is 2712ʺ, and the second distance is 2712ʺ shorter than the third distance is 2712' ''. In various cases, the first distance 2712 'may define the first gap for the fabric between the first step 2711' and the stop 20, the second distance 2712ʺ may define the second gap for the fabric between the second step 2711ʺ and the stop 20, and the third distance 2712 '' 'may define the gap for tissue between the third step 2711 '' 'and the stop 20. The first clearance for fabric, located above the extreme inner row of recesses 2750 for brackets, may be less than the third clearance for cloth, located above the outermost row of recesses 2750 for brackets. The second fabric gap, located above the middle row of recesses 2750 for the staples, may be larger than the first fabric gap and less than the third fabric gap.

In addition to the above, as shown in FIGS. 49 and 49A, the first longitudinal row of projections 2751 'may extend from the first stage 2711', the second longitudinal row of protrusions 2751ʺ may extend from the second stage 2711 второй, and the third longitudinal row of protrusions 2751 "' go from the third stage to 2711 '' '. The first protrusions 2751 'can be defined by the first height of 2755', the second protrusions 2751ʺ can be defined by the second height of 2755ʺ, and the third protrusions 2751 '' 'can be defined by the third height of 2755' ''. The first height, the second height and / or the third height may be different. As shown in FIG. 49 and 49A, the first height of 2755 'may be less than the second height of 2755ʺ, and the second height of 2755ʺ may be less than the third height of 2755' ''. In various cases, the longitudinal row of the shortest projections, i.e. protrusions 2751 ', can go along the extreme inner row of recesses 2750 for brackets, the longitudinal row of the highest protrusions, i.e. protrusions 2751 "', can go along the outermost row of recesses 2750 for brackets, and protrusions having an average height, i.e. protrusions 2751ʺ, can go along the middle row of recesses 2750 for brackets. In FIG. 76 depicts an alternative embodiment in which the longitudinal row of the highest protrusions, i.e. protrusions 2751 "', goes along the extreme inner row of recesses 2750 for brackets, the longitudinal row of the shortest protrusions, i.e. protrusions 2751 ', goes along the outermost row of recesses 2750 for the brackets, and protrusions having an average height, i.e. protrusions 2751ʺ, go along the middle row of recesses 2750 for brackets.

As shown in FIG. 76, a cassette 4000 with brackets may in many respects be similar to the cassette 2700 with brackets described above. Similarly, a cassette 2700 with brackets, a cassette 4000 with brackets can have longitudinal rows of recesses 2750 for brackets containing the first row of recesses 2750 for brackets, including the first brackets 2730 ', removable in them, the second row of recesses 2750 for brackets, including the second brackets 2730, removable located in them, and the third row of recesses 2750 for brackets, including third brackets 2730 "", removable located in them. Unlike cassette 2700 with brackets, the first row of brackets 2730 'is the outermost row of brackets, and the third row of brackets 2730' '' is the innermost row of brackets. A cassette with brackets 4000 may contain ejectors 4040 and 4042, which are designed to support the third brackets 2730 "'' at the third forming distance 2732" "from the stop 20, the second brackets 2730ʺ at the second forming distance 2732 from the stop 20 and the first brackets 2730 ' at the first formative distance of 2732 'from the stop 20, when the ejectors 4040 and 4042 are in the non-activated, or un-raised position. The pushers 4040 and 4042 can deform the innermost row of brackets, i.e. brackets 2730 '' ', to the third height, intermediate row of brackets, i.e. brackets 2730 27, to the second height, and the outermost row of brackets, i.e. brackets 2730 ', to third height. For example, the third height in the formed state may be greater than the second height, and the second height may be greater than the first height. Similar to a cassette 2700 with brackets, a cassette 4000 with brackets may contain a stepped platform surface; however, the third step 2711 ″ ″ can go along the outermost row of recesses 2750 for the staples, and the first step 2711 ′ can go along the outermost row of the grooves 2750 for the staples. The first fabric gap formed by the first space 2712 'may be positioned laterally outwards with respect to the second fabric gap defined by the second space 2712, which may be positioned sideways outward with respect to the third fabric gap defined by the third space 2712' ''.

A cassette 3600 with brackets is shown in FIG. 70-72. A cassette 3600 with brackets may contain a cassette body 3610. The cassette body 3610 may comprise a distal end 3613, a proximal end 3616 and opposite sides 3612. The cassette body 3610 may further comprise a platform 3611, a plurality of recesses 3650 for brackets made in platform 3611, and a longitudinal groove 3615 adapted to receive, for example, blades starting element. Cassette case 3610 may additionally comprise protrusions 2051 and 2053 extending from platform 3611. Cassette case 3610 may also include protrusions 3651 extending from platform 3611. Similar to protrusions 2051, protrusions 3651 can be made with the possibility of a mesh engaging between an emphasis and a cassette 3600 , and control the movement of the fabric relative to the cassette 3600. In various cases, the protrusions 3651 may be configured to limit or prevent movement of the fabric relative to the cassette with brackets. The protrusions 3651 may be located at the proximal end and / or the distal end of the recesses 3650 for brackets. In various cases, each protrusion 3651 may contain a cuff protruding around the end of the recess 3650 for brackets. In certain cases, each protrusion 3651 may contain a curved protrusion located around the end of the recess for brackets 3650. In various cases, protrusions 3651 may not be as high as protrusions 2051 and / or protrusions 2053. Higher protrusions 2051 may exert more localized pressure to the fabric than the shorter protrusions 3651. In various cases, the protrusions 2051 can provide sufficient control over the fabric to hold it in the desired position during the stapling process. In such cases, the protrusions 3651 can provide additional control over the fabric, in addition to protecting and guiding the brackets located in the recesses 3650 for the brackets.

In addition to the above, platform 3611 may include steps 2711 ', 2711ʺ and 2711' '', which are designed to compress the fabric located between the cassette case 3610 and the abutment. In various cases, the third stage 2711 '' 'may contain the extreme lower surface of the platform, which runs along the outermost row of recesses 3650 for the brackets and around the distal end 3613 of the body 2610 of the cassette. The second stage 2711ʺ can go upwards from the extreme lower surface of the 2711 '' 'platform, and the first stage 2711' can go upwards from the second stage 2711ʺ. When the case 3610 of the cassette is moved relative to the fabric, the fabric can pass over the distal end 3613 of the case 3610 of the cassette and enter the steps 2711 ', 2711ʺ and 2711' ''. The cassette case 3610 may additionally contain bevels 3614 'and 3614ʺ, which provide free entry of fabric at the steps 2711' and 2711ʺ, respectively. Also as discussed above, steps 2711 ', 2711ʺ and 2711' '' can be used to control the movement of the fabric relative to the cassette 3600 with brackets. As predominantly shown in FIG. 71, the step 2711 'may, in various cases, form a smaller gap for the fabric between the cassette 3600 and the stop opposite the cassette 3600 compared to the gap for the cloth made between the step 2711ʺ and the stop, and / or the gap for the cloth between a step of 2711 '' 'and an emphasis. In cases where the step 2711 'and the smallest gap for the fabric are located near the longitudinal groove 3615, the fabric near the longitudinal groove 3615 may be more compressed and controlled than the fabric located on the side of the step 2711'. Such an embodiment may have advantages for a number of reasons. For example, the cutting member extending through the longitudinal groove 3615 may displace the tissue gripped between the cassette 3600 with the staples and the abutment, and as a result of the compression applied by the extreme inner step 2711 ', the displacement of the tissue can be prevented or reduced.

As discussed above in connection with the embodiment shown in FIG. 76, the staple cassette may contain a stepped platform surface on which the smallest fabric gap has the same length with the outermost longitudinal rows of recesses for the staples. In such cases, the smallest gap can be located near the sides of the cassette and, as a result of the compression applied by the outermost steps, the displacement of the fabric, especially its lateral displacement, can be prevented or reduced. In certain cases, as shown in FIG. 70-72, the lateral displacement of the tissue trapped between the cassette 3600 with the brackets and the abutment can be prevented or reduced by the side walls 3617. Each side wall 3617 can extend from the side 3612 of the cassette body 3610 and block the lateral movement of the fabric. The side walls 3617 may have any suitable configuration. In at least one case, each sidewall 3617 may include, for example, a grooved top surface. As shown in FIG. 73, the bracket cassette 3700 may comprise a cassette body 3710, including side walls 3717, extending from the sides 3712 of the cassette body 3710. In at least one case, each side wall 3717 may comprise, for example, a straight upper surface.

As shown in FIG. 74, the staple cartridge 3800 may comprise a cartridge case 3810 having a distal end 3813 and recesses 3850 for the staples. As described above, the cassette case 3810 may have protrusions 2053 at the distal ends of the outermost distal recesses 3850 for the staples. In addition, as described above, the cassette body 3810 may have protrusions 2051 that may surround the proximal end and / or the distal end of at least some recesses 3850 for the staples. In addition to or instead of the protrusions 2051 and 2053, the case of the staple cartridge 3810 may further comprise protrusions 3851 extending from it. Each protrusion 3851 may go around the end of more than one recess 3850 for brackets. In at least one case, each protrusion 3851 may go, for example, around the end of the recess 3850 for brackets in the outermost row of recesses 3850 for brackets, the end of the groove 3850 for brackets in the outermost row of recesses 3850 for brackets and / or the end of the groove 3850 for brackets in the middle row of grooves for brackets. In at least one such case, the first part of the protrusion 3851 may extend beyond the first recess 3850 for brackets above the surface of the cassette platform, the second part of the protrusion 3851 may extend beyond the second recess 3850 for brackets above the surface of the cassette's platform, and the third part of the protrusion 3851 may extend the third recess 3850 for brackets above the surface of the cassette platform. The first part of the protrusion 3851 may protect, guide and / or hold the first bracket; the second part can protect, guide and / or hold the second bracket; the third part can protect, guide and / or hold the third bracket. In various cases, the protrusion 3851 can go between the longitudinal groove 3615, made in the cassette case 3810, and the side wall 3717, extending from the cassette case 3810. In at least one case, the protrusion 3851 may go across the first stage 2711 ', the second stage 2711 and / or the third stage 2711' ''. In other words, the protrusion 3851 can go across the height variations in the platform of the cassette case 3810. In some cases, the upper, or engaging fabric, surface of the protrusion 3851 may be flat, despite changes in the height of the surface of the cassette platform. In other cases, the upper, or engaging fabric, surface of the protrusion 3851 may also vary in height. In at least one such case, the upper surface of the protrusion 3851 may, for example, increase in height when the platform surface increases in height and decrease in height when the platform surface decreases in height. In other cases, the upper surface of the protrusion 3851 may, for example, decrease in height when the platform surface increases in height, and increase in height when the platform surface decreases in height.

In various cases, as shown in FIG. 74, the cassette housing 3810 may include transverse protrusions, or ribs, 3817 extending from it. The transverse protrusion 3817 may run transversely to the longitudinal groove 3615 and / or side walls 3717. In at least one case, the transverse protrusion 3817 may go in a direction that is perpendicular to the longitudinal groove 3615 and / or to the side walls 3717. In at least one case transverse protrusions 3817 may be between protrusions 3851 and side walls 3717. Transverse protrusions 3817 may also be between protrusions 2051 and side walls 3717 and, similarly, between protrusions 2053 and side walls 3717. In some cases, protrusions 3817 and side 3717 can have the same height. In other cases, the protrusions 3817 and the side walls 3717 may have different heights. As shown in FIG. 74, side walls 3717, for example, are higher than protrusions 3817. In any case, transverse protrusions 3817 can be made, for example, with the ability to limit or prevent movement of the fabric relative to the cassette 3800 with brackets, especially in the distal or longitudinal direction.

As shown in FIG. 81, the bracket cassette 4500 may have a cassette housing 4510 comprising a platform 4511, a proximal end, a distal end 4513 and a longitudinal groove 3615 for a scalpel, located between the proximal end and the distal end 4513. The cassette case 4510 may have an inclined transition 2014, protrusions 2051, 2053 and 3651, at least partially surrounding recesses 3650 for brackets, and side walls 3617, in addition to other elements. In fact, various embodiments are provided in which the tissue control elements of the various embodiments described herein can be combined with the tissue control elements of other embodiments described herein. In addition, this document describes various embodiments in which the recesses for the brackets made in the cassette with the brackets may have protrusions that are at least partially surrounding the recesses for the brackets. Other embodiments are provided in which virtually all recesses for brackets have protrusions, at least partially surrounding recesses for brackets. As shown in FIG. 82, the staple cassette 4600 may have a cassette body 4610 comprising a platform 4611, a proximal end 4616, a distal end 4613, and a longitudinal groove 4615 for a scalpel located between the proximal end 4616 and the distal end 4613. The case 4610 of the cassette may have projections 2051 and 2053, extending from platform 4611 and at least partially surrounding some recesses 4650 for brackets. For example, the proximal and / or distal ends of the recess 4650 for brackets, made in the distal end 4613 of the cartridge 4600 with brackets, may be at least partially surrounded by projections 2051 and, similarly, the proximal and / or distal ends of the recesses 4650 for brackets, made in the proximal end 4616 of the cassette 4600 with the brackets may be at least partially surrounded by the protrusions 2051. In this embodiment, the recesses 4650 for the brackets made in the middle of the cassette 4610, i.e. between the proximal end 4616 and the distal end 4613 of the cartridge with brackets, for example, may not be surrounded by the protrusions 2051 and / or any other protrusions. As shown in FIG. 83, the staple cartridge 4700 may comprise a cartridge case 4710 having a platform 4711, a proximal end and a distal end 4713. The cartridge case 4710 may include a plurality of recesses 4750 for brackets provided therein. Extreme distal recesses 4750 for brackets contain a distal end surrounded by a protrusion 2053, and a proximal end surrounded by a protrusion 2051. Other recesses 4750 for brackets may contain a distal end surrounded by a protrusion 2051, and a proximal end that is not surrounded by a protrusion. Certain recesses 4750 for brackets may contain a proximal end surrounded by a protrusion 2051, and a distal end that is not surrounded by a protrusion.

As discussed above, the protrusion extending from the surface of the platform may be configured to protect, support, and / or direct the bracket located in the recess for the bracket. In FIG. 77 depicts a cassette 4100 with brackets, comprising a cassette body 4110, a platform 4111, a cavity cavity 4150 made in platform 4111, and a protrusion 4151 extending from platform 4111. The cassette 4100 with brackets may additionally contain a bracket 4130 removably accommodated in cavity 4150 for brackets. The protrusion 4151 may have a groove 4154 therein, which may be configured to support the leg 4132 of the bracket 4130 when the bracket 4130 is placed in the cavity 4150 for brackets and / or when the bracket 4130 is pushed out of the cavity 4150 for brackets. The groove 4154 may comprise an extension of the end wall 4152 of the cavity for the staples. The end wall 4152 of the cavity for brackets and / or the groove 4154 may jointly support the leg 4132 of the bracket when the bracket 4130 is in an unused position. When pushing the staple 4130 out of the cavity 4150, the leg 4132 may extend from the protrusion 4151, as shown in FIG. 77. In such cases, the end wall 4152 and / or groove 4154 may support part of the bracket 4130, which has not yet left the cavity 4150 for the brackets. In certain cases, the protrusion 4151 may not provide lateral support for the leg 4132 of the bracket. In particular, as shown in FIG. 77, the groove 4154 may contain opposite sides 4155, which may be located at a distance from the sides of the leg 4132 of the bracket, and not in contact with them. In various cases, the staple 4130 may be deformed into a fully deformed shape, while the staple 4130 continues to be at least partially located in the staple cavity 4150. In at least one case, the end wall 4152 and / or the groove 4154 can support the bracket 4130 during the entire process of forming the bracket 4130. In other cases, the bracket 4130 can reach a completely deformed shape after it has been lifted from the groove 4154 and is located above the protrusion 4151. In such cases, the end wall 4152 and the groove 4154 may not support the bracket 4130 during the entire process of its formation.

In FIG. 78 depicts a cassette 4200 with brackets, comprising a cassette body 4210, a platform 4211, a recess 4250 for brackets made in platform 4211, and a protrusion 4251 extending from platform 4211. The cassette 4200 with brackets may additionally contain a bracket 4130 removable in recess 4250 for brackets. The protrusion 4251 may have a groove 4254 therein, which may be adapted to support the leg 4132 of the bracket 4130 when the bracket 4130 is placed in the recess 4250 for the brackets and / or when the bracket 4130 is pushed out of the recess 4250 for the brackets. The groove 4254 may comprise an extension of the end wall 4252 of the recess for the staples. End wall 4252 grooves for brackets and / or groove 4254 can jointly support the leg 4132 brackets when the bracket 4130 is in an unused position. When pushing the staple 4130 out of the recess 4250, the leg 4132 may exit the protrusion 4251, as shown in FIG. 78. In such cases, the end wall 4252 and / or groove 4254 may support part of the bracket 4130, which has not yet left the recess 4250 for the brackets. In certain cases, the protrusion 4251 may provide lateral support for the leg 4132 of the bracket. In particular, as shown in FIG. 78, the groove 4254 may have opposite sides 4255 that may come into contact with the sides of the leg 4132 of the bracket. In various cases, the staple 4130 may be deformed into a fully deformed shape, while the staple 4130 continues to be at least partially located in the recess 4250 for the staples. In at least one case, the end wall 4252 and / or groove 4254 may support the bracket 4130 during the entire process of forming the bracket 4130. In other cases, the bracket 4130 may reach a completely deformed shape after it has been lifted from the groove 4254 and is located over the protrusion 4251. In such cases, the end wall 4252 and the groove 4254 may not support the bracket 4130 during the entire process of its formation.

In FIG. 79 depicts a cassette 4300 with brackets, comprising a cassette case 4310, a platform 4311, a cavity cavity 4350 made in platform 4311, and protrusions 4351 extending from platform 4311. A cassette 4300 with brackets may additionally contain a bracket 4130 removably housed in cavity 4350 for brackets. Each protrusion 4351 may have a tapered groove 4354 therein, which may be configured to support leg 4132 of bracket 4130 when bracket 4130 is placed in cavity 4350 for brackets and / or when bracket 4130 is pushed out of cavity 4350 for brackets. Each groove 4354 may include an extension of the end wall 4352 of the cavity for brackets and have side walls 4355. The side walls 4355 of each groove 4354 may jointly support the leg 4132 of the bracket when the bracket 4130 is in an unused position. As the reader will understand from FIG. 79, the leg 4132 of the bracket may not be supported by the end wall 4352. When pushing the bracket 4130 out of the cavity 4350, the legs 4132 may come out of the protrusions 4351. In such cases, the side walls 4355 of the grooves 4354 can support part of the bracket 4130 that has not yet left the cavity 4350 for the brackets . In certain cases, the side walls 4155 of the protrusions 4351 may provide lateral support for the legs 4132 of the bracket. In various cases, the staple 4130 may be deformed into a fully deformed shape, while the staple 4130 continues to be at least partially located in the cavity 4350 for the staples. In at least one case, the grooves 4354 can support bracket 4130 during the entire process of forming the bracket 4130. In other cases, bracket 4130 can achieve a completely deformed shape after it has been lifted out of the grooves 4354 and located above the protrusions 4351. In such In cases, the front grooves 4354 may not support bracket 4130 during the entire process of its formation.

In FIG. 80 depicts a cassette 4400 with brackets, comprising a cassette body 4410, a platform 4411, a bracket cavity 4450 formed in platform 4411, and protrusions 4451a and 4451b extending from platform 4411. A cassette 4400 with brackets may additionally contain bracket 4130, for example, removable in cavity 4450 for brackets. The bracket cavity 4450 may include a first end wall 4452a, configured to support and guide the first leg of the bracket 4130, and a second end wall 4452b, configured to support and guide the second leg of the bracket 4130. The protrusion 4451a may extend from the platform 4411 to the first distance 4455a , and the protrusion 4451b can go from the platforms 4411 to a second distance 4455b over the protrusion 4451a. In various cases, as a result, the protrusion 4451a can support and guide the first leg of the bracket to the first distance, and the protrusion 4451b can support and guide the second leg of the bracket to the second distance, with the second distance longer than the first distance. Under certain conditions, the protrusion 4451b may be located at the distal end of the cavity 4450 for brackets, and the protrusion 4451a may be located at the proximal end of the cavity 4450 for brackets. Such an embodiment may be needed when the staple 4130 is pushed out distally as a result of the distal movement of the trigger and a scalpel for cutting the fabric, as discussed above. In addition, the protrusion 4451b may be located at the proximal end of the cavity 4450 for brackets, and the protrusion 4451a may be located at the distal end of the cavity 4450 for brackets. In any case, the protrusion 4451b may have, for example, a stepped shape. In at least one case, the protrusion 4451b may comprise a first part defined, for example, a height of 4455a, and a second part defined by a height of 4455b.

In FIG. 85A-85C depicts a cassette 4900 with brackets comprising a cassette body 4910 having a platform 4911. In various embodiments, the cassette body 4910 may be made of a flexible material. In certain embodiments, the cassette case 4910 may be made of a rigid material and a flexible material, and at least the platform 4911 may be made of a flexible material. The flexible material can be plastic materials, for example polypropylene, and / or elastomeric materials, for example rubber, thermoplastic elastomer and / or stattoprene. In various cases, the platform 4911 may be made of plastic material. In any case, the platform 4911 may have a protrusion 4951 coming from it. Similar to that described above, the protrusion 4951 can protect, support and / or direct the bracket 4130. In addition, similarly to the above, the protrusion 4951 can be prevented or at least limit the movement of the fabric relative to the cartridge 4900 with the brackets. When the stop moves to the closed position opposite the cartridge 4900 with brackets or, conversely, the cassette 4900 with brackets moves to the closed position relative to the stop, the protrusion 4951 can be compressed with a cloth located between the stop and the cartridge 4900 with brackets. In FIG. 85A-85C depict a sequence of events in which the protrusion 4951 is subject to increasing compression forces. In FIG. 85A shows a protrusion 4951 in an uncompressed state. In this state, between the protrusion 4951 and the leg of the bracket 4130 there may be a compressive or tight fit. In FIG. 85B shows a protrusion 4951 in a compressed state as a result of a compressive force. When comparing FIG. 85A and 85B, it can be seen that the upper surface 4956 of the protrusion 4951 was pressed down to the platform 4911 at a distance of 4955, and that the shape of the protrusion 4951 became curved. In this state, the protrusion 4951 can grip the leg of the bracket 4130 and / or hold the leg of the bracket in position. In FIG. 85C depicts a greater compression force applied to the protrusion 4951. When comparing FIG. 85B and 85C, it can be seen that the upper surface 4956 of the protrusion 4951 was further pressed down to the platform 4911, and that the shape of the protrusion 4951 became even more curved. In addition, in this state, the protrusion 4951 may increase the gripping force applied to the leg of the bracket.

In FIG. 86A and 86B depict a cassette 5000 with brackets, comprising a cassette housing 5010 having a platform 5011. The cassette housing 5010 may further comprise a plurality of recesses 5050 for brackets made therein, and a plurality of projections 5051 extending from the platform 5011, which are designed to be protected supports and / or directions of brackets 5030, detachably housed in recesses 5050 for brackets. Similar to the above, the cartridge with the staples 5000 may additionally contain ejector 5040 and 5042 brackets, which are configured to support and lift the staples 5030 between the unused and used position. In FIG. 86A and 86B depict brackets 5030 in a partially used position, with the tips of brackets 5030 partially protruding from the protrusions 5051. As described above, the cassette body 5010 can be made of flexible material. The flexible material can be plastic materials, for example polypropylene, and / or elastomeric materials, for example rubber, thermoplastic elastomer and / or stattoprene. In various cases, the case 5010 cassettes can be made of plastic material. When a compressive force is applied to the cassette case 5010, the cassette case 5010 may be bent as shown in FIG. 86B. When the platform 5011 of the cassette case 5010 is bent down as shown in FIG. 86B, the protrusions 5051 may deviate downward a distance of 5055. Thus, the protrusions 5051 may be movable.

There are various embodiments in which the protrusions extending from the platform of the bracket with brackets can be moved relative to the platform. In at least one case, the protrusion may move between the first position, in which the protrusion extends beyond the recess for brackets over the platform, and the second, lowered position, in which the protrusion may or may not extend beyond the recess for brackets above the platform. In various cases, one or more protrusions extending from the platform may be compressible. A compressible protrusion may move between the first position, in which the protrusion extends beyond the recess for brackets above the platform, and the second, compressed, position, in which the protrusion may or may not extend beyond the recess for brackets above the platform. In at least one case, the contracted protrusions can elastically return to the uncompressed state. In this case, in certain cases, the projections may not fully return to the uncompressed state. In various cases, one or more protrusions extending from the platform may be crushed. The crushable protrusion may move between the first position, in which the protrusion extends beyond the recess for brackets above the platform, and the second, crumpled, position, in which the protrusion may or may not extend beyond the recess for the brackets above the platform. Wrinkled protrusions may not return to a non-crumpled position.

As discussed above, cassette brackets can be supported by ejectors when the brackets are detachable in a cassette holder. Also as discussed above, the ejector brackets can be raised upward trigger element, for example, the starting element 2760. In various cases, as shown in FIG. 53 and 54, the trigger element may be adapted to move the slide for the staples, for example, the slide for the staples 2870, distal to raise the ejector and the staples to the stop. The slide for the staples 2870 may include a housing 2871 and a shoulder 2876, which may be adapted to engage and support the starting element 2760. The slide 2870 may further comprise, for example, inclined surfaces 2872, 2873, 2874 and / or 2875, which are moveable under the ejector brackets and lifting them up, while moving the slide 2870 below them. In various cases, in addition to the above, for example, the first inclined surface 2872 can be configured to contact and lift the ejector brackets in the first row of ejectors, the second inclined surface 2873 can be configured to contact and lift the ejector brackets in the second row of ejectors, the third inclined surface 2874 can be made with the possibility of contact and lifting of the ejector brackets in the third row of ejectors, and the fourth inclined surface 2875 can be performed on with the possibility of contact and lifting of the ejector brackets in the fourth row of ejector.

In various cases, in addition to the above, the sled 2870 can be made with the possibility of simultaneously raising the ejector brackets in four rows of ejectors. In some cases, the slide 2870 can simultaneously lift the ejector brackets in four rows of ejector. In such cases, the distal ends of the four inclined surfaces 2872, 2873, 2874 and 2875 can be made to simultaneously contact four ejector brackets and lift them along four parallel lifting surfaces so that the ejector brackets simultaneously reach the same height. In addition, in such cases, the inclined surfaces 2872, 2873, 2874 and 2875 may have the same length. In other cases, the sled 2870 can simultaneously lift the ejector brackets in each of the four rows of ejector, although in a staggered manner. As predominantly shown in FIG. 54, the distal end 2872a of the first inclined surface 2872 may be aligned with the distal end 2875a of the fourth inclined surface 2875. In various cases, the first inclined surface 2872 may be parallel to the fourth inclined surface 2875. In addition, the first inclined surface 2872 may determine the length of the first inclined surface, which is equal to the length of the fourth inclined surface defined by the fourth inclined surface 2875. The distal end 2873a of the second inclined surface 2873 may be distal relative to eniyu to the distal end 2872a of the first inclined surface 2872, and the distal end 2875a of the fourth inclined surface 2875 is located in the region indicated by the distance 2879a. The second inclined surface 2873 may not be parallel to the first inclined surface 2872 and / or the fourth inclined surface 2875. In addition, the second inclined surface 2873 may determine a length of the second inclined surface that is longer than the length of the first inclined surface and / or the length of the fourth inclined surface. The distal end 2874a of the third inclined surface 2874 may be distal with respect to the distal end 2873a of the second inclined surface 2873 at a distance indicated by the distance 2878a. The third inclined surface 2874 may not be parallel to the first inclined surface 2872, the second inclined surface 2873 and / or the fourth inclined surface 2875. In addition, the third inclined surface 2874 may determine the length of the third inclined surface that is longer than the first inclined surface, the length of the second inclined surface and / or the length of the fourth inclined surface.

When the slide is in contact with the staple ejector, in addition to the above, there can be a counter-force and / or torque between the slide and the ejector of the staples, which can cause the rotation of the slide and / or the ejector of the staples. The design of the inclined surfaces shown in FIG. 53 and 54, may prevent, or at least limit, rotation of the sled 2870 when the sled 2870 contacts with the ejector brackets and raises them. In addition, the sled 2870 may have a stabilizing element 2877 that protrudes distally, providing stabilization of the sled 2870 and preventing and / or eliminating the movement or rotation of the sled 2870. The stabilizing element 2877 may protrude distally towards surfaces 2872, 2873, 2874 and 2875, respectively.

As shown in FIG. 54A-54D, the slide 2870 can be configured to install brackets, for example, from a cassette 2000 with brackets when the slide 2870 moves from the proximal end 2016 of the cassette 2000 with brackets to the distal end of 2013 the cassette 2000 with brackets. The cassette 2000 with brackets and / or slide 2870 may have elements that can detachably hold the slide 2870 in the proximal end of the 2016 tape 2000 with brackets. In various cases, the body 2010 of the cassette 2000 with brackets may have recesses 2019, made with the ability to capture the sled 2870 and hold the sled 2870 in the proximal, non-activated position, as shown in FIG. 54A. In at least one case, as predominantly shown in FIG. 54B and 54C, each recesses 2019 may include an edge or protrusion that goes inward to the longitudinal groove 2015. The protrusion may go, for example, vertically in the longitudinal groove 2015. In addition to the above, the body 2871 of the slide 2870 may be located in the longitudinal groove 2015 and may engage with recesses 2019 when the carrier 2870 is in a proximal, non-activated position, as shown in FIG. 54A. In various cases, the recesses 2019 may form a gap between themselves that is smaller than the width of the body 2871. In such cases, between the recesses 2019 and the body 2871 of the sled 2870 there may be such a tight fit that the recesses 2019 can grip and hold the sled 2870 in position. When the trigger member pushes the rails 2870 distally, the housing 2871 can be pushed out of engagement with the recesses 2019, and the rails 2870 can advance distally to apply the staples that are placed in the cartridge 2000 with the brackets. In various cases, as shown in FIG. 54D, the body 2871 of the carrier 2870 may include grooves 2018 formed therein that can be adapted to receive the recesses 2019 in a detachable manner. When aligning the grooves 2018 and the recesses 2019, the proximal, non-activated position of the carriage 2870 can be determined. grooves 2018 and recesses 2019, one set can be used to detachably hold the sled 2870 in position. In other cases, more than two sets of grooves 2018 and recesses 2019 may be used. In some cases, the recesses 2019 may extend from the body 2871 of the sled 2870, and the grooves 2018 may be provided in the body of the 2010 cassette.

As discussed above, the cassette case may contain a platform for supporting the fabric and protrusions extending from the platform, which can be performed with the ability, firstly, to control the movement of the fabric relative to the cassette case, and secondly, speaking of grooves for brackets made in the case cassettes above the platform and / or, thirdly, maintaining, protecting and / or directing the brackets in the recesses for the brackets. In various cases, the cassette body and the protrusions can be made from a single piece of material. In at least one case, the protrusions can be made completely with the cassette case. The body of the cassette and the protrusions can be made, for example, from plastic and formed by injection molding. In certain cases, the protrusions may be connected to the cassette case. In at least one case, the protrusions may, for example, be glued to the cassette case. Cassette body and protrusions can be made of the same or different materials. In at least one case, the cassette body may be made of plastic, and the protrusions may be formed, for example, from an elastomeric material, for example, rubber, a thermoplastic elastomer, and / or santoprene. In various cases, the protrusions can be made of plastic material that does not allow injury to the fabric, sandwiched between the protrusions. The protrusions 3051 (FIG. 60) and / or, the protrusions 3151 (FIG. 61), for example, may be made of an elastomeric material, for example, rubber, a thermoplastic elastomer and / or santoprene. In at least one case, the cassette case may be formed by pouring under pressure, and the protrusions may be formed on the cassette case during the second casting process using a material that is more ductile than the material from which the cassette case is made. In various cases, the protrusions 3051 and / or 3151, for example, may have a textured surface platform. In certain cases, the protrusions 3051 and / or 3151, for example, may be made of a material having a higher coefficient of friction than the material of the body of the cassette. Such embodiments increase the gripping force between the cassette case and the fabric.

In various cases, the protrusions extending from the body of the cassette may be fixed and not move relative to it. In certain cases, as discussed above, the projections can be flexible and deformed relative to the cassette case. In some cases, as also discussed above, the cassette case may be flexible, which allows the protrusion to move when the cassette case is bent. A cartridge with brackets may contain protrusions that can be extended relative to the cassette body. As shown in FIG. 75, a cassette 3900 with brackets may comprise a cassette body 3910 with a plurality of recesses 3950 made therein. In various cases, a recessed element 3940 may be placed in the recess 3950, grabbing the fabric. Each element 3940 can move from the idle position to the working position. When element 3940 is in an idle position, element 3940 may not protrude above platform 3911 and, when element 3940 is in working position, element 3940 may protrude above platform 3911. In addition, element 3940 may protrude above platform 3911 when it is in non-working position In at least one such embodiment, element 3940 can grab the fabric in its non-working and working position. In any case, the element 3940 may contain protrusions 3951 coming from it, which can be made to grip, stabilize and / or compress the fabric located between the stop 20 and the cassette 3900.

As shown in FIG. 75, the elements 3940 can be positioned with a sled 3970, which longitudinally moves the cassette case 3910 from its proximal end to the distal end. The slide 3970 may comprise an inclined surface 3972, which is adapted to successively engage the elements 3940 and lift the elements 3940 between their non-working and working position. At least in one case, each element 3940 may contain a beveled or inclined surface 3942, which is in contact with the inclined surface 3972. The inclined surface 3972 can fit under the elements 3940 and lift the elements 3940 onto the surface 3979. The surface 3979 can hold the elements 3940 in their working position when the distal advancement of the slide 3970 trigger element, for example, the starting element 2760. As shown in FIG. 75, the surface 3979 may be long enough to support several elements 3940 on it. In addition, the surface 3979 may be long enough to support the elements 3940 during the formation of the staple and cutting the tissue performed by the starting element 2760. At least in one case, the surface 3979 may precede the blade 2761 of the starting element 2760 or be distal with respect to it. In such cases, the elements 3940 can hold the fabric located distally with respect to the blade 2761, while the distal movement of the blade 2761 through the fabric. In other words, the elements 3940, which capture the fabric, can be placed so as to capture a part of the fabric in front of the part that is fastened with brackets and / or cut tissue. The recesses 3950 can be configured to support and guide the elements 3940, as well as prevent lateral movement or rotation of the elements 3940 in the recesses 3950. The proximal end of the surface 3979 can be designed and positioned so that the slide 3970 can release the element 3940 after the blade passes through 2761 3940. In at least one case, the surface 3979 may no longer support element 3940 after passing the blade 2761 of element 3940.

In addition to the above, as shown in FIG. 75, the recesses 3950 may be located in longitudinal rows. For example, the recesses 3950 may be located in six longitudinal rows containing two outermost rows, two outermost rows, and a row located between each outermost and outermost row. Other embodiments are provided in which the recesses 3950 are located in less than six rows or in more than six rows. In any case, some recesses 3950 in the cassette case 3910 may be configured to support and guide the element 3940, as discussed above, and some recesses 3950 may contain a bracket, for example, a bracket 2630 removably housed therein. Sled 3970 can be made with the possibility of placing elements 3940 and the imposition of brackets. In at least one such case, the slide 3970 may additionally comprise at least one bevel 2873 having an inclined surface 3971 adapted to raise, for example, the ejector 2640 of the brackets to the stop 20, which, as discussed above, may impose brackets 2630 In various cases, bevel 3972 may precede bevel 2873. In such cases, bevel 3972 may place element 3940 in its working position before bevel 2873 lifts the brackets, next to element 3940, to a fully formed position. Various embodiments are envisaged in which the outermost rows of the recesses 3950 have elements 3940 placed therein that capture the fabric, and the innermost rows and middle rows of the recesses 3950 have brackets removably accommodated therein. Such an embodiment may have two rows of brackets and one row of elements 3940 grabbing the fabric, on each side of the longitudinal groove for the scalpel, made in the body of the cassette. Other embodiments are provided in which any suitable arrangement of elements 3940 and brackets may be used.

As discussed above, embodiments are provided in which a cartridge with brackets can have rows of brackets and rows of disposable elements grabbing fabric. In at least one embodiment, the disposable elements that capture the fabric may not be interspersed with a number of brackets. Other embodiments are provided in which the fabric grab elements are placed within a series of brackets. Also as discussed above, embodiments are provided in which recesses for brackets are used to accommodate elements that capture the fabric. Certain embodiments are envisaged in which the elements that capture the fabric are not placed in the recesses for the brackets and can be placed in the row of recesses next to the recesses for the brackets.

In FIG. 90-93, another embodiment is shown comprising accommodated protrusions engaging a fabric. A cassette 5300 with brackets, for example, may include a cassette case 5310 having a platform 5311 and a plurality of recesses 5350 for brackets provided therein. A cartridge 5310 with brackets may have brackets 5330 removably accommodated in recesses 5350 for brackets, and a plurality of ejector 5340s configured to remove brackets 5330 from recesses 5350 for brackets. The bracket cartridge 5310 may additionally have one or more protrusions 5351 to be disposed of, removable to be placed in recesses 5350 for the brackets, which will be described further in more detail below. Each ejector 5340 may have a bed 5341, configured to support the bracket 5330, and a moving surface 5342, configured to grip the slide, for example, a slide 5370. Similar to the above, the slide 5370 can be configured to lift the ejector 5340 between the non-working position and the working position. position. In FIG. 92 shows ejector 5340 and brackets 5330 in non-operating positions. As shown mainly in FIG. 93, the ejector 5340 may be configured to lift the protrusions 5351 to be placed between the non-operating position and the working position. In at least one embodiment, as shown predominantly in FIG. 90 and 91, each ejector 5340 can be assembled between a first hosted protrusion 5351 located around the proximal end of the ejector 5340 and a second hosted protrusion 5351 located around the distal end of the ejector 5340, and the upward movement of the ejector 5340 can be transferred to the protrusions 5351 to move protrusions 5351 in their working position. In at least one case, the protrusions 5351 can be pressed against the ejector 5340 by friction. When the ejector 5340 rises up, the protrusions 5351 can rise up due to a frictional fit between the ejector 5340 and the protrusions 5351. Each protrusion 5351 can contain a section 5352, an exciting a fabric that can be made with the possibility of contact with the fabric and the application of a compressive force to it. In various cases, the protrusion 5351 may apply a compressive force to the fabric, until the compressive force exceeds the static friction force between the protrusion 5351 and the ejector 5340, which moves the protrusion 5351 upwards. At this time, the ejector 5340 can move freely relative to the protrusion 5351. In other words, the ejector 5340 can be detached from the protrusions 5341 associated with it.

In various cases, as shown in FIG. 93, portions 5352, grab the fabric, protrusions 5351 may not protrude above the platform 5311, when the protrusions 5351 are in an idle position. In other cases, areas 5352, grabbing the fabric, placed protrusions 5351 may protrude above the platform 5311, when the protrusions 5351 are in an idle position. In any case, areas 5352, exciting tissue, placed protrusions 5351 can act above the platform 5311, when the protrusions 5351 are in working position. In addition to the above, the friction fit between each protrusion 5351 and the ejector 5340 may be the same. In this case, the force at which the ejector 5340 will move relative to the protrusion 5351, i.e. the slip force may be the same for each protrusion 5351. Other embodiments are contemplated in which a frictional fit between certain protrusions 5351 and certain ejector 5340 may differ from other protrusions 5351 and other ejector 5340. In such embodiments, the slip force between the protrusions 5351 and ejector 5340 may be different. In at least one embodiment, the first protrusion 5351 located at the distal end of the ejector 5340 may begin to slip at the first slip force, and the second protrusion 5351 located at the proximal end of the ejector 5340 may begin to slip at the second slip force that differs from first slipping effort. In various cases, as a result of the foregoing, the compressive force that the protrusion 5351 may exert on the tissue may be limited. In addition, as a result of the above, the distance that the protrusion 5351 may extend from the platform 5311 of the cassette case 5310 may be limited. In various cases, the protrusions 5351 may have variable sensitivity to the type and / or thickness of the fabric stitched with brackets. For example, the protrusions 5351 may be placed farther from the platform 5311 when the fabric is thinner and / or has greater plasticity, compared to when the fabric is thicker and / or more rigid. In any case, the free sliding connection between the ejector 5340 and the protrusions 5351 may prevent excessive compression of the fabric by the protrusions 5351.

In addition to the above, the protrusions 5351 can move freely relative to the cassette platform 5311. In various cases, the protrusions 5351 may dynamically respond to the compression pressure that occurs in the fabric, sandwiched between the stop 20 and the cassette 5300 with brackets. In at least one case, the trigger 2760 can lift or move the stop 20 to the cassette 5300 with brackets when distal advancing the trigger 2760. When the stop 20 moves to the cassette 5300, the fabric can be compressed by the stop 20, and in response to this the protrusions 5351 may, for example, be moved or led down into the cassette case 5310.

In various cases, the cartridge with brackets may contain protrusions that are rigidly protruding from the platform of the cassette case. In at least one case, the platform and the projections may not move relative to each other. In other cases, the platform may move relative to the projections. In at least one such case, the protrusions may rigidly protrude from the cassette case, and the platform may contain a moving surface. when the fabric is compressed between the anvil and such a staple cassette, the platform can move downward relative to the protrusions. The platform can move between the first position and the second position. When the platform is in the first position, the projections may not protrude above the upper surface of the platform. In such cases, the protrusions may be sunk below the upper surface of the platform when the platform is in the first position. When the platform moves to the second position, the projections may extend and protrude above the upper surface of the platform. In addition, the protrusions may protrude above the upper surface of the platform when the platform is in the first position and the second position. In any case, the distance that the platform moves relative to the ridges depends on the pressure applied to the fabric. For example, the platform may move a greater distance when a greater compression pressure is applied to the fabric, and a smaller distance when a smaller compression pressure is applied to the fabric. The upper surface of the platform can move freely in response to the compression pressure applied to it. Various embodiments are provided in which the platform is made of a single piece of material. Other embodiments are provided in which the platform comprises a plurality of parts. In at least one such embodiment, each part may act independently of the other parts. In various cases, the platform may be made of an elastic material that can flex in response to the compression pressure applied to it. In at least one case, the platform can be made, for example, from foamed material. In certain cases, the platform can be made, for example, from oxidized regenerated cellulose. The platform can be made of implantable material. The platform may or may not be implanted into the patient. In various cases, the platform may have openings made therein which provide for relative movement between the platform and the protrusions. In at least one such case, there may be through-holes in which the projections may be located. In certain cases, the hole may have a gap-forming groove that goes around the recess for the bracket, and a protrusion or protrusions extending around the recess for the bracket. When pushing the staples out of the recesses for the staples, they can pass through the holes provided by the grooves forming the gap. In some cases, at least part of the platform can be grabbed with brackets for implantation of the platform against the fabric that is stitched with brackets.

In various cases, the bracket with brackets described in this document may contain additional material. The additional material may contain at least one layer of material that is located above the platform of the cassette with brackets and is implanted in the patient, for example, with brackets installed from the cassette with brackets. In various cases, this at least one layer of material may contain, for example, a support material and / or a fabric thickness compensator. This at least one layer of material may consist, for example, of Gore SeamGuard material, Synovis Peri-Strips material and / or polyurethane. This document has already included numerous references to the description of such layers. A full description of US Patent Application Serial No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, is now the publication of US Patent No. 2013/0161374, which is incorporated by reference into this document. A complete description of US Patent Application Serial No. 13 / 531,619 entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, filed June 25, 2012, currently US Patent Publication No. 2012/0318842, US Patent Application Serial No. 13 / 531,623, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, filed June 25, 2012, currently published US Patent No. 2012/0318843, US Patent Application Serial No. 13 / 531,627, entitled TISSUE STAPLLER COMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT, filed June 25, 2012, is currently published US Patent No. 2012/0312860, and and US Patent Serial No. 13 / 531,630, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT, filed June 25, 2012, the current publication of US Patent No. 2012/0318844, is incorporated herein by reference. The layer may consist of a bioabsorbable material and / or a non-bioabsorbable material. In some cases, a layer of material may be attached to the platform. In at least one case, the at least one adhesive may be used to detach the layer to the platform. In some cases, a layer of material may be removably attached to the platform, for example, using one or more surgical threads or strips. In certain cases, the layer may consist of a single piece of material. In some cases, the layer may have holes made in it. In at least one such case, the layer can be used, for example, with a cassette 2000 with brackets and have, for example, holes, cuts and / or grooves made therein that are aligned with the protrusions 2051 and / or the protrusions 2053 extending from the platform 2011 cassettes 2010 with brackets. In certain cases, the layer may have through holes or windows running through the entire layer. Holes, cuts and / or grooves, for example, can be cut in a layer, for example, using a cutting element. In some cases, holes, cuts and / or grooves may, for example, be formed during the casting of a layer. In certain cases, holes, cuts and / or grooves can, for example, be formed using a laser cutting process. In some cases, the holes may be recesses made in the layer that do not pass completely through the layer. In various cases, the protrusions may fit tightly into the holes. In this case, the relative movement between the cassette case 2010 and the layer is prevented or at least limited. In at least one such case, a tight fit may exist between the projections and the side walls of the openings.

In addition to the above, an additional layer may consist, for example, of a woven layer and / or a nonwoven layer. The layer may consist, for example, of a film. In various cases, the layer can have, for example, a textured surface and / or protrusions extending from it, which can be made to prevent or at least limit the movement of the fabric relative to the cartridge with brackets. A layer may contain a first set of sections that are hooked and / or captured by brackets pushed out of a cassette with brackets, and a second set of sections that are not hooked or captured by brackets. In various cases, the second set of plots may vary. In at least one case, the layer can consist of a film, and the second set of film sections can be modified by making, for example, holes, cuts and / or grooves. In at least one case, the perimeter of such a layer may contain incisions made therein that can soften the edges of the layer. In certain cases, a set of cuts can be made in the layer. In at least one such case, the set of cuts may have cuts, for example, running at an angle of 45 degrees relative to each other. In some cases, the depth, width of the cuts and / or the distance between them can be arbitrary. The cuts described above can make the film layer more flexible, resilient and / or elastic. The cuts described above can be made, for example, in woven or non-woven material. The cuts described above can be made using any suitable process, for example, a mechanical cutting system and / or a laser cutting system. In various cases, the first set of layer regions may not be changed, as discussed above.

As discussed above, the layer consisting of a single piece of material can be modified to be more flexible, resilient and / or elastic. A layer can be composed of several pieces of materials that are glued together. In at least one case, for example, holes, cuts and / or grooves may be present between the glued pieces of materials. In certain cases, inelastic absorbable polymer bands may be welded into a thinner and more flexible film to provide stretch in certain desired directions and limit stretch in other directions. Such bands can also be used to reinforce parts of a film that are under a heavy load, while allowing other parts of the film to remain soft and elastic. One way to achieve this is to use several thin strips of a more solid polymer, for example, Vicryl. These strips can have a width, for example, from about 0.038 to 0.076 cm (approximately from 0.015 to 0.030), and go, for example, the entire length of the line of brackets. Six strips can be made, corresponding to the lateral expansion of the line of brackets for six longitudinal rows of brackets. Then a thin, continuous film of thickness, for example, from about 0.008 to 0.013 cm (about 0.003 to 0.005ʺ), consisting of a soft and elastic polymer, for example, Monocryl or 36/64 PGA / PCL, can be welded to six strips. In some cases, compression molding may be used. The result is a high-strength line of brackets with soft edges and the ability to expand in the lateral but not longitudinal direction. The strips extending from the film can even act as retaining elements minimizing the movement of tissue along the film in the desired direction. Under certain conditions, the layer consisting of woven and / or nonwoven material can be modified in such a way as to strengthen certain areas of the layer, for example, the first set of sections. A flat extruded fiber can be woven into a strip, and then, for example, using felting and / or other thermal technology, the first set of sections can be fused with it for hardening. In some cases, the entire layer can be completely fused.

As discussed above, a cassette with brackets may have protrusions extending from the cassette case. In addition to or instead of these protrusions, the emphasis may contain protrusions extending from it, which can be performed with the ability, firstly, to control the movement of the fabric relative to the support and the body of the cassette, secondly, appearances for recesses for brackets on the opposite side of the fabric and / or Thirdly, maintain and / or direct the brackets when pushing them out of the recesses for the brackets.

Stop 3320 presented in FIG. 66 and 67. The cassette stop 3320 may include a distal end 3323, a proximal end 3326, and a tissue-engaging surface 3321. The stop 3320 may further comprise a hinge 3327, around which the stop 3320 may rotate between the open position and the closed position. The stop 3320 may further comprise a longitudinal groove 3325 therein, which is adapted to receive a portion of the starting and / or cutting member. The stop 3320 may also contain sides, which may have a longitudinal protrusion, or a wall, 3323, extending from them. In various cases, the longitudinal wall 3323 may contain, for example, a grooved surface. In some cases, the longitudinal wall 3323 may comprise, for example, a flat surface. As described above, walls 3323 can be made, for example, with the possibility of limiting or blocking the lateral movement of the fabric with respect to the stop 3320.

In addition to the above, the stop 3320 may have a plurality of forming brackets pockets 3322 made therein, which may be arranged in longitudinal rows that can be combined with recesses for the brackets made in a cassette with brackets. For example, the forming pockets 3322 may be located in the outermost rows 3328a, the outermost rows 3328c and the rows 3328b located between the outermost rows 3328a and the outermost rows 3328c. In at least one case, each forming pocket 3322 may comprise a first, or distal, forming hole 3322a and a second, or proximal, forming hole 3322b. The first forming hole 3322a may be configured to receive and deform the first leg of the bracket, and the second forming hole 3322b may be configured to receive and deform the second leg of the bracket. The first shaping well 3322a and the second shaping well 3322b can be separated by a flat surface 3322c. The stop 3320 may further comprise protrusions 3324, exciting the fabric. The protrusions 3324 may be located between the first shaping hole 3322a and the second shaping hole 3322b. The first protrusion 3324 may be located on the first lateral side of the flat surface 3322c, and the second protrusion 3324 may be located on the second lateral side of the flat surface 3322c. The protrusions 3324, coming from the stop 3320, can, together with the projections coming from the cassette with brackets, guide and support the brackets pushed out of the cassette with brackets. In at least one case, the protrusions 3324 of the stops and the protrusions of the cassette with brackets can be connected. In various cases, the protrusions of the cassette may, for example, come from the ends of the recess for the bracket, and the protrusions 3324 of the stop may be located between the protrusions of the cassette above the middle of the recess for the brackets. The protrusions 3324 of the stop along with the tabs of the cassette can continue the recess for the bracket, and also support and guide the bracket during its formation on the 3320. and contact with the stop 3320. When deforming the legs of the brackets in the forming holes 3322a and 3322b, the legs of the brace can be supported and guided by the protrusions 3324 coming from the stop. In various cases, the feet of the bracket can be simultaneously supported and guided by the tabs of the cassette and the tabs 3324 of the stop. In some cases, the legs of the bracket can be supported and guided by the tabs of the cassette and the tabs 3324 of the stop, but not simultaneously.

In various instances, the shaping wells 3322a and 3322b may be configured to receive at least a portion of the protrusions extending from the cassette with brackets. In at least one such case, each forming well 3322a and 3322b may include a wide, outer end configured to receive a protrusion extending from a cassette with brackets and a narrow, inner end. The wide, outer end of the shaping holes 3322a and 3322b can also be configured to initially receive the staples. The shaping wells 3322a and 3322b may additionally have curved surfaces configured to guide the legs of the bracket towards the narrow, inner ends of the shaping holes 3322a and 3322b. The legs of the bracket can then exit the forming holes 3322a and 3322b from the narrow inner ends where the protrusions 3324, the supporting and guiding legs of the bracket are located. Each forming well 3322a and 3322b may have inclined surfaces between the wide, outer end and the narrow, inner end. Inclined surfaces can guide the staple legs in the shaping holes 3322a and 3322b, limit lateral movement of the staple legs, and improve the alignment of the staple legs relative to the narrow, inner ends.

In addition to the above, the protrusions 3324 may be configured to engage the fabric and hold it in the desired position when brackets are applied and / or cut. In certain instances, each protrusion 3324 may comprise a plateau extending from the tissue-engaging surface 3321, which has a flat surface. In FIG. 89 depicts an alternative embodiment comprising an abutment 5220 having forming pockets 3322 formed therein, and fabric engaging protrusions 5224 engaging a fabric extending therefrom. Similar to the protrusions 3224, each protrusion 5224 may include a plateau section 5224a and a flat surface 5224b configured to mesh the fabric. In addition, each protrusion 5224 may contain a transition surface 5224c between the plateau 5224a and the flat surface 5224c. In various cases, the transition surface 5224c may have, for example, a radius. In certain cases, the transition surface 5224c may have, for example, a chamfer.

Emphasis 5120 presented in FIG. 87 and 88. The stop 5120 of the cassette may include a distal end 5123, a proximal end 5126, and a tissue-engaging surface. The fabric-engaging surface may contain steps. For example, a fabric-engaging surface may comprise a first step 5121 'and a second step 5121ʺ. The second step 5121ʺ may be higher than the first step 5121 'and may extend from the first step 5121'. The stop 5120 may further comprise a hinge 3327, around which the stop 3320 may rotate between an open position and a closed position. The stop 5120 may further comprise a longitudinal groove 5125 therein, which is adapted to receive a portion of the starting and / or cutting element. The stop 5120 may also contain sides 5123, which may or may not have a longitudinal protrusion, or a wall extending from them. In various cases, the higher second step 5121ʺ may be located near the longitudinal groove 5125, and the first step 5121 'may be located near the lateral sides 5123. In various cases, the second step 5121ʺ may exert a greater compressive force on the fabric than the first step 5121'. In various alternative embodiments, the higher second step 5121ʺ may be located near the sides 5123, and the first step 5121 'may be located near the longitudinal groove 5125. The stop 5120 contains two steps, and the stop 5120 may contain more than two steps. In any case, the stop 5120 may contain an inclined surface 5128ʺ, extending between the first step 5121 'and the second step 5121ʺ, which facilitates the positioning of the stop 5120 relative to the fabric.

In addition to the above, the stop 5120 can have a plurality of forming brackets pockets 5122, made therein, which can be arranged in longitudinal rows, which can be combined with recesses for brackets, made in a cassette with brackets. In various cases, the outermost rows of forming pockets 5122 can be made in the first step 5121 '. Extreme inner rows of forming pockets 5122 and middle rows of forming pockets 5122 can be performed, for example, in the second step 5121. Other embodiments are provided in which the middle rows of forming pockets 5122 are made in the first step 5121 ′. In any case, the stop 5120 may contain fabric engaging protrusions 5124 extending from it. In various cases, each protrusion 5124 may be, for example, H-shaped. The protrusion 5124 may go, for example, between adjacent forming pockets 5122. The protrusion 5124 may go, for example, between adjacent forming holes in the forming pocket 5122. In various cases, the protrusion 5124 may go around the end of the forming hole to support and guide the leg formed by the hole. The protrusion 5124 may go, for example, along the sides of the forming pocket 5122. The protrusion 5124 may go, for example, along the sides of the first forming pocket 5122 and the second forming pocket 5122. The sides of the forming pockets 5122 may be, for example, parallel. In various cases, the protrusions 5124 may guide the legs of the bracket in the forming holes and limit their lateral movement. In FIG. 88 shows a protrusion 5124 on each side of the forming pocket 5122. In FIG. 88 also shows a protrusion 5124 on each side of the forming hole of the forming pocket 5122. In various other embodiments, the protrusion may be located adjacent only to the forming pockets 5122 of the stop 5120 and / or only with the forming holes of the forming pockets 5122.

In various cases, the protrusions coming from the stop may have the same height. In other cases, the protrusions coming from the stop may have different heights. As shown in FIG. 69, the stop 3520 may have a fabric-engaging surface 3321 and a longitudinal groove 3325, which is adapted to receive a portion of the starting and / or cutting member. The stop 3520 may also contain sides, which may have a longitudinal protrusion, or a wall, 3323, extending from them. Similar to that described above, the stop 3520 may have forming pockets located in the outermost rows 3328a, the outermost rows 3328c and rows 3328b located between the outermost rows 3328a and the outermost rows 3328c. In various cases, the stop 3520 may contain, for example, the longitudinal rows of the first protrusions 3551a near the extreme inner rows 3328a, the longitudinal rows of the second projections 3551b close to the middle rows 3328b, the longitudinal rows of the third protrusions 3551c close to the outermost rows 3228c. The first protrusions 3551a may extend from the fabric-engaging surface 3221 to the first distance, and the second protrusions 3551b may extend from the fabric-engaging surface 3221 to a second distance that differs from the first distance. Third protrusions 3551c may extend from a tissue-engaging surface 3221 to a third distance, which may differ from the first distance and / or the second distance. In various cases, the third protrusions 3551c may be higher than the second protrusions 3551b, and the second protrusions 3551b may be higher than the first protrusions 3551a. In various alternative embodiments, the protrusions 3551a may be located, for example, near the middle rows 3328b and / or the outermost rows 3328c, the protrusions 3551b may be placed, for example, along the outermost rows 3328a and / or the outermost rows 3328c, and / or the projections 3551c may be located, for example, near extreme inner rows 3328a and / or middle rows 3328b.

The stop 3420 is depicted in FIG. 68. The cassette stop 3420 may comprise a distal end 3423, a proximal end, and a tissue-engaging surface 3321. The stop 3420 may further comprise a hinge 3327 around which the stop 3420 may rotate between an open position and a closed position. The stop 3420 may further comprise a longitudinal groove 3325 therein, which is adapted to receive a portion of the starting and / or cutting member. The stop 3420 may also contain sides, which may have a longitudinal protrusion, or a wall, 3323, extending from them. The stop 3420 may have a plurality of pocket forming brackets 3322 made therein, which may be arranged in longitudinal rows that may be combined with recesses for the brackets made in the cassette with the brackets. In various cases, in addition to the above, the stop 3420 may contain protrusions from it. For example, the stop 3420 may have pyramidal protrusions 3051 and / or dome-shaped protrusions 3151 coming from it. The protrusions 3051 and / or protrusions 3151 can increase the grip force applied to the fabric.

In various cases, the emphasis and the protrusions coming from it, can be made of a single piece of material. In at least one case, the protrusions can be made completely with emphasis. The stop and the protrusions may be made of a metallic material, for example, stainless steel, and may be formed by machining and / or stamping. In certain cases, the projections can be connected to the stop. In at least one case, the protrusions may, for example, be glued to the stop. The stop and the protrusions may be made of the same or different materials. In at least one case, the abutment may be made of a metallic material, and the protrusions may be formed, for example, of an elastomeric material, for example, rubber, a thermoplastic elastomer and / or santoprene. In various cases, the protrusions can be made of plastic material that does not allow injury to the fabric, sandwiched between the protrusions. The protrusions 3051 and / or, the protrusions 3151, for example, can be made of elastomeric material, for example, rubber, thermoplastic elastomer and / or santoprene. In at least one case, the abutment may be formed by machining and / or stamping, and the protrusions may be formed on the abutment during the casting process using a material that is more ductile than the material from which the abutment is made. In various cases, the protrusions 3051 and / or 3151, for example, may have a textured abutment surface. In certain cases, the protrusions 3051 and / or 3151, for example, may be made of a material having a higher friction coefficient than the abutment material. Such embodiments increase the grip force between the abutment and the fabric.

In addition to the above, the abutment may contain a homogeneous matrix of protrusions extending from it. In other cases, the matrix may be heterogeneous. As shown in FIG. 68, the protrusions 3051 may extend from the abutment surface 3321 on the first side of the longitudinal groove 3325, and the protrusions 3151 may extend from the abutment surface 3321 on the second side of the longitudinal pair 3325. In various cases, the projections may be located, for example, distal to the forming pockets 3322. In certain cases, the protrusions may be distributed among the forming pockets 3322. The protrusions may extend, for example, from the surface 3429a, formed between the outermost forming pockets 3322 and the groove 3325, from the surface 3429b, between the outer edges. the firing pockets 3322 and the middle forming pockets 3322, from the surface 3429c, formed between the middle forming pockets 3322 and the outermost forming pockets 3322, and / or from the surface 3429d, formed between the outermost forming pockets 3322 and the side walls 3323.

In FIG. 98 shows stop 5920. The stop 5920 of the cassette may have a distal end 5923, a proximal end 5926, and a fabric-engaging surface 5921. The stop 5920 may additionally contain fabric-engaging elements extending from the surface 5921, which are designed to prevent or limit the movement of the fabric relative to the stop 5920. In at least one case, the stop 5920 may have, for example, protrusions 5924 'and 5924ʺ. The protrusions 5924ʺ can be higher than the protrusions 5924 '. This difference in height is indicated in size 5925. As shown in FIG. 98, the protrusions 5924ʺ may be distal with respect to the protrusions 5924 '. In various cases, protrusions 5924ʺ and 5924 'may be part of a longitudinal row of protrusions. In various cases, protrusions 5924ʺ and 5924 'may be part of different longitudinal rows of protrusions. In certain cases, although not shown, protrusions 5924 'may be located distal to protrusions 5924ʺ.

In various cases, the stop described in this document may contain additional material. The additional material may contain at least one layer of material that is located above the surface of the anchor of the support catching the fabric and implanted into the patient, for example, with brackets mounted from a cartridge with brackets. In various cases, this at least one layer of material may contain, for example, a support material and / or a fabric thickness compensator. This at least one layer of material may consist, for example, of Gore SeamGuard material, Synovis Peri-Strips material and / or polyurethane. This document has already included numerous references to the description of such layers. A full description of US Patent Application Serial No. 13 / 763,095, entitled LAYER ARRANGEMENTS FOR SURGICAL STAPLE CARTRIDGES, filed February 28, 2013, is now the publication of US Patent No. 2013/0161374, which is incorporated by reference into this document. A complete description of US Patent Application Serial No. 13 / 531,619 entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR COMPRISING INCORPORATING A HEMOSTATIC AGENT, filed June 25, 2012, currently US Patent Publication No. 2012/0318842, US Patent Application Serial No. 13 / 531,623, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN OXYGEN GENERATING AGENT, filed June 25, 2012, currently published US Patent No. 2012/0318843, US Patent Application Serial No. 13 / 531,627, entitled TISSUE STAPLLER COMPENSATOR INCORPORATING AN ANTI-MICROBIAL AGENT, filed June 25, 2012, is currently published US Patent No. 2012/0312860, and and US Patent Serial No. 13 / 531,630, entitled TISSUE STAPLER HAVING A THICKNESS COMPENSATOR INCORPORATING AN ANTI-INFLAMMATORY AGENT, filed June 25, 2012, the current publication of US Patent No. 2012/0318844, is incorporated herein by reference. The layer may consist of a bioabsorbable material and / or a non-bioabsorbable material. In some cases, a layer of material may be attached to the stop. In at least one case, the at least one adhesive may be used to attach the layer to the abutment removably. In some cases, a layer of material can be removably attached to the stop, for example, using one or more surgical threads or strips. In various cases, the layer may contain protrusions extending from it, which may enter the forming pockets made in the support. The tabs can be arranged in a matrix, or a set that is aligned with a matrix, or a set, forming pockets in the support. In at least one case, the protrusions may have a tight fit in the forming pockets. The protrusions can be made with the possibility of limiting the lateral and / or longitudinal movement of the layer relative to the stop.

In certain cases, the layer may consist of a single piece of material. In some cases, the layer may have holes made in it. At least in one such case, the layer can be used, for example, with the stop 3320 and have, for example, holes, cuts and / or grooves made therein that are aligned with the protrusions extending from the tissue-engaging surface 3321 of the stop 3320. the layer may have through holes or windows running through the entire layer. Holes, cuts and / or grooves, for example, can be cut in a layer, for example, using a cutting element. In some cases, holes, cuts and / or grooves may, for example, be formed during the casting of a layer. In certain cases, holes, cuts and / or grooves can, for example, be formed using a laser cutting process. In some cases, the holes may be recesses made in the layer that do not pass completely through the layer. In various cases, the protrusions may fit tightly into the holes. However, the relative movement between the stop 3320 and the layer is prevented or at least limited. In at least one such case, a tight fit may exist between the projections and the side walls of the openings.

In addition to the above, an additional layer may consist, for example, of a woven layer and / or a nonwoven layer. The layer may consist, for example, of a film. In various cases, the layer may have, for example, a textured surface and / or protrusions extending from it, which can be designed to prevent or at least limit the movement of the fabric relative to the abutment. A layer may contain a first set of sections that are hooked and / or captured by brackets pushed out of a cassette with brackets, and a second set of sections that are not hooked or captured by brackets. In various cases, the second set of plots may vary. In at least one case, the layer can consist of a film, and the second set of film sections can be modified by making, for example, holes, cuts and / or grooves. In at least one case, the perimeter of such a layer may contain incisions made therein that can soften the edges of the layer. In certain cases, a set of cuts can be made in the layer. In at least one such case, the set of cuts may have cuts, for example, running at an angle of 45 degrees relative to each other. In some cases, the depth, width of the cuts and / or the distance between them can be arbitrary. The cuts described above can make the film layer more flexible, resilient and / or elastic. The cuts described above can be made, for example, in woven or non-woven material. The cuts described above can be made using any suitable process, for example, a mechanical cutting system and / or a laser cutting system. In various cases, the first set of layer regions may not be changed, as discussed above.

As discussed above, the layer consisting of a single piece of material can be modified to be more flexible, resilient and / or elastic. A layer can be composed of several pieces of materials that are glued together. In at least one case, for example, holes, cuts and / or grooves may be present between the glued pieces of materials. In certain cases, inelastic absorbable polymer bands may be welded into a thinner and more flexible film to provide stretch in certain desired directions and limit stretch in other directions. Such bands can also be used to reinforce parts of a film that are under a heavy load, while allowing other parts of the film to remain soft and elastic. One way to achieve this is to use several thin strips of a more solid polymer, for example, Vicryl. These strips can have a width, for example, from about 0.038 to 0.076 cm (about 0.015 to 0.030ʺ), and go, for example, the entire length of the line of recesses for forming brackets. Six strips can be made, corresponding to the lateral expansion of the line of brackets for six longitudinal rows of brackets. Then a thin, continuous film of thickness, for example, from about 0.008 to 0.013 cm (about 0.003 to 0.005ʺ), consisting of a soft and elastic polymer, for example, Monocryl or 36/64 PGA / PCL, can be welded to six strips. In some cases, compression molding may be used. The result is a high-strength line of brackets with soft edges and the ability to expand in the lateral but not longitudinal direction. The strips extending from the film can even act as retaining elements minimizing the movement of tissue along the film in the desired direction. Under certain conditions, the layer consisting of woven and / or nonwoven material can be modified in such a way as to strengthen certain areas of the layer, for example, the first set of sections. A flat extruded fiber can be woven into a strip, and then, for example, using felting and / or other thermal technology, the first set of sections can be fused with it for hardening. In some cases, the entire layer can be completely fused.

This document describes various embodiments of brackets that are removably arranged in a bracket with brackets in a continuous manner within one or more longitudinal rows. Similarly, various embodiments are described herein, comprising a stop having pockets for forming staples arranged in an appropriate continuous manner. Provides other arrangements of brackets and pockets for the formation of brackets, which can be adapted to the variants of the implementation described in this document. Such structures may or may not contain a continuous arrangement of elements. A full description of US Patent No. 8,186,560 entitled SURGICAL STAPLING SYSTEMS AND STAPLE FOR DEPLOYING SURGICAL STAPLES WITH TISSUE COMPRESSION FEATURES, issued May 29, 2012, is incorporated into this document by reference. A full description of US Patent No. 8,365,976, entitled SURGICAL STAPLES HAVING DISSOLVABLE, BIOABSORBABLE OR BIOFRAGMENTABLE PORTIONS AND STAPLING INSTRUMENTS FOR DEPLOYING THE SAME, issued February 5, 2013, is incorporated herein by reference.

In FIG. 19-22 depict a surgical cutting and stapling instrument with an electric drive 1010 that may or may not be used multiple times. In the shown embodiment, the surgical instrument 1010 has a housing 1012 that includes a handle 1014 adapted to be gripped, manipulated, and activated by a physician. The housing 1012 is configured to be operatively attached to the interchangeable node of the rod 1200, which has an end effector 1300 operatively connected to it, which is adapted to perform one or more surgical tasks or procedures. As you study this detailed description, it will be understood that the various unique and innovative mechanisms of various forms of interchangeable rod assemblies disclosed herein can also be effectively applied in connection with robotic-controlled surgical systems. Thus, the term "casing" can also encompass a casing or similar part of a robotic system that accommodates or otherwise functionally supports at least one drive system configured to generate and apply at least one control movement that can used to activate the interchangeable rod assemblies disclosed herein and their respective equivalents. The term “frame” may refer to a part of a hand surgical instrument. The term "frame" can also be a part of a surgical instrument with a robotic control and / or a part of a robotic system that can be used to functionally control the surgical instrument. For example, the interchangeable rod assemblies described in this document can be used with various robotized systems, tools, components, and methods described in US patent application Ser. No. 13 / 118,241, entitled "SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS", is currently the publication of US Patent Application No. 2012/0298719. US Patent Application Ser. No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, the current publication of US Patent Application No. US 2012/0298719, is fully incorporated into this document by reference.

The housing 1012 shown in FIG. 19-21 is shown in conjunction with a replaceable rod assembly 1200, which has an end effector 1300 containing a surgical cutting and stapling device, which is adapted to functionally support the cassette 1304 with brackets therein. The housing 1012 can be adapted to be used with interchangeable rod assemblies that have end effectors adapted to support cassettes with brackets of various sizes and types, and have different rod lengths, sizes, types, etc. In addition, the housing 1012 can be effectively used with various interchangeable rod assemblies, including those that are designed to apply other movements and forms of energy, such as, for example, radio frequency (RF) energy, ultrasonic energy and / or movement, in the form of structures end effector, adapted for use in various applications and procedures. Moreover, in end effectors, rod assemblies, handles, surgical instruments, and / or surgical instrument systems, any suitable fastener or fasteners may be used to fix the tissue. For example, a cassette with fasteners containing a plurality of fasteners removably stored therein may be removably inserted and / or attached to an end effector of a rod assembly.

In FIG. 19 shows a surgical instrument 1010 with a replaceable rod assembly 1200 operatively connected to it. In FIG. 20 and 21 depict the attachment of the plug-in assembly of the rod 1200 to the housing 1012 or the handle 1014. As shown in FIG. 21, the handle 1014 may comprise a pair of handle segments 1016 and 1018 that can be connected with screws, latches, adhesive, etc. In the construction shown, the handle segments 1016 and 1018 together form a section 1019 of the pistol handle that can be gripped by hand and which the doctor can manipulate. As will be further described in more detail below, the handle 1014 functionally supports a plurality of drive systems therein, which are configured to generate and apply various control movements to the respective parts of the interchangeable rod assembly to which these systems are functionally attached.

As shown in FIG. 21, the handle 1014 may additionally have a frame 1020 functionally supporting a plurality of drive systems. For example, the frame 1020 may functionally support the first or closing drive system, substantially designated as element 1030, which may be implemented to apply closing and opening movements to the removable stem node 1200, which is functionally connected or attached to it. In at least one form, the closing drive system 1030 may include an actuator in the form of a closing trigger 1032, which is rotationally supported by the frame 1020. In particular, as shown in FIG. 21, the closing trigger 1032 is connected by a hinge pin 1033 to the housing 1014. This design allows the doctor to manipulate the closing trigger 1032 so that when the doctor grasps the portion of the pistol grip 1019 of the handle 1014, the closing trigger 1032 can be easily rotated from its original or inactivated position activated position, and more specifically to the fully depressed or fully activated position. The closing trigger 1032 may be shifted to an unactivated position with a spring or other displacement mechanism (not shown). In various forms, the closing drive system 1030 further includes a closing link assembly 1034, which is rotatably coupled to the closing trigger 1032. As shown in FIG. 21, the closing link assembly 1034 may have a first closing link 1036 and a second closing link 1038 pivotally connected to the closing trigger 1032 by a pin 1035. The second closing link 1038 may also be referred to as a “fastener” in this document and have a transverse fastening pin 1037.

As shown in FIG. 21, it can be seen that on the first closing link 1036 there can be a blocking wall or an end 1039 adapted to work together with the release unit of the closing mechanism 1060 pivotally connected to the frame 1020. In at least one form, the release unit of the closing mechanism 1060 can contain a release button assembly 1062, on which there is a distally projecting locking pawl 1064. The release button assembly 1062 can be rotated in a counterclockwise direction using a release spring (not shown). When the doctor presses the closing trigger 1032 in its unactivated position in the direction of the portion of the pistol grip 1019 of the handle 1014, the first closing link 1036 rotates up to the point at which the locking pawl 1064 enters the holding engagement with the blocking wall 1039 on the first closing link 1036, through this does not allow the closing trigger 1032 to return to the non-activated position. Thus, the release unit of the closing mechanism 1060 serves to block the closing trigger 1032 in a fully activated position. When the doctor needs to unlock the closing trigger 1032 so that he can shift to an unactivated position, the doctor simply rotates the release button of the release button 1062 so that the locking dog 1064 goes out of engagement with the locking wall 1039 on the first closing link 1036. After the locking dog 1064 is disengaged from the first closing link 1036, the closing trigger mechanism 1032 can rotate back to the non-activated position. It is also possible to implement other blocking and releasing mechanisms for closing the trigger mechanism.

The lever 1061 may come from the release button 1062 of the closing mechanism. The magnetic element 1063, such as, for example, a permanent magnet, can be mounted on the lever 1061. When the release mechanism button 1062 of the closing mechanism is rotated from its first position to the second position, the magnetic element 1063 can move to the printed circuit board 1100. The printed circuit board 1100 can have at least one sensor that is configured to determine the movement of the magnetic element 1063. In at least one embodiment, for example, a sensor can be mounted on the bottom surface of the printed circuit board 1100 Hall (not shown). The Hall sensor can be configured to determine the change in the magnetic field surrounding the Hall sensor caused by the movement of the magnetic element 1063. The Hall sensor can be in communication, for example, with a microcontroller, which can detect when the closing mechanism release button 1062 is in the first position associated with the inactivated position of the closing trigger 1032 and the open configuration of the end effector, in the second position, which is associated with the activated zack position yvayuschego trigger 1032 and a closed configuration of the end effector, and / or in any position between the first and second position.

In at least one form, the handle 1014 and the frame 1020 can functionally support another drive system, which in this document is called a start-up drive system 1080, adapted to apply start-up movements to the corresponding parts of the removable core assembly attached thereto. Also herein, a 1080 drive system may be referred to as a “second drive system.” The start-up drive system 1080 can use an electric motor 1082, which is located in the area of the pistol grip 1019 of the handle 1014. In various forms, the engine 1082 can be a driving brush DC motor with a maximum turning speed, for example, approximately 25,000 revolutions per minute. In other designs, the motor may include a brushless motor, a cordless motor, a synchronous motor, a stepper motor, or any other suitable electric motor. The motor 1082 may receive power from the power source 1090, which in one form may contain a removable power supply 1092. As shown, for example, in FIG. 21, the power supply unit 1092 may comprise a proximal part 1094 of the body, which is adapted to be fixed to the distal part 1096 of the body. The proximal part 1094 of the housing and the distal part 1096 of the housing are adapted to the functional support of a plurality of batteries 1098 in them. Each battery 1098 may be, for example, a lithium ion (“LI”) or other suitable battery. The distal part 1096 of the housing is adapted to be removably connected to the printed circuit board assembly 1100, which is also functionally connected to the electric motor 1082. A series of batteries connected in series 1098 can be used as the power source of the surgical instrument 1010. In addition, the power supply 1090 can be replaceable and / or rechargeable.

As briefly described above with respect to various other forms, the electric motor 1082 may include a rotatable rod (not shown), functionally coupled to the gear reducer assembly 1084, which is mounted so that it engages with a set or rack of driving teeth 1122 on the completed with the possibility of longitudinal movement of the drive element 1120. When using the polarity of the voltage provided by the power supply 1090, allows the motor 1082 to rotate in a clockwise direction, and olyarnost voltage applied to the motor, the battery can be reversed to run the electric motor 1082 in the anticlockwise direction. When the electric motor 1082 is rotated in one direction, the drive element 1120 will be driven in the distal direction DD along the axis. When the motor 82 is set in motion in the opposite direction of rotation, the drive element 1120 will be driven axially in the proximal direction PD. The handle 1014 may have a switch that may be configured to reverse polarity attached to the motor 1082 by the power supply 1090. As in the other forms described in this document, the handle 1014 may also include a sensor capable of detecting the position a drive member 1120 and / or a direction in which the drive member 1120 moves.

The activation of the engine 1082 can be controlled using a trigger 1130, rotationally supported on the handle 1014. The trigger 1130 can be rotated between the non-activated position and the activated position. The trigger 1130 can be displaced to an unactivated position by means of a spring 1132 or other displacement mechanism, so that when the doctor releases the trigger 1130, it can be rotated or otherwise returned to an unactivated position by means of a spring 1132 or displacement mechanism. In at least one form, the trigger 1130 may be located “away” from the closing trigger 132, as described above. At least one form of the closing trigger mechanism 1032 can be hinged to mount the button of the safety trigger 1134 with a pin 1035. The safety button 1134 can be located between the trigger 1130 and the closing trigger 1032 and have a protruding pivoting arm 1136. See FIG. . 21. When the closing trigger 1032 is in a non-activated position, the fuse button 1134 is contained in the handle 1014, where the doctor cannot easily access it and move it between the safe position preventing the activation of the trigger 1130 and the trigger position in which the trigger 1130 can be pressed. When the doctor presses the closing trigger 1032, the fuse button 1134 and the trigger 1130 rotate down, and in this position the doctor can manipulate them.

As stated above, in at least one form, the drive element 1120, which is made with the possibility of longitudinal movement, has a rail of teeth 1122 formed thereon for meshing with the corresponding drive gear 1086 of the gear reducer assembly 1084. At least one form also has manual action "emergency" node 1140, made with the possibility that the doctor could manually pull back with the possibility of longitudinal movement of the drive element 1120, if the electric motor 1082 becomes unavailable. Emergency unit 1140 may include a lever or emergency handle assembly 1142, configured to manually rotate into ratchet engagement with the teeth 1124 of the actuator 1120. Thus, the doctor can manually pull the actuator 1120 using the emergency handle assembly 1142 to move the actuator 1120 using a ratchet mechanism in the proximal direction of PD. US Patent Application Publication No. US 2010/0089970, now US Patent No. 8,608,045, describes emergency mechanisms and other components, mechanisms, and systems that can also be used with the various tools described in this document. US Patent Application Ser. No. 12 / 249,117, entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, currently US Patent No. 8,608,045, is hereby incorporated by reference in its entirety.

As shown in FIG. 20 and 22, the interchangeable core assembly 1200 has a surgical end effector 1300, which includes an elongated passage 1302, which is configured to functionally support therein a cassette 1304 with brackets. The end effector 1300 may further comprise a stop 1306, which is hingedly supported with respect to the elongated channel 1302. The interchangeable stem assembly 1200 may further comprise an articulation 1270 and a hinge lock, which can be configured to detachably hold the end effector 1300 in a desired position relative to the axis of the stem SA- SA. A detailed description of the design and operation of the end effector 1300, the hinge joint 1270 of the hinge lock is presented in US patent application Ser. No. 13 / 803,086, filed March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK. A full description of the application for US Patent Ser. No. 13 / 803,086, filed March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK is incorporated herein by reference. As shown in FIG. 22, the replaceable rod assembly 1200 may further comprise a proximal body or cone 1201 consisting of cone portions 1202 and 1203. The plug-in assembly of the rod 1200 may additionally have a closing tube 1260, which can be used to close and / or open the stop 1306 of the end effector 1300. The node 1200 of the rod may have a pin 1210, which is configured to, firstly, slide the starting element in it, and, secondly, a sliding support of the closing tube 1260, which extends around the axle 210. The axle 210 can also be adapted to the sliding support of the proximal pulley of the hinge. The hinge pulley has a distal end, which is made with the possibility of functional engagement of the hinge lock. The hinge latch mates with a hinge frame, which is made with the possibility of functional engagement of the guide pin of the frame end of the effector. As noted above, additional information regarding the operation of the hinge lock and hinge frame is contained in US Patent Application Ser. No. 13 / 803.086. In various cases, the trunnion 1210 may contain a distal end 1211, which is supported rotatably on the chassis 1240. In one embodiment, for example, the proximal end 1211 of the trunnion 1210 has a thread 1214, made thereon for a threaded attachment to the trunnion 1216, configured to maintaining on the 1240 chassis. See FIG. 22. This design facilitates the rotating connection of the trunnion 1210 to the chassis 1240 so that the trunnion 1210 can selectively rotate around the axis of the rod SA relative to the chassis 1240.

As shown mainly in FIG. 22, the interchangeable rod assembly 1200 has a closure shuttle 1250 that is slidably supported in the chassis 1240 so that it can move axially relative to it. The closure shuttle 1250 has a pair of proximally protruding hooks 1252 that are configured to be attached to a mounting pin 1037 (FIG. 20 and 21), which is attached to the second closing link 1038, as will be further described in more detail below. The proximal end 1261 of the closing tube 1260 is connected to the closing shuttle 1250 for rotation relative to it. For example, the U-shaped connector 1263 is inserted into the annular groove 1262 at the proximal end 1261 of the closing tube 1260 and is held within the vertical grooves 1253 in the shutter of the closing 1250. This design serves to attach the closing tube 1260 to the closing shuttle 1250 for axial movement with it, allowing the closing tube 1260 to pivot about the closing shutter 1250 around the axis of the rod SA. The closure spring 1268 rests on the closure tube 1260 and serves to displace the closure tube 1260 in the proximal direction PD, which may serve to rotate the closure trigger in a non-activated position when the stem assembly is functionally connected to the handle 1014.

In at least one form, the replaceable core assembly 1200 may additionally include the articulation 1270. However, other interchangeable stem assemblies may not make a hinge rotation. As shown in FIG. 22, for example, the articulation 1270 includes a double-hinged closing sleeve 1271. In accordance with various forms, the double-hinged closing sleeve 1271 includes the end effector closing sleeve 1272, which has distally protruding upper and lower shanks 1273, 1274. end effector liner 1272 includes a horseshoe 1275 hole and tongue 1276 for engaging with the opening tongue on the stop 1306 in various ways described in US Patent Application Ser. No. 13 / 803,086, filed March 14, 2013, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING AN ARTICULATION LOCK, which is incorporated herein by reference in its entirety. As described in more detail in this document, the horseshoe-shaped hole 1275 and tongue 1276 engage with the tongue on the stop when the stop 1306 is open. The upper double-joint link 1277 includes upwardly projecting distal and proximal pivot pins which engage, respectively, with an upper distal pin hole in the upper proximally projecting tang and 1273 with an upper proximal pin hole in the upper distally projecting tang closure tube 1264 to 1260. The lower double-joint link 1278 includes protruding upward distal and proximal hinge pins, which engage, respectively, with the lower distal pin hole A nose in the lower proximally projecting shank 1274 and with a lower proximal pin hole in the lower distally projecting shank 1265. See also FIG. 22

During application, the closing tube 1260 progressively moves distally (in the direction of the DD) to close the stop 1306, for example, in response to the activation of the closing trigger 1032. The stop 1306 is closed by moving the distally closing tube 1260 and, thus, the node of the closing sleeve rod 1272 , as a result of which it hits the proximal surface of the stop 1360 in the manner described in the above by reference to US patent application Ser. No. 13 / 803.086. Also, as described in detail in this reference, the stop 1306 is opened by moving the proximally closing tube 1260 and the node of the closing sleeve of the rod 1272, resulting in the tongue 1276 and the horseshoe hole 1275 coming into contact with the tongue and pushing it, lifting the stop 1306. In the open position, the closing tube of the 1260 rod moves to the proximal position.

As indicated above, the interchangeable rod assembly 1200 further includes a trigger element that is supported for axial movement within the shaft 1210 of the rod. The starting element includes an intermediate part 1222 of the starting rod, made with the possibility of attachment to the distal cutting part or the cutting blade. The intermediate portion 1222 of the trigger rod may have a longitudinal groove at its distal end, which may be configured to receive a tongue at the proximal end of the distal cutting blade. The longitudinal groove and the proximal end can be made in shape and size with the possibility of allowing relative movement between them, and may contain a sliding joint. The sliding articulation may move the intermediate portion 1222 of the starting rod of the starter drive to move in such a way as to ensure the pivotal rotation of the end effector 1300 without moving or at least without moving the substantially cutting blade. After the end effector 1300 has acquired a suitable orientation, the intermediate portion of the trigger bar 1222 can be advanced distally until the proximal side wall of the longitudinal groove comes into contact with the tongue to advance the cutting blade and place brackets from the cassette located inside the channel 1302. An additional description of the operation of the starting element can be found in US patent application Ser. No. 13 / 803.086.

As shown in FIG. 22, the stem assembly 1200 further has a switch drum 1500, which is rotatably applied to the closure tube 1260. The switch 1500 drum has a hollow core segment 1502 that has a hub formed thereon for receiving a drive pin protruding to the outside. In various cases, the drive pin passes through a longitudinal groove provided in the locking sleeve to allow axial movement of the locking sleeve when it engages with the pulley of the hinge. Rotary torsion spring 1420 is made with the possibility of engagement with the hub on the drum switch 1500 and part of the housing 1203 cone for application of bias force to the drum switch 1500. The drum of the switch 1500 may additionally contain at least partially annular holes 1506 formed in it, which can be able to receive ring racks extending from the cone halves 1202, 1203 and provide relative rotation, but not translational movement, between the skip drum the clamp 1500 and the proximal cone 1201. Racks also pass through the openings 1266 in the closing tube 1260 and are fixed in recesses in the trunnion 1210 of the rod. However, rotating the cone 1201 to the point at which the racks reach the end of their respective grooves 1506 in the drum of the switch 1500 causes the drum of the switch 1500 to rotate around the axis of the rod SA. The rotation of the drum switch 1500 ultimately leads to rotation of the drive pin and the locking sleeve between the engaged and disengaged position. Thus, essentially the cone 1201 can be used for the functional engagement and disengagement of the hinge drive system using the start-up drive system in various ways, described in detail in US Patent Application Ser. No. 13 / 803,086 and US patent application Ser. No. 14 / 226,142, entitled SURGICAL INSTRUMENT COMPRISING A SENSOR SYSTEM, filed March 26, 2014, a full description of which is incorporated herein by reference.

As also shown in FIG. 22, the stem assembly 1200 may comprise a slip ring assembly 1600, which may be configured, for example, to conduct electrical power to and / or from an end effector 1300 and / or communication signals to and / or from an end effector 1300. Slip ring assembly 1600 may contain a proximal connecting flange 1604, which is mounted on the flange 1242 of the chassis, coming from the chassis 1240, and the distal connecting flange, which is located in a groove made in the sheaths of the rod. The proximal coupling flange 1604 may comprise a first front surface, and the distal coupling flange may comprise a second front surface that is located adjacent to the first surface and can be moved relative to it. Distal connecting flange can rotate relative to the proximal connecting flange 1604 around the axis of the rod SA. The proximal connecting flange 1604 may comprise a plurality of concentric, or at least substantially concentric, conductors formed in its first front surface. The connector can be installed on the proximal side of the connecting flange and can have many contacts, each contact corresponds to one of the conductors and has electrical contact with it. This design provides a relative rotation between the proximal connecting flange 1604 and the distal connecting flange, while maintaining electrical contact between them. The proximal connecting flange 1604 may have an electrical connector 1606, which provides communication with the printed circuit board 1610 of the rod, for example, mounted on the chassis 1240 of the rod. In at least one instance, a wiring harness consisting of a plurality of conductors may extend between the electrical connector 1606 and the core PCB 1610. The electrical connector 1606 may go proximally through the connector hole 1243 made in the mounting flange 1242 of the chassis. See FIG. 22. US Patent Application Ser. No. 13 / 800,067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed on March 13, 2013, which is fully incorporated into this document by reference. US Patent Application Ser. No. 13/800 025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013, which is fully incorporated into this document by reference. Further details regarding the collector ring assembly 1600 are given in U.S. Patent Application Ser. No. 13 / 803.086.

As discussed above, the stem assembly 1200 may have a proximal portion that is fixedly mounted on the handle 1014, and a distal portion that can rotate around a longitudinal axis. The pivotal distal portion of the rod may pivot relative to the proximal portion around the slip ring assembly 1600, as discussed above. The distal connecting flange of the assembly of the collector ring 1600 may be located in the rotary distal part of the rod. In addition, in addition to the above, the drum of the switch 1500 can also be located in the rotary distal part of the rod. By rotating the pivotal distal part of the rod, the distal connecting flange and the drum of the switch 1500 can rotate synchronously. In addition, the drum switch 1500 can be rotated between the first position and the second position relative to the distal coupling flange. When the drum of the switch 1500 is in its first position, the hinge drive system can be functionally disconnected from the start-up drive system and thus, when the start-up drive system is operating, the end effector 1300 of the stem 1200 assembly does not turn. When the drum of the switch 1500 is in its second position , the hinge drive system can be functionally connected to the starter drive system and, thus, when the starter drive system is operating, the end effector 1300 is rotated evil rod 1200. When the switch 1500 drum moves between its first position and a second position, drum switch 1500 is moved relative to the distal flange. In various cases, the node of the rod 1200 may contain at least one sensor configured to determine the position of the drum switch 1500.

As shown in FIG. 22, chassis 1240 includes at least one, and preferably two, conical connecting parts 1244, which are fitted to the entrance to the corresponding dovetail grooves 1702, formed in the distal part 1700 of the connecting flange of the frame 1020. See FIG. 21. Each dovetail slot 1702 can be tapered or, in other words, somewhat V-shaped for receiving the connecting parts 1244 into itself. As further shown in FIG. 22, the eyelet for fastening the rod 1226 is formed at the proximal end of the intermediate starting rod 1222. As further described in more detail below, when the interchangeable rod assembly 1200 is connected to the handle 1014, the eyelet for fastening the rod 1226 is received in the bed for fastening the start rod 1126 formed at the distal end 1125 longitudinal drive element 1120. See FIG. 21.

In various embodiments of the rod assembly, a locking system 1710 is used for detachably connecting the shaft assembly 1200 to the housing 1012 and in particular to the frame 1020. As shown in FIG. 22, for example, in at least one form, the locking system 1710 comprises a locking element or locking plug 1712, which is detachably connected to the chassis 1240. In the shown embodiment, for example, the locking plug 1712 is U-shaped with two at some distance legs 1714, pointing down. Each leg 1714 has a pivoting eye 1715 formed on them, which is adapted to enter the corresponding hole 1245 formed on the chassis 1240. This design provides a pivotal attachment of the locking fork 1712 to the chassis 1240. The locking fork 1712 can have two proximally protruding locking ears 1716 which are made with the possibility of detachable engagement with the corresponding grooves or grooves lock 1704 in the distal connecting flange 1700 of the frame 1020. See FIG. 21. In various forms, the locking fork 1712 is displaced in the proximal direction by means of a spring or a bias element (not shown). Lock 1717 is activated by a lock button 1722, which is slidably mounted on the latch actuator assembly 1720, which is mounted on chassis 1240. The lock button 1722 can be displaced in the proximal direction relative to the lock plug 1712. As will be further described in more detail below, locking plug 1712 can move to the unlocked position by moving the locking button in the distal direction, which also causes the locking fork 1712 to rotate out of the locking pin Linkage with the distal connecting flange 1700 of the frame 1020. When the locking plug 1712 is in retaining engagement with the distal connecting flange 1700 of the frame 1020, the locking ears 1716 are fixed in the corresponding recesses or locking grooves 1704 in the distal connecting flange 1700.

When using a replaceable rod assembly that includes an end effector of the type described here, which is adapted for cutting and fixing tissue, as well as other types of end effectors, it is desirable to prevent the unintended disconnection of the replaceable core assembly from the body during the actuation of the end effector. For example, in the application process, the physician may actuate the closing trigger 32 to capture and move the target tissue to the desired position. When the target tissue is located in the end effector 1300 in the desired orientation, the physician can fully activate the closing trigger 1032 to close the stop 1306 and clamp the target tissue in position for cutting and stapling. In this case, the first drive system 1030 was fully powered. After the target tissue is clamped in the end effector 1300, it is desirable to prevent inadvertently disconnecting the plug-in assembly of the stem 1200 from the housing 1012. One form of the locking system 1710 is configured to prevent such an unintentional detachment.

As best shown in FIG. 22, the locking plug 1712 includes at least one and preferably two locking hooks 1718, which are adapted to come into contact with the corresponding parts of the locking ears 1256, which are formed on the closure hook 1250. When the locking hook 1250 is in the non-activated position (t. e. the first drive system 1030 is not activated and the stop 1306 is open), the lock plug 1712 can be rotated in the distal direction to unlock the plug-in assembly of the rod 1200 from the housing 1012. In this position, the lock hooks 1718 do not contact parts of the lugs 1256 on the shuttle block 1250. However, when closing the closure shuttle 1250 moves into an activated position (i.e. the first drive system 1030 is activated 1306 and the abutment is in the closed position), the lock plug 1712 can not be rotated to the unlocked position. In other words, if the doctor tries to turn the locking plug 1712 to an unlocked position or, for example, the locking fork 1712 was accidentally hit and touched in a way that could cause it to distally turn, the locking hooks 1718 on the locking fork 1712 will come into contact with the locking ears 1256 on shuttle closure 1250 and prevent the 1712 lock fork from moving to the unlocked position.

The attachment of the plug-in assembly of the stem 1200 to the handle 1014 will now be described. To begin the connection process, the doctor can position the chassis 1240 of the plug-in assembly of the stem 1200 on or adjacent to the distal connecting flange 1700 of the frame 1020 so that the conical fittings 1244 formed on the chassis 1240 are aligned with corresponding dovetail 1702 slots on the frame 1020. The doctor can then move the stem assembly 1200 along the axis of the installation, which is perpendicular to the stem axis SA, to install the connecting parts 1244 into the functional center baking with corresponding dovetail receiving slots 1702. Thus, the eyelet for fastening the rod 1226 on the intermediate starting rod 1222 will also be installed in the bed 1126 in the drive element 1120 configured for longitudinal movement, and parts of the pin 1037 on the second closing link 1038 will be installed in the corresponding hooks 1252 on the closure fork 1250. As used in this document, the term "functional engagement" for two components means that the two components are sufficiently Linking to each other in such a way that after applying an activating motion to them, the components can perform the assigned action, function, and / or procedure.

At least five interchangeable rod assembly systems 1200 can be functionally connected to at least five corresponding handle systems 1014. The first system may comprise a frame system that connects and / or combines the frame or axle of the stem 1200 assembly with the handle frame 1020 1014. Another system may contain a closing actuator system 1030, which can functionally connect the closing trigger mechanism 1032 of the handle 1014 and the closing tube 1260 to the stop 1306 of the stem 1200 assembly. As briefly described above, the support bar for crepe The hub of the stem 1200 assembly of the shaft 1200 can engage with the pin 1037 of the second closing link 1038. Another system can include a start-up drive system 1080, which can functionally connect the trigger 1130 of the handle 1014 to the intermediate start rod 1222 of the stem 1200. As described briefly above, eyelet fastener rod 1226 may be functionally connected to the bed 1126 of the longitudinal drive element 1120. Another system may contain an electrical system that can signal the controller in the handle 1014, such as a microcontroller, that, for example, a node of a rod, such as a node of a rod 1200, functionally engages with a handle 1014 and / or, secondly, supply power and / or communication signals between the node of a rod 1200 and a handle 1014. For example, a node rod 1200 may include an electrical connector 1810, which is functionally mounted on a rod printed circuit board 1610. The electrical connector 1810 is configured to be paired with a corresponding electrical connector 1800 on the control board 1100 with a handle. More detailed information regarding electronic circuits and control systems is provided in U.S. Patent Application Ser. No. 13 / 803,086 and US patent application Ser. No. 14 / 226,142, the full descriptions of which were previously incorporated herein by reference. The fifth system may consist of a locking system for releasably locking the stem assembly 1200 on the handle 1014.

Surgical suturing instruments were used in the prior art to simultaneously perform a longitudinal incision of the tissue and to establish lines of staples on opposite sides of the incision. Such instruments usually include a pair of interacting elements of the branch, which, if the instrument is intended for endoscopic or laparoscopic use, can pass through the cannula channel. One of the branch elements accepts a cassette with brackets, having at least two brackets located on each side. Another element of the branch forms an emphasis having recesses for the formation of staples aligned with rows of staples in the cassette. The tool contains a set of wedges with reciprocating motion, which, when moved into the distal region, pass through the holes in the bracket with brackets and use the ejector serving as a support for the brackets in order to push the brackets towards the stop element.

Dissection of the tissue, performed simultaneously with the suturing of the suture brackets on each side of the incision, reduces bleeding and simplifies surgery. Endoscopic and laparoscopic procedures are preferred over open procedures due to the shorter recovery period after surgery and other benefits. In endoscopic stapling and cutting instruments, a long, thin element of the branch is used, which bends upwards when clamped on thick tissues. On thick tissue, this bend upward of the free (distal) end of the branch can lead to a difference in the height of the formed brackets, since the distal gap between the stop and the cassette is greater than the proximal gap. To ensure uniform proximal and distal formation of the staples, the abutment often bends or tilts inward to the bracket with the staples. This deflection is suitable for thicker tissue and leads to the imposition of more dense forms of brackets on the distal end when used on thicker tissue. To prevent this tight distal closure, pins or protrusions were added to the locking surfaces of the cassette located near the distal end of the cassette. Closing the stop on the pin provides a minimum clearance at the distal end. However, surgeons are bothered by pins or protrusions, which lead to tissue injury.

Various implementation options have been developed to solve these problems. One design, for example, contains a cutting head with an E-shaped element or a starting rod, made with the possibility of moving the stop away from the elongated channel that supports the cassette with brackets. Such a design of the cutting head with the E-shaped element and the starting rod is described, for example, in US patent No. 6,978,921, entitled SURGICAL STAPLING INSTRUMENT INCORPORATING AN E-BEAM FIRING MECHANISM, the contents of which are fully incorporated herein by reference.

For example, as shown in FIG. 2 and 3 herein, the tissue-cutting head comprises an E-shaped element 50, which can progressively move in the end effector 16. As described above, the E-shaped element 50 can consist of a vertical part 52, which can pass through a narrow longitudinal groove 58 a narrow vertical groove 62 in the cassette 42 with brackets and a narrow longitudinal channel 64 in the elongated channel 40 for the brackets when the E-shaped element 50 moves distally. The stop groove 58 can go upwards into the stop 20 and from one end have a longitudinal channel 66 extended to the sides, having an appropriate size and shape for receiving the upper pin 54, which expands to the sides starting from the vertical part 52. Similarly, the channel 64 groove can be located below in channel 40 and at one end to have extended to the sides a longitudinal channel 68 having an appropriate size and shape for receiving one or more lower legs 70 extending to the side from the vertical part 52. The E-shaped element 50 may additionally contain one more secondary pins 72, which may extend in the direction of the vertical part 52 and which can be configured to slide over the upper surface of the lower chute 74 the cassette 42 with brackets. In certain embodiments of the implementation of the middle rods 72 can be configured to accommodate the cassette with brackets 42 and to ensure that the cassette with brackets 42 in the channel 40. The longitudinal working cavity 75 formed in the cassette with brackets 42 over the lower groove 74, has a certain size allowing middle rods 72 to pass through the staple cartridge 42.

Various designs of the elongated channel include an elongated or longitudinal groove that extends between the initial position of the cutting head with the E-shaped element in the proximal part of the elongated channel and the end position near the distal end of the elongated channel. The vertical part of the cutting head with the E-shaped element passes through this longitudinal groove, and the lower supporting part of the E-shaped element passes along the lower surface of the elongated channel. The supporting part allows you to move the emphasis on the elongated channel and can also serve as a convenient means for the doctor to set the position of the cutting head in the elongated channel. Observing the position of the cutting support of the cutting head during the distal movement of the head through the cassettes, the doctor will know exactly where the cutting head is located in the cassette. Providing effective means for removing the stop and for controlling the position of the cutting head, this design, however, has a longitudinal groove in the elongated channel, which can reduce the rigidity of the channel, as well as its resistance to twisting and dilution.

To avoid such a dilution of the elongated channel, it is desirable to eliminate the longitudinal channel to increase resistance to twisting and dilution when brackets are applied to a thick fabric. However, such a construction can make it impossible for the surgeon to see how far the overlapping of the brackets is made by observing the position of the scalpel support. In FIG. 32 depicts an elongated channel 6022, which may be similar to the various elongated channels described herein, including, for example, elongated channels 22 and 302, except for the following differences. The elongated passage 6022 may be made by casting and / or machining and / or otherwise from a suitable polymeric material and include a substantially intact portion 6024 of the bottom surface. The elongated channel 6022 is configured to functionally support a cassette with surgical brackets (not shown). The elongated channel 6022 may include an elongated inner groove 6026, which is formed by two inwardly directed portions of the protrusions 6028. Inwardly directed portions of the projections 6028 also form an elongated inner channel 6030 between the portions of the projections 6028 and the integral portion of the lower surface 6024. Although most of the length of the elongated channel 6022, it does not pass through the lower surface 6024 of the elongated channel 6022. The inner channel 6030 has a size that allows you to place with a possibility of sliding a support or a support, about azovannye at the cutting head or in any other way attached thereto.

In FIG. 42, for example, is shown a cutting head with an E-shaped element 6050, which can be used together with an elongated channel 6022. However, as will become apparent, an elongated channel 6022 can also be used with various designs of cutting heads that use one support or multiple supports on the bottom surface of the cutting head. As shown in FIG. 42, the cutting head 6050 includes a vertical portion 6052, which ends with two side-facing lower supports 6070. The vertical portion 6052 is configured to extend through the elongated groove 6026 so that the lower supports 6070 are received under the respective parts of the projections 6028.

As shown in FIG. 32, elongated canal 6022 may additionally include a proximal bore 6040 of the bore that is provided at the proximal end of the lower portion 6024 of the elongated bore 6022. The proximal bore 6040 of the bore may allow the doctor to observe at least one support 6070 or another part (part) of the cutting heads 6050 when the cutting head 6050 is in the initial or non-activated position. This initial position may also correspond to the position in which the cutting head 6050 is in when the cutting head 6050 is in the locked position, as will be described in detail below. Similarly, the distal opening 6042 of the channel is located at the distal end of the lower part 6024 and allows the doctor to observe at least one support 6070 or another part (s) of the cutting head 6050 when the cutting head 6050 is in a fully activated or end position. This design provides the physician with a method for determining whether the cutting head is in the initial position or end position, and also provides a relatively more rigid elongated channel, compared to other channels that have a longitudinal groove running longitudinally through the lower part of the elongated channel. The proximal bore 6040 of the channel and the distal bore 6042 of the channel may have the shape shown in FIG. 32, which provides, for example, a simple installation of the cutting head 6050 in the elongated channel 6022 (through the proximal channel hole 6040) and the removal of the cutting head 6050 from the elongated channel 6022 (through the distal hole 6042 channel). Thus, the elongated channel 6022 has a closed bottom with holes 6040 and 6042 corresponding to the beginning and end, respectively, of the starting stroke of the cutting head. This arrangement provides visual access to the beginning and end of the starting stroke, as well as downward movement of the cutting head to the locked position, which will be discussed in detail below.

The extended channel 6022 can be effectively used with a cutting head assembly, which is advanced manually or by means of a starting system equipped with an electric drive. For example, the surgical instrument 10 described above includes a cutting head 50, which is advanced manually by activating the trigger hook 32. In various designs, the cutting head 50 can advance from the initial to the end position by activating the trigger hook 32 three times. Thus, for example, activation of the trigger 32 once can move the cutting head distally in the elongated channel one third of the distance between the initial position and the end position (first start position). Activating the trigger a second time may cause the cutting head 50 to move two thirds of the way between the initial and end position (second starting position), and activating the trigger 32 a third time may cause the cutting head 50 to move from the first starting position to the end position. Thus, when the cutting head 6050 is visible through the distal opening 6042 of the channel, the doctor will know that the cutting head 6050 has been fully activated. Such an elongated passage 6022 may also be used with an electrically operated surgical instrument 1010 (FIG. 19-22).

In FIG. 33-35 depict another design of elongated channel 6122, which is similar to elongated channel 6022, with the exception of these differences. Those parts of the design of the elongated channel 6122, which are identical to the parts of the construction of the elongated channel 6022, have the same element numbers. In particular, as shown in FIG. 33, a series of spaced indicator holes 6144 is provided in the lower part 6124. Indicator holes 6144 may vary in number, size, and spacing, but in at least one design, indicator holes 6144 are the same size and evenly spaced in line so that they open into the elongated internal passage 6030. As shown in these figures, the openings 6144 may have a circular shape. As shown in FIG. 33, the light source 6160 can be installed at the proximal end of the elongated channel 6122 so that the light source 6160 emits light into the internal channel 6030 (shown by the dotted line L in FIGS. 33 and 34). The light source 6160 may contain, for example, one or more LEDs or another light source device that can receive power through conductor 6164, which is connected to the handle of a surgical instrument, a robotic system, etc., to which an elongated channel 6122 is functionally attached. applying power to the 6160 light source, the light will be directed to the internal channel 6030. When the cutting head 6050 is in the initial position, the cutting head 6050 can block the light L, making it invisible beyond indicator hole 6144. Thus, when the light L is not visible through any opening indicator 6144, the physician will know that the cutting head 6050 is in the initial position. With distal advancement of the cutting head 6050 past the indicator holes 6144, the light L will collide with the cutting head 6050 and will be visible at least through the open indicator hole 6144, which is directly proximal to the cutting head 6050, as shown in FIG. 34. Thus, this design allows the doctor to control the advancement of the cutting head 6050 during its distal movement in the elongated channel 6122 from the initial position to the end position. This elongated duct design is also more rigid and durable than the elongated duct structures, which have an elongated groove that passes completely through most of the lower surface of the elongated duct. In one design, the doctor can determine the position of the cutting head due to the fact that the light will not shine through the indicator hole, where the cutting head is located. At the same time, the light will be visible through all other indicator holes. Thus, in one design, a dark or unlit indicator opening shows the location of the cutting head. In other embodiments, the light source may be absent. while the doctor has the ability to control the position of the cutting head 6050 in the elongated channel 6122, watching the location of the supports 6070 through the indicator holes 6144.

In FIG. 36 depicts another design of elongated channel 6222, which is similar to elongated channel 6122, with the exception of these differences. Those parts of the design of the elongated channel 6222, which are identical to the parts of the structure of the elongated channel 6122, have the same element numbers. As shown in this figure, a series of indicator holes 6144 arranged at intervals is provided in the bottom surface 6224. In the construction shown, the indicator holes 6144 have the same size and shape, but are made in the bottom surface 6224 with different spacing. For example, the extreme proximal indicator hole 6144P may be spaced from the proximal hole 6040 to the first FSD distance, which allows, for example, at least one of the supports 6070 or another part of the cutting head 6050 to be visible through it when the cutting head 6050 is in the initial position . Similarly, the extremely distal indicator hole 6144D can be separated from the neighboring indicator hole 6144 by a second SSD distance, which differs from the first FSD distance. As shown in FIG. 36, for example, SSD is larger than FSD. The extreme distal indicator hole 6144D may correspond to the position of the cutting head 6050 in its end position. Thus, the design of the elongated channel 6222 has indicator holes located at different distances from each other, and the number of holes decreases when moving from the proximal end to the distal one.

In FIG. 37 depicts another design of elongated channel 6322, which is similar to elongated channel 6122, with the exception of these differences. Those parts of the design of the elongated channel 6322 that are identical to the parts of the construction of the elongated channel 6122 have the same element numbers. As shown in this figure, the design of the elongated channel 6322 includes a series of elongated individual indicator holes 6144 '. In the construction shown, the indicator holes 6144 'have the same size and shape and are made with the same spacing.

In FIG. 38 depicts another design of elongated channel 6422, which is similar to elongated channel 6222, except for the differences indicated. Those parts of the construction of the elongated channel 6422 that are identical to the parts of the construction of the elongated channel 6222 have the same element numbers. As shown in this figure, only two separate indicator holes 6144 ″ are provided in the bottom surface 6424. In the construction shown, the indicator holes 6144 "have the same size and shape, but are made in the bottom surface 6424 with different spacing. For example, the extreme proximal indicator hole 6144Pʺ may be separated from the proximal hole 6040 by the first FSD distance, and the extreme distal indicator hole 6144Dʺ may be separated from the extreme proximal indicator hole 6144ʺ by the second SSD distance, which is different from the first FSD distance. In at least one design, for example, when an elongated channel 6422 is used with a cutting head assembly that is advanced manually by activating the trigger, at least one support or another part of the cutting head assembly is visible through the proximal indicator hole 6144Pʺ when the cutting head assembly advances at the first move or the first activation of the trigger. Similarly, at least one support or another part of the cutting head assembly is visible through the extreme distal indicator hole 6144Dʺ during the second turn or second activation of the trigger. Thus, the elongated passage 6422 includes elongated slit indicator holes, as well as round indicator holes that provide more / fewer holes when moving from the proximal end to the distal one.

In FIG. 39 depicts another design of elongated channel 6522, which is similar to elongated channel 6422, with the exception of these differences. Those parts of the design of the elongated channel 6522, which are identical to the parts of the construction of the elongated channel 6422, have the same element numbers. As shown in this figure, the elongated channel 6522 includes a combination of extreme proximal elongated indicator holes 6144Pʺ, which allows the doctor to see at least one leg or another part of the cutting head assembly during the first turn or first activation of the hook, along with the combination round indicator holes 6144 located at the same distance from each other. Thus, the elongated channel 6522 uses a combination of slotted and elongated slots. Any of the structures of the elongated channel described above may contain a light source 6160, which has been described in detail in this document in connection with the embodiment shown in FIG. 33, or these designs can be used without a light source.

Other designs for controlling the position of the cutting head may include, for example, one or more light source designs or LED-based designs that throw light through holes in the channel or through a groove inside the channel. This greatly enhances the user's ability to determine the location of the cutting head as it moves and determine the execution of the entire stroke. In some designs, for example, multi-colored LEDs can be used, which change color from green to blue (or have a different color scheme) as the cutting head moves along the channel, allowing it to be distinguished.

In various designs of the end effector, it is desirable to use the system to prevent the cutting head from advancing or starting if the unspent bracket with brackets has been functionally installed in an elongated channel. For example, US Patent No. 6,988,649, entitled SURGICAL STAPLING INSTRUMENT HAVING A SPENT CARTRIDGE LOCKOUT, and US Patent No. 7,044,352, entitled SURGICAL STAPLING INSTRUMENT HAVING A SINGLE LOCKOUT MECHANISM FOR PREVENTION OF FIRING various locking systems. In such locking constructions, the cutting head or starting rod is usually biased in the locked position by a spring mechanism. Until the unused cassette is installed in the elongated canal, the cutting head cannot be advanced by the drive system of the surgical instrument.

In FIG. 40-42, there is shown a cutting head 6050 which is attached to the starting bar 6080. As shown, the starting rod 6080 has a multi-layer structure. However, the trigger rod 6080 may have a solid structure. In any case, the trigger bar 6080 functionally interacts with the trigger drive system of the surgical instrument, as described herein, or in any other known manner. When the start-up drive system is activated, axial advancement of the starting rod 6080 and the cutting head 6050 attached to it occurs through a cassette with surgical brackets, which is installed inside the elongated channel 6122. The vertical part 6052 of the cutting head 6050 includes a cutting fabric the upper end portion 6054 and the center portion 6056 of the hook. See FIG. 42. The upper pin or upper tongue 6058 goes sideways from each side of the upper end portion 6054. The upper tongues 6058 are made with the possibility of sliding insertion into the upper channel in the support, which is functionally installed on the elongated channel, as will be described below.

In FIG. 41 shows the position of the cutting head 6050 and the starting rod 6080 when the cassette with surgical brackets is not in the elongated channel 6122. In this position, the starting rod 6080 and the cutting head 6050 are displaced downward in the D direction with the spring lever 6090 supported by the trunnion shaft (not shown) which is connected to the elongated channel 6122. As shown in this figure, the spring arm 6090 is in sliding engagement with the spring tail 6082, formed at the distal end of the starting rod 6080. The lower part of the tail tail the toggle 6082 moves to the inclined surface 6123 formed on the elongated channel 6122 when the cutting head 6050 is in this locked position, as shown in FIG. 41. As shown below in FIG. 41 when the cutting head 6050 is in the locked position, if the doctor accidentally attempts to push the cutting head 6050 distally through the elongated channel 6122, the lower supports or the 6070 support come into contact with the bottom of the elongated channel 6122. In other words, when the cutting head 6050 is in the locked position , supports 6070 are not aligned with the internal channel 6030 in the elongated channel 6122, and therefore the cutting head assembly 6050 cannot move in it in the axial direction. The doctor will know that the cutting head is blocked by observing the position of the supports 6070 through the proximal hole 6040.

In FIG. 40 illustrates the position of the cutting head 6050 and the starting rod 6080 when the unspent cassette with surgical brackets is functionally supported in the elongated channel 6122. Although the cassette case with surgical brackets is not shown in FIG. 40, it depicts a node wedge-shaped sled 6078. It will be understood that the node wedge-shaped sled 6078 will be in the position shown in FIG. 40, in a non-activated or unspent cartridge with brackets. In this position, the node wedge-shaped sled 6078 engages with part of the hook 6056 on the cutting head 6050 to lift the cutting head 6050 up (arrow U in FIG. 40) to a certain point, and when the cutting head 6050 moves distally, supports 6070 on it enter the inner channel 6030 inside the elongated channel 6122. When using an elongated channel that has closed lower parts or substantially closed lower parts, such as those described in this document, an accumulation of dimensions may occur, resulting in A renewed obstacles between the channel bottom and a support or supports scalpel when the end effector is used for cutting and stapling on a very thin fabric. If the fabric, for example, is too thin, compensation for the resistance of the fabric may not be sufficient to push the stop away from the elongated channel and result in pressing these two components against the tongues of the cutting head. If this situation occurs, the support or scalpel supports can extend so far under the bottom of the elongated canal that the cutting head cannot move distally. The node of the cutting head 6050 and the design of the elongated channel 6122, shown in FIG. 40 and 41, prevent this situation.

As shown in FIG. 40 and 41, for example, the distal end of each support 6070 may have a chamfer 6072 formed thereon. The chamfer 6072 is adapted to engage the corresponding parts of the elongated channel 6122 while moving the cutting head 6050 distally, allowing the supports 6070 to enter the internal channel 6030. Thus, the chamfers 6072 form small input slopes that help guide the supports 6070 to the channel 6030. As also shown in FIG. 40 and 41, the portion of the elongated canal 6122, defining the proximal end 6131 of the inner canal 6030, may have a chamfer 6133 on it or have another inclined surface. In alternative designs, the supports 6070 (or one pore) may have a chamfer 6072 or a portion of the proximal end 6131 of the inner channel 6030 may have a chamfer 6133, or both chamfers can be made, as shown in FIG. 40 and 41.

In FIG. 43 and 44 depict end effector 7016, which may be similar, for example, end effector 16 or 300, or other end effectors described herein. In this design, the closing tube or sleeve 7028 has a number of indicator holes 7144, made therein, through which the doctor can see the trigger bar 6080. The trigger bar 6080 can be equipped with status mark 6084, which can be seen by the doctor through the indicator holes 7144 during distal advance rod 6080. The status mark 6084 is simply a paint mark or other element that serves as a reference mark. In one design, the status mark 6084 contains one or more LEDs or another light source that receives power from the power source of a surgical instrument or surgical system to which the end effector 7016 is attached.

In FIG. 45 depicts another end effector 7016, in which the segment of the closing sleeve 7030 includes an indicator window 7032 that allows the physician to determine whether the cutting head is in the locked position. In this design, if the doctor can see the spring shank 6082 through the indicator window 7032, the cutting head is in the unlocked position. If the doctor cannot see the spring shank 6082 through the indicator window 7032, the cutting head is in the locked position. In alternative designs, the indicator window 7032 may be provided in such a place (for example, in the lower part of the segment of the closing sleeve) that if the spring shank 6082 is visible through the indicator window 7032, the cutting head is in the locked position, and if the spring shank 6082 is not visible through the indicator hole, cutting head is in unlocked position. To assist the physician in determining the position of the cutting head, the cutting head can be made in particularly bright or fluorescent light. These color designs may, for example, be based on radium. In addition, the color of the cutting head can vary along its length, allowing the doctor to easily determine its position.

In FIG. 47 depicts an anvil 7020 that includes a plurality or a series of indicator holes 7044 that provide visual access to the channel 7022, in which an upper end portion 6054 extends axially on the cutting head 6050. In the embodiment shown in FIG. 47, the indicator holes 7044 are circular in shape and spaced at regular intervals along the length of the stop 7020. In the embodiment shown in FIG. 48, the indicator holes 7044 are located with a smaller interval at the proximal end of the stop 7020. The interval between the indicator holes 7044 gradually increases, moving distally on the stop 7020. The size, shape and interval of the indicator holes 7044 may however vary. As shown in FIG. 42, an indicator element 6059 may be provided in the upper end portion 6054 of the cutting head 6050. In one embodiment, the indicator element 6059 comprises one or more LEDs or other light sources that can receive power from a surgical instrument through a conductor 6081 that passes through the starting rod 6080. This design allows the doctor to see the position of the indicator element 6059 through the indicator holes 7044 in the stop 7020 with the distal advancement of the cutting head 6050 through the end fektor. In other designs, the indicator element (LED, light source) may be missing. However, the upper end part of the cutting head can be made in color or have a fluorescent marking, which increases its visibility through the indicator holes in the support. For example, color may be based on radium. It is possible that the cutting head is equipped with laser-engraved figures, used to determine the position of the cutting head in the channel or the stop.

The stop 7020 shown in FIG. 46, uses an indicator system, generally corresponding to the 7200 system. In this design, the 7200 indicator system includes a flexible strip or wave spring 7202, which is supported at least at its proximal end 7204 in a notch 7021, which is made in the stop 7020. Wave undressed 7202 increases the length of the stop 7020 and at least the same length with part of the stop 7020, which has an indicator hole 7044 in it. As shown in FIG. 46, the row of indicator elements 7206 is fixed on the flexible strip 7202 so that each indicator element 7206 is slidably supported in the corresponding indicator hole 7044. Each indicator element 7206 is first supported in the corresponding indicator hole 7044 so that it does not protrude from it. In other words, the wavy spring 7202 is designed in such a way that the indicator elements 7206 are displaced to the initial position, and they do not protrude from their respective indicator holes 7044. However, as the cutting head 6050 advances through the end effector, the upper part 6054 of the cutting head 6050 slides along the bottom wavy spring 7202 and serves to bias the wavy spring 7202 upward in such a way that when the cutting head slides under the part of the wavy spring 7202 to which the indicator element 7206 is attached, the indicator The element 7206 protrudes from the indicator hole 7044, as shown in FIG. 46. Thus, the doctor can control the position of the cutting head 6050 inside the end effector, paying attention to which indicator element 7206 protrudes from the indicator hole 7044.

Thus, several of the elongated duct structures described herein offer significant improvements over previous elongated duct structures. For example, at least in some structures of the elongated channel, an elongated groove that passes through the lower surface of the channel is not used. Thus, this design of the elongated channel has greater rigidity and resistance to dilution during operation. In addition to these benefits, the doctor receives funds to monitor the progress of the cutting head. For example, some extended canal designs provide periodic visibility along the canal length, informing the clinician about the location of the cutting head during the start-up cycle. At least some of the elongated duct designs also allow the clinician to see at least part of the cutting head when it is in the fully working position, as well as when the cutting head is in the fully extended position. In addition, at least some of the channel and / or abutment structures provide visibility to at least part of the cutting head from the side or above the end effector or otherwise provide means for determining the position of the cutting head from the side or top of the end effector.

As described above, the cassette with surgical brackets functionally supports a series of ejector brackets in it in such a way that each supports one or more surgical brackets on it. Ejector brackets are supported in pockets for brackets with the corresponding shape, arranged in a linear orientation in the cassette case. Surgical brackets are movably supported on the pushers in such a way that when the pushers move up in the cassette, the brackets pass through the tissue that is clamped between the cassette and the anvil and come into formative contact with the underside of the anvil. When the stop opens, the brackets remain in the stitched fabric. Because brackets are freely supported in their respective pockets on the ejector brackets, they can fall out of the cassette with the brackets in case of accidentally turning the cassette with the brackets before use. To prevent this from happening, usually covers are removably attached to the bracket with brackets. After installation on the cassette, the covers close the pockets for the brackets, keeping the brackets in the cassette, regardless of its position. When the doctor needs to install a cassette into the end effector, the cover can be removed before installation.

As discussed above, the staple pushers are sequentially moved up in the cassette using a wedge-shaped sled, which moves distally along with the cutting head assembly. In at least some designs, the wedge-shaped sled is oriented in the extreme proximal initial position in the unspent cassette before launch. As also discussed above, at least some designs require interaction between the wedge-shaped sled and (when they are in the initial position) and the cutting head (when it is in the locked position) in order to bring the cutting head out of the locked position and prepare it for launch. . However, at least in some previous designs, the cassette did not have the means or elements to ensure that the wedge-shaped sled remained in the initial position before use. Cassette cover 7250, shown in FIG. 64 and 65, solves this problem.

In FIG. 64 shows a cassette 7220 with surgical brackets, which has a cassette body 7222, functionally supporting a plurality of brace ejector in it (not shown) on each side of the longitudinal groove 7224. The longitudinal groove 7224 is designed to facilitate longitudinal movement of the cutting head through the cassette. As shown in FIG. 65, the cassette 7220 also supports the wedge-shaped sled 7230 in the initial position near the proximal end of the cassette body 7222. In FIG. 64 and 65 also depicts the cassette cover 7250, which has an upper portion 7252 configured to cover the cassette platform 7226 when the cassette cover 7250 is mounted on the cassette 7220. In particular, the upper portion 7252 is adapted to cover all the holes in the slot for fasteners in platform 7226 of cassette housing 7222 when the upper portion 7252 is in the covering position. The cassette cover 7250 can be detachably attached to the cassette 7220 with brackets using a pair of flexible fastening arms 7254, which are adapted to be fixedly engaged with the cassette case 7222. The doctor can easily remove the cassette cover 7250 by removing the flexible mounting shoulders 7254 from fixed engagement with the cassette housing 7222. The cassette cover 7250 may additionally have a pair of side plates 7255 going down, which serve to set the cover 7250 to the desired position on the cassette 7220. For example, the side plates 7255 may be positioned to engage with a lateral edge 7227 made on each side of the platform 7226 cassette. The cassette cover 7250 may also have a centrally located mounting rib 7256, which is oriented so as to fit into a longitudinal groove 7224 when the cassette cover 7250 is attached to the cassette 7220, as shown in FIG. 65. The setting rib 7256 has an engaging groove 7258 or other element (s) which are adapted to be fixed in engagement with a part of the wedge-shaped sled 7230 and to hold the wedge-shaped sled 7230 in the initial position. Thus, when the cassette cover 7250 is mounted on the cassette 7220 with brackets, the brackets are held inside their respective pockets, regardless of the orientation of the cassette 7220. In addition, the wedge-shaped sled 7230 is held in its initial position. In various designs, the installation rib may have a size corresponding to the longitudinal groove 7224, so that a friction fit is provided between them. In such constructions, the friction fit can be used to hold the cover 7250 in position on the cassette 7220 without the need to use the mounting shoulders 7254. In other designs, the friction fit between the mounting rib 7256 and the cassette housing 7222 and the mounting shoulders 7254 can be used to hold the cover 7250 on the housing 7222 cassettes in covering position. In addition, retaining ribs 7257 may be formed on the mounting rib 7256 to provide an additional frictional fit between the cover and the cassette housing 7222. As also depicted in FIG. 65, the distal end 7221 of the cartridge 7220 with surgical brackets may have a nasal surface 7223 that is oriented at an angle to the platform 7226 of the cartridge. In various designs, the cover 7250 of the cassette may also have a nose section 7251, which is adapted to be fixedly engaged with the distal end 7221 of the cartridge 7220 with surgical brackets. For example, the nose portion 7251 may be provided to cover the nose surface 7223 of the cartridge 7220 and include a distal retaining tongue 7253, which hooks the distal end 7221 of the cartridge 7220 with a hook. In addition, a release tongue or protrusion 7259 may be performed on the nose 7251 , which ensures the detachment of the retaining tongue 7253 from the cassette 7220. Thus, in certain designs, the distal end of the cassette cover 7250 can absorb all the force when the bow is lowered and transmit this force directly per cassette 7220 with a minimum longitudinal movement of the 7250 cover relative to the cassette case 7222. This design serves to prevent the proximal movement of the cover 7250 sled 7230 under such conditions. When the doctor needs to use the cassette 7220, the cassette cover 7250 is removed. In at least some designs, the cassette cover 7250 can be made in a specific color that matches the size of the brackets placed in the cassette 7220 with brackets.

As described in detail above, in various embodiments, surgical brackets are supported by ejectors that are functionally supported in pockets made in the body of the cassette with brackets. Different forms of ejector can be used. For example, the ejector may be configured to support one surgical brace, while other ejectors may support multiple surgical brackets. The pushers are supported in the cassette case in longitudinally running rows that are made on each side of a centrally located elongated groove in which a channel for the cutting element or cutting head is located. As previously described in this document, the cutting head includes or interacts with the wedge-shaped sled. The wedge-shaped skids are arranged to be in series with the ejector to move upwards to their respective pockets. When moving the pushers up in the staple cassette, the surgical staples supported on them move upward through the fabric clamped between the cassette and the abutment and enter forming contact with the underside of the abutment.

As is well known, the bottom side of the abutment has a surface forming bracket, which usually contains a number of pockets for forming brackets in contact with the ends of the legs of the brackets. The pockets are arranged and have such a shape that when they are in contact with the legs of the bracket, the legs are bent in the pocket, ultimately forming a closed bracket that is a bit like a B-shaped. Misalignment of the legs of the brackets during the process of their formation can lead to irregularly shaped brackets, which in serious cases can lead to undesirable leaks. The configuration of the ejector brackets shown in FIG. 94 and 95, can help maintain the alignment of the brackets during the blending process. In addition, if during the stapling process, the ejector is not aligned in its respective pocket, large starting forces must be applied to apply the staples supported by it.

In FIG. 94 and 95 depicts a double ejector of 7300 brackets. As shown in these figures, the ejector 7300 of the staples includes the first part 7310 of the ejector and the second part 7350 of the ejector, which are staggeredly divided into a centrally arranged separation part 7340. The ejector 7300 of the brackets can be one-piece construction and, for example, be cast from a suitable plastic . The first ejector portion 7310 includes a centrally located first recess 7312, which divides the first ejector 7310 into a first proximal vertical support part 7320 and a first distal vertical support part 7330. The first proximal vertical support part 7320 has a first proximal part 7321 of the body, which has an upper edge 7322, which has a first proximal section 7324 of the bed, made in it. Similarly, the first distal vertical support part 7330 has a first distal part 7331 of the body, which has a first distal end 7332, which has a first distal section 7334 of the bed made therein. The first proximal section 7324 of the bed and the first distal section 7334 of the bed are aligned with each other and are configured to support the base of the surgical brace in them. As shown in FIG. 94, the first proximal vertical support part 7320 has a slightly conical shape when viewed from above. In other words, the first proximal vertical support part 7320 has a first proximal end 7326, having a width PW that is smaller than the central width CW of the first proximal part 7321 of the body. Similarly, the first distal vertical support part 7330 has a first distal end 7336, having a width DW, which is smaller than the central width CW of the first distal part 7331 of the housing. In at least one design, the distal width DW is equal to the proximal width PW.

As shown in FIG. 94, the second ejector portion 7350 includes a centrally located second recess 7352, which divides the second ejector 7310 into a second proximal vertical support part 7360 and a second distal vertical support part 7370. The second proximal vertical support part 7360 has a second proximal case part 7361, the upper edge 7362, which has a second proximal section 7364 of the bed, made in it. Similarly, the second distal vertical support part 7370 has a second distal part 7371 of the body, which has a second distal end 7372, which has a first distal section 7374 of the bed made therein. The second proximal section of the bed 7364 and the second distal section of the bed 7374 are aligned with each other and configured to support the base of the other surgical brace in them. As shown in FIG. 94, the second proximal vertical support part 7360 has a slightly conical shape when viewed from above. In other words, the second proximal vertical support part 7360 has a proximal end 7366 having a width PW which is smaller than the central width CW of the second proximal part 7361 of the body. Similarly, the second distal vertical support part 7370 has a first distal end 7376, having a width DW that is smaller than the central width CW of the second distal part 7371 of the body. Thus, the first part of the ejector 7310 and the second part of the ejector 7350 have similar forms.

To improve the stability of the ejector 7300 brackets during the imposition of brackets, the first and second parts 7310, 7350 of the ejector can be additionally equipped with stabilizing elements that interact with pockets for brackets of the corresponding form in the cassette case with brackets. For example, the first part 7310 of the staple ejector may have a first proximal set of 7327 laterally protruding support struts 7328, 7329, made at its first proximal end 7326. The first distal set 7337 of lateral protruding supports 7338, 7339 may also be provided at the first distal end 7336 of the first distal vertical support portion 7330, as shown. Similarly, the second part 7350 of the staple ejector may have a second proximal set 7367 laterally protruding support struts 7368, 7369, made at its second proximal end 7366. A second distal set 7377 laterally supporting poles 7378, 7379 may also be provided at the second distal end 7376 the second distal vertical support portion 7370, as shown.

As stated above, the ejector 7300 brackets are movably supported using pockets for brackets of the corresponding form in a cassette with brackets. In the distal movement of the wedge-shaped slide, their respective part comes into contact with the centrally located separation part 7340 to transfer the driving force and moves the ejector 7300 upwards. Each sideways support 7328, 7329, 7338, 7339, 7368, 7369, 7378 and 7379 go into the grooves of the appropriate shape in the case of the cartridge with brackets and serve to maintain the alignment of the ejector 7300 and prevent it from twisting during its advance to the stop. In one design, the ejector 7300 is molded or otherwise formed from a solid material. However, in other designs, the first ejector part 7310 and the second ejector part 7350 may be hollow, allowing these parts of the ejector 7300 to be slightly flexible and resilient to further maintain the alignment of the ejector in its respective pocket, thus further reducing the required driving force. In any design, the installation of leveling pads at both ends of both parts of the ejector further enhances the alignment of the ejector in the corresponding pocket.

In FIG. 96 depicts another double ejector 7400 brackets, which is made with the possibility of entering the pocket for brackets of the corresponding form, made in the case of the cartridge with surgical brackets. As shown in FIG. 96, the ejector 7400 of the staples includes the first ejector part 7410 and the second ejector part 7450, which are stagmatically separated by a centrally arranged separation part 7440. The ejector 7400 of the brackets may be one-piece construction and, for example, be molded from a suitable plastic material. The first ejector part 7410 includes a centrally located first recess 7412 that divides the first ejector 7410 into a first proximal vertical support 7420 and a first distal vertical support 7430. The first proximal vertical support 7420 has a first proximal body 7421, which has an upper edge 7422, which has a first proximal section 7424 of the bed, made in it. Similarly, the first distal vertical support part 7430 has a first distal part 7431 of the body, which has a first distal end 7432, which has a first distal section 7434 of the bed formed therein. The first proximal section 7424 of the bed and the first distal section 7434 of the bed are aligned with each other and configured to support the base of the surgical brace in them. As further shown in FIG. 96, the first proximal vertical support 7420 and the first distal vertical support are slightly conical.

As shown in FIG. 96, the second ejector portion 7450 includes a centrally located second recess 7452, which divides the second ejector 7450 into a second proximal vertical support 7460 and a second distal vertical support 7470. The second proximal vertical support 7460 has a second proximal housing 7461, which has upper edge 7462, which has a second proximal section of the bed 7464, made in it. Similarly, the second distal vertical support portion 7470 has a second distal housing portion 7471, which has a second distal end 7472, which has a second distal bed section 7474, formed therein. The second proximal section of the bed 7464 and the second distal section of the bed 7474 are aligned with each other and made with the possibility of supporting the base of another surgical brace in them.

To increase the stability of the ejector 7400 brackets during the imposition of brackets, the first and second parts 7410, 7450 of the ejector can be additionally equipped with stabilizing elements that interact with pockets for brackets of the corresponding form in the cassette case with brackets. For example, the first part 7410 of the ejector brackets may have a first proximal set 7427 laterally protruding support columns 7428, 7429, made the first proximal part 7421 of the housing. A first distal set 7437 of laterally protruding support columns 7438, 7439 may also be provided on the first distal part 7431 of the housing of the first distal vertical support part 7430, as shown. Similarly, the second part 7450 of the ejector brackets may have a second proximal set 7467 protruding laterally support columns 7468, 7469, performed on its second proximal part 7461 of the housing. A second distal set 7477 of laterally protruding support columns 7478, 7479 may also be provided on the second distal part 7471 of the case of the second distal vertical support part 7470, as shown.

As indicated above, the ejector 7400 brackets are movably supported using pockets for brackets of the corresponding form in a cassette with brackets. In the distal movement of the wedge-shaped slide, their respective part comes into contact with the centrally arranged separation part 7440 to transfer the driving force and moves the ejector 7400 upwards. Each sideways support 7428, 7429, 7438, 7439, 7468, 7469, 7478, and 7479 go into the grooves of the corresponding shape in the case of the cartridge with brackets and serve to maintain the alignment of the ejector 7400 and prevent it from twisting during its advance to the stop. In one design, the ejector 7400 is molded or otherwise formed from a solid material. However, in other designs, the first ejector part 7410 and the second ejector part 7450 may be hollow, allowing these parts of the ejector 7400 to be slightly flexible and resilient to further maintain the alignment of the ejector in its respective pocket, thus further reducing the required driving force. In any design, the installation of leveling pads at both ends of both parts of the ejector further enhances the alignment of the ejector in the corresponding pocket.

In FIG. 97 shows a pocket for brackets or a pocket of the ejector 7510, which is made in part 7502 of the cassette 7500 with brackets. This pocket for brackets or pocket 7510 ejector made with the possibility of functional support in it a single ejector of the appropriate form. As shown in this figure, the pocket pocket 7510 is provided with two inward proximal support members 7512, 7514 and two inwardly distal supports 7516, 7518. The supports 7512, 7514, 7516 and 7518 are slidable in the respective side grooves provided for in the ejector brackets. Such constructions of the pockets of the ejector serve to additionally provide stabilization and alignment of the ejector when it is removed from the pocket. Although FIG. 97 depicts a pocket for brackets or a pocket for an ejector, which is designed to functionally support a single ejector of brackets in it, the same concept can be applied to pockets of ejectors that are designed to support ejector, designed to support multiple surgical brackets. For example, support stands used in the embodiments of the ejector shown in FIG. 94-96, can be replaced by grooves, which are made with the possibility of sliding the introduction of corresponding supports, made in the sides of the pockets for brackets in the body of the cassette.

As shown in FIG. 94-96, various ejector structures in general may include an ejector body or a portion of an ejector body that contains an outer surface as well as a front and rear end. In various designs, the outer surface may have a shape and size that allows you to avoid contact with other parts of the inner wall of the pocket for brackets, in which it is movably supported - except for the side elements / support posts made on it. For example, a double ejector 7400 brackets shown in FIG. 96 comprises a first ejector part 7410 and a second ejector part 7450. The first part 7410 of the ejector and the second part 7450 of the ejector may have a size relative to the pocket for the staples so that the only parts that are in contact with the inner wall of the pocket for the staples are sideways elements made on it, for example, elements 7428, 7429, 7438 , 7439, 7468, 7469. The extreme proximal end of the first part of the ejector 7410 may include the front end, and the extreme distal end of the second part of the ejector 7450 may contain the rear end. For example, in another design, the front end and the rear end may have a size relative to the pocket portions for the staples, which they enter so that the gap between these ends and their respective pocket portions is smaller than the gap between the other ejector portions and the other portions of the pocket for the brackets. Such clearance values can be made to increase the lateral stability of the ejector during activation without creating a frictional fit between the outer surface of the ejector and the inner wall of the pocket for the staples. In another design, the ejector can be made (i.e., have a size and shape) relative to the pocket for the staples so that the only parts of the ejector that come into contact with the parts of the inner wall of the pocket for the staples are one or more elements (support posts) at the front and / or rear ends of the ejector. Conversely, one or more grooves can be equipped with front and / or rear ends, which are configured to receive corresponding elements on parts of the inner wall of the pocket for the brackets; however, these elements are the only points of contact between the ejector and the inner walls of the pocket for brackets during activation of the ejector. As indicated above, the ejector may be generally supported in the cassette case in longitudinally extending rows of pockets for brackets that are provided on each side of a centrally located elongated groove in which the channel for the cutting element or cutting head is located. In certain designs, the various ejector described in this document, in which one or more support posts / side-running elements are used, can be used in one or more longitudinal rows of pockets for brackets (or parts of longitudinal rows) on one or both sides of the elongated groove. For example, a row of pockets for brackets on each side of the elongated groove that is closest to the edge of the cassette case may include ejectors that use support posts / sideways elements, and for other rows of pockets for brackets, standard ejector can be used. This design can also be used with pockets 7510 for brackets. In other words, pockets 7510 for brackets can only be used in certain longitudinal rows of pockets for brackets (or parts of longitudinal lines) on one or both sides of the elongated groove.

Tissue movement may be one of the factors contributing to the incorrect formation of staples. During the stapling, the tissue moves distally and laterally, and the lateral movement is more harmful than the longitudinal movement. When the fabric is moved and high compressive forces are applied, the staples are directed sideways and distally from their respective pockets. When increasing the density of landing between the ejector and the parts of the cassette next to it, the brackets have less ability to swing to the side or forward during its imposition, because the ejector also has less ability to swing. The various designs of the ejector and the pocket for the staples described in this document serve to minimize this swing. The uprights / sideways elements described herein may be provided on all of the ejector or only on the ejector in certain areas (for example, on the ejector in the outer rows in the cassette). Such support posts / sideways elements may be located, for example, on the sides of the ejector and / or the ends of the ejector. The term “support post”, used to describe in this document, devices for stabilizing ejectors, includes various sideways, vertically elongated elements shown in the respective figures. The term “support stand” may also include sideways elements of various shapes, which are made with the possibility of movable entry into grooves of the corresponding form, made in the inner wall of the pocket for brackets (in structures where the support columns / sideways elements are located on the ejector) or in different parts of the ejector (in constructions where support posts / sideways components protrude from the inner walls of the pocket for the brackets), depending on the situation. The anvil may, for example, contain a single sideways element or a plurality of aligned sideways elements. For example, a support post may consist of rack segments or aligned pieces / elements. However, in other designs can use other forms of protrusions.

In relation to the various embodiments described in this document, a cassette with fasteners may include a layer of material that can be implanted into a patient. Such a layer may contain, for example, one or more pieces of support material and / or one or more fabric thickness compensators. US Patent Application Ser. No. 13 / 097,856, entitled STAPLE CARTRIDGE COMPRISING STAPLES POSITIONED WITHIN A COMPRESSIBLE PORTION THEREOF, filed April 29, 2011, is incorporated herein by reference. As shown in FIG. 99-102, the staple cassette 8000 includes a cassette body 8010 and an implantable layer 8020. The cassette body 8010 includes a proximal end 8012, a distal end 8014, and a platform 8016 located between the proximal end 8012 and the distal end 8014. Platform 8016 is adapted to maintaining the fabric when the fabric is sandwiched between a cassette 8000 with brackets and a stop. Case 8010 cassettes additionally has grooves that are made in it with the possibility of accommodating them fastener, for example, brackets. Each recess for the brackets has a proximal end and a distal end. The proximal end of each recess for fasteners is located closer to the proximal end 8012 of the cassette case 8010 than the distal end of each recess for fasteners and, accordingly, the distal end of each recess for fasteners is located closer to the distal end 8014 of the cassette case 8010.

In addition to the above, the cassette housing 8010 may include protrusions extending from platform 8016. In various instances, the protrusions may be located in any suitable arrangement. For example, the distal protrusions 8017 may be located near the distal ends of the recesses for fasteners, and the proximal protrusions 8019 may be located near the proximal ends of the recesses for fasteners. Similar to the above, distal protrusions 8017 and / or proximal protrusions 8019 can be made with the possibility of guiding fasteners placed in the recesses when pushing the fasteners from their recesses. In such cases, the distal protrusions 8017 and / or proximal protrusions 8019 may continue recesses for fasteners above platform 8016. Some recesses for fasteners may have an adjacent distal protrusion 8017 and proximal protrusion 8019, and other recesses for fasteners may have only one or the other ledge Some recesses for fasteners may not have either the distal protrusion 8017 or the proximal protrusion 8019 associated with them.

Layer 8020 comprises a layer body 8026 having a proximal end 8022 and a distal end 8024. A proximal end 8022 of the layer body 8026 is located near or relative to the proximal end 8012 of the case 8010 of the cartridge, and the distal end 8024 is located near or in the distal end 8014. In certain cases, layer 8026 may consist of a single sheet of material. In various cases, the layer housing 8026 may extend over one or more recesses for fasteners made in the cartridge case 8010. In at least one such case, the layer body 8026 contains parts 8025 that extend over the recesses for the fasteners. when the fasteners are pushed out of the recesses, they can grip the parts of the 8025, thus fixing the layer 8020 on the fabric. In some cases, the layer body 8026 may comprise openings aligned with some recesses for fasteners in the cartridge case 8010.

The layer body 8026 may include holes formed therein that are aligned with protrusions extending from platform 8016. For example, the layer body 8026 may include distal holes 8027 that are aligned with at least some distal projections 8017, and / or proximal protrusions 8029, which are aligned with at least some distal protrusions 8019. In various cases, the size and configuration of the distal holes 8027 and distal protrusions 8017 can be selected so that there is a gap between them. Similarly, the size and configuration of the proximal holes 8029 and the proximal protrusions 8019 can be chosen so that there is a gap between them. In some cases, the size and configuration of the distal holes 8027 and the distal protrusions 8017 can be chosen so that between them there is a tight fit. In addition, in a similar way, the size and configuration of the proximal holes 8029 and the proximal protrusions 8019 can be chosen so that there is a tight fit between them. In at least one such case, a tight fit between the protrusions and the openings can detachably hold the layer 8020 on the cassette case 8010. During use, fasteners placed in cassette case 8010 may contact parts 8025 of layer 8020 when pushing fasteners out of cassette case 8010, lift layer 8020 from platform 8016, and also release the protrusions from the holes.

The layer body 8026 may have holes 8028 that are configured to receive a distal protrusion 8017 and a proximal protrusion 8019. Each hole 8028 may include an elongated groove having a proximal end configured to receive a distal protrusion 8017, a distal end configured to receive proximal protrusion 8019. In some cases, between the holes 8028 and protrusions 8017 and 8019 may be a free landing. In some cases, a tight fit may be present between the holes 8028 and the protrusions 8017 and 8019 to detachably hold the layer 8020 on the cassette case 8010. In at least one case, the openings 8028 may have a size and configuration that allows them to stretch to enter distal protrusion 8017 and proximal protrusion 8019.

Layer 8020 can be detachably attached to cassette case 8010. In some cases, the distal end 8024 of the layer 8020 can be detachably attached to the distal end 8014 of the body 8010 of the cassette. In some cases, the proximal end 8022 of the layer 8020 may be detachably attached to the proximal end 8012 of the body 8010 of the cassette. In at least one example, the fastener parts 8021 can be used to detachably hold the 8020 layer on the cassette case 8010.

A layer, for example a support material, may be made of any biocompatible material. The support material may be made of natural and / or synthetic material. The support material may be bioabsorbable and / or non-bioabsorbable. It should be understood that any combination of natural, synthetic, bioabsorbable, and non-bioabsorbable materials can be used to form the support material. Some non-limiting examples of materials from which the support material can be made include, among others, poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyethers, polyethylene glycols, polyethylene oxides, polyacrylamides, polyhydroxyethyl methyl acrylates , polyvinylpyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyethers, glycerols, poly (amino acids), copolymers of ethers and esters, polyalkylene oxalates, polyamides, p olys (iminocarbonates), polyalkylene oxalates, polyoxethers, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, for example, mixtures thereof and / or combinations.

Natural biological polymers can be used to make a support material. Examples of natural biological polymers include collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, hydroxyethylcellulose, cellulose, oxidized cellulose, hydroxypropylcellulose, carboxyethylcellulose, carboxymethylcellulose, chitano, chitosan, chitosan, chitosan, chitosan, chitosan, chitosan, chitosane, chitosan, chitosan, chitosan, chitosan, chitosan, chitosan, chitosan, chitosan, chitosan, chitosan Natural biological polymers can be combined with any other polymeric materials described herein for the manufacture of a reference material. For the manufacture of the support material, collagen of human and / or animal origin can be used, for example, porcine or bovine type I collagen, human type I collagen or type III human collagen. The support material can be made of denatured collagen or collagen, which at least partially lost their spiral structure due to heating or the use of any other method, consisting mainly of non-hydrated chains with a molecular weight of, for example, up to 100 kDa. The term "denatured collagen" means collagen, which has lost its spiral structure. The collagen used for the porous layer, as described herein, may be native collagen or atelocollagen, in particular obtained by pepsin cleavage and / or, for example, after moderate heating, as indicated earlier. Collagen can be pre-chemically modified by oxidation, methylation, succinylation, ethylation, and / or any other known process.

If the supporting material has a fibrous structure, the fibers can be yarns suitable for knitting or weaving, or staple fibers, for example, which is often used to prepare nonwoven materials. The fibers can be made from any biocompatible material. Fibers can be made from natural or synthetic material. The material from which the fibers are made may be bioabsorbable or non-bioabsorbable. It should be understood that any combination of natural, synthetic, bioabsorbable, and non-bioabsorbable materials can be used to form fibers. Some non-limiting examples of materials from which fibers can be made include poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (phosphazine), polyesters, polyethylene glycols, polyethylene oxides, polyacrylamides, polyhydroxyethylmethylacrylates, polyvinylpyrrolidone, polyvinyl alcohols, polyacrylic acid, polyacetate, polycaprolactone, polypropylene, aliphatic polyethers, glycerols, poly (amino acids), copolymers of ethers and esters, polyalkylene oxalates, polyamides, poly (imine ocarbonates), polyalkylene oxalates, polyoxethers, polyorthoesters, polyphosphazenes and copolymers, block copolymers, homopolymers, mixtures thereof and / or combinations. If the support material has a fibrous structure, it can be formed, for example, using any method suitable for forming fibrous structures, including knitting, weaving, non-woven techniques and similar methods. If the support material has a foamy structure, the porous layer can be formed, for example, using any method suitable for forming foamed or spongy materials, including freeze-drying or freeze-drying.

The support material may have hemostatic properties. Typical examples of materials that can be used to make a support material to help stop bleeding or hemorrhage include poly (lactic acid), poly (glycolic acid), poly (hydroxybutyrate), poly (caprolactone), poly (dioxanone), polyalkylene oxides, copolymers of ethers and esters, collagen, gelatin, thrombin, fibrin, fibrinogen, fibronectin, elastin, albumin, hemoglobin, ovalbumin, polysaccharides, hyaluronic acid, chondroitin sulfate, hydroxyethyl starch, hydroxyethylcellyl oz, cellulose, oxidized cellulose, hydroxypropyl cellulose, carboxyethyl cellulose, carboxymethyl cellulose, chitosan, agarose, maltose, maltodextrin, alginate, blood clotting factors , protamine sulfate, epsilon-aminocaproic acid, ferrous sulfate, basic ferrous sulfates, ferric chloride, zinc, zinc chloride, aluminum chloride, aluminum sulfates, aluminum acetates, permanganates, tannins, wax, polyethylene glycols, fucans and / or, for example, their combinations. The use of natural biological polymers, and in particular proteins, can be useful in the formation of a support material with hemostatic properties. Suitable natural biological polymers include collagen, gelatin, fibrin, fibrinogen, elastin, keratin, albumin, and / or, for example, combinations thereof. For the manufacture of a porous support material layer, natural biological polymers can be combined with any other hemostatic agents. A full description of US Patent No. 8,496,683, entitled BUTTRESS AND SURGICAL STAPLING APPARATUS, issued July 30, 2013, is hereby incorporated by reference.

Full description:

U.S. Patent No. 5,403,312, entitled ELECTROSURGICAL HEMOSTATIC DEVICE, issued April 4, 1995;

U.S. Patent No. 7,000,818, entitled SURGICAL STAPLING INSTRUMENT HAVING SEPARATE DISTINCT CLOSING AND FIRING SYSTEMS, issued February 21, 2006;

U.S. Patent No. 7,422,139, entitled MOTOR-DRIVEN SURGICAL CUTTING AND FASTENING INSTRUMENT WITH TACTILE POSITION FEEDBACK, issued September 9, 2008;

U.S. Patent No. 7,464,849, entitled ELECTRO-MECHANICAL SURGICAL INSTRUMENT WITH CLOSURE SYSTEM AND ANVIL ALIGNMENT COMPONENTS, issued December 16, 2008;

U.S. Patent No. 7,670,334, entitled SURGICAL INSTRUMENT HAVING AN ARTICULATING END EFFECTOR, issued March 2, 2010;

U.S. Patent No. 7,753,245, entitled SURGICAL STAPLING INSTRUMENTS, issued July 13, 2010;

U.S. Patent No. 8,393,514, entitled SELECTIVELY ORIENTABLE IMPLANTABLE FASTENER CARTRIDGE, issued March 12, 2013;

US patent application ser. No. 11 / 343,803, entitled SURGICAL INSTRUMENT HAVING RECORDING CAPABILITIES; currently US Patent No. 7,845,537;

US patent application No. 12 / 031,573, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT HAVING RF ELECTRODES, filed February 14, 2008;

US patent application ser. No. 12 / 031,873, entitled END EFFECTORS FOR A SURGICAL CUTTING AND STAPLING INSTRUMENT, filed February 15, 2008, currently US Patent No. 7,980,443;

US patent application ser. 12 / 235,782, entitled MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT, is currently US Patent No. 8,210,411;

US patent application ser. No. 12 / 249,117 entitled POWERED SURGICAL CUTTING AND STAPLING APPARATUS WITH MANUALLY RETRACTABLE FIRING SYSTEM, currently US Patent No. 8,608,045;

US patent application ser. No. 12 / 647,100, entitled MOTOR-DRIVEN SURGICAL CUTTING INSTRUMENT WITH ELECTRIC ACTUATOR DIRECTIONAL CONTROL ASSEMBLY, filed on December 24, 2009; currently US Patent No. 8,220,688;

US patent application ser. No. 12 / 893,461, entitled STAPLE CARTRIDGE, filed September 29, 2012, currently US Patent No. 8,733,613;

US patent application ser. No. 13 / 036,647, entitled SURGICAL STAPLING INSTRUMENT, filed February 28, 2011, currently US Patent No. 8,561,870;

US patent application ser. No. 13 / 118,241, entitled SURGICAL STAPLING INSTRUMENTS WITH ROTATABLE STAPLE DEPLOYMENT ARRANGEMENTS, is currently publishing US Patent Application No. 2012/0298719;

US patent application ser. No. 13 / 524.049, entitled ARTICULATABLE SURGICAL INSTRUMENT COMPRISING A FIRING DRIVE, dated June 15, 2012; currently US patent application no. 2013/0334278;

US patent application ser. No. 13 / 800,025, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed March 13, 2013;

US patent application ser. No. 13/800 067, entitled STAPLE CARTRIDGE TISSUE THICKNESS SENSOR SYSTEM, filed on March 13, 2013;

US Patent Application Publication No. 2007/0175955, entitled SURGICAL CUTTING AND FASTENING INSTRUMENT WITH CLOSURE TRIGGER LOCKING MECHANISM, filed January 31, 2006; and

US Patent Application Publication No. 2010/0264194, entitled SURGICAL STAPLING INSTRUMENT WITH AN ARTICULATABLE END EFFECTOR, filed on April 22, 2010, is now US Patent No. 8,308,040, which is incorporated herein by reference.

Although various embodiments of products are described herein in connection with certain disclosed embodiments, various modifications and changes may be made to the product. Also for some components for which materials are disclosed, other materials may be used. In addition, in accordance with various embodiments, one component can be replaced by several components, and several components by one component (to perform certain functions). The above description and the appended claims cover all the indicated changes and additions.

The devices described herein may be adapted for disposal after a single use, or they may be configured to be used a plurality of times. However, in any case, the device can be restored for re-use after at least one application. Recovery may include any combination of device disassembly steps, subsequent cleaning or replacement of specific parts and subsequent reassembly. In particular, the device can be disassembled and any number of specific parts 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 surgery. It will be apparent to those skilled in the art that various techniques for disassembling, cleaning, replacing, and reassembling can be used to restore the device. The use of such techniques, as well as the resulting reconstructed device, are entirely within the scope of this application.

Preferably, the subject matter described herein will be processed prior to surgery. First, after receiving a new or already used tool, it is cleaned if necessary. The instrument can then be sterilized. According to one method of sterilization, the instrument is placed in a sealed and sealed container, such as a plastic bag or a Tyvek bag (TYVEK). The container and the instrument are then placed in a field of radiation that can enter the container, such as gamma radiation, x-rays, or fast electrons. Radiation kills bacteria on the instrument and in the container. The sterilized instrument can then be stored in a sterile container. Hermetic packaging keeps the instrument sterile until it is opened in a medical facility.

Although the present invention is described as having examples of configurations, the present invention can be further modified within the spirit and scope of the description. Therefore, it is assumed that the present application covers all possible variations, methods of application or adaptation of the invention using its general principles. In addition, it is assumed that this application covers such deviations from the present description, which fall within the known or common practice in the field to which the present invention relates.

Any patent, publication or other description material, in whole or in part, which is indicated as incorporated herein by reference, is included in this document only to the extent that the included material does not contradict the existing definitions, provisions and other description material provided in this description. Thus, to the extent necessary, the description, as explicitly presented in this document, takes precedence over any contradictory material included in this document by reference. Any material or part thereof, as incorporated herein by reference, but contrary to existing definitions, provisions, or other description material presented herein, will be included in this document only to the extent that between the material included and the existing description material is not there are contradictions.

Claims (32)

1. A cassette with fasteners for use with a surgical stapling instrument, comprising: the cassette case, which includes a platform made with the ability to maintain tissue; the protrusion extending from the platform, the protrusion contains a conical groove; cavity for fasteners made in the platform, and the cavity for fasteners has a first end of the cavity and a second end of the cavity, the first end of the cavity has a first side wall and a second side wall, and the first side wall and the second side wall converge at one point; and fastener placed with the possibility of release in the cavity for fasteners, containing:  base;  the first leg extending from the base, the first leg being disposed at the first end of the cavity, wherein the first side wall and the second side wall are arranged to keep the first leg at a distance from the convergence of the side walls at one point so that between the convergence of the side walls one point and the first leg there is a gap; and  the second leg extending from the base, the second leg being disposed in the second end of the cavity. 2. The cassette according to claim 1, wherein the second end of the cavity has a first side wall and a second side wall configured to hold the second leg at a distance from the convergence of the second side at one point so that between the convergence of the second side at one point and the second leg has a gap. 3. The cassette according to claim 2, further comprising a recess extender extending from the platform, the recess extender being configured to support the first leg while pushing the fastener out of the cavity for the fasteners. 4. The cassette according to claim 3, further comprising a second recess expander extending from the platform, the second recess expander being configured to support the second leg when pushing the fastener out of the cavity for the fasteners. 5. A cassette with fasteners for use with a surgical stapling instrument, comprising: the cassette case, which includes a platform made with the ability to maintain tissue; the protrusion extending from the platform, the protrusion contains a conical groove; a cavity for fasteners, made in the platform, and the cavity for fasteners contains the first end of the cavity, the second end of the cavity and a wedge; and fastener placed with the possibility of release in the cavity for fasteners, containing:  base;  the first leg extending from the base, the first leg being disposed with respect to the first end of the cavity, the wedge being configured to hold the first leg at a distance from the first end of the cavity so that there is a gap between the first end of the cavity and the first leg; and  the second leg extending from the base, the second leg being disposed with respect to the second end of the cavity. 6. The cassette according to claim 5, further comprising a second wedge, configured to hold the second leg at a distance from the second end of the cavity so that there is a gap between the second end of the cavity and the second leg. 7. The cassette according to claim 6, further comprising a recess extender extending from the platform, wherein the recess extender is configured to support the first leg when pushing the fastener out of the cavity for the fasteners. 8. The cassette according to claim 7, further comprising a second recess expander extending from the platform, the second recess expander being configured to support the second leg when pushing the fastener out of the cavity for the fasteners. 9. Cassette with fasteners for use with surgical stapling instrument, containing: the cassette case, which includes a platform made with the ability to maintain tissue; the protrusion extending from the platform, the protrusion contains a conical groove; a cavity for fasteners made platform, and the cavity for fasteners contains a longitudinal groove, which includes the first end of the cavity and the second end of the cavity; and fastener placed with the possibility of release in the cavity for fasteners, containing:  base;  the first leg extending from the base; and  the second leg extending from the base; the first biasing means for displacing the first leg from the first end of the cavity; and the second biasing means for biasing the second leg from the second end of the cavity.

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